Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NUR 141 > 2.1 Respiratory > Flashcards

2.1 Respiratory Flashcards

1
Q

Define perfusion

A

Blood flow throughout the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define defusion

A

Gas exchange

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does the upper respiratory system do?

A

Function:
cleansing, filtering, humidifying and warming inhaled air

Nose/sinuses:
nostrils separated by nasal septum
sinuses lighten skull, assist speech
produce mucus that drains to nasal cavities to help trap debris

Pharynx:
nasopharynx: passageway only for air
oropharynx: part of the pharynx that lies between the soft palate and the hyoid bone
Laryngopharynx: where both food and air pass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Upper respiratory system

Larynx

A

Larynx:
provides airway
routes air, food
contains vocal cords

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Upper respiratory system

Trachea

A

Trachea:
seromucous glands that produce thick mucus
either swallowed or coughed out through mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The lower respiratory system

Lungs

A

Lungs:
elastic connective tissue called stroma
left lung smaller with two lobes
right lung larger with three lobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The lower respiratory system

Pleura

A

Pleura:

pleural fluid allows lungs to move over thoracic wall during breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The lower respiratory system

Bronchi and Alveoli

A

Bronchi (larger) and Alveoli (smaller):

respiratory membrane where gas exchange

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

The lower respiratory system

Rib cage and Intercostal muscles

A

Rib cage and intercostal muscles:
Protect lungs
Sternum: manubrium, body and xiphoid process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Factors affecting respiration
Oxygen, carbon dioxide, hydrogen ion concentrations
Controlled by?

A

Oxygen, carbon dioxide, hydrogen ion concentrations:
Controlled by:
Respiratory centers of the medulla oblongata, pons of brain
Chemoreception in medulla and carotid, aortic bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Factors affecting respiration

Airway resistance, lung compliance, elasticity?

A

Airway resistance, lung compliance, elasticity?
Distensibility of lungs
Essential in inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Factors affecting respiration

Alveolar surface tention?

A

Alveolar surface tension:
Surfactant
Lipoprotein interferes with adhesiveness of water molecules
Helps expand lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Factors affecting respiration

Respiratory volume and capacity:

A

Respiratory volume and capacity:
Pulmonary function test
-total lung capacity (TLC): max inflation
-vital compacity: total amount of air that can be exhaled after max inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Factors affecting respiration

Air pressure

A

Air pressure:

  • inspiration: diaphragm contracting
  • expiration: passive, diaphragm relaxes
  • intrapulmonary pressure: measured inside the alveoli
  • intrapleural pressure: within pleural space
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Respiratory assessments

thoracic

A 
Thoracic:
Respiratory rate (12-20 bpm)
Anteroposterior diameter/transverse diameter ratio
Intercostal retraction or bulging
Chest expansion
Trachea position
Lung sounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Respiratory assessments

Health interview

A 
Health interview:
Current manifestations: onset, characteristics course, severity, precipitating, relieving factors
History of respiratory or lung conditions
Present health status
Medical history
Family history
Risk factors
Lifestyle questions:
-smoking
-environmental exposures
-occupational exposures
-exercise
-recreational drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Respiratory assessment

Nasal and sinus assessment

A 
Nasal:
Size
Shape
Color
Nasal cavity health
Ability to smell

Sinus:
No pain during palpitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Breath sounds

A

Breath sound assessment:
Auscultation
Sounds
Crackles: short, discrete, crackling, bubbling (pneumonia, bronchitis, CHF)
Wheezes : continuous, musical sounds ( bronchitis, emphysema, asthma
Friction rubs: loud, dry, creaking sounds (pleural inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where are vesicular lung sounds heard?

A

Peripheries of lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Where are bronchiolar vascular sounds heard?

A

Over the bronchi
Each side of sternum
Back between scapula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Where are bronchiolar sounds heard

A

Closer to the throat, near the manubrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Diagnostic tests

A

Sputum: gram stain, C&S, Cytology, acid-fast bacilli (AFB), detect bacterial infections in lungs. collected in A.M.

Chest x-ray

CT scan

MRI

PET scan

Thoracentesis: inserting needle, sample, remove fluid

Endoscopy: laryngoscopy, bronchoscopy, mediastinoscopy

Skin test

Blood test: arterial blood gasses (ABG’s), serology, CBC

Pulmonary function testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Age related changes in the respiratory system

A 
Decrease in elastic recoil of lungs
Loss of skeletal muscle strength in thorax/diaphragm
Fibrosis in alveoli
Fewer functional capillaries
Less effective cough
Decrease in pulmonary O2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Patients with pneumonia

A

Pt with pneumonia
Leading cause of death due to infectious disease in the US
Highest incidence, mortality in older adults
Infectious or noninfectious
**causes by bacteria, viruses, fungal, other pathogens, aspiration of contents, inhalation of toxic material

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Patient with pneumonia

Infectiuous classifications

A 
Community acquired:
Streptococcus pneumonia (most common)
Mycoplasma pneumonia
Haemophilus pneumonia
Influenzae
Chlamydia pneumonia
Influenza virus
Nosocomial (hospital acquired):
Staphylococcus aureus
Gram negative bacterial
-Klebsiella pneumonia
-Pseudomonas aeruginosa
-E coli

Opportunistic:
Pneumocystis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Physiology review of lower respiratory tract

A

Lower respiratory tract normally sterile

Defense mechanisms:
mucous membranes of nose (sneezing)
reflex closure of epiglottis, bronchial tree
cilia, mucus lining respiratory tract (coughing)

Aging impairs immune responses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Define pneumonia

A

Pneumonia:
The inflammatory response causes fluid to accumulate in the alveoli and edema to form as alveolar capillaries dilate and allow fluid to leak into interstitial tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Pneumonia develops

Four patterns

A

Four patterns:

Lobar pneumonia- involves the entire lobe of lung

Bronchopneumonia- fluid tends to remain in the bronchia’s and bronchi with less congestion in the alveoli

Interstitial pneumonia- found in the interstitial tissue

Miliary pneumonia- primarily seen in pts who are immunocompromised, typically enters through blood stream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Acute bacterial pneumonia

A

Acute bacterial pneumonia (quick onset):

Respiratory: cough productive of rust colored or purulent sputum

  • Chest aching or pleuritic pain when coughing/breathing
  • Limited breathing sounds, fine crackles, rales heard over affected area of lung
  • Pleural friction rub may be audible
  • Systemic: shaking chills (rigor), fever

Bronchopneumonia (slower onset):
-Insidious onset, low grade fever, cough, scattered crackles

Atypical presentation (older adults): fever, tachypnea, altered mental status, agitation, slight cough, minimal distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Complications of Acute Bacterial Pneumonia

A

Typically infection resolves uneventfully
Pleuritis is most common complication
Lung abscess (relatively uncommon):
-Most common etiology
-Aspiration, resultant pneumonia
-At-risk population
Empyema- accumulation of purulent exudate in the pleural cavity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Manifestations of Infectious Pneumonias
Pneumococcal or lobar pneumonia

Onset?
Respiratory manifestations?
Systemic manifestations?

A

Pneumococcal or lobar pneumonia

Onset? abrupt

Respiratory manifestations? Cough productive of purulent or rust-colored sputum; pleuritic or aching chest pain; decreased breath sounds and crackles over affected area; possible dyspnea and cyanosis

Systemic manifestations? Chills and fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Manifestations of Infectious Pneumonias
Bronchopneumonia

Onset?
Respiratory manifestations?
Systemic manifestations?

A

Bronchopneumonia

Onset? gradual

Respiratory manifestations? Cough, scattered crackles; minimal dyspnea and respiratory distress

Systemic manifestations? Low-grade fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Manifestations of Infectious Pneumonias
Legionnaire disease

Onset?
Respiratory manifestations?
Systemic manifestations?

A

Legionnaire disease

Onset? gradual

Respiratory manifestations? Dry cough; dyspnea

Systemic manifestations? Chills and fever; general malaise; headache; confusion; anorexia and diarrhea; myalgias (muscle pain) and arthralgias (joint pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Manifestations of Infectious Pneumonias
Primary atypical pneumonia

Onset?
Respiratory manifestations?
Systemic manifestations?

A

Primary atypical pneumonia

Onset? gradual

Respiratory manifestations? Dry, hacking, nonproductive cough

Systemic manifestations? Fever, headache, myalgias, and arthralgias dominate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Manifestations of Infectious Pneumonias
Viral pneumonia

Onset?
Respiratory manifestations?
Systemic manifestations?

A

Viral pneumonia

Onset? sudden or gradual

Respiratory manifestations? Dry cough

Systemic manifestations? Flulike symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Manifestations of Infectious Pneumonias
Pneumocystis pneumonia

Onset?
Respiratory manifestations?
Systemic manifestations?

A

Pneumocystis pneumonia

Onset? abrupt

Respiratory manifestations? Dry cough; tachypnea and shortness of breath; significant respiratory distress

Systemic manifestations? Fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Primary Atypical Pneumonia info, manifestations?

A

Mycoplasma pneumoniae

College students and military recruits are primary affected population

Primary atypical pneumonia is highly contagious

Called “walking pneumonia”

Mild respiratory manifestations

Pharyngitis or bronchitis

Dry, hacking, nonproductive cough

Systemic manifestations
Fever
Headache
Myalgias
Arthralgias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Viral Pneumonia info, manifestations

A

Mild disease

Affects older adults, people with chronic conditions

Cytomegalovirus (CMV) pneumonia is increasing in immunocompromised people.

Occurs in community epidemics

Influenza and adenovirus

Respiratory
Dry cough
Systemic
Flulike symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Pneumocystis Pneumonia info, manifestation

A

AIDS and other immunocompromised patients

Pneumocystis jiroveci

Produces patchy involvement throughout the lungs

Alveoli thicken, swell, and fill with fluid

Abrupt onset of symptoms: 
Fever
Tachypnea
Shortness of Breath
Nonproductive cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Manifestations of Pneumocystis Pneumonia

A 
Tachypnea, SOB
Dry, nonproductive cough
Intercostal retractions
Cyanosis
Fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Aspiration Pneumonia, risk factors, complications

A

Risk Factors: Emergency Surgery or Obstetric Procedure, depressed cough reflexes, impaired swallowing, elderly surgical patients, nutrition via NG or Gastric tube, and decreased LOC

Aspiration of gastric contents into lungs

Low p H of gastric contents causes inflammation

Pulmonary edema/respiratory failure can result

Complications:
abscesses
bronchiectasis
gangrene of pulmonary tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Interprofessional Care of the Patient with Pneumonia-Diagnosis, tests

A 
Chest x-ray
Sputum gram stain
Sputum C&S
CBC, WBC w/ dif
Serology when blood and sputum tests are negative
Pulse ox, continuously
ABG's
Fiberoptic bronchoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Interprofessional Care of the Patient with Pneumonia-Medications

A

Agents that “break up” mucus
Acetylcysteine
Potassium iodide
Guaifenesin

Broad spectrum antibiotic
Macrolide
Penicillin
Second- or third-generation cephalosporin
Fluoroquinolone

Bronchodilators
Sympathomimetic drugs
Methylxanthines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Interprofessional Care of the Patient with Pneumonia-Treatment and Prevention

A

Immunization
Pneumococcal vaccine
-Pneumococcal Conjugate (PCV13, Prevnar), common used in children
-Pneumococcal Polysaccharide (PPSV23, Pneumovax), given to adults, lifetime one dose.
Influenza vaccine

Treatments
Oxygen therapy
-For patients who are tachypneic, hypoxemic
-Low- or high-flow systems
Chest physiotherapy
-Percussion
-Vibration
-Postural drainage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Nursing Care of the Patient with Pneumonia

A

Diagnoses, outcomes, and interventions

  • Ineffective Airway Clearance
  • Ineffective Breathing Pattern
  • Activity Intolerance

Continuity of care
Usually treated in the community unless their respiratory status is significantly compromised or risk factors
-Advanced age
-Coexisting heart, kidney, or liver disease are present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

The Patient with Tuberculosis

A

Chronic, recurrent infectious disease usually affecting the lungs

Mycobacterium tuberculosis: Relatively slow-growing, acid-fast organism with a waxy outer capsule

Airborne transmission by droplet nuclei: Suspended in air for hours

47
Q

Epidemiology of Tuberculosis

A

Incidence and prevalence

United States

  • Incidence fell until the mid-1980s
  • Resurgence late 1980s and early 1990s
  • Link to H I V/AIDS
  • Incidence is now declining

Worldwide

  • Continues to be a significant health problem
  • An estimated 2 million deaths each year
48
Q

Risk Factors for Tuberculosis

A

Characteristics of infected person
Extent of air contamination
Duration of exposure
Susceptibility of host: Those in lower socioeconomic groups, injection drug users, the homeless, and people with alcoholism or H I V infection

49
Q

Manifestations and Complications of Tuberculosis

A 
Fatigue
Weight loss
Anorexia
Low-grade afternoon fever
Dry cough
Night sweats
Tuberculosis empyema
Bronchopleural fistula
50
Q

Interprofessional Care of the Patient with Tuberculosis

A 
Early detection
Accurate diagnosis
Effective disease treatment
Preventing spread to others
Screening
-Methods of tuberculin testing
-Intradermal P P D (mantoux) test
-Multiple-puncture (tine) testing
51
Q

TB testing

A

Intradermal injection for tuberculin testing.
The injection causes a local inflammatory response (wheal).
Measurement of induration following tuberculin testing.

The PPD will be administered intradermally on the dorsal aspect of the forearm , causing a wheel to develop approximately 6-10mm in diameter. the patient will have to return to the clinic after 48 to 72 hours to have the test read. The health care professional will measure the diameter of the induration.

52
Q

Interpretation of Tuberculin Test

A

Less than 5 millimeter: Negative response, does not rule out infection

5-9 millimeter: Positive for people who are in close contact with someone with T B, are immunocompromised, have an organ transplant

10-15 millimeter: Positive for people who have other risk factors

Greater than 15 millimeter: Positive for all people

53
Q

TB Diagnosis

A

A positive tuberculin test alone does not indicate active disease

Sputum smear is microscopically examined for acid-fast bacilli

Positive sputum culture is definitive

Sensitivity testing to determine appropriate drug therapy

Polymerase chain reaction (P C R)-rapid detection of M. tuberculosis D N A

Chest x-ray

Liver function tests

54
Q

TB Medication

A

Single-drug therapy: Isoniazid (I N H)

Bacillus Calmette-Guerin (B C G) vaccination

Not widely used in the United States
Two-or-more-drugs therapy: 
Isoniazid
Rifampin
Pyrazinamide
Ethambutol
Streptomycin

If a drug-resistant strain of T B: Therapy tailored to that resistance

55
Q

TB Nursing Care

A

Health promotion
-Risk to public health

Awareness of TB as reemerging threat

Early diagnosis and appropriate treatment is best for prevention

Focus on infection control and ensuring compliance with prescribed treatment

Diagnoses, outcomes, and interventions

  • Deficient Knowledge
  • Ineffective Therapeutic Regimen Management
  • Risk for Infection
56
Q

The Patient with a Fungal Infection

A

Spores are present in the air that everyone breathes.
Normal respiratory and immune defenses prevent infection in most people.
Risk factors
-Inadequate immune system

57
Q

Pathophysiology of Fungal Infection

A

Histoplasmosis

  • Most common fungal infection in US
  • Found in soil and linked to bird and bat droppings
  • Histoplasma capsulatum
  • Most infections develop into latent asymptomatic disease
  • Primary acute histoplasmosis: Mild, self-limiting influenza type illness
  • Chronic progressive disease: Older adults in lungs but can involve other organs

Disseminated histoplasmosis

  • Oftentimes fatal
  • Fever
  • Dyspnea
  • Cough
  • Weight Loss
  • Ulcerations of mouth and oropharynx
  • Muscle Wasting
  • Hepatomegaly
  • Splenomegaly
58
Q

Aspergillosis

A

Spores are common in the environment; rarely cause disease except in the immunocompromised

Invade blood vessels and produce hyphae that can cause thrombosis

Manifestations

  • Dyspnea
  • Nonproductive cough
  • Pleuritic chest pain
  • Chills, fever
  • Hemoptysis or massive pulmonary hemorrhage can occur if the organism invades a pulmonary blood vessel
59
Q

Diagnosis and Treatment of Fungal Infections

Diagnosis

A 
Diagnosis
Microscopic examination of sputum specimen
Blood cultures
Cerebrospinal fluid cultures
Chest x-ray
60
Q

Diagnosis and Treatment of Fungal Infections

Treatments

A 
Treatments
Oral itraconazole (Sporanox), a broad-spectrum antifungal agent, is commonly prescribed to treat histoplasmosis

Intravenous amphotericin B

surgery (lobectomy)

61
Q

Nursing Care of the Patient with a Fungal Infection

A

Education
-Geographical locations and risk factors (exposure to bird droppings)

Antifungal drugs
-Teach about drug and interactions

Pregnancy and birth control
-Itraconazole is contraindicated during pregnancy and lactation.

Monitor carefully during infusion and therapy
-Amphotericin B is toxic must be monitored closely

62
Q

The Patient with Obstructive Sleep Apnea

what is it?

A

Obstructive and Central Sleep Apnea
Obstructive Sleep Apnea: Respiratory drive remains intact but airflow ceases due to occlusion of airway (most common type)
Central sleep apnea rare: Caused by a neurological disorder

63
Q

The Patient with Obstructive Sleep Apnea

Pathophysiology

A

Pathophysiology

  • Loss of normal pharyngeal muscle tone
  • Pharynx collapses during inspiration & tongue pulls against post. pharyngeal wall
  • Obstruction causes O2 sat, P O2, and p H to fall, P C O2 to rise

-Asphyxia causes brief arousal from sleep
Restores airway patency and airflow
Episodes can occur hundreds of times a night

64
Q

Manifestations of Obstructive Sleep Apnea

A 
Loud, cyclic snoring, and restless sleep
Excessive daytime sleepiness
Irritability
Gasping or choking during sleep
Morning headache

Later Manifestations:
Depression, intellectual impairment, and impotence
Hypertension

65
Q

Complications of Obstructive Sleep Apnea Factors

A 
Complications
Sleep fragmentation
Loss of slow-wave sleep
Dysrhythmias
Sudden cardiac death
Pulmonary hypertension
Common in those who are morbidly obese
66
Q

Obstructive Sleep Apnea and Risk Factors

A 
Risk Factors 
Male gender
Increasing age
Obesity
Large neck circumference
Use of alcohol and C N S depressants
67
Q

Diagnosis of Sleep Apnea

A

Overnight sleep study

  • Electroencephalogram
  • Measurements of ocular activity and muscle tone
  • Ventilatory activity and airflow
  • Continuous arterial oxygen saturation
  • Heart rate
  • Transcutaneous arterial P C O2
68
Q

Treatment of Sleep Apnea

A

Mild-to-moderate apnea

  • Weight reduction
  • Abstaining from alcohol
  • Improving nasal patency
  • Avoiding supine sleeping position
  • Nasal continuous positive airway pressure (C P A P) is the treatment of choice for sleep apnea
  • Bi P A P ventilator provides less resistance to exhaling
69
Q

Surgical Intervention for Sleep Apnea

A

Tonsillectomy
Adenoidectomy
Uvulopalatopharyngoplasty (U P P P)
Tracheostomy

70
Q

Nursing Care of the Patient with Sleep Apnea

A

Obstructive sleep apnea is often treated in the home

Education of patient and family

  • Equipment use
  • Strategies to decrease contributing factors
  • Diagnoses, outcomes, and interventions
  • Disturbed Sleep Pattern
  • Fatigue
  • Ineffective Breathing Pattern
  • Impaired Gas Exchange
  • Risk for Injury
  • Risk for Sexual Dysfunction
71
Q

The Patient with Lung Cancer info

A
  • Leading cause of cancer deaths in United States
  • Accounts for 25% of all cancer deaths
  • Most people with lung cancer die within 1 year of initial diagnosis
72
Q

Pathophysiology of Lung Cancer

A

Vast majority of primary lung lesions are bronchogenic carcinomas.
-Bronchogenic carcinoma further differentiated by cell type

Small-cell carcinomas
-15% of lung cancers

Non-small-cell carcinomas (adenocarcinoma, squamous cell carcinoma, and large cell carcinoma)
-85% of lung cancers

Spread via lymph system to other organs

73
Q

Types of Lung Cancer

Small-cell (oat cell) carcinoma

A

Small-cell (oat cell) carcinoma, 15% of all lung cancers

  • Central mass
  • Aggressive tumor
74
Q

Types of Lung Cancer

Adenocarcinoma

A

Adenocarcinoma, 20-40% of all lung cancers

  • Peripheral mass
  • Early metastasis
75
Q

Types of Lung Cancer

Squamous cell

A

Squamous cell, 25-30% of all lung cancers

-Central mass in large bronchi

76
Q

Types of Lung Cancer

Large cell carcinoma

A

Large cell carcinoma, 10-15% of all lung cancers

-Peripheral mass larger than adenocarcinoma

77
Q

Incidence and Risk Factors of Lung Cancer

A

Populations at risk

  • Exposure to tobacco smoke
  • Age over 50
  • Exposure to ionizing radiation and inhaled irritants
  • Exposure to radon
78
Q

Manifestations of Lung Cancer

A 
Chronic cough
Hemoptysis
Wheezing SOB
Dull, aching chest pain or pleuritic pain
Hoarseness and/or dysphagia
Weight loss, anorexia
Fatigue, weakness
Bone pain
Clubbing of fingers/toes
79
Q

Complications and Course of Lung Cancer

A

Superior vena cava syndrome
-Partial or complete obstruction of superior vena cava

Paraneoplastic syndromes
-Syndrome of inappropriate ADH secretion (SIADH), hyponatremia, edema, Cushing Syndrome, hypercalcemia, venous thrombosis or pulmonary embolism.

80
Q

Diagnosis of Lung Cancer

A 
Chest x-ray
Sputum specimen
Bronchoscopy
C T scan
Cytologic examination, biopsy
C B C, liver function, serum electrolytes
Tuberculin test
Pulmonary function tests, A B G s
81
Q

Treatment of Lung Cancer

A

Medications

  • Combination chemotherapy treatment of choice for small-cell lung cancer
  • Bronchodilators

Surgery

  • Only real chance for cure in non-small cell lung cancers
  • Most tumors inoperable

Radiation therapy

  • Used alone or in combination with surgery or chemotherapy
  • Either curative or palliative
  • “Debulks” tumors prior to surgery
  • Relieve manifestations, complications
  • External beam, intraluminal radiation, brachytherapy
82
Q

Nursing Care of the Patient with Lung Cancer

A

Diagnoses, outcomes, and interventions

Ineffective Breathing Pattern
Assess respiratory status and oxygenation, pain, elevate HOB, Incentive Spirometer, Cough and Deep Breathe, Suction, Chest Physiotherapy.

Activity Intolerance
Assess physiologic responses to activity, plan rest periods between activities, increase activities gradually, teach energy conserving measures, keep frequently used objects within reach, administer O2 as prescribed, encourage physical activity

Pain
Assess pain, PRN pain meds for comfort or “around the clock” schedule for cancer pain, distraction, massage, positioning, and relaxation techniques.

Anticipatory Grieving
Spend time with patient/family, encourage expression of feelings/concerns, assist in grieving process, identify healthy coping measures, and encourage use of support systems

83
Q

The Patient with a Laryngeal Tumor

A

Benign or malignant

  • Benign: Papillomas, Nodules, Polyps
  • Malignant: Squamous Cell Carcinoma most common

Chronic shouting, projecting, or vocalizing

Cigarette smoking and chronic irritation from industrial pollutants

84
Q

Pathophysiology and Manifestations of Laryngeal Tumors part 1 or 2

A

Laryngeal
-Most common malignancy is squamous-cell carcinoma

-Leukoplakia
White, patchy, and precancerous lesions on tongue/mouth

-Erythroplakia
Red, velvety patches thought to represent a later stage

  • Initial cancerous lesion, carcinoma in situ (CIS), will develop into squamous-cell cancer if untreated
  • Laryngeal cancer can develop in glottis, supraglottis, and subglottis
85
Q

Pathophysiology and Manifestations of Laryngeal Tumors

part 2 of 2

A

Pathophysiology and manifestations

Laryngeal cancer

  • Cancers of the vocal cords or glottis tend to be well-differentiated, slow-growing
  • Metastasis occurs late in illness
  • Manifestations

Hoarseness: Change in voice quality

  • Cancer of supraglottis (epiglottis, aryepiglottic folds, arytenoid muscles, cartilage, and false vocal cords): Invades locally, metastasizes early
  • Subglottic tumors (below vocal cords): Often asymptomatic until enlarging tumor obstructs airway
86
Q

Risk Factors for Laryngeal Tumors

A 
Tobacco
Alcohol
Poor nutrition
Human papillomavirus infection
Exposure to asbestos
Race: More common in African Americans
87
Q

Interprofessional Care of the Patient with a Laryngeal Tumor

A

Benign tumors may resolve with correction of underlying issue

Early detection of malignant tumors is critical to survival

Diagnosis

  • Direct or indirect laryngoscopy when cancer is suspected
  • Biopsy
  • C T scan, MRI, chest x-ray, & PET
88
Q

Treatment of Laryngeal Tumors

A

Benign vocal cord polyps

  • Inhaled steroid spray
  • Some cases call for surgery
Radiation therapy
-Treatment of choice
-Preserves voice
-Chemoradiotherapy
Chemotherapy
  • Treats distant metastasis
  • Palliation when tumor unresectable
  • Cisplatin and 5-fluorouracil
89
Q

Surgical Intervention for Laryngeal Tumors

A

Goals

  • Remove the malignancy
  • Maintain airway patency
  • Achieve optimal cosmetic appearance
Laser laryngoscopy (carcinoma in situ, vocal cord 
polyps, & early vocal cord cancers)

Laryngectomy

  • Partial laryngectomy
  • —Hemilaryngectomy
  • —Vertical partial laryngectomy
  • Total

Radical neck dissection

Modified neck dissection

90
Q

total laryngectomy

A

Following a total laryngectomy, the patient has a permanent tracheostomy. No connection between the trachea and esophagus remains.

91
Q

tracheoesophageal prosthesis (T E P)

A

The tracheoesophageal prosthesis (T E P) allows diversion of air from the trachea through a one-way valve into the esophagus and oropharynx, producing speech when the tracheostomy stoma is occluded. The one-way valve prevents food from entering the trachea.

92
Q

Post-Surgical Care for the Patient with a Laryngeal Tumor

A

Speech rehabilitation

Necessary if entire larynx is removed

Techniques

  • Tracheoesophageal puncture (TEP) with placement of a one-way shunt valve
  • Esophageal speech
  • Use of speech generators
93
Q

Nursing Care of the Patient with a Laryngeal Tumor

A

Emphasize the need for patients with chronic hoarseness to seek treatment

Health promotion

Prevent tobacco use in children, adolescents, and young adults

Discourage use of alcohol

94
Q

Nursing Care of the Patient with a Laryngeal Tumor

Diagnoses, outcomes, and interventions

A

Diagnoses, outcomes, and interventions

  • Risk for Impaired Airway Clearance
  • Impaired Verbal Communication
  • Impaired Swallowing
  • Imbalanced Nutrition: Less Than Body Requirements
  • Anticipatory Grieving
95
Q

The Patient with Asthma

what is it?

A

Asthma

  • Chronic inflammatory disorder of airways
  • Recurrent episodes of wheezing, breathlessness, chest tightness, coughing

Rare acute cases can be severe enough to cause respiratory failure, death

96
Q

Pathophysiology of Asthma
Chronic
Subacute
Acute

A

Chronic inflammatory disorder of airways

Subacute state

  • Inflammation quiet
  • Inflammatory cells present in airway tissues

Acute episodes

  • Widespread airflow obstruction
  • Antigen-antibody response
  • Inflammatory mediators released
  • Bronchoconstriction, airway edema, impaired mucociliar clearance
97
Q

Triggers for Asthma

A 
Allergens
Chemical agents in the workplace
Respiratory infections
Exercise
Emotional stress
Pharmacologic
-N S A I D s, beta-blockers, sulfites
98
Q

Responses to Asthma
Acute or early response
Late phase response

A

Acute or early response

  • Inflammatory mediators
  • Activation of inflammatory cells
  • Stimulation of parasympathetic receptors
  • Bronchoconstriction and impaired gas exchange

Late phase response
-4-12 hours after trigger

99
Q

Manifestations and Complications

A 
Wheezing
Breathlessness
Chest tightness
Coughing
Dyspnea
Status asthmaticus
-Severe, prolonged asthma
-Does not respond to treatment
100
Q

Diagnosis of Asthma

A 
History and manifestations
Pulmonary function tests (P F T s)
Challenge or bronchial provocation tests
A B G s
Skin tests
101
Q

Interprofessional Care of the Patient with Asthma

A

Disease monitoring

  • Peak expiratory flow rate (P E F R)
  • Evaluated by traffic signals

Preventative measures

  • Avoiding allergens, environmental triggers
  • Eliminating tobacco
  • Early treatment of respiratory infections
102
Q

Medications for asthma

A

Long-term control

  • Anti-inflammatory agents
  • Long-acting bronchodilators
  • Leukotriene modifiers

Quick relief

  • Short-acting adrenergic stimulants
  • Anticholinergic drugs
  • Methylxanthines

Routes of administration

  • Metered-dose inhaler (M D I)
  • Dry powder inhaler (D P I)
  • Nebulizer

Bronchodilators
-Adrenergic stimulants, anticholinergic agents, and methylxanthines
In combination with anti-inflammatory

Anti-inflammatory agents

  • Corticosteroids
  • Cromolyn sodium and nedocromil

Leukotriene modifiers

  • Montelukast, zafirlukast, zileuton
  • Reduce need for short-acting bronchodilators
103
Q

Nursing Care of the Patient with Asthma

A

Health promotion

  • Link between smoking, childhood asthma
  • Smoking cessation
104
Q

Nursing Care of the Patient with Asthma

Diagnoses, outcomes, and interventions

A

Diagnoses, outcomes, and interventions

  • Ineffective Airway Clearance- monitor LOC, assess pulse oximetry, assess cough effort and sputum, raise HOB, administer O2 and nebulizer Tx as ordered
  • Ineffective Breathing Pattern-Assess RR, pattern and breath sounds, vital signs, labs, assist with ADL’s, provide rest between scheduled activities, teach pursed lip breathing and relaxation techniques, Administer O2 and bronchodilators/anti-inflammatories as ordered.
  • Anxiety-Assess level of anxiety, identify coping skills, provide physical and emotional support, active listening, provide clear instructions, reduce excessive environmental stimuli, relaxation techniques.
  • Ineffective Therapeutic Regimen Management-Assess level of understanding about treatment and diagnosis, discuss perceptions of illness, identify problems integrating tx plan into lifestyle, provide verbal and written instructions
105
Q

The Patient with Chronic Obstructive Pulmonary Disease

A

Also known as C O P D

Pathophysiology
-Chronic bronchitis and/or emphysema
-Characterized by slow progressive obstruction of airways:
Resistance to airflow increases
Expiration becomes slow or difficult
Mismatch between alveolar ventilation and perfusion
Impaired gas exchange

106
Q

Pathophysiology of COPD

Chronic bronchitis

A

Chronic bronchitis

  • Inhaled irritants cause chronic inflammation
  • Production of thick mucus
  • Productive cough lasting 3 or more months in 2 consecutive years
  • Narrowing of airways
  • Common recurrent infection
107
Q

Pathophysiology of COPD

Emphysema

A

Emphysema

  • Destruction of the walls of the alveoli
  • Enlargement of abnormal air spaces
  • Airway collapse
  • Loss of alveolar surface area for gas exchange
108
Q

Manifestations of COPD

A

COPD is classified according to severity, staged from 0 to 4

Productive cough, often in mornings

Dyspnea with activity, exercise intolerance

Presence of a barrel-shaped chest

109
Q

Incidence and Risk Factors of C O P D

A 
Fourth leading cause of death in U.S
Cigarette smoking
Air pollution
Occupational exposures
Airway infection
Familial and genetic factors
110
Q

Diagnosis of COPD

A 
Pulmonary function tests
Ventilation-perfusion scanning
Serum alpha1-antitrypsin levels
A B G s
Pulse oximetry
C B C with W B C differential
Chest x-ray
111
Q

Medications for C O P D

A
  • Immunizations against pneumococcal pneumonia and influenza
  • Broad-spectrum antibiotics for suspected infection
  • Bronchodilators- improves airflow and reduce air trapping
  • Corticosteroids when asthma is component
  • Alpha1-antitrypsin replacement therapy for those with genetic deficiency
112
Q

Treatments for C O P D

A 
Smoking cessation
Avoidance of airway irritants and allergens
Pulmonary hygiene measures
Adequate hydration
Pulmonary rehabilitation (P R)
Pursed Lip Breathing 
Regular aerobic exercise, if applicable
Oxygen
-Long-term oxygen therapy
Surgery
-Lung transplant
-Lung reduction surgery
113
Q

Nursing Care of the Patient with C O P D

Diagnoses, outcomes, and interventions

A

Diagnoses, outcomes, and interventions

  • Ineffective Airway Clearance- assess respiratory status, rate, cough, secretions, oxygen saturation, I/O, mucous membranes, encourage fluid intake of 2500ml/day, elevate HOB, coughing/deep breathing, suction, provide rest periods, oxygen, expectorants/bronchodilators.
  • Imbalanced Nutrition: Less Than Body Requirements- assess nutritional status, monitor food intake, provide frequent, small feedings, elevate HOB for meals, provide snacks at bedside, assist with choosing preferred foods, and consult with dietician.
  • Compromised Family Coping- Assess family interactions and effects of illness on them, identify coping strengths/weaknesses, provide teaching on COPD, encourage expression of feelings and avoid judgment, encourage family participation in care, family care conferences.
  • Decisional Conflict: Smoking- Assess knowledge and understanding, acknowledge concerns and beliefs, listen nonjudgmentally, encourage expression of feelings, assist with creating plan to quit, provide referrals to outside support personal or groups.

NUR 141 (48 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions