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7th Semester > 400 Exam 3--Respiratory > Flashcards

400 Exam 3--Respiratory Flashcards

1
Q
  • Highly contagious; now have multiple strains
  • Local outbreaks can occur—especially in pediatric and older populations
  • S/s: Fever, headache, malaise
  • Airborne, droplet, and direct contact precautions
A

influenza

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2
Q

scarlatina-form rash with urticaria

A

scarlet fever

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3
Q

sx of tonsillitis

A

sore throat, fever, snoring, difficulty swallowing

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4
Q

sx of Adenoiditis

A

mouth-breathing, earache, draining ears, frequent head colds, bronchitis, foul smelling breath, voice impairment, noisy respiration

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5
Q

tx for tonsillitis

A

(supportive measures)

increased fluid intake
analgesics
salt-water gargles
rest

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6
Q

− Patients who have experienced no adverse events for ___hours have a low overall risk of later bleeding and other complications after tonsillectomy and adenoidectomy

A

6

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7
Q

why would a patient need tonsillectomy or adenoidectomy

A

♣ Has had repeated episodes of tonsillitis despite antibiotic therapy

♣ Hypertrophy of tonsils & adenoids that could cause obstruction and obstructive sleep apnea

♣ Repeated attacks of purulent otitis media

♣ Suspected hearing loss due to serous otitis media that has occurred in association with enlarged tonsils and adenoids

exacerbation of asthma or rheumatic fever

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8
Q

how to patients lye post op Tonsillectomy and Adenoidectomy

A

prone with head turned to side to allow drainage

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9
Q

− Do not remove oral airway until ?

A

patient’s gag and swallowing reflexes have returned

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10
Q

what is provided for expectoration of blood and mucous after tonsillectomy

A

− Ice collar applied to the neck and basin and tissues are

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11
Q

sx of post op complications

A

fever
throat pain
ear pain
bleeding

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12
Q

− When examining for bleeding have what handy?

A

a mirror, light, gauze, curved hemostats, and a waste basin

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13
Q

− Instruct patient to refrain from too much

A

talking and coughing

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14
Q

sent home after tonsillectomy when ?

A

awake oriented and able to drink liquids and void

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15
Q

bleeding may occur up to ____ days after surgery

A

8

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16
Q

pain will subside in the first ___-___ days post op tonsillectomy

A

3-5

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17
Q

what sx may occur in first 24 hours

A

sore throat, stiff neck, minor ear pain and vomiting

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18
Q

avoid ___ and ___ for 10 days

A

smoking and heavy lifting

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19
Q

Risk for developing airway closure

A

ϖ Epiglottitis

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20
Q

n/d for upper airway infection

A

ineffective airway clearance
acute pain
deficient fluid volume
deficient knowledge

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21
Q

goals for upper airway infection

A

o Maintenance of a patent airway, relief of pain, effective means of communication, normal hydration, knowledge of how to prevent upper airway infections, and absence of complications

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22
Q

nursing interventions for upper airway infection

A

maintain patent airway
promote comfort and communication
encourage fluids
educate prevention strategies

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23
Q

ϖ Cessation of breathing during sleep usually caused by repetitive upper airway obstruction. Characterized by recurrent episodes of upper airway obstruction and a reduction in ventilation.

A

sleep apnea

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24
Q

major risk factors for sleep apnea

A 
male
obesity
man with really thick neck
post-menopausal status
alterations in upper airway
age
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25
Q

o Characterized by frequent and loud snoring with breathing cessation for 10 seconds or longer for at least 5 episodes per hour followed by awakening abruptly with a loud snort as blood-oxygen level drops

A

sleep apnea

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26
Q

repetitive apnic events result in _____ and ____

A

hypoxia and hypercapnia

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27
Q

patients with OSA have a high prevalence of

A

HTN, and increased risk of MI and stroke

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28
Q

sleep apnea is More prevalent in people with ?

A

CAD, congestive HF, metabolic syndrome, type II diabetes

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29
Q

classic sx of sleep apnea?

A

snoring
shorting
gasping
choking

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30
Q

ϖ What health promotion strategies will aid in the treatment of OSA?

A

o Tonsillectomy

o Uvula removal

o Start off doing sleep studies to evaluate person’s oxygenation, heart rate, and sleep pattern

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31
Q

CPAP

A

continuous positive airway pressure

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32
Q

BiPAP

A

bi-level positive airway pressure

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33
Q

o 1 predetermined level of pressure

  • Gives a continuous flow of air in and out—can only be set at 1 speed
  • May or may not be used with oxygen in the hospital as well
A

CPAP

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34
Q

o 2 levels of pressure

  • High level when person breaths in, and a low level when person exhales (but enough to keep airway open)
  • Usually for those with a respiratory disorder
  • Usually used before the person is put on mechanical ventilation (often to avoid ventilation)
  • Can be used to control reparations (more control)
A

BiPAP

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35
Q

Biggest concern with CPAP and BiPAP machine?

A

o Monitor O2 sat, that machine is functioning properly, & mask is on and fits properly—make sure mask & machine are on

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36
Q

NOSEBLEED

A

epistaxis

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37
Q

ϖ Hemorrhage from the nose, caused by the rupture of tiny, distended vessels in the mucous membranes of any area of the nose

A

epistaxis

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38
Q

causes of epistaxis

A

coumadin
allergies
High BP
change in climate

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39
Q

ϖ Risk factors for epistaxis

A

o Local infection (vestibulitis, rhinitis, sinusitis)

o Systemic infections (scarlet fever, malaria)

o Drying of nasal mucous membranes

o Nasal inhalation of illicit drugs (cocaine)

o Trauma (digital trauma as in picking the nose; blunt trauma; fracture; forceful blowing of nose)

o Arteriosclerosis

o Hypertension

o Tumor (Sinus or nasopharynx)

o Thrombocytopenia

o Use of aspirin

o Liver disease
Redu-Osler-Weber syndrome

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40
Q

what to do first for nose bleed?

A

position upright

pinch the softer outer portion of the nose for 5-10 min

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41
Q

may need to use what meds if nose bleed doesn’t stop?

A

nitro or coccaine

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42
Q

if all unsuccessful, a ___ ___ may be inserted into the nostril and suction may be used to remove excess blood and clots

A

cotton tampon

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43
Q

what to watch for with nose bleeds?

A

♣ Watch for aspiration and monitor for continuous swallowing

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44
Q

education for nose bleed

A

o Avoid vigorous exercise for several days
o No heavy lifting or straining
o Avoid spicy foods and tobacco/smoking—may cause vasodilation and increase risk of re-bleeding
o Avoid excessive nose blowing, straining, high altitudes, and nasal trauma (nose picking)
o Adequate humidification may prevent drying of nasal passages
o Patients with nasal cannulas may want humidified O2 ordered, nonpetroleum based ointment also

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45
Q

risk factors for cancer of the larynx

A 
carcinogens
voice straining
gender
age
african american
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46
Q

sx of cancer of the larynx

A

hoarseness for more than 2 weeks duration
persistent cough or sore throat
burning in the throat, especially when consuming hot liquids or citrus juices

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47
Q

diagnostic tests for cancer of the larynx

A

barium swallow

MRI

PET scan

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48
Q

education for barium swallow

A

NPO 8-12 hours prior and NPO post procedure until gag reflex is present again

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49
Q

goal of treatment for cancer of the larynx?

A

cure, preserve safe, effective swallowing, preserve useful voice, and avoidance of permanent tracheostomy

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50
Q

implanted seeds at tumor site (preserves vocal cords)

used for cancer of the larynx

A

brachytherapy

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51
Q

advantage of radiation

A

retain a near normal voice

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52
Q

complications of radiation with cancer of the larynx?

A

♣ damage to parotid gland which is responsible for saliva production

  • They will get xerostomia
  • Patient will probably get mucositis
  • Ulceration of the mucous membranes
  • Skin is burned around area
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53
Q

• They’ll lose their sense of taste during radiation but it’ll return about ___ months after they finish

A

3

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54
Q

late complications for cancer of the larynx?

A

laryngeal necrosis, edema, and fibrosis

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55
Q

surgery options for cancer

A

vocal cord stripping, cordectomy, laser surgery

partial/hemilaryngectomy

total laryngectomy

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56
Q
  • Voice rest at least a week or so
  • Usually if early and tumor is not causing too much damage

• Usually can resume to a near normal speaking voice
May or may not have to have a temporary trach until the swelling goes down

A

♣ Vocal cord stripping, cordectomy, laser surgery

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57
Q
  • Portion of larynx is removed (about 50% or more), along with one vocal cord and the tumor
  • Usually come back with a temporary trach until the swelling goes down

wil have hoarse voice

A

♣ Partial/Hemilaryngectomy

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58
Q

with Partial/Hemilaryngectomy what is important to tell pt. before surgery?

A

must relearn to swallow.

prevent aspiration of food and liquids

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59
Q

best way for pts with ♣ Partial/Hemilaryngectomy to eat ?

A

sitting up.

suction at bedside.

put the head down and to unaffected side then swallow.

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60
Q

Will have permanent stoma & tracheostomy

neck breather

♣ Still can swallow normally, but will be sore at 1st..no aspiration risk when eating d/t closed off airway from mouth

A

o Total Laryngectomy

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61
Q

o Methods used to restore speech after Laryngectomy

A

o Esophageal Speech (Burp talking)

o Electrolarynx (Robot voice)

o Tracheoesophageal Puncture/Fistula (Blom-Singer)

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62
Q

♣ Swallow air and make yourself burp to talk

♣ Can be taught once patient begins oral feedings—approximately 1 week after surgery

A

o Esophageal Speech (Burp talking)

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63
Q

♣ Person has the vibration thing or a straw one, when air comes out it causes vibration

♣ Pt removes trach and puts battery operated voice box up to stoma, which uses vibrations to form words

A

o Electrolarynx (Robot voice)

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64
Q

♣ Most commonly used after a total laryngectomy

♣ Valve placed in pouch b/w esophagus and trachea to divert air into the esophagus and out of the mouth. A prosthesis (Blom-Singer) is then put over the stoma cover hole to talk

A

o Tracheoesophageal Puncture/Fistula (Blom-Singer)

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65
Q

pre-op teaching

A 
type of surgery
expected changes in speech
tubes used postop
nutrition education
exercises for strength and flexibility of neck and shoulder muscles
stoma care and suctioning
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66
Q

nursing interventions

A 
Deficit knowledge (big one) 
Ineffective airway clearance
altered tissue perfusion
pain
altered nutrition: less than body requirements
impaired verbal communication
anxiety and depression
disturbed body image
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67
Q

♣ Suctioning secretions frequently and suction no longer than ___-___ sec at a time

A

10-15 seconds

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68
Q

♣ Encourage early ambulation to avoid

A

atelectasis, pneumonia, and DVT

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69
Q

♣ Prevent aspiration by

A

sitting up 45 degrees

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70
Q

♣ Most important factor in decreasing cough, mucus production, and crusting is

A

adequate humidification

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71
Q

♣ Keep inner cannula clean, usually recommended ?

A

3 times a day (q8hrs)

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72
Q

sx of hypoxia

A

increased HR and mental status changes

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73
Q

how to prevent altered tissue perfusion

A

elevate HOB

monitor VS

assess JP drains

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74
Q

draining with JP drains post op should be?

A

serosangenous and decreases over a few days (drastically decrease over 24-48 hours)

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75
Q

♣ Prior to oral feedings, _____/_____ does a swallow study to assess risk for aspiration.

A

speech therapist/radiologist

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76
Q

♣ Once cleared for oral feedings, nurse explains that ____liquids will be used first because they are easy to swallow and that ___ liquids should be avoided.

A

thick; thin

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77
Q

stoma education

A

don’t cut gauze and put around the airway

use a stoma guard

can’t swim

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78
Q

how to know how deep to go for suctioning

A

go until you feel resistance or till they cough

usually 3 inches

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79
Q

closed suctioning is used?

A

when patient is on vent (not sterile)

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80
Q

always suction ____ after ____.

A

mouth after trach

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81
Q

number for suctioning an adult

A

100-150 mmHg

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82
Q

movement of air in and out of the airways

A

¥ Ventilation -

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83
Q

(movement of air into lungs)

A

o Inspiration

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84
Q

(movement of air out of lungs)

A

o Expiration

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85
Q

labored breathing or shortness of breath (accessory muscles help)

A

¥ Dyspnea:

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86
Q

dyspnea is by the ____ of the patient

A

perception

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87
Q

SOB when they perform an activity

A

dyspnea on exertion

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88
Q

unable to breathe flat

inability to breathe easily except in upright position

A

orthopnea

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89
Q

unable to sleep flat

sudden/acute nighttime SOB

A

paroxysmal nocturnal dyspnea

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90
Q

sx of paroxysmal nocturnal dyspnea

A

labored breathing
shallow breathing
rapid breathing

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91
Q

—due to elastin fibers in alveolar walls and capillaries

A

¥ Elasticity (recoil)

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92
Q

o Ability of the lungs to Decrease in volume passively due to elastin fibers

A

¥ Elasticity (recoil)

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93
Q

o When you breathe in and then breathe out (when you aren’t thinking about it), that’s the _____.

A

recoil

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94
Q

o Someone with poor elasticity, will have trouble ____ ____ _____.

A

pushing air out.

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95
Q

what decreases elasticity

A

pulmonary fibrosis
interstitial lung disease
aging

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96
Q

—a measure of the ease of expansion of the lungs (the elasticity and expandability of the lungs and the thoracic structures)

A

¥ Compliance

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97
Q

decreased compliance =

A

more difficult to inflate

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98
Q

with decreased compliance the ____ and ___ are stiff

A

lungs and thorax

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99
Q

conditions that cause decreased compliance:

A

increased fluid in lungs

conditions that decrease elasticity

conditions that restrict movement

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100
Q

▪ Increased fluid in lungs:

A

Pulmonary edema

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101
Q

▪ Conditions that decrease elasticity:

A

Pulmonary Fibrosis

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102
Q

▪ Restrict movement:

A

Pleural effusion

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103
Q

easier to inflate (the lungs have lost their elasticity and the thorax is overdistended)

A

o Increased compliance:

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104
Q

▪ Destruction of alveolar walls due to less elastin that causes increased compliance

A

Emphysema

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105
Q

detection of the vibration of sound on the chest wall by touch (p. 500)

A

¥ Tactile fremitus—

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106
Q

¥ Tactile fremitus is influenced by the ____ of the chest wall, especially if it is muscular

A

thickness

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107
Q

blood flow through lungs (controlled by cardiac system)

A

perfusion

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108
Q

—exchange of O2 and CO2

A

¥ Diffusion

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109
Q

amount of oxygen dissolved in plasma (when you draw blood)

A

o PaO2:

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110
Q

: amount of O2 bound to hemoglobin molecules

A

o SaO2

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111
Q

¥ What is the primary muscle of inspiration?

A

diaphragm

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112
Q

¥ The relationship between the PaO2 and SaO2

¥ Represents the saturation percentage that occurs with various PaO2 levels

A

OXYGEN DISSOCIATION CURVE

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113
Q

¥ O2 sat starts to decrease when a PaO2 goes below ____.

A

60

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114
Q

normal PaO2

A

80-100

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115
Q

¥ Person could have a good O2 sat for a little longer after the

A

PaO2 stat drops

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116
Q

¥ Alkalosis is when you have an

A

elevated pH above 7.45 and the O2 has an increased affinity for the hemoglobin molecule may have an increased or normal O2 sat

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117
Q

¥ Acidosis is a

A

low pH below 7.35 and O2 has a decreased affinity for hemoglobin decrease in O2 saturations

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118
Q

o What is left over after the maximal exhalation

A

residual volume (RV)

1200 ml

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119
Q

o Volume of air in the lungs after the biggest inhalation

A

¥ Total Lung Capacity (TLC)

5800 ml

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120
Q

o Volume of air combined that is inhaled and exhaled with each breath

A

tidal volume

500 ml

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121
Q

o Maximum volume of air exhaled from the point of maximal inhalation

A

vital capacity

4600 ml

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122
Q

changing with ages

A
  • Cartilage calcification
  • Arthritis
  • Osteoporosis
  • Loss of elastic recoil of the lungs
  • Decrease muscle strength
  • Increased thickness of alveolar membranes
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123
Q

most common problems with aging are related to:

A

pneumonia

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124
Q

o Noninvasive procedure that gives a good idea of the amount of oxygen contained in the hemoglobin

A

pulse oximetry

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125
Q

what to look at for upper airway:

A 
nasal and septal deviation
congestion
obstruction
sinus pressure
red throat
swollen larynx
mid-line uvula
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126
Q

(usually checked after surgery & endoscopic procedures)

A

o gag reflex

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127
Q

what to look at with chest and lungs

A 
barrel chest?
tender?
use of accessory muscles?
petechiae?
midline trachea?
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128
Q

cues to resp. problems

A 
dyspnea
hemoptysis
cyanosis
pleuritic chest pain
clubbing
abnormal sputum
coughing
voice changes
wheezing
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129
Q

subjective feeling of difficult or labored breathing, breathlessness, SOB

A

¥ Dyspnea:

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130
Q

coughing up of blood or bloody secretions

A

¥ Hemoptysis:

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131
Q

bluish discoloration of skin and mucous membranes (Very late indicator of hypoxia, however is not a reliable sign of hypoxia)

A

¥ Cyanosis:

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132
Q

discomfort w/ initial inspiration and sharp intense pain at the end of inspiration.

A

¥ Pleuritic Chest Pain:

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133
Q

: changes in the appearance of the nail bed

A

¥ Clubbing

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134
Q

¥ Clubbing is common with

A

chronic hypoxic conditions

chronic lung infection

lung malignancies

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135
Q

protective reflex that expels secretions and irritants from the lower airways

A

¥ Coughing:

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136
Q

(whistling sound during inspiration)

A

stridor

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137
Q

¥ Wheezing: High-pitched musical sound heard mainly on expiration (asthma) or inspiration (bronchitis)

A

wheezing

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138
Q

o Often indicative of bronchoconstriction or airway narrowing

A

wheezing

139
Q

sx of pulmonary disease

A

hypercapnia

hypoxemia

140
Q

¥ : Increased PaCO2 (progressing to respiratory acidosis) r/t decreased drive to breathe or an inadequate ability to respond to respiratory stimulation

A

hypercapnia

141
Q

Too much ___ in the body causes vasodilation and sedative effect on the nervous system,

A

CO2

142
Q

Reduced oxygenation of the arterial blood (decreased PaO2) r/t respiratory alterations

A

¥ Hypoxemia:

143
Q

o Assess respiratory function and determine the extent of the dysfunction

A

¥ Pulmonary Function Tests (PFTs)—incentive spirometer

144
Q

incentive spirometer’s test for?

A

tital volume

145
Q

o Patients with ???? use pulmonary function test to monitor their response to therapy

A

chronic lung illness

146
Q

o ABG levels are obtained through an arterial puncture at the ____, _____, or _____ artery

A

radial, brachial, or femoral

147
Q

normal pulse ox

A

95-100%

148
Q

¥ V/Q (ventilation/perfusion) Scan (p. 510)—diagnoses vascular diseases like _____ _____.

A

pulmonary embolisms (PE)

149
Q

o Performed by injecting a radioactive agent into a peripheral vein and then obtaining a scan of the chest to detect radiation

A

V/Q (ventilation/perfusion) Scan

150
Q

how is the V/Q (ventilation/perfusion) Scan done?

A

o Isotope particles pass through right side of the heart and are distributed into the lungs in proportion to the regional blood flow

151
Q

o A decreased uptake of this isotope high probability of ______ _____.

A

pulmonary embolisms

152
Q

o the direct inspection and examination of the larynx, trachea, and bronchi through either a flexible fiberoptic (used more frequently) bronchoscope or a rigid bronchoscope

A

bronchoscopy

153
Q

diagnostic bronchoscopy looks for?

A

¥ tissues and collect secretions, determine location and extent of pathologic process and obtain tissue, to determine whether a tumor can be resected surgically, diagnose bleeding sites

154
Q

therapeutic bronchoscopy is to?

A

¥ Remove foreign bodies, secretions, treat post-op atelectasis, destroy and excise lesions

155
Q

possible complications for bronchoscopy

A 
▪	Reaction to local anesthetic
▪	Infection
▪	Aspiration
▪	Bronchospasm
▪	Hypoxemia
▪	Pneumothorax
▪	Bleeding
▪	Perforation
156
Q

nursing interventions for bronchoscopy

A

confirm signed consent

restrict fluids and food 6 hours before

explain procedure

admin pre op meds

remove dentures

NPO after until gag reflex returns

157
Q

meds for bronchoscopy

A

atropine and sedative to opioid to inhibit vagal stimulation

158
Q

¥ Once gag reflex returns after bronchoscopy?

A

, may offer ice chips then eventually fluids

159
Q

o Aspiration of fluid or air from the pleural space

A

thoracentesis

160
Q

o Very important to get ????? prior to thoracentesis

A

full set of vital signs plus breath sounds

161
Q

nursing duties for thoracentesis

A

make sure X-ray was ordered and consents were signed

allergies?

admin sedation

education

position the patient

162
Q

what type of discomfort is expected after a thoracentesis?

A

minimal discomfort

163
Q

how to position patient?

A

¥ Position pt sitting on edge of bed w/ feet supported and arms and head on a padded over-the-bed table or

164
Q

if unable to sit?

A

Lying on the unaffected side with HOB elevated 30-40 degrees

165
Q

▪ After the needle is withdrawn?

A

pressure is applied over the puncture site and a small, airtight, sterile dressing is fixed in place

166
Q

what to educate patient on after thoracentesis

A

they will be on bed rest and CXR will be obtained

167
Q

▪ Record total amount of fluid w/drawn from procedure and document the nature of the fluid, its ???

A

color, and its viscosity

168
Q

sx of hemorrhage post thoracentesis

A

low BP and tachycardia

169
Q

o Diagnostic procedure in which the pleural cavity is examined with an endoscope

A

thoracoscopy

170
Q

sx of hypoexemia

A 
decreased PO2
o	Dyspnea, tachypnea
o	cyanosis
o	Restlessness
o	Tachycardia
o	Dysrhythmias
o	Agitation
o	Uncoordinated muscle movement
o	Diaphoresis
o	Impaired Judgment/confusion/Delirium
171
Q

sx of hypercapnia

A

¥ respiratory acidosis d/t decreased breathing

o COPD, asthma, drug overdose,

o anything prevent pt. breathing out the CO2

172
Q

collapse of alveoli

A

atelectasis

173
Q

atelectasis leads to

A

pneumonia
hypoxemia
resp. failure

174
Q

atelectasis is most commonly seen in

A

ϖ post-operative patients,
immobile patients, and
patients with COPD

175
Q

prevention of atelectasis

A 
change position
early mobilization
deep breathing/coughing
incentive spirometry
suctioning
postural draining/chest percussion

admin prescribed opioids and sedative judiciously to prevent resp. depression

176
Q

goal of tx for atelectasis

A

improve ventilation and remove secretions

177
Q

ϖ

Leading cause of death from infectious disease in US

ϖ Can be infectious or noninfectious

A

pneumonia

178
Q

non infectious pneumonia is caused from

A

aspiration

inhalation of toxic substance

179
Q

infectious pneumonia is caused by

A

fungus

bacteria

180
Q

pneumonia results from?

A

invading MO gets into alveoli–> causes immune response–> exudate form in the alveoli

181
Q

prevention of pneumonia mainly by?

A

vaccine

182
Q

classifications of pneumonia

A 
hospital acquired
community acquired
viral pneumonia
oportunistic pneumonia
aspiration
183
Q

decreases pH in stomach—makes it easier for bacteria to go up and colonize

A

• Protonix

184
Q

at increased risk for hospital acquired pneumonia

A

> 60 y/o

pts intubated or ventilator for >48 hours

post op surgery

limited mobility

decreased LOC

185
Q

community acquired is more common in elderly or those with ______.

A

COPD

186
Q

d/t Flu, RSV, less noticeable than bacteria

A

o Viral pneumonia

187
Q

Immunocompromised pts (HIV/AIDs, chemo, RA meds, long term steroid use)

A

o Opportunistic pneumonia (viral or bacterial)—

188
Q

d/t food, secretions, etc.

A

o Aspiration—

189
Q

risk factors for pneumonia

A

o Smoking/air pollution

o Altered levels of consciousness

o URI infections/ Chronic diseases (asthma)

o Immunocompromised

o Prolonged immobility

o Tracheal intubation

o Altered oral flora

o Ventilator—Associated pneumonia (VAP)

190
Q

o with Ventilator—Associated pneumonia (VAP) it is important to do what ?

A

frequent suctioning
turn patients
good oral care

191
Q

types of pneumonia you may see in patients chart

A

acute bacterial pneumonia

primary atypical pneumonia

viral pneumonia

192
Q

o neumococcal pneumonia (direct spread of drop in lungs)

• Ex. Lobar pneumonia, Bronchopneumonia

A

Acute Bacterial Pneumonia

193
Q

sx of Acute Bacterial Pneumonia

A

− Rapid onset
− Fever, chills, malaise, elevated WBC
− Productive cough purulent or rust colored sputum, blood tinged sputum
− Pleuritic chest pain sharp with breathing or coughing
− Dullness or percussion
− Breath sounds diminished, crackles, rales, or may hear pleural friction rub
− Activity intolerance chart s/s on ambulation
− If severe impaired gas exchange, dyspnea, cyanosis
− Obvious infiltrates on x-ray

194
Q

Primary Atypical Pneumonia AKA

A

pharyngitis

bronchitis

“walking pneumonia”

195
Q

“walking pneumonia” is more common in?

A

younger adults not often in the hospital

196
Q

viral pneumonia is often seen in older adults and the sx include?

A

• vague “flu-like” symps, low fever, slight WBC increase, X-ray normal at 1st then progresses to minimal changes

197
Q

complications of pneumonia include:

A 
pleuritis
necrosis of lung tissue
lung abscess
empyema
pleural effusion
resp. failure
198
Q

inflammation of pleura causing stabbing pain when deep breathing or coughing

A

o Pleuritis

199
Q

Loss of blood supply to lungs; Eventually has to be removed

A

o Necrosis of lung tissue

200
Q

• Cough up purulent (pus), foul smelling mucous

A

lung abscess

201
Q

• Occurs when thick, purulent fluid accumulates within the pleural space, often with fibrin development and a lobulated (walled-off) area where the infection is located

A

empyema

202
Q

Excess fluid in pleural space

A

o Pleural effusion

203
Q

Need to be placed on mechanical ventilation

A

o Respiratory failure

204
Q

how to dx pneumonia

A 
CXR
pulse ox
sputum gram stain
blood cultures
ABGs
205
Q

blood cultures are done prior to starting any antibiotics and it requires ____ ____ to confirm it

A

2 sets (of venipuncture)

206
Q

meds for pneumonia

A

broad spectrum ATB

analgesics/antipyretics

steroids

bronchodilator/nebulizer

mucolytics and mucamyst

207
Q

nursing management of pneumonia patient

A 
hydration
O2 therapy
turn patients
incentive spirometry
chest physiotherapy
208
Q

elderly considerations for pneumonia

A

may not have obvious symptoms

general deterioration

weakness

anorexia

confusion

209
Q

who’s at risk for aspiration?

A

tube feeders

patients with seizure activity

brain injury

stroke

swallowing disorders

post op patients

decreased LOC

ET intubation

flat body positioning

cardiac arrest

210
Q

mucous or gastric contents enter the lungs without them knowing

A

silent aspiration

211
Q

how to prevent aspiration

A

elevate HOB
suction often
residuals for tube feedings

212
Q

ϖ Viral illness (coronavirus) NO KNOWN CURE, treat symptoms

A

SARS

severe acute respiratory syndrome

213
Q

SARS are spread by?

A

droplet (coughing, sneezing, mucous membranes, contaminated water)

214
Q

SARS intubation period

A

2-7 days

215
Q

nursing interventions for SARS

A

contact and airborne precautions

monitor resp. status

no opioids

216
Q

max precautions for SARS such as:

A

N95 mask

gown

gloves

booties on feet

Notify CDC

217
Q

ϖ An infectious disease that primarily affects the lung parenchyma but can be transmitted to other parts of the body, including the meninges, kidneys, bones, and lymph nodes.

A

TUBERCULOSIS (TB)

218
Q

pathology of TB

A

o Droplets enter lungs and cause an inflammatory response and forms a capsule that hangs around until the immune system decreases or something causes TB to become active—not usually contagious immediately, can stay dormant

219
Q

transmission of TB

A

airborne

spread through talking, coughing, sneezing, laughing or singing

220
Q

TB is ____ by a susceptible person

A

inhaled

221
Q

seen on X-ray (calcification)

A

tubercule

222
Q

people with TB usually is unknown until?

A

CXR or mantoux test

or it becomes active

223
Q

high risk for TB

A

low income

homeless persons

healthcare workers with frequent exposure

elderly and young adults

persons living in close quarters

drug/alcohol users

immunosuppressed

224
Q

screening for TB test include:

A

mantoux test

quantiferon –TB gold

BCG vaccine

225
Q

what to look at on mantoux test

A

induration NOT redness or grooving

226
Q

want under ____ mm for one in close contact with person or immunocompromised

A

5mm

227
Q

0-4 mm

A

not significant

228
Q

5-9 mm

A

o (+); may be significant in people who are considered to be at risk (have close contact w/ active TB, abnormal x-ray and have HIV)

229
Q

10 mm or greater

A

o (+); is usually considered significant in people who have normal or mildly impaired immunity

230
Q

• Want under ____mm for someone that is unexposed and general population, over that want to do investigation

A

10mm

231
Q

good for someone that has gone through treatment already or who is allergic to mantoux

looks at the shape of the WBCs

A

Quantiferon (TB Gold)

232
Q
  • Same agent for bladder cancer

* Actual tuberculosis immunization—not used in the US

A

BCG vaccine

233
Q

after what test will the mantoux be invalid?

A

BCG vaccine

234
Q

meds for TB

A

isoniazid (INH)

rifampin, rifabutin, rifapetine

pyrazinamide

ethambutol

235
Q

education on INH

A

hepatotoxic

no liquor

236
Q

INH can cause peripheral neuropathy..what will prevent this

A

vitamin B6 (pyrodoxine)

237
Q

education with the Rif- drugs

A

flu-like symptoms

causes sweat and secretions to turn orange

238
Q

Rif- drugs react with

A 
birth control
BB
cardiac meds
anticoagulants
digoxin
239
Q

education with pyrazinamid

A

hepatotoxic

hyperuricemia

240
Q

ethambutol education

A

vision screenings
blurred vision
changes in red and green color

241
Q

ethambutol can cause renal disease so we need to monitor for ____ and ____.

A

BUN and creatinine

242
Q

prophylactic treatment is necessary for TB when?

A

anyone who has been exposed

243
Q

for prophylactic treatment they will be placed on single-dose drug therapy of INH for __-__ months

A

6-12

244
Q

o If compliance is a problem, medications are administered under direct supervision ______ _____.

A

twice weekly

245
Q

DOT (direct observed therapy) can be done how?

A

Home health or TB clinic

246
Q

if you’re exposed

A

repeat PPD 2-3 mo

CXR

INH prophylactic

247
Q

ND for TB

A

deficient knowledge

risk for infection

ineffective therapeutic regimen

248
Q

prevent spread of TB to protect yourself

A

o Mask patient immediately if you suspect TB
o

Place in isolation room
o	Staff—get fitted for a TB mask (surgical masks do not filter droplet bacilli)
o	Annual PDD
o	Wear a mask or respirator
o	Encourage pt to cough in tissue
o	Mask pt if must leave isolation room
o	Educate family
o	Teach good hygiene & oral care
 bv
249
Q

when looking for TB what do they test for in the sputum?

A

acid fast bacilli

250
Q

typical discharge planning for TB

A

home health nurse will admin meds to them every two weeks for 2 months

they are still contagious for 3 weeks

251
Q

o Inflammation of both layers of the pleurae—fluid fills tissue (friction rub no longer heard, pain decreases)

A

pleurisy

252
Q

sx of pleurisy

A
  • Sharp knife like pain with inspiration
  • May hear friction rub
  • Taking a deep breath, coughing, or sneezing may worsen the pain
  • Usually occurs only on one side
  • Pain may be localized or radiate to the shoulder or abdomen
253
Q

• As pleural fluid develops=

A

pain decreases

254
Q

tx of pleurisy

A

treatment of underlying cause

treat pain

255
Q

nursing management of pleurisy

A

turn freq. to affected side to splint the chest wall

splint with pillow when coughing

encourage breathing

256
Q

o Collection of fluid in the pleural space

o Could cause compression on adjacent tissue

A

pleural effusion

257
Q

tx of pleural effusion

A
  • Discover underlying cause
  • Relieve discomfort
  • Support oxygenation

Thoracentesis

258
Q

nursing management with pleural effusion

A

record throacocentesis fluid amount

pain management for chest tube

frequent turning

259
Q

A patient underwent a thoracentesis a few hours earlier, what finding should the nurse report immediately to the physician?

A

onset of crepitus

260
Q

ϖ “Drowning”

ϖ Abnormal accumulation of fluid in the lung tissue, the alveolar space, or both

ϖ Severe, life threatening condition

A

pulmonary edema

261
Q

causes of pulmonary edema

A

heart failure, blood backs up in lung, left sided heart failure

262
Q

pulmonary edema is a complication of

A

pneumonectomy,
abnormal cardiac function, and
hypervolemia

263
Q

sx of pulmonary edema

A 
ϖ	Dyspnea, 
anxiety, 
air hunger, 
central cyanosis, 
pink frothy sputum, 
posterior crackles, 
tachycardia, 
low O2 saturation and 
hypoxemia, 
nail beds blue, 
tachycardia,
 agitated, 
restless, 
acute respiratory distress,  
may become confused
264
Q

prevention of pulmonary edema

A

recognize s/s of fluid volume overload

265
Q

treatment of pulmonary edema

A 
oxygen (15L non-rebreather)
diuretics
vasodilators (Nitrates)
sit up right with feet dangling
psychological suport
insert foley
266
Q

how to position patient with pulmonary edema

A

upright with feet dangling

267
Q

ϖ Can be a primary disease or can occur on its own—just happens

A

pulmonary HTN

268
Q

causes of pulmonary HTN

A

COPD (pulmonary artery constriction)

pulmonary embolism

269
Q

dx of pulmonary HTN by?

A

dyspnea that begins on exertion and progresses to all the time

peripheral edema
JVD
crackles in lungs
heart murmur

270
Q

goal for pulmonary HTN is to prevent ____ and _____.

A

hypoexemia and hypercapnia

271
Q

ϖ R ventricle enlarges with or without heart failure

A

pulmonary heart disease (cor pulmonale)

272
Q

causes of pulmonary heart disease

A

COPD or any disease that causes hypotension

273
Q

goals of pulmonary heart disease (cor pulmonale)

A

improve gas exchange
O2 therapy
ECG monitoring

274
Q

dx of for pulmonale by

A

EKG
pulmonary function test
right sided heart cath to check arterial pressure

275
Q

education for (cor pulmonale)

A 
daily weights
go home on O2
stop smoking
diuretics
LOW sodium diet
276
Q

pulmonary embolism is not a disease it is the result of a ____ ____

A

venous thrombosis

277
Q

ϖ Often undetected but rarely occurs without risk factors

A

pulmonary embolism

278
Q

pulmonary embolism risk factors:

A 
o	Thrombophlebitis (DVT) or Hx of DVT or PE
o	Immobility
o	Recent surgery (esp. ortho and gynecologic)
o	Obesity
o	Congestive heart failure or MI
o	Recent fracture
o	Estrogen therapy (contraceptives)
o	Pregnancy
o	Elderly

also CA and chemo

279
Q

Pulmonary embolism sxs

A

o Pulmonary HTN (substernal chest pain)

o Cardiogenic shock

o Sudden onset Tachypnea with dyspnea (lowered PaCO2)

o Anxious & restless, hyperventilation

o Fever, increased leukocyte count

o Sudden onset wheezing

o Cough, Hemoptysis (pulmonary infarction)

o Cyanosis with a massive PE–hypotension

o Unexplained anxiety

o It’s a perfusion problem not oxygenation Still give oxygen

280
Q

prevention of pulmonary embolism

A

get mobile
prevent DVT
SCDs
leg exercises

281
Q

dx of pulmonary embolism

A 
VQ scan
CT scan
pulmonary angiography
PT-PTT
CXR
D-dimer
ABGs
EKG
282
Q

ϖ Diagnosis of PE

o Can be tricky—several things cause the symptoms, death occurs within ____ hr of onset of symptoms

A

1

283
Q
  • Looks at ventilation (air flow) and perfusion (blood flow in and out of lung)
  • Helps to rule out COPD and other conditions
  • Involves the IV administration of a contrast agent
A

VQ scan

radioisotope ventilation/perfusion scan

284
Q

most definitive diagnosis for PE

A

Pulmonary angiography

285
Q

assess specific presence of a thrombus

A

o D-dimer

286
Q

what does D-dimer detect in blood

A

• Fibrin split product released into circulation by pasmin during fibrinolysis

287
Q

ABGs with PE usually show?

A

Resp. alkalosis

288
Q

Tx of PE

A 
anticoagulant therapy
high fowlers
oxygen
IV fluids
emotional support
Thrombolytic therapy (TPA)
Heparin (drip)
pulmonary embolectomy
289
Q

is the standard treatment for prevention of PE

A

o Anticoagulant therapy

290
Q
  • Clot busters—dissolve clot
  • Urikynase, streptokinase
  • Can only be used for very specific patients—many risks
A

o Thrombolytic therapy (TPA)

291
Q

TPA can not be used in patient who:

A

high risk for bleeding
recent stroke
active bleeding
CVA within past 2 months

292
Q

• Antidote for heparin is

A

protamine sulfate

293
Q

• Antidote for Coumadin is

A

vitamin K

294
Q
  • Enter vessel and suction out clots
  • Done with massive PE where action needs to be

done quickly at TPA is contraindicated

A

o Pulmonary embolectomy

295
Q

For the hospitalized patient, which manifestation would the nurse assess to be a symptom of pulmonary embolism?

A

• Abrupt onset of dyspnea and apprehension

296
Q

What pharmacological treatment would the nurse administer aimed at prevention of pulmonary embolism

A

• Enoxaparin (lovenox)

297
Q

people with lung CA typically die within ____ year

A

1

298
Q

risk factors for lung CA

A 
african american men who are 50-64
smoking
hereditary
inhaled carcinogens
chronic inflammation of the lung
299
Q

tumor types for lung CA:

A

squamous cell
large cell
small cell

300
Q

early sx of lung CA

A

persistent pneumonia
cough
SOB
chest pain

301
Q

late sx of lung CA

A 
fatigue
weight loss
hoarseness
palpable lymph nodes
superior vena cava syndrome
302
Q

_____ and _____ is sign that presence of CA is close to trachea

A

o Dysphagia and hoarseness

303
Q

dx of lung CA

A 
CXR
CT scan
PET
sputum sample
bronchoscopy
fine needle aspiration under CT guidance
304
Q

small cell carcinoma often gets what type of treatment

A

chemo and radiation

305
Q

surgery for lung CA

A

pneumonectomy

lobectomy

306
Q

o Removal of entire lung—may have some drains but no chest tube

A

pneumonectomy

307
Q

with pneumonectomy what will typically happen after the portion is removed?

A

serous fluid will fill the space

308
Q

how to position pneumonectomy patient

A

ON the AFFECTED side

(incision side down) in semi fowlers

309
Q

o Will have one or two chest tubes—help inflate the lung

A

lobectomy

310
Q

how to position lobectomy

A

on Unaffected side
(incision side up)
semi fowlers

311
Q

post op pneumonectomy of lobectomy:

A

comfort measures
cough/deep breathing/incentive spirometer
splint incision when sneezing/coughing

312
Q

what is usual after lung surgery

A

crepitus

313
Q

unusual after lung surgery

A

bleeding

314
Q

ϖ Anything that interferes w/ negative pressure in the lungs and causes the lung to collapse is a

A

pneumothorax (Ex. Bronchoscopy, Trauma)

315
Q

ϖ Broad category to describe a set of symptoms: Emphysema and Chronic bronchitis

A

chronic obstructive pulmonary disease

COPD

316
Q

risk factors for COPD:

A 
tobacco smoke
increased age
occupational exposure
indoor/outdoor pollution
genetic abnormalities (alpha1-trypsin deficiency)
chronic inflammation
317
Q

ϖ Pulmonary Function Tests—help confirm diagnosis of COPD; determine severity and monitor disease progression

A

Pulmonary Function Tests

318
Q

—evaluates obstruction and reversibility of obstruction

A

o Spirometry

319
Q

– performed in acute setting for acute exacerbation of COPD

A

ϖ ABG’s

320
Q

– lungs will be enlarged with

A

emphysema

321
Q

o Abnormal enlargement of alveoli

o Over inflation of the lungs – air is trapped and lungs never go back to normal size

o Loss of lung recoil, increased lung compliance

A

emphysema

322
Q

etiology of emphysema

A

def of alpha 1 antitrypsin

smoking

323
Q

sx of emphysema

A

dyspnea that worsens over time

pursed lip breathing

barrel chest

anorexic

no edema unless R sided HF

324
Q

emphysema patients are “____ ____” due to chronic CO2 retention

A

pink puffers

325
Q

o Chronic inflammation in small airways

A

chronic bronchitis

326
Q

manifestations for chronic bronchitis

A

hacking wet cough–lots of mucous!!!!
hypoxia
rales and rhonchi

327
Q

complications of COPD

A

resp acidosis
pulmonary HTN
cor pulmonale
acute respiratory failure

328
Q

medications for COPD

A 
oxygen 
bronchodilators
beta agonists
anticholinergic
menthylxanthines
corticosteroids
mucolytics, anti-tussives
anti-anxiety
smoking cessation
flu/pneumonia vaccines
ATB
329
Q

how to use MDI

A

o Remove cap and hold inhaler upright

o Shake inhaler

o Tilt head back slightly and breathe out slowly and all the way

o Position inhaler 1-2 in away from open mouth, or use a spacer

o Start breathing in slowly through mouth, and press inhaler once

o Breathe in slowly and deeply as long as possible
Hold breath as you count to 10 slowly to allow the med to reach down into airways

330
Q

repeat puffs as directed, allowing ___-__ sec between each puff.

A

15-30

331
Q

After inhalation with MDI

A

rinse mouth with water

332
Q

ϖ Chronic inflammatory disease (mucosal edema) with acute exacerbations, which are followed by increased mucus after acute episode

A

asthma

333
Q

ϖ Spastic contraction of the bronchiolar smooth muscle causes a narrowed airway that’s reversible

A

asthma

334
Q

asthma is triggered by?

A

allergens
environmental pollutants
emotional stress
respiratory infections

335
Q

slow-reacting substance of anaphylaxis

A

o Histamine,

336
Q

o Histamine produces

A

leukotrines

337
Q

leukotrines cause:

A

Localized edema in small bronchioles & mucus production

Spasm of the bronchiolar smooth muscle

338
Q

complications of asthma attack

A

tachycardia
pneumothorax
resp. fatigue
status asthmaticus

339
Q

emergency situation when asthma is prolonged or back to back attacks occur

A

o Status asthmaticus

340
Q

indicates definite worsening of asthma symptoms and is life threatening

A

o “Silent chest”

341
Q

nursing diagnosis for asthma

A

o Ineffective breathing pattern

o Ineffective airway clearance

o Anxiety

Risk for infection

342
Q

Rescue meds for asthma

A

beta-adrenergic agnosits/adrenergic stimulants

mix albuterol and atrovent

anticholinergics

corticosteroids

343
Q

maintenance medications:

A

anti-inflammatory agents

theophylline

leukotriene inhibitors

7th Semester (14 decks)

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