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
2
Q
scarlatina-form rash with urticaria
A
scarlet fever
3
Q
sx of tonsillitis
A
sore throat, fever, snoring, difficulty swallowing
4
Q
sx of Adenoiditis
A
mouth-breathing, earache, draining ears, frequent head colds, bronchitis, foul smelling breath, voice impairment, noisy respiration
5
Q
tx for tonsillitis
A
(supportive measures)
increased fluid intake
analgesics
salt-water gargles
rest
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
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
8
Q
how to patients lye post op Tonsillectomy and Adenoidectomy
A
prone with head turned to side to allow drainage
9
Q
− Do not remove oral airway until ?
A
patient’s gag and swallowing reflexes have returned
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
11
Q
sx of post op complications
A
fever
throat pain
ear pain
bleeding
12
Q
− When examining for bleeding have what handy?
A
a mirror, light, gauze, curved hemostats, and a waste basin
13
Q
− Instruct patient to refrain from too much
A
talking and coughing
14
Q
sent home after tonsillectomy when ?
A
awake oriented and able to drink liquids and void
15
Q
bleeding may occur up to ____ days after surgery
A
8
16
Q
pain will subside in the first ___-___ days post op tonsillectomy
A
3-5
17
Q
what sx may occur in first 24 hours
A
sore throat, stiff neck, minor ear pain and vomiting
18
Q
avoid ___ and ___ for 10 days
A
smoking and heavy lifting
19
Q
Risk for developing airway closure
A
ϖ Epiglottitis
20
Q
n/d for upper airway infection
A
ineffective airway clearance
acute pain
deficient fluid volume
deficient knowledge
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
22
Q
nursing interventions for upper airway infection
A
maintain patent airway
promote comfort and communication
encourage fluids
educate prevention strategies
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
24
Q
major risk factors for sleep apnea
A
male obesity man with really thick neck post-menopausal status alterations in upper airway age
25
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
sleep apnea
26
repetitive apnic events result in _____ and ____
hypoxia and hypercapnia
27
patients with OSA have a high prevalence of
HTN, and increased risk of MI and stroke
28
sleep apnea is More prevalent in people with ?
CAD, congestive HF, metabolic syndrome, type II diabetes
29
classic sx of sleep apnea?
snoring
shorting
gasping
choking
30
ϖ What health promotion strategies will aid in the treatment of OSA?
o Tonsillectomy
o Uvula removal
o Start off doing sleep studies to evaluate person’s oxygenation, heart rate, and sleep pattern
31
CPAP
continuous positive airway pressure
32
BiPAP
bi-level positive airway pressure
33
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
CPAP
34
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)
BiPAP
35
Biggest concern with CPAP and BiPAP machine?
o Monitor O2 sat, that machine is functioning properly, & mask is on and fits properly—make sure mask & machine are on
36
NOSEBLEED
epistaxis
37
ϖ Hemorrhage from the nose, caused by the rupture of tiny, distended vessels in the mucous membranes of any area of the nose
epistaxis
38
causes of epistaxis
coumadin
allergies
High BP
change in climate
39
ϖ Risk factors for epistaxis
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
40
what to do first for nose bleed?
position upright
| pinch the softer outer portion of the nose for 5-10 min
41
may need to use what meds if nose bleed doesn't stop?
nitro or coccaine
42
if all unsuccessful, a ___ ___ may be inserted into the nostril and suction may be used to remove excess blood and clots
cotton tampon
43
what to watch for with nose bleeds?
♣ Watch for aspiration and monitor for continuous swallowing
44
education for nose bleed
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
45
risk factors for cancer of the larynx
```
carcinogens
voice straining
gender
age
african american
```
46
sx of cancer of the larynx
hoarseness for more than 2 weeks duration
persistent cough or sore throat
burning in the throat, especially when consuming hot liquids or citrus juices
47
diagnostic tests for cancer of the larynx
barium swallow
MRI
PET scan
48
education for barium swallow
NPO 8-12 hours prior and NPO post procedure until gag reflex is present again
49
goal of treatment for cancer of the larynx?
cure, preserve safe, effective swallowing, preserve useful voice, and avoidance of permanent tracheostomy
50
implanted seeds at tumor site (preserves vocal cords)
used for cancer of the larynx
brachytherapy
51
advantage of radiation
retain a near normal voice
52
complications of radiation with cancer of the larynx?
♣ 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
53
• They’ll lose their sense of taste during radiation but it’ll return about ___ months after they finish
3
54
late complications for cancer of the larynx?
laryngeal necrosis, edema, and fibrosis
55
surgery options for cancer
vocal cord stripping, cordectomy, laser surgery
partial/hemilaryngectomy
total laryngectomy
56
* 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
♣ Vocal cord stripping, cordectomy, laser surgery
57
* 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
♣ Partial/Hemilaryngectomy
58
with Partial/Hemilaryngectomy what is important to tell pt. before surgery?
must relearn to swallow.
prevent aspiration of food and liquids
59
best way for pts with ♣ Partial/Hemilaryngectomy to eat ?
sitting up.
suction at bedside.
put the head down and to unaffected side then swallow.
60
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
o Total Laryngectomy
61
o Methods used to restore speech after Laryngectomy
o Esophageal Speech (Burp talking)
o Electrolarynx (Robot voice)
o Tracheoesophageal Puncture/Fistula (Blom-Singer)
62
♣ Swallow air and make yourself burp to talk
♣ Can be taught once patient begins oral feedings—approximately 1 week after surgery
o Esophageal Speech (Burp talking)
63
♣ 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
o Electrolarynx (Robot voice)
64
♣ 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
o Tracheoesophageal Puncture/Fistula (Blom-Singer)
65
pre-op teaching
```
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
```
66
nursing interventions
```
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
```
67
♣ Suctioning secretions frequently and suction no longer than ___-___ sec at a time
10-15 seconds
68
♣ Encourage early ambulation to avoid
atelectasis, pneumonia, and DVT
69
♣ Prevent aspiration by
sitting up 45 degrees
70
♣ Most important factor in decreasing cough, mucus production, and crusting is
adequate humidification
71
♣ Keep inner cannula clean, usually recommended ?
3 times a day (q8hrs)
72
sx of hypoxia
increased HR and mental status changes
73
how to prevent altered tissue perfusion
elevate HOB
monitor VS
assess JP drains
74
draining with JP drains post op should be?
serosangenous and decreases over a few days (drastically decrease over 24-48 hours)
75
♣ Prior to oral feedings, _____/_____ does a swallow study to assess risk for aspiration.
speech therapist/radiologist
76
♣ 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.
thick; thin
77
stoma education
don't cut gauze and put around the airway
use a stoma guard
can't swim
78
how to know how deep to go for suctioning
go until you feel resistance or till they cough
| usually 3 inches
79
closed suctioning is used?
when patient is on vent (not sterile)
80
always suction ____ after ____.
mouth after trach
81
number for suctioning an adult
100-150 mmHg
82
movement of air in and out of the airways
¥ Ventilation -
83
(movement of air into lungs)
o Inspiration
84
(movement of air out of lungs)
o Expiration
85
labored breathing or shortness of breath (accessory muscles help)
¥ Dyspnea:
86
dyspnea is by the ____ of the patient
perception
87
SOB when they perform an activity
dyspnea on exertion
88
unable to breathe flat
inability to breathe easily except in upright position
orthopnea
89
unable to sleep flat
sudden/acute nighttime SOB
paroxysmal nocturnal dyspnea
90
sx of paroxysmal nocturnal dyspnea
labored breathing
shallow breathing
rapid breathing
91
—due to elastin fibers in alveolar walls and capillaries
¥ Elasticity (recoil)
92
o Ability of the lungs to Decrease in volume passively due to elastin fibers
¥ Elasticity (recoil)
93
o When you breathe in and then breathe out (when you aren’t thinking about it), that’s the _____.
recoil
94
o Someone with poor elasticity, will have trouble ____ ____ _____.
pushing air out.
95
what decreases elasticity
pulmonary fibrosis
interstitial lung disease
aging
96
—a measure of the ease of expansion of the lungs (the elasticity and expandability of the lungs and the thoracic structures)
¥ Compliance
97
decreased compliance =
more difficult to inflate
98
with decreased compliance the ____ and ___ are stiff
lungs and thorax
99
conditions that cause decreased compliance:
increased fluid in lungs
conditions that decrease elasticity
conditions that restrict movement
100
▪ Increased fluid in lungs:
Pulmonary edema
101
▪ Conditions that decrease elasticity:
Pulmonary Fibrosis
102
▪ Restrict movement:
Pleural effusion
103
easier to inflate (the lungs have lost their elasticity and the thorax is overdistended)
o Increased compliance:
104
▪ Destruction of alveolar walls due to less elastin that causes increased compliance
Emphysema
105
detection of the vibration of sound on the chest wall by touch (p. 500)
¥ Tactile fremitus—
106
¥ Tactile fremitus is influenced by the ____ of the chest wall, especially if it is muscular
thickness
107
blood flow through lungs (controlled by cardiac system)
perfusion
108
—exchange of O2 and CO2
¥ Diffusion
109
amount of oxygen dissolved in plasma (when you draw blood)
o PaO2:
110
: amount of O2 bound to hemoglobin molecules
o SaO2
111
¥ What is the primary muscle of inspiration?
diaphragm
112
¥ The relationship between the PaO2 and SaO2
| ¥ Represents the saturation percentage that occurs with various PaO2 levels
OXYGEN DISSOCIATION CURVE
113
¥ O2 sat starts to decrease when a PaO2 goes below ____.
60
114
normal PaO2
80-100
115
¥ Person could have a good O2 sat for a little longer after the
PaO2 stat drops
116
¥ Alkalosis is when you have an
elevated pH above 7.45 and the O2 has an increased affinity for the hemoglobin molecule may have an increased or normal O2 sat
117
¥ Acidosis is a
low pH below 7.35 and O2 has a decreased affinity for hemoglobin decrease in O2 saturations
118
o What is left over after the maximal exhalation
residual volume (RV)
1200 ml
119
o Volume of air in the lungs after the biggest inhalation
¥ Total Lung Capacity (TLC)
5800 ml
120
o Volume of air combined that is inhaled and exhaled with each breath
tidal volume
500 ml
121
o Maximum volume of air exhaled from the point of maximal inhalation
vital capacity
4600 ml
122
changing with ages
* Cartilage calcification
* Arthritis
* Osteoporosis
* Loss of elastic recoil of the lungs
* Decrease muscle strength
* Increased thickness of alveolar membranes
123
most common problems with aging are related to:
pneumonia
124
o Noninvasive procedure that gives a good idea of the amount of oxygen contained in the hemoglobin
pulse oximetry
125
what to look at for upper airway:
```
nasal and septal deviation
congestion
obstruction
sinus pressure
red throat
swollen larynx
mid-line uvula
```
126
(usually checked after surgery & endoscopic procedures)
o gag reflex
127
what to look at with chest and lungs
```
barrel chest?
tender?
use of accessory muscles?
petechiae?
midline trachea?
```
128
cues to resp. problems
```
dyspnea
hemoptysis
cyanosis
pleuritic chest pain
clubbing
abnormal sputum
coughing
voice changes
wheezing
```
129
subjective feeling of difficult or labored breathing, breathlessness, SOB
¥ Dyspnea:
130
coughing up of blood or bloody secretions
¥ Hemoptysis:
131
bluish discoloration of skin and mucous membranes (Very late indicator of hypoxia, however is not a reliable sign of hypoxia)
¥ Cyanosis:
132
discomfort w/ initial inspiration and sharp intense pain at the end of inspiration.
¥ Pleuritic Chest Pain:
133
: changes in the appearance of the nail bed
¥ Clubbing
134
¥ Clubbing is common with
chronic hypoxic conditions
chronic lung infection
lung malignancies
135
protective reflex that expels secretions and irritants from the lower airways
¥ Coughing:
136
(whistling sound during inspiration)
stridor
137
¥ Wheezing: High-pitched musical sound heard mainly on expiration (asthma) or inspiration (bronchitis)
wheezing
138
o Often indicative of bronchoconstriction or airway narrowing
wheezing
139
sx of pulmonary disease
hypercapnia
hypoxemia
140
¥ : Increased PaCO2 (progressing to respiratory acidosis) r/t decreased drive to breathe or an inadequate ability to respond to respiratory stimulation
hypercapnia
141
Too much ___ in the body causes vasodilation and sedative effect on the nervous system,
CO2
142
Reduced oxygenation of the arterial blood (decreased PaO2) r/t respiratory alterations
¥ Hypoxemia:
143
o Assess respiratory function and determine the extent of the dysfunction
¥ Pulmonary Function Tests (PFTs)—incentive spirometer
144
incentive spirometer's test for?
tital volume
145
o Patients with ???? use pulmonary function test to monitor their response to therapy
chronic lung illness
146
o ABG levels are obtained through an arterial puncture at the ____, _____, or _____ artery
radial, brachial, or femoral
147
normal pulse ox
95-100%
148
¥ V/Q (ventilation/perfusion) Scan (p. 510)—diagnoses vascular diseases like _____ _____.
pulmonary embolisms (PE)
149
o Performed by injecting a radioactive agent into a peripheral vein and then obtaining a scan of the chest to detect radiation
V/Q (ventilation/perfusion) Scan
150
how is the V/Q (ventilation/perfusion) Scan done?
o Isotope particles pass through right side of the heart and are distributed into the lungs in proportion to the regional blood flow
151
o A decreased uptake of this isotope high probability of ______ _____.
pulmonary embolisms
152
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
bronchoscopy
153
diagnostic bronchoscopy looks for?
¥ 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
therapeutic bronchoscopy is to?
¥ Remove foreign bodies, secretions, treat post-op atelectasis, destroy and excise lesions
155
possible complications for bronchoscopy
```
▪ Reaction to local anesthetic
▪ Infection
▪ Aspiration
▪ Bronchospasm
▪ Hypoxemia
▪ Pneumothorax
▪ Bleeding
▪ Perforation
```
156
nursing interventions for bronchoscopy
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
meds for bronchoscopy
atropine and sedative to opioid to inhibit vagal stimulation
158
¥ Once gag reflex returns after bronchoscopy?
, may offer ice chips then eventually fluids
159
o Aspiration of fluid or air from the pleural space
thoracentesis
160
o Very important to get ????? prior to thoracentesis
full set of vital signs plus breath sounds
161
nursing duties for thoracentesis
make sure X-ray was ordered and consents were signed
allergies?
admin sedation
education
position the patient
162
what type of discomfort is expected after a thoracentesis?
minimal discomfort
163
how to position patient?
¥ Position pt sitting on edge of bed w/ feet supported and arms and head on a padded over-the-bed table or
164
if unable to sit?
Lying on the unaffected side with HOB elevated 30-40 degrees
165
▪ After the needle is withdrawn?
pressure is applied over the puncture site and a small, airtight, sterile dressing is fixed in place
166
what to educate patient on after thoracentesis
they will be on bed rest and CXR will be obtained
167
▪ Record total amount of fluid w/drawn from procedure and document the nature of the fluid, its ???
color, and its viscosity
168
sx of hemorrhage post thoracentesis
low BP and tachycardia
169
o Diagnostic procedure in which the pleural cavity is examined with an endoscope
thoracoscopy
170
sx of hypoexemia
```
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
sx of hypercapnia
¥ respiratory acidosis d/t decreased breathing
o COPD, asthma, drug overdose,
o anything prevent pt. breathing out the CO2
172
collapse of alveoli
atelectasis
173
atelectasis leads to
pneumonia
hypoxemia
resp. failure
174
atelectasis is most commonly seen in
ϖ post-operative patients,
immobile patients, and
patients with COPD
175
prevention of atelectasis
```
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
goal of tx for atelectasis
improve ventilation and remove secretions
177
ϖ
Leading cause of death from infectious disease in US
ϖ Can be infectious or noninfectious
pneumonia
178
non infectious pneumonia is caused from
aspiration
| inhalation of toxic substance
179
infectious pneumonia is caused by
fungus
| bacteria
180
pneumonia results from?
invading MO gets into alveoli--> causes immune response--> exudate form in the alveoli
181
prevention of pneumonia mainly by?
vaccine
182
classifications of pneumonia
```
hospital acquired
community acquired
viral pneumonia
oportunistic pneumonia
aspiration
```
183
decreases pH in stomach—makes it easier for bacteria to go up and colonize
• Protonix
184
at increased risk for hospital acquired pneumonia
>60 y/o
pts intubated or ventilator for >48 hours
post op surgery
limited mobility
decreased LOC
185
community acquired is more common in elderly or those with ______.
COPD
186
d/t Flu, RSV, less noticeable than bacteria
o Viral pneumonia
187
Immunocompromised pts (HIV/AIDs, chemo, RA meds, long term steroid use)
o Opportunistic pneumonia (viral or bacterial)—
188
d/t food, secretions, etc.
o Aspiration—
189
risk factors for pneumonia
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
o with Ventilator—Associated pneumonia (VAP) it is important to do what ?
frequent suctioning
turn patients
good oral care
191
types of pneumonia you may see in patients chart
acute bacterial pneumonia
primary atypical pneumonia
viral pneumonia
192
o neumococcal pneumonia (direct spread of drop in lungs)
| • Ex. Lobar pneumonia, Bronchopneumonia
Acute Bacterial Pneumonia
193
sx of Acute Bacterial Pneumonia
− 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
Primary Atypical Pneumonia AKA
pharyngitis
bronchitis
"walking pneumonia"
195
"walking pneumonia" is more common in?
younger adults not often in the hospital
196
viral pneumonia is often seen in older adults and the sx include?
• vague “flu-like” symps, low fever, slight WBC increase, X-ray normal at 1st then progresses to minimal changes
197
complications of pneumonia include:
```
pleuritis
necrosis of lung tissue
lung abscess
empyema
pleural effusion
resp. failure
```
198
inflammation of pleura causing stabbing pain when deep breathing or coughing
o Pleuritis
199
Loss of blood supply to lungs; Eventually has to be removed
o Necrosis of lung tissue
200
• Cough up purulent (pus), foul smelling mucous
lung abscess
201
• 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
empyema
202
Excess fluid in pleural space
o Pleural effusion
203
Need to be placed on mechanical ventilation
o Respiratory failure
204
how to dx pneumonia
```
CXR
pulse ox
sputum gram stain
blood cultures
ABGs
```
205
blood cultures are done prior to starting any antibiotics and it requires ____ ____ to confirm it
2 sets (of venipuncture)
206
meds for pneumonia
broad spectrum ATB
analgesics/antipyretics
steroids
bronchodilator/nebulizer
mucolytics and mucamyst
207
nursing management of pneumonia patient
```
hydration
O2 therapy
turn patients
incentive spirometry
chest physiotherapy
```
208
elderly considerations for pneumonia
may not have obvious symptoms
general deterioration
weakness
anorexia
confusion
209
who's at risk for aspiration?
tube feeders
patients with seizure activity
brain injury
stroke
swallowing disorders
post op patients
decreased LOC
ET intubation
flat body positioning
cardiac arrest
210
mucous or gastric contents enter the lungs without them knowing
silent aspiration
211
how to prevent aspiration
elevate HOB
suction often
residuals for tube feedings
212
ϖ Viral illness (coronavirus) NO KNOWN CURE, treat symptoms
SARS
severe acute respiratory syndrome
213
SARS are spread by?
droplet (coughing, sneezing, mucous membranes, contaminated water)
214
SARS intubation period
2-7 days
215
nursing interventions for SARS
contact and airborne precautions
monitor resp. status
no opioids
216
max precautions for SARS such as:
N95 mask
gown
gloves
booties on feet
Notify CDC
217
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.
TUBERCULOSIS (TB)
218
pathology of TB
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
transmission of TB
airborne
| spread through talking, coughing, sneezing, laughing or singing
220
TB is ____ by a susceptible person
inhaled
221
seen on X-ray (calcification)
tubercule
222
people with TB usually is unknown until?
CXR or mantoux test
| or it becomes active
223
high risk for TB
low income
homeless persons
healthcare workers with frequent exposure
elderly and young adults
persons living in close quarters
drug/alcohol users
immunosuppressed
224
screening for TB test include:
mantoux test
quantiferon --TB gold
BCG vaccine
225
what to look at on mantoux test
induration NOT redness or grooving
226
want under ____ mm for one in close contact with person or immunocompromised
5mm
227
0-4 mm
not significant
228
5-9 mm
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
10 mm or greater
o (+); is usually considered significant in people who have normal or mildly impaired immunity
230
• Want under ____mm for someone that is unexposed and general population, over that want to do investigation
10mm
231
good for someone that has gone through treatment already or who is allergic to mantoux
looks at the shape of the WBCs
Quantiferon (TB Gold)
232
* Same agent for bladder cancer
| * Actual tuberculosis immunization—not used in the US
BCG vaccine
233
after what test will the mantoux be invalid?
BCG vaccine
234
meds for TB
isoniazid (INH)
rifampin, rifabutin, rifapetine
pyrazinamide
ethambutol
235
education on INH
hepatotoxic
| no liquor
236
INH can cause peripheral neuropathy..what will prevent this
vitamin B6 (pyrodoxine)
237
education with the Rif- drugs
flu-like symptoms
causes sweat and secretions to turn orange
238
Rif- drugs react with
```
birth control
BB
cardiac meds
anticoagulants
digoxin
```
239
education with pyrazinamid
hepatotoxic
| hyperuricemia
240
ethambutol education
vision screenings
blurred vision
changes in red and green color
241
ethambutol can cause renal disease so we need to monitor for ____ and ____.
BUN and creatinine
242
prophylactic treatment is necessary for TB when?
anyone who has been exposed
243
for prophylactic treatment they will be placed on single-dose drug therapy of INH for __-__ months
6-12
244
o If compliance is a problem, medications are administered under direct supervision ______ _____.
twice weekly
245
DOT (direct observed therapy) can be done how?
Home health or TB clinic
246
if you're exposed
repeat PPD 2-3 mo
CXR
INH prophylactic
247
ND for TB
deficient knowledge
risk for infection
ineffective therapeutic regimen
248
prevent spread of TB to protect yourself
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
when looking for TB what do they test for in the sputum?
acid fast bacilli
250
typical discharge planning for TB
home health nurse will admin meds to them every two weeks for 2 months
they are still contagious for 3 weeks
251
o Inflammation of both layers of the pleurae—fluid fills tissue (friction rub no longer heard, pain decreases)
pleurisy
252
sx of pleurisy
* 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
• As pleural fluid develops=
pain decreases
254
tx of pleurisy
treatment of underlying cause
treat pain
255
nursing management of pleurisy
turn freq. to affected side to splint the chest wall
splint with pillow when coughing
encourage breathing
256
o Collection of fluid in the pleural space
o Could cause compression on adjacent tissue
pleural effusion
257
tx of pleural effusion
* Discover underlying cause
* Relieve discomfort
* Support oxygenation
Thoracentesis
258
nursing management with pleural effusion
record throacocentesis fluid amount
pain management for chest tube
frequent turning
259
A patient underwent a thoracentesis a few hours earlier, what finding should the nurse report immediately to the physician?
onset of crepitus
260
ϖ “Drowning”
ϖ Abnormal accumulation of fluid in the lung tissue, the alveolar space, or both
ϖ Severe, life threatening condition
pulmonary edema
261
causes of pulmonary edema
heart failure, blood backs up in lung, left sided heart failure
262
pulmonary edema is a complication of
pneumonectomy,
abnormal cardiac function, and
hypervolemia
263
sx of pulmonary edema
```
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
prevention of pulmonary edema
recognize s/s of fluid volume overload
265
treatment of pulmonary edema
```
oxygen (15L non-rebreather)
diuretics
vasodilators (Nitrates)
sit up right with feet dangling
psychological suport
insert foley
```
266
how to position patient with pulmonary edema
upright with feet dangling
267
ϖ Can be a primary disease or can occur on its own—just happens
pulmonary HTN
268
causes of pulmonary HTN
COPD (pulmonary artery constriction)
pulmonary embolism
269
dx of pulmonary HTN by?
dyspnea that begins on exertion and progresses to all the time
peripheral edema
JVD
crackles in lungs
heart murmur
270
goal for pulmonary HTN is to prevent ____ and _____.
hypoexemia and hypercapnia
271
ϖ R ventricle enlarges with or without heart failure
pulmonary heart disease (cor pulmonale)
272
causes of pulmonary heart disease
COPD or any disease that causes hypotension
273
goals of pulmonary heart disease (cor pulmonale)
improve gas exchange
O2 therapy
ECG monitoring
274
dx of for pulmonale by
EKG
pulmonary function test
right sided heart cath to check arterial pressure
275
education for (cor pulmonale)
```
daily weights
go home on O2
stop smoking
diuretics
LOW sodium diet
```
276
pulmonary embolism is not a disease it is the result of a ____ ____
venous thrombosis
277
ϖ Often undetected but rarely occurs without risk factors
pulmonary embolism
278
pulmonary embolism risk factors:
```
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
Pulmonary embolism sxs
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
prevention of pulmonary embolism
get mobile
prevent DVT
SCDs
leg exercises
281
dx of pulmonary embolism
```
VQ scan
CT scan
pulmonary angiography
PT-PTT
CXR
D-dimer
ABGs
EKG
```
282
ϖ Diagnosis of PE
| o Can be tricky—several things cause the symptoms, death occurs within ____ hr of onset of symptoms
1
283
* 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
VQ scan
| radioisotope ventilation/perfusion scan
284
most definitive diagnosis for PE
Pulmonary angiography
285
assess specific presence of a thrombus
o D-dimer
286
what does D-dimer detect in blood
• Fibrin split product released into circulation by pasmin during fibrinolysis
287
ABGs with PE usually show?
Resp. alkalosis
288
Tx of PE
```
anticoagulant therapy
high fowlers
oxygen
IV fluids
emotional support
Thrombolytic therapy (TPA)
Heparin (drip)
pulmonary embolectomy
```
289
is the standard treatment for prevention of PE
o Anticoagulant therapy
290
* Clot busters—dissolve clot
* Urikynase, streptokinase
* Can only be used for very specific patients—many risks
o Thrombolytic therapy (TPA)
291
TPA can not be used in patient who:
high risk for bleeding
recent stroke
active bleeding
CVA within past 2 months
292
• Antidote for heparin is
protamine sulfate
293
• Antidote for Coumadin is
vitamin K
294
* Enter vessel and suction out clots
* Done with massive PE where action needs to be
done quickly at TPA is contraindicated
o Pulmonary embolectomy
295
For the hospitalized patient, which manifestation would the nurse assess to be a symptom of pulmonary embolism?
• Abrupt onset of dyspnea and apprehension
296
What pharmacological treatment would the nurse administer aimed at prevention of pulmonary embolism
• Enoxaparin (lovenox)
297
people with lung CA typically die within ____ year
1
298
risk factors for lung CA
```
african american men who are 50-64
smoking
hereditary
inhaled carcinogens
chronic inflammation of the lung
```
299
tumor types for lung CA:
squamous cell
large cell
small cell
300
early sx of lung CA
persistent pneumonia
cough
SOB
chest pain
301
late sx of lung CA
```
fatigue
weight loss
hoarseness
palpable lymph nodes
superior vena cava syndrome
```
302
_____ and _____ is sign that presence of CA is close to trachea
o Dysphagia and hoarseness
303
dx of lung CA
```
CXR
CT scan
PET
sputum sample
bronchoscopy
fine needle aspiration under CT guidance
```
304
small cell carcinoma often gets what type of treatment
chemo and radiation
305
surgery for lung CA
pneumonectomy
| lobectomy
306
o Removal of entire lung—may have some drains but no chest tube
pneumonectomy
307
with pneumonectomy what will typically happen after the portion is removed?
serous fluid will fill the space
308
how to position pneumonectomy patient
ON the AFFECTED side
| (incision side down) in semi fowlers
309
o Will have one or two chest tubes—help inflate the lung
lobectomy
310
how to position lobectomy
on Unaffected side
(incision side up)
semi fowlers
311
post op pneumonectomy of lobectomy:
comfort measures
cough/deep breathing/incentive spirometer
splint incision when sneezing/coughing
312
what is usual after lung surgery
crepitus
313
unusual after lung surgery
bleeding
314
ϖ Anything that interferes w/ negative pressure in the lungs and causes the lung to collapse is a
pneumothorax (Ex. Bronchoscopy, Trauma)
315
ϖ Broad category to describe a set of symptoms: Emphysema and Chronic bronchitis
chronic obstructive pulmonary disease
| COPD
316
risk factors for COPD:
```
tobacco smoke
increased age
occupational exposure
indoor/outdoor pollution
genetic abnormalities (alpha1-trypsin deficiency)
chronic inflammation
```
317
ϖ Pulmonary Function Tests—help confirm diagnosis of COPD; determine severity and monitor disease progression
Pulmonary Function Tests
318
—evaluates obstruction and reversibility of obstruction
o Spirometry
319
– performed in acute setting for acute exacerbation of COPD
ϖ ABG’s
320
– lungs will be enlarged with
emphysema
321
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
emphysema
322
etiology of emphysema
def of alpha 1 antitrypsin
smoking
323
sx of emphysema
dyspnea that worsens over time
pursed lip breathing
barrel chest
anorexic
no edema unless R sided HF
324
emphysema patients are "____ ____" due to chronic CO2 retention
pink puffers
325
o Chronic inflammation in small airways
chronic bronchitis
326
manifestations for chronic bronchitis
hacking wet cough--lots of mucous!!!!
hypoxia
rales and rhonchi
327
complications of COPD
resp acidosis
pulmonary HTN
cor pulmonale
acute respiratory failure
328
medications for COPD
```
oxygen
bronchodilators
beta agonists
anticholinergic
menthylxanthines
corticosteroids
mucolytics, anti-tussives
anti-anxiety
smoking cessation
flu/pneumonia vaccines
ATB
```
329
how to use MDI
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
repeat puffs as directed, allowing ___-__ sec between each puff.
15-30
331
After inhalation with MDI
rinse mouth with water
332
ϖ Chronic inflammatory disease (mucosal edema) with acute exacerbations, which are followed by increased mucus after acute episode
asthma
333
ϖ Spastic contraction of the bronchiolar smooth muscle causes a narrowed airway that’s reversible
asthma
334
asthma is triggered by?
allergens
environmental pollutants
emotional stress
respiratory infections
335
slow-reacting substance of anaphylaxis
o Histamine,
336
o Histamine produces
leukotrines
337
leukotrines cause:
Localized edema in small bronchioles & mucus production
Spasm of the bronchiolar smooth muscle
338
complications of asthma attack
tachycardia
pneumothorax
resp. fatigue
status asthmaticus
339
emergency situation when asthma is prolonged or back to back attacks occur
o Status asthmaticus
340
indicates definite worsening of asthma symptoms and is life threatening
o “Silent chest”
341
nursing diagnosis for asthma
o Ineffective breathing pattern
o Ineffective airway clearance
o Anxiety
Risk for infection
342
Rescue meds for asthma
beta-adrenergic agnosits/adrenergic stimulants
mix albuterol and atrovent
anticholinergics
corticosteroids
343
maintenance medications:
anti-inflammatory agents
theophylline
leukotriene inhibitors
