ATI: Chapter 20 - Acute Respiratory Disorders Flashcards
The airway structures permit air to enter and provide for adequate ______ and tissue perfusion. Common acute and chronic disorders affect these airway structures.
oxygenation
A nursing priority for clients who have acute respiratory disorders is to maintain a _______ to promote oxygenation.
patent airway
Acute respiratory disorders include rhinitis, sinusitis, influenza, and _______.
pneumonia
______ is an inflammatory process in the lungs that produces excess fluid. it is triggered by infectious organisms or by the aspiration of an irritant, such as fluid or a foreign object.
Pneumonia
The inflammatory process in the lung parenchyma results in ______ and exudate that fills the alveoli.
edema
Pneumonia can be a primary disease or a complication of another disease or condition. It affects people of all ages, but young clients, older adult clients, and clients who are _______ are more susceptible.
immunocompromised
Immobility is a contributing factor in the development of ______.
pneumonia.
There are two types of pneumonia.
Community-acquired pneumonia (CAP)
Healthcare-associated pneumonia (HAP)
______ pneumonia is the most common type and often occurs as a complication of influenza.
community-acquired (CAP)
_____ associated pneumonia has a higher mortality rate and is more likely to be resistant to antibiotics.
Heath care (HAP)
It usually takes ___ to ___ hours from the time the client is exposed to acquire HAP.
24 to 48
Older adult clients are more susceptible to infections and have decreased _______ due to normal lung changes, including decreased lung elasticity and thickening alveoli.
pulmonary reserves
Perform ______ to prevent the spread of infection by bacteria and viruses.
hand hygiene
Encourage immunizations that prevent ________, especially immunizations for influenza, and pneumonia to younger children and older adults, and people who have chronic illnesses or who are immunocompromised.
respiratory disorders
Limit exposure to airborne allergens, which trigger a ________.
hypersensitivity reaction
Promote ______ cessation in health promotion to prevent acute respiratory disorders.
smoking
A risk factor for acute respiratory disorders is extremely young or _______.
advanced age
A risk factor for acute respiratory disorders is recent exposure to viral, bacterial, or _____ infections.
influenza
A risk factor for acute respiratory disorders is lack of current _______.
immunization status
A risk factor for acute respiratory disorders is exposure to plant pollen, molds, animal dander, foods, medications, and __________.
environmental contaminants
A risk factor for acute respiratory disorders is _____ smoke.
tobacco
A risk factor for acute respiratory disorders is _____ use.
substance (cocaine, alcohol)
A risk factor for acute respiratory disorders is chronic ______.
lung disease (asthma, emphysema)
A risk factor for acute respiratory disorders is _______ status.
immoncompromised status
A risk factor for acute respiratory disorders is the presence of a ______.
foreign body
A risk factor for acute respiratory disorders are conditions that increase the risk of ______.
aspiration (dysphagia)
A risk factor for acute respiratory disorders is impaired ability to _______ secretions.
mobilize
decreased LOC, immobility, recent abdominal or thoracic surgery
A risk factor for acute respiratory disorders is inactivity or _____.
immobility
A risk factor for acute respiratory disorders is mechanical _____.
ventilation (ventilator-acquired pneumonia)
______ is an inflammation of the nasal mucosa and often the mucosa in the sinuses that can be caused by infection (viral or bacterial) or allergens.
Rhinnitis
The common cold (coryza) is caused by viruses spread from person to person in droplets from sneezing and coughing or ______.
direct contact
Rhinitis often coexists with other disorders, such as asthma and ____, and can be acute or chronic, nonallergic or allergic (seasonal or perennial).
allergies
The presence of an allergen causes histamine release and other mediators from WBCs in the nasal mucosa. The mediators bind to blood vessel receptors causing ______, which leads to local edema and swelling.
capillary leakage
Expected findings of rhinitis include ________, runny nose (rhinorrhea), and nasal congestion.
excessive nasal drainage
Expected findings of rhinitis include purulent ______.
nasal discharge
Expected findings of rhinitis include _____ and pruritus of the nose, throat, and ears.
sneezing
Expected findings of rhinitis include itchy, watery _____.
eyes
Expected findings of rhinitis include sore, ______.
dry throat
Expected findings of rhinitis include red, inflammed, _______ mucosa.
swollen nasal
Expected findings of rhinitis include a _____ fever.
low-grade
Expected findings of rhinitis include diagnostic testing can include _______ to identify possible allergens.
allergy tests
Encourage rest (_____) and increased fluid intake (at least 2,000 mL/day) with acute respiratory disorders.
8 to 10 hours/day
Encourage the use of a home _____ or breathing steamy air after running hot shower water with acute respiratory disorders.
humidifier
Promote proper disposal of tissues and use of cough ______ (sneeze or cough into tissue, elbow or shoulder and not the hands) with acute respiratory disorders.
etiquette
Antihistamines
brompheniramine/pseudoephedrine
Leukotriene inhibitors
montelukast
mast cell stabilizers
cromolyn
Meds are used to block the release of ______ from WBCs that bind with receptors in nasal tissues, which prevent edema and itching.
chemicals
Older adults should be aware of adverse effects such as vertigo, hypertension, and ______.
urinary retention
_______, such as phenylephrine, constrict blood vessels and decrease edema.
decongestants
Endourage clients to use decongestants as prescribed for ___ to ____ days to avoid rebound nasal congestion.
3 to 4
Intranasal glucocorticoid sprays are the most effective for prevention and treatment of seasonal and perennial _____.
v
______ are used if fever is present.
antipyretics
______ are give if a bacterial infection can be identified.
antibiotics
For client education review hand hygiene as a measure to prevent ______.
transmission
Complementary therapies such as echinacea, large doeses of vitamin C1 and ____ preparations (lozenges and nasal sprays) can be useful in promoting improved immune response to acute respiratory disorders.
zinc
Limiting exposure to others will prevent and reduce _______ of acute respiratory disorders. This is especially important for vulnerable populations such as the very young, older adults, and people who are immunosuppressed.
transmission
______ often called rhinosinusitis, is an inflammation of the mucous membranes of one or more of the sinuses, usually that maxillary or frontal sinus.
sinusitis
Swelling of the mucosa can block the drainage of secretions, which can cause a ______.
sinus infection
Sinusitis often occurs after _____ and can be associated with a deviated nasal septum, nasal polyps, inhaled air pollutants or cocaine, facial trauma, dental infections, or loss of immune function.
rhinitis
The infection is commonly caused by ______, Haemophilus influenzae, diplococcus, and bacteroides.
streptococcus pneumoniae
Sinusitis’s expected findings include nasal _______.
congestion
Sinusitis’s expected findings include facial pressure or pain (worse when head is tilted forward) or ______.
headache
Sinusitis’s expected findings include cough or _______ or purulent nasal drainage.
bloody
Sinusitis’s expected findings include ____ to palpation of forehead, orbital, and facial areas.
tenderness
Sinusitis’s expected findings include _____ fever.
low-grade
CT scan or ______ confirm the diagnosis of sinusitis, which is typically based upon findings and physical assessment.
sinus x rays
________ cavity lavage or surgery to relive the obstruction and promote drainage of secretions may be done for sinusitis.
Endoscopic sinus
Encourage the use of steam humidification, sinus irrigation, saline nasal sprays, and _______ packs to relieve sinus congestion and pain for sinusitis.
hot and wet
Teach the client to increase ______ and rest for sinusitis.
fluid intake
Discourage air travel , ______, and diving for a pt with sinusitis.
swimming
Encourage pt’s with sinusitis to stop ______ use in any form.
tobacco
Instruct the client on correct technique for sinus ______ and self-administration of nasal sprays for pts with sinusitis.
irrigation
_______ such as phenylephrine, are used to reduce swelling of the mucosa.
nasal decongestants
Clients should be encouraged to begin OTC decongestant use at the first manifestation of _______.
sinusitis
Signs of rebound nasal congestion may occur if decongestants are used for more than ___ to ___ days.
3 to 4
________ antibiotics, such as amoxicillin, are used on a limited basis for a confirmed causative bacterial pathogen.
broad-spectrum
_______ medications include NSAIDs, acetaminophen, and aspirin.
pain relief
Sinus irrigation and saline nasal sprays are an ______ alternative to antibiotics for relieving nasal congestion.
effective
Contact the provider for manifestations of a severe headache, neck stiffness (nuchal rigidity), and ______, which can indicate possible complications of sinusitis.
high fever
_____ and encephalitis can occur if pathogens enter the bloodstream from the sinus cavity.
meningitis
_____ influenza, or “flu” occurs as an epidemic, usually in the fall and winter months.
seasonal
______ is a highly contagious acute viral infection that occurs in children and adult of all ages.
influenza
Influenza can be caused by one of several virus families, and this can vary yearly. Adults are contagious from 24 hr before manifestations develop and up to ____ days after they begin.
5
______ influenza refers to a viral infection among animals or birds that has mutated and is becoming highly infectious to humans. the resulting viral infection has the potential to spread globally, such as H1N1 (sine flu) and H5N1 (avian flu).
pandemic
Expected findings of influenza include severe headache and muscle ____.
aches.
Expected findings of influenza include chills, fatigue, and _____.
weakness
Expected findings of influenza include severe ______, hypoxia, and cough with the avian flu.
diarrhea
Expected findings of influenza include _____.
fever
Maintain droplet and contact precautions for hospitalized clients who have ________ influenza.
pandemic
Provide saline ______ for patients with influenza.
gargles
Monitor ______ status, intake and output to patients with influenza.
hydration
Administer fluid _____ as prescribed for flu patients.
therapy
Monitor respiratory ______ of influenza patients.
status
_______ such as amantadine, rimantadine, and ribavirin may be prescribed for treatment and prevention of influenza.
antivirals
Duration of the influenza infection can be shortened by ______ such as the oral inhalant zanamivir and the oral tablet oseltamivir. In cases of pandemic influenza, these medications may be distributed widely among the populations.
antivirals
Encourage clients with ______ to begin antiviral medications within 24 to 48 hour after the onset of manifestations.
influenza
______ vaccines are prepared yearly depending upon the suspected strain of influenza expected to appear. They include an IM injection of Fluvirin or Fluzone and a live attenuated influenza vaccine by intranasal spray.
Trivalent
Vaccination is encouraged for everyone older than ______ of age for influenza.
6 months
Clients who have a history of pneumonia, chronic medical conditions, and those over age 65, pregnant women, and _______ are at higher risk and require influenza vaccination.
health care providers
H1N1 vaccines are available for the _______
general populations
H5N1 vaccine is stockpiled for distribution if a ______ occurs.
pandemic
Respiratory services should be consulted for ______ support for influenza patients.
respiratory
Community health officials are notified of influenza _____.
outbreaks
State and federal public health officials are consulted for _____ and prevention directives during pandemic influenza.
containment
Encourage ____ influenza vaccination when vaccines become available.
annual
Reduce the risk for spreading viruses by thoroughly washing hands and following cough ______.
etiquette
Flu pts should avoid places where people gather. Avoid close __________ (handshaking, kissing, and hugging).
personal contact
If flu manifestations develop, increase fluid intake, _____ and stay home from work or school.
rest
Avoid travel to areas where pandemic influenza is ______.
identified.
Be aware of public health announcements and activation of the early _______ by public health officials in the case of pandemic influenza.
warning system
________ is a complication of influenza and affects older adults and clients who are debilitated or immunocompromised.
pneumonia
An expected finding of pneumonia includes anxiety, fatigue, and _______.
weakness.
An expected finding of pneumonia includes chest discomfort due to ______.
coughing
An expected finding of pneumonia includes _____ from hypoxia is the most common manifestation of pneumonia in older adult clients.
confusion
Physical assessment findings of _______ include fever, chills, flushed face, diaphoresis, and SOB/dyspnea.
pneumonia
Physical assessment findings of pneumonia include tachypnea, pleuritic chest pain (sharp), sputum production (yellow tinged) and crackles and ______.
wheezes
Coughing, dull chest percussion over areas of consolidation, and decreased oxygen saturation levels are expected physical findings of ______.
pneumonia
Purulent, blood-tinged or rust colored sputum, may or may not be present with_________.
pneumonia
To perform a sputum culture and sensitivity test for pneumonia, obtain specimen before staring _______.
antibiotic therapy.
To perform a sputum culture and sensitivity test for pneumonia, obtain specimen by suctioning if the client is unable to ____.
cough
Older adult clients have a _______ and decreased muscle strength. Therefore, older adult clients have trouble expectorating, which can lead to difficulty in breathing and make specimen retrieval more difficult.
weak cough reflex
CBC lab tests display an elevated _____ count with pneumonia, but might not be present in older clients.
WBC
ABGs display ______ with pneumonia.
hypoxemia (decreased PaO2 less than 80 mm Hg)
Blood culture is done for pneumonia pts to rule out _______ in the blood.
organisms
Serum electrolytes are used to identify the cause of ______ in pneumonia patients.
dehydration
A ______ will show consolidation (solidification, density) of lung tissue of pneumonia patients.
chest x ray
A chest x ray might not indicate _____ for a few days after manifestations.
pneumonia
A chest x ray is an important diagnostic tool because the ealry manifestations of pneumonia are often vague in _______.
older adult clients
Clients who have pneumonia usually have oximetry levels less than the expected reference range of ____ to ___.
95% to 100%
Position the client with pneumonia to maximize ventilation (________ + 90%) unless contraindicated.
high fowlers
Encourage coughing or suction to remove ________ from pneumonia patients.
secretions
Administer breathing ______ and meds to pneumonia patients.
treatments
For pneumonia patients monitor skin ______ around the nose and mouth from the oxygen device.
breakdown
Encourage deep breathing with an incentive spirometer to prevent __________ in pneumonia patients.
alveolar collapse
Determine the client’s physical limitations and structure activity to include _________ for pneumonia patients.
periods of rest
Promote adequate nutrition and ______ for pneumonia patients.
fluid intake
The increased work of breathing requires additional ______.
calories
Proper ______ in the prevention of secondary respiratory infections.
nutrition aids
Encourage fluid intake to ___ to ____ L/day to promote hydration and thinning of secretions, unless contraindicated due to another condition.
2 to 3
Provide rest periods for clients who have _____.
dyspnea
______ the client who is experiencing respiratory distress.
Reassure
_____ are given to destroy infectious pathogens. Commonly used _____ include penicillins and cephalosporins.
antibiotics
antibiotics
Antibiotics are often initially given via ___ and then switched to an oral form as the condition improves.
IV
It is important to obtain any culture specimens prior to giving the first dose of antibiotic. Once the specimen has been obtained, the _______ can be given while waiting for the results of the prescribed culture.
antibiotics
Observe clients taking cephalosporins (pneumonia pts) for _______.
frequent stools
Monitor ____ function, especially in older adults who are taking penicillins and cephalosporins.
kidney
Encourage clients to take penicillins and cephalosporins with _____. Some penicillins should be taken ___ hour before meals or ____ hours after.
food
1 hour before
2 hours after
______ are given to reduce bronchospasms and reduce irritation.
bronchodialators
Short acting beta2 agonists such as ________, provide rapid relief.
albuterol
Cholinergic antagonists such as ipratroplum, block the ________ nervous system, allowing for increased bronchodilation and decreased pulmonary secretions.
parasympathetic
Methylxanthines, such as theophylline, require close monitoring of ______ levels due to the narrow therapeutic range.
serum medication
Monitor serum med levels for _____ for clients taking theophylline. Adverse effects will include tachycardia, nausea, and diarrhea.
toxicity
Watch for ______ and tachycardia for clients taking albuterol.
tremors
Observe for _______ in clients taking ipratroplum, and monitor HR. Adverse effects can include headache, blurred vision, and palpatations, which can indicate toxicity.
dry mouth
Encourage clients to suck on ______ to moisten dry mouth while taking ipratroplum.
hard candies
Encourage increased fluid intake unless contraindicated with _______.
bronchodilators
Anti-inflammatories decrease airway ______.
inflammation
Glucocorticosteroids, such as fluticasone and predisone, are prescribed to reduce inflammation. Monitor for immunosuppression, fluid retention, hyperglycemia, hypokalemia, and _________.
poor wound healing
Montior for decreased ______ function when using anti-inflammatories.
immunity
Monitor for ________ when using anti-inflammatories.
hyperglycemia
Advise the client to report _________ stool when using anti-inflammatories.
black, tarry
Observe for fluid retention and _____, which is common with anti-inflammatories.
weight gain
Monitor the throat and mouth for aphthous lesion (__________) when taking anti-inflammatories.
canker sores
Encourage the client to drink plenty of fluids to promote ______ when taking anti-inflammatories.
hydration
Encrouage the client to take glucocorticosteroids with _______ when taking anti-inflammatories.
food
Encourage the client to avoid discontinuing ________ without consulting the provider when taking anti-inflammatories.
glucocorticosteroids
_______ services should be consulted for inhalers, breathing treatments,and suctioning for airway management.
respiratory
______ services can be contacted for weight loss or gain related to medications or diagnosis (anti-inflammatories)
nutritional
_______ care can be consulted if the client has prolonged weakness and needs assistance with increasing level of activity.
rehabilitation
Educate the client on the importance of continuing medications for treatment of _______.
pneumonia
Encourage rest ______ when needed.
periods
Encourage the client to maintain ______ to prevent infections.
hand hygeine
Encourage the client to avoid _______ to reduce the risk of infection.
crowded areas
Remind the client that treatment and recovery from pneumonia can take ____.
time
Encourage immunizations for influenza and _____.
pneumonia
Promote smoking _____ if needed.
cessation
______ is a complication of pneumonia in which the airway inflammation and edema lead to alveolar collapse and increase the risk of hypoxemia.
atelectasis
With atelectasis the client reports ______ and exhibits findings of hypoxemia.
SOB
With _______ the has diminished or absent breath sounds over the affected area with pneumonia.
atelectasis
A _______ shows an area of density of atelectasis, a complication of pneumonia.
chest x ray
______ occurs if pathogens enter the bloodstream from the infection in the lungs.
bacteremia (sepsis)
Acute respiratory distress syndrome occurs when ______ persists despite oxygen therpay.
hypoxemia
Acute respiratory distress syndrome occurs when _____ worsens as bilateral pulmonary edema develops that is noncardiac related.
dyspnea
Acute respiratory distress syndrome looks like an area of density on a chest x-ray with a ______ appearance.
ground glass
Blood gas findings demonstrate high arterial blood levels of ________ even though pulse oximetry shows decreased saturation.
carbon dioxide (hypercarbia)
Which of the following clients have an increased risk for developing pneumonia? (Select all that apply)
A. Client who has dysphagia
B. Client who has AIDS
C. Client who was vaccinated for pneumococcus and influenza 6 months ago
D. Client who is postoperative and has received local anesthesia
E. Client who has a closed head injury and is receiving ventilation
F. Client who has myasthenia gravis
A. Client who has dysphagia
B. Client who has AIDS
E. Client who has a closed head injury and is receiving ventilation
F. Client who has myasthenia gravis
A nurse in a clinic is caring for a client who was brought to the clinic by her partner. The partner states that the client woke up this morning, did not recognize him, and did not know where she was. The client reports chills and chest pain that is worse upon inspiration. Which of the following is the priority nursing action?
A. Obtain baseline vital signs and oxygen saturation
B. Obtain a sputum culture
C. Obtain a complete history from the client
D. Provide a pneumococcal vaccination
A. Assessment is the first step of the nursing process and is essential to patient centered care
A nurse is caring for a client who has pneumonia. Assessment findings include temperature 37.8 (100 F), respirations 30/min, BP 130/76, HR 100/min, and SaO2 91% on room air. Using a scale of 1 to 4, with 1 being the highest priority, prioritize the following nursing intervention:
A. Administer antibiotics as prescribed
B. Administer oxygen therapy
C. Perform a sputum culture
D. Administer an antipyretic medication to promote client comfort
BCAD is the correct order
A nurse in a clinic is caring for a client who has sinusitis. Which of the following techniques should the nurse use to identify clinical manifestations of this disorder?
A. Percussion of posterior lobes of lungs
B. Auscultation of the trachea
C. Inspection of the conjunctiva
D. Palpation of the orbital areas
D. Palpation of the orbital, frontal, and facial areas will elicit a report of tenderness, which is a clinical manifestation in a client who has sinusitis
A nurse is teaching a group of clients about influenza. Which of the following statements by a client requires clarification?
A. I should wash my hands after blowing my nose to prevent spreading the virus
B. I need to avoid drinking fluids if I develop symptoms
C. I need a flu shot every year because of the different flu strains
D. I should sneeze into my elbow rather than my hands
B. Fluid intake should be increased if findings develop to maintain hydration and effectiveness of expectoration of mucous
