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NURS3313 Adult Health > Chapter 19 Management of Patients w/ Chest & Lower Respiratory Tract Disorders > Flashcards

Chapter 19 Management of Patients w/ Chest & Lower Respiratory Tract Disorders Flashcards

1
Q

Atelectasis

A

Closure/collapse of alveoli

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2
Q

Signs & Symptoms of Atelectasis

A

Dyspnea

Cough

Sputum prod

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3
Q

Common Causes of Acute Atelectasis

A

People who are immobilized and have a shallow, monotonous breathing pattern due to thoracic/abdominal surgery

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4
Q

Signs & Symptoms of Acute Atelectasis

A

Lobar atelectasis (large amount of lung tissue)

Dyspnea

Cough

Sputum prod

Tachycardia

Tachypnea

Pleural

Central cyanosis

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5
Q

How does non-obstructive atelectasis occur?

A

Occurs as a result of reduced ventilation

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6
Q

How does obstructive atelectasis occur?

A

Occurs due to a reabsorption of gas (trapped alveolar air is absorbed into the bloodstream)-> no additional air can come in-> collapse

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7
Q

Assessment Findings: Atelectasis

A

Increased work of breathing & hypoxemia
-Decrease in O2 tension in arterial blood

Auscultation: Decreased breath sounds & crackles over affected area

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8
Q

Nursing Measures to Prevent Atelectasis

A

Frequent turning

Early mobilization

Strategies to expand the lungs and to manage secretions

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9
Q

Incentive Spirometry

A

A method of deep breathing that provides visual feedback to encourage the patient to inhale slowly & deeply to max lung inflation & prevent/reduce atelectasis

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10
Q

Purpose of Incentive Spirometry

A

Ensure that the vol of air inhaled is increased gradually as the patient takes deeper breaths

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11
Q

Steps in Performing Incentive Spirometry

A

1) Assume a semi-Fowler position/upright position before initiating therapy

2) Use diaphragmatic breathing

3) Place the mouthpiece of the spirometer firmly in the mouth, inspire slowly through the mouth, and hold the breath at the end of inspiration for about 3 secs to maintain the ball/indicator between the lines. Exhale slowly through the mouthpiece

4) Cough during and after each session. Splint the incision when coughing postoperatively

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12
Q

How many times should incentive spirometry be performed?

A

~10 times in succession, 10 breaths/hr

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13
Q

Goal of Atelectasis Treatment

A

Improve ventilation & remove secretions

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14
Q

Positive End-Expiratory Pressure (PEEP)

A

A simple mask and one-way valve system that provides varying amounts of expiratory resistance, usually 10-15 cm H2O

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15
Q

ICOUGH Program for Atelectasis

A

Incentive Spirometry
Coughing & deep breathing
Oral care: brushing teeth using mouthwash 2x a day
Understanding (patient & staff education)
Getting out of bed at least 3X daily
HOB elevation

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16
Q

Thoracentesis

A

Removal of the fluid by needle aspiration

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17
Q

Acute Tracheobronchitis

A

Acute inflammation of mucous membranes of the trachea & bronchial tree
-Often follows upper respiratory tract infection
-> Pts w/ viral infections have decreased resistance & can readily develop a secondary bacterial infections

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18
Q

Acute Tracheobronchitis Clinical Manifestations

A

Dry, irritating cough

Expectorates a scanty amount of mucoid sputum

Sternal soreness from coughing

Fever/chills

Night sweats

Headache

Gen malaise

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19
Q

What causes bloody sputum in severe tracheobronchitis?

A

Due to airway mucosa irritation

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20
Q

Nursing Management of Tracheobronchitis

A

Encourage fluid intake & coughing

Assist px to sit up (prevent accumulation of sputum)

A complete full course of antibiotics as prescribed

Rest to avoid overexertion->relapse

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21
Q

Why are histamines not usually prescribed for tracheobronchitis?

A

They can cause excessive drying & make secretions more difficult to expectorate

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22
Q

Pneumonia

A

Inflammation of the lung parenchyma caused by various microorganisms: bacteria, mycobacteria, fungi, & viruses

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23
Q

Pneumonia Risk Factors

A

Smoking

Neutropenia

Prolonged immobility

Depressed cough reflex

Endotracheal tube

Alcohol intoxication

Sedation (respiratory depression)

Advanced age

Upper respiratory infection

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24
Q

Underlying Disorders that put People at Risk for Developing Pneumonia

A

HF
Diabetes
ETOH abuse
COPD
Aids
Cancer
Influenza
Cystic Fibrosis

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25
Q

What occurs in the body during pneumonia?

A

Exudate os produced interfering w/diff of O2 & CO2

WBCs fill the airspace

Areas of the lung are not properly ventilating

Hypoxemia occurs

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26
Q

Clinical Manifestations of Pneumonia

A

Fever

Chills

Pleuritic chest pain

Tachypnea

Shortness of breath

Use of accessory muscles with respirations

Headache

Myalgia

Mucopurulent sputum

Cough

Fatigue

Orthopnea

**Older Adult: Change in mentation: Developing sepsis, Desaturation

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27
Q

Community-Acquired Pneumonia (CAP)

A

Type of pneumonia that occurs w/in a comm or w/in first 48hrs post hospitalization
- Viral origin in infants & children
- Rate of infection increases w/age

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28
Q

Healthcare-Associated Pneumonia (HCAP)

A

Often caused by multidrug-resistant organisms

Early diagnosis and treatment are critical

Non-hospitalized patient with extensive health
care contact with one or more of the following:
* Hospitalized for 2 or more days within past 90
days of infection
* Resident of a long-term care facility
* Hemodialysis patient
* Home infusion therapy
* Wound care

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29
Q

Common Causes of HCAP

A

Hospitalized for 2+ days w/in past 90 days of infection

Resident of a long-term care facility

Hemodialysis patient

Home infusion therapy

Wound care

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30
Q

Hospital-Acquired Pneumonia

A

Develops 48hrs or more after hospitalization

Subtype of health care–associated pneumonia

Potential for infection from many sources
* Infections are usually:
* Virulent organism such as MRSA
* MDR- multi drug resistant organisms
* Occur with underlying medical disorders
* Associated with high mortality rate

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31
Q

Ventilator-Associated Pneumonia

A

Develops 48hrs or more after endotracheal tube intubation

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32
Q

Nursing Interventions for VAP Prevention

A

Elevate HOB 30-45 degrees

Oral care w/chlorhexidine daily

Daily sedation vacations & assess readiness to extubate

Peptic ulcer disease prophylaxis

DVT prophylaxis

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33
Q

Medical Management of Pneumonia

A

Supportive treatment includes rest, fluids, antipyretics, antitussives, decongestants, antihistamines, and oxygen for hypoxia

Antibiotics not indicated for viral infections but are used for secondary bacterial infection

Administration of appropriate antibiotic with bacterial pneumonia

IV antibiotic if hemodynamically unstable, unable to take PO meds, and GI tract is functioning normally

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34
Q

Hemodynamically Unstable Vital Signs Criteria

A

Temp > 100
HR > 100
RR > 24
Systolic BP 90
O2 Sat

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35
Q

Nursing Interventions for Pneumonia

A

Oxygen therapy as needed

Administration of ordered antibiotics (for bacterial infections)
* Make sure if blood cultures are ordered that they are obtained before starting antibiotics

Removal of secretions
* Hydration: thins and loosens secretions, ↑RR → ↑ fluid loss
* Humidification: loosens secretions- retained secretions impair gas exchange

Turning & positioning
* Encourage deep breathing and coughing
* Rest & avoidance of over exertion
* Maintain nutrition

Monitoring for complications- vital signs are VITAL
* Sepsis/Septic shock
* Respiratory failure

Should start responding within 24 – 48 hours after treatment starts

Incentive spirometer: prevent atelectasis

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36
Q

Sepsis

A

Systemic response to infection

Manifested by two of the following:
* Temp > 38 Celsius or 100.4
* HR > 90
* RR > 20
* WBC > 12,000

37
Q

Septic Shock

A

Circulatory imbalances occur and are profound
* Hemodynamically unstable
* Perfusion that is not adequate to promote organ function

Hypotension
Increased mortality

38
Q

Planning and Goals of Care for Patients with Pneumonia

A

Improved airway patency

Increased activity

Maintenance of proper fluid volume

Maintenance of adequate nutrition

Understanding of the treatment protocol and preventive measures

Absence of complications

Based on patient outcomes plan for home, community, and transitional care

39
Q

Expected Outcomes for Pneumonia

A

Demonstrates improved airway patency

Rests and conserves energy and then slowly increasing activities

Maintains adequate hydration; adequate dietary intake

Verbalizes increased knowledge about management strategies

Complies with management strategies

Exhibits no complications

40
Q

Aspiration Pneumonia

A

Inhalation of foreign substance into the lung

Result is:
* Tachycardia
* Dyspnea
* Central cyanosis
* Hypotension
* Can be fatal

41
Q

Risk Factors for Aspiration Pneumonia

A

Seizure

Brain injury

Decreased LOC

Lying flat

Stroke

Swallowing disorders

Cardiac arrest

42
Q

Preventing Aspiration

A

Maintain HOB up at a 30-45-degree angle

Use sedatives sparingly

Before starting tube feedings - confirm placement

Swallow evaluation by speech therapy

43
Q

Chronic Obstructive Pulmonary Disease (COPD)

A

Chronic lung inflammation that narrows the airways

44
Q

What occurs in the body with COPD?

A

Narrowing occurs in the airways via inflammatory response to noxious air particles

Hypersecretion of mucus

Over time scar tissue is formed-> further narrowing of the lumen

45
Q

True or False (T or F): COPD is a reversible condition

A

False

46
Q

Chronic Bronchitis

A

Inflammation of bronchi persisting over a long time; type of chronic obstructive pulmonary disease (COPD)

47
Q

What occurs in bronchitis?

A

Presence of cough and sputum production for at least 3 months in each of 2 consecutive years

Hypersecretion of mucus occurs

Bronchial lumen decreases

Increased susceptibility to respiratory infections

48
Q

Emphysema

A

Impaired O2 & Co2 exchange resulting from destruction of walls of over distended alveoli

49
Q

What occurs w/emphysema?

A

Alveolar surface in direct contact with pulmonary capillaries continuously decreases

Leading to an increase in dead space, ↓O2 diffusion → Hypoxemia

Co2 elimination is impaired → Co2 retention →Respiratory acidosis

End stage progresses slowly over years

50
Q

COPD Risk Factors

A

Tobacco

Second hand smoke

Increased age

Occupational exposure

Air pollution

51
Q

Clinical Manifestations of COPD

A

Chronic cough

Sputum prod

Dyspnea

Barrel chest

Shoulders may go up on inspiration

As COPD worsens → Dyspnea at rest may develop

Weight loss

Dyspnea interferes with eating

↑ work of breathing takes more energy

Accessory muscle use

↑ risk for respiratory infections

Tend to lean forward

52
Q

COPD Physical Assessment Findings

A

↓ breath sounds

Expiratory wheeze

Use of accessory muscles

Barrel chest

Clubbing of the fingers

Unable to finish a sentence w/out becoming SOB

53
Q

COPD Medical Management

A

Smoking cessation (zyban/ aventyl & chantix)

Supplemental O2 as needed

Prescribe meds

Surgical interventions

Palliative Care

54
Q

Advantages of Bronchodilators

A

Relieve bronchospasm

Reduce airway obstruction

Allow increased O2 distribution

Improves alveolar ventilation

55
Q

At what level of SpO2 do you want a COPD patient to be?

A

At 90% or higher

56
Q

Advantages of Diaphragmatic Breathing

A

Reduces RR

Increases alveolar ventilation

Helps expel as much air as possible during expiration

57
Q

Advantages of Pursed Lip Breathing

A

Prolongs exhalation

Prev collapse of small bronchioles

Helps px to control rate & depth of expiration

Reduces the amnt of air trapped

Enables the px to gain control of dyspnea

Help reduces feeling of panic

58
Q

Tripod Position

A

Sit w/arms propped on the overbed table or sit w/ams propped on knees

59
Q

Causes of Pneumothorax

A

Changes can develop in large bullae-> may rupture-> pneumothorax

Severe coughing

60
Q

Signs of Pneumothorax

A

Rapid onset of SOB

Chest pain

Asymmetry of chest movement

Absence of breath sounds on the affected side

61
Q

Asthma

A

A chronic inflammatory diseases of the airways characterized by episodes of severe breathing difficulty, coughing, and wheezing.

62
Q

Causes of Asthma

A

Airway hyper responsiveness

Mucosal edema

Mucus prod

63
Q

Common Asthma Triggers

A

Air pollutants, cold, heat, wether changes, perfumes, smoke

Foods: shellfish, nuts

Exercise

Stress

Viral resp infections

64
Q

Clinical Manifestations of Asthma Exacerbations

A

Cough (prod or not)

Chest tightness

Wheezing

Dyspnea

Diaphoresis

Tachycardia

Hypoxemia & central cyanosis

65
Q

Quick-Relief Asthma Meds

A

Beta-2 adrenergic meds

Anticholinergics

66
Q

Complications of Asthma

A

Status asthmaticus

Respiratory failure

Pneumonia

Hypoxia

67
Q

Long-Acting Asthma Meds

A

Corticosteroids

Long-acting beta-2 adrenergic agonists

Leukotriene modifiers

68
Q

Quick-Relief for Acute Asthma Episodes

A

Short-acting, beta2-adrenergic agonists:

-Side effects: ↑ Bp & HR, ↑ risk dysrhythmias, shakiness

-Use cautiously in patients with cardiac disorders

Most common meds: Albuterol Proventil Ventolin Xopenex

Anticholinergics (if beta2-adrenergic agonists are not tolerated):Atrovent

69
Q

Long-Acting Asthma Meds Control

A

Corticosteroids (Most potent anti-inflammatory)

Reduce bronchial hyper-responsiveness

Inhaled SystemicInhaled CorticosteroidsFluticasoneBudesonideSpacer should be used*Rinse mouth out with water after use to prevent thrush

70
Q

Asthma Life-Threatening Exacerbations (S/S)

A

Vital signs: RR > 30, HR > 120, ↓O2 saturation

Dyspneic at rest

Audible wheezing

Speaks in words not sentences

Patient usually sitting forward

Accessory muscles in the neck are used

Patient often is agitated

Neck vein distention

Maybe drowsy or confused

Deteriorating blood gases (Resp. acidosis)

71
Q

If the patient has been wheezing & then there is an absence of a wheeze…

A

…the chest is silent & the patient is in respiratory arrest

72
Q

Nursing Interventions for Asthma

A

Admin meds as ordered

Works w/resp therapy

Px may become dehydrated & may need IV fluids if very diaphoretic

ABGs

Monitor responses to meds

Assess for impending respiratory failure

73
Q

Goal of Oxygen Therapy

A

Provide adequate transport of oxygen in the blood

Decreasing the work of breathing

Reducing stress of myocardium

74
Q

Key Indications for Oxygen Therapy

A

Change in respiration rate or pattern early indicator of need for O2

Hypoxemia

Avoid oxygen toxicity in COPD
patients - nurse should administer

75
Q

Nasal Cannula

A

Suggested Flow Rate:1-2 L/min
-O2 percentage setting: 24-28

Suggested Flow Rate: 3-5 L/min
-O2 percentage setting: 32-40

Suggested Flow Rate: 6 L/min
-O2 percentage setting: 44

76
Q

Simple Mask

A

Suggested Flow Rate: 5-8 L/min
-O2 percentage setting: 40-60

77
Q

Partial Rebreathing Mask

A

Suggested Flow Rate: 8-11 L/min
-O2 percentage setting: 50-75

Moderate oxygen concentration

78
Q

Non-rebreathing Mask

A

Suggested Flow Rate: 10-15 L/min
-O2 percentage setting: 80-95

High oxygen concentration

79
Q

Face Tent

A

Suggested Flow Rate: 8-10 L/min
-O2 percentage setting: 28-100

80
Q

Venturi Mask

A

Suggested Flow Rate: 4-6 L/min
-O2 percentage setting: 24, 26, 28 (Provides low level of supplemental O2)

Suggested Flow Rate: 6-8 L/min
-O2 percentage setting: 30, 35, 40

81
Q

Aerosol Mask

A

Suggested Flow Rate: 8-10 L/min
-O2 percentage setting: 28-100

82
Q

Trach-Collar

A

Suggested Flow Rate: 8-10 L/min
-O2 percentage setting: 28-100

83
Q

A 63-year old client w/ a 35-year history of smoking two packs of cigarettes per day has a chronic cough that produces thick sputum, peripheral edema, and cyanotic nail beds. Based on these assessment findings, the nurse suspects that the client may be experiencing which of the following?

A) Acute respiratory disease syndrome (ARDS)
B) Asthma    C) Chronic obstructive bronchitis    D) Emphysema
A

C) Chronic obstructive bronchitis

84
Q

A client w/ acute asthma is experiencing inspiratory & expiratory wheezing & decreased force expiratory volume. What is the nurse’s priority intervention?

A) Beta-adrenergic blockers
B) Bronchodilator
C) Inhaled steroids
D) Oral steroids

A

B) Bronchodilator

85
Q

The nurse is auscultating the lungs of a patient with asthma. The nurse describes the high-pitched, sibilant, musical sounds heard as?

A) Rales
B) Crackles
C) Wheezes
D) Rhonchi

A

C) Wheezes

86
Q

A nurse is planning to instruct a client on how to perform pursed-lip breathing. Which of the following statements should the nurse include?
A) “Take quick breaths upon inhalation”
B) “Place your hand over your stomach”
C) “Take a deep breath through your nose”
D) “Puff your cheeks upon exhalation”

A

C) “Take a deep breath through your nose”

87
Q

The nurse is caring for a client w/ COPD experiencing hypoxemia and hypercapnia. Which outcome will the nurse evaluate?
A) The client will demonstrate adequate oxygenation.
B) The client will avoid use of supplemental oxygen to decrease hypoxic drive.
C) Monitor pulse oximetry every 8 hours while awake.
D) Educate the client about the use of diaphragmatic breathing techniques.

A

A) The client will demonstrate adequate oxygenation

88
Q

A client is seen with chronic bronchitis. Which clinical symptoms does the nurse assess in this client?
A) Chest pain during respiration
B) Sputum & productive cough
C) Fever, chills, and diaphoresis
D) Tachypnea and tachycardia

A

B) Sputum & productive cough

NURS3313 Adult Health (27 decks)

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