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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
What occurs in the body during pneumonia?
Exudate os produced interfering w/diff of O2 & CO2 WBCs fill the airspace Areas of the lung are not properly ventilating Hypoxemia occurs
26
Clinical Manifestations of Pneumonia
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
27
Community-Acquired Pneumonia (CAP)
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
28
Healthcare-Associated Pneumonia (HCAP)
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
29
Common Causes of HCAP
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
30
Hospital-Acquired Pneumonia
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
31
Ventilator-Associated Pneumonia
Develops 48hrs or more after endotracheal tube intubation
32
Nursing Interventions for VAP Prevention
Elevate HOB 30-45 degrees Oral care w/chlorhexidine daily Daily sedation vacations & assess readiness to extubate Peptic ulcer disease prophylaxis DVT prophylaxis
33
Medical Management of Pneumonia
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
34
Hemodynamically Unstable Vital Signs Criteria
Temp > 100 HR > 100 RR > 24 Systolic BP 90 O2 Sat
35
Nursing Interventions for Pneumonia
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
36
Sepsis
Systemic response to infection Manifested by two of the following: * Temp > 38 Celsius or 100.4 * HR > 90 * RR > 20 * WBC > 12,000
37
Septic Shock
Circulatory imbalances occur and are profound * Hemodynamically unstable * Perfusion that is not adequate to promote organ function Hypotension Increased mortality
38
Planning and Goals of Care for Patients with Pneumonia
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
Expected Outcomes for Pneumonia
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
Aspiration Pneumonia
Inhalation of foreign substance into the lung Result is: * Tachycardia * Dyspnea * Central cyanosis * Hypotension * Can be fatal
41
Risk Factors for Aspiration Pneumonia
Seizure Brain injury Decreased LOC Lying flat Stroke Swallowing disorders Cardiac arrest
42
Preventing Aspiration
Maintain HOB up at a 30-45-degree angle Use sedatives sparingly Before starting tube feedings - confirm placement Swallow evaluation by speech therapy
43
Chronic Obstructive Pulmonary Disease (COPD)
Chronic lung inflammation that narrows the airways
44
What occurs in the body with COPD?
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
True or False (T or F): COPD is a reversible condition
False
46
Chronic Bronchitis
Inflammation of bronchi persisting over a long time; type of chronic obstructive pulmonary disease (COPD)
47
What occurs in bronchitis?
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
Emphysema
Impaired O2 & Co2 exchange resulting from destruction of walls of over distended alveoli
49
What occurs w/emphysema?
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
COPD Risk Factors
Tobacco Second hand smoke Increased age Occupational exposure Air pollution
51
Clinical Manifestations of COPD
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
COPD Physical Assessment Findings
↓ breath sounds Expiratory wheeze Use of accessory muscles Barrel chest Clubbing of the fingers Unable to finish a sentence w/out becoming SOB
53
COPD Medical Management
Smoking cessation (zyban/ aventyl & chantix) Supplemental O2 as needed Prescribe meds Surgical interventions Palliative Care
54
Advantages of Bronchodilators
Relieve bronchospasm Reduce airway obstruction Allow increased O2 distribution Improves alveolar ventilation
55
At what level of SpO2 do you want a COPD patient to be?
At 90% or higher
56
Advantages of Diaphragmatic Breathing
Reduces RR Increases alveolar ventilation Helps expel as much air as possible during expiration
57
Advantages of Pursed Lip Breathing
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
Tripod Position
Sit w/arms propped on the overbed table or sit w/ams propped on knees
59
Causes of Pneumothorax
Changes can develop in large bullae-> may rupture-> pneumothorax Severe coughing
60
Signs of Pneumothorax
Rapid onset of SOB Chest pain Asymmetry of chest movement Absence of breath sounds on the affected side
61
Asthma
A chronic inflammatory diseases of the airways characterized by episodes of severe breathing difficulty, coughing, and wheezing.
62
Causes of Asthma
Airway hyper responsiveness Mucosal edema Mucus prod
63
Common Asthma Triggers
Air pollutants, cold, heat, wether changes, perfumes, smoke Foods: shellfish, nuts Exercise Stress Viral resp infections
64
Clinical Manifestations of Asthma Exacerbations
Cough (prod or not) Chest tightness Wheezing Dyspnea Diaphoresis Tachycardia Hypoxemia & central cyanosis
65
Quick-Relief Asthma Meds
Beta-2 adrenergic meds Anticholinergics
66
Complications of Asthma
Status asthmaticus Respiratory failure Pneumonia Hypoxia
67
Long-Acting Asthma Meds
Corticosteroids Long-acting beta-2 adrenergic agonists Leukotriene modifiers
68
Quick-Relief for Acute Asthma Episodes
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
Long-Acting Asthma Meds Control
Corticosteroids (Most potent anti-inflammatory) Reduce bronchial hyper-responsiveness Inhaled Systemic*Inhaled Corticosteroids*Fluticasone*Budesonide*Spacer should be used*Rinse mouth out with water after use to prevent thrush
70
Asthma Life-Threatening Exacerbations (S/S)
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
If the patient has been wheezing & then there is an absence of a wheeze...
...the chest is silent & the patient is in respiratory arrest
72
Nursing Interventions for Asthma
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
Goal of Oxygen Therapy
Provide adequate transport of oxygen in the blood Decreasing the work of breathing Reducing stress of myocardium
74
Key Indications for Oxygen Therapy
Change in respiration rate or pattern early indicator of need for O2 Hypoxemia Avoid oxygen toxicity in COPD patients - nurse should administer
75
Nasal Cannula
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
Simple Mask
Suggested Flow Rate: 5-8 L/min -O2 percentage setting: 40-60
77
Partial Rebreathing Mask
Suggested Flow Rate: 8-11 L/min -O2 percentage setting: 50-75 Moderate oxygen concentration
78
Non-rebreathing Mask
Suggested Flow Rate: 10-15 L/min -O2 percentage setting: 80-95 High oxygen concentration
79
Face Tent
Suggested Flow Rate: 8-10 L/min -O2 percentage setting: 28-100
80
Venturi Mask
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
Aerosol Mask
Suggested Flow Rate: 8-10 L/min -O2 percentage setting: 28-100
82
Trach-Collar
Suggested Flow Rate: 8-10 L/min -O2 percentage setting: 28-100
83
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
C) Chronic obstructive bronchitis
84
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
B) Bronchodilator
85
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
C) Wheezes
86
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"
C) "Take a deep breath through your nose"
87
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) The client will demonstrate adequate oxygenation
88
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
B) Sputum & productive cough

NURS3313 Adult Health (27 decks)

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