Chapter 30: Lower Respiratory Problems- Pfieffer Flashcards
Interprofessional care for pulmonary embolism: _________________ hygiene to prevent atelectasis
pulmonary
before chest tubes are inserted, a tension pneumothorax needs this immediate treatment
needle decompression
chest trauma initial interventions: __________ impaled objects
stabilize
main diagnostic study for lung abscess
chest X-ray
pulmonary fungal infections have manifestations similar to this disease
bacterial pneumonia
enlargement of the right ventricle caused by a primary respiratory disorder
cor pulmonale
emergency treatment of pneumothorax involves covering the wound with ____________ dressing secured on (1, 2, 3, 4) sides
occlusive, 3
transmission of pulmonary fungal infections
inhalation of spores
normal mean pulmonary artery pressure
12-16 mmHg
pain management for fractured ribs can include these three methods
NSAIDs
opioids
nerve blocks
massive pulmonary embolisms, hemodynamically unstable patients, and patients in which thrombolytic therapy is contraindicated may need this type of surgery
pulmonary embolectomy
type of pneumothorax that occurs due to rupture of small blebs (air-filled sacs) on the surface of the lung
spontaneous pneumothorax
diagnostic study for pnemothorax
chest X-ray
diagnostic study for flail chest
chest X-ray
nursing management for lung abscess involves monitoring for signs of __________ and _________________; applying __________
hypoxemia, respiratory distress, oxygen
lung condition characterized by collapsed, airless alveoli
atelectasis
name of type of breathing movement in flail chest
paradoxical
inspiration: chest sucked in
expiration: chest bulges out
chest trauma: assess for these six signs of cardiovascular compromise
rapid, thready pulse
decreased BP with narrowed pulse pressure and/or asymmetric readings
distended neck veins
muffled heart sounds
chest pain
dysrhythmias
most common manifestation of pulmonary embolism
dyspnea
elevated pulmonary artery pressure due to an increase in resistance to blood flow through the pulmonary circulation
pulmonary hypertension
conservative treatment for chylothorax
Octerotide
type of pleural effusion in which the fluid is protein-poor, cell-poor, clear, pale yellow
transudate effusion
diagnosis for atypical mycobacteria
sputum culture
complication of pulmonary embolism: results from hypoxemia associated with massive (>50%) or recurrent emboli; right ventricular hypertrophy
pulmonary hypertension
type of pleural effusion in which the fluid is protein-rich
exudative effusion
teaching for lung abscess includes these two things
effective coughing
supportive measures (rest, nutrition, fluids)
progression of pulmonary hypertension is indicated by these two things
dyspnea at rest
right ventricular hypertrophy
complication of heart and lung diseases characterized by abnormal accumulation of fluid in alveoli and interstitial spaces
pulmonary edema
Patient education for pulmonary embolism addresses long-term ________________ therapy, measures to prevent _______, and importance of ________________
anticoagulant, VTE, follow-up exams
pneumothorax: stabilize any impaled objects with __________________ but do not pull it out
bulky dressing
this method is used to diagnose pulmonary embolism if patient cannot have contrast
ventilation-perfusion (V/Q) scan
a tension pneumothorax causes a _________________ and _____________ instability with reduced ______________ and ______________
mediastinal shift, hemodynamic, venous return, cardiac output
Prevention of pulmonary embolism involves intermittent ____________________ devices, early ______________, and __________________ therapy.
pneumatic compression, ambulation, anticoagulation
abnormal collection of fluid in the pleural space
pleural effusion
treatment for pulmonary fungal infections
antifungal drugs
this type of fungal pathogen occurs in immunocompromised patients and patients with CF and HIV
opportunistic fungal pathogens
these two patients are at risk for atelectasis
bedridden patients
postop patients (abdominal, chest)
flail chest results from the fracture of _____ or more consecutive ribs in _____ or more separate places; can also result from fractured ____________ and several consecutive ribs
3, 2, sternum
treatment for atypical mycobacteria
similar to TB
prolonged antibiotics
mechanism of chest injury involving shearing and compression injuries of chest structures; external appearance may be minor but may have severe internal organ damage
blunt
this part of ventilation-perfusion (V/Q) scan involves IV injection of a radioisotope
perfusion scanning
collection of purulent fluid in the pleural space
empyema
hallmark manifestation of lung abscess
dark brown, purulent, foul-smelling, foul-tasting sputum
multiple lung abscesses is known as
necrotizing pneumonia
gold standard treatment for pneumothorax
chest tubes with water-seal drainage
pulmonary embolisms most commonly affect these lobes of the lung
lower lobes
type of pneumothorax that can occur due to laceration or puncture of the lung during medical procedures
iatrogenic pneumothorax
Treatment for flail chest involves ensuring adequate _______________ and ______________; ________ management. If needed, _____________ and ____________ ventilation and/or _________ fixation are done.
ventilation, oxygenation, pain, intubation, mechanical, surgical
mechanism of chest injury involving foreign object impaling or passing through body tissues creating an open wound
penetrating
three diagnostic methods for pulmonary fungal infections
skin testing
serology
biopsy (via bronchoscopy)
chest trauma initial interventions: place in ______________ position or on ___________ side after ruling out cervical spine injury
semi-Fowler’s, injured
two refractory treatment options for chylothorax
surgery, pleurodesis
type of pleural effusion that occurs mainly in non-inflammatory conditions
transudate effusion
five risk factors for spontaneous pneumothorax
tall, thin, male, family history, previous spontaneous pneumothorax
most common cause of pulmonary edema
left-sided heart failure
Risk factors for pulmonary embolism include ____________ or reduced ___________, _____________ within 3 months, history of ______, ____________, ____________, oral ___________/____________ therapy, _______________, prolonged ______________, ______________, _______________, and ________ disorders.
immobility, mobility, surgery, VTE, cancer, obesity, contraceptives, hormone, smoking, air travel, heart failure, pregnancy, clotting
in diagnosing pleural effusion, these two methods reveal the volume and location of the effusion
chest X-ray, CT
Drug therapy for pulmonary hypertension focuses on pulmonary ________________, reducing _______________ overload, reverse __________, managing _________, and preventing ___________ and ___________
vasodilation, right ventricular, remodeling, edema, thrombi, hypoxia
definitive test to diagnose pulmonary hypertension
right-sided heart catheterization
Interprofessional care for pulmonary embolism: provide _____________ with intubation if needed
oxygen
pleurisy: pleural friction rub is heard at the _______ of inspiration
peak
treatment for pleurisy
underlying cause
pain management
pleural effusion: this treatment method is done to obliterate the pleural space and prevent reaccumulation of effusion fluid
chemical pleurodesis
penetrating chest wound in which air enters the pleural space through the chest wall during inspiration
sucking chest wound
pulmonary embolisms are commonly diagnosed with these two tests
D-dimer (have a clot but not where it is)
spiral (helical) CT scan
two manifestations/assessment findings of large pneumothorax
respiratory distress
absent breath sounds over affected area
type of hemothorax that occurs with a pneumothorax
hemopneumothorax
two manifestations of small pneumothorax
mild tachycardia and dyspnea
six causes of pleurisy
infection
cancer
autoimmune disorders
chest trauma
GI disease
some medications
cause of atelectasis
secretions obstructing small airways
two classic manifestations of pulmonary hypertension
dyspnea on exertion
fatigue
pleurisy: breathing is (deep, shallow) with (increased, decreased) movement
shallow, decreased
large thrombus lodged at an arterial bifurcation is known as
saddle embolus
chest trauma initial interventions: cover sucking chest wound with ___________ dressing taped on (1, 2, 3, 4) sides
nonporous, 3
type of pleural effusion that results from increased capillary permeability due to an inflammatory reaction
exudative effusion
in a patient with cor pulmonale, a ruddy complexion indicates this
polycythemia
insertion of this device can prevent migration of clots into the pulmonary system (prevent pulmonary embolism)
inferior vena cava (IVC) filter
pulmonary embolisms treated with this significantly reduce mortality
anticoagulants
occurs when positive pressure in pleural space causes lung to partially or fully collapse
pneumothorax
type of pneumothorax that occurs when the visceral (inner) lining of the pleura is disrupted, allowing air to enter the pleural space from the lung; has no external wound
closed pneumothorax
chest trauma initial interventions: establish IV access with (1, 2, 3) large-bore catheters and begin _________________________ as appropriate
2, fluid resuscitation
causes of pleural effusion include increased pulmonary ___________ pressure, decreased ____________ pressure, increased _________________ permeability, and ______________ obstruction
capillary, oncotic, pleural membrane, lymph flow
patients with cor pulmonale have a (low, normal, high) epoietin level
low
patient teaching for fractured ribs includes these three things
deep breathing and coughing
incentive spirometry
appropriate use of analgesics
in a patient with cor pulmonale, elevated BNP indicates this
heart failure
chest injury complication that involves blood rapidly collecting in pericardial sac which compresses myocardium and prevents ventricles from filling
cardiac tamponade
necrosis of lung tissue from aspiration of bacteria from periodontal disease; also IV drug use, cancer, pulmonary embolism, lung infarction, tuberculosis, parasitic/fungal disease, sarcoidosis
lung abscess
most pulmonary embolisms arise from this condition
deep vein thrombosis (DVT)
chest trauma initial interventions: do this to keep SpO2 >90%
apply oxygen
long-term antibiotics are typically delivered via a(n) ____________; a ___________ is used if WBCs are high with a risk for infection
PICC line; midline
manifestations for fractured ribs include _________ with inspiration and coughing, _____________ and ___________ respirations
pain, splinted, shallow
manifestations include exertional dyspnea, tachypnea, cough, fatigue, right ventricular hypertrophy, increased intensity in S2 heart sound, polycythemia
cor pulmonale
pleurisy: chest pain is ________ and (better, worse) with movement
sharp, worse
this disease has 30+ varieties that can cause pulmonary disease, lymphadenitis, skin or soft tissue disease, or disseminated disease
atypical mycobacteria
manifestations of cardiac tamponade include ___________ heart sounds, _____________, ____________ distention, increased _________________
muffled/distant, hypotension, neck vein, central venous pressure
three ways to prevent atelectasis
deep breathing exercises
incentive spirometry
early mobility
chest trauma initial interventions: remove ____________ to assess injury
clothing
ribs that are most commonly fractured
ribs 5-9
chest trauma ongoing monitoring of these six things
vital signs
LOC
O2 sat
cardiac rhythm
respiratory status
urinary output
when antibiotics are ineffective to treat lung abscess, these two treatment methods may be used
percutaneous drainage of abscess
surgery (lobectomy or pneumonectomy)
physical examination of flail chest reveals ________ and ___________ respirations, _____________ and _____________ chest movement, inadequate __________, ______________, and ________ near fractures
rapid, shallow, asymmetric, uncoordinated, ventilation, splinting, crepitus
chest trauma: assess for these seven signs of respiratory distress
dyspnea
cough (with or without hemoptysis)
cyanosis
tracheal deviation
decreased breath sounds
decreased oxygen saturation
frothy secretions
four manifestations of tension pneumothorax
severe dyspnea
marked tachycardia
neck vein distention
profuse diaphoresis
atelectasis is characterized by these breath sounds and this percussion
decreased/absent breath sounds
dullness on percussion
found in tap water, soil, house dust, or bird feces
atypical mycobacteria
this type of fungal pathogen causes infection in healthy people and immunocompromised people in certain areas
endemic fungal pathogens
type of pneumothorax that occurs when air enters the pleural space but cannot escape, resulting in increased intrapleural pressure
tension pneumothorax
treatment for cor pulmonale requires early _________________, ________ therapy, and _______________ diet
identification, O2, low sodium
treatment for lung abscess
IV antibiotics initially, then switched to oral antibiotics
four complications of lung abscess
pulmonary abscess
bronchopleural fistula
bronchiectasis
empyema
chest trauma initial interventions: prepare for emergency _________________
needle decompression
this disease presents similarly to tuberculosis
atypical mycobacteria
type of pneumothorax characterized by accumulation of blood in the pleural space from injury to the chest wall, diaphragm, lung, blood vessels, or mediastinum
hemothorax
Immediate treatment of pulmonary embolism involves bed rest in ___________________ position; assessing _______________ status; administering _____________, IV ___________, and IV __________________; and monitoring for _________________ and ___________________.
Semi-Fowler’s, cardiopulmonary, oxygen, fluids, medications, coagulation, complications
Patient support for pulmonary embolism involves these four aspects
anxiety, pain, dyspnea, fear of death
blockage of one or more pulmonary arteries by a thrombus, fat or air embolus, or tumor tissue
pulmonary embolism
this part of ventilation-perfusion (V/Q) scan involves inhalation of a radioactive gas, such as xenon
ventilation scanning
treatment for hemothorax
chest tubes
two complications that can occur from fractured ribs
atelectasis, pneumonia
complication of pulmonary embolism: occlusion of medium or large-sized vessel, inadequate collateral blood flow, and preexisting lung disease results in alveolar necrosis and hemorrhage which may result in abscess and pleural effusion
pulmonary infarction
most common cause of cor pulmonale
COPD
goals of treatment of pulmonary embolism are ensuring adequate ________________ and __________ function and prevention of ____________ and ______________
tissue perfusion, respiratory, thrombi, embolization
type of pneumothorax characterized by the presence of lymphatic fluid in the pleural space
chylothorax
Early recognition to stop progression of pulmonary hypertension involves reporting unexplained _______, ________, ________ discomfort, and _______ of feet and ankles
SOB, syncope, chest, edema
treatment for cardiac tamponade
immediate pericardiocentesis (needle decompression) with surgical repair as appropriate
mean pulmonary artery pressure with pulmonary hypertension
> 20 mmHg
type of pneumothorax in which air enters through an opening in the chest wall and parietal (outer) lining of the pleura
open pneumothorax
