chapter 30 upper respiratory conditions - week 2

Question 1

acute bronchitis

Answer 1

• Acute bronchitis is an inflammation of the bronchi in the lower respiratory tract,
  usually caused by infection. It is one of the most common conditions seen in primary
  care.
• It usually occurs as a sequel to an upper respiratory tract infection.
• The cause of most cases of acute bronchitis is viral (rhinovirus, influenza). However,
  bacterial causes are also common both in smokers and nonsmokers.
• It is a self-limiting condition; treatment is supportive.
• Cough, the primary symptom, may last up to 3 weeks.

Question 2

pneumonia

Answer 2

• Pneumonia is an acute inflammation of the lung parenchyma caused by a microbial
  agent.
• More likely to result when defense mechanisms become incompetent or are
  overwhelmed by the virulence or quantity of infectious agents.
• Pneumonia can be classified according to the causative organism, such as bacteria,
  viruses, Mycoplasma, fungi, parasites, and chemicals

Question 3

two ways to cassify pneumonia

Answer 3

Community-acquired pneumonia (CAP) is defined as a lower respiratory tract
infection of the lung parenchyma with onset in the community or during the first
two days of hospitalization.

Hospital-acquired pneumonia (HAP) is pneumonia occurring 48 hours or
longer after hospital admission and not incubating at the time of hospitalization.

Question 4

asiprtiaiton pnemonia

Answer 4

Aspiration pneumonia refers to the sequelae occurring from abnormal entry of
secretions or substances into the lower airway.

Question 5

oppurunisitic pnemonia

Answer 5

Opportunistic pneumonia presents in certain patients with altered immune responses
who are highly susceptible to respiratory infections.

Question 6

what are the four charactserists stages of pnemonia

Answer 6

There are four characteristic stages of pneumonia: congestion, red hepatization, grey
hepatization, and resolution.

1. Congestion. After the pneumococcus organisms reach the alveoli via droplets or saliva, there is an outpouring of fluid into the alveoli. The organisms multiply in the serous fluid, and the infection is spread. The pneumococci damage the host by their overwhelming growth and interference with lung function.
2. Red hepatization. There is massive dilation of the capillaries, and alveoli are filled with organisms, neutrophils, red blood cells, and fibrin The lung appears red and
   granular, similar to the liver, which is why the process is called hepatization.
3. Grey hepatization. Blood flow decreases, and leukocytes and fibrin consolidate in the affected part of the lung.
4. Resolution. Complete resolution and healing occur if there are
   no complications.

Question 7

nursing managment of pneumonia

Answer 7

In the hospital, the nursing role involves identifying the patient at risk and taking
measures to prevent the development of pneumonia.

o The essential components of nursing care for patients with pneumonia include
monitoring physical assessment parameters, facilitating laboratory and diagnostic
tests, providing treatment, and monitoring the patient’s response to treatment.

o Treatment with antibiotics is necessary for bacterial pneumonia; all patients
require supportive measures.

Question 8

tuberculosis

Answer 8

Tuberculosis is an infectious disease caused by M. tuberculosis, a gram-positive,
acid-fast bacillus that is usually spread from person to person via airborne droplets.

The very small droplets, 1 to 5 mcm in size, remain airborne indoors for minutes to
hours. Once inhaled, these small particles lodge in the bronchiole and alveolus. The
bacillus replicates slowly and spreads via the lymphatic system, finding favourable
environments for growth primarily in the upper lobes of the lungs, kidneys, epiphyses
of the bone, cerebral cortex, and adrenal glands.

Question 9

m. tuberculosis

Answer 9

M. tuberculosis is usually spread from person to person via airborne droplets, which
are produced when the infected individual with pulmonary or laryngeal TB coughs,
sneezes, speaks, or sings. Once released into a room, the organisms are dispersed and
can be inhaled. TB is not highly infectious, and transmission usually requires close,
frequent, or prolonged exposure

Question 10

m. tuberculosis

Answer 10

M. tuberculosis is usually spread from person to person via airborne droplets, which
are produced when the infected individual with pulmonary or laryngeal TB coughs,
sneezes, speaks, or sings. Once released into a room, the organisms are dispersed and
can be inhaled. TB is not highly infectious, and transmission usually requires close,
frequent, or prolonged exposure

Question 11

m. tuberculosis

Answer 11

M. tuberculosis is usually spread from person to person via airborne droplets, which
are produced when the infected individual with pulmonary or laryngeal TB coughs,
sneezes, speaks, or sings. Once released into a room, the organisms are dispersed and
can be inhaled. TB is not highly infectious, and transmission usually requires close,
frequent, or prolonged exposure

Question 12

m. tuberculosis

Answer 12

M. tuberculosis is usually spread from person to person via airborne droplets, which
are produced when the infected individual with pulmonary or laryngeal TB coughs,
sneezes, speaks, or sings. Once released into a room, the organisms are dispersed and
can be inhaled. TB is not highly infectious, and transmission usually requires close,
frequent, or prolonged exposure

Question 13

what complications can tuberolsis present

Answer 13

Can present with a number of complications, including: the spread of the disease with
involvement of many organs simultaneously (miliary or hematogenous TB), pleural
effusion, empyema, and pneumonia.

Question 14

what is the best way to disgonse m tuberculsois infection

Answer 14

The tuberculin skin test using purified protein derivative (PPD) is the primary way to
diagnose latent M. tuberculosis infection, whereas the diagnosis of tuberculosis
disease requires demonstration of tubercle bacilli bacteriologically.

Question 15

what is the best way to disgonse m tuberculsois infection

Answer 15

The tuberculin skin test using purified protein derivative (PPD) is the primary way to
diagnose latent M. tuberculosis infection, whereas the diagnosis of tuberculosis
disease requires demonstration of tubercle bacilli bacteriologically.

Question 16

what is the best way to disgonse m tuberculsois infection

Answer 16

The tuberculin skin test using purified protein derivative (PPD) is the primary way to
diagnose latent M. tuberculosis infection, whereas the diagnosis of tuberculosis
disease requires demonstration of tubercle bacilli bacteriologically.

Question 17

what is the best way to disgonse m tuberculsois infection

Answer 17

The tuberculin skin test using purified protein derivative (PPD) is the primary way to
diagnose latent M. tuberculosis infection, whereas the diagnosis of tuberculosis
disease requires demonstration of tubercle bacilli bacteriologically.

Question 18

what is the best way to disgonse m tuberculsois infection

Answer 18

The tuberculin skin test using purified protein derivative (PPD) is the primary way to
diagnose latent M. tuberculosis infection, whereas the diagnosis of tuberculosis
disease requires demonstration of tubercle bacilli bacteriologically.

Question 19

if a patient is suspected of having TB they should be..

Answer 19

Patients strongly suspected of having TB should (1) be placed on respiratory
isolation, (2) receive four-drug therapy, and (3) receive an immediate medical
workup, including chest x-ray examination, sputum smear, and culture.

Question 20

pulmonary fungal infections

Answer 20

Lung infections include aspergillosis, cryptococcosis, and candidiasis. These
infections are not transmitted from person to person, and the patient does not have to
be placed in isolation.

Are found frequently in seriously ill patients being treated with corticosteroids,
antineoplastic and immuno-suppressive drugs, or multiple antibiotics.
Are also found in patients with AIDS and cystic fibrosis.

Question 21

medications that help treat fungal infections

Answer 21

• IV Amphotericin B (Fungizone) is the drug most widely used in treating serious
  systemic fungal infections. Oral antifungal drugs such as ketoconazole (Nizoral), fluconazole (Diflucan), and itraconazole (Sporanox) have also been successful in the
  treatment of fungal infections..

Question 22

bronchiectasis

Answer 22

Bronchiectasis is characterized by permanent, abnormal dilation of one or more large
bronchi. The pathophysiological change that results in dilation is destruction of the
elastic and muscular structures supporting the bronchial wall.

The hallmark of bronchiectasis is persistent or recurrent cough with production of
greater than 20 mL of purulent sputum per day.

Question 23

how to treat bronchiectasis

Answer 23

Bronchiectasis is difficult to treat. Therapy is aimed at treating acute flare-ups and
preventing decline in lung function.

Antibiotics are the mainstay of treatment and are often given empirically, but
attempts are made to culture the sputum.

Long-term suppressive therapy with
antibiotics is occasionally used but is fraught with risks of antibiotic resistance.

An important nursing goal is to promote drainage and removal of bronchial mucus

Question 24

lung abcess descriotion and treatment

Answer 24

A lung abscess is a pus-containing lesion of the lung parenchyma that gives rise to a
cavity.

• In many cases, the causes and pathogenesis of lung abscess are similar to those of
  pneumonia.
• The onset of a lung abscess is usually insidious, especially if anaerobic organisms are
  the primary cause. A more acute onset occurs with aerobic organisms.
• Antibiotics given for a prolonged period (up to 2 to 4 months) are usually the primary
  method of treatment.

Question 25

enironmental lung disease desciprtion and mangement

Answer 25

Environmental or occupational lung diseases result from inhaled dust or chemicals.
The duration of exposure, the amount of inhalant, and the susceptibility of the host
influence whether the exposed individual will have lung damage

Pneumoconiosis is a general term for a group of lung diseases caused by inhalation
and retention of dust particles.

The best approach to management of environmental lung diseases is to try to prevent
or decrease exposure to the harmful agent.

Question 26

biggest risk factor for lung cancer

Answer 26

Cigarette smoking is the most important risk factor in the development of lung cancer.
Smoking is responsible for approximately 85% of all lung cancers in Canada.

Question 27

lung cancer types and scanning

Answer 27

Primary lung cancers are often categorized into two broad subtypes: non–small cell
lung cancer (NSCLC; 75%–80%) and small cell lung cancer (SCLC; 20%–25%).

CT scanning is the single most effective noninvasive technique for evaluating lung
cancer. Biopsy is necessary for a definitive diagnosis.

Question 28

treaatment options for lung cancer

Answer 28

Surgical resection is the treatment of choice in non–small cell lung cancer Stages
I and II, because the disease is potentially curable with resection.
o Radiation therapy used with the intent to cure may be moderated in the individual
who is unable to tolerate surgical resection due to comorbidities. It may also be
used as adjuvant therapy after resection of the tumour.
o Stereotactic radiotherapy (SRT) is a new type of radiation therapy that uses high
doses of radiation delivered very accurately to the tumour and provides an option
to older-adult patients, patients with severe lung or heart disease, and other
patients in poor health who are not good candidates for surgery.
o Chemotherapy may be used in the treatment of nonresectable tumours or as
adjuvant therapy to surgery in non–small cell lung cancer.
o Biological (targeted) therapy aas adjuvant therapy has been used in individuals
with malignant lung tumours.

Question 29

overall goal of nursing manganement with a paiatnet with lung cancer

Answer 29

The overall goals of nursing management of a patient with lung cancer will include
(1) effective breathing patterns, (2) adequate airway clearance, (3) adequate
oxygenation of tissues, (4) minimal to no pain, and (5) a realistic attitude toward
treatment and prognosis.

Question 30

penetrating trauma

Answer 30

O Penetrating trauma occurs when a foreign body impales or passes through the
body tissues.

Question 31

blunt trauma

Answer 31

Blunt trauma occurs when the body is struck by a blunt object. The external
injury may appear minor, but the impact may cause severe, life-threatening
internal injuries, such as a ruptured spleen.

Question 32

pnueumothorax

Answer 32

A pneumothorax is the presence of air in the pleural space. As a result of the
accumulation of air, there is partial or complete collapse of the lung.

Question 33

closed pheumothorax

Answer 33

Closed pneumothorax has no associated external wound. The most common form
is a spontaneous pneumothorax, which is accumulation of air in the pleural space
without an apparent antecedent event. It is caused by the rupture of small blebs
(air-filled alveolar dilations <1 cm in diameter on the edge of the lung at the apex
of the upper lobe or superior segment of the lower lobe) on the visceral pleural
space

Question 34

open pneumothorax

Answer 34

Open pneumothorax occurs when air enters the pleural space through an opening
in the chest wall. Examples include stab or gunshot wounds and surgical
thoracotomy.

Question 35

tension pneumothorax

Answer 35

Tension pneumothorax is a pneumothorax with rapid accumulation of air in the
pleural space causing severely high intrapleural pressures with resultant tension
on the heart and great vessels. It may result from either an open or a closed
pneumothorax

Question 36

hemothorax

Answer 36

Hemothorax is an accumulation of blood in the intrapleural space. It is frequently
found in association with open pneumothorax and is then called a
hemopneumothorax.

Question 37

chylothorax

Answer 37

Chylothorax is lymphatic fluid in the pleural space due to a leak in the thoracic
duct. Causes include trauma, surgical procedures, and malignancy.

Question 38

frail chest description and treatment

Answer 38

Flail chest results from multiple rib fractures, causing an unstable chest wall. The
affected (flail) area will move paradoxically to the intact portion of the chest during
respiration. During inspiration, the affected portion is sucked in, and during
expiration, it bulges out. This paradoxical chest movement prevents adequate
ventilation of the lung in the injured area.
* Initial therapy consists of adequate ventilation, administration of humidified O2,
careful administration of crystalloid IV solutions, and pain control.
* The definitive therapy is to re-expand the lung and ensure adequate oxygenation.

Question 39

chest tubes decription and consdierations

Answer 39

The purpose of chest tubes and pleural drainage is to remove the air and fluid from
the pleural space and to restore normal intrapleural pressure so that the lungs can reexpand.
* Chest tube malposition is the most common complication.
* Routine monitoring is done by the nurse to evaluate if the chest drainage is successful
by observing for tidalling in the water-seal chamber, listening for breath sounds over
the lung fields, and measuring the amount of fluid drainage.

Question 40

restrictive respirtory disorders

Answer 40

These disorders are characterized by a restriction in lung volume (caused by
decreased compliance of the lungs or chest wall). This is in contrast to obstructive
disorders, which are characterized by increased resistance to airflow.

Question 41

pleural effusion

Answer 41

Pleural effusion is a collection of fluid in the pleural space. It is not a disease but
rather a sign of a serious disease.

• Pleural effusion is frequently classified as transudative or exudative according to
  whether the protein content of the effusion is low or high, respectively.
  o A transudate occurs primarily in noninflammatory conditions and is an
  accumulation of protein-poor, cell-poor fluid.
  o An exudative effusion is an accumulation of fluid and cells in an area of
  inflammation.
  o An empyema is a pleural effusion that contains pus
• The type of pleural effusion can be determined by a sample of pleural fluid obtained
  via thoracentesis (a procedure done to remove fluid from the pleural space).
• The main goal of management of pleural effusions is to treat the underlying cause

Question 42

pleurisry

Answer 42

Pleurisy (pleuritis) is an inflammation of the pleura. The most common causes are
pneumonia, TB, chest trauma, pulmonary infarctions, and neoplasms.
* Treatment of pleurisy is aimed at treating the underlying disease and providing pain
relief.

Question 43

atelectasis

Answer 43

• Atelectasis is a complete or partial collapse of a lung or segment of a lung that occurs
  when the alveoli become deflated.
• The most common cause of atelectasis is airway obstruction that results from retained
  exudates and secretions. This is frequently observed in the postoperative patient.

Question 44

intersistial lung disease

Answer 44

• Atelectasis is a complete or partial collapse of a lung or segment of a lung that occurs
  when the alveoli become deflated.
• The most common cause of atelectasis is airway obstruction that results from retained
  exudates and secretions. This is frequently observed in the postoperative patient.

Question 45

idiopathic pulmonary fibrosis description and treatment

Answer 45

• Idiopathic pulmonary fibrosis (IPF) is characterized by scar tissue in the connective
  tissue of the lungs as a sequel to inflammation or irritation.
• The clinical course is variable, with a 5-year survival rate of 30% to 50% after
  diagnosis.
• Treatment includes corticosteroids, cytotoxic agents, and antifibrotic agents.
  However, there is no good evidence that any of these treatments improves survival or
  quality of life. Lung transplantation is an option that should be considered for those
  who meet the criteria.

Question 46

sacriodosis

Answer 46

Sarcoidosis is a chronic, multisystem granulomatous disease of unknown cause that
primarily affects the lungs. The disease may also involve the skin, eyes, liver, kidney,
heart, and lymph nodes.
* The disease is often acute or subacute and self-limiting, but in some cases it is chronic
with remissions and exacerbations.

Question 47

pulmonary edema

Answer 47

Pulmonary edema is an abnormal accumulation of fluid in the alveoli and interstitial
spaces of the lungs.
* It is considered a medical emergency and may be life-threatening.
* The most common cause of pulmonary edema is left-sided heart failure.

Question 48

pulmonary embolism risk factors

Answer 48

Pulmonary embolism (PE) is the blockage of pulmonary arteries by a thrombus, fat,
or air emboli, or tumour tissue.

• Most pulmonary embolisms arise from deep vein thrombosis (DVT) in the deep veins
  of the legs.
• The most common risk factors for pulmonary embolism are immobility, surgery
  within the last 3 months (especially pelvic and lower extremity surgery), stroke,
  paresis, paralysis, history of DVT, malignancy, obesity in women, heavy cigarette
  smoking, and hypertension.

Question 49

pulmonary embolism risk factors

Answer 49

Pulmonary embolism (PE) is the blockage of pulmonary arteries by a thrombus, fat,
or air emboli, or tumour tissue.

• Most pulmonary embolisms arise from deep vein thrombosis (DVT) in the deep veins
  of the legs.
• The most common risk factors for pulmonary embolism are immobility, surgery
  within the last 3 months (especially pelvic and lower extremity surgery), stroke,
  paresis, paralysis, history of DVT, malignancy, obesity in women, heavy cigarette
  smoking, and hypertension.

Question 50

pulmonary infarction

Answer 50

Pulmonary infarction (death of lung tissue) and pulmonary hypertension are common
complications of pulmonary embolism.

Question 51

prevention of pulmonary embolism

Answer 51

Prevention of PE begins with prevention of VTE. VTE prophylaxis includes the use
of sequential compression devices, early ambulation, and prophylactic use of
anticoagulant medications. To reduce mortality risk, treatment is begun as soon as PE
is suspected.

Question 52

objective for treatment of pulmonary embolisms

Answer 52

The objectives of treatment are to (1) prevent further growth or multiplication of
thrombi in the lower extremities, (2) prevent embolization from the upper or lower
extremities to the pulmonary vascular system, and (3) provide cardiopulmonary
support if indicated.

Question 53

pulmonary hypertension

Answer 53

Pulmonary hypertension can occur as a primary disease (primary pulmonary
hypertension) or as a complication of a respiratory, cardiac, autoimmune, hepatic, or
connective tissue disorder (secondary pulmonary hypertension).

Question 54

primary pulmonary hypertension

Answer 54

Primary pulmonary hypertension (PPH) is a severe and progressive disease. It is
characterized by mean pulmonary arterial pressure greater than 25 mm Hg at rest
(normal 12 to 16 mm Hg) or greater than 30 mm Hg with exercise in the absence of a
demonstrable cause

Primary pulmonary hypertension is a diagnosis of exclusion. All other conditions
must be ruled out

Although there is no cure for primary pulmonary hypertension, treatment can relieve
symptoms, increase quality of life, and prolong life.

Question 55

secondary pulmoary hypertension

Answer 55

Secondary pulmonary hypertension (SPH) occurs when a primary disease causes a
chronic increase in pulmonary artery pressures. Secondary pulmonary hypertension
can develop as a result of parenchymal lung disease, left ventricular dysfunction,
intracardiac shunts, chronic pulmonary thrombo-embolism, or systemic connective
tissue disease

Question 56

cop pulmoale, cause and mangement

Answer 56

• Cor pulmonale is enlargement of the right ventricle secondary to diseases of the
  lung, thorax, or pulmonary circulation. Pulmonary hypertension is usually a preexisting condition in the individual with cor pulmonale.
• The most common cause of cor pulmonale is COPD; however, almost any disorder
  that affects the respiratory system can cause cor pulmonale.
• The primary management of cor pulmonale is directed at treating the underlying
  pulmonary problem that precipitated the heart problem.

Question 57

four types of lung transplant

Answer 57

There are four types of transplant procedures available: single lung transplant,
bilateral lung transplant, heart-lung transplant, and transplant of lobes from living
related donor.

Question 58

lung transplant considerations

Answer 58

Lung transplant recipients are at high risk for bacterial, viral, fungal, and protozoal
infections. Infections are the leading cause of death in the early period after the
transplant.
* Immuno-suppressive therapy usually includes a triple-drug regimen of cyclosporine,
azathioprine (Imuran), and prednison