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Iggy Respiratory Test 2 > Diseases > Flashcards

Diseases Flashcards

1
Q

Cystic Fibrosis
When is it dx?
What causes?

A

Present from birth dx as a child

It is a recessive gene that must be given by both parents.

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2
Q

Cystic Fibrosis
What is the mechination?
What does it effect?

A

Chloride transport is blocked and produces thickened mucous

Effects lungs, liver, pancreas, salivary glands and testes

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3
Q

Cystic Fibrosis

So what? What is the big deal?

A

Most serious is airway obstruction due to thickened secretions.

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4
Q

Cystic Fibrosis

Diagnostic test - lab values

A

Chloride sweat: 5-35 mEq/L is normal a positive for cystic fibrosis is 60-200mEq/L (Pilocarpine is given to cause pt to sweat) done twice

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5
Q

Cystic Fibrosis:

Assessment findings- General

A 
Severe GERD
ABD distension
Fatty Stools (Steatorrhea)
Vitamin deficiencies (at risk for Osteoporosis)
Small body build
Liver cirrhosis
Sterility
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6
Q

Cystic Fibrosis

Assessment - Lungs

A 
Frequent respiratory infections
Chest congestion
Limited exercise tolerance
Cough
Sputum production
Sinus infection
Decreased pulmonary function
Crackles
Hemoptysis
Dyspnea
Acidosis
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7
Q

Cystic Fibrosis

Tx

A 
Cure=none
daily  pulmonary interventions to loosen secretions 
Vitamin replacement
Pancreatic replacement
Draining positions
Chest percussion
Medications Heliox
Antibiotics
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8
Q

Cystic Fibrosis

Exacerbation

A 
Increased chest congestion
Increased coughing
***Crackles***
Increased mucous
10% decrease in FEV1
Weight loss & fatigue
Ventilatory muscle retraction
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9
Q

Cystic Fibrosis

Tx of exacerbation

A

Improve airway clearance- medications, precussion
Prevent infection- antibiotics(Burkholderia cepacia
Increase o2- supplement Heliox

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10
Q

Cystic Fibrosis

Pt. education

A

Avoid others bodily fluids
Avoid contact with others(shaking hands, kissing)
Wash hands often
Adhere to medication

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11
Q

Cystic Fibrosis

Surgical Tx

A

lung or pancreatic transplant

double lung transplant

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12
Q

Cystic Fibrosis

not a candidate for lung transplant

A 
Hx of noncompliance
Self harm behaviors
5 yr hx of cancer
Irreversible damage to kidney, heart, liver
Systemic infection
>55y.o
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13
Q

Lung Transplant

A 
intubated for <48hrss
prevent infection
monitor for bleeding, infection, rejection
Anti-rejection meds for life
Avoid corticosteroids for 10-14 days
Prophylactic antibiotics
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14
Q

Head and Neck Cancer

etiology

A

Slow growing squamous cells
Curable early on
Risks: pollution smoking
Spread to lymph nodes, muscle, bone, lungs, liver
Effects breathing, eating, facial appearance, self image speech and communication

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15
Q

Head and Neck Cancer

locations

A 
Mouth
Throat
Larynx
Salivary Glands
Thyroid
Paranasal sinuses
Lymph nodes in upper neck
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16
Q

Head and Neck Cancer

risks

A

Alcohol and Tobacco
Men
>60
North America

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17
Q

Head and Neck Cancer

warning signs

A 
Pain
Shortness of breath
difficulty swallowing
change in mouth
oral lesion that wont heal
numbness
change of denture fit
burning sensation with eating
ear pain
voice change
persistent sore throat
late stage= anorexia
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18
Q

Head and Neck Cancer

testing

A 
Physical
Lab tests- CBS, urinalysis, liver, kidney
Panendoscopy
X-rays, skull, neck, sinuses, chest
CT scan
MRI
PET
Biopsy
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19
Q

Head and Neck Cancer

Nursing priorities

A

Maintain patent airway
Decrease anxiety
Pt. will have body image disturbance

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20
Q

Head and Neck Cancer

Tx

A

Radiation(small cancer) S/E skin redness, edema, xerostomia, dehydration NOT done before surgery
Chemotherapy- used before and after surgery or radiation, decreases WBC, dehydration, hypotension
Surgery

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21
Q

Supraglottic method of swallowing

A 
Pt. siting upright
Clear throat
take deep breath
1/2 teaspoon to 1 teaspoon of food per bite
hold breath and bear down
swallow twice
breathe normally
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22
Q

Communication Post laryngectomy

A

Esophageal- burping
Mechanical-battery powered uses air
Tracheoesophageal- puncture b/w trachea and esophagus covering of stoma to create words

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23
Q

Lung Cancer

Etiology

A

Poor survival rate, high rate metastasis

Occurs as a result of inhaled substances Tobacco, smoke, dusts

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24
Q

Lung Cancer

Risk Factors

A

Cigarette smoke
Inhaled irritants
Air pollution
Tp53 gene

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25
Q

Lung Cancer

Bronchogenic Carcinomas

A 
small cell:
rapid growth
spread easily
secretes hormones
non-small
adenocarinoma
squamous cell
large cell
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26
Q

Lung Cancer

Assessment

A 
Smoking hx
Sputum
Chronic cough
hemoptysis
wheezing
shortnes of breath
dull, aching chest pain
pain!
hoarseness
dysphagia
finger clubbing
weight loss
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27
Q

Pulmonary Arterial Hypertension

pathophysiology

A

Cause unknown
occurs in the absence of other lung diseases
found most often in women between the ages of 20-40

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28
Q

PAH

assessment findings

A

Dyspnea
Fatigue
Chest Pain
Syncope

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29
Q

Cor Pulmonale

What is it?

A

Right sided heart failure
S&S dependent edema, engorged jugular veins, enlarged liver.
results in: Death or heart transplant

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30
Q

PAH

Diagnosis

A 
Right side heart cath to measure pulmonary pressure
normal pressure 8-25 mm Hg PAH >25mmHg
Ventilation Perfusion scans
Pulmonary Function Test reduced capacity
CT
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31
Q

PAH

Tx

A

Drug therapy CA Channel blockers(procardia, cardizem, endothelin receptor antagonist[relax blood vessels–> hypotension], IV prostacyclins[ decrease pulmonary pressure, increase blood flow to lungs IV or SQ], Coumadin)
Digoxin and Diuretics can be used due to hypertrophy

With these drugs monitor Hypertension and Syncope(fainting)
Heart or lung transplant

INR theraputic 1.5-2.0
Use K with Lasix and Demadex

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32
Q

Flolon Therapy for PAH

A

IV or SQ
Continuous infusion, have back up batteries, go to ER immediately is interruption occurs
Use aseptic technique(central line)
CBC q 7days

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33
Q

Interstitial pulmonary disease

includes:

A

Sarcoidosis

Pulmonary Fibrosis

34
Q

Interstitial pulmonary disease

pathophysiology

A

Restrictive, decrease in expansion and recoil

35
Q

Sarcoidosis

pathophysiology

A 
cause unknown
growth of granulas(collection of immune cells)
affects mostly young adults
first indication abnormal chest x-ray
can lead to cor pulmonale
36
Q

Sarcoidosis

Assessment

A 
Dyspnea!
Enlarge lymph nodes in hilar area
Eye lesions(Hypercalcemia)
Cough
Abnormal PFTs
Hemophotysis
37
Q

Sarcoidosis

dx

A

Abnormal chest x-ray
Bronchoscopy and biopsy to rule out cancer
Sarcoidosis is staged according to amount of fluid in lungs

38
Q

Sarcoidosis

tx

A

Tx to lessen symptoms and prevent fibrosis of lung tissue
if PFTs are not affected it is unlikely that anything will be done
Decrease in TLC or FVC= involvement of other organs so tx will occur

Corticosteriods 6-12 month maintenance dose
Thalomid or Remicade
Not usually lethal but can lead to pulmonary fibrosis

39
Q

Pulmonary Fibrosis

A 
restrictive pulmonary disease
over-healing of scar tissue
High mortality rate
less than 5yr survival rate
Impaired gas exchange
40
Q

Pulmonary Fibrosis

pathophysiology

A

Occupational hazards(inhaled)
genetic components
chronic lung disorder

41
Q

Pulmonary Fibrosis

Dx/Assessment

A 
CT
Mild dyspnea
Decreased FVC
Hypoximia
Rapid shallow breathing

PFTs
Chest x-ray
CT scan

Onset of symptoms may occur many years after damage has been done

42
Q

Pulmonary Fibrosis

Tx

A 
Corticosteroids
Immunosuppresants
Reduce anxiety
O2 therapy
Pt and family support
Curative tx is lung transplant( not likely because these pts are older and generally have a hx of smoking)
43
Q

BOOP Bronchiolitis Obliterans Organizing Pnuemonia

A 
resembles respiratory infection
fibroblast occlude airways
cancer tx may be a cause
30-60 persons most likely to have it
can be chronis
Dyspnea
Fever
Crackles
Mild Fever
Flu-like symptoms
Biopsy is what diagnosis this disease
Tx corticosteroids
44
Q

Lower Respiratory medication of choice?

A

Corticosteroids

45
Q

Lung Cancer

Dx

A 
Sputum testing
CXR nodule
Bronchoscopy
CT Scan MRI
Video assisted thoracospoy
CBC
Liver function studies
Serum electrolytes
46
Q

Lung Cancer

Nonsurgical Management

A

Chemo
Targeted therapy- antibodies destroy cancer cell division
Raiation
Photodynamic therapy light up cancer cells, use laser on cancer cells

47
Q

Lung cancer

chemo

A

Chemotherapy- small cancer
side effects nausea, vomiting, alopecia, mucositis, immunosuppression, anemia, thrombocytopenia, peripheral neuropathy
Antiemtics are usually used with chemo

48
Q

Lung Cancer

radiation

A

Used prior to surgery to shrink tumor
daily 5-6x a week
side effects: skin irritation, peeling, fatigue, nausea, taste changes
do not scrub off markings

49
Q

Lung cancer

Photodynamoc therapy

A

remove small brinchial tumors
injected to sensitizes cells to light
side effects blocked airway from sloughing of cells, bronchial hemorrhage, fistula, super sensitivity to light not sunlight exposure for 30-90 days post treatment
pt. is intubated during procedure

50
Q

Lung cancer

surgical

A

Remove all tissue involved, maitain function of lung

can be removal of tumor, lobe or lung

51
Q

Post thoracotomy

A

pain management!
assess O2 sat, cap refill, lung sounds
chest tubes: drain air and blood

52
Q

Chest tube

assessment

A

Pt. breath sounds, RR, depth effort, SpO2, VS, anxiety, pain
Entry site: dressing? crepitus?
Tubing: tight, kinks, compressions
Water seal: 2cm of fluid, never should buble- bad
Drainage: below heart, upright
NEVER milk the tubing

53
Q

Chest tube

removal

A

Physician, PA, NP
chest x-ray post removal
premidcate
cut suture

54
Q

Palliation care

A 
Humidified air
Bronchodilators
Corticosteroids
Mucolytics
Radiation therapy
THoracentesis(fluid removal)
Pleurodesis(relieve pleural effusion)
Dyspnea control(position, morphine, O2)
Pain control
Hospice
55
Q

Pulmonary Embolism

risk factors

A 
Prolonged bed rest
CV cath- flush freq, never force
Major surgery
Obesity
Advanced age
56
Q

Pulmonary embolism

Clinical finding

A

sudden dyspnea
sharp chest pain
feeling of impending doom
cough

57
Q

PE lab test

A

ABGs 7.35 Co2 decreases

derum D detects fibrin

58
Q

PE

dx

A

CT scan

59
Q

PE tx

A 
improve lung perfusion
monitor VS
anitcoagulants
fibrinolytic- large PEs
INR - coumadin 2.0-3.0

emboectomy- surgical removal
inferior vena cave filter- filter placed in heart to catch emolus

60
Q

PE teaching

A

Adhere to medication!!

prevention of further PE

61
Q

asthma

A

genetic factors
environmental
allergies

Reversible inflammatory airway obstruction
bronchial hyperactivity
mast cell degranulation

Inflammation
Increased mucous production
Bronchospasm and constriction)less room air in pt. lungs

62
Q

Astma triggers

A

stress
exercise
medications: asprin of NSAIDs
respiratory infection

63
Q

Asthma S&S

A 
intermitten dyspnea
tightness of chest
increased coughing
wheezing
increase mucous production
64
Q

Asthma dx

A

ABGs and Oximetry measure during an acute attack

PFTs during attck (PEFR, FVC, FEV1)

65
Q

Acute Asthma

A 
audible wheezes
accessory mucles
inc. cough mucous
dec. ability to speak
chest tightness
66
Q

Severe Asthma

A

Atelectasis
Pneumothorax
Cor Pulmonale
Status asthmaticus

67
Q

Status Asthmaticus

A 
severe asthma
does not respond to typical medication
severe hypoxia
hypercapnea
acidosis
respiratory failure
CAN BE LIFE-THREATENING
68
Q

Goals for pts. with Asthma

A

No limitations to daily life

Control of asthma through use of medications(little to no daily symptoms, normal PFTs, infrequent exacerbation)

69
Q

Asthma pt. education

A

avoid triggers
maintain >80% best PEFR
USE meds
Measure peak flow 2x a day

70
Q

Asthma colors

A

Green- >80% personal best
Yellow 50-80% if continues in yellow after administration of drug contact physician
Red- <50% serious airway obstruction seek immediate help

71
Q

COPD

A 
includes emphysema and chronic bronchitis
is NOT reversible
loss of lung elasticity
hyper inflates lungs
S&S dyspne incr RR
72
Q

COPD Etiology

A

Traps air in aveoli causes tissue damage and the diaphragm becomes weak
Less surface area more work inc RR

73
Q

COPD risks

A

Smoking and chronic exposure to inhaled irritants

74
Q

Chronic bronchitis

A

inflamed bronchi- vasodilation occurs, congestion, mucosal edmea, bronchospasms
Mucus plug constricts airway
Dx productive cough 3 months of the yr 2 consecutive yrs

75
Q

COPD

assessment

A 
Hypoximia- NO air exchange low PO2
Acidosis O2 dec CO2 inc
Respiratory infection
Cardiac failure- cor pulmoale
Dysrhythmias
Dyspnea
Productive cough
Rapid shallow breaths
Tri-pod position
Later Stage:
weight loss 
clubbing
edema
76
Q

COR PULMONALE

A

right side heart failure
manifestations: dyspnea, S3, loud pulmonic S2, increase P wave, R axis dev., JVD, RUQ tenderness, ascites, weight gain, edema, hypoxia
Tx O2 vasodilator, diuretics

77
Q

COPD prevention

A

Vaccinate! Flu! Pneumococcal

Discontinue brochodilators or corticosteroids

78
Q

COPD dx

A 
H&P
lab testing
X-ray
EKG- ectopic beat
Stress test
79
Q

COPD lab results

A

high WBC & RBC inc

ATT- genetic?

80
Q

COPD goals

A 
improve O2
 reduce CO2 retention
relieve symptoms
prevent weight loss
minimize anxiety(4th leading death in US)
long term knowledge and use of meds
81
Q

COPD interventions

A

Huff cough
High fowlers
Pursed breathing
O2 therapy

Iggy Respiratory Test 2 (2 decks)

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