Exam 1 Flashcards
how are sputum studies obtained
expectoration
trach suction
bronchoscopy
how is sputum induced for a sputum study
use of hypertonic saline
what is sputum examined for
C&S
AFB
Cytology
Gram stain
what is a bronchoscopy
procedure where bronchi are visualized through a tube
what are the interventions for a bronchoscopy
informed consent
NPO
sedative
Assess lung sounds
NPO
Assess mucus
Semi-fowlers position
nursing care after bronchoscopy is done
assess frequent VS
O2 sats
assess return of gag reflex
maintain NPO until cleared to eat or drink medication will be given to supress cough/gag reflex high risk for aspiration
open airway is priority
what is a lung biopsy
used to obtain tissue cells or fluid for evaluation
nursing interventions for lung biopsy
Based on type
TTNA:
Check breath sounds Q4H
Assess incision
Chest x-ray
VATS
Chest tube
Assess breath sounds
Deep breathing
what is a thoracentesis
Aspiration of intrapleural fluid for diagnostic and therapeutic purposes, remove fluid that builds up n pleura space or install med
positioning for thoracentesis
Sitting up on side of bed (usually leaning forward on bed side table with pillow for support)
how much fluid can be removed during thoracentesis
can remove 1000-1200 mL of fluid at a time
not supposed to be done can cause hypotension, hypoxemia, pulmonary edema, fluid removed slowly
what should happen after thoracentesis is done
Once done O2 sats should increase, and breathing will improve, decreased O2 sats mean complication occurred
spirometry
measures airflow
patient inserts mouthpiece, takes a deep breath, exhales as hard, as fast, and for as long as possible
pulmonary function test
Measures lung volume and airflow
Diagnosis, monitors disease progression, evaluates response to bronchodilators
peak flow meter
used at home
hand held device , used for CF, asthma, COPD,
6 min walk test
Measures functional capacity
Pulse ox monitored during walk
what is a CXR for
used to diagnose and evaluate changes
what is a ct scan for
to diagnose lesions
what is V/Q scan for
to diagnose a PE
What is an MRI for
diagnosis of lesions, differentiating vascular/nonvascular structures
compensation in ABGs
uncompensated: CO2 or HCO3 normal
Partially compensated: nothing is normal
compensated: normal ph
causes of respiratory acidosis
oversedation
brain stem trauma
COPD, ARDs, PE, Pneumonia
respiratory muscle paralysis
immobility
pulmonary edema
emphysema
bronchitis
symptoms of respiratory acidosis
hypoventilation
hypoxia
rapid, shallow respirations
low BP
skin mucosa pale/cyanotic
headache
hyperkalemia
dysrhythmias
drowsiness, dizziness, disorientation
muscle weakness, hyperreflexia
treatment of respiratory acidosis
Fix respirations
Bronchodilators
Respiratory stimulants
Drug antagonists
Oxygen
Vent support
causes of respiratory alkalosis
Hyperventilation
Hypoxemia
Pneumonia
Pulmonary Embolus
Pregnancy (normal finding)
Ventilatory settings too high or too fast
High altitudes
Liver failure
Septicemia (fever)
Stroke
Overdose of salicylates or progesterone
symptoms of respiratory alkalosis
seizures
deep, rapid, breathing
hyperventilation
tachycardia
low or normal bp
hypokalemia
numbness/tingling of extremities
lethargy/confusion
light headedness
nausea, vomiting
treatment of respiratory alkalosis
Treat underlying cause
Decrease tidal volume or resp rate
Pain control/sedation
Breathe into paper bag
Antidepressants
Correct Co2 slowly
causes of metabolic acidosis
Diabetic ketoacidosis
Lactic acidosis
Starvation
Diarrhea
Renal tubular acidosis
Renal failure
GI fistulas
Shock
Ileostomy
symptoms of metabolic acidosis
headache
decreased bp
hyperkalemia
muscle twitching
warm flushed skin
nausea, vomiting, diarrhea
changes in LOC (confusion, drowsiness)
Kussmaul respirations
fruity breath (DKA)
treatment of metabolic acidosis
Raise plasma pH > 7.20
Treat underlying cause
Sodium Bicarb
Follow ABGs
Continuously monitor patient.
causes of metabolic alkalosis
Vomiting
NG suctioning
Diuretic therapy
Hypokalemia
Excess bicarb intake
symptoms of metabolic alkalosis
restlessness followed by lethargy
dysrhythmias (tachycardia)
compensatory hypoventilation
confusion ( decreased LOC, dizzy, irritable)
Nausea, vomiting, diarrhea
tremors, muscle cramps, tingling
treatment of metabolic alkalosis
Treat underlying cause
Stop K+ wasting diuretics
Spironolactone
Acetazolamide
IV fluids
Sodium chloride
Replace K+
Monitor Resp rate
Monitor HR
Seizure precautions
types of nasal fractures
simplex - unilateral , no displacement
complex - more damage to others facial structures
complications of nasal fractures
airway obstruction,
epistaxis,
meningeal tears causing CSF leakage
symptoms of nasal fracture
pain,
crepitus on palpation,
swelling,
ecchymosis,
deformity,
epistaxis,
difficulty breathing through the nose.
interventions for nasal fracture
Maintain airway
Sit patient upright
Ice (edema/bleeding)
Analgesia (no NSAIDs/aspirin for 48 hrs)
Decongestants, saline, humidification
Avoid hot showers and alcohol for 48 hrs
Decrease smoking
Surgical options (septoplasty for deviated septum or rhinoplasty for reconstruction)
Evaluation of drainage if necessary (persistent clear or pink tinged drainage can be meningeal tear, leak css fluid, risk for meningitis)
preop prep for nasal fracture
Stop aspirin or nsaids, blood thinners, 5 days or 2 weeks before
post op nursing care for nasal fracture
maintain airway, check respiratory status, control pain, no bleeding or infection
sleep in sitting position
causes of epistaxis
trauma, hypertension, low humidity, URI, allergies, sinusitis, foreign bodies, chemical irritants, nasal sprays
treatment of anterior nose bleeds
Pledget
Packing
Silver nitrate ( cauterizes area)
Thermal cauterization
treatment of posterior nose bleeds
Packing with merocel
Epistaxis balloons (rapid rhino)
Foley catheter.
indications for tracheostomy
Establish a patent airway
Bypass an upper airway obstruction
Facilitate removal of secretions
Permit long term mechanical ventilation
Facilitate weaning from mechanical vent
specific precautions for tracheostomy
Will require a sterile field
Will require use of solutions from non-sterile containers
Will require oxygen and suction
Use only sterile manufacture precut dressings or folded 4X4, never use cotton-filled gauze spongemay cause aspiration from fiber
assessments prior to trash care
Assess patient’s respiratory status prior to care
Respiratory rate, depth, rhythm, breath sounds, color, pulse oximetry (determines whether patientcan tolerate trach care
Assess trach site for drainage, redness or swelling
Assess when patient last ate, schedule care at least 3 hours after meal to decrease risk of vomiting oraspirating stomach contents
trach care procedure
look at slide 61
trach care documentation
- Date and time performed
- Note color, amount consistency and odor of secretions
- Note condition of stoma and skin around stoma site, any drainage, redness, or swelling
- Document respiratory status before and after
- Patient’s tolerance of procedure
- Note any problems that arose and interventions provided for those problems
what size suction catheter should be used
size of catheter should be no more than 1/2 size of internal diameter of airway tube
suctioning trach instructions
- Dominant hand sterile, non-dominant hand unsterile
- Sterile hand controls suction tube
- Place patient in semi-fowler position
- do not force catheter
- do not suction while inserting
- rotate catheter when withdrawing
- apply suction while removing catheter no more than 15 secs
- repeat as needed allowing 30 sec intervals
hyperoxygenate before suction and in between passes
suctioning trach documentation
Date and time suction was performed
Note suction techniques and catheter size used
Note color, consistency, and odor of secretions
Document patient’s respiratory status before and after the procedure
Document patient’s tolerance of procedure and any complications encountered
Document any interventions performed to address complications.
community acquired pneumonia (CAP)
pt not in facility in 14 days, may or may not be hospitalized
Hospital associated pneumonia types
nosocomial - 48 hrs after admission, not intubated pts, did not have lung issues before admission
Ventilator associated pneumonia - intubated, after 48 hrs of intubation
aspiration pneumonia
Abnormal entry of material from mouth or stomach into trach and lungs, can happen after head injury or stroke , impaired gag reflex, cant cough, stroke pts who lay on side or upright , turn to prevent pooling of secretions, monitor o2 sats and LOC
pneumonia symptoms
Chills
Dyspnea
Tachypnea
Pleuritic Chest pain
Altered mental status
Fatigue
SOB
Crackles (fine or coarse)
Wheezes
Increased tactile fremitus
cough
yellow/green sputum
diagnosis of pneumonia
H&P
CXR
Thoracentesis
Sputum culture
ABGs
pneumonia treatment
antibiotics
oxygen
analgesics
antipyretics
rest
cough syrup
mucolytics
bronchodilators
corticosteroids
nursing interventions for pneumonia
Semi-fowlers, side-lying, q2h turns
Incentive Spirometer q2h
Pain treatment
Cough and Deep breath
Fatigue
Vaccines
Follow up chest x-ray in 6-8 weeks
risk factors for TB
homeless, workers in prison, iv drug users, poor access to healthcare, immunosuppressed pts
what is primary tb
when bacterial is inhaled and initiates and inflammation reaction
Healthy body will initiate an immune response in which organism will be encapsulated, no progress in infection , but can activate later on
what is latent tb
bacteria is not active but person can show positive tb test, asymptomatic, cant transmit cuz no symptoms, can become active later
what is reactivated tb
pts start showing symptoms 2 years after initial infection due to stress, immunosuppression, other illnesses
is TB contagious
Not highly contagious unless in close proximity for prolonged period of time
Negative pressure room, airborne precautions
Tb symptoms
Cough
Fatigue
Malaise
Anorexia
Weight loss
Fevers
Night sweats
Dyspnea
hemoptysis
dysuria
hematuria
bone/join pain
Symptoms of TB meningitis
headache, vomiting, lymphadenopathy
when do tb symptoms occur
can develop 2 week after infection
tb diagnostics
Tuberculin Skin Test (Mantoux test)
PPD
Blood test
Chest x-ray
Bacteriologic studies
Education for pts with TB
Side effects of common drugs: Isoniazid, rifampin, and pyrazinamide
Frequent lab work , risk of hepatitis , monitor LFTs every 2-4 wks
educate on vaccine
what is a pneumothorax
Air or gas in the pleural cavity causing a partial or complete lung collapse
types of pneumothorax
Spontaneous
Iatrogenic
Tension
Hemothorax
Chylothorax
what is a chylothorax pneumothorax
lymphatic fluid in lung
what is a spontaneous pneumothorax
rupture of small blebs
risk factors for spontaneous pneumothorax
Lung disease
Smoking
Tall and thin
Male gender
Family hx
Previous occurence
occurs in young ppl cuz of asthma, copd, chf, pneumonia, cystic fibrosis
what is an iatrogenic pneumothorax
laceration/puncture during medical procedure
what is a tension pneuothorax
Medical Emergency
Affects pulmonary and cardiac function
air enters pleural space but cant escape
Compression of lungs that puts pressure on heart and vessels, trach will be deviated
Need chest tube asap
symptoms of tension pneumothorax
Dyspnea, tachycardia, tracheal deviation, decreased or absent breath sounds, neck vein distention, cyanosis, profuse diaphoresis, tachypnea
causes of tension pneumothorax
open chat wound, CPR, mechanical ventilation , clamped chest tube
interventions for tension pneumothorax
Needle decompression followed by chest tube insertion with chest drainage system
what is a hemothorax
accumulation of blood in pleural space
what causes a hemothorax
Result of injury to chest wall, diaphragm, lungs, mediastinum
Requires stat insertion of chest tube to evacuate blood
symptoms of fractured ribs
pain at site during inspiration and with cough
interventions for fractured ribs
Ice
Rest
Pain meds
Deep breathing
incentive spirometer
Lie on injured side
prevent atelectasis and Pneumonia
what is flail chest
Result of 3 or more severe rib fractures in 2 or more places
Instability to chest wall , paradoxical movement during breathing, chest sucked in during inspiration, and bulges out during expiration , prevents adequate ventilation and increases work of breathing
what is the priority with flail chest
stabilize gas exchange, can quickly become hypoxemia
symptoms of flail chest
Chest wall pain, increased pulses, chest bruising
what are chest tubes used for
Inserted to drain pleural space and reestablish negative pressure
what is a large chest tube for
drain blood from pleural space
what is a medium size chest tube used for
to remove fluid
what is a small chest tube used for
for air leakage
what is the position for chest tube insertion
Pt should have HOB elevated 30-60 degrees
Arm raised above head
chest tube placement precedure and management
Area will be cleaned by Dr, incision over rib
Ribs have nerve endings, rubbing can be painful
Covered with plastic dressing after insertion , sutured in place , confirm placement with x-ray, connected to drainage device, must be kept on floor
Can get up and carry device but has to be lower
Make sure tubing is not kinked
Surgical tape at bedside
risk factors for Pulmonary embolism
Immobility,
surgery,
DVT,
Cancer
obesity,
contraceptives,
hormones,
smoking,
HF,
pregnancy,
clotting disorders
symptoms of pulmonary embolism
Dyspnea,
hypoxemia,
tachypnea,
cough,
chest pain,
hemoptysis,
crackles,
wheezing,
fever,
tachycardia,
syncope,
LOC,
hypotension,
impending doom
diagnostics for PE
D-Dimer
Spiral CT
VQ scan
what is atelectasis
collapsed airless alveoli
what causes atelectasis
obstruction
risk factors for atelectasis
sedentary lifestyle
post-op
frequent napper
smoker
pain
nursing interventions
incentive spirometer
mobility
deep breathing and coughing
treat asap to prevent pneumonia
atelectasis symptoms
absence of breath sounds
dullness of percussion of affected area
contraindication for lung transplant
Hepatitis b/c, HIV, smoker, poor nutrition, cancer in last 2 years, psychological problems
