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Respiratory semester 3 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

how are sputum studies obtained

A

expectoration
trach suction
bronchoscopy

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2
Q

how is sputum induced for a sputum study

A

use of hypertonic saline

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3
Q

what is sputum examined for

A

C&S
AFB
Cytology
Gram stain

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4
Q

what is a bronchoscopy

A

procedure where bronchi are visualized through a tube

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5
Q

what are the interventions for a bronchoscopy

A

informed consent
NPO
sedative
Assess lung sounds
NPO
Assess mucus
Semi-fowlers position

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6
Q

nursing care after bronchoscopy is done

A

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

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7
Q

what is a lung biopsy

A

used to obtain tissue cells or fluid for evaluation

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8
Q

nursing interventions for lung biopsy

A

Based on type
TTNA:
Check breath sounds Q4H
Assess incision
Chest x-ray
VATS
Chest tube
Assess breath sounds
Deep breathing

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9
Q

what is a thoracentesis

A

Aspiration of intrapleural fluid for diagnostic and therapeutic purposes, remove fluid that builds up n pleura space or install med

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10
Q

positioning for thoracentesis

A

Sitting up on side of bed (usually leaning forward on bed side table with pillow for support)

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11
Q

how much fluid can be removed during thoracentesis

A

can remove 1000-1200 mL of fluid at a time
not supposed to be done can cause hypotension, hypoxemia, pulmonary edema, fluid removed slowly

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12
Q

what should happen after thoracentesis is done

A

Once done O2 sats should increase, and breathing will improve, decreased O2 sats mean complication occurred

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13
Q

spirometry

A

measures airflow
patient inserts mouthpiece, takes a deep breath, exhales as hard, as fast, and for as long as possible

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14
Q

pulmonary function test

A

Measures lung volume and airflow
Diagnosis, monitors disease progression, evaluates response to bronchodilators

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15
Q

peak flow meter

A

used at home
hand held device , used for CF, asthma, COPD,

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16
Q

6 min walk test

A

Measures functional capacity
Pulse ox monitored during walk

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17
Q

what is a CXR for

A

used to diagnose and evaluate changes

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18
Q

what is a ct scan for

A

to diagnose lesions

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19
Q

what is V/Q scan for

A

to diagnose a PE

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20
Q

What is an MRI for

A

diagnosis of lesions, differentiating vascular/nonvascular structures

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21
Q

compensation in ABGs

A

uncompensated: CO2 or HCO3 normal
Partially compensated: nothing is normal
compensated: normal ph

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22
Q

causes of respiratory acidosis

A

oversedation
brain stem trauma
COPD, ARDs, PE, Pneumonia
respiratory muscle paralysis
immobility
pulmonary edema
emphysema
bronchitis

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23
Q

symptoms of respiratory acidosis

A

hypoventilation
hypoxia
rapid, shallow respirations
low BP
skin mucosa pale/cyanotic
headache
hyperkalemia
dysrhythmias
drowsiness, dizziness, disorientation
muscle weakness, hyperreflexia

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24
Q

treatment of respiratory acidosis

A

Fix respirations
Bronchodilators
Respiratory stimulants
Drug antagonists
Oxygen
Vent support

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25
Q

causes of respiratory alkalosis

A

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

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26
Q

symptoms of respiratory alkalosis

A

seizures
deep, rapid, breathing
hyperventilation
tachycardia
low or normal bp
hypokalemia
numbness/tingling of extremities
lethargy/confusion
light headedness
nausea, vomiting

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27
Q

treatment of respiratory alkalosis

A

Treat underlying cause
Decrease tidal volume or resp rate
Pain control/sedation
Breathe into paper bag
Antidepressants
Correct Co2 slowly

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28
Q

causes of metabolic acidosis

A

Diabetic ketoacidosis
Lactic acidosis
Starvation
Diarrhea
Renal tubular acidosis
Renal failure
GI fistulas
Shock
Ileostomy

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29
Q

symptoms of metabolic acidosis

A

headache
decreased bp
hyperkalemia
muscle twitching
warm flushed skin
nausea, vomiting, diarrhea
changes in LOC (confusion, drowsiness)
Kussmaul respirations
fruity breath (DKA)

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30
Q

treatment of metabolic acidosis

A

Raise plasma pH > 7.20
Treat underlying cause
Sodium Bicarb
Follow ABGs
Continuously monitor patient.

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31
Q

causes of metabolic alkalosis

A

Vomiting
NG suctioning
Diuretic therapy
Hypokalemia
Excess bicarb intake

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32
Q

symptoms of metabolic alkalosis

A

restlessness followed by lethargy
dysrhythmias (tachycardia)
compensatory hypoventilation
confusion ( decreased LOC, dizzy, irritable)
Nausea, vomiting, diarrhea
tremors, muscle cramps, tingling

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33
Q

treatment of metabolic alkalosis

A

Treat underlying cause
Stop K+ wasting diuretics
Spironolactone
Acetazolamide
IV fluids
Sodium chloride
Replace K+
Monitor Resp rate
Monitor HR
Seizure precautions

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34
Q

types of nasal fractures

A

simplex - unilateral , no displacement
complex - more damage to others facial structures

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35
Q

complications of nasal fractures

A

airway obstruction,
epistaxis,
meningeal tears causing CSF leakage

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36
Q

symptoms of nasal fracture

A

pain,
crepitus on palpation,
swelling,
ecchymosis,
deformity,
epistaxis,
difficulty breathing through the nose.

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37
Q

interventions for nasal fracture

A

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)

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38
Q

preop prep for nasal fracture

A

Stop aspirin or nsaids, blood thinners, 5 days or 2 weeks before

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39
Q

post op nursing care for nasal fracture

A

maintain airway, check respiratory status, control pain, no bleeding or infection
sleep in sitting position

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40
Q

causes of epistaxis

A

trauma, hypertension, low humidity, URI, allergies, sinusitis, foreign bodies, chemical irritants, nasal sprays

41
Q

treatment of anterior nose bleeds

A

Pledget
Packing
Silver nitrate ( cauterizes area)
Thermal cauterization

42
Q

treatment of posterior nose bleeds

A

Packing with merocel
Epistaxis balloons (rapid rhino)
Foley catheter.

43
Q

indications for tracheostomy

A

Establish a patent airway
Bypass an upper airway obstruction
Facilitate removal of secretions
Permit long term mechanical ventilation
Facilitate weaning from mechanical vent

44
Q

specific precautions for tracheostomy

A

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

45
Q

assessments prior to trash care

A

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

46
Q

trach care procedure

A

look at slide 61

47
Q

trach care documentation

A
  1. Date and time performed
  2. Note color, amount consistency and odor of secretions
  3. Note condition of stoma and skin around stoma site, any drainage, redness, or swelling
  4. Document respiratory status before and after
  5. Patient’s tolerance of procedure
  6. Note any problems that arose and interventions provided for those problems
48
Q

what size suction catheter should be used

A

size of catheter should be no more than 1/2 size of internal diameter of airway tube

49
Q

suctioning trach instructions

A
  1. Dominant hand sterile, non-dominant hand unsterile
  2. Sterile hand controls suction tube
  3. Place patient in semi-fowler position
  4. do not force catheter
  5. do not suction while inserting
  6. rotate catheter when withdrawing
  7. apply suction while removing catheter no more than 15 secs
  8. repeat as needed allowing 30 sec intervals
    hyperoxygenate before suction and in between passes
50
Q

suctioning trach documentation

A

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.

51
Q

community acquired pneumonia (CAP)

A

pt not in facility in 14 days, may or may not be hospitalized

52
Q

Hospital associated pneumonia types

A

nosocomial - 48 hrs after admission, not intubated pts, did not have lung issues before admission

Ventilator associated pneumonia - intubated, after 48 hrs of intubation

53
Q

aspiration pneumonia

A

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

54
Q

pneumonia symptoms

A

Chills
Dyspnea
Tachypnea
Pleuritic Chest pain
Altered mental status
Fatigue
SOB
Crackles (fine or coarse)
Wheezes
Increased tactile fremitus
cough
yellow/green sputum

55
Q

diagnosis of pneumonia

A

H&P
CXR
Thoracentesis
Sputum culture
ABGs

56
Q

pneumonia treatment

A

antibiotics
oxygen
analgesics
antipyretics
rest
cough syrup
mucolytics
bronchodilators
corticosteroids

57
Q

nursing interventions for pneumonia

A

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

58
Q

risk factors for TB

A

homeless, workers in prison, iv drug users, poor access to healthcare, immunosuppressed pts

59
Q

what is primary tb

A

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

60
Q

what is latent tb

A

bacteria is not active but person can show positive tb test, asymptomatic, cant transmit cuz no symptoms, can become active later

61
Q

what is reactivated tb

A

pts start showing symptoms 2 years after initial infection due to stress, immunosuppression, other illnesses

62
Q

is TB contagious

A

Not highly contagious unless in close proximity for prolonged period of time
Negative pressure room, airborne precautions

63
Q

Tb symptoms

A

Cough
Fatigue
Malaise
Anorexia
Weight loss
Fevers
Night sweats
Dyspnea
hemoptysis
dysuria
hematuria
bone/join pain

64
Q

Symptoms of TB meningitis

A

headache, vomiting, lymphadenopathy

65
Q

when do tb symptoms occur

A

can develop 2 week after infection

66
Q

tb diagnostics

A

Tuberculin Skin Test (Mantoux test)
PPD
Blood test
Chest x-ray
Bacteriologic studies

67
Q

Education for pts with TB

A

Side effects of common drugs: Isoniazid, rifampin, and pyrazinamide
Frequent lab work , risk of hepatitis , monitor LFTs every 2-4 wks
educate on vaccine

68
Q

what is a pneumothorax

A

Air or gas in the pleural cavity causing a partial or complete lung collapse

69
Q

types of pneumothorax

A

Spontaneous
Iatrogenic
Tension
Hemothorax
Chylothorax

70
Q

what is a chylothorax pneumothorax

A

lymphatic fluid in lung

71
Q

what is a spontaneous pneumothorax

A

rupture of small blebs

72
Q

risk factors for spontaneous pneumothorax

A

Lung disease
Smoking
Tall and thin
Male gender
Family hx
Previous occurence
occurs in young ppl cuz of asthma, copd, chf, pneumonia, cystic fibrosis

73
Q

what is an iatrogenic pneumothorax

A

laceration/puncture during medical procedure

74
Q

what is a tension pneuothorax

A

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

75
Q

symptoms of tension pneumothorax

A

Dyspnea, tachycardia, tracheal deviation, decreased or absent breath sounds, neck vein distention, cyanosis, profuse diaphoresis, tachypnea

76
Q

causes of tension pneumothorax

A

open chat wound, CPR, mechanical ventilation , clamped chest tube

77
Q

interventions for tension pneumothorax

A

Needle decompression followed by chest tube insertion with chest drainage system

78
Q

what is a hemothorax

A

accumulation of blood in pleural space

79
Q

what causes a hemothorax

A

Result of injury to chest wall, diaphragm, lungs, mediastinum
Requires stat insertion of chest tube to evacuate blood

80
Q

symptoms of fractured ribs

A

pain at site during inspiration and with cough

81
Q

interventions for fractured ribs

A

Ice
Rest
Pain meds
Deep breathing
incentive spirometer
Lie on injured side
prevent atelectasis and Pneumonia

82
Q

what is flail chest

A

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

83
Q

what is the priority with flail chest

A

stabilize gas exchange, can quickly become hypoxemia

84
Q

symptoms of flail chest

A

Chest wall pain, increased pulses, chest bruising

85
Q

what are chest tubes used for

A

Inserted to drain pleural space and reestablish negative pressure

86
Q

what is a large chest tube for

A

drain blood from pleural space

87
Q

what is a medium size chest tube used for

A

to remove fluid

88
Q

what is a small chest tube used for

A

for air leakage

89
Q

what is the position for chest tube insertion

A

Pt should have HOB elevated 30-60 degrees
Arm raised above head

90
Q

chest tube placement precedure and management

A

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

91
Q

risk factors for Pulmonary embolism

A

Immobility,
surgery,
DVT,
Cancer
obesity,
contraceptives,
hormones,
smoking,
HF,
pregnancy,
clotting disorders

92
Q

symptoms of pulmonary embolism

A

Dyspnea,
hypoxemia,
tachypnea,
cough,
chest pain,
hemoptysis,
crackles,
wheezing,
fever,
tachycardia,
syncope,
LOC,
hypotension,
impending doom

93
Q

diagnostics for PE

A

D-Dimer
Spiral CT
VQ scan

94
Q

what is atelectasis

A

collapsed airless alveoli

95
Q

what causes atelectasis

A

obstruction

96
Q

risk factors for atelectasis

A

sedentary lifestyle
post-op
frequent napper
smoker
pain

97
Q

nursing interventions

A

incentive spirometer
mobility
deep breathing and coughing
treat asap to prevent pneumonia

98
Q

atelectasis symptoms

A

absence of breath sounds
dullness of percussion of affected area

99
Q

contraindication for lung transplant

A

Hepatitis b/c, HIV, smoker, poor nutrition, cancer in last 2 years, psychological problems

Respiratory semester 3 (2 decks)

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