Exam 1 - Respiratory Flashcards
narrowest portion of the upper airway
laryngeal
frequent location of airway obstruction
laryngeal
laryngeal obstruction is a ___-___ _____
life-threatening emergency
most common cause of laryngeal obstruction in adults
ingested meat
s/sx of laryngeal obstruction
subq emphysema/crepitus voice changes dysphagia pain with swallowing inspiratory stridor hemoptysis cough asphyxia anxiety/wide eyes abdominal contraction (late s/sx)
being deprived from O2
asphyxia
s/sx of asphyxia
coughing choking gagging obvious difficulty breathing AMU inspiratory stridor
when an individual is choking and stops breathing, what do you initiate?
CPR
how can the airway become obstructed with laryngeal trauma?
edema
fracture of laryngeal structures
hematoma
treatment goal with laryngeal injury
maintaining an open airway
laryngeal injury diagnostic test
CT
fiber optic laryngoscopy
flexible bronchoscopy
cerebral anoxia
when the brain does not get enough O2
hypoxemia
inadequate oxygenation
atelectasis
alveoli collapse
pulmonary edema
fluid in lungs or pleural space
hypoventilation
slow RR
how often to cough-turn-deep breathe
q2h
what is removed with a total laryngectomy?
larynx hyoid bone epiglottis cricoid cartilage several tracheal rings
can a pt speak with a laryngectomy tube is closed?
No
what to monitor for with trach/laryngectomy tubes
airway
breathing
infection control
surgically created stoma in the trachea to establish an airway
tracheostomy
3 resons for a tracheostomy
bypass airway obstruction
facilitate removal of secretions
permit long-term mechanical vent
preferred tracheostomy method
minimally invasive percutaneous tracheostomy
use of local sedation and analgesia
better option for long term mechanical ventilation
tracheostomy
when is a pt able to eat and/or speak with a tracheostomy
when the cuff is deflated
be familiar with the different parts of a trach
be familiar with the different parts of a trach - slide 21
how often are nondisposable inner cannula trachs cleaned?
q8h
trach suction time should be limited to how many seconds?
10 seconds
d/c trach suctioning if HR decreases __ bpm or increases by ___ bpm
decrease: 20 bpm
increase: 10 bpm
do you suction if pt is able to clear secretions on their own by coughing
No
how often to reoxygenate after trach suctioning?
30 seconds
5-6 breaths/vent
trach cuff should not exceed
20 mmHg or 25 cm H2O
how often to monitor cuff pressure?
q8h
if the trach becomes dislodged, what can be inserted?
obturator
suction catheter
if the trach tube can not be replaced, what should be done?
level of respiratory distress
place in semi-Fowler’s
cover stoma with a sterile dressing
ventilate with a bag-mask
3 C’s to trouble-shoot potential trach problems
cannula
cuff
call for help/code
if using an ambubag and the pt has a trach, what do you do with the stoma?
cover with a sterile gauze
spontaneous breathing can do what to the trach cuff?
deflate
how long to trach a cap before removal to ensure the pt can breathe on their own without complications
24 hours
how soon after trach removal does epithelial tissue form? how soon will the stoma close?
24-48 hours
4-5 days
___ TB is when TB is in other parts of the body
miliary
leading cause of death in HIV/AIDs
TB
highest risk for TB
homeless inner city neighborhoods IV injection users LTC facilities prisions working in a healthcare facility
TB occurs more frequently in these individuals
poor, under-serviced and minorities
how is TB spread?
person-person via airborne particles
requires close, frequent, or prolonged exposure
hallmark sign of TB
granuloma
long term granuloma can lead to ___ and/or ___
calcification; fibrosis
granuloma in latent TB
walled off
granuloma in active TB
liquify, pour contents into lungs
develops within the first 2 years of TB infection
active TB disease
TB disease occurring 2 or more years after the initial infection
reactivation TB (post-primary)
is reactivation TB considered dormant?
no
NCLEX TB trigger words
blood tinged sputum night sweats fever fatigue anorexia
with latent TB, will a pt be symptomatic?
asymptomatic with a (+) TB skin test
pleural effusion lung sounds
crackles
rales
the time from TB exposure to infection can take how long?
a couple of weeks
TB test is aka
Mantoux test
when to assess for TB induration
48-72 hours
(+) TB in any person
15 mm induration
(+) TB with chronic disease, recent immigration, IV drug users
10 mm induration
(+) TB in immunocompromise
5 mm induration
does a positive reaction mean active TB?
No
where is the Mantoux test performed?
forearm; 4” below the elbow
where are TB vaccines administered?
UK
Latin American
When is the QuantiFERON-TB and T.SPOT.TB test performed?
when an individual has been vaccinated against TB
how often are sputum samples obtained for TB testing?
3 consecutive days
how long can it take for TB sputum tests to result
6-8 weeks
what can be present in older individuals who have TB?
AMS
how long can TB treatment last?
6-12 weeks
when is a person considered MDRTB?
resistant to INH and Rifampid
initial TB treatment last how long and continues for…
8 weeks; 18 weeks - 1 year
Isoniazid labs
LFT
Isoniazid education
take 1 hour before meals or on an empty stomach
Rifampin education
will change bodily fluids orange
Ethambutol education
ocular-toxicity
color discrimination
what is directly observed therapy (DOT)?
requires watching a TB pt swallow their meds
how is latent TB treated?
Isoniazid for 6-9 months unless HIV +, take for 9 months
Isoniazid can lead to what deficiency?
vitamin b
TB isolation
airborne
negative pressure room
nutrition needed for TB
proteins vitamins calorie replacement adequate hydration remain active
most common cause of lung abscess
aspiration
PNA
where are lung abscesses typically found?
upper lobe
risk factors for lung abscess
aspiration
TB
substance abuse
immunocompromised
localized area of lung destruction or necrosis and pus formation
lung abscess
s/sx lung abscess
productive cough chills, fever pleurtic chest pain malaise anorexia temperature elevation purulent sputum (foul-smelling, bad tasting, dark brow or blood streaked)
what breath sound will be heard if a lung abscess is in the pleural cavity?
friction rub
CXR will show an area greater than __cm if there is a lung abscess
2cm
large dose of abx therapy will be taken for __ weeks and then PO for __ weeks for a lung abscess
IV: 3 weeks
PO: 12 weeks
what may be needed for prior to dental procedures for lung abscess
abx
pneumothorax
air in the pleural cavity
what kind of pressure space should the chest cavity be?
negative
what kind of pressure space is the chest cavity with pneumothorax?
positive
open vs. closed pneumothorax
O: external wound
C: no external wound
closed pneumothorax increases the risk for ___ ____
tension pneumothorax
what are the 5 types of pneumothorax?
traumatic - open traumatic - closed Iatrogenic tension hemothorax
cause of iatrogenic pneumothorax
puncture, laceration that occurs during a procedure/heath care associated
open pneumothorax will have what type of chest wound?
sunken
spontaneous pneumothorax occurs in which individuals?
tall, skinny, males
spontaneous pneumothorax risk factors
smoking
family hx
high-altitude flying
previous hx of spontaneous pneumothorax
s/sx of spontaneous pneumothorax
pleuritic chest pain SOB tachycardia tachypnea asymmetrical chest wall movement diminished, absent breath sounds hyperresonant tone unequal lung expansion
tension pneumothorax is a medical emergency that affects the ___ and ___ systems
respiratory; cardiovascular
s/sx of tension pneumothorax
dyspnea tachycardia **tracheal deviation** decreased, absent breath sounds neck vein distension cyanosis profuse diaphoresis
how to tx tension pneumothorax
needle decompression; chest tube insertion
what type of pneumothorax can lead to tension pneumothorax?
closed
cause of hemothorax
chest trauma
tumors (most common)
pulmonary infarction
infections (ex: TB)
hemothorax treatment
thoracentesis
thoracostomy with chest tube
how to proceed with a penetrating chest wound
cover with an occlusive dressing that is secured on 3 sides
when is a partial pleurectomy, stapling, or pleurodesis needed?
repeated spontaneous pneumothorax
proper chest tube placement is confirmed by ….
CXR
chest tube placement/location for pneumo and hemothorax
p: 2nd intercostal space
h: 5th intercostal space
when is a flutter/heimlich valve used
emergency transport
small-to-moderate pneumothorax
what are you looking when managing a chest tube
tidal
continuous bubbling
nothing
continuous bubbling with a chest tube system indicates…
air leak
nothing happening with a chest tube system indicates…
potential blockage
normal fluctuation of the water within the water-seal chamber
tidaling
chest tube systems are usually filled with how much water?
20 cm
removing too much fluid too quickly (1-1.5L) from a chest tube can potentially lead to which complications?
re-expansion pulmonary edema
vasovagal response with symptomatic hypotension
how to mark chest tube output
mark the line on the chamber
what to do when the chest tube is disconnected
submerge in 2cm sterile water
do not clamp
most common rib fractures occur with ribs __ - __
5-9
do you strap or bind the chest with a rib fracture?
No
rib fracture treatment
NSAIDs
opioids
nerve block
pt education: deep breathing, coughing, IS
when does flail chest occur?
fracture of several consecutive ribs, in 2 or more separate places
when will flail chest bulge out?
during expiration
the underlying lung of a flail chest may have what?
pulmonary contusion
aggravating hypoxemia
flail chest s/sx
rapid, shallow respirations
tachycardia
asymmetric, uncoordinated chest movement
paradoxic movement
occurs with flail chest
chest wall sinks in during inspiration, expands during expiration
first thing a nurse should do with respiratory distress
assess the pt!
pleural effusion
collection of fluid in the pleural space
is pleural effusion a symptom or diagnosis?
symptom
2 fluid types with pleural effusion
transudative
exudative
how much fluid should be in the pleural space?
5-15 mL
transudative pleural effusion color and indication
clear, pale yellow
increased hydrostatic pressure in HF
decreased oncotic pressure in liver, renal failure
exudative pleural effusion color and indication
protein-rich fluid
cancer
empyema is aka
pus
what is chylothorax?
when lymph is found in the chest cavity
s/sx of pleural effusion
dyspnea cough may have pain decreased, absent breath sounds limited chest wall movement dull percussion
**fever + chills if systemic
less than 1.5 L of fluid is removed during a thoracentesis to prevent what kind of response?
vasovagal response
pt positioning for a throancentesis
tripod
how should a pt be positioned after a throancentesis and for how long?
lying on the unaffected side x1 hour
pleuritis
inflammation of the pleura
s/sx of pleuritis
pain aggravated by deep breathing, coughing, movement rapid, shallow respirations limit chest wall movement diminished breath sounds pleural friction rub
pleuritis treatment
analgesics
NSAIDs
codeine: relieve pain, suppress cough
positioning, splinting chest while coughing
___ ___ can be a complication of pleuritis
pleural effusion
pleuritis s/sx to report to HCP
increased fever
productive cough
difficulty breathing
SOB
pleurodesis
creating of adhesions between parietal and visceral pleura
catheter inserted into pleural space, then a chemical is inserted
why would a pt have a pleurodesis performed?
prevent recurrent pneumothorax
chest tightness and pain associated with pleurodesis is __ __
short term
what f/u diagnostic test is performed to ensure pleurodesis is holding
CXR
mobile clot
embolis
clot
thrombus
blockage of one or more pulmonary arteries by a thrombus, fat or air embolus, or tumor
PE
PE risk factors
immobility sx within last 3 months hx of DVT oral contraceptives smokers prolonged travel hx of afib
most common presenting symptom of PE
dyspnea
s/sx of PE mimic s/sx of
R sided HF
can a d-dimer result be definitive of a PE or clot?
No
most common used test to Dx PE
spiral (helical) CT scan
aka CT angiography or CTA
if a pt can not have contract, which test is used to Dx PE
ventilation-perfusion (VQ) scan
what are the 2 components to a VQ scan?
perfusion: pulmonary circulation
ventilation: distribution of gas throughout the lung
PE drug of choice
heparin
PE prevention
early ambulation SCD elevate lower extremities active, passive ROM exercises prophylactic anticoags
is you suspect a PE, what positioning should a pt be in?
bedrest, semi-Fowler’s
pulmonary hypertension
elevated pulmonary artery pressure resulting from an increase in resistance to blood flow through pulmonary circulation
normal pulmonary wedge pressure
12-16
wedge pressure with pulmonary hypertension
> 25 at rest
> 30 with exercise
is there a cure for pulmonary hypertension
no, meds given to increase survival rate
may become a transplant canidate
causes of pulmonary hypertnesion
primary: idopathic
secondary: complication r/t respiratory, cardiac, autoimmune, hepatic or connective tissue disorder
pulmonary hypertension s/sx
SOB dyspnea on exertion chest pain on exertion fatigue dizzy snycope
*R sided HF s/sx as progresses
meds for pulmonary hypertension
Diuretics (PRN) O2 Digoxin anticoags possibly CCB
