Exam 1; Week 3 Flashcards
define ventilation
the process of moving gases into and out of the lungs,
- requires muscular and elastic properties of the lungs and thorax to be coordinated
define perfusion
the cardiovascular system must have the ability to pump oxygenated blood to the tissues and then return it to the lungs.
define diffusion
the movement of respiratory gases from one area to another by concentration gradients
Contraction of WHAT pumps blood to lungs via pulmonary arteries?
rt. ventricle
Oxygenated blood returns from lungs via WHAT to left arteries of heart?
pulmonary veins
What is the condition where normal exchange of oxygen and carbon is altered by a collapse in the alveoli?
atelectasis
Is atelectasis a disease or a condition that results from disease or abnormalities?
condition that results…
What are 5 causes of atelectasis?
- infection
- blockage of airways (mucus, tumor, or foreign body)
- compression
- scarring from radiation
- pneumothorax or immature lungs
What are 7 risk factors for atelectasis>
- advanced age
- immaturity
- smoking
- immobility
- CHF
- trauma
- obesity
- lung disease
What are 4 clinical manifestations of atelectasis?
- dyspnea
- diminished lung sounds
- rales
- decreased O2 sat
What are 4 treatment options for atelectasis?
- IS
- TCDB
- Adequate pain relief
- pulmonary hygiene
What is inflammation of the lung parenchyma (alveolar spaces) creating a build up of fluid and excitement in the alveoli; decreasing gas exchange:
pneumonia
What can cause pneumonia
- bacteria
- virus
- fungus
- gastric contents
- chemical
What are 5 types of pneumonia?
- community-acquired
- hospital acquired
- ventilator-associated
- aspiration
- opportunistic
What are 7 clinical manifestations of pneumonia?
- dry or productive cough
- colorful sputum
- fever
- pleuritic CP
- SOB
- increased heart rate
- adventitious lung sounds - rhonchi, crackles
What are ways to diagnose pneumonia?
- CXR
- CBC
- sputum culture
- gram stain
- blood cultures - obtain cultures prior to antibiotic admin
What are 5 treatment options for pneumonia?
- oxygen therapy as indicated
- antibiotics
- rest
- fluids
- antipyretics
- nutrition
What do you want to encourage with pneumonia?
adequate pulmonary toilet
What are ways to prevent pneumonia?
- good hand washing
- vaccinations
- avoid exposure and aspiration precautions
What is a blockage of one or more pulmonary arteries by fat or thrombus, amniotic fluid or tumor tissue.
Pulmonary embolism
Why are the lungs an ideal place for a PE?
due to its extensive vascular network.
What part of the lungs are most often affected by PE?
lower lobes
the majority of fatalities occur within how many hours after onset of a PE?
1-2 hours
What does a PE often present as?
code arrest
A thrombosis is triggered by what 3 things?
- venostasis
- hypercoagulability
- vessel wall inflammation
What is the patho of a PE?
Obstruction of pulmonary blood flow causes:
- Reflex broncho-constriction in the affected region
- Impaired gas exchange
- Loss of alveolar surfactant
- V/Q mismatch- ventilation without perfusion
- RVF, Pulmonary HTN, tricuspid regurgitation
- Compression of RCA
- Elevated BNP and troponins
- Necrosis of lung parenchyma
How is PE diagnosed?
- CT scan
- ventilation perfusion scen
- D-dimes appear within 1 hour after thrombus
- EKG may show tachycardia and RV involvement
How is PE treated?
- fibronolytics
- anticoags (heparin, lovenox, Coumadin)
- embolectomy
clinical manifestations of PE are dependent on what?
the size of the emboli
How does a small emboli feel?
- Pleuritic chest pain
- cough
- fever
- wheezing
- crackles
- dyspnea
- hemoptysis
- hypoxia
How does a massive emboli feel?
- change in mental status
- a sense of pending doom
- hypotension
- pallor
- sudden cardiac arrest
What is early thrombus prevention?
- early ambulation
2. SCDs
What is supportive therapy for PE?
- IV fluids
- med admin
- monitor lab values for safe admin of anticoagulant (PTT, PT, INR)
What is tuberculosis caused by?
mycobacterium tuberculosis; and is infectious
What type of precaution spreads tuberculosis?
airborne droplets
What does tuberculosis mostly affect? Where can it spread?
a. the lungs
b. can travel through lymph system and settle in the cerebral cortex, spine, bone, liver, kidneys, lymph nodes and adrenal glands
Who is most at risk for TB:
- homeless
- inner city neighborhoods
- those living or working in institutions - prisons, long term care, psychiatric facilities
- immunosuppressed
- foreign-born
- Poor and IV drug users
What is a Latent TB infection?
TB germs are in the body, but not enough to cause sickness or spread germs to others
What are other illnesses that are put in airborne precautions?
- measles
- varicella - chicken pox
- Severe acute respiratory. syndrome (SARS).
What are signs and symptoms of TB?
- A bad cough that lasts longer than three weeks.
- Chest Pain
- Coughing up blood or
- tenacious sputum
- Fatigue or weakness
- Weight loss / no appetite
- Chills and Fever
- Night sweats
- Lungs may sound normal or have crackles or other adventitious sounds
How long is treatment for TB?
6 to 9 months
What are the 4 most common meds to treat TB?
- Isoniazid
- Rifampin
- Ethambutol
- Pyrazinamide
What are the 3 things that make up COPD?
- Emphysema
- Bronchitis
- Asthma
What is a preventable disease with persistent airflow limitation that is usually progressive?
COPD
What are the primary sources of illness in COPD patients?
- cigarette smoking
- recurrent rasp infections
- alpha-1 antitrypsin deficiency or exposure to other noxious particles
What is the 3rd leading cause of death in the U.S.?
COPD
What are clinical manifestations of COPD?
- Cough
- sputum production
- progressive dyspnea first with exertion then later with rest
- use of accessory muscles,
- barrel chest
- fatigue
- polycythemia
- CO2 retention.
People with COPD generally have a history of what 4 things?
- smoking
- chem exposure
- GERD
- Infection
What are lab tests used for COPD?
- strep pneumonia
2. Haemophilus influenzae
What is there an increase in with COPD patients?
increase in residual volume because of air trapping
What are the 4 parts of pulmonary rehabilitation for COPD?
- exercise program
- disease management training
- nutrition counseling
- psychological counseling
Important nursing education for COPD:
- What is COPD?
- Breathing and Airway Clearance 3. Exercises
- Energy conservation Techniques
- Medications (including correct use of inhalers, spacers or nebulizers).
- Home Oxygen
- Psychosocial/Emotional Support
- COPD management Plan
- Healthy Nutrition
What is a persistent but variable inflammation of the airways
asthma
What is the inflammation result in-in asthma?
results in edema of the airways, bronchoconstriction, and airway hyperactivity
What are 2 treatment options for asthma?
- bronchodilators
- anti-inflammatory meds
- O2 admin and monitoring
- IV fluid admin
- pt. education regarding drug therapy and med adherence. Also teach pt. to identify triggers and eliminate them if possible
What are symptoms of asthma?
- Wheezing
- diminished lung sounds
- paroxysmal coughing
- chest tightness
- dyspnea
- tachycardia
- tachypnea
What are diagnostics for asthma?
- H & P
- PFTS
- peak flow meter
- eosinophil count
- IgE levels (allergic propensity)
- allergy skin testing
define enteral nutrition/tube feeding
nutrition delivered in the GI tract through a surgically placed tube in the stomach.
What are 3 reasons why a child might use a GI tube?
- child has functioning GI tract but cannot take any or enough oral nourishment OR it is unsafe to do so.
- When passage of a tube through the mouth, pharynx, esophagus or cardiac sphincter of the stomach is contraindicated.
- To avoid the constant irritation of NG tube in children who require tube feeding over an extended period of time.
Who gets G-tubes?
- neurologic impairment
- prematurity with poor suck/swallow
- GI anomalies
- craniofacial anomalies
- cystic fibrosis
- genetic disorders
- metabolic disorders
- malignancy
- inflammatory bowel disease
- burns/trauma
How is a G-tube placed? with what?
under general anesthesia
What does PEG stand for?
percutaneous endoscopic gastrostomy
What is the state of patient when they are getting a PEG?
Pt. sedated and local anesthesia for placement with an endoscope
What is a gastrostomy feeding button?
MIC
What is a MIC
a flexible silicone device
When is a MIC used?
in children who require long term enteral feedings
What is nice about a MIC?
allows extension tubing to be put on and taken off, easy to care for, cosmetically pleasing, extension tubing has med port and washable with soap and water.
What kind of device bypasses the stomach?
GJ-tube (gastric jejunum)
Why would someone use a GJ-tube?
- recurrent aspiration
- pneumonia
- severe gastroesophageal reflux
- gastric outlet obstruction
- poor gastric emptying
What are 4 sources of nutrition for someone who has a G-tube?
- breast milk
- formula
- H2O
- special ordered formula
What are 2 methods of feeding with a G-tube?
- Bolus - by gravity in a syringe
2. intermittent or continuous - feeding pump
How do you want to take care of a site where there is a G tube?
- keep clean and dry
- use soap and water
- avoid dressings
- avoid ointments unless prescribed
- prevent pulling on tube
What can pulling on a tube do?
granulation tissue may develop around site
A child with a G-tube can bathe, swim, or lay on abdomen how many weeks after placement?
1 week
What are 4 complications that can come with a G-tube?
- feeding intolerance - nausea and diarrhea
- tube placement, breakage, occlusion, or migration
- excessive granular tissue from pulling
- site infection
What are some things to remember when administering a med through a G-tube?
- use correct port
- do not add med to the formula in the feeding bag
- give each med separately, using a syringe
- always flush with water before, during, and after
- use liquid form of med whenever possible; dilute med if needed
- Crush immediate release tablets and mix with water
- do not crush extended release, enteric coated or capsules
- always follow facility protocol and consult pharmacy as needed
Define gavage feeding:
feeding by gravity
Why would a child use gavage feeding tube?
- If they are unable to feed orally
- unable to coordinate suck, swallow, and breathing
- too weak to suck effectively
- lack of a gag reflex
Why are feeding tubes utilized?
to instill the feeding for infants as well as other children
Where are feeding tubes placed?
- nose
2. mouth
When inserting a feeding tube, what point is the second marker?
between diploid and umbilicus
How can you check the placement of a feeding tube? (hint: 3 ways)
- auscultate small amount of air given through the tube using a syringe.
- Listen to air pop with stethoscope - x-ray
- aspirate stomach contents
When administering NG/OG feedings, what do you need to remember to check?
placement
Gavage feeding is by what?
gravity/bolus
Intermittent feeding is by what?
syringe of kangaroo pump
