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Med-Surg I > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

tuberculosis

A

Reportable, communicable inflammatory destructive disease

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2
Q

extrapulmonary TB sites (6)

A

bones, spine, kidneys, reproductive organs, CNS, larynx

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3
Q

facts about mycobacterium tuberculosis

A

aerobic
acid fast
slow growing, sensitive to heat and UV
destroyed by sunlight, heat, and pasteurization
grows inside the body, not outside

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4
Q

risk factors of TB (gender, age, geographical)

A

alcoholism r/t malnutrition
elderly
homeless
overcrowded
men
children <15
young adults (15-44 with preexisting conditions)
africa, asia, latin america, europe, carribean

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5
Q

BCG vaccine

A

makes you test + on skin test
need to do chest x-rays or blood test to get accurate result

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6
Q

routes of TB

A

airborne (droplet)
inhalation of infected droplet nuclei from COUGHING, laughing, sneezing
large droplets settle, small ones are inhaled

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7
Q

treatment of TB

A

6-12 months
bed rest until no symptoms
isolation until - sputum

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8
Q

sensitization of TB

A

phagocytes bombard area with bacteria, lymphocytes start inflammatory response and destroy some lung tissue
2-10 weeks after primary infection

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9
Q

patho of TB

A

inhaled infected droplet deposited in lungs
inflammatory reaction at site
body attempts to phagocytize the wall-off the tubercule
ghon tubercle formed
granuloma in lung tissue

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10
Q

how can dormant TB become active again

A

mental and physical stress
immunosuppressive drugs
oncology agents
inadequate drug prescription

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11
Q

latent TB

A

lives and doesn’t grow
doesn’t make you feel sick
CAN’T spread

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12
Q

active TB

A

grows in the body
makes you feel sick
CAN spread

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13
Q

sputum culture for TB

A

identify tubercule bacilli
essential to confirm diagnosis
3 specimens on consecutive days

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14
Q

TB skin test

A

appearance of “wheal” if done properly
read result within 48-72 hours
10mm or more is +
5-9 is doubtful, repeat
for HIV, 5mm or more is +

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15
Q

what to do with TB converters

A

they are at risk for developing TB
give INH prevention

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16
Q

TB symptoms (8)

A

Fatigue
Malaise
Anorexia
Weight loss
Chronic productive cough
Night sweats
Advanced state hemoptysis=blood in sputum
Low grade fever in the late afternoon

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17
Q

primary resistance to TB

A

resistance to 1 or more TB agents with no previous treatment

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18
Q

secondary resistance to TB

A

resistant to 1+ TB agent, undergoing therapy

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19
Q

multidrug resistance to TB

A

resistant to 2+ agents (INH and rifampin)

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20
Q

what to give with INH (TB)

A

vitamin B6

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21
Q

anti TB drugs

A

INH, rifampin
pyrazinamide
ethambutol (myambutol)

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22
Q

foods to avoid with INH

A

Tuna
aged cheese
red wine
soy sauce
yeast extract bc it could have histamine (causes side effects [headaches, diaphoresis, etc] and decreased absorption)

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23
Q

nutrition for TB

A

high protein, calories, and Ca+
iron and vit B6

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24
Q

labs for TB

A

AST and ALT

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25
Q

purpose of alveoli

A

gas exchange
diffusion
separates alveolar from vascular membrane
damage permits exchange between lungs and blood

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26
Q

how much mucus production a day

A

3 oz

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27
Q

pleura

A

Lines lungs and thoracic cavity
Kept moist from fluids secreted between pleural surfaces, prevents friction and facilitates filling and emptying of lungs
Secretes pleural fluid–smooth motion of lungs within pleural cavity (air filled so it’s subject to 3rd spacing with pleural effusion)
Depends on mucus and surfactant

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28
Q

when does surfactant develop

A

34 weeks of gestation

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29
Q

what does surfactant do

A

facilitates inflation of alveoli
prevents the alveoli from collapsing (keeps them slightly open even when lungs are empty)

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30
Q

tidal volume (what is it, amount, and what effects it)

A

The amount of air inspired and expired in a normal breath
500 mL
May not vary

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31
Q

total lung capacity (what is it, amount, and what effects it)

A

the maximum amount the lungs can expand
TV+IRV+ERV+RV (5800 mL)
decreased with atelectasis and pneumonia
increased in COPD

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32
Q

vital capacity (what is it, amount, and what effects it)

A

the maximum amount of air exhaled after maximal inhalation
TV+IRV+ERV (4600 mL)
decrease in neuromuscular disease, generalized fatigue, atelectasis, pulmonary edema, COPD, and obesity

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33
Q

inspiratory reserve volume (what is it and amount)

A

the maximum amount of air inhaled after a normal inhalation
3000 mL

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34
Q

expiratory reserve volume (what is it, amount, and what effects it)

A

maximum amount of air that can be exhaled forcibly after normal exhalation
1100 mL
decreased with obesity, ascites, pregnancy

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35
Q

residual volume (what is it, amount, and what effects it)

A

volume of air remaining in lungs after maximum exhalation
1200 mL
may be increased with obstructive disease

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36
Q

inspiratory capacity (what is it, amount, and what effects it)

A

maximum amount of air inhaled after normal expiration
TV+IRV (3500 mL)
decrease in restrictive disease or obesity

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37
Q

functional residual capacity (what is it, amount, and what effects it)

A

amount of air remaining in lungs after normal expiration
ERV+RV (2300 mL)
may be increased in COPD
decreased in ARDS and obesity

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38
Q

what do accessory muscles do

A

get rid of trapped air and increase tidal volume

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39
Q

Why does pursed lip breathing work

A

increases exhalation time to reduce airway resistance and prevent airway collapse

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40
Q

How often to do diaphragmatic breathing

A

5x/hour for 1 minute with 2 min rest periods

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41
Q

controlled cough

A

breath normally for one cycle, end next cycle with cough

42
Q

lordosis

A

inward curvature of spine

43
Q

kyphosis

A

forward rounding of upper back

44
Q

peak lung function ages

A

20-25

45
Q

premature babies are at risk for what (no surfactant)

A

poor alveolar exchange

46
Q

older adults respiratory

A

less capillaries in alveolar walls
tissues of resp tract become more rigid
inefficient diaphragm and coughs
poor compliance
dilation of air sacs (emphysema)
low O2 from smaller airway
kyphosis, barrel chest, SOB, abd breathing, decreased gas exchange

47
Q

why is losing gravity in resp bad

A

prevents alveoli from expanding

48
Q

mucus with bacterial infection

A

purulent and green

49
Q

mucus from allergies

A

sticky and white

50
Q

hemoptysis

A

blood in sputum

51
Q

sputum collections

A

done in the morning
sterile container
RIGHT AWAY

52
Q

pleural pain (avoid what)

A

activity that will make you breathe hard

53
Q

ratio in barrel chest vs normal

A

barrel chest- 1:1
normal: 1:2

54
Q

fine crackles

A

mucus in small airways
heard in emphysema with distended alveoli
heard on inspiration
high pitched
alveoli heard near the end of inspiration

55
Q

coarse crackles

A

loud, bubbling
larger airways
may be heard in inspiration AND expiration
CHF, pneumonia, emphysema

56
Q

rhonchi

A

gurgles
Thick secretions
Loud, harsh, low pitched, like snoring
May be cleared with coughing
Large airways
Mostly expiration but also inspiration
Asthma, bronchiectasis, emphysema, chronic bronchitis

57
Q

wheezes

A

from swollen airways
asthma or partial obstruction
blocked by mucus or tumor
heard throughout the lung on inspiration or expiration
WITHOUT A STETHOSCOPE
abrupt cessation of wheezing is BAD!! It means complete obstruction

58
Q

pleural friction rub

A

inflamed pleura
harsh, cracking sounds like leather
inflammation or pleural effusion

59
Q

consolidation

A

solidification of lung tissue that causes poor ventilation in certain areas (gets filled with mucus and debris)

60
Q

Q scan

A

detects abnormal functioning of pulmonary blood vessels and blood flow (PE)

61
Q

V scan

A

detects abnormalities in ventilation such as emphysema

62
Q

bronchoscopy

A

tubes examine larynx, bronchi, and trachea
flexible
NPO for 4-6 hours

63
Q

what to give for throat irritation after endoscopy

A

warm gargle

64
Q

ABG time to put pressure

A

5 min for radial and brachial
10 for femoral

65
Q

compensation for decreased O2 in COPD

A

increased RBCs causing polycythemia

66
Q

how long before a pulmonary function test should pts not smoke or use bronchodilators

A

6 hrs

67
Q

what makes O2 sat ineffective

A

hypotension
sepsis
hypothermia
vasoconstriction (these reduce arterial blood flow)

68
Q

thoracentesis

A

fluid removed from pleural space and send for biopsy or just for therapeutic purposes
upright position and lean forward to increase intercostal space
do VS and place pt on unaffected side

69
Q

nasal cannula oxygen

A

1-3 Liters

70
Q

oxygen toxicity (6)

A

dyspnea
restlessness
substernal pain
fatigue
headache
coughing

71
Q

how much liquids to get rid of secretions

A

2-3 quarts

72
Q

guaifenesin

A

expectorant

73
Q

dextromethorphan

A

cough suppressant

74
Q

ineffective airway clearance treatment

A

warm, humid air

75
Q

diet for respiratory pts

A

high fat and protein
avoid foods that cause constipation

76
Q

what stimulates peristalsis

A

fluids and fruit juices

77
Q

who shouldn’t take flu vaccine

A

allergies to eggs or history of guillain-barre

78
Q

community acquired pneumonia (another name, when diagnosed, who is at risk and what seasons)

A

legionnaires disease
on admission or within 48 hours
smokers, elderly, substance abusers
summer and fall

79
Q

hospital acquires pneumonia

A

bacterial
nosocomial (from a hospital)
most lethal (pts already immunocompromised and abx resistant)

80
Q

aspiration pneumonia

A

from inhaling foreign matter
keep head of bed elevated during feeding
assess gag reflex

81
Q

Patho of pneumonia

A

bacteria gets into alveolar space, weakens the fragile membrane, capillary leak, bacteria spreads to lungs and blood stream. septicemia
RBC goes from blood vessels to damaged alveoli, causing lung infection and blood tinged sputum

82
Q

slow surfactant production leads to

A

decrease in compliance, atelectasis and consolidation

83
Q

symptoms of pneumonia

A

high fever (101-105) in bacterial
shaking chills
headache
productive cough (green, purulent, or rust colored sputum)
orthopnea
tachypnea/cardia
cyanosis of lips and nails
anorexia
N/V
anxiety
cerebral hypoxia
increased metabolic rate
pleural pain
malaise

84
Q

what happens when you give antitussives (bad)

A

retains secretions, causing atelectasis and hypoxia

85
Q

greenish yellow sputum

A

STREP

86
Q

yellow or blood tinged sputum

A

STAPH

87
Q

precautions for bronchoscopy

A

need consent
no jewelry, contacts, dentures, allergies
may cause lower airway spasms
gag reflex returns after 2 hours
pulse ox every 15 min

88
Q

how often to do incentive spirometry

A

10 breaths per hour
hold for 2-10 seconds

89
Q

how much fluids to drink to thin secretions

A

2 L

90
Q

pneumonia diet

A

high fat, calorie, protein
avoid gassy foods or hard candies
warm liquids increase peristalsis (good)
10 glasses of fluids a day

91
Q

empiemia

A

pus in blood

92
Q

how to prevent superinfection

A

lactobacillus tablets or yogurt (live cultures)

93
Q

strongest predisposing factor of asthma

A

allergies

94
Q

3 chronic airflow limitations and are they COPD

A

asthma (not COPD)
chronic bronchitis and emphysema (COPD)

95
Q

asthma risk factors

A

allergies (most common)
esophageal reflux
genetics
male
elderly
urban bad conditions
black, white, and hispanic

96
Q

4 chemical mediators in asthma and what they do

A

bradykinin, histamine (immediate), prostaglandins, and leukotrienes
causes inflammatory response
capillary leak in airway

97
Q

vasoactive amines

A

vasodilation
capillary leak
edema of airway
increased secretions

98
Q

what type of oxygen for asthma pts

A

nasal cannula (less suffocating feeling)

99
Q

clear and foamy sputum

A

allergies

100
Q

thick, white, stringy sputum

A

nonallergic asthma

101
Q

2 CBC results of asthma

A

elevated eosinophils
immunoglobin levels

Med-Surg I (6 decks)

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