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NRSG 110: Med Surg 2 > [Exam 2] Chapter 23: Management of Patients with Chest and Lower Respiratory Tract Disorders (Page 583-605, 608-609) > Flashcards

[Exam 2] Chapter 23: Management of Patients with Chest and Lower Respiratory Tract Disorders (Page 583-605, 608-609) Flashcards

1
Q

Atelectasis: This refers to

A

closure or collapse of alveoli and often escribed in relation to chest x-ray findings

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2
Q

Atelectasis: Caused by

A

hypoventilation, obstruction of airways, or compression

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3
Q

Atelectasis: Who is at highest risk?

A

Postoperative patients

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4
Q

Atelectasis: Happens to hospitalizezd patiens due to

A

decreased lung expansion, decreased movement of secretions and shallow breathing

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5
Q

Atelectasis: Symptoms include

A

Insidious, Cough, Sputum Production, Low-Grade Fever, Diminished breaht sounds

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6
Q

Atelectasis: What can occur if large areas of lung affected?

A

Respiratory distress, anxiety, hypoxia

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7
Q

Atelectasis: Acute atelectasis occurs most often in

A

the postoperative setting or in people who are immoblized or have shallow breathing pattern

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8
Q

Atelectasis: Chronic airway obstruction seen in those that have what issue?

A

Blockage that impedes the flow of air to an an area of the lung

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9
Q

Atelectasis - Patho: May occur in adults as a result of

A

reduced ventilation or any blockage of air to and from the alveoli

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10
Q

Atelectasis - Patho: Obstructive Atelectasis results from

A

reabsorption of gas where no additional air can enter the alveoli

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11
Q

Atelectasis - Patho: Low tidal breathing volume may cause

A

airway closure and alveolar collapse

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12
Q

Atelectasis - Clinical Manifestations: In acute atelectasis involving large amount of lung tissue, what may be observed?

A

Marked respiratory distress. This may include cyanosis and tachycardia

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13
Q

Atelectasis - Assessment and Diagnostic Findings: When clinically significant atelectasis develops, it is characterized by

A

increased work of breathing and hypoxemia . and decreased breath sounds and crackles heard over area

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14
Q

Atelectasis - Prevention: This includes

A

frequent turning, early mobilization, and strategies to expand the lungs and manage secretions

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15
Q

Atelectasis - Prevention: What tests / procedures be done to prevent this?

A

Incentive Spirometer

Chest Physiotherapy

Oxygen Therapy with Mechanical Ventilation

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16
Q

Atelectasis - Prevention: Why would a bronchoscopy be done?

A

To remove obstruction and to open airway

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17
Q

Atelectasis - Prevention: Why would a thoracentesis be done?

A

To relieve compression but removing the fluid by needle aspiration

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18
Q

Acute Tracheobronchitis: What is this?

A

Acute inflammation of the mucous membranes of the trachea and bronchial tree and often followes infection of upper respiratory tract

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19
Q

Acute Tracheobronchitis - Patho: Inflames mucosa o fthe bronchi produces

A

mucopurulent sputum.

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20
Q

Acute Tracheobronchitis - Clinical Manifestations: Initially patient has what?

A

Dry, irritating cough and expectoraes a scanty amount of mucoid sputum

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21
Q

Acute Tracheobronchitis - Clinical Manifestations: Patient may report what symptoms?

A

Sternal soreness from coughing and have fever / chills

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22
Q

Acute Tracheobronchitis - Clinical Manifestations: As infection progresses, patient may have

A

short of breath, noisy inspiration / expiration adn produce purulent sputum

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23
Q

Pneumonia: What is this?

A

Inflammation fo the lung parenchyma cause by various microorganisms.

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24
Q

Pneumonia: Pneumonitis is a more general term that describes

A

an inflammatory process in the lung itsue that may predispose or place patient at risk

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25
Q

Pneumonia: Classified into what four types?

A

Community Acquired (CAP)

Health-Care Associated (HCAP)

Hospital-Acquired (HAP)

Ventilator Associated (VAP)

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26
Q

Pneumonia - Community-Acquired Pneumonia: What is this?

A

Pneumonia occuring in the community or less than 48 hours after hopsital admission

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27
Q

Pneumonia: What is Health Care-Associated Pneumonia (HCAP)

A

Pneumonia occuring in a nonhospitalized patient with extensive health care contact

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28
Q

Pneumonia: What is Hospital-Acquired Pneumonia (HAP)?

A

Pneumonia occuring > 48 hours after hospital admission that did not appear to be incutating at time of admisssion

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29
Q

Pneumonia: What is Ventilator associated pneumonia?

A

Develops >48 hours after endotracheal tube intubation

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30
Q

Pneumonia - Community- Acquired Pneumonia: What is S. Pneumoniae?

A

Most common cause of CAP in people 60 years or younger

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31
Q

Pneumonia - Community- Acquired Pneumonia: Who does H. Influenzae affect?

A

Older adults and those with comorbid illnesses

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32
Q

Pneumonia - Community- Acquired Pneumonia: How is Mycoplasma pneumonia spread?

A

Infected respiratory droplets through person to person contact

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33
Q

Pneumonia - Aspiration Pneumonia: What is this?

A

Refers to pulmonary consequences resulting from entry of endogenous or exogenous substances into the lower airway

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34
Q

Pneumonia - Aspiration Pneumonia: Most common form is

A

bacterial infection from aspiration of bacteria that normally reside in upper airways

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35
Q

Pneumonia - Patho: Inflammation of what?

A

Parenchyma (bronchioles and aveoli)

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36
Q

Pneumonia - Patho: Inflammatory response results in

A

alveolar edema

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37
Q

Pneumonia - Patho: Serous exudate, blood cells, fibrin, and baceria fill the alveoli and respiratory bronchioles interfering with

A

gas exchange

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38
Q

Pneumonia - Patho: Resolves when

A

macrophages can dominate and remove exudate (empyema)

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39
Q

Pneumonia - Patho: Usually viral but bacterial can result as complication of

A

viral pneumonia

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40
Q

Pneumonia - RF: This occurs in patients that already have disorders such as

A

HF, Diabetes, Alcoholism

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41
Q

Pneumonia - Clinical Manifestations: Patient with Streptococcal pneumnia usually has sudden onset of

A

chills, rapidly rising fever and chest pain

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42
Q

Pneumonia - Clinical Manifestations: Symptoms of upper respiratory tract infection include

A

headache, low-grade fever, rash

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43
Q

Pneumonia - Clinical Manifestations: Purulent sputum or slight changes in respiratory symptoms may be the only sign of pneumonia in patients with

A

COPD

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44
Q

Pneumonia - Assessment and Diagnostic Findings: Diagnosis is made by what tests?

A

Physical Exam

Chest X-ray

Blood Culture

Sputum Exam

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45
Q

Pneumonia - Assessment and Diagnostic Findings: Sputum sample obtained how?

A
  1. Rinse mouth with water
  2. Breathe deeply
  3. COugh Deeply
  4. Expectorate raised sputu in container
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46
Q

Pneumonia - Assessment and Diagnostic Findings: Bronchoscopy is used in patients with

A

acute severe infection, those with chronic infection and in immunocompromised patients

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47
Q

Pneumonia - Prevention: What cn reduce the incidience of pneumonia and deaths in older adult populations?

A

Pneumoccal vaccinvation

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48
Q

Pneumonia - Prevention: What Pneumoccocal vaccines are recommended?

A

PCV13 and PPSV23

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49
Q

Pneumonia - Prevention: PCV13 protects against

A

13 types of pneumococcal bacteria

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50
Q

Pneumonia - Prevention: PCV13 recommended for who?

A

Adults 65 years or older or those 19 or older that are immunocompromised.

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51
Q

Pneumonia - Prevention: What is PPSV23?

A

Newer vaccine and protects against 23 bacteria.

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52
Q

Pneumonia - Prevention: Who is PPSV23 recommended for?

A

Adults 65 or older and those 19-64 that smoke or have asthma

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53
Q

Pneumonia - Medical Management. Pharmacologic Therapy: Inpatients should be switched from IV to oral therapt when they are

A

hemodynamically stable, improve clinically, and can take meds/fluids by mouth

54
Q

Pneumonia - Medical Management. Pharmacologic Therapy: What is clinical stability of Pneumonia range for temp, HR, RR, and BP

A

LEss than 100 degrees

HR < 100 bpm

RR < 24 bpm

Systolic BP > 90

55
Q

Pneumonia - Medical Management. Pharmacologic Therapy: How is suspected HAP treated?

A

With broad-sprectrum IV antiboitic

56
Q

Pneumonia - Medical Management. Pharmacologic Therapy: CDC recommends all acute care hospitals participate in an antibiotic stewardship program. This means that

A

There is a set of coordinated strategies to improve the use of antimicrobial medications with the goal of enhancing patient health outcomes

57
Q

Pneumonia - Medical Management, Therapeutic Regimens: Antibiotics are ineffective in

A

viral upper respiratory tract infections and pneumonia and may be associated with adverse side effects

58
Q

Pneumonia - Medical Management, Therapeutic Regimens: When should antibiotics be used?

A

Viral respiratory infection only if a secondary bacterial pneumonia is present

59
Q

Pneumonia - Medical Management, Therapeutic Regimens: Treatment of viral pneumonia includes?

A

Hydrating, because fever and tachypnea may result in insensible fluid losses

60
Q

Pneumonia - Medical Management, Therapeutic Regimens: Antipyretics may be used to treat

A

headache and fever

61
Q

Pneumonia - Medical Management, Therapeutic Regimens: Antitussive medictions may be used for

A

the associated cough

62
Q

Pneumonia - Medical Management, Therapeutic Regimens: What helps relieve bronchial irritation?

A

Warm, moist inhalations

63
Q

Pneumonia - Medical Management, Therapeutic Regimens: Antihistamines may provide benefits with

A

reduced sneezing and rhinorrhea

64
Q

Pneumonia - Medical Management, Therapeutic Regimens: Nasal decongestants may be used to treat

A

symptoms and improve sleep

65
Q

Pneumonia - Medical Management, Therapeutic Regimens: Bed rest is assigned until

A

infection shows signs of clearing

66
Q

Pneumonia - Gerenologic Considerations: What may signal onset of pneumonia?

A

General deterioration, weaknesss, and abdominal symptoms

67
Q

Pneumonia - Complications, Pleural Effusion: What is this?

A

Accumulation of pleural fluid in the pleural space (space between the parietal and visceral pleurae of the lung)

68
Q

Pneumonia - Complications, Pleural Effusion: What procedure performed after pleural effusion detected on chest x-ry?

A

Thoracentesis may be performed to remove flui

69
Q

Pneumonia, Nursing Process - Assessment: What would alert the nurse of bacterial pneumonia?

A

Fever, chills, or night sweats.

70
Q

Pneumonia, Nursing Process - Assessment: What does the nurse assess for?

A

VS, Pulse Ox, ABG

Secretions, Color and Thickness

71
Q

Pneumonia, Nursing Process - Planning and Goals: Goals include

A

Improved airway patency

Increased activity

Maintenance of Nutrition

72
Q

Pneumonia, Nursing Process - Improving Airway Patency: TO improve airway patency, nurse encougages the patient to perform…

A

an effective directed cough, which includes correct positioning

73
Q

Pneumonia, Nursing Process - Improving Airway Patency: When would chest physiotherapy be used?

A

With sputum retention that is not responsive to spontneous or directed cough

74
Q

Pneumonia, Nursing Process - Improving Airway Patency: Why would oxygen and humidication be provided?

A

Oxygen for hypoxia and humidifcations to loosen secretions

75
Q

Pneumonia, Nursing Process - Promoting Fluid Intake: Increased respiratory rate leds to an increase in

A

insensible fluid loss during exhalation adn can lead to dehydration

76
Q

Aspiration: What is this?

A

Inhalation of foreign material into the lungs

77
Q

Aspiration: What problems can this cause?

A

Pneumonia and result in tachycardia dyspnea and cyanosys

78
Q

Aspiration - Patho: Aspiration Pneumonia develops after

A

inhalation of colonized oral or pharyngeal material

79
Q

Aspiration - Patho: What is the patho here, how does the body rspond to aspiration?

A

Triggers an acute inflammatory response to bacteria and bacterial products

80
Q

Aspiration - Prevention: Aspiration may occur if the patient cannot adequately coordinate

A

protective glottic, laryngeal, and cough reflexes

81
Q

Aspiration - RF: What are some riskk factors?

A

CVA (Stroke)

Tubefeedings

82
Q

Aspiration - Nursing Interventions?

A

Keep HOB >30 degrees

Avoid stimulation of gas reflex with suctioning

Check for tube placement

Provide thickened fluids for swallowing problems

83
Q

Pulmonary Tuberculosis: What is TB?

A

Infectious disease that primarily affeect shte lung parenchyma

84
Q

Pulmonary Tuberculosis: How does TB spread?

A

Airbone transmission. Infect person releases droplet nuclei through talking, coughing, sneezing, laughing, or singing

85
Q

Pulmonary Tuberculosis - Patho: Begins when?

A

When person inhales mycobacteria and becomes infected

86
Q

Pulmonary Tuberculosis - Patho: The bacteria are transmitted where in the body?

A

through the airways to the alveoli, where they are deposited and begin to multiple

87
Q

Pulmonary Tuberculosis - Patho: Bodys immune system responds by initiating

A

an inflammatory reaction

88
Q

Pulmonary Tuberculosis - Patho: Immune systme surrounds the bacilli with

A

neutrophiles and macrophages. Unable to destroy it but prevent its spread

89
Q

Pulmonary Tuberculosis - Patho: If the immune system is weakened, the lesions can be..

A

activated into active disease

90
Q

Pulmonary Tuberculosis - Patho: Where can TB travel in the body?

A

Travel throughout the lymph system and affect other organs

91
Q

Pulmonary Tuberculosis - Patho: What are granulomas?

A

New tissue masses of live and dead bacilli that are surrounded by macropahes. These are called Ghon Tubercle

92
Q

Pulmonary Tuberculosis - Patho: What happens if Ghon Tubercle ulcerates?

A

Releaes cheesy material into the bronchi and bacteria becomes airborne

93
Q

Pulmonary Tuberculosis - Clinical Manifestations: Most patients have what signs and symptoms?

A

Low-grade fever, couhg, night sweats, and fatiguee

94
Q

Pulmonary Tuberculosis - Assessment and Diagnostic Findings: Skin test is performed to test for what bacteria?

A

Acid-Fast Bacilli

95
Q

Pulmonary Tuberculosis - Assessment and Diagnostic Findings: If the patient is infected with TB, chest x-ray usually reveals what?

A

Lesions in the upper lobes

96
Q

Pulmonary Tuberculosis - Assessment and Diagnostic Findings, TB skin test: How does this work?

A

Works by injecteing protein derivative of TB under skin and body responds bby sending macrophages.

97
Q

Pulmonary Tuberculosis - Assessment and Diagnostic Findings, TB skin test: Test is read how long after administration?

A

48-72 hours after injection

98
Q

Pulmonary Tuberculosis - Assessment and Diagnostic Findings, TB skin test: Reaction occurs when both what are present?

A

Induration and erythema (redness)

99
Q

Pulmonary Tuberculosis - Assessment and Diagnostic Findings, TB skin test: What does a reaction of 0-4 mm mean?

A

Not significant

100
Q

Pulmonary Tuberculosis - Assessment and Diagnostic Findings, TB skin test: What does a size of 5 mm or greater mean?

A

May be significant in people who are considered to be at risk.

101
Q

Pulmonary Tuberculosis - Assessment and Diagnostic Findings, TB skin test: Size of 10 mm or greater significant in those who are

A

normal or have a mildly impaired immunity

102
Q

Pulmonary Tuberculosis - Assessment and Diagnostic Findings, TB skin test: A significant positive reaction means that all significaant reactors are…

A

candiates for active TB

103
Q

Pulmonary Tuberculosis - Assessment and Diagnostic Findings, TB skin test: In general , the more intense the reaction,

A

the greater the likelihood of an active infection

104
Q

Pulmonary Tuberculosis - Assessment and Diagnostic Findings, TB skin test: A nonsignifcant (negative) skin test means that

A

the persons immune system did not react to the test and that latent TB infection is not likely

105
Q

Pulmonary Tuberculosis - Assessment and Diagnostic Findings, QuantiFeron TB Gold : These tests are preferred for individuals who

A

have received the BCG vaccien and for patients who are not likely to return for 2nd test

106
Q

Pulmonary Tuberculosis - Assessment and Diagnostic Findings, QuantiFeron TB Gold : Positive IGRA signifies

A

that patient has been infected with TB bacteria .

107
Q

Pulmonary Tuberculosis - Assessment and Diagnostic Findings, Sputum Culture: What must be present to indicate disease?

A

AFB on sputum smear may indicate but does not confirm the diagnosis of TB

108
Q

Pulmonary Tuberculosis - Medical Management: Pulmonary TB treated primarily with

A

anti-TB for 6-12 months

109
Q

Pulmonary Tuberculosis - Medical Management: Population at greatest risk for multidrug resistance are those who are

A

HIB positive, institutionalized, or homeless

110
Q

Pulmonary Tuberculosis - Medical Management: Multidrug treatment is guided by

A

sputum speciemn culture and sensitivity testing

111
Q

Pulmonary Tuberculosis - Medical Management: REcommended treatment guidelines for newlt diagnosed cases of pulmonary TB have two phases which are

A

initial treatment phase and continuation phase

112
Q

Pulmonary Tuberculosis - Medical Management: Initial treatment duration?

A

8 weeks

113
Q

Pulmonary Tuberculosis - Medical Management: COntinuous regamin lasts for how long?

A

Additional 4-7 months

114
Q

Pulmonary Tuberculosis - Medical Management: YOu shoudl teach to cover

A

mouth and dispose of tissues (it is not transmitted on inanimate objects

115
Q

Pulmonary Tuberculosis - Medical Management: What does single-drug therapy compose of?

A

Used to prevent TB in exposed pt.

Uses Isoniazid (INH) for 6-12 months

116
Q

Pulmonary Tuberculosis - Medical Management: Multidrug therapy used for active TB. This includes what meds and for how long?

A

INF, Rifampin, Pyrazinamide and Ethambutol for 2 months

INH and Rifampin weekly for 4 months

117
Q

Pulmonary Tuberculosis - Medical Management: Since drugs have risk for hepatoxicity, what is required?

A

Close monitiring and alcohol should be avoided

118
Q

Pulmonary Tuberculosis - Medical Management: Complaince to medicaitons is measured with

A

sputum cultures showing improvement

Urine with appropriate levels of metabolite of INH and color change of rifampin

119
Q

Histoplasmosis: What are these?

A

Spores present in the air that everyone breathes

120
Q

Histoplasmosis: Normal respiratory and immune defenses prevent

A

infection in most people

121
Q

Histoplasmosis: Manifestions and course disease resemble

A

TB and develop slow, mild symptoms and can disseminate to other organs

122
Q

Histoplasmosis: Risk for

A

inadequate immune system

123
Q

Histoplasmosis: Diagnosis includes

A

microscopic examiniation of sputum speciemn

124
Q

Histoplasmosis: Interventions include

A

Oral Antifungal agents

IV AMphotercin B

Lobectomy

Maintain good health

Protein diet

IV ANtibitoic therapy for 3-5 days followed by antibiotics for 4-12 weeks

125
Q

Empyema: What is this?

A

Accumulation of thick, purulent fluid within the pleural space often with fibrin development and walled-off area where isolation is located

126
Q

Empyema, Patho: Occur often as compliactions of

A

bacterial pneumonia or lung abscess

127
Q

Empyema, Patho: Result from penetrating

A

chest trauma, and hematogenous infection

128
Q

Empyema, Patho: At first the pleural fluid is thin with low leukocyte count is frequently progresses to a

A

fibropurulent stage and finally a stage where it encloses the lung within a thick exudative membrane

129
Q

Empyema, Clinical Manifestations: HAs signs and symptoms similar to those of an

A

acute respiratory infection or pneumonia (fever, night sweats)

130
Q

Empyema, Assessment and Diagnostic Findings: Chest Auscultation demonstrates

A

decreased or absent breath sounds over affected area, and there is dullness on chest percussion.

131
Q

Empyema, Medical Management: Objective of treatment is to

A

drain the pleural cavity and achieve complete expansion of the lung

132
Q

Empyema, Medical Management: With long standing inflammation, an exudate can form over the lung, doing what?

A

Trapping it and interfering with its normal expansion.

NRSG 110: Med Surg 2 (29 decks)

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