Exam 2 - Respiratory Flashcards
An upper airway infection that blocks breathing and has a distinctive barking cough?
Croup
What age range is affected by croup?
3 months to 8 years
what kind of infection is croup?
VIRAL
symptoms of croup?
*Slow progression
*attacks at night
*INSPIRATORY stridor
*hoarsness
*Risk for narrowing airway
*Mild elevation of temp
Nonpharma intervention for croup?
humidity
Inflammation of epiglottis?
Epiglottitis
What kind of infection is epiglottitis?
Bacterial
What should you NEVER do when taking care of a client who has epiglottitis/Croup? Why?
Never put anything in the mouth. Laryngeal spasms can occur.
S+S of epiglottitis?
ADD AIR NURSE
*Abnormal positioning
*Dysphagia/Drolling
*Dysphonia
*Apprehension
*Increased temp
*Rapid onset
*Nasal flaring
*Using accessory muscles
*Retractions (chest)
*Stridor (inspiratory/no supine)
*Enlarged epiglottis
Age range affected by epiglottitis
2 years to 8 years old
Treatment for Croup?
*Beta agonists (albuterol)
*Beta-adregenic (Epi through face mask)
*Corticosteroids (not for acute attack)
*Croup Tent w/pulse ox
Treatment for Epiglottitis?
*Beta agonists (albuterol)
*Beta-adregenic (Epi through face mask)
*Corticosteroids (not for acute attack)
*Antibiotics
what must be kept bedside for clients with epiglottitis?
Endotracheal tube and trach kit
How might a child with epiglotitis be positioned?
Tripod position - sitting up and leaning forward with tongue out
What is a preventative measure for epiglottitis?
Hib Vaccine
What are some possible causes of lung cancer?
*Inhailed carcinogens - cigg smoke, asbestos
*COPD
Most lung cancers arise as a result of failure of cellular regulation in__________.
Bronchial epithelium
Lung cancers are collectively called?
Bronchogenic carcinomas
Two classifications for lung cancer?
*Small cell lung cancer (SCLC) (oat cell) (poor prognosis)
*Non-Small cell lung cancer (NSCLC) (Most common)
How dose metastasis of lung cancer occur?
Direct extension through blood and lymph nodes
Common sites for metastatic growth from lung cancer?
*Liver
*Brain
*Bones
*Lymph nodes
*Adrenal glands
What is lung cancer staging based on?
TNM system
Grade for a primary tumor that cannot be assessed?
Tx
Grade for no evidence of primary tumor?
T0
Grade for carcinoma in situ?
Tis
Grade for Increasing size and/or local extent of primary tumor.
T1, T2, T3, T4
Grade for regional lymph node with no regional lymph node metastasis.
N0
Grade for regional lymph node with increasing involvement of regional lymphnodes?
N1, N2,N3
Grade for regional lymph nodes that cannot be assessed?
Nx
Grade for Presence of distant Metastasis cannot be addressed?
Mx
Grade for no distant metastasis?
M0
Grade for Distant Metastasis?
M1
Stage of LC where cancer is only in lungs and has not spread to any lymph nodes?
Stage 1
Stage of LC where cancer is in lungs and nearby lymph nodes?
Stage ll
Stage of LC where cancer is found in lung and in lymph nodes in the middle of the chest? (Locally advanced disease)
Stage lll
A subtype of stage__ used If cancer has spread to only lymphnodes on same side of chest where cancer started
Stage lllA
a subtype of stage__ used if cancer has spread to lymphnodes on opposite side of chest or above collar bone
Stage lllB
Stage of LC where cancer has spread to both lungs, fluid around lungs, or another part of body
Stage IV
What are the types of NSCLC? Prognosis?
*Squamous cell
*Adenocarcinoma -(early invasion of lymphatics)
*Large cell
*5 year survival rate is good if diagnosed early
Prognosis for Small Cell cancer?
*Oat Cell
*grows quickly and metastasizes to other organs
*Poor prognosis, only 5-10% survive for 5 years
S&S for Lung Cancer?
*Persistent cough (may be productive/bloody)
*Chest, arm, back pain
*Dyspnea
*N/V/Anorexia/Fatigue/Weight loss
*Pallor
what might you hear upon auscultation for Lung cancer?
*Unilateral wheezing
*Friction Rub
*Possible unilateral paralysis of Diaphragm
Used to identify change in body’s metabolism and function rather than structure?
PET scan - can be used in lung cancer screening
Diagnostic tests for lung cancer?
*Chest x-ray - shows tumor/metastasis
*Sputum - reveals malignant cells
*Bronchoscopy
*Thoracentesis - plueral fluid contains malignant cells
*Biopsy of lymph nodes
Three main treatments for lung cancer?
*Radiation
*Chemo
*Surgery
surgery to remove lung (either right or left)?
Pneumonectomy
Surgery to remove a lobe?
Lobectomy
Surgery to remove a segment of the lung (tissue)?
Segmentectomy
Surgery to remove ribs? When is this usually done? Why?
*thoracoplasty
*After pneumonectomy
*reduce size of empty thorax to prevent mediastinal shift
Some side effects of radiation therapy for lung cancer?
*Fatigue
*Decreased nutritional intake
*radiodermatitis
*Decreased hematopoietic function
*N/V
*Risk for pneumonitis, esophagitis, cough
Some side effects of chemotherapy for lung cancer?
*Anemia/Thrombocytopenia
*Fatigue/dizzy
*alopecia
*SOB
*Tingling
What is primary prevention?
An intervention implemented before there is evidence of disease or injury. This reduces/eliminates risk factors.
Primary Prevention for lung cancer?
*Avoid tobacco
*Personal/Family HX
*Know environmental caciogens - arsenic, radon, asbestos
Evidence suggests that smokers with a diet low in _____ and ___have an increased risk of developing lung cancer.
Fruits and Vegetables
In take of _____ and ____ has been associated with decreased risk of lung cancer?
Beta carotene and Vitamin A
What is secondary prevention?
An intervention implemented after a disease has begun, but before symptomatic. Early identification through screening and treatment.
Secondary prevention for lung cancer?
*Early diagnose high risk population via screening (over 45 who have smoked heavily)
*CXR, MRI, CT Scan, Sputum cytology
What is tertiary prevention?
An intervention implemented after disease/injury is established. Stop things from getting worse.
Tertiatry prevention for lung cancer?
*For people who survived disease
*Retain optimal living regardless of potential disabling disease.
What is the priority intervention for lung cancer?
Patent airway
What are a couple possible interventions for Lung cancer?
*Breathing exercises
*Pain relief
*Control N/V
*Chest tube management
CF is an ______ which means person must have two altered CF genes to get this.
Autosomal Recessive Disorder - One defective gene from each parent
When is CF present? When is it seen?
Present at birth but usually not seen until childhood years
The Thick sticky mucus associated with cystic fibrosis causes problems in what organ systems?
*Respiratory
*GI
*Reproductive (testes)
*Integumentary
The lethal sticky mucus associated with cystic fibrosis is known as?
Carol
A person with this condition produces thick, sticky, mucus that clogs the lungs and causes repeated infection and difficulty Breathing?
Cystic Fibrosis
CF is most common in?
caucasians - Seen in hispanics, African american, and Native populations as well
the average life span for a person with CF is?
37 years
The specific gene that is mutated in CF and what is associated with this gene?
CFTR gene - exocrine glands
What are the Fat soluble vitamins recommended for CF?
D,E,K,A
Underlying problem of CF is? What does this cause to happen?
Blocked chloride transport in cell membranes. Causes formation of thick mucus with little water content.
CF Symptoms in newborns?
*delayed growth/weight gain
*No bowel movements in first 24-48 hours of life
*Salty-tasting skin
What is the gold standard test for CF? What does it test? What is the Level that signifies CF?
*Sweat test
*Tests for high salt level in sweat
*60 or more mmol/L POSITIVE for cystic fibrosis
Pulmonary manifestations of CF?
*Respiratory infections
*Chest congestion/Stuffy nose
*Cough and thick sputum production
*Decreased pulmonary function
*Use of accessory muscles
*limited exercise tolerance
*changes in x-ray results
*increased anteroposterior diameter
Non-pulmonary manifestations of CF?
*Thin/Small - malnutrition
*Abdominal distention/intestinal blockage/constipation
*Gerd, Rectal prolapse, Fatty/foul stools
*Vitamin deficiencies
*DM
*Osteoporosis
describe the CF test typically done on newborns.
Blood sample to check levels of IRT chemical released by pancreas. <55 is normal result.
Maintenance diagnostic testing for CF?
*Sputum culture - bacteria
*Imaging tests - damage to lungs or intestine
*Lung function tests
Surgical management for CF?
*lung and/or pancreatic transplant - extends life by 10 to 20 years, does not cure.
*nasal polyp removal
*Bowel surgery
The patient with CF, who has pancreatic insufficiency, will lack the ability to use which pancreatic digestive enzymes?
**PAL**
*Protease
*Amylase
*Lipase
Nutritional management of CF?
*Weight
*vitamins
*DM management
*Pancreatic enzyme replacement
Preventive/Maintenance therapy for CF?
*Chest physiotherapy
*Positive expiratory pressure - flutter valve
*active cycle breathing techniques
*exercise
Exacerbation therapy for CF?
*O2
*Avoid mechanical ventilation
*Airway clearance techniques
*Drug therapy
*prevention
Drug therapy for CF?
*Antibiotics for lung infections
*Mucolytic agents
*Bronchodilators
*Oral pancreatic enzymes (normal enzymes in body cant escape because of mucus)
circulatory condition characterized by a plug of fat blocking an artery.
Fat emboli
What occurences can cause a fat emboli to enter circulatory system?
*Fracture of a long bone
*Traumatic injury to adipose tissue
*Traumatuic injury to a fatty liver
how long after an injury do Fat emboli usually occur?
12-36 hours
Risk Factors for Fat embolism
*Males
*Multiple fractures
*truama to adipose tissue or liver
*Burns
*Osteomyelitis
*Sickle cell crisis
abnormal presence of air in the cardiovascular system resulting in obstruction of blood flow?
Air Emboli
Risk Factors/causes of air emboli?
*Surgical procedures that can lead to infusion of air (craniotomy)
*Creation of pressure gradient of air entry (Peripheral Ivs, CVCs, Lumbar puncture)
*Blunt trauma to chest, abodmen, neck, face leading to air entry
_______occurs when ______ is drawn into maternal circulation and carried to lungs.
amnotic fluid emboli - amniotic fluid
What in the amniotic fluid is responsible for obstructing pulmonary vessels?
*skin cells
*vernix
*hair
*meconium
What parts of the heart fail during amniotic fluid emboli?
Right ventricle fails early, leading to hypoxemia, followed by left ventricular failure
Risk factors for amniotic fluid emboli?
*Medical induction of labor
*Multipara
*C-section/operative vaginal delivery
*placenta previa (low lying placenta covering cervix)
*Cervical laceration
*uterine rupture
A condition in which a blood vessel is obstructed by a clot carried in the bloodstream from its site of formation?
Thrombus (clot emboli)
What might happen to an area with an obstructed artery?
*Center City Night Tramp*
*Cold
*Cyanotic
*Numb
*Tingling
What can thrombi result from?
*Blood stasis (slowing or pooling of blood)
*Alterations in clotting factors
*Injury to vessel walls
Risk factor for Thrombus?
*Immobility
*Afib/HF/MI
*Prolonged surgery (longer than 30 minutes)
*Pregnancy
*Postpartum period
*Trauma
*Obesity
*Older than 50 years of age
Major risk factors for PEs?
*THROMBOSIS*
*T-Trauma,Travel
*H-Hypercoagulability
*R-Recreational drugs/smoking
*O-Old age
*M-Malignancy
*B-Birth control
*O-Obesity/Obstetric(1st 6 weeks postpartum)
*S- Surgery
*I- Immobilization (long term)
*S - Serious illness (sickle cell, chronic A-fib, Long bone fx)
What are the 4 most common signs of of a PE?
*That Damn Thick Ass Cock*
sudden onset of unexplained:
*Tachycardia
*Dspnea
*Tachypnea
*Anxiety
*Chest Pain
Three classic signs of a PE that occur in 20% of patients?
*Dyspnea
*Chest pain
*Bloody cough (hemoptysis)
What are two symptons that occur as a result of hypoxemia from a PE?
*Crackles
*sudden change in mental status
What happens to O2 and PaCo2 levels in relation to a PE?
*Moderate hypoxemia with low PaCO2
What are the 4 “S”s patients typically report during a PE?
*Sudden onset of pain
*Swelling/warmth of proximal/distal extremity
*Skin discoloration
*Superficial vein distention
________results in sudden collapse of PT, shock, pallor, Severe dspynea, hypoxemia, crushing chest pain (not alway), rapid/weak pulse, low BP, ECG shows right ventricular strain.
Massive Emboli
________ is often cause plueratic chest pain, dyspnea, slight fever, productive cough w/bloody sputum, tachy, and plueral friction rub upon examination.
Medium Sized Emboli
________ usually go undetected or produce vague symptoms, gradually cause reduction in capilarry bed and eventually pulmonary hypertension.
Small emboli
What is the gold standard diagnostic test for PE? What does it do?
PULMONARY ANGIOGRAPHY - X-Ray of blood vessels that supply the lungs in order to find blood clot.
A diagnostic test that examines protien/firin left behind after lysis is increased. What is the name of the protein and what does an increase signify?
*D-Dimer/Fibrin degradation test
*protein is called D-Dimer and increase signifies presence of clot
*Result below 500 are considered negative
*requires further testing
List some diagnostic testing for PE?
*Pulmonary angiography (gold standard)
*Spiral CT scan
*Ventilation-perfusion scan
*D-Dimer
*Cardiac Markers
*Venous Ultrasound
*ABG
Anticoagulant that decreases fibrin formation by inactivating thrombin and factor XA?
Heparin
Anticoagulant that inhibits the synthesis of clotting factors?
Warfarin
What is the antiodte for Heparin?
Protamine
What is the antidote for Warfarin?
Vitamin K
What is the difference in onset and duration of Heparin and Warfarin?
*Warfarin has a slow onset and effects last for several day
*Heparin has a rapid onset and effects fade quickly.
What test is done with heparin? what is the normal range?
*aPTT
*21-35 seconds (want this to be longer when on heparin)
What test is done with warfarin? What is the normal range?
*INR
*0.8 to 1.1 (want this to be higher on warfarin)
LMWHS is associated with much lower incidence of _______ and ________
*Heparin-induced thrombocytopenia
*Osteoporosis
How can LMWHS be administered?
*fixed does by SQ injection
*Can be done at home
What needs to be monitored with LMWHS? What is the normal range?
*Platelet Count
*150,000 to 450,000
If the PE is caused by a temporary risk factor such as surgery, how long is anticoagulant therapy?
2 to 3 months
If the PE is caused by a long term problem, such as prolonged bed rest, how long is anticoagulant therapy?
*3 to 6 months
*Sometimes indefinetly for problem such as recurret PE
What should be avoided when taking anticoagulants?
*Foods high in vitamin K (spinach)
*Other drugs and OTCs, unless OKd by physician
Medications that break up and dissolve clots? Examples?
*Thrombolytics
*Streptokinase and Tissue plaminogen activator (TPA)
Thrombolytics are associatedf with a higher risk of?
Bleeding
When are Thrombolyrics used instead of Anticoagulants
*People who appear to be in danger of dying from PE
*Dire situations
When should Thrombolytic drugs NOT be used? (with the exception of dire situations)
*Client that has had surgery in the past two weeks
*Pregnant Client
*Recent stroke
*Tend to bleed excessively
What is the most common surgical procedure used to prevent life threatening PE? What does it do? Describe the procedure.
*inferior vena cava interruption - filters
*Prevents large clots from travelling to lungs by mechanically blocking their migration
*Pulmonary angiography done to visualize or rule out embolus, then filter (Permanent or retrievable) is placed in IVC (typically beneath renal vein)
What is the approximate NORMAL level range for an activated partial thromboplastin time (aPTT)?
30-40 seconds
Rare procedure where clot is surgically removed. When is this done? What happens prior to and after the procedure?
*Pulmonary Embolectomy*
*Emergent if client has severe obstruction and not responding to usual therapies
*Angiography done prior to find and confirm embolism
*IVC filter placed after embolectomy
What is the mortality rate for a pulmonary embolectomy?
20%
Nursing Interventions for PE?
*PREVENTION (Weight loss/Exercise, Smoking Cessation, Med adherence)
*Frequent ambulation
*Active and passive leg exercises
*Pain Management
*Turn and reposition frequently to improve ventilation-perfusion ratio
*Manage O2 therap (Assess /Monitor for hypoxemia/pulseox values)
*Relieve anxiety
A patient is receiving continuous IV Heparin. In order for this medication to have a therapeutic effect on the patient, the aPTT should be?
1.5-2.5 times the normal value range
Any aPTT value greater than_____places the patient at risk for bleeding
80 seconds
This details 3 factors of blood clot formation?
*VIRCHOWS TRIAD* (SHE)
*Stasis of venous blood
*Hypercoagulability
*Endothelial damage (Lining of blood vessels)
