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Nursing 231 - Exam 2 > Exam 2 - Respiratory > Flashcards

Exam 2 - Respiratory Flashcards

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1
Q

An upper airway infection that blocks breathing and has a distinctive barking cough?

A

Croup

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2
Q

What age range is affected by croup?

A

3 months to 8 years

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3
Q

what kind of infection is croup?

A

VIRAL

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4
Q

symptoms of croup?

A

*Slow progression
*attacks at night
*INSPIRATORY stridor
*hoarsness
*Risk for narrowing airway
*Mild elevation of temp

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5
Q

Nonpharma intervention for croup?

A

humidity

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6
Q

Inflammation of epiglottis?

A

Epiglottitis

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7
Q

What kind of infection is epiglottitis?

A

Bacterial

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8
Q

What should you NEVER do when taking care of a client who has epiglottitis/Croup? Why?

A

Never put anything in the mouth. Laryngeal spasms can occur.

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9
Q

S+S of epiglottitis?

A

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

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10
Q

Age range affected by epiglottitis

A

2 years to 8 years old

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11
Q

Treatment for Croup?

A

*Beta agonists (albuterol)
*Beta-adregenic (Epi through face mask)
*Corticosteroids (not for acute attack)
*Croup Tent w/pulse ox

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12
Q

Treatment for Epiglottitis?

A

*Beta agonists (albuterol)
*Beta-adregenic (Epi through face mask)
*Corticosteroids (not for acute attack)
*Antibiotics

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13
Q

what must be kept bedside for clients with epiglottitis?

A

Endotracheal tube and trach kit

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14
Q

How might a child with epiglotitis be positioned?

A

Tripod position - sitting up and leaning forward with tongue out

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15
Q

What is a preventative measure for epiglottitis?

A

Hib Vaccine

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16
Q

What are some possible causes of lung cancer?

A

*Inhailed carcinogens - cigg smoke, asbestos
*COPD

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17
Q

Most lung cancers arise as a result of failure of cellular regulation in__________.

A

Bronchial epithelium

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18
Q

Lung cancers are collectively called?

A

Bronchogenic carcinomas

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19
Q

Two classifications for lung cancer?

A

*Small cell lung cancer (SCLC) (oat cell) (poor prognosis)
*Non-Small cell lung cancer (NSCLC) (Most common)

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20
Q

How dose metastasis of lung cancer occur?

A

Direct extension through blood and lymph nodes

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21
Q

Common sites for metastatic growth from lung cancer?

A

*Liver
*Brain
*Bones
*Lymph nodes
*Adrenal glands

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22
Q

What is lung cancer staging based on?

A

TNM system

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23
Q

Grade for a primary tumor that cannot be assessed?

A

Tx

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24
Q

Grade for no evidence of primary tumor?

A

T0

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25
Q

Grade for carcinoma in situ?

A

Tis

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26
Q

Grade for Increasing size and/or local extent of primary tumor.

A

T1, T2, T3, T4

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27
Q

Grade for regional lymph node with no regional lymph node metastasis.

A

N0

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28
Q

Grade for regional lymph node with increasing involvement of regional lymphnodes?

A

N1, N2,N3

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29
Q

Grade for regional lymph nodes that cannot be assessed?

A

Nx

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30
Q

Grade for Presence of distant Metastasis cannot be addressed?

A

Mx

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31
Q

Grade for no distant metastasis?

A

M0

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32
Q

Grade for Distant Metastasis?

A

M1

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33
Q

Stage of LC where cancer is only in lungs and has not spread to any lymph nodes?

A

Stage 1

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34
Q

Stage of LC where cancer is in lungs and nearby lymph nodes?

A

Stage ll

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35
Q

Stage of LC where cancer is found in lung and in lymph nodes in the middle of the chest? (Locally advanced disease)

A

Stage lll

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36
Q

A subtype of stage__ used If cancer has spread to only lymphnodes on same side of chest where cancer started

A

Stage lllA

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37
Q

a subtype of stage__ used if cancer has spread to lymphnodes on opposite side of chest or above collar bone

A

Stage lllB

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38
Q

Stage of LC where cancer has spread to both lungs, fluid around lungs, or another part of body

A

Stage IV

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39
Q

What are the types of NSCLC? Prognosis?

A

*Squamous cell
*Adenocarcinoma -(early invasion of lymphatics)
*Large cell
*5 year survival rate is good if diagnosed early

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40
Q

Prognosis for Small Cell cancer?

A

*Oat Cell
*grows quickly and metastasizes to other organs
*Poor prognosis, only 5-10% survive for 5 years

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41
Q

S&S for Lung Cancer?

A

*Persistent cough (may be productive/bloody)
*Chest, arm, back pain
*Dyspnea
*N/V/Anorexia/Fatigue/Weight loss
*Pallor

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42
Q

what might you hear upon auscultation for Lung cancer?

A

*Unilateral wheezing
*Friction Rub
*Possible unilateral paralysis of Diaphragm

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43
Q

Used to identify change in body’s metabolism and function rather than structure?

A

PET scan - can be used in lung cancer screening

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44
Q

Diagnostic tests for lung cancer?

A

*Chest x-ray - shows tumor/metastasis
*Sputum - reveals malignant cells
*Bronchoscopy
*Thoracentesis - plueral fluid contains malignant cells
*Biopsy of lymph nodes

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45
Q

Three main treatments for lung cancer?

A

*Radiation
*Chemo
*Surgery

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46
Q

surgery to remove lung (either right or left)?

A

Pneumonectomy

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47
Q

Surgery to remove a lobe?

A

Lobectomy

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48
Q

Surgery to remove a segment of the lung (tissue)?

A

Segmentectomy

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49
Q

Surgery to remove ribs? When is this usually done? Why?

A

*thoracoplasty
*After pneumonectomy
*reduce size of empty thorax to prevent mediastinal shift

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50
Q

Some side effects of radiation therapy for lung cancer?

A

*Fatigue
*Decreased nutritional intake
*radiodermatitis
*Decreased hematopoietic function
*N/V
*Risk for pneumonitis, esophagitis, cough

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51
Q

Some side effects of chemotherapy for lung cancer?

A

*Anemia/Thrombocytopenia
*Fatigue/dizzy
*alopecia
*SOB
*Tingling

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52
Q

What is primary prevention?

A

An intervention implemented before there is evidence of disease or injury. This reduces/eliminates risk factors.

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53
Q

Primary Prevention for lung cancer?

A

*Avoid tobacco
*Personal/Family HX
*Know environmental caciogens - arsenic, radon, asbestos

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54
Q

Evidence suggests that smokers with a diet low in _____ and ___have an increased risk of developing lung cancer.

A

Fruits and Vegetables

55
Q

In take of _____ and ____ has been associated with decreased risk of lung cancer?

A

Beta carotene and Vitamin A

56
Q

What is secondary prevention?

A

An intervention implemented after a disease has begun, but before symptomatic. Early identification through screening and treatment.

57
Q

Secondary prevention for lung cancer?

A

*Early diagnose high risk population via screening (over 45 who have smoked heavily)
*CXR, MRI, CT Scan, Sputum cytology

58
Q

What is tertiary prevention?

A

An intervention implemented after disease/injury is established. Stop things from getting worse.

59
Q

Tertiatry prevention for lung cancer?

A

*For people who survived disease
*Retain optimal living regardless of potential disabling disease.

60
Q

What is the priority intervention for lung cancer?

A

Patent airway

61
Q

What are a couple possible interventions for Lung cancer?

A

*Breathing exercises
*Pain relief
*Control N/V
*Chest tube management

62
Q

CF is an ______ which means person must have two altered CF genes to get this.

A

Autosomal Recessive Disorder - One defective gene from each parent

63
Q

When is CF present? When is it seen?

A

Present at birth but usually not seen until childhood years

64
Q

The Thick sticky mucus associated with cystic fibrosis causes problems in what organ systems?

A

*Respiratory
*GI
*Reproductive (testes)
*Integumentary

65
Q

The lethal sticky mucus associated with cystic fibrosis is known as?

A

Carol

66
Q

A person with this condition produces thick, sticky, mucus that clogs the lungs and causes repeated infection and difficulty Breathing?

A

Cystic Fibrosis

67
Q

CF is most common in?

A

caucasians - Seen in hispanics, African american, and Native populations as well

68
Q

the average life span for a person with CF is?

A

37 years

69
Q

The specific gene that is mutated in CF and what is associated with this gene?

A

CFTR gene - exocrine glands

70
Q

What are the Fat soluble vitamins recommended for CF?

A

D,E,K,A

71
Q

Underlying problem of CF is? What does this cause to happen?

A

Blocked chloride transport in cell membranes. Causes formation of thick mucus with little water content.

72
Q

CF Symptoms in newborns?

A

*delayed growth/weight gain
*No bowel movements in first 24-48 hours of life
*Salty-tasting skin

73
Q

What is the gold standard test for CF? What does it test? What is the Level that signifies CF?

A

*Sweat test
*Tests for high salt level in sweat
*60 or more mmol/L POSITIVE for cystic fibrosis

74
Q

Pulmonary manifestations of CF?

A

*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

75
Q

Non-pulmonary manifestations of CF?

A

*Thin/Small - malnutrition
*Abdominal distention/intestinal blockage/constipation
*Gerd, Rectal prolapse, Fatty/foul stools
*Vitamin deficiencies
*DM
*Osteoporosis

76
Q

describe the CF test typically done on newborns.

A

Blood sample to check levels of IRT chemical released by pancreas. <55 is normal result.

77
Q

Maintenance diagnostic testing for CF?

A

*Sputum culture - bacteria
*Imaging tests - damage to lungs or intestine
*Lung function tests

78
Q

Surgical management for CF?

A

*lung and/or pancreatic transplant - extends life by 10 to 20 years, does not cure.
*nasal polyp removal
*Bowel surgery

79
Q

The patient with CF, who has pancreatic insufficiency, will lack the ability to use which pancreatic digestive enzymes?

A

**PAL**
*Protease
*Amylase
*Lipase

80
Q

Nutritional management of CF?

A

*Weight
*vitamins
*DM management
*Pancreatic enzyme replacement

81
Q

Preventive/Maintenance therapy for CF?

A

*Chest physiotherapy
*Positive expiratory pressure - flutter valve
*active cycle breathing techniques
*exercise

82
Q

Exacerbation therapy for CF?

A

*O2
*Avoid mechanical ventilation
*Airway clearance techniques
*Drug therapy
*prevention

83
Q

Drug therapy for CF?

A

*Antibiotics for lung infections
*Mucolytic agents
*Bronchodilators
*Oral pancreatic enzymes (normal enzymes in body cant escape because of mucus)

84
Q

circulatory condition characterized by a plug of fat blocking an artery.

A

Fat emboli

85
Q

What occurences can cause a fat emboli to enter circulatory system?

A

*Fracture of a long bone

*Traumatic injury to adipose tissue

*Traumatuic injury to a fatty liver

86
Q

how long after an injury do Fat emboli usually occur?

A

12-36 hours

87
Q

Risk Factors for Fat embolism

A

*Males

*Multiple fractures

*truama to adipose tissue or liver

*Burns

*Osteomyelitis

*Sickle cell crisis

88
Q

abnormal presence of air in the cardiovascular system resulting in obstruction of blood flow?

A

Air Emboli

89
Q

Risk Factors/causes of air emboli?

A

*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

90
Q

_______occurs when ______ is drawn into maternal circulation and carried to lungs.

A

amnotic fluid emboli - amniotic fluid

91
Q

What in the amniotic fluid is responsible for obstructing pulmonary vessels?

A

*skin cells

*vernix

*hair

*meconium

92
Q

What parts of the heart fail during amniotic fluid emboli?

A

Right ventricle fails early, leading to hypoxemia, followed by left ventricular failure

93
Q

Risk factors for amniotic fluid emboli?

A

*Medical induction of labor

*Multipara

*C-section/operative vaginal delivery

*placenta previa (low lying placenta covering cervix)

*Cervical laceration

*uterine rupture

94
Q

A condition in which a blood vessel is obstructed by a clot carried in the bloodstream from its site of formation?

A

Thrombus (clot emboli)

95
Q

What might happen to an area with an obstructed artery?

A

*Center City Night Tramp*

*Cold

*Cyanotic

*Numb

*Tingling

96
Q

What can thrombi result from?

A

*Blood stasis (slowing or pooling of blood)

*Alterations in clotting factors

*Injury to vessel walls

97
Q

Risk factor for Thrombus?

A

*Immobility

*Afib/HF/MI

*Prolonged surgery (longer than 30 minutes)

*Pregnancy

*Postpartum period

*Trauma

*Obesity

*Older than 50 years of age

98
Q

Major risk factors for PEs?

A

*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)

99
Q

What are the 4 most common signs of of a PE?

A

*That Damn Thick Ass Cock*

sudden onset of unexplained:

*Tachycardia

*Dspnea

*Tachypnea

*Anxiety

*Chest Pain

100
Q

Three classic signs of a PE that occur in 20% of patients?

A

*Dyspnea

*Chest pain

*Bloody cough (hemoptysis)

101
Q

What are two symptons that occur as a result of hypoxemia from a PE?

A

*Crackles

*sudden change in mental status

102
Q

What happens to O2 and PaCo2 levels in relation to a PE?

A

*Moderate hypoxemia with low PaCO2

103
Q

What are the 4 “S”s patients typically report during a PE?

A

*Sudden onset of pain

*Swelling/warmth of proximal/distal extremity

*Skin discoloration

*Superficial vein distention

104
Q

________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.

A

Massive Emboli

105
Q

________ is often cause plueratic chest pain, dyspnea, slight fever, productive cough w/bloody sputum, tachy, and plueral friction rub upon examination.

A

Medium Sized Emboli

106
Q

________ usually go undetected or produce vague symptoms, gradually cause reduction in capilarry bed and eventually pulmonary hypertension.

A

Small emboli

107
Q

What is the gold standard diagnostic test for PE? What does it do?

A

PULMONARY ANGIOGRAPHY - X-Ray of blood vessels that supply the lungs in order to find blood clot.

108
Q

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?

A

*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

109
Q

List some diagnostic testing for PE?

A

*Pulmonary angiography (gold standard)

*Spiral CT scan

*Ventilation-perfusion scan

*D-Dimer

*Cardiac Markers

*Venous Ultrasound

*ABG

110
Q

Anticoagulant that decreases fibrin formation by inactivating thrombin and factor XA?

A

Heparin

111
Q

Anticoagulant that inhibits the synthesis of clotting factors?

A

Warfarin

112
Q

What is the antiodte for Heparin?

A

Protamine

113
Q

What is the antidote for Warfarin?

A

Vitamin K

114
Q

What is the difference in onset and duration of Heparin and Warfarin?

A

*Warfarin has a slow onset and effects last for several day

*Heparin has a rapid onset and effects fade quickly.

115
Q

What test is done with heparin? what is the normal range?

A

*aPTT

*21-35 seconds (want this to be longer when on heparin)

116
Q

What test is done with warfarin? What is the normal range?

A

*INR

*0.8 to 1.1 (want this to be higher on warfarin)

117
Q

LMWHS is associated with much lower incidence of _______ and ________

A

*Heparin-induced thrombocytopenia

*Osteoporosis

118
Q

How can LMWHS be administered?

A

*fixed does by SQ injection

*Can be done at home

119
Q

What needs to be monitored with LMWHS? What is the normal range?

A

*Platelet Count

*150,000 to 450,000

120
Q

If the PE is caused by a temporary risk factor such as surgery, how long is anticoagulant therapy?

A

2 to 3 months

121
Q

If the PE is caused by a long term problem, such as prolonged bed rest, how long is anticoagulant therapy?

A

*3 to 6 months

*Sometimes indefinetly for problem such as recurret PE

122
Q

What should be avoided when taking anticoagulants?

A

*Foods high in vitamin K (spinach)

*Other drugs and OTCs, unless OKd by physician

123
Q

Medications that break up and dissolve clots? Examples?

A

*Thrombolytics

*Streptokinase and Tissue plaminogen activator (TPA)

124
Q

Thrombolytics are associatedf with a higher risk of?

A

Bleeding

125
Q

When are Thrombolyrics used instead of Anticoagulants

A

*People who appear to be in danger of dying from PE

*Dire situations

126
Q

When should Thrombolytic drugs NOT be used? (with the exception of dire situations)

A

*Client that has had surgery in the past two weeks

*Pregnant Client

*Recent stroke

*Tend to bleed excessively

127
Q

What is the most common surgical procedure used to prevent life threatening PE? What does it do? Describe the procedure.

A

*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)

128
Q

What is the approximate NORMAL level range for an activated partial thromboplastin time (aPTT)?

A

30-40 seconds

129
Q

Rare procedure where clot is surgically removed. When is this done? What happens prior to and after the procedure?

A

*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

130
Q

What is the mortality rate for a pulmonary embolectomy?

A

20%

131
Q

Nursing Interventions for PE?

A

*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

132
Q

A patient is receiving continuous IV Heparin. In order for this medication to have a therapeutic effect on the patient, the aPTT should be?

A

1.5-2.5 times the normal value range

133
Q

Any aPTT value greater than_____places the patient at risk for bleeding

A

80 seconds

134
Q

This details 3 factors of blood clot formation?

A

*VIRCHOWS TRIAD* (SHE)

*Stasis of venous blood

*Hypercoagulability

*Endothelial damage (Lining of blood vessels)

Nursing 231 - Exam 2 (4 decks)

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