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Acute and Chronic > Exam 2 Respiratory > Flashcards

Exam 2 Respiratory Flashcards

Exam 2 Respiratory

1
Q

what is a common site for infection?

A

paranasal sinuses

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2
Q

______________ _________ are 4 paired of bony cavities lined with nasal mucosa connected to ducts that _______ into nasal cavity

A

paranasal sinuses
drain

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3
Q

__________ (_________) serves as the passage between the _______ and the right and left main stem bronchi.

A

Trachea windpipe
larynx

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4
Q

t/f has left Lung has upper and lower

A

TRUE

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5
Q

t/f the right lung only has upper and lower

A

FALSE; Right lung has upper, middle and lower lung

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6
Q

what are the parts of the lower respiratory tract?

A

Voice box (larynx)
Windpipe (trachea)
Lungs.
Airways (bronchi and bronchioles)
Air sacs (alveoli)

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7
Q

The lungs and pleural wall are lined with a membrane called the _______.

A

pleura

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8
Q

There is _________ fluid between the membranes that __________ the __________ and lungs and permit smooth motion of the lungs during ___________ and expiration.

A

There is pleural fluid between the membranes that lubricates the thorax and lungs and permit smooth motion of the lungs during inspiration and expiration.

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9
Q

t/f Bronchi breach out into smaller bronchi then to bronchioles.

A

TRUE

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10
Q

Bronchi and ___________ are lines with cells that have mucous and _____ that move the mucous and foreign __________ away from the lungs and toward the larynx.

A

Bronchi and bronchioles are lines with cells that have mucous and cilia that move the mucous and foreign substances away from the lungs and toward the larynx.

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11
Q

where does oxygen change take place

A

alveoil

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12
Q

Down to __________ bronchioles then the respiratory bronchioles. Those lead to ________- where oxygen and _________ dioxide exchange takes place.

A

Down to terminal bronchioles then the respiratory bronchioles. Those lead to alveoli- where oxygen and carbon dioxide exchange takes place.

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13
Q

what is determined by the size of airway, lung volumes, and airflow velocity?

A

airway resistance

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14
Q

_________ resistance requires _______ effort to move air

A

Increased
greater

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15
Q

airway resistance causes:- __________ of bronchial smooth muscles __________

A

contraction
asthma

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16
Q

______________ __________ thickening of bronchial smooth muscles

A

chronic bronchitis

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17
Q

________________ ______ ___________ mucous, a tumor, foreign body

A

obstruction of airway

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18
Q

lung condition that causes shortness of breath

A

emphysema

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19
Q

Loss of lung elasticity- ____________- tissue encircling airway stays open during inspiration and expiration

A

emphysema

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20
Q

Gradual decline in respiratory function
Alveoli have less available surface area available for exchange of 02 and carbon dioxide
Then alveoli begin to lose elasticity
Decreased ability to move air in and out of lungs

A

Gerontologic changes

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21
Q

t/f older pt have a
Increased risk of infection
Increased risk of aspiration
Decreased exercise capacity

A

TRUE

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22
Q

ABG

A

Arterial blood gases

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23
Q

_______ assess for appropriate oxygenation and ______ removal of carbon dioxide- _______ puncture of (usually) radial artery

A

ABG
adequate
arterial

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24
Q

________ _________ monitor for subtle or sudden changes in oxygen saturation Values normal values 95-100% (except for COPD patients)

A

pulse oximetry

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25
Q

anemia, abnormal hemoglobin, high carbon monoxide, dark skin, wearing nail polish

A

Inaccurate reading OF PULSE OX

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26
Q

what may be performed to check for the pathogen responsible?

A

cultures may be preformed
sputum or blood

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27
Q

All cultures should be performed _____ to antibiotic therapy

A

prior

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28
Q

Cultures may be done on ________ for severe and ongoing sore throats

A

throat

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29
Q

If patient isn’t able to _________ sputum- coughing can be induced by administering __________ hypertonic solution by nebulizer.

A

expectorate
aerosolized

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30
Q

Sputum….

A

needs to be taken to lab quickly
is not spit

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31
Q

Routine on patient with lower respiratory problems

A

Chest X-ray

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32
Q

what shows up as density in X-rays?

A

tumors,fluid

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33
Q

t/f normal pulmonary tissues shows up as density

A

FALSE; it shows up as radiolucent

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34
Q

what is determined by arteiral blood gases?

A

appropriate O2 levels

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35
Q

what is used most often? and at what concentration?

A

nasal cannual
low to medium

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36
Q

what O2 amount causes irritation of the nose and pharynx?

A

over 4-6

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37
Q

what do you check if a pt has to wear oxygen?

A

If your patient is wearing oxygen make sure to check skin around mask, nares, and behind ears for breakdown.

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38
Q

t/f If your patient is wearing a mask and needs to remove it, it will be necessary to place a nasal cannula

A

TRUE

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39
Q

how many liters will you be able to give via nasal cannula?

A

6 liters

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40
Q

how many liters will you be able to give via simple mask?

A

6 to 10 liters

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41
Q

Do not use for less than __ liters to prevent rebreathing of CO2

A

6
simple mask
nonrebreather mask

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42
Q

What is used for a pt who have some type of nasal/tonsil surgery for extra humidification/ oxygen

A

Face tent

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43
Q

what mask ensire that oxygen is being delivered?

A

nonrebreather mask

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44
Q

______________ ______ has ports on each side that have one-way valves that keep the patient from breathing in room air to ensure that a high concentration of oxygen is delivered.

A

nonrebreather mask

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45
Q

What mask has a reservoir bad that is inflated with pure oxygen?

A

nonrebreather mask

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46
Q

Between the mask and the bag is another _________ ______that allows the patient to breathe in the oxygen supplied by the source as well as oxygen from the reservoir. This provides the patient with an oxygen concentration of nearly ____%.

A

one-way valve
100

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47
Q

who is at a higher risk for aspiration and infection related to physical change?

A

older adult

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48
Q

increased risk for infection
cough reflex may not trigger as readily and cough may be less forceful
cilia less able to move mucus up and out of airway
nose and breathing passages secrete less IgA
are more susceptible to pneumonia than other ling infections

A

older adult changes in respiratory system

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49
Q

what does IgA protect the body aganist?

A

antibody that protects against viruses

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50
Q

Handheld
Delivers a mist to lungs as patient inhales
Med- bronchodilator or mucolytic
Visible mist must be available for it to work

A

Nebulizer treatments

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51
Q

There are also ___________ _________for those who are unable to correctly hold and use the ____________.

A

There are also nebulizer masks for those who are unable to correctly hold and use the nebulizer.

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52
Q

Upper airway infection: ______ common cause of illness
Common cold is most frequently occurring URI.
URI occur when virus or bacteria are ________.
___________ are more common

A

Upper respiratory disorders
Upper airway infection: most common cause of illness
Common cold is most frequently occurring URI.
URI occur when virus or bacteria are inhaled.
Viruses are more common

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53
Q

group of disorders characterized by inflammation and irritation of the mucous membranes of the nose- viral such as common cold. Also due to allergens, seasonal or drug induced.

A

Rhinitis

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54
Q

Avoid exposures to _______ if related to allergies

A

allergens

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55
Q

what are potential allergens?

A

dusts, molds, animals fumes, odors, powders, sprays, and tobacco smoke.

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56
Q

___________ flu vaccine especially to _________ adults and high risk population

A

Encourage
older

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57
Q

s/s of rhinitis

A

Runny nose, nasal congestion, sneezing, nasal itching, headache

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58
Q

common cold is…

A

Viral Rhinitis

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59
Q

Sx- low grade fever, nasal congestion, rhinorrhea, nasal discharge, halitosis, sneezing, watery eyes, scratchy throat, general malaise, chills, headache, muscle aches- may exacerbate fever blister (herpes simplex)

A

s/s pf Viral Rhinitis

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60
Q

Symptomatic management- adequate fluids, prevention of chilling, rest, expectorants, NSAIDS, antihistamines for sneezing ,runny nose and congestion
Mucinex (Guaifenesin)- expectorant may help with removal of secretions
No antibiotics

A

what would you use viral rhinitis?

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61
Q

________ _______Infectious acute inflammation of mucous membranes of the nasal cavity Highly contagious because virus is shed 2 days before symptoms appear

A

Viral Rhinitis

62
Q

Formerly called sinusitis (either viral or bacterial)

A

Rhinosinusitis

63
Q

Inflammation of sinuses and nasal cavity
Usually follows a viral URI or cold or allergic rhinitis
Nasal congestion caused by inflammation edema, and fluid secondary to URI leads to obstruction of sinuses Good medium for bacteria growth

A

Rhinosinusitis

64
Q

purulent nasal drainage, nasal obstruction, facial pain, pressure or sense of fullness, headache, fever symptoms for more than 10 days after initial onset

A

s/s of bacterial Rhinosinusitis

65
Q

similar but without high fever and generally no facial pain, pressure, or fullness- occur for fewer than 10 days

A

s/s of viral Rhinosinusitis

66
Q

what assessment would you do for rhinosinusitis?

A

Assessment- tenderness to palpation of sinuses

67
Q

t/f you use decongestants and saline spary for bacterial rhinosinusitis?

A

FALSE; those are treatment for viral rhinosinusitis

68
Q

Treatment 5-7 days of antibiotics
Antibiotics should be administered as soon as __________ __________ is determined
Antibiotics- Augmentin, Levaquin

A

bacterial rhinosinusitis

69
Q

Instruct patients to humidify the air and use warm compresses. Avoid swimming, diving, and air travel during infection. Instruct and have patient demonstrate use of nasal spray
Educate that prolonged use of decongestant should be avoided due to rebound congestion
Pain relief= Tylenol, advil, naproxen, aspirin

Teach the importance of use of antibiotics correctly and to continue medications until complete

Teach that fever, severe headache, and nuchal rigidity (stiffness of neck inability to bend neck are signs of complication

A

Nursing care assessment

70
Q

__________ acute- sudden painful inflammation of the _______- sore throat

A

Pharyngitis
pharynx

71
Q

_________ is a more severe illness can cause infection in the blood stream, meningitis, rheumatic fever, nephritis

A

Strep

72
Q

Pharyngitis bacterial most often is group __ ___________(strep throat)

A

A streptococcus pharyngitis

73
Q

Which type of pharyngitis is more common?

A

viral infection

74
Q

how is viral pharyngitis treated?

A

Viral is treated with supportive measures. Antibiotics have no effect

75
Q

Sudden development of painful sore throat 1-5 days after exposure
Malaise, fever, myalgia, __________, nausea
Tonsils _______and red
May or may not have exudate
Roof of mouth may be _____
________ breath

A

s/s of strep a pharyngitis?

Sudden development of painful sore throat 1-5 days after exposure
Malaise, fever, myalgia, headache, nausea
Tonsils swollen and read
May or may not have exudate
Roof of mouth may be red
Foul breath

76
Q

Amoxicillin
Penicillin 5 days
Once daily Zithromax may be used for 3 days
aspirin, acetaminophen, acetaminophen with codeine may be prescribed
Gargles with benzocaine may be used
Liquid or soft diet during acute stage
Severe situations when patient unable to take fluids– IV

A

treatment for strep a pharyngitis

77
Q

what kind of test would you use to identify strep?

A

rapid strep test

78
Q

Symptom management
instruct to report s/s of worsening
Ice collar around throat
Warm salt water gargle
Delay returning to work until 24 hours after start of antibiotic
Don’t share eating utensils
Clean telephone after use
Use of tissue, disposal of tissue
Replace toothbrush with new one

A

nursing care for pharyngitis

79
Q

what kind of s/s would you have a pt report for worsening pharyngitis?

A

instruct to report s/s of worsening: dyspnea, drooling, inability to swallow, inability to fully open mouth

80
Q

t/f tonsillitis can be confused with pharyngitis?

A

TRUE

81
Q

what bleeding signs should you check for post op of tonsillectomy?

A

after surgery look for sx of bleeding such as patient with frequent swallowing, bleeding from mouth

82
Q

what is a risk post op of tonsillectomy?

A

risk for hemorrhage

83
Q

Reoccurring or hypertrophy of tonsils- may have __________

A

tonsillectomy

84
Q

what are the s/s of tonsillitis

A

Symptoms: sore throat, fever, snoring, and difficulty swallowing

85
Q

po op complication of tonsillectomy

A

Sx of postop complication- bleeding, fever, throat pain, ear pain

86
Q

Warm salt water rinses may be used to deal with thick mucous and halitosis after surgery
Maintain good hydration
Soft diet
Avoid smoking
Teach- use liquid Tylenol with or without codeine
May be required to take a full course of antibiotics

A

treatment for tonsillitis

87
Q

what are risk factors for obstructive sleep apnea?

A

Obesity, male gender, postmenopausal status, and advanced age

88
Q

what are the 3 S’s for OSA?

A

3 S’s: snoring, sleepiness, and significant other report of sleep apnea

89
Q

CPAP, devices to prevent lying on back, weight loss, avoidance of alcohol

A

treatment for OSA

90
Q

s/s for OSA

A

Frequent loud snoring with breathing cessation

91
Q

Breathing cessation of ___ _________ or longer- at least 5 episodes in an hour followed by awakening abruptly with a loud snort as blood oxygen level drops.

A

what happens during OSA?
10 seconds

92
Q

Larger neck circumference and increased amounts of fat can compress the upper airway.
Upper airway tone is reduced during sleep. Pharynx is a collapsible tube
High prevalence of HTN
Increased risk of MI and stroke

A

how does tisk factors affect OSA?

93
Q

2-4% of women and 8-9% of men

A

number of mena and women with sleep apnea

94
Q

how many go undiagnosed with OSA?

A

80%

95
Q

how does OSA interfere with a pt?

A

Interferes with ability to get adequate rest, affects memory, learning, and decision making

96
Q

Recurrent episodes of upper airway obstruction and reduction of ventilation. Apnea during sleep caused by repetitive upper airway obstruction

A

what is OSA?

97
Q

when does atelectasis often happen?

A

Atelectasis often happens after surgery due to not moving around, no deep breaths etc.

98
Q

what is atelectasis?

A

Closure or collapse of alveoli- most common seen in post op

99
Q

what are s/s of atelectatsis?

A

S/S: dyspnea, cough, and sputum production

100
Q

what helps prevent atelectatsis?

A

Prevention: frequent turning, early mobilization, deep breathing, incentive spirometer, directed cough

101
Q

Excessive secretions or mucus plus may cause obstruction of airflow and cause __________ in an area of the lung

A

atelectasis

102
Q

what dose I COUGH stand for?

A

Incentive Spirometry
Cough
Oral Care
Understanding pt Education
GEt out of Bed
Head of bed elvated

103
Q

IIncentive Spirometry: Deep breathing exercises will help keep your lungs healthy and prevent lung problems. This breathing exercise needs to be done 10 times each hour.
CCough and Deep Breathe: After surgery taking deep breaths and coughing helps to clear your lungs. This helps the lungs do the vital job of delivering oxygen to the tissues in your body.
OOral Care: Brushing your teeth and using mouthwash twice a day keeps your mouth clean from germs.
UUnderstanding Patient Education: Is important for you and your family to take an active part in your recovery. We want your pain to be controlled so you can take deep breaths, cough, get out of bed for a walk and be sitting up at mealtime.
GGet out of Bed: Walking will help clear secretions from your lungs, help your circulation and help to regain your strength.
HHead of Bed Elevated: It is important to keep the head of the bed elevated between 30-45 degrees. Being in an upright position after your operation will help with your breathing

A

The acronym I COUGH stands for:

104
Q

__________________ __________Deep breathing exercises will help keep your lungs healthy and prevent lung problems. This breathing exercise needs to be done 10 times each hour.

A

Incentive Spirometry

105
Q

________ ___ ________ __________After surgery taking deep breaths and coughing helps to clear your lungs. This helps the lungs do the vital job of delivering oxygen to the tissues in your body.

A

Cough and Deep Breathe

106
Q

___________ ___________Brushing your teeth and using mouthwash twice a day keeps your mouth clean from germs.

A

Oral Care

107
Q

______________ ___________ ____________Is important for you and your family to take an active part in your recovery. We want your pain to be controlled so you can take deep breaths, cough, get out of bed for a walk and be sitting up at mealtime.

A

Understanding Patient Education

108
Q

________ _____ _____ _____Walking will help clear secretions from your lungs, help your circulation and help to regain your strength.

A

Get out of Bed

109
Q

________ ____ ______ _________It is important to keep the head of the bed elevated between 30-45 degrees. Being in an upright position after your operation will help with your breathing

A

Head of Bed Elevated:

110
Q

Acute inflammation of the trachea and bronchial tree. Often follows infection of upper respiratory tract; Inflamed mucosa produce mucopurulent drainage

A

Tracheobronchitis

111
Q

Dry irritating cough and scant amount of mucous, may have sternal soreness, fever, chills, night sweats, headache, and general malaise.

A

s/s of tracheobronchitis

112
Q

what occurs when tracheobronchitis progresses?

A

short of breath, noisy breathing, and purulent sputum. If severe may have blood in secretions

113
Q

what are treatment options for tracheobronchitis?

A

Antibiotics based on organism
Fluid intake
Humidification
Analgesics

114
Q

what are the different types of pneumonia?

A

Community acquired pneumonia
Healthcare associated pneumonia
Hospital acquired pneumonia
Ventilator association pneumonia

Could be bacterial, viral, or fungal

115
Q

what are the most common causes of death by infectious organisms?

A

Pneumonia and influenza

116
Q

Inflammation of lung parenchyma (functioning parts of the lungs- bronchi, alveoli…)

A

Pneumonia

117
Q

In the past HCAP, HAP and VAP were all called _________ infections

A

nosocomial

118
Q

Occurs either in the community or within 48 hours of entering a facility
Pneumococcus most common cause in adults younger than 60
H. Influenza frequently affects over 60 and those with comorbid conditions
Viruses are most common cause in infants and children, rare in adults

A

Community Acquired pneumonia

119
Q

I will not ask you the difference in hospital acquired and healthcare acquired because the literature is differing on this

A

what will blatnick not ask

120
Q

Often multidrug resistant organisms
Identifying is crucial, hard to treat
Long term care center

A

Heath care acquired pneumonia

121
Q

Comorbid conditions, supine positioning and aspiration, coma, malnutrition, prolonged hospitalization, hypotension, metabolic disorders
Inappropriate use of antibiotics, use of NG tubes

A

Some things that put a patient at high risk are for hospital acquired pneumonia

122
Q

private room, contact precautions used (gown, mask, gloves, antibacterial soap), decreased number of people in contact

A

MRSA pneumonia-

123
Q

E coli, H influenzae, MRSA, s. pneumoniae.
Most colonized with multiple bacteria
Often accompanied by bacteremia, and positive blood cultures

A

common organism ass. with hospital acquired pneumonia

124
Q

Entry of substances into lower airway
Bacterial infection from aspiration of bacteria that normally live in upper airway
Gastric contents, chemicals, or irritating gases may be aspirated

A

Aspiration pneumonia

125
Q

Inflammatory reaction can occur in alveoli producing exudate which interferes with exchange of oxygen and carbon dioxide
WBC migrate to the alveoli and fill the normally air filled space
Secretions and edema may partially occlude bronchi or alveoli .
In a person with reactive airway disease may also have bronchospasms

A

pneumonia

126
Q

Residence in LTC facility
Tube feedings
COPD, diabetes, heart failure, malnutrition, AIDS

A

Pneumonia Risk factors

127
Q

Depends on type of __________
Shortness of breath, fever, chest discomfort due to cough, history of upper respiratory infection, rapid respiration, orthopnea, poor appetite, diaphoresis, tires easily, rusty- blood tinged sputum, crackles, purulent sputum

A

s/s of pneumonia
pneumonia

128
Q

what are prevention for pneumonia?

A

Pneumococcal vaccine- for all 65 and over

129
Q

History (recent uri)
Chest xray, blood culture, sputum exam
CBC, chemistry

A

Assessment/Diagnostic Findings for pneumonia

130
Q

Primarily supportive
Hydration and antipyretics
Antitussives
Warm moist inhalation
Bedrest
If hypoxemia occurs- oxygen administered
Pulse ox/ABG

A

Viral pneumonia

131
Q

If suspected _________ _________ __________ treatment broad spectrum antibiotic may be one or multiple antibiotics. Rocephin, Unasyn, Levaquin.

A

Hospital acquired pneumonia

132
Q

Status must be assessed ___ hours after the initiation of antibiotics and should be ___________ or ________ based on culture results.

A

72
discontinued or modified

133
Q

Appropriate antibiotic (will do antibiotic prior to culture results (but after collection) as culture takes 24 hours for preliminary report)
IV fluids and antibiotics if patient needs
PO antibiotics as soon as patient is able

A

Medical management of hospital acquired

134
Q

__________ _____- discharge from hospital (varies, temp below 100, heart rate less than 100, resp less than 24, bp greater than 90 and 02 greater than 90% and able to maintain oral intake and normal baseline mental status)

A

Clinically stable
Medical management of hospital acquired

135
Q

t/f do older pt have different sx for viral pneumonia?

A

TRUE; General deterioration, weakness, abdominal sx, anorexia, confusion, tachycardia, and tachypnea may signmal onset.

136
Q

General deterioration, weakness, abdominal sx, anorexia, confusion, tachycardia, and tachypnea may signmal onset.

A

sx of geruatric patient viral pneumonia

137
Q

what are the classic sx of viral pneumonia?

A

Classic sx of cough chest pain sputum production and fever may be masked or absent.

138
Q

____________ _____ of cough chest pain sputum production and fever may be masked or absent.

A

Classic sx for viral pneumonia

139
Q

what kind of treat would you give older pt for viral pneumonia?

A

Supportive treatment: caution and frequent assessment due to risk of fluid overload- IV hydration, supplemental 02, assist with deep breathing, cough, position changes frequently, and early ambulation

140
Q

_____________ ____________: caution and frequent assessment due to risk of fluid overload- IV hydration, supplemental 02, assist with deep breathing, cough, position changes frequently, and early ambulation

A

viral pneumonia
Supportive treatment

141
Q

Gerontological considerations pneumonia

A

May be primary dx or complication of chronic disease
Often difficult to treat and have higher mortality rate

142
Q

May be primary dx or complication of chronic disease
Often difficult to treat and have higher mortality rate

A

Gerontological considerations pneumonia

143
Q

pneumonia assessment

A

Pulse ox
Lung sounds
Vital signs (fever, tachycardia, tachypnea)
Cough and sputum production
Pain, fatigue
Dyspnea
Older adults( unusual behavior, altered mental status, and heart failure)

144
Q

Pulse ox
Lung sounds
Vital signs (fever, tachycardia, tachypnea)
Cough and sputum production
Pain, fatigue
Dyspnea
Older adults( unusual behavior, altered mental status, and heart failure)

A

pneumonia assessment

145
Q

what are the pneumonia goals of care?

A

Improved airway patency
Maintenance of proper fluid volume
Maintenance of proper nutrition
Understanding of treatment protocol
Increased activity

146
Q

Improved airway patency
Maintenance of proper fluid volume
Maintenance of proper nutrition
Understanding of treatment protocol
Increased activity

A

what are the pneumonia goals of care?

147
Q

__________ _________:
Increase fluids to thin secretions
Humidification of oxygen or air
Deep breathing, incentive spirometer
Administer and titrate oxygen per protocol or as prescribed
__________ ______ _________:
Increase fluids (carefully in those with heart failure)
Maintain nutrition (decreased appetite):
Fluids with electrolytes
Small frequent meals
Nutritional drinks
IV fluids and nutrients if needed

A

Nursing pneumonia interventions
Airway patency:
Promote fluid intake:

148
Q

__________ respirations leads to an increased loss of __________ fluids

A

Increased
insensible

149
Q

____________ related to worsening of pneumonia is a poor sign. _________ may be related to hypoxemia, fever, dehydration, sleep __________, or __________ sepsis.

A

Confusion
Confusion
dehydration
deprivation
developing

150
Q

Patients usually respond within __ to ___hours

A

24 to 48

151
Q

Monitoring and managing potential complications pneumonia

A

Observe for response to antibiotic therapy
Check culture to see if correct antibiotic
Assess for confusion and other more subtle changes to cognitive status

152
Q

Observe for response to antibiotic therapy
Check culture to see if correct antibiotic
Assess for confusion and other more subtle changes to cognitive status

A

Monitoring and managing potential complications pneumonia

Acute and Chronic (15 decks)

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