Exam 2 Respiratory Flashcards
Exam 2 Respiratory
what is a common site for infection?
paranasal sinuses
______________ _________ are 4 paired of bony cavities lined with nasal mucosa connected to ducts that _______ into nasal cavity
paranasal sinuses
drain
__________ (_________) serves as the passage between the _______ and the right and left main stem bronchi.
Trachea windpipe
larynx
t/f has left Lung has upper and lower
TRUE
t/f the right lung only has upper and lower
FALSE; Right lung has upper, middle and lower lung
what are the parts of the lower respiratory tract?
Voice box (larynx)
Windpipe (trachea)
Lungs.
Airways (bronchi and bronchioles)
Air sacs (alveoli)
The lungs and pleural wall are lined with a membrane called the _______.
pleura
There is _________ fluid between the membranes that __________ the __________ and lungs and permit smooth motion of the lungs during ___________ and expiration.
There is pleural fluid between the membranes that lubricates the thorax and lungs and permit smooth motion of the lungs during inspiration and expiration.
t/f Bronchi breach out into smaller bronchi then to bronchioles.
TRUE
Bronchi and ___________ are lines with cells that have mucous and _____ that move the mucous and foreign __________ away from the lungs and toward the larynx.
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.
where does oxygen change take place
alveoil
Down to __________ bronchioles then the respiratory bronchioles. Those lead to ________- where oxygen and _________ dioxide exchange takes place.
Down to terminal bronchioles then the respiratory bronchioles. Those lead to alveoli- where oxygen and carbon dioxide exchange takes place.
what is determined by the size of airway, lung volumes, and airflow velocity?
airway resistance
_________ resistance requires _______ effort to move air
Increased
greater
airway resistance causes:- __________ of bronchial smooth muscles __________
contraction
asthma
______________ __________ thickening of bronchial smooth muscles
chronic bronchitis
________________ ______ ___________ mucous, a tumor, foreign body
obstruction of airway
lung condition that causes shortness of breath
emphysema
Loss of lung elasticity- ____________- tissue encircling airway stays open during inspiration and expiration
emphysema
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
Gerontologic changes
t/f older pt have a
Increased risk of infection
Increased risk of aspiration
Decreased exercise capacity
TRUE
ABG
Arterial blood gases
_______ assess for appropriate oxygenation and ______ removal of carbon dioxide- _______ puncture of (usually) radial artery
ABG
adequate
arterial
________ _________ monitor for subtle or sudden changes in oxygen saturation Values normal values 95-100% (except for COPD patients)
pulse oximetry
anemia, abnormal hemoglobin, high carbon monoxide, dark skin, wearing nail polish
Inaccurate reading OF PULSE OX
what may be performed to check for the pathogen responsible?
cultures may be preformed
sputum or blood
All cultures should be performed _____ to antibiotic therapy
prior
Cultures may be done on ________ for severe and ongoing sore throats
throat
If patient isn’t able to _________ sputum- coughing can be induced by administering __________ hypertonic solution by nebulizer.
expectorate
aerosolized
Sputum….
needs to be taken to lab quickly
is not spit
Routine on patient with lower respiratory problems
Chest X-ray
what shows up as density in X-rays?
tumors,fluid
t/f normal pulmonary tissues shows up as density
FALSE; it shows up as radiolucent
what is determined by arteiral blood gases?
appropriate O2 levels
what is used most often? and at what concentration?
nasal cannual
low to medium
what O2 amount causes irritation of the nose and pharynx?
over 4-6
what do you check if a pt has to wear oxygen?
If your patient is wearing oxygen make sure to check skin around mask, nares, and behind ears for breakdown.
t/f If your patient is wearing a mask and needs to remove it, it will be necessary to place a nasal cannula
TRUE
how many liters will you be able to give via nasal cannula?
6 liters
how many liters will you be able to give via simple mask?
6 to 10 liters
Do not use for less than __ liters to prevent rebreathing of CO2
6
simple mask
nonrebreather mask
What is used for a pt who have some type of nasal/tonsil surgery for extra humidification/ oxygen
Face tent
what mask ensire that oxygen is being delivered?
nonrebreather mask
______________ ______ 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.
nonrebreather mask
What mask has a reservoir bad that is inflated with pure oxygen?
nonrebreather mask
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 ____%.
one-way valve
100
who is at a higher risk for aspiration and infection related to physical change?
older adult
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
older adult changes in respiratory system
what does IgA protect the body aganist?
antibody that protects against viruses
Handheld
Delivers a mist to lungs as patient inhales
Med- bronchodilator or mucolytic
Visible mist must be available for it to work
Nebulizer treatments
There are also ___________ _________for those who are unable to correctly hold and use the ____________.
There are also nebulizer masks for those who are unable to correctly hold and use the nebulizer.
Upper airway infection: ______ common cause of illness
Common cold is most frequently occurring URI.
URI occur when virus or bacteria are ________.
___________ are more common
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
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.
Rhinitis
Avoid exposures to _______ if related to allergies
allergens
what are potential allergens?
dusts, molds, animals fumes, odors, powders, sprays, and tobacco smoke.
___________ flu vaccine especially to _________ adults and high risk population
Encourage
older
s/s of rhinitis
Runny nose, nasal congestion, sneezing, nasal itching, headache
common cold is…
Viral Rhinitis
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)
s/s pf Viral Rhinitis
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
what would you use viral rhinitis?
________ _______Infectious acute inflammation of mucous membranes of the nasal cavity Highly contagious because virus is shed 2 days before symptoms appear
Viral Rhinitis
Formerly called sinusitis (either viral or bacterial)
Rhinosinusitis
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
Rhinosinusitis
purulent nasal drainage, nasal obstruction, facial pain, pressure or sense of fullness, headache, fever symptoms for more than 10 days after initial onset
s/s of bacterial Rhinosinusitis
similar but without high fever and generally no facial pain, pressure, or fullness- occur for fewer than 10 days
s/s of viral Rhinosinusitis
what assessment would you do for rhinosinusitis?
Assessment- tenderness to palpation of sinuses
t/f you use decongestants and saline spary for bacterial rhinosinusitis?
FALSE; those are treatment for viral rhinosinusitis
Treatment 5-7 days of antibiotics
Antibiotics should be administered as soon as __________ __________ is determined
Antibiotics- Augmentin, Levaquin
bacterial rhinosinusitis
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
Nursing care assessment
__________ acute- sudden painful inflammation of the _______- sore throat
Pharyngitis
pharynx
_________ is a more severe illness can cause infection in the blood stream, meningitis, rheumatic fever, nephritis
Strep
Pharyngitis bacterial most often is group __ ___________(strep throat)
A streptococcus pharyngitis
Which type of pharyngitis is more common?
viral infection
how is viral pharyngitis treated?
Viral is treated with supportive measures. Antibiotics have no effect
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
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
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
treatment for strep a pharyngitis
what kind of test would you use to identify strep?
rapid strep test
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
nursing care for pharyngitis
what kind of s/s would you have a pt report for worsening pharyngitis?
instruct to report s/s of worsening: dyspnea, drooling, inability to swallow, inability to fully open mouth
t/f tonsillitis can be confused with pharyngitis?
TRUE
what bleeding signs should you check for post op of tonsillectomy?
after surgery look for sx of bleeding such as patient with frequent swallowing, bleeding from mouth
what is a risk post op of tonsillectomy?
risk for hemorrhage
Reoccurring or hypertrophy of tonsils- may have __________
tonsillectomy
what are the s/s of tonsillitis
Symptoms: sore throat, fever, snoring, and difficulty swallowing
po op complication of tonsillectomy
Sx of postop complication- bleeding, fever, throat pain, ear pain
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
treatment for tonsillitis
what are risk factors for obstructive sleep apnea?
Obesity, male gender, postmenopausal status, and advanced age
what are the 3 S’s for OSA?
3 S’s: snoring, sleepiness, and significant other report of sleep apnea
CPAP, devices to prevent lying on back, weight loss, avoidance of alcohol
treatment for OSA
s/s for OSA
Frequent loud snoring with breathing cessation
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.
what happens during OSA?
10 seconds
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
how does tisk factors affect OSA?
2-4% of women and 8-9% of men
number of mena and women with sleep apnea
how many go undiagnosed with OSA?
80%
how does OSA interfere with a pt?
Interferes with ability to get adequate rest, affects memory, learning, and decision making
Recurrent episodes of upper airway obstruction and reduction of ventilation. Apnea during sleep caused by repetitive upper airway obstruction
what is OSA?
when does atelectasis often happen?
Atelectasis often happens after surgery due to not moving around, no deep breaths etc.
what is atelectasis?
Closure or collapse of alveoli- most common seen in post op
what are s/s of atelectatsis?
S/S: dyspnea, cough, and sputum production
what helps prevent atelectatsis?
Prevention: frequent turning, early mobilization, deep breathing, incentive spirometer, directed cough
Excessive secretions or mucus plus may cause obstruction of airflow and cause __________ in an area of the lung
atelectasis
what dose I COUGH stand for?
Incentive Spirometry
Cough
Oral Care
Understanding pt Education
GEt out of Bed
Head of bed elvated
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
The acronym I COUGH stands for:
__________________ __________Deep breathing exercises will help keep your lungs healthy and prevent lung problems. This breathing exercise needs to be done 10 times each hour.
Incentive Spirometry
________ ___ ________ __________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.
Cough and Deep Breathe
___________ ___________Brushing your teeth and using mouthwash twice a day keeps your mouth clean from germs.
Oral Care
______________ ___________ ____________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.
Understanding Patient Education
________ _____ _____ _____Walking will help clear secretions from your lungs, help your circulation and help to regain your strength.
Get out of Bed
________ ____ ______ _________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
Head of Bed Elevated:
Acute inflammation of the trachea and bronchial tree. Often follows infection of upper respiratory tract; Inflamed mucosa produce mucopurulent drainage
Tracheobronchitis
Dry irritating cough and scant amount of mucous, may have sternal soreness, fever, chills, night sweats, headache, and general malaise.
s/s of tracheobronchitis
what occurs when tracheobronchitis progresses?
short of breath, noisy breathing, and purulent sputum. If severe may have blood in secretions
what are treatment options for tracheobronchitis?
Antibiotics based on organism
Fluid intake
Humidification
Analgesics
what are the different types of pneumonia?
Community acquired pneumonia
Healthcare associated pneumonia
Hospital acquired pneumonia
Ventilator association pneumonia
Could be bacterial, viral, or fungal
what are the most common causes of death by infectious organisms?
Pneumonia and influenza
Inflammation of lung parenchyma (functioning parts of the lungs- bronchi, alveoli…)
Pneumonia
In the past HCAP, HAP and VAP were all called _________ infections
nosocomial
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
Community Acquired pneumonia
I will not ask you the difference in hospital acquired and healthcare acquired because the literature is differing on this
what will blatnick not ask
Often multidrug resistant organisms
Identifying is crucial, hard to treat
Long term care center
Heath care acquired pneumonia
Comorbid conditions, supine positioning and aspiration, coma, malnutrition, prolonged hospitalization, hypotension, metabolic disorders
Inappropriate use of antibiotics, use of NG tubes
Some things that put a patient at high risk are for hospital acquired pneumonia
private room, contact precautions used (gown, mask, gloves, antibacterial soap), decreased number of people in contact
MRSA pneumonia-
E coli, H influenzae, MRSA, s. pneumoniae.
Most colonized with multiple bacteria
Often accompanied by bacteremia, and positive blood cultures
common organism ass. with hospital acquired pneumonia
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
Aspiration pneumonia
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
pneumonia
Residence in LTC facility
Tube feedings
COPD, diabetes, heart failure, malnutrition, AIDS
Pneumonia Risk factors
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
s/s of pneumonia
pneumonia
what are prevention for pneumonia?
Pneumococcal vaccine- for all 65 and over
History (recent uri)
Chest xray, blood culture, sputum exam
CBC, chemistry
Assessment/Diagnostic Findings for pneumonia
Primarily supportive
Hydration and antipyretics
Antitussives
Warm moist inhalation
Bedrest
If hypoxemia occurs- oxygen administered
Pulse ox/ABG
Viral pneumonia
If suspected _________ _________ __________ treatment broad spectrum antibiotic may be one or multiple antibiotics. Rocephin, Unasyn, Levaquin.
Hospital acquired pneumonia
Status must be assessed ___ hours after the initiation of antibiotics and should be ___________ or ________ based on culture results.
72
discontinued or modified
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
Medical management of hospital acquired
__________ _____- 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)
Clinically stable
Medical management of hospital acquired
t/f do older pt have different sx for viral pneumonia?
TRUE; General deterioration, weakness, abdominal sx, anorexia, confusion, tachycardia, and tachypnea may signmal onset.
General deterioration, weakness, abdominal sx, anorexia, confusion, tachycardia, and tachypnea may signmal onset.
sx of geruatric patient viral pneumonia
what are the classic sx of viral pneumonia?
Classic sx of cough chest pain sputum production and fever may be masked or absent.
____________ _____ of cough chest pain sputum production and fever may be masked or absent.
Classic sx for viral pneumonia
what kind of treat would you give older pt for viral pneumonia?
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
_____________ ____________: 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
viral pneumonia
Supportive treatment
Gerontological considerations pneumonia
May be primary dx or complication of chronic disease
Often difficult to treat and have higher mortality rate
May be primary dx or complication of chronic disease
Often difficult to treat and have higher mortality rate
Gerontological considerations pneumonia
pneumonia assessment
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)
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)
pneumonia assessment
what are the pneumonia goals of care?
Improved airway patency
Maintenance of proper fluid volume
Maintenance of proper nutrition
Understanding of treatment protocol
Increased activity
Improved airway patency
Maintenance of proper fluid volume
Maintenance of proper nutrition
Understanding of treatment protocol
Increased activity
what are the pneumonia goals of care?
__________ _________:
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
Nursing pneumonia interventions
Airway patency:
Promote fluid intake:
__________ respirations leads to an increased loss of __________ fluids
Increased
insensible
____________ related to worsening of pneumonia is a poor sign. _________ may be related to hypoxemia, fever, dehydration, sleep __________, or __________ sepsis.
Confusion
Confusion
dehydration
deprivation
developing
Patients usually respond within __ to ___hours
24 to 48
Monitoring and managing potential complications pneumonia
Observe for response to antibiotic therapy
Check culture to see if correct antibiotic
Assess for confusion and other more subtle changes to cognitive status
Observe for response to antibiotic therapy
Check culture to see if correct antibiotic
Assess for confusion and other more subtle changes to cognitive status
Monitoring and managing potential complications pneumonia
