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NURS 500 > Exam 2 - respiratory > Flashcards

Exam 2 - respiratory Flashcards

1
Q

Which individuals should be prioritized for the influenza vaccine?

A

Adults with chronic pulmonary and cardiovascular conditions and renal, hepatic, neurologic, hematologic, or metabolic disorders Immunocompromised, morbidly obese, adults >50 years of age Pregnant women and women up to 2 weeks postpartum Residents in nursing homes and longterm care facilities, healthcare personnel Household contacts and caregivers of children <5 years and adults >50 years with clinical conditions placing them at higher risk

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2
Q

Which individuals should be prioritized for the pneumococcal vaccine?

A

Adults >65 years Children and adults 2-64 years with chronic illnesses associated with increased risk (sickle cell, cardiovascular and pulmonary disease, DM, alcoholism, cirrhosis, cochlear implants, leaks of CSF) Adults 19-64 who are smokers or have asthma Adults and children >2 years who are immunocompromised Residents of nursing homes or longterm care facilities

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3
Q

What are the various lung cancer screening recommendations?

A

Annual low-dose computed tomography (LDCT) for current smokers (or those who have quit within the last 15 years) aged 55-79 years American Cancer Society - annual screening until 74 years old

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4
Q

Causes of chest pain: angina pectoris - process

A

Temporary myocardial ischemia (secondary to coronary atherosclerosis)

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5
Q

Causes of chest pain: angina pectoris - symptoms

A

Dyspnea, nausea, sweating

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6
Q

Causes of chest pain: angina pectoris - quality

A

Pressing, squeezing, tight, heavy, occasionally burning Often described as discomfort rather than pain

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7
Q

Causes of chest pain: MI - process

A

Prolonged myocardial ischemia, resulting in irreversible muscle necrosis

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8
Q

Causes of chest pain: MI - symptoms

A

Dyspnea, N/V, sweating, weakness

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9
Q

Causes of chest pain: MI - quality

A

Pressing, squeezing, tight, heavy, occasionally burning

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10
Q

Causes of chest pain: pericarditis - process

A

Irritation of parietal pleura adjacent to pericardium

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11
Q

Causes of chest pain: pericarditis - symptoms

A

Seen in autoimmune disorders, post myocardial infarction, viral infection, chest irradiation

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12
Q

Causes of chest pain: pericarditis - quality

A

Sharp, knife-like

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13
Q

Causes of chest pain: aortic dissection - process

A

Splitting within layers of aortic wall, allowing passage of blood to dissect a channel

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14
Q

Causes of chest pain: aortic dissection - symptoms

A

Hoarseness, dysphagia, syncope, hemiplegia, paraplegia

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15
Q

Causes of chest pain: aortic dissection - quality

A

Ripping, tearing

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16
Q

Causes of chest pain: pleuritic pain - process

A

Inflammation of parietal pleura (e.g. pleurisy, PNA, pulmonary infarction)

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17
Q

Causes of chest pain: pleuritic pain - symptoms

A

Of underlying illness

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18
Q

Causes of chest pain: pleuritic pain - quality

A

Sharp, knife-like

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19
Q

Causes of chest pain: GERD - process

A

Irritation or inflammation of esophageal mucosa

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20
Q

Causes of chest pain: GERD - symptoms

A

Regurgitation, dysphagia, cough, laryngitis, asthma

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21
Q

Causes of chest pain: GERD - quality

A

Burning, squeezing

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22
Q

Causes of chest pain: diffuse esophageal spasm - process

A

Motor dysfunction of esophageal muscle

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23
Q

Causes of chest pain: diffuse esophageal spasm - symptoms

A

Dysphagia

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24
Q

Causes of chest pain: diffuse esophageal spasm - quality

A

Squeezing

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25
Q

Causes of chest pain: chest wall pain, costochondritis - process

A

Trauma, inflammation of costal cartilage

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26
Q

Causes of chest pain: chest wall pain, costochondritis - symptoms

A

Local tenderness

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27
Q

Causes of chest pain: chest wall pain, costochondritis - quality

A

Stabbing, sticking, or dull, aching

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28
Q

Causes of chest pain: anxiety, panic disorder - symptoms

A

Breathlessness, palpitations, weakness, anxiety

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29
Q

Causes of chest pain: anxiety, panic disorder - quality

A

Stabbing, sticking, or dull, aching

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30
Q

Causes of dyspnea: left sided HF - process

A

Elevated pressure in pulmonary capillary bed with fluid into interstitial spaces and alveoli, decreased compliance, increased work of breathing

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31
Q

Causes of dyspnea: left sided HF - timing

A

Dyspnea may progress slowly or suddenly like in acute pulmonary edema

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32
Q

Causes of dyspnea: left sided HF - symptoms

A

Cough, orthopnea, paroxysmal nocturnal dyspnea, sometimes wheezing

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33
Q

Causes of dyspnea: chronic bronchitis - process

A

Excessive mucus production in bronchi followed by chronic obstruction of airways

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34
Q

Causes of dyspnea: chronic bronchitis - timing

A

Chronic productive cough followed by slowly progressive dyspnea

35
Q

Causes of dyspnea: chronic bronchitis - symptoms

A

Chronic productive cough, recurrent respiratory infections, wheezing

36
Q

Causes of dyspnea: COPD - process

A

Over distention of air spaces distal to terminal bronchioles, with destruction of alveolar septa, alveolar enlargement, limitations of expiratory air flow

37
Q

Causes of dyspnea: COPD - timing

A

Slowly progressive dyspnea, mild cough later

38
Q

Causes of dyspnea: COPD - symptoms

A

Cough, scant mucoid sputum

39
Q

Causes of dyspnea: asthma - process

A

Reversible bronchial hyper responsiveness, increased airway secretions, bronchoconstriction

40
Q

Causes of dyspnea: asthma - timing

A

Acute episodes, separated by symptom-free periods (nocturnal periods common)

41
Q

Causes of dyspnea: asthma - symptoms

A

Wheezing, cough, tightness in chest

42
Q

Causes of dyspnea: diffuse interstitial lung diseases - process

A

Abnormal and widespread infiltration of cells, fluid, collagen into interstitial space between alveoli

43
Q

Causes of dyspnea: diffuse interstitial lung diseases - timing

A

Progressive dyspnea

44
Q

Causes of dyspnea: diffuse interstitial lung diseases - symptoms

A

Weakness, fatigue, cough less common

45
Q

Causes of dyspnea: PNA - process

A

Infection of lung parenchyma from the respiratory bronchioles of the alveoli

46
Q

Causes of dyspnea: PNA - timing

A

Acute illness; timing varies with causative agent

47
Q

Causes of dyspnea: PNA - symptoms

A

Pleuritic pain, cough, sputum, fever

48
Q

Causes of dyspnea: spontaneous pneumothorax - process

A

Leakage of air into pleural space through blebs on visceral pleura –> partial or complete collapse of the lung

49
Q

Causes of dyspnea: spontaneous pneumothorax - timing

A

Sudden onset dyspnea

50
Q

Causes of dyspnea: spontaneous pneumothorax - symptoms

A

Pleuritic pain, cough

51
Q

Causes of dyspnea: acute pulmonary embolism - process

A

Sudden occlusion of part pulmonary arterial tree by blood clot that usually originates in deep veins of legs or pelvis

52
Q

Causes of dyspnea: acute pulmonary embolism - timing

A

Sudden onset dyspnea, tachypnea

53
Q

Causes of dyspnea: acute pulmonary embolism - symptoms

A

Retrosternal oppressive pain if massive occlusion, pleuritic pain, cough, syncope, hemoptysis, unilateral leg swelling and pain from instigating DVT

54
Q

Causes of dyspnea: anxiety with hyperventilation - process

A

Overbreathing, with resultant respiratory alkalosis and fall in arterial partial pressure of CO2

55
Q

Causes of dyspnea: anxiety with hyperventilation - timing

A

Episodic, often recurrent

56
Q

Causes of dyspnea: anxiety with hyperventilation - symptoms

A

Sighing, lightheadedness, numbness or tingling of hands and feet, palpitations, chest pain

57
Q

Causes of cough and hemoptysis: laryngitis - symptoms

A

Acute fairly minor illness with hoarseness Often associated with viral rhino sinusitis

58
Q

Causes of cough and hemoptysis: acute bronchitis - symptoms

A

Acute, often viral, illness general w/o fever or dyspnea At times with burning retrosternal discomfort

59
Q

Causes of cough and hemoptysis: mycoplasma and viral PNA - symptoms

A

Acute febrile illness, often with malaise, HA, possible dyspnea

60
Q

Causes of cough and hemoptysis: bacterial PNA - symptoms

A

Acute illness with chills, high fever, dyspnea, chest pain

61
Q

Causes of cough and hemoptysis: postnasal drip - symptoms

A

Seen in posterior pharynx Associated with allergic rhinitis, with or without sinusitis

62
Q

Causes of cough and hemoptysis: chronic bronchitis - symptoms

A

Recurrent wheezing and dyspnea

63
Q

Causes of cough and hemoptysis: bronchiectasis - symptoms

A

Recurrent bronchopulmonary infections, sinusitis may co-exist

64
Q

Causes of cough and hemoptysis: pulmonary TB - symptoms

A

Early, no symptoms Later, anorexia, weight less, fatigue, fever, night sweats

65
Q

Causes of cough and hemoptysis: lung abscess - symptoms

A

Usually from aspiration PNA with fever and infection Often with dysphagia or episodes of impaired consciousness

66
Q

Causes of cough and hemoptysis: asthma - symptoms

A

Episodic wheezing and dyspnea, cough may occur alone History of allergies

67
Q

Causes of cough and hemoptysis: GERD - symptoms

A

Wheezing (at night, often mistaken for asthma), early morning hoarseness, repeated attempts to clear throat Heartburn and regurgitation

68
Q

Causes of cough and hemoptysis: lung cancer - symptoms

A

Dyspnea, weight loss

69
Q

Causes of cough and hemoptysis: left ventricular failure or mitral stenosis - symptoms

A

Dyspnea, orthopnea, paroxysmal nocturnal dyspnea

70
Q

Causes of cough and hemoptysis: pulmonary embolism - symptoms

A

Tachypnea, chest or pleuritic pain, dyspnea, fever, syncope, anxiety

71
Q

Causes of cough and hemoptysis: irritating particles, chemicals, gases

A

Exposure to irritants; eyes, nose, throat

72
Q

What exam findings would the FNP expect in the patient with: pneumonia?

A

Percussion: dull Trachea: midline Breath sounds: bronchial over involved area Adventitious sounds: late inspiratory crackles Tactile fremitus: increased (w/ egophony, bronchophony)

73
Q

What exam findings would the FNP expect in the patient with: COPD?

A

Percussion: hyperresonant Trachea: midline Breath sounds: decreased to absent, with delayed expiration Adventitious sounds: none Tactile fremitus: decreased

74
Q

What exam findings would the FNP expect in the patient with: atelectasis?

A

Percussion: dull Trachea: shifted toward involved side Breath sounds: usually absent when bronchial plugs persist Adventitious sounds: none Tactile fremitus: usually absent when bronchial plugs persist

75
Q

What exam findings would the FNP expect in the patient with: pleural effusion?

A

Percussion: dull Trachea: shifted toward unaffected side in large effusions Breath sounds: decreased to absent Adventitious sounds: none except a possible pleural rub Tactile fremitus: decreased to absent, but may be increased toward top of large effusion

76
Q

What exam findings would the FNP expect in the patient with: pneumothorax?

A

Percussion: hyper resonant Trachea: shifted toward unaffected side if tension Breath sounds: decreased to absent Adventitious sounds: none, except possible pleural rub Tactile fremitus: decreased to absent

77
Q

What exam findings would the FNP expect in the patient with: asthma?

A

Percussion: resonant to diffusely hyperresonant Trachea: midline Breath sounds: often obscured by wheezes Adventitious sounds: wheezes, possibly crackles Tactile fremitus: decreased

78
Q

What exam findings would the FNP expect in the patient with: rib fracture?

A

Tenderness, bruising, bony “step offs”, increase in local pain

79
Q

What exam techniques would the FNP use to assess for a rib fracture?

A

AP compression of chest will elicit local pain and tenderness One hand on sternum, and other side of thoracic spine, squeeze chest

80
Q

What are the various locations in which retractions can occur?

A
81
Q

What is different about the pediatric thorax and lung exam as compared to the adult?

A

Infant breath sounds louder and harsher than those adults because stethoscope closer to origin of sounds

Periodic breathing (5-10 seconds)

Check for retractions, nasal flaring, grunting, wheezing

82
Q

What are the pediatric cutoffs for bradypnea? Tachypnea?

A

Tachypnea >60/min from birth to 2 months and >50/min from 2-12 months

83
Q

What exam findings would the FNP expect in the patient with: PNA in peds?

A

Best physical finding to r/o PNA is absence of tachypnea

Rapid respirations (up to 80-90/min) and increased work of breathing (grunting, nasal flaring, use of acessory muscles)

84
Q

What exam findings would the FNP expect in the patient with: croup?

A

Stridor, hoarse voice plus cough, prolonged inspiration

NURS 500 (8 decks)

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