exam 2 study guide Flashcards
what is the purpose of a chest X-ray
used to determine the position of tubes, catheters, and other objects inserted into the chest. also used to follow the progression of lung diseases.
what are the terms related to CXR for pleural effusion
- blunting of the costophrenic angles
- meniscus sign (fluid tracking up the chest wall)
- partially obscured diaphragm
- tracheal deviation away
what are the terms related to CXR for CHF
- pulmonary edema
- batwing/butterfly pattern
- increased interstitial markings
- fluffy opacities
- cardiomegaly
- Kerley B lines
what are the terms related to CXR for interstitial lung disease
- diffuse opacities
- nodular opacities
- reticular opacities
- reticulonodular opacities
- honeycombing
what are the terms related to CXR for pneumothorax
- increased radiolucency
- loss of vascular markings
- deep sulcus sign
what is the definition of silhouette sign
when examining the lung fields of a normal CXR, the silhouettes of the heart borders, the ascending and descending aorta, the aortic knob and the hemidiaphragms should be clear. Obliteration of any of these silhouettes by consolidated lung tissue is know as a silhouette sign.
what CXR is used to assess the extent of pleural effusion
lateral decubitus view is used to demonstrate pleural fluid
what is the most common site for arterial punctures
radial due to it being more superficial, has collateral circulation, and is easier.
what is CaO2
arterial oxygen content
formula to calculate CaO2
(1.34 X HB X SaO2) + (0.003 X PaO2)
what causes a oxyhemoglobin disassociation to curve right?
- decreased PH, increase PaCO2
- increased T(fever), increased 2-3 DPG
- decreased HB O2 bond
- increased tissue release
what causes a oxyhemoglobin disassociation to curve left?
- increased PH, decrease PaCO2
- decreased T(fever), decreased 2-3 DPG
- increased HB O2 bond
- decreased tissue release
formula for calculating PAO2
PAO2= FiO2 X (PB-PH2O) - (PaCO2 X 1.25)
a/A ratio
calculate PAO2 and PaO2 is given divide them to find a/A ratio
PaO2/PAO2
what to check prior to ABG draw
- patient name/DOB
- order
- Allens test (collateral circulation)
- dominant hand
- Check meds/blood thinners
- oxygen
what is the best indicator for adequate ventilation
ABG taken, PaCO2 is the best index of adequacy for alveolar minute ventilation (35-45mmHg)
gold standard for diagnosis of cystic fibrosis
sweat chloride test is considered the gold standard for CF diagnosis, it measures the amount of sodium and chloride in patient’s sweat
less than or equal to 29= unlikely CF
30-59 possible CF
greater than or equal to 60 diagnostic for CF
what is the treatment for CF
- oxygen therapy-treat hypoxemia
- airway clearance- mobilize secretions (pep therapy, vest, percussion, postural drainage)
- lung expansion therapy- IS, CPAP, IPV
- aerosolized meds
SABA: albuterol
LABA: salmeterol/formoterol
SAMA: ipratropium bromide
LAMA: tiotropium
nebulizer antibiotics for CF
1.Tobramycin: given for pseudomonas infection
2. Azithromycin: anti-inflammatory helps improve lung function
3. ibuprofen: helps reduce progression of disease
4. corticosteroids: only given when having asthmatic exacerbation
Mucolytics used for CF
- dornase alpha (pulmozyme): specific to CF pts
- Hypertonic saline (7%): used to hydrate mucus in airways
(mucomyst should not be given to CF patients)
genetic % with carrier parents
25% chance of getting CF with two carrier parents
50% chance of getting CF with one parent having CF and one being a gene carrier
factors that play a role in the development of atelectasis
- inadequate lung expansion
- weak or impaired cough
- decreased ciliary movement
what are the risk factors for atelectasis
- HX of pulmonary disease
- obesity
- increased age
- smoking
- increased surgery length
- inadequate Vt during procedure
- malnutrition
what surgery has the greatest risk for the development of atelectasis
most common after upper abdominal or thoracic surgery in adults, children, and infants
what are the breath sounds associated with early developing atelectasis
- absent/diminished
- inspiratory crackles
- bronchial breath sounds
what are the most common ABG findings in patients with atelectasis
hypoxemia is the most common finding
severity of hypoxemia doesn’t always correlate with the extent of atelectasis on CXR
treatment for mild atelectasis
oxygen therapy: treat hypoxemia
Lung expansion therapy:
1. incentive spirometry
2. deep breathe/cough
3.PAP therapy
4. IPPB (not common)
secretion mobilization
1. adequate hydration
2. vest therapy
3. OPEP (aerobika)
4. IPV
bronchoscopy: only used when obstruction (mucus plug) is suspected
mechanical ventilation: only in severe cases
what is the definition of atelectasis
partial or complete collapse of previously expanded alveoli
most common type of pneumonia
nosocomial infection
most common bacteria to cause pneumonia
streptococcus pneumoniae
what are the symptoms for pneumonia
- fever
- chills
- cough
- sputum production
- SOB
- pleuritic chest pain
- dyspnea (more common when multiple regions of the lungs are involved)
- headache
- skin rash
- diarrhea
what to look for when assessing pneumonia
1.tachypnea
2. tachycardia
3. cyanosis
4. unilateral chest expansion or decrease in chest expansion
5. palpation: increased fremitus
6. percussion: dull/decreased resonance note
7. auscultation: bronchial breath sounds over consolidated areas, crackles, pleural rub, or diminished/absent bs
secondary assessment testing for PNA
- CBC: WBCS increase with bacterial infection, WBCs may be normal if viral or non-bacterial
- Sputum culture: performed to identify pathogen responsible for infection
- ABG: typically reveal respiratory alkalosis, or may eventually show respiratory failure (respiratory acidosis)
- CXR: helps confirms pneumonia
Lobar pneumonia- consolidation over entirety of lungs
bronchopneumonia- patchy segmental distribution
factors that increase the risk for developing pneumonia
- diabetes
- cirrhosis
- renal/heart disease
- AIDS
- cancer/leukemia (chemo/radiation)
- steroid use
risk of artificial airways vs not
with an artificial airway it bypasses natural defenses, which can cause bacteria to directly enter the lower respiratory tract. with an artificial airway there is a higher risk of aspiration, most commonly in the right lung (micro aspiration of oropharyngeal or gastric contents) vs without. no ventilator= less exposure to hospital acquired bacteria
routes for developing pneumonia
- droplet: transmitted through small, aerosolized droplets that are produced by cough, sneeze, talking. can land on surfaces and contaminate them (fomite)
- CAP: community acquired
- HAP: hospital acquired pneumona- 48 hours after hospital admission
- HCAP: healthcare associated- such as care home facilities
- VAP: ventilator associated (secondary)
- aspiration pneumonia: most common in right lung
- pneumocystis jiroveci pneumonia: fungal pneumonia seen in immunocompromised (HIV/AIDS)
treatment for pneumonia
- fluid and nutritional therapy
- oxygen- adress hypoxemia
- bronchodilators- if wheezing is occurring or with HX of asthma/COPD
- antipyretics/analgesics- for fever/pain
- lung expansion therapy
- airway clearance therapy
- suctioning
- NIPPV or mechanical ventilation (severe)
- Antibiotics (important to give early)
azithromycin- streptococcus pneumoniae
cefepime(cephalosporin)- pseudomonas aeruginosa
Ceftriaxone- haemophilus influenzae
organisms that cause pneumonia
- streptococcus pneumoniae
- pseudomonas aeruginosa
- Haemophilus influenzae
