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Adult health 2 > Exam 2: Upper Resp > Flashcards

Exam 2: Upper Resp Flashcards

1
Q

Rhinitis

A

inflammation of the mucous membranes of the nose

can be acute (coryza), chronic, allergic

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2
Q

What are the symptoms of acute rhinitis

Nasal discharge

Eyes

Turbinates

Nasal polyps

Headache

A

watery then mucoid

tearing early

edematous

No

generalized

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3
Q

What are the symptoms of allergic rhinitis

Nasal discharge

Eyes

Turbinates

Nasal polyps

Headache

A

thin, watery

tearing, itching

pale, mucoid, edamatous

sometimes

generalized

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4
Q

What are the symptoms of chronic rhinitis

Nasal discharge

Eyes

Turbinates

Nasal polyps

Headache

A

serous, purulent

no tearing

enlarged

sometimes

generalized

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5
Q

Sinusitis

A

inflammation of the mucous membranes lining the sinuses (air-filled cavities)

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6
Q

Sinusitis

acute

subacute

chronic bacterial

fungal

A

Acute: less than 4 weeks: allergic, viral, and bacterial

Subacute: 4 to 12 weeks

Chronic bacterial: over 12 weeks

Fungal

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7
Q

Acute bacterial sinusitis is usually caused by

A

Strep pneumoniae, H. influenzae

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8
Q

Acute bacterial sinusitis: symptoms worsen over

A

48 to 72 hours with severe, localized pain and tenderness over involved sinu

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9
Q

Acute bacterial sinusitis examination revelas

A

enlarged turbinates with visible fluid

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10
Q

Acute bacterial sinusitis diagnosis

A

H and P, X ray, CT, MRI

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11
Q

Acute laryngitis

A

inflammation of the mucous membrane lining the larynx and edema of the vocal cords

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12
Q

Acute laryngitis symptoms

A

sore throat, hoarseness, loss of voice

WE DO SYMPTOMATIC TREATMENT

if persistant we may do a laryngoscopy

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13
Q

Laryngeal paralysis

A

laryngeal nerves or vagal nerve due to varied reason (prolonged intubation) that can be unilateral or bilateral

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14
Q

What are possible treatments of laryngeal paralysis

A

treat the underlying cause

tracheostomy

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15
Q

Acute laryngeal edema includes

A

anaphylaxis, urticaria, acute laryngitis, edema related to intubation

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16
Q

Acute laryngeal edema treatment

A

corticosteroid, epi, intubation, trach

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17
Q

What do traumas to upper airway include

A

fractures of nasal bones, septum

fractures of maxillary or zygomatic bones

jaw wiring

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18
Q

Epistaxis

A

kiesselbach plexus damage due to trauma, irritation, coagulant disorder resulting in nose bleeding

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19
Q

Epistaxis is

A

unilateral

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20
Q

Management of epistaxis

A

ice 10 to 15 minutes
alpha 1 agonist
silver nitrate cauterizing
nasal packing

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21
Q

Obstructive sleep apnea

A

airflow obstruction from narrowing of the air passages or obstruction of the pharynx by the tongue

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22
Q

What are complications of obstructive sleep apnea

A

HTN, cardiovascular disease, weight gain, memory loss, mood changes, job impairement

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23
Q

Sleep apnea s/s

A

snoring, choking, daytime sleepiness

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24
Q

management of sleep apnea

A

avoid alcohol, sleep medication

weight loss

lateral sleep position

CPAP if over 15 episodes in one hour

surgery if all else fails: uvulopalatopharyngoplasty

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25
Q

Restrictive pulmonary disorder

A

limited expansion of the lungs

intrinsic: pneumonia, acute bronchitis)
extrinsic: chest trauma, obesity, kyphoscoliosis

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26
Q

Vascular (pulmonary) disorders

A

narrowing or occlusion of the pulmonary blood vessels (PE)

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27
Q

Obstructive pulmonary disorder

A

limited airflow on expiration

e.g. COPD

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28
Q

When are antivirals effective with seasonal flu

A

if started within 24 to 48 hours of symptoms

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29
Q

Risk factors of COVID

A

cardio, DM, HTN, Lung disease, CKD, obesity, smoking, cancer

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30
Q

Physical findings with COVID

A

tachypnea, tachycardia, respiratory distress, abnormal CN l, rales, rhonchi, wheezing

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31
Q

Acute bronchitis

A

acute inflammation of the bronchi and usually the trach

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32
Q

Clinical manifestations of acute bronchitis

A

painful cough, sputum production, low-grade fever, malaise, rhonchi, wheeze

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33
Q

Acute bronchitis can progress to

A

pneu

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34
Q

Pneumonia

A

acute inflammation of the lung tissue

most common cause of death in US

35
Q

Prevention of pneu

A

PCV 13, PPSV 23, flu vaccine

36
Q

Patho of pneu

A

inflammatory response, alveoli fill with fluid (consolidation) and/or increased production of mucus (obstruction), decreased gas exchange, resolution of infection

37
Q

Types of pneu

A

community acquired

hospital acquired

ventilator associated (over 48 hours on it)

38
Q

What do we hear with pneumonia

A

tactile fremitus over these areas because fluid emphasizes vibration and ecophene

39
Q

What are the guidelines for hospital acquired pneu

A

following 48 hours or more hospital stay

VAP

40
Q

Pleural effusion vs empysema

A

Pleural: fluid in pleural space

Emphysema is fluid with pus in pleural space

41
Q

W/ emphysema what can we do to test the fluid

A

a thoracentesis

42
Q

COPD

A

disease state characterized by airflow obstruction resulting from chronic bronchitis or emphysema

43
Q

COPD is commonly caused by

A

smoking

tissue damage is not reversible and increases in severity lead to respiratory failure

44
Q

What are the two major changes that occur with emphysema

A

loss of lung elasticity and hyperinflation of the lung and use of accessory muscles

45
Q

With emphysema air is

A

trapped due to loss of elastic recoil in the alveolar walls, overstretching and enlarging the alveoli into bullae

46
Q

Drug therapy for COPD

A

beta adrenergic agents: bronchodilator prior to anticholinergic

choinergic antagonist

methylxanthines

corticosteroid (inhaled; IV for emergent)

muculytics

47
Q

What is asthma

A

bronchial asthma is intermittent and reversible airflow obstruction affecting only the airways, not the alveoli

inflammation
airway hyperresponsiveness

48
Q

Which nurse assessment finding during an acute asthma attack requires immediate interventions

A

diminished breath sounds

49
Q

What is status asthmaticus

A

severe, life threatening, acute episode of airway obstruction

intensifies once it begins and does not respond to common therapy

50
Q

TB is

A

highly contagious cause by mycobacterium TB transmitted via aerosolization

51
Q

What are signs of TB

A

low grade fever, hemoptysis, weight loss, night sweats

52
Q

Later with TB what do we see

A

elevated liver enzymes, RUQ pain, dyspnea, chest pain

53
Q

If the TB test is over 5mm induration what is the possible cause

A

HIV

people who had contact w/ a person with TB

people with fibrotic lesion on chest x ray consistent with TB

organ tranplants

immunosupressant

54
Q

If the TB test is over 10 mm induration what is the cause

A

recent immigrants

IV drug users

Residence and employees of high risk settings

people w/ clinical conditions

mycobacteriology lab personnel

55
Q

If the TB test is over 15 mm induration what is the cause

A

all other people who are at low risk

56
Q

Latent TB meds

A

6 to 9 months of INH and Vitamin B6

57
Q

Active TB meds

A

INH + RIF + PZA + ETM + Vitamin B6 x 2 months

INH + RIF + vitamin B6 x 4 months

58
Q

Negative sputum culture = ______ TB

A

no longer TB infection

59
Q

Rifampin can turn

A

urine, saliva or tears orange so avoid contact use

make patients sensitive to the sun

decrease birth control

decrease methadone levels

60
Q

What isolation is TB

A

airborne

61
Q

Both lungs connect to the _______ through the vessels and bronchus

A

mediastinum

62
Q

Who do we breathe: inspiration

A

CNS stimulates diaphragm to contract and descend

external intercostals contract and raise ribs

volume of chest cavity increases

pull them outwards

negative pressure increases

air flows in

63
Q

How do we breathe: expiration

A

respiratory muscles relax

chest wall and diaphragm return to normal position

volume of chest decreases

pressure increases

air flows out of the lungs

64
Q

what is flail chest

A

Flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks(usually 4 or more in 2 or more locations) due to trauma and becomes detached from the rest of the chest wall. Two of the symptoms of flail chest are chest pain and shortness of breath

65
Q

Management of flail chest

A

supplemental O2, pain contro, respiratory care

66
Q

Pneumothorax causes

A

surgery
trauma
line placement

air enters the lung and moves through the visceral pleura to the pleural space

makes the pressure more positive

67
Q

Open pneumothorax

A

opening in the chest wall allows outside air to enter through the chest and parietal pleura into the pleural space

68
Q

Hemothorax

A

blood or serosanguineous fluid collects in the pleural space instead of air

69
Q

Hemopneumothorax

A

air and blood

70
Q

Tension pneumothorax

A

more serious than simple

air leaks in and becomes trapped so volume of air continues to build

can cause a mediastinal shift

compression of heart and great vessels

71
Q

Chest tube sizes

A

small for air
large for blood/fluid

72
Q

Placement of chest tube

A

air rises so high on chest for pneumothorax and blood settles so low on chest for hemothorax

73
Q

Collection chamber

A

collects drainage

allows for monitoring of the volume, rate, and nature of drainage

holds up to 2500 cc

74
Q

Collection chamber: blood drainage should be monitored for

A

clots –> notify HCP if they are seen

75
Q

stripping a collection tube

A

a technique used to remove clots or debris from the tube by squeezing and moving it in a way that pushes the contents toward the drainage chamber

do not routinely strip the tube as stripping can create high negative pressure, causing discomfort and tissue damage

76
Q

Water seal chamber

A

used as a seal or a one way valve to allow air or fluid to drain from the patient’s chest but not return

77
Q

What do we monitor for with water seal chamber

A

bubbling, tidaling, negative pressure

bubbling may be present after initial insertion when patient has an air leak into the pleural space

78
Q

What is true about bubbling in a water seal chamber

A

in large amounts it can indicate a large air leak

should stop once lung is re inflated

if excessive rule out a leak in drainage system

check all connection sites and notify MD

79
Q

What is tidaling

A

fluctuation in the fluid level of the water seal chamber

reflects changes in pressure in the pleural space

normally will fluctuate 5 to 10 cm, the column of water will go up with inspiration and down with expiration

80
Q

Suction control chamber

A

suction will increase the drainage rate and help re expand the lungs

dry system the suction is controlled by a dial

wet system it is controlled by water

81
Q

Chest tubes should be _______ below a patients chest

A

1 foot

82
Q

What do we do if a chest tube becomes dislodged

A

place a gauze with tape on three sides, leave lower part untaped

either case, notify HCP and prepare x ray

83
Q

When do we change dressings for chest tubes

A

every 48 hours

do not remove Dsg for 24 hours post insertion

use petroleum gauze

84
Q
A

Adult health 2 (15 decks)

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