Exam 3 (Ch. 27, 28, 29, & 30) Flashcards
Diagnostic Tests
What is pulse oximetry (Pulse Ox)?
What does it measure?
A noninvasive method to monitor the oxygen saturation of hemoglobin in arterial blood (SpO2).
Provides a quick and easy way to assess oxygenation.
Diagnostic Tests
What is a sputum culture?
What does it help diagnose?
A laboratory test to identify the presence of bacteria or other microorganisms in a sample of sputum (phlegm) coughed up from the lungs.
Helps diagnose respiratory infections and guide antibiotic treatment.
Diagnostic Tests
What does an allergy skin test identify?
What is a TB skin test (PPD) used for?
Allergies: Skin tests can identify allergens that trigger respiratory symptoms, such as asthma or allergic rhinitis.
Tuberculosis (TB): The tuberculin skin test (TST) is used to detect latent TB infection.
Diagnostic Tests
What is a lung biopsy?
What does it help diagnose?
A procedure to obtain a tissue sample from the lung for examination under a microscope.
Helps diagnose lung cancer, infections, and other lung diseases.
Diagnostic Tests
What is a capnography?
What does it measure?
CO2 Monitoring
Measures the level of carbon dioxide (CO2) in exhaled breath.
Provides information about ventilation and gas exchange.
Diagnostic Tests
What do arterial or mixed venous blood gas analysis measure?
What kind of assessment do they provide?
Arterial or Mixed Venous: Measures the levels of oxygen, carbon dioxide, and pH in arterial or mixed venous blood.
Provides a comprehensive assessment of respiratory and metabolic function.
Diagnostic Tests
What is a bronchoscopy?
What is it used to diagnose?
A procedure that involves inserting a thin, flexible tube with a camera into the airways to visualize the lungs and collect samples.
Used to diagnose and treat various lung conditions.
Diagnostic Tests
What is a pulmonary function test?
What does it assess?
A group of tests that measure lung volume, capacity, and flow rates.
Helps assess lung function and diagnose respiratory diseases.
Diagnostic Tests
What is a thoracentesis?
What does it help diagnose?
A procedure to remove fluid or air from the pleural space (the space between the lungs and chest wall).
Helps diagnose and treat pleural effusions (fluid buildup) or pneumothorax (air in the pleural space).
Risk Factors, Symptoms & Diagnosis
What is a V/Q scan?
(Ventilation/Perfusion Scan):
Used if the patient cannot have contrast dye (e.g., due to kidney problems).
Assesses airflow (ventilation) and blood flow (perfusion) in the lungs.
Risk Factors, Symptoms & Diagnosis
What is a CT Angiography?
A specialized type of computed tomography (CT) scan used to visualize blood vessels throughout the body
- Uses intravenous (IV) contrast dye to visualize blood vessels in the lungs.
Considered the gold standard for diagnosing PE.
Detection of Head/Neck Cancer
What diagnostic tools are used for head/neck cancer?
Direct Visualization: Using techniques like laryngoscopy or endoscopy to directly visualize the larynx and other areas of the head and neck.
Chest X-Ray: To check for lung involvement or metastasis.
Biopsy: Taking a tissue sample for microscopic examination to confirm the diagnosis of cancer.
Lung Cancer: Diagnosis, Treatment & Management
What diagnostic tools are used for lung cancer?
Chest X-ray: Initial imaging to identify potential lung abnormalities.
CT Guided Biopsy: Obtaining a tissue sample for microscopic examination under CT guidance to confirm the diagnosis.
Bronchoscopy: Visual examination of the airways and collection of tissue or fluid samples.
Importance of Diagnosis: Diagnosis is necessary for appropriate staging and treatment planning.
Nursing management of TB
For patients discharged with TB, what should be included in their discharge education?
Avoid Heavily Populated Areas: Instruct patients to avoid crowded places.
Wear Mask in Public: Advise patients to wear a mask when in public.
Use Kleenex for Cough/Sneeze: Teach patients to cover their mouth and nose with a tissue when coughing or sneezing.
Sleep Alone: Recommend that patients sleep alone to minimize the risk of transmission to family members.
Pt. should also avoid the very young/old & pregnant
Pneumonia
What is Pneumonia?
Inflammation of the lung parenchyma (the functional tissue of the lung) caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses.
Still associated with significant morbidity (illness) and mortality (death).
8th leading cause of death in the US (CDC).
Pneumonia
What are the classifications of pneumonia?
Community-Acquired Pneumonia (CAP): Acquired outside of a hospital or healthcare setting.
Hospital-Acquired Pneumonia (HAP): Acquired during a hospital stay.
Ventilator-Associated Pneumonia (VAP): Acquired by patients on mechanical ventilators.
Pneumonia
What scale is used to assess the severity of pneumonia?
CURB-65 Scale
Pneumonia
What is one of the biggest complications when it comes to treating pneumonia?
Multi-Drug Resistant Pathogens:
* MRSA (Methicillin-resistant Staphylococcus aureus).
* Gram-negative bacilli.
Medical Management
How is the antibiotic used for pneumonia treatment determined?
Based on culture and sensitivity results to target the specific pathogen causing the infection.
Antibiotics are not effective against viral infections.
Antibiotics may be used if a secondary bacterial infection develops.
Medical Management
What are some supportive pneumonia treatments?
Fluids: To maintain hydration.
Oxygen for Hypoxia: To address low oxygen levels.
Antipyretics: To reduce fever.
Antitussives: To suppress cough.
Decongestants: To relieve nasal congestion.
Antihistamines: To alleviate allergy symptoms.
Balance Rest with Activity: To promote recovery without overexertion.
VTE Prophylaxis: To prevent venous thromboembolism (blood clots).
Prevention
What is the primary prevention of pneumonia?
other than avoiding the those with pneumonia
Pneumococcal vaccination
- Reduces the incidence of pneumonia, hospitalizations for cardiac conditions, and deaths in the older adult population.
Prevention
Who are the pneumococcal vaccines recommended for?
Recommended for all adults 65 years of age or older and 19 years or older with conditions that weaken the immune system.
There are two types of pneumococcal vaccines.
Chest Tube Dislodgement
What actions should be taken when a patient’s chest tube becomes dislodged?
A dislodged chest tube is a medical emergency that requires immediate intervention.
- Immediately cover the insertion site with a sterile occlusive dressing (such as petroleum gauze) to prevent air from entering the pleural space. If sterile petroleum gauze is not immediately available, use any clean dry gauze and cover with tape.
- Secure the Dressing: Tape the dressing securely on three sides, creating a “flutter valve” effect. This allows air to escape but prevents it from re-entering.
- Notify the Physician, Immediately.
- Closely monitor the patient’s respiratory status, including oxygen saturation, respiratory rate, and breath sounds.
- Be prepared to assist with the reinsertion of a new chest tube.
Crackles in Lungs - Pharmacology
What are crackles (rales)?
Abnormal lung sounds that indicate fluid in the alveoli or small airways.
They are often associated with conditions like pulmonary edema, pneumonia, and heart failure.
Crackles in Lungs - Pharmacology
What are some pharmacological interventions for crackles?
- Diuretics (e.g., furosemide): Used to remove excess fluid from the body, including the lungs.
- Effective in treating pulmonary edema caused by heart failure.
- Antibiotics: Used to treat pneumonia caused by bacterial infections.
- Oxygen Therapy: To improve oxygenation in patients with respiratory distress.
- Bronchodilators: These may be used if the crackles are accompanied by bronchospasm.
- Cardiac Medications: If the crackles are caused by heart failure medications to improve heart function are needed.
Bronchodilators
What do bronchodilators do?
Relax the smooth muscles of the airways, leading to bronchodilation (widening of the airways).
Bronchodilators
What are some examples of Bronchodilators?
Beta-2 Agonists (e.g., albuterol, salmeterol):
* Short-acting beta-2 agonists (SABAs) like albuterol are used for acute bronchospasm.
* Long-acting beta-2 agonists (LABAs) like salmeterol are used for long-term control of asthma and COPD.
Anticholinergics (e.g., ipratropium, tiotropium):
* Block the action of acetylcholine, leading to bronchodilation.
* Often used in combination with beta-2 agonists for COPD.
Methylxanthines (e.g., theophylline):
* Less commonly used due to their narrow therapeutic index and potential for side effects.
Oxygen delivery devices
What are low-flow systems?
Examples?
Systems that deliver oxygen at a flow rate that is less than the patient’s inspiratory flow, so room air is mixed with the supplemental oxygen.
Examples:
Nasal Cannula:
* Flow rate: 1-6 L/min.
* FiO2: 24-44%.
Simple Face Mask:
* Flow rate: 5-10 L/min.
* FiO2: 35-55%.
Oxygen Reservoir Masks (Partial Rebreather and Non-Rebreather):
* Flow rate: 6-11 L/min.
* FiO2: 40-70%.
Non-Rebreather:
* Flow rate: 10-15 L/min.
* FiO2: 60-90%.
Oxygen delivery devices
What are high-flow systems?
Examples?
These systems deliver oxygen at a flow rate that meets or exceeds the patient’s inspiratory flow, providing a more precise FiO2.
Examples:
Venturi Mask:
* Uses a Venturi principle to deliver a precise FiO2.
* Different color-coded adapters are used to deliver different FiO2 levels.
* Flow rates and FiO2 vary depending on the adapter.
High-Flow Nasal Cannula (HFNC):
* Delivers heated and humidified oxygen at high flow rates through a nasal cannula.
* Flow rates: up to 60 L/min.
* FiO2: up to 100%.
Aerosol Mask/Face Tent/Tracheostomy Collar:
* These devices deliver humidified oxygen.
* Used for patients with tracheostomies or those who require high humidity.
* FiO2 is controlled by the flow meter and oxygen source.
Oxygen Safety
What are some key aspects of oxygen safety?
No smoking or open flames should be allowed in the vicinity of oxygen use.
Equipment Safety:
Ensure that oxygen equipment is in good working order and properly maintained.
Use appropriate flow rates and delivery devices as prescribed.
Instruct patients to avoid using flammable materials near oxygen.
Storage:
Store oxygen tanks upright and secured to prevent falls in a cool, well-ventilated area away from heat sources.
Electrical Safety:
Ensure all electrical equipment is properly grounded to prevent sparks.
Do not use electrical equipment with frayed cords or damaged plugs.
Post “No Smoking” signs in areas where oxygen is in use.
Pneumothorax
What is a Pneumothorax?
Air that has entered the pleural cavity (the space between the lungs and the chest wall).
Pneumothorax
What are the types of Pneumothoraxes?
Types:
Open: Air enters the pleural space through an opening in the chest wall.
Closed: Air enters the pleural space from within the lung or airway.
Spontaneous: Occurs without an apparent cause.
Iatrogenic: Caused by a medical procedure.
Tension: A life-threatening condition where air accumulates in the pleural space and cannot escape, leading to increased pressure and compression of the heart and other organs.
Diagnosis:
Based on the situation (cause), symptoms, and chest X-ray (if time allows).
Pneumothorax
What are some symptoms of Pneumothorax?
Symptoms:
Dyspnea (shortness of breath).
Mild tachycardia (rapid heart rate).
Air hunger.
Respiratory distress.
O2 desaturation (low oxygen levels).
Absent breath sounds over the affected area.
Mediastinal shift towards the unaffected side (in tension pneumothorax).
Pneumothorax
What treatments are used for Pneumothorax?
Treatment:
Supportive Care: May be sufficient for small pneumothoraces with minimal symptoms.
Chest Tube: Insertion of a chest tube to remove air from the pleural space and allow the lung to re-expand.
Thoracentesis
What is a Thoracentesis?
A procedure to remove fluid or air from the pleural space (the space between the lungs and the chest wall).
Thoracentesis
What is the purpose of a thoracentesis?
2
Diagnostic: To obtain a sample of pleural fluid for analysis to diagnose the cause of the effusion (fluid buildup).
Therapeutic: To remove excess fluid or air and relieve symptoms such as shortness of breath or chest pain.
Thoracentesis
How is a thoracentesis performed?
A needle is inserted through the chest wall into the pleural space under local anesthesia.
Fluid or air is withdrawn using a syringe or drainage system.
Thoracentesis
What are some
nursing considerations before, during, & after a thoracentesis?
Pre-Procedure:
* Obtain informed consent.
* Explain the procedure to the patient.
* Assess vital signs and respiratory status.
* Position the patient appropriately (usually sitting upright, leaning forward).
During Procedure:
* Monitor vital signs and respiratory status.
* Provide emotional support to the patient.
* Assist the physician as needed.
Post-Procedure:
* Monitor vital signs and respiratory status.
* Assess for complications such as bleeding, pneumothorax (air in the pleural space), or infection.
* Apply a sterile dressing to the puncture site.
* Send the fluid sample for laboratory analysis.
* Document the procedure and patient’s response.
Thoracentesis
What are some potential complications of thoracentesis?
Pneumothorax (collapsed lung)
Bleeding
Infection
Pain
Cough
Thoracentesis
What is some pt. education for thoracentesis?
Explain the procedure and its purpose.
Instruct the patient about post-procedure care, including monitoring for complications and activity restrictions.
Answer any questions the patient may have.
Tracheostomy
What is a tracheostomy?
Surgical procedure in which an opening (stoma) is made in the trachea.
Tracheostomy Tube:
The indwelling tube inserted into the trachea is called a tracheostomy tube
Cuffed and uncuffed
Tracheostomy
What are some potential complications for tracheostomies?
- Air leak
- Airway obstruction
- Altered body image
- Aspiration
- Bleeding
- Fistula formation
- Impaired cough
- Infection
- Subcutaneous emphysema
- Tracheal necrosis
- Tracheal stenosis
- Tube displacement
Terminology
Adventitious Breath Sounds
Abnormal sounds heard during breathing, such as crackles, wheezes, or rhonchi.
Terminology
Chemoreceptor
Sensory receptors that respond to changes in chemical concentrations, such as oxygen or carbon dioxide levels in the blood.
Terminology
Compliance
The ease with which the lungs and chest wall expand.
Terminology
Crackles (Rales)
Discontinuous, popping lung sounds heard on auscultation, often indicating fluid in the alveoli.
Terminology
Dyspnea
Shortness of breath or difficulty breathing.
Terminology
Fremitus
Vibrations felt on the chest wall during palpation.
Terminology
Mechanical Receptors
Sensory receptors in the lungs and airways that respond to changes in lung volume and stretch.
Terminology
Oximetry
Measurement of oxygen saturation in the blood using a pulse oximeter.
Terminology
Oxygenation
The process of delivering oxygen to the blood.
Terminology
Resistance
Opposition to airflow in the airways.
Terminology
Surfactant
A substance that reduces surface tension in the alveoli, preventing them from collapsing.
Terminology
Tidal Volume (VT)
The volume of air inhaled or exhaled during a normal breath.
Terminology
Ventilation
The process of moving air into and out of the lungs.
Terminology
Wheezes
High-pitched, whistling lung sounds heard on auscultation, often indicating airway narrowing.
Terminology
Assist-Control (AC) Ventilation
A mode of mechanical ventilation in which the ventilator delivers a set tidal volume or pressure with each breath, whether initiated by the patient or the ventilator.
Terminology
Continuous Positive Airway Pressure (CPAP)
A form of noninvasive ventilation that delivers constant positive pressure to keep the airways open.
Terminology
Decannulation
Removal of a tracheostomy tube.
Terminology
Endotracheal (ET) Tube
A tube inserted into the trachea through the mouth or nose to provide an airway.
Terminology
Extubation
Removal of an endotracheal tube.
Terminology
Intubation
Insertion of an endotracheal tube.
Terminology
Mechanical Ventilation
Use of a machine to assist or control breathing.
Terminology
Negative Pressure Ventilation
A form of mechanical ventilation that applies negative pressure to the chest wall to expand the lungs.
Terminology
Noninvasive Ventilation (NIV)
Delivery of ventilatory support without an endotracheal tube or tracheostomy.
Terminology
Positive End-Expiratory Pressure (PEEP)
A mode of mechanical ventilation that maintains positive pressure in the airways at the end of exhalation.
Terminology
Positive Pressure Ventilation (PPV)
A form of mechanical ventilation that delivers positive pressure to inflate the lungs.
Terminology
Pressure Control (PC) Ventilation
A mode of mechanical ventilation in which the ventilator delivers a set pressure with each breath.
Terminology
Pressure Support Ventilation (PSV)
A mode of mechanical ventilation that provides positive pressure during spontaneous breaths to reduce the work of breathing.
Terminology
Pressure Ventilation
Mechanical ventilation that delivers a set pressure.
Terminology
Pursed-Lip Breathing (PLB)
A breathing technique that involves inhaling through the nose and exhaling through pursed lips to improve ventilation.
Terminology
Synchronized Intermittent Mandatory Ventilation (SIMV)
A mode of mechanical ventilation in which the ventilator delivers a set number of breaths, synchronized with the patient’s spontaneous breaths.
Terminology
Thoracotomy
A surgical incision into the chest wall.
Terminology
Tracheostomy
A surgical opening in the trachea to provide an airway.
Terminology
Volume Ventilation
Mechanical ventilation that delivers a set tidal volume.
Terminology
Weaning
The process of gradually discontinuing mechanical ventilation.
Terminology
Acute Laryngitis
Inflammation of the larynx (voice box).
Terminology
Airway Obstruction
Blockage of the airway.
Terminology
Allergic Rhinitis
Inflammation of the nasal mucous membranes due to allergies.
Terminology
Epistaxis
Nosebleed.
Terminology
Influenza
A viral respiratory infection.
Terminology
Laryngectomy
Surgical removal of the larynx.
Terminology
Pharyngitis
Inflammation of the pharynx (throat).
Terminology
Rhinoplasty
Surgical repair of the nose.
Terminology
Sinusitis
Inflammation of the sinuses.
Terminology
Upper Respiratory Infections
Infections of the nose, sinuses, and throat.
Terminology
Acute Bronchitis
Inflammation of the bronchi (airways).
Terminology
Community-Acquired Pneumonia (CAP)
Pneumonia acquired outside of a hospital or healthcare setting.
Terminology
Cor Pulmonale
Right-sided heart failure caused by pulmonary hypertension.
Terminology
Empyema
Accumulation of pus in the pleural space.
Terminology
Flail Chest
A condition in which multiple rib fractures cause a segment of the chest wall to move paradoxically with breathing.
Terminology
Hemothorax
Accumulation of blood in the pleural space.
Terminology
Hospital-Acquired Pneumonia (HAP)
Pneumonia acquired during a hospital stay.
Terminology
Lung Abscess
A localized area of pus and infected tissue in the lung.
Terminology
Pertussis (Whooping Cough)
A highly contagious respiratory infection.
Terminology
Pleural Effusion
Accumulation of fluid in the pleural space.
Terminology
Pleurisy (Pleuritis)
Inflammation of the pleura.
Terminology
Pneumoconiosis
A lung disease caused by inhalation of dust.
Terminology
Pneumonia
Infection of the lungs.
Terminology
Pneumothorax
Accumulation of air in the pleural space.
Terminology
Pulmonary Edema
Accumulation of fluid in the lungs.
Terminology
Pulmonary Embolism (PE)
Blockage of a pulmonary artery by a blood clot or other substance.
Terminology
Pulmonary Hypertension
High blood pressure in the pulmonary arteries.
Terminology
Tension Pneumothorax
A life-threatening condition in which air accumulates in the pleural space and cannot escape.
Terminology
Tuberculosis (TB)
A contagious bacterial infection that primarily affects the lungs.
