Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS 502 > Exam 3 - Respiratory > Flashcards

Exam 3 - Respiratory Flashcards

1
Q

What is epiglottitis?

A

Life threatening illness characterized by inflammation of the epiglottis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causative organisms of epiglottitis

A
  • GAS
  • Strep pneumonia
  • Klebsiella sp.
  • Staph aureus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What vaccine has made the incidence of epiglottitis low?

A

Hib vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Clinical findings (history) of epiglottitis

A
  • Abrupt onset fever
  • Irritability
  • Muffled voice
  • Severe sore throat
  • Dyspnea
  • Dysphagia
  • Drooling
  • Increased respiratory distress
  • Child appears acutely ill and toxic appearing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Epiglottitis physical examination

A
  • Inspiratory and expiratory stridor
  • Aphonia (muffled voice)
  • Nasal flaring and retractions
  • Child assumes a position of hyperextension of the neck
  • Sitting in tripod position
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What should the provider NOT due during the physical examination of a child with epiglottitis?

A

Do not examine/swab the throat because of reflex laryngospasm → suffocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Diagnostic studies for epiglottitis

A
  • Blood culture
  • Lateral neck radiograph → “thumb” print sign is (+) for epiglottitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Epiglottitis management

A
  • Refer to ER → establish airway, start IV antibiotics, oxygen
  • Early consultation with pediatric otolaryngology and anesthesiologist
  • Do not place child in supine position
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Epiglottitis prevention

A
  • Immunization (hib)
  • Hand washing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is bronchiolitis?

A

Most common respiratory infection in infancy (peak incidence in infants < 6 months)

  • Destruction of bronchiole lining + bronchospasm + copious mucus production
  • Insidious onset of URI symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clinical findings (history) of bronchiolitis

A
  • Initial: cough, coryza, rhinorrhea, fever for 1-2 days
  • Mild fever, apnea, decreased feeding
  • Wheezing, course crackles, tachypnea, mild severe chest retractions starting 1-2 days after URI symptoms and lasts up to 12 days
  • Severe cases: cyanosis, air hunger, retractions, nasal flaring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Bronchiolitis physical examination findings

A
  • Upper respiratory → coryza, mild conjunctivitis
  • Lower respiratory → tachypnea, retractions, wheezing, crackles, signs of respiratory distress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Bronchiolitis diagnostic studies

A
  • History and physical exam findings
  • If severe, chest x-ray to rule out pneumonia or pneumothorax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most common cause of bronchiolitis?

A

RSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Bronchiolitis management

A
  • Supportive care → fever control (Tylenol), hydration, nutrition, oxygenation >90%
  • Nasal suction
  • Saline drops
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is an URI?

A

Aka common cold

  • Can indicate the beginning or advancing signs of a more serious illness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

URI clinical findings (history)

A

Symptoms typically resolve after 10 days

  • Nasal congestion, cough, sneezing, rhinorrhea, fever, hoarseness, pharyngitis
  • Gradual onset low grade fever
  • Sore throat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

URI physical exam findings

A
  • Mild conjunctival injection
  • Red nasal mucosa
  • Mild erythema of pharynx
  • Anterior cervical lymphadenopathy <2 cm
  • Chest clear to auscultation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

URI diagnostic studies

A
  • Throat culture not indicated if there are nasal symptoms with throat pain
  • If presenting symptom is sore throat, and not rhinitis, collect rapid strep test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

URI management

A
  • Supportive care → antipyretics, pain management, nasal congestion, hydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is bronchitis?

A

Acute and self limiting inflammation of the trachea and bronchi with a cough that lasts 1-3 weeks without pulmonology consolidation (can last 6 weeks)

  • Usually viral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Viral vs bacterial bronchitis

A
  • Viral: flu A and B, parainfluenza, RSV
  • Bacterial: m. pneumoniae, c. pneumoniae
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Acute bronchitis triggers

A
  • Cigarette smoking
  • Chemical irritants
  • Undiagnosed asthma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Acute bronchitis clinical presentation

A
  • Cough with or without sputum production (sputum may be clear and become mucoid)
  • Low grade fever
  • Wheezes, rhonchi, coarse rales
  • Burning substernal pain with inspiration
  • Nasopharyngeal symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Acute bronchitis diagnostic studies

A

Clinical diagnosis

  • Cough with normal vital signs
  • Absence of tachypnea, tachycardia, rales, egophony
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Acute bronchitis

A
  • Symptom reduction and supportive care → rest, hydration, humidifier, antipyretics, smoking cessation
  • WEAK evidence for antitussives and bronchodilators
  • Antibiotics only if b. pertussis is suspected (macrolide)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is a pneumothorax?

A

Presence of air in the pleural space resulting in loss of negative intrathoracic pressure

28
Q

What type of pneumothorax is most common in young adults ages 20-30 years?

A

Spontaneous

29
Q

Pneumothorax risk factors

A
  • Cannabis or cigarette smoking
  • Male
  • Underlying lung disease
  • Tall
  • Thin body hiatus
  • Family history
  • Pregnancy
30
Q

Pneumothorax clinical presentation

A
  • Acute onset breathlessness
  • Unilateral pleuritic chest pain
31
Q

Is a pneumothorax a medical emergency?

A

Tension or large pneumothorax

32
Q

What are signs/symptoms of a tension or large pneumothorax?

A
  • Acute respiratory distress
  • Diaphoresis
  • Tachycardia
  • Hypoxemia
  • Tachypnea
  • Tracheal deviation
  • Cyanosis
33
Q

Pneumothorax diagnostic studies

A
  • Chest x-ray
  • Gold standard → CT scan (due to ability to differentiate between pneumothorax and bullous lung disease)
  • Pulse oximetry and ABGs to determine level of hypoxia
34
Q

Pneumothorax management

A
  • Observation
  • Needle aspiration
  • Small bore catheter
  • Chest tube (can be with pleurodesis, thoracotomy, or sternotomy)
35
Q

What conditions would treatment not be indicated for pneumothorax?

A
  • Small (<2 or 3 cm)
  • Patient clinically stable
36
Q

Pneumothorax patient education

A
  • Smoking cessation
  • Air travel and scuba diving must be avoided until resolution
37
Q

What is pneumonia?

A

Leading cause of morbidity and mortality in the U.S. (especially in older adults and those with chronic conditions)

38
Q

Causes of typical pneumonia

A

Strep pneumoniae

  • Accounts for 60-70% of all bacterial CAP cases
39
Q

Causes of atypical pneumonia

A
  • Mycoplasma pneumoniae
  • Chlamydophila pneumoniae
  • Legionella
  • Respiratory viruses
40
Q

Pneumonia clinical presentation

A

Diagnosis is made by history and physical examination

  • History of fever, chills or rigors, malaise, cough with or without sputum production
  • Hemoptysis, dyspnea, pleuritic chest symptoms
41
Q

Pneumonia physical exam findings

A
  • Chest auscultation reveals rales that do not clear with cough (found in bacterial and atypical pneumonia)
  • Bacterial pneumonia
    • Consolidation (dullness to percussion)
    • Bronchial breath sounds
    • Egophony (E to A changes)
42
Q

Pneumonia diagnostic findings

A
  • Chest x-ray
  • CT scan
  • Pulse oximetry
  • Labs → sputum analysis, viral culture, complement fixation, CBC with diff, CMP, blood culture, ABGs)
  • Bronchoscopy
43
Q

When to consider bacterial pneumonia

A

Caused by strep pneumoniae

  • Leading cause in all age groups
  • History of abrupt onset high fever with shaking chills, productive cough with purulent sputum
  • Starts with URI, rales on exam, respiratory distress
44
Q

When to consider atypical pneumonia

A
  • More common in school ages children, military recruits, and college students
  • “Walking pneumonia” → more mild (appear less ill appearing than those with bacterial)
  • May have fine rales with NO consolidation
  • Gradual onset of headache, dry cough, fevers
45
Q

When to consider viral pneumonias

A
  • More common in infants and children than bacterial
  • Fever less prominent
  • Coryza, diffuse findings on lung exam including wheezing
  • RSV, parainfluenza, influenza
46
Q

Can the provider always prescribe antibiotics to treat pneumonia?

A

Can treat for pneumonia if clinical presentation is suggestive, EVEN IF chest x-ray is negative

47
Q

Pneumonia antibiotic therapy of for patients with no coexisting illnesses and no recent use of antimicrobial agents

A
  • Amoxicillin
  • Macrolide
  • Doxycycline
48
Q

Pneumonia antibiotic therapy for patients with coexisting illnesses or recent use of antimicrobial agents

A
  • Fluoroquinolone alone OR
  • Beta lactam (augmentin or cephalosporin) + macrolide or doxycycline
49
Q

What vaccines should be encouraged for older adults to fight against pneumonia?

A

PPSV23 and PCV13

50
Q

For adults 65+ years who are not immunocompromised, have a CSF leak, or cochlear implant, when can they receive the PPSV23 vaccine?

A
  • Can get one dose PPSV23 if not previously
  • If had gotten one previously, should get one more at least 5 years after last dose
51
Q

Can older adults receive both the PPSV23 and PCV13 vaccine?

A

Can administer one PCV13 first then PPSV23 one year later (vice versa)

52
Q

What is the incubation period of influenza?

A

1-4 days

53
Q

When does viral shedding occur with influenza?

A

24 hours before symptoms onset

  • Peaks at day 3 and stops at day 7
  • Shedding is longer in school age children (10 days)
54
Q

Who is considered high risk in catching the flu?

A
  • Children <2 years old
  • People over 65 years old
  • Immunocompromised
55
Q

Influenza clinical presentation

A
  • Systemic: fever, chills, headache, malaise, myalgia, loss of appetite
    • Fever declines on second or third day
  • Respiratory: dry cough, nasal congestion with clear discharge, sore throat
56
Q

Influenza physical examination findings

A
  • Flushed
  • Eyes watery and red
  • Skin hot and moist
  • Inflamed nasal passages
  • Enlarged cervical lymph nodes
  • Pharyngeal erythema
  • Cough but lung sounds normal
57
Q

Influenza diagnostics

A
  • A & B nasal and throat swabs (collected within 12-36 hours of onset)
  • Gold standard → viral culture or RT-PCR (influenza antigen)
58
Q

Influenza management

A
  • Symptomatic relief
  • Antipyretics and analgesics
  • Antiviral therapy within 48 hours of symptom onset (oseltamivir for patients >2 years)
59
Q

Who is considered high risk for influenza?

A
  • >65 years old
  • <2 years old
  • Pregnant
  • Asthma/COPD
  • DM
  • Immunocompromised
60
Q

Pulmonary embolism risk factors

A
  • Recent history of surgery, trauma, travel, period of immobility, previous PE
  • Malignancy
  • Stroke
  • Paralysis
  • HF
  • Smoking
  • Pregnancy or postpartum status
  • Estrogen therapy
61
Q

Pulmonary embolism clinical presentation

A
  • Classic → dyspnea, tachypnea, pleuritic chest pain, calf or thigh pain and swelling
  • Hemoptysis, orthopnea, tachycardia, jugular venous distention, abnormal lung sounds
62
Q

What is the most sensitive clinical sign when it comes to pulmonary embolism?

A

Tachypnea

63
Q

Pulmonary embolism physical examination

A
  • Acute respiratory distress
  • Tachycardia
  • Hypotension
  • Abnormal heart sounds
  • Jugular vein distention
  • Hypoxemia
  • Tachypnea
  • Cyanosis
  • Abnormal lung sounds
64
Q

What clinical prediction models can be used to determine the risk of pulmonary embolism?

A

Help determine need for imaging

  • Wells score
  • Revised Geneva score
  • PERC
65
Q

What tests are not diagnostic for PE but help with identification of other causes?

A
  • ECG → cannot diagnose, but can r/o MI, afib, RVD
  • Chest x-ray → identifies pleural effusion, diaphragmatic elevation, Hamptom hump, Westermark sign, atelectasis
66
Q

Pulmonary embolism diagnostic studies

A
  • V/Q scan
  • Gold standard → CT angiography
  • Spiral chest CT with IV contrast
  • Labs: ABGs, troponin, BNP, d-dimer
67
Q

Pulmonary embolism management

A
  • Initial: hemodynamic stability and adequate oxygenation (at least 92%)
  • Anticoagulation→ heparin, warfarin, (-xabans)
  • Surgery → embolectomy or IVCF placement

NURS 502 (43 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions