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NUR 355: Med Surg I > Exam 3 Study Guide: Leonard > Flashcards

Exam 3 Study Guide: Leonard Flashcards

1
Q

what is the respiratory system responsible for?

A

o ventilation
o vocalization

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2
Q

what occurs during ventilation respiration cycle?

A

o gas exchange

  • occurs in the alveoli
  • oxygen and carbon dioxide are exchanged
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3
Q

how does vocalization occur in the respiration cycle?

A

o air comes up from the lungs and into the voicebox

  • air through lungs and vocal cords
  • vibration of our vocal cords (how were able to vocalize)
  • how were able to speak
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4
Q

normal pH level

A

7.35 - 7.45

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5
Q

acidosis pH level

A

< 7.35

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6
Q

alkalosis pH level

A

> 7.45

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7
Q

inflammation of an airway causing narrowing and production of mucous

A

asthma

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8
Q

is asthma genetic/related to family hx?

A

yes, genetics

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9
Q

what position should a patient be in when experiencing SOB?

A

High Fowler’s

  • unless ordered by physician not to
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10
Q

what muscle is used to breath?

A

accessory muscle

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11
Q

expected findings of Asthma Exacerbation

A

o dyspnea
o chest tightness
o anxiety or stress

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12
Q

physical S/S of Asthma

A

o coughing
o wheezing
o mucous production
o use of accessory muscles
o prolonged exhalation
o poor oxygen saturation (low SaO2)
o barrel chest or increased chest diameter

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13
Q

what develops during asthma exacerbation

A

sputum

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14
Q

what do you hear from asthma patients?

A

expiratory wheezes

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15
Q

What is the normal O2 level

A

92 - 100

always make sure O2 is normal in asthma patients

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16
Q

anything on the exam that has a low O2 level, know the intervention is what?

A

Oxygen intervention

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17
Q

decreased PaO2
< than 80mmHg

A

Hypoxemia

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18
Q

decreased PaCO2
< than 35mmHg
o early in attack

A

Hypocarbia

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19
Q

increased PaCO2
> than 45mmHg
later in attack

A

Hypercarbia

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20
Q

what is the most commonly used bronchodilator?

A

albuterol

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21
Q

albuterol comes in what 2 types of form?

A

o Inhaler Form
- powder

o ambuel form
- used in nebulizer
- liquid form
- mist created that is inhaled

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22
Q

when do we administer bronchodilators?

A

during acute asthma attacks

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23
Q

what is considered a rescue inhaler?

A

albuterol

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24
Q

what are the steps for using an inhaler?

A

o patients must rinse their mouth out with mouthwash first
(to prevent thrush)
o breath out
o then seal lips around inhaler
o inhale 2-3 seconds
o press button
o hold breath for 5-10 seconds
o breath out for 20 - 60 seconds
o wait another 20 - 60 seconds in between each puff

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25
Q

does albuterol provide rapid relief?

A

yes

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26
Q

what are corticosteroids used for?

A

decrease inflammation

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27
Q

what do we teach diabetic patients who are on corticosteroids?

A

it increases blood sugars

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28
Q

when should a client take their corticosteroid medications?

A

in the mornings

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29
Q

how should corticosteroids be taken?

A

must be taken with food

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30
Q

damage to lung tissues due to emphysema and chronic bronchitis

A

COPD
o chronic obstructive pulmonary disease

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31
Q

S/S of COPD

A

o SOB
o wheezing
o chronic cough

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32
Q

risk factors of COPD

A

o obesity
o smoking

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33
Q

are CNA’s allowed to administer or adjust oxygen?

A

no, they are only allowed to take pulse ox

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34
Q

what types of foods/snacks should a patient with COPD consume?

A

o foods that are soft
o foods that have protein

  • no overeating
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35
Q

what should we teach COPD patients?

A

conserve energy

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36
Q

what can a COPD patient do to ease breathing and enhance gas exchange?

A

sit up and lean forward to open lungs

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37
Q

the loss of lung elasticity and hyperinflation of lung tissue that causes destruction of the alveoli, leading to decreased surface are for gas exchange, carbon dioxide retention, and respiratory acidosis

A

Emphysema

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38
Q

inflammation of the bronchi and bronchioles due to chronic exposure to irritants

A

chronic bronchitis

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39
Q

can be latent for a long time in patients who have already had this disease

A

TB
tuberculosis

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40
Q

contributing factors that can reactivate TB

A

o chronic renal disease (kidney cant filter toxins which will reactivate TB)
o diabetes
o malnutrition related to loss of appetite
o noncompliance with medication regimen

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41
Q

how long do patients with TB need to take their medications for?

A

9 - 12 months

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42
Q

Mantoux

A
  • 2 step PPD with results in 48-72 hrs
  • skin test induration
    > 10mm is positive for TB
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43
Q

TB blood test

A

Quantiferon

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44
Q

what is performed in TB patients to visualize lesions on lungs, gas filled spaces and gaps in lungs

A

chest x-ray

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45
Q

what are the 3 testing methods for TB?

A

o Manoux
o Quantiferon
o Chest X-ray

46
Q

S/S of TB

A

o bacterial infection
o blood-tinged sputum or blood with cough
o weight loss
o night sweats
o chest pain
o fatigue
o low grade fever

47
Q

what type of precaution for TB

A

Airborne precaution

48
Q

what PPE should be used when caring for a TB patient

A

o N-95 mask
o gloves

49
Q

what type of sputum is seen in patients with bacterial pneumonia (PNA)?

A

o thick, greenish, purulent sputum

50
Q

we want to encourage our patients with pneumonia to do what?

A

o ambulate
o cough/take deep breaths
o use incentive spirometer

51
Q

what is the proper way to use an incentive spirometer

A

o have client exhale
o then place mouth on spirometer
o inhale through incentive spirometer

52
Q

teachings on antibiotic medications

A

o prescribed after a sputum culture
o must be taken as prescribed
o do not stop if feeling better
o must take until prescription says

53
Q

why do we encourage fluid intake for pneumonia patients

A

o it will help liquify secretion for expectoration
o helps breakdown secretion

54
Q

which elevated WBC indicate infection/pneumonia?

A

neutrophils

55
Q

accumulation of excess mucous throughout the body

o impairs breathing, digestion, elimination, and GI function

A

Cystic Fibrosis

56
Q

daily therapy of airway management for Cystic Fibrosis

A

o continuous chest percussion (vest)

o treat with mucolytics
- to thin and decrease amount of mucous

o pancreatic enzymes supplements
- pancreatic enzymes depleted and aren’t being produced because mucous is blocking so must replenish with supplements

o protein modulators (CFTR - cystic fibrosis transmembraneconductive regulator)
- protein replacement

57
Q

what do Cystic Fibrosis patients suffer from

A

o malnutrition
o fatigue
- must conserve energy

58
Q

Cystic Fibrosis Diet

A

o high in fat
o high calories
o salt (need to replenish salt and potassium)
o fluids to liquify mucous secretions

59
Q

o highly contagious acute viral infection
o occurs as an epidemic (usually in fall and winter months)

A

seasonal influenza

60
Q

viral infection among animals or birds that has mutated and is becoming highly infections in humans

A

pandemic influenza

61
Q

Flu S/S

A

o severe headache and muscle aches
o chills
o fatigue, weakness
o severe diarrhea and cough (avian flu)
o fever
o hypoxia (avian flu)

62
Q

contraindications for giving the flu vaccine

A

o age
- 68 yo or older must receive the live attenuated (weaker/lessened vaccine)

o allergies
- eggs

o Asthma can be exasperated by the flu vaccine

63
Q

precautions implemented with flu patients

A

o maintain droplet and contact precautions (pandemic influenza)
o provide saline gargles
o monitor hydration status, intake, output
o administer fluid therapy as prescribed
o monitor respiratory status

64
Q

home education for O2 use

A

o flammable (no smoking)
o DO NOT use vaseline for nasal dryness (water based lubricant only)
o humidify oxygen (keep from drying out)
o educate family members on importance of use and compliance (don’t ever leave oxygen tank at home away from patient)

65
Q

what position should a patient be in for enhanced breathing?

A

High Fowler’s

66
Q

method used to measure force of your exhalation

A

FEV (Forced Expiratory Volume)
FEV1

67
Q

used for diagnosis as well as determining the effectiveness of the therapy

comparisons of forced expiratory volume (FEV) to forced vital capacity (FVC) are used to classify COPD as mild to severe

A

pulmonary function test

68
Q

everything to know about FEV/FVC

A

o comparisons of forced expiratory volume (FEV) to forced vital capacity (FVC) are used to classify COPD as mild to severe

o as COPD advances, the FEV-to-FEV ratio decreases
- expected reference range is 100% for mild COPD, the FEV/FVC ratio is decreased to less than 70%
- as the disease progresses to moderate and severe, the ratio decreases to less than 50%

69
Q

what is the pulmonary function test used for?

A

classify COPD as mild to severe

70
Q

1-6L/min

A

Nasal Cannula

71
Q

6-10L/min

A

Simple Mask

72
Q

10-15L/min

A

Nonrebreather

73
Q

15L/min or higher

A

Venturi Mask

74
Q

what is the normal pulse ox waveform pattern

A

o normal signal = mountain peaks

o low perfusion = almost flat line

75
Q

S/S of O2 toxicity

A

o lethargy
o difficult to arouse

76
Q

minimum mmHg for trach suctioning

A

80mmHg

77
Q

maximum mmHg for trach suctioning

A

120mmHg

78
Q

how long do you wait in between each trach suctioning?

A

30 seconds

79
Q

how long do you suction for during trach suctioning?

A

10 seconds

80
Q

how long does a patient have to be at 100% hyperoxygenation before suctioning

A

10-15 seconds

81
Q

o keep a tight mouth seal around the mouth piece
o inhale and hold breath for 3-5 seconds
o during inhalation, needle of spirometry machine will rise

A

proper use and technique of incentive spirometer

82
Q

what is incentive spirometer used for

A

promotes lung expansion

83
Q

o used to conserve energy
o looks like you are kissing someone or drinking through a straw
o for COPD patients

A

pursed lip breathing

84
Q

how many blood cultures is needed for diagnosis?

A

2 blood cultures need from two different areas

85
Q

can you collect a sputum sample from a trach?

A

no, only thing allowed to go in is for suction

86
Q

when is the best time to collect a sputum specimen

A

mornings

87
Q

what should a patient do before collecting specimen?

A

make sure patient rinses mouth out with mouthwash

88
Q

low concentration of O2 in your blood

A

hypoxemia

89
Q

S/S of hypoxemia

A

o agitation/anxiety
o cyanosis
o SOB
o wheezing
o cough
o confusion

90
Q

not breathing properly during sleep

A

obstructive sleep apnea (OSA)

91
Q

what causes OSA?

A

o tongue obstructs by moving to top or back of mouth when laying down

o respiration cycle is not being completed
- O2 being deprived
- oxygen not going down to alveoli and exchanging with carbon dioxide to complete cycle

92
Q

what 2 treatments are used for OSA?

A

o CPAP
o Bi-PAP

93
Q

o continuous pressure flow that opens airways

o must always take it with you if you will be sleeping away from home

A

CPAP
Continuous Positive Airway Pressure

94
Q

o one level of exhalation and another level for inhalation
o two different types of pressure

A

Bi-PAP
Bi-Level Positive Airway Pressure

95
Q

Anatomy of OSA

A

o airway narrows and collapses as the body relaxed during sleep, decreasing gas exchange and apnea occurs - meaning there is no air being moved in or out of the body and no alveolar gas exchange

96
Q

risk factor for OSA

A

o obesity
o smoking
o ETOH use
o males age 40 - 65 yo
o menopause
o avoid sleeping pills
o heavy meals

97
Q

benefits of OSA treatment (CPAP/BiPAP)

A

o sleep quality improves
o decreased or no snoring
o will help both yourself and your partners sleep quality

98
Q

important teaching for CPAP/BiPAP users

A

o must clean devices and masks regularly
o change filters

99
Q

inflammation of the nasal mucosa and often the mucosa in the sinuses that can be caused by infection (viral or bacterial) or allergens

A

Rhinitis

100
Q

S/S of Rhinitis

A

o more severe than sinusitis
o excessive nasal drainage, runny nose (rhinorrhea), nasal congestion
o purulent nasal discharge
o sneezing and pruritus of the nose, throat, and ears
o watery/itchy eyes
o sore/dry throat
o red, inflamed, swollen nasal mucosa
o low-grade fever
o diagnostic testing can include allergy tests to identify possible allergens

101
Q

an inflammation of the mucous membranes of one or more of the sinuses

A

sinusitis

102
Q

where should you palpate when assessing sinusitis

A

orbital areas

103
Q

S/S of sinusitis

A

o nasal congestion
o headache
o facial pressure or pain (worse when head is tilted forward)
o cough
o bloody or purulent nasal drainage
o tenderness to palpation of forehead, orbital, and facial areas
o low-grade fever

104
Q

inflammation/infection of the mucous membranes of the voicebox (larynx)

A

laryngitis

105
Q

what causes larryngitis

A

o upper respiratory infection
o environmental pollutants
o use of asthma inhalers
o singing
o talking (overuse)
o GERD - acidity - burns vocal chords

106
Q

what should people with laryngitis avoid?

A

o acidic food
o alcohol
o smoking
o dry air

107
Q

how to treat laryngitis/hoarseness

A

o rest
o rest vocal cords
o find other means to communicate
o humidify your air

o see Dr. if it lasts for a long period of time

108
Q

risk factors of laryngeal cancer

A

o tobacco use
o alcohol use
o poor dietary habits
o compromised immune system
o genetic syndromes
o occupational hazards
o gender
o age
o race
o GERD
o 4x more common in men than in women
o occupations where workers have intense and long exposure to certain chemicals
o more common in people who have compromised immune status

109
Q

CPAP Essay

A

 CPAP prevents collapse of the upper airway through the use of pressure delivered through the use of a nasal, oral, or oronasal mask during sleep
 CPAP machine delivers a continuous stream of positive pressure, keeping the airway open and providing an unobstructed airway
 Weight management and loss are encouraged as a first-line intervention in conjunction with the use of CPAP
 Positioning during sleep in a nonsupine position by using pillows in an effective secondary intervention
 Avoid alcohol and sedatives before bedtime

110
Q

You hear wheezing sounds in lungs of which 3 patients?

A

o CF
o Asthma
o Lung Cancer

NUR 355: Med Surg I (6 decks)

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