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exam 4 Flashcards

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1
Q

Collapse of the alveoli – leads to loss of lung volume

A

atelectasis

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2
Q

caused by surfactant inactivation
 Causes: Acute respiratory distress syndrome (ARDS) most common condition that causes decreased surfactant
 Reduces alveoli surface tension, collapses alveoli

A

absorptive atelectasis

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3
Q

external forces compress lung tissue
 Causes: pleural effusions: fluid around lungs (fluid compresses lungs os it doesn’t expand well), lung tumors, pneumothorax, hemothorax, abdominal distention

A

Compressive atelectasis

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4
Q

mechanical obstruction of airway

 Causes: secretions, tumors foreign body

A

obstructive atelectasis

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5
Q

Postoperative patients especially abdominal or thoracic surgery related to:
• Anesthetic or narcotic induced hypoventilation
• Incisional pain
• Abdominal distension
• Immobility

COPD
Obesity (puts compression on lungs)
CVA
Smoking and lung cancer
Pleural effusions
A

Risk factors of Atelectasis

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6
Q 
Dyspnea
Cough
Leukocytosis
Sputum production
Breath sounds
•Crackles/ Diminished
Obstruction-wheezing and stridor
Large areas:
•	Dyspnea
•	Tachycardia
•	Tachypnea
•	Anxiety
•	Restlessness
•	Hypoxemia
A

Manifestations of Atelectasis

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7
Q

Chest x-ray/ CT scan and hypoxia (detected by oxygen saturation and arterial blood gases)

A

Diagnosis of atelectasis

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8
Q
  • Prevention is key!
  • Patient education
  • Turn immobile patients frequently
  • Ambulate surgical patients-improves lung expansion and mobilizes secretions
  • Expand lungs-cough and deep breathe/incentive spirometer
  • COPD, asthma, lung cancer-nebulized bronchodilators & chest physiotherapy
A

nursing management of atelectasis

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9
Q

helps inflate lungs (slow and controlled)

• Stimulates alveolar cells to secrete surfactant – decrease the surface tension in alveoli, improves muscle performance

A

incentive spirometer for atelectasis

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10
Q
  • Dispenses aerosolized medications to lungs via hand held or face mask devices
  • Medication injected with compressed air or oxygen
  • Breathe through mouth
  • Coughing during treatment-promotes secretion expectoration
A

nebulizer therapy for atelectasis

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11
Q
  • Includes postural drainage and chest percussion
  • Goal-remove bronchial secretions, improve ventilation, increase efficiency of the respiratory muscles
  • Postural drainage-uses positioning that allow gravity to aid in the removal of pulmonary secretions
  • Percussion or vibration is used to loosen secretions-either manually or with a vest
A

chest physiotherapy for atelectasis

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12
Q

Cough, ciliary clearance & alveolar macrophages prevent potentially infectious particles from reaching the lower respiratory tract
Bacteria may be inhaled
Aspirated
From contaminated water sources or respiratory equipment
From blood-borne organisms that enter the pulmonary circulation
Inflammatory response-alveolar edema and lung tissue consolidation
Consolidation seen on x-ray
Toxins and inflammatory mediators interfere with exchange of oxygen and carbon dioxide

A

patho of pneumonia

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13
Q

mismatching of lung ventilation in relation to perfusion that results in deoxygenated blood reaching systemic circulation and lowering oxygen supply to tissues

A

ventilation perfusion mismatch of pneumonia

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14
Q 
Fever
Cough
•	Productive
•	Non productive
Dyspnea
Pleuritic chest pain
Tachypnea
Tachycardia
Fatigue
May be proceeded by upper respiratory infection
Onset of symptoms may be gradual & non specific
Crackles 
Dullness on percussion
A

manifestations of pneumonia

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15
Q 
History
Physical examination
Chest x-ray
Blood culture (bloodstream invasion-bacteremia)
Can get by suctioning or bronchoscopy
Sputum (gram stain and culture)
•	Obtain in morning
•	Rinse mouth
•	Breathe and cough deeply
•	Expectorate into sterile container
A

diagnosis of pneumonia

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16
Q 
Antibiotic therapy-5-10 days of therapy
Take all required doses
Increase fluids-thin out secretions
Antipyretics-treat fever and body aches
Oxygen-to correct hypoxia
Nebulizer treatments/inhalers
Rest
A

nursing management of pneumonia

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17
Q 
Primary diagnosis or complication of chronic illness
	Symptoms:
•	Weakness
•	Abdominal symptoms
•	Anorexia 
•	Confusion
•	Tachycardia
•	Tachypnea
	Pneumococcal vaccine- ages 2-64 with chronic illness and for >65 yr old
A

pneumonia in elderly

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18
Q

in hospital less than 48 hours

A

community acquired pneumonia CAP

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19
Q

occurs more than 48 hours of being in hospital

A

hospital acquired / nosocomial pneumonia HAP

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20
Q

on ventilators at least 48 hours

A

ventilator associated pneumonia VAP

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21
Q

nursing home, chemo patients get it

A

health care associated pneumonia HCAP

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22
Q

AIDS, chemo, long term steroids use, home ventilator patients

A

pneumonia in an immunocompromised pateitn

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23
Q

destruction of Alveoli
Abnormal enlargement of air spaces, destruction of walls of alveoli
Dyspnea
Scant sputum

A

Emphysema

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24
Q

inflammation of bronchioles
Bronchus is narrowed, inflamed
Cough
Copious sputum production

A

Chronic Bronchritis

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25
Q

Increase in mucus producing cells
Inflammation in parts of lung
Structural changes
• Due to continuous cycle of destruction and repair

A

Patho of COPD

26
Q 
Tobacco smoke-cigarettes, pipe, cigar
2nd hand smoke
Occupational dust/chemicals
Indoor/outdoor air pollution
Infection-history of TB
Deficiency of alpha-anti-trypsin (enzyme in body that protects lung tissue)
A

Risk factors of COPD

27
Q

Diagnosed based on history/physical exam
Progressive dyspnea, chronic cough, sputum production
Dyspnea interferes with ADLS
Smoking history
• Numbers of packs per day smoked time the amount of years they smoked gives the average of how many packs per day they smoke
Barrel chest (hyperinflation)
Diminished breath sounds, rhonchi, wheezes
Pulmonary function test-confirms diagnosis, determines severity
Arterial blood gases (gives us base line oxygen status – you will see a CO2 retention and that shows what kind of gas exchange they have)

A

manifestations of COPD

28
Q

Stabilize, manage and monitor disease
Reduce symptoms-maximize pulmonary function
Reduce exacerbation risk
Assist patient to adapt to the handicap/limited prognosis
Smoking cessation is key
• Smoking cessation classes, nicotine replacement, antidepressants, varenicline (Chantix)

A

goal of treatment for COPD

29
Q 
Bronchodilators: albuterol
•	Relieve bronchospasms
•	Reduce airways obstruction
•	Aid in secretion clearance
Sympathomimetics (cause bronchodilation)-also called beta adrenergic: sudafed
Anticholinergic: atrovant 
Delivered by 
•	metered dose inhalers (MDI)
•	Dry powder inhaler (DPI)
•	Nebulizer
Long acting beta adrenergic & anticholinergic bronchodilators are used for maintenance
A

meds for COPD

30
Q
  • Inhaled: Flovent
  • Oral: Prednisone
  • IV: Methylprednisolone – patient co2 levels high, hard to breath so give this
  • What are side effects of long term treatment? Immunosuppression, hypoglycemia, osteoporosis
A

corticosteroids for COPD

31
Q
  • May be used during an acute exacerbation
  • Long term continuous therapy for chronic hypoxemia
  • Used with sleep
  • Goal: Maintain tissue oxygenation, Decrease the work of the cardiopulmonary system, Maintain oxygen saturation level above 90%
A

oxygen therapy for COPD

32
Q

Some patients with COPD and chronic hypercapnia are at risk for respiratory failure if they receive too high an O2 concentration
Lose their ‘drive to breathe’
At risk for respiratory failure
O2 should be at 1-2L/min
• Observe for changes in mental status: drowsiness, fatigue
• Assess lung sounds, monitor pulse oximetry

A

nursing alert of COPD

33
Q

Goal of treatment: reduce symptoms, improve quality of life, and increase participation in ADLs
Assessment of client
Breathing exercises
Learn how to pace activities-energy conservation skills
Physical exercise-increase endurance
Nutritional counseling – eating small, frequent meals with lots of protein

A

pulmonary rehabilitation

34
Q

o Common with patients with moderate to severe COPD
o Dyspnea occurs when the patient says it does and it is as bad as the patient says it is!
o Administer bronchodilators, O2 as needed
o Assist with ADLs
o Teach strategies: Pursed lip breathing (control breathing) and Tripod Positioning (expands lungs)

A

manage chronic dyspnea

35
Q

Genetic pre-disposition
Chronic exposure to airway allergens sensitizes antibodies
Exposure to environmental factors, airborne allergens, viral respiratory infections
Exposure to tobacco smoke, air pollution

A

risk factors of asthma

36
Q

History of cough, especially at night
Wheeze and diminished lungs sounds
Chest tightness and/or difficulty breathing
Symptoms occur or worsen with exercise, exposure to allergens, irritants, weather changes or stress
Exercise induced asthma
Occupational asthma
Intercostal retraction

A

manifestation of asthma

37
Q

Spirometry and chest X-ray

Categorized as intermittent, mild, moderate or severe

A

diagnosis of asthma

38
Q

Prevent symptoms, maintain normal pulmonary function tests and normal activity, prevent exacerbations

A

medication management goals of asthma

39
Q

Severe episode that is not responding to initial therapy – airway management*

A

status asthmaticus

40
Q

Pressure in arteries during contraction of heart muscle

A

diastolic

41
Q

Pressure in arteries between beats; filling/resting

A

systolic

42
Q

Based on the average of two or more accurate blood pressure measurements taken during two or more contacts with health care provider

A

hypertension

43
Q

95%; unidentifiable cause

A

primary hypertension - essential/idiopathic

44
Q

5%; pregnancy, renal artery disease, kidney/renal failure and meds

A

secondary hypertension

45
Q

o Age – baby boomers getting older
o Obesity
o Often coexists with dyslipidemia, diabetes mellitus, sedentary lifestyle & metabolic syndrome
o African Americans-especially males
o Oral contraceptive use-when accompanied with obesity and smoking
o Metabolic syndrome: (when 3 of these are present)
o -BP > 130/85
o -insulin resistance
o -dyslipidemia
o -abdominal obesity

A

risk factors for hypertension

46
Q

o Lifestyle modifications-exercise & diet changes
o Medications- start low & go slow
o Compliance
o Nursing interventions – pill box

A

treatment of hypertension

47
Q 
o	Coronary artery disease with angina
o	Myocardial infarction (heart attack)
o	Left ventricular hypertrophy
o	Heart failure (90% of the time HTN precedes congestive heart failure)
o	Changes in kidneys
o	Stroke/TIA
A

manifestations of hypertension

48
Q

o Goal-BP

A

Nursing management for hypertension

49
Q 
o	Support patient-education
o	Thiazide diuretic-Hydrochlorothiazide (HCTZ)
	Potassium wasting
o	Beta blockers - 
o	ACE inhibitors – “prils”
o	ARBs – “tans” 
	Angion reception 2 blocker
o	Calcium Channel Blockers
o	Always ask about OTC meds the patient takes
o	Can decrease medications when BP is
A

medications for hypertension

50
Q

o SBP >180 or DBP >120
o Poorly controlled hypertension
o Stopped taking their meds
o Goal is to decrease blood pressure immediately
o MI, dissecting aortic aneurysm, intracranial hemorrhage
o Shouldn’t lower too quickly-can reduce tissue perfusion

A

hypertensive crisis/emergency

51
Q

o BP is severely elevated but no organ damage suspected. However, organ damage can occur if left untreated.
o Severe headaches, epistaxis (nose bleeds), anxiety
o Goal is to decrease blood pressure SOON

A

hypertensive urgency

52
Q

Alteration in ventricular contraction by weakened heart muscle

A

systolic heart failure

53
Q

stiff heart muscle - ventricle can’t fill properly

A

diastolic heart failure

54
Q

o EF is normal in diastolic heart failure

o EF reduced in systolic heart failure

A

determined by measure ejection fraction

55
Q 
o	Age
o	Males
o	Hypertension
o	Left ventricular hypertrophy
o	Myocardial infarction
o	Valvular heart disease
o	Obesity
o	Dyslipidemia
o	Smoking
o	Chronic kidney disease
o	Sedentary lifestyle
A

risk for heart failure

56
Q 
o	Long standing heart disease
	Dyspnea at rest
	Cyanosis
	Cachexia (muscle wasting)
o	Tachycardia
o	Murmur due to mitral and tricuspid regurgitation that happens
o	Crackles in lungs, wheezes due to aioli filling with fluid
o	Edema in extremities
A

manifestations of heart failure

57
Q 
o	Pulmonary Congestion due to impaired left ventricle
o	Dyspnea
o	Cough
o	Crackles
o	Decreased O2 sats
A

left sided heart failure

58
Q 
o	Hepatomegaly
o	Edema in lower extremities
o	Weight gain
o	Anorexia, nausea
o	JVD – jugular vein distention
A

right sided heart failure

59
Q

o Chest Xray-determines cardiac enlargement and/or pulmonary congestion
o 12 lead EKG-presence of cardiac arrhythmias, left ventricular hypertrophy, MI
o Echocardiogram-outlines the heart and measures EF*
o Lab tests-blood cell count, electrolytes, liver and kidney enzymes, BNP
o BNP-B type or brain natriuretic peptide
 Hormone that is released from ventricles in response to fluid overload
 Should be 500 diagnosed with heart failure

A

diagnostic tests for heart failure

60
Q

o PREVENTION! Identify at risk patients
o Goals after diagnosis
 Relieve patient symptoms
 Improve functional status/quality of life
 Extend survival
o Treatment is aimed at
 Reducing contributing factors: HTN, arrhythmias, etc.
 Reduce workload on heart, optimize therapeutic regimens
 Prevent exacerbations of heart failure

A

medical management of heart failure

61
Q 
o	Patient education.  Support groups for patients & families
o	Diet-limit sodium.   1500 gm
o	Decrease alcohol and smoking
o	Weight reduction
o	Regular exercise
o	Recognize signs & symptoms to report to the doctor
	Weight gain
	Shortness of breath
	Fatigue
	Edema
A

life style changes for elderly with heart failure

62
Q 
o	Diuretics-promote excretion of NA, Chloride and H2O to reduce fluid volume
	Furosemide (Lasix)
	Torsemide (Demadex)
	Bumetadine (Bumex)
	Spironolactone (Aldactone)
A

pharmacologic therapy of heart failure

nursing 101 (4 decks)

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