Final Flashcards
LUNG DIAGNOSTIC STUDIES: arterial blood gas
measured to determine O2 status and acid-base balance
includes measurement of the PaO2, PaCO2, pH, HCO3 [bicarb.], and Sp O2
LUNG DIAGNOSTIC STUDIES: allen test
testing for collateral circulation to the hand by evaluating the patency of the radial and ulnar arteries
- should be done prior to radial arterial blood sampling
LUNG DIAGNOSTIC STUDIES: sputum specimen
should consist of recently-discharged material from the bronchial tree w/ minimum amounts of oral or nasal material
obtain sputum before eating
LUNG DIAGNOSTIC STUDIES: throat culture
used to determine organism from viral to bacterial
- false negative can occur due to poor technique
LUNG DIAGNOSTIC STUDIES: pulmonary function test
measures lung volumes and airflow
used to diagnose pulmonary disease, monitor disease progression, evaluate disability, and evaluate response to bronchodilators
airflow measured by a spirometer and administered by trained professionals
LUNG DIAGNOSTIC STUDIES: peak flow meter
instrument used to monitor lung function
measures peak expiratory flow rate [PEFR]
- highest flow rate is recorded
LUNG DIAGNOSTIC STUDIES: chest radiograph [x-ray]
minimal exposure to radiation
hospital gown required, preg. women and children should wear lead aprons
LUNG DIAGNOSTIC STUDIES: magnetic resonance imaging
uses powerful magnetic field and radio waves to create computer images
shows injury, disease processes, abnormal conditions
no metal objects are allowed in the room
- includes metal in the pt.’s body
nursing implications: iodine allergy, loud noise, claustrophobia
LUNG DIAGNOSTIC STUDIES: computed tomography [CT] scan
performed for diagnosis of lesions
pt. may need to be NPO b/c of the contrast media
- keep pt. hydrated pre and post op. to facilitate contrast excretion
- renal function pre-op. to check if excretion will occur
nursing implications: iodine allergy, remove metal [interferes w/ image quality/clarity]
LUNG DIAGNOSTIC STUDIES: ventilation-perfusion [V/Q] scan
used to assess ventilation [inhalation of radioactive gas which outline the alveoli] and perfusion of lungs
nursing implications: egg whites and albumin allergies [protein-based contrast dye]
LUNG DIAGNOSTIC STUDIES: positron emission tomography [PET] scan
injection of radioactive glucose
nursing implication: no food 4 hours ac, remove metal/plastic, check glucose in diabetics, encourage fluids [to excrete contrast]
LUNG DIAGNOSTIC STUDIES: bronchoscopy
flexible fiber optic scope is used for diagnosis, biopsy, specimen collection, or assessment of changes
local anesthesia may be used to relax throat muscle
- also for aspiration or removal of foreign object
nursing implications: NPO 6-12 hr.’s ac [prevent complicated aspiration] and pc until gag reflex returns
LUNG DIAGNOSTIC STUDIES: transbronchial needle biopsy
a needle is used to penetrate the bronchial wall and entering a mass of subcarinal lymph nodes or tumor
LUNG DIAGNOSTIC STUDIES: thoracentesis
an invasive procedure to remove fluid from the pleural space for diagnostic/therapeutic purposes
- pt. will be sat upright, leaning over a table staying very still; local anesthetic will be sued
- normally there should be ~ 3-10 mL in space; more than that is considered a pleural effusion
nursing implications: post-op [pressure over sterile dressing, monitor for bleeding/ infection/ pneumothorax/ pain/ soreness/ hypoxia
LUNG DIAGNOSTIC STUDIES: tuberculin skin testing
purified protein derivative [PPD] is used to test for TB exposure
- rx [dormant or active] occurs 2-12 weeks after shot
- rx may require a two-step TST
LUNG DIAGNOSTIC STUDIES: lung biopsy
performed to obtain tissues, cells, or secretions for evaluation
UPPER RESP. DISORDER: deviated septum
deflection of normally str8 nasal septum
complications: air movement, epitaxis, infection
tx: nasal allergy control, surgery
UPPER RESP. DISORDER: nasal fracture
types: unilateral, bilateral, complex
s/s: d/o severity [ecchymosis, edema, bleeding]
tx: ice, surgery
UPPER RESP. DISORDER: nasal surgery
concerns: respiratory status, pain management, edema, ecchymosis, antibiotics, hemorrhage [avoid valsalva, sneezing w/ mouth closed, blowing nose]
UPPER RESP. DISORDER: epitaxis
causes: trauma, foreign bodies, nasal sprays, street drug use, allergic rhinitis, tumors, med.’s, HTN
tx: anterior: keep quiet, sitting position, lean forward, pinch soft portion of nose for 10 min., apply ice; posterior: humidified O2, bed rest, pain management, hydration, oral care, tubes to drain/stop bleeding
- pc tube use: avoid bigorous nose blowing, strenuous activity, NSAIDS, aspirin
UPPER RESP. DISORDER: rhinitis
inflammation of the nasal mucosa that does not typically interfere w/ a pt.’s ability to maintain oxygenation or adequate tissue perfusion
causes: sensitivity rx to air-borne allergens
UPPER RESP. DISORDER: acute viral rhinitis
viruses invade the upper resp. system via droplet
s/s: nasal irritation, post-nasal tickling, copious secretions, obstructed nasal passages, watery eyes, elevated temp., H/A
tx: rest, fluids, analgesics, antihistamines, decongestants
UPPER RESP. DISORDER: sinusitis
exit from sinus is narrowed or blocked by inflammation of the mucosa
- secretions may build up behind the obstruction [may > infection]
causes: acute [infection, allergic rhinitis, swimming], chronic [acute sinusitis, allergies, polyps]
s/s: pain, purulent nasal drainage, nasal obstruction, congestion, fever, malaise, dental pain, H/A [esp. w/ position change]
tx: control underlying cause, antibiotics, decongestants, nasal corticosteroids, avoid antihistamines, increase fluids, humidifier, nasal cleaning techniques, avoid smoking
UPPER RESP. DISORDER: pharyngitis
inflammation of the mucous membranes of the pharynx
- often occurs w/ rhinitis and sinusitis
causes: bacteria, viruses, trauma, dehydration, irritants, alcohol, strep. [strep. must be treated]
s/s: throat pain, odynophagia [painful swallowing], dysphagia, hyperemia, possible exudate, fever
diagnosed by rapid strep test or throat cultures
tx: fluids, rest, analgesics, warm gargles, antibiotics [for the prescribed period of time]
LOWER RESP. DISORDER: acute bronchitis
inflammation of the bronchi
causes: infection [viral, bacterial] esp. following upper resp. infection
s/s: cough, sputum production, fever, H/A, malaise, S.O.B. on exertion, rhonchi, wheezing [brought on by inflammation of airway]
tx: fluids, rest, anti-inflammatory agents, antitussives [cough suppressants], bronchodilators,
LOWER RESP. DISORDER: asthma
a clinical syndrome characterized by increased responsiveness of the tracheobronchial tree to a variety of stimuli
- there is mucosal inflammation, constriction of bronchial smooth muscles, excess production of mucus
types: extrinsic, intrinsic/idiopathic
causes: allergens, viral upper resp. infection, sinusitis, exercise, COLD DRY AIR, med.’s, hormones/menses, GERD, psychological factors, stress
s/s: wheezing, feeling of suffocation, COUGH, upright sitting, dyspnea, use of accessory muscles, anxiety, hypoxemia, prolonged expiration, diminished breath sounds, hypoxia [> tachycardia, tachypnea, HTN]
tx [d/o severity]: drugs [B-agonist’s, anti-inflammatory, methylxanthines, mucolytics, anticholinergics, leukotriene modifiers, neb. tx.’sl], O2
LOWER RESP. DISORDER: drugs to treat asthma
B-2 adrenergic agonists relaxes the muscles, opens the airways by activating beta-2 receptors
- short-acting beta agonist [SABA] for rescue and long-acting beta agonist [LABA] for maintenance
anticholinergics relax and dilate the airways in the lungs for maintenance
- S.E.: dry mouth
methyxanthines slightly relax the airways in the lungs through bronchodilation and increases the strength of the diaphragm by stimulating the breathing control centers in the brain for maintenance of chronic asthma
anti-inflammatory agents
- S.E.: thrush if mouth is not rinsed after drug use
leukotriene modifiers works to block the effect of leukotrienes in our bodies by binding to receptors on smooth muscle and other tissue in the airways
mucolytic agents [i.e. water] help loosen and clear the mucus from the airways by breaking up the sputum used for maintenance
LOWER RESP. DISORDER: asthma nursing care
assessment of resp. and cardiac status, bed rest [w/ H.O.B. elevated, encourage deep breathes, chest physiotherapy [if there is an open airway], encourage pursed lip breathing [promotes opening of the alveoli], balance activity/rest, fluids, small frequent meals, NO SEDATIVES, relaxation exercises
teach that inhaled med.’s should be taken 1-2 min.’s b/w each puff w/ same med. and 5 min.’s b/w each puff w/ diff. med.
LOWER RESP. DISORDER: COPD
disease state characterized by the presence of airflow obstruction
- chronic bronchitis [presence of chronic productive cough] and emphysema [abnormal enlargement of air spaces accompanied by destruction of walls
cause: SMOKING, heredity, aging, infection, inhaled irritants
complications: cor-pulmonale, resp. failure, peptic ulcer disease and GERD, pneumonia
LOWER RESP. DISORDER: chronic bronchitis
blue bloaters
a syndrome of excessive mucus production in the bronchi accompanied by a recurrent daily cough that persists for at least 3 months of the year during at least 2 consecutive years
- the problem is getting air in [decreased O2] and getting air out [increased CO2]
consequences: hypertrophy & hyperplasia of bronchial glands, increased # of goblet cells, decreased cilia, chronic inflammation [airway narrowing], altered function of alveoli
s/s: frequent productive cough, frequent resp. infections, dyspnea upon exertion, hypoxemia, hypercapnia, edematous, robust appearance, finger clubbing, coarse rhonchi, wheezing
LOWER RESP. DISORDER: emphysema
pink puffers
a condition of the lung characterized by abnormal, permanent enlargement of the air spaces distal to the terminal bronchioles [causes inability to recoil], accompanied by destruction of their walls and w/o obvious fibrosis
- problem is getting the air out [increased CO2]
consequences: destruction of alveolar walls, alveolar air trapping, loss of elastic recoil capabilities, stimulation of the macrophages and neutrophils
s/s: dyspnea, minimal cough, barrel chest, thin and underweight, finger clubbing, pursed-lip breathing, diminished breath sounds
LOWER RESP. DISORDER: cor pulmonale
right-sided heart failure 2o to lung constriction
causes: increased cardiac work due to constricted vessels in the lungs
LOWER RESP. DISORDER: polycythemia
physiologic compensation for hypoxemia where there is an increase in unoxygenated RBC’s since there is not O2 available
- inadequate O2 stimulates release erythropoietin from the kidneys causing more RBC but since there is no O2 available, the action does not help
tx: provide adequate fluids [not too much, not too little]
LOWER RESP. DISORDER: COPD diagnostic studies
history and physical examination CXR pulmonary function studies ABG studies electrocardiogram sputum specimen for culture SERUM A1-ANTITRYPSIN LEVELS - TELLS US WHETHER IT IS GENETIC EMPHYSEMA OR NOT exercise testing w/ oximetry echocardiagram
LOWER RESP. DISORDER: COPD nursing care
drugs
- [B-adrenergic agents, anticholinergic agents, methylxanthines, corticosteroids], smoking cessation, flu and pneumonia vaccines, immediately treat URI’s, O2-low flow [prevents CO2 narcosis
diet
- fluids [not during meals], small frequent meals, high-kcal high-protein, low CHO [by-product is CO2], pre-prandial rest and bronchodilation, Na+ restriction, avoid foods that require a lot of chewing
teaching
- pursed-lip breathing [prevents atelectasis and gets rid of CO2], diaphragmatic breathing, chest physiotherapy
MANAGEMENT OF HEART PT.’S: cardiac output
CO= stroke volume X heart rate
stroke volume= amount of blood ejected from the left ventricle w/ each heartbeat
- stroke volume is influenced by pre-load an after-load
– pre-load refers to amount of blood in left ventricle at the end of diastole, the greater the pre-load the greater the contractility of the heart muscle resulting in a greater stroke volume
– after-load reflects the amount of resistance the ventricles have to contract against, an increase in after-load results in a decrease in stroke volume
MANAGEMENT OF HEART PT.’S: serum diagnostic assessment
creatine kinase of cardiac muscles [CK-MB] is an enzyme released pc heart cell death
- onset= 6 hours
- peak= 10-24 hours
troponin I [most preferred since it lasts longer in the blood] is released pc myocardial injury
- onset= 6 hours
- duration= 1-2 weeks
serum lipids
- triglycerides [40 mg/dL]
- LDL [<1.0 mg/L
homocysteine indicate platelet aggregation an turbulent blood flow when increased
- 5.2-12.9 [M]; 3.7 [10.4 [F]
b-type natriuretic peptide [BNP] found in ventricles indicate dyspnea w/ cardiac origin
