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Exam 3 > Lower Respiratory > Flashcards

Lower Respiratory Flashcards

1
Q

atelectasis:

A

collapse of the (lungs) alveoli caused by hypoventilation, obstruction or compression

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2
Q

hemothorax:

A

partial or complete collapse of the lung due to blood accumulating in the pleural space; may occur after surgery or trauma

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3
Q

induration:

A

an abnormally hard lesion or reaction, as in a positive tuberculin skin test

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4
Q

orthopnea:

A

shortness of breath when reclining or in the supine position

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5
Q

pleural effusion:

A

abnormal accumulation of fluid in the pleural space

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6
Q

pneumothorax:

A

partial or complete collapse of the lung due to positive pressure in the pleural space

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7
Q

respiratory weaning:

A

process of gradual, systematic withdrawal or removal of ventilator, breathing tube, and oxygen

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8
Q

thoracentesis:

A

insertion of a needle or catheter into the pleural space to remove fluid that has accumulated and decrease pressure on the lung tissue; may also be used diagnostically to identify potential causes of a pleural effusion

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9
Q

thoracotomy:

A

surgical opening into the chest cavity

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10
Q

Acute Tracheobronchitis Pathophysiology

A
  1. Acute inflammation of the mucous membranes of the trachea and bronchial tree.
  2. Produces mucopurulent sputum
  3. Occurs In response to Streptococcus pneumonia, Haemophilus influenza, or Mycoplasma pneumonia
  4. Can also come from a fungal infection.
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11
Q

what is important for diagnosis of Acute Tracheobronchitis

A

Sputum culture

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12
Q

Acute Tracheobronchitis of Clinical Manifestations

A 
Dry irritating cough
Mucoid to purulent sputum
Fever, chills, Night sweats
Headache & malaise
Shortness of breath
inspiratory stridor and expiratory wheeze
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13
Q

Mucoid Sputum

A

clear or white

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14
Q

Malaise:

A

general discomfort

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15
Q

explain dry cough

A

its unproductive cough, pt still has sputum but its sitting in their lungs.

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16
Q

Acute Tracheobronchitis Medical Management

A
  1. Treat symptoms
  2. Antibiotic treatment if bacterial
  3. Increase fluid intake
  4. Suctioning may be needed
  5. Steam inhalations
  6. Moist heat to chest
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17
Q

antihistamines for Acute Tracheobronchitis Medical Management

A

are not prescribed, because they can cause excessive drying and make secretions more difficult to expectorate

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18
Q

Acute Tracheobronchitis Nursing Management

A
  1. Encourage bronchial hygiene
  2. Use analgesics
  3. Effective coughing techniques
  4. Prevention of overexertion
  5. Promote rest/semi or high fowlers position
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19
Q

Encourage bronchial hygiene

A

(bronchial hygiene consists of increased fluids and coughing to remove secretions)

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20
Q

Acute Tracheobronchitis Nursing Assessment

A 
1. Health history*
(Smoking
Vaccinations
Surgeries
Injuries
Hospitalizations)
Current health problems
Date of last x-ray, PFT*
Diagnostic results 
Recent weight loss*
Night sweats*
Sleep disturbances*
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21
Q

why is recent weight loss important when assessing Tracheobronchitis

A

overexertion and SOB can lead to weightless

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22
Q

PFT

A

pulmonary function test

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23
Q

Its good to ask about x-rays and PFTs

A

to compare old imaging to current imaging results.

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24
Q

So if a patient is experiencing a new onset of night sweats

A

it could potentially be because of tracheobronchitis

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25
Q

goals for acute tracheobronchitis

A

Patient will:
Have no difficulty with breathing.
Remain over 92% oxygen saturation.
Sustain adequate respiratory function.
Free of symptoms of respiratory distress.
Demonstrate an effective productive cough to clear secretions.`

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26
Q

nursing interventions for acute tracheobronchitis

A 
Prevent complications by:
(Monitoring vital signs, respiratory status.)
Elevate the head of the bed.
Encourage pursed lip breathing and clearing of sputum.
(Suction when necessary)
Evaluate level of activity tolerance.
Note presence and degree of dyspnea.
Increase fluid intake.
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27
Q

Pneumonia patho

A

Inflammation of the lung caused by various microorganisms

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28
Q

causes of Pneumonia

A

Bacteria, mycobacteria, fungi, viruses

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29
Q

statistics about pnemonia

A
  1. Most common cause of death from infectious disease in the US
  2. Viruses are most common cause in infants and children.
  3. 8th leading cause of death in the US in 2012.
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30
Q

pnemonia patho

A

Inflammation in the alveoli producing exudate (sticky substance) that interferes with diffusion of O2 and CO2

WBCs fill the normally air-filled alveoli causing bronchospasms.
Poorly oxygenated blood eventually results in arterial hypoxemia.

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31
Q

Bronchospasm occurs when

A

the airways (bronchial tubes) go into spasm and contract. This makes it hard to breathe and causes wheezing

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32
Q

V./Q. refers to

A

the ratio between ventilation and perfusion in the lung, which is normally approximately 4 to 5

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33
Q

lobar pneumonia is defined

A

If a substantial portion of one or more lobes is involved, the disease is referred to as

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34
Q

classifications of pnemonia

A

Community-acquired pneumonia (CAP)
Health care-associated pneumonia (HCAP)
Hospital-acquired pneumonia (HAP)
Ventilator-associated Pneumonia (VAP)

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35
Q

Community-acquired pneumonia (CAP)

A

Occurring in the community or <48 hours after hospital admission.

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36
Q

Health care-associated pneumonia (HCAP)

A 
Non-hospitalized patient with contact with one or more of: 
hospitalization for >2 days, 
nursing home, 
antibiotic therapy, 
hemodialysis, 
wound care, 
infected family member
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37
Q

Hospital-acquired pneumonia (HAP)

A

Occurring >48 hours after hospitalization

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38
Q

Ventilator-associated Pneumonia (VAP)

A

Occurring >48 hours after endotracheal intubation

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39
Q

An important distinction of HCAP

A

is that the causative pathogens are often MDROs

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40
Q

A multidrug resistant organism (MDRO)

A

isa germ that is resistant to many antibiotics

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41
Q

HCAP is often difficult to treat, thats why ____

A

initial antibiotic treatment must not be delayed

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42
Q

HAP is associated with a high mortality rate, in part because

A

of the severity of the organisms, the resistance to antibiotics, and the patient’s underlying disorder

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43
Q

preventative measure for: Patients who are immunosuppressed or neutropenic (low neutrophil count)

A

Initiate special precautions against infection

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44
Q

preventative measure for: Prolonged immobility and shallow breathing pattern

A

Reposition frequently and promote lung expansion exercises

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45
Q

preventative measure for: Depressed cough reflex (due to medications, a debilitated state, or weak respiratory muscles)

A

Reposition frequently to prevent aspiration

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46
Q

preventative measure for: placement of nasogastric, orogastric, or endotracheal tube

A

Minimize risk for aspiration by checking placement of tube

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47
Q

preventative measure for: Supine positioning in patients unable to protect their airway

A

Elevate head of bed at least 30 degrees

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48
Q

Pnemonia Risk Factors

A 
>65 years old
Comorbidities:
COPD, Heart failure, Diabetes, AIDs (they are immunosuppressed)
Prolonged immobility
Long-term care residence
Prolonged NPO
Aspiration (of bacteria/infection)
Use of tobacco or alcohol
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49
Q

Pnemonia Clinical Manifestations

A 
Nasal Congestion
Cough
Sore throat
tachypnea
Flushed cheeks
Headache
fever
Orthopnea
Pleuritic Pain
Myalgia
Purulent Sputum
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50
Q

Consolidation of lung, a sign of pnemonia

A

is density of lungs due to fluids filling characterized by:

  1. Tactile fremitus (vocal vibration detected on palpation)
  2. Dull percussions
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51
Q

Pnemonia diagnostic studies

A 
History and physical
Chest X-ray 
Pulse oximetry and ABGs
Blood culture
Sputum culture
Bronchoscopy (may be completed in severe cases)
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52
Q

Chest X-ray in Pnemonia patients is used for (

A

to detect anatomical abnormalities

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53
Q

Bronchoscopy

A

is a procedure to look directly at the airways in the lungs using a thin, lighted tube (bronchoscope)

54
Q

complications of pnemonia

A

Lung abscess
Pleurisy
Pleural Effusion
Atelectasis

55
Q

Lung abscess

A

Localized collection of pus caused by microbial infection.

56
Q

Lung abscess patho

A

Caused by aspiration of anaerobic bacteria

57
Q

Lung abscess symptoms

A 
foul smelling sputum
Fever
Productive cough
Dyspnea
Weakness
Weight loss
58
Q

Lung abscess assessment findings

A

Pleural friction rub (grating or creaking sound)
Crackles
Percussion dullness

59
Q

Lung abscess prevention

A

Dental and oral hygiene

60
Q

Lung abscess treatment

A

These pts will need strong IV antibiotics or surgical resection in rare cases.

61
Q

Pleurisy

A

Inflammation of both layers of pleurae

62
Q

Pleurisy patho

A

Surfaces rub together with respirations, causes sharp pain that worsens with inspiration

63
Q

Pleurisy patient education

A

The nurse educates the pt to turn and splint frequently onto the affected side to splint the chest wall.

64
Q

Pleural Effusion

A

Collection of fluid in pleural space.
Usually secondary to another disease process.
Thoracentesis may be performed

65
Q

what is a sign of Pleural Effusion

A

Empyema: Accumulation of thick, purulent fluid in pleural space

66
Q

Thoracentesis

A

(aspiration of fluid and air from the pleural space)

Nurse’s job is to record the output and report findings to doctor

67
Q

Atelectasis

A

Collapsed or airless condition of the alveoli.

68
Q

Atelectasis patho

A

Caused by hypoventilation, obstruction to airways, or compression

69
Q

Atelectasis signs

A 
Increased dyspnea
Cough
Sputum production
Pleural pain
Central cyanosis
70
Q

Atelectasis is one of the most commonly encountered abnormalities seen on _________

A

a chest x-ray

71
Q

Nursing measures to prevent atelectasis include

A

frequent turning, early mobilization, and strategies to expand the lungs and to manage secretions

72
Q

Medical management for pnemonia

A
  1. Antibiotic therapy based on culture and sensitivity.
  2. Bronchodilators (albuterol)
  3. Supportive treatment
73
Q

“Supportive treatment” for Medical management for pnemonia includes:

A 
Hydration
Oxygen for hypoxemia
Antipyretics
Antitussives (cough)
Nasal decongestant
Antihistomines
74
Q

_______ are ineffective in viral upper respiratory tract infections and pneumonias,

A

Antibiotics

75
Q

Antibiotics are indicated with a viral respiratory infection only if a secondary _____ pneumonia, bronchitis, or rhinosinusitis is present

A

bacterial

76
Q

Nursing Management for pnemonia

A 
Patient positioning
Oxygen supplementation
Monitor intake and output
Activity grouping
Administer medications as ordered
Education about symptoms to report
77
Q

Prevention for pnemonia

A

Vaccines if older than 65 or w/ chronic health issues:
(PCV 13) Pneumococcal conjugate vaccine
(PPSV23) Pneumococcal polysaccharide vaccine

& Seasonal influenza vaccination yearly

78
Q

PPSV23

A

is a newer vaccine and protects against 23 types of pneumococcal bacteria

79
Q

adults age 65 or older who have not received PCV13

A

a dose of PCV13 should be given followed by PPSV23 one year later

80
Q

renewal of PPSV23 vaccines

A

after 5 years of previous dose

81
Q

Nursing Assessment for pnemonia

A 
History and physical
Signs and symptoms of illness
Vital signs
Respiratory assessment
Peripheral pulses
Skin color
82
Q

nursing interventions for pnemonia

A 
Provide humidification
Suction as needed
Promote fluid intake and coughing
Encourage rest and activity grouping
Administer oxygen as necessary
Education
Medication administration
Monitor for complications
83
Q

why is removing secretions is important

A

because retained secretions interfere with gas exchange and may slow recovery.

84
Q

(CPT) Chest Physiotherapy

A

is postural drainage, important in loosening and mobilizing secretions

85
Q

Pneumonia symptoms the nurse must educate the pt to report to Physician

A

difficulty breathing,
worsening cough,
recurrent/increasing fever,
and medication intolerance

86
Q

for Bacterial Pnemonia, patients usually begin to respond to treatment within

A

24 to 48 hours after antibiotic therapy is initiated.

87
Q

Tuberculosis

A

An infectious disease that affects the lung parenchyma (functioning portion of the lung tissue)

88
Q

the infectious agent of Tuberculosis

A

“M. tuberculosis” is the infectious agent

89
Q

Tuberculosis infects

A

one third of the world’s population

90
Q

Tuberculosis is associated

A

with poverty, malnutrition, substandard housing, and inadequate healthcare

91
Q

Pathophysiology of TB

A
  1. Bacteria are transmitted through the airway to the alveoli
  2. Immune response occurs to lyse (destroy) the bacilli and normal tissue
    3, Accumulation of exudate occurs in the alveoli which can cause pneumonia
92
Q

TB’s Initial infection usually occurs

A

2 to 10 weeks after exposure

93
Q

TB Could be dormant. Becomes Active disease

A

due to Immunosuppressed patients or reinfections

94
Q

TB spreads from person to person by

A

airborne transmission

95
Q

Risk Factors for TB

A

Inadequate healthcare
Preexisting medical conditions
Travel to countries with high prevalence
Health care workers providing high risk activities

96
Q

countries with a high prevalence of TB

A

(southeastern Asia, Africa, Latin America, Caribbean).

97
Q

preventing the transmission of TB

A

Early identification

Initiate isolation precautions for any patient with suspected TB

Surveillance for TB transmission via tuberculin skin testing

98
Q

Isolation for TB includes:

A

negative pressure private room and use of ultraviolet lamps

99
Q

TB symptoms

A 
Progresses gradually
Low grade fever
Cough
Night sweats (common)
Fatigue
Weight loss (common)
Cough 
Nonproductive or mucopurulent 
Hemoptysis (coughing blood)
100
Q

TB assessments and diagnostics

A
  1. Complete history (traveled to countries?)
  2. Physical examination
  3. Thorough respiratory assessment
  4. Tuberculin skin test
  5. Chest X-ray
101
Q

Thorough respiratory assessment for TB includes:

A

assessing the lungs for consolidation by evaluating breath sounds (diminished, bronchial sounds; crackles), fremitus, and egophony.)

102
Q

If the patient is infected with TB, the chest x-ray usually

A

reveals lesions in the upper lobes.

103
Q

The Mantoux method is used to determine

A

whether a person has been infected with the TB bacillus

104
Q

what are the steps for injecting TB skin test?

A
  1. purified protein derivative (PPD), is injected into the intradermal layer of the inner aspect of the forearm, approximately 4 inches below the elbow.
  2. The needle, with the bevel facing up, is inserted beneath the skin.
  3. Then, 0.1 mL of PPD is injected,
105
Q

A significant (positive) PPD reaction does

A

not necessarily mean that active disease is present in the body.

106
Q

Mantoux test readings

A

(Negative) = redness only

(Positive) = Wheel greater than 6-10 mm

(positive) = “immunosuppressed” wheel is 5+ mm diameter

107
Q

A significant (positive) reaction indicates

A

past exposure to M. tuberculosis or vaccination with bacille Calmette-Guérin (BCG) vaccine

108
Q

QuantiFERON-TB Gold In-Tube and T-SPOT

A

TB blood tests.
Preferred test for patients who have received the vaccine.
Available within 24 to 36 hours.
A positive test indicates a possible infection.
Sputum culture is completed to confirm positive diagnosis.

109
Q

TB Can cause atypical manifestations in geriatrics such as

A

Unusual behavior

Altered mental status

110
Q

in geriatrics, TB skin test reaction is

A

delayed by 1 week, and a second TB skin test should be performed 1-2 weeks after

111
Q

Geriatrics are at a higher risk when

A

living at a long term care facility

112
Q

TB medical management

A

Anti-TB agents for 6 to 12 months to eradicate organisms and prevent relapse

113
Q

Four anti-TB medications given at beginning of treatment (given as a cocktail)

A

Isoniazid (INH)
Rifampin (Rifadin)
Pyrazinamide (PZA)
Ethambutol (Myambutol)

114
Q

those 35 years or younger who have PPD test results with 10 mm of induration or more and who are foreign-born from countries with a high prevalence of TB are suggested to take

A

Prophylactic isoniazid (INH) treatment involves taking daily doses for 6 to 12 months.

115
Q

pulmonary TB medications regimen

A

Take the 4 Medication cocktail once a day for 2 months and are oral medications then continues a 4-7 months PO depending on culture result

116
Q

Common side effects of TB medications:

A

Hepatitis
Neuritis
(nausea + vomiting)

117
Q

Nursing Management for TB patients

A

Promoting airway clearance

Advocating adherence to treatment regiment

Promoting activity and nutrition

Preventing transmission

118
Q

Promoting Airway Clearance for TB

A

Increase fluid intake to promote systemic hydration

Positioning for breathing comfort

119
Q

lower and middle lobe bronchi drain more effectively when

A

the head is down

120
Q

the upper lobe bronchi drain more effectively when

A

the head is up.

121
Q

Rifampin lowers the effectiveness of these medications.

A

beta blockers,
anticoagulants
or contraceptives

122
Q

rifampin, it can cause an

A

orange tint to their urine.

123
Q

TB is a communicable disease and that taking medications

A

is the most effective means of preventing transmission

124
Q

The nurse educates the patient to take the medication either

A

on an empty stomach or at least 1 hour before meals,

125
Q

Patients taking isoniazid should avoid foods that contain

A

tyramine and histamine (tuna, aged cheese, red wine, soy sauce, yeast extracts), to avoid headaches and hypotension

126
Q

Patients should also avoid alcohol because

A

of the high potential for hepatoxic effects.

127
Q

Promoting Activity and Adequate Nutrition for TB

A

Goal: To increase activity tolerance and muscle strength
Willingness to eat may be altered
Identify facilities that provide meals to patients with limited resources
Small frequent meal planning
Liquid nutritional supplements

128
Q

Preventing Transmission patient teachings include:

A

Covering mouth and nose while sneezing and coughing.
Hand hygiene.
Proper disposal of tissues.
Watch for transmission signs to other organs in the body.

129
Q

Watch for transmission signs to other organs in the body by:

A

Frequent vital signs
Spikes in temperature
Changes in renal or cognitive function

130
Q

miliary TB

A

Spread of TB infection to nonpulmonary sites of the body

Exam 3 (6 decks)

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