lower respiratory

Question 1

pulmonary embolism (PE)

Answer 1

most likely a DVT that breaks loose
clinical manifestations: SOB, coughing, dyspnea, tachypnea, chest pain, crackles and wheezing, fever, syncope.

massive PE: hypotension and shock

complications associated with PE’s: pulmonary infarction (death of lung tissue, may become infected and abscess may develop)
pulmonary hypertension (massive/recurrent PE’s)

Diagnostics:
spiral (helical) CT scan–used most frequently
chest x-ray
d dimer

Question 2

PE collaborative care and interventions

Answer 2

IMMEDIATE Tx as soon as PE suspected
bed rest, semi-folwers position
O2 by NC or mask
cardiac monitoring, VS, O2, ABGs, breath sounds
Fibrinolytic agent –IV heparin drip (RN management by protocol), lovenox, or warfarin (monitor INR/PT).

opioids for pain, medications PRN for anxiety

IVC filter, or pulmonary embolectomy are more radical options

Question 3

Pneumonia (what is it, types)

Answer 3

acute infection of lung parenchyma, usually caused by gram negative bacilli

three main kinds: opportunistic and community acquired

opportunistic: altered immune system, malnutrition, HIV/AIDs, radiation or chemo

community acquired pneumonia: pre-hospital onset or within first 2 days of admit
highest incidence in winter

hospital acquired pneumonia:
48 hours or more after infection
risk factors: immunosuppression, ET tube, fungal/aspiration pneumonia (altered LOC), gag/cough reflex impairment, tube feedings.

Question 4

general clinical manifestations for pneumonia

nursing considerations

Answer 4

clinical manifestations: productive cough, difficulty breath, SOB,

nursing considerations: tachycardia, changes in mental status

Question 5

Diagnostic studies for pneumonia

Answer 5

H/P, chest X ray, vitals (esp. O2 sats and ABGs)
CBC, CMP, blood cultures
Sputum culture PRIOR to antibiotic therapy

Question 6

collaborative therapy for pneumonia

Answer 6

antibiotic therapy
increased fluids (3L/day)
limit activity, more rest

Question 7

complications from pneumonia

Answer 7

pleurisy or pleural effusion
atelectasis
persistent infection
lung abscess
pneumothorax
sepsis
respiratory failure

Question 8

teaching for pneumonia

Answer 8

nutrition, exercise, rest, vaccination, finish all antibiotics, drug-drug interactions, strict asepsis, turn cough deep breathe.

Question 9

Lung Cancer Overview

Answer 9

high mortality and low cure rate (thus, early detection is important)
risk factors are smoking or breathing secondhand smoke in (taxis, occupational hazard, etc).

Question 10

NSCLC (80% of all lung cancers)

Answer 10

squamos cell (large cell, slow)
adenocarcinoma (alveoli, moderate, nonsmokers)
large cell (rapid, high mets)

Question 11

SCLC (20% of all lung cancers)

Answer 11

larger airways
most malignant
associated endocrine disorders
early mets
more sensitive to chemo but poorer prognosis
associated with paraneoplastic syndrome

Question 12

Diagnostic studies–Lung Cancer

Answer 12

chest X ray

Question 13

Clinical Manifestations of lung cancer

Answer 13

Early: persistent cough, blood tinged sputum, dyspnea, or wheezing

Later: anorexia, fatigue, weight loss, n/v, hoarseness, palpable lymph nodes

Question 14

treatment of lung cancer

Answer 14

radiation
chemo is primarily used for SCLS and adjuvant to surgery in NSCLC

“wedge resection” surgery, lobectomy, punemonectomy

immunotherapy

Question 15

Pneumothorax overview

Answer 15

a pneumothorax is when there is positive air pressure in the pleural space, causing the lung to partially or fully collapse.

Question 16

pneumothorax manifestations
diagnostics: chest X ray

Answer 16

small: mild tachycardia and dyspnea
large: respiratory distress, absent breath sounds over affected area.

diagnostics: chest X ray