Lower Respiratory Disorders: Inflammatory and Infectious Disorders

Question 1

atelectasis
disease process

Answer 1

closure of alveoli

Question 2

atelectasis
common causes

Answer 2

shallow breathing
S/P anesthesia from surgery
pain
impaired cough
excess secretions
mucus plugs (block bronchiole)
COPD

Question 3

atelectasis
prevention

Answer 3

early mobilization
deep breathing
pain meds
IS (incentive spiro)
positioning

Question 4

atelectasis
positioning

Answer 4

high fowlers

Question 5

atelectasis
why is pain a risk factor

Answer 5

patient don’t want to get up and move or cough

Question 6

atelectasis
stroke/anestheisa

Answer 6

impaired cough/gag

Question 7

atelectasis
increase secretions

Answer 7

mucus plug

Question 8

how often do we want patients to cough and deep breath

Answer 8

10x hour

Question 9

pain medication

Answer 9

stay on top of pain
hard to get pain down from a 9-10

Question 10

atelectasis
manifesations

Answer 10

increase HR
RR
decreased ability to oxygenate
diminished lung sounds

Question 11

focused respiratory assessment occurs of what

Answer 11

plus ox
lung sounds
respirations
cyanotic
cough
sputum
work of breathing
accessory muscles
depth and rate

Question 12

pneumonia
causes

Answer 12

bacteria
virus
fungi (normal immune system should be able to fight off fungi so this is seen in immunocompromised individuals)

Question 13

pneumonia can be a complication of _________

Answer 13

atelectasis

Question 14

4 types of pneumonia and which ones are never events

Answer 14

community acquired pneumonia (CAP)
health care acquired pneumonia (HCAP)
hospital acquired pneumonia (HAP) NEVER
ventilator acquired pneumonia (VAP) NEVER

Question 15

pneumonia
manifestations

Answer 15

change in temp, pulse
secretions (color, consistency, amount)
cough
tachypnea
shortness of breath
crackles on auscultation

Question 16

pneumonia
manifestations ELDERLY

Answer 16

mental status change
fatigue
do not get fever as easily

Question 17

why do we want sputum and urine cultures

Answer 17

sputum for the organism and possible antibiotics
urine to rule out UTI

Question 18

pneumonia
risk factors

Answer 18

long term care (spreads quickly)
immunosuppression (chemo, steroids, HIV/AIDS)
smoking
prolonged immobility (espcially in elderly, they will rapidly decline)
depressed cough reflex
NPO
supine positioning (increase risk for atelectasis)
alcohol (inhibits airway protection)
transmission from healthcare providers

Question 19

pneumonia
order of priority

Answer 19

1. culture
2. antibiotic administration with in 60 min

Question 20

pneumonia
diagnosis

Answer 20

history
CXR, CBC, blood, urine, sputum culture

Question 21

pneumonia
supportive treatment

Answer 21

fluids (concern about FVE, especially in elderly)
oxygen for hypoxia
antipyretics (aches)
antitussives (cough sup)
decongestants
antihistamines

Question 22

when are antibiotics used for a viral infection

Answer 22

not indicated for vital but used for secondary bacterial infection

Question 23

pneumonia
improving airway clearance

Answer 23

encourage hydration: 2-3L a day (as tolerated by cardiovascular to thin secretions)
humidification (loose secretions)
coughing techniques (splint)
chest physiotherapy (pulmonary toilet)

Question 24

pneumonia
nutrition

Answer 24

provide nutritionally enriched foods and fluids

Question 25

aspiration defintion

Answer 25

inhalation of foreign material (oropharyngeal or stomach)

Question 26

aspiration clinical presentation

Answer 26

tachycardia dyspnea hypotension hypertension central cyanosis ultimately death

Question 27

aspiration prevention

Answer 27

tube feeding-placement verification swallow assessment HOB elevated

Question 28

pulmonary tuberculosis risk factors

Answer 28

poverty poor housing malnutrition immunocompromised forgein travel immigration exposure

Question 29

pulmonary tuberculosis signs and symptoms

Answer 29

persistent cough weight loss anorexia night sweats hemoptysis shortness of breath fever/chills rust colored sputum

Question 30

what is the only way we can confirm pulmonary tuberculosis

Answer 30

sputum culture of M. tuberculosis

Question 31

what is the QuantiFERON

Answer 31

blood test, tells us exposure only not affected by BCG vaccine

Question 32

Mantoux test sight

Answer 32

intradermally in the forearm

Question 33

Mantoux test reading

Answer 33

48-72 hours later

Question 34

Mantoux test exposure in person with normal immunity

Answer 34

10mm

Question 35

Mantoux test exposure in person who is high risk (HIV/immunocompromised)

Answer 35

5mm

Question 36

does the Mantoux test prove exposure or confirmation

Answer 36

exposure

Question 37

latent TB

Answer 37

exposed immune system able to suppress it no signs and symptoms, might have ghon focus (walled off bacteria)

Question 38

how do we confirm if a patient is no longer infectious

Answer 38

negative sputum culture x3

Question 39

tuberculosis health teaching

Answer 39

follow exact drug regimen - empty stomach - 1 hour prior to meals avoid wine, tuna, alcohol, aged cheese proper nutrition and reverse weight loss

Question 40

pleurisy

Answer 40

inflammation of both layers of pleurae

Question 41

pleurisy are at risk for

Answer 41

atelectasis

Question 42

why are pleurisy at risk for atelectasis

Answer 42

inflamed surfaces rub together with respirations cause sharp pain intensified with inspirations

Question 43

pleural effusion

Answer 43

collection fluid in the pleural space usually secondary to another disease

Question 44

pleural effusion manifestations

Answer 44

dyspnea diminished or absent sound over lungs

Question 45

empyema

Answer 45

accumulation of thick purulent fluid in pleural space

Question 46

pulmonary edema

Answer 46

accumulation of fluid in the lung tissue, alveolar space or both

Question 47

pulmonary edema non cardiogenic causes

Answer 47

chest trauma aspiration smoke inhalation sepsis pancreatitis multiple transfusion cardiopulmonary bypass

Question 48

pulmonary edema mainfesations

Answer 48

increase in RR shortness of breath decrease pulse ox crackles when provided oxygen they continue to remain hypoxemia, frothy sputum

Question 49

acute respiratory failure

Answer 49

sudden and life threatining deterioration

Question 50

acute respiratory failure ABG

Answer 50

PO2 less than 50 PCO2 greater than 50 pH less than 7.35

Question 51

acute respiratory failure manifestations early, late, and turning point

Answer 51

restlessness (early) dyspnea air hunger confusion/lethargy (turning point) tachycardia and tachypnea diaphoresis cyanosis (late) respiratory arrest (LATE)

Question 52

what does actor respiratory failure require

Answer 52

intubation and mechanical ventilation