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MedSurg Nursing; N1110 > Lower Respiratory Tract Disorders > Flashcards

Lower Respiratory Tract Disorders Flashcards

1
Q

What is the name of the infection that is a common cause of death?

A

Pneumonia

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2
Q

What populations are at risk for developing pneumonia?

A

Very young individuals
Elderly individuals (>65 years)
Those with chronic disease
Those who smoke
Those with compromised immune systems, such as AIDS
Those who are intubated and are mechanically ventilated

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3
Q

Define Hospital Acquired Pneumonia (HAP)

A

Pneumonia that develops at least 48 hours after a hospital admission

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4
Q

Define Ventilator Associated Pneumonia (VAP)

A

Pneumonia that can occur after an individual is intubated and placed on mechanical ventilation

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5
Q

What is happening within the body when a patient develops pneumonia?

A

There is an acute inflammation and/or infection within the lungs
The alveoli become damaged and fill with fluid and exudate

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6
Q

Pneumonia can commonly develop after what hospital procedure?

A

After surgery
Individuals are taking short and shallow breaths due to pain
The lungs and alveoli aren’t expanding appropriately, bacteria festers and grows within the alveoli

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7
Q

What patient does aspiration pneumonia usually develop in?

A

Those with decreased LOC and or an impaired gag reflex

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8
Q

How does an individual prevent pneumonia from developing?

A

Hand washing
Pneumococcal vaccine
Influenza vaccine
Encouraging coughing and deep breathing
Promoting position changes and turning while in bed
Encouraging movement/walking if patient is able to

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9
Q

How can the nurse prevent hospital acquired pneumonia from developing?

A 
Encouraging coughing and deep breathing
Promoting position changes and turning while in bed
Encouraging movement/walking if patient is able to
Incentive Spirometer
Hand hygiene
Oral hygiene
Pneumococcal vaccine
Influenza vaccine
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10
Q

List the signs and symptoms of pneumonia

A

Fever
Shaking
Chills
Chest pain
Dyspnea
Fatigue
Malaise
Productive Cough
Yellow, Rusty or blood tinged (hemoptysis) sputum
Adventitious Lung Sounds (crackles, coarse, wheezes)
New onset confusion and/or lethargy within the older adult patient

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11
Q

List some complications of pneumonia

A

Plueral Effusion
Atelectasis
Spread of Infection

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12
Q

What diagnostic tests can diagnose pneumonia?

A

Chest X Ray
Sputum Culture
Blood Cultures
Complete Blood Count

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13
Q

What medications will assist with signs and symptoms that have developed from pneumonia? How do they help?

A

Bronchodilators (Beta Two Agonist Medications); dilate the bronchioles and improve airflow and gas exchange
Expectorants; aide in ridding sputum from the lungs by breaking mucus up

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14
Q

What medications will treat bacterial pneumonia?

A

PO or IV antibiotics

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15
Q

What medications will treat viral pneumonia?

A

None usually given, patient instructed to rest and drink a lot of fluid

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16
Q

List therapeutic interventions for pneumonia

A 
Encourage fluids (helps thin exudate)
Encourage rest
Encourage deep breathing and coughing (clear exudate from body)
Encourage incentive spirometry
Supplemental O2 if necessary
Chest Physiotherapy
Administer bronchodilator if necessary
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17
Q

What is the definition of atelectasis?

A

Collapse of the alveoli, a restrictive disorder

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18
Q

Why does atelectasis occur?

A

Due to hypoventilation

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19
Q

When does atelectasis most commonly occur? Why?

A

In postsurgical patients
They are not taking deep breaths and coughing effectively secondary to pain
The alveoli don’t expand to their full capacity so they eventually collapse

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20
Q

List the signs and symptoms of atelectasis

A

Adventitious lung sounds; fine crackles, diminished breath sounds, possibly absent
Dyspnea
Pain with breaathing

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21
Q

What measures are taken to prevent atelectasis?

A

Coughing and deep breathing
Use of incentive spirometer
Turning patient
Ambulating patient

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22
Q

What is the issue that occurs when a patient has an obstructive lung disorder?

A

Air is trapped

Air can get into lungs but it cannot exit properly

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23
Q

Name the obstructive lung disorders

A

Chronic Obstructive Pulmonary Disease

Asthma

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24
Q

What two diseases are examples of COPD?

A

Emphysema

Chronic Bronchitis

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25
Can COPD be treated and go away?
No, COPD is progressive and irreversible | With appropriate lifestyle changes symptoms can improve, but the disease never goes away completely
26
What happens with the lungs during chronic bronchitis?
Airways are inflammed and narrowed | Mucus develops and remains in the alveoli and lungs
27
What happens with the lungs during emphysema?
Alveolar walls are destroyed which causes the alveoli to "pop" are merge together Elasticity within the lung tissue is lost Air becomes trapped in the alveoli
28
What is the number one cause of COPD?
Smoking
29
List the signs and symptoms of Chronic Bronchitis
``` Adventitious lung sounds; wheezing, crackles, rhonchi Chronic productive cough Thick, tenacious sputum Dyspnea, SOB Dyspnea on Exertion Activity intolerance Prolonged expiration Increased susceptibility to infection Mucous plugs develop Use of accessory muscles to aide in breathing ```
30
List the signs and symptoms of Emphysema
``` Chronic cough Diminished breath sounds Dyspnea, SOB Dyspnea on Exertion Activity intolerance Barrel Chest Prolonged expiration Use of accessory muscles to aide in breathing ```
31
What happens in the late stages of COPD?
Patient has difficulty eating due to severe dyspnea | Patient becomes malnourished and experiences weight loss
32
What diagnostic tests are performed when a patient has an acute exacerbation of COPD or an acute exacerbation of asthma?
Chest Xray and/or CT Scan Complete Blood Count Sputum Culture Arterial Blood Gases (hospital setting only)
33
What is the baseline range SpO2 for a patient with COPD?
88% - 92%
34
How much baseline supplemental oxygen should a patient with COPD be on?
1 to 2 LPM
35
If a patient with COPD is having an acute exacerbation, can they be placed on more than the recommended 1 to 2 LPM of supplemental oxygen?
Yes. However, provider should decrease the oxygen as quickly as possible with the patient keeping SpO2 levels greater than or equal to 88%
36
Is a patient with COPD required to be on oxygen?
No. If the patient can maintain appropriate oxygen saturations (88-92%) without O2, there is no need to be placed on the oxygen
37
If the student nurse knows a patient has a history of COPD and their assessment yields an O2 reading of 90%, should they be concerned?
Yes, always concerned if O2 is less than 94%. Performed appropriate assessments, interventions, reassessments and reporting to instructor!
38
What is the goal of COPD treatment?
To reduce symptoms, slow progression and reduce the amount of exacerbations Increase quality of life
39
List therapeutic interventions for COPD
Stop smoking Provide 1 to 2 LPM oxygen if necessary (if SpO2 <88%) Increase activity as tolerated Administer medications as necessary Encourage vaccinations; pneumococcal and influenza Encourage a diet high in protein and high in fat Teaching breathing exercises
40
What medication drug class should be avoided when a patient has COPD?
Antitussive Agents These medications reduce coughing Want to promote coughing in the COPD patient to expectorate secretions
41
Why does a patient with COPD have an ineffective airway clearance? How can the nurse aide with this issue?
Airway is congested with mucus The cough is weak and congested Crackles are present Nurse should encourage and increase fluids
42
What can the nurse do when a patient has an ineffective breathing pattern?
Encourage pursed lip and/or diaphragmatic breathing
43
What is occurring within the lungs when a patient has asthma?
Airways are chronically inflammed Bronchioles are spasming Airways are narrow Air gets trapped
44
List the causes (etiology) of asthma
Heredity/Genetics Airborne allergies Pollution Smoking
45
List triggers of asthma
They're different for every person. Common triggers include: Smoking, second hand smoke Allergens such as pollen, pets, environmental triggers Respiratory infection Sinusitis Stress Medications (non specific beta one blockers)
46
List signs and symptoms of asthma
``` Dyspnea Tachypnea Wheezing Chest tightness Cough Sputum Use of accessory muscles ```
47
The nurse knows what is happening if the patient with asthma has absent lung sounds? What medication should be given? What lung sounds would be heard next?
Bronchioles are completely constricted, minimal air flow, emergency! Medication: beta two adrenergic agonist to promote bronchodilation After the medication is given, should hear wheezing. Bronchioles are beginning to open back up, but they're still very narrow
48
During acute exacerbations of asthma or COPD, what therapeutic interventions will the nurse implement?
High Fowlers position Pursed lip breathing Supplemental O2 if necessary Nebulized mist treatments (beta two agonists) Possible corticosteroid treatment to reduce inflammation
49
What is the purpose of the peak flow meter? Why is it useful?
To measure the peak expiratory flow | Measurement is useful in detecting changes in airways, this could signal worsening respiratory symptoms
50
What is the purpose of tracking peak flow measurements on the chart?
So the patient and provider can see if current therapy is working, if it is effective, or if it needs to be adjusted
51
What does the green zone on the peak flow chart mean?
Green = Good | No changes made in treatment
52
What does the yellow zone on the peak flow chart mean?
Yellow = Caution Asthma is beginning to worsen Use rescue inhaler to help improve s/s Patient needs to see provide if yellow zone is frequently occurring
53
What does the red zone on the peak flow chart mean?
Red = Get Help! Less than 50% of personal best Use rescue inhaler, go get help
54
What is the difference between daily/maintenance medications and rescue medciations?
Daily/maintenance medications are taken every day to improve symptoms long-term, they are not used for immediate relief or acute issues Rescue medications are taken when symptoms worsen and immediate relief is needed
55
What is a pulmonary embolism?
Blood clot within the pulmonary artery
56
What is the most common cause of pulmonary embolism development?
A deep vein thrombosis (DVT) that dislodged and traveled to the pulmonary artery
57
How is a pulmonary embolism prevented?
Prevent development of a DVT; move/ambulate regularly, prophylactic DVT treatment if the patient is hospitalized/immobile
58
How is a DVT treated?
With anticogulant medication
59
List the signs and symptoms of a pulmonary embolism
Respiratory distress; suddent onset dyspnea, tachypnea, anxiety, decreased oxygen saturation Tachycardia Cough Crackles
60
How can a pulmonary embolism be diagnosed?
If a D-Dimer is elevated above 500 ng/mL, a CT Angiogram of the Chest will be ordered If a patient cannot receive a CTA, a ventilation perfusion scan will be performed
61
List therapeutic interventions for a pulmonary embolism
High Fowlers Oxygen (Non-Rebreather at 15LPM if severe respiratory distress present) Anticoagulant medication (heparin or lovenox)
62
List signs and symptoms of acute respiratory distress
``` Tachypnea Dyspnea Labored breathing Accessory muscle use Adventitious / Absent lung sounds Decreasing oxygen sats Tachycardia HTN Restlessness Confusion Lethargy ```
63
What can the nurse do if a patient presents with respiratory distress?
``` Place in high Fowlers or tripod position Apply oxygen; non rebreather, 15 LPM Encourage pursed lip breathing Administer medications ordered (short acting bronchodilators, corticosteroids) Assist in intubation ```

MedSurg Nursing; N1110 (15 decks)

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