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adults exam 1 > management of pts with chest and lower respiratory > Flashcards

management of pts with chest and lower respiratory Flashcards

1
Q

atelectasis

A

complete or partial collapse of the entire lung or area of the lung. When tiny alveoli within the lung become deflated

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2
Q

pneumonia

A

fluid in the lungs, one of the most common causes of death in U.S.

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3
Q

aspiration

A

something going down the wrong pip (ex. fluid into lung)

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4
Q

tracheobronchitis

A

inflammation of the trachea and bronchi (purulent sputum) classified as respiratory tract infection

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5
Q

pulmonary tuberculosis

A

serious infection caused by bacterium mycobacterium tuberculosis that involves the lungs but may spread to other organs, highly contagious (put in negative pressure room)

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6
Q

acute atelectasis

A

when the lung recently collapsed and is primarily notable only for airlessness (take care of right away)

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7
Q

chronic atelectasis

A

the affected area characterized by a complex mixture of airlessness, infection, widening of the bronchi, destruction, and scarring (maintenance)

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8
Q

who’s at risk for atelectasis

A

surgical patients, immobilized patients, increased age

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9
Q

symptoms of atelectasis

A

increasing dyspnea, cough, sputum production, respiratory distress, tachycardia, tachypnea, central cyanosis (late sign)

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10
Q

prevention for atelectasis

A

early mobilization, frequent turns, manage secretions, IS, deep breathing, fluids

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11
Q

before and after breathing treatment, what do you assess

A

pulse ox

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12
Q

types of pneumonia: community acquired

A

get it when out in public, symptoms can occur less than 48 hours after admitted

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13
Q

types of pneumonia: health care associated

A

non hospital areas (nursing homes, rehab) occurred in another health care setting

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14
Q

types of pneumonia: hospital acquired

A

more than 48 hours after admitted they develop pneumonia (hospitals fault)

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15
Q

types of pneumonia: ventilator associated

A

48 hours after intubated (ex. came into hospital had brain bleed and needed to be intubated, 48 hours after admitted on a ventilator)

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16
Q

types of pneumonia: immunocompromised

A

HIV/ AIDS/ cancer pts

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17
Q

types of pneumonia: aspiration pneumonia

A

water down into lungs and can’t cough it up (risk are stroke pts/ babies/ older population with weakness in swallowing muscles)

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18
Q

pneumonia can be

A

viral, fungal, or bacterial

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19
Q

path-physiology of pneumonia

A

presence of bacterial, mycobacterial, viral, or fungal in the lung -> causes inflammation in the lung tissues (alveoli) -> affects ventilation and diffusion -> decrease in alveolar oxygen tension mismatched ventilation & perfusion -> arterial hypoxemia

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20
Q

risk factors for pneumonia

A

age, exposure, immune state, nutritional state/ impaired swallowing, prolonged mobility, smoking

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21
Q

what types of patients may have pneumonia onto of another disease

A

COPD pts, cystic fibrosis pts, cancer pts

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22
Q

s/sx of pneumonia

A

hypoxia, fever, orthopnea, tires easily, sputum production (green/ blood tinged)

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23
Q

how to diagnose pneumonia

A

initial assessment (check BUN & creatinine before giving dye), sputum culture, chest xray, bronchoscopy, tissue biopsy

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24
Q

for pneumonia, when checking the CBC what might you see

A

high WBC, decrease in hemoglobin (all protein is going to make WBC to fight infection and leaves hemoglobin on back burner -> oxygen level will go down)

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25
Q

Tx for pneumonia

A

check cultures (need deep mucus, not just spit), start with broad spectrum antibiotic and later change as needed, oral or IV

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26
Q

prevention of pneumonia

A

flu shot, pneumococcal vaccine (older adults or chronic illness pt), avoid pollutants, avoid infectious situations, maintain hydration, physical activity, isolate if infected, hand hygiene

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27
Q

pleural effusion

A

extra fluid in the pleural space between the visceral and parietal membrane (doesn’t allow lungs to expand)

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28
Q

if WBC is low you can indicate

A

viral infection or chronic stress

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29
Q

if WBC is high you can indicate

A

bacterial infection or acute stress

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30
Q

complications if covid 19

A

pleural effusion, shock & respiratory failure

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31
Q

covid 19 is what type of transmission

A

viral, air borne, droplet

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32
Q

TB is transmited by

A

airborne, droplet (coughing, sneezing laughing)

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33
Q

TB can spread to

A

lungs, meninges (in brain), kidneys, bones, lymph nodes

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34
Q

s/sx of pulmonary TB

A

low grade fever, cough, night sweats, fatigue, weight loss

35
Q

how to diagnose pulmonary TB

A

being suspicious, pt history, rust colored sputum, acid fast bacillus smear, sputum culture, skin testing, chest xray, TB blood tests

36
Q

CDC recommended TB test

A

quantiferon TB gold test instead of Mantoux

37
Q

if you get the Mantoux TB test (intradermal injection of PPD), if it comes back positive what does that mean

A

it does not mean you have active TB, just means you may have been exposed

38
Q

positive result of Mantoux testing will look like what

A

induration at site (hardening)

39
Q

TB treatment

A

combination of 4 drugs (INH, rifampin, ethambutol, pyrazinamide

40
Q

with TB to prevent neuropathy what do you treat with

A

INH & vit B6

41
Q

2 phases when treating TB

A

initial phase: INH, rifampin, pyrazinamide, ethambutol for 8 weeks
continuation phase: INH & rifampin for 4-7 months more
(risk or transmission decreases after 2-3 weeks of therapy)

42
Q

side effect of INH

A

polyneuropathy (treat with vitamin B6)(monitor liver function)

43
Q

side effect of rifampin

A

orange urine, secretions, strains contacts & clothes & skin (monitor AST/ALT & liver function)

44
Q

side effects of ethambutol

A

optic neuritis (monitor vision changes, renal function, liver function)

45
Q

side effects of pyrazinamide

A

joint pain (monitor uric acid/ can get hyperuricemia, AST/ALT, liver function)

46
Q

pt education when treating for TB

A

liver function must be monitored, assure that meds are being taken, no alcohol intake, teach prevention of transmission, staff be fit tested for N95

47
Q

with a pleural effusion what can be done to tx

A

thoracentesis

48
Q

pleurisy

A

inflammation of the pleural space, when you take a deep breath since there is not enough surfactant in between the two membranes, it tears, sharp stabbing pain on inspiration

49
Q

pneumothorax

A

occurs when the pleural space is exposed to positive atmosphere pressure (air in thoracic cavity)

50
Q

pneumothorax can occur from

A

a stabbing, gun shot, punctured lung from the ribs, chest surgery, putting a central line in place

51
Q

symptoms of a pneumothorax

A

SOB, acute chest pain, decreased blood pressure, decreased blood O2, increased HR/ acute distress, pain, tachypnea, respiratory discomfort, absent breath sounds, will be gasping for air, cyanosis

52
Q

pneumothorax is what type of diagnosis

A

an emergency

53
Q

tx for pneumothorax

A

chest tube (so positive air pressure doesn’t go into cheat cavity)

54
Q

thoracotomy

A

creation of a surgical opening into the thoracic cavity (may be for diagnose of lung or chest disease, obtain biopsy)

55
Q

lung wedge resection

A

takes a small chunk of lung, will heal and be fine

56
Q

lobectomy

A

takes the upper lobe of lung

57
Q

pneumonectomy

A

takes the whole lung out (whole one side)

58
Q

segmentectomy

A

takes part of a lobe (part of one lobe of three on one side)

59
Q

decortication

A

removing scar tisse

60
Q

chest tubes are placed

A

in pleural space to drain fluid, air, or blood/ keep chest tubes machine below chest level

61
Q

placement of chest tube on upper chest for

A

air removal

62
Q

placement of chest tube on lower chest for

A

fluid, blood removal

63
Q

chest tubes are

A

one way system to allow air or fluid out of cavity and non back in

64
Q

with chest tubes you want to look for

A

redness, drainage, crepitus (bubble wrap looking under skin) DO NOT WANT

65
Q

ocean chest tube: chamber A

A

chamber A: suction chamber, where the water level should be, water up to ml of suction

66
Q

ocean chest tube: chamber B

A

water seal, should see water go up and back down (tidaling)

67
Q

ocean chest tube: chamber C

A

should not see any bubbling in chamber C- if you see bubbling then you have a leak somewhere

68
Q

ocean chest tube: chamber D

A

drainage: will go from sangious to serous sanguineous to serous (at the end of each shift mark and initial drainage mark)

69
Q

if tidaling has stopped in chamber B that means

A

lung have reexpanded or if fluctuation has stopped that could mean a blockage

70
Q

when to assess chest tubes

A

every hour for the first 8 hours after placement then every 8 after that (if see bright red blood over 100ml/hr notify provider/ dark red drainage is normal: old blood just document

if drainage stops assess pt first (auscultate lungs- you do not want to hear diminished lung sounds)

71
Q

what never to do with chest tubes

A

never strip or milk chest tube, never want to see continuous bubbling in water seal/ air leak (only want to see in A), never clamp a chest tube during transport

72
Q

if a chest tube becomes disconnected

A

cough and exhale immediately (you don’t want air rushing in) apply occlusive dressing (petroleum gauze) secured on 3 side (not 4, one side needs to be open to allow air out)

73
Q

lung cancer is the leading cause of

A

death and 2 most common cancer in both men and women

74
Q

risks factors for lung cancer

A

smoking, genetic, environmental exposures (radon gas, 2nd hand smoke, asbestos, workplace)

75
Q

classification of lung cancer

A

small cell (SCLC) 10-15%, non small cell large cell (NSCLC) 80-85%/ squamous- adenocarcinoma (most prevalent)

76
Q

symptoms of lung cancer

A

cough, voice changes, hemoptysis, dyspnea, weight loss, pain (depends on location, existence of metastases, site)

77
Q

90% of lung cancers start where

A

bronchial epithelium

78
Q

tx for lung cancer

A

radiation, surgery, chemotherapy, palliative

79
Q

pulmonary embolism

A

obstruction of the pulmonary artery or one of its branches by a clot from the venous system (blood clot in circulation of the lung, comes from a DVT through vein coming back to R side through pulmonary artery into either lung)

80
Q

what medication to give with PE/ treatment

A

heparin/ enoxaparon/ tPA, surgery (IVC filter), anticoagulation therapy, IV lines

81
Q

s/sx of PE

A

dyspnea, chest pain, anxiety, fear, diaphoresis, hemoptysis (coughing up blood), syncope, tachypnea, sudden death

82
Q

prevention of PE

A

active leg exercises, early ambulation, SCDs/ ted hose

83
Q

diagnoses if PE

A

blood tests (ABGs), chest xray, ultrasound (check for DVT), CT, V/Q scan (measures perfusion and ventilation), pulmonary angiogram, MRI

adults exam 1 (9 decks)

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