Med Surg: Lower Respiratory Problems Flashcards
What is chronic airflow limitation?
Asthma
Chronich Bronchitis
Pulmonary Emphysema
Chronic Obstructive Pulmonary Disease
What is Asthma and what does is occur from?
Chronic inflammatory disorder of the airways that result in intermittent and reversible airflow obstruction of the bronchioles
Occurs from inflammation and airway hyperresponsiveness
What are the manifestations of Asthma?
Mucosal edema
Bronchoconstriction
Excessive mucous production
What are the S&S of asthma?
Dyspnea
Chest tightness
Wheezing
Anxiety and or stress
coughing sputum
Mucous production
Use of accessory muscles
Tachypnea with hyperventilation
Low oxygen saturation
Diaphoresis
How do you assess asthma?
ABG: hypoxemia, hypocarbia, hypercarbia
Sputum culture
PFT: decreased FEV1 or PEF
What is the treatment for asthma?
High fowlers position
Oxygen therapy
Monitor cardiac rate and rhythm
Medications
What are the medications for asthma?
Bronchodilatiors: inhalers, Theophalin, Methylxanthines
Anti-inflammatory agents: decrease inflammation in airway, corticosteriods, leukotriene antagonists, mast cell stabilizers and monoclonal antibodies
Combination agents-bronchodilator and anti-inflammatory
What is asthma care?
Respiratory care: teach how to use, not overuse
Nutrition: have wt gain if thin
Rehabilitation services: for generalized weakness
What are asthma complications?
Respiratory failure: persistent hypoxemia, mechanical ventilation
Status asthmaticus: life threatening acute episode airway obstruction that intensifies once beings, doesnt respond to common therapy
What is COPD?
Emphysema: can be genetic
Loss of elasticity: destruction of alveoli, deacrease gas exchange, CO2 retention, respirators
Hyperinflation of lung tissue: chronic exposure to irritants
Chronic Bronchiits: inflammation of bronchi and bronchioles
What is Emphysema and the S&S?
Dyspnea
Decreased exercise tolerance
cough-minimal except with infection
Sputum expectoration if have cough
Barrel chest due to air trapping, round chest, disphragmatic flattening
What is chronic Bronchitis and its S&S?
Productive cough: lasting at least 3 months out of a year for 2 successive years
Production of thick, gelatinous sputum
Wheezing and dyspnea
What is Exacerbation of COPD and the triggers?
acute change in baseline dyspnea, cough or sputum
Triggers: viral or bacterial infection, air pollution, allergens, sedatives, heart failure and pulmonary embolism
Increased sputum production with bacterial infection
How do you evaluate COPD?
PFT: decrease FFV and forced vital capacity and increased residual volume trapping
ABG: decrease PaO2, pH, SaO2 and increase CO2
CXR: flattened diaphram, hyperinflated lungs
Alphat antitrpsin assay
What are COPD complications?
Hypoexmia and acidosis
Respiratory infection risk increased
Cardiac failure
Cardiac dysrhythmias
What is COPD Management?
Smoking cessation/irritant reduction
Airway maintenance
Cough enhancement
Oxygen therapy
Drug therapy
Pulmonary rehab
Energy conservation/dietary needs
Lung transplant
Lung reduction
What is interstitial pulmonary dieases?
actue and chronic lung disorders with variable degress of pulmonary inflammation and fibrosis
Idiopathic pulmonary fibrosis: scar tissue formation in the connective tissue of the lung
Sarcoidosis: chronic multi-system granulomatous disease of unknown cause
What is pneumonia?
excess of fluid in the lungs resulting from an inflammation
Inflammation triggered by infectious organisms and inhalation of irritants
Inflammation occurs in interstitial spaces, alveoli and bronchioles
Organisms penetrate the airway mucosa and multiply in the alveolar spaces
Reduced lung compliance and vital capacity
Atelectasis-decreased oxygenation of blood
Lobar with consolidation
Bronchopneumonia
What is infectious pneumonia?
Hospital acquired
Community acquited: complication of influenza
What is the assessment of pneumonia?
Chest or pleuritic pain
Fever, chills
Cough, muscle weakness from sustained coughing
Tachycardia and tachypnea
Dyspnea
Sputum production
Lung sounds
Labs
Radiological studies
What are interventions for pneumonia?
Oxygen therapy: combat hypoxemia
Bronchial hygiene: suction cough, deep breathing
Hydration: careful if CHF, help with status
Medications
What is severe acute respiratory syndrome?
Coronavirus infects cells of respiratory tract and causes inflammatory response
Easily spread by airborne droplets
Portal of entry is mucous membranes of the eyes, nose and mouth
What is the assessment for SARS?
Respiratory infection S&S
Dry cough and difficulty breathing
CXR
Rapid SARS test
What are interventions for SARS?
Oxygen
Medications
Prevent spread
What is pulmonary Tuberculosis?
Highly communicable disease caused by mycobacterium tuberculosis
Transmitted by aerosolization
Sets up inflammatory process
Cell-mediated immunity occurs and get positive TB test
What is TB progression?
area of inflammation gets surrounded by collagen, fibroblasts and lymphocytes
Caseation necrosis-center of lesion turns into granular mass
Caseation get resorbed, degenerated or fibrosed
Necrotic area get calcified or liquefied
What is the assessment for TB?
Suspect in patients with persistent cough, weight loss, anorexia, night sweats, hemoptysis, SOB, fever or chills
History of travel or recent immigration
Labs:
sputum for AFB
Blood for QFT-G
Sputum culture
TB test
What are TB interventions?
Combination drug therapy: multidrug and extensively drug resistant strains-organism is highly resistant
Prevention of spread
Proper nutrition
What is the surgical procedure for lung cencer?
Segmentectomy: bronchus, pulm artery and vein and involved lung tissue
Wedge resection: removal or peripheral portion of small localized areas of disease
Lobectomy: removal of a lobe
Pneumonectomy: removal of an entire lung
What is a Thoracotomy?
Surgical incision of the chest wall
Chest tube: drain placed in pleural space to restore intrapleural pressure
Pain management
Respiratory management
Pneumonextomy care
What is a flail chest?
inward movement of the thorax during inspiration and outward movement during expiration
Usually from rib fractures or carilage separation anteriorly
What is a flail chest assessment?
Paradoxical movement of the chest
Dyspnea
Cyanosis
Hypotension
ABG
What is flail chest intervention?
Humidified oxygen
Pain management
Lung expanion
Clear secretions
Mechanical ventilation if needed
Monitor Vital Signs
What is a Pneumothorax (open, closed and tension)?
Closed: air enters pleural space from within the lung
Open: chest injury allows air to enter the pleural space
Tension: pressure in plerual space becomes higher then in adjacent lung
Hemothorax:
Blood loss into the chest cavity
Simple: less than 1500mL
Massive: more than 1500mL
What is the assessment for a Pneumothroax?
Lung sounds
Tracheal deviation
Pleuritic pain/cough
Tachypnea
Subcutaneous emphysema
CXR
What is a Hemothroax assessment?
Same as pneumothorax
What are interventions for Pneumothorax/Hemothorax?
Chest tubes: remove air or blood from pleural space, allow re-expansion of lung
What is chest tube management?
Placement of tubes in chest
Collection device
Care:
- tape conections
- keep padded hemostats at bedside
- keep sterile gauze at bedside
- position tubing for drainage
- monitor for leaks
What is a pulmonary embolism?
collection of particulate matter that enters venous circulation and lodges in pulmoary vessels
Blood clot is most common
Obstruct pulmonary blood flow= reduces oxygenation of body, pulmonary tissue hypoxia and death
What is Actue Respiratory Failure?
PaO2: less then 60 mmHg
SaO2: less than 90% (arterial)
PaCO2: more than 50 mmHg (arterial)
Acidemia: (pH less than 7.30)
Venilatory
Oxygenation
Combination of ventilatory and oxygenation
What are interventions of acute respirtory failure?
Oxygen
Mechanical ventilation
Bronchodilators
Anxiety control
What is the ARDS form of pulmonary edema?
Lung inflammation
Severe hypoxemia
Decreased compliance of lungs
Leads to both ventilatory and oxygenation failure
What are manifestations of Lower Respiratory System?
Severe dyspnea
rapid shallow breathing
tachycardia
increasing requirements for oxygen without improvement in oxygenation
scattered crackles and bronchi on auscultation
CXR-bill infiltrates (ground glass apperance)
What are interventions for ARDS?
Intubation and mechanical ventilation
Suctioning
Positioning and turning
Corticosteriods
Antibiotics
IV fluids
Enternal feedings
