med surg resp Flashcards
what procedure should be performed for a patient with a pneumothorax secondary to blunt chest trauma?
chest tube insertion connected to a water seal drainage
what procedure should be performed for a pt with pneumothorax secondary to cancer, pleurisy, or tuberculosis
thoracentesis
how does a thoracentesis provide relief for a pt
removes air or fluid from lungs
measure of air lungs can hold after maximum inhalation
total lung capacity
measure of amount of air pt can exhale after maximum inhalation
vital lung capacity
measure of amount of air in lungs after normal expiration
functional residual capacity
measure of air in lungs after forced expiration
residual volume
will tracheostomy with inflated cuff allow pt to speak
no
how often should a nurse assess tracheostomy pt for suctioning
every 2 hrs
after the pt coughs suctionin for a tracheostomy pt should only be performed if the nurse asses what
pt is unable to exporate secretions
where will trachea be deviated in a pt with a tension pneumothorax?
unaffected side
what breath sounds will u auscultate on afftected side of a tension pneumothorax
none they will be absent
how will neck veins be in a pt with tension pneumothorax
distended
breathing rhythm of pt with tension pneumothorax
tachypnea
can a pt wear dentures, glasses or contacts during a bronchoscopy
no
can a tissue sample be obtained during an endoscopy?
yes
what does a friction rub during lung auscultation indicate?
pleurisy
what do crackles/rales indicate during lung auscultation
pneumonia
increased tactile fremitus is an indication of what
pneumonia
how many meals should emphysema pt eat daily
4-6 small meals
why should emphysema pts eat 4-6 small meals daily
to prevent exhaustion and SOB from big meals
how long will a pt who undergoes a total laryngectomy need a tracheostomy?
forever
will a pt who had a total laryngectomy be able to cough and breath deeply after surgery
yes and should to clear secretions
can total laryngectomy pts eat immediately surgery
no will receive enteral feedings for 7-10 days after surgery
will a pt s/p laryngectomy be able to speak with their normal voice?
no they will have no natural voice
what should u do if pt s/p rhinoplasty has edema of nose, eyes and face
nothing its an expected finding
how should pts s/p rhinoplasty breath
through their mouth
what should u do if pt s/p rhinoplasty has frequent swallowing
notify surgeon
why should u notify surgeon of frequent swallowing in pt s/p rhinoplasty
could be posterior nasal bleeding/hemorrhage
what is transillumination used for
to diagnose occluded sinuses by seeing if light is able to be passed through tissues
can symptoms be used to diagnose lung cancer in its early stages
no because cancer is metastasized by time pt shows sxs
what does inspiratory stridor indicate?
airway obstruction
what should be done if pt has inspiratory stridor
notify rapid response team
give humidified oxygen
how will pts neck be during bronchoscopy
hyperextended to align pharynx w trachea so no trauma occurs w scope insertion
signs of inhalation injury
-singed hair on face, neck or torso
-trouble talking
-soot in nose/mouth
-confusion/anxiety
why does CO (carbon monoxide) poisoning cause hypoxia
CO binds to Hgb faster than Oxygen
cherry red skin is a sign of what kind of inhalation injury
carbon monoxide poisoning
how to treat CO (carbon monoxide) poisoning
100% oxygen
which side of the chest can u hear the upper lung lobes
anterior
which side of the chest will u hear lower lung lobes the best
posterior
what position should pt sit when auscultating lungs
semi fowlers
what are the 3 normal lung sounds
-bronchial
-vesicular
-bronchovesicular
how will brochial lung sounds sound
-high
-loud
-hollow
where can u hear brochial lung sounds
over the trachea/larynx
can u hear bronchial lung sounds posteriorly
no only anteriorly over trachea/larynx
what part of breathing will bronchial sounds be longer
expiration
what of breathing will vesicular sounds be longer
on inspiration
when will brochovesicular sounds be longer
they will be equal on inspiration and expiration
how will vesicular breath sounds sound
-soft
-low-pitched
-rushing sound
where can vesicular sounds be heard
anteriorly and posteriorly
how will bronchovesicular breath sounds sound
medium pitched
hollow
adventitious lung sounds are
abnormal lung sounds
what are the 2 categories of adeventitious lung sounds
-discontinuous lung sounds
-continuous lung sounds
discrete crackling sounds in the lungs are what category of adventitious lung sounds
discontinuous
what are the 3 types of discontinuous adventitious lung sounds
-fine crackles
-coarse crackles
-pleural friction rub
high pitched crackling sounds are what type of discontinuous adventitious lung sounds
fine crackles
low pitched wet bubbling sounds are what discontinuous adventitious lung sounds
coarse crackles
low pitched harsh grating sounds are what discontinuous adventitious lung sounds
pleural friction rub
connected musical sounds are what kind of adventitious lung sounds
continuous sounds
what are the 2 types of continuous adventitious lung sounds
wheezes
stridor
high pitched musical with polyphonic sound quality is what continous adventitious breath sound
wheezing
high pitched whistling/gasping with harsh sound quality is what continuous adventitious lung sound
stridor
what causes fine crackles
deflated airways popping back open (i.e pulmonary edema, asthma, COPD)
what causes coarse crackles
inhaled air colliding with secretions [anything where fluid in lungs] (i.e pulmonary edema, pneumonia, depressed cough reflex)
what causes pleural friction rub
surfaces rubbing together during respirations because of pleural inflamation (I.e pleuritis)
what causes wheezing
air moving through narrow airway (I.e asthma, bronchitis, chronic emphysema)
what causes stridor
disturbed air flow in larnx or trachea (I.e croup, epiglottitis, airway obstruction)
how to diagnose COPD
-ABGs
-CXR
-pulmonary function test (spirometry)
pt with COPD would have what ratio of FEV1/FVC
less than 70%
what is FEV1
forced expiratory volume
what is FVC
forced vital capacity
what are the 2 types of COPD
emphysema
chronic bronchitis
s/s of emphysema
-barrel chest (hyperinflation of the lungs)
-weight loss
-SOB
-dyspnea
what causes barrel chest
hyperinflation of the lungs (puffed up lungs)
s/s of chronic bronchitis
-overweight
-cyanotic
-peripheral edema
-rhonchi
-wheezing
-chronic cough
diet education for COPD pt
-increase calories
-small frequent meals
-stay hydrated
why should COPD increase calories
to replace burned calories from breathing
why should COPD pts stay hydrated
to thin secretions
how should COPD pts breath
pursed lips
using diaphragm
why should COPD pts breath through pursed lips
to eliminate CO2 while keeping air passages open
what vaccines should be suggested to COPD pts
-influenza
-pnemococcal vaccine
meds for COPD
bronchodilators
corticosteroids
how should u give meds for COPD
bronchodilator and then corticosteroids
corticosteroid suffixes
-asone
-inide
-olone
what kind of med ends in -asone
corticosteroid
what kind of med ends in inide
corticosteroid
what kind of med ends in olone
corticosteroid
how to diagnose pneumonia
-cxr
-wbc
-sputum culture
