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med surg > medsurg 3 > Flashcards

medsurg 3 Flashcards

1
Q

protective mechanisms of the respiratory system

A

-irritant receptors
-alveolar macrophages
-nasal hairs
-mucous membranes
-cilia

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2
Q

what do irritant receptors do

A

-trigger sneeze and cough
-project out particles or bacteria

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3
Q

what do alveolar macrophages do

A

attack foreign particles and bacteria

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4
Q

what do nasal hairs do

A

trap dust and microorganisms

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5
Q

what do mucous membranes do

A

-warm and moisten air
-trap inhaled particles in the mucous

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6
Q

what do cilia do

A

move particles to be swallowed or coughed

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7
Q

3 parts of the pharynx

A

-nasopharynx
-oropharynx
-laryngopharynx

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8
Q

airway between the pharynx and trachea contains the vocal chords

A

larynx

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9
Q

what protects the airway of the larynx

A

epiglottis at the top of the larynx
vestibular folds close the glottis
walls lines with ciliated epithelium

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10
Q

what closes the vocal cords when we swallow and open when we talk

A

vestibular folds

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11
Q

lined with ciliated epithelium mucosa and extends to the carina

A

trachea

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12
Q

parts of the bronchial tree

A

-primary bronchi
-secondary bronchi
-tertiary bronchi
-bronchioles
-alveolar ducts
-alveolar sacs

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13
Q
A
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14
Q

what is responsible for gas exchange

A

alveoli

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15
Q

problems with alveoli = ________ gas exchange and _______ SPO2

A

decreased
decreased

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16
Q

the exchange of air occurs through whaaht is called the ____________ which consists of the alveolar epithelium the capillary endothelium and their joined basement membrane

A

respiratory membranes

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17
Q

the alveoli are wrapped in a fine _____ of capillaries

A

mesh

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18
Q

the extremely _______ walls of the alveoli and the _________ of the capillaries allow for efficient gas exchange

A

thin
closeness

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19
Q

what is the most important muscle of the respiratory system

A

diaphragm

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20
Q

how many lobes does the right lung have

A

3

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21
Q

how many lobes does the left lung have

A

2

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22
Q

what fissures does the right lung contain

A

horizontal
oblique

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23
Q

what fissure does the left lung contain

A

oblique

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24
Q

primary muscles of the respiratory system

A

diaphragm
intercostal

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25
Q

muscles used during respiratory distress or exercise

A

accessory muscles

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26
Q

what accessory muscles are used during respiratory distress or exercise

A

shoulder muscles and abdominal muscles

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27
Q

when the diaphragm contracts what does it do to the lungs

A

fills lungs with air

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28
Q

when the diaphragm relaxes what does it do to the lungs

A

the air is pushed out of the lungs

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29
Q

what happens when the external intercostal muscles pull the ribs upward and outward widening the thoracic cavity

A

inspiration

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30
Q

what happens when the internal intercostal muscles pull the ribs downward as the external intercostals relax

A

expiration

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31
Q

what happens when the diaphragm relaxes bulging upward and pressing against the base of the lungs, reducing the size of the thoracic cavity

A

expiration

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32
Q

what happens when the diaphragm contracts flattens and drops pressing the abdominal organs downward and enlarging the thoracic cavity

A

inspiration

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33
Q

what happens when air rushes in to equalize pressure

A

inspiration

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34
Q

what happens when air is pushed out of the lungs

A

expiration

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35
Q

respiratory assessment involves:

A

health history
inspection
respiratory patterns
spo2
auscultation

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36
Q

what do you need to find out of a patients health history for a respiratory system

A

-conditions
-symptoms
-family history
-use whats up for complaints

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37
Q

whats up means:

A

where is it?
how does it feel?
aggravating/alleviating factors?
timing?
severity?
useful data?
patients perception?

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38
Q

when asking a patient the severity of their respiratory issues you should always use what

A

a scale

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39
Q

inspection on respiratory system involves:

A

symmetry
swelling
abnormalities
respirations rate pattern and depth
work of breathing
cyanosis
dyspnea
apnea

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40
Q

difficulty breathing is called what

A

dyspnea

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41
Q

absence of breathing is called what

A

apnea

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42
Q

work of breathing inspection involves

A

-labored or unlabored
-accessory muscle use
-retractions

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43
Q

soft tissue pulled inward during distressed inhalation

A

retractions

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44
Q

normal rate and rhythm respiratory pattern 12-20 breaths per minute

A

eupnea

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45
Q

deeper respirations

A

hyperventilation

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46
Q

increased rate >20 breaths per minute

A

tachypnea

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47
Q

decreased rate <12 breaths per minute

A

bradypnea

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48
Q

deep fast respirations which then slow down and a period of apnea occurs

A

cheyne-stokes

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49
Q

much faster and deeper without pauses seen with diabetic acidosis

A

kussmauls

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50
Q

gasping respirations due to brain stem reflux - not affecting breathing

A

agonal breathing

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51
Q

which respiratory pattern is a medical emergency

A

agonal breathing

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52
Q

what condition is usually seen when a patient has barrel chest

A

copd

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53
Q

o2 deprivation to the tissues causes:

A

clubbed fingers

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54
Q

what condition is usually seen with clubbed fingers

A

cardiac problems

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55
Q

if a patient has clubbed fingers what can you expect their normal o2 to be?

A

usually sats stay in the 80s

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56
Q

what is a respiratory assessment you don’t do from across the room

A

spo2

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57
Q

what does spo2 measure

A

percentage of hgb saturated with oxygen

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58
Q

when may spo2 readings be inaccurate

A

trembling or shivering
cold extremities
nail polish

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59
Q

how do you do auscultation of the lungs

A

-listen to anterior, lateral and posterior chest
-listen during inspiration and expiration
-compare sounds from side to side

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60
Q

air sounds with fluid in the airways

A

coarse crackles (rales)

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61
Q

air sounds caused by narrowed airways

A

wheezes

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62
Q

lung sounds caused by decreased air movement

A

diminished

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63
Q

lung sounds caused by alveoli popping open

A

fine crackles

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64
Q

lung sounds caused by airway obstruction

A

stridor

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65
Q

lung sounds caused by obstruction from secretions

A

rhonchi

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66
Q

lung sounds caused by no air movement

A

absent

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67
Q

lungs sounds that sound like high-pitched violin on expiration

A

wheezes

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68
Q

lung sounds that sound like moist bubbling sound

A

coarse crackles

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69
Q

lung sounds that sound like loud crowing without stethoscope

A

stridor

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70
Q

lung sounds that sound like faint lung sounds

A

diminished

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71
Q

lung sounds that sound like velcro being torn apart or hair between fingers

A

fine crackles

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72
Q

lung sounds that sound like low pitched rattling, snoring

A

rhonchi

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73
Q

no lung sounds

A

absent

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74
Q

lung sound you would hear if a patient has pulmonary edema or pneumonia

A

coarse

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75
Q

lung sounds you would hear if the patient has atelectasis

A

fine crackles

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76
Q

lung sounds you would hear if a patient has secretions, copd or pneumonia

A

rhonchi

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77
Q

lung sounds you would hear if a patient has asthma

A

wheezes

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78
Q

lung sounds you would hear if a patient had a tumor, foreign object, swelling

A

stridor

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79
Q

lung sounds you would hear when angela doesnt take her allergy medicine

A

stridor

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80
Q

lung sounds you would hear if a patient ahs emphysema, hypoventilation, pneumonia

A

diminished

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81
Q

lung sounds you would hear if a patient has pneumothorax, pneumectomy

A

absent

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82
Q

what are the lung sounds that are considered an emergency

A

stridor
absent

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83
Q

why would a patient have absent lung sounds

A

-they have had a lobectomy
-emergency

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84
Q

if you hear rhonchi lung sounds what should you have the patient do

A

cough

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85
Q

what tests can be done for respiratory issues not imaging

A

sputum
throat swab
nasal sample
arterial blood gases

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86
Q

what should you encourage to get a good sputum sample

A

deep breathing and coughing

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87
Q

a sputum sample will tell us what

A

if there is an infection within the lungs

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88
Q

what does arterial blood gases show

A

the amount of gas exchange present in the arterial blood o2 and co2

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89
Q

when is an arterial blood gas done

A

only in emergent settings because you have to get the sample from an artery

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90
Q

what specific lab tests will we run if a patient has respiratory issues

A

cbc
d-dimer

91
Q

what will we look for on cbc

A

white blood cells will be increased if theres an infection
rbc, hemoglobin, hematocrit will be increased if they have copd pr something respiratory
d-dimer will be elevated if there is a possible blood clot present

92
Q

diagnostic tests that will be done for respiratory problems

A

chest xray
ct scan of chest
ct angiogram
ventilation perfusion scan

93
Q

if a patient has suspected pneumonia what diagnostic tests can be done

A

chest xray
ct scan of chest

94
Q

if a patient has suspected pulmonary embolism what diagnostic tests can be done

A

ct angiogram
ventilation perfusion scan

95
Q

if you want to evaluate the blood vessels what test should be done

A

ct angiogram

96
Q

if you want to evaluate the circulation of air and blood within a patients lungs what test should be done

A

ventilation perfusion scan

97
Q

interventions for respiratory concerns

A

-deep breathing
-coughing
-breathing exercises
-huff coughing
-turning/ambulation
-o2 therapy
-smoking cessation
-positioning to help with lung expansion

98
Q

what are two types of breathing exercises

A

diaphragmatic breathing
pursed lip breathing

99
Q

pursed lip breathing promotes co2 _______ by leaving airways open during exhalation

A

excretion

100
Q

what positions help with lung expansion

A

-high fowlers
-tripod
-good lung down

101
Q

how does good lung down work

A

gravity helps increase blood circulation in healthier lung promoting increased spo2

102
Q

device that helps expand the lungs and encourages deep breathing

A

incentive spirometer

103
Q

_______ on use of spirometer is important

A

education

104
Q

when using a spirometer patient needs to breathe _____

A

in

105
Q

a incentive spirometer helps prevent lung infections by preventing _______

A

atelectasis

106
Q

use incentive spirometer ______ per hour while awake

A

10 times

107
Q

respiratory distress interventions

A

hob up to expand lungs
Encourage deep breathing
Encourage coughing to clear secretions
Check SPO2
Focused respiratory assessment COMPARE TO LAST ASSESSMENT
Apply oxygen as needed to achieve appropriate SPO2

108
Q

disorders of the lower respiratory tract

A

bronchitis
pneumonia
copd
asthma
pulmonary embolism

109
Q

inflammation of the bronchi

A

bronchitis

110
Q

bronchitis can progress into what condition

A

pneumonia

111
Q

with bronchitis you have ______ mucus production from irritation

A

excess

112
Q

excess mucus = what

A

congested airway

113
Q

what is bronchitis usually cause by?

A

viral infection

114
Q

what is the collapse of the alveoli

A

atelectasis

115
Q

what causes atelectasis

A

occurs due to shallow breaths and trapped secretions
mucus exudate plugs areas of lungs that are not well aerated, alveoli cannot inflate thus they collapse

116
Q

atelectasis is common in what kind of patients and why

A

post op they take shallow breathes because they are in pain and they are on bed rest and have decreased movement

117
Q

what is key to avoid atelecatsis and pneumonia

A

prevention

118
Q

how can transmission of infectious particles be spread and cause pneumonia

A

-cough of an infected individual
-contaminated respiratory therapy equipment
-infections in other parts of the body
-aspiration of bacteria from the mouth pharynx or stomach

119
Q

what populations are at risk for pneumonia

A

-very young
-elderly
-chronic diseases such as copd
-smokers
-compromised immune systems
-post op patients

120
Q

what is one of the high preventable things that happens in the hospital

A

pneumonia

121
Q

various strains of bacteria cause what type of pneumonia

A

bacterial pneumonia

122
Q

influenza is the most common cause of this type of pneumonia and increases the patients susceptibility to a secondary bacterial pneumonia

A

viral pneumonia

123
Q

caused by foreign substances entering the lungs and commonly occurs if a patient has a decreased gag reflex

A

aspiration pneumonia

124
Q

three types of pneumonia

A

bacterial viral aspiration

125
Q

signs and symptoms of pneumonia

A

-fever
-chest pain
-dyspnea
-fatigue
-oxygenation problems
-productive cough
-lung sounds
-older adults may show new onset confusion or lethargy

126
Q

what kind of sputum would be produced with pneumonia

A

hemoptysis
purulent

127
Q

what kind of lung sounds would you expect to hear with pneumonia

A

coarse crackles
wheezes

128
Q

what diagnostic tests would be done for penumonia

A

-chest xray
ct scan
sputum culture
wbc
est and crp
blood culture

129
Q

therapeutic interventions for pneumonia

A

fluids
rest
deep breathing
incentive spirometry
supplemental oxygen
chest physiotherapy

130
Q

medications for pneumonia

A

-antibiotics
-expectorants
-bronchodilators

131
Q

bronchodilators used for pneumonia

A

albuterol
duoneb

132
Q

how do you prevent pneumonia

A

-good hand and oral hygein
-coughing into elbow
-influenza vaccine because flu can cause viral pneumonia
-pneumococal vaccine

133
Q

who can get the pneumococcal vaccine

A

anyone 65 or older
immunocompromised
chronic disease

134
Q

how to prevent pneumonia in the hospital

A

*prevent atelectasis
encourage coughing and deep breathing
abulation
changing positions
incentive spirometer

135
Q

chronic inflammation of airs and hyperresponsiveness of bronchioles

A

asthma

136
Q

what are the classifications of asthma

A

mild, moderate, severe

137
Q

how is asthma classified

A

by the type of medications required to control it

138
Q

a substance pr reason that can cause an asthma flare or attack

A

triggers

139
Q

asthma triggers

A

-smoking or second hand smoke
-allergens
-respiratory infection
-ecxercise
-stress

140
Q

signs and symptoms of asthma

A

-chest tightness
-dyspnea
-tachypnea
-wheezing
-use of accessory muscles
-may be worse at night

141
Q

if lung sounds move to no sounds at all or very diminished sounds it is what

A

a medical emergency

142
Q

_________ is necessary to avoid acute asthma attacks

A

daily management

143
Q

patients can self-monitor asthma with what daily?

A

peak flow meter

144
Q

attack prevention for asthma

A

daily management
peak flow meter daily
avoid triggers
educate on taking prevention meds
educate on when to take rescue inhalers
develop asthma action pain

145
Q

this device measures the patients peak expiratory flow

A

peak flow meter

146
Q

the fastest speed at which air is forced out from the lungs

A

peak expiratory flow

147
Q

use peak flow meter to check for ______

A

changes

148
Q

using peak flow meter you breathe _____

A

out forcefully

149
Q

log peak expiratory flow on what?

A

peak flow chart

150
Q

what zone means the patient has current drug therapy and lifestyle choices that are working and no changes need to be made

A

green zone

151
Q

what zone means asthma is beginning to worsen and pt needs to use rescue inhaler to improve s/s, if s/s dont improve pt may need to seek help

A

yellow

152
Q

what zone means pt needs to use rescue inhaler asap and seek help

A

red zone

153
Q

if yellow zone is a fequent reading patient should what

A

see dr for medication change

154
Q

who fills out the asthma action plan

A

dr

155
Q

what is the nurses role in the asthma action plan

A

educated patient on how to implement it

156
Q

daily preventative medications for asthma

A

antihistamine
inhaled corticosteroids
inhaled corticosteroids+bronchodilator
bronchodilator
inhaled steroids

157
Q

what are two inhaled cortocosteroid medications

A

fluticasone (flovent)
budesonide (pulmicort)

158
Q

two inhaled corticosteroid+bronchodilator medications

A

fluticasone + salmeterol (advair)
budesonide + formoterol (symbicort)

159
Q

what should a patient do after using an inhaler

A

rinse and spit to prevent thrush

160
Q

rescue asthma medications

A

-bronchodilators
corticosteroids

161
Q

rescue bronchodilators

A

albuterol (ventolin)
ipratropium (atrovent)
duoneb (combo of albuterol and ipratropium)

162
Q

rescue corticosteroid for asthma

A

methylprednosolone (solu-medrol) IV
prednisone - oral

163
Q

what is a metered dose inhaler

A

handheld device that delivers medication directly to the lungs

164
Q

how do you use a metered dose inhaler

A

-shake it
exhale
-place lips to inhaler
-push canister down while breathing in slowly and deeply
-hold breath for 5-10 seconds

165
Q

ensure patient knows how to use inhaler by having them do a ______ demonstration

A

return

166
Q

this is used for a metered dose inhaler to increase the amount of medication that administered into the lungs and not stuck to oral mucosa

A

spacer

167
Q

device used to administer misted medications directly to the lungs

A

nebulizer

168
Q

where are nebulized mist treatments most often used

A

hospital settings during acute respiratory issues

169
Q

nebulized mist treatments helps _______ everything and helps break up _______

A

moisten
secretions

170
Q

nursing interventions for asthma

A

-educate on medications
-high fowlers
-spo2 monitoring
-respiratory assessment
-breathing interventions
-supplemental o2
-medication as prescribed

171
Q

what is status asthmaticus

A

a medical emergency due to severe and sustained asthma attacked

172
Q

when is status asthmaticus seen?

A

when patients do not get to the hospital in time for asthma attack treatment

173
Q

status asthmaticus causes ______ respiratory rate to compensate lack of _______ causing ____ to be blown off too quickly which causes changes to the blood __

A

increased
oxygen
co2
ph

174
Q

status asthmaticus can lead to what

A

respiratory failure
death

175
Q

characterized by air trapping and difficulty getting air out of the lungs

A

obstructive disorders

176
Q

types of obstructive disorders

A

-chronic obstructive pulmonary disease
-emphysema
-chronic bronchitis
-asthma

177
Q

a group of pulmonary disorders characterized by difficulty exhaling (air trapping)

A

copd

178
Q

copd is progressive and _______

A

irreversible

179
Q

symptoms of copd can _______ with lifestyle changes, but disease never ______

A

improve
goes away

180
Q

copd is classified as

A

-chronic bronchitis
-emphysema
-a combo of both

181
Q

symptoms of this disorder occurs at least 3 months of the year for two consecutive years

A

chronic bronchitis

182
Q

chronic bronchitis causes:

A

-chronic inflammation
-hypertrophied mucous glands in bronchi
-impaired ciliary function

183
Q

chronic bronchitis narrows airways blocked by ________ and _______ and cause an ineffective airway clearance

A

inflammation and mucus

184
Q

destruction and loss of elastic recoil of bronchioles and alveolar walls cause alveoli to enlarge and merge together causing damage to pulmonary capillaries surrounding damaged alveoli and reduced surface area for gas exchange

A

emphysema

185
Q

air trapped causes

A

co2 retention and impaired gas exchange

186
Q

copd etiology

A

-smoking
-passive smoke exposure
-air pollutants
-exposure to industrial chemicals
-familial predisposition

187
Q

what is the number one risk factor for copd

A

smoking

188
Q

copd signs and symptoms - emphysema

A

-chronic cough
-diminished breath sounds
-dyspnea
-activity intolerance
-barrel chest
-prolonged expiration
-use of accessory muscles

189
Q

copd signs and symptoms: chronic bronchitis

A

-wheezing, crackles, rhonchi
-chronic cough, productive
-thick, tenacious sputum
-dyspnea
-activity intolerance
-prolonged expiration
-increased susceptibility to infection
-mucous plugs
-use of accessory muscles

190
Q

what are the signs and symptoms of copd emphysema and chronic bronchitis that are the same

A

-chronic cough
-dyspnea
-activity intolerance
-prolonged expiration
-use of accessory muscles

191
Q

what are the signs and symptoms of copd emphysema and chronic bronchitis that are the different

A

-chronic cough characteristics
-lung sounds
-barrel chest
-sputum
-susceptibility to infection
-mucous plugs

192
Q

what is different about the cough with emphysema and chronic bronchitis

A

chronic bronchitis cough is productive

193
Q

which disorder causes diminished breath sounds

A

emphysema

194
Q

which disorder causes wheezing, crackles, rhonchi

A

chronic bronchitis

195
Q

which condition causes barrel chest

A

emphysema

196
Q

which condition causes thick tenacious sputum

A

chronic bronchitis

197
Q

which condition causes increases susceptibility to infection

A

chronic bronchitis

198
Q

which condition causes mucous plugs that a person has a hard time coughing up and can stoop airation

A

chronic bronchitis

199
Q

diagnostic tests for copd

A

-chest xray or ct scan
-cbc
-wbc - can cause infection
-rbc - body compensating by making more rbc to help with oxygenation
-sputum culture
-arterial blood gasess

200
Q

during acute exacerbation of copd expect ____ levels to decrease and ____ levels to increase

A

o2 to decrease and co2 to increase

201
Q

which diagnostic test is typically used to diagnose copd

A

ventilation profusion scan

202
Q

therapeutic interventions for copd

A

-smoking cessation
-encourage breathing exercises
-encourage fluids
-huff cough to expel air
-pneumococcal and yearly influenza vaccination
-increase activity as tolerated

203
Q

what diet should a pt be on with copd

A

high protein and high fat
high calorie meals that are smaller and easier to eat so it is less work for the patient

204
Q

medications for copd

A

bronchodilators
corticosteroids
expectorants

205
Q

when will you apply oxygen on a patient with copd and about how many liters

A

when spo2 is <88% and 1-2 L/m

206
Q

spo2 ranges between what at baseline for copd paatients

A

88-92%

207
Q

copd patients depend on ______o2 levels to stimulate breathing and respirations

A

lower

208
Q

high supplemental oxygen flow rates can _______ respirations

A

depress

209
Q

if patient with copd get flooded with oxygen what can happen

A

patients body thinks it does not have to breath

210
Q

a foreign object traveling through blood stream

A

embolism

211
Q

embolism in a pulmonary artery

A

pulmonary embolism

212
Q

Embolism in the pulmonary artery does not allow

A

blood to flow into the lungs for gas exchange to occur

213
Q

where do most pulmonary emboli develop from

A

a deep vein thrombosis

214
Q

how do you prevent a PE

A

prevent a DVT

215
Q

signs and symptoms of PE

A

-sudden onset dyspnea and sob
-chest pain
-tachypnea
-gasping for breath
-anxious
-decreased spo2
-tachycardia
-cough
-crackles
-hemoptysis

216
Q

tell-tale sign something bad is going to happen to a patient is when the patient has what type of feeling

A

impending doom feeling

217
Q

diagnostic test for PE

A

-d-dimer
-ct angiogram chest

218
Q

interventions for PE

A
  • high fowlers
    -oxygen
    -thrombolytics
    -anticoagulants
219
Q

what kind of medication will treat current clots

A

tpa

220
Q

what medication prevents new clots from forming

A

anticoagulants

221
Q

names of anticoagulants

A

heparin
enoxaparin (lovenox)
warfarin (coumadin)

222
Q

what do medications for PE put patients at risk for?

A

bleeding

223
Q

prevention of PE

A

-prevent dvt
-abulation
-promote circulation
-prophylactic dvt treatment
-prompt treatment of dvgt if present

med surg (7 decks)

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