Medsurg hesi 2 respiratory Flashcards
asthma: the volume of air blown out as hard and fast as possible during the first second of the most forceful exhalation after the greatest full inhalation.
Forced expiratory volume in the first second (FEV1)
asthma: the fastest airflow rate reached during exhalation
Peak expiratory flow
asthma: beta2 agonists, such as albuterol (Proventil, Ventolin), provide rapid relief of acute symptoms and
prevent exercise-induced asthma
asthma: Anticholinergic medications, such as ipratropium are ___ acting and
long-acting and used to prevent bronchospasms
asthma: Methylxanthines, use only when
other medications aren’t working
asthma: salmeterol
Long-acting beta2 agonist, primarily used for attack prevention.
Salmeterol – Advise client to use to
prevent an asthma attack and not at the onset of an attack.
Encourage the client to take prednisone with
food
bronchodilator and anti-inflammatory combination: If prescribed for inhalation administration at the same time, administer the
bronchodilator first in order to increase the absorption of the anti-inflammatory agent.
This is a life-threatening episode of airway obstruction that is often unresponsive to common treatment
Status asthmaticus
Emphysema is characterized by
the loss of lung elasticity and hyperinflation of lung tissue
characterized by the loss of lung elasticity and hyperinflation of lung tissue
Emphysema
Chronic bronchitis is an
inflammation of the bronchi and bronchioles due to chronic exposure to irritants.
Chronic bronchitis is an inflammation of the bronchi and bronchioles due to
chronic exposure to irritants
Alpha1-antitrypsin (AAT) deficiency is a risk factor for
COPD
COPD includes 2 main things
emphysema and chronic bronchitis
Barrel chest or increased chest diameter with
emphysema
COPD: you may have Dependent edema secondary to
right-sided heart failure
COPD findings of extremities
arms and legs thing, clubbing of fingers and toes
In clients who have dark-colored skin or in older adults, oxygen saturation levels
can be slightly lower
COPD findings of hematocrit
An increased hematocrit level is due to low oxygenation levels.
Comparisons of __ to ___ are used to classify COPD as mild to very severe.
forced expiratory volume (FEV) to forced vital capacity (FVC)
Chest x-ray and COPD
not often used to dx early stages, more for the advanced disease
a special enzyme produced by the liver that helps regulate other enzymes (that help breakdown pollutants) from attacking lung tissue.
AAT
COPD: Increased work of breathing increases
caloric demands
COPD: Dyspnea decreases energy available for eating, so
soft, high-calorie foods should be encouraged
For pursed lip breathing, instruct the client not to:
puff the cheeks
Incentive spirometry: Instruct the client to keep a tight mouth seal around mouthpiece and to inhale and
hold breath for 3 to 5 seconds
It is important to recognize in COPD that low arterial levels
of oxygen serve as the primary drive for breathing
Omalizumab (Xolair) can cause
anaphylaxis
COPD: Encourage the client to eat __ ___ foods to promote energy
high-calorie
cor pulmonale
Right-sided heart failure
Air trapping, airway collapse, and stiff alveoli lead to increased
pulmonary pressures (and eventually cor pulmonale, which is right side failure)
COPD: Blood flow through the lung tissue is difficult. This increased workload leads to
enlargement and thickening of the right atrium and ventricle. (and eventually cor pulmonale, which is right side failure)
Right-sided heart failure (cor pulmonale): finding of palpation
liver enlarged
TB: The risk of transmission decreases after _____ of antituberculin therapy.
2 to 3 weeks
TB: A client will have a positive intradermal TB test within _____ of exposure to the infection
2 to 10 weeks
TB: Mantoux test should be read in
48 to 72 hr
TB: Skin test: An induration of _ mm is considered a positive test for immunocompromised clients.
5
TB: Streptomycin sulfate should only be used
for pts with multi resistance
TB: Streptomycin sulfate can cause
ototoxicity
TB: Inform the client that sputum samples are needed every _____ to monitor therapy effectiveness
2 to 4 weeks
TB: The organism invades the bloodstream and can spread to multiple body organs
Miliary TB
PE: in the beginning, PaCO2 levels are
low (because the person is hyperventilating)
These tests provide initial identification of a PE
x ray and CT scan (x ray can only show a large PE)
dx test where a catheter is inserted into the vena cava to visually see a PE.
Pulmonary Angiography
to prevent hypotension give streptokinase
slowly
PE patient Care After Discharge: If the client is homebound, set up home care services to
perform weekly blood draws
prevention of a PE: Encourage the client to wear
compression stockings to promote circulation
Advise the client to monitor intake of foods high in _______ if taking warfarin
vitamin K (green, leafy vegetables)
Vitamin K can reduce the anticoagulant effects of
warfarin
Patient has PE, what might you hear on auscultation of their heart
S3 and S4
Decreased cardiac output: Administer inotropic agents (milrinone, dobutamine), to
increase myocardial contractility.
Decreased cardiac output: ___ may be needed if pulmonary artery pressure is high enough that it interferes with cardiac contractility
Vasodilators
Decreased cardiac output: Vasodilators may be needed if
pulmonary artery pressure is high enough that it interferes with cardiac contractility
A tension pneumothorax occurs when air
enters the pleural space during inspiration through a one-way valve and is not able to exit upon expiration
occurs when air enters the pleural space during inspiration through a one-way valve and is not able to exit upon expiration
tension pneumothorax
the most important complication of tension pneumothorax
the increase in pressure compresses blood vessels and limits venous return, leading to a decrease in cardiac output.
As a result of a tension pneumothorax, air and pressure continue to rise in the pleural cavity, which causes a ___ ___
mediastinal shift
A flail chest occurs when
several ribs, usually on one side of the chest, sustain multiple fractures
Tracheal deviation to the unaffected side suggests
tension pneumothorax
How will a thoracentesis feel to the client
When the needle is inserted into the lung, some pressure may be felt, but no pain.
When the amount of blood pumped by the heart decreases as intrathoracic pressure rises, _____ develops.
Hypotension
the inability of the injured side of the chest to expand adequately upon inhalation and contract upon exhalation.
Flail chest
Flail chest caused by rib fractures is often related to
car crash or CPR
Acute respiratory failure (ARF) is caused by failure to adequately
ventilate and/or oxygenate.
Acute respiratory failure (ARF): PaO2 less than __ mm Hg
60
Acute respiratory failure (ARF): SaO2 less than
90%
___ is the result of a viral infection from a mutated strain of the coronaviruses, a group of viruses that also cause the common cold.
SARS
SARS is the result of a viral infection from a mutated strain of the
coronaviruses, a group of viruses that also cause the common cold.
Severe acute respiratory syndrome (SARS): The virus does not spread to the
bloodstream because it flourishes at temperatures slightly below normal core body temperature.
Orthopnea
difficulty breathing lying flat
Chest x ray showing Diffuse infiltrates and white-out or ground-glass appearance
ARDS
Chest x ray showing cardiomegaly
ARF
Chest x ray showing infiltrates
SARS
Pulmonary capillary wedge pressure with ARDS is usually
low or within the expected reference range
often is used to prevent alveolar collapse during expiration.
PEEP
Medication: Reduces WBC migration, decreases inflammation, and helps stabilize the alveolar-capillary membrane during ARDS
prednisone
Corticosteroids: administer with an __ __ medications
anti-ulcer
PEEP is added to the ventilator setting to
increase oxygenation and improve lung expansion
special kinetic bed
rotates laterally alters client positioning to reduce atelectasis and improve ventilation.
Blocked endotracheal tube is indicated by ___-pressure alarm on ventilator
high
a neuromuscular blocking agent given to facilitate
ventilation and decrease oxygen consumption.
Vecuronium
A client who experienced a near-drowning incident is at risk for developing ___ due to trauma to the lungs and cerebral edema
ARDS
A client following coronary artery bypass graft surgery is at risk for developing ___ due to trauma to the chest.
ARDS
A client who experienced a drug overdose is at risk for developing ARDS due to
damage to the central nervous system
Administration of _____ should be included in the plan of care for SARS. They are used to vasodilate the client’s airway
bronchodilators
an ultrasound of the heart
echocardiogram
echocardiogram is used to diagnose
valve disorders and cardiomyopathy.
echocardiogram: Instruct the client to lie on
left side and remain still.
