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NURADN 28 > Module 9 Respiratory > Flashcards

Module 9 Respiratory Flashcards

1
Q

Name the structures of the upper respiratory tract

A

•Nose
•Mouth
•Pharynx
•Larynx
•Trachea

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2
Q

Name the structures of the lower respiratory tract

A

•Bronchi
•Bronchioles
•Alveolar ducts
•Alveoli

Lungs :
Left = 2 lobes
Right = 3 lobes

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3
Q

Explain Gas exchange in the lungs

A

•Alveoli – primary site of gas exchange (over 300 million in the body)

•Gases exchange across the alveolar-capillary membrane

•Surfactant – reduces the amount of pressure needed to inflate alveoli. (Surfactant makes alveoli less likely to collapse. Every few breathes we take a larger one and this ‘sigh’ increases surfactant secretion/stretches the alveoli)

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4
Q

What is Atelectasis?

A

•Collapsed, airless alveoli
Interventions: cough/deep breath, IS, ambulation

•Causes: reduction of surfactant or obstruction of airways with secretions

•At risk: Post-op or bedridden patients

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5
Q

What are the structures of the chest wall?

A

•Thoracic Cage 24 ribs total, 12 each side, sternum in the middle. Protects heart & lungs
•Mediastinum
•Parietal Pleura
•Visceral Pleura
•Diaphragm

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6
Q

What are pleurae? (Important to know to several disease processes/test!)

A

•2 Parietal Pleura – lines the chest cavity
•Visceral pleura – lines the lungs
•Intrapleural space – space between the layers
•Provides lubrication (allows movement & expansion w/o friction of organs)
•Increases unity between the layers
•Fluid drains from the pleural space via the lymphatic circulation.

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7
Q

Physiology of respiration

A

•Oxygenation – process of obtaining air from the atmosphere and making it available to the organs and tissues of the body
•Ventilation =
-Inspiration (inhale!)
-Expiration (exhale!)
•Compliance (measure of how easy it is for lung expansion)
•Resistance (how much the lung needs to overcome to expand)

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8
Q

Explain central/peripheral chemoreceptors in the control of Respiration

A

•Chemoreceptors = central (medulla) peripheral (carotid/aortic arch).

-Central Receptors respond to change in hydrogen ion concentration and either increase or decrease RR based upon PH levels (acidosis or alkalosis)

-peripheral receptors respond to a decrease in blood oxygen levels (pao2) or an increase in CO2 (paco2) and PH levels.

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9
Q

Explain mechanical receptors and where they’re found.

A

•Mechanical receptors =
Irritant, stretch, & juxtacapillary receptors

-located in structures of the lungs & respond to physiologic factors

-irritant = conducting airways (sensitive to inhaled particles)

-stretch = smooth muscle (activate respiratory center to inhibit over-expansion of the lungs)

-Juxta = capillaries of the alveoli. Stimulated with increased pulmonary capillary pressure.

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10
Q

Respiratory Defense Mechanisms

A

“Keep us from getting sick/keeps things out of our lungs”

•Filtration of air (nose hairs filter dust particles)

•Mucociliary Clearance System (moves mucus. Goblet cells secrete mucus that assist in the clearance of debris. Cilia help)

•Cough Reflex (is a back up to the clearance system to expel mucus and debris)

•Reflex Bronchoconstriction (close in response to irritating substances)

•Alveolar Macrophages (primary defense below level of the bronchioles. They phagocytize inhaled particles like bacteria to fight infection)

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11
Q

Gero considerations - respiratory

A

•Changes in :
-Structures (chest wall stiffening, decrease elastic recoil and compliance decreasing vital capacity. Decreased Breath sounds or barrel chest)

-Defense Mechanisms (overall decrease. Force of cough, ciliary function, macrophage ability, cough effectiveness, secretion clearance)

-Respiratory Control (decrease in response to hypoxemia /increased CO2

•TABLE 25.2 Pg. 460* important!

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12
Q

Subjective/physical assessment of respiratory

A

Subjective:
•Shortness of breath
•Pain with breathing
•Cough/Sputum production (color, quality)

•Physical Assessment:
•Inspection*
•Palpation
•Percussion
•Auscultation*

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13
Q

Diagnostic studies - respiratory

A

•Sputum Studies (common: culture & sensitivity to help diagnose bacterial infection and choose antibiotic)
•Chest X-Ray (screening/ evaluation)
•CT Scan (evaluate PE)
•Bronchoscopy (Dr)
•Thoracentesis (Dr)
•Pulmonary Function Tests
•ABGs (tells acid base levels & blood co2 /o2)
•Lung Biopsy (surgical)

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14
Q

Signs of respiratory distress

A

•Central Nervous System (symptoms are a progression. Early
Onset = restlessness/irritability—> confused & lethargic

•Respiratory ( onset: tachypnea & dyspnea on exertion—-> dyspnea at rest/using accessory muscles)

•Cardiovascular (onset: tachycardia/HTN—> hypotension)

•TABLE 25.1 Manifestations of Inadequate O2* important*

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15
Q

Ventilation interventions

A

•Oxygenation Administration
-Nasal Cannula
-Simple Mask
-Non-rebreather
-High-Flow Nasal Cannula
-Incentive spirometry

•Chest physiotherapy (done by RT: postural drainage, percussion, vibration for Pt’s w/excessive secretions

•Closed chest drainage (thoracentesis, chest tube)

•Intubation (emergency airway)

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16
Q

TB overview

A

•Organism: Mycobacterium Tuberculosis (Gram + Bacillus)
•Aerobic organism (oxygen loving)
•Airborne droplets viable from minutes to hours
•Spread by breathing, talking, sneezing or coughing
•Usually requires close contact
•Only infects humans
•Lungs are prime site but can infect any organ (brain, kidneys, bone)
•Can be carried by lymphatic system

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17
Q

MDR-TB

A

•Multi-drug resistant TB (BAD!)
•Does not respond to first-line treatment**
•Cases of MDR-TB increasing annually
•Treatment 9-20 months with second-line drugs (expensive, chemo-based drugs)
•if 2nd line doesn’t work, there’s no other options

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18
Q

TB Risk Factors

A

•Poor, homeless, medically underserved
•Foreign-born individuals
•People living or working in institutions or in overcrowded living conditions*
•Those with less-than-optimal sanitation
•Immunosuppression (HIV, cancer, corticosteroid use)
•IV drug use, smoking(impacts lungs), alcohol use disorder
•Malnutrition

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19
Q

TB- Factors Affecting Transmission

A

•Number of organisms expelled into the air
•Concentration of organisms (higher risk)- Small spaces with limited ventilation
•Length of time of exposure
•Immune system of the person exposed

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20
Q

TB- Progression

A

•Once inhaled, bacteria lodges into bronchioles & alveoli
•Local inflammatory reaction
•Ghon lesion or ’focus’ – calcified TB granuloma*
•Body’s defense to wall off infection & stop the spread
•Most immune systems can completely kill the bacillus
•Dormancy
•5-10 % develop active TB (bc of calcified ganuloma)
•Can occur months to years later
•Can spread to other organs

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21
Q

TB Lung Erosion

A

-infection initially in the right upper lobe
-progresses to erosion or cavitation
-more holes are in lungs as time goes on
-holes remain there even after TB is healed

22
Q

TB- classification

A

-can be classified based on presentation or pulmonary (inside lung) / extrapulmonary (outside lung)

Ones to know:
Latent & Active TB

•primary infection = 1st exposure
•Latent = walled off
•Active TB = Pt is sick
-1-2 years = primary Disease
-more than 2 years = post Primary

23
Q

Latent TB

A

•TB lives but doesn’t grow in the body
•doesn’t make a person feel sick or have symptoms
•can’t spread from person-to-person
•can advance to TB disease
•if the calcified/walled off portion breaks open it becomes “active TB”

24
Q

Active TB Disease

A

•TB is active & grows in the body
•Makes a person feel sick & have symptoms
•CAN* spread from person-to-person
•Can cause death if not treated

25
Q

TB S/S

A

•usually no S/S for 2-3wks

•Initial manifestations: dry cough leading to productive cough

•Active TB typical onset: fatigue, malaise, anorexia, weight loss, low-grade fevers (Dyspnea & hemoptysis are late signs)

•Acute onset: sudden high fever, chills, malaise, flu like symptoms, pleuritic pain, productive cough

•Atypical presentations in immunocompromised & elderly

26
Q

TB -Complications

A

•Lung scarring and cavitation

•Miliary TB: widespread dissemination of mycobacterium in the bloodstream or lymphatic system

•Pleural TB: spread to the pleural space

•Pott’s Disease: TB in the spine

•Other organ involvement: kidneys, bone, joint tissues, lymph nodes

27
Q

TB DX

A

•TB skin testing (Mantoux test) (looking for induration- small bump. + result means Pt has antibodies)

•Bacterial studies
-Standard for TB testing
-Three consecutive day sputum specimens
-Definitive Dx: mycobacterial growth, may take 6-weeks
-Initial testing: AFB smear (quick look under microscope- not definitive)

•Chest x-ray: not diagnostic by itself

•IGRA – Interferon release assays (not definitive)

•Example: QuantiFERON-TB Gold
-More expensive than skin testing, NOT subject to readers bias

28
Q

TB Drug Therapy, Active TB

A

Two phases of drug therapy: initial & continuation

•Initial: 2-months w/ 4 drugs; ISONIAZID, RIFAMPIN (burnt orange sweat, urine, stool, tears)(high risk for liver condition -no alcohol**) -pyrazinamide, and ethambutol

•Monitor liver function tests every 2-4wks repeat

•Continuation: Drugs based on susceptibility; continue for 18 weeks

•Infectious for 2 weeks after starting treatment

•Hospitalization may be needed for the severely ill

•Sensitivity testing for MDR-TB (different regimen)

•Directly observed therapy (DOT) for people who can’t remember to take their meds. Dispense daily for them

29
Q

TB Drug therapy, Latent

A

•Treatment aimed at preventing active disease
•Fewer bacteria present = simpler treatment

Not tested:
•Six to nine months of isoniazid daily
•Alternate 3-month plan uses rifapentine & isoniazid daily
•Four-month rifampin treatment if patient is resistant to isoniazid

30
Q

TB -Nursing care

A

•Airborne isolation (N95, negative airflow room)
•Patient education
-Medication adherence (finish full regimen to avoid resistance!)

-Infection prevention measures (don’t cough on people, clean up tissues etc)

-Smoking Cessation
-Avoid alcohol (liver toxicity of meds!)

•Public health will be notified (people in same house will be tested to find latent cases)
•Evaluation of close contacts

•Vaccine: BCG (live virus) given to high-risk populations, immunocompromised, it interacts w/screenings

31
Q

Atypical Mycobacteria (Test!)

A

•More than 30 varieties
•Found in tap water, soil, bird feces, house dust**

•Can cause lymphadenitis, pulmonary, or skin & soft tissue infections*

•At risk individuals: Immunosuppressed or chronic pulmonary disease

•Pulmonary symptoms: cough, SOB, weight loss, fatigue, blood-tinged sputum

•Dx: Culture required
•Treatment: Similar to TB

32
Q

Pulmonary Fungal Infections

A

•Endemic: Found in specific regions

•Opportunistic: Occurs in immunocompromised patients

•Acquired by inhalation of fungal spores

•Signs and Symptoms: Similar to bacterial pneumonia (when normal Tx isn’t working, further investigation is needed. Ask if Pt traveled recently!)*

•Dx: Skin testing, serology, & biopsy

Not tested:
•Treatment: Based on identified pathogen: Amphotericin B, fluconazole (Diflucan), voriconazole (Vfend)

33
Q

Lung Abscess (TEST)

A

Happens when bacteria has been aspirated into lungs

•Necrosis of lung tissue

•Causes: Periodontal disease(poor oral hygiene), IV drug use, cancer, PE, TB, parasitic or fungal disease

•Signs and Symptoms: Cough w/ foul smelling, purulent or dark brown sputum(sour tasting! Distinguishing factor From TB ***) , hemoptysis, fever, chills, night sweats, pleuritic pain, dyspnea, anorexia, & weight loss

34
Q

Lung abscess Dx, Tx, Nursing considerations

A

•TEST QUESTION: NO chest physiotherapy or postural drainage!!!* don’t want pus to get spread around and sit ***

Dx: Chest x-ray, CT scan, Bronchoscopy, pleural fluid/blood cultures

•Treatment: Prolonged antibiotic therapy, CT or US guided drainage of the abscess, surgery

•Nursing Assessment: Dullness on percussion, decreased breath sounds over involved area, crackles(bc of fluid!) in later stages

•Nursing Considerations: Monitor for signs of hypoxemia, O2 PRN, effective coughing(HUFF COUGH**), rest, nutrition, fluids, proper dental hygiene*, antibiotic education

35
Q

Environmental Lung Disease causes

A

•Pneumoconiosis: Caused by inhaled dust or chemicals
-Extent of damage based on toxicity of inhaled substance, amount & duration of exposure, & individual susceptibility
-Disease classified by the origin of the dust

•Coal workers pneumoconiosis (CWP), aka “Black Lung”
-Particles lead to inflammation then fibrosis

•Chemical Pneumonitis
-Exposure to toxic fumes
-Acute: Diffuse lung injury – pulmonary edema
-Chronic: Bronchiolitis Obliterans (obstruction/inflammation of bronchioles)

36
Q

Environmental Lung Disease cont. (Pneumonitis/Asbestos)

A

•Hypersensitivity Pneumonitis (Extrinsic Allergic Alveolitis)
-Inhalation of antigens that patient is allergic to: Bird fancier’s lung, farmers lung

•Lung Cancer from Asbestos Inhalation
-Microscopic fibers deposit in the lungs
-Asbestosis: Chronic inflammation of the lung
-Squamous cell carcinoma or adenocarcinoma most common
•Time lapse: 15-19 yrs between exposure and lung CA
•Mesothelioma

37
Q

Effects of Asbestos Exposure

A

Mesothelioma: Asbestos enters the lungs and plaque forms in Pleura (lining of the lungs)

-Can cause scar tissue in the lining of the lungs and Make it difficult/painful to Breathe.

38
Q

Environmental Lung Disease S/S, Dx

A

•May not occur for 10-15 years from exposure

•Common manifestations include dyspnea, cough, wheezing, & weight loss,
Long term: Cor pulmonale, COPD, pulmonary edema, CA, mesothelioma, TB

•Diagnostics
-Pulmonary function – reduced vital capacity
-Chest x-ray, CT Scan

39
Q

Environmental Lung Disease Tx, Nursing management

A

•Treatment: Directed at preventing disease progression & controlling respiratory symptoms. Based on cause & severity of condition

•Nursing Management
-Prevent or decrease exposure
-Educate about appropriate PPE
-Encourage regular check-ups & vaccinations

40
Q

Pleurisy S/S, assessment, Nursing Considerations

A

•Inflammation of the pleura

•Causes: Infectious diseases, cancer, autoimmune disorders, chest trauma

•Signs & Symptoms: Sharp pain, worse with inspiration (ask Pt to take deep
Breath. “Is there more Or Less
Pain?” More pain = pleural rub)

•Assessment: Shallow, rapid breathing, pleural friction rub

•Treat the underlying disease

•Nursing Considerations: Pain relief, teach patient to splint rib cage

41
Q

Pleural Effusion (Test!)

A

•An abnormal collection of fluid in the pleural space.

•Transudative:* Occurs in non-inflammatory conditions with protein-poor, cell-poor fluid
-Fluid is clear, pale yellow
-Found in renal or liver disease patients

•Exudative:* Occurs in inflammatory conditions due to increased capillary permeability
-Common with infections or malignancies (cancer)

42
Q

Pleural Effusion S/S, Assessment, DX

A

•Signs & Symptoms:
-Pt’s can’t take deep breath bc fluid is in the way of lung expansion
-Progressive dyspnea and cough
-Decreased movement of chest wall
-Pleuritic pain

•Assessment:
-Dullness to percussion
-Absent or decreased breath sounds

•Diagnostics:
-Chest x-ray/Chest CT: show volume & location of effusion

43
Q

Pleural Effusion Thoracentesis Test

A

Treat underlying cause

•Thoracentesis* (pg. 473)
-Insertion of large-bore needle through the chest wall to remove pleural fluid
-Position patient upright, leaning over table to expand space between ribs
-Local anesthetic is used (Lidocaine)
-Observe for signs of hypoxia(use continuous pulse Ox) or pneumothorax(collapsed lung- assess
Breathe/lung sounds*)

44
Q

Contraindications for Thoracentesis

A

If Pt is on:
Blood thinners
Or if Pt is Confused /combative

45
Q

Empyema causes, S/S, Tx

A

Collection of purulent(pus) fluid in the pleural space

•Causes: Pneumonia, TB, lung abscess, or infected surgical wounds

•Symptoms: Manifestations of pleural effusion AND fever, night sweats, cough, weight loss

•Treatments: Antibiotic therapy, thoracentesis (secretions may
Be too Thick to remove)

46
Q

Bronchiectasis causes, S/S

A

•Permanent abnormal dilation of medium sized bronchi

•Destruction of muscular structures supporting the bronchial wall
•Bacteria & mucus accumulate

•Causes: Cystic Fibrosis, bacterial infection, immune disorders

•Signs & Symptoms:
-Persistent cough with thick, tenacious, purulent sputum
-Pleuritic chest pain, dyspnea, wheezing, clubbing weight loss, anemia

47
Q

Bronchiectasis DX, TX

A

Diagnostics: CT scan, Sputum culture, Pulmonary function tests, CBC

•Treatment:
-Chest physiotherapy & postural drainage*
-HUFF cough*
-Antibiotics
-Bronchodilators, Corticosteroids
-Direct hydration to liquify mucus (nebulized saline into
Tissues)
-Nutrition/hydration (oral)
-Surgical resection/transplant is last resort

48
Q

Test question: what is need to know to patient positioning?

A

“Different types of Positioning is used to drain different areas/portions of the lungs.”

49
Q

Rifampin

A

Rifampin is an antibiotic that is used to treat or prevent tuberculosis (TB).

Side effects: can cause burnt orange urine, stools, sweat, tears

*High risk for liver condition patients
*repeat Liver tests every 2-4wks
*don’t drink alcohol

50
Q

Isoniazid

A

MOA: Isoniazid is an antibiotic that fights bacteria, and is used to treat & prevent TB

Note: Take isoniazid on an empty stomach, at least 1 hour before or 2 hours after a meal.

Side effects:
-Clumsiness or unsteadiness
-dark urine
-loss of appetite
-nausea or vomiting
-numbness, tingling, burning, or pain in hands and feet
-unusual tiredness or weakness
-yellow eyes or skin

*High risk for liver condition patients
*repeat Liver tests every 2-4wks
*don’t drink alcohol

NURADN 28 (12 decks)

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