Non-Infectious Upper & Lower Respitory Disorders Flashcards by Jade Ring

Epistaxis …

Nosebleed

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Nasal fractures

3 key assessments

Breathing
Pain
Leaking CFS

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Medical management of Epitaxis…

(2)

Apply pressure

Nasal packing

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Management of Nasal Polyps…

(2)

Inhaled steroids

Polypectomy

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Assessments

Airway
Edema
Pain
CSF leaking
6 fields of vision
Extra Occular motions
Convergence, PERRLA

Facial trauma

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Risk factors

Neck 17” or bigger
Being over weight

HTN
Stroke
MI
MOTOR VEHICLE ACCIDENTS

Sleep apnea

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The CPAP provides positive air pressure to keep your airway open and breathes for you

T or F

It doesn’t breath for you

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Type of cancer that affects head and neck

Squamous cell

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Head and neck cancer usually begins with…

Chronically irritated mucous

Becomes thicker & tougher

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Pre-op with laryngeal cancer.
According to ED this is the most important

Arrange for communication

They won’t be able to talk post op

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MVA ….

Motor vehicle accident

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Most important nursing intervention for post rhinoplasty

Patient remains in Semi-Fowlers posistion for 48 hrs to prevent increase in edema

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Admitting patient with R/O laryngeal cancer.

Which info do they teach

A. Demonstrate proper gargling with normal saline

B. Perform voice exercises 30 min daily

C. Explain that a lighted instrument will be used to biopsy

D. Teach monthly self-exam tech

C. Explain that a lighted instrument will be used to biopsy

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Preparing a patient for total laryngectomy which intervention has priority

Take them on tour of ICU

Explain they will need to ask for pain meds

Demonstrate proper use of TED hose

Determine if they can read or write

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Is asthma reversible?

Generally, yes

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Mucosal edema
Mucus secretion
Bronchial construction

Antigen-Antibody reaction

Describes….

Asthma

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Peak flow zones

Green zone
Yellow zone
Red zone

Green zone: >80% personal best
Yellow zone 50 - 80% - increase meds / treatments
Red zone <50% - Urgent care needed

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Inhaled corticosteroids
Fluticasone
Budesonide
Mometasone
Beclomethasone
Ciclesonide

Leukotriene modifiers

Montelukast (Singulair®).
Zafirlukast (Accolate®).
Zileuton (Zyflo®).

LABS- long acting beta agonist
Salmeterol
Formoterol

Theophylline (Bronchodilator)

Combination inhalers both corticosteroids & LABA

Used for what purpose

Long term asthma control

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Short-Acting beta agonist
Albuterol

Ipratropium
(Atrovent)

Oral & IV corticosteroids
(For serious asthma attacks

Used for…

Quick relief/ Rescue medications

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Omalizumab ( Xolair) is used for…

Allergy induced asthma

Long-term

monoclonal anti-immunoglobulin E (IgE) antibody

Anti-inflammatory

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Brand names: Proventil, Ventolin, ProAir

Bronchodilator relives Wheezing & chest tightness caused by COPD & Asthma

Works by relaxing airways

Inhaler or Nebulizer

Contradictions:

Heart rhythm disorder, seizures, diabetes

Drug interactions:

Beta blockers, antidepressants, Bronchodilators

SE: Sleep problemas, muscle pain, dry mouth, dizzy

Albuterol

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Combines 2 medications
Budesonide & formoterol fumarate

Prevents bronchospasms in COPD & Asthma

Aerosol Inhalation

Budesonide = corticosteroids (reduces inflammation)

Formoterol long acting beta 2 adrenergic agonist (relaxes muscles)

Only use in patients whose asthma is not well controlled by other meds

Symbicort - Maintenance Inhaler

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Formoterol:
long acting beta 2 adrenergic agonist

Function

relaxes muscles

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Formoterol
Long-acting beta 2 adrenergic

This serious risk

Increased risk of asthma related death

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Combines fluticasone (steroid Reduces Inflammation) & salmeterol (long-acting beta 2 adrenergic) Relaxes airway muscles Prevent breathing difficulties & tight chest associated with COPD & Asthma Inhalation: Powder discus Increases risk of Asthma related deat SE: Sinus pain, sore throat, sneezes, stomach pain

Advair - Long-term

Brand name: Xopenex Short acting Similar to albuterol in chemistry & action

Levalbuterol

Similar to Albuterol & levalbuterol Sold under brand name Maxair Not for use by children

Pirbuterol

Brand name: Serevent (Salmeterol) Increases risk for: Heart rate, tremor, nervous, headache Long / Rescue inhaler

Long-term

Foradil/ Perforomist (Formoterol) Dry powder inhaler SE Tachycardia, insomnia, lightheaded, headaches Long / Rescue inhaler

Long

Long acting bronchodilator Oral pill or tab Many drug interactions

Theophylline

Aformoterol aka Brovana Longterm bronchodilator Is taken how

Nebulizer

Ipratropium Short term bronchodilator Nebulizer or inhaler SE: Cough, Dry mouth, blurr3d vision Commonly taken with this medication

Albuterol

Tiotropium is sold under brand name____ Comes in capsules for use in a Handihaler device SE: Dry mouth, cough amd slowing of heart NOT FOR USE IN CHILDREN

Spiriva - long term anticholinergic

Short & Long acting beta² agonist Methylxanthines Cholinergic Antagonist This type of medication

Bronchodilators

(-terol) Suffix Which medication

Rapid acting Beta² agonist

Monitor patient for what after bronchodilator

Tachycardia

Use bronchodilator (after/before) other medications Exp of bronchodilators

short-acting bronchodilators: Albuterol, Proventil HFA, ProAir, Ventolin HFA (albuterol), and Xopenex HFA. Anticholinergics: Like ipratropium, tiotropium, aclidinium, and glycopyrronium Theophylline

(Long / Short-acting beta-2 agonists): Albuterol, levalbuterol. (Long / Short-acting beta-2 agonists): Formoterol, salmeterol, indacaterol

Short-acting beta-2 agonists: Albuterol, levalbuterol. Long-acting beta-2 agonists: Formoterol, salmeterol, indacaterol

Steroids cause Hypoglycemia/Hyperglycemia

Hyperglycemia

Flovent (fluticasone) Pulmicort (Budesonide) Vanceril: (Beclomethasone) Advair (fluticasone propionate and salmeterol) All which type of medication? Monitor for... How to discontinue?

Inhaled steroids Monitor for oral candidiasis Gradual tapering off of medication

Teaching for using an inhaled steroid

Swish and spit Water or mouth wash

Why give mast cell stabilizers to asthma patients?

Prevents mast cells from opening Mast cells are associated with allergies and inflammation

Leukotriene Antagonist Treats persistent asthma Prevent bronchconstriction Example...

Singular (Oral Medication)

Status Asthmaticus Describe

Life threatening Tachycardia/ Tachypnea Wheezing Possible intubation

COPD is an umbrella term that covers

Emphysema, Chronic Bronchitis, ect

The alveoli get damaged and trap air inside of them instead of sending it throughout the body Describes this disease

COPD

Rupture of air sacs and the creation of one large air pocket instead of many smaller ones. Reduction in lung surface area traps air in the damaged tissue, making breathing difficult Describes which COPD disease

Emphysema

Smokers cough Mucus cough for 3 or more months for 2 or more years This COPD disease

Chronic Bronchitis

Primary symptom Dyspnea on exertion

Emphysema

Emphysema causes alveoli to become smaller & less effective T or F

F They become enlarged and Trap Air inside

Levels of CO2 & Oxygen with Emphysema

Increased CO2 > 45 Decreased Ox < 80

Chronic bronchitis is caused by Smoking Primary symptom is (Productive/ Non-Productuve) cough

Productive

Interventions FOR COPD

Airway Maintenane Breathing techniques Positioning Conservative energy Cough Enhancement

COPD Keep sPO² between these levels

90 - 92 %

What is the mechanism by which chemoreceptors trigger breathing in COPD patients

Oxygen levels NOT CO² Levels like regular peeps

Complications of COPD (4)

Hypoxemia, Acidosis Infections Cor pulmonale (Right sided heart failure) Dysrhthmias

Cor Pulmonale (Right-Sided Heart Failure) Describe

Cor pulmonale is an enlarged right ventricle in your heart. Pushing against high pressure in your pulmonary artery can cause your right ventricle to fail

Dependent edema (lower extremities) Dyspnea Fatigue Neck vein distention Polycythaemia (increased RBC) Happen in this disease related to COPD

Cor pulmonale Right sided heart failure

Clinical features Thin Dyspnea Clubbing Absent cough Increased AP diameter Prolonged expiration Hyperresonant upon percussion (Snap, Crackle, Pop) Which disease

Emphysema

Clinical features Recurrent respiratory infections Persistent cough Copious sputum Edematus, bloated JVD Peripheral edema Rhonchi & Wheezing Clubbing Normal percussion

Chronic bronchitis

Blue bloated = (emphysema/ chronic bronchitis) Pink puffer = (emphysema/ chronic bronchitis)

Blue bloated = Chronic bronchitis Pink puffer = Emphysema

Chronic bronchitis/ Emphysema Increased Hgb & RR SMOKER Cardiac enlarge JVD Sputum Increase Dusky / Cyanotic color Airway flow Problem

Chronic Bronchitis

Chronic bronchitis/ Emphysema Pursed lip Thin Barrel chest3d Speaks short choppy sentences Anxoius

Emphysema

Drugs for COPD (3)

Antitussives (Robotussin) anticough Expectorant (Guaifenesin) makes cough produce mucus Mucolytics (Acetylcyseine) breaks up mucus in lungs

Enlarged right ventricle & narrowing of Pulmonary Artery leads to...

Pulmonary HTN

Sarcoidosis Pulmonary/ Cystic fibrosis Are this type of Pulmonary disease

Restrictive Disease Sarcoidosis immune system to overreact, forming small, red, swollen lumps called granulomas in one or more organs

Most cancers can't be detected until they are this size... Where do cancers develop in the airway

1cm Occur in segmental bronchi and upper lobes

Classify lung cancer PERCENTAGES Small cell lung cancer ____ % Non-small cell lung cancer ____ % NSCLC squamous Adenocarcinoma Large cell

SCLC = 20% NSCLC = 80%

Non-small cell lung cancer Squamous Location

Towards middleish

Non-small cell lung cancer Small cell (oat cell) Location

Large mass nearest the trachea

Non-small cell lung cancer Adenocarcinoma Location

Outer edges

Non-small cell lung cancer Large cell Location

Top and bottom of lungs

This system is used to stage lung cancer

T: Tumor size, location, invasion N: Node, Lymph involvement M: Metastasis

Why is TNM not used to stage Small Cell Lung Cancer?

Cancer has Metastasis before diagnosis is made

Cancer Staging 1,2,3 A = (Operable/ Inoperable) 3B and above (Operable/ Inoperable)

1,2,3 A Operable 3B and above Inoperable

Which stages for small cell lung cancer are Operable

None. By time it's diagnosed it's Metastasis

Chest tube management

See other flashcards

Small cell lung cancer is associated with Asbestos or Smoking

Smoking

COPD patient Which requires immediate intervention by the nurse A. Pulse Ox 92% B. ABG pO² 74% C. SOB when walking to the bathroom D. Sputum is rusty colored

C. SOB when walking

Which medication should the nurse discuss with patients who have mild persistent asthma A: Daily inhaled steroids B. Rescue inhaler C. Systemic steroids D. Leukotriene agonist

Systemic steroids

Signs and symptoms associated with asthma

Dyspnea & Wheezing

2 long lasting Maintenance inhalers that combine steroids & beta-2 agonists for daily maintenance

Symbicort & advair

a class of drugs that relax smooth muscles

Beta 2 agonists

Symbicort Spiriva Singulair

Symbicort: 2 meds in 1 inhaler Asthma/ COPD. Budesonide / Formoterol Spiriva: Tiotropium bromide Bronchodilator COPD. Singulair: (Pill) Montelukast Anti-inflammatory It can treat allergies and prevent asthma attacks.

Asthma, chronic bronchitis, Emphysema Lung protease collapse the walls of the bronchioles ams alveolar sacks. Transforming from numerous small elastic air-exchanging surface area to 1 large less efficient air-exchange area Airway overreacts to common stimuli with bronchospams, edematous swelling, & production of thick mucus Infection or bronchial irritants cause increased secretion, edema, bronchospasm & impaired mucus clearance.

Emphysema: Lung protease collapse the walls of the bronchioles and alveolar sacks. Transforming from numerous small elastic air-exchanging surface area to 1 large less efficient air-exchange area Asthma Airway overreacts to common stimuli with bronchospams, edematous swelling, & production of thick mucus Chronic bronchitis Infection or bronchial irritants cause increased secretion, edema, bronchospasm & impaired mucus clearance.

With inhaler use Do you put the inhaler directly to your lips ? How long do you hold your breath after breathing in

No. 1 to 2 inches away 10 secs

Do you wrap your lips tightly around the inhaler? How long do you hold the breath in for

No. 1 to 2 inches away 10 seconds

Ipratropium is this type of medication Use...

Anticholinergic Short term must be taken several times a day. Most anticholinergic are like this

Tiotropium is this type of medication

Spiriva Long term anticholinergic 1x daily

This type of medicine is only given when other treatments are ineffective. The therapeutic dosage is close to the toxic dosage

Theophylline (Xanthine) bronchodilators long lasting

Oxygen delivery for asthma

Heliox 50-50 mixture of helium & oxygen

What is given to help in condition of Status Asthmaticus (5)

IV Fluids Systemic bronchodilator Steroids Epinephrine Oxygen

Status Asthmaticus Labored breathing & Wheezing Accessory muscles use &.....

JVD

Sudden absence of Wheezing in Status Asthmaticus.... Treatment....

Complete obstruction Tracheostomy

Protease in higher than normal amounts breakdown alveoli and sacs lose elasticity, small airways collapse, alveoli become large and rigid. Alveoli trap air inside and air filled spaces call bullae. This flattens the diaphragm and hence use of accessory muscles to breathe. This breathing problem

Emphysema

Singulair a once a day oral medication is in this class of drugs.

Leukotriene receptor Antagonist

Spiriva an anticholinergic has this precaution

Not for use in children

Numbness of face, lips, mouth Burning sensation when drinking citrus or hot liquids

Head and neck cancer Squamous cell (Slow)

Lung cancer causes change in _____ (this area,this type of cell)

Bronchial epithelium

How long for a tumor in the bronchus epithelium to reach 1cm

8 - 10 years

Uses: Strep & Staph pneumonia Syphilis & meningoccous

Penicillin

SE of bronchodilators

Esp. Albuterol Shakes/ Tremors Tachycardia Nervous Muscle cramps

What to teach about Singulair (Montelukast) - A Leukotriene receptor Antagonist Type of administration? Rescue medicine? Prescribed for?

Oral: Pill No, long-term Asthma, allergic rhinitis

Exam findings with pneumonia Percussion sound? Fremitus?

Dull sound Fremitus increase

____ work by Suppressing the body's immune response and reducing inflammation

Steroids (-one)