Non-Infectious Upper & Lower Respitory Disorders Flashcards
Epistaxis …
Nosebleed
Nasal fractures
3 key assessments
Breathing
Pain
Leaking CFS
Medical management of Epitaxis…
(2)
Apply pressure
Nasal packing
Management of Nasal Polyps…
(2)
Inhaled steroids
Polypectomy
Assessments
Airway
Edema
Pain
CSF leaking
6 fields of vision
Extra Occular motions
Convergence, PERRLA
Facial trauma
Risk factors
Neck 17” or bigger
Being over weight
HTN
Stroke
MI
MOTOR VEHICLE ACCIDENTS
Sleep apnea
The CPAP provides positive air pressure to keep your airway open and breathes for you
T or F
F
It doesn’t breath for you
Type of cancer that affects head and neck
Squamous cell
Head and neck cancer usually begins with…
Chronically irritated mucous
Becomes thicker & tougher
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
MVA ….
Motor vehicle accident
Most important nursing intervention for post rhinoplasty
Patient remains in Semi-Fowlers posistion for 48 hrs to prevent increase in edema
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
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
Determine if they can read or write
Is asthma reversible?
Generally, yes
Mucosal edema
Mucus secretion
Bronchial construction
Antigen-Antibody reaction
Describes….
Asthma
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
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
Short-Acting beta agonist
Albuterol
Ipratropium
(Atrovent)
Oral & IV corticosteroids
(For serious asthma attacks
Used for…
Quick relief/ Rescue medications
Omalizumab ( Xolair) is used for…
Allergy induced asthma
Long-term
monoclonal anti-immunoglobulin E (IgE) antibody
Anti-inflammatory
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
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
Formoterol:
long acting beta 2 adrenergic agonist
Function
relaxes muscles
Formoterol
Long-acting beta 2 adrenergic
This serious risk
Increased risk of asthma related death
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)
