Nursing 106 Fall Final Flashcards
Where can bronchial sounds be heard and how would you describe them?
Heard over the trachea, loud, high pitched, harsh, hollow, tubular sound
Where can you hear bronchial-vesicular sounds and how would you describe them?
Heard over the main stem bronchi (middle of the sternum), sound is moderate pitch and amplitude with mixed quality over major bronchi
Where can you hear vesicular lung sounds and how would you describe them?
Heard over the lung periphery, low, soft pitched, rustling sound over peripheral lung fields
What are fine crackles and why do they occur?
Heard mainly when you inhale, dry high-pitched popping or crackling due to movement of air through fluid in the airways and alveoli. Formerly known as Rales.
What are course crackles and why do they occur?
Heard when you exhale, moist, low-pitched gurgling, bubbling. Due to air moving through large bronchi and trachea that are intermittently occluded with secretions.
When do you hear a sonorous wheeze and why?
Heard expiratory, continuous. Low pitch, Snoring due to narrowing of large airways from secretions, spasms, tumors, or swelling.
When do you hear a sibilant wheeze and why?
Heard expiratory, continuous. High pitched, musical. Due to narrowing of large and small airways.
When do you hear pleural friction rub and why?
Heard late expiratory and early inspiratory, continuous. Loud grating or creaking sound. Due to inflamed pleura rubbing against each other.
When do you hear stridor and why?
Heard inspiratory, continuous. Crowing, harsh honking wheeze. Due to partially obstructed upper airway.
What symptoms in a childs breathing would suggest a problem?
Nasal flaring, accessory muscle use.
What is parenchyma?
The essential or functional elements of an organ, as distinguished from its stroma or framework.
There is how many ml of deadspace in the respiratory system?
150ml
Define mucocillary clearance?
Self clearing mechanisms of the bronchii
These four things in the respiratory tree make of the?
Bronchioles, alveolar ducts, alveolar sacs, alveoli
What marks the site of tracheal bifurcation?
Manubrium
What is the lowest part of the sternum called?
Xyphoid process
The top of the scapula is called the?
Acromion process
When tipping head forward, the top prominent spinal vertebrae is called what and where is it located?
Vertebral prominens and its located at C7
The vertebral prominens is a landmark for IM of the?
deltoid muscle
The vertebral prominens is also a landmark for what in the lungs?
Apex
What vertebra aligns with the bottom of the lungs?
T10
Thoracic reference lines on anterior chest: the line that is in middle of body_____; line that run through nipple area ______; line that runs along side of anterior body _____. On posterior chest: middle line ___; line between middle and edge ____. Lateral chest: line near front of body ____; middle of body ___; back of body ____.
Midsternal line; midclavicular line; anterior axillary line; vertebral line; scapular line; anterior axillary line; midaxillary line; posterior axillary line.
The right lung is ___than the left and has ___lobes.
Shorter; three
The left lung is ___than the right and has ___lobes.
Narrower; two
A/P ratio should be ___as wide as ___.
Twice; deep
RR in breaths per min: newborn ___; one year old__ ; 3 years old ___; 6 years old ___; 10 years old ___; 17 and older ___.
Newborn 30-70; 1 yr 20-40; 3 yr 20-30; 6 yr 16-22; 10 yr 16-20; 17 yr + 12-20
___ ___ are caused by obstruction of the free inflow of air thus creating increased negative pulmonary pressure.
Intercostal retractions
The ___ position allows easier use of ___ muscles when trying to improve breathing.
Tripod; accessory
Name at least 5 reasons why there would be asymmetry to the thoracic cavity when breathing.
Mass, musculoskeletal disorders, rib fracture, pneumonia, atelectasis
Define tachypnea?
> 24 bpm
Define bradypnea
<10 bpm
Define hyper and hypo ventilation
Increased rate & depth; decreased rate & depth
Define Cheyne -stokes
Alternating deep breaths with periods of apnea
Define Agonal breathing
Lasts breaths of life
What do the colors of the following sputums indicate? Yellow/green; rust or blood tinged; black; pink - frothy
Bacterial infection, pneumonia, pulmonary infarction, or TB; black lung disease; pulmonary edema
Define therapeutic and pharmacologic classifications of drugs and give examples?
Therapeutic is based on WHAT the drug does clinically, ex: antibiotics, anticoagulants; Pharmacologic classifications are based on HOW the drug produces its effect, ex: bacteriostatic, bactericidal.
What is a prototype drug?
It serves as a model for a drug class. It is well understood and has known actions and adverse effects. Used to compare other drugs in the same pharm class.
What are the pregnancy categories?
A - is no risk per studies
B - is no risk in animals and controlled studies on pregnant women no available
C - is shown evidence of risk so risk vs benefit must be determined
D - is risk proved, only used in life threatening conditions
X - is risk proven and outweighs the good, to be avoided
What is bioavailability? How can this effect generic and trade drugs?
The rate and extent to which active ingredients are absorbed and available at the site of action; Can be different between generic and trade so some states don’t allow subs for generic.
Controlled substances: what are the 3 main responsibilities when administering? Drugs must be kept under a ___lock. Refills by phone are/are no allowed.
Count and record # of drugs on hand, document amount of drug given, wasted portion must be witnessed and recorded; double; are NOT.
Name the schedule categories for controlled substances, and give examples for each?
Schedule I - V, I being highest potential for abuse and V being least potential for abuse. Schedule I: heroin, pot; Schedule II: morphine, amphetamines; Schedule III: codeine; Schedule IV: benzodiazepines; Schedule V: opiod-controlled substances for diarrhea and cough, codeine in cough preparations.
Define pharmacokinetics and name the 4 phases?
“medicine action”, the study of drug movement throughout the body and how the body deals with it; absorption, distribution, metabolism, and excretion
Hepatic microsomal enzyme system is also known as what? What are the 2 ways it can modify drugs?
P-450 system; it can inactivate it or it can activate it (as it does in pro drugs)
Define pharmocodynamics?
What the drug does to the body, knowing this will ensure that drug will provide a safe, effective treatment.
Define and describe the 3 different types of multiple drug therapies?
Additive effect: 1 + 1=2
Synergeistic effect: 1 + 1=3
Antagonistic effect: 1+ 1 <1
Define median effective dose?
ED50 is the dose needed to produce DESIRED effect in 50% of clients aka “average dose”
Define the median lethal dose?
LD50 is lethal to 50% of test subjects
What is the therapeutic index and how does it work?
It is the LD50 divided by ED50. Low TI reflects narrow safety margin, high TI is higher safety so the higher the value the safer the drug. So a drug with a low TI has low margins of safety and will likely have plasma levels drawn to monitor.
What are peak and trough levels and what do the indicate?
Peak is the highest plasma concentration of drug and indicates the rate of absorption; the trough is the lowest plasma concentration of drug and indicates the rate of elimination.
Define Pharmacogenomics?
Newer branch of study looking into genetic factors and hereditary influence since factors can alter metabolism.
Define tachyphylaxis?
Acute tolerance of a drug (rapid decrease in response to drug); narcotics prime example
Name the four types of parenteral administration?
Intravenous
Subcutaneous
Intradermal
Intramuscular
