Part 3 Flashcards by Kensia Saintluc

Chronic lung disease characterized by reversible airway obstruction
Airway edema or swelling from inflammation and increased airway hypersensitivity to a variety of stimuli

S/s

Asthma

Wheezing
Cough worse at night
Difficulty breathing
Chest tightness

Dx by history, physical examination,pulmonary function testing chest radiograph

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Unrelieved asthma attack becomes

Respiratory distress w/out wheeze is an

Death from

Status asthmatic are very serious

Ominous sign for the asthma pt which indicates further constriction w very little air movement

Hypoxia

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If your pt takes an ACE inhibitors what should you teach them

Report a cough
Excessive coughing can tigger or worsen an asthma attack

Minimize irritation of the air passages and relieve obstruction by secretions, edema, or bronchospasm.

Prevent or control infection and allergy.

Increase the patient’s tolerance for activity.

Determine the best drug combination in the least amount that will control symptoms.

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What antibiotics are prescribed for asthma

Oxygen is prescribed for

Theophylline
Ipratropuim
Mucolytic

Moderate and severe hyopxemia

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helps determine the drug dosage needed to control the asthma, predict the effectiveness of therapy, and detect airflow obstruction buildup before it becomes serious and requires hospitalization.

What should you teach your pt

Peak flow meter

Know your “green zone” (when airflow is normal),

your “yellow zone” (when usual airflow has decreased and routine medications should be increased),

and your “red zone” (when you need to use rescue medications and call your health care provider).

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When a pt respiratory distress

If there is a history of COPD

Apply high-flow oxygen and monitor the saturation level with a pulse oximeter.

Observe and monitor continuously.

Immediately alert the RN and the physician.

, the oxygen rate should be changed, as ordered, to a lower flow of 1 to 3 L per nasal cannula after the respiratory crisis has been resolved.

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Is high blood pressure In the blood vessels of lung

How is lung pressure

Pulmonary hypertension

Measure during right heat cartheterization using pulmonary artery catheter

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Type
1
2
3
4
5

1 involves increase pressure in pulmonary arterial system from drug

2 develop from left heart disease

3 is due to lung disease COPD and hypoxemia

Development of chronic pulmonary blood clot
Captures all other causes including the unknowns

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Is enlargements of the right side of the heart as a complication of PH caused by constriction of the pulmonary vessel in response hypoxia

Cor pulmonale

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Is twice as likely to occur in pt w Copd

S/s

Gastroesophageal

Reflux acid
Bronchi construction

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What should be the normal color of sputum for COPD

What are some additional things that can help to stop smoking

White slightly viscous and has no taste or odor
Changes in sputum should be reported to your health care provider

Nicotine patches and gum and nasal spray and inhaler

Burpropion alleviate w/drawal symptoms

Varenicline

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Is the leading cause of cancer

What age does this cancer
What substance causes it

What account for 85% of all lung cancer
What makes up for 15%of oat cells tumors grow rapidly

Chronic irritation of the epithelial tissue in the lung cause

S/s
Dx

Lung cancer

40
Cigarettes

Non-small cell lung
Small cell lung cancer

cause change in cell structure

Dysplasia ,Wheezing
Ulceration ,Hoarness
Paralysis ,Fatigue
Anorexia ,Wt loss

Chest radiograph & sputum cytology
PET&VAS
Biopsy

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Treatment for lung cancer

Lobectomy which is mainly used

Pneumonectomy

Radiation

Stage l &ll surgical resection

Higher stage chemotherapy drug, bio therapy agent
Radiotherapy

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Occur when a pulmonary vessel is plugged w a mass or clot

What can occur

What should you avoid

Pulmonary embolism

Fat embolism from child birth

Long airplane ✈️ ride

Dyspnea &Chest pain
Cough& Hemoptysis
Anxiety& Hypotension 
Tachycardia & Confusion 
Drop in Soa2

Dx is made by ruling out other problem 
Plasma D-Sumer 
Computed tomographic pulmonary angiography 
Chest radiograph 
Echocardiogram

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Treatment for pulmonary embolism

Oxygen therapy 
Intravenous heparin LMWH
Thrombolytic therapy
Pulmonary embolectomy 
Inferior vena cava filter

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The classic s/s are dyspnea and fatigue
Chest pain , dizziness and syncope

There is no cure

Pulmonary hypertension
Drug therapy
Endothelium-receptor antagonist
Anticoagulant

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Major Concerns for Patients with  Chest Injuries

Maintenance of an airway

Assurance of adequate ventilation

Treatment of circulatory problems to ensure circulation of oxygenated blood

Involve either the lung and air passages
Heart major blood vessels

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Occurs as a result of a blunt or penetrating injury to the chest wall

What can it causes

Is a threat in chest injury and usually present in the period after thoracic surgery

When it happens out of no where is

How is it removed

Pneumonthorax
Hemothorax

Partial or total collapse of the lung

Pneumonthorax

Spontaneous pneumonthorax

Thoracotomy for H
Rest and O2 for p or Thoracotomy for greater amount of fluid

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this is an abnormal collection of fluid in the interstitial spaces of the lung and inside the alveoli, and is a medical emergency

Pulmonary edema

Nursing care for pulmonary edema involves

placing pt in high fowlers

Oxygen is started-in the form of CPAP or intubation. Furosemide is given, and morphine.

is a form of acute lung injury that results from pulmonary changes that occur with sepsis, major trauma major surgery, or any critical illness.

When the alveolar capilary meebrane is injured it becomes more permeable to intravascular fluid. ALveoli fill with fluid and oxygen and CO2 cannot cross the membrane into and out of the capillaries
Acute respiratory Distress syndrome

Acute respiratory distress syndrome

S&S of ARDS

Nursing treatment for ARDS

Dyspnea, tachypnea, Tachycardia, and hypoxemia Crackles

ventilation with low tidal volumes, positive and expiratory pressure (CPAP) treatment of the underlying disorder, careful fluid and electrolyte management.

this is the result of insufficent oxygen or excessive carbon dioxide

this occurs when Pao2 is lower than 60 mmHg and a normal or low Pco2 is present

is the result of hypoventilation during which usual amount of carbon dioxide is not eliminated by exhalation

The final outcome of Respiratory failure is

Respiratory failure

hypoxemic respiratory failure (type1)

Hypercapnia

cardiac arrest

By vigilant observation and assessment of patients with respiratory problems and close attention to ________________________________ you can often prevent respiratory failure

Monitoring _______ is particularly important when there is concurrent heart or multiorgan failure

Turning, deep breathing and coughing

fluid balance

Surgery such as resection of lung tissue and other pulmonary structures require opening the chest wall and entering the pleural cavity Is also necessary to repair the heart and great vessel or defects of the esophagus

Intrathoracic surgery

Preoperative thoracotomy nursing care

health history subjective and objective assesment data improve the respiratory status as much as possible prepare postop equipment, chest tubes suctioning, mechanical ventilation, incentive spirometer

Postoperative thoracotomy nursing care How long does it take to recover

routine positioning and turning deep breathing.specific observations of chest tubes and the closed drianage system. Watch for signs of pnemothorax and hemothorax 4 to 6 weeks to recover VATS CAN go back doing ADLs 3 to 4 days And can return to work w/in 1 week

Auscultation and palpitation of the upper chest and neck for swelling caused by________ an accumulation of air or gas under the skin which feels like bubble wrap on palpation

subcutaneous emphysema or crepitus subcutaneous emphysema

Distention of the _____ and ____ is particulary hazardous for post-thoracotomy patient because distention can cause these organs to push up on the diaphragm and impair ventilation, which is already compromised by the surgery.

stomach & Intestines

Many surgeons do not permit lying on the unaffected side b/c this position diminshes the ________ of the good While doing a intrathoracic surgery

lung | expansion

What purpose of chest and closed drainage The three major areas of assessment for chest tubes

Purposes Provide for drainage of air and blood from within the pleural cavity. Allow for gradual re-expansion of the lung. - The respiratory status of the patient - The site at which the tube is inserted into the chest and the length of the tube for kinks or clots - The amount and character of the drainage in the collection chamber

The drainage system

should provide natural drainage of air and blood from within the pleural cavity allow for gradual re-expansion of the lung by isolating the intrsthoracic pressure from atmospheric pressure

The left hand chamber serves has the ______ control chamber. When the unit is attached to wall suction there will be ________in the compartment. The _______ of fluid determines the amount of suction applied to the chest.

suction bubbling level

The middle chamber is the___________chamber that prevents air from entering the chest cavity

water-seal

The apparatus and all connections must remain_____at all times all connections should be tape.

airtight

Do not allow the tubing to become ______or__________ by the weight of the patient.

kinked, obstructed

The chest tube system operates by ______ and must remain below the patient's chest level at all times

gravity

If the chest tube becomes unattached, _______ clamp the tube.

do not

Place the end of an unattached chest tube in_______. This creates a "water seal"

normal saline

A _________ appearance of the chest could indicate a _________. "

puffed up", subcutaneous emphysema

The patient should be medicated ____ to ___ minutes before the removal of a chest tube?

30 to 60

Are drugs that directly act on and relax the smooth muscle of the bronchi and thereby relieve bronchospasms This is the medication for intrathoracic surgery

bronchodilators Liquefying agent Antiinfective ``` Tetracycline Penicillin Cephalosporin Macrolides Fluroquinolones ```

inhibitors are the newest addition to the treatment for asthma. They help control symptoms by blocking the activity of substances that mediate inflammation What is a major part of inhalation therapy for pt w COPD Are fine suspensions of very small particles of liquid or solid that constitute a gas Intrathoracic surgery

Leukotriene and immunomodulators helps control asthma systems by blocking the activity Corticosteroids Aerosol

A device producing a fine spray

Nebulizer Are usually 20 to 30 minutes long given two, three or four times a day

For oxygen of ___L minute or less

humidification is not necessary. Room air is not artificially humidified 4