Part 3 Flashcards
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
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
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.
What antibiotics are prescribed for asthma
Oxygen is prescribed for
Theophylline
Ipratropuim
Mucolytic
Moderate and severe hyopxemia
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).
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.
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
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
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
Is twice as likely to occur in pt w Copd
S/s
Gastroesophageal
Reflux acid
Bronchi construction
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
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
Treatment for lung cancer
Lobectomy which is mainly used
Pneumonectomy
Radiation
Stage l &ll surgical resection
Higher stage chemotherapy drug, bio therapy agent
Radiotherapy
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
Treatment for pulmonary embolism
Oxygen therapy Intravenous heparin LMWH Thrombolytic therapy Pulmonary embolectomy Inferior vena cava filter
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
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
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
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
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