Pts w/ Chest & Lower Resp Disorders- Exam 2 Flashcards
The closure or collapse of alveoli, may be filled with alveolar fluid is known as what?
Atelectasis
What is one of the most common breathing respiratory complications after surgery?
Atelectasis
Clinical manifestations of atelectasis
Insidious, increasing dyspnea, cough, and sputum production
If a patient is experiencing an acute atelectasis, what specific manifestations will be seen?
Tachycardia, tachypnea, pleural pain, central cyanosis if large areas are affected
In what clinical setting is it most common for a patient to experience an acute atelectasis?
Postoperative setting
If a patient is experiencing a chronic atelectasis, what specific manifestations will be seen?
Still similar to acute: Tachycardia, tachypnea, pleural pain, central cyanosis - but a pulmonary infection may also be present
What is different about a chronic atelectasis versus an acute atelectasis?
Chronic has the same symptoms as acute, but the pt may also have a pleural infection
Common risk factors for atelectasis
Older age, bedrest with immobility, recent surgery, lung disease
When a patient with atelectasis presents, what will the nurse see in the physical assessment?
Increased WOB
Hypoxemia
Decreased breath sounds with crackles
Patty is 65 years old, she presents to the ED complaining of SOB and headache. She is wheezing, tachycardic, and obvious accessory muscle use. Her O2 sats are 88%. What is Patty likely experiencing?
Atelectasis
Symptoms of hypoxemia
HA, SOB, tachycardia, wheezing, confusion, blueish tint in lips, fingers
What diagnostic test can be used to diagnosis atelectasis before symptoms appear?
CXR
Administering oxygen does what for a patient with hypoxia/atelectasis?
Decreases WOB and reduces stress on myocardium
What is the goal when treating a patient with atelectasis?
Improve ventilation and remove secretions
What are the first line interventions for prevention of atelectasis?
Frequent turning, early ambulation, lung volume expansion maneuvers (incentive spirometry, deep breathing), and coughing
A patient has just had surgery, in order to prevent an atelectasis, what should the nurse ensure the patient does same day?
Ambulation
A patient with atelectasis has a high fluid content, what is the standard treatment?
Thoracentesis
Last line of defense treatments for severe atelectasis?
Endotracheal intubation and mechanical ventilation
What does postural drainage allow for?
Removal of bronchial secretions
Postural drainage uses what to clear secretions?
Force of gravity
Your patient has copious amounts of bronchial secretions, how can you prevent the build up these secretions?
Postural drainage
Why do bronchial secretions accumulate?
Patients sit upright too much
Most common influenza strain
A
Most virulent influenza strain
A
What are the subtypes of influenza?
Hemagglutinin and Neuraminidase
Which subtype of influenza A allows the virus to enter the cell?
Hemagglutinin
Which subtype of influenza A facilitates cell to cell transmission?
Neuraminidase
Which influenza type can only spread human to human?
B
Which influenza type can spread animal to human?
A
A patient presents to the ED and tests positive for influenza A, what contact precautions will you place them on?
Droplet
How long is the influenza incubation period?
1-4 days
When are you most contagious if you have the flu?
1 day before symptoms appear
Clinical Manifestations of Influenza
Abrupt onset, Fever, chills, myalgias, HA, sore throat, fatigue
You are a nurse working in a PCP office when a patient a presents with flu-like symptoms, what test will you perform to confirm?
Rapid followed up with RT-PCR sent to lab for confirmation
Who is approved to receive the flu vaccine?
Anyone over 6 months
Pregnant women
Immunocompromised pts
Nursing home residents
Common side effects of the inactivated flu vaccine
fatigue, low grade fever, HA, injection site reaction
How is the LSIV administered?
Nasally
Who is approved to receive the LSIV?
Healthy people age 2-49
The live influenza vaccine cannot be given to whom?
Immunocompromised pts and children or adolescents receiving ASA or salicylates
Common side effects of the live flu vaccine
Runny nose, congestion
Adults - sore throat
Children 2-6 years old - fever
Dyspnea and crackles are an early sign of what?
Pulmonary complication
Your patient has developed complications secondary to influenza, what complications could your patient be experiencing
Pneumonia
Ear or sinus infection
Dehydration
Condition characterized by an Acute infection of lung parenchyma
Pneumonia
8th leading cause of death from infection disease
pneumonia
What is the functional part of an organ?
parenchyma
What physiological change makes patients susceptible to developing pneumonia?
Damaged cilia that is unable to clear secretion build up
How does lung cilia get damaged throughout our lives?
Pollution
Smoking
URIs
Tracheal intubation
Aging
Risk Factors for developing PNA
Smoking, ETOH use
Immunocompromization/lack of immunization
HF, COPD, DM, flu
Prolonged immobility
NGT, OGT, ETT placement
Age
HOB not elevated
4 types of PNA
Community-acquired (CAP)
Hospital-acquired (HAP)
Aspiration
Covid PNA
When a patient has HAP PNA, what specifically is it most associated with?
Having a ventilator
Which is more virulent - HAP or CAP?
HAP
When does VAP occur in a hospitalized patient?
Develops more than 48 hrs after endotracheal intubation
PNA resulting from entry of secretions into lower lungs
Aspiration pneumonia
Risk factors for developing Aspiration PNA
Decreased LOC
s/p CVA
Difficulty swallowing
NGT insertion
What do the clinical manifestations of PNA depend on?
Type
Causative organism
Presence of underlying disease
How does streptococcal PNA present?
Sudden onset of chills, fever, pleuritic chest pain, tachypnea, and respiratory distress
What specific symptom is seen with PNA caused by viral, mycoplasma, or legionella?
Bradycardia
What diagnostics are performed on PNA patients?
CXR
CBC
Sputum analysis
Bronchoscopy
What further diagnostics may be done for pneumonia patients not responding to treatment?
Blood cultures
Thoracentesis
Bronchoscopy
Bio markers like CRP and procalcitonin
A thoracentesis and/or bronchoscopy is used not only to diagnose, but also to?
Treat
What is CURB-65?
C - confusion
U - BUN > 19 mg/dL
R - respiratory rate > 30
B - SBP < 90 mmHg or DBP <60 mmHg
Age - >65
What is CURB-65 used for?
It is used as a tool to aid in the decision to hospitalize or not
Complications of pneumonia
Atelectasis
Pleurisy
Pleural effusion
Pneumothorax
Meningitis
Acute Respiratory Failure
Sepsis
Lung abscess
Empyema
Condition in which air collects in the pleura space causing the lungs to collapse
Pneumothorax
Condition marked by fluid in the pleural space
Pleural effusion
Condition characterized by inflammation of the pleura
Pleurisy
What are two rare complications of pneumonia?
Lung abscess or empyema
Complication of pneumonia diagnosed by having pus in the pleural space
Empyema
What is the priority treatment for pneumonia over anything else?
Starting abx immediately
What does it mean when someone says ‘treatment of PNA is empiric’?
Treatment is based on the best educated guess
What supportive interventions are provided to pneumonia patients aside from abx?
Oxygen
Meds - analgesics, antipyretics
Individualized rest and activity
What sort of drug therapy should be started with a pneumonia patient?
IV abx and then switched to PO asap
Your patient with pneumonia is discharging, what educational points do you want to provide?
Take full course of meds
Drug-drug or drug-food interactions
Adequate rest and hydration
Avoid alcohol and smoking
Use cool mist humidifier
Follow up appts
Vaccination
A tracheostomy is a surgically created stoma used for?
Establishing an airway
Facilitating secretion removal
Long-term mechanical ventilation or weaning of ventilation
Complications of tracheostomy
- Air bypasses the nose and throat leading to loss of humidification and filtration
- Swallowing difficulty
What are the advantages of a tracheotomy?
Easier to keep clean
Better hygiene
More patient comfort
Less long-term risk to vocal cords
What can patient do with a tracheostomy that they cannot do with an endotracheal tube?
Patient can close mouth and brush teeth
Why might a patient need a tracheostomy?
Laryngeal cancer
Prolonged ventilator dependence
Upper airway obstruction
Neuromuscular disease
Why would a neuromuscular disease be cause for a trach placement?
Impaired lung function
What part of the trach effects swallowing?
Inflated cuff
Why is an inflated cuff used on a trach with certain patients?
used for patients who have risk of aspiration
If there is no risk for aspiration, what is done with the cuff of a trach?
It is left deflated or a cuffless trach is placed
When is it appropriate to remove a trach?
When pt no longer requires ventilatory support, can breathe spontaneously, protect airway, and can swallow or cough up secretions on their own
When a trach is removed, what does a patient need to remain?
NPO until evaluated for swallowing difficulties
T, C, DB = ?
Turn, cough, deep breathe
An infectious disease caused by mycobacterium tuberculosis
TB
Risk Factors for TB
Homeless or incarcerated
Living in inner city
Foreign-born
Living or working in an institution
IV drug use
Poverty or lack of healthcare access
Immunosuppression
What precautions are needed for TB?
Airborne
Transmission of TB requires what?
Prolonged and close contact or exposure
What is the main thing to remember about the clinical manifestations of latent TB?
It is asymptomatic
Why are there no symptoms with latent TB?
The immune system is controlling the infection
Clinical manifestations of pulmonary TB
Dry cough that becomes productive
Fatigue, malaise, weight loss, low fever, night sweats, dyspnea, and hemoptysis
What are the two most common manifestations of TB (aside from a cough)?
weight loss and night sweats
What are the two manifestations of a LATE TB infection?
Dyspnea and hemoptysis
How long do TB symptoms typically take to develop?
2-3 weeks
Diagnostic studies performed for TB
Tuberculosis skin test
T-Spot
CXR
Sputum cultures
How long is a patient contagious with TB after starting therapy IF their sputum is positive?
2 weeks
What is specific about the sputum testing for TB?
Needs cultures 3 days in a row
What criteria is necessary for a patient with TB to discharge to home?
Started on therapy and tolerating
Medically stable and able to care for self or has help
Able to understand and comply with isolation
Follow up plan with directly observed therapy in place
How long is the initial round of treatment for TB?
8 weeks
How many weeks can follow up treatment for TB last?
16-42 weeks if still positive
4-drug regimen for TB
Isoniazid
Rifampin
Pyrazinamide
Ethambutol
Rifanpentine - latent TB
What lab should be monitored during treatment TB?
Liver function
Latent TB is usually treated how?
With Isoniazid for 6-9 months
OR
3-month regimen of Isoniazid and rifapentine
OR
4 months of rifapentine
When teaching your patient about incentive spirometry, is the volume or force of exhalation more important?
Force- should be within the window the entire time, not too fast, not too slow
What are some strategies to expand lungs and manage secretions?
-Incentive spirometry
-Voluntary deep breathing
-Secretion management
-Metered-dose inhaler (bronchodilator)
To prevent PNA in at risk patients in the acute care setting, at what level should the bed be elevated?
HOB 30 degrees & up to chair or high Fowler’s for all meals
What are the most common clinical manifestations of PNA?
-Cough
-Low grade fever, chills
-Dyspnea, tachypnea
-Myalgia
-Pleuritic chest pain, use of accessory muscles
-Orthopnea, crackles, increased tactile fremitus, purulent sputum
What would a change in mentation for older or debilitated patients with PNA be attributed to? And what nursing intervention should be performed?
Hypoxia (check SpO2)
What are some nursing interventions for PNA?
-Humidification (face mask or nasal cannula)
-Coughing techniques
-Chest physiotherapy
-Position changes
-Nutrition
-Hydration
-Rest
-Activity as tolerated
-Patient education
-Self-care: vaccinations if 65+
What are some goals for a patient with PNA?
-Improved airway patency
-Increased activity
-Normal CXR
-Absence of complications
What does the blue rhino do when a patient is being trached?
Dilator- makes the opening bigger
What is the function of the obturator?
Does it stay in when a patient has a trach?
Only used for placement of a track
No, it closes the airway
Is suctioning to maintain patency of a trach a clean or sterile procedure?
Sterile
Why is humidification necessary for a pt. with a trach?
Because they are just getting raw air into their trachea, not humidified by the nose and mouth
What kind of care needs to be performed 2x a day for a patient with a trach?
Oral care
What are clinical manifestations of increased WOB?
-Fatigue
-Increased RR
-Use of accessory muscles
-Tachycardia w/ PVC
What are the 4 drugs used for TB?
-Isoniazid
-Rifampin
-Pyrazinamide
-Ethambutol
What is the most common side effect of anti tuberculin medications?
Elevated liver enzymes
What type of isolation is TB?
Airborne
How long can TB be spread after tx has started?
As long as the bacilli can be coughed into the air
What type of bacteria is TB?
Acid Fast Bacillus (AFB)
How and when should sputum samples be collected from a patient with TB?
3 samples on 3 consecutive days
How long will a patient be on treatments for TB?
3-6 months or longer
A blood pH of 7.52 is considered what?
Alkalotic
A blood pH of 7.29 is considered what?
Acidotic
A pt. with a blood pH of 7.33 and PaCO2 of 50 would be considered to be in what?
Respiratory acidosis
What nursing diagnoses could you formulate?
-SOB
-Use of accessory muscles
-Pulse ox 85%
-Tachypnea
-Respiratory acidosis
Impaired gas exchange
Ineffective breathing pattern
How long does it take for the kidneys to buffer serum pH in respiratory acidosis?
24 hours
What goals should you develop for a pt. with PNA?
-Improved airway patency
-Improved breathing pattern
-Improved gas exchange
-Rest to conserve energy
-Absence of complications
-Understanding tx protocol & preventative measures
-Maintain adequate fluid balance & nutrition
Elevating the HOB to semi-Fowler position does what?
Promotes oxygenation
How many Liters of fluid should you encourage a patient with PNA to consume per day? (if no other contraindications)
2 Liters
How quickly do antibiotics need to be administered after diagnosis of PNA?
Within 4 hours
What type of medication does CO2 act like?
A sedative
What drugs are naloxone an antidote for?
Opioids
A post-surgical pt. w/ bacterial PNA has coarse crackles & thick sputum. Which action should the nurse plan to promote airway clearance?
A. Restrict oral fluids during the day
B. Teach purse-lip breathing technique
C. Assist the pt. to splint the chest when coughing
D. Encourage the pt. to wear the nasal O2 cannula
C.
The nurse is caring for a patient with PNA. If a pleural effusion is developing, the nurse would expect which finding?
A. Barrel-shaped chest
B. Paradoxical respirations
C. Hyperreasonance on percussion
D. Localized decreased breath sounds
D.
24 hrs after a pt. had a trach, the tube is accidentally dislodged after a coughing episode. Which action should the nurse take first?
A. Call the health care provider
B. Place the obturator in the trach tube
C. Position the pt. in a semi-Fowlers position
D. Grasp the retention sutures to spread the trach opening
D
The nurse is caring for a client recently diagnosed with lung disease encourage the client not to smoke. What is the primary rationale behind this nursing action?
A. Smoking decreases the amount of mucus production
B. Smoke particles compete for binding sites on hemoglobin
C. Smoking causes atrophy of the alveoli
D. Smoking damages the ciliary cleaning mechanism
D
The nurse is caring for a client who is receiving oxygen therapy for PNA. How should the nurse best assess whether the client is hyperemic? By monitoring the client’s:
A. LOC
B. Extremities for signs of cyanosis
C. O2 saturation level
D. H&H, & RBC levels
C
The nurse at a LTC facility is assessing each of the residents. Which resident most likely faces the greatest risk for aspiration?
A. A resident who suffered a stroke several weeks ago
B. A resident w/ mid-stage Alzheimer disease
C. A 92 y/o resident who needs extensive help w/ ADL’s
D. A resident w/ severe & deforming RA
A
The nurse is caring for a client at risk for atelectasis. The nurse implements a first-line measure to prevent atelectasis development in the client. What is an example of a first-line measure to minimize atelectasis?
A. Incentive spirometry
B. Intermittent positive-pressure breathing (IPPB)
C. Positive end-expiratory pressure (PEEP)
D. Bronchoscopy
A
A hospital has been the site of an increased incidence of HAP. What is an important measure for the prevention of HAP?
A. Administration of prophylactic abx
B. Administration of pneumococcal vaccine to vulnerable pts
C. Obtaining C&S swabs from all newly admitted pts
D. Administration of antiretroviral meds to clients over age 65
B
When assessing a pt who has just arrived after an automobile accident, the ED nurse notes tachycardia and absent breath sounds over the right lung. For which intervention will the nurse prepare the pt.?
A. Emergency pericardiocentesis
B. Stabilization of the chest wall
C. Bronchodilator administration
D. Chest tube connected to suction
D
