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Adult Nursing II Exam 3 > Pulmonary Disorders > Flashcards

Pulmonary Disorders Flashcards

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1
Q

What are the 3 phases of Acute Respiratory Distress Syndrome (ARDS)?

A
  • Exudative Phase: 24 hours after initial insult
  • Proliferative Phase: 7-10 days
  • Fibrotic Phase: 2-3 weeks
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2
Q

What is the hallmark of Acute Respiratory Distress Syndrome (ARDS)?

KNOW THIS!!!…In Red

In Red

A

Refractory Hypoxemia: as you give patients O2, their O2 levels are not improving

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3
Q

What happens with CO2 in patients who have ARDS (in exudative phase)

KNOW THIS!!!…In Red

In Red

A

**1.) fast breathing → increase in CO2 → respiratory alkalosis

2.) Tired / Shallow Breathing → hold onto CO2 → respiratory acidosis

  • CO2 lowers –> CO2 rises (fast breathing) –> CO2 decreases (CO2 can’t leave due to shallow breathing & being tired)
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4
Q

What are the primary signs & symptoms of Acute Respiratory Distress Syndrome (ARDS)?

KNOW THIS!!!…In Red

In Red

A
  • Atelectasis
  • Refractory hypoxemia
  • Decrease in lung compliance
  • Surfactant (damaged cells)
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5
Q

What are the 8 P’s of Acute Respiratory Distress Syndrome?

KNOW THIS!!!…In Red

In Red

A
  • Prevention
  • PEEP: mechanical ventilation w/ positive pressure to help keep alveoli open
  • Pipes & Pumps: BP is not a good indicator of fluid status (lungs must be filled for heart to work)
  • Paralysis: not all intubated patients get paralytics (remember the patient needs pain meds too)
  • Positioning: prone poistion
  • Protein: 10 mL/hr (helps decrease complications)
  • Protocol: A through F bundle (helps decrease complications)
  • Pharmacologic Interventions: steroids are very helpful for decreasing inflammation
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6
Q

Nursing Management of Acute Respiratory Distress Syndrome (ARDS)

KNOW THIS!!!…In Red

In Red

A
  • Optomize oxygenation & ventilation (lowest setting possible)
  • Positioning: prone position & HOB at 30-45 degrees to prevent aspiration
  • Prevent pressure injuries
  • Promote secretion clearance (suctioning)
  • PREVENT VENTILATIOR ASSOCIATED PNEUMONIA (VAP)
  • Nutrition
  • Monitor I&Os
  • Monitor mental status changes
  • Educate patients & family
  • Medications: steroids, antibiotics, & GI drugs
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7
Q

What is a key sign / symptom of pulmonary disease?

KNOW THIS!!!…In Red

In Red

A

Cheyne-Stokes Respirations: alternating periods of deep (hyperapnea) & shallow (apnea) breathing

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8
Q

Other Signs & Symptoms of Pulmonary Disease

A
  • Fingernail Clubbing: (Schamroth’s sign - window between nailbeds)
  • Cyanosis
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9
Q

What are the signs & symptoms in early ARDS vs. Later ARDS?

A

EARLY:
* normal breath sounds to random crackles
* SOB
* decreased O2 levels

LATER:
* Increased respiratory rate
* Decreased O2
* Air hungry
* Pulmonary edema – cyanosis, mental status changes, crackles

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10
Q

What is the point of PEEP (Positive End Expiratory Pressure) / What does PEEP do?

A

Helps keep the alveoli open every time it fires

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11
Q

Explain the ARDS Protocol (A to F)

KNOW THIS!!!!…In Red

In Red

A
  • Assess, prevent, & manage pain
  • Both Spontaneous Awakening Trials (SAT) & Spontaneous Breathing Trials (SBT)
  • Choice of analgesia & sedation
  • Delerium assess, prevent, & manage
  • Early management
  • Family engagement & empowerment
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12
Q

Nursing management of the patient with acute lung fialure includes which of the following interventions? (Select all that apply)

a.) Positioning the patient with the least affected side down
b.) Providing adequate rest between treatments
c.) Performing percussion & postural drainage every 4 hours
d.) Controlling fever
e.) Pharmaceutical medications to control anxiety

A

a.) Positioning the patient with the least affected side down

b.) Providing adequate rest between treatments

d.) Controlling fever

e.) Pharmaceutical medicaitons to control anxiety

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13
Q

What is a pulmonary embolism? What are common signs & symptoms? What is used to diagnose a PE? How are PEs treated?

KNOW THIS!!!…In Red

IN RED

A

PE: blood clot in the lung

Signs & Symptoms
* Virchow Triad (venous stasis, endothelial injury, & hypercoaguability)
* Pulmonary hypertension
* Tachycardia
* Tachypnea
* Crackles
* Cough

Diagnostics:
* CT Scan (gold standard)
* ABGs
* VQ (ventilation perfusion scan)
* D-dimer

Treatment:
* Oxygen
* Heparin / Anti-coagulants (IV heparin –> oral heparin)
* Check aPTT & INR

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14
Q

Hallmark signs & symptoms of pulmonary embolisms

KNOW THIS!!!…In Red

IN RED

A

Virchow Triad (venous stasis, endothelial injury, & hypercoaguability)

Sudden onset of:
* tachycardia
* tachypnea
* anxiety
* crackles
*cough

Pulmonary Hypertension

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15
Q

What is Virchow Triad?

KNOW THIS!!!…IN RED

IN RED

A
  • Venous stasis (blood can’t go from legs back to heart)
  • Endothelial injury (injury to blood vessel walls)
  • Hypercoaguability (increased clotting of blood)
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16
Q

How are PEs diagnosed?

KNOW THIS!!!…IN RED

IN RED

A
  • CT (gold standard)
  • ABGs
  • VQ Scan
  • D-dimer
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17
Q

What is the treatment for PEs?

KNOW THIS!!!…IN RED

IN RED

A
  • Oxygen
  • Heparin / anti-coagulants (IV can then go to oral when pt is dc)
  • Check aPTT & INR levels regularly
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18
Q

The nurse is discussing the pharmacologic treatment of a pulmonary embolsim with a nursing student. Which statement made by the nursing student indicates that the education was effective?

a.) Heparin is administered to break down the existing clots
b.) Heparin is titrated to achieve a prothrombin time of 2-3 times the control value
c.) Heparin should be continued until the warfarin is started
d.) Streptokinase can be used to treat patients with massive PEs & hemodynamic instability

A

d.) Streptokinase (type of TPA) can be used to treat patients with massive pulmonary embolsim & hemodynamic instability

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19
Q

What is atelectasis?

A

Complete or partial collapse of the lung

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20
Q

What is emphesema?

A

permanently enlarged air spaces in the lungs causing difficulty breathing

air trapped in the lungs causing overinflation

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21
Q

What are blebs or bulla (emphysema)?

A

Large pockets of air that sit on the lungs

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22
Q

What is a tension pneumothorax?

KNOW THIS!!!…IN RED

IN RED

A

Air build up in the pleural cavity leading to

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23
Q

What are risk factors for pulmonary embolisms?

KNOW THIS!!!…per hayley

A
  • Smoking (3x the risk)
  • Oral birth control
  • Virchow Triad
24
Q

What is pulmonary hypertension & how can it lead to right sided heart failure?

KNOW THIS!!!…per Hayley

A

Pulmonary HTN: blood can’t get through due to clot causing an increase in blood pressure

How does pulmonary HTN cause R sided HF?
* Pulmonary HTN → increased afterload → R-sided HF

25
Q

What side does the trachea deviate to when a patient has a tension pneumothorax?

KNOW THIS!!!…IN RED…per Hayley*

IN RED

A

To the OPPOSITE side of the pneumothorax

R pneumothorax = L tracheal deviation

L pneumothorax = R tracheal deviation

26
Q

What are the signs of a tension pneumothorax seen on physical assessment?

KNOW THIS!!!…IN RED

A
  • Tracheal Deviation (on inspection)
  • Hyperresonantn (all air) (percussion)
  • Decreased / absent breath sounds (auscultation)
  • Shortness of breath
  • Tachycardia
  • Hypotensive
  • Possible JVD
  • Chest pain

Treated with needle decompression & chest tube

27
Q

What medication class is most commonly used in asthma & what does it do?

KNOW THIS!!!…per Hayley

IN RED

A

Beta-2 Agonists
* bronchodilation

28
Q

What is status asthmaticus? What are the key signs?

KNOW THIS!!!…IN RED

IN RED

A

Bronchospasm that is not reversing
* Life-Threatening

Signs & Symptoms:
* Silent chest
* CO2 > 70
* Chest constriction
* Expiratory wheezing
* Dyspnea
* Non-productive coughing
* Prolonged expiration
* Tachycardia
* Tachypnea
* Use of accessory muscles
* Pulsus paradoxus (systolic is 10 mmHg less on inspiration than expiration)

29
Q

What are the life-threatening signs / signs of impending death in a patient with status asthmaticus?

KNOW THIS!!!…IN RED

IN RED

A

Silent chest (no audible air movement)
CO2 > 70 mmHg

30
Q

At what GCS score is a patient intubated?

KNOW THIS!!!…IN RED

IN RED

A

UNDER 8

31
Q

What are potential complications associated with mechanical ventilation?

KNOW THIS!!!…IN RED

IN RED

A

Cardiovascular Compromise: positive pressure ventilation increases intrathoracic pressure which decreases cardiac output

32
Q

What is cardiovascular compromise (mechanical ventilation complication)?

KNOW THIS!!!…IN RED

IN RED

A

positive pressure ventilation leads to increased intrathoracic pressure which decreases cardiac output

33
Q

What should the cuff be inflated to in post-inbtubation management?

KNOW THIS!!!…per Hayley

A

20 - 25

34
Q

The patient with reactive airway disease is taking the oral sympathomimetic bronchodilator metaproterenol (Alupent) 3 times a day. Which intervention should the nurse implement?

a.) Instruct the patient to take the last dose a few hours before bed
b.) Teach the patient to decrease fluid intake when taking this medication
c.) Have the patient demonstrate the correct way to use the inhaler
d.) Encourage the patient to take the medication with an antacid

A

a.) Instruct the patient ot take the last dose a few hours before bedtime (can cause insomnia)

35
Q

Which information should the nurse teach the patient who is prescribed a glucocorticoid inhaler?

a.) Advise the patient to gargle after each administration
b.) Instruct the patient to use the inhaler on a PRN basis
c.) Encourage the patient not to use a spacer when using the inhaler
d.) Teach the patient to check his or her forced expiratory volume daily

A

a.) Advise the patient to gargle after each administration

36
Q

What are potential complications of patients who are intubated?

A
  • VTE (venous thromboembolism)
  • GI Bleeds (stress ulcers)
  • Cardiac dysrhythmias (PACs & PVCs)
  • Ishcemic-anoxic encephalopathy
37
Q

A patient is started to be weaned off a ventilator. Before the weaning was started they had normal vitals. Now their respiratory rate is 32, systolic blood pressure increased by 30 mmHg, & their SpO2 is 91%. What is occuring in this patient?

KNOW THIS!!!…per Hayley

A

Failure to Wean

38
Q

How can we prevent ventilator associated pneumonia?

KNOW THIS!!!…IN RED

IN RED

A
  • Handwashing
  • Avoid ET intubation if possible
  • Maintain HOB at 30 degrees
  • Watch skin sheer on coccyx
  • Type of endotracheal tube / cuff
  • Euglycemia
  • **Oral Care **(brushing chlorhexidine)
  • Subglottic secretions
  • Position the patient on the least damaged portion of the lungs in a dependent position
39
Q

What signs & symptoms are seen when a patient is experiencing weaning intolerance?

A
  • Decreased level of consciousness (LOC)
  • Systolic BP increased or decreased by 20 mmHg
  • Diastolic BP > 100 mmHg
  • HR increased by 20 BPM
  • Changes in ST segment
  • RR >30 or < 10
  • SpO2 less than 90%
  • Accessory muscle use
  • Diaphoresis
  • Dyspnea
  • Fatigue or pain
40
Q

Explain the postoperative nursing management for a lobectomy

KNOW THIS!!!…IN RED

IN RED

A
  • Non-operative side down (Operative side up)
  • Turn frequently
41
Q

Explain postoperative nursing management for a pneumonectomy

KNOW THIS!!!…IN RED

IN RED

A

Good Side UP

  • Supine or operative side down
42
Q

Explain Management of Chest Tubes

KNOW THIS!!!…IN RED

IN RED

A
  • NEVER milk a chest tube

VOLUME
* Dcoument fluid in drainage chamber hourly
* Notify provider of sudden increase in amount of drainage
* Blocked drains are concern for cardiac surgery (can lead to increased risk of cardiac tamponade)

COLOR & CONSISTENCY
* Monitor color & type of drainage

OSCILLATION (fluctuation / swing)
* Stopped Swing: make sure the chest tube isn’t blocked, kinked, or has a large air leak

AIR LEAK
* Bubbling occurs in the chambers when there is a large air leak

43
Q

Chest Tube Management Per Hayley

A
  • Stopped Swing: make sure the chest tube isn’t blocked, kinked, or has a large air leak

Bubbling occurs in the chambers when there is a large air leak

44
Q

Explain the ARDS Protocol (A to F)

KNOW THIS!!!!…In Red

In Red

A
  • Assess, prevent, & manage pain
  • Both Spontaneous Awakening Trials (SAT) & Spontaneous Breathing Trials (SBT)
  • Choice of analgesia & sedation
  • Delerium assess, prevent, & manage
  • Early management
  • Family engagement & empowerment
44
Q

What is the point of PEEP (Positive End Expiratory Pressure) / What does PEEP do?

A

Helps keep the alveoli open every time it fires

45
Q

What are the signs & symptoms in early ARDS vs. Later ARDS?

A

EARLY:
* normal breath sounds to random crackles
* SOB
* decreased O2 levels

LATER:
* Increased respiratory rate
* Decreased O2
* Air hungry
* Pulmonary edema – cyanosis, mental status changes, crackles

46
Q

What is the point of PEEP (Positive End Expiratory Pressure) / What does PEEP do?

A

Helps keep the alveoli open every time it fires

46
Q

Explain the ARDS Protocol (A to F)

KNOW THIS!!!!…In Red

In Red

A
  • Assess, prevent, & manage pain
  • Both Spontaneous Awakening Trials (SAT) & Spontaneous Breathing Trials (SBT)
  • Choice of analgesia & sedation
  • Delerium assess, prevent, & manage
  • Early management
  • Family engagement & empowerment
46
Q

What are the signs & symptoms in early ARDS vs. Later ARDS?

A

EARLY:
* normal breath sounds to random crackles
* SOB
* decreased O2 levels

LATER:
* Increased respiratory rate
* Decreased O2
* Air hungry
* Pulmonary edema – cyanosis, mental status changes, crackles

47
Q
A
48
Q
A
49
Q

What does medical management of patient with status asthmaticus that supports oxygenation & ventilation include? (Select all that apply)

a.) Oxygen therapy
b.) Bronchodilators
c.) Corticosteroids
d.) Antibiotics
e.) Intubation & mechanical ventilation

A

a.) Oxygen therapy
b.) Bronchodilators
c.) Corticosteroids
e.) Intubation & mechanical ventilation

50
Q

A patient was admitted to the critical care unit after a left pneumonectomy. The patient is receiving 40% oxygen via a simple facemask. The morning chest radiography study reveals right lower lobe pneumonia. After eating breakfast, the patient suddenly vomits & aspirates. The patient becomes agitated, has decreased level of consciousness - Glasgow coma scale is 7, & has an inability to maintain saturation. The nurse expects the next action will include what?

a.) Placing the patient on a mechanical ventilator
b.) Change in antibiotics to control infection
c.) Suctioning & repositioning
d.) Administering a sedative to control anxiety

A

a.) Placing the patient on a mechanical ventilator

51
Q

A patient has been admitted to the critical care unit with the diagnosis of acute respiratory distress syndrome (ARDS). Arterial blood gasses (ABGs) revealed an elevated pH & decreased PaCO2. The patient is becoming fatigued, & the HCP orders a repeat ABG. The nurse can anticipate which of the following results?

a.) Elevated pH & decreased PaCO2
b.) Elevated pH & elevated PaCO2
c.) Decreased pH & decreased PaCO2
d.) Decreased pH & elevated PaCO2

A

d.) Decreased pH & elevated PaCO2

First patients with ARDs are in respiratory alkalosis (fast breathing)

Once patients become fatigued they go into respiratory acidosis (low pH & high PaCO2)

52
Q

Which of the following nursing interventions should be used to optimize oxygenation & ventilation in the patient with acute respiratory failure?

a.) Provide adequate rest & recovery time between procedures
b.) Position the patient with the good lung up
c.) Suction the patient every hour
d.) Avoid hyperventilating the patient

A

a.) Provide adequate rest & recovery time between procedures

Adult Nursing II Exam 3 (7 decks)

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