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Exam 2 - Block 2 > Respiratory 1 > Flashcards

Respiratory 1 Flashcards

1
Q

What is important to note about older adults when it comes to PNA (presentation)?

A

Older adults often lack the classic signs and symptoms of pneumonia

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2
Q

What assessment method would the nurse use to determine the areas of the lungs that need draining?

A

Auscultation

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3
Q

For a client with an endotracheal (ET) tube, what nursing action is the most important?

A

Auscultating the lungs for bilateral breath sounds

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4
Q

For a PT with TB, what vitamin is likely to be given with isoniazid(INH) to prevent INH-associated peripheral neuropathy?

A

Vitamin B6

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5
Q

What is the most common early sign of acute respiratory distress syndrome (ARDS)?

A

Rapid onset of severe dyspnea

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6
Q

Bacterial pneumonia presents with?

A

Dyspnea and wheezing

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7
Q

Why are chest tubes inserted?

A

To remove air/fluid from the pleural space

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8
Q

What is a cardinal sign of lung cancer?

A

Cough or change in chronic cough

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9
Q

Post thoracotomy what is important to teach the patient to do when coughing?

A

How to splint the incision

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10
Q

When there is fluid in the pleural space this is known as?

A

Pleural effusion

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11
Q

Paradoxical chest movement is seen with?

A

Flail chest

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12
Q

Besides death, what is the most serious complication of influenza?

A

Staphylococcal pneumonia

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13
Q

What is monitored to tell if a PT is Hypoxemic?

A

Oxygen saturation level

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14
Q

What nursing diagnosis takes the highest priority with chest trauma?

A

Impaired gas exchange

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15
Q

When weaning a PT off the ventilator, what is the order of steps taken?

A

Removal from the Ventilator > Tube > Oxygen

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16
Q

Which complication may occur if the chest tube is clamped during transportation?

A

Tension pneumothorax

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17
Q

The mortality rate is high in lung cancer clients due to which factor?

A

Few early symptoms

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18
Q

A mediastinal shift occurs in which type of chest disorder?

A

Tension Pneumothorax

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19
Q

What is the antibiotic of choice used to treat acute bacterial rhinosinusitis (ABRS)?

A

Amoxicillin

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20
Q

What can be done for Atelectasis Prevention?

A

Frequent turning
Early mobilization
Use of incentive spirometer
Secretion management

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21
Q

How does PNA present?

A

Cough, Low grade fever/chills, Dyspnea, Pleuritic chest pain, Orthopnea, Crackles, Sputum

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22
Q

What is commonly seen in older adults with PNA?

A

Change in mentation with aggression

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23
Q

Goals for patients with PNA include?

A

Improved airway patency
Increased activity
Normal CXR’s
Absence of complications

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24
Q

What continuous monitoring is done for someone with a Tracheostomy?

A

Bilateral lung sounds and SpO2

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25
Q

What do we always want to provide to those with a tracheostomy?

A

Humidity

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26
Q

What is the time frame for a high chance of dislogement of a tracheostomy?

A

5-7 days post implant

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27
Q

What are the 2 phases of treatment for TB?

A

Initial (8 weeks)
Continuation (18 weeks)

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28
Q

What 4 drugs are used for TB?

A

Isoniazid
Rifampin
Pyrazinamide
Ethambutol

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29
Q

Lethargy and somnolence are suggestive of retaining what?

A

CO2

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30
Q

What are the common risk factors for Atelectasis?

A

Old age, Bedrest, Recent surgery, Lung disease

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31
Q

How does Atelectasis present?

A

Increased WOB, hypoxemia and decreased breath sounds

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32
Q

Which is the most common Influenza type?

A

Influenza A

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33
Q

True or False: Influenza A is zoonotic?

A

True

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34
Q

What are the subtypes of Influenza A

A

H & N

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35
Q

True or False: Influenza B is zoonotic?

A

False, only spreads human to human

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36
Q

Which Influenza can be spread throughout the year?

A

Influenza B

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37
Q

What is the mildest version of Influenza

A

Influenza C

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38
Q

What is the most common type of Influenza?

A

Influenza A at 75%

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39
Q

What is the incubation period for Influenza?

A

1-4 days

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40
Q

What is the peak transmission period of Influenza?

A

5-7 days

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41
Q

How does Influenza present?

A

Abrupt, fever and chills, muscle/joint pain, HA, fatigue

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42
Q

How is Influenza diagnosed?

A

Reverse transcription polymerase chain reaction (RT-PCR)

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43
Q

Who can get the Influenza vaccine?

A

Anyone over 6mo, Pregnant women, Immunocompromised persons

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44
Q

What is different between the Influenza shot and nasal vaccines?

A

Nasal vaccines contain LIVE virus while shots do not

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45
Q

What are Influenza complications?

A

PNA, Ear/Sinus infections, Dehydration

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46
Q

PNA is an acute infection of what part of the lungs?

A

Parenchyma, the function part where gas exchange occurs

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47
Q

What are the different types of acquired PNA?

A

Community acquired
Hospital acquired (Ventilator-associated)
COVID PNA

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48
Q

Hospital acquired PNA presents how soon after admission?

A

48 hours or longer

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49
Q

How is PNA caused usually?

A

Aspiration caused by abnormal entry of secretions/fluid into airway

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50
Q

Who’s at greatest risk for Aspiration PNA?

A

Patients post stroke/CVA, those with decreased LOC, those with dysphagia, patients with NGT’s

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51
Q

What are the S/S of Streptococcal PNA?

A

Sudden chills
Pleuritic chest pain
Tachypnea/Respiratory distress

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52
Q

What are the S/S of Legionella PNA?

A

Bradycardia

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53
Q

What are the Diagnostics for PNA?

A

CXR, CBC w/ diff, Sputum analysis

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54
Q

What Biomarkers are looked at for diagnosing PNA?

A

C-reactive protein (CRP): measures inflammation
Procalcitonin: tells if viral or bacterial

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55
Q

What 2 items are used as both diagnostic tools and treatment tools?

A

Thoracentesis and Bronchoscopy

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56
Q

Physicians uses what tool to aide if a patient requires hospitalization with PNA?

A

CURB-65

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57
Q

CURB-65 looks at what?

A

Confusion
BUN
Respiratory Rate
Systolic BP
Age

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58
Q

What are complications of PNA?

A

Atelectasis
Pleurisy (inflammation of pleura)
Pleural effusion (fluid in pleural cavity)
Pneumothorax (air in pleural cavity)
Meningitis
Acute respiratory failure
Sepsis/shock
Lung abcess

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59
Q

How soon after starting drug therapy for PNA should improvements been seen?

A

3-5 days

60
Q

What are the indications for a Trachestomy?

A

Laryngeal cancer
Prolonged ventilator dependence
Upper airway obstruction
Neuromuscular Disease

61
Q

TB is what type of bacterium?

A

Aerophilic

62
Q

TB requires what type of isolation precautions?

A

Airborne

63
Q

Pulmonary TB presents how?

A

Initial dry cough that becomes productive
Constitutional symptoms (fatigue, malaise, weight loss, fever)
Dyspnea and hemoptysis

64
Q

What is important to know about Latent TB infections?

A

They are often asymptomatic

65
Q

Isoniazid is taken for how long?

A

6-9 months

66
Q

Rifampin is taken for how long?

A

4 months

67
Q

What combination of drugs is taken for 3 months with TB?

A

Isoniazid and Rifapentine

68
Q

What does PaO2 tell us?

A

Is the patient is experiencing hypoxemia

69
Q

What 3 things are seen in acute respiratory failure?

A

Hypercapnia
Hypoventilation
Hypoxemia

70
Q

What are common side effects of TB medications?

A

Reddish-brown urine, sweat, saliva, or tears
Liver toxicity

71
Q

What is a common side effect of Ethambutol?

A

Vision changes/disturbances

72
Q

How do TB medications work?

A

They’re bactericidal and alter DNA to reduce growth of bacteria

73
Q

What is Hypoxia?

A

A decrease in O2 supply to the tissues/cells

74
Q

What is Hypoxemia?

A

An abnormally low concentration of oxygen (arterial oxygen tension) in the blood

75
Q

Due to patients sitting upright what can occur?

A

Accumulation of secretions in the lower parts of the lungs

76
Q

How often do patients need to use their Incentive Spirometer?

A

10x’s an hour

77
Q

What type of Trache allows ease of speaking with valves?

A

Passy Muir

78
Q

What type of room are TB positive patients in?

A

Negative pressure rooms

79
Q

What test is ran for TB?

A

Acid-Fast Bacillus (AFB)

80
Q

Absent breath sounds over lung fields is indicative of what?

A

Pneumothorax

81
Q

If pleural effusion is forming what is expected on auscultation?

A

Localized decreased breath sounds

82
Q

When a patient has PNA what nurse teaching is important to do?

A

Education on splinting the chest while coughing to reduce pain

83
Q

What is Chronic bronchitis defined as?

A

The presence of a chronic cough with excessive sputum production for at least 3 months

84
Q

What is Emphysema defined as?

A

Abnormal distention of the airspaces beyond the terminal bronchioles due to destruction of the alveoli causing an increase in dead space

85
Q

What is COPD defined as?

A

Chronic inflammation of the airways with air trapping

86
Q

What causes COPD?

A

Cigarette smoking
Exposure to noxious particles and gases
Recurring respiratory infections

87
Q

What happens in the lungs with COPD?

A

Loss of elastic recoil in alveoli
Mucous hypersecretion
Bronchospasm

88
Q

If someone has not been exposed to cigarette smoke but has COPD what is suspected?

A

Alpha 1 antitrypsin deficiency

89
Q

What does Nicotine do to the body?

A

Decreases amount of functional Hgb
Increases platelet aggregation
Makes CAD worse

90
Q

How does smoking affect the respiratory tract?

A

Hyperplasia of goblet cells
Loss of ciliary activity
Abnormal dilation and destruction of alveoli
Chronic inflammation
Decreased O2 carry capacity of Hgb

91
Q

COPD rates are higher in what demographic?

A

Females

92
Q

What are the effects of aging on the respiratory system?

A

Loss of elastic recoil in lungs
Stiffening of chest wall (age-related kyphosis)
Decreased exercise tolerance
Rounder and smaller lungs
Decrease in functional alveoli

93
Q

How does COPD present?

A

Chronic cough
Sputum production
Dyspnea
Use of accessory muscles
Inefficient breathing pattern
Weight loss
Exercise intolerance
Decreased breath sounds & crackles
Prolonged expiratory phase

94
Q

In COPD how does dyspnea manifest?

A

Progressive and present daily
Exertion in early stages
Present at rest as COPD worsens

95
Q

What diagnostic studies are done for COPD?

A

H&P
ABG
CXR (shows flat diaphragm)
CT
Alpha 1-antitrypsin screening < 45

96
Q

How are COPD diagnoses confirmed?

A

Spirometry and Pulmonary function tests

97
Q

What FEV1FVC ratio is considered COPD?

A

< 70%

98
Q

What complications come from COPD?

A

Exacerbation
Respiratory insufficiency leading to Respiratory failure
Pulmonary HTN
PNA

99
Q

What is Cor pulmonale?

A

The hypertrophy or dilation of the R side heart caused by pulmonary HTN

100
Q

What causes enlargement and failure of the R ventricle?

A

Increased ventricular resistance
High BP in lungs

101
Q

When does Cor pulmonale appear in COPD?

A

Late in their diagnosis

102
Q

How does Cor pulmonale present?

A

Dyspnea / Lung crackles
JVD
Weight gain
Peripheral edema
Hepatomegaly w/ upper right quadrant tenderness

103
Q

What diagnostics are done for Cor pulmonale?

A

CXR
R-sided cardiac catheterization (best)
Echocardiogram
BNP levels

104
Q

What is the treatment for Cor pulmonale?

A

Treating the underlying cause (COPD)
Medications to lower BP and encourage O2 back to lungs
Diuretics to reduce fluid retention
Continuous low-flow O2

105
Q

What is COPD exacerbation?

A

A sudden/worsening of COPD symptoms due to poor outcomes that can last several days

106
Q

How does COPD exacerbation present?

A

Increased dyspnea / SOB
Increased cough
Increases sputum volume and/or purulence
Use of accessory muscles
Central cyanosis

107
Q

What causes COPD exacerbation?

A

Bacterial or Viral infections

108
Q

What are treatments for COPD exacerbation?

A

Short-acting bronchodilators
Oral systemic corticosteroids
ABX if infection present

109
Q

What causes COPD Acute Respiratory Failure?

A

Exacerbations
Overuse of sedatives (benzos and opiods)
Surgery or severe painfull illness R/T chest/abd

110
Q

What 2 mental issues come up from COPD?

A

Depression and Anxiety

111
Q

What medication can be used to treat anxiety in COPD?

A

Buspirone

112
Q

What O2 saturation is wanted for COPD?

A

> 90%

113
Q

COPD O2 therapy includes what?

A

Low-flow mixed with room air
High-flow
Humidification

114
Q

CO2 narcosis causes what?

A

Depression of LOC

115
Q

What respiratory training is done for COPD?

A

Pursed lip and Diaphragmatic breathing
Effective coughing
Use of Airway clearance devices

116
Q

What diet is recommended for COPD patients?

A

High protein and High calorie

117
Q

What is Lung volume reduction surgery?

A

Removal of diseased lung to allow O2 to flow to only healthy lung

118
Q

What is Bronchoscopic lung volume reduction surgery?

A

Placement of a one-way valve that only allows air to exit the diseased part of the lung it is placed in

119
Q

What is a Bullectomy?

A

Removal of one or more enlarged air sacs that are no longer useful

120
Q

How long does it take a tumor to reach 1 cm typically?

A

8-10 years

121
Q

Lung tumors occupy what part of the lungs typically?

A

Segmental bronchi and upper lobes

122
Q

What are the causes of Lung cancer?

A

Cigarette smoking
Pollution
Radon
Asbestos
Radiation

123
Q

What prompts screening for Lung cancer?

A

Age 55-80 with history of smoking
30 year pack history
Current smoker
Quit < 15 years ago

124
Q

What diagnostic studies are done to DX Lung cancer?

A

CT scans
CXR
Fiberoptic bronchoscopy
PET scan
Lung biopsy

125
Q

What are the 2 types of lung cancer classes?

A

Small-cell (13%)
Non-small-cell (84%)

126
Q

What are the 3 types of Non-small-cell lung cancer?

A

Squamous cell carcinoma
Adenocarcinoma
Large-cell carcinoma

127
Q

How does Squamous cell carcinoma present?

A

With early symptoms but slow growth

128
Q

How does Adenocarcinoma present?

A

As the most common in non-smokers and moderate growth

129
Q

How does Large-cell carcinoma present?

A

As fast growing and highly metastatic

130
Q

How does Small-cell lung cancer present?

A

Rapid growing
Most malignant
Metastasis early and to the brain first
Poor prognosis

131
Q

What are the ways Lung cancer metastasizes?

A

Direct extension
Blood circulation
Lymph system

132
Q

Where does Lung cancer metastasize?

A

Brain first
Lymphnodes
Liver
Bones
Adrenal glands

133
Q

What are the clinical manifestations of Lung cancer?

A

Dyspnea
Hemoptysis
Chest/Shoulder pain
Pneumonitis
Persistent cough with sputum

134
Q

The symptoms of Lung cancer are usually what?

A

Non-specific and appear late in the disease

135
Q

What is the TNM system?

A

The way to stage Non-small-cell lung cancer (1-4)

136
Q

What does TNM stand for?

A

T: tumor size/location
N: extent of lymph node invasion
M: presence/absence of metastases

137
Q

How is Small-cell lung cancer staged?

A

Limited or Extensive

138
Q

What is a Pneumonectomy?

A

The removal of an entire lung

139
Q

What is a Lobectomy?

A

The removal of one or more lobes of a lung

140
Q

What are Segmental/ Wedge procedures?

A

Removal of a section of a lobe

141
Q

What is VATS?

A

Video-assisted thoracoscopic surgery

142
Q

What is Lung cancer radiation therapy used for?

A

Treatment of both NSCLC and SCLC
Palliative therapy
Adjuvant therapy

143
Q

Stereotactic Radiotherapy is given over what time frame?

A

1-3 days

144
Q

Chemotherapy is the primary treatment for what Lung cancer?

A

Small-cell lung cancer
Nonresectable tumors
Adjuvant to surgery in Non-small-cell lung cancer

145
Q

What is included in possible palliative care for Lung cancer?

A

Radiation therapy
Bronchoscopic interventions to place stents
Pain management

Exam 2 - Block 2 (2 decks)

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