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Illness and Patho 1 > Respiratory 1 > Flashcards

Respiratory 1 Flashcards

1
Q

Bronchodialators that relax the smooth muscles of the bronchial tree and decrease airway resistance

A

Short Acting Beta Agonists

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2
Q

Medication for short term relief for asthma attacks, or premedication when attacks are likely

A

Albuterol

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3
Q

What are the side effects of Albuterol?

A

Tachycardia

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4
Q

How should Albuterol be used?

A

Before other inhaled drugs to better enable penetration of other medications

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5
Q

Group of medications that relaxes bronchospasms and increases ciliary motility

A

Long Acting Beta Agonists

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6
Q

Medication for the maintenance of asthma or bronchospasms

A

Salmeterol

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7
Q

How long before exercise should Salmeterol be taken?

A

30-60 minutes

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8
Q

What is the therapeutic range of Theophylline?

A

10-20 mcg/mL

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9
Q

Name a Cholinergic antagonist

A

Ipratropium

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10
Q

If a patient has over 20 mcg/mL of Theophylline, what will happen?

A

Adverse reactions of the nervous system

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11
Q

Bronchodialators that are xanthine derivatives and are given via PO or IV drip

A

Theophylline and Aminophylline

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12
Q

What is Ipratropium used for?

A

Maintenance therapy for chronic bronchitis and emphysema

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13
Q

What is a side effect of Aminophylline?

A

Rash

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14
Q

What are the side effects of Theophylline?

A

Nausea, vomiting, diarrhea, tachycardia, dysrhythmias, restlessness

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15
Q

How should Ipratropium be taken?

A

Wait 30-60 seconds between puffs and 5 minutes between this and other inhaled meds and rinse mouth after taking to get rid of the bitter taste

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16
Q

What is the action of Theophylline?

A

Relieves broncho spasms of bronchitis, emphysema, and asthma

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17
Q

Medications that block the parasympathetic nervous system and are bronchodialators

A

Anticholinergic agents

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18
Q

If a patient has over 35 mcg/mL of Theophylline, what will happen?

A

Seizure and cardiac arrhythmias

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19
Q

Name the 5 types of Bronchodialators

A

Short acting Beta agonists, long acting Beta agonists, Methylxanthines, Cholinergic antagonists, and Leukotriene antagonists

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20
Q

Inhaler, nebulizer, or nasal spray that inhibits acetylcholine, blocking cholinergic bronchomotor tones and therefore stops vagally mediated bronchospasms

A

Ipratropium

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21
Q

What is the nasal spray form of Ipratropium used to treat?

A

Rhinitis and the common cold

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22
Q

Name examples of Methylxanthines

A

Theophylline and Aminophylline

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23
Q

Name Leukotriene antagonists

A

Accolate and Singulair

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24
Q

What are the types of Anti-Inflammatories?

A

Corticosteroids and Inhaled or Nasal Sprays

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25
Q

Bronchodialator that inhibits leukotriene and therefore inhibits inflammation and bronchoconstricition

A

Leukotriene Antagonists

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26
Q

What are side effects of Leukotriene antagonists?

A

Headache and increased incidence of URI if given with corticosteriods

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27
Q

What are the side effects of Ipratropium?

A

Blurred vision, eye pain, headache, palpitations, nervousness

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28
Q

Name a corticosteroid

A

Prednisone

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29
Q

What do Leukotriene antagonists do?

A

Prevents airway edema, smooth muscle constriction, altered cell activity due to inflammation

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30
Q

Which side effect of Ipratropium is an overdoes symptom?

A

Nervousness

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31
Q

At what point is the maximum effectiveness of an inhaled anti-inflammatory obtained?

A

2-3 days after initiation

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32
Q

Medications with anti-inflammatory properties used for severe respiratory symptoms

A

Corticosteroids

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33
Q

Which drug, when taken with Leukotriene antagonists, increases plasma concentration of Accolate?

A

Aspirin

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34
Q

Name types of inhaled anti-inflammatories

A

Budesonide, Veramyst, Flonase, and Beclomethasone

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35
Q

What are Singulair and Accolate used for?

A

Prophylaxis and chronic treatment of asthma associated with increased leukotriene production

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36
Q

What are the side effects of inhaled anti-inflammatories

A

Predisposition towards oral infection, dry mouth, hoarseness, sore throat, transient nasal irritation, epistaxis, nasalpharyngeal itching, dryness, crusting, headache, nausea, and vomiting

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37
Q

What are inhaled anti-inflammatories used for?

A

Steriod dependent asthma, and seasonal rhinitis

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38
Q

When giving Prednisone, what education should be completed?

A

Dose should be tapered off and never abruptly stopped, should be taken with food to decrease GI irritation

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39
Q

Which drug do mucolytics bind with?

A

Aspirin

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40
Q

Systemic mucolytic that reduces surface tension and adhesiveness of secretions for easier expectoration

A

Guaifenisin (Mucinex)

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41
Q

Reduces viscosity of mucus in patients with COPD, cystic fibrosis, and acetylcysteine

A

Mucolytics

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42
Q

In what forms does Guaifenisin come in?

A

Capsules and syrup

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43
Q

Name a mucolytic

A

Mucomyst

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44
Q

What effect does Prednisone have on electrolytes?

A

It causes sodium retention and potassium excretion

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45
Q

When taking Mucinex, what should the patient incease?

A

Fluids

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46
Q

What forms are mucolytics given in?

A

Nebulized, PO, IV

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47
Q

Combines Serevent, a long-lasting Beta agonist, and Flovent, a steroid

A

Advair

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48
Q

Which type of infection can occur while using inhaled anti-inflammatories if the patient does not rinse out their mouth?

A

Candidiasis

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49
Q

What are the side effects of Mucinex?

A

Stimulates sympathetic nervous system, elevates blood pressure, and causes tachycardia

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50
Q

Which type of medication smells like sulfur?

A

Mucolytics

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51
Q

How should inhalers be used?

A

Shake before use, inhale slowing while activating inhaler, hold breath for 5-10 seconds and exhale slowly

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52
Q

How long should a patient wait between puffs from an inhaler with the same medication?

A

1 minute

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53
Q

How often should inhalers be cleaned?

A

Daily

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54
Q

After taking an inhaled steroid, how can the patient prevent thrush?

A

Rinse mouth and gargle with warm water

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55
Q

What are the side effects of all inhaled steroids?

A

Irritation, dryness, and thrush

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56
Q

How should nasal inhalants be given?

A

Blow nose, shake medication well, instill medication, wash nose piece with warm water and dry

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57
Q

If two sprays of nasal inhalants are ordered, how should they be aimed?

A

One towards the upper part of the nostil and one towards the lower part

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58
Q

How often should the nasal inhalant nose peice be washed?

A

Daily

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59
Q

Oxygen exchange in tissues

A

Perfusion

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60
Q

What should you look for when examining the external nose?

A

Deformities or tumors

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61
Q

If a patient is using accessory muscles to breath, what lung sounds will generally be heard?

A

Stridor

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62
Q

Why do patients with sleep apnea have increased hemoglobin levels?

A

To have more places for oxygen to join up

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63
Q

What history should you aquire when are assessing the respiratory system?

A

Family and personal data, smoking (pack-years), drugs, allergies, travel, nutritional status, cough, sputum production, chest pain, dyspnea, PND, orthopnea, occupation and hobbies

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64
Q

Oxygen exchange in lungs

A

Oxygenation

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65
Q

Why do people have sinus issues in the winter?

A

Because heaters make sinuses very dry

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66
Q

Everything above the alveoli in the lungs

A

Dead space

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67
Q

What should you look for when examining the mucous membranes?

A

Abnormalities

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68
Q

What should you look for when examining the nares?

A

Symmetry of size and shape

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69
Q

What respiratory diseases should you assess a patient for when getting a health history?

A

Respiratory failure, asthma, COPD, abnormal blood tests, sleep apnea, and exercise endurance

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70
Q

In what position will the patient be if they are using accessory muscles to breath

A

Tripod

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71
Q

What is the purpose of turbinates?

A

To force inhaled air to flow in a steady, regular patter around the largest possible surface of cilia and climate controlling tissue

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72
Q

What population is likely to have mucous membrane abnormalities?

A

Drug abusers

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73
Q

Taking in lots of oxygen but not much goes to tissues

A

Shunting

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74
Q

What should you look for when examining the nasal cavity?

A

Color, swelling, drainage, and bleeding

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75
Q

What are considered accessory muscles for breathing?

A

Face muscles, sternoclidomastoid, intercostals, and stomach muscles

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76
Q

When assessing the neck, what are you looking for?

A

Symmetry, alignment, masses, swelling, bruises, and the use of accessory muscles for breathing

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77
Q

Which respiratory organ reflects the heart?

A

The mouth

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78
Q

Patients with sleep apnea will have high levels of what?

A

Hemoglobin

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79
Q

Long, narrow, and curled bone shelves that protrude into breathing passages of the nose

A

Turbinates

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80
Q

Which patients are generally barrel chested?

A

Patients with COPD and pregnant women

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81
Q

Where are bronchial lung sounds normal?

A

Over the trachea

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82
Q

When assessing the trachea, what are you looking for?

A

Palpate for position, mobility, tenderness, and masses

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83
Q

What population is most likely to have septal deviations?

A

Athletes

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84
Q

Cracking air in muscles

A

Crepitus

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85
Q

Where are bonchocesicular lung sounds normal?

A

Over the mid lungs

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86
Q

When assessing the mouth, what are you looking for?

A

Ulcerations and the presence of pink mucous membranes

87
Q

What would cause a patient to have wheezing?

A

Inflammation, mucus, asthma, or excess secretions

88
Q

Chest is wider than it is long

A

Barrel chest

89
Q

How should the thorax be assessed?

A

With the patient sitting up, observe the chest and compare for symmetry; check the rate, rhythm, and depth of inspiration; examine the AP diameter and the distance between the ribs

90
Q

When assessing respiratory function, what specifically are you looking for in the blood?

A

Abnormal hemoglobin levels

91
Q

When is weight loss a bad sign?

A

When 10% of teh body fat is lost without trying

92
Q

Where can crackles be heard?

A

Over the bases of the lungs or in the right upper lobes

93
Q

When preparing to administer pulmonary function tests, what teaching should take place?

A

No smoking six hours before the test, no inhalers or medications during the test, and notify the testers if SOB or chest pain develops

94
Q

Aspiration of pleural fluid or air from pleural space

A

Thoracentesis

95
Q

When is wheezing very bad?

A

On expiration

96
Q

What does the end tidal of CO2 value tell you?

A

Whether the patient has good oxygen exchange or not

97
Q

Where are vesicular lung sounds normal?

A

Over the lower lobes

98
Q

What laboratory tests should be performed on patients during a respiratory assessment?

A

Blood, sputum, CXR, CT, V/Q scan, and pulse ox

99
Q

What are the strongest bones in the body?

A

The scapula and first rib

100
Q

What is the normal pressure of PETCO2?

A

20-40 mmHg

101
Q

Obtain tissue for histological analysis, culture, and cytologic examination

A

Lung biopsy

102
Q

Which medications put a patient into twilight sedation?

A

Versed and fentanyl

103
Q

Evaluates lung volume and capacities, flow rates, diffusion capacity, gas exchange, airway resistance, and distribution of ventilation

A

Pulmonary function tests

104
Q

What psychosocial aspect worsens respiratory problems?

A

Stress

105
Q

What are the signs and symptoms of pneumothorax?

A

Sudden and severe shortness of breath

106
Q

Measures the amount of carbon dioxide present in exhaled air

A

Capnometry and Capnography

107
Q

After a lung biopsy, how often do vital signs and breath sounds need to be assessed?

A

At least every 4 hours for 24 hours

108
Q

Type of medical imaging using scintigrapy and meidcal isotopes to evaluate the circulation of air and blood within a patient’s lungs

A

V/Q Scan

109
Q

What is the purpose of a biopsy?

A

Diagnosis

110
Q

Which medications wake a patient from twilight sedation?

A

Narcan and benzodiazepam

111
Q

What should be reported immediately if found on a patient after a lung biopsy?

A

Reduced or absent breath sounds

112
Q

Coughing blood

A

Hemoptysis

113
Q

Nose bleed

A

Epistaxis

114
Q

What are the clinical manifestations of respiratory distress?

A

Dyspnea, nasal flaring, use of accessory muscles, pursed-lips or diaphragmatic breathing, decreased endurance, and skin and mucous membrane changes

115
Q

Low levels of oxygen in the blood

A

Hypoxemia

116
Q

What systems work together to provide sufficient tissue perfusion to the body?

A

Respiratory, cardiovascular, and hematologic systems

117
Q

What are the hazards and complications of oxygen therapy?

A

Combustion, oxygen-induced hypoventilation, oxygen toxicity, absorption atelectasis, drying of the mucous membranes, and infection

118
Q

What is the best way to determine the need for oxygen therapy?

A

Arterial Blood Gas analysis

119
Q

What patient population is most susceptible to oxygen toxicity?

A

Premature babies

120
Q

Loss of senstivity to high levels of CO2

A

CO2 Narcosis

121
Q

What are the late signs of respiratory distress?

A

Pallor and cyanosis

122
Q

Why are COPD patients most susceptable to CO2 Narcosis?

A

Because their drive to breath is based on low O2 levels and raising the level of O2 only decreases this drive

123
Q

Why do we need oxygen?

A

It is essential for life and function of cells and tissues

124
Q

Decreased tissue oxygenation

A

Hypoxia

125
Q

Does not provide enough flow to meet total oxygen and air volume

A

Low flow oxygen delivery systems

126
Q

What is the purpose of oxygen therapy?

A

To improve oxygenation and, hopefully, tissue perfusion; to treat hypoxemia

127
Q

Retention of CO2

A

Hypercarbia

128
Q

What is the most important value in arterial blood gases?

A

pH of the blood

129
Q

What is the goal of oxygen therapy?

A

To use the lowest fraction of inspired oxygen to obtain acceptable blood oxygen levels without causing harmful side effects

130
Q

What does the type of oxygen delivery system used depend on?

A

Oxygen concentration required, the importance of accuracy and control of oxygen concentration, patient comfort, the importance of humidity and patient mobility

131
Q

What is the flow rate of a nasal cannula?

A

1-6 L/min

132
Q

How can oxygen tubing be made safer for mobile patients?

A

Duct tape the oxygen extention to the floor

133
Q

New onset of crackles and decreased breath sounds while on oxygen therapy

A

Absorption atelectasis

134
Q

Why does a flow rate of greater than 6 L/min on a nasal cannula not increase oxygen saturation?

A

Because the anatomical dead space is full

135
Q

Which patients are most susceptable to CO2 narcosis?

A

Patients with COPD

136
Q

What should be assessed before placing a patient on a nasal cannula?

A

Patency of the nostrils and changes in respiratory rate and depth

137
Q

What are the types of low flow oxygen delivery systems?

A

Nasal cannual, simple facemasks, partial rebreather facemasks, and non-rebreather facemasks

138
Q

How much oxygen requires humidification?

A

If the patient is on any amount of oxygen for more than 15 minutes or if the patient is on 4 liters or more

139
Q

What is the oxygen concentration of a nasal cannula?

A

24%-44%

140
Q

What is the oxygen concentration of a partial rebreather?

A

60%-75%

141
Q

How should the rate of a partial rebreather be adjusted?

A

To keep the reservoir bag inflated

142
Q

Which patients are non-rebreathers used for?

A

Unstable patients requiring intubation

143
Q

What is the oxygen concentration of a simple facemask?

A

40%-60%

144
Q

What is the flow rate of a non-rebreather?

A

10-15 L/min

145
Q

What is the flow rate of high flow oxygen delivery systems?

A

8-15 L/min

146
Q

What are the types of high-flow oxygen delivery systems?

A

Venturi masks, face tent, aerosol masks, tracheostomy collar and T-piece

147
Q

What should be added to simple facemasks?

A

Humidity

148
Q

Where is a Venturi facemask titrated?

A

At the bottom of the mask

149
Q

What is the oxygen concentration of high-flow delivery systems?

A

24%-100%

150
Q

How much tidal volume is exhaled with each breath when using a partial rebreather?

A

1/3

151
Q

What should be assessed before putting a patient on a non-rebreather mask?

A

Ensure that the valves are patent and functional

152
Q

What is the minimum amount of oxygen a simple facemask delivers?

A

5 L/min

153
Q

What is the oxygen concentration of a non-rebreather mask?

A

Greater than 90%

154
Q

What is the flow rate of a partial rebreather?

A

6-11 L/min

155
Q

When a patient has a simple facemask, what should they be closely monitored for?

A

Aspiration

156
Q

When are CPAPs used?

A

For patients with sleep apnea, cardiac-induced pulmonary edema, and for atelectasis after surgery

157
Q

What does the T-piece do?

A

Ensures humidifier creates enough mist

158
Q

What are the types of Pressure Ventilation?

A

BiPAP and CPAP

159
Q

How does a patient using a Venturi facemask eat?

A

By switching to a nasal cannula

160
Q

How are TTO systems set up?

A

A small, flexible catheter is passed into the trachea through a small incision

161
Q

Fits over the chin, with the top extending halfway across the face

A

Face tent

162
Q

Why are TTO systems not used?

A

Probability of infection

163
Q

What is the best oxygen delivery system for patients with chronic lung disease?

A

Venturi Masks

164
Q

Uses positive pressure to keep alveoli open, improving gas exchange without airway intubation

A

Pressure Ventilation

165
Q

Long term delivery of oxygen directly into lungs

A

Transtracheal oxygen delivery

166
Q

What patients are face tents used for?

A

Patients with facial trauma or burns

167
Q

Delivers desired FIO2 for tracheostomy, laryngectomy, and ET tube patients

A

T-Piece

168
Q

Why are transtracheal oxygen delivery systems used?

A

To avoid the irritation that nasal prongs cause

169
Q

Delivers set positive airway pressure throughout each cyle of inhalation and exhalation

A

CPAP

170
Q

How do you know that a T-piece is working?

A

Mist should be seen during inspiration and expiration

171
Q

How much oxygen do face tents deliver?

A

10 L/min

172
Q

Used when high humidity is needed after extubation or upper airway surgery or for thick secretions

A

Aerosol Masks

173
Q

What is the oxygen concentration of a Venturi facemask?

A

24%-50%

174
Q

How much oxygen does a Trach collar deliver?

A

10 L/min

175
Q

What patient education needs to take place before there can be home oxygen therapy?

A

Safety, tripping hazards, fire hazards, humidification, don’t self-diagnose and treat with increased oxygen

176
Q

What is the oxygen concentration of an aerosol mask?

A

24%-100%

177
Q

Surgical incision into the trachea for the purpose of establishing an airway

A

Tracheotomy

178
Q

What is the oxygen concentration for face tents?

A

24%-100%

179
Q

What are the priority problems for tracheostomy patients?

A

Reduced oxygenation, inadequate communication, inadequte nutrition, potential for infection, and damaged oral mucosa

180
Q

What is the most important post-operative care to give to tracheostomy patients?

A

Ensure the airway is patent

181
Q

What is the concentration of a Trach collar?

A

24%-100%

182
Q

If a post-operative tracheostomy patient has a constant, non-productive cough, what does this indicate?

A

Tube dislodgement

183
Q

How much oxygen does a Venturi mask deliver?

A

4-10 L/min

184
Q

How much oxygen does a aerosol mask deliver?

A

10 L/min

185
Q

Used to deliver high humidity and the desired oxygen to the patient with a tracheostomy

A

Trach collar

186
Q

How should oxygen be weened?

A

0.5-1.0 liters at a time over 15-30 minutes with ambulation

187
Q

Stoma that results from a tracheotomy

A

Tracheostomy

188
Q

What is the oxygen concentration of a T-piece?

A

24%-100%

189
Q

Why are tracheostomy patients at risk for damaged oral mucosa?

A

Because the mouth is bipassed and dried out, making it an infection breeding ground

190
Q

How much oxygen does a T-piece deliver?

A

10 L/min

191
Q

What assessments should be done on a post-operative tracheostomy patient?

A

Tube obstruction or dislodgement, assess for crepitus, excessive bleeding, and constant non-productive cough

192
Q

What nursing interventions should be done with a patient who has a tracheostomy?

A

Check cuff pressure often, keep extras at the bedside, make sure suction equipment works, prevent tube friction and movement, and prevent malnurtition, hemodynamic instability and hypoxia

193
Q

Why is suctioning so important for tracheostomy patients?

A

To maintain patent aitways and promote adequate gas exchange

194
Q

What does over inflation of the tracheostomy cuff do?

A

Causes damage to the trachea and mucosal ischemia

195
Q

How can hypoxia be prevented during the suctioning of a patient with a tracheostomy?

A

Apply suction on the way out and only suction 10-15 seconds at a time

196
Q

What possible complications accompany a tracheotomy?

A

Pneumothorax, subcutaneous emphysema (crepitus), bleeding, and infection

197
Q

How can a nurse prevent friction and movement of a tracheostomy?

A

Secure trach ties

198
Q

Why would a patient have a fenestrated tracheostomy?

A

To talk

199
Q

What does under inflation of the tracheostomy tube do?

A

Causes the patient to not be able to talk

200
Q

How should tracheostomy patients be suctioned?

A

Through their nose and mouths

201
Q

Why must air be humidified for tracheostomy patients?

A

Because the air they are breathing bypasses the nose and mouth, which normally warms, humidifies, and filters it

202
Q

If a patient has vagal stimulation during suctioning, what will happen to their heartrate?

A

It will drop dramatically

203
Q

What are some side effects of suctioning?

A

Hypoxia, tissue and mucosal trauma, infection, vagal stimulation and bronchospasms, and cardiac dysrhythmias

204
Q

How should a tracheostomy tube be weaned?

A

Gradually decrease tube size until you ultimately remove the tube

205
Q

How can you encourage good bronchial and oral hygeine of a tracheostomy patient?

A

Turn and repostion every 1-2 hours, support out of bed activities, encourage early ambulation, encourage coughing and deep breathing, chest percussion, postural drainage, and avoid glycerin swabs

206
Q

How should a client who has a tracheostomy be positioned when they are eating?

A

Tuck chin down and forward when swallowing

207
Q

What should you do if a patient’s tracheostomy accidentally dislodges?

A

Check for breathing, get a pulse ox, and call someone to recannulate as you are staying with them

208
Q

When can a tracheostomy cuff be deflated?

A

When the patient can manage their secretions and they don’t need assissted ventilation

209
Q

What should you do when feeding a patient with a tracheostomy?

A

Elevate head of bed for at least 30 minutes after eating to prevent aspiration, and use thickening

210
Q

Breath sounds that E>I

A

Bronchial

211
Q

Breath sounds that I>E

A

Vesicular

212
Q

Breath sounds that I=E

A

Bronchial vesicular

213
Q

High pitched breath sounds

A

Bronchial

214
Q

Low pitched and breezy breath sounds

A

Vesicular

Illness and Patho 1 (12 decks)

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