Respiratory 1 Flashcards
1
Q
What is atelectasis?
A
Closure or collapse of alveoli or possibly filled with alveolar fluid
2
Q
What are the common clinical manifestations of atelectasis?
A
- Insidious, increasing dyspnea
- Cough
- Sputum production
Acute:
* Happens quickly
* Tachycardia
* Tachypnea
* Pleural pain
* Central cyanosis if large areas of the lung are affected
Chronic:
* Similar to acute
* Pulmonary infection may be present
Acute is most common - occuring in postoperative setting
3
Q
What are some common risk factors for atelectasis?
A
- Older age
- Bedrest without frequent changes in position
- Recent surgery
- Lung disease (COPD, asthma, etc.)
4
Q
Which diagnostic methods may suggest atelectasis?
A
- Chest x-ray
- Pulse oximetry (SpO2) may be less than 90%
- Increased WOB (Work of Breathing) and Hypoxemia
- Decreased breath sounds and crackles over affected area (usually in bases, but not always)
5
Q
What is the primary goal of atelectasis management?
A
To improve ventilation and remove secretions
6
Q
What are the first line measures for managing atelectasis?
A
- Frequent turning
- Early ambulation
- Lung volume expansion maneuvers
- Coughing
7
Q
What is the ICOUGH program?
To prevent atelectasis
A
I: Incentive Spirometry
C: Coughing and Deep Breathing
O: Oral care (brushing teeth and using mouthwash twice a day)
U: Understanding (patient and staff education)
G: Getting out of bed at least three times daily
H: Head of bed elevation
8
Q
What are multidisciplinary management measures for atelectasis?
A
- CPT (Chest Physiotherapy)
- Thoracentisis (to relieve compression)
- Endotracheal intubation and mechanical ventilation
9
Q
What is hypoxemia?
Won’t be on exam
A
Decrease in the arterial oxygen tension in the blood
10
Q
What is hypoxia?
Won’t be on exam
A
Decrease in oxygen supply to the tissues and cells (can also be caused by problems outside the respiratory system)
Can be life threatening
11
Q
What is postural drainage used for?
Ex: Prone positioning, turning
A
- To assist in the removal of bronchial secretions using the force of gravity
- Used to prevent or relieve bronchial obstruction caused by accumulation of secretions
12
Q
What is influenza?
A
- Highly contagious respiratory illness caused by a virus
- 490,000 people hospitalized annually
- 61,000 deaths annually
13
Q
What are the peak months for influenza season?
A
September to April with a peak in November
14
Q
Which Influenza serotype can infect different species and how?
A
Influenza A
By viral mutation
15
Q
Which influenza serotype is most common and virulent?
A
Influenza A
(known to cause pandemics, 75% of confirmed seasonal infections)
16
Q
What are the subtypes of Influenza A?
Won’t be on exam… good to know
A
- Hemagglutinin: Allows virus to enter the cell
- Neuraminidase: Facilitates cell to cell transmission
Influenza named based on these subtypes
H1N1: Swine Flu (easily spread, rarely fatal)
H5N1: Bird Flu (spreads slowly, often fatal)
17
Q
What is important to know about Influenza C?
A
- Mildest version
- Does not cause significant illness in humans
18
Q
What is important to know about Influenza B?
A
- Similar to type A
- Only spreads from human to human
- Can cause seasonal outbreaks
- Can also be transferred throughout the year
19
Q
What is the incubation period for influenza?
A
1- 4 days
20
Q
How does Influenza spread?
A
Droplets and inhalation of particles
21
Q
What is the peak transmission period for Influenza?
A
- One day before symptoms appear
- Continues for 5-7 days after first appearing ill
22
Q
What are common clinical manifestations of influenza?
A
- Abrupt onset
- Fever / chills
- Myalgia
- Headache
- Sore throat
- Fatigue
Symptoms typically subside within 7 days
23
Q
What diagnostic tests are used for influenza?
A
Viral cultures:
* Reverse transcription polymerase chain reaction: RT-PCR
* Results may take 1-2 days
* Can identify which strain is present
Rapid influenza diagnostic test:
* Available from PCP, outpatient facilities
* Results in 10-15 minutes
* Useful to differentiate flu from other infections
* Diagnosis missed or false positive possible (50-70% correct)
* Followed up with RT-PCR
Also assess health history… who has been sick around them
24
Q
What are the best prevention strategies for Influenza?
A
- Quit smoking
- Stay home if having flu-like symptoms (or mask if having to go out)
- Frequent hand washing
- Keeping hands away from face
- Avoid close contact with infected persons
- Influenza vaccine
25
Who is the **Trivalent Inactivated Influenza Vaccine** approved for?
* Anyone over 6 months of age
* Pregnant women
* Immunocompromised persons
* Residents of nursing homes
26
How is the **Trivalent Inactivated Influenza Vaccine** adminstered?
Intramuscular injection
27
What is pneumonia?
**Acute infection of lung parenchyma**
* Associated with significant morbidity and mortality rates
* Pneumonia and influenza are 8th leading cause of death from infectious diseases in the US
* 880,000 deaths from pneumonia in children under the age of 5 in 2016 *(most less than 2 years)*
28
What are the risk factors for pneumonia?
* Smoker
* Alcohol use
* Immunosuppressed *(AIDS, cancer pt., organ transplant, etc.)*
* Chronic diseases (HF, COPD, DM)
* Flu
* NGT, OGT, or ETT placement
* Older
* Poor HOB *(Head of Bed)*
* Prolonged immobility
* Lack of vaccination
29
What defines CAP?
| Community Acquired Pneumonia
Occurs in patients who have **NOT** been:
* Hospitalized within 14 days of onset of symptoms
* Residing in a long-term care facility
30
How is CAP typically treated?
* Empiric antibiotic therapy started ASAP
* May be treated at home or hospital depending on patient's condition
31
What defines Hospital Acquired Pnemonia (HAP)?
* Occurs 48 hours or longer after admission
* Not present at time of admission
* Ventiliator Associated: occurs more than 48 hours after endotracheal intubation
32
What is HAP associated with?
* Longer hospital stays
* Increased costs
* Sicker patients
* Increased risk of morbidity and mortality
* More virulent than other types
33
What defines Aspiration Pneumonia?
Results from abnormal entry of secretions into lower airway
(ex. water, saliva, food, liquids, etc.)
34
What are the risk factors for Aspiration Pneumonia?
* Decreased level of consciousness
* S/P CVA
* Difficulty swallowing
* Insertion of NGT with or without tube feeding
35
What are the common clinical manifestations of **Pneumonia**?
* Varies depending on type, causal organism, and presence of underlying disease
**Common:**
* Cough
* Low grade fever, chills
* Dyspnea, tachypnea
* Myalgia
* Pleuritic Chest Pain, use of accessory muscles
* Orthopnea
* Crackles
* Increased tactile fremitus
* Purulent sputum
36
What is different about how **viral, mycoplasma, or Legionelle pneumonia** normally presents?
relative bradycardia
37
What is different about how **streptococcal pneumonia** normally presents?
* Sudden onset of chills
* fever
* pleuritic chest pain
* tachypnea
* respiratory distress
38
What is the CURB-65 tool used for?
To aid in decision to hospitalize pneumonia patients
39
What does the CURB-65 tool look at?
**C**onfusion
B**U**N (> 19mg/dL)
**R**espiratory Rate > or equal to 30
**B**lood Pressure: Systolic under 90 or Diastolic under or equal to 60
Age > or equal to **65**
| ~ 3 positive indicators = admit
40
How is Pneumonia diagnosed?
**FIRST: Chest X-Ray**
Then:
* CBC with differential
* WBC count is usually > 15,000 with presence of bands
* Sputum analysis: Culture and gram to identify organism *(Ideally collect before Abx are started)*
41
What further diagnostics are implemented for those not responding to treatment in Pnemonia infections?
* Blood cultures
* Thoracentesis *(can also treat infection)*
* Bronchoscopy *(can also treat)*
* Biologic markers to guide clinical decisions: C-Reactive protein *(inflammation marker)*; Procalcitonin *(viral or bacterial?)*
42
What are some complications of pneumonia?
* **Atelectasis**
* **Pleurisy** *(inflammation of the pleura)*
* **Pleural effusion** *(fluid in the pleural space)*
* **Pneumothorax** *(air in the pleura space, causing the lungs to collapse)*
* **Meningitis** *(pt. may be disoriented, confused, drowsy)*
* **Acute respiratory failure** *(leading cause of death in PNA, lungs can no longer exchange O2 for CO2 - needs intubation)*
* **Sepsis** *(occurs when bacteria within alveoli enter bloodstream)*
* **Rare complications:** Lung abscess, empyema
43
What is the primary treatment for pneumonia?
**Prompt treatment with antibiotics**
Initial therapy is empiric: based on likely infecting organism, varies with local patterns of antibiotic resistance
| **Should see improvement in 3-5 days**
44
What are supportive care interventions for PNA?
* Oxygen therapy
* Analgesics
* Antipyretics
* Individualized rest and activity
45
What are important patient teachings for home care after PNA?
* Emphasize need to take full course of ABX
* Drug-drug and drug-food interactions
* Adequate rest
* Adequate hydration
* Avoid alcohol and smoking
* Cool mist humidifier
* Chest xray
* vaccinations
46
What is the purpose of a tracheostomy?
* To establish a patent airway
* bypass an airway obstruction
* facilitate secretion removal
* permit long-term mechanical
* Facilitate weaning from mechanical ventilation
47
What is one complication of air entering through a tracheostomy tube vs. through nasal passages?
Since air is bypassing nasal passages, it is unhumidified and not filtered *(for infection/particles)*
48
What are the advantages of a tracheostomy over and endotracheal tube?
* Easier to keep clean
* Better oral and bronchial hygiene
* Patient comfort increased
* Less risk of long term damage to vocal cords
49
What are indications for a tracheostomy?
* Laryngeal Cancer
* Prolonged ventilator dependence
* Upper airway obstruction
* Neuromuscular Disease
50
What determines when a tracheostomy tube is removed?
When a patient no longer requires ventilatory support, can breathe spontaneously, and protects own airway *(effectively coughing up secretions, swallows)*
51
What needs to happen after a tracheostomy tube is removed?
* Occlusive dressing applied over stoma
* NPO until swallowing is evaluated
* Encourage patient to T,C,DB every hour
* Incentive spirometry use
52
What is tuberculosis (TB)?
**Infectious disease caused by Mycobacterium tuberculosis**
* Lungs are most commonly affected as it is aerophilic *(oxygen loving)*
* 1/3 of world population has TB
* 10 million get TB each year, 1.6 million die from it
* Leading cause of death in HIV/AIDs
* Prevalence is decreasing in US
53
What are common risk factors for tuberculosis?
* Homelessness
* Living in inner-city neighborhoods
* Foreign-born individuals
* Living or working in institutions
* Immunosuppression
* IV injecting drug users
* Poor access to health care *(poverty)*
54
How is TB transmitted?
* Airborne particles
* Can be suspended in air for minutes to hours
* Requires close, frequent, or prolonged exposure
NOT spread by kissing, touching, sharing food utensils, or other physical contact
55
What are the symptoms of pulmonary TB?
**Initial:**
* Initial dry cough that becomes productive
* fatigue
* malaise
* anorexia
* weight loss
* low-grade fever
* night sweats
**Late:**
* Dyspnea
* Hemoptysis
| **takes 2-3 weeks for symptoms to develop**
56
What is the Tuberculin Skin Test (TST)?
AKA: Mantoux test
**A test to assess for induration after injecting purified protein derivative (PPD) intradermally**
**Presence of induration at injection site indicates development of antibodies secondary to exposure to TB**
* Assess for induration in 48-72 hours
57
What is the recommended testing method for health care workers with repeated testing and decreased response to allergens?
Two-step testing
## Footnote
This method helps to improve the detection of latent TB infection.
58
What will patients who have received the BCG vaccine test positive for?
Mantoux test (TB)
*(The BCG vaccine can cause a false positive in TB testing)*
59
What are Interferon-γ gamma release assays (IGRAs) used for?
To diagnose tuberculosis
## Footnote
Examples include T-SPOT, TB GOLD
60
What might a chest x-ray show in a patient with tuberculosis?
Lesions in upper lobes
## Footnote
This is a common finding in TB cases.
61
What is required for the bacteriologic diagnosis of tuberculosis?
Consecutive sputum samples obtained on 3 different days
## Footnote
This ensures accuracy in diagnosis.
62
Is hospitalization necessary for most tuberculosis patients?
No
## Footnote
Most patients can be managed without hospitalization.
63
For how long are patients with sputum positive for TB considered infectious after starting treatment?
First 2 weeks
## Footnote
This highlights the risk of transmission before treatment begins.
64
What criteria must be met for a tuberculosis patient to be discharged to home?
The patient must be:
* Started on an appropriate multiple drug regimen
* Medically stable
* Able to care for self
* Understands and can comply with home isolation
* Have a follow-up plan established
## Footnote
These criteria ensure patient safety and compliance.
65
What is the initial treatment duration for newly diagnosed active tuberculosis?
8 weeks
## Footnote
Followed by a continuation phase of 16-42 weeks if still positive.
66
List the four-drug regimen commonly used for treating active tuberculosis.
* Isoniazid
* Rifampin
* Pyrazinamide
* Ethambutol
## Footnote
Each drug has specific side effects and nursing considerations.
67
What should patients be taught regarding tuberculosis drug therapy?
* About side effects and when to seek medical attention
* Monitoring liver function (AST & ALT) is essential.
* How long they are considered infectious
68
After how many weeks of continuous medication therapy are tuberculosis patients considered noninfectious?
2 to 3 weeks
69
What is directly observed therapy (DOT) in tuberculosis treatment?
* It helps prevent multidrug resistance and treatment failures.
* A strategy to ensure adherence by watching patients swallow drugs
* May be administered by public health nurses at clinic site
70
What is the standard treatment for latent TB infection in health care workers?
Isoniazid for 6 to 9 months
## Footnote
Alternatives include a 3-month regimen of Isoniazid and rifapentine or 4 months of rifampin.
71
How is the **Live Attenuated Influenza Vaccine (LSIV)** adminstered?
Nasally
72
Who is the **Live Attenuated Influenza Vaccine (LSIV)** approved for?
* Healthy persons 2-49 years old
73
Who is the **Live Attenuated Influenza Vaccine (LSIV)** NOT approved for?
* Immunocompromised persons
* Children/adolescents receiving ASA or salicylates
* Under age 2, over age 49
74
What are common side effects of **Live Attenuated Influenza Vaccine (LSIV)**?
* Runny nose/congestion
* Sore throat in adults
* Fever in children (2-6y/o)
75
What are complications of Influenza?
* Pneumonia
* Ear or sinus infection
* Dehydration
76
How do Alveoli change in lung diseases?
Normal alveoli are inflated and facilitate gas exchange; collapsed alveoli hinder this process
77
List three nursing interventions for atelectasis prevention.
* Frequent turning
* Early mobilization
* Strategies to expand lungs and manage secretions: IS, Voluntary deep breathing, Secretion management, Pressurized metered-dose inhaler
78
What is the purpose of an incentive spirometer?
To encourage voluntary deep breathing and lung expansion
## Footnote
It helps prevent atelectasis.
79
What positioning is recommended for using an incentive spirometer?
Semi-Fowler or upright position
80
What are realistic goals for Incentive Spirometer use?
10 times/hour *(doesn't need to be all at once)*
Allow patient to determine initial volume
81
What does chest physiotherapy (CPT) include?
* Chest percussion
* Vibration
82
Describe chest percussion
A technique involving cupping the hands and lightly striking the chest wall rhythmically over lung segments
## Footnote
This helps in draining secretions.
83
Describe vibration in regards to Chest Physiotherapy
The technique of applying manual compression and tremor to the chest wall during the exhalation phase of respiration
84
What are some health promotion strategies for pneumonia?
* Teach hygiene
* Nutrition and fluids
* Rest
* Regular exercise
* Avoid cigarette smoke
* Vaccination
* Cough or sneeze into elbow, not hands
* Prompt treatment of URIs
85
What nursing interventions are important for managing pneumonia?
* Humidification *(face mask or NC)*
* Coughing techniques
* Chest physiotherapy
* Position changes
* Incentive spirometry
* Nutrition management
* Adequate hydration
* Rest, activity as tolerated
86
What Nutrition management is important for PNA?
* Hydration: thins and loosens secretions
*(adjust for HF, older adults, renal or pre-existing respiratory conditions)*
* High calorie, small, frequent meals *(monitor for weight loss)*
87
What are the planning goals for a patient with pneumonia?
* Improved airway patency
* Increased activity
* Maintenance of proper fluid volume
* Normal chest X-ray
* Understanding of treatment protocol
* Absence of complications
88
What are the parts of a tracheostomy tube?
89
What is included in the nursing management of tracheostomy?
* Frequent monitoring of lung sounds and SpO2
* Maintain patency by suctioning
* Monitor cuff pressure and trach ties for proper placement/tension
* Provide humidification
* Semi-Fowler's position
* Effective communication means
* Spontaneous Breathing Trials
* Use of track mask post intubation
* Monitor for increased WOB
* Educate patient and family about daily care and how to prevent an emergency
* Proper oral hygiene
90
When is a tube with an inflated cuff used?
* Risk of aspiration
* In mechanical ventilation
| **Inflate cuff with minimum volume required to create an airway seal**
91
What is the maximum cuff pressure to prevent tracheal necrosis?
Should not exceed 24 to 30 cm H2O
92
What should be done in the case of an accidental dislodgement of a tracheostomy tube?
* Immediately call for help
* Use a bag-valve mask device to ventilate patient through the upper airway
* Ventilate gently to prevent air escaping though the stoma *(may occlude the stoma with a gloved hand)*
## Footnote
**Provider or specially trained RT wil intubate pt orally unless stoma is mature and easily visualized**
93
True or False: A spontaneously breathing patient may deflate the cuff to allow exhaled air to flow over vocal cords.
**True**
*This is a technique to promote speech*
## Footnote
**Other techniques: Use a Fenestrated trach tube or a Passy Muir speaking valve**
94
What precautions should be taken to prevent accidental dislodgement of a tracheostomy tube?
* Have a complete replacement tube at bedside
* Do not change ties for 24 hours
* Physician performs first tube change
| **Most dangerous in first 5-7 days**
95
What should a patient do to prevent the spread of TB?
* Cover nose and mouth when coughing
* Hand washing after handling sputum-soiled tissues
* Wear a mask outside of negative-pressure room
96
How should a patient manage exposure to close contacts while undergoing TB treatment?
* Sleep alone
* Spend time outdoors
* Minimize time in close proximity with others *(and on public transportation)*
## Footnote
**Until sputum is negative**
97
What precautions are taken for a hospitalized pt with TB?
**Airborne isolation**
* Single occupancy
* Negative pressure room with 6-12 airflow exchanges/hour
* Health care workers wear high efficiency particulate air masks (HEPA)
98
What patient education should be given to a pt with TB?
* Emphasize importance of complying with medication regimen *(ensure pt has access to medications before D/C)*
* Minimize exposure to close contacts
* Open windows and ventilate rooms
* Emphasize importance of treatment compliance
