Respiratory Flashcards
what is rhinitis
inflammation of the mucus membrane of the nose
marked by rhinorrhea (runny nose), nasal congestion, itching and sneezing
rhinitis manifestation
excessive nasal drainage
congestion
postnasal drip with sore throat
nasal itchiness, sneezing
itchy watery eyes if allergies are the cause
if viral:
sore thraot
general malaise
headache
bactericidal:
purulent nasal discharge
fever
rhinitis diagnostic studies
hx and note quality of drainage and color
rhinitis care
first step: determine whether cause is allergic, viral or bacterial
can use OTC antihistamines or decongestatns to manage symptoms
acetminophen or NSAID for minor aches and pians
if bacterial: anti-infectives
if allergic: avoid exposure to allergen
both viral and bacterial causes, encourage to;
- increase fluid intake
- rest
- gargle with warm salt water
increase intake on Vit C and zinc
rhinitis management
reduce allegens
teach how to administer med properly
use good handwashing technique
what is sinusitis
inflammation of one or more of the paranasal sinuses
sinusitis manifestations
frontal hedache
tenderness over affect sinus
purulent nasal drainage and congestion
tooth pain
general malaise
fever
sinusitis diagnostic studies
X-ray or CT scan
sinusitis care
pharamcological interventions:
nasal saline
decongestants
nasal corticosteroids
mucolytics antihistamines analgesics antipyretics antibiotics
sinusitis management
take prescribed meds
intake fluids at least 6-8 glasses of non-carbonated, non-alcoholic beverages daily
nasal cleansing techniques:
- hot showers
- steam inhalation
- nasal irrigation with saline spray
what is pharyngitis
inflammation of the mucous membranes of the pharync
pharyngitis manifestation
complain of a scratchy throat
throat pain that is severe and worsens with swallowing
pharynx can appear red and edmatous, with or without patchy white or yellow exudates
pharyngitis diagnostic studies
throat cultures
rapid strep antien test
pharyngitis care
pharmacologic interventions:
antimicrobial therapy
- penicillin for strep throat
- erythromycin if client is allergic to penicillin
antifungal - nystatin
analgesics - ibuprofen or topical anesthetic sprays or lozenges
pharyngitis management
administer prescribed medications as ordered
encourage increased fluid intake
eat cool, bland liquids
eat soft foods such as gelatin
avoid citrus juices and carbonated beverages
- you dont want something acidic to pass through the a=pharynx
take all antiinfective pills
what is tonsillitis and adenoiditis
inflammation and infection of the tonsils
adenoidits = inflammation of the adenoid tissue
tonsillitis and adenoiditis manifestations
sore throat
fever
difficulty swallowing
enlarged tonsils or even kissing tonsils
halitosis (bad smelling breath)
noisy respirations
recurring ear infections
throat cultures for causative microbes
tonsillits and adenoiditis care
anti-infectives
antipyretics
analgescis
increase fluid intake and rest
if infections are recurrent - tonsillectomy and adenoidectomy may be indicated
tonsillitis and adenoiditis management
meds
post op:
- hemorrhage
- airway obstruction
- provide positioning that allows for comfrot and drainage of the mouth and pharync
- HOB elevated, head turned to the side
- apply ice collar/pack for comfort
- prescribed mouthwashes and pain meds
- should eat a clear or full liquid diet for 48-72 hours
- frequent swallowing can indicate that bleeding is there
what is peritonsillar abscess
caused by group A hemolytic streptococci infection
peritonsillar abscess manifestations
difficulty swallowing
unable to swallow
will observe drooling
marked tonsillar enlargement, possible threatening the airways
muffled voice
high fever and chills
increased WBC, facial swelling
** monitor for airway patency and for resolution of infection
what is laryngitis
inflammation of the larynx
nurses should NOT use laryngoscope, but amy be asked to assist HCP
laryngitis care
resting voice
gargling with warm salt water
avoiding irritants:
- smoking
- spicy foods
- citrus fruits
- carbonated beverages
may use cool or moist air to bring relief
- sitting in a steamy bathroom
- outside in cool night air
- next to a cool air vaporizer
chronic obstructive pulmonary disease
includes:
emphysema
chronic bronchitis
primary cause: smoking cigarettes
COPD clinical manifestations:
purulent sputum production
dyspnea on exertion
- may occur with minimal activity or at rest
must use accessory muscles to breathe
restlessness, respiratory difficulty or distress, anxiety
eating interference
weight loss
chronic bronchitis:
edema
cyanosis
barrel chest
COPD diagnostic studies
spirometry
chest x-ray
sputum cltures
increased PaCO2, low PaO2
low O2 levels
COPD care
quit smoking
reduce second hand exposure to tabocco smoke
pharmacological include:
inhaled bronchodilator
- albuterol, ipratropium
inhaled oral corticosteroids
- prednisone
expectorant
- guaifenesin
supplemental oxygen therapy may be needed
airway clearance techniques:
- effective coughing
- chest physiotherapy
- vibration
- postural drainage
postural drainage: position that uses gravity to help move mucus from lungs up to the throat
COPD management
diaphragmatic breathing
pursed lip breathing
inspiratory muscle training
controlled coughing
pacing of daily activities
physical conditioning
small frequent meals, with nutritional supplments
avoid temperature and humiditiy extremes, air pollution and high altitudes
for hospitalized clients:
monitor O2 sat
administer oxygen at lowest dose- O2 sat of 90%
monitor for complications
asthma manifestations
expiratory wheezing, often audible
shortness of breath
cough with sputum production
normal or low oxygen saturation
chest tightness
tachycardia
use of accessory muscles with resp distress
high/normal PaCO2 and low PaO2`
asthma diagnostic studies
acute phase:
- physcial exma and hx
- ABGs
- chest x-ray
- pulmonary function tests
chronic phase:
- peak expiratory flow rate
- allergy testing
- pulmonary function tests
- bronchoscopy
asthma care
pharmacological interventions: long acting control medications; - fluticasone - beclomethasone - salmeterol - montekulast - tiotropium - cromolyn sodium inhaler
short acting “rescue” medications:
- albuterol
- inhaler
- nebulizer
- prednisone
- methyprednisolone
asthma management
same as COPD
asthma complications
low PaO2- hypoxemia
hypercapnia - high PaCO2
recurrence of other resp infections
resp failure
absence of wheezing
what is pneumothorax
pleural space is filled with either air or lung or both which reduces lung capacity
open pneumothorax
air enters into pleural space due to a hole in the chest wall
ex: gunshot wound
close pneumothroax
air enters into pleural space through a hole in the lung tissue
ex: after lung resection
tension pneumothorax
closed pneumothorax with rapid accumulation of air into pleural space
causes mediastinal and tracheal shift from the midline
most types of pneumothorax are treated with chest tube insertion
pneumothorax manifestations
asymmetrical chest movement - unequal
progressive dyspnea
diminished or absent lung sounds on affected side
low O2 levels
fatigue
activity intolerance
tachycardia
restlessness
anxiousness
ches pain
progressive cyanosis
pneumothorax diagnostic studies
chest x-ray
CT scan
leukocytosis
decreased hgb and hct
pneumothorax care
thoracentesis:
with or without chest turb drainage device
pneumothorax nursing management
monitor O2 sat and resp
recumbent position for comfort
maintain and monitor chest tube and closed chest drainage system
ensure chest tube drainage is closed, has no leaks or kinks
monitor volume and characteristic of drainage
- notify if drainage exceeds 10mL/hr and/or bright red or free-flowing drainage suddenly appears
keep collection device below chest level or insertion site at all times
- should expect water level to fluctuate with respirations (tidaling)
ensure that client has appropriate chest x-rays, daily
what is pneumonia
characterized by inflammation and consolidation of lung tissue
aspiration pneumonia
chemical irritation and inflammation associated with aspiration of food, stomach contents, or saliva
risk factors of pneumonia
preexisting pulmonary diease depressed immune function atelectasis mechnical ventilation advanced age
decreased ability to protect the airway, swallow safely
pneumonia manifestations
fever
chills
malaise
SOB with decreased oxygen saturation
productive cough with purulent sputum
pleuritic chest pain
crackles or ronchi in affected lobes
pneumonia diagnostic studies
chest x ray
positive sputum culture
leukocytosis
low pH
high PaCO2, low PaO2
** bronchoscopy may be performed when an organism is difficulty to identify
pneumonia care
pharamcological interventions:
antinfectives
antipyretics and analgesics
- acetaminophen or NSIADs
expectorants
- guaifenesin
antitussives
antitussives and cough suppressants are contraindicated in clients with a propductive cough
pneumonia management
monitor pulse oximetry
titrate oxygen
promote hydration to liquefy secretions
effective coughing techniques
should experience improvement within 48-72 hours of initation of therapy
-contact HCP if not improving
encourage influenza and pneumococcal vaccines for high risk clients
influenza
best prevention is to get vaccinated
symptoms usually begin about 2 days after virus enters body
- can range from 1-4 days
is transmissble
clients should be placed in a private room and droplet precautions
influenza manifestations
rapid onset of sever headache, muscle aches fever chills fatigue weakness
contagious from 24 hours before symptoms occur
sore throat
cough
watery nasal discharge
with strain B:
- nausea
- vomiting
- diarrhea
influenza diagnostic studies
rapid influenza diagnostic test
blood and sputum cultures
chest x-ray
influenza care
get vaccinated
rapid flu virus
strict adherence to infection ctronl
implementing droplet precautions
start antivirals within 48 hours of onset of illness
influenza management
adequate fluid intake 2-3 L/day
monitor resp status
administer analgesics
antibiotics
cough etiquette
hand hygiene
avoid contact with infected persons
receive flu vaccine
encourage pneumococcal vaccine
pulmonary tuberculosis
chronic infection caused by acid-fast bacillus
pulmonary tuberculosis manifestations
weakness with fatigue
anorexia with weight loss
night sweats
chest pain
a cough usually begins dry and progresses toa productive cough with purulent and/or bood tinged sputum
pulmonary tuberculosis diagnostic tudies
interferon gamma release arrays aka Quantiferon TB
nucleic acid amplification test
GOLD STANDARD:
TB culture
- but can take up to 2-6 weeks to obtain
alternative test –> acid fast bacillus smear
other tests:
chest x-ray
Mantoux test
- 48-72 hours after PPD injection
tuberculosis care
long term (6-24 months) antimicrobial therapy with at least 2 antitubercular drugs
surgical resection of involved lung
high carb, high protein diet, small frequent meals
TB is a reportable disease
- appropriate agency, family and close contacts
tuberculosis management
airborne precautions
negative airflow
N95
visitors can wear surgical mask
client with surigcal mask when leaving room
tuberculosis health promotion
report bloody sputum
DO NOT use OTC meds without HCP approval
DO NOT wear soft contact lenses if taking rifampin
- cause reddish-oragneish discoloration of saliva
adherence to treatment regimen
return at scheduled time
common side effect of antitubercular:
- increased in vit B
what is pulmonary embolism
blood clots that prevents blood from perfusing to the lungs
types of embolism
blood: DVT
fat embolism: from fractured femur or bone
amniotic fluid: post delivery
air: from injection of large air bolus through a central venous or arterial catheter
pulmonary embolism manifestations
if its small, asymptomatic
large:
- sudden onset of dyspnea and cough with low O2
- pleuritic chest pain
- anxiety apprehension - feeling of impending doom
- cough productive or nonproductive
- tachycardia and tachypnea
pulmonary embolism diagnostic studies
chest CT scan with contrast
D-dimer will be elevated
VP scan
ABG
- low PaO2, high PaCO2
ECG
pulmonary embolism care
prevention is best treatment
oxygen and anticoagulants
- may need non rebreather mask
pharmacological interventions:
anticoagulation
-heparin IV
- warfarin for chronic PE
thrombolytics
a filter surgically placed in vena cava may be needed for long term prevention
DVT= primary cause of pulmonary embolism
what is acute respiratory distress syndrome
inflammatory response to a signficiant acute injury or inflammation process
refractory hypoxemia = HALLMARK of ARDs
ARDs manifestations
restlessness
atelectasis - use PEEP
does not respond to oxygen
tachycardia
cyanosis (late sxs)
intercostal retractions, accessory muscle use
in early stage, lung tends to be clear
in later stage, coarse crackles might be present
ARDs care
oxygenation to maintain greater than 88%
correct respiratory acidosis
use PEEP and ECMO
- prevents alveoli from collapsing, improving oxygenation
sedation may be required
paralytic agents may be necessary
corticosteroids
fluid restrictions
ARDs management
bedrest with frequent position changes
ROM exercise
monitor O2 sat with ABGs
observe for behavioral changes
vitals
