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NCLEX > Respiratory > Flashcards

Respiratory Flashcards

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1
Q

what is rhinitis

A

inflammation of the mucus membrane of the nose

marked by rhinorrhea (runny nose), nasal congestion, itching and sneezing

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2
Q

rhinitis manifestation

A

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

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3
Q

rhinitis diagnostic studies

A

hx and note quality of drainage and color

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4
Q

rhinitis care

A

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

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5
Q

rhinitis management

A

reduce allegens
teach how to administer med properly

use good handwashing technique

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6
Q

what is sinusitis

A

inflammation of one or more of the paranasal sinuses

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7
Q

sinusitis manifestations

A

frontal hedache
tenderness over affect sinus

purulent nasal drainage and congestion

tooth pain
general malaise
fever

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8
Q

sinusitis diagnostic studies

A

X-ray or CT scan

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9
Q

sinusitis care

A

pharamcological interventions:
nasal saline
decongestants
nasal corticosteroids

mucolytics
antihistamines
analgesics
antipyretics
antibiotics
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10
Q

sinusitis management

A

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
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11
Q

what is pharyngitis

A

inflammation of the mucous membranes of the pharync

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12
Q

pharyngitis manifestation

A

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

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13
Q

pharyngitis diagnostic studies

A

throat cultures

rapid strep antien test

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14
Q

pharyngitis care

A

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

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15
Q

pharyngitis management

A

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

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16
Q

what is tonsillitis and adenoiditis

A

inflammation and infection of the tonsils

adenoidits = inflammation of the adenoid tissue

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17
Q

tonsillitis and adenoiditis manifestations

A

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

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18
Q

tonsillits and adenoiditis care

A

anti-infectives
antipyretics
analgescis

increase fluid intake and rest

if infections are recurrent - tonsillectomy and adenoidectomy may be indicated

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19
Q

tonsillitis and adenoiditis management

A

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
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20
Q

what is peritonsillar abscess

A

caused by group A hemolytic streptococci infection

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21
Q

peritonsillar abscess manifestations

A

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

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22
Q

what is laryngitis

A

inflammation of the larynx

nurses should NOT use laryngoscope, but amy be asked to assist HCP

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23
Q

laryngitis care

A

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
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24
Q

chronic obstructive pulmonary disease

A

includes:
emphysema
chronic bronchitis

primary cause: smoking cigarettes

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25
Q

COPD clinical manifestations:

A

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

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26
Q

COPD diagnostic studies

A

spirometry
chest x-ray
sputum cltures

increased PaCO2, low PaO2
low O2 levels

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27
Q

COPD care

A

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

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28
Q

COPD management

A

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

29
Q

asthma manifestations

A

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`

30
Q

asthma diagnostic studies

A

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
31
Q

asthma care

A 
pharmacological interventions:
long acting control medications;
- fluticasone
- beclomethasone
- salmeterol
- montekulast
- tiotropium
- cromolyn sodium inhaler

short acting “rescue” medications:

  • albuterol
  • inhaler
  • nebulizer
  • prednisone
  • methyprednisolone
32
Q

asthma management

A

same as COPD

33
Q

asthma complications

A

low PaO2- hypoxemia
hypercapnia - high PaCO2

recurrence of other resp infections
resp failure

absence of wheezing

34
Q

what is pneumothorax

A

pleural space is filled with either air or lung or both which reduces lung capacity

35
Q

open pneumothorax

A

air enters into pleural space due to a hole in the chest wall

ex: gunshot wound

36
Q

close pneumothroax

A

air enters into pleural space through a hole in the lung tissue

ex: after lung resection

37
Q

tension pneumothorax

A

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

38
Q

pneumothorax manifestations

A

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

39
Q

pneumothorax diagnostic studies

A

chest x-ray
CT scan
leukocytosis
decreased hgb and hct

40
Q

pneumothorax care

A

thoracentesis:

with or without chest turb drainage device

41
Q

pneumothorax nursing management

A

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

42
Q

what is pneumonia

A

characterized by inflammation and consolidation of lung tissue

43
Q

aspiration pneumonia

A

chemical irritation and inflammation associated with aspiration of food, stomach contents, or saliva

44
Q

risk factors of pneumonia

A 
preexisting pulmonary diease
depressed immune function
atelectasis
mechnical ventilation
advanced age

decreased ability to protect the airway, swallow safely

45
Q

pneumonia manifestations

A

fever
chills
malaise

SOB with decreased oxygen saturation

productive cough with purulent sputum
pleuritic chest pain

crackles or ronchi in affected lobes

46
Q

pneumonia diagnostic studies

A

chest x ray
positive sputum culture
leukocytosis

low pH
high PaCO2, low PaO2

** bronchoscopy may be performed when an organism is difficulty to identify

47
Q

pneumonia care

A

pharamcological interventions:
antinfectives
antipyretics and analgesics
- acetaminophen or NSIADs

expectorants
- guaifenesin

antitussives

antitussives and cough suppressants are contraindicated in clients with a propductive cough

48
Q

pneumonia management

A

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

49
Q

influenza

A

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

50
Q

influenza manifestations

A 
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
51
Q

influenza diagnostic studies

A

rapid influenza diagnostic test

blood and sputum cultures
chest x-ray

52
Q

influenza care

A

get vaccinated
rapid flu virus

strict adherence to infection ctronl
implementing droplet precautions

start antivirals within 48 hours of onset of illness

53
Q

influenza management

A

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

54
Q

pulmonary tuberculosis

A

chronic infection caused by acid-fast bacillus

55
Q

pulmonary tuberculosis manifestations

A

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

56
Q

pulmonary tuberculosis diagnostic tudies

A

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

57
Q

tuberculosis care

A

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

58
Q

tuberculosis management

A

airborne precautions
negative airflow
N95

visitors can wear surgical mask
client with surigcal mask when leaving room

59
Q

tuberculosis health promotion

A

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

60
Q

what is pulmonary embolism

A

blood clots that prevents blood from perfusing to the lungs

61
Q

types of embolism

A

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

62
Q

pulmonary embolism manifestations

A

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
63
Q

pulmonary embolism diagnostic studies

A

chest CT scan with contrast
D-dimer will be elevated

VP scan
ABG
- low PaO2, high PaCO2

ECG

64
Q

pulmonary embolism care

A

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

65
Q

what is acute respiratory distress syndrome

A

inflammatory response to a signficiant acute injury or inflammation process

refractory hypoxemia = HALLMARK of ARDs

66
Q

ARDs manifestations

A

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

67
Q

ARDs care

A

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

68
Q

ARDs management

A

bedrest with frequent position changes
ROM exercise
monitor O2 sat with ABGs

observe for behavioral changes
vitals

NCLEX (21 decks)

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