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NUR5002 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is pneumonia:

A
  • Acute infection of the lower respiratory tract caused by bacteria, viruses, fungi, protozoa or parasites
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2
Q

Types of pneumonia:

A
  • Community-acquired
  • Medical-care associated (eg. hospital-acquired)
  • aspiration pneumonia
  • opportunistic pneumonia
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3
Q

Pathophysiology of pneumonia:

A
  • infection with pathogen
  • inflammatory response (release of mediators, neutrophils, accumulation of exudates)
  • alveoli fill with fluid & debris (consolidation)
  • increased mucus production (airway obstruction)
  • decreased gas exchange, SOB, hypoxaemia
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4
Q

Diagnosis of pneumonia:

A
  • CXR - shows patchy, white consolidation
  • FBC - increased WCC may indicate infection
  • Sputum sample - culture & sensitivity will show what/if bacteria is causing the infection and which antibiotics will resolve the infection
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5
Q

What is COPD

A

A progressive chronic disease characterised by irreversible obstruction of the airways
- preventable and treatable
- not curable
- biggest cause = smoking

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6
Q

Two clinical manifestations of COPD:

A
  • Emphysema
  • Chronic bronchitis
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7
Q

Emphysema

A

Alveolar hyperinflation and destruction
- older and thin
- severe dyspnoea
- barrel chest
- quiet chest
- hyperinflation of chest with flattened diaphragm
- gas trapping

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8
Q

Chronic bronchitis

A

Daily sputum production (3/12 in 2 + consecutive years)
- overweight and cyanotic
- elevated haemoglobin
- peripheral oedema
- rhonchi and wheezing
- mucus plug
- thick and narrow bronchial airways

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9
Q

Pathophysiology of COPD:

A

a. Exposure to noxious particles (eg. Cigarette smoke, air pollution) can cause chronic inflammation of the alveoli, airways and pulmonary vessels
b. The persistent inflammation and infiltration of inflammatory cells can cause two clinical manifestations of COPD:
i. Chronic bronchitis: continuous bronchial inflammation resulting in mucus hypersecretion and bronchial oedema. This causes mucus plugs, narrowed airways and thickened airway walls
ii. Emphysema: breakdown in the lung elastic tissue, causing destruction of alveolar septa, loss of elastic recoil of bronchial walls
c. These manifestations result in air trapping, hyperinflation of lungs (barrel chest), airway obstruction, loss of surface area for gas exchange and remodelling

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10
Q

O2 sats for COPD

A

Aim for 88-92%

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11
Q

What is Cor pulmonale?

A

a. A condition caused by long-term pulmonary hypertension that causes the right side of the heart to fail, due to alternating it’s structure and function
b. Complication of COPD

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12
Q

Treatment/management of COPD:

A
  • Bronchodilators: salbutamol, salmeterol, ipratropium, tiotropium
  • chest physio/rehab
  • O2 therapy
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13
Q

Gentamicin:

A
  • Class: aminoglycoside
  • Actions: inhibits protein synthesis causing cell death (bactericidal)
  • Indications: susceptible gram -ve, UTI, chest infection
  • Side effects: nephrotoxicity, ototoxicity, oliguria
  • nursing considerations: ensure adequate hydration, monitor for nephro- and oto-toxicity
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13
Q

Cefazolin

A
  • Drug class: cephalosporins
  • Actions: interferes with cell wall-building ability of bacteria when they divide
  • indication: infection, prophylaxis (surgery)
  • side effects: itchiness, heartburn, white patches in mouth
  • nursing considerations: Educate about importance of taking full dose, ensure adequate hydration, monitor for anaphylaxis
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14
Q

Penicillins

A
  • Actions: inhibits synthesis of cell wall, causing cell death (bactericidal)
  • Indications: prophylaxis for anthrax, helicobacter infections
  • Eg. amoxycillin
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15
Q

Tetracyclines

A
  • Action: inhibits protein synthesis in susceptible bacteria, preventing cell replication (bacteriostatic)
  • Eg. doxycycline
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16
Q

Factors to consider when selecting an injection site:

A
  • muscle mass
  • BMI
  • rotation of sites
  • type of medication being injected
  • condition of skin
  • person’s preferences
  • access to site
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17
Q

patchy consolidation involving more than one lobe:

A

bronchopneumonia

**lobar pneumonia is affecting one lobe

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18
Q

Visceral vs parietal pleura

A
  • Visceral pleura: delicate and lines the lungs
  • Parietal pleura: thicker and lines inner thoracic cavity
19
Q

Pleural space

A
  • Between visceral and parietal pleura
  • Approx. 20mL of serous fluid as lubricant
  • negative pressure
20
Q

Pneumothorax pathophysiology

A
  • A rupture in the visceral or parietal pleura causes air to leak into the pleural space
  • Air creates a separation between parietal and visceral pleura, disrupting the negative pressure in that space and causing the lung to collapse
21
Q

Types of pneumothorax

A
  • Closed: spontaneous, lung air enters because of disruption to visceral pleura
  • Open: outside air enters because of disruption to chest wall and parietal pleura
22
Q

Clinical manifestations of pneumothorax:

A
  • Dyspnoea
  • Chest pain
  • Increased RR
    No breath sounds over the affected area
23
Q

Diagnosis of pneumothorax

A
  • CXR: shows air in apices and partial collapse
24
Q

Treatment of pneumothorax

A
  • Depends on size & severity
  • Conservative management with repeat CXRs
  • ICC and UWSD
25
Q

Nursing care considerations of pneumothorax:

A
  • Full set of vital signs
  • respiratory assessment
  • end of bed test - full sentences?
  • pain assessment
26
Q

Most significant complication of a pneumothorax?

A
  • Tension pneumothorax
  • Pressure in the pleural space pushes against the already collapsed lung
  • air in pleural space pushes against mediastinum which displaces and compresses heart and great vessels, preventing pumping and leaving patient with no CO
27
Q

Pleural effusion pathophysiology:

A
  • Abnormal collection of fluid in the pleural space
  • Can be caused by increased capillary permeability due to inflammatory reactions due to infection or malignancy
  • Can also be caused by increased hydrostatic pressure in heart failure or decreased oncotic pressure in renal/liver disease
28
Q

Causes of pleural effusion:

A
  • heart failure: increased hydrostatic pressure, interstitial pulmonary flooding
  • pneumonia: inflammation/infection increases permeability of pleura
  • tumour: mechanically blocks lymphatic stoma that absorbs fluid back from pleural space
29
Q

Clinical manifestations of pleural effusion

A
  • pain: worse on inhalation
  • dyspnoea
  • tachypnoea
  • anxiety, stress, agitation
  • tachycardia
  • decreased AE on affected side
30
Q

diagnosis of pleural effusion

A
  • CXR
  • CT
  • ultrasound
31
Q

Treatment of pleural effusion

A
  • Treat underlying cause (eg. diuretics for HF, Abx for infection)
  • Conservative management
  • Chest drainage (ICC and UWSD)
32
Q

Nursing care considerations of pleural effusion:

A

a. Analgesia
b. Vital signs
c. Respiratory assessment to monitor for deterioration
d. ICC and UWSD management
i. Insertion site care
ii. Escort patient
iii. Hospital protocol
iv. Monitor output

33
Q
  1. Haemothorax
  2. haemopneumothorax
  3. empyema
A
  1. Collection of blood in pleural space
  2. collection of air and blood in pleural space
  3. pus in pleural space
34
Q

Placement of ICC for pneumothorax vs pleural effusion:

A
  • Pleural effusion = bases to drain fluid
  • Pneumothorax = apices to drain air
35
Q

Nursing care considerations for patients with ICC and UWSD

A
  • insertion site
  • vital signs
  • respiratory assessment
  • analgesia
  • mobilise
  • CXR
  • hospital protocols
  • escort patients
36
Q

Indications for tracheostomies:

A
  • overcome airway obstruction
  • facilitate mechanical ventilatory support
  • enable the removal of tracheo-bronchial secretions
37
Q

Manometer & cuff of tracheostomy

A
  • Manometer: measures pressure in the cuff
  • Cuff: pressure in the cuff secures it in place and prevents aspiration
  • too low pressure = dislodgement of cuff & tracheostomy, aspiration
  • too high pressure = irritation, inflammation and pressure injuries
38
Q

Potential negative side effects of suctioning with tracheostomy:

A
  • hypoxia (<10-15secs per suction)
  • tracheal mucosal damage
  • raised ICP
  • cardiac arrhythmias due to vagus nerve stimulation
  • hospital acquired pneumonia
  • anxiety
  • bronchospasm
    ONLY DO WHEN NECESSARY
39
Q

Adverse events with tracheostomy:

A
  • obstruction: caused by inadequate humidification causing sputum plug, suction & ventilate, MET/code blue
  • haemorrhage: problem with stoma, CODE BLUE
  • dislodged/removed tracheostomy tube: ventilate, Code blue, completely removed –> administer O2 via face mask
40
Q

Emergency equipment for tracheostomy patients:

A
  • Spare tracheostomy tubes
  • dilator
  • air-viva
  • 10mL syringe (for emergency cuff deflation)
  • functioning O2
  • function suction with Y-suction catheters
41
Q

Air for patients with a tracheostomy must be:

A

Humidified
- Air bypasses the nose and mouth which are usually responsible for humidification

42
Q

Which cannula of a tracheostomy must be removed and replaced each shift?

A

Inner

43
Q

What are the 3 sections of a UWSD system?

A
  1. Suction control chamber (wall suction -80mmHg)
  2. Underwater seal chamber (air leak visualised by bubbles, ideally decreases over time)
  3. Fluid collection chamber
44
Q

What is swing in a UWSD system?

A

Oscillation of the water in the underwater seal chamber with respirations

45
Q

Vancomycin

A
  • Drug class: glycopeptide
  • Actions: inhibit cell wall synthesis, preventing bacteria replication
  • indications: septicaemia, lower respiratory tract infection, bone infection
  • side effects: dysuria, ototoxicity, nephrotoxicity
  • nursing considerations: monitor for ototoxicity and nephrotoxicity

NUR5002 (10 decks)

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