Respiratory Flashcards
1
Q
Define
Interstitial Lung Disease
A
Umbrella term used for a large group of diseases that cause pulmonary fibrosis (scarring)
2
Q
Two most common presenting symptoms of Interstitial Lung Disease
A
- Dry hacking cough
- Dyspnea (trouble breathing)
3
Q
What are five possible causes of Interstitial Lung Disease?
A
- idiopathic fibrosis (25%)
- AIDS (lupus, sarcoidosis, rheumatoid arthritis)*
- Side effects of medications of treatment (radiation)
- Connective tissue dysfunction
- Occupational hazards (asbestos)
conditions that cause systemic inflammation
4
Q
What may be clarifying questions to ask a patient if you suspect ILD r/t medical treatment?
Interstitial Lung Disease
A
- Have you ever had cardiovascular issues (Amiodarone)?
- Have you experienced radiation therapy?
- Do you have a Hx of UTIs (nitrofurantoin)?
5
Q
Define
Hypoxemia
A
Low O2 in the blood
6
Q
- Can ILD be treated?
- What medications are indicated?
Interstitial Lung Disease
A
- ILD is non-reversible
- Cough suppressants and Anti-Fibrotic agents
7
Q
What is the main difference b/w obstructive and restrictive pulmonary Dx?
A
- Obstructive pulmonary diseases have increased residual volume.
- Restrictive pulmonary diseases have decreased inspiratory capacity.
8
Q
- What diseases are considered obstructive?
- Define increased residual volume.
A
- COPD and Asthma
- Struggle to get air out
9
Q
- What diseases are considered Restrictive?
- Define Decreased inspiratory capacity
A
- Pulmonary fibrosis (ILD)
- Trouble pulling air in.
10
Q
How is residual volume or inspiratory capacity measured?
A
Pulmonary Function Tests (PFT) through spirometry
11
Q
A client is scheduled to have a series of pulmonary function tests (PFTs). For which med should the nurse anticipate an order to withhold six hours prior to the test?
A
Bronchodilators (albuterol)
opens airways can skew results from normal baseline
12
Q
What is COPD?
A
group of diseases commonly bronchitis + emphysema that cause airflow blockage and breathing-related problems
13
Q
Define
Bronchitis
A
Inflammation of bronchioles and and mucus accumulation
14
Q
Define
Emphysema
A
condition in which alveoli are damanged and enlarged causing air trapping and breathlessness
15
Q
What positions would you recommend for COPD?
A
- Tripod
- High-fowlers
16
Q
What are the 4 recommendations for meals/nutrition in regards to COPD
A
- Clear airways before eating
- Small meals
- nutrient dense and protein diet
- stay hydrated
17
Q
What oxygen would you administer to a COPD patient?
A
Low-Flow oxygen
18
Q
Why is a COPD patient kept at 88 to 92% SpO2?
A
COPD patient may have lost the bodies normal breathing trigger to elevated CO2 levels, because the body has adapted to COPD hypercapnia. These COPD patients are now triggered to breathe by low O2 (hypoxemia) which is counteracted w/ high SpO2.
19
Q
What is the ratio for pursed-lipped breathing?
A
1:2
Inspiratory:Expiratory
(Prolong exhalation & increase airway pressure to open airway during exhalation to reduce trapped air)
20
Q
What would be indicated for patients w/ COPD that cannot expectorate their own mucus
A
nasotracheal suction
21
Q
What two changes are recommended in daily activities for a patient w/ COPD?
A
- Alternative activity w/ rest
- Stress reduction
22
Q
What physiological changes are seen w/ COPD and Asthma vs ILD?
interstitial lung disease
A
- Chronic airtrapping from COPD and Asthma can cause barrel chest*
- Clubbing is often seen w/ ILD. Can be seen in late stages of COPD.
A-P to Transverse diameter = 1:1
23
Q
What are the common symptoms of COPD? (Many listed)
A
- Wheezing
- Productive cough
- Weight-loss (r/t expending calories from cough)
- Frequent respiratory infections (r/t trapped sputum)
- Fatigue
- Dyspnea and Orthopnea
- Clubbing (late stage)
24
Q
How is the cough distinguished b/w COPD and ILD?
interstitial lung disease
A
COPD will have productive cough due to bronchitis
25
Why should COPD patients avoid physical activity in the morning?
Time of day when sputum production is highest
| Stasis of sputum overnight while sleeping
26
What adventitious sound is heard w/ asthma?
Inspiratory and expiratory wheezing
27
What are the two characteristics of asthma?
1. Airway inflammation
2. Bronchial hyper-responsiveness
**additionally wheezing, coughing
28
Which medication for obstructive pulmonary disorders can cause tachycardia as a side effect?
Methylxanthines
| *Theophylline (Theo-Dur) or aminophylline*
29
What are the 4 common type of medications for obstructive pulmonary disorders?
1. Bronchodilators
2. Corticosteroids
3. Mucolytics
4. Antibiotics*
| For secondary infections that's happened
30
What patient education is given after steroid inhaler use?
Rinse mouth to prevent fungal infection (*thrush*)
31
What are the 3 types of bronchodilators?
1. B2 Adrenergic **agonist**
2. **Anti**-cholinergic (Ipratropium bromide (Atrovent)
3. Methylxanthines
32
Why would a RR setting on a ventilator be changed
Change in settings to compensate acid/base imbalances
33
What is the common suffix for Corticosteroids?
-sone
34
What are the long-acting inhalers for obstructive pulmonary disorders?
Corticosteroids
35
How should the nurse instruct the client to take quick-relief and long-acting inhalers together?
Take the short-acting first; wait 5 mins to allows for airways to open then take long-acting inhaler.
36
What pain relief is used during a bronchoscopy?
| (same considerations with laryngoscopy)
* Conscious sedation
* Topical anesthesia in the mouth and throat
37
What are the 4 ventilator settings?
1. Fraction of inspired oxygen (**FiO2**)
2. Positive end expiratory pressure (**PEEP**)
3. RR
4. Tidal Volume (**VT**)
38
What is the purpose of the PEEP setting on a ventilator?
Pressure needed to keep the alveoli open after **expiration** (help keep airways from collapsing)
| Helps facilitate gas exchange.
39
What must be kept at the bed side for a ventilated patient?
Ambu-bag
| Risk of ventilation failing
40
What 3 patient education is provided post-procedure for bronchoscopy?
1. Risk for aspiration (*start w/ ice cubes*)
2. Hoarseness
3. Bleeding (*pinkish sputum*) is normal
41
Frequent swallowing after bronchoscope/rhinoplasty is an indicator for?
active bleeding at surgical site
42
# define
Hypercapnic
elevation of CO2 levels
43
What ventilator setting may be changed if a patient is hypercapnic?
Temporary increase in RR.
44
What are 4 indicators for a patient to be put on a ventilator?
1. Unable to meet oxygen demand (*e.g., ARDS*)
2. Cardiac/Respiratory Arrest
3. Hemodyanamically unstable* (*e.g., shock*)
4. Surgery (*e.g., CABG*)
| when there's unstable BP, which cause inadequate blood flow to organs.
45
What is SIMV?
| Synchronized intermittent mandatory ventilation
Ventilator mode that allows patient to fully initate breaths and the machine serves as a backup.
46
Which ventilator mode involves the machine controlling all the patients breaths?
Controlled Mode
47
What causes **low** pressure alarms on the ventilator?
* Air leaks due to disconnection of system or patient
48
What is the most appropriate response when a patient is coughing up copious secretions when intubated?
Suction the client
49
What four interventions should be done after intubation has been placed?
1. Note the placement (*cm*) of the tube at the lip
2. Assess breath sounds
3. Bilateral chest expansion
4. Pulse Oximetry
50
How is an endotracheal tube placement confirmed?
Chest x-ray
51
What two interventions should be done daily for endotrachael patients?
1. Move the tube from lip to other side (*prevents lip sores*)
2. Change the inner canula
52
What infections are patients on ventilators at risk for?
pneumonia
53
What 4 interventions can prevent ventilator associated pneumonia?
1. HOB 30-45 (semi-fowlers)
2. Oral care
3. Prophylaxis for PUD*
4. Sedation titration
| ulcerations can lead to esophageal reflux causing aspiration into lungs
54
What is a common s/sx would you expect for an elderly client w/ an infection?
Change in mental status
(*LOC, confusion, etc*)
55
What are 3 common signs of pneumonia?
1. Productive cough (*rust-colored, green*)
2. Tachypnea
3. Tachycardia
56
What is the main reason for a patient to recieve a tracheostomy instead of endotrachael?
trach is if the patient requires a longer term mechanical ventilation.
57
What should the nurse do before suctioning a trach patient?
**Hyper**oxyinate
(SpO2 drops during suctioning)
| If they are on a ventilator can push a button to give them puffs of O2
58
Why is hydration recommended for effective airway clearance?
Thins secretions
59
* When should humidification be added with oxygenation?
* Why is it humidification important?
* Once 4 L of oxygen is used
* Prevents nose from drying out
60
What three events are chest tube indicated for?
1. Pneumothorax
2. Pleural effusion
3. post cardiac surgery
61
What is the difference b/w pleura effusion and pulmonary edema?
* Pleura effusion is fluid accumulation in the parietal space;
* Pulmonary edema is fluid accumulation in the lungs.
62
What does water bubbling in chest tube chamber indicate?
Air leak
63
When pressing on a patients skin and feeling bubble wrap or rice Krispies it is indicative of what?
SubQ emphysema
64
# Define
* SubQ emphesema
* What can cause it?
* when air gets into tissues under the skin.
* Risk after thoracentesis
65
What should be done if a chest tube falls out?
Put Vaseline gauze on hole of the patient; than call provider
66
What is an abnormal change that requires provider notification w/ a chest tube?
A significant change in the **quantity or quality** of output
E.g., change in color from serosanguineous (*yellowish; scans amt of blood*) to sanguineous (*bloody red*)
67
# Define
Refractory hypoxemia
Persistent low SpO2 even when O2 is given
68
What is the treatment for ARDS?
Oxygen support through intubation (*endotracheal tube or tracheostomy *)
69
What position should a patient be w/ thoracentesis?
Tripod position - patient sitting upright and leaning slightly forward with arms supported
70
What treatment is indicated for pulmonary edema?
Diuretics
| NOT thoracentesis
71
During thoracentesis, **sanguineous** drainage suggests the presence of ____, while **purulent** drainage suggests ____.
1. Sanguineous (*blood red*) = **hemothorax**
2. Purulent (*white, yellow, brown fluid*) = **Infection - empyema**
72
How is a pneumothorax diagnosed?
Chest x-ray
73
What are three possible treatments for Pneumothorax?
1.O2 support for small pneumos
2.Needle decompression
3.Chest tube
74
What are the 2 main symptoms of pneumothorax?
(Additional sx listed)
**1. Diminished/absent sounds on the affected side
2. Uneven chest expansion**
3. SOB, pain, decreased SpO2, altered breathing pattern.
75
# define
Flail chest
Trauma to chest that causes 3+ broken ribs into two more places
76
Paradoxical rise and fall of the chest is a sign of what?
| Breathe in chest falls on affected side instead
Flail chest
77
What is the treatment for flail chest?
**Chest binder** to reduce movement and allow for healing over time
78
Difference between pneumothorax and atelectasis?
Pneumothorax = Collapsed lung
Atelectasis = complete or partial collapse of a alveolar sacs
79
What is the difference in pressures b/w closed, open and tension pneumothorax?
* Closed pleural cavity < atmospheric
* Open pleural cavity = atmospheric
* Tension pleural cavity > atmospheric
80
# Define
Cystic Fibrosis
genetic disorder that causes excessive thick and sticky mucus production
| most letal gentic in white americans
81
How is cystic fibrosis Dx?
* Through genetic testing or
* sweat test (**Cl > 60** meq/L)
82
What are the top 2 nursing interventions for Cystic Fibrosis?
1. Chest PT
2. Infection prevention
83
What are the two infection prevention methods for patients w/ cystic fibrosis?
1. Isolation (Neutropenic precautions)
2. Prophylactic abx
84
What are the three main infectious organisms that CF patients are at risk for?
1. Multi-Drug resistant Pseudomonas
2. MRSA
3. Nontuberculous mycobacteria (NTM)
85
What is the purpose of an Allen test?
Ensure patency of both arteries* in the wrist.
| radial and ulnar
86
What 4 measures does ABG take?
(2 other ones too but not relevant right now)
1. PaO2
2. pH
3. PaCO2
4. HCO3
87
# Normal values for ABG
1. PaO2
2. pH
3. PaCO2
4. HCO3
1. PaO2 = 80 to 100 mmHg
2. pH = 7.35 to 7.45
3. PaCO2 = 35 to 45
4. HCO3 = 22 to 26
88
What changes in ABG are associated w/ respiratory **acidosis**?
Low pH (< 7.35)
High CO2 (> 45)
89
What changes in ABG are associated w/ respiratory **alkalosis**?
High pH (> 7.45)
Low CO2 (< 35)
90
What intervention should a nurse perform for a client with acute respiratory alkalosis?
Have patient breath into paper bag
91
What changes in ABG are associated w/ metabolic **acidosis**?
Low pH (< 7.35)
Low HCO3 (< 22)
92
What changes in ABG are associated w/ metabolic **alkalosis**?
High pH (> 7.45)
High HCO3 (> 26)
93
Hypoventilation and heavily sedated patients are associated w/ which ABG disorder?
Respiratory acidosis
94
Hyperventilation is associated w/ which ABG disorder?
Respiratory alkalosis
95
Diarrhea, kidney failure, or liver failure is associated w/ which ABG disorder?
metabolic acidosis
| HCO3 expelled in stool
96
Vomiting and excess diuretics is associated w/ which ABG disorder?
metabolic alkalosis
| Vomiting stomach acids; loss of H+, leaving behin alkaline environment.
97
Four Non-Pharmalogical Nursing Interventions to Clear airway
1. Suctioning
2. Chest PT
3. Respositioning
4. Promote mobility
98
How long can a patient tolerate 100% O2 for w/o serious tissue damage?
24 to 48 hours
99
* Define Blebs
* What are they associated with?
* **small collection of air** between the lung and the outer surface of the lung (visceral pleura) usually found in the **upper lobe of the lung**.
* When a bleb **ruptures** the air escapes into the chest cavity causing a **spontaneous pneumothorax**
100
What is the difference in pressure between the atmospheric space and pleural space of lungs?
Pleural space is 4 mmHg < atmospheric
101
What would the nurse suspect to be administered before intubating a patient?
Paralyzing and sedating agents
102
What intervention may be required if the patient is biting or fighting the endotrachial tube?
Increase sedation
103
Which pneumothroax is associated w/ death in young atheletics
Spontaneous pneumothroax
