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NUR 326 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

upper respiratory tract

A

nasal passages
Sinuses
Nasopharynx
Pharynx
Larynx
Tonsils
Glottis

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2
Q

Allergic rhinitis

A

inflammation of upper airway, lower airway, or eyes

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3
Q

Sx allergic rhinitis

A

sneezing
Rhinorrhea
Pruritus
Nasal congestion
Water, itchy eyes

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4
Q

Allergic rhinitis triggers

A

allergens – binds to IgE antibodies on mast cells to release, inflammatory mediators

Environmental Dash dust, mites, mold, pollen

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5
Q

histamine

A

Causes majority of symptoms with allergic reactions

Can be drug induced, food, or contact

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6
Q

Where is histamine stored?

A

mast cells – skin and soft tissue

Basophils– blood

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7
Q

What occurs when histamine is activated?

A

Hives and itching skin
Dilation of blood vessels
Erythema
Hypotension
Bronchoconstriction – SOA, wheezing
Affect sleep/wake cycles
Increased secretion of stomach acid

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8
Q

Upper respiratory infection – bacterial manifestations

A

White patches
Swollen tonsils
Red throat
Gray/furry tongue
Swollen uvula

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9
Q

Upper respiratory infection –viral manifestations

A

red/swollen tonsils and throat
No white patches

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10
Q

will antibiotics work against viral upper respiratory infections?

A

No, negative strep test

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11
Q

rhinitis

A

Common cold

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12
Q

how is rhinitis transmitted?

A

Droplet

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13
Q

sx rhinitis

A

Low-grade fever <104
Headache
Fatigue
Nasal congestion
Runny nose
Cough

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14
Q

sinusitis

A

Can occur as secondary infection

Anything in nose can increase risk

Reduces or blocks sinus drainage

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15
Q

rhinovirus

A

Cause for common cold

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16
Q

how is rhino virus spread?

A

Droplet
Contaminated objects

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17
Q

how long can run a virus live outside the body?

A

Up to three hours
Skin surface, objects

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18
Q

sx sinusitis

A

Pain above or below eyes
Cloudy, green or yellow discharge
Congestion
Throat, irritation

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19
Q

How is sinusitis treated?

A

difficult to treat
Fluids, decongestants, treat symptoms

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20
Q

pharyngitis

A

Inflammationinfection of pharynx

palate, tonsils, uvula

Bacterial or viral

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21
Q

how is pharyngitis diagnosed?

A

Culture and rapid, strep test

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22
Q

sx pharyngitis

A

difficulty swallowing
White patches (bacterial)
Redness (viral)

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23
Q

Laryngitis

A

inflammation of Larynx
(vocal cords)

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24
Q

sx laryngitis

A

Difficulty speaking
Scratchy/hoarse voice

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25
Q

croup

A

Inflammation of larynx, trachea and bronchi

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26
Q

Who is croup common in?

A

Children

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27
Q

Distinguisher’s of croup

A

Bark like cough
Strider breath sounds
Expiratory wheezing

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28
Q

Acute bronchitis

A

increased cough, and sputum production

Inflammation of bronchial tree

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29
Q

Is acute bronchitis, viral, or bacterial?

A

Viral

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30
Q

Influenza

A

viral infection
A, B, C types

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31
Q

sx influenza

A

fever
Chills
Body ache

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32
Q

are flu symptoms rapid, or slow onset?

A

Rapid

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33
Q

What can be deadly as a result of the flu?

A

Secondary conditions – pneumonia

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34
Q

sputum

A

Mucus secreted by respiratory tract

Traps particles that enter bronchioles

Cilia help move, mucus in captured particles out

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35
Q

normal sputum

A

Clear, whitish
thin

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36
Q

Infected sputum

A

Yellow, brown color

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37
Q

epiglottitis

A

Swelling of epiglottis

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38
Q

what blocks the trachea when swallowing?

A

Epiglottis

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39
Q

sx epiglottitis

A

Inspiratory stridor and retractions
Rapid onset, fever
Pain
difficulty swallowing
Drooling

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40
Q

what is the difference between croup and epiglottitis?

A

epiglottitis: The absence of a barking cough

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41
Q

what sign is indicative of epiglottal swelling?

A

Steeple sign

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42
Q

obstructive airway condition

A

Narrowed, causes airway obstruction

Worse on expiration

Causes increase work of breathing

Emptying of lungs is slowed

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43
Q

What kind of mismatch occurs in obstructive airway conditions?

A

Perfusion and ventilation

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44
Q

Air trapping

A

occurs when patient isn’t able to fully exhale

High carbon dioxide levels

Air is trapped in alveoli

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45
Q

what is seen on a chest x-ray for air trapping?

A

Lungs are hyperinflated

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46
Q

asthma

A

Chronic information of bronchial airways

Bronchial hyper responsiveness

Inconsistent airflow obstruction

Chronic disease state with acute exacerbations

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47
Q

is asthma reversible?

A

Yes

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48
Q

risk factors for asthma

A

Children
Allergies
Familia link
Level of allergen exposure
Urban residency
Exposure to indoor and outdoor pollution
Tobacco exposure/smoke
Recurrent respiratory viral infections

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49
Q

Pathophys of asthma

A

trigger factor
Airway inflammation
1- hypersecretion of mucus
2- airway muscle construction
3- swelling bronchial membranes
Narrow, breathing passages
Wheezing, cough, SOB, tight chest

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50
Q

what is the number one trigger of asthma?

A

Exertion from exercise

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51
Q

other triggers from asthma

A

Second hand smoke
Climate
Dust, pollen, pet dander

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52
Q

early asthmatic response

A

Immediate
Release of inflammatory mediators within minutes

Vasodilation
Increased capillary permeability
Mucosal edema
Smooth muscle contraction
Mucus secretions

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53
Q

late asthmatic

A

4 to 8 hours after early response
Another release of inflammatory mediators

Teach – keep meds nearby, identify triggers

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54
Q

What phase of asthma is irreversible?

A

Airway remodeling – chronic asthma

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55
Q

what is the number one symptom of an asthma attack?

A

Bronchoconstriction
Difficulty breathing

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56
Q

what is the biggest problem/seriousness of asthma?

A

Inflammation
Causes airway remodeling – long-term

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57
Q

diagnosis of asthma

A

History – allergies, recurrent, wheezing, episodes, exercise intolerance

Pulmonary function test **

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58
Q

sx of asthma

A

wheezing
Breathlessness, SOB
Cough
Chest tightness

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59
Q

sx severe asthma attack

A

Use of accessory muscles
Distant breath sounds
Sweating
Inability to speak

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60
Q

sx respiratory failure

A

inaudible breath sounds
Patient decline
Repetitive hacking cough

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61
Q

Status asthmaticus

A

unrelenting asthma attack
Life-threatening emergency
IV epi needed

pCO2 >70mmHg

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62
Q

chronic bronchitis

A

Hypersecretion of mucus and chronic, productive cough

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63
Q

timeline for chronic bronchitis

A

Three months for two consecutive years

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64
Q

acute bronchitis

A

Inflammation of bronchi and bronchioles
viral or bacterial

Usually better in 3 to 4 weeks

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65
Q

Chronic bronchitis cause

A

cigarettes
Positive airflow obstruction

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66
Q

s/sx chronic bronchitis

A

hypoxic
Overweight and cyanotic
Elevated hemoglobin
Peripheral edema
rhonchi and wheezing

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67
Q

dx chronic bronchitis

A

History – symptoms, physical exam, chest imaging, PFTs

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68
Q

pathophys of chronic bronchitis

A

inhaled irritants – airway inflammation
infiltration into bronchial walls
Increase in number and size of goblet cells

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69
Q

why can thick secretions not be cleared and chronic bronchitis?

A

Damaged cilia bronchial walls become inflamed

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70
Q

late sx of chronic bronchitis

A

Pulmonary hypertension
Syncope
Fatigue
Dyspnea

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71
Q

cor pulmonale

A

right sided heart failure
Late symptom of chronic bronchitis

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72
Q

does smoking cessation reverse, chronic bronchitis?

A

No, but can be halted
If smoking is stopped before symptoms, the risk decreases

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73
Q

emphysema

A

Abnormal, permanent enlargement of gas exchange airways

Destruction of alveolar walls

Obstruction from inflammatory and destructive changes in lung tissues

Loss of elastic recoil

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74
Q

Is emphysema destruction by tissue changes or mucus production?

A

Tissue changes

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75
Q

genetic emphysema

A

Inherited deficiency of enzyme, alpha – antitrypsin

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76
Q

s/sx emphysema

A

Gradual increase in breathlessness with exertion

Eventually, SOB at rest

Prolonged, expiratory phase

May become oxygen dependent

Wheezing, malnourished, decreased muscle mass, barrel chest, pursed, lip breathing, decreased breath sounds

77
Q

dx tests for emphysema

A

Pulmonary function test
FEV1
Chest x-ray
ABG
AP diameter

78
Q

signs of emphysema

A

Older and thin
Severe dyspnea
Quiet chest, diminished
Hyperinflated lungs with flattened diaphragms
Hypercarbonic

79
Q

pneumonia

A

Any type of infection in lower respiratory system

Causes inflammation of the lungs tissues

Alveolar air spaces filled with purulant, inflammatory cells and fibrin

80
Q

transmission of pneumonia

A

Inhaled, infectious droplets

81
Q

Who and when is pneumonia? More common in?

A

Winter
Men

82
Q

risk factors for pneumonia

A

Age extremes
Compromised immunity
Underlying lung disease
Alcoholism
Altered LOC
Impaired swallowing
Nursing home resident
Intubated, anesthesia, Immobile

83
Q

What is the most common cause of pneumonia?

A

Flu

84
Q

what are the age extremes for pneumonia?

A

<5
>70

85
Q

CAP

A

Community acquired pneumonia

most common reason for hospitalization

Easier to treat

86
Q

risk groups for CAP

A

Elderly
Healthy people with underlying disease

87
Q

HAP

A

Hospital acquired pneumonia

Developed within 48 hours after admin

ventilator associated pneumonia

88
Q

Which type of pneumonia is more violent and deadly?

A

Hospital acquired pneumonia

89
Q

risk groups for HCAP

A

Nursing homes
Hospitalization for chronic disease
Outpatients – dialysis, chemo

90
Q

pneumonia pathogenesis

A

aspiration of oral pharyngeal secretions

Inhalation of droplets containing bacteria/pathogens

91
Q

pathogenesis cont.

A

inflammation reaction stimulated in lungs – vasodilation

Goblet cells stimulated – mucus secreted between alveoli and capillaries

Decreased gas exchange

92
Q

main problem of pneumonia

A

Failure of mucociliary defense mechanism allows exudated fluid and inflammatory cells to invade alveoli

93
Q

what group of people have ineffective mucociliary clearance?

A

Smokers

94
Q

s/sx pneumonia

A

Preceded by URI – fever, chills, cough, malaise, plural pain, hemoptysis, dyspnea

95
Q

Bacterial cough with pneumonia

A

Productive/purulent
Green, rusty, red currant jelly
Gram negative in HAP

96
Q

viral cough pneumonia

A

Non-productive
CAP

97
Q

severe pneumonia cough

A

tachypnea
Respiratory distress and failure

98
Q

Respiratory distress

A

Increase in work of breathing

99
Q

Respiratory failure

A

can compensate for inadequate 02

Extra respiratory effort and rate

Circulatory and respiratory system collapse

100
Q

Diagnosis of pneumonia– physical exam

A

wet breath sounds – rhonchi
Pleuritic chest pain
Exercise intolerance

101
Q

pulmonary consolidations

A

Dullness due to percussion, inspiratory crackles, tactilefremitus, egophony

102
Q

diagnostic tests

A

chest x-ray – infiltrates
CBC – leukocytosis with bacterial
Positive sputum for C & S

103
Q

bacterial pneumonia

A

Gram positive staph

Enters the bloodstream through IV to lungs

HAP, MRSA

104
Q

What color is the sputum in bacterial pneumonia?

A

Brown, Rusty, colored tinge

105
Q

Are gram-positive or gram-negative more difficult to treat?

A

Gram negative
pseudomonas, klebsiella , acerietobacter

106
Q

Aspiration pneumonia

A

material from G.I. tract
Stimulates inflammatory reaction

107
Q

What does the severity of information in aspiration pneumonia depend on?

A

PH of aspirate

108
Q

What does a more acidic pH indicate?

A

Increased inflammation

109
Q

what type of inhibitor is given to decrease acidity of gastric contents?

A

Protein pump inhibitor

110
Q

Who is at risk for aspiration pneumonia

A

NG tube
Decreased LOC, gag, reflex, gastric, emptying

111
Q

viral pneumonia

A

Flu – most common cause of CAP

Adenovirus, RSV

Alters pulmonary immune defense – lungs vulnerable to secondary bacterial infection

112
Q

Pneumo-cytosis Carini

A

atypical pneumonia

HIV, transplant patients

yEast like fungus

113
Q

mycoplasma

A

Atypical “ walking “ pneumonia

Mild – complains of persistent, cough, headache, Ear ache

Bacterial and viral properties

114
Q

Legionella

A

gram-negative, atypical, pneumonia

Spread by water systems, old AC, mist sprayed on produce, hot tubs

115
Q

Aspergillus

A

A typical fungal pneumonia

Walls of old buildings, reconstruction, dead leaves, compost

116
Q

PCV 13 vaccine

A

Prevents pneumococcal caused by 13 strains of strep

117
Q

PPSV 23 vaccine

A

Prevents additional 23 types of pneumonia bacteria

118
Q

tuberculosis

A

Infection by mycobacterium

Aerobic bacillus – rod shaped, needs lots of oxygen to grow in proliferate

Granulomas in lungs – nodular accumulations

119
Q

transmission of tuberculosis

A

Humans, cattle, birds

Airborne droplets- tubercle bacilli

120
Q

is tuberculosis slow or fast growing?

A

Slow growing
Harder to treat

121
Q

latent TB

A

Infected bacilli are isolated in granulomas

Remain dormant for life

No clinical signs or symptoms of disease

122
Q

when can TB be reactivated

A

HIV
Immunosuppression meds
Poor nutritional status
Renal failure

123
Q

Active TB

A

symptoms develop gradually –
Fatigue, weight, loss, lethargic, anorexia, low-grade fever, productive, cough, night sweats, anxiety

Fever in afternoon

124
Q

extra pulmonary TB

A

Decrease in neuro function
Meningitis symptoms
Bone pain
Urinary problems

125
Q

Screening for high risk populations

A

IGRA blood test

126
Q

screening for non-high-risk populations

A

TB skin test

127
Q

what to do if positive result

A

Confirm through sputum stain & culture

Chest x-ray – granulomas

128
Q

Who is affected by drug resistant TB

A

HIV community
Homeless, undernourished, substance users, cancer, patients, immuno, suppressed, people, living in crowded/poor sanitation housing

** Asian and Hispanic

129
Q

drug resistant TB

A

MDR – TB

130
Q

how is MDR-TB TREATED

A

Second line drugs

131
Q

Hemoglobin

A

carries oxygen
Iron is center of him unit

binds to: carbon monoxide, glucose

132
Q

anemia

A

Not enough RBC to bind or deliver to tissues

Low RBC

133
Q

what is anemia caused by?

A

Blood loss
Low nutrition
Defective hemoglobin
Bone marrow disorders
Chronic diseases

Iron deficiency
Maturation disorders
Bleeding

134
Q

what indicates more red blood?

A

High SPO2

135
Q

Absolute anemia

A

not enough RBC
Decrease in number

136
Q

Relative anemia

A

delusional
Increase in plasma volume

Pregnancy, fluid, volume overload, athletes

137
Q

polycythemia

A

Too many RBC

138
Q

dehydration

A

Decrease in plasma volume

139
Q

s/sx anemia

A

Pale
Fatigue quickly
Increased heart rate and respiratory rate

140
Q

s/sx of mod-severe anemia

A

Increased RR and HR
Hypotension
Pallor
Faintness
Angina with exertion

141
Q

s/sx of mild anemia

A

May have none

142
Q

s/sx of mild-mod anemia

A

Fatigue
Weakness
Tachycardia
Dyspnea

143
Q

abnormal hemoglobin anemia

A

Increased rate of destruction
Decreased lifespan

Sickle cell disease
Thalassemia

144
Q

is the count or shape abnormal for hemoglobin?

A

Shape

145
Q

Sickle cell disease

A

inability to bind to hemoglobin normally

HGBS distorts shape

146
Q

when cells Sickle, they clump together and block blood flow where?

A

Liver
Spleen
Heart
Kidneys
Retina

147
Q

Thalassemia

A

genetic, defective hemoglobin
Destroyed in bone marrow or spleen

148
Q

How is hemoglobin classified?

A

Size and shape of RBC

149
Q

what indicates a lower MCV?

A

Microcytic anemia
Decreased iron
Sickle cell disease

150
Q

what indicates a higher MCV?

A

Vitamin B 12/folate deficiency
Macrocytic, anemia

151
Q

what is the most common cause of anemia?

A

Iron deficiency

152
Q

causes of iron deficiency

A

Decreased intake
Decreased absorption
Increased demand – pregnancy
Excessive loss – bleeding

153
Q

what drinks can decrease absorption of iron?

A

Coffee and tea

154
Q

s/sx iron deficiency

A

Epithelial atrophy
Brittle hair and nails
Spoon nails - koilonychia
Smooth tongue
Mouth sores
Dysphasia
PICA

155
Q

koilonychia

A

spoon nails

156
Q

PICA

A

craving of non-food
Pagophagia- craving and chewing ice, clay, starch, dirt

157
Q

Causes of folate deficiency

A

Decreased intake – alcoholism, diet, liver disease

Increase need – pregnancy

158
Q

vitamin B 12 deficiency

A

Intrinsic factor needed for absorption in terminal ileum

159
Q

conditions that decrease intrinsic factor or reduce absorption of vitamin B 12

A

Gastric bypass
Gastrectomy
Bowel resection

160
Q

neuro s/sx B12 deficiency

A

depression
Paranoia
Confusion
Anger/irritable
Anxiety
Balance issues
Memory loss

161
Q

decreased number of circulating erythrocytes

A

Chronic kidney disease – impaired erythropoietin production

162
Q

aplastic anemia

A

Primary condition of bone marrow stem cells

Pancytopenia

163
Q

Causes of a plastic anemia

A

idiopathic – unknown
High-dose exposure to toxic agents – radiation, chemicals, insecticides, chemo
Auto immune – viral, hepatitis, mono

164
Q

Acquired hemolytic anemia

A

premature destruction of RBC by external agents

165
Q

causes of acquired hemolytic anemia

A

Auto immune
Blood incompatibility
Drug reactions
Severe burns

166
Q

hemolytic anemia

A

Formation of immune complex- leads to lysis

167
Q

What to look for in hemolytic anemia

A

Low hemoglobin
Increased reticulocyte count
Mild jaundice
Bloody urine
Decreased haptoglobin

168
Q

blood loss anemia

A

Results from: gross, occult

Acute/rapid loss – unable to compensate

Slow loss – body able to compensate

169
Q

Chronic blood loss

A

slower rate, insidious
Body able to compensate
Maybe asymptomatic
G.I. bleed, erosion

170
Q

what organ should you watch for with chronic blood loss?

A

Heart
Brain
Lungs
Kidneys

171
Q

10% blood loss symptoms

A

Rarely any, syncope

172
Q

20% blood loss symptoms

A

None at rest
Increased heart rate with exercise

173
Q

30% blood loss symptoms

A

flat neck veins when supine
Increased heart rate with exercise
Decreased blood pressure with sitting up/standing

174
Q

40% blood loss symptoms

A

increased heart rate, decreased blood pressure when supine
Air hungry, clammy skin

175
Q

50% blood loss symptoms

A

Shock and death

176
Q

Relative polycythemia

A

isolated decrease in plasma volume
Increased, hemoglobin, hematocrit, RBC

177
Q

causes of relative polycythemia

A

Severe dehydration
Smokers

178
Q

primary polycythemia

A

Polycythemia vera
>60 years old
Overproduction of blood cells
Easy blood, clotting, thick blood

179
Q

is primary polycythemia benign or malignant

A

Malignant
Neoplastic disease, uncontrolled proliferation
Precursor to leukemia

180
Q

s/sx primary polycythemia

A

Headache
Fatigue
Dyspnea
Weight loss
Hypertension
Clotting problems
Rudy color/redness

181
Q

Pathogenesis of primary polycythemia

A

Single stem cell mutate into sell that over produces all blood cells

182
Q

cause of secondary polycythemia

A

Adaptive compensatory response to tissue hypoxia

183
Q

purpose of secondary polycythemia

A

Provide more oxygen carriers by increasing RBC production

184
Q

Who is at risk for polycythemia?

A

COPD
Chronic hypoxia
Living at high altitudes – chronic mountain disorder
Long-term smoking
Genetic predisposition
Long-term exposure to carbon monoxide – tunnel worker, high levels of pollution, garage attendants

185
Q

pathogenesis of secondary polycythemia

A

Hypoxemia, long-term
Stimulation of erythropoietin in kidneys
Increased RBC production

186
Q

Increased blood viscosity and volume consequences

A

HTN. – headache, inability to concentrate, Rudy, cyanosis in lips, nails, mucous membrane.

187
Q

decrease blood flow consequences

A

DVT
Hemorrhage
Angina
Cerebral insufficiency, stroke

188
Q

Hypermetabolism consequences

A

Night sweats
Weight loss

189
Q

increased RBC, H&H consequences

A

Pruritus
Pain in fingers and toes

NUR 326 (32 decks)

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