Respiratory Flashcards

1
Q

wherer is the lower respiratory tract found?

A

in the lungs

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2
Q

what is the paranasal sinus?

A

4 airfilled cavities that drain into the nasal cavity

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3
Q

what does the paranasal sinus serve as?

A

crumple zone (protectz against trauma)

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4
Q

what can be damaged during a trach suction?

A

the carina

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5
Q

what does the pulmonary circulation of the lungs do?

A

provides lungs with blood for gas exchange

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6
Q

what does the bronchial circulation of the lungs do?

A

provides oxygen to the lungs

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7
Q

where is the mediastinum and what does it hold?

A

middle of the thoracic cavity
holds the heart, aorta, and esophagus

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8
Q

what happens when the pleura is inflammed or irratated?

A

causes pain so it will hurt to breath

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9
Q

what is pleural effusion?

A

accumulation is fluid between the lungs and the chest

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10
Q

what happens if there is a block or problem with the lymphatic circulation?

A

fluid will build up (pleural effusion)

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11
Q

what is empyema?

A

purulent fluid with bacterial infection during pleural effusion

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12
Q

injury to the phrenic nerve results in what?

A

hemidiaphragm paralyiss
c3 and c5: mechanical ventilation

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13
Q

what mechanisms are used to get rid of bacteria?

A

filtration of air
mucocilary clearance
cough reflex
relfex bronchoconstriction
alveolar macrophage

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14
Q

what are the general manifestations of respiratory diease?

A

sneezing/coughing
speutum discharge
altered breathing
cyanosis
pleural pain
friction rub
clubbed fingers
ABG changes

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15
Q

what can cause clubbing?

A

hypoxemia
cystic fibrosis
bronchiectasis

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16
Q

what can cause barrell chest?

A

COPD
asthma
cystic fibrosis

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17
Q

what is viscosity?

A

state of being thick or sticky

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18
Q

what does a throat swab do?

A

differentiates between bacteria and virus

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19
Q

what does a nasal swab do?

A

RSV

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20
Q

if a patients trachea is deviated to one side, what does the nurse do?

A

immediate intervention
monitor for hypoxia

could cause tension pneumothorax

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21
Q

what is tension pneumothorax?

A

continuous entrance of air into the pleura which compresses the lungs, heart, and chest
Life threatening

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22
Q

what is the procedure for a thoracentesis?

A

patient sits upright
leaned on overbed table
clean skin
apply lidocaine
percutaneous cathetar inserted for drainage of fluid

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23
Q

what is epistaxis?

A

nosebleed

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24
Q

what is a kiessalbach plexus?

A

source of the nose bleed

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25
Q

what does the nurse do for a pateint with an anterior epistaxis?

A

patient in sitting position
lean slightly forward with head
apply pressure by squeezing nostrils for 5-15min
reassure the pateint

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26
Q

what can prolong bleeding time for epistaxis?

A

anticoagulants
aspirin
NSAIDS
Warafrin

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27
Q

what is the difference between an anterior and posterior epistaxis?

A

anterior is a random nose bleed
posterior is post nasal surgery

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28
Q

What does the nurse do for a patient with posterior epistasis?

A

Nasal packing (tampon or ballon) for 2-6 days
ATB
Pain meds

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29
Q

What does the urse teach a patient who is post op nasal surgery?

A

Sleep in upright position
Apply ice
Brush teeth softly
Avoid sneezing/ blowing nose
Avoid heavy lifting or straining
Take acetimophen not NSAIDS

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30
Q

What is required for a posterior epistasis?

A

Packing (baloon or rapid rhino)

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31
Q

What is allergic rhinitis?

A

Inflamation of nasal mucosa in response to a specific allergy

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32
Q

What is an episodic allergic rhinitis?

A

Exposure to an allergy not typically encountered in a pateints normal enviroment

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33
Q

What is intermittent allergic rhinitis?

A

Symptoms are present less than 4 days a week ot less than 4 weeks per year

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34
Q

What is persistant allergic rhinitis?

A

Symptoms last more than 4 days a week and for more than 4 weeks per year

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35
Q

What is perennial rhinitis?

A

Year-round
Exposure to dust, animals, fungi, molds

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36
Q

What happnes during allergic rhinits?

A

Increased capillary permebility and inflammatory response after exposure

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37
Q

What are the symptoms of allergic rhinitis?

A

Rhinorrhea- thin, watery, nasal drainage
Irrated sclera
Chapped lips/ dry mouth
Pale and edematous nasal mucosa
Congestion
Watery eyes
Sneezing
Nasal voice change

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38
Q

What are the diagnostics for allergic rhinitis?

A

Nasal smear for underlying cause
Allergy testing

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39
Q

What type of medications are given for allergic rhinitis?

A

Antihistamines
Decongestants
Intranasal corticosteroids
Eye drops
Saline nasal spray

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40
Q

What does the nurse teach a patient with allergic rhinitis?

A

Avoid trigger of allergen
Reduce symptoms
Proper use of nasal sprays
Diary of allergic reactions

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41
Q

What is viral rhinitis?

A

Common cold
Nasopharyngitis

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42
Q

What accounts for majority of colds?

A

Rhinovirus

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43
Q

What percaution are patients with viral rhinitis on?

A

Droplet
Extremely contagious

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44
Q

What are the symptoms of viral rhinitis?

A

Tickling of throat
Fever
Congestion
Runny nose
Sneezing
Hoarsness
Cough

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45
Q

Why do you give antihistamines to a pateint with viral rhinitis?

A

To releive sneezing

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46
Q

What is the treatment for viral rhinitis?

A

No cure or ATB
Topical decongestants (OTC nasal spray)

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47
Q

If symptoms of viral rhinittis last for 7 days, what should the pateint do?

A

Call doctor
Could have bacteria
Get ATB

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48
Q

When is flu season?

A

September- April

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49
Q

What is infliuenza A?

A

Most common and most sever
Can infect animals and humans
- Avian and Swine

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50
Q

What is influenza B?

A

Only humans
Can lead to regional epidemic

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51
Q

What is influenza C?

A

Very mild
Only humans
Does not lead to epidemics

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52
Q

How does influenza spread?

A

Droplet
Contact
Inhalation

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53
Q

What are the symptoms oof influenza?

A

Couch
Fever
Myalgia
HA
Sore throat
N/V

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54
Q

What are the common complications of influenza?

A

Pneumonia
Ear/ sinus infections

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55
Q

What medications are given for influenza?

A

Antivirals
- Symmetrel (Amantadine)
- Flumadine (Rimantadine)
- Relenza (zanamivir)
- Tamiflu (oseltamivir)

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56
Q

What medication is used for influenza A?

A

Adamantanes
- amantadine
-rimantidine

Educate oon insomnia

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57
Q

What is acute sinitis?

A

Prolonged nasal congestion
Viral or bacterial

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58
Q

What is used to diagnose acute sinusitis?

A

CT/ X-ray
Occipito water view- xray of sinus to detect congestion

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59
Q

What are the symptoms of acute sinusitis?

A

Tender sinus
Purulent nasal draininage
Nasal obstruction
Congestion
Fever
HA
Halitosis

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60
Q

What is the common fungal infection with chronic sinusitis?

A

Aspergillus Fumigates

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61
Q

What are the symptoms of chronic sinusitis?

A

Hard to diagnose
Facial pain
Dental pain
Increased drainage
Patients with asthma
4-6 weeks

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62
Q

What diagnostic test are used for chronic sinusitis?

A

Red mucosa with purulent drainage
Nasal swab for culture
Nasal endoscopy
CT

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63
Q

What types of medication is given for chronic sinusitis?

A

ATB for 4-6 weeks
Topical decongestants (no longer than 3 days)
Intranasal steroid
Oral corticosteroid

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64
Q

What surgery can be used for chronic sinusitis?

A

Caldwell Luc to drain the sinus

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65
Q

What teaching is given for treatment of sinusitis?

A

Rest
Warm shower/compress
Hydration
ATB
Netipot
Avoid smoking

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66
Q

What are the medications for sinusitits?

A

Amoxicillin
Bactrim (Sulfonamide)
Eryhromycin- Macrobid
Cephalosporins
Cipro and Levaquin

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67
Q

what do you need before administering amoxicllin?

A

creatinine clearance

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68
Q

when do you take amoxicllin?

A

1 hr before meals or 2 hours after meals

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69
Q

when do you take eryhromycin?

A

1 hour before meals or 2 hours after meals
avoid grapefruit juice
watch for hepatic impairment

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70
Q

what do you avoid when taking cipro and levaquin?

A

dairy and calcium

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71
Q

what are antihistamines used for?

A

allerfy control

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72
Q

what are the first generation H1 receptor antagonist?

A

Diphenhydramine (Benadryl)
Chlorpheniramine (Chlor-trimeton)

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73
Q

what are the second generation H1 receptor antagonist?

A

Fexofenadine (Allegra)
Cetirizine (Zyrtec)
Bratadine (Claritin)

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74
Q

what are H1 receptors?

A

antihistamines

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75
Q

what is loratadine (claritin) used for?

A

seasonal allergic rhinitis
Urticaria (hives)

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76
Q

what can cause rebound congestion?

A

nasal decongestants

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77
Q

what are antitussives used for?

A

to suppress dry, hacking cough

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78
Q

what are non-narcotic antitussives?

A

Dextromethorpan (Delsym)
Benzonatate (Tessalon)

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79
Q

wha are the narcotic antitussives?

A

codeine and hydrocodone

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80
Q

what do expectorants do?

A

treats productive wet coughs

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81
Q

what are the expectorants?

A

Guaifenesin (Robitussin or mucinex)

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82
Q

what are the inranasal corticosteroids used to treat?

A

Rhinitis

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83
Q

what are the decongestants?

A

Pseudoephedrine (sudafed)
Oxymetazoline (Afrin)

dont use more than 3 days

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84
Q

what are nasal polyps?

A

soft painless and beign
can impair breathing

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85
Q

what do the pharygeal walls consist of?

A

tonsils
palate
uvula

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86
Q

what are most acute pharangitis infections?

A

viral

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87
Q

what are the complications of acute pharyngitis?

A

peritonsillar cellulitis and abscess
otitis media
pneumonia
rheumatic fever
post streptococcal glomerulonephritis

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88
Q

what are the symptoms of acute pharyngitis?

A

sore scrathcy throat
painful swallowing
fiery red pharynx and tonsils

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89
Q

what are the symptoms of bacterial acute pharyngitits?

A

fever
lymph node enlargement
tonsil exudate
absence of cough

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90
Q

how do you diagnose acute pharyngitis?

A

rapid strep test
throat culture

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91
Q

what is the treatment for bacterial pharyngitis?

A

PCN
Cephalosporins and macrolides

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92
Q

how do you treat fungal pharyngitis?

A

Nystatin for thrush

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93
Q

where is nyastatin excreted?

A

in the feces

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94
Q

what is a peritonsillar abscess a complication of?

A

tonsillititis

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95
Q

what are the signs of a peritonsillar abscess?

A

high fever
chills
leukocytosis
dif. swallowing
muffled voice

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96
Q

where are laryngeal polyps and what can cause them?

A

on vocal cords
-excess talking
-singing
-intubation
-smoking

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97
Q

what are the signs of laryngeal polyps?

A

hoarsness ‘dysphagia
dyspnea
stridor

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98
Q

what is the treatment of laryngeal polyps?

A

voice rest and hydration

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99
Q

what is acute laryngitis?

A

inflammed voice box

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100
Q

what are the symptoms of acute laryngitits?

A

tingling or burning in back of throat
in need to clear throat
hoarsness or lose voice

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101
Q

what is the prep for a bronchoscopy?

A

NPO for 4-8 hr
give bronchoddialator
review CBC and bleeding times

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102
Q

what is the surgical treatment for an airway obstruction?

A

Tonsillactomy
UPPP
Genioglossal advancement
Hyoid Myotomy
RFA

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103
Q

what do you give if an airway obstruction is due to an allergic reaction?

A

Epinephrine or corticosteroids

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104
Q

what does a tracheostomy do?

A

bypass airway obstruction
removal of secretions
long term ventilation
- allows for oral intake and speech
facilitate weaning from a ventilator

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105
Q

what is a cuffed trach tube used for?

A

if a pateint is at risk for aspiration or on a ventilator

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106
Q

what is an uncuffed trach tube used for?

A

long term managemnet
these pateints can talk and eat

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107
Q

what do you use to verify cuff pressure of a trach and how often?

A

manometer
evry 8 hours

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108
Q

what are the requirments to change a trach?

A

keep replacement tube at bedside
do not change for the first 24 hr
- physician does the 1st tube change

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109
Q

what do you do is the trach is accidentally dislodged?

A

spread openeing by grasping retention sututews or with a hemostat
insert obturator into replacement tube
lubricate with saline
insert at 45 degree angle
remove obturator

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110
Q

when is trach tubing normally changed?

A

7 days

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111
Q

what do you do if a trach tube cannot be replaced?

A

cover stoma with sterile dressing
ventilate with a bag mask

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112
Q

what should you assess for with a deflated trach cuff?

A

aspiration

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113
Q

intitally after insertion of a trach, what is given for speeech?

A

paper and pencil

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114
Q

what do you assess in an elderly pateint with a trach?

A

self care abilities
- dexarity
-ROM
- cognitive function
-vision

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115
Q

what do you clean a trach stoma with?

A

NS

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116
Q

what is completed every shift for a trach?

A

assesment for infection
Clean in
sterile pre cut dressing
suction airway
trach collar changed

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117
Q

what is head and neck cancer?

A

squamous cell carcinoma

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118
Q

where is the supraglottic area?

A

above true vocal cords and below the tounge

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119
Q

what is the glottis area?

A

true vocal cords

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120
Q

what are symptoms of head and neck cancer?

A

hoarsness
sore throat
coughing up blood
dif. swallowing
otalgia-ear pain
weight loss
dif. breathing

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121
Q

what do you asses for head and neck cancer?

A

oral cavity
tounge floor
palpate lymph nodes

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122
Q

what is used to detect head and neck cancer?

A

laryngoscope
CT/MRI
PET to stage it

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123
Q

what can a cordectomy lead to?

A

partieal- hoarsness
total- no speech

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124
Q

what will the patient have after a hemilaryngectomy?

A

trach and NG tube for 2 weeks
voice will be hoarse

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125
Q

what is required after all head and neck cancer surgeries?

A

extensive rehab due to dif swallowing

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126
Q

what is a total laryngectomy done for?

A

invasive stages of head and neck cancer

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127
Q

what will a patient have/need after a total laryngectomy?

A

permanent trach
permanent altered speech
permanent breathing dif
rehab for voice restoration

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128
Q

What is a patient at high risk for after a total laryngectomy?

A

Lung infections due to dry air

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129
Q

What can happen after a total laryngectomy?

A

Saliva leak
Fistulas
Stenosis of the stoma

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130
Q

Why is a pateint placed in smei fowlers after a surgical treatment for head and neck cancer?

A

to decrease edema and limit tension on sutures

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131
Q

what do you do when radiation causes dry mouth?

A

Xerostomia
give artifical saliva
increase fluids
‘chew sugar free gum

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132
Q

if radiation causes oral irritation, what should the pateint eat?

A

bland soft rich foods
protein
eggs
nutbutters
soy
tofu
dairy
poultry
fish

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133
Q

what does apatient need to avoid when doing radiation therapy?

A

Toast
lotions
sun exposure

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134
Q

what can chemotherapy cause?

A

fatigue
anorexia
taste alteration

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135
Q

when must flu antivirals be given?

A

within 2 days of symptoms

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136
Q

what are complications of acute sinusitis?

A

osteomyeltitis
bacterial mengitis
brain abscess

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137
Q

what can trigger acute bronchitits?

A

viruses
air pollution
dust
inhalation of chemicals
smoking
chronic sinusitis
asthma

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138
Q

what are the symptoms of acute bronchitis?

A

cough
clear mucous secretions
HA
fever
malaise
hoarsness
dyspnea
chest pain

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139
Q

what are the diagnosis of acute bronchitis based on?

A

crackles and wheezes on expiration and exertion
consolidation (fluid in lungs) is absent
chest x ray is normal

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140
Q

what is given for the treatments of bronchitis?

A

cough suppresents
increase oral intake
humidifier
inhalers for wheezing
avoid smoke

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141
Q

if bronchitits is caused from influenza, how do you treat it?

A

give antivirals
-zanamivir
-oseltamivir

if within 48 hours of symptoms

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142
Q

what do you not give for bronchitis?

A

oxygen

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143
Q

what is pertussis?

A

whooping cough

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144
Q

what vaccine needs to be given for pertussis?

A

booster for Tdap over 19

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145
Q

what is stage 1 of pertussis?

A

Catarrhal
-occurs in the first 2 weeks of infection
-spreads easily by direct contact or respiratory droplets from cough

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146
Q

what are the symptoms of the catarrhal stage of pertussis?

A

mild upper respiratory symptoms
low grade fever
runny nose
wattery eyes
non-productive cough

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147
Q

what is stage 2 of pertussis?

A

paroxysmal
2nd to 10th week of infection

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148
Q

what are the symptoms during the paroxysmal stage of pertussis?

A

extreme cough thats painful

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149
Q

what is stage 3 of pertussis?

A

Convalescent
last 2-3 weeks
less severe cough and weakness

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150
Q

what is the hallmark sign of pertussis?

A

uncontrollable, violent cough
-inspiration after a cough produces a whooping sound bc of the obstructed glottis

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151
Q

what do you treat pertussis with?

A

antibiotics (macrolides-erythromycin)

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152
Q

what should not be used in the treatment of pertussis?

A

cough suppresants
antihistamines
corticosteroids
bronchodialators

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153
Q

pneumonia affects oxygen transport, which can cause what?

A

hypoxia
- taachypnea
-dyspnea
-tachycardia
consolidation (fluid in the lungs)
increase mucous production

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154
Q

how long should a patient with community acquired pneumonia (CAP) be on isolation?

A

after 48 hours on antibiotic and fever free for 24 hours

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155
Q

if community acquired pneumonis is suspected, what is started?

A

emperic ATB therapy
-initiate treatment before definitive diagnosis

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156
Q

who is at risk for aspiration pneumonia?

A

anesthsia
head injurt
stroke
alcohol intake
NG/feeding tubes

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157
Q

what is necrotizing pneumonia?

A

complication of bacterial pneumonia
-causes immediate respiratory insuffciency/failure, leukopenia, and bleeding into airways

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158
Q

what is oppurtunistic pneumonia?

A

infection/inflammed lower respiratory tract in immunocompromized pateints
-malnutrition
-HIV
-radiation/chemo
-long term corticosteroid

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159
Q

what are the symptoms of pneumonia?

A

fever
cough
chills
dyspnea
tachypnea
pleuritic chest pain

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160
Q

what are the symptoms of pneumonia in older pateints?

A

confusion
stupor
hypothermia

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161
Q

what is a good indication of pneumonia?

A

crackles

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162
Q

what are the complications of pneumonia?

A

atelactasis
pleurisy
pleural effusion
bacteremia
pneumothorax
meningitis
acute respiratory failure
sespsis
lung abscess
empyema

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163
Q

what does a pateint need if they have empyema?

A

antibiotics

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164
Q

how should tou draw blood cultures for pneumonia if patient has sepsis?

A

draw from 2 different sites

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165
Q

what can you use to diagnose pneumonia?

A

chest xray
thoracentesis/ bronchoscope to obtain fluid samples
speutum sample
ABG
CBC

166
Q

what is the drug therapy for pneumonia?

A

macrolides (erythcomycin)
Fluroeoquinolones (Levofloxacin)
ATB ( amoxicillin, ceftin)

merrem
maxipime
zosyn
linezolid
vancomycin

167
Q

what is the prevention od pneumonia?

A

turn/reposition every 2 hours
encourage and assist ambulation
strict adhearance to vent patients
HOB 30 degrees
Assess for gag reflex before giving food or fluids

168
Q

what should you teach a patient with pneumonia?

A

appropriate ATB use
rest/hydrate
avoid alcohol and smoke
cool mist humidiifer
follow up chest x ray

169
Q

how is TB spread?

A

through the air after long exposure
cannot be spread through kissing, sharing utensils, or physical contact

170
Q

what is the primary TB infection?

A

bacteria is inhaled and initiate inflammatory response

171
Q

what is a latent TB infection?

A

positive TB test but no symotoms
cannot transmit TB to others but can develop active TB
use mono therapy drugs

172
Q

what is an active TB infection?

A

contagious
body cannot contain organism

173
Q

what are used to diagnose TB?

A

TB skin test
Interferon-Y release assay (blood test)
chest xray
Bacteriologic studies (speutum)

174
Q

what is the mantoux test?

A

TB skin test
intradermally
read in 48-72 hours

175
Q

what are the 2 types of blood test?

A

Quantiferon
T-spot

176
Q

what are the bacteriologic studies?

A

3 consecutive speutum specimins
different days

177
Q

what are the symptoms of TB?

A

dry cough
fatigue/malaise
anorexia/ wt loss
afternoon low grade fever
NIGHT SWEATS

178
Q

what are the symptoms of TB in older adults?

A

flu-like
cognitive changes

179
Q

what is milary TB?

A

fever
cough
lymphadenopathy
hepatomegaly
splenomegaly

180
Q

what is pleural TB?

A

chest pain
fever
cough
unilateral pleural effusion

181
Q

what meds are given for TB during the 2 month initial phase?

A

Isoniazid
Rifampin
Pyrazinamide
Ethambutol

182
Q

if a patient is admitted with TB what should the nurse do?

A

airborne isolation (pulmonary and larygeal TB)
place in a negative presure and airflow room
ensure chest xray, speutum, and culture is ordered
HEPA mask is worn on nurse
Pt must wear a standard isolation mask if leaving the room

183
Q

what can reactivate TB?

A

immunosuprreive therapy
malignancy
prolonged debilitating events

184
Q

what should a patient avoid when taking isoniazid?

A

alcohol

185
Q

what patient can not take pyrazinamide?

A

preganant women

186
Q

what does the nurse need to assess for in a pateint taking isoniazid?

A

hepatitis
-anorexia
-nausea
-fatigue/malaise
-jaundice

187
Q

before giving meds for TB what labs need to be assessed?

A

AST
ALT
billirubin

188
Q

what can rifampin cause?

A

orange secretions

189
Q

what can pyrazinamide cause and what needs to be assessed?

A

gout
labs for liver every 2 weeks

190
Q

what is the latent TB treatment ?

A

Isoniazid daily 6-9mon
OR
isoniazid and rifampin 1 time a week for 3 mon
OR
rifampin daily for 4 month

191
Q

what is the endimic pulmonary fungal pneumonia?

A

occurs in healthy and immunocompromised pateints
Histoplasmosis: spores in ground from birds and bats
Coccidioidomycosis: soil
Blastomycosis: soil

192
Q

what is oppurtunistic pulmonary fungal pneumpnia?

A

occur only in immunocompromized
yeast
aspergillosis: mold
cryptoccosis

193
Q

what is pulmonary fungal pneumonia?

A

acquired by inhalation of spores
no isolation required

194
Q

how do you diagnose pulmonary fungal pneumonia?

A

skin test
serology
biopsy

195
Q

what is the drug therapy for pulmonary fungal pneumonia?

A

antifingals
-amphotericin B
-ketoconazole
-fluconazole
-voriconazole
-itraconazole

196
Q

what is amphotericin B?

A

only used in serious fungal infections
IV for 4-12 weeks
-multiple organ failure
-cardiac/respiratory arrest

197
Q

what do you need to monitor for when giving amphotericin B?

A

nephrotoxcitiy
hypokalemia

198
Q

what meds are given for fungus?

A

zole

199
Q

what is a lung abscess?n

A

necrosis of lung tissue
-enlarging infection
-necrosis
-forms cavity filled with purulent drainage

200
Q

what can cause lung abscess?

A

bacteria aspirated from oral cavity
IV drugs
malignancy
TB
pulmonary emboli

201
Q

What can lung abscess lead to?

A

Necrotizing pneumonia

202
Q

What are the symptoms of a lung abscess?

A

Cough with purulent speutum
Hemoptysis
Fever/chills
Prostration (exhaustion)
Pleuritic pain
Dyspnea
Anorexia/ weight loss

203
Q

Whats the difference between anaerobic bacterua abscess and aerobic bacteria abscess?

A

Anaerobic develop slowly
Aerobic resemble bacteria pneumonia

204
Q

What is used to diagnose lung abscess?

A

Chest xray shows air filled fluid and infiltrate
CT
speutum sample
Bronchoscopy
Pleural fluid
Blood cultures
CBC will show increase in neutrophils

205
Q

What should the nurse monitor for with a lung abscess?

A

Vitals
LOC
Respiratory signs of hypoxia

206
Q

What does the nurse administer for lung abscess?

A

Oxygen
ATB
-start with parenteral clindimycin
-express need to complete all ATB

207
Q

What is pneumoconiosis?

A

Group of lung diseases caused by inhlation and retention of mineral/dust particles

208
Q

What are the different pneumoconisis?

A

Coal miner (black lung): pulmonary fibrosis
Chemical pneumonitits (Silo filler)
Hypersensitivity pneumonitis (bird fancier or farmers lung: inhales antigens thats allergic
Asbestosis

209
Q

What are the symptoms of pneumoconosis?

A

May not occur for 10-15 years
-dyspnea
-cough
-wheezing
-wt loss

210
Q

What are the complications of pneumonconiosis?

A

COPD
Lung cancer
TB

211
Q

What is the pt teaching for pneumoconiosis?

A

Protective equipment
-mask
-ventilation system
-decrease 2nd hand smoke

212
Q

What is given to improve respiratory symptoms of pneumoconiosis?

A

Oxygen
Inhaled bronchodialtors
Percussion therapty
Pulmonary rehab

213
Q

What is the difference of treatments for bronchitits and pertussis?

A

Bronchitis give cough suppresants and increase oral fluid intake
Pertussis give ATB and do not give antihistamine or cough suppresants

214
Q

what are the most common causes of lung cancer?

A

increased levels of pollution
radiation
absestos
TOBACCO smoke
heavy and prolonged exposure to industrial agents

215
Q

when getting a history of a patient with lung cancer, what would you ask?

A

occupation
radiation hx
smoke hx
asbestos

recommend no smoking

216
Q

how long foes it take to detect a primary lung tumor?

A

8-10 years to be 1cm (detectable)

217
Q

what are the 2 types of lung tumors?

A

nonsmall cell lung cancer (NSCLC)
small cell lung cancer (SCLC)

218
Q

what is paraneoplastic syndrome r/t lung cancer?

A

when the body produces hormones and enzymes from the tumor that destroy healthy cells
most common in SCLC

219
Q

what can paraneoplastic syndrome cause?

A

hypercalcemia
SIADH
adrenal hypersecretion
polycythemia
cushings

220
Q

what are the symptoms of lung cancer?

A

persistant cough
dyspnea
wheezing
bloody speutum
chest pain

221
Q

what are the diagnostic studies for lung cancer?

A

chest x ray: first
chest CT: location and lymph involvement
speutum studies: identify malignant cells
Biopsy: definitive diagnosis
-CT with guided needle
-bronchoscopy
-mediastinoscopy
-VATS

222
Q

what do you assess for in a patient who had a biopsy by a bronchoscopy?

A

decreased cough and gag reflex

223
Q

what is used to stage lung cancer?

A

CBC
Chemistry panel
liver, renal, and pulmonary function test
MRI/PET

224
Q

what system is used to stage NSCLC?

A

TNM
Tumor size
Node lymph involvement
Metasis

225
Q

what is the difference between limited and extensive SCLC?

A

limited if confines to 1 spot in the chest
extensive extends beyond the limited stage

226
Q

what surgical treatment for lung cancer is for cancer that is near the outside of the lung?

A

VATS

227
Q

surgery is not indicated for which type of lung cancer?

A

SCLC bc it is rapidly growing and invasive

228
Q

why is radiation used for lung cancer?

A

relieve symptoms of dyspnea and hemoptysis
control pain
used pre op to reduce size of tumor

229
Q

what are the complications of radiation therapy for lung cancer?

A

esophagitis
skin irritation
N/V
anorexia
radiation pneumonitits

230
Q

what is the primary treatment of SCLC?

A

chemotherapy

231
Q

what is the immunotherapy used for?

A

metasis of NSCLC
-Nivolumab (opdivo)
-Pembrolizumbab (keytruda)

232
Q

what should the nursing care/ education be for lung cancer?

A

smoke prevention
decrease pollution exposure
ambulatory care
teach s/s to report

233
Q

what signs of lung cancer should a pateint report?

A

hemoptysis
dysphagia
chest pain
hoarsness

234
Q

what is the difference in a blunt trauma and a penetrating trauma to the chest?

A

blunt is when the chest strikes ot is struck by something
Penetrating is an injury where a foreign object impales through body tissues (open wound)

235
Q

what is the most common type of chest injury caused from blunt trauma?

A

fractured ribs

236
Q

what are the symptoms of fractured ribs?

A

pain on inspiration
atelectasis and pneumonia can develop

237
Q

what is given to decrease pain due to fractered ribs?

A

NSAIDS

238
Q

what can result from fractered ribs?

A

flail chest

239
Q

what can flail chest cause?

A

paradoxical chest movement
-movement in opisite direction
-impairs gas exchange and hypoxemia

240
Q

what are the symptoms of flail chest?

A

rapid, shallow respirations
tachycardia
pt may splint chest while breathing

241
Q

what is the difference in an open and closed pneumothorax?

A

open is when air enters through opening in the chest wall
closed is when this happens but no external wound

242
Q

what is a spontaneous pneumothorax?

A

rupured blebs

243
Q

what are spontantious pneumothorax caused from?

A

COPD
asthma
cystic fibrosis
pneumonia

244
Q

what are the symptoms of a spontaneous pneumothorax?

A

sharp side pain
c/o that they cant breath
dyspnea
hyperesinence during percussion
absence of breath sounds

245
Q

what happens to air during a pneumothorax?

A

air enters pleural cavity causing postivie pressure which collapses lung

246
Q

what is an iatrogenic pneumothorax?

A

occur due to laceration or puncture during a medical procedure

247
Q

what is a tension pneumothorax?

A

air enters pleural space and cannot escape

248
Q

what can cause a tesion pneumothorax?

A

open chest wound
resescitative efforts
mechanical ventilation
clamped or blocked chest tube

249
Q

what is a hemothorax?

A

accumulation of blood in the pleural space

250
Q

what do you do for a hemothorax?

A

immediatly insert chest tube to evacuate blood

251
Q

what is a chylothorax?

A

presence of lymphatic fluid in pleural space
milky, white, fluid with high lipids

252
Q

what is the treatment for a chylothorax?

A

drain chest
bowel rest
diet modifications

Octreotide can decrease fluid production

253
Q

what is the emergency treatment of a pneumothorax?

A

cover wound with an acclusive dressing that is secures on 3 sides (vented dressing)
-vasoline

254
Q

what are the different sized chest tubes used to drain?

A

Large: 36-40 blood
Medium: 24-36 fluid
Small: 10-14 air

255
Q

what is used to evacuate air for a small pneumothorax?

A

flutter valve (heimlich)

256
Q

what is the suction control chamber?

A

applies negative pressure
-should have continuoes bubbling

257
Q

what is a water sealed chamber for a chest tube?

A

should be tidaling at all times
-no continuous bubbling bc if it is it means an air leak
-if tidaling has stopped it means the lungs have re expanded or there is a blockage

258
Q

where shoukd the chest tube stay below and why?

A

below the chest to keep negative pressure

259
Q

when a chest tube is being removed what does the nurse do?

A

instrict pateint to take a deep breath and hold it

260
Q

when should the drainage from a chest tube be assessed?

A

hourly for the first 8 hours
then every 8 hours

261
Q

what could a crackling sensation when palpating around the chest tube indicate?

A

subq emphysmesa from an air leak

262
Q

what is the difference between a median sternotomy and a lateral thoractomy for a thoractomy procedure?

A

median splits sternum (heart)
lateral is used for lung surgeries

263
Q

what is the preop care for chest surgery?

A

PFT
chest xray
ABG, BUN, CBC, creatnine, glucose
PT/INR, aPTT,

264
Q

what is the post op care for a chest surgery?

A

pain management
assess respiratory status
assess chest tube function and drainage
observe surgical site

265
Q

what is restrictive respiratory disorders?

A

they impair abilities of chest wall and diaphragm to move with respiration

266
Q

what is the hallmark sign of restrictive respiratory disorders?

A

decreased total lung capacity (TLC)

267
Q

what are the symptoms of atelectasis?

A

dyspnea
increased HR and RR
chest pain

268
Q

what are the symptoms of pleurisy?

A

abrupt, sharp pain with inspiration
shallow and rapid breathing

269
Q

what is the treatment of pleurisy?

A

NSAIDS/ analgesics
splinting

270
Q

what is transudate pleural effusion?

A

clear, pale, yellow, protein and cell poor fluid

271
Q

what is transudate pleural effusion caused by?

A

increased hydrostatic pressure
decreased oncotic pressure

272
Q

what is exudative pleural effusion?

A

results from increased capillary permability
-infection
-malignancy

273
Q

what are the symptoms of pleural effusion?

A

dyspnea
cough
occasional sharp non radiating chest pain (worse on inspiration)
decreased movement of the chest
dull percussion
diminished breath sounds

274
Q

what is the treatment of pleural effusion?

A

thoracentesis
-limit fluid removal to 1000-1200ml
-tripod position

275
Q

if more than 100-1200ml of fluid is taken during a thoracentesis what can happen?

A

hypotension
hypoxemia
re expansion of pulmonary edema
shock

276
Q

what is idopathic pulmonary fibrosis?

A

interstitual lung disease
chronic inflammation and scarring

277
Q

what can cause idiopathic pulmonary fibrosis?

A

smoking
wood/metal dust

278
Q

what are the symptoms of idiopathic pulmonary fibrosis?

A

exertional dyspnea
clubbing
dry, non productive cough

279
Q

what is the gold standard diagnostic of idiopathic pulmonary fibrosis?

A

VATS

280
Q

what is the treatment of idiopathic pulmonary fibrosis?

A

corticosteroids (prednisone)
methotrexate
cyclosporine

long term:
- kinase inhibitors
Ofev
Esbriet

very poor prognosis

281
Q

what is sarcoidosis?

A

an interstitual lung disease

282
Q

what are the symptoms of sarcoidosis?

A

dyspnea
cough
chest pain

283
Q

what are the diagnostics of sarcoidosis?

A

PFT
CT
xray

284
Q

what is the treatment for sarcoidosis?

A

supress inflamation

285
Q

what are the symptoms of pulmonary edema?

A

cough
orthopnea
rales
frothy speutum
pt feels like they are drowning

286
Q

what will be elevated with a pulmonary embolism?

A

troponin levels and BNP

287
Q

what is the prevention of a pulmonary embolism?

A

anticoagulants for 3 month then a follow up
ted hose every day (DVT prophylaxis)
teach s/s of bleeding and PE re occurance

288
Q

what are the signs of a re occurance of a pulmonary embolism?

A

SOB
chest pain
Increased anxiety
feeling of impending doom

289
Q

what is the treatment for a pulmonary embolism?

A

Heparin (enoxapair) starts at diagnosis
Warafrin for 3 mon

290
Q

what do you use for a pulmonary embolism if anticoagulants are contradicted?

A

inferior vena cava filter

291
Q

what does the nurse do for a patient with a pulmonary embolism?

A

semi-fowler
o2
cardiopulmonary status (vital)
Monitor:
-ABG
-PT/INER
-aPTT

292
Q

what is pulmonary hypertension and its level?

A

increase artery pressure from increase blood flow through pulmonary circulation

normal: 12-16

293
Q

what are the 5 categories of pulmonary hypertension?

A
  1. meds, disease, genetic
  2. left sided heart failure
  3. lungs and hypoxia
  4. cardiovascular and thromboembolic occlusion
  5. unclear with hematoligic or metabolic involvement
294
Q

what are the symptoms of idiopathic pulmonary arterial hypertension (IPAH)?

A

SOB on exertion
chest pain
dizziness
syncope
abnormal heart sounds

295
Q

what are the diagnostics for pulmonary hypertension?

A

right side cardiac cathetar
-no cure
-only treat symptoms

296
Q

what is secondary pulmonary arterial hypertension caused by?

A

primary disease

297
Q

what are the symptoms of secondary pulmonary arterial hypertension?

A

dyspnea
fatigue
chest pain
signs of right ventricle failure

298
Q

what is cor pulmonale?

A

enlarged right ventricle

299
Q

what is cor pulmonale caused from?

A

COPD

300
Q

what is the sign and treatment of cor pulmonale?

A

high s2 (dub) sound
no cure only oxygen

301
Q

if heart failure accompanies cor pulmonale, what will the symptoms be?

A

peripheral edema
wt gain
distended neck veins
full bounding pulse
enlarged liver

302
Q

what is present if cor pulmonale is secondary to COPD?

A

polycycthemia (increased RBC)

303
Q

what indicated a lung transplant?

A

COPD
idiopathic pulmonary fibrosis
Idiopathic pulmonary hypertension
Cystic fibrosis
antirypsin deficency

304
Q

what is the post op care for a lung transplant?

A

ICU
monitor for:
-venous thromboembolism
-diaphragmatic dysfunction
-malignancy
-infection
-acute rejection

305
Q

what is the discharge teaching for a lung transplant?

A

keep log pf meds, lab levels, and spirometer uses

306
Q

what are the triggers of asthma?

A

air polluntants
allergen inhalation
drugs
food additivies
occupational exposure
viral or bacterial infections

307
Q

what is the early phase response of asthma?

A

runny nose
itching
brochial spasms/airway narrowing
mucous production

occurs 30-60 min of exposure to allergens

308
Q

what are the symptoms od asthma?

A

wheezing
cough
dyspnea
chest tightness
runny nose, hives, eczema

309
Q

what is not used to gauge severity of an asthma attack?

A

wheezing

310
Q

what is status asthmaticus?

A

extreme form of asthma that can result in
hypoxia
hypercapnia
acute respiratory failure

311
Q

what do you do if a patient is suspected of status asthmaticus?

A

intubate and mechanical ventilate immediatly

312
Q

what are the diagnostics for asthma?

A

H&P
spirometry and peak expiratory flow rate
oximetry level
chest xray

313
Q

how often should a metered does inhaler (MDI) be cleaned?

A

2x per week
use SABA first (bronchodialators)

314
Q

what is a neubulizer for asthma?

A

mist of a drug
high risk for bacteria due to mositure

315
Q

what can OTC inhalers (primatene) do?

A

relieve bronchospams (epinephrine and Guaifensin)

but can cause:
anxiety
heart palpatations
increase BP
tremors

316
Q

what is the pt teaching for asthma?

A

avoid triggers
explain URI and sinusitis symptoms to prevent asthma exerbation
fluid intake 2-3L/day
nutrition and rest
immunotherapy can decrease sensitivitiy to allergy

317
Q

what interventions for asthma are used to decrease anxiety and pain?

A

pursed lips breathing
abdominal breathing

318
Q

in what order do you give asthma meds?

A

AIM
albuterol
Ipratropium
methoylprednisone (solu-medrol)

319
Q

if a pateint with asthma had a sudden drop in wheezing, what needs to happen?

A

mechanical ventilate immediatly and listen to lungs

320
Q

what do bronchodialtors do?

A

relieves cheezing
first choice meds to relieve acute asthma

321
Q

what are the classes for bronchodialators?

A

beta adrenergic agonist
anticholingers
xanthine derivities

322
Q

what are the 3 types of beta adrenergicagonist (bronchodialtor)?

A

nonselective agrenergic drugs (epinephrine)
nonselctive betaagrenergic drugs (metaproterenol)
selective beta 2 drugs (albuterol)

323
Q

what can beta adrenergic agonist be used to treat?

A

bronchial asthma
bronchitis
hypotension and shock use epinephrine

324
Q

what are the adverse effects od bronchodialators?

A

heart palpatations
tremors
GI distress
increase urination

325
Q

what beta adrenergic agonist are used for quick relief or short acting relief of asthma?

A

albuterol (proventil)
salmetrol (serevent diskus)

326
Q

what do anticholinergics do?

A

relax and dialate airway
prevent bronchospasms with COPD
not to manage acute symptoms

327
Q

what is the most common anticholinergic?

A

Ipratropium

328
Q

what do xanthine deritivies do?

A

bronchodialation by increasing levels of cAMP
asthma and COPD

329
Q

what is the most common xanathine deritive?

A

Theophylline

330
Q

What do you need to avoid when taking a xanthine deritive (Theophylline)?

A

Caffeine
Charcoaled broiled foods
High protien and low carbed foods
Smoking
Oral contraceptives
Flu vaccine

331
Q

What do you give if a pt overdoses on theophylline?

A

Activated charcoal

332
Q

What are the non bronchodialating respiratory drugs?

A

Leukotriene receptor antagonist
Corticosteroids
Mast cell stabalizer

333
Q

What are leukotriene receptor antagonist given for?

A

Long term treatment of asthma
Redice vascular permeability
Prevent acute asthma attakcs

334
Q

What is the leukotrine receptor antagonist?

A

Montelukast (singulair)

335
Q

What do corticosteroids do?

A

Long term meds for asthma
Decrease mucus
Decrease airway mucosa edema
Repairs epiltheim damage
Reduce airway reactivity

336
Q

What is used in acute exerbation of asthma or COPD?

A

Iv corticosteroids

337
Q

What can corticosteriods cause?

A

Increase glucose levels
Addisonian crisis

338
Q

What are the corticosteriods?

A

Flutlcasone proplponate
Methyprednisone (solu-medrol)
Beclomethasone
Budesonide (pulmlcort)

339
Q

What are the different flutlcasone proplonate?

A

Flonase
Flovent
Adavair: flutioasone w/ salmetrol

340
Q

What can budesonide (pulmicort) and fluticasone cause?

A

Osteopenia and osteoporosis

341
Q

What is used as a prophylatic treatment of asthma?

A

Bedomethasone daily
Mast cell stabalizer

342
Q

What is a common mast cell stabalizer?

A

Cromoyln (nasalcrom)

343
Q

What is the difference in COPD and emphysema?

A

You have to have COPD to get emphsyema, but just because you have COPD does not mean you will get emphysema

344
Q

What is emphysema?

A

Destruction of the alveoli

345
Q

What are the risk factors for COPD?

A

Smoking
Occupational chemicals
Air pollution
Infection
Genetics
Aging
Asthma

346
Q

What is the main characterisitc of COPD?

A

Inability to expel air
Leads to barrell chest

347
Q

What can COPD cause?

A

Hypoxemia
Hypercapnia
Destroy alevoli
Formation of blebs

348
Q

what diseases is a pt more likely to get if they have COPD?

A

CVD
Cachexia (skeletal muscle wastin)
osteoporosis
diabetes
metabolic syndrome

349
Q

what can the use of accesory muscles with COPD mean?

A

right sided heart involvement

350
Q

what are the symptoms of COPD?

A

chronic intermittent cough
dyspnea on exertion
heavy chest, and air hunger (gasping)
wheezing
increased RBC
Paroxysms (suden attack) of coughing can fracture ribs

351
Q

what are the complications of COPD?

A

cor pulmonale
recurrent exerbations
acute respiratory failure

352
Q

what should a pateint get if they have COPD?

A

yearly flu vaccine
pneumonia vaccine
stop smoking

353
Q

if a pateint has COPD and cor pulmonale results, what was the cause?

A

pulmonary hypertension
chronic hypoxia
polycythemia
-right sided heart failure eventually develops

354
Q

what are the symptoms of COPD if cor pulmonale develops?

A

increased BNP
distended neck veins
hepatomegaly
peripheral edema
wt gain
increase pressure on R side cardiac cath

355
Q

what can you see w/o asking that indicates a COPD exerbation or acute respiratory failure?

A

tri pod position
altered mental status
cant speak withoput getting out of breath
onset HA

356
Q

oxygen needs to be what with COPD?

A

humidified

357
Q

what are the comoplications of 02 therapy?

A

combustion: no smoke or flames
o2 tocicity
infection: clean equipement

358
Q

what are the airway clearance techniques?

A

huff coughing
chest physiotherapy: percussion
pursed lips: slows breathing rate

359
Q

what should the diet be for COPD?

A

increase protein and fat
moderate carb
5-6 small meals a day
rest and take a bronchodialtor before eating

360
Q

what should a pateint with COPD be taught?

A

AMBULATE
erectile dysfunction can occur
SLEEP

361
Q

what is cystic fibrosis?

A

autosomal recessive altered transport of sodium and chloride
mucous dehydrates and adheres to airways

362
Q

what finding can diagnose cystic fibrosis in newborns?

A

meconium illeus

363
Q

what are the symptoms of cystic fibrosis?

A

wheeze, cough, pneumonia
malnutrition
steattorhea
bronchitis
right lowere quadrant pain (DIOS)
dealayed puberty

364
Q

what is the gold standard test for cystic fibrosis?

A

sweat chloride test

365
Q

what are positive expiratory devices that help airway clearance?

A

flutter device
acapella

366
Q

what type of vitamins does a pt with cystic fibrosis need?

A

fat soluable

367
Q

what needs to be added to meals with cystic fibrosis?

A

salt

368
Q

what is bronchiectasis?

A

abnormal dialation of airways

369
Q

what are the symptoms of broncheictasis?

A

persistant cough with thick, tenacious, purulent speutum
wheezing
chest pain
clubbing
dyspnea
anemia

370
Q

what is the hallmark sign of bronchiectasis?

A

wheezing

371
Q

what teaching should you give for COPD if smoking is not reported?

A

a1-antitrypsin

372
Q

what is the difference btwn hypoxemic and hypercapnic?

A

hypoxemic is not enough oxygen
hypercapnic is to much co2

373
Q

what can casue hypoexemic respiratory failure?

A

V/Q mismatch
Shunt
diffusion limitation
alveolar hypoventilation

374
Q

what is V/Q mismatch?

A

when the volume of blood around the lungs and the amount of gas reaching the alveoli are not identical

375
Q

what can cause a v/Q mismatch?

A

increased secretions in airway
bronchospasms
pain
atelactasis
PE

376
Q

how do you treat a V/Q mismatch?

A

oxygen then treat the cause

377
Q

what is a shunt?

A

occurs when blood exits heart without gas exchange
no oxygen in blood

378
Q

what is the treatment for a shunt?

A

mechanical ventialtion bc oxygen is not enough

379
Q

what is diffusion limitation?

A

gas exchange is compromised due to damaged alveoli and decreased blood flow

380
Q

what is a classic sign of diffusion limitation?

A

hypoxemia is present during excersize but not at rest

381
Q

what is alveolar hypoventilation?

A

decrease in ventialtion that results in excess co2

382
Q

what is hypernapnia respiratory failure?

A

either increase in co2 or decrease in alveolar ventilation

383
Q

what can casue acute respiratory failure related to CNS?

A

overdose in opidods
TBI
spiinal cord injuries
CNS problems can suppress the drive to breath

384
Q

what can cause acute respiratory failure r/t neuromuscular system?

A

Guillian Barre and sclerosis causes muscle weakness paralysis (diaphram wont move)n
toxins

385
Q

what can cause acute respiratory failure r/t the chest wall?

A

flail chest
rib fx
kyphoscolosis
obeisty

386
Q

what is the main sign to look for in ARF?

A

change in mental status

387
Q

what does a CXR diagnosis do?

A

helps identify causes of ARF such as atelactasis or PNA

388
Q

what is the drug therapy for ARF?

A

corticosteroids (decreases airway inflammation)
albuterol (decreases bronchospsams)
lasix and morphine
ATB
Lorazepam, fentayl

389
Q

whats the most common cause of acute respiratory distress syndrome?

A

sepsis

390
Q

what is the injury or exudative phase of ARDS?

A

24-72 hours after injury
last 7 days

391
Q

what is the reparative or proliferative phase of ARDS?

A

1-2 weeks after injury

392
Q

what is the fibrotic or fibroproliferative phase of ARDS?

A

2-3 weeks after injury

393
Q

what are the intial symptoms of ARDS?

A

mild dyspnea
tachypnea
cough
restless

394
Q

what are the symptoms of ARDS as it progresses?

A

symptoms worsen bc increase in fluid in the lungs and secretions

395
Q

what is the proper position for a pateitn with ARDS?

A

prone

396
Q

what are the 2 common non invasive ventilation options?

A

CPAP
BIPAP

397
Q

what is a CPAP?

A

continuous positve airway pressure
delivered through a face mask, nasl mask, or nasal pillow

398
Q

what does the pt have to do with a CPAP?

A

forcibly exhale

399
Q

what is a BIPAP?

A

bilevel positive airway pressure
pushes air in and sucks air out

400
Q

what is a negative pressure mechanical ventialtion?

A

pulls chest outward
air rushes in through outside chamber

401
Q

what is a postivie pressure mechanical ventilation?

A

intubation
forces air into lungs
expiration is passive

402
Q

what are the mechanical ventilator settings?

A

repiratory rate (F)
Tidal volume
o2 concentration (FIO2)
positive and expiratory pressure (PEEP)

403
Q

what is the tidal volume setting of a mechanical ventilator?

A

amount of air given each breath (5-7)

404
Q

what is the postive and expiratory pressure (PEEP) seeting on a ventilator?

A

mimicks pressure left in lungs by closing the vocal cord
allows for more gas exchange

405
Q

what is the volume ventilation?

A

its preset to how manay breaths will be given

406
Q

what is pressure ventilation?

A

given by amount that pt needs to allow for expiration short term

407
Q

what is the assist control ventialtion (ACF)?

A

full ventialtion support

408
Q

what is the intermittent mandatory ventilation (IMV)?

A

patient can controll RR but volume is varibale

it allows pateint to use their own muscles to decrease airway pressure

409
Q

what is the syncronized intermiitent mandatory ventialtion (SIMV)?

A

patient can spontaneously breath while ventilation will change to their breath rate

410
Q

what is pressure support ventilation?

A

patient intiates every breath and ventilator puts pressure to pull c02 out