Respiratory Flashcards
wherer is the lower respiratory tract found?
in the lungs
what is the paranasal sinus?
4 airfilled cavities that drain into the nasal cavity
what does the paranasal sinus serve as?
crumple zone (protectz against trauma)
what can be damaged during a trach suction?
the carina
what does the pulmonary circulation of the lungs do?
provides lungs with blood for gas exchange
what does the bronchial circulation of the lungs do?
provides oxygen to the lungs
where is the mediastinum and what does it hold?
middle of the thoracic cavity
holds the heart, aorta, and esophagus
what happens when the pleura is inflammed or irratated?
causes pain so it will hurt to breath
what is pleural effusion?
accumulation is fluid between the lungs and the chest
what happens if there is a block or problem with the lymphatic circulation?
fluid will build up (pleural effusion)
what is empyema?
purulent fluid with bacterial infection during pleural effusion
injury to the phrenic nerve results in what?
hemidiaphragm paralyiss
c3 and c5: mechanical ventilation
what mechanisms are used to get rid of bacteria?
filtration of air
mucocilary clearance
cough reflex
relfex bronchoconstriction
alveolar macrophage
what are the general manifestations of respiratory diease?
sneezing/coughing
speutum discharge
altered breathing
cyanosis
pleural pain
friction rub
clubbed fingers
ABG changes
what can cause clubbing?
hypoxemia
cystic fibrosis
bronchiectasis
what can cause barrell chest?
COPD
asthma
cystic fibrosis
what is viscosity?
state of being thick or sticky
what does a throat swab do?
differentiates between bacteria and virus
what does a nasal swab do?
RSV
if a patients trachea is deviated to one side, what does the nurse do?
immediate intervention
monitor for hypoxia
could cause tension pneumothorax
what is tension pneumothorax?
continuous entrance of air into the pleura which compresses the lungs, heart, and chest
Life threatening
what is the procedure for a thoracentesis?
patient sits upright
leaned on overbed table
clean skin
apply lidocaine
percutaneous cathetar inserted for drainage of fluid
what is epistaxis?
nosebleed
what is a kiessalbach plexus?
source of the nose bleed
what does the nurse do for a pateint with an anterior epistaxis?
patient in sitting position
lean slightly forward with head
apply pressure by squeezing nostrils for 5-15min
reassure the pateint
what can prolong bleeding time for epistaxis?
anticoagulants
aspirin
NSAIDS
Warafrin
what is the difference between an anterior and posterior epistaxis?
anterior is a random nose bleed
posterior is post nasal surgery
What does the nurse do for a patient with posterior epistasis?
Nasal packing (tampon or ballon) for 2-6 days
ATB
Pain meds
What does the urse teach a patient who is post op nasal surgery?
Sleep in upright position
Apply ice
Brush teeth softly
Avoid sneezing/ blowing nose
Avoid heavy lifting or straining
Take acetimophen not NSAIDS
What is required for a posterior epistasis?
Packing (baloon or rapid rhino)
What is allergic rhinitis?
Inflamation of nasal mucosa in response to a specific allergy
What is an episodic allergic rhinitis?
Exposure to an allergy not typically encountered in a pateints normal enviroment
What is intermittent allergic rhinitis?
Symptoms are present less than 4 days a week ot less than 4 weeks per year
What is persistant allergic rhinitis?
Symptoms last more than 4 days a week and for more than 4 weeks per year
What is perennial rhinitis?
Year-round
Exposure to dust, animals, fungi, molds
What happnes during allergic rhinits?
Increased capillary permebility and inflammatory response after exposure
What are the symptoms of allergic rhinitis?
Rhinorrhea- thin, watery, nasal drainage
Irrated sclera
Chapped lips/ dry mouth
Pale and edematous nasal mucosa
Congestion
Watery eyes
Sneezing
Nasal voice change
What are the diagnostics for allergic rhinitis?
Nasal smear for underlying cause
Allergy testing
What type of medications are given for allergic rhinitis?
Antihistamines
Decongestants
Intranasal corticosteroids
Eye drops
Saline nasal spray
What does the nurse teach a patient with allergic rhinitis?
Avoid trigger of allergen
Reduce symptoms
Proper use of nasal sprays
Diary of allergic reactions
What is viral rhinitis?
Common cold
Nasopharyngitis
What accounts for majority of colds?
Rhinovirus
What percaution are patients with viral rhinitis on?
Droplet
Extremely contagious
What are the symptoms of viral rhinitis?
Tickling of throat
Fever
Congestion
Runny nose
Sneezing
Hoarsness
Cough
Why do you give antihistamines to a pateint with viral rhinitis?
To releive sneezing
What is the treatment for viral rhinitis?
No cure or ATB
Topical decongestants (OTC nasal spray)
If symptoms of viral rhinittis last for 7 days, what should the pateint do?
Call doctor
Could have bacteria
Get ATB
When is flu season?
September- April
What is infliuenza A?
Most common and most sever
Can infect animals and humans
- Avian and Swine
What is influenza B?
Only humans
Can lead to regional epidemic
What is influenza C?
Very mild
Only humans
Does not lead to epidemics
How does influenza spread?
Droplet
Contact
Inhalation
What are the symptoms oof influenza?
Couch
Fever
Myalgia
HA
Sore throat
N/V
What are the common complications of influenza?
Pneumonia
Ear/ sinus infections
What medications are given for influenza?
Antivirals
- Symmetrel (Amantadine)
- Flumadine (Rimantadine)
- Relenza (zanamivir)
- Tamiflu (oseltamivir)
What medication is used for influenza A?
Adamantanes
- amantadine
-rimantidine
Educate oon insomnia
What is acute sinitis?
Prolonged nasal congestion
Viral or bacterial
What is used to diagnose acute sinusitis?
CT/ X-ray
Occipito water view- xray of sinus to detect congestion
What are the symptoms of acute sinusitis?
Tender sinus
Purulent nasal draininage
Nasal obstruction
Congestion
Fever
HA
Halitosis
What is the common fungal infection with chronic sinusitis?
Aspergillus Fumigates
What are the symptoms of chronic sinusitis?
Hard to diagnose
Facial pain
Dental pain
Increased drainage
Patients with asthma
4-6 weeks
What diagnostic test are used for chronic sinusitis?
Red mucosa with purulent drainage
Nasal swab for culture
Nasal endoscopy
CT
What types of medication is given for chronic sinusitis?
ATB for 4-6 weeks
Topical decongestants (no longer than 3 days)
Intranasal steroid
Oral corticosteroid
What surgery can be used for chronic sinusitis?
Caldwell Luc to drain the sinus
What teaching is given for treatment of sinusitis?
Rest
Warm shower/compress
Hydration
ATB
Netipot
Avoid smoking
What are the medications for sinusitits?
Amoxicillin
Bactrim (Sulfonamide)
Eryhromycin- Macrobid
Cephalosporins
Cipro and Levaquin
what do you need before administering amoxicllin?
creatinine clearance
when do you take amoxicllin?
1 hr before meals or 2 hours after meals
when do you take eryhromycin?
1 hour before meals or 2 hours after meals
avoid grapefruit juice
watch for hepatic impairment
what do you avoid when taking cipro and levaquin?
dairy and calcium
what are antihistamines used for?
allerfy control
what are the first generation H1 receptor antagonist?
Diphenhydramine (Benadryl)
Chlorpheniramine (Chlor-trimeton)
what are the second generation H1 receptor antagonist?
Fexofenadine (Allegra)
Cetirizine (Zyrtec)
Bratadine (Claritin)
what are H1 receptors?
antihistamines
what is loratadine (claritin) used for?
seasonal allergic rhinitis
Urticaria (hives)
what can cause rebound congestion?
nasal decongestants
what are antitussives used for?
to suppress dry, hacking cough
what are non-narcotic antitussives?
Dextromethorpan (Delsym)
Benzonatate (Tessalon)
wha are the narcotic antitussives?
codeine and hydrocodone
what do expectorants do?
treats productive wet coughs
what are the expectorants?
Guaifenesin (Robitussin or mucinex)
what are the inranasal corticosteroids used to treat?
Rhinitis
what are the decongestants?
Pseudoephedrine (sudafed)
Oxymetazoline (Afrin)
dont use more than 3 days
what are nasal polyps?
soft painless and beign
can impair breathing
what do the pharygeal walls consist of?
tonsils
palate
uvula
what are most acute pharangitis infections?
viral
what are the complications of acute pharyngitis?
peritonsillar cellulitis and abscess
otitis media
pneumonia
rheumatic fever
post streptococcal glomerulonephritis
what are the symptoms of acute pharyngitis?
sore scrathcy throat
painful swallowing
fiery red pharynx and tonsils
what are the symptoms of bacterial acute pharyngitits?
fever
lymph node enlargement
tonsil exudate
absence of cough
how do you diagnose acute pharyngitis?
rapid strep test
throat culture
what is the treatment for bacterial pharyngitis?
PCN
Cephalosporins and macrolides
how do you treat fungal pharyngitis?
Nystatin for thrush
where is nyastatin excreted?
in the feces
what is a peritonsillar abscess a complication of?
tonsillititis
what are the signs of a peritonsillar abscess?
high fever
chills
leukocytosis
dif. swallowing
muffled voice
where are laryngeal polyps and what can cause them?
on vocal cords
-excess talking
-singing
-intubation
-smoking
what are the signs of laryngeal polyps?
hoarsness ‘dysphagia
dyspnea
stridor
what is the treatment of laryngeal polyps?
voice rest and hydration
what is acute laryngitis?
inflammed voice box
what are the symptoms of acute laryngitits?
tingling or burning in back of throat
in need to clear throat
hoarsness or lose voice
what is the prep for a bronchoscopy?
NPO for 4-8 hr
give bronchoddialator
review CBC and bleeding times
what is the surgical treatment for an airway obstruction?
Tonsillactomy
UPPP
Genioglossal advancement
Hyoid Myotomy
RFA
what do you give if an airway obstruction is due to an allergic reaction?
Epinephrine or corticosteroids
what does a tracheostomy do?
bypass airway obstruction
removal of secretions
long term ventilation
- allows for oral intake and speech
facilitate weaning from a ventilator
what is a cuffed trach tube used for?
if a pateint is at risk for aspiration or on a ventilator
what is an uncuffed trach tube used for?
long term managemnet
these pateints can talk and eat
what do you use to verify cuff pressure of a trach and how often?
manometer
evry 8 hours
what are the requirments to change a trach?
keep replacement tube at bedside
do not change for the first 24 hr
- physician does the 1st tube change
what do you do is the trach is accidentally dislodged?
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
when is trach tubing normally changed?
7 days
what do you do if a trach tube cannot be replaced?
cover stoma with sterile dressing
ventilate with a bag mask
what should you assess for with a deflated trach cuff?
aspiration
intitally after insertion of a trach, what is given for speeech?
paper and pencil
what do you assess in an elderly pateint with a trach?
self care abilities
- dexarity
-ROM
- cognitive function
-vision
what do you clean a trach stoma with?
NS
what is completed every shift for a trach?
assesment for infection
Clean in
sterile pre cut dressing
suction airway
trach collar changed
what is head and neck cancer?
squamous cell carcinoma
where is the supraglottic area?
above true vocal cords and below the tounge
what is the glottis area?
true vocal cords
what are symptoms of head and neck cancer?
hoarsness
sore throat
coughing up blood
dif. swallowing
otalgia-ear pain
weight loss
dif. breathing
what do you asses for head and neck cancer?
oral cavity
tounge floor
palpate lymph nodes
what is used to detect head and neck cancer?
laryngoscope
CT/MRI
PET to stage it
what can a cordectomy lead to?
partieal- hoarsness
total- no speech
what will the patient have after a hemilaryngectomy?
trach and NG tube for 2 weeks
voice will be hoarse
what is required after all head and neck cancer surgeries?
extensive rehab due to dif swallowing
what is a total laryngectomy done for?
invasive stages of head and neck cancer
what will a patient have/need after a total laryngectomy?
permanent trach
permanent altered speech
permanent breathing dif
rehab for voice restoration
What is a patient at high risk for after a total laryngectomy?
Lung infections due to dry air
What can happen after a total laryngectomy?
Saliva leak
Fistulas
Stenosis of the stoma
Why is a pateint placed in smei fowlers after a surgical treatment for head and neck cancer?
to decrease edema and limit tension on sutures
what do you do when radiation causes dry mouth?
Xerostomia
give artifical saliva
increase fluids
‘chew sugar free gum
if radiation causes oral irritation, what should the pateint eat?
bland soft rich foods
protein
eggs
nutbutters
soy
tofu
dairy
poultry
fish
what does apatient need to avoid when doing radiation therapy?
Toast
lotions
sun exposure
what can chemotherapy cause?
fatigue
anorexia
taste alteration
when must flu antivirals be given?
within 2 days of symptoms
what are complications of acute sinusitis?
osteomyeltitis
bacterial mengitis
brain abscess
what can trigger acute bronchitits?
viruses
air pollution
dust
inhalation of chemicals
smoking
chronic sinusitis
asthma
what are the symptoms of acute bronchitis?
cough
clear mucous secretions
HA
fever
malaise
hoarsness
dyspnea
chest pain
what are the diagnosis of acute bronchitis based on?
crackles and wheezes on expiration and exertion
consolidation (fluid in lungs) is absent
chest x ray is normal
what is given for the treatments of bronchitis?
cough suppresents
increase oral intake
humidifier
inhalers for wheezing
avoid smoke
if bronchitits is caused from influenza, how do you treat it?
give antivirals
-zanamivir
-oseltamivir
if within 48 hours of symptoms
what do you not give for bronchitis?
oxygen
what is pertussis?
whooping cough
what vaccine needs to be given for pertussis?
booster for Tdap over 19
what is stage 1 of pertussis?
Catarrhal
-occurs in the first 2 weeks of infection
-spreads easily by direct contact or respiratory droplets from cough
what are the symptoms of the catarrhal stage of pertussis?
mild upper respiratory symptoms
low grade fever
runny nose
wattery eyes
non-productive cough
what is stage 2 of pertussis?
paroxysmal
2nd to 10th week of infection
what are the symptoms during the paroxysmal stage of pertussis?
extreme cough thats painful
what is stage 3 of pertussis?
Convalescent
last 2-3 weeks
less severe cough and weakness
what is the hallmark sign of pertussis?
uncontrollable, violent cough
-inspiration after a cough produces a whooping sound bc of the obstructed glottis
what do you treat pertussis with?
antibiotics (macrolides-erythromycin)
what should not be used in the treatment of pertussis?
cough suppresants
antihistamines
corticosteroids
bronchodialators
pneumonia affects oxygen transport, which can cause what?
hypoxia
- taachypnea
-dyspnea
-tachycardia
consolidation (fluid in the lungs)
increase mucous production
how long should a patient with community acquired pneumonia (CAP) be on isolation?
after 48 hours on antibiotic and fever free for 24 hours
if community acquired pneumonis is suspected, what is started?
emperic ATB therapy
-initiate treatment before definitive diagnosis
who is at risk for aspiration pneumonia?
anesthsia
head injurt
stroke
alcohol intake
NG/feeding tubes
what is necrotizing pneumonia?
complication of bacterial pneumonia
-causes immediate respiratory insuffciency/failure, leukopenia, and bleeding into airways
what is oppurtunistic pneumonia?
infection/inflammed lower respiratory tract in immunocompromized pateints
-malnutrition
-HIV
-radiation/chemo
-long term corticosteroid
what are the symptoms of pneumonia?
fever
cough
chills
dyspnea
tachypnea
pleuritic chest pain
what are the symptoms of pneumonia in older pateints?
confusion
stupor
hypothermia
what is a good indication of pneumonia?
crackles
what are the complications of pneumonia?
atelactasis
pleurisy
pleural effusion
bacteremia
pneumothorax
meningitis
acute respiratory failure
sespsis
lung abscess
empyema
what does a pateint need if they have empyema?
antibiotics
how should tou draw blood cultures for pneumonia if patient has sepsis?
draw from 2 different sites