Respiratory Flashcards
1
Q
wherer is the lower respiratory tract found?
A
in the lungs
2
Q
what is the paranasal sinus?
A
4 airfilled cavities that drain into the nasal cavity
3
Q
what does the paranasal sinus serve as?
A
crumple zone (protectz against trauma)
4
Q
what can be damaged during a trach suction?
A
the carina
5
Q
what does the pulmonary circulation of the lungs do?
A
provides lungs with blood for gas exchange
6
Q
what does the bronchial circulation of the lungs do?
A
provides oxygen to the lungs
7
Q
where is the mediastinum and what does it hold?
A
middle of the thoracic cavity
holds the heart, aorta, and esophagus
8
Q
what happens when the pleura is inflammed or irratated?
A
causes pain so it will hurt to breath
9
Q
what is pleural effusion?
A
accumulation is fluid between the lungs and the chest
10
Q
what happens if there is a block or problem with the lymphatic circulation?
A
fluid will build up (pleural effusion)
11
Q
what is empyema?
A
purulent fluid with bacterial infection during pleural effusion
12
Q
injury to the phrenic nerve results in what?
A
hemidiaphragm paralyiss
c3 and c5: mechanical ventilation
13
Q
what mechanisms are used to get rid of bacteria?
A
filtration of air
mucocilary clearance
cough reflex
relfex bronchoconstriction
alveolar macrophage
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
15
Q
what can cause clubbing?
A
hypoxemia
cystic fibrosis
bronchiectasis
16
Q
what can cause barrell chest?
A
COPD
asthma
cystic fibrosis
17
Q
what is viscosity?
A
state of being thick or sticky
18
Q
what does a throat swab do?
A
differentiates between bacteria and virus
19
Q
what does a nasal swab do?
A
RSV
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
21
Q
what is tension pneumothorax?
A
continuous entrance of air into the pleura which compresses the lungs, heart, and chest
Life threatening
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
23
Q
what is epistaxis?
A
nosebleed
24
Q
what is a kiessalbach plexus?
A
source of the nose bleed
25
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
26
what can prolong bleeding time for epistaxis?
anticoagulants
aspirin
NSAIDS
Warafrin
27
what is the difference between an anterior and posterior epistaxis?
anterior is a random nose bleed
posterior is post nasal surgery
28
What does the nurse do for a patient with posterior epistasis?
Nasal packing (tampon or ballon) for 2-6 days
ATB
Pain meds
29
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
30
What is required for a posterior epistasis?
Packing (baloon or rapid rhino)
31
What is allergic rhinitis?
Inflamation of nasal mucosa in response to a specific allergy
32
What is an episodic allergic rhinitis?
Exposure to an allergy not typically encountered in a pateints normal enviroment
33
What is intermittent allergic rhinitis?
Symptoms are present less than 4 days a week ot less than 4 weeks per year
34
What is persistant allergic rhinitis?
Symptoms last more than 4 days a week and for more than 4 weeks per year
35
What is perennial rhinitis?
Year-round
Exposure to dust, animals, fungi, molds
36
What happnes during allergic rhinits?
Increased capillary permebility and inflammatory response after exposure
37
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
38
What are the diagnostics for allergic rhinitis?
Nasal smear for underlying cause
Allergy testing
39
What type of medications are given for allergic rhinitis?
Antihistamines
Decongestants
Intranasal corticosteroids
Eye drops
Saline nasal spray
40
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
41
What is viral rhinitis?
Common cold
Nasopharyngitis
42
What accounts for majority of colds?
Rhinovirus
43
What percaution are patients with viral rhinitis on?
Droplet
Extremely contagious
44
What are the symptoms of viral rhinitis?
Tickling of throat
Fever
Congestion
Runny nose
Sneezing
Hoarsness
Cough
45
Why do you give antihistamines to a pateint with viral rhinitis?
To releive sneezing
46
What is the treatment for viral rhinitis?
No cure or ATB
Topical decongestants (OTC nasal spray)
47
If symptoms of viral rhinittis last for 7 days, what should the pateint do?
Call doctor
Could have bacteria
Get ATB
48
When is flu season?
September- April
49
What is infliuenza A?
Most common and most sever
Can infect animals and humans
- Avian and Swine
50
What is influenza B?
Only humans
Can lead to regional epidemic
51
What is influenza C?
Very mild
Only humans
Does not lead to epidemics
52
How does influenza spread?
Droplet
Contact
Inhalation
53
What are the symptoms oof influenza?
Couch
Fever
Myalgia
HA
Sore throat
N/V
54
What are the common complications of influenza?
Pneumonia
Ear/ sinus infections
55
What medications are given for influenza?
Antivirals
- Symmetrel (Amantadine)
- Flumadine (Rimantadine)
- Relenza (zanamivir)
- Tamiflu (oseltamivir)
56
What medication is used for influenza A?
Adamantanes
- amantadine
-rimantidine
Educate oon insomnia
57
What is acute sinitis?
Prolonged nasal congestion
Viral or bacterial
58
What is used to diagnose acute sinusitis?
CT/ X-ray
Occipito water view- xray of sinus to detect congestion
59
What are the symptoms of acute sinusitis?
Tender sinus
Purulent nasal draininage
Nasal obstruction
Congestion
Fever
HA
Halitosis
60
What is the common fungal infection with chronic sinusitis?
Aspergillus Fumigates
61
What are the symptoms of chronic sinusitis?
Hard to diagnose
Facial pain
Dental pain
Increased drainage
Patients with asthma
4-6 weeks
62
What diagnostic test are used for chronic sinusitis?
Red mucosa with purulent drainage
Nasal swab for culture
Nasal endoscopy
CT
63
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
64
What surgery can be used for chronic sinusitis?
Caldwell Luc to drain the sinus
65
What teaching is given for treatment of sinusitis?
Rest
Warm shower/compress
Hydration
ATB
Netipot
Avoid smoking
66
What are the medications for sinusitits?
Amoxicillin
Bactrim (Sulfonamide)
Eryhromycin- Macrobid
Cephalosporins
Cipro and Levaquin
67
what do you need before administering amoxicllin?
creatinine clearance
68
when do you take amoxicllin?
1 hr before meals or 2 hours after meals
69
when do you take eryhromycin?
1 hour before meals or 2 hours after meals
avoid grapefruit juice
watch for hepatic impairment
70
what do you avoid when taking cipro and levaquin?
dairy and calcium
71
what are antihistamines used for?
allerfy control
72
what are the first generation H1 receptor antagonist?
Diphenhydramine (Benadryl)
Chlorpheniramine (Chlor-trimeton)
73
what are the second generation H1 receptor antagonist?
Fexofenadine (Allegra)
Cetirizine (Zyrtec)
Bratadine (Claritin)
74
what are H1 receptors?
antihistamines
75
what is loratadine (claritin) used for?
seasonal allergic rhinitis
Urticaria (hives)
76
what can cause rebound congestion?
nasal decongestants
77
what are antitussives used for?
to suppress dry, hacking cough
78
what are non-narcotic antitussives?
Dextromethorpan (Delsym)
Benzonatate (Tessalon)
79
wha are the narcotic antitussives?
codeine and hydrocodone
80
what do expectorants do?
treats productive wet coughs
81
what are the expectorants?
Guaifenesin (Robitussin or mucinex)
82
what are the inranasal corticosteroids used to treat?
Rhinitis
83
what are the decongestants?
Pseudoephedrine (sudafed)
Oxymetazoline (Afrin)
dont use more than 3 days
84
what are nasal polyps?
soft painless and beign
can impair breathing
85
what do the pharygeal walls consist of?
tonsils
palate
uvula
86
what are most acute pharangitis infections?
viral
87
what are the complications of acute pharyngitis?
peritonsillar cellulitis and abscess
otitis media
pneumonia
rheumatic fever
post streptococcal glomerulonephritis
88
what are the symptoms of acute pharyngitis?
sore scrathcy throat
painful swallowing
fiery red pharynx and tonsils
89
what are the symptoms of bacterial acute pharyngitits?
fever
lymph node enlargement
tonsil exudate
absence of cough
90
how do you diagnose acute pharyngitis?
rapid strep test
throat culture
91
what is the treatment for bacterial pharyngitis?
PCN
Cephalosporins and macrolides
92
how do you treat fungal pharyngitis?
Nystatin for thrush
93
where is nyastatin excreted?
in the feces
94
what is a peritonsillar abscess a complication of?
tonsillititis
95
what are the signs of a peritonsillar abscess?
high fever
chills
leukocytosis
dif. swallowing
muffled voice
96
where are laryngeal polyps and what can cause them?
on vocal cords
-excess talking
-singing
-intubation
-smoking
97
what are the signs of laryngeal polyps?
hoarsness ‘dysphagia
dyspnea
stridor
98
what is the treatment of laryngeal polyps?
voice rest and hydration
99
what is acute laryngitis?
inflammed voice box
100
what are the symptoms of acute laryngitits?
tingling or burning in back of throat
in need to clear throat
hoarsness or lose voice
101
what is the prep for a bronchoscopy?
NPO for 4-8 hr
give bronchoddialator
review CBC and bleeding times
102
what is the surgical treatment for an airway obstruction?
Tonsillactomy
UPPP
Genioglossal advancement
Hyoid Myotomy
RFA
103
what do you give if an airway obstruction is due to an allergic reaction?
Epinephrine or corticosteroids
104
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
105
what is a cuffed trach tube used for?
if a pateint is at risk for aspiration or on a ventilator
106
what is an uncuffed trach tube used for?
long term managemnet
these pateints can talk and eat
107
what do you use to verify cuff pressure of a trach and how often?
manometer
evry 8 hours
108
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
109
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
110
when is trach tubing normally changed?
7 days
111
what do you do if a trach tube cannot be replaced?
cover stoma with sterile dressing
ventilate with a bag mask
112
what should you assess for with a deflated trach cuff?
aspiration
113
intitally after insertion of a trach, what is given for speeech?
paper and pencil
114
what do you assess in an elderly pateint with a trach?
self care abilities
- dexarity
-ROM
- cognitive function
-vision
115
what do you clean a trach stoma with?
NS
116
what is completed every shift for a trach?
assesment for infection
Clean in
sterile pre cut dressing
suction airway
trach collar changed
117
what is head and neck cancer?
squamous cell carcinoma
118
where is the supraglottic area?
above true vocal cords and below the tounge
119
what is the glottis area?
true vocal cords
120
what are symptoms of head and neck cancer?
hoarsness
sore throat
coughing up blood
dif. swallowing
otalgia-ear pain
weight loss
dif. breathing
121
what do you asses for head and neck cancer?
oral cavity
tounge floor
palpate lymph nodes
122
what is used to detect head and neck cancer?
laryngoscope
CT/MRI
PET to stage it
123
what can a cordectomy lead to?
partieal- hoarsness
total- no speech
124
what will the patient have after a hemilaryngectomy?
trach and NG tube for 2 weeks
voice will be hoarse
125
what is required after all head and neck cancer surgeries?
extensive rehab due to dif swallowing
126
what is a total laryngectomy done for?
invasive stages of head and neck cancer
127
what will a patient have/need after a total laryngectomy?
permanent trach
permanent altered speech
permanent breathing dif
rehab for voice restoration
128
What is a patient at high risk for after a total laryngectomy?
Lung infections due to dry air
129
What can happen after a total laryngectomy?
Saliva leak
Fistulas
Stenosis of the stoma
130
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
131
what do you do when radiation causes dry mouth?
Xerostomia
give artifical saliva
increase fluids
‘chew sugar free gum
132
if radiation causes oral irritation, what should the pateint eat?
bland soft rich foods
protein
eggs
nutbutters
soy
tofu
dairy
poultry
fish
133
what does apatient need to avoid when doing radiation therapy?
Toast
lotions
sun exposure
134
what can chemotherapy cause?
fatigue
anorexia
taste alteration
135
when must flu antivirals be given?
within 2 days of symptoms
136
what are complications of acute sinusitis?
osteomyeltitis
bacterial mengitis
brain abscess
137
what can trigger acute bronchitits?
viruses
air pollution
dust
inhalation of chemicals
smoking
chronic sinusitis
asthma
138
what are the symptoms of acute bronchitis?
cough
clear mucous secretions
HA
fever
malaise
hoarsness
dyspnea
chest pain
139
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
140
what is given for the treatments of bronchitis?
cough suppresents
increase oral intake
humidifier
inhalers for wheezing
avoid smoke
141
if bronchitits is caused from influenza, how do you treat it?
give antivirals
-zanamivir
-oseltamivir
if within 48 hours of symptoms
142
what do you not give for bronchitis?
oxygen
143
what is pertussis?
whooping cough
144
what vaccine needs to be given for pertussis?
booster for Tdap over 19
145
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
146
what are the symptoms of the catarrhal stage of pertussis?
mild upper respiratory symptoms
low grade fever
runny nose
wattery eyes
non-productive cough
147
what is stage 2 of pertussis?
paroxysmal
2nd to 10th week of infection
148
what are the symptoms during the paroxysmal stage of pertussis?
extreme cough thats painful
149
what is stage 3 of pertussis?
Convalescent
last 2-3 weeks
less severe cough and weakness
150
what is the hallmark sign of pertussis?
uncontrollable, violent cough
-inspiration after a cough produces a whooping sound bc of the obstructed glottis
151
what do you treat pertussis with?
antibiotics (macrolides-erythromycin)
152
what should not be used in the treatment of pertussis?
cough suppresants
antihistamines
corticosteroids
bronchodialators
153
pneumonia affects oxygen transport, which can cause what?
hypoxia
- taachypnea
-dyspnea
-tachycardia
consolidation (fluid in the lungs)
increase mucous production
154
how long should a patient with community acquired pneumonia (CAP) be on isolation?
after 48 hours on antibiotic and fever free for 24 hours
155
if community acquired pneumonis is suspected, what is started?
emperic ATB therapy
-initiate treatment before definitive diagnosis
156
who is at risk for aspiration pneumonia?
anesthsia
head injurt
stroke
alcohol intake
NG/feeding tubes
157
what is necrotizing pneumonia?
complication of bacterial pneumonia
-causes immediate respiratory insuffciency/failure, leukopenia, and bleeding into airways
158
what is oppurtunistic pneumonia?
infection/inflammed lower respiratory tract in immunocompromized pateints
-malnutrition
-HIV
-radiation/chemo
-long term corticosteroid
159
what are the symptoms of pneumonia?
fever
cough
chills
dyspnea
tachypnea
pleuritic chest pain
160
what are the symptoms of pneumonia in older pateints?
confusion
stupor
hypothermia
161
what is a good indication of pneumonia?
crackles
162
what are the complications of pneumonia?
atelactasis
pleurisy
pleural effusion
bacteremia
pneumothorax
meningitis
acute respiratory failure
sespsis
lung abscess
empyema
163
what does a pateint need if they have empyema?
antibiotics
164
how should tou draw blood cultures for pneumonia if patient has sepsis?
draw from 2 different sites
165
what can you use to diagnose pneumonia?
chest xray
thoracentesis/ bronchoscope to obtain fluid samples
speutum sample
ABG
CBC
166
what is the drug therapy for pneumonia?
macrolides (erythcomycin)
Fluroeoquinolones (Levofloxacin)
ATB ( amoxicillin, ceftin)
merrem
maxipime
zosyn
linezolid
vancomycin
167
what is the prevention od pneumonia?
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
what should you teach a patient with pneumonia?
appropriate ATB use
rest/hydrate
avoid alcohol and smoke
cool mist humidiifer
follow up chest x ray
169
how is TB spread?
through the air after long exposure
cannot be spread through kissing, sharing utensils, or physical contact
170
what is the primary TB infection?
bacteria is inhaled and initiate inflammatory response
171
what is a latent TB infection?
positive TB test but no symotoms
cannot transmit TB to others but can develop active TB
use mono therapy drugs
172
what is an active TB infection?
contagious
body cannot contain organism
173
what are used to diagnose TB?
TB skin test
Interferon-Y release assay (blood test)
chest xray
Bacteriologic studies (speutum)
174
what is the mantoux test?
TB skin test
intradermally
read in 48-72 hours
175
what are the 2 types of blood test?
Quantiferon
T-spot
176
what are the bacteriologic studies?
3 consecutive speutum specimins
different days
177
what are the symptoms of TB?
dry cough
fatigue/malaise
anorexia/ wt loss
afternoon low grade fever
NIGHT SWEATS
178
what are the symptoms of TB in older adults?
flu-like
cognitive changes
179
what is milary TB?
fever
cough
lymphadenopathy
hepatomegaly
splenomegaly
180
what is pleural TB?
chest pain
fever
cough
unilateral pleural effusion
181
what meds are given for TB during the 2 month initial phase?
Isoniazid
Rifampin
Pyrazinamide
Ethambutol
182
if a patient is admitted with TB what should the nurse do?
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
what can reactivate TB?
immunosuprreive therapy
malignancy
prolonged debilitating events
184
what should a patient avoid when taking isoniazid?
alcohol
185
what patient can not take pyrazinamide?
preganant women
186
what does the nurse need to assess for in a pateint taking isoniazid?
hepatitis
-anorexia
-nausea
-fatigue/malaise
-jaundice
187
before giving meds for TB what labs need to be assessed?
AST
ALT
billirubin
188
what can rifampin cause?
orange secretions
189
what can pyrazinamide cause and what needs to be assessed?
gout
labs for liver every 2 weeks
190
what is the latent TB treatment ?
Isoniazid daily 6-9mon
OR
isoniazid and rifampin 1 time a week for 3 mon
OR
rifampin daily for 4 month
191
what is the endimic pulmonary fungal pneumonia?
occurs in healthy and immunocompromised pateints
Histoplasmosis: spores in ground from birds and bats
Coccidioidomycosis: soil
Blastomycosis: soil
192
what is oppurtunistic pulmonary fungal pneumpnia?
occur only in immunocompromized
yeast
aspergillosis: mold
cryptoccosis
193
what is pulmonary fungal pneumonia?
acquired by inhalation of spores
no isolation required
194
how do you diagnose pulmonary fungal pneumonia?
skin test
serology
biopsy
195
what is the drug therapy for pulmonary fungal pneumonia?
antifingals
-amphotericin B
-ketoconazole
-fluconazole
-voriconazole
-itraconazole
196
what is amphotericin B?
only used in serious fungal infections
IV for 4-12 weeks
-multiple organ failure
-cardiac/respiratory arrest
197
what do you need to monitor for when giving amphotericin B?
nephrotoxcitiy
hypokalemia
198
what meds are given for fungus?
zole
199
what is a lung abscess?n
necrosis of lung tissue
-enlarging infection
-necrosis
-forms cavity filled with purulent drainage
200
what can cause lung abscess?
bacteria aspirated from oral cavity
IV drugs
malignancy
TB
pulmonary emboli
201
What can lung abscess lead to?
Necrotizing pneumonia
202
What are the symptoms of a lung abscess?
Cough with purulent speutum
Hemoptysis
Fever/chills
Prostration (exhaustion)
Pleuritic pain
Dyspnea
Anorexia/ weight loss
203
Whats the difference between anaerobic bacterua abscess and aerobic bacteria abscess?
Anaerobic develop slowly
Aerobic resemble bacteria pneumonia
204
What is used to diagnose lung abscess?
Chest xray shows air filled fluid and infiltrate
CT
speutum sample
Bronchoscopy
Pleural fluid
Blood cultures
CBC will show increase in neutrophils
205
What should the nurse monitor for with a lung abscess?
Vitals
LOC
Respiratory signs of hypoxia
206
What does the nurse administer for lung abscess?
Oxygen
ATB
-start with parenteral clindimycin
-express need to complete all ATB
207
What is pneumoconiosis?
Group of lung diseases caused by inhlation and retention of mineral/dust particles
208
What are the different pneumoconisis?
Coal miner (black lung): pulmonary fibrosis
Chemical pneumonitits (Silo filler)
Hypersensitivity pneumonitis (bird fancier or farmers lung: inhales antigens thats allergic
Asbestosis
209
What are the symptoms of pneumoconosis?
May not occur for 10-15 years
-dyspnea
-cough
-wheezing
-wt loss
210
What are the complications of pneumonconiosis?
COPD
Lung cancer
TB
211
What is the pt teaching for pneumoconiosis?
Protective equipment
-mask
-ventilation system
-decrease 2nd hand smoke
212
What is given to improve respiratory symptoms of pneumoconiosis?
Oxygen
Inhaled bronchodialtors
Percussion therapty
Pulmonary rehab
213
What is the difference of treatments for bronchitits and pertussis?
Bronchitis give cough suppresants and increase oral fluid intake
Pertussis give ATB and do not give antihistamine or cough suppresants
214
what are the most common causes of lung cancer?
increased levels of pollution
radiation
absestos
TOBACCO smoke
heavy and prolonged exposure to industrial agents
215
when getting a history of a patient with lung cancer, what would you ask?
occupation
radiation hx
smoke hx
asbestos
recommend no smoking
216
how long foes it take to detect a primary lung tumor?
8-10 years to be 1cm (detectable)
217
what are the 2 types of lung tumors?
nonsmall cell lung cancer (NSCLC)
small cell lung cancer (SCLC)
218
what is paraneoplastic syndrome r/t lung cancer?
when the body produces hormones and enzymes from the tumor that destroy healthy cells
most common in SCLC
219
what can paraneoplastic syndrome cause?
hypercalcemia
SIADH
adrenal hypersecretion
polycythemia
cushings
220
what are the symptoms of lung cancer?
persistant cough
dyspnea
wheezing
bloody speutum
chest pain
221
what are the diagnostic studies for lung cancer?
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
what do you assess for in a patient who had a biopsy by a bronchoscopy?
decreased cough and gag reflex
223
what is used to stage lung cancer?
CBC
Chemistry panel
liver, renal, and pulmonary function test
MRI/PET
224
what system is used to stage NSCLC?
TNM
Tumor size
Node lymph involvement
Metasis
225
what is the difference between limited and extensive SCLC?
limited if confines to 1 spot in the chest
extensive extends beyond the limited stage
226
what surgical treatment for lung cancer is for cancer that is near the outside of the lung?
VATS
227
surgery is not indicated for which type of lung cancer?
SCLC bc it is rapidly growing and invasive
228
why is radiation used for lung cancer?
relieve symptoms of dyspnea and hemoptysis
control pain
used pre op to reduce size of tumor
229
what are the complications of radiation therapy for lung cancer?
esophagitis
skin irritation
N/V
anorexia
radiation pneumonitits
230
what is the primary treatment of SCLC?
chemotherapy
231
what is the immunotherapy used for?
metasis of NSCLC
-Nivolumab (opdivo)
-Pembrolizumbab (keytruda)
232
what should the nursing care/ education be for lung cancer?
smoke prevention
decrease pollution exposure
ambulatory care
teach s/s to report
233
what signs of lung cancer should a pateint report?
hemoptysis
dysphagia
chest pain
hoarsness
234
what is the difference in a blunt trauma and a penetrating trauma to the chest?
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
what is the most common type of chest injury caused from blunt trauma?
fractured ribs
236
what are the symptoms of fractured ribs?
pain on inspiration
atelectasis and pneumonia can develop
237
what is given to decrease pain due to fractered ribs?
NSAIDS
238
what can result from fractered ribs?
flail chest
239
what can flail chest cause?
paradoxical chest movement
-movement in opisite direction
-impairs gas exchange and hypoxemia
240
what are the symptoms of flail chest?
rapid, shallow respirations
tachycardia
pt may splint chest while breathing
241
what is the difference in an open and closed pneumothorax?
open is when air enters through opening in the chest wall
closed is when this happens but no external wound
242
what is a spontaneous pneumothorax?
rupured blebs
243
what are spontantious pneumothorax caused from?
COPD
asthma
cystic fibrosis
pneumonia
244
what are the symptoms of a spontaneous pneumothorax?
sharp side pain
c/o that they cant breath
dyspnea
hyperesinence during percussion
absence of breath sounds
245
what happens to air during a pneumothorax?
air enters pleural cavity causing postivie pressure which collapses lung
246
what is an iatrogenic pneumothorax?
occur due to laceration or puncture during a medical procedure
247
what is a tension pneumothorax?
air enters pleural space and cannot escape
248
what can cause a tesion pneumothorax?
open chest wound
resescitative efforts
mechanical ventilation
clamped or blocked chest tube
249
what is a hemothorax?
accumulation of blood in the pleural space
250
what do you do for a hemothorax?
immediatly insert chest tube to evacuate blood
251
what is a chylothorax?
presence of lymphatic fluid in pleural space
milky, white, fluid with high lipids
252
what is the treatment for a chylothorax?
drain chest
bowel rest
diet modifications
Octreotide can decrease fluid production
253
what is the emergency treatment of a pneumothorax?
cover wound with an acclusive dressing that is secures on 3 sides (vented dressing)
-vasoline
254
what are the different sized chest tubes used to drain?
Large: 36-40 blood
Medium: 24-36 fluid
Small: 10-14 air
255
what is used to evacuate air for a small pneumothorax?
flutter valve (heimlich)
256
what is the suction control chamber?
applies negative pressure
-should have continuoes bubbling
257
what is a water sealed chamber for a chest tube?
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
where shoukd the chest tube stay below and why?
below the chest to keep negative pressure
259
when a chest tube is being removed what does the nurse do?
instrict pateint to take a deep breath and hold it
260
when should the drainage from a chest tube be assessed?
hourly for the first 8 hours
then every 8 hours
261
what could a crackling sensation when palpating around the chest tube indicate?
subq emphysmesa from an air leak
262
what is the difference between a median sternotomy and a lateral thoractomy for a thoractomy procedure?
median splits sternum (heart)
lateral is used for lung surgeries
263
what is the preop care for chest surgery?
PFT
chest xray
ABG, BUN, CBC, creatnine, glucose
PT/INR, aPTT,
264
what is the post op care for a chest surgery?
pain management
assess respiratory status
assess chest tube function and drainage
observe surgical site
265
what is restrictive respiratory disorders?
they impair abilities of chest wall and diaphragm to move with respiration
266
what is the hallmark sign of restrictive respiratory disorders?
decreased total lung capacity (TLC)
267
what are the symptoms of atelectasis?
dyspnea
increased HR and RR
chest pain
268
what are the symptoms of pleurisy?
abrupt, sharp pain with inspiration
shallow and rapid breathing
269
what is the treatment of pleurisy?
NSAIDS/ analgesics
splinting
270
what is transudate pleural effusion?
clear, pale, yellow, protein and cell poor fluid
271
what is transudate pleural effusion caused by?
increased hydrostatic pressure
decreased oncotic pressure
272
what is exudative pleural effusion?
results from increased capillary permability
-infection
-malignancy
273
what are the symptoms of pleural effusion?
dyspnea
cough
occasional sharp non radiating chest pain (worse on inspiration)
decreased movement of the chest
dull percussion
diminished breath sounds
274
what is the treatment of pleural effusion?
thoracentesis
-limit fluid removal to 1000-1200ml
-tripod position
275
if more than 100-1200ml of fluid is taken during a thoracentesis what can happen?
hypotension
hypoxemia
re expansion of pulmonary edema
shock
276
what is idopathic pulmonary fibrosis?
interstitual lung disease
chronic inflammation and scarring
277
what can cause idiopathic pulmonary fibrosis?
smoking
wood/metal dust
278
what are the symptoms of idiopathic pulmonary fibrosis?
exertional dyspnea
clubbing
dry, non productive cough
279
what is the gold standard diagnostic of idiopathic pulmonary fibrosis?
VATS
280
what is the treatment of idiopathic pulmonary fibrosis?
corticosteroids (prednisone)
methotrexate
cyclosporine
long term:
- kinase inhibitors
Ofev
Esbriet
very poor prognosis
281
what is sarcoidosis?
an interstitual lung disease
282
what are the symptoms of sarcoidosis?
dyspnea
cough
chest pain
283
what are the diagnostics of sarcoidosis?
PFT
CT
xray
284
what is the treatment for sarcoidosis?
supress inflamation
285
what are the symptoms of pulmonary edema?
cough
orthopnea
rales
frothy speutum
pt feels like they are drowning
286
what will be elevated with a pulmonary embolism?
troponin levels and BNP
287
what is the prevention of a pulmonary embolism?
anticoagulants for 3 month then a follow up
ted hose every day (DVT prophylaxis)
teach s/s of bleeding and PE re occurance
288
what are the signs of a re occurance of a pulmonary embolism?
SOB
chest pain
Increased anxiety
feeling of impending doom
289
what is the treatment for a pulmonary embolism?
Heparin (enoxapair) starts at diagnosis
Warafrin for 3 mon
290
what do you use for a pulmonary embolism if anticoagulants are contradicted?
inferior vena cava filter
291
what does the nurse do for a patient with a pulmonary embolism?
semi-fowler
o2
cardiopulmonary status (vital)
Monitor:
-ABG
-PT/INER
-aPTT
292
what is pulmonary hypertension and its level?
increase artery pressure from increase blood flow through pulmonary circulation
normal: 12-16
293
what are the 5 categories of pulmonary hypertension?
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
what are the symptoms of idiopathic pulmonary arterial hypertension (IPAH)?
SOB on exertion
chest pain
dizziness
syncope
abnormal heart sounds
295
what are the diagnostics for pulmonary hypertension?
right side cardiac cathetar
-no cure
-only treat symptoms
296
what is secondary pulmonary arterial hypertension caused by?
primary disease
297
what are the symptoms of secondary pulmonary arterial hypertension?
dyspnea
fatigue
chest pain
signs of right ventricle failure
298
what is cor pulmonale?
enlarged right ventricle
299
what is cor pulmonale caused from?
COPD
300
what is the sign and treatment of cor pulmonale?
high s2 (dub) sound
no cure only oxygen
301
if heart failure accompanies cor pulmonale, what will the symptoms be?
peripheral edema
wt gain
distended neck veins
full bounding pulse
enlarged liver
302
what is present if cor pulmonale is secondary to COPD?
polycycthemia (increased RBC)
303
what indicated a lung transplant?
COPD
idiopathic pulmonary fibrosis
Idiopathic pulmonary hypertension
Cystic fibrosis
antirypsin deficency
304
what is the post op care for a lung transplant?
ICU
monitor for:
-venous thromboembolism
-diaphragmatic dysfunction
-malignancy
-infection
-acute rejection
305
what is the discharge teaching for a lung transplant?
keep log pf meds, lab levels, and spirometer uses
306
what are the triggers of asthma?
air polluntants
allergen inhalation
drugs
food additivies
occupational exposure
viral or bacterial infections
307
what is the early phase response of asthma?
runny nose
itching
brochial spasms/airway narrowing
mucous production
occurs 30-60 min of exposure to allergens
308
what are the symptoms od asthma?
wheezing
cough
dyspnea
chest tightness
runny nose, hives, eczema
309
what is not used to gauge severity of an asthma attack?
wheezing
310
what is status asthmaticus?
extreme form of asthma that can result in
hypoxia
hypercapnia
acute respiratory failure
311
what do you do if a patient is suspected of status asthmaticus?
intubate and mechanical ventilate immediatly
312
what are the diagnostics for asthma?
H&P
spirometry and peak expiratory flow rate
oximetry level
chest xray
313
how often should a metered does inhaler (MDI) be cleaned?
2x per week
use SABA first (bronchodialators)
314
what is a neubulizer for asthma?
mist of a drug
high risk for bacteria due to mositure
315
what can OTC inhalers (primatene) do?
relieve bronchospams (epinephrine and Guaifensin)
but can cause:
anxiety
heart palpatations
increase BP
tremors
316
what is the pt teaching for asthma?
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
what interventions for asthma are used to decrease anxiety and pain?
pursed lips breathing
abdominal breathing
318
in what order do you give asthma meds?
AIM
albuterol
Ipratropium
methoylprednisone (solu-medrol)
319
if a pateint with asthma had a sudden drop in wheezing, what needs to happen?
mechanical ventilate immediatly and listen to lungs
320
what do bronchodialtors do?
relieves cheezing
first choice meds to relieve acute asthma
321
what are the classes for bronchodialators?
beta adrenergic agonist
anticholingers
xanthine derivities
322
what are the 3 types of beta adrenergicagonist (bronchodialtor)?
nonselective agrenergic drugs (epinephrine)
nonselctive betaagrenergic drugs (metaproterenol)
selective beta 2 drugs (albuterol)
323
what can beta adrenergic agonist be used to treat?
bronchial asthma
bronchitis
hypotension and shock use epinephrine
324
what are the adverse effects od bronchodialators?
heart palpatations
tremors
GI distress
increase urination
325
what beta adrenergic agonist are used for quick relief or short acting relief of asthma?
albuterol (proventil)
salmetrol (serevent diskus)
326
what do anticholinergics do?
relax and dialate airway
prevent bronchospasms with COPD
not to manage acute symptoms
327
what is the most common anticholinergic?
Ipratropium
328
what do xanthine deritivies do?
bronchodialation by increasing levels of cAMP
asthma and COPD
329
what is the most common xanathine deritive?
Theophylline
330
What do you need to avoid when taking a xanthine deritive (Theophylline)?
Caffeine
Charcoaled broiled foods
High protien and low carbed foods
Smoking
Oral contraceptives
Flu vaccine
331
What do you give if a pt overdoses on theophylline?
Activated charcoal
332
What are the non bronchodialating respiratory drugs?
Leukotriene receptor antagonist
Corticosteroids
Mast cell stabalizer
333
What are leukotriene receptor antagonist given for?
Long term treatment of asthma
Redice vascular permeability
Prevent acute asthma attakcs
334
What is the leukotrine receptor antagonist?
Montelukast (singulair)
335
What do corticosteroids do?
Long term meds for asthma
Decrease mucus
Decrease airway mucosa edema
Repairs epiltheim damage
Reduce airway reactivity
336
What is used in acute exerbation of asthma or COPD?
Iv corticosteroids
337
What can corticosteriods cause?
Increase glucose levels
Addisonian crisis
338
What are the corticosteriods?
Flutlcasone proplponate
Methyprednisone (solu-medrol)
Beclomethasone
Budesonide (pulmlcort)
339
What are the different flutlcasone proplonate?
Flonase
Flovent
Adavair: flutioasone w/ salmetrol
340
What can budesonide (pulmicort) and fluticasone cause?
Osteopenia and osteoporosis
341
What is used as a prophylatic treatment of asthma?
Bedomethasone daily
Mast cell stabalizer
342
What is a common mast cell stabalizer?
Cromoyln (nasalcrom)
343
What is the difference in COPD and emphysema?
You have to have COPD to get emphsyema, but just because you have COPD does not mean you will get emphysema
344
What is emphysema?
Destruction of the alveoli
345
What are the risk factors for COPD?
Smoking
Occupational chemicals
Air pollution
Infection
Genetics
Aging
Asthma
346
What is the main characterisitc of COPD?
Inability to expel air
Leads to barrell chest
347
What can COPD cause?
Hypoxemia
Hypercapnia
Destroy alevoli
Formation of blebs
348
what diseases is a pt more likely to get if they have COPD?
CVD
Cachexia (skeletal muscle wastin)
osteoporosis
diabetes
metabolic syndrome
349
what can the use of accesory muscles with COPD mean?
right sided heart involvement
350
what are the symptoms of COPD?
chronic intermittent cough
dyspnea on exertion
heavy chest, and air hunger (gasping)
wheezing
increased RBC
Paroxysms (suden attack) of coughing can fracture ribs
351
what are the complications of COPD?
cor pulmonale
recurrent exerbations
acute respiratory failure
352
what should a pateint get if they have COPD?
yearly flu vaccine
pneumonia vaccine
stop smoking
353
if a pateint has COPD and cor pulmonale results, what was the cause?
pulmonary hypertension
chronic hypoxia
polycythemia
-right sided heart failure eventually develops
354
what are the symptoms of COPD if cor pulmonale develops?
increased BNP
distended neck veins
hepatomegaly
peripheral edema
wt gain
increase pressure on R side cardiac cath
355
what can you see w/o asking that indicates a COPD exerbation or acute respiratory failure?
tri pod position
altered mental status
cant speak withoput getting out of breath
onset HA
356
oxygen needs to be what with COPD?
humidified
357
what are the comoplications of 02 therapy?
combustion: no smoke or flames
o2 tocicity
infection: clean equipement
358
what are the airway clearance techniques?
huff coughing
chest physiotherapy: percussion
pursed lips: slows breathing rate
359
what should the diet be for COPD?
increase protein and fat
moderate carb
5-6 small meals a day
rest and take a bronchodialtor before eating
360
what should a pateint with COPD be taught?
AMBULATE
erectile dysfunction can occur
SLEEP
361
what is cystic fibrosis?
autosomal recessive altered transport of sodium and chloride
mucous dehydrates and adheres to airways
362
what finding can diagnose cystic fibrosis in newborns?
meconium illeus
363
what are the symptoms of cystic fibrosis?
wheeze, cough, pneumonia
malnutrition
steattorhea
bronchitis
right lowere quadrant pain (DIOS)
dealayed puberty
364
what is the gold standard test for cystic fibrosis?
sweat chloride test
365
what are positive expiratory devices that help airway clearance?
flutter device
acapella
366
what type of vitamins does a pt with cystic fibrosis need?
fat soluable
367
what needs to be added to meals with cystic fibrosis?
salt
368
what is bronchiectasis?
abnormal dialation of airways
369
what are the symptoms of broncheictasis?
persistant cough with thick, tenacious, purulent speutum
wheezing
chest pain
clubbing
dyspnea
anemia
370
what is the hallmark sign of bronchiectasis?
wheezing
371
what teaching should you give for COPD if smoking is not reported?
a1-antitrypsin
372
what is the difference btwn hypoxemic and hypercapnic?
hypoxemic is not enough oxygen
hypercapnic is to much co2
373
what can casue hypoexemic respiratory failure?
V/Q mismatch
Shunt
diffusion limitation
alveolar hypoventilation
374
what is V/Q mismatch?
when the volume of blood around the lungs and the amount of gas reaching the alveoli are not identical
375
what can cause a v/Q mismatch?
increased secretions in airway
bronchospasms
pain
atelactasis
PE
376
how do you treat a V/Q mismatch?
oxygen then treat the cause
377
what is a shunt?
occurs when blood exits heart without gas exchange
no oxygen in blood
378
what is the treatment for a shunt?
mechanical ventialtion bc oxygen is not enough
379
what is diffusion limitation?
gas exchange is compromised due to damaged alveoli and decreased blood flow
380
what is a classic sign of diffusion limitation?
hypoxemia is present during excersize but not at rest
381
what is alveolar hypoventilation?
decrease in ventialtion that results in excess co2
382
what is hypernapnia respiratory failure?
either increase in co2 or decrease in alveolar ventilation
383
what can casue acute respiratory failure related to CNS?
overdose in opidods
TBI
spiinal cord injuries
CNS problems can suppress the drive to breath
384
what can cause acute respiratory failure r/t neuromuscular system?
Guillian Barre and sclerosis causes muscle weakness paralysis (diaphram wont move)n
toxins
385
what can cause acute respiratory failure r/t the chest wall?
flail chest
rib fx
kyphoscolosis
obeisty
386
what is the main sign to look for in ARF?
change in mental status
387
what does a CXR diagnosis do?
helps identify causes of ARF such as atelactasis or PNA
388
what is the drug therapy for ARF?
corticosteroids (decreases airway inflammation)
albuterol (decreases bronchospsams)
lasix and morphine
ATB
Lorazepam, fentayl
389
whats the most common cause of acute respiratory distress syndrome?
sepsis
390
what is the injury or exudative phase of ARDS?
24-72 hours after injury
last 7 days
391
what is the reparative or proliferative phase of ARDS?
1-2 weeks after injury
392
what is the fibrotic or fibroproliferative phase of ARDS?
2-3 weeks after injury
393
what are the intial symptoms of ARDS?
mild dyspnea
tachypnea
cough
restless
394
what are the symptoms of ARDS as it progresses?
symptoms worsen bc increase in fluid in the lungs and secretions
395
what is the proper position for a pateitn with ARDS?
prone
396
what are the 2 common non invasive ventilation options?
CPAP
BIPAP
397
what is a CPAP?
continuous positve airway pressure
delivered through a face mask, nasl mask, or nasal pillow
398
what does the pt have to do with a CPAP?
forcibly exhale
399
what is a BIPAP?
bilevel positive airway pressure
pushes air in and sucks air out
400
what is a negative pressure mechanical ventialtion?
pulls chest outward
air rushes in through outside chamber
401
what is a postivie pressure mechanical ventilation?
intubation
forces air into lungs
expiration is passive
402
what are the mechanical ventilator settings?
repiratory rate (F)
Tidal volume
o2 concentration (FIO2)
positive and expiratory pressure (PEEP)
403
what is the tidal volume setting of a mechanical ventilator?
amount of air given each breath (5-7)
404
what is the postive and expiratory pressure (PEEP) seeting on a ventilator?
mimicks pressure left in lungs by closing the vocal cord
allows for more gas exchange
405
what is the volume ventilation?
its preset to how manay breaths will be given
406
what is pressure ventilation?
given by amount that pt needs to allow for expiration short term
407
what is the assist control ventialtion (ACF)?
full ventialtion support
408
what is the intermittent mandatory ventilation (IMV)?
patient can controll RR but volume is varibale
it allows pateint to use their own muscles to decrease airway pressure
409
what is the syncronized intermiitent mandatory ventialtion (SIMV)?
patient can spontaneously breath while ventilation will change to their breath rate
410
what is pressure support ventilation?
patient intiates every breath and ventilator puts pressure to pull c02 out
