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Adults 1 > respiratory > Flashcards

respiratory Flashcards

1
Q

upper airway infections

A

upper respiratory infection, acute tracheobronchitis, acute rhinosinusitis, acute pharyngitis

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2
Q

upper respiratory tract consists of…

A

nasal cavity, pharynx, ;larynx

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3
Q

lower respiratory tract consists of…

A

trachea, primary bronchi, lungs

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4
Q

viral rhinitis

A

aka the common cold; most common URI, occurs d/t inhalation of bacteria or virus (majority viral); hospitalization is rare

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5
Q

clinical manifestations of URI

A

10 symptoms- low grade fever, nasal congestion, rhinorrhea (runny nose), halitosis (odorous breath), sneezing, teary/watery eyes, sore throat, general malaise, chills, headache/muscle aches

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6
Q

managing URI

A

pharmacologic interventions vary depending on causative organism; nursing promotes supportive care such as treating symptoms with antipyretics, decongestants, nasal spray, analgesics, fluids, and rest; if given anti biotic encourage completion

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7
Q

acute bronchitis

A

inflammation of trachea and bronchi; usually follows a URI; most often it is mild and caused viral; usually URI travels down

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8
Q

clinical manifestations of brinchitis

A

mucopurulent sputum (cloudy appearance), dry cough that worsens at night and becomes productive in 2-3 days, progressive symptoms can be dyspnea stridor or wheezing (watch for progressive symptoms because of severity)

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9
Q

managing bronchitis

A

watch for resp. distress, treat the symptoms with antipyretics/cough suppressants etc., increase fluids intake

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10
Q

acute rhinosinusitis

A

inflammation/infection of the nose and sinuses that usually follows a URI; can be bacterial or viral (ABRS or AVRS) but bacterial accounts for >60%;

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11
Q

risk factors for developing acute rhinosinusitis

A

deviated septum, hypertrophied turbinates, nasal polyps, tumors

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12
Q

treating ABRS vs AVRS

A

ABRS is treated with antibiotics and supportive care and AVRS is treated with supportive care

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13
Q

role of sinuses

A

help voice sound the way it does (congestion of sinus makes voice sound congested), filters air

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14
Q

clinical manifestations fo ABRS/AVRS

A

purulent nasal drainage, nasal obstruction, facial pain/pressure/fullness, congestion/stuffiness, localized/diffuse headache,

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15
Q

difference in clinical manifestations of ABRS vs AVRS

A

ABRS- high fever and symptoms lasing >10 days, more severe; AVRS- lower intensity of symptoms, shorter duration (<10 days), no high fever

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16
Q

management of ABRS/AVRS

A

medication depends on cause (bacterial or viral), supportive care (nasal saline lavage, decongestants, topical nasal decongestants, adequate fluids, rest), educate pt on appropriate use f OTC and nasal spray, complete antibx fully

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17
Q

complications of ABRS/AVRS

A

MENINGITIS; educate pt on symptoms such as fever, severe headache, nuchal rigidity

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18
Q

acute pharyngitis

A

sudden inflammation of pharynx (usually caused by virus); 5-15% have group A beta-hemolytic streptococcus (strep throat- bacterial)

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19
Q

viral pharyngitis vs bacterial pharyngitis

A

viral subsides in 3-10 days; bacterial is more severe and an lea to complications if untreated

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20
Q

general clinical manifestations of pharyngitis

A

fiery-red pharyngeal membrane and tonsils; lymphoid follicles swollen with white-purple exudate, enlarged cervical lymph nodes, no cough, possible fever and malaise, halitosis

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21
Q

difference in manifestations of pharyngitis bacterial vs viral

A

bacterial pharyngitis- swollen uvula, red/swollen tonsils, white spots, red/swollen throat, gray/furry tongue; viral pharyngitis- red/swollen tonsils, red/swollen throat

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22
Q

management of acute pharyngitis

A

determine if viral or bacterial with RADT; antibx if bacterial, supportive care for viral and bacterial, analgesics; soft/liquid diet in acute stage; severe cases may require IV fluids; educate pt to call with severe symptoms- dyspnea, drooling, inability to swallow, inability to fully open mouth

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23
Q

upper airway conditions

A

obstructive sleep apnea and epistaxis

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24
Q

OSA- obstructive sleep apnea

A

periods of apnea during sleep caused by recurrent airway obstruction and decreased ventilation; pt typically unaware of obstruction but report insomnia and difficult staying asleep; muscles relax when sleeping obstructing airway causing pt to jar awake

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25
Q

risk factors for developing sleep apnea

A

obesity, male gender, postmenopausal status, advanced age

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26
Q

clinical manifestations of OSA

A

3 S’s- snoring sleepiness, significant other reporting sleep apnea episodes; chronic fatigue, hypersomnolence (daytime sleepiness); awakening at night and unable to return to sleep

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27
Q

management of sleep apnea

A

diagnosed with sleep study; mandibular advancement device are first step; CPAP/BiPAP are second or alternative option; surgeries like tonsillectomy to create more space, uvulopalatopharyngoplasty (reconstruction), or nasal septoplasty

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28
Q

CPAP vs BiPAP

A

CPAP- continuous positive airway pressure- keeps airway from collapsing; BiPAP- bilevel positive airway pressure- makes breathing easier and results in lower average airway pressure

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29
Q

epistaxis

A

rupture or distended vessels in mucous membrane of nose (commonly anterior septum)

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30
Q

management of epistaxis

A

sit pt upright with head tilting forward (to prevent swallowing/aspiration of blood) and pinch soft outer nose at mid septum for 5-10 minutes; prolonged bleeding may require nasal decongestants to vasoconstrict; if both ineffective then cauterization

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31
Q

if cause of epistaxis cannot be identified…

A

nose is packed with impregnated gauze and may remain in nose for 3-4 days; antibx may be prescribed

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32
Q

education for pt with epistaxis

A

avoid exercise, spicy foods, smoking tobacco, blowing nose, straining, high altitudes, nasal trauma; instruct pt to call if recurrrent bleed cannot be stopped after 15 minutes of pressure

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33
Q

lower respiratory infections

A

pneumonia, influenza, COVID-19, tuberculosis

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34
Q

pneumonia

A

infection of pulmonary tissue (bacterial, viral, or fungal); inflammatory edema stiffens lung, decreases compliance and capacity to cause hypoxemia; community acquired or healthcare associated

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35
Q

community acquired pneumonia

A

rate increases with age, bacterial- S.pneumoniae is most common, viral- RSV or COVID-19

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36
Q

healthcare associated pneumonia

A

48+ hours post hospitalization and often caused by MDROs (multi drug resistant organisms)

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37
Q

clinical manifestations of pneumonia

A

CXR shows consolidation, infiltrates, or pleural effusion, elevated WBCs and ESR, fever, chills, cough, dyspnea, tachypnea, rhonchi/wheezing, pleuritic pain, sputum production (culture needed to identify cause), mental status changes

38
Q

management of pneumonia

A

oxygen therapy, antibx, supportive care meds; monitor resp. status for signs of distress; encourage cough/deep breathing/incentive spirometer; place in semi-fowlers and change position frequently; suction if unable to clear secretions; encourage fluid intake, high cal/high protein diet, balance rest and activity; should receive pneumococcal vaccine as recommended

39
Q

influenza

A

highly contagious acute viral infection with several strains (A, B, C, H1N1); prevention is key

40
Q

ways to prevent influenza

A

annual vaccine, avoiding infected people, frequent and proper handwashing, cleaning and disinfecting contaminated surfaces

41
Q

clinical manifestations of influenza

A

acute onset, fever, myalgias (pain/aches), headache, fatigue/weakness/anorexia, sore throat/cough, rhinorrhea

42
Q

management of influenza

A

supportive care measures- rest, fluids, antipyretics, antitussives; administer antiviral meds as prescribed (tamiflu within 48 hours)

43
Q

COVID-19

A

infectious respiratory illness caused by novel coronavirus SARS-CoV-2; primarily spreads via respiratory droplets (cough sneeze or close contact); incubation period usually 2-14 days

44
Q

clinical manifestations of COVID-19

A

common- fever, cough, SOB, fatigue, aches, loss of smell/taste; less common- sore throat, headache, chills, GI symptoms; severe symptoms- pneumonia, ARDS, organ failure; some individuals are asymptomatic

45
Q

COVID-19 diagnosis/management

A

based on symptoms, history, and lab resuls (PCR/antigen test); supportive care; severe cases may require hospitalization for O2 therapy, ventilator support; antiviral meds may be indicated (nirmatrelvir-ritonavir) and must be administered within 5 days of symptom onset; COVID vaccines are vital in preventing severe illness/transmission

46
Q

antiviral should be reserved for…

A

those individuals who cannot handle the virus

47
Q

COVID-19 nursing interventions

A

infection prevention (hand hygiene, masks, PPE), isolation precautions (droplet, airborne, contact), respiratory support, emotional support, health education, monitoring and reporting

48
Q

Tubeculosis

A

highly contagious communicable disease caused by M. tuberculosis; airborne, exudative response causes nonspecific pneumonitis and granulomas in lung tissue; onset is insidious and pt are unaware until disease is advanced

49
Q

tuberculosis causes

A

bacteria forms tubercle lesion and immune system encapsulates tubercle leaving a scar; if no encapsulation then bacteria can enter lymph and cause inflammatory response called granulomatous inflammation leading to primary lesions forming

50
Q

active phase of TB

A

infection causes necrosis and cavitation in lesions that can rupture and spread necrotic tissue damaging various parts of body; need Xray to confirm because recent BCG vaccine causes positive skin test (mantioux/PPD)

51
Q

risk factors for developing TB

A

12- elderly, <5 years old, unpasteurized milk if cow infected, homeless, low socieoconomic group, minorities, refugees, frequent contact with untreated/undiagnosed individual, those in crowded living areas, malnutrition, immune dysfunction, alcohol abuse/IV drug use

52
Q

clinical manifestations of TB

A

may be asymptomatic in primary phase, fatigue, lethargy, anorexia, weight loss, low grade fever, chills, night sweats, persistent cough (can be blood streaked but usually dry), chest tightness, dull aching chest pain with cough

53
Q

testing for TB

A

CXR may show caseation and inflammation, advanced may show partial obstruction of bronchus from endobronchial disease (wheezing and dyspnea present), TB skin test (positive result does not mean active), quantiferon TB gold test (sensitive and rapid blood test), sputum culture to confirm

54
Q

managing TB

A

goal is to prevent transmission, reduce symptoms, and prevent progression; risk of transmission decreases after 2-3 weeks of treatment, treatment for up to 12 months, educate importance on compliance; well balanced diet; sputum culture every 2-4 week until 3 negative test consecutively

55
Q

chronic pulmonary disorders

A

asthma, COPD, cystic fibrosis

56
Q

asthma

A

chronic inflammatory disorder of airways causing varying degrees of obstruction; marked by hyperresponsiveness to stimuli, bronchioole inflammation, bronchoconstriction, mucus production; often reversible with treatment

57
Q

status asthmaticus

A

severe life-threatening episode refractory to treatment

58
Q

clinical manifestations of asthma

A

wheezing or crackles, absent/diminished lug sounds, restlessness, diaphoresis, cyanosis, decreased O2 sat., accessory muscle use, tachypnea/hyperventilation, prolonged exhalation, tachycardia

59
Q

management of acute asthma attack

A

monitor vitals (O2 sat and peak flow), high fowlers, administer O2, stay with client to decrease O2, administer bronchodilators corticosteroids and ag. sulfate, auscultate lung sounds before during and after treatment

60
Q

IV Magnesium sulfate works

A

by further dilating bronchioles and relaxes muscles

61
Q

cystsic fibrosis

A

chronic multisystem autosomal recessive trait disorder characterized by exocrine gland dysfunction; progressive and incurable; mucus produced by exocrine glands is abnormally thick tenacious and copious causing obstruction of small passageways of affected organs

62
Q

organsprimarily affected by CF

A

respiratory, gastointestinal (pancreas), and reporductive

63
Q

diagnosing CF

A

positive chloride sweat test; increased sodium and chloride in sweat/saliva

64
Q

clinical manifestations of cystic fibrosis

A

emphysema and atelectasis as airways increasingly obstructed; chronic hypoxemia that leads to pulmonary HTN and eventually cor pulmonale d/t contraction and hypertrophy of pulmonary arteries, pneumothorax d/t bullae rupture, hemoptysis, wheezing/cough/dyspnea/cyanosis, clubbing and barrel chest, recurrent bronchitis and pneumonia, O2 therapy, lung transplant, supplemental pancreatic enzymes

65
Q

goal during CF

A

prevent and treat pulmonary infections by improving aeration, removing secretions, administering antibiotics; encourage physical exercise to stimulate mucus expectoration; encourage high cal/high protein diet (vit. ADEK)

66
Q

medications for CF

A

bronchodilators and meds to decrease viscocity of mucus such as pulmozyne or 7% N.S.

67
Q

treatment of CF

A

chest physiotherapy, flutter mucus clearing device, handheld percussors, special vest device, positive expiratory pressure mask (CPAP)

68
Q

chronic obstructive pulmonary disease

A

characterized by airflow obstruction- emphysema and chronic bronchitis; both are caused by tobacco smoke; both lead to pulmonary insufficiency, pulmonary HTN, cor pulmonale; not completely reversible

69
Q

chronic bronchitis

A

productive cough >3 months at a time for more than two consecutive years; bronchial tubes become inflamed and excessive mucus production occurs, “blue bloater”, causes peripheral edema

70
Q

emphysema

A

air sacs are damaged and enlarged causing hyperinflation and breathlessness; “pink puffer”, barrel chest

71
Q

clinical manifestations of COPD

A

cough, exertional dyspnea, wheezing/crackles, sputum production, weight loss, barrel chest, accessory muscle use, prolonged expiration, orthopnea, cardiac dysrhythmias, congestion/hyperinflation on CXR, ABG show acidosis and hypoxemia, decreased capacity on PFT

72
Q

cor pulmonale

A

vasoconstriction in one part of the lung causing blood to shunt to another area of lung but pressure is increased in that area

73
Q

managing COPD

A

monitor vitals (O2 sat., ABG), admin O2, fowlers position and leaning forward, respiratory treatments and CPT, educate on tripod breathing and pursed lip breathing, bronchodilators, corticosteroids, mucolytics, antibiotics, high cal/high protein diet with 2-3L fluids, suction as needed

74
Q

lower respiratory conditions

A

atelectasis, pleural effusion, empyema, pleurisy, aspiration

75
Q

atelectasis

A

collapse of alveoli; can be acute or chronic; occurs as a result of ventilation; can be caused by reduced ventilation or obstruction; post-op pt at high risk

76
Q

causes of atelectasis

A

foreign body, tumor/growth, altered breathing patterns, retained secretions, pain, prolonged supine position, increased abdominal pressure, reduced lung volumes from MSK/neuro disorders, surgery

77
Q

clinical manifestations of atelectasis

A

dyspnea, cough, sputum production, hypoxemia, decreased breath sounds/crackles, respiratory distress, tachycardia, tachypnea, pleural pain, central cyanosis

78
Q

prevention of atelectasis

A

frequent turning, early ambulation, lung volume expansion maneuvers (deep breathing/incentive spirometer), positive end respiratory pressure (PEEP), CPAP

79
Q

pleural effusion

A

collection of fluid in pleural space; any condition that interferes with secretion or drainage will lead to pleural effusion

80
Q

clinical manifestations of pleural effusion

A

pleuritic pain that worsens with inspiration, progressive dyspnea, nonproductive cough, tachycardia, possible fever, decreased breath sounds over affected area, shown on CXR

81
Q

management of pleural effusion

A

treat underlying cause, fowlers position, encourage coughing/deep breaths, monitor lung sounds, prep for thoracentesis, if recurrent then prep for pleurectomy or pleurodesis

82
Q

empyema

A

collection of pus within pleural cavity; mainly caused by pulmonary infection or lung abscess; thick malodorous opaque fluid

83
Q

clinical manifestations of empyema

A

recent febrile illness or trauma, chest pain, cough, dyspnea, anorexia, weight loss, malaises, fever, chills, night sweats, pleural exudate on CXR

84
Q

management of empyema

A

monitor lung sounds, semi/high fowlers, encourage deep breath and cough, administer antibx, educate on chest splinting, assist with thoracentesis or chest tube

85
Q

pleurisy

A

inflammation of visceral and parietal membranes; caused by pulmonary infarction or pneumonia; visceral and parietal membranes rube during respiration and cause pain; usually only on one side and lower lateral region

86
Q

clinical manifestations of pleurisy

A

stabbing pain that worsens during cough or deep breathing; pleural friction rub auscultated

87
Q

management of pleurisy

A

treat underlying cause, monitor lung sounds, administer analgesics, apply heat/cold, encourage cough and deep breath with chest splinting

88
Q

aspiration

A

inhalation of foreign materials causing inflammatory reaction, hypoventilation, and ventilation-perfusion mismatch

89
Q

risk factors for apsiration

A

decreased LOC, brain injury, swallowing disorders, stroke

90
Q

why is aspiration so dangerous?

A

can lead to pneumonia

91
Q

preventing aspiration

A

swallowing screening, elevate head off bed, avoid stimulation of gag reflex with suctioning and other procedures, check NG placement prior to feeding, soft diet with small bites, no use of straws

Adults 1 (10 decks)

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