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NSG 2321 Theory Exam 1 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Where does the upper respiratory tract end?

A

Stops at the level of the trachea

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2
Q

What lung will aspirated particles go into? Why?

A

If patient is at risk for aspiration pneumonia, any fluid/sputum/food will enter the right lung

Right bronchus is more horizontal and shorter than the left. In addition, it is wider

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3
Q

Which lung are you more likely to hear adventitious sounds in for someone presenting with aspiration pneumonia?

A

The right lung due to it being more horizontal and shorter

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4
Q

Describe the sternal line, midclavicular line, and auxiliary line

A

Sternal line - directly vertically through the middle of the chest

Midclavicular line - directly vertically through the nipple line

Auxiliary - directly vertically through the armpit

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5
Q

Define atelectasis

A

Collapsed lung or airless alveoli

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6
Q

What is indrawing breathing?

A

Straining of the neck as the individual breathes in

Tells us the patient is using a lot of pressure to breathe in

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7
Q

Which is active and passive, inspiration & expiration?

A

Inspiration is active and expiration is passive (recoil)

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8
Q

What does an ABG (arterial blood gas) test tell us about the lungs?

A

The diagnostic test that indicates overall diffusion of the lungs – determine oxygenation status and acid-base balance

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9
Q

What two tests indicate the overall diffusion of the lungs?

A

O2 sats and ABGs

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10
Q

What 3 things controls respirations of the lungs?

A
  1. Brainstem - medulla
  2. Mechanical receptors in the lungs - stretch
  3. Chemoreceptors - acidosis/alkalosis
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11
Q

Where is the respiratory centre located in the brain?

A

Medulla

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12
Q

Acidosis/increased H+ in the blood will lead to?

A

Increased respiration rate and depth - the body is trying to rid hydrogen

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13
Q

Alkalosis/decreased H+ in the blood will lead to?

A

Decreased respiration rate and depth

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14
Q

What are the three respiratory defence mechanisms?

A

Mucosa, muco-ciliary clearance system, and macrophages

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15
Q

How does the mucosa protect the respiratory tract?

A
  • Filtration of air into the system
  • Is moist and catches debris
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16
Q

How does the muco-ciliary clearance system protect the resp tract?

A
  • Move irritated particles and bacteria up the respiratory tract
  • Cough reflex moves particles out of the body
  • Reflex bronchoconstriction – irritants like toxic gases cause the airway to constrict to limit the amount of air that can enter the system; Will result in shortness of breath, struggles to breathe
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17
Q

What is reflex bronchoconstriction?

A

irritants like toxic gases cause the airway to constrict to limit the amount of air that can enter the system
- Will result in shortness of breath, struggles to breathe

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18
Q

How do macrophages protect the resp system?

A

Undergo phagocytosis to eat harmful bacteria

The debris is moved to the level of the bronchioles for removal from the lungs by the lymphatic system

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19
Q

What does hematocrit tell us about the blood?

A

Fluid vol status - ratio of RBCs to plasma cells

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20
Q

What is required of a patient/how is a C&S sputum study collected?

A

Patient uses a sailor’s cough, cannot brush teeth or use mouthwash prior to this test

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21
Q

What is an AFB (acid fast basili) test and when should it be performed?

A

Testing for TB – first morning specimen, as it is when they typically produce the most sputum

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22
Q

What is a tuberculin test?

A

Looking for an area of induration under the skin - testing for TB

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23
Q

What is contrast made of?

A

Shellfish and iodine

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24
Q

What patient hardware cannot be placed in an MRI?

A

Pacemaker

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25
Q

What is a ventilation-perfusion scan and what is the patient injected with?

A

Injected with radioisotopes, which outline circulation in the lungs

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26
Q

What does a PET scan test for?

A

Looking for cells with increased glucose uptake (i.e., cancerous cells)

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27
Q

What does a bronchoscopy test/visualize and what is post-care focused on?

A

– visualizes the trachea and bronchi

  • Will administer a conscious sedation (i.e., valium)
  • Concern of aspiration following this procedure, as the throat is frozen. Additionally, may have sanguineous sputum
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28
Q

What does a mediastinoscopy visualize?

A

Lymph nodes are observed and sampled to look for malignant cells

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29
Q

What is a pulmonary function test?

A

Testing expiration, breathe holding, and exhalation

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30
Q

Why are individuals with influenza hospitalized?

A

Individuals are not admitted based on influenza, but rather the complications arising from the influenza

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31
Q

What are the clinical manifestations of influenza?

A

Sudden/abrupt onset of systemic symptoms – Fever, running nose, sore throat, malaise, sore muscles, aches, headaches, crackles, productive cough

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32
Q

What is the primary goal of nursing management of influenza?

A

supportive management that focuses on symptoms and reducing secondary infection of others

33
Q

How many days should it take for influenza symptoms to subside?

A

7 days

34
Q

What lab/diagnostic test would be completed for someone presenting with influenza symptoms?

A

C & S

35
Q

What types of fluids would you administer to a patient presenting with influenza?

A

Hypotonic if the patient is dehydrated then to isotonic

36
Q

What is Oseltamivir and Zanamivir? How does it work? How long should the patient use this medication for? Adverse effects?

A

Agent for influenza A and respiratory viruses - does not kill the virus, but prevents the virus from escaping and reproducing in other cells

Shortens the duration of the illness and reduces the symptom severity

Patient must take it for the full 5 day duration, even if they are feeling better

Nausea, diarrhea & vomiting - worry of dehydration

37
Q

What medication may be administered prophylactically in settings where a flu outbreak has occurred?

A

Oseltamivir

38
Q

How many days within symptom onset do Oseltamivir and Zanamivir need to be administered?

A

Within two days of symptom onset to be effective

39
Q

Define pneumonia

A

An acute inflammation of the lung parenchyma caused by a microbial agent

40
Q

What six factors may predispose/increase risk of pneumonia?

A

Altered LOC (cannot protect their airways), air pollution, smoking/vaping, autoimmune, general aging physiological changes, and  hematogenesis (having an illness that then transforms into pneumonia (i.e., staphylococcus aureus that begins in elsewhere))

41
Q

What is hematogenesis?

A

having an illness that then transforms into pneumonia (i.e., staphylococcus aureus that begins in elsewhere)

42
Q

What are the five types of pneumonia? Explain each

A
  1. Community acquired - inhaling the agent just within the community
  2. Hospital acquired – patient is in the hospital and has developed pneumonia after 48 hours of being admitted
  3. Fungal – inhalation of fungus
  4. Aspiration – altered LOC, difficulties swallowing (inhaling the causal agent)
  5. Opportunistic – altered immune response of the patient’s body, the body is unable to manage
43
Q

Where do 50% of cases of pneumonia come from? How can we combat this?

A

50% of cases from the community, need to promote vaccinations

44
Q

What are the four phases of pneumonia?

A

Congestion, red hepatization, grey hepatization, and resolution

45
Q

Describe the congestion phase of pneumonia and its duration

A

first 24 hours – outpouring of fluid that is coming to the alveoli as a part of the immune response, serous fluid accumulates (crackles), sudden onset of symptoms: fever, cough, sputum, pleuritic chest pain (sharp chest pain that worsens during breathing), confusion, stupor

46
Q

Describe the red hepatization phase of pneumonia and its duration

A

2-3 days – capillaries around the alveoli dilate to send neutrophils, macrophages, producing sang-tinged mucous

lungs appear red and granular

47
Q

Describe the grey hepatization phase of pneumonia

A

blood flow decreased, WBCs and fibrin groups/consolidated in the area that is infected - produces green/yellow/brown mucous

48
Q

Describe the resolution phase of pneumonia

A

Symptoms begin to resolve

49
Q

List the four symptoms of pneumonia

A

Sudden onset of fever, chills, a cough producing purulent sputum, and pleuritic chest pain

50
Q

List the 10 complications of pneumonia

A

Pleurisy, pleural effusion, atelectasis, delayed resolution, lung abscess, empyema, pericarditis, bacteremia, meningitis, and endocarditis

51
Q

Define pleurisy and pleural effusion

A

o Pleurisy – inflammation of the tissue that lines the lungs and chest cavity causing a sharp chest pain when breathing deeply

o Pleural effusion – a buildup of fluid between the tissues that line the lungs (parietal and visceral pleura) of the chest causing SOB, coughing, and chest pain

52
Q

Define atelectasis and delayed resolution

A

o Atelectasis – complete or partial collapse of the lung or a section of the lung (lobe) – more specifically collapsing of the lungs

o Delayed resolution – pneumonia that does not improve clinically (stays in the congestion, red or grey phase), or even worsens, despite 10 days of adequate antibiotic therapy

53
Q

Define lung abscess and empyema

A

Lung abscess – a microbial infection of the lung that results in necrosis of the pulmonary parenchyma – a collection of pus in the lungs, which will be taken in for suctioning

Empyema – a collection of pus in the pleural cavity causing chest pain that worsens when you breathe deeply, dry cough, excessive sweating – abscess that is located on the outside of the lungs (pleural cavity) which will be taken for thoracentesis

54
Q

Define pericarditis and bacteremia

A

Pericarditis – swelling and irritation of the thin sac-like membrane surrounding the heart

Bacteremia – refers to viable bacteria in the blood (blood infection), enters the circulatory system and can travel anywhere

55
Q

Define meningitis and endocarditis

A

Meningitis – inflammation of the brain and spinal cord membranes caused by an infection

Endocarditis – an infection of the heart valves

56
Q

How many times should an individual receive the pneumococcal vaccine? What about immunocompromised patients?

A

Typically, one vaccine for life is sufficient.

Immunocompromised every 5 years

57
Q

What type of medication is administered to someone with pneumonia? What is important to consider when choosing the med?

A

Antibiotic or antiviral, dependent on the type

58
Q

How many cals min should a patient with pneumonia be eating?

A

1500

59
Q

How many L per day should someone with pneumonia be drinking?

A

3L/day

60
Q

Typically how long does it take for clients to feel better after pneumonia?

A

6-8 weeks

61
Q

What are the three generations of cephalosporins? Why are there three?

A

1st - Ancef
2nd - Cefaclor
3rd - Ceftriaxone

generations are a response to resistance developing in the virus

62
Q

What are the adverse effects/cautions for cephalosporins?

A

Allergy, oral or vaginal infections, diarrhea (C-diff) due to reduced microbiome - dehydration/reduced electrolytes

63
Q

Define COPD

A

Air flow limitations caused by decreased diameter of the air passages, overall decreases the amount of air that can enter into the lungs and creates an adventitious sound of wheezing

Chronic, enhanced inflammatory response – excess mucous production which leads to more difficulties with clogged airways (crackles)

64
Q

What are the five causes of COPD?

A
  1. Tobacco smoke and vaping (first, second, and third exposure)
  2. Occupation chemicals, dust, and air pollution
  3. Infection
  4. Heredity
  5. Aging
65
Q

What is the leading cause of COPD?

A

Smoking

66
Q

An antirypsin deficiency is associated with what disease?

A

COPD

67
Q

Define the pathophysiology of COPD

A

A combination of emphysema (inability for the alveoli sacs to expand with inhalation) and chronic bronchitis (damage to the linings of the airways causing them to become inflamed and create excess mucous)

68
Q

What are the 14 clinical manifestations of COPD?

A
  1. Dyspnea – breathing will not look like a passive process for the individual (The act of breathing requires more energy for these patients)
  2. Limitations when performing exercise (i.e., getting out of bed, toileting, eating)
  3. Can progress toward skeletal muscle dysfunction – muscle of the chest cavity become hyper-inflated and push out the rib cage (barrel chest)
  4. Atrophy of leg and arm muscles due to their patient’s working so hard to simply breathe
  5. Right side heart hypertrophy (cardiomegaly) due to the heart having to work harder to push against the enlarged chest
  6. RBCs will be inflated due to compensatory mechanism to increasing oxygen carrying capacity
  7. Depression and anxiety – feelings related to an altered lifestyle and a fear of an inability to breathe
  8. Altered nutrition – time is taken away from eating to be used towards breathing
  9. Inability to expire air – due to hyper-inflated muscles, promote pursed lip breathing
  10. Abnormal blood gas – PaCO2 and PaO2
  11. Excessive mucous – chronic, productive cough
  12. Vasoconstriction of the vasculature – impairing circulation to the lungs
  13. Pulmonary hypertrophy and thickening of skeletal muscle around the lung
  14. Cachexia – losing skeletal mass due to nutrition going to the lungs and not the limbs
69
Q

What are the four complications of COPD?

A

Cor pulmonale, acute exacerbation, acute respiratory failure, and depression/anxiety

70
Q

Define cor pulmonale and acute exacerbation

A
  • Cor pulmonale – enlargement of the right ventricle leading to chronic heart failure
  • Acute exacerbation – suggesting that a small exposure to any illness will create a much larger impact due to the affects that it has on the symptoms related to COPD (i.e., a pt with COPD catches a cold and it can become life-threatening)
71
Q

Define acute respiratory failure and depression/anxiety as complications for COPD

A
  • Acute respiratory failure – an accumulation of a large number of symptoms related to the inability of the lungs to complete appropriate respiration
    o SOB, tachycardia, coughing, wheezing, pulmonary hypertension
  • Depression and anxiety – in moments of anxiety, move the patient’s focus onto you and direct them to follow your directions to help manage their symptoms
    o Anxiety can exacerbate the symptoms of COPD (hyperventilation, shallow breathing, and increased HR)
72
Q

What is the primary nursing intervention that should be addressed for COPD?

A

Smoking cessation

73
Q

What is Ipratropium (Atrovent)? How does it work?

A

Anticholinergic drug that prevents bronchoconstriction and indirectly causes airway dilation and they reduce mucosal secretions

74
Q

What is Fluticasone (Flovent)? How does it work? Cautions? Procedure of administration?

A

Inhaled corticosteroid that reduces inflammation and bronchoconstriction

Caution - reduces immune response, which increases the risk of opportunistic infections

Always swish and spit after administration to avoid the development of thrush

75
Q

How long can the effects of withdrawal last for?

A

Up to 4 weeks

76
Q

How long after a cigarette will someone feel a physical urge to smoke again?

A

May feel physical urges to smoke again within twenty to thirty minutes from last cigarette

77
Q

Do men or women have a greater risk of smoking-related diseases?

A

Women

78
Q

What are the agonist and antagonist effects of nicotine replacement therapy?

A
  • Agonist – provides some nicotine effects to ease withdrawal symptoms
  • Antagonist – if person resumes smoking, it will block the effects of nicotine at another subtype nicotinic receptor, which mutes the effects

NSG 2321 Theory Exam 1 (6 decks)

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