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Med surg Exam 3 > Respiratory 2 > Flashcards

Respiratory 2 Flashcards

1
Q

What are the indications for a thoracentesis

A

diagnostic or management, microscopic examination, relief pressure on blood vessel or lung compression, relieve respiratory distress, to give meds

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2
Q

what are the nursing considerations for a thoracentesis

A

verify consent, assess for allergies, stress importance of not coughing moving or deep breathing to avoid lung puncture, remove more than 1000 milliliters to prevent reexpansion, apply pressure to site follow up with chest X-ray, assess site for bleeding and drainage, assess for pneumothorax it can occur up to 24 hours after procedure

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3
Q

what should you document after a thoracentesis

A

procedure, response, fluid remove, specimens, site, respiratory assessment

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4
Q

what are the complications of a thoracentesis

A

fluid accumulation, subcutaneous emphysema, infection, attention pneumothorax

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5
Q

what are the cardiovascular changes with acidosis

A

heart rhythm changes (Brady cardia, heart block), tall T waves, widened QRS complex, prolonged PR interval, hypotension, thready peripheral pulses

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6
Q

what are the respiratory changes with acidosis

A

kussmaul respirations (metabolic), variable respirations (respiratory)

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7
Q

what are the CNS changes with acidosis

A

depressed activity like lethargy, confusion, stupor, coma

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8
Q

what are the neuromuscular changes with acidosis

A

hyporeflexia, skeletal muscle weakness, flacid paralysis

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9
Q

what are the skin changes with acidosis

A

warm, flushed, dry skin in metabolic and pale cyanotic forespore

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10
Q

what is a pneumothorax

A

air enters pleural cavity, opened or closed, loss of negative pressure, spontaneous rupture of bleb, iatrogenic secondary to medical procedure

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11
Q

what is a tension pneumothorax

A

complication of pneumothorax life threatening, air enters but doesn’t exit, increase pressure collapses lungs and compresses blood vessels which decreases cardiac output

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12
Q

what is a hemothorax

A

bleeding in chest cavity, may occur with pneumothorax

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13
Q

what is a simple hemothorax

A

blood loss less than 1000 milliliters

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14
Q

what is a massive hemothorax

A

blood loss over 1000 milliliters

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15
Q

what are the risk factors for pneumothorax

A

tall thin males, history of chronic respiratory disease

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16
Q

how do you diagnose pneumothorax

A

chest X-ray, CT, ultrasound, ABGs

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17
Q

what is the treatment for pneumothorax

A

needle decompression, chest tube

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18
Q

what are the signs and symptoms of pneumothorax

A

reduced or absent breath sounds, hyperresonance, dull (hemo), asymmetrical chest movement, tracheal deviation

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19
Q

what are the signs of symptoms specific for tension pneumothorax

A

extreme respiratory distress, cyanosis, distended neck veins, hemodynamic instability

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20
Q

what is a pleural effusion

A

fluid in pleural space

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21
Q

what is the normal amount of fluid in the pleural space

A

5 to 15

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22
Q

what are the risk factors for pleural effusion

A

transudate (left sided heart failure, chronic liver disease, malnourished), exudate (infections or malignancy),

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23
Q

what is the treatment for pleural effusion

A

spontaneous resolution, chest tube, diuretics, antibiotics, surgery

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24
Q

what are the nursing interventions for pleural effusion

A

positioning for optimal gas exchange, pain management, monitor respiratory status

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25
Q

how do you diagnose pleural effusion

A

chest X-ray, thoracentesis

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26
Q

what is pleurisy

A

inflammation of the pleural space

27
Q

what are the risk factors for pleurisy

A

infection, cancer, trauma

28
Q

what are the signs and symptoms of pleurisy

A

sharp pain with inspiration, shallow rapid breathing, plural friction rub

29
Q

what is the treatment for pleurisy

A

treat underlining cause, anti inflammatories, splinting, pain control

30
Q

what is a pulmonary embolism

A

blockage of pulmonary arteries (thrombus, fat, air, tumor), saddle embolus (large embolus lodged arterial bifurcation)

31
Q

what are the risk factors for pulmonary embolism

A

prolonged immobilization, central venous catheter, surgery, obesity, older, disorder that affects increased blood clotting, history of thromboembolism

32
Q

what are the signs and symptoms of pulmonary embolism

A

sudden dyspnea, hypoxemia, tachypnea, dry cough, pleuritic chest pain, increased heart rate, distended neck veins, syncope, hemoptysis, cyanosis, abnormal heart sounds, abnormal ECG, impending doom

33
Q

how do you diagnose pulmonary embolism

A

d-dimer (quick but not specific), CT with contrast looks at blood vessels in the pulmonary system, V/Q scan inhalation of radioactive gas look at air flow, IV injection of radiootope to look at blood flow, pulmonary angiography most invasive done in the Cath lab, ABGs

34
Q

what is the treatment for pulmonary embolism

A

heparin drip, full dose Lovenox with oral anticoagulant for three months, thrombolytics if large PE, severe may require surgical intervention like pulmonary embolectomy, EKO, IVC filter

35
Q

what are the nursing interventions for pulmonary embolism

A

give O2, position for maximum ventilation, initiate and maintain IV access, assess cardiac and respiratory status every 30 minutes, provide emotional support

36
Q

what is blunt trauma

A

appears minor is a striking or being struck by an object

37
Q

what is a penetrating trauma

A

open wound, a foreign object impales or passes through the body

38
Q

what do chest injuries include

A

pulmonary contusion, rib fracture, flail chest, thoraxs, trauma

39
Q

what is the respiratory assessment for someone with a chest trauma

A

dyspnea, cough, tracheal deviation, diminished breast sounds, hypoxemia asymmetric chest movement subcutaneous emphysema, cyanosis

40
Q

what are the signs and symptoms of a pulmonary contusion

A

asymptomatic early then rest then, diminished breath sounds, crackles, wheezing, increased heart rate, tachypnea, dry cough, dullness to percussion, bruising over injury

41
Q

What are the diagnostics of pulmonary contusion

A

visual assessment, chest X-ray

42
Q

what is the treatment for a pulmonary contusion

A

high fowlers or good lung down, frequent respiratory assessment, focused on maintaining ventilation and oxygenation

43
Q

what are the signs and symptoms of a rib fracture

A

pain with movement, splints chest defensively, shallow breathing

44
Q

what are the complications of a rib fracture

A

deep chest injuries with poor prognosis (first or second rib, flail chest, over 7 fractures), pulmonary contusion, hemothorax

45
Q

what is the treatment for an uncomplicated rib fracture

A

ribs unite spontaneously, chest usually not splinted, pain is treated with intercostal nerve block and patient controlled analgesia

46
Q

What is a flail chest

A

fracture of equal to or more than three adjacent ribs and equal to or more than two locations, related to blunt force trauma may have additional injuries

47
Q

what are the signs and symptoms of flail chest

A

paradoxical chest movement, one side involvement, impaired gas exchange, dyspnea, cyanosis, increased heart rate, decreased blood pressure

48
Q

what is the treatment for flail chest

A

mechanical vent, stabilized with PPV

49
Q

what are the nursing interventions for flail chest

A

monitor fluid and electrolytes, give IV fluids, humidified O2, pain management, promote deep breathing, position for optimal gas exchange, promote cough, suction secretions as needed

50
Q

what is acute respiratory distress

A

sudden and progressive acute lung injury, alveolar capillary membranes are damaged causes increased permeability to intravascular fluid, noncardiogenic pulmonary edema, imbalance of ventilation and perfusion related to chanting no gas exchange occurring

51
Q

what are the signs and symptoms of acute respiratory distress

A

shortness of breath dyspnea with or without exertion, orthopnea, rapid shallow breathing, cyanotic molted dusky skin, increased heart rate, decreased blood pressure, retractions, decreased S BO2, adventitious breath sounds, cardiac arrhythmias, confusion, pulmonary edema, decreased lung compliance, severe hypoxemia even with O2 at 100%

52
Q

what are the risk factors for acute respiratory distress syndrome

A

localized lung damage secondary to a systemic worsening problem like aspiration near drowning damage to CNS transfusion reaction sepsis pneumonia or PE

53
Q

what is the diagnostic testing for acute respiratory distress syndrome

A

X-ray shows pulmonary edema, ECG to rule out cardiac involvement

54
Q

what is the treatment for acute respiratory distress syndrome

A

intubation and mechanical vent, monitor ECG, S PO2, lung sounds, skin color, suction as needed, kinetic therapy, extracorporeal membrane oxygenation

55
Q

there’s a complication that can occur to the vocal cords because of acute respiratory distress syndrome

A

traumatic or long term intubation cause damage to vocal cords placement of the tube check placement queue one to two hours, assess lung sounds, chest movement and SP O2 frequently secured tube per policy

56
Q

what is barotrauma

A

vent with positive pressure subq emphysema so monitor O2 assess for subq emphysema document all vent changes high pressure vent alarm may mean pneumothorax

57
Q

What is a weaning method for mechanical ventilation

A

spontaneous breathing trials(spontaneously breathing through artificial airway for a set time), pressure support ventilation (tolerates progressive decrease in pressure support),

58
Q

what is weaning criteria

A

the cause of respiratory compromise has improved, able to initiate respiratory effort, adequate oxygenation hemodynamically stable

59
Q

What is the surgical management for lung cancer

A

lobectomy, pneumoectomy, segmenectomy, wedge resection

60
Q

what are the lung transplant indications

A

emphysema, cystic fibrosis, pulmonary fibrosis, pulmonary hypertension, sarcoidosis

61
Q

what are the risk factors for lung cancer

A

genetic exposure, smoking

62
Q

what is the nonsurgical management for lung cancer

A

chemo, targeted therapy (thorocentesis or pleurodesis), radiation therapy, photodynamic therapy

63
Q

what are the risks for lung transplant

A

bleeding, infection, PE, severe pulmonary edema, rejection

Med surg Exam 3 (6 decks)

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