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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
how do you diagnose pleural effusion
chest X-ray, thoracentesis
26
what is pleurisy
inflammation of the pleural space
27
what are the risk factors for pleurisy
infection, cancer, trauma
28
what are the signs and symptoms of pleurisy
sharp pain with inspiration, shallow rapid breathing, plural friction rub
29
what is the treatment for pleurisy
treat underlining cause, anti inflammatories, splinting, pain control
30
what is a pulmonary embolism
blockage of pulmonary arteries (thrombus, fat, air, tumor), saddle embolus (large embolus lodged arterial bifurcation)
31
what are the risk factors for pulmonary embolism
prolonged immobilization, central venous catheter, surgery, obesity, older, disorder that affects increased blood clotting, history of thromboembolism
32
what are the signs and symptoms of pulmonary embolism
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
how do you diagnose pulmonary embolism
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
what is the treatment for pulmonary embolism
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
what are the nursing interventions for pulmonary embolism
give O2, position for maximum ventilation, initiate and maintain IV access, assess cardiac and respiratory status every 30 minutes, provide emotional support
36
what is blunt trauma
appears minor is a striking or being struck by an object
37
what is a penetrating trauma
open wound, a foreign object impales or passes through the body
38
what do chest injuries include
pulmonary contusion, rib fracture, flail chest, thoraxs, trauma
39
what is the respiratory assessment for someone with a chest trauma
dyspnea, cough, tracheal deviation, diminished breast sounds, hypoxemia asymmetric chest movement subcutaneous emphysema, cyanosis
40
what are the signs and symptoms of a pulmonary contusion
asymptomatic early then rest then, diminished breath sounds, crackles, wheezing, increased heart rate, tachypnea, dry cough, dullness to percussion, bruising over injury
41
What are the diagnostics of pulmonary contusion
visual assessment, chest X-ray
42
what is the treatment for a pulmonary contusion
high fowlers or good lung down, frequent respiratory assessment, focused on maintaining ventilation and oxygenation
43
what are the signs and symptoms of a rib fracture
pain with movement, splints chest defensively, shallow breathing
44
what are the complications of a rib fracture
deep chest injuries with poor prognosis (first or second rib, flail chest, over 7 fractures), pulmonary contusion, hemothorax
45
what is the treatment for an uncomplicated rib fracture
ribs unite spontaneously, chest usually not splinted, pain is treated with intercostal nerve block and patient controlled analgesia
46
What is a flail chest
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
what are the signs and symptoms of flail chest
paradoxical chest movement, one side involvement, impaired gas exchange, dyspnea, cyanosis, increased heart rate, decreased blood pressure
48
what is the treatment for flail chest
mechanical vent, stabilized with PPV
49
what are the nursing interventions for flail chest
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
what is acute respiratory distress
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
what are the signs and symptoms of acute respiratory distress
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
what are the risk factors for acute respiratory distress syndrome
localized lung damage secondary to a systemic worsening problem like aspiration near drowning damage to CNS transfusion reaction sepsis pneumonia or PE
53
what is the diagnostic testing for acute respiratory distress syndrome
X-ray shows pulmonary edema, ECG to rule out cardiac involvement
54
what is the treatment for acute respiratory distress syndrome
intubation and mechanical vent, monitor ECG, S PO2, lung sounds, skin color, suction as needed, kinetic therapy, extracorporeal membrane oxygenation
55
there's a complication that can occur to the vocal cords because of acute respiratory distress syndrome
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
what is barotrauma
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
What is a weaning method for mechanical ventilation
spontaneous breathing trials(spontaneously breathing through artificial airway for a set time), pressure support ventilation (tolerates progressive decrease in pressure support),
58
what is weaning criteria
the cause of respiratory compromise has improved, able to initiate respiratory effort, adequate oxygenation hemodynamically stable
59
What is the surgical management for lung cancer
lobectomy, pneumoectomy, segmenectomy, wedge resection
60
what are the lung transplant indications
emphysema, cystic fibrosis, pulmonary fibrosis, pulmonary hypertension, sarcoidosis
61
what are the risk factors for lung cancer
genetic exposure, smoking
62
what is the nonsurgical management for lung cancer
chemo, targeted therapy (thorocentesis or pleurodesis), radiation therapy, photodynamic therapy
63
what are the risks for lung transplant
bleeding, infection, PE, severe pulmonary edema, rejection

Med surg Exam 3 (6 decks)

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