Respiratory #2 Flashcards
1
Q
Measures lung volume and airflow-
A
Pulmonary Function Test
2
Q
Used to Diagnosis, monitors disease progression, evaluates response to bronchodilators
A
Pulmonary Function Test
3
Q
Spirometry- given by a trained personal
A
Measures airflow.asked to take a deep breath and blow as hard as possible. Lung function test. Hand held
4
Q
Peak Flow meter
A
Used at home. Hand help. Blows forefully and quickly. Can be done by the pt.
5
Q
6-minute walk test
A
Measures functional capacity
Pulse ox monitored during walk
6
Q
ABGs: Acid Base regulation
A
Buffer System, Respiratory System (happens in mins, maximum effectiveness in hours), Renal System
7
Q
Fastest-Immediate Reaction
A
Buffer System
8
Q
Primary Regulator
A
Buffer System
9
Q
Neutralize Acids
A
Buffer System
10
Q
Respiratory and Renal systems must have adequate function
A
Buffer System
11
Q
Excrete CO2 and H20
A
Respiratory System
12
Q
Respiratory Regulation in Medulla
A
Respiratory System
13
Q
Normal Acid elimination
A
Renal System
14
Q
Absorb HCO3 increasing blood PH and decreasing urine acidity
A
Renal System
15
Q
Keep on eye of ABGs to see if
A
tx is working
16
Q
Chemically change stronger acid to weaker ones or completely neutralize it-
A
buffer system
17
Q
Both have to work together-
A
resp and renal
18
Q
Lungs help maintain normal ph by excreting co2 and h2o=
A
cellular metabolism
19
Q
Respiratory Center in the medulla controls the rate of
A
excretions of CO2
20
Q
If co2 or hydrogen is high the respiratory system is stimulated it will
A
increase rate of breathing to get rid of CO2
21
Q
If co2 is low the level of respirations are
A
inhibited
22
Q
Renal system-
A
last resort, hours to days.
23
Q
Kidney function is to balance through the
A
urine.
24
Q
Normal ph is 6 for urine but can go to
A
4 or 8 depending what is needed.
25
Kidneys will reabsorb additional bicarb and eliminate excess of hydrogen for
Acidosis
26
___ normal pH
7.35-7.45
27
ABGs- goes on wrist.
Measures acidity and alkalinity in arteries.
28
Nurses need to note when the ABGs values are
abnormal.
29
pH “acidity” or “alkalinity”
7.35 – 7.45
30
PaCO2 (pulmonary) Carbon dioxide “Acid"
35 - 45
31
HCO3 (Kidney) Bicarbonate “Base”
22 - 26
32
PaO2 Oxygen Hypoxemia
80 - 100
33
Breath co2 and hydrogen-which is linked to acid.
The more co2 the higher the acid
34
Is it Acidosis or Alkalosis? pH
3 Step ABG Interpretation
35
Is it Respiratory or metabolic? Co2/HCo3
3 Step ABG Interpretation
36
Is it compensated or uncompensated?
3 Step ABG Interpretation
37
pH <7.35
Acidosis
38
pH >7.45
Alkalosis
39
PaCO2
Respiratory
Acid
40
HCO3
Metabolic
Base
41
PaC02- abnormal and HC03- is normal =
respiratory
42
HC03-abnormal and PaC02 is normal =
kidney
43
CO2 is high-
acid, lungs will breathe deep and fast to get risk of co2 loss
44
CO2 is low or alkaline=
respirations will be decreased
45
Kidneys will absorb the
bicarb
46
PaCO2 <35
Respiratory Alkalosis
47
PaCO2 >45
Respiratory Acidosis
48
HCO3 <22
Metabolic Acidosis
49
HCO3 >26
Metabolic Alkalosis
50
Respiratory acidosis is a sign of
respiratory failure
51
Lung working too hard- pulmonary edema, etc
Respiratory acidosis
52
Too slow lungs- sedated or problem with brainstem, problem with mobility, muscle paralysis of respiratory muscles
Respiratory acidosis
53
Respiratory acidosis Cardio symptoms
Low BP, v-fib, warm flushed skin
54
Respiratory acidosis Neuromuscular symptoms
Seizures, muscle weakness, hyperflexia
55
Respiratory acidosis S/sx
Hypoventilation= Hypoxia
Rapid, shallow respirations
Skin/Mucosa Pale to Cyanotic
HA
Hyperkalemia
Dysrhythmias
Drowsiness, Dizziness, Disorientation
56
Respiratory acidosis Causes
Respiratory depression (Anesthesia, Overdose, Increase intracranial pressure), Airway obstruction, decrease alveolar capillary diffusion (Pneumonia, COPD, ARDS, PE)
57
Respiratory acidosis
Fixing the problem
58
Respiratory Acidosis Tx: Fix respirations- exhale co2 to decrease carbonic acid in blood
59
Respiratory Acidosis Tx: Bronchodilators-
reverse airway obstruction (inflammation)
Beta agonist- albuterol
Anticholinergic- ipratropium
Methylxanthines- theophylline
60
Respiratory Acidosis Tx: Respiratory stimulants-
to increase respiratory drive and help breathe.
61
Respiratory Acidosis Tx: Increase respiratory drive and stimulate ventilation, pts w copd
can have respiratory acidosis.
62
Respiratory Acidosis Tx: Diuretic- acetazolamide-
causes metabolic acidosis by increasing bicarb excretion causing body to increase body ventilation.
63
Respiratory Acidosis Tx: Drug antagonists-Antidotes- reverse effects-
Narcan, flumazenil-reverse effects of benzodiazepines
64
Respiratory Acidosis Tx: O2 improves gas exchange.
Prevent hypoxemia and restore acid base balance.
65
CO2 is the main drive for
breathing.
66
Copd patients do not have the drive anymore.
O2 sat 88-92 percent is normal.
67
Respiratory Acidosis Tx: Vent
Support
68
Respiratory Alkalosis:
pH: >7.45 and PaCO2 <35
69
Hyperventilation with anxiety (Rapid rate)
Respiratory Alkalosis Causes
70
Hypoxemia (primary cause of alkalosis)
Respiratory Alkalosis Causes
71
Pneumonia
Respiratory Alkalosis Causes
72
Pulmonary Embolus
Respiratory Alkalosis Causes
73
Pregnancy (normal finding)
Respiratory Alkalosis Causes
74
Ventilatory settings too high or too fast
Respiratory Alkalosis Causes
75
High altitudes
Respiratory Alkalosis Causes
76
Liver failure
Respiratory Alkalosis Causes
77
Septicemia (fever)
Respiratory Alkalosis Causes
78
Stroke
Respiratory Alkalosis Causes
79
Overdose of salicylates or progesterone
Respiratory Alkalosis Causes
80
Seizures
Deep Rapid Breathing
Respiratory Alkalosis s/sx
81
Hyperventilation
Tachycardia
Respiratory Alkalosis s/sx
82
Low or normal BP
Respiratory Alkalosis s/sx
83
Hypokalemia
Numbness and tingling of extremities
Respiratory Alkalosis s/sx
84
Lethargy and confusion
Respiratory Alkalosis s/sx
85
Light headedness
N/V
Respiratory Alkalosis s/sx
86
Respiratory Alkalosis causes
Hyperventilation (Anxiety, PE, Fear)
Mechanical Ventilation
87
Treat underlying cause to resolve problem
Respiratory Alkalosis Tx
88
Decrease tidal volume or resp rate- slow down
Respiratory Alkalosis Tx
89
Pain control/sedation-help with anxiety
Respiratory Alkalosis Tx
90
Breathe into paper bag- Used during acute episodes
Respiratory Alkalosis Tx
91
Antidepressants- to depress CNS and help slow down breathing. Unresponsive to paper bag or decrease stress.
Respiratory Alkalosis Tx
92
Correct Co2 slowly to prevent metabolic acidosis. The kidney will try to compensate and decrease bicarb reabsorption.
Respiratory Alkalosis Tx
93
Metabolic Acidosis
pH < 7.35 HCo3 < 22
94
Diabetic ketoacidosis- accumulation of acid. Keto acid accumulation
Metabolic Acidosis
95
Lactic acidosis- accumulation of acid, pts that have shock
Metabolic Acidosis
96
Starvation
Metabolic Acidosis
97
Diarrhea- losing bicarb
Metabolic Acidosis
98
Renal tubular acidosis
Metabolic Acidosis
99
Renal failure
Metabolic Acidosis
100
GI fistulas
Metabolic Acidosis
101
Shock
Metabolic Acidosis
102
Ileostomy- risk for metabolic acidosis bc fluid is
higher than the plasma
103
Carbonic acid accumulates in the body and losing bicarb through body fluids
metabolic acidosis
104
Always accompined with hyperkalemia
metabolic acidosis
105
Metabolic acidosis S/Sx
HA, Decreased BP, Hyperkalemia, Muscle twitching, Warm flushed skin, N/V/D, LOC changes, Kussmaul respirations (compensatory hyperventilation).
106
Metabolic acidosis Causes
Diabetic Ketoacidosis, Severe diarrhea, Renal Failure, Shock
107
Raise plasma pH > 7.20
Metabolic Acidosis Tx
108
Treat underlying cause to get problem resolved faster
Metabolic Acidosis Tx
109
Sodium Bicarb
Metabolic Acidosis Tx
110
Follow ABGs- to track pt and to see if better
Metabolic Acidosis Tx
111
Continuously monitor patient.- vital signs
Metabolic Acidosis Tx
112
Kidney-
potassium bicarbonate
113
Diabetic Keto Acidosis-
Insulin and hydration
114
Lactic acid-
bicarbonate and reversal agent for ethanol and methanol poising
115
Sodium bicarbonate low- give
bicarbonate
116
If pt not responding to therapy give-
sodium bicarbonate meanwhile
117
Metabolic alkalosis
pH > 7.45 HCO3 > 26
118
Metabolic alkalosis Causes
Vomiting
NG suctioning
Diuretic therapy- loss acid, potassium, and gi/renal hydrogen. Decrease in chloride.
Hypokalemia
Excess bicarb intake
119
Loses potassium
Metabolic alkalosis
120
Seeing in pts overusing antacids- makes gut alkaline
Metabolic alkalosis
121
Lose much bicarbonate and little acid
Metabolic alkalosis
122
Metabolic Alkalosis s/sx
Restlessness followed by lethargy, dysrhythmias, Compensatory hypoventilation, confusion (Decreased LOC, Dizzy, Irritable), N/V/D, tremors, muscle cramps, tingling of fingers and toes
123
Metabolic Alkalosis Cause
Severe vomiting
Excessive GI suctioning
DIuretics
Excessive NaHCO3 (Sodium Bicarbonate)
124
Treat underlying cause
Metabolic alkalosis tx
125
Stop K+ wasting diuretics- change to loop or thiazide like diuretics
Metabolic alkalosis tx
126
Spironolactone- potassium sparing
Metabolic alkalosis tx
127
Acetazolamide- potassium sparing
Metabolic alkalosis tx
128
IV fluids- NS
Metabolic alkalosis tx
129
Sodium chloride
Metabolic alkalosis tx
130
Replace K+ by food or IV therapy
Metabolic alkalosis tx
131
Monitor Resp rate- respirations decreased which leads to hypoxia. if any decrease in oxygenation report to doctor
Metabolic alkalosis tx
132
Monitor HR- changes due to electrolyte disturbances
Metabolic alkalosis tx
133
Seizure precautions
Metabolic alkalosis tx
134
Change in o2 sats put them on high flow non rebreather mask, seizure precaution (electrolyte imbalance)
Metabolic alkalosis tx
135
Sodium choride- helps sodium, fluid, and water
Metabolic alkalosis tx
136
Be careful with HF and renal insufficiency
Metabolic alkalosis tx
137
Pt has large amout of mucosity (thick)- position to help move secretions in the lungs
Chest Physiotherapy (CPT)
138
Group with physical therapy technique to improve function and breath better
Chest Physiotherapy (CPT)
139
Expands lungs- strengthens muscles, loosens and drain thick lung secretion
Chest Physiotherapy (CPT)
140
Needed to unclog the airways, uses gravity, and percussion
Chest Physiotherapy (CPT)
141
Head should be lower than the chest
Chest Physiotherapy (CPT)
142
Same intention connected to machine.
High Frequency Chest Wall Oscillation Vest
143
Vibration at high vibration.
High Frequency Chest Wall Oscillation Vest
144
Every 5 minutes the pt is supposed to cough and bring out secretion
High Frequency Chest Wall Oscillation Vest
145
Incentive speedometer- common
Vibratory Positive Expiratory Pressure Device (PEP)
146
Causes vibration also to remove secretions
Hand held
Vibratory Positive Expiratory Pressure Device (PEP)
147
Establish a patent airway due to mass- temporary or permanent.
TRACHEOSTOMY needed
148
Object not allowing person to take breaths
TRACHEOSTOMY needed
149
Bypass an upper airway obstruction
TRACHEOSTOMY needed
150
Facilitate removal of secretions
TRACHEOSTOMY needed
151
Permit long term mechanical ventilation
TRACHEOSTOMY needed
152
Facilitate weaning from mechanical vent
TRACHEOSTOMY needed
153
Surgical creates stoma in interior portion of trachea
TRACHEOSTOMY
154
Post op- NPO
TRACHEOSTOMY
155
Monitoring for abnormal lung sounds, check o2 sats min q4h.
Post op more often- when they get there q 15 mins, q30 mins, q1h
TRACHEOSTOMY
156
Nothing restricting the stoma
TRACHEOSTOMY
157
Inflated cuff most common with mechanical ventilation or pts at risk for ventilation or no cuff
TRACHEOSTOMY
158
Cuffless- for pts with longer term trache for eating and talking. Inner part, may be fenestrate (hole) to allow pts to breathe and speak
TRACHEOSTOMY
159
Trachcolar to keep in place
TRACHEOSTOMY
160
Not much humidity there where the ostomy is. If have humidifier watch for condensation
TRACHEOSTOMY
161
Will require a sterile field
Tracheostomy Care
162
Will require use of solutions from non-sterile containers
Tracheostomy Care
163
Will require oxygen and suction
Tracheostomy Care
164
Delegation: established trachs may delegate to unlicensed personnel, but
new fresh trachs, RN’s must perform the care and assess
165
Use only sterile manufacture precut dressings or folded 4X4,
never use cotton-filled gauze sponge.
Already prepared for cleaning
166
EBP: patient may aspirate
cotton or gauze fibers
167
If there is powder, hair or chemicals present-
protect trachea ostomy
168
Assess patient’s respiratory status prior to care
Tracheostomy Care Assessment
169
Respiratory rate, depth, rhythm, breath sounds, color, pulse oximetry (determines whether patient can tolerate trach care)
Tracheostomy Care Assessment
170
Assess trach site for drainage, redness or swelling (indications of infection)
Tracheostomy Care Assessment
171
Assess when patient last ate, schedule care at least 3 hours after meal to decrease risk of vomiting or aspirating stomach contents
Tracheostomy Care Assessment
172
Shouldn’t be taking a long time
Tracheostomy Care Assessment
173
If any think yellow tenuous secretion-
sign of infection
174
-Lower head of the bed to access trach
dressing and ties
175
-Loosen one side of trach ties, remove
old dressing and discard with gloves
176
-Prepare sterile field and
loosen caps to sterile saline
177
-Open sterile gloves and don
***ENSURE contents of the tray remain dry****
178
-Using non-dominate hand open and pour sterile saline into each
compartment of the tray
179
-Remove inner cannula of trach and place in larger compartment
**CLEAN PROCEDURE**
180
-Use the brush to clean the inner cannula thoroughly with
saline
181
-Rinse inner cannula by immersing in one compartment of
sterile saline
182
-Use pipe cleaners to dry .
inner cannula thoroughly
183
-Replace inner
cannula
184
-Use sterile swabs and remaining UNUSED compartment of sterile saline to
cleanse stoma area.
185
-Pat stoma dry with sterile
4x4
186
-Replace sterile trach
dressing.
187
Re-secure
trach tie.
188
Date and time performed
Tracheostomy Care Documentation
189
Note color, amount consistency and odor of secretions
Tracheostomy Care Documentation
190
Note condition of stoma and skin around stoma site, any drainage, redness, or swelling
Tracheostomy Care Documentation
191
Document respiratory status before and after
Tracheostomy Care Documentation
192
Patient’s tolerance of procedure
Tracheostomy Care Documentation
193
Note any problems that arose and interventions provided for those problems
Tracheostomy Care Documentation
194
On documentation always-
how you found the patient, what you did in-between, and how you leaving patient
195
Suction only when necessary
Suctioning Tracheostomy
196
Use suction catheter no more than ½ size of internal diameter of airway tube
Suctioning Tracheostomy
197
Adjust suction regulator per policy, lowest possible setting to accomplish suction (just to remove secretion:
Adults 100-150 mm Hg
Children: 100-120 mm Hg
Infants: 50-95 mm Hg
Suctioning Tracheostomy
198
Too much secretion=
suction
199
Suction only when necessary.
The more suction the more mucus.
200
Dominant hand sterile, non-dominant hand unsterile
Suctioning Tracheostomy
201
Dominant hand sterile, non-dominant hand unsterile
Suctioning Tracheostomy
202
Place patient in semi-fowler position
Suctioning Tracheostomy
203
Hyperoxygenate patient prior to suction
Suctioning Tracheostomy
204
Insert catheter gently without applying suction (closing suction opening with thumb)
Suctioning Tracheostomy
205
Place pt in semifolwers position, hyper oxygenate(take deep breaths) insert gently then when coming out apply suction
Suctioning Tracheostomy
206
Do NOT force catheter
Suctioning Tracheostomy
207
Do NOT apply suction as you enter the airway
Suctioning Tracheostomy
208
Rotate the suction catheter when withdrawing it
Suctioning Tracheostomy
209
Apply suction as you remove the catheter but no longer than 15 seconds
Suctioning Tracheostomy
210
Avoid saline lavage during suctioning
Suctioning Tracheostomy
211
Repeat suction as needed allowing 30 second intervals hyper oxygenate between passing catheter
Suctioning Tracheostomy
212
When suctioning is completed, provide oxygen source
Suctioning Tracheostomy
213
Provide oral care
Suctioning Tracheostomy
214
Reposition patient
Suctioning Tracheostomy
215
Provide for safety
Suctioning Tracheostomy
216
Date and time suction was performed
Suctioning Tracheostomy: Documentation
217
Note suction techniques (sterile) and catheter size used
Suctioning Tracheostomy: Documentation
218
Note color, consistency, and odor of secretions
Suctioning Tracheostomy: Documentation
219
Document patient’s respiratory status before and after the procedure
Suctioning Tracheostomy: Documentation
220
Document patient’s tolerance of procedure and any complications encountered
Suctioning Tracheostomy: Documentation
221
Document any interventions performed to address complications.
Suctioning Tracheostomy: Documentation
222
Epistaxis- Nose bleed.
223
Mucosa erodes and vessels become exposed and break.
Epistaxis Patho/Etiology
224
Caused by trauma, mucosa irritation, inflammation, tumors, septal abnormalities, foreign bodies, prolonged inhalation of dry air, hypertension, migraines, heat.
Epistaxis Patho/Etiology
225
Nose bleeding
Epistaxis S/Sx
226
Monitor h&h
Epistaxis Diagnostic/Labs
227
Apply pressure.
Epistaxis Interventions
228
Forward and down.
Epistaxis Interventions
229
Breathe through mouth.
Epistaxis Interventions
230
If not stopping may need to cauterize to stop bleeding.
Epistaxis Interventions
231
Packing-folded gauze with petroleum or nasal tampon.
Epistaxis Interventions
232
If bleeding more towards back will do a balloon system through the mouths
Epistaxis Interventions
233
Topical vasoconstriction.
Epistaxis Medications
234
Large bleed- or tetracaine, or lidocaine solution, 4% cocaine solution.
Epistaxis Medications
235
Hemostatic packing with absorbable gelatin
Epistaxis Medications
236
Nose bleeding disorder
Epistaxis
237
Epistaxis Patho/Etiology
Dry cracked mucosa and Trauma
238
Dry cracked mucosa Meds
Nasal Saline
239
Trauma Interventions
Ice Packs
Pressure
240
Pressure interventions
Pack with petroleum or iodoform gauze
Rapid Rhino / small foley cath / nasal tampons
241
Pack with petroleum or iodoform gauze Medications
Antibiotics
242
Pack with petroleum or iodoform gauze
Rapid Rhino / small foley cath / nasal tampons
Conceptual concern
Gas exchange/Oxygenation
243
Epistaxis Interventions
Sit upright leaning forward
Educate not to blow nose x 48 hrs, avoid nose picking, avoid bending over
244
Epistaxis S/Sx
Nose Bleed
245
Epistaxis/Nose Bleed Conceptual Concern
Clotting
246
Clotting Interventions
Monitor Vitals and Bleeding
247
Clotting Medications
Phenylephrine-vasoconstriction
Silver nitrate- to clot
248
Clotting Labs/Diagnostics
Hgb
249
At Home tx for epistaxis
Pinch tip of nose with two fingers for 15-20 mins
Sit up
Slightly lean forward and tilt head forward
250
If bleeding continues use
topical nasal sprays- vasoconstricts and local anesthetics
251
If medication doesn't work
posterior epistaxis
252
Hospital setting tx
In case of recurrent or non stopbleeding
Nasal packing- insert gauze like material or nasal tampon in nasal cavity
253
Nasopharyngeal cancer-
recurring nosebleeds
254
Inflammation of sinuses
Sinusitis Patho/Etiology
255
Due to bacterial infection, upper respiratory illness.
Sinusitis Patho/Etiology
256
Most commong organism is streptococcus pneumonia and hemophilius influenzas.
Sinusitis Patho/Etiology
257
Can be acute or chornic and unresponsive to tx.
Sinusitis Patho/Etiology
258
Maxillary and ethmoid sinus are most effected
Sinusitis Patho/Etiology
259
Nasal inflammation, thick discolored discharge,
Sinusitis S/Sx
260
runny noise, nasal drainage,
Sinusitis S/Sx
261
stuffy nose, difficulty through nose,
Sinusitis S/Sx
262
pain and swelling eyes, cheeks, nose, forehead.
Sinusitis S/Sx
263
Reduced sense of smell and taste.
Ear pain, headache, aching up upper jaw and teeth, sore throat, bad breath, fatigue
Sinusitis S/Sx
264
Insensitive nasal swab to determine antibiotics.
Sinusitis Diagnostics/Labs
265
Xray for sinus problems. Nasal endoscopy. Ct scan, MRI
Sinusitis Diagnostics/Labs
266
Nasal irrigation with NS solution to clear mucous
Sinusitis Interventions
267
Can give warm packs for 1 2 hours twice a day and to decrease inflammation.
Sinusitis Interventions
268
Oral fluids and humidifier helps loosen secretion.
Sinusitis Interventions
269
Antihistamines can help dry secretions.
Sinusitis Interventions
270
If tx doesn’t work they will drain sinus and irrigate with NS and antibiotic solution.
Sinusitis Interventions
271
Nasal spray, fluticasone or Flonase (corticosteroid).
Sinusitis Interventions
272
Constrict blood vessels- osetavesolamine be cautious with heart problems. Used up to three day bc will cause rebound congestion
Sinusitis Interventions
273
Acetaminophen or ibuprofen for fever.
Antibiotics for most sinus infections.
Sinusitis Meds
274
Benedryl makes mucus thick can cause
bronchitis.
275
Inflammation of sinuses disorder
Sinusitis
276
Sinusitis Patho/Etiology
Inflammation of sinus membranes, Allergies, NG tube irrigation and Bacteria/Virus/Fungus
277
Inflammation of sinus membranes conceptual concern
inflammation
278
Inflammation of sinus membranes s/sx
Swelling/Inflammation, Pain
279
Inflammation of sinus membranes interventions
Warm moist packs
280
Swelling/Inflammation meds
Adrenergic nasal sprays (Afrin), Corticosteriods (Flonase)
281
Adrenergic nasal sprays (Afrin) Interventions
Educate to only use for up to 3 days
282
Pain interventinos
Semi fowlers position
283
Pain meds
Analgesics (Acetaminophen, ibuprofen)
284
bacteria/Virus/Fungus medications
antibiotics
285
Antibiotics labs/diagnostics
culture
286
Bacteria/Virus/Fungus S/Sx
Purulent nasal discharge
287
Purulent nasal discharge labs/diagnostics
Culture
288
Purulent nasal discharge intervention
8-10 glasses of water and generalized fatigue to rest
289
Purulent nasal discharge Meds
Nasal irrigation
290
Purulent nasal discharge conceptual concern
Gas Exchange / Oxygen
291
Bacteria / Virus / Fungus conceptual concern
Infection
292
Bacteria / Virus / Fungus S/sx
Fever, generalized fatigue
293
Inflammation of nasal mucous membrane, release of histamine that causes vasodilation and edema.
Viral Rhinitis Patho/Etiology
294
Pollen, dust, foods cause.
Viral infection like common cold, rhinovirus or bacterial infection
Viral Rhinitis Patho/Etiology
295
Slow onset, nasal congestion, localized itching, cough, sneezing, sore throat, nasal discharge.
Viral Rhinitis S/Sx
296
Rare head ache. Malaise, fever, commonly muscle aches
Viral Rhinitis S/Sx
297
throat culture and rapid flu.
Viral Rhinitis Labs/Diagnostics
298
Control stress.
Stop slow down drinking.
Stay away allergens dander dust pollen and mold.
Viral Rhinitis Interventions
299
Does not cure but tx symptoms OTC Ibrophen, Tylenol, Vicks, nasal spray, cough drops, syrups and warm fluids to sooth the throat
Viral Rhinitis Meds
300
Inflammation of nasal mucous membrane disorder
Viral Rhinitis (Common Cold)
301
Viral Rhinitis (Common Cold) Patho/Etiology
Inflammation of nasal membranes, Virus, Rhinovirus
302
Inflammation of nasal membranes s/sx
Sore throat, nasal congestion
303
Inflammation of nasal membranes conceptual concern
Inflammation
304
Sore throat labs/diagnostics
Throat culture or rapid flu test
305
nasal congestion intervetions
Fluids
306
nasal congestion S/Sx
Nasal discharge, Localized itching, and sneezing
307
nasal congestion meds
decongestants
308
Virus conceptual concern
Infection
309
Virus S/Sx
Fever, Malaise
310
Virus interventions
Educate why antibiotics are not used
311
Malaise intervention
Rest
312
Viral Rhinitis (Common Cold) labs/diagnostics
s/sx to diagnose
313
Sore throat.
Inflammation of pharynx main cause if viral
Pharyngitis patho/etiology
314
Sore throat, dysphagia due to inflammation.
Red swollen with exudate(bacterial infection).
Can be accompanied by fever child and headache
Pharyngitis s/sx
315
Strep, throat culture, sensitivity test
Pharyngitis labs/diagnostics
316
Salt water gargles and honey (antibacterial), lemon mixed with warm water and push fluids
Pharyngitis Interventions
317
Antibiotics if bacterial-penicillin. Tylenol. Throat Lozenges
Pharyngitis Meds
318
Inflammation of pharynx disorder
Pharyngitis
319
Pharyngitis Patho/etiology
Inflammation of pharynx, Virus, Bacteria, Beta-hemolytic streptococci
320
Inflammation of pharynx CC
Inflammation
321
Beta-hemolytic streptococci causes
Strep throat
322
Strep throat not treated can cause -
Rheumatic fever-may go away or cause problems in long run
Glomerulonephritis-damage inside kidney
323
Strep Throat Labs/diagnostics
Rapid strep test
324
Rapid strep test meds
Antibiotics (Penicillin)
325
Bacteria labs/diagnostics
Throat culture and sensitivity
326
Throat culture and sensitivity meds
Antibiotics (Penicillin)
327
Bacteria s/sx
Fever/chills, exudate, generalized malaise
328
Fever/chills meds
Acetaminophen
329
Bacteria CC
Infection
330
Fever/chills interventions
fluids
331
generalized malaise interventions
Rest
332
Exudate s/sx
Sore throat that is red and swollen and dysphagia
333
Sore throat that is red and swollen meds
throat lozenges
334
Sore throat that is red and swollen interventions
saltwater
335
Pharyngitis pediatric considerations
Highest incidence in ages 4-7
336
Occurs when filtering function of the tonsils become overwhelmed with virus or bacteria and results in infection.
Tonsillitis Patho/Etiology
337
Masses of lymphoid tissue that lie on each side of pharynx. Filter micro organisms protects lungs.
Tonsils
338
Viral bc of bacterial-stepococcus aureus and influenza.
Tonsillitis Patho/Etiology
339
Pneumococcus species tonsillitis more prevalent in children but more serious in adults
Tonsillitis Patho/Etiology
340
Sore throat. Pain when swallowing, ear ache, temp 100.4
Tonsillitis S/Sx
341
Chills. Malaise. Headache. Muscle pain. Redness with selling.
Tonsillitis S/Sx
342
Culture and sensitivity of tonsils and throat. WBCs count.
Vitals for fever and visual inspection of tonsils
Tonsillitis L/D
343
Yellow or white exudate on tonsils. Symptoms sudden and will go away within 3-4 days
Tonsillitis S/Sx
344
Monitor airways.
push fluids.
encourage rest. Put high fowlers to breathe better. Worst case- tonsillectomy
Tonsillitis interventions
345
Acetaminophen
Tonsillitis Meds
346
Inflammation of the tonsils disorder
Tonsillitis
347
Tonsillitis s/sx
HA, pain on swallowing, sore throat Malaise, Fever/Chills, Myalgia
348
Headache and sore throat meds
acetaminophen
349
Pain on swallowing interventions
Saltwater gargles
350
Sore throat s/sx
red and swollen tonsils with exudate
351
red and swollen tonsils with exudate interventions
Monitor airway, tonsillectomy
352
tonsillectomy interventions
monitor for bleeding, semi fowlers, keep suction equipment readily available
353
red and swollen tonsils with exudate CC
Gas exchange, oxygen and inflamamtion
354
Myalgia meds
acetaminophen
355
Malaise interventions
rest
356
Fever/chills interventions
fluids
357
Tonsillitis Pediatric concerns
Highest incidence in ages 4-7
358
Tonsillitis etiology
virus/bacteria
359
Virus and bacteria L/D
Throat and culture sensitivity and WBC with differential
360
Virus and bacteria CC
Infection
361
Bacteria meds
antibiotics
362
If big tonsils-
monitor airway or tonsillectomy
363
If bleeding call doctor asap
Cold shakes/ice cream
Tonsillitis
364
Viral infection of respiratory tract.
Influenza patho/etiology
365
Young children and critical patients, and older at increased risk complications such as immunocompromised system= death.
Influenza patho/etiology
366
Transsmsion of cough- droplet and contact with object that has virus. 1-3 days incubation
Influenza patho/etiology
367
Fever, aching muscles, chills, sweat, tiredness weakness, stuffy nose, sore throat, eye pain, vomiting diarrhea common in children
Influenza s/sx
368
Throat culture and flu test
Influenza L/D
369
Rest fluids
Influenza interventions
370
Acetaminophen. Aspirin. Antiviral meds-tamaflu
Influenza meds
371
Viral infection of respiratory tract disorder
Influenza
372
Influenza S/Sx
Malaise, HA, Sore throat, myalgia, fever/chills
373
Malaise interventions
rest
374
Acetaminophen pediatric consideration
avoid aspirin
375
HA and Myalgia meds
acetaminophen
376
Myalgia CC
Comfort
377
Fever/Chills interventions
fluids and monitor for dehydration
378
Influenze Patho/etiology
Virus
379
Virus meds
Antivirals (Tamiflu)
380
Virus L/D
Viral throat culture rapid flu test
381
Viral throat culture rapid flu test CC
Infection
382
Virus patho/etiology
Transmitted via droplets and physical contact
382
Transmitted via droplets s/sx
cough
383
vitals and lung sounds q4h disorder
pneumonia
384
cough interventions
vitals and lung sounds q4h
385
Transmitted via physical contact interventions
hand hygiene
386
Virus interventions
preventative measures
387
preventative measures meds
antivirals(tamiflu) and flu vaccine
388
flu vaccine interventions
Assess Allergies/ Educate
389
Could develop pneumonia- common complication monitor ABGs
Influenza
390
Avoid crowds for flu season, sharing food and drinks/utensils
Influenza
391
Antibiotics not effective for viruses
Influenza
392
Cold Onset
Slow
393
Cold fever
none or low grade
394
cold HA
rar
395
cold myalgia
less common
396
cold cough
present
396
cold chest pain
absent
396
cold fatigue
slight
397
cold sore throat
common
397
cold runny nose
common
398
cold complications
rare
399
cold tx
rest/fluids
400
flu onset
sudden
401
flu fever
comon
402
flu HA
common
403
flu myalgia
common (severe)
403
flu chest pain
common
403
flu fatigue
common (prolonged)
404
flu cough
present (dry)
405
flu runny nose
less common
405
flu complications
pnemonia
405
flu sore throat
less common
405
Bacterial Infection onset
usually slow
406
flu tx
rest/fluids and antivirals (Tamiflu)
407
Bacterial Infection HA
less common
407
Bacterial Infection fever
common
407
Bacterial Infection Myalgia
less common
408
Bacterial Infection chest pain
common
408
Bacterial Infection fatigue
common
408
Bacterial Infection cough
present (dry/productive)
408
Bacterial Infection runny nose
less common
409
Bacterial Infection sore throat
less common
410
Bacterial Infection complications
pneumonia
411
Bacterial Infection tx
antibiotics
412
inflammation of the bronchial tree s/sx
excessive mucus and congested airways
412
Acute bronchitis patho/etiology
virus, inflammation of the bronchial tree
413
Inflammation of Bronchial Tree patho/etiology
Occurs >3 months of year x 2 years
413
Occurs >3 months of year x 2 years disorder
chronic bronchitis
414
Dilation of the bronchiole airways where area becomes scarred.
Bronchiectasis patho/etiology
415
Can be localized in the bronchus then goes to the lungs.
Bronchiectasis patho/etiology
416
Excessive sections = risk for infections.
Bronchiectasis patho/etiology
417
It’s a secondary disease from asthma.
Bronchiectasis patho/etiology
418
Inflammation of the airways (comes after dilation), dyspnea. cough, purulent sputum, bloody sputum (hemoptysis)
Bronchiectasis s/sx
419
sputum culture to know organism. Xray, CT and lung function tests.
Bronchiectasis D/L
420
Chest Physiotherapy
Flu and pneumonia shot encouragement
Bronchiectasis interventions
421
Azithromycin.
Bronchiectasis meds
422
If they develop distended neck veins- call provider bc life threatening condition
Bronchiectasis meds
423
Bronchiectasis patho/etiology
Secondary to chronic respiratory disorder
424
Secondary to chronic respiratory disorder
L/D
Chest x-ray / CT Scan
Bronchoscopy
425
inflamed airways meds
bronchodilators and corticosteroids/leukotriene inhibitors
426
inflamed airways s/sx
bloody sputum
427
Secondary to chronic respiratory disorder patho/etiology
Dilation of Bronchial Airways
428
Secondary to chronic respiratory disorder
s/sx
inflamed airways
429
Dilation of Bronchial Airways s/sx
cough, dyspnea
430
Dilation of Bronchial Airways patho/etiology
Secretions pool in dilated areas
431
copious purulent sputum L/D
sputum cultures
432
copious purulent sputum interventions
fluids and Chest physiotherapy
433
copious purulent sputum meds
mucolytic (bronchitol)/expectorant
434
Secretions pool in dilated areas s/sx
wheezes/crackles, copious purulent sputum, recurrent lower respiratory tract infection
435
recurrent lower respiratory tract infection meds
antibiotics
436
recurrent lower respiratory tract infection s/sx
fever during active infection
437
fever during active infection interventions
oxygen and prevent infection
438
prevent infection meds
Flu & Pneumonia vaccines
Azithromycin
438
Bronchiectasis CC
infection and gas exchange
439
Bronchoscopy-
goes through nose then bronchus.
440
After procedure make sure gag reflex.
Bronchoscopy
441
Bronchospasm can happen
bc a lot of secretion in airways-wheezing crackles
Bronchoscopy
442
Check for edema
Bronchoscopy
442
Could heart problems- distended neck veins
Bronchoscopy
442
Expectorants for mucus
Bronchiectasis
443
Mucus causes bacteria/inflammation
Bronchiectasis
443
Lungs become scarred and damage causing dyspnea.
Pulmonary Fibrosis patho/etiology
444
Could be due to autoimmune disease or environmental hazards such as asbestos, cigarettes', radiation therapy
Pulmonary Fibrosis patho/etiology
444
clubbing, crackles in inspiration, SOB, cough,
Pulmonary Fibrosis s/sx
444
CT, chest xray, bronchoscopy-Gag reflex before fluids, rebound bronchospasm right away, spirometry
Pulmonary Fibrosis L/D
445
O2 therapy, pulmonary rehabilitation or lung transplant
Pulmonary Fibrosis interventions
446
Pulmonary Fibrosis (interstitial lung disease) interventions
smoking cessation
447
Pirfenidone-decreases progress of disease. Nintendanib- slows rate of lung function decline. Both does not cure it but slows down progress
Pulmonary Fibrosis meds
448
Pulmonary Fibrosis (interstitial lung disease)
meds
flu and penmonia vaccines, antifibrotics (pirfenidone, nintedanib)
449
Pulmonary Fibrosis (interstitial lung disease) s/sx
flu like symptoms
450
Pulmonary Fibrosis (interstitial lung disease) and Scarring and fibrosis of lung tissue. L/D
Chest x-ray, CT Scan, bronchoscopy, ABGs, Spirometry
451
Pulmonary Fibrosis (interstitial lung disease) patho/etiology
Injury to alveoli = chronic inflammation
452
Injury to alveoli = chronic inflammation
patho/etiology
Scarring and fibrosis of lung tissue.
453
Scarring and fibrosis of lung tissue. s/sx
Inspiratory Crackles
Cough
454
Scarring and fibrosis of lung tissue. CC
Gas exchange
455
Gas exchange s/sx
Clubbing, fatigue, SOB
456
Airways are narrow and blocked by inflammation, mucus, and loss of elasticity in the alveoli.
COPD patho/etiology
457
dyspnea, SOB, wheezing, Chronic cough with sputum production (clear, white , yellow, green.)
COPD s/sx
458
Need more effort to push air out.
more prone to respiratory infections.
Infection can cause exacerbation of copd.
COPD patho/etiology
459
Can hear coarse crackles. Decrease in O2 sat with exacerbation. Increase in CO2
COPD s/sx
460
Smoking cessation, breathing exercises, huff cough to expel air.
Dyspnea- help repositioning. CPT.
Educate to increase calories and protein.
COPD interventions
460
Sputum cultures. WBCs, chest xray, CT, ventilation perfusion scan.
COPD L/D
461
Bronchodilators-can cause rebound bronchospasm if not used right.
Albuterol-fast acting.
Corticosteroids- decrease inflammation.
Antibiotics spectrum.
COPD meds
462
COPD L/D
Spirometry
463
COPD patho/etiology
Smoking, air pollution, industrial chemicals
464
Smoking, air pollution, industrial chemicals interventions
smoking cessation
465
Smoking, air pollution, industrial chemicals patho/etiology
Chronic Bronchitis and emphysema
466
Chronic Bronchitis s/sx
cough, diminished breathe sounds/crackles/wheezes, increased mucus and inflammation
467
Emphysema s/sx
Increased mucus and inflammation, decreased alveolar elasticity, prolonged exhalation, air trapping, barrel chest
468
increased mucus and inflammation patho/etiology
blocked airways
469
blocked airways s/sx
dyspnea, accessory muscle use, activity intolerance, weight loss, chronic hypoxemia
470
blacked airways L/D
ABGs (Respiratory acidosis)
470
weight loss intervention
High protein, high calorie
471
increased mucus and inflammation meds
adrenergic and anticholinergic, corticosteroids
472
Dyspnea CC
Gas exchange
473
Dyspnea interventions
tripod position and breathing exercise
474
High protein, high calorie CC
nutrition
475
chronic hypoxemia disorder
polycythemia
476
chronic hypoxemia meds
oxygen
477
Chronic inflammation of the airways and hyperresponsiveness of the bronchiole smooth muscle (bronchospasm).
Asthma Patho/etiology
478
Genetic, exercise induced, certain drugs. Does not grow out of it.
Asthma Patho/etiology
479
Wheezing, SOB, chest tightness, coughing,
Asthma s/sx
480
Spirometry, peak flow meter, allergy skin test- asthma triggers,
Asthma L/D
480
Albuterol(bronchodilator)- gives fasted relief, Prednisone or methyl prednisone, solumedrol- corticosteroids (increase BGL) for attack, Montelukast-pill for inflammation
Asthma meds
481
4Educate about peak expiratory flow rate- which level green, yellow, or red(emergency).
Animal dander, food, dander.
O2, vital signs, wheezes.
Accessory muscles to breathe- High fowlers position
c interventions
482
Asthma patho/etiology
chronic inflammation of airways
483
chronic inflammation of airways L/D
Spirometry and peak expiratory flow rate
484
chronic inflammation of airways patho/etiology
asthma triggers
485
asthma triggers L/D
allergy skin test
486
Asthma triggers patho/etiology
bronchospasms
487
Bronchospasm S/sx
accessory muscle use, dyspnea, air trapping, prolonged expiration, increased RR, wheezing, chest tightness, cough
488
Bronchospasm CC
Gas exchange
489
Measures the maximum speed of expiration
Peak Expiratory Flow Rate
490
Results are higher when well lower when airflow is constricted
Peak Expiratory Flow Rate
490
Expected value depends on the patients sex, age, and height
Peak Expiratory Flow Rate
491
Higher result good
Low result- airway constricted
Helps to figure out Tx
Peak Expiratory Flow Rate
492
Peak flow results
Green Zone
Usually 80% to 100% of personal best
Remain on medications to prevent asthma attack
493
Peak flow results
Yellow Zone
Usually 50% to 80% of personal best
Indicates caution
Something is triggering asthma.
494
Peak flow results
Red Zone
50% or less of personal best
Indicates serious problem
Definitive action must be taken with health care provider
495
Short-Acting Beta-Agonists (SABAs)
Albuterol
496
Albuterol S/E
Tremors, anxiety, tachycardia, palpitations and nausea
497
Inhaled corticosteroids (ICS) – Flovent, Budesonide
Inhibit the inflammatory process
498
Long-acting Beta-Agonists (LABAs)
Salmeterol (Servent Diskus, Formoterol (Perforomist), Arformoterol (Brovana).
Teach to rinse mouth after using bc of thrush.
Used in combination with ICS
499
Leukotriene Receptor Antagonists (LTRAs)
Montelukast (Singulair).
Prophylacitc-blocks IgE to prevent bronchospasm.
Used when ICS cannot/will not be used or if ICS not controlling asthma
500
Theophylline
Bronchodilator
501
Theophylline Therapeutic range
>20 = toxic
502
Theophylline Toxicity s/sx:
N/V, rapid HR, seizures, dysrhythmias
503
Xolair
Omalizumab
504
Reduces sensitivity to allergens
Omalizumab
505
Used when high doses of corticosteroids does not work
Omalizumab
506
Not a rescue med
Omalizumab
507
SubQ Q2-4 weeks
Omalizumab
508
Genetic. Exocrine gland.
Cystic Fibrosis Patho/Etiology
509
Abnormal sodium and chloride. Effects GI tract, respiratory system and lungs.
Cystic Fibrosis Patho/Etiology
510
inhale in producing mucus and sweat- sodium and chloride. If defected- thick mucous
Cystic Fibrosis Patho/Etiology
511
Salty tasting skin, persistent coughing with phlegm. prone to lung infections-Pneumonia and bronchitis.
Cystic Fibrosis S/sx
512
Poor gross weight with no anorexia.
Cystic Fibrosis S/sx
513
Frequent bulky stools. Fowl odor and greasy stools steatorrhea.
Cystic Fibrosis S/sx
514
Developed pancreatic insufficiency- takes pancreatic enzymes before meals.
Cystic Fibrosis S/sx
514
Sweat and chloride test to see sodium in sweat. Genetic testing. Spirometry.
Cystic Fibrosis L/D
515
Feeding tube sometimes. Lung transplant-urgent. Increase fluids.
Cystic Fibrosis interventions
515
4.Lifetime changes-support groups. teach airway clearance techniques.
Cystic Fibrosis interventions
515
Chest physiotherapy. Pulmonary rehab. O2 therapy.
Cystic Fibrosis interventions
516
Pancreatic Enzymes given before they eat even if snack- helps with digestive system.
Cystic Fibrosis Meds
517
If foul odor stool the med is not working.
Cystic Fibrosis Meds
518
Pancrelipase. Oral pancreatic enzymes to help absorb nutrients.
Cystic Fibrosis Meds
519
If chest therapy do it before eating and if doing after eat wait
2 hours to prevent emesis.
520
give bronchodilators to open airways.
Cystic Fibrosis Meds
521
Pay attention to stools to see if med is working.
Cystic Fibrosis Meds
522
Teach airway clearance- observe coughing techinique
Cystic Fibrosis Meds
523
Cystic fibrosis patho/etiology
genetic exocrine gland disorder
524
genetic exocrine gland disorder L/D
genetic testing
525
genetic exocrine gland disorder patho/etiology
Abnormal NA and Cl transport
526
Abnormal NA and Cl transport L/D
Sweat chloride test
527
Sweat chloride test intervention
hydration
528
Abnormal NA and Cl transport patho/etiology
lungs, reproductive tract, sweat glands/skin, gi tract
529
sweat glands/skin L/D
sweat chloride test
530
sweat glands/skin s/sx
salty sweat glands
531
GI tract s/sx
Steatorrhea, bowel obstruction, pancreatic blocked ducts
532
Bowel obstruction CC
Elimination
533
pancreatic blocked ducts s/sx
malabsorption of nutrients, retained enzymes
534
malabsorption of nutrients intervention
High-calorie nutrient dense diet
535
retained enzymes meds
pancreatic enzymes
536
Reproductive s/sx
delayed sexual maturity and infertility
537
infertility CC
reproduction
538
Lungs CC
Gas exchange
539
Lungs s/sx
thick tenacious respiratory secretions, air trapping, resp infections
540
thick tenacious respiratory secretions meds
Pulmozyme, bronchitol, bronchodilators, NMTs
541
Thick tenacious resp secretions interventions
High-frequency chest wall oscillation
CPT
542
respiratory infections intervention
Prevention of infection
543
respiratory infections meds
antibiotics
544
Both parents carry gene- genetic testing
cystic fibrosis
545
Abdominal pain, bloating, steatorrhea- pancreatic enzyme is not working
cystic fibrosis
546
Amylase-
carbs digestion
547
Protease-
protein digestion
548
Mucous- prevent respiratory infections.
cystic fibrosis
549
Put on antibiotics and bronchodilator.
cystic fibrosis
550
1-2 hrs after meals- CPT
cystic fibrosis
551
Keep effective airway clearance.
cystic fibrosis
552
15 seconds for
suction.
553
Lipase-
digest fat
554
metabolic acidosis-
aspiration
555
Tonsillectomy and vomiting for kids-
turn to side and suction
556
Listen to lungs after
surgery
557
Albuterol can stop
asthma attack
557
Teach vaccine, wash hands, no drinking-
flu teaching
558
Trach patient-
reposition q2h, do not restrict fluids,
558
Crackles and wheezes in
asthma
559
Sore throat-
salt and water gargle
560
Labs for infection-
WBCs
560
Icepack lean forward-
nose bleed
560
Hemoptysis-
bloody sputum
561
Emergency-
JVD
562
Education- cystic fibrosis-
fluids, postural drainage, monitor stools
563
Normal pH and abnormal pH
7.35-7.45= normal
