Respiratory 2 Flashcards
What are the five top priorities of a patient with a broken nose?
Airway, halo test, vision test, facial xray, and crepitus
Why are fractured noses so dangerous?
The airway could be obstructed and it can be a potential source of infection
Which type of epistaxis is more serious?
Posterior bleed
Which patient populations are more likely to develop epistaxis?
Patients with hypertension, leukemia, and those who snort cocaine
Why are sinus infections so painful?
Sinus infections are accompanied by pressure because they are very small spaces to begin with
What is battle’s sign?
A bruise behind the ear
Benign, grapelike clusters of mucous membranes and connective tissue
Nasal Polyps
How is CSF identified?
Glucose and halo tests
After a rhinoplasty, how often should vitals be taken?
Every 4 hours
What is the treatment of choice for nasal polyps?
Polypectomy
What is the nursing priority for patients with non-infectious URI?
Promote oxygenation by ensuring a patent airway
What would a posterior epistaxis look like?
Frank blood emesis
What interventions should be done for a patient with a broken nose?
Closed reduction, rhinoplasty, and nasosetoplasty
If giving two units of blood, what should also be administered?
FFP
What does CSF dripping from a broken nose indicate?
A skull fracture
What are carcinogens for nose and sinus cancer?
Wood dust, textiles, leather, flour, nickel, chromium, mustard gas and radium
What is dangerous about large nasal polyps?
They may obstruct the patient’s airway
What can a bruise behand the ear signify?
A fractured skull
What are cancers of the nose and sinuses so rare?
Because their cells are very fast growing
After a rhinoplasty, what should be observed?
Edema and bleeding
How are cancers of the nose and sinuses usually diagnosed?
Local lymph node enlargement on the side of the tumor often alerts doctors to the problem
What is done for a patient with epitaxis?
Pack the nose and possible cauterization of the affected capillaries
What is the priority action for a patient with facial trauma?
Airway assessment
What are cancers of the sinuses and nose so hard to diagnose?
Because they have a slow onset and their manifestations resemble sinusitis
How much fluid should a patient who has just had a rhinoplasy drink?
2500 mL/day
If giving blood rapidly, what extra step must be taken?
Warm the blood
What are the priority nursing intervention for patients with epistaxis?
Make sure the airway is patent, assess for respiratory distress and tolerance of packing or tubes, humidification, oxygen, bedrest, antibiotics, and pain medication
What are the clinical manifestations of nasal polyps?
Obstructed nasal breathing, increased nasal discharge, and a change in voice quality
How should a patient who has had a rhinoplasty be positioned?
WIth the head elevated
How are nasal polyps managed?
Inhaled steroids
What are the other names of the Le Fort III fractures?
Craniofacial disjunction or floating face fracture
Maxillary and nasoethmoid complex fracture
Le Fort II
What are the manifestations of facial trauma?
Stridor, dyspnea, anxiety, hypoxia and hypercarbia, decreased O2 saturation, cyanosis, LOC, sternal retractions, and echymosis behind the ear
Why are wire cutters so important to have for patients with facial trauma?
Incase of vomiting
How are cancers of the sinuses and nose treated?
Surgical removal generally, and that may be combined with radiation
Breathing disruption during sleep
Obstructive sleep apnea
What should the diet of a patient with a facial fracture be?
High calorie, proteins, and lipids
What are the signs and symptoms of obstructive sleep apnea?
Excessive daytime sleepiness, inability to concentrate, and irritability
What interventions should be done for patients with facial fractures?
Airway assessment, anticipate need for emergency intubation, tracheotomy, cricothyroidotomy, fixed occlusion, and debridement
What should be assessed for patients with facial trauma?
The mechanism of injury and any injuries occuring due to bracing the fall
Nasoethmoid complex fracture
Le Fort I
What is the nonsurgical management for obstructive sleep apnea?
Change of sleep position, weight loss, and positive pressure ventilaiton
What are the common disorders of the larynx?
Vocal cord paralysis, vocal cord nodules and polyps, and laryngeal trauma
What teaching should be done for patients with facial trauma?
Use of wire cutters, sleeping with the head of the bed elevated, nutrition, and appearance
Interruption in airflow through the nose, mouth, pharynx, or larynx
Upper airway obstruction
What are the intervention for upper airway obstruction?
Assess cause and mainatain a patent airway and ventilation
What is the surgical management for obstructive sleep apnea?
Adenoidectomy, uvulectomy or uvulopalatopharyngoplasty
Why is a high protein diet so important for patients with facial trauma?
They need albumin to heal
What is the clinical sign of aspiraction?
Coughing after swallowing
Facial fracture in which the bones are completely lifted off the face and no longer attached
Le Fort III
What is the priority for patients with neck trauma?
Assess for and maintain patent airway
If a patient has a neck injury, what should immediately be done?
Stabilize the neck
If a patient’s upper airway is obstructed, how can a patient airway be maintained?
Cricothyroidotomy, endotracheal intubation, or tracheotomy
What can obstruction occur from in a patient with neck trauma?
The initial injury or resultant swelling
What are the inital signs of head and neck cancer?
Mucous that is chronically irritated, becoming tougher, thicker, and harder to expectorate
What is the number one way upper airway obstruction occurs?
Foreign objects
What kind of lesions are seen in patients with head and neck cancer?
Leukoplakia and erythroplakia
What are the clinical manifestations of head and neck cancer?
lumps in the mouth, throat and neck that cause difficulty swallowing, color changes in the mouth or tongue, oral lesions, persistent, unilateral ear pain, unexplained oral bleeding, numbness of the mourth, lips, or face, change in the fit of the dentures, a burning senstation when drinking citrus or hot liquids, hoarseness or change in voice quality, persistent sore throat, SOB, and anorexia and unexplained weight loss
After airway, what should be assessed for a patient with neck trauma?
Carotid artery and esophagus and cervical spine injury
What kind of cancer cell is usually seen in head and neck injury?
Squamous cell carcinoma
After a laryngectomy, how can a patient communicate?
With a white board
What teaching should be done for a patient post laryngectomy?
Stoma care, communication, and smoking cessation
What should the diet of a patient post laryngectomy not include?
Spicy foods, citrus, or acidic foods
How is head and neck cancer treated?
Radiation therapy, chemotherapy, cordectomy, and laryngectomy
How can aspiration be prevented in a patient with head and neck cancer?
Sit up in chair for meals
Why do the signs and symptoms of head and neck cancer not appear until late?
Because there is a lot of potential space
What should a nurse give to a patient with radiation therapy of the throat to aleviate discomforts?
Vicous zylocaine
In older patients with dementia, what can be done to prevent airway obstruction?
Maintain head of bed at or above 45 degrees
What post operative care should be done for a patient who had a laryngectomy?
Airway maintenance and ventilation, hemorrhage, wound breakdown, pain management, nutrition, speech and language rehabilitation, and dopplar pulses on wound and reconstructed tissue
What causes an asthma attack?
Specific allergens, general irritants, microorganisms, aspirin, NSAIDs, exercise, and URIs
What are the clinical manifestations of asthma?
Audible wheezes, increased respiratory rate, increased cough, use of accessory muscles, barrel chest, long breathing cycles, cyanosis, and hypoxemia
In what ways does asthma occur?
Inflammation and airway hyper-responsiveness leading to bronchoconstriction
What laboratory assessments should be done on a patient with asthma?
ABGs
What would blood assessments show in a patient who had an allergic asthma attack?
There would be elevated serum eosinophil and IgE levels
What happens to the arterial CO2 levels of an asthma patient?
They decrease early in asthma attacks and increase later
Airway hyper-responsiveness leads to and over production of what?
Mucus
Where do the airway obstructions occur in asthma patients?
Lumen
What race is asthma more prevalent in?
African American
What is the hyper-responsiveness of asthma is cause by?
Exercise and URIs
What would the sputum assessment show in a patient who had an allergic asthma attack?
The sputum would have eosinophils, mucous plugs, and shed epithelial cells
The processes of asthma affect what part of the respiratory anatomy?
Airways only
When are pulmonary function tests most accurate?
When used with spirometry
What would happen to the arterial O2 levels of asthma levels?
They decrease during acute asthma attacks
What sex is asthma more common in?
Women
What does a yellow peak flow meter indicate?
50-79% of normal peak flow, indicates caution, may mean that respiratory airways are narrowing and additional measures may be required
Maximum amount of lung expansion
Forced vital capacity
How can a patient tell if their inhaler is full?
Float it in water
What do the arterial CO2 levels of an asthma patient indicate?
Poor gas exchange
What is the drug therapy for asthmatics based on?
It is a step category for severity and treatment
In what patient population does asthma increase the odds of health care use?
Obese patients
What interventions should be done for a patient with asthma?
Teaching for self management, use of peak flow meter twice daily, and a personal drug therapy
What does a green peak flow meter value indicate?
80-100% of normal peak flow, asthma is under good control
Drugs for asthma that change airway responsiveness to prevent asthma attacks
Preventative therapy or controller drugs
What three tests are done in a pulmonary function test?
Forced vital capacity, forced expiratory volume in the first second, and peak expiratory flow rate
Drugs used by asthmatics to stop attacks once they’ve started
Rescue drugs
Why is finding a personal drug therapy for an asthmatic patient so difficult?
Because the symptoms are not consistent
Besides drug therapy, what other treatments can be used for asthma?
Exercise and activity and oxygen therapy
How often should controller drugs be used by asthmatic patients?
Everyday, regardless of symptoms
What does a red peak flow meter value indicate?
Less than 50% of normal peak flow, indicates a medical emergency and severe airway narrowing may be occurring, immediate action needs to be taken
Why is it important that asthmatics exercise?
To promote ventilation and perfusion
What types of oxygen therapy are used for asthmatics?
Masks, nasal cannula, or ET Tubes
Why are ET tubes sometimes useless for some asthmatics?
Because even though you can intubate, you can’t force the oxygen into constricted airways
Why is status asthmaticus so dangerous?
Because it is unrelenting, intensifies once it begins, and does not respond to common therapy
What is the treatment for status asthmaticus?
IV fluids, potent systemic bronchodilator, steriods, epinephrine, and oxygen
Severe, life-threatening, acute episode of airway obstruction
Status Asthmaticus
What complications can arise from stats asthmaticus?
Patient can develop pneumothorax amd cardiac/respiratory arrest
What part of the lung does emphysema affect?
Alveoli
Inflammation of the bronchi and bronchioles caused by chronic exposure to irritants
Chronic Bronchitis
What is COPD characterized by?
Bronchospasms and dyspnea
What are the clinical signs of emphysema?
Dyspnea and the need for an increased respiratory rate
Why does air get trapped in the lungs of a patient with emphysema?
Because of the loss of elastic recoil in the alveolar walls
What is the goal of COPD management?
To minimize the damage that takes place
What diseases does COPD include?
Emphysema and chronic bronchitis
What complications can arise with chronic bronchitis?
Hypoxemia, tissue anoxia, ACIDOSIS, RESPIRATORY INFECTIONS, cardia failure, cardiac dysrhythmias
What are the clinical signs of chronic bronchitis?
Inflammation, vasodilation, congestion, mucosal edema, and bronchospasms
Loss of lung elasticity and hyperinflation of the lung
Emphysema
What is the end result of COPD?
Respiratory failure
What lab studies should be done to confirm a COPD diagnosis?
ABG, sputum samples, CBC, H&H, serum electrolytes, serum AAT, chest x-ray, and PFT
Cor Pulmonale
Right sided CHF
A bubble of air in a weak area of the lung that may pop and collapse that lung
Bleb
What is important to teach patients with COPD about mucolytics?
They have to drink water every time they cough
Which type of oxygen mask is best for patients with COPD?
Venturi mask
What is the purpose of a serum AAT for COPD patients?
It looks for a hereditary component
What types of drugs can be used to treat COPD?
Beta-adrenergic agents, cholinergic antagonists, methylxanthines, corticosteroids, NSAIDs, and mucolytics
What interventions should be done for patients with COPD?
Improve oxygenation and reduce carbon dioxide retention, prevent weight loss, minimize anxiety, improve activity tolerance, and prevent respiratory infections
What serum electrolytes will be raised in a patient with COPD?
Potassium and Magnesium
Occurs in the absence of other lung disorders; cause unknown
Pulmonary Arterial Hypertension
Genetic disease affecting many organs, lethally impairing pulmonary function
Cystic Fibrosis
How can patients with COPD manage their dyspnea?
By resting before meals and eating 4-6 small meals a day
What should the diet of a patient with CF include?
High fat and protein with low carbs
What is the nonsurgical preventative therapy for patients with CF?
Chest physiotherapy, positive expiratory pressure, active cycle breathing technique, and exercise
How can COPD be managed surgically?
Lung reduction surgery
How does CF affect breathing?
There is an error of chloride transport, producing thick mucus with low water content; the mucus plugs up glands and leads to atrophy and organ dysfunction
What are the home care needs for a patient with COPD?
Long term use of oxygen and pulmonary rehabilitation
How can CF be prevented?
Genetic counseling
What breathing techniques can a patient with COPD be taught?
Pursed lip breathing to maximize the amount of air in their alveoli
What is the nonsurgical management for COPD?
Weight management, vitamin supplement, diabetes management, and pancreatic enzyme replacement
What types of surgical management are available for patients with CF?
Lung and/or pancreatic transplantation
What is the nonsurgical management for exacerbation therapy?
Avoid mechanical ventilation, supplemental oxygen, heliox, airway clearance techniques, drug therapy and prevention
What are the clinical manifestations of CF?
Malnutrition, abdominal distention, GERD, rectal prolapse, steatorrhea, DM, osteoporosis, respiratory infections, chest congestion, cough and sputum production, use of accessory muscles, increased AP diameter
How long does surgical management extend the life of a patients with CF?
10 to 20 years
Restrictive disease in which the alveoli, blood vessels, and surrounding support lung tissue thickens and stiffens, reducing gas exchange
Interstitial pulmonary diseases
Granulomatous disorder of unknown causes that most often affects lungs in which normally protective T-lymphocytes increase and damage lung tissue
Sarcoidosis
High lethal, common restrictive lung disease in which there is extensive fibrosis and scarring
Idiopathic pulmonary fibrosis
Caused by occupational or environmental exposure
Occupational pulmonary disease
What do patients with pulmonary arterial hypertension die of?
Heart failure within 2 years
What is the main therapy for sarcoidosis?
Corticosteroids
What are pharmacological interventions for patients with CF?
Warfarin therapy, calcium channel blockers, endothelin-receptor antagonists, natural and synthetic prostacyclin agents, digoxin, diuretics, and oxygen therapy
What is the most common manifestation in patients with interstitial pulmonary diseases?
Dyspnea
What are the clinical manifestations of pulmonary arterial hypertension?
Blood vessel constriction with increasing vascular resistance in the lungs
How can occupational pulmonary disease be prevented?
Through special respirators and adequate ventilation
What is the therapy for idiopathic pulmonary fibrosis?
Corticosteroids and other immunosuppressants
Who is pulmonary arterial hypertension more common in?
Young women
What exposures causes occupational pulmonary disease?
Fumes, dust, vapors, gases, bacterial/fungal antigens, allergens, and cigarette smoke
Leading cause of cancer deaths worldwide, this disease is caused by bronchogenic carcinomas and paraneoplastic syndromes
Lung cancer
What are palliative interventions for patients with lung cancer?
Oxygen therapy, drug therapy, radiation therapy, thoracentesis and pleurodesis, dyspnea, pain management, and hospice care
What is the first chest tube chamber for?
Collects fluid draining from the patient
What is the nonsurgical management for lung cancer?
Chemotherapy, targeted therapy, radiation therapy, and photodynamic therapy
What are the nursing interventions for after a thoractomy?
Pain management, respiratory management, and pneumonectomy care
Inflammation of nasal mucosa
Rhinitis
Why is lung cancer staged?
To assess size and extent of the disease
What are the clinical manifestations of rhinitis?
Headache, nasal irritation, sneezing, nasal congestion, and rhinorrhea
What is the second chest tube chamber for?
Water seal to prevent air from re-entering the patient’s pleural space
What is the surgical management for lung cancer?
Lobectomy, pneumonectomy, segmentectomy, and wedge resection
What is the third chest tube chamber for?
Suction control of the system
What kind of supportive therapy can be used for patients with rhinitis?
Drinking fluids, humidification, elevate the head of the bed, and staying away from the allergen
Common inflammation of pharyngeal mucous membranes
Pharyngitis
What are the nonsurgical interventions for sinusitis?
Broad spectrum antibiotics, analgesics, decongestants, steam humidification, hot/wet packs over sinus areas, nasal saline irritants, and increased fluids
Screening process for group A bet-hemolytic streptococcal antigen
Rapid Antigen Test
What complementary therapies can be used for patients with rhinitis?
Vitamin C ad zinc
Inflammation/infection of tonsils and lymphatic tissues caused by contagious, airborne bacteria
Tonsillitis
What are the symptoms of pharyngitis?
Odynophagia, dysphagia, fever, and hyperemia
Inflammation of sinus mucous membranes usually caused by streptococcus pneumoniae
Sinusitis
What drugs are used for patients with rhinitis?
Antihistamines, leukotriene inhibitors, mast cell stabilizers, decongestants, antipyretics, and antibiotics
Complication of acute tonsillitis in which pus causes one-sided swelling with deviation of the uvula
Peritonsillar Abscess
What is the problem with using decongestants for sinusitis?
A rebound effect
What are the symptoms of peritonsillar abscess?
Trismus, difficulty breathing, bad breath, and swollen lymph nodes
How long do the results from a rapid antigen test take?
15 minutes
What is the surgical management for sinusitis?
Functional endoscopic sinus surgery
How many days are antibiotics used for patients with tonsillitis?
7-10 days
What is the treatment for laryngitis?
Voice rest, steam inhalation, increased fluid intake, throat lozenges, and reduce use of tobacco and alcohol
Inflammation of mucous membranes lining the larynx with possible edema of the vocal cords
Laryngitis
What are the symptoms of influenza?
Severe headache, muscle ache, fever, chills, fatigue, weakness, and anorexia
What type of infection is laryngitis?
Viral
When are antiviral agents effective?
Within 24 hours of flu symptoms
What is the treatment for peritonsillar abscesses?
Percutaneous needle aspiration of the abscess, antibiotics, and IV fluids
Which antiviral drugs treat influenza?
Oseltamivir and zanamivir
Highly contagious acute viral respiratory infection
Influenza
What are the symptoms of laryngitis?
Acute hoarseness, dry cough, difficulty swallowing, and temporary voice loss
What types of precautions are used for patients with pandemic influenza?
Strict isolation
What is the only way to differentiate between viral and bacteria pneumonia?
Chest x-rays
What is pneumonia triggered by?
Infectious organisms or the inhalation of irritants
What does the chest x-ray of bacterial pneumonia look like?
Consolidation
How can Ventilator-Associated Pneumonia be prevented?
Hand hygiene, oral care, and head of bed elevation
Excess fluid in lungs resulting from inflammatory process
Pneumonia
Virus infection of respiratory tract cells, triggering the inflammatory response
Severe Acute Respiratory Syndrome (SARS)
What are the symptoms of pneumonia?
Atelectasis, hypoxemia, a harsh, productive cough, pleuresy, and lung fractures
What type of pneumonia is the most common?
Nosocomial
What does the chest x-ray of viral pneumonia look like?
Mucus
What type of isolation should a patients with SARS be in?
Strict airborne isolation
How can the spread of SARS be prevented?
Hand washing
What types of isolation should a TB patient have?
Negative airflow and droplet precautions
What are the drug interventions for TB?
Isoniazid, rifampin, pyrazinamide, and ethambutol
Localized area of lung destruction caused by liquefaction necrosis, usually relate to pyogenic bacteria?
Lung Abscess
How is TB transmitted?
Aerosolization
What does a positive PPD indicate?
Exposure to TB
What are the clinical manifestations of TB?
Progressive fatigue, lethargy, nausea, anorexia, weight loss, irregular menses, low grade fever, night sweats, and cough with mucopurulent sputum and blood streaks
How is TB ruled out?
Three negative morning sputum cultures
Highly communicable disease caused by a mycobacterium
Pulmonary Tuberculosis
What is the sign of a lung abscess?
Pleuritic chest pain
What should the diet of a TB patient consist of?
Lots of protein
Why is TB incidence increased in patients with HIV?
Because they have reduced T lymphocytes
What does a positive PPD look at?
Induration of 10 mm or greater
Why is there a recent upswing of TB?
Immigration
What are the interventions for patients with lung abscess?
Antibiotics, drainage of abscess, and frequent mouth care
Collection of pus in the pleural space commonly caused by pulmonary infection, lung abscesses, and infected pleural effusions
Pulmonary Empyema
What interventions can be done for patients with pulmonary empyema?
Empty the empyema cavity, re-expand the lung, and control the infection
Bacterial infection caused by contaminated soil
Inhalation anthrax
What are the two stages of inhalation anthrax?
Prodromal stage and fulminant stage
What drugs are used for inhalation anthrax?
Ciprofloxacin, doxycycline, and amoxicillin
