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Med-Surg Nursing > Respiratory > Flashcards

Respiratory Flashcards

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1
Q

Where does gas exchange take place?

A

The alveoli

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2
Q

What is the lining of the chest cavity called?

A

The parietal pleura

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3
Q

What is the lining of the lungs called?

A

The visceral pleura

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4
Q

What is the name of the fluid found between the parietal and visceral pleura?

A

Pleural fluid

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5
Q

What is the function of the pleural fluid?

A

Allows the lungs to expand and move against the thoracic cage smoothly, easily and without pain.

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6
Q

How is excess pleural fluid disposed of?

A

Drained by lymphatic circulation

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7
Q

What is a pleural effusion?

A

A buildup of excess pleural fluid

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8
Q

What is the name of the muscles found between the ribs?

A

Intercostal muscles

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9
Q

About how much air do you take in with a normal breath?

A

500 mL

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10
Q

What is hypoxia?

A

Oxygen deficiency in the body tissues

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11
Q

What is hypoxemia?

A

Oxygen deficiency in the blood

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12
Q

What is hypercapnia?

A

Increased arterial CO2

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13
Q

What nursing diagnoses would be associated with hypoxia, hypoxemia or hypercapnia?

A

Impaired gas exchange

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14
Q

What lab tests would be evidence for a diagnoses of impaired gas exchange?

A

Decreased O2 and Increased CO2

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15
Q

Describe normal findings of a respiratory assessment of the nose.

A

Symmetric with no deformities, mucosa pink with no edema, exudate, blood or polyps. Nasal septum straight, nares patent bilaterally.

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16
Q

Describe normal findings of a respiratory assessment of the oral mucosa.

A

Light pink, moist, no exudate or ulcerations.

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17
Q

Describe normal findings of a respiratory assessment of the tonsils.

A

Not inflamed or enlarged

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18
Q

Describe normal findings of a respiratory assessment of the pharynx.

A

Smooth, moist and pink.

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19
Q

Describe normal findings of a respiratory assessment of the neck.

A

Trachea midline, no cervical nodes palpable.

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20
Q

Describe normal findings of a respiratory assessment of the chest.

A

AP (Anterior-Posterior) diameter 1:2, respirations non-labored 12-20 bpm, equal chest expansion, breath sounds equal and vesicular.

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21
Q

What subjective data would you ask about during a respiratory assessment?

A

Dyspnea, orthopnea, cough, sputum, chest pain, wheezing, hemoptysis

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22
Q

What is pleurisy?

A

Inflammation of the pleural linings.

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23
Q

What is hemoptysis?

A

Coughing up blood.

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24
Q

What is a pack year?

A

The number of years a person has been smoking multiplied by how many packs smoked per day.

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25
Q

Describe what you would expect to find while using percussion during a respiratory assessment. What would be abnormal?

A

A resonant sound. A dull sound would be abnormal.

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26
Q

4 adventitious breath sounds

A

Crackles, rhonchi, wheezes, stridor

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27
Q

When are crackles heard?

A

On inspiration

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28
Q

When are rhonchi heard?

A

On inspiration and expiration

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29
Q

Where is stridor heard?

A

The upper airway

30
Q

Where are wheezes heard?

A

The lower airway

31
Q

What are 2 early signs of inadequate oxygenation?

A

Tachypnea and dyspnea on exertion

32
Q

What are 4 late signs of inadequate oxygenation?

A
  1. Dyspnea at rest
  2. Use of accessory muscles
  3. Retraction of interspaces on inspiration
  4. Pause for breath between sentences or words
33
Q

Name this disease

  1. Increased pCO2
  2. Headache
  3. Conjunctival hyperemia
  4. Flushed skin
  5. Mental status changes
  6. Tachycardia
  7. Diaphoresis
  8. Increased BP
A

Hypercapnia

34
Q

What is conjunctival hyperemia?

A

Bloodshot eyes

35
Q

Name 4 things that can trigger asthma

A
  1. Infection
  2. Allergens
  3. Exercise
  4. Irritants
36
Q

3 nursing diagnoses used for asthma

A
  1. Impaired gas exchange r/t airway obstruction
  2. Ineffective airway clearance
  3. Anxiety
37
Q

Name this disease

  1. Retractions
  2. Night-time cough
  3. ↑ mucus
  4. Shortness of breath
  5. Expiratory wheeze
  6. ↑ CO2 retention
  7. Prolonged expiration
A

Asthma

38
Q

When should a person seek medical attention when experiencing signs and symptoms of asthma?

A

If symptoms do not respond to usual treatment within 30 minutes.

39
Q

What is “status asthmaticus”?

A

Acute severe asthma which doesn’t respond to treatment. This is life threatening, a medical emergency.

40
Q

8 things the nurse can do for a patient during an asthma attack.

A
  1. Stay calm.
  2. Position the patient in the high fowler’s position
  3. Teach them breathing techniques such as pursed lip breathing or diaphragmatic breathing.
  4. Do a respiratory assessment
  5. Administer prescribed medications
  6. IV fluids to keep them hydrated
  7. Small frequent meals
  8. Ask yes or no questions
41
Q

5 types of medications are given for asthma?

A
  1. Beta 2 agonists
  2. Mast cell stabilizers
  3. Corticosteroids
  4. Leukotriene receptor antagonists
  5. Bronchodilator
42
Q

Patient education. 3 things the nurse can teach the asthma patient.

A
  1. Avoiding triggers
  2. Proper medication administration
  3. How to use the peak flow meter
43
Q

What does a peak flow meter measure?

A

How much air they can move out of their lungs in one breath

44
Q

How does obstructive pulmonary disease affect breathing?

A

Air flow is limited in and out of the lungs.

45
Q

Name this disease

  1. Easily fatigued
  2. Frequent respiratory infections
  3. Accessory muscle use
  4. Orthopneic
  5. Thin body
  6. Wheezing
  7. Pursed lip breathing
  8. Chronic cough
  9. Barrel chest
  10. Dyspnea
  11. Prolonged expiratory time
  12. Digital clubbing
  13. Hypoxemia
  14. Hypercapnia
  15. Edema in ankles
A

COPD

46
Q

What causes COPD?

A

Noxious particles and gases such as tobacco smoke or air pollution.

47
Q

What is the pathology involved with COPD?

A
  1. Mucus hypersecretion
  2. Cilia dysfunction
  3. Airflow limitation
  4. Hyperinflation of the lungs
  5. Gas exchange abnormalities
  6. Pulmonary hypertension
  7. Cor pulmonale
48
Q

What is cor pulmonale?

A

An alteration in the structure and function of the right ventricle (RV) of the heart resulting in right sided heart failure due to lung disease.

49
Q

How is chronic bronchitis defined?

A

The presence of cough and sputum production for 3 consecutive months, 2 years in a row.

50
Q

How is chronic bronchitis different from asthma?

A

It is not reversible.

51
Q

The following are clinical manifestations of what disease?

  1. Skin color is dusky to cyanotic
  2. Recurrent cough
  3. ↑ sputum
  4. Hypoxia
  5. Hypercapnia
  6. Acidosis
  7. Edematous
  8. ↑ Respiratory rate
  9. Exertional dyspnea
  10. ↑ incidence in heavy smokers
  11. Digital clubbing
  12. Cardiac enlargement
  13. Accessory muscle use
  14. Cor pulmonale
A

Chronic bronchitis

52
Q

What are 3 causes of emphysema?

A
  1. Smoking
  2. Air pollution
  3. Family history of pulmonary disease
53
Q

How does pursed lip breathing benefit the patient with emphysema?

A

It helps to get rid of CO2.

54
Q

The following are clinical manifestations of what disease?

  1. ↑ CO2 retention resulting in a pink skin color
  2. No cyanosis
  3. Pursed lip breathing
  4. Dyspnea
  5. Ineffective cough
  6. Hyperresonance on chest percussion
  7. Orthopneic
  8. Barrel chest
  9. Exertional dyspnea
  10. Prolonged expiratory time
  11. Speaks in short jerky sentences
  12. Anxious
  13. Accessory muscle use
  14. Thin body appearance
  15. Leads to right sided heart failure
A

Emphysema

55
Q

What is the difference between Chronic Bronchitis and Emphysema in regards to the obstruction?

A

Chronic bronchitis is due to mucus. Emphysema is due to lack of elastic recoil of the alveoli.

56
Q

Name 5 nursing diagnoses for COPD

A
  1. Ineffective airway clearance
  2. Impaired gas exchange
  3. Imbalanced nutrition, less than body requirements
  4. Insomnia
  5. Risk for infection
57
Q

What 9 things can the nurse do for the COPD patient?

A
  1. Stay calm
  2. Assess respiratory system
  3. Ask only yes or no questions
  4. Assist the patient into a high fowler’s or tripod position.
  5. Teach them breathing techniques such as pursed lip breathing and diaphragmatic breathing.
  6. Administer prescribed medications appropriately.
  7. Teach them to enhance their coughing with diaphragmatic breathing.
  8. IV fluids to keep them hydrated
  9. Small frequent meals.
58
Q

For the patient with COPD where should PAO2 and SpO2 be?

A

PAO2 should be between 50 and 90.

SpO2 should be at 90%.

59
Q

Why shouldn’t SpO2 be higher than 90%?

A

Any higher will decrease the respiratory drive.

60
Q

Patient education. What 7 things should the nurse teach the COPD patient?

A
  1. Smoking cessation.
  2. Vaccines
  3. Oxygen
  4. Activity tolerance
  5. Self-care
  6. Avoid emotional triggers
  7. Correct medication administration
61
Q

What is a pulmonary embolism?

A

A portion of the pulmonary blood vessels that get occluded by an embolus.

62
Q

What are possible sources of a pulmonary embolism?

A
  1. A clot, such as a DVT
  2. Tumors
  3. Air
  4. Fat
  5. Bone marrow
  6. Septic thrombi
  7. Vegetation on heart valves (endocarditis)
  8. Major operations
  9. Atrial fibrillation in the right side of the heart
63
Q

What is the classic triad of symptoms of a PE?

A
  1. Chest pain
  2. Dyspnea
  3. Hemoptysis
64
Q

Other than the classic triad, what are 10 other symptoms of a PE?

A
  1. Tachypnea
  2. Anxiety
  3. Hypoxemia
  4. Apprehension
  5. Sense of impending doom
  6. Pallor
  7. Severe dyspnea
  8. Crushing chest pain
  9. Right sided heart failure
  10. Low grade fever
65
Q

What lab test can detect a pulmonary embolism?

A

Increased D-Dimer, ABG, PTT, PTINR,

66
Q

What diagnostic imaging tests helps to diagnose pulmonary embolism?

A

A ventilation–perfusion (VQ) scan, Spiral CT, pulmonary angiography

67
Q

What 2 nursing diagnoses can be used with a pulmonary embolism?

A
  1. Impaired gas exchange

2. Anxiety

68
Q

Nursing management of a patient with pulmonary embolism.

A
  1. Prevention
  2. Stay calm and stay with patient
  3. Assess vital signs and respiratory status
  4. Keep the head of the bed elevated (bedrest)
  5. Oxygen
  6. IV access
69
Q

What medications are used to treat a PE?

A

Anticoagulants such as heparin or coumadin.
Thrombolytics
Analgesics such as morphine for pain and anxiety

70
Q

Patient education: What can the nurse teach the patient to prevent a future PE?

A
  1. Turning, coughing, deep breathing.
  2. The use of an Incentive spirometer
  3. The signs and symptoms of right sided heart failure
  4. Correct medication administration
71
Q

What do studies show is even more effective than anti-coagulants in preventing PE?

A

3x a day range of motion exercises.

Med-Surg Nursing (11 decks)

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