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Med surg > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Define tension pneumothorax

A

air in the pleural space that enters the pleural space through a one way valve leading to
increased pressure on the lungs and
heart. Compressing blood vessels and
limiting venous return -> decreased CO

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2
Q

Symptoms of pneumothorax

A

Tracheal shift to unaffected side. (upper

mediastinal shift)

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3
Q

montelukast (singular)

A

used for maintaince therapy. Must be

taken once daily in the evenings.

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4
Q

Interventions for COPD

A
  • provide meals after respiratory treatment.

- high calorie and high protein diet

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5
Q

if the tubing of a chest tube becomes disconnected what should you do?

A

place the tube in sterile water to prevent

pneumothorax.

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6
Q

thoracentesis procedure

A
  • dawn PPE
  • position client in either a lateral position on the unaffected side or leaning over the bedside table
  • instruct to hold breath and remain as still as possible
  • apply pressure to site after removal of needle
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7
Q

Normal Chest tubes

A
  • fluctuation of drainage in the tubing with inspiration.
  • little bubbling in the water seal chamber (continuous bubbling suggests air leak)
  • under 100 mL of drainage per hour
  • small, dark red clots
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8
Q

interventions for nasal cannula

A

assess patency of the nares, provide humidification for flow rates greater then 4L, and use a water soluble gel to prevent drying of the nares

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9
Q

disadvantages of face mask

A

if flow rate is less then 5 L/min can result in rebreathing of CO2

  • cannot eat
  • moisture and pressure can collect under the mask and cause skin breakdwon
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10
Q

nursing interventions for partial rebreather

A

make sure the flow rate is high enough so that the bag does not completly deflate during inspiration which causes CO2 buildup.

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11
Q

what are high flow oxygen delivery systems and give examples

A

they give precise amounts of oxygen regardless of the clients breathing pattern such as the Venturi mask, trach colar, aerosol mask

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12
Q

pros and cons of venturi mask

A
  • Humidification not required therefore its good for people with chronic lung disease but its expensive
  • good for avoiding oxygen induced hypoventilation which occurs in COPD patients because you can deliever precise amounts of oxygen
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13
Q

advantages of aerosol mask, face tent, and trach collar

A

fit loosly therefore good for burns or thick secretions

-have to provide alot of humidification which requires nurse to empty condensation from the tubing often.

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14
Q

s/s of oxygen toxicity

A

nonproductive cough

  • substernal pain
  • nasal stuffiness
  • n/v
  • fatigue
  • headache,
  • sore throat
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15
Q

intervention for oxygen toxicity

A

monitor for fatigue, restlessness, dyspnea, tachycardia/pnea, crackles, cyanosis.
-use a positive airway pressure machine to minimize the amount of oxygen needed.

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16
Q

why my patients recieving mechanical ventilation develop fluid retention? what should you do?

A

decreased cardiac output, activation of RAAS and/or ventilator humidification
Monitor I&O, weight, breath sounds and secretions

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17
Q

how can mechanical ventilation lead to hemodyanmic compromise

A

it increases the thoracic pressure leading to decreased venous return.
Monitor for tachycardia, hypotension, decreased urine, cool and clammy skin, decreased pulses, decreased LOC

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18
Q

what are the 4 main acute respiratory disorders

A

rhinitis, sinusitis, influenza, pneumonia

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19
Q

rhinitis

A

inflammation of the nasal mucosa and often the mucosa in the sinuses that can be viral or bacterial or caused by allergens. Allergens cause histamine release and other mediators which bind the blood vessels and cause leakage, leading to local edema and swelling.

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20
Q

expected findings in rhinitis

A
  1. runny nose(rhinorrhea) and nasal congestion
  2. purulent nasal discharge
  3. pruritus of the nose, throat, and ears
  4. itchy, watery eyes
  5. sore, dry throat
  6. red, inflamed, nasal mucosa
  7. low grade fever
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21
Q

interventions for rhinitis

A
  1. encourage rest
  2. increase fluids atleast 2000 mL
  3. humidifer and/or breathing steamy air
  4. Antihistamines (brompheniramine/psuedoephedrine)
  5. Leukotriene inhibitors (montelukast
  6. Mast cell stabilizers (cromolyn)
    - all meds block the release of mediators which lead to blood vessel leakage.
    - adverse effects of these medications are important, especially for older adults: vertigo, HTN, and urinary retention
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22
Q

more medications for rhinitis

A
  1. Decongestants (phenylephrine)-constrict blood vessels -> decrease edema
    - use as prescribed to avoid rebound nasal congestion
  2. Intranasal glucocorticoid sprays
    - for prevention
  3. antipyretics
  4. antibiotics
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23
Q

complementary therapies for rhinitis

A
  1. echinacea (herb)
  2. large doses of vitamin C
  3. zinc
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24
Q

assessment for sinusitis

A
  1. nasal congestion
  2. headache
  3. facial pressure which is worse when head is tilted forward
  4. cough
  5. bloody or purulent nasal drainage
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25
Q

interventions for sinusitis

A
  1. humidifcation
  2. hot and wet packs
  3. increase fluid intake and rest and stop smoking
  4. teach correct admin of nasal sprays
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26
Q

complications of sinusitis

A

Meningitis and Encephalitis

-contact providor if severe headache, neck stiffness(nuchal rigidity(cannot flex neck)) and high fever develops

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27
Q

meds for sinusitis

A
  1. nsal decongestants (phenylephrine)
    - teach about rebound congestation
  2. broad spectrum antibiotics (amoxicillin)
28
Q

which antivirals can be used to treat influenza

A

Amantadine, Rimantadine, and ribavirin or Oral antivirals such as zanamivir oseltamivir

29
Q

who should get flu vaccine

A

everyone older then 6 months, history of pneumonia, chronic medical condition, over 65, pregnant

30
Q

what labs do you run for pneumonia

A
  1. sputum culture and sensitivity
  2. CBC (indicates elevated WBCs)
  3. ABGs will be below 80 mmhg. Above 80 is the range you want
  4. blood culture to rule out sepsis
  5. electrolytes to identify causes of dehydration
  6. xray will show consolidation
31
Q

what is something you wanna look out for when a client is on cephalosporins

A

diarrhea

32
Q

meds for pneumonia

A
  1. albuterol
    - watch for tachycardia and tremors
  2. anticholinergic(ipratropium) blocks PNS allowing for increased bronchodilation and decreased pulmonary secretions
    - watch for dry mouth, headache, blurred vision, palpitations
  3. Methylxanthines(theophylline)
    - have narrow theraputic range, watch for tachycardia, nausea, and diarrhea
  4. glucocorticosteroids(-sone)
    - watch for immunosuppression, fluid retention, hyperglycemia, hypokalemia, poor wound healing
    - report black tarry stools
    - monitor mouth and throat for aphthous lesions (canker sores)
    - take with food
    - avoid abrupt discontinuation
33
Q

complications of pneumonia

A
  1. Atelectasis
    - inflammation and edema lead to alveolar collapse
    - look for diminished or absent breath sounds
  2. sepsis
  3. acute respiratory disress syndrome
    - hypoxemia persists despite oxygen therapy
    - ground glass appearance on cxr
34
Q

risk factors for pulmonary embolism

A
  1. oral contraceptive use and estrogen therapy
  2. elevated platelet count
  3. tabacco use
  4. central venous catheters
  5. afib or HF
  6. sickle cell anemia
  7. long bone fractures
35
Q

expected findings in pulmonary embolism

A
  1. pain upon inspiration and chest wall tenderness
  2. cough, anxiety, feelings of impending doom
  3. dyspnea, hemoptysis
  4. pleural friction rub
  5. tachycardia and hypotension
  6. s3 and s4 murmur
  7. distended neck veins
  8. pleural effusion
  9. diaphoresis
  10. petechiae over chest and axillae
36
Q

lab test for Pulmonary embolism

A
  1. ABG will first show respiratory alkalosis due to the hyperventilation but then will progress to metabolic acidosis due to hypoxia and lactic acid build up
  2. CBC-to monitor H&H
  3. D-dimer: will be elevated (.43-2.33) due to the release of fibrin degradation products
  4. CT scan to confirm
  5. ventilation-perfusion scan (V/Q scan) can show circulation of air and blood in the lungs and detect PE
  6. Pulmonary angiography(the gold standard to detect PE)
37
Q

interventions for pulmonary embolism

A
  1. give O2 and put in high fowlers
  2. IV access
  3. respiratory assessment every 30 mins
    - auscultate
    - rate, rhythm, and ease of respirations
    - skin color and cap refill
    - position of trachea
  4. assess cardiac status
    - compare BP in both arms
    - palpate pulses
    - dysrhymthmia check
    - distended neck veins check
    - petechiae on thorax?
38
Q

medications for pulmonary embolism

A
  1. anticoagulants(Heparin(PTT and CBC),enoxaparin,warfarin(PT and INR), and fondaparinux) prevents clots from growing or new ones from forming
    - contraindications:active bleeding, peptic ulcer, history of stroke, recent trauma,HTN
    - side effects:thrombocytopenia, anemia, hemorrhage
  2. Direct factor Xa inhibitors (Rivaroxaban) binds to the active center of factor Xa which inhibits the production of thrombin.
    - watch for bleeding/hematomas
    - discontinue 18 hours prior to removal of epidural
  3. Thrombolytics (-plase)
    - similar side effects and contradictions of anticoagulants
    - monitor vitals throughout treament
39
Q

interventions for pulmonary embolism

A
  1. weekly blood draws needed(warfarin)
  2. vitamink K (green leafies) should be monitored if taking warfarin
  3. avoid aspirin unless specificed
  4. use electirc shavers and soft bristled toothbrush, avoid blowing nose hard
  5. avoiding PE
    - arise from sitting position for 5 mins every hour
    - wear support stocking
    - hydration
    - ROM when sitting
40
Q

management of decreased cardiac output

A
  1. monitor for hypotension, tachycardia, cyanosis, JVD, and syncope
    2.monitor urine output and replace with crystalloids
    3.monitor PAP
    4,admin inotropic agents (milrinone, dobutamine)
    5.vasodilators if PAP is high enough to interfere with contracility
41
Q

management of hemorrhage

A
  1. asses cardio status
    - BP, HR and rhythm
  2. CBC
    - h&h and platelets
    - bleeding times
  3. test stools, urine, and vomit for occult blood
    - measure abdominal girth
42
Q

Pulmonary function Test

A
  1. measure lung volumes and capacities, diffusion capacities, gas exchange, flow rates, airway resistance
  2. instruct not to smoke 6-8 hours prior
  3. withhold inhalers 4-6 hours prior to testing
43
Q

ABGs

A
  1. get heparinized syringe for sample collection
  2. perform allens test prior to arterial puncture
  3. put speciment into a basin of ice and water to preserve pH and oxygen pressure
  4. apply pressure for atleast 5 mins…. 20 if client is on anticoagulants
44
Q

management of hematoma

A
  1. observe for changes in temp, swelling, color, pulse, pain

2. apply pressure to the hematoma site

45
Q

air embolism management

A
  1. place patient on left side in trendelenburg position
  2. admin oxygen
  3. ABGs
46
Q

Bronchoscopy

A

Allows visualization of larynx, trachea, and bronchi.

  • Can also perform biopsys
    1. NPO
    2. preprocedure medication(anxiolytic,atropine,lidocaine)
    3. monitor vitals before, during, and after
    4. after assess LOC, gag reflex and ability to swallow before removing NPO. Start with ice chips
    5. Teach: gargling with salt water or using throat lozenges can help sore throat
47
Q

thoracentesis

A

Used to obtain speciment for diagnostic eval, instill medication into the pleural space, and remove fluid or air from the pleural space. Max of 1 L can be removed at one time to prevent re-expansion pulmonary edema.

  1. position client upright with arms and shoulders raised and supported on pillows or an overbed table with feet well supported.
  2. tell client to remain totally still and not to talk or cough
48
Q

manifestations of pneumothorax

A
  1. diminished breath sounds
  2. JVD
  3. asymmetry of chest wall
  4. cyanosis
  5. deviated trachea
  6. pain that is worse at the end of inhalation and exhalation
  7. rapid shallow respirations
49
Q

flail chest

A

when atleast two neighboring ribs, usually on the same side, sustain multiple fractures causing instability of the chest wall and paradoxical chest all movement

  1. tachycardia with hypotension
  2. give O2
  3. Assess respiratory
  4. positive pressure ventilation usually fixes it
50
Q

dull percussion

A

means fluid

51
Q

hyperresonance

A

trapped air

52
Q

Opioids side effects

A
  1. respiratory depression
  2. hypotension
  3. n/v
  4. constipation
53
Q

Chest tubes

A

are inserted into the pleural space to drain fluids in order to re-establish negative pressure.

54
Q

what are the three types of respiratory failure

A
  1. acute respiratory failure(ARF)
  2. acute respiratory diestress syndrome(ARDS)
  3. severe acute respiratory syndrome (SARS)
55
Q

why do older adults have decreased pulmonary reserves

A
  1. decreased lung elasticity

2. thickening of alveoli

56
Q

ARF

A

cannot adequately ventilate and/or oxygenate

  1. ventilatory failure occurs from mechanical errors such as impaired diaphragm or malfunction of respiratory control centers in brain
  2. oxygenation failure occurs in due to low perfusion
  3. CXR will show cardiomegaly
57
Q

ARDS

A

a systemic inflammatory response injures the alveolar-capillary membrane causing fluid to leak OR a reduction in surfactant weakens the alveoli which causes them to collapse or fill with fluid
1.CXR may show pulmonary edema and diffuse infiltrates and white out or ground glass appearance

58
Q

SARS

A

a viral infection from a coronavirus (common cold). the virus invades the pulmonary tissues causing inflammation. The virus is airborne but does not spread into the bloodstream b/c it flourishes at temperatures slightly below normal core body temp.
1.CXR will show infiltrates

59
Q

interventions for any respiratory failure

A
  1. monitor for pneumothorax (a high PEEP can cause lungs to collapse)
  2. ABG
  3. steroids to help reduce WBC migration, decreaes inflammation
    - ARDS specific: stablize the alveolar capillary membrane
60
Q

Propofol contraindications

A

hyperlipidemia and egg allergies or soy bean oil allergy

61
Q

Propofol

A
  1. rate must be slowed to assess neuro
  2. Monitor for hypotension
    - only give to clients who are intubated and ventilated
62
Q

steroid teachings

A
  1. never stop abruptly
  2. admin with antiulcer medication
  3. monitor weight and BP
  4. monitor glucose and electrolytes
  5. take with food
63
Q

Neuromuscular blocking agent

A

Vecuronium

  • facilitates ventilation and decreases O2 consumption
  • only give to clients who are intubated and ventilated
    1. does not sedate or relieve pain
    2. monitor ECG, BP, muscle strength
64
Q

reversal agent for neuromusuclar blocking agents

A

neostigmine and atropine

65
Q

vancomycin

A
  1. culture and sensitivity before starting
  2. monitor for hypersensitivity reaction
  3. give over atleast 60 mins to avoid red man syndrome(red face, neck and chest)
  4. do not give with other meds
  5. monitor coagulopathy and renal function
  6. take oral dose with food

Med surg (35 decks)

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