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Basic Med-Surg > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What should a respiratory history include?

A

Smoking history, pack years, exposure to second and third hand smoke
Occupational history, socioeconomic status, travel/area of residence
All medications and allergies

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2
Q

What do diagnostic tests for the resp include?

A

Blood tests, arterial blood gas (ABGs), CBC. Cultures like sputum. Pulse ox, pulmonary function test (PFT), exercise testing, skin testing (PPD)
Endoscopic procedures like bronchoscopy and laryngoscopy

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3
Q

What are the uses for endotracheal intubation?

A

Emergency or mechanical ventilation. Airway protection. Allows suctioning more easily.

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4
Q

How does one care for an intubated patient?

A

Check breath sounds, CXR for placement, secure the ET in place (may need hands restrained), when suctioning use sterile technique, check on the pilot ballon, pt will not be able to talk so communication, reposition patient, provide oral hygiene

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5
Q

Aspiration of pleural fluid or air from pleural space

A

Thoracentesis

Post-proceudre be sure to assess for pneumothorax

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6
Q

COPD is a group of what diseases? Explain?

A

Chronic bronchitis (non-reversible), pulmonary emphysema (non-reversible). Permanent tissue damage the leads to death. Stimulus to breathe is hypoxia.

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7
Q

Emphysema and chronic bronchitis are both what?

A

Non-reversible. Permanent tissue damage that leads to death. Stimulus to breathe is hypoxia.

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8
Q

What is the most important risk factor in COPD?

A

Smoking. COPD is rare in people who have never smoked. Breaks down elastin which is a major part of the alveoli

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9
Q

An inflammation of the bronchi and bronchioles cause by chronic exposure to irritants. Usually seen with emphysema.

A

Chronic bronchitis.

Affects only the airways and not the alveoli. Airways become blocked due to production of thick mucus.

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10
Q

Clinical manifestations of COPD?

A

Think barrel chest, enlarged neck muscles. Slow-moving, stooped, tripod position, rapid, shallow respirations. Chest restrictions, wheezing, dusky appearance, cardiac changes, excessive sputum, finger clubbing

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11
Q

What occurs with emphysema?

A

Loss of lung elasticity, hyperinflation of the lung expansion, dyspnea, increased respirations

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12
Q

Blue bloater clinical diagnosis and s/s?

A

Chronic bronchitis with a daily productive cough for three months or more, in at least two consecutive years. Overweight, cyanotic, elevated hemoglobin, peripheral edema, rhonchi and wheezing

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13
Q

Pink puffer pathologic diagnosis and s/s?

A

Emphysema. Permanent enlargement and destruction of airspaces distal to the terminal bronchiole. Older, thin, severe dyspnea, quiet chest, x-ray, hyperinflation with flattened diaphragms

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14
Q

COPD complications?

A

Hypoxemia, acidosis, respiratory infections, cardiac failure, other cardiac problems

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15
Q

What determines the need or oxygen with COPD? How should it be delivered?

A

ABG determines the need. Low levels of oxygen delivery (1-2L). 88% saturation or less give them oxygen.

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16
Q

What can help improve secretion removal?

A

Cough, chest PT, postural drainage, suctioning

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17
Q

How do you use a metered-dose inhaler?

A

Shake canister 3-4 times and then squeeze canister when activating. Take a slow, deep breath. Hold breath for 5-10 secs, wait 1 minute between puffs, 10% of the med reaches the lung. Good hand-eye coordination needed.

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18
Q

How to educate and care for inhaler users?

A

Do not take more than two inhalations at the same time. Wait at least 1 minute between with one med, 5 with two meds. Rinse mouth out after use. Use of a spacer delivers more meds to the lung.

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19
Q

If the pt is using more than one type of inhaler have them use what first?
How to check if the canister is full?

A

Bronchodilator first

Place the canister in water. empty floats, full sinks.

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20
Q

What does a lung biopsy provide?

A

Histologic analysis, cytology exam, cultures

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21
Q

Tongue causes airway obstruction. 3 S’s?

A

Obstructive sleep apnea. Lasts at least ten seconds. Occurs a minimum of 5x an hour.
Sleepiness, snoring, significant other

22
Q

Treatment for sleep apnea?

A

Weight loss, continuous costive airway (CPAP), bilevel positive airway pressure (BiPAP)

23
Q

This type of drug is preventive, not a rescue medication. They do not cause bronchodilation.

A

Anti-inflammatory agents. Help to improve airflow by the decreased inflammatory responses of the mucus membranes in the airways. Systemically or by inhalation. Have many side effects.

24
Q

Nutrition for the COPD patient?

A

Increase calorie and protein intake. Nutrition consult. Rest before meals. Small/frequent feedings. May need bronchodilator prior to eating. Dietary supplements. Encourage fluid if appropriate.

25
Q

An excess of fluid in the lungs due to an inflammatory process triggered by an infection. Five different types?

A

Pneumonia. Community acquired (CAP), Health-care associated (HCAP), hospital acquired (HAP), ventilator associated (VAP), aspiration pneumonia.

26
Q

The process of pneumonia?

A

Organisms into the airway multiply. WBC go to the site of infection, causing capillary leakage, edema, exudate. Infection spreads. Fluid collects and interferes with gas exchange. Alveoli collapse. Infection into the blood stream.

27
Q

People at risk of community acquired pneumonia?

A

Older people, those with no pneumonia or flu vaccine, poorer overall health, chronic conditions, recent exposure to the flu, alcohol and tobacco usage.
Usually occurs in the the fall/winter related to complications of the flu.

28
Q

Health promotion for those with CAP (pneumonia)?

A

Vaccine every 5 years, yearly flu vaccine, avoid large crowds, see HCP with fever after 24 hours, avoid pollutants, do not smoke, adequate rest/nutrition/fluids: 3L

29
Q

People at risk of nosocomial pneumonia?

A

Older patient, chronic lung disease, gram negative colonization, altered LOC, aspiration, poor nutrition, compromised immune system

30
Q

Clinical manifestations of pneumonia?

A

Chest/pleuritic pain, high fever, chills, cardiac signs (tachycardia, hypotension), productive cough with rust colored sputum, hemoptysis, dyspnea, tachypnea, confusion, congested breath sounds, wheezing, crackles

31
Q

Diagnostic tests for pneumonia?

A

Sputum culture and sensitivity, CBC, ABGs, chest x-ray, pulse oximetry

32
Q

Common anti-infective for pneumonia?

A

azithromycin (Zithromax), levofloxacin (Levaquin), ciprofloxacin, ticarcillin, vancomycin

33
Q

Decreases the viscosity of tenacious secretions by increasing respiratory tract fluid.

A

Mucolytics. Increased fluid intake helps it to work better. Mobilization and expectoration of mucus.

34
Q

What are examples of mucolytics?

A 
Oral guaifenesin (Robitussin, Humibid
Neubulizer acetylcysteine (Mucomyst, Mucosil)
35
Q

What are core measures for pneumonia?

A

Appropriate antibiotic selection; blood culture drawn before antibiotic administered

36
Q

Airflow in airways is obstructed.

A

Asthma.
Inflammation, constriction of airways (bronchospasm), both conditions. Triggered by inflammatory factors, irritants, others.

37
Q

What to ask for the asthma history?

A

Childhood asthma, seasonal, during sleep, specific exposures, exercise, family history, smoking

38
Q

Clinical manifestations of asthma?

A

May be asymptomatic. Audible wheezes, increased respirations, coughing, use of accessory muscles, dyspnea, cyanosis, decreased oxygen saturation

39
Q

The different classes of asthma?

A

Mild intermittent: 2x/week or less
Mild persistent: More than 2x/week but not daily
Moderate persistent: Daily
Severe persistent: Continuous with physical activity

40
Q

What kinds of treatments should be given for asthma?

A

Treatment for obstruction of airways, meds such as anti-inflammatory agents, bronchodilators. Eliminate triggers, ensure hydration, pulmonary toilet

41
Q

An example of treatment for air trapping in relation to asthma?

A

Teach the patient to purse lip breathe

42
Q

Treatment for respiratory acidosis and hypoxemia?

A

Administration of oxygen.

43
Q

Leading cause of death from a single infectious agent worldwide.

A

Tuberculosis. Increasing incidence. Related to HIV, immigrants from third-world countries.

44
Q

Drug resistant TB?

A

MDR-TB, multi-drug resistant TB

45
Q

Pathophysiology of tuberculosis?

A

Respiratory acquired infection (airborne). Reaction depends on susceptibility, size of the dose, virulence of the organism. Inflammation occurs within the alveoli and the body’s defenses. Usually pulmonary but can also be extra pulmonary

46
Q

Etiology of tuberculosis?

A

Mycobacterium tuberculosis

47
Q

Risk factors for tuberculosis?

A

Close contact with someone who has active TB. HIV, immunosuppression. Homeless or living in crowded, unsanitary conditions. Very young, old. Poor nutrition. ETOH, drug abuse. Immigrants.

48
Q

Prevention of active TB?

A

Isolation of infected persons. Adequate housing and ventilation. Frequent screening high risk persons.

49
Q

How does the TB organism get eradicated?

A

Treating persons with positive skin tests with INH for 6 months (HIV 1 year). Concern drug therapy adverse reactions and non adherence.

50
Q

S/s of tuberculosis?

A

Persistent cough, mucopurulent blood, streaked sputum, dyspnea, weight loss, progressive fatigue, anorexia, low grade fever, chills, night sweats, positive skin test

51
Q

Diagnosis of tuberculosis?

A

Tuberculin skin testing (Mantoux test), chest x-ray, sputum smear for AFB, sputum culture, QuantiFERON-TB gold

52
Q

Treatment of tuberculosis?

A

Isolation until symptoms subside and 3 negative smears. Initial regiment is with combo therapy of 3-4 drugs. Pts can be held against their will for treatment if they do not comply. Lifestyle changes to improve health.

Basic Med-Surg (11 decks)

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