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Med Surg Exam 2 > Respiratory COPY > Flashcards

Respiratory COPY Flashcards

1
Q

what changes happen to respiratory system with age

A

structure chest stiffness, decrease muscle mass (harder to expand lungs, less elasticity, alveolar are enlarged) a lifetime exposure to environmental pollutants could also harm the body over time

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2
Q

how can you prevent respiratory problems

A

Minimize exposure to inhalation irritants, stop smoking (including 2nd/3rd hand smoke),

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3
Q

what does the IPREPARE assessment stand for

A

Investigate, presenting work, resident, environment, past work, activity, resources/referral, educate

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4
Q

what should you ask when talking about patient history

A

allergies, current health problems, current meds, genetic risk, smoking, drug use, travel, veterans (deployment location)

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5
Q

what does a chest x-ray show you

A

Assess lung pathology (pneumonia, atelectasis, pneumothorax, tumor), Detects (pleural fluid, ETT placement, invasive line placement, chest tube placement

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6
Q

what position should the pt be in for chest x ray

A

position= posteroaneterior and left lateral (so air will rise),

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7
Q

what is the limitation for chest xray

A

may appear normal even with severe disease present

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8
Q

what does a CT show you

A

assess soft tissue, consecutive cross section of the chest, identifies lesions or clots, IV contrast to enhance,

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9
Q

what are the nursing considerations for CT

A

considerations allergies to IV contrast, iodine, shellfish, renal function, stop taking metformin 24 hours before, restart when renal function is good

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10
Q

what does a pulse ox do

A

infrared light is used to identify the percentage of hemoglobin saturated with oxygen, placement on finger, toe, earlobe, or forehead

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11
Q

what does a Capnometry/capnography do

A

measures carbon dioxide in exhaled air, provides info about: Co2 production, pulmonary perfusion, alveolar ventilation, respiratory patters, ventilator effectiveness, rebreathing of exhaled air, it is a more sensitive indicator of gas exchange then pulse ox

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12
Q

what does a pulmonary function test do

A

determines lung function/breathing diffuclties, compare data to expected findings, screen for lung disease or guide management, preoperative testing to identify patient’s at risk for lung complications

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13
Q

what does an exercise pulmonary function test do

A

identifies cause of dyspnea (cardiac, lung or muscle weakness)

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14
Q

what are the considerations for pulmonary function test

A

: explain the procedure of the test, no smoking 6-8 hours before, assess patient for dyspnea and bronchospasms after, doc meds administered during

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15
Q

what is exercise testing

A

– assesses the patient ability to work and perform ADLs, differentiates reasons for exercise limitations, evaluated influence of disease on exercise capacity, self paced 12 min walk/treadmill/bike, pulmonary patient’s limited by breathing capacity, gas exchange compromise or both

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16
Q

what should be considered for exercise testing

A

explain the test, assure the patient, monitor closely

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17
Q

what is a laryngoscopy

A

visualize the vocal cords, remove foreign objects, obtain tissue samples

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18
Q

what is a mediastiniscopy

A

insertion above the sternum to the area between the lungs, visualize tumors, obtain tissue samples

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19
Q

what is a bronchoscopy

A

diagnose and manage pulmonary disease, evaluate the airway, placement of ETT tube, collect specimen, remove secretions, stent to open airways, rigid scope – general anesthesia, flexiable scope – low dose sedations

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20
Q

what are the complications of bronchoscopy

A

bleeding, hypoxia, pneumothorax

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21
Q

what are the considerations for bronchoscopy

A

explain procedure, obtain pre procedure diagnostics like CBC, PT, platelet count, NPO for 4-8 hours,

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22
Q

what are the indications for a throcentesis

A

needle aspiration of pleural fluid or air , to diagnosis, manage, exam, relieve pressure on blood vessel or lung compression, relieve respiratory distress, instill meds

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23
Q

what are the considerations for thoracentesis

A

explain procedure, get consent, assess for allergies to anesthetic, do not cough/move/deep breath to avoid puncturing lung, provider should wear goggles, remove no more then 1000ml, apply pressure to site, follow up chest xray, assess for bleeding/drainage, doc everything

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24
Q

what are the complications of thoracentesis

A

fluid accumulation, subcutaneous emphysema, infection, tension, pneumothorax (crunchy

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25
Q

when would you see ss of pneumothorax after thoracentesis

A

may occur up to 24 hours after procedure

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26
Q

what are the indications for lung biopsy

A

obtain tissue for histological analysis, culture, or cytology, differential diagnosis of cancer, infection, inflammation, or lung disease

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27
Q

what are the different types of lung biopsies

A

transbrochial biopsy, transbrochial needle aspiration, thansthoracic needle aspiration

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28
Q

what are the considerations of lung biopsy

A

explain procedure, assess allergies, may need chest tube

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29
Q

what is the post op monitoring for lung biopsy

A

VS, respiratory assessment q4 for 24 hours, pneumothorax, respiratory distress, hemoptysis

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30
Q

what is allergic rhinitis

A

inflammation r/t exposure to allergens (plant pollen, animal dander, molds, foods)

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31
Q

what are the ss of allergic rhinitis

A

sneezing, itchy nose, rhinorrhea, watery eyes, congestion

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32
Q

what is the treatment for allergic rhinitis

A

nasal corticosteroid spray (non-systemic – flonase), second generation antihistamines (non-sedating = loratadine, cetirizine, fexofendadine), allergy shots

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33
Q

what are the interventions for allergic rhinitis

A

avoid triggers, med as prescribed, supportive care

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34
Q

what is an upper respiratory infection

A

inflammation of the nasal mucosea and sinuses, common cold cause by a virus spread by droplets, allergic or non allergic, cute or chronic, coexists with other disorders (asthma, allergies)

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35
Q

what are the risks for upper respiratory infection

A

extremely young/advanced age, recent exposure, lack of current immunization, smoker, chronic lung disease immunocompromised

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36
Q

what are the ss of upper respiratory infection

A

rhinorrhea, purulent nasal drainage, sneezing, itchy nose, dry sore throat, redden, swollen nasal mucosa, low-grade fever, watery eyes, congestion

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37
Q

what are the interventions/education for upper respiratory infection

A

encourage 6-8 hours rest, humidified air, cough etiquate, hand hygiene, vaccination, limit exposure espically is immunocompromised

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38
Q

what is the treatment for upper respiratory infection

A

– decongestants (phenylephrine – constricts blood vessels and decrease edema), antipyretics for fever, antibiotics for bacterial infection

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39
Q

what are some complementary options for upper respiratory infection

A

echinacea, large dose of vitamin c, zinc preparations, improve immune response

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40
Q

what is sinusitis

A

inflammation of the mucous membrane of one or more of the sinuses, swelling and inflammation block drainage and lead to infection occurs after rhinitis

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41
Q

what are the risk factors for sinusitis

A

deviates septum, nasal polyps, inhaled air pollutants or cocaine, facial trauma, dental infection, immunocompromised

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42
Q

what are the ss of sinusitits

A

nasal congestion, headache, facial pressure/pain, cough, bloody or purulent nasal drainage, tenderness on palpation of sinuses, low-grade fever

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43
Q

what are the interventions/education for sinusitis

A

encourage rest, humidified air, increased fluid intake, cough etiquate, hand hygiene, decrease swimming, driving, air travel, smoking cessation, sinus irrigation

44
Q

what is the treatment for sinusitits

A

decongestants (phenylephrine), antipyretics for fever, broad spectrum antibiotics for bacterial infection (amoxicillin, antibiotic stewardship) Pain relievers (NSAIDs, Acetaminophen, Asprin)

45
Q

what are some complications of sinusitis

A

meningitis – report suspected findings to provider

46
Q

what is seasonal and pandemic influenza

A

fall/winter, highly contagious acute viral infection, contagious from 24 hours before symptoms manifest to 5 days after onset, pandemic influenza – viral infection in birds or animals that has mutated and is highly infectious to humas (swine and avian flu)

47
Q

what are the risk factors for seasonal and pandemic influenza

A

history of pneumonia, over 65, pregnant women, health care workers

48
Q

what are the ss of seasonal and pandemic influenza

A

severe headache, muscle aches, chills, fatigue, weakness, severe diarrhea, fever, cough (avian flu) hypoxia (avian flu)

49
Q

what are some antivirals used for seasonal and pandemic influenza

A

amantadine, rimatadine, ribavirin, zanamivir, oseltamivir, begin antiviral treatment within 24-48 hours of symptoms onset

50
Q

what are some vaccines used for seasonal and pandemic influenza

A

trivalent vaccines prepared annually, IM injection, vaccines encouraged for everyone 6 mths and older

51
Q

what are the interventions for seasonal and pandemic influenza

A

encourage rest, droplet precautions, saline gargles, monitor hydration status, administer fluids, monitor respiratory status, encourage vaccination, avoid personal contact, avoid identified areas of pandemic flu

52
Q

how do you diagnosis seasonal and pandemic influenza

A

AV advantage A/H5N1 flu test

53
Q

what are the complications of seasonal and pandemic influenza

A

pneumonia in older adults and immunocompromised

54
Q

what is covid

A

caused by SARS-CoV-2 virus, spreads quickly through droplets

55
Q

what are the risks for covid

A

older adults, immunocompromised, people with certain medical conditions – asthma, cancer, chronic lung/kidney/liver disease, diabetes, dementia, cystic fibrosis

56
Q

what are the ss of covid

A

fever, chills, cough, SOB, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestions or runny nose, nausea, vomiting, diarrhea

57
Q

how do you diagnosis covid

A

PCR (most reliable), rapid antigen test, home/self test (antigen)

58
Q

what is the education for covid

A

follow CDC guidelines, testing, isolation, seek higher level of care

59
Q

how are you considered up to date for covid vaccine

A

based on – age, first vaccine date, length of time since last dose

60
Q

what are some approved vaccines for covid

A

Pfizer-BioNTech, Moderna, Novavax, J&J

61
Q

what is bronchitis

A

inflammation of the bronchi

62
Q

what are the risks for bronchitis

A

viral, air pollution, dust, chemical inhalation, smoking, sinuisitis, asthma

63
Q

what are the ss of bronchitis

A

cough up to 3 weeks, clear sputum, headache, fever, hoarseness, myalgia, chest pain, dyspnea

64
Q

how do you diagnose bronchitis

A

chest x-ray

65
Q

what is the treatment for bronchitis

A

cough suppressants/expectorants, antipyretic, beta2 agonist for wheezing (albuterol), Antibiotics (if prolonged over 3 weeks with purulent sputum)

66
Q

what should be considered for bronchitis

A

encourage increased fluid intake, cough etiquette, hand hygiene, stop smoking, encourage ambulation, prevent pneumonia

67
Q

what is pneumonia result in

A

in reduced gas exchange (aspiration, inhalation, hematogenous), excess fluid in the lungs, acute infection of lung parenchyma

68
Q

what are the risks for getting pneumonia

A

older adult, smoking, recent respiratory infection, immunocompromised, tracheal intubation, decreased LOC, immobility, lack of vaccines, smoking, chronic disease

69
Q

what is community acquired pneumonia

A

contracted outside the healthcare system,

70
Q

what is healthcare associated pneumonia

A

occurs less then 48 hours of hospital admission

71
Q

what is hospital acquired pneumonia

A

onset/diagnosis over 48 hours of hospital admission

72
Q

what is ventilator associated pneumonia

A

onset/diagnosis within 48-72 hours after ETT intubation

73
Q

what is aspiration pneumonia

A

chemical pneumonitis of gastric contents

74
Q

what is necrotizing pneumonia

A

rare, cavitation of lungs and abcess

75
Q

what is opprotunistic pnumonia

A

immunocompromised leading to pneumocystis, jiroveci and cytomegalovirus

76
Q

what are some ss of pneumonia

A

: anxiety, fear, weakness, chest discomfort r/t to coughing, confusion, fever, chills, flushing, diaphoresis, dyspnea, tachypnea, pleuritic chest pain, yellow tinged sputum, crackles, wheezes, dull chest percussion, decrease O2 sats, purelent, blood tinged sputum

77
Q

how do you diagnosis pneumonia

A
  • sputum culture/sensitivity, CBC, ABG, Blood culture, serum electrolytes, chest xray, pulse ox
78
Q

what are some interventions for pneumonia

A

– high fowlers, encourage cough and deep breathing, incentive spirometer, give breathing treatments and meds, oxygen therapy, cluster care, promote adequate nutrition, increase fluid intake, provide rest periods, reassure client experiencing respiratory distress

79
Q

what are some antibiotics prescribed for pneumonia

A

– pencillin and cephalosporins mostly used, sputum culture and sensitivity FIRST, start with IV then oral as condition improves, monitor renal function, observe for diarrhea with cephalosporins, encourage to take with food, some PNC must be taken 1 hour before or 2 hours after meals

80
Q

what do bronchodilators do

A

reduce bronchospasm and irritation, short acting beta 2 agonist (albuterol – rapid relief), Anticholinergics (ipratropium – allow for increase bronchodilation – suck on hard candy, rinse mouth, increase fluid intake), Methylxanthines (theophylline – requires close monitoring for therapeutic range

81
Q

what do glucocorticoids do for pneumonia

A

– fluticasone and prednisone – reduces airway inflammation

82
Q

what are some complications of pneumonia

A

atelectasis, bacteremia (sepsis), acute respiratory distress syndrome

83
Q

what is tuberculosis

A

caused by mycobacterium tb, airborne transmission, lodges in bronchioles and alveoli, primary infection, reactivated infection, latent (exposed not infected)

84
Q

what are the risks for TB

A

low seriocomic status, homeless, foreign born, travel to endemic area, immigration from Mexico, Philippines, Vietnam, china, Japan, easter Mediterranean countries, employed of living in prisons, long-term facilities shelters or healthcare, IV drug users, immunocompromised

85
Q

what are some ss of TB

A

persistent cough over 3 weeks, purulent blood tinged sputum, fatigue, lethargy, weight loss, anorexia, night sweats, low- grade fever in the afternoon

86
Q

what test show an active phase of TB

A

QuantiFERON-TB, Chest Xray, Acid-fast bacilli smear and culture

87
Q

what tests show a latent phase of TB

A

QuantiFERON, Mantoux

88
Q

what are some considerations/education for TB

A

heated/humidified o2, prevent infecition, promote adequate nutrition, encourage adequate fluid intake, encourage foods rish in protein, iron, and vitamins B and C, provide emotional support, airborne precautions not required at home

89
Q

why are some pts non compliant to TB treatment

A

duration of therapy being 6-12 months, follow up for 1 year

90
Q

how can you prevent TB

A
  • wear N95 mask, negative air flow room, barrier protection, have patient wear surgical mask when transported, cough etiquette
91
Q

what is Histoplasmosis

A

fungal infection inhalation of spores, not trasnmitttable

92
Q

what are the risks for getting Histoplasmosis

A

immunocompromised

93
Q

what are some ss of Histoplasmosis

A

similar to pneumonia but very ill

94
Q

what is the treatment of choice for Histoplasmosis

A

Amphotericin B-IV

95
Q

what is epitaxis

A

nose bleed

96
Q

what are the risks for epitaxis

A

hypertension, low humidity, allergies, sinusitis, upper respiratory infection

97
Q

how do you diagnosis epitaxis

A

ENT-scope

98
Q

what is the treatment for epitaxis

A

sit with head forward apply uninterrupted pressure for 5-15 minutes

99
Q

what are some differnt types of epitaxis

A

anterior bleeds pledget placed for 48-72 hours, posterior- rapid rhino-balloon or packing (prophylactic antibiotic if left in place over 48-72 hours)

100
Q

what is the teaching involved for epitaxis

A

sneeze with mouth open, saline nasal spray daily, avoid straining 4-6 weeks, afrin for no more then 3 days

101
Q

what is obstructive sleep apnea

A

obstruction or narrowing of air passages r/t relaxation, tongue/soft palate fell back, results in hypoxemis and hypercapnia, central – cessation of breathing- neuro cause

102
Q

what are the risks for obstructive sleep apnea

A

BMI over 30, over 65 years, neck circumference over 17cm, craniofacial abnormalities, acromegaly (over production of growth hormone), smoking, male

103
Q

what are some ss of obstructive sleep apnea

A

insomnia, frequent arousal, daytime sleepiness, snoring, headaches, irritability, observation of apnea over 10 seconds

104
Q

how do you diagnosis obstructive sleep apnea

A

questonaire and polysomnography = positive if over 5 apnea episodes per hour with a decrease of SPO2 3-4%

105
Q

what is the treatment for obstructive sleep apnea

A

side sleeping, HOB elevated, avoid alcohol, weight loss, mouth guard, CPAP or BiPAP with severe apnea (over 15 episodes in an hour)

106
Q

what are some complications of obstructive sleep apnea

A

untreated can lead to cardiac dysrhythmias, heart failure, and pulmonary hypertension

Med Surg Exam 2 (8 decks)

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