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Nursing Semester 2 (Med surg & Peds) > Respiratory exam > Flashcards

Respiratory exam Flashcards

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1
Q

Purpose of oxygen therapy:

A

use lowest fraction of inspired oxygen (FiO2) to have an acceptable blood oxygen level without causing harmful side effects

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2
Q

Most patients with hypoxia require an oxygen flow of:

A

2-4L/min via nasal cannula or up to 40% Venturi mask to achieve an oxygen saturation of at least 95%

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3
Q

For a patient who is hypoxemia and has chronic hypercarbia, the FiO2 delivered should be titrated to..

A

correct the hypoxemia to achieve generally acceptable oxygen saturations in the range of 88%-92%

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4
Q

Best measure for determining the need for oxygen therapy and evaluating its effects:

A

ABG (arterial blood gas)

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5
Q

Parameters to monitor for hypoxemia include:

A

level of consciousness

respiratory pattern and rate

pulse oximetry

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6
Q

Lung injury from oxygen toxicity (same as ARDS) include problems such as

A

dyspnea

nonproductive cough

chest pain beneath the sternum

GI upset

crackles on auscultation

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7
Q

Prolonged exposure to high oxygen levels can cause:

A

atelectasis

pulmonary edema

hemorrhage

hyaline membrane formation may form

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8
Q

Notify the healthcare provider when PaO2 levels become:

A

greater than 90 mm Hg

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9
Q

Nitrogen purpose:

A

Nitrogen in air maintains patent airways and alveoli.

Prevents alveolar collapse

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10
Q

What happens during atelectasis?

A

When nitrogen is diluted, oxygen diffuses from the alveoli into the blood and the alveoli collapse

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11
Q

Atelectasis is detected as

A

crackles and decreased breath sounds on auscultation

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12
Q

Monitor the patient receiving high levels of oxygen closely for indications of:

A

absorptive atelectasis (new onset of crackles and decreased breath sounds) every 1-2 hours when oxygen therapy is started and as often as needed thereafter

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13
Q

Humidify delivery system when oxygen flow rate is:

A

higher than 4L/min

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14
Q

Humidifier or nebulizer must be changed

A

as per agency policy which ranges from 24 hours-every 7 days

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15
Q

Low flow systems have a low:

A

fraction if inspired oxygen (FiO2)

do not provide enough oxygen to meet the total oxygen need and air volume of patient.

part of tidal volume is supplied by the patient as he or she breathes room air

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16
Q

High flow systems have:

A

a flow rate that meets the entire oxygen need and tidal volume regardless of the patient’s breathing pattern

used for critically ill patients

when delivery of precise levels of oxygen is needed

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17
Q

Low flow systems include:

A

nasal cannula

simple facemask

partial rebreather mask

non-rebreather mask

(oxygen is diluted with RA 21% oxygen, which lowers the amount actually inspired)

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18
Q

Nasal cannula (prongs) are used at which flow rates?

A

1-6L/min

Oxygen concentrations of 24% (1L/min) to 44% (6L/min) can be achieved

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19
Q

Nasal cannula is often used for:

A

chronic lung disease

any patient needing long-term oxygen therapy

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20
Q

Simple facemarks are used to deliver oxygen concentrations of and minimum flow rate:

A

40%-60% for short-term oxygen therapy or in an emergency

5L/min is needed to prevent the rebreathing of exhaled air

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21
Q

Partial rebreather masks provide oxygen concentrations of and flow rates:

A

60%-75% with flow rates of 6-11L/min

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22
Q

Non-rebreather masks provide/flow rate/purpose:

A

Highest oxygen level of the low-flow systems and can deliver an FiO2 greater than 90% depending on patient’s breathing pattern

Used with patients whose respiratory status is unstable and who may require intubation

Flow rate is kept high 10-15L/min

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23
Q

High flow systems include/oxygen concentrations/flow rates:

A

Venturi mask

Aerosol mask

Face tent

Tracheostomy collar

T-piece

oxygen concentrations from 24%-100%

8-15L/min

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24
Q

Which O2 therapy delivers the most accurate oxygen concentration without intubation?

A

Venturi masks

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25
Q

Noninvasive positive-pressure ventilation is used to manage:

A

dyspnea

hypercarbia

acute exacerbations of COPD

cardiogenic pulmonary edema

acute asthma attacks

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26
Q

Bronchial (tubular, tracheal) characteristics:

A

High pitch

Loud amplitude

Inspiration < expiration

Harsh, hollow, tubular blowing

Trachea and larynx

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27
Q

Bronchovesicular characteristics:

A

Moderate pitch

Moderate amplitude

Inspiration=expiration

Mixed quality

Located over major bronchi

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28
Q

Vesicular characteristics:

A

Low pitch

soft amplitude

Inspiration > expiration

Rustling, like the sound of the wind in the trees

Located over peripheral lung fields

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29
Q

Fine crackles, fine rales, high-pitched rales association: (6)

A

Asbestosis

Atelectasis

Interstitial fibrosis

Bronchitis

Pneumonia

Chronic pulmonary disease

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30
Q

Fine crackles, fine rales, high-pitched rales character:

A

Popping, discontinuous sounds caused by air moving into previously deflated airways

hair being rolled between fingers near ear

“velcro” sounds late in inspiration

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31
Q

Coarse crackles, low-pitched crackles association: (4)

A

Bronchitis

Pneumonia

Tumors

Pulmonary edema

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32
Q

Coarse crackles, low-pitched crackles character:

A

Lower-pitched, coarse, rattling sounds caused by fluid or secretions in large airways; likely to change with coughing or suctioning

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33
Q

Wheeze association: (5)

A

Inflammation

Bronchospasm

Edema

Secretions

Pulmonary vessel engorgement (as in cardiac “asthma”)

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34
Q

Wheeze character:

A

squeaky, musical, continuous sounds associated with air rushing through narrowed airways

may be heard without a stethoscope

arise from small airways

do not clear with coughing

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35
Q

Ronchi association: (4)

A

Thick, tenacious secretions

sputum production

obstruction by foreign body

tumors

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36
Q

Ronchi character:

A

lower-pitched, coarse, continuous snoring sounds

arise from large airways

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37
Q

Pleural friction rub association: (5)

A

Pleurisy

TB

Pulmonary infarction

Pneumonia

Lung cancer

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38
Q

Pleural friction character:

A

Loud, rough, grating, scratching sounds caused by inflamed surfaces of the pleura rubbing together; often associated with pain on deep inspirations

heard in lateral lung fields

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39
Q

Smoking while using drugs for nicotine replacement therapy is bad because

A

it greatly increases circulating nicotine levels and the risk for stroke or heart attack

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40
Q

Bupropion and varenicline carry a black box warning that use of these drugs can cause

A

manic behavior

hallucinations

may unmask serious mental health issues

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41
Q

Black people and others with dark skin usually show what kind of oxygen saturation

A

lower o2 sat (3%-5%) as measured by pulse ox

this results from deeper coloration of the nail bed and does not reflect true oxygen status

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42
Q

Manifestations of pneumothorax:

A

pain on the affected side that is worse at the end of inhalation and the end of exhalation

rapid heart rate

rapid shallow respirations

feeling of air hunger

prominence of the affected side that does not move in and out with respiratory effort

trachea slanted more to the unaffected side instead of being in the center of the neck

new onset of “nagging” cough

cyanosis

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43
Q

Red blood cell range:

A

Females: 4.2-5.4 million/mm3

Males: 4.7-6.1 million/mm3

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44
Q

Hemoglobin range:

A

Females: 12-16g/dL

Males: 14-18g/dL

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45
Q

Hematocrit range:

A

Females: 37%-47%

Males: 42%-52%

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46
Q

WBC range:

A

5,000-10,000/mm3

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47
Q

PaO2 range:

A

80-100mmHg

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48
Q

PaCO2 range:

A

35-45mmHg

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49
Q

pH ranges:

A

Up to 60 year: 7.35-7.45

60-90 year: 7.31-7.42

> 90 year: 7.26-7.43

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50
Q

HCO3- range:

A

21-28mEq/L

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51
Q

SpO2 range:

A

95%-100%

Older adults: values may be slightly lower

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52
Q

Factors affecting right shift:

A

Acidosis

Hypercapnia

Hyperthermia

Elevated DPG

Hyperthyroidism

Anemia

Chronic hypoxia

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53
Q

Factors affecting left shift:

A

Alkalosis

Hypocapnia

Hypothermia

Decreased DPG

CO poisoning

Blood transfusion

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54
Q

Subjective data in assessment of respiratory system:

A

Coughing (productive, non productive)

Sputum (type and amount)

Allergies, dyspnea, SOB (at rest or exertion)

Chest pain, hx of asthma, bronchitis, emphysema, TB

Cyanosis, pallor

Exposure to environmental inhalants (chemicals, fumes)

Hx of smoking (amount and length of time)

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55
Q

4 techniques for respiratory exam (IPPA)

A

Inspect

Palpate

Percussion

Auscultation

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56
Q

Tachypnea rate:

A

over 20 for adult!

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57
Q

Bradypnea rate:

A

Less than 10!

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58
Q

Absent or decreased breath sounds can occur in: (4)

A

Foreign body

Bronchial obstruction

Shallow breathing

Emphysema

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59
Q

Stridor character:

A

Inspiratory musical wheeze

loudest over trachea

suggests obstructed trachea or larynx

requires immediate attention

associated condition

inhaled foreign body

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60
Q

Medical conditions associated with decreased or absent of breath sounds:

A

Asthma

COPD

Pleural effusion (fluid accumulating within pleural space)

Pneumothorax (accumulation of air or gas in the pleural space)

ARDS (adult respiratory distress syndrome)

Atelectasis (lung collapses)

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61
Q

5 main symptoms of respiratory disease:

A

Cough

Breathlessness

Sputum

Wheeze

Pain

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62
Q

Psychosocial respiratory assessment:

A

Lifestyle

occupational hazards

sleep apnea

anxiety/stress

sedentary jobs

athletes

eating habits

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63
Q

Diagnostic lab/imaging assessments used:

A

Chest x-rays

CT scans

VQ scan

ABG’s

CBC

Sputum test

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64
Q

Noninvasive diagnostic assessment:

A

Pulse ox

capnometery or Capnography (measures amount of carbon dioxide present in exhaled air)

Pulmonary function test (evaluates lung volumes and capacities, flow rates, diffusion capacity, gas exchange, airway resistance, distribution of ventilation)

Exercise testing

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65
Q

Invasive diagnostic assessment:

A

Endoscopic examinations

thoracentesis (aspiration of pleural fluid or air from pleural space)

lung biopsy (obtain tissue for histologic analysis, culture, cytologic examination)

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66
Q

Alveoli changes in aging

A

Alveolar surface area decreases

Diffusion capacity decreases

Elastic recoil decreases

Bronchioles and alveolar ducts dilate

Ability to cough decreases

Airways close early

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67
Q

Lung changes in aging:

A

RV increases

vital capacity decreases

Efficiency of oxygen and carbon dioxide exchange decreases

elasticity decreases

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68
Q

Pharynx and Larynx changes in aging

A

Muscles atrophy

Vocal cords become slack

Laryngeal muscles lose elasticity and airways lose cartilage

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69
Q

Pulmonary Vasculature changes in aging:

A

Vascular resistance to blood flow through pulmonary vascular system increases

Pulmonary capillary blood volume decreases

risk for hypoxia increases

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70
Q

Exercise tolerance changes in aging

A

Body’s response to hypoxia and hypercarbia decreases

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71
Q

Muscle strength changes in aging:

A

Respiratory muscle strength, especially the diaphragm and the intercostals decreases

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72
Q

Susceptibility to infection changes in aging:

A

Effectiveness of cilia decreases

Immunoglobulin A decreases

Alveolar macrophages are altered

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73
Q

Chest wall changes in aging:

A

Anteroposterior diameter increases

Thorax becomes shorter

Progressive kyphoscoliosis occurs

Chest wall compliance (elasticity) decreases

Mobility of chest wall may decrease

Osteoporosis is possible, leading to chest wall abnormalities

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74
Q

Follow up care for lung biopsy:

A

Assess vital signs, breath sounds at least every 4 hours for 24 hours

assess for respiratory distress

report reduced/absent breath sounds immediately

monitor for hemoptysis

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75
Q

Respiratory distress signs:

A

dyspnea

nasal flaring

use of accessory muscles to breathe

Pursed-lip or diaphragmatic breathing

decreased endurance

pallor

diaphoresis

tachypnea

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76
Q

Hypoxemia:

A

low levels of oxygen in the blood

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77
Q

Hypoxia:

A

decreased tissue oxygenation

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78
Q

Goal of oxygen therapy:

A

Use lowest fraction of inspired oxygen for acceptable blood oxygen level without causing harmful side effects

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79
Q

Hazards and complications of oxygen therapy:

A

combustion

oxygen induced hypoventilation

  • hypercarbia: retention of CO2
  • CO2 narcosis: loss of sensitivity to high levels of CO2

Oxygen toxicity

Absorption atelectasis- new onset of crackles/decreased breath sounds

drying of mucous membranes

infection

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80
Q

Must assess for what with nasal cannula

A

latency of nostrils

changes in respiratory rate and depth

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81
Q

High flow oxygen delivery system can deliver:

A

24%-100% at 8-15L/min

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82
Q

Venturi mask:

A

delivers precise O2 concentration-best for chronic lung disease

switch to nasal cannula during mealtimes

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83
Q

T-Piece:

A

delivers desired FiO2 for tracheostomy, laryngectomy, ET tubes

ensures humidification through creation of mist

mist should be seen during inspiration and expiration

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84
Q

Noninvasive positive pressure ventilation (NPPV):

A

uses positive pressure to keep alveoli open, improve gas exchange without airway intubation

BiPAP
CPAP

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85
Q

CPAP:

A

Delivers set positive airway pressure throughout each cycle of inhalation and exhalation

opens collapsed alveoli

used for atelectasis after surgery or cardiac induced pulmonary edema, sleep apnea

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86
Q

Transtracheal oxygen delivery (TTO)

A

Long-term delivery of O2 directly into lungs

small, flexible catheter is passed into trachea through small incision

avoids irritation that nasal prongs cause, more comfortable

flow rates prescribed for rest, activity

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87
Q

Possible complications of tracheostomy:

A

pneumothrorax

subcutaneous emphysema

bleeding

infection

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88
Q

Prevention of tissue damage with tracheostomy:

A

Cuff pressure can cause mucosal ischemia

use minimal leak and occlusive techniques

check cuff pressure often

prevent tube friction and movement

prevent/treat malnutrition, hemodynamic instability, hypoxia

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89
Q

Causes of hypoxia in the tracheostomy:

A

ineffective oxygenation before, during, after suctioning

use of catheter that is too large for the artificial airway

prolonged suctioning time

excessive suction pressure

too frequent suctioning

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90
Q

air warming and humidification with tracheostomy:

A

tube bypasses nose and mouth which normally humidifies, warms, and filters air

air must be humidified

maintain proper temperature

ensure adequate hydration

91
Q

Suctioning purpose for tracheostomy:

A

maintains patent airway, promotes gas exchange by removing secretions when the patient cannot cough adequately

done through nose or mouth

92
Q

Complications of suctioning:

A

Hypoxia

tissue (mucosal) trauma

infection

vagal stimulation, bronchospasm

cardiac dysrhythmias from induced hypoxia

93
Q

Bronchial and oral hygiene for trach patient:

A

turn/reposition every 1-2 hours

support out of bed activities

encourage early ambulation

cough and deep breathe

chest percussion, vibration, postural drainage promote pulmonary cure

avoid glycerin swabs or mouthwash containing alcohol for oral care

assess for ulcers, bacterial/fungal growth, infection

94
Q

Nutrition with tracheostomy:

A

swallowing can be major problem for patients with tracheostomy tube

if balloon is inflated, can interfere with passage of food though esophagus

elevate head of bed for at least 30 minutes after eating to prevent aspiration during swallowing

95
Q

Weaning from a tracheostomy tube:

A

gradual decrease in tube size–> ultimate removal of tube

cuff is deflated when patient can manage secretions; does not need assisted ventilation

change from cuffed to uncured tube

size of tube decreased by capping; use smaller fenestrated tube

tracheostomy button has potential danger of getting dislodged

96
Q

Check the patient’s skin around the ears, back of neck and face every

A

4-8 hours for pressure points and signs of irritation

97
Q

Ensure that mouth care is provided every

A

8 hours and as needed

assess for nasal and oral mucous membranes for cracks or other signs of dryness

98
Q

Cleanse the cannula or mask, skin under the tubing, straps every

A

4-8 hours

99
Q

Obtain a prescription for humidification if oxygen is being delivered at

A

4L/min or more

100
Q

Monitor the patient receiving high levels of oxygen closely for

A

indications of absorptive atelectasis (new onset of crackles and decreased breath sounds) every 1-2 hours when oxygen therapy is started and as often as needed thereafter

101
Q

To prevent bacterial contamination of the oxygen delivery system…

A

never drain the fluid from the water trap back into the humidifier or nebulizer.

102
Q

When is tube dislodgment an emergency?

A

first 72 hours of surgery because the tracheostomy tract has not matured and replacement is difficult.

tube may end up in the subcutaneous tissue instead of in the trachea “false passage”

103
Q

Tracheomalacia:

A

constant pressure exerted by the cuff causes tracheal dilation and erosion of cartilage

104
Q

Tracheal stenosis:

A

narrowed tracheal lumen is due to scar formation from irritation of tracheal mucosa by the cuff

105
Q

Tracheoesophageal fistula (TEF)

A

excessive cuff pressure causes erosion of the posterior wall of the trachea.

hole is created between the trachea and the anterior esophagus.

patient with NG tube is at highest risk

106
Q

Trachea-innominate artery fistula:

A

malpositioned tube causes its distal top to push against the lateral wall of the tracheostomy.

continued pressure causes NECROSIS and erosion of the innominate artery

MEDICAL EMERGENCY

107
Q

If a tube is dislodged on an immature tracheostomy, what do you do?

A

Ventilate the patient using a manual resuscitation bag and facemark while another nurse calls the rapid response team

108
Q

If the skin around a new tracheostomy is puffy and you can feel a crackling sensation when pressing on the skin, what do you do?

A

Notify the physician immediately!!

109
Q

Bleeding in small amounts from tracheotomy incision is

A

expected for the first few days but constant oozing is abnormal

110
Q

Temperature of air entering the tracheostomy:

A

between 98.6- 100.4 degrees

NEVER EXCEED 104 degrees

111
Q

Preoxygenate patient with ___ before suctioning

A

100% oxygen for 30 seconds to 3 minutes to prevent hypoxemia

do not apply suction when inserting

112
Q

Never suction longer than

A

10-15 seconds

only suction three phases

113
Q

Hyperoxygenate for ____ or until patient’s baseline heart rate and oxygen saturation are within normal limits

A

1-5 minutes

114
Q

Never use oral suction equipment for suctioning an artificial airway because

A

this can introduce oral bacteria into the lungs

115
Q

Assessing how a patient swallows after nasal surgery is a priority because

A

repeated swallowing may indicate posterior nasal bleeding

use a penlight to examine the throat for bleeding, notify surgeon if bleeding is present

116
Q

Nosebleeds (epistaxis) can occur as a result of

A

trauma

hypertension

blood dyscrasia (leukemia)

inflammation

tumor

decreased humidity

nose blowing

nose picking

chronic cocaine use

ng suctioning

117
Q

Posterior nasal bleeding is an emergency because

A

it cannot be easily reached and the patient may lose a lot of blood quickly

118
Q

Priority action when caring for a patient with facial trauma is:

A

airway assessment for gas exchange

119
Q

Manifestations of airway obstruction:

A

stridor

SOB

dyspnea

anxiety

restlessness

hypoxia

hypercarbia (elevated blood levels of CO2)

decreased O2 sat

cyanosis

loss of consciousness

120
Q

OSA:

A

obstructive sleep apnea that lasts at least 10 seconds and occurs a minimum of 5 times an hour

most common: upper airway obstruction

121
Q

Factors that contribute to OSA

A

obesity

large uvula

short neck

smoking

enlarged tonsils or adenoids

oropharyngeal edema

122
Q

Assessment for OSA:

A

Epworth Sleepiness scale

123
Q

Most accurate tests for sleep apnea:

A

EEG

ECG

EMG

124
Q

Drug that is helpful for patients who have narcolepsy from sleep apnea

A

Modafinil (Attenace, Provigil)

125
Q

Notify the rapid response team if what occurs with stridor? what will be needed?

A

Dyspnea

emergency endotracheal intubation or tracheotomy may be needed

126
Q

Manifestations of open bilateral vocal cord paralysis include

A

hoarseness

a breathy, weak voice

aspiration of food

place patient in high fowler’s position to aid in breathing and proper alignment of airway structures

127
Q

for patients with laryngeal injuries, check vital signs…

A

every 15-30 minutes

128
Q

Cricothyroidotomy is

A

an emergency procedure

stab wound at the cricothyroid membrane between the thyroid cartilage and the cricocartilage

any hollow tube can be placed through this opening to hold this airway open until a tracheotomy can be performed

this procedure is used when it is the ONLY way to secure an airway

129
Q

Endotracheal intubation is:

A

performed by inserting a tube into the trachea via the nose (nasotracheal) or mouth (orotracheal)

by physician, anesthesia provider or other specially trained personnel

130
Q

Tracheotomy:

A

surgical procedure (5-10 minutes to perform)

best performed in OR

local or general anesthesia

reserved for the patient who cannot be easily intubated with an endotracheal tube

emergency tracheotomy can establish airway in less than 2 minutes

131
Q

Warning signs of head and neck cancer: (5)

A

Pain

lump in mouth, throat or neck

difficulty swallowing

color changes in the mouth or tongue to red, white, gray, dark, brown or black

oral lesion or sore that does not heal in 2 weeks

132
Q

What happens when a carotid artery leak is suspected

A

call the rapid response team and DO NOT TOUCH THE AREA BECAUSE ADDITIONAL PRESSURE COULD CAUSE AN IMMEDIATE RUPTURE.

133
Q

If carotid artery ruptures because of drying or infection….

A

immediately place constant pressure over the site and secure the airway

maintain direct manual, continuous pressure on the carotid artery and immediately transport patient to the OR for carotid resection

do not leave patient

134
Q

carotid artery rupture has a high risk for

A

stroke and death

135
Q

Areas to assess with patients after laryngectomy:

A

respiratory status

condition of wound

psychosocial status

take patient’s temp

assess the patients understanding of illness and adherence to treatment

nutrition status

136
Q

Increase humidity by:

A

using saline in the stoma as instructed

bedside humidifier

pans of water

houseplants

137
Q

What might you notice if the patient is experiencing inadequate gas exchange as a result of upper airway problems?

A

Voice changes (nasal quality if the problem is above the palate, “breathy” or “whispery” if the problem is in the larynx or trachea

snoring/mouth breathing

change in level of consciousness/acute confusion

decreased O2 sat by pulse ox

skin cyanosis/pallor

cyanosis or pallor of lips and oral mucous membranes

tachycardia and dysrhythmia

138
Q

Asthma:

A

airways overreact to common stimuli with bronchospasm. edematous swelling of the mucous membranes and copious production of thick, tenacious mucus by abundant hypertrophied mucous glands

airway obstruction is usually intermittent

139
Q

Chronic bronchitis:

A

Infection or bronchial irritants cause increased secretions, edema, bronchospasm and impaired mucociliary clearance

inflammation of the bronchial walls causes them to thicken

this thickening, together with excessive mucus blocks the AIRWAYS and hinders GAS EXCHANGE

140
Q

Which drugs can trigger asthma?

A

Aspirin and other NSAIDS

141
Q

Common drug therapy used for Asthma prevention and treatment

A

Bronchodilators

Short/Long acting Beta 2 Agonist

cholinergic antagonist

Methylxanthines

anti-inflammatories

corticosteroids

142
Q

2 major changes that occur with emphysema and what they result in:

A

loss of lung elasticity

hyperinflation of lung

result in dyspnea and need for an increased respiratory rate

air trapping caused by loss of elastic recoil in alveolar walls

143
Q

Bronchitis

A

is an inflammation of the bronchi and bronchioles caused by exposure to irritants, especially cigarette smoke

144
Q

Bronchitis ONLY affects the ____ not the ___

A

AIRWAYS

NOT ALVEOLI

145
Q

Chronic inflammation increases:

A

the number and size of mucus glands, which produces large amounts of thick mucus

146
Q

Chronic bronchitis impairs:

A

airflow and GAS EXCHANGE because mucus plugs and infection narrow the airways

as a result, PaO2 level decreases (hypoxemia) and the arterial carbon dioxide (PaCo2) level increases (respiratory acidosis)

147
Q

Greatest risk factor for COPD

A

SMOKINGGGG!!

148
Q

Complications from COPD include:

A

hypoxemia

acidosis

respiratory infection (this risk increases because the increased mucus and poor oxygenation)

cardiac failure

dysrhythmias

respiratory failure

(hypoxemia and acidosis occur because the pt has reduced GAS EXCHANGE)

149
Q

Key features of Cor Pulmonale (right sided heart failure)

A

Hypoxia/Hypoxemia

Increasing dyspnea

Fatigue

Enlarged and tender liver

Cyanotic hands, feet, lips

Distended neck veins

150
Q

Nonpulmonary problems of Cystic Fibrosis

A

pancreatic insufficiency

malnutrition- vitamin deficiencies

intestinal obstruction

poor growth

male sterility

cirrhosis of liver

osteoporosis

diabetes mellitus

GERD, rectal prolapse, foul-smelling stools, steatorrhea

151
Q

2 nursing priorities before surgery are (respiratory)

A

teaching the patient the expected regimen of pulmonary hygiene to be used in the period immediately after surgery and assisting the patient in a pulmonary muscle strengthening/conditioning regimen

152
Q

Drug therapy for pulmonary arterial hypertension

A

Warfarin therapy

Calcium channel blockers

endothelia-receptor antagonists

natural/synthetic prostacyclin agents

digoxin and diuretics

oxygen therapy

153
Q

Critical nursing priority for a patient undergoing therapy with IV prostacyclin agents is to

A

ensure that the drug therapy is never interrupted.

deaths have been reported if the drug delivery is interrupted even for a matter of minutes

teach patients to always have backup drug cassettes and battery packs

154
Q

Sarcoidosis

A

inflammation of unknown cause that can affect any organ but the lung is involved most often

develops over time noncancerous inflammatory growths (granulomas)

corticosteroids main therapy

155
Q

Warning signals associated with lung cancer:

A

hoarseness

change in respiratory pattern

persistent cough or change in cough

blood-streaked sputum

rust colored/purulent sputum

156
Q

Complications of group A streptococcal infection:

A

rheumatic fever

acute glomerulonephritis

peritonsillar abscess

retrophraryngeal abscess

otitis media

sinusitis

mastoiditis

bronchitis

pneumonia

scarlet fever

157
Q

Acute tonsillitis key features:

A

sudden onset of a mild to severe sore throat

fever

muscle aches

chills

dysphagia

pain in ears

158
Q

Intranasal flu spray only recommended for

A

healthy people up to 49 years old

159
Q

Dyspnea assessment guide:

A

indicates the amount of shortness of breath you are having at this time by marking the line

160
Q

Asthma is a condition that occurs ____ and in 2 ways:

A

intermittently and in 2 ways

Inflammation
Airway hyper responsiveness leading to bronchoconstriction

161
Q

Pathophysiology of asthma

A

intermittent and reversible airflow obstruction affecting airways only, NOT ALVEOLI

162
Q

Asthma etiology:

A

different types based on how attacks are triggered

caused by specific allergens, general irritants, microorganisms, aspirin

hyper responsiveness caused by exercise, upper respiratory infection, unknown reasons

163
Q

Physical assessment/clinical manifestations of asthma:

A

audible wheeze, increased respiratory rate

increased cough

use of accessory muscles

barrel chest from air trapping

long breathing cycle

cyanosis

hypoxemia

164
Q

Laboratory assessment of asthma:

A

ABG’s

arterial O2 may decrease in acute asthma attack

arterial CO2 may decrease early in attack and increase later (indicating poor gas exchange)

allergic asthma with elevated serum eosinophil count, immunoglobulin E levels

Sputum with eosinophils, mucous plugs with shed epithelial cells

165
Q

Pulmonary function tests of asthma:

A

Most accurate with use of spirometry

forced vital capacity (FVC)

forced expiratory volume in first second (FEV1)

Peak expiratory flow rate (PEFR)

166
Q

COPD includes (2)

A

Emphysema

Chronic bronchitis

characterized by bronchospasm and dyspnea

167
Q

Tissue damage is NOT reversible and increases severity…leads to respiratory failure

A

Chronic Obstructive Pulmonary Disease (COPD)

168
Q

Pulmonary emphysema is an ______ problem

A

ALVEOLAR PROBLEM

NOT AIRWAY

169
Q

Chronic bronchitis:

A

inflammation of bronchi and bronchioles caused by chronic exposure to irritants, ESPECIALLY CIGARETTE SMOKE

170
Q

Chronic bronchitis affects only

A

AIRWAYS….NOT ALVEOLI

production of large amounts of thick mucus

171
Q

Lab assessment of chronic bronchitis

A

ABG

sputum samples

CBC

H&H

Serum electrolytes

Serum AAT

Chest x-ray

Pulmonary function test

172
Q

Drug therapy for chronic bronchitis

A

Beta-adrenergic agents

cholingergic antagonists

methylxanthines

corticosteroids

NSAIDS

Mucolytics

173
Q

Pulmonary manifestations of CF

A

Respiratory infections

chest congestion

limited exercise tolerance

cough and sputum production

use of accessory muscles

decreased pulmonary function

changes in chest x-ray result

increased anteroposterior diameter

174
Q

Nonsurgical management of CF

A

Nutritional management

Preventive/maintenance therapy

Exacerbation

175
Q

Pulmonary Arterial Hypertension (PAH) etiology

A

occurs in absence of other lung disorders

cause unknown

Blood vessel constrictor with increasing vascular resistance in lung

Heart fails (for pulmonale)

Without treatment, death within 2 years

176
Q

Idiopathic pulmonary fibrosis:

A

common restrictive lung disease

highly lethal

extensive fibrosis and scarring

corticosteroids, other immunosuppressants mainstays of therapy

177
Q

Major diagnostic test for CF

A

sweat chloride test

178
Q

Bronchitis not associated with

A

cigarette smoke

179
Q

85% of lung cancer cases are caused by

A

cigarette smoke!!!

180
Q

A special feature of inhalation anthrax is

A

that it is NOT accompanied by upper respiratory manifestations of sore throat or rhinitis

181
Q

Pulmonary embolism can lead to

A

obstructed pulmonary blood flow

leading to reduced gas exchange

reduced oxygenation

pulmonary tissue hypoxia

decreased perfusion

potential death

182
Q

Major risk factors for VTE leading to PE:

A

prolonged immobility

central venous catheters

surgery

obesity

advancing age

conditions that increase blood clotting

hx of thromboembolism

183
Q

Classic manifestations of pulmonary embolism:

A

dyspnea, sudden onset

sharp, stabbing chest pain

apprehension, restlessness

feeling of impending doom

cough

hemoptysis

184
Q

Signs of pulmonary embolism:

A

tachypnea

crackles

pleural friction rub

tachycardia

S3, S4 heart sound

diaphoresis

fever-low grade

Petechiae over chest

185
Q

Any patient who has SOB, chest pain, and or hypotension without an obvious cause should be assessed for _____

A

Pulmonary embolism and rapid response team should be notified

186
Q

Management options for a massive pe (mortality rate may be as high as 65%)

A

CPR

Inotropic/vasopressor support; fluids

Fibrinolytic therapy

Tissue plasminogen activator (tPA)

Ateplase (Activase)

Unfractionated heparin initial treatment

187
Q

PE drug therapy begins:

A

immediately with ANTICOAGULANTS to prevent embolus enlargement and to prevent more clotting

enoxparin (lovenox)

fondaparinux (Arixtra)

usually used unless the PE is massive or occurs with hemodynamic instability

make sure to review patient’s PTT before therapy is started

188
Q

Which drugs are used for treatment of PE when specific criteria are met such as…

A

Fibrinolytic drugs (alteplase)

criteria such as shock, hemodynamic collapse, instability

these drugs are used to break up existing clot

189
Q

Blood tests used to monitor anticoagulation therapy:

A

Partial thromboplastin time (PTT)

Prothrombin Tim (PT)

International normalized ratio (INR) (HIGHER THAN 4 IS BAD)

190
Q

Antidote for Heparin is

A

protamine sulfate

191
Q

antidote for warfarin

A

vitamin K

192
Q

Antidotes for fibrinolytic therapy:

A

clotting factors

fresh frozen plasma

aminocaproid acid (amircar)

193
Q

Indicators that the patient has appropriate clotting factors: (2)

A

does not have bruising or petechiae

maintains H&H, platelet count within normal range

194
Q

Evidence of bleeding:

A

oozing

bruises that cluster

petechiae

purport at least ever 2 hours

195
Q

Measure abdominal girth every ___ hrs and why

A

8 hours because increasing girth can indicate internal bleeding

196
Q

Critical values for ARF

A

Partial pressure of arterial oxygen (PaO2) less than 60 mm Hg (hypoxemia/oxygenation failure)

OR partial pressure of (PaCo2) more than 45 mm Hg occurring with academia (pH < 7.35) (hypercapnia/ventilatory failure)

AND arterial oxygen sat (SaO2) less than 90% in both cases

197
Q

Acute respiratory failure can be:

A

Ventilatory failure

oxygenation (GAS EXCHANGE) failure

combination of both ventilatory and oxygenation failure

198
Q

Common causes of oxygenation failure:

A

Low atmospheric oxygen concentration (high altitudes, closed spaces, smoke inhalation, carbon monoxide poisoning)

pneumonia

congestive heart failure with pulmonary edema

PE

ARDS

199
Q

Hallmark of respiratory failure:

A

dyspnea (perceived difficulty breathing)

200
Q

Manifestations of hypercapnia failure: (5)

A

decreased LOC

headache

drowsiness

lethargy

possible seizures

201
Q

Effects of acidosis can lead to

A

decreased LOC

drowsiness

confusion

hypotension

bradycardia

weak peripheral pulses

202
Q

Acute respiratory distress syndrome features

A

Hypoxemia that persists even when 100% oxygen is given (refractory hypoxemia, cardinal feature)

decreased pulmonary compliance

dyspnea

noncardiac-associated bilateral pulmonary edema

dense pulmonary infiltrates on x-ray

203
Q

What kind of monitoring is valuable for those with ARF:

A

end tidal CO2 (ETCO2 or PETCO2) monitoring

pulse ox might show adequate oxygen saturation but because of increased ETCO2 the pt may be close to resp failure

204
Q

ARDS can happen after:

A

an acute lung injury (ALI) in people who have no pulmonary disease as a result of other conditions such as

sepsis

burns

pancreatitis

trauma

transfusion

205
Q

Common causes of acute lung injury

A

shock

trauma

serious nervous system injury

pancreatitis

fat and amniotic fluid emboli

sepsis

206
Q

The diagnosis of ARDS is established by:

A

a lowered partial pressure of arterial oxygen (PaO2) value (decreased gas exchange) determined by arterial blood gas measurements

207
Q

The patient with ARDS often needs:

A

intubation and mechanical ventilation with positive end-expiratory pressure (PEEP) or continuous positive airway pressure (CPAP)

208
Q

3 phases of ARDS care:

A

Exudative phase

fibroproliferative phase

resolution phase

209
Q

Exudative phase:

A

early changes of dyspnea and tachypnea resulting from the alveoli becoming fluid-filled and from pulmonary shunting and atelectasis

interventions focus on supporting the patient and providing oxygen

210
Q

Fibroproliferative phase:

A

increased lung damage leads to pulmonary hypertension and fibrosis

body attempts to repair damage and increasing lung involvement reduces gas exchange and oxygenation

interventions focus on delivering adequate oxygen, preventing complications and supporting the lungs

211
Q

Resolution phase:

A

usually 2 weeks after

if this doesn’t occur patient dies

fibrosis may or may not occur

research shows that patients surviving ards often has neuropsychological deficits and poor quality of life scores

212
Q

Most accurate way to verify ET placement:

A

checking end-tidal carbon dioxide levels

chest xray

213
Q

If an intubated patient shows manifestations of decreased oxygenation, check for DOPE:

A

D: displaced tube

O: obstructed tube (most often with secretions)

P: pneumothorax

E: equipment problems

214
Q

If a patient develops respiratory distress during mechanical ventilation…

A

immediately remove the ventilator and provide ventilation with a bag valve mask device

this action allows quick determination of whether the problem is with the ventilator or with the patient

215
Q

To prevent bacterial contamination with a ventilator:

A

do not allow moisture and water in the ventilator tubing to enter the humidifier

216
Q

Assess the area around the ET tube or tracheostomy site at least every

A

4 hours for color, tenderness, skin irritation and drainage and document findings

217
Q

Lung problems from mechanical ventilation include: (5)

A

Barotrauma (damage to lungs by positive pressure)

Volutrauma (damage to lung by excess volume delivered to one lung over the other)

atelectrauma (shear injury to alveoli from opening and closing)

biotrauma (inflammatory response0mediated damage to alveoli)

Ventilator-associated lung injury/Ventilator induced lung injury

218
Q

Factors that reduce the likelihood of weaning

A

age related changes (chest wall stiffness, reduced ventilatory muscle strength, decreased lung elasticity)

219
Q

Assessment findings with tension pneumothorax include:

A

asymmetry of thorax

tracheal movement away from midline toward unaffected side

extreme respiratory distress

absence of breath sounds on one side

distended neck veins

220
Q

Initial management of pneumothorax

A

NEEDLE THORACOSTOMY

then a Chet tube is placed

221
Q

Simple hemothorax

A

blood loss of less than 100 mL into the chest cavity

222
Q

Massive hemothorax:

A

blood loss more than 1000mL

223
Q

Hemothorax is

A

common problem after blunt chest trauma or penetrating injuries

224
Q

Open thoracotomy is needed when there is

A

initial blood loss of 1000 mL from chest or persistent bleeding at the rate of

150-200mL/hr over 3-4 hours

Nursing Semester 2 (Med surg & Peds) (7 decks)

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