Respiratory In Class

Question 1

what is atelectasis and what are the causes, how do we prevent it?

Answer 1

collapse of the alveoli
caused by obstructions in the small airways like with secretions
-common post-op (especially abdominal or thoracic pts b/c of the pain of deep breathing)
*** splint cough, incentive spirometer, pain meds

Question 2

what is pneumonia

Answer 2

acute inflammation of the alveoli/lungs, through the inflammatory response fluid leaks from the capillaries into the alveoli
-most commonly caused by infection, but not always
Risk Factors: depressed cough reflex, intubation, viral URI, air pollution
COPD exacerbation often leads to pneumonia

Question 3

prevention of pneumonia

Answer 3

-get the flu and pneumococcal vaccines
especially those with chronic illness, in a long term care facility, 65 years of older
-avoid cigarette smoke
-encourage ambulation
-careful about aspirating

Question 4

S/S of penumonia

Answer 4

productive cough
yellow green or bloody tinged sputum
SOB
snap crackle pops sounds over the alveoli
restlessness and confusion from the hypoxemia
high RR, and high HR

Question 5

how are we going to take care of the patient with penumonia

Answer 5

broncho dilator inhaler or nebulizer, antibiotic therapy , expectorant, antipyretics, analgesics , oxygen as needed

Question 6

what diagnostic tests

Answer 6

sputum culture, CBC, chest xray, c-reactive protein , BNP, electrolytes,

Question 7

how is TB spread?

Answer 7

through airborne droplets
in a healthy immune system, your immune system will surround it into a granuloma, this is called latent TB

Question 8

what is a primary tuberculosis infection

Answer 8

the bacilli are not contained, they multiply and spread

Question 9

Primary progressive TB infection symptoms

Answer 9

weight loss, fatigue, night sweats
progresses to crackles, dyspnea, orthopnea (SOB when laying down), productive cough with rusty colored sputum

Question 10

taking care of someone with active TB

Answer 10

PIER
pyrazinamide
isoniazid
ethambutol
rifampin
*drugs are highly hepatotoxic

Question 11

for which patients do we do airborne precautions?

Answer 11

TB, measles, influenza, SARS

Question 12

clinical manifestations of lung cancer

Answer 12

-often silent
-latent manifestations are fatigue weight loss, nausea and vomiting
-then frequently presents as pneumonia but does not respond to treatment (and xray would look different)

Question 13

paraneoplastic syndrome

Answer 13

often associated with small cell
the cancer cells are secreting hormones, cytokines, and enzymes,
manifestations can include hypercalcemia, SIADH, adrenal hypersecretion, polycythemia

Question 14

knowing that someone will have contrast media, what are some nursing actions that need to happen?

Answer 14

check kidney function (asses BUN and creatinine)
-stop metformin 48 hours (this is a concern b/c of lactic acidosis)
- contrast media is really hard on the kidneys
-check allergies to shellfish or iodine

Question 15

nursing management of pulmonary hypertension

Answer 15

-happens when the pulmonary artery pressure is elevated due to an increase in resistance to blood flow (can be from COPD or left sided heart failure)
-give meds that vasodilate the pulmonary blood vessels
*vasodilators like Epoprostrenol
*PDE5 Inhibitors like Sildenafil,
*Calcium Channel blockers like Nifedipine,
* Loop Diuretics like Furosemide

Question 16

what is a pulmonary angiography

Answer 16

we are looking at the vessels in the pulmonary vasculature with contrast media

Question 17

how do we diagnose pulmonary artery hypertension

Answer 17

with a right-sided cardiac catheterization (this will measure cardiac output, pressure, pulmonary vascular resistance )

Question 18

nursing management of asthma

Answer 18

2 drugs to treat: broncho-constriction and inflammation
*Beta 2 adrenergic agonists like methylxanthines and anticholinergics
*anti inflammatory agents like glucocorticoids, leukotriene modifier, mast cell stabilizers (cromolyn)

Question 19

what is a complication of asthma

Answer 19

Status Asthmaticus
-resistant to the usual treatment
-pt will speak in words not sentences & be extremely anxious
-may result in pneumothorax, respiratory arrest
TREATMENT: IV aminophyllin, IV corticosteroids like Methylpredinosolone, subcutaneous epinephrine

Question 20

risk factor for developing COPD that is not their fault

Answer 20

-heredity (A1-Antitrypsin Deficiency)
-leads to destruction of the alveoli

Question 21

COPD acid base inbalance

Answer 21

respiratory acidosis

Question 22

drug therapy for COPD

Answer 22

bronchodilators (SABA and LABA) , inhaled corticosteroid therapy , antibiotics as needed

Question 23

weight loss and emphysema

Answer 23

pressure on diaphragm from full stomach causes dyspena
encourage small, frequent meals

Question 24

drive to breath for emphysema people

Answer 24

hypoxemia

Question 25

COPD complications

Answer 25

pulmonary hypertension, cor pulmonale, acute respiratory failure, depression/anxiety

Question 26

T/F:
emphysema is a progressive disorder
weight loss and malnutrition are common with emphysema
pts with emphysema need high levels of supplementary oxygen 24/7
respiratory alkalosis is the expected acid-base imbalance
-purse-lipped breathing should be encouraged

Answer 26

T, T, F, F, T

Question 27

what is a cbc result you might see for the pt with emphysema

Answer 27

RBC high, HGB high, HCT high
this is normal because they are overproducing in order to compensate for the lower perfusion

Question 28

nursing care for someone with emphysema entering the ED

Answer 28

high fowlers, give her oxygen, she needs an IV for in case she crashes on us
lab tests: CBC, ABG, BNP, chest xray (to help check for pneumonia) , ECG
medications: albuterol beta 2 agonist , IV Methylprednisolone