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Nur 3010 exams > Respiratory pt. 2 > Flashcards

Respiratory pt. 2 Flashcards

1
Q

what is restrictive lung disease

A

impair ability to fully expand lungs
- atelectatsis
- pleural conditions (pleurisy, empyema)
- ARDS
- pneumoconoises
- lung cancer
- chest wall injuries

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2
Q

what is obstructive lung disease

A

prevent exhalation
- asthma
- COPD (chronic bronchitis, emphysema)
- bronchietasis
- cystic fibrosis

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3
Q

what are vascular diseases we learned

A
  • pulmonary HTN
  • pulmonary embolisms
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4
Q

describe atelectasis (r/t, sx)

A
  • closure or collapse of alveoli
  • most common is acute atelectasis (d/t post anesthesia)
  • symptoms: increasing dyspnea, cough, sputum production
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5
Q

acute symptoms of atelectasis

A

tachycardia (decrease O2)
tachypynea (decrease O2)
pleural pain
central cyanosis if large areas of lung affected

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6
Q

chronic symptoms of atelectasis

A

similar to acute, pulmonary infection may be present
- can’t expand lungs
- vent dependent
-non ambulatory
- functional or development ds.

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7
Q

how to identify atelectasis

A

auscultation posterior base of lungs

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8
Q

assessment / diagnosis of atelectasis 3

A
  • increased work of breathing and hypoxemia
  • increased temp
  • decreased breath sounds/crackles over affected area (base)
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9
Q

what may suggest atelectasis before clinical sysmptoms appear

A

chest x-ray
pulse ox low O2 sat (less than 90%)

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10
Q

prevention of atelectasis

A

strategies to expand lungs and manage secretions
- q2 turning
- early mobilization post op
- IS
- voluntary deep breathing
- secretion management (coughing)
- CPT
- MDI
- thoracentesis (pleural effusions)

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11
Q

4 types of pleural conditions

A

visceral pleura (pleura covering lungs) and parietal pleura (pleura covering chest wall)
- pleurisy
- pleural effusion
- empyema
- pulmonary edema

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12
Q

describe pleuritis/diagnosis/sound on stethoscope

A

inflammation of both layers of pleurae
- pleuritic pain is associated with respiratory movement (rubbing of pleural layers together, sharp inspiratory pain)
- pleural friction rub = heard in stethoscope
- diagnostics: chest xray, sputum analysis, thoracentesis (used for infectious etiology)

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13
Q

nursing role in pleuritis

A
  • treat underlying cause
  • provide analgesia (allows for more appropriate expansion)
  • splint rib cage when coughing (hold pillow while coughing to clear airways)
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14
Q

describe pleural effusion (s/sx, diagnostic, sound on stethoscope)

A

fluid collection in pleural space usually secondary to heart failure, TB, pulmonary infections, cancer (recurrent)
- s/sx: fever, chills, pleuritic pain, dyspnea
- decreased/absent breath sounds, decreased fremitus, dull sound on percussion
-diagnostic: chest RX, chest CT, thoracentesis

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15
Q

which pleural condition has tracheal deviation away from affected side

A

pleural effusion (more common with tension pneumonia)

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16
Q

describe empyema (s/sx, diagnostic, sounds on stethoscope)

A

accumulation of thick, purulent fluid in pleural space (pleural effusion with thick fluid/pus)
- (S/D) complication of bacterial pneumonia or lung abscess
- acutely ill
- s/sx: similar to acute respiratory infection/pneumonia
- decreased breath sounds over affected area, dull sound on percussion
- diagnostic: chest CT, thoracentesis

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17
Q

how to relieve empyema

A

drain fluid via thoracentesis
- antibiotics for 4-6 weeks

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18
Q

describe ARDS (acute respiratory distress syndrome) - NOT ON EXAM

A

sudden, progressive pulmonary edema
- increased B/L lung infiltrates visible on chest XR (white opacities = decreased airflow)
- absence of an elevated left atrial pressure (independent of HF)
- worsening PaO2/FiO2 ratios (untreatable)
- rapid onset of severe dyspnea

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19
Q

ARDS management

A
  • identification/treatment of underlying cause
  • intubation, mechanical vent with PEEP to keep alveoli open
  • hypovolemia treated
  • prone positioning (BEST FOR OXYGENATION)
  • nutritional support, enteral feeding preferred
  • reduce anxiety
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20
Q

describe pulmonary hypertension (cause, s/sx, diagnosis, management)

A

HTN isolated to pulmonary arteries (running flight of stairs and taking break after to catch breath)
causes: vascular ds., congenital heart disease, HIV, illicit drug use
s/sx: exertional dyspnea (exercise), SOB, weakness, fatigue
diagnosis: right sided heart Cath/pulmonary artery catherization
mangement: anti-hypertensives, selective PA vasodilators (remodulin, sildenafil)

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21
Q

what are the s/sx of right sided heart failure in pulmonary HTN

A

peripheral edema, ascites, distended neck veins (JVD)

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22
Q

describe pulmonary embolism (PE)

A

blocked pulmonary artery or one of its branches by a clot (thrombus) in the venous system or in the right side of the heart -> lungs
- inflammatory process further obstructs area, results in diminished or absent blood flow (tissue perfusion abnormalities)
- bronchioles constrict, increasing pulmonary vascular RESISTANCE, pulmonary arterial pressure, and right ventricular workload (extra workload of heart)

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23
Q

what does PE result in (3)

A
  • ventilation perfusion imbalance (vent > perf)
  • right ventricular failure
  • obstructive shock
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24
Q

risk factors of PE

A

trauma, surgery, pregnancy, HF, hyper coagulability, immobility, venous stasis (sitting still for hours)

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25
Q

s/sx of PE

A

concomitant DVT, SOB, chest pain, coughing, anxiety, dizziness, cyanosis, hypoxemia, low O2 sat

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26
Q

prevention of PE

A
  • exercises to avoid venous stasis (early ambulation, antiembolism stockings)
    treatments:
  • measures to improve respiratory and vascular status (low flow to mechanical vent, fluids/pressors (increase BP)
  • anticoagulation ad thrombolytic therapy (bolus heparin IVP followed by IV drip and subsequent direct oral anti coagulation (DOAC) or Coumadin therapy) - eliquis
  • thrombolytics: TPA, altepase when hemodynamically unstable (dangerous, breaks clots in path)
  • surgical interventions (mechanical/percutaneous clot removal/embolectomy)
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27
Q

what happens if patient is contraindicated to anticoagulations

A

IVC filters that sit in IVS -> Catch potential clots that break off to prevent going into lungs

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28
Q

describe pneumoconioses

A

occupational lung ds. and includes asbestosis, silicosis, coal workers pneumoconiosis
- nonneoplastic alt. of lung resulting from inhalation of mineral/inorganic dust (may lead to neoplasms)
- preventable but NOT TREATABLE (reduce exposure, wear gear)
- role of nurse: advocate and education patient

29
Q

describe lung cancer

A

leading causes of cancer deaths in US
- 85% contributed cigarette smoke (1st or 2nd hand)
- classicification: SCLC/NSCLC tumors
treatment: surgery (wedge resection (remove part lung), lobectomy (remove whole lobe), pneumonectomy (remove one side of lung), radiation/chemo

30
Q

what is the nursing care for lung cancer

A
  • drain rangement
  • airway clearance - track or oral airway
  • dyspnea
  • fatigue, pain, psychosocial support (end of life)
  • palliative care/end of life goals
  • risk reduction: SMOKING CESSATION
  • screening: adults 50+ w/ 20+ pack per year (annual CA screening, CT screen)
31
Q

describe chest injuries causes

A
  • blunt trauma
  • sternal, rib fractures
  • flail chest (sucked in when inspiration)
  • pulmonary contusion (supp. O2)
  • penetrating trauma (surgical correction)
  • pneumothorax (collapse lung) (spontaneous or simple, traumatic, tension pneumothorax)
32
Q

what is tension pneumothorax

A

one way valve air leaks occurs from lung or through the chest wall/lung itself

33
Q

treatment of chest injuries (tension pneumothorax)

A
  • chest tube 2nd intercostal space
34
Q

iclicker: an initial characteristic symptom of a simple pneumothorax is sudden onset of chest pain (t/f)

A

true

35
Q

describe asthma

A

chronic inflammatory disease of the airways that cause (1) hyper responsiveness, (2) bronchial, mucosal edema, (3) mucus production
- inflammation leads to cough, chest tightness, wheezing, dyspnea
- largely reversible (spontaneously with/without treatment
- very uncontrolled in US
- can cause scarring

36
Q

what part of the lung does asthma only affect?

A

bronchi and bronchioles -> bronchoconstriction
- goblet cells in bronchioles produce mucus
- lack of oxygen, build up of CO2 -> acidosis (hypercapnia resp. failure)

37
Q

asthma triggers and meds

A
  • allergy (eosinophilia) is a strong predisposing factor
  • triggers: stress, smoke, URIs/infections, cold weather, exercise
    drugs:
  • NSAIDS (naproxen, ketorolax)
  • beta blockers (nonselective specifically bc it prevents bronchodilation & cause bronchospasm (if allergic to metoprolol)
38
Q

clinical manifestations of asthma

A
  • cough (productive/nonproductive)
  • diaphoresis
  • tachycardia
  • hypoxemia/cyanosis
39
Q

what does ASTHMA stand for

A

A - accessory muscle use (paradoxical breathing (with whole thorax) or diaphragmatic fatigue (CRITICAL)
S - SOB/dyspnea (single word dyspnea..say one word per breath)
T - tightness in chest/tachycardia (increased RR, shallow breaths)
H - high pitched wheezing (d/t narrowed airways)
M - minimal diminished breath sounds
A - absent breath sounds, acidosis, air trapping (prolonged exhalation)

40
Q

what is the hallmark of asthma

A

wheezing

41
Q

iclicker: what ABGs would you expect to see in a patient with acute asthma attack?

A

pH: low
PaCO2: high
PaO2: low

42
Q

sx of hypoxia

A

agitation
restlessness
drowsiness

43
Q

describe status asthmatics

A

asthma attack that is refractory to medication (r/t resp. acidosis)
- primary intervention: endotracheal intubation (however, still difficult d/t distal bronchioles still constricted)
- demand > supply

44
Q

what are the quick relief medications for asthma (rescue)

A

beta 2 adrenergic agonists
- bronchodilator, improve airflow
- ADR: tachycardia, insomnia, tremors
- ex: ALBUTEROL (rescue drug)
Anticholinergics
- dries secretions, dilates airways, inhaled
- ex: IPRATROPUM BROMIDE (duoneb - albuterol + anticholinergic)
methylxanthines (not common)
- bronchodilator
- ex: theophylline 10-20 mg/dl

45
Q

what re the long acting medications for asthma (maintenance)

A

corticosteroids
- causes oral thrush, decreases immune response (decrease airway edema), increases glucose
- ex: prednisolone, solumedrol (inhaled, PO, IV) - WASH MOUTH/INHALER AFTER USE
long acting beta 2 adrenergic agonists
- LABA
- ex: salmeterol

46
Q

MDI use

A

during acute asthma attack - albuterol 2-4 puffs Q20m x3 times
- if not relieved, ER
- wash inhalers 2x/week
- steroid inhaler: wash after each use to prevent infection
- efficacy: improved O2 sat, reduced RR, patient states relief, palpitations d/t beta sympathetic stimulant
- other expected findings: increased productive cough (sputum

47
Q

what is peak flow expiratory rate

A

how fast to get air out of airway (3 zones)
- green (no worsening symptoms)
- yellow (SABA Q4 for 1-2 days, follow up with MD)
-red (emergency tx)

48
Q

describer COPD (chronic obstructive pulmonary disease) & associated respiratory diseases

A

slowly progressive respiratory disease of airflow obstruction
- emphysema (pink puffer)
- chronic bronchitis ( blue bloater)
- preventable and treatable, NOT REVERSIBLE
- involves airways, pulmonary parenchyma, or both

49
Q

other associated respiratory diseases

A

cystic fibrosis, bronchiectasis, asthma (uncontrolled -> COPD)

50
Q

describe pathophysiology of COPD

A
  • airflow limitation is progressive, associated with an inflammatory response to noxious particles or gases (chronic inflammation damages tissue)
  • scar tissue -> narrowing airway
  • scar tissue in parenchyma -> decreases elastic recoil (stiff lungs, hard time expand)
  • scar tissue in pulmonary vasculature -> thickens vessel lining and hypertrophy of smooth muscles (pul. HTN, RHF(for pulmonale)
51
Q

risk factors of COPD 4

A
  • smoking (primary)
  • fume inhalation
  • wood dust
  • chemical exposure
52
Q

chronic bronchitis - blue bloater (indication, what occurs, susceptibility)

A

inflammation of bronchioles
- cough & sputum production 3 months x2years
- ciliary function reduced, bronchial walls thicken, bronchial airways narrow, mucus plus airways
- alveoli damaged, fibrosed, alveolar macrophage function diminishes -> right HF
- MORE susceptible to respiratory infections (can’t get stuff out)

53
Q

s/sx of chronic bronchitis

A
  • cyanosis (blue bloater)
  • long term chronic cough
  • sputum production (some)
  • crackles + wheezes (distal alveoli collapses, increases mucous production)
  • edema/bloating (S/D right HF)
  • decreased O2 expected
54
Q

describe emphysema - pink puffer

A

abnormal distention of air spaces beyond the terminal bronchioles with destruction of walls of alveoli
- decreased alveolar surface area increases in “dead space” (large alveolar sacs) -> impaired oxygen diffusion (trapped air)
- hypoxemia results
- increased pulmonary artery pressure -> right sided heart failure (for pulmonale)

55
Q

emphysema s/sx

A
  • pursed lipped breathing: prolonged exhalation phase -> relapses O2
  • barrel chest (A/P ratio 1:1)
  • NO CHRONIC COUGH
  • hyper resonant percussion (air trapping)
  • tripodingto improve air exchange (lean forward, brings cardiac tissues off lungs)
56
Q

COPD s/sx overal (emphysema & bronchitis)

A
  • O2 sat 88-90%
  • dyspnea/ SOB
  • weight loss
  • barrel chest
  • clubbing fingernails
  • restlessness, decreased ms, confusion (hypoxia)
    labs:
  • increased WBCs, RBCs (r/t hypoxia to circulate gas)
  • low paO2, high paCO2, normal pH (due to compensation)
57
Q

assessment/diagnosis COPD

A
  • health hx
  • pulmonary function tests
  • spirometry
  • arterial blood gas (elevated paCO2, decreased paO2, decreased/normal pH, elevated pHCO3)
  • chest XR (barrel chest, pneumonia)
58
Q

complications of COPD 5

A
  • respiratory insufficiency and failure (no abx unless long term COPD)
  • pneumonia
  • chronic atelectasis
  • pneumothorax
  • cor pulmonale
59
Q

medical management of COPD

A
  • BiPAP (acute exacerbations esp w/ high PaCO2) *AVOID SEDATION/RESP DEPRESSANT (benzos, narcs)
  • promote smoking cessation
  • reducing risk factors
  • providing supp. O2 (caution d/t CO2 retention)
  • vaccines: pneumococcal, influenza, covid)
  • pulmonary rehabilitation (exercise regimen, intermittent PFTs)
  • managing exacerbations
60
Q

surgical management of COPD

A
  • bullectomy ( remove large alveolar sacs)
  • lung volume reduction
  • lung transplant
61
Q

pharmacological mangement of COPD

A

bronchodilators, MDI (rescue)
- beta adrenergic agonists: ALBUTEROL
- muscarinic antagonists (anticholinergics): ipratropium bromide (SABA), tiotroprium bromide (LABA)
- combination agents: DUONEB (ipratroprim + salbutamol)
corticosteroids (maintenance) (decrease rate exacerbation, improve response to bronchodilators, decrease dyspnea)
- inhaled: beclomethasone (QVR), budesonide (pulmicort), fluticasone (Flovent)
- PO: prednisone, medrol dose pack: regime to dose down medication
- IV: solumedrol
TIP: no difference PO vs. IV meds
long acting beta agonists
- formotreol, cilantro, salmeterol
combos (LABA + ICS)
- Symbicort (formotreol + budesonide)
- breo (vilanterol + fluticasone)
- Advair (salmeterol + fluticasone)
other
- antibiotics
- mucolytics (mucinex)
- antitussives (AVOID unless bronchitis)
- pulmonary vasodilators (remodeling, sildenafil)

62
Q

nursing management of COPD

A
  • history
  • diagnostics test review
  • achieve/maintain airway clearance (BIGGEST)
  • improve breathing pattern (exercise)
  • improve activity tolerance
  • MDI patient education (wash out everything w/ steroids)
  • nursing care plan
  • oral care BEFORE meals
  • secretion clearance: coughing, sitting upright, deep slow inhalation, hold breath, forceful exhale
  • pursed lip breathing education: inhale through nose (3s), exhale (7s) through mouth (prevent air trapping)
63
Q

describe bronchiectasis

A

chronic, irreversible dilation of bronchi and bronchioles

64
Q

what is bronchiectasis caused by:

A
  • airway obstruction, pulmonary infections
  • diffuse airway injury
  • genetic disorders
  • abnormal host defenses
  • idiopathic causes
65
Q

bronchiectasis clinical manifestations and medical management

A
  • chronic cough
  • purulent sputum in copious amounts
  • clubbing fingers (hypoxemia)
  • postural drainage
    Medical management
  • chest physiotherapy
  • smoking cessation (IMPORTANT)
  • antimicrobial therapy
  • bronchodilators and mucolytics
66
Q

bronchiectasis nursing management

A

focus on ALLEVIATING symptoms and clearing pulmonary sections
patient teaching:
- smoking cessation
- postural drainage
- early s/sx respiratory infections
- conserving energy

67
Q

describe cystic fibrosis

A
  • autosomal recessive disease among caucasian population
  • genetic screening to detect carrier
  • genetic counseling for couples at risk
  • genetic mutation changes chloride transport, leading to thick vicious secretions in lungs, pancreas, liver, intestines, reproductive tract
  • respiratory infections are leading cause of MORBIDITY and MORTALITY
68
Q

medical management of CF (meds)

A
  • chronic: control infections via abx
  • acute: aggressive therapy involves airway clearance and abx.
  • anti inflammatory agents
  • corticosteroids: inhaled, oral, IV during exacerbations
  • inhaled bronchodilators
  • oral pancreatic enzymes supplementation with meals
69
Q

nursing management of CF

A
  • promote removal of pulmonary secretions (CPT, deep breathing exercises, vibrating vest)
  • remind patient to reduce risk factors for respiratory infection
  • adequate fluid and electrolyte intake
  • palliative care (short life span)
  • discuss end of life issues and concerns
  • diabetes mangement (CF r/t diabetes -> increase glucose)

Nur 3010 exams (13 decks)

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