Respiratory System Alterations Flashcards
Diagnostic Tests for Respiratory Disorders: Noninvasive
1.Chest x-ray (CXR): Use lead shield for adults of childbearing age.
2.Pulse oximetry
3.Pulmonary function tests
4.Sputum culture
5.Computed tomography (CT)
6.Magnetic resonance imaging (MRI)
Bronchoscopy
Used to:
Visualize larynx, trachea, bronchi; obtain tissue biopsy; foreign body removal
Interventions:
1.Obtain informed consent.
2.Maintain NPO 8 to 12 hr.
3.Provide local anesthetic throat spray.
4.Position upright.
5.Administer medications as prescribed (e.g., atropine [to reduce oral secretions], sedation, and/or anti-anxiety).
6.Label specimens.
7.Observe post-procedure:
a.)Gag reflex
b.)Bleeding
c.)Respiratory status, vital signs, and level of consciousness
Mantoux test
-Positive test indicates exposure to tuberculosis. Diagnosis must be confirmed with sputum culture for presence of acid-fast bacillus (AFB).
1.Administer 0.1 mL of purified protein derivative intradermal to upper half inner surface of forearm (insert needle bevel up).
2.Assess for reaction in 48 to 72 hr following injection; induration (hardening) of 10 mm or greater is considered a positive test; 5 mm may be considered significant if immunocompromised.
Asthma: Contributing Factors, Manifestations, Diagnostic Procedures, Interventions, Medications
-chronic inflammatory disorder of the airways resulting in intermittent and reversible airflow obstruction of the bronchioles
Contributing Factors:
1.Extrinsic: antigen-antibody reaction triggered by food, medications, or inhaled substances
2.Intrinsic: pathophysiological abnormalities within the respiratory tract
3.Older clients: beta receptors are less responsive to agonist and trigger bronchospasms
Manifestations:
1.Sudden, severe dyspnea with use of accessory muscles
2.Sitting up, leaning forward
3.Diaphoresis and anxiety
4.Wheezing, gasping
5.Coughing
6.Cyanosis (late sign)
7.Barrel chest
Diagnostic Procedures:
1.ABGs
2.Sputum cultures
3.Pulmonary function tests
Nursing Interventions:
1.Remain with the client during the attack.
2.Position in high-Fowler’s.
3.Assess lung sounds and pulse oximetry.
4.Administer oxygen therapy.
5.Maintain IV access.
6.Therapeutic Measures:
a.)Respiratory treatments
b.)Oxygen administration
7. Educate Avoidance of allergens and triggers
8.Educate Proper use of inhaler and peak flow monitoring
Medications:
1.Bronchodilators
a.)Short-acting inhaled: albuterol for rapid relief
b.) Methylxanthines: theophylline; monitor therapeutic range for toxicity
2.Anti-inflammatory
a.)Corticosteroids: fluticasone and prednisone
b.)Leukotriene antagonists: montelukast
3.Combination Agents
a.)Ipratropium and albuterol
b.) Fluticasone and salmeterol
NOTE: With inhaled agents, administer bronchodilators BEFORE anti-inflammatory medication.
Status Asthmaticus: Manifestations & Nursing Interventions
-a life-threatening episode of airway obstruction that is often unresponsive to treatment.
Manifestations:
1.Extreme wheezing
2.Labored breathing
3.Use of accessory muscles
4.Distended neck veins
5.High risk for cardiac and/or respiratory arrest
Nursing Interventions:
1.Place in high-Fowler’s.
2.Prepare for emergency intubation.
3.Administer oxygen, epinephrine, and systemic steroid as prescribed.
4.Provide emotional support.
Pulmonary Emphysema: Contributing Factors &Manifestations
-destruction of alveoli, narrowing of bronchioles, and trapping of air resulting in loss of lung elasticity
Contributing Factors:
1.Cigarette smoking (main causative factor); passive smoke inhalation
2.Advanced age
3.Exposure to air pollution
4.Alpha-antitrypsin deficiency (inability to break down pollutants)
5.Occupational dust and chemical exposure
Manifestations:
1.Dyspnea with productive cough
2.Difficult exhalation, use of pursed-lip breathing
3.Wheezing, crackles
4.Barrel chest
5.Shallow, rapid respirations
6.Respiratory acidosis with hypoxia
7.Weight loss
8.Clubbed fingernails
9.Fatigue
Chronic Bronchitis: Contributing Factors, Manifestations, Diagnostic Procedures, Interventions
-inflammation and hypersecretion of mucus in the bronchi and bronchioles caused by chronic exposure to irritants
Contributing Factors:
1.Cigarette smoking (main causative factor)
2.Exposure to air pollution and other environmental irritants
Manifestations:
1.Productive cough
2.Thick, tenacious sputum
3.Hypoxemia
4.Respiratory acidosis
Diagnostic Procedures:
1.Chest x-ray
2.Pulmonary function tests: air remains trapped in lungs
3.Pulse oximetry: often less than 90%
4.ABGs: chronic respiratory acidosis
5.Computed tomography (CT)
Interventions:
1.Assess respiratory status.
2.Assess cardiac status for signs of right-sided failure.
3.Position upright and leaning forward.
4.Schedule activities to allow for frequent rest periods.
5.Administer oxygen therapy as prescribed.
6.Use incentive spirometry, breathing techniques, effective coughing.
7.Encourage fluids 2 to 3 L per day unless contraindicated.
8.Encourage high-calorie diet.
9.Provide emotional support.
Medications:
1.Bronchodilators
2.Beta adrenergic agents
3.Cholinergic antagonists
4.Corticosteroids
5.Methylxanthines
6.Anti-inflammatory agents
7.Mucolytic agents
Therapeutic Measures:
1.Chest physiotherapy/pulmonary drainage
2.Lung reduction surgery
Client Education and Referral:
1.Breathing techniques
2.Oxygen therapy
3.Medications
4.Nutrition
5.Promote smoking cessation
6.Infection prevention measures
7.Encourage immunizations for pneumonia and influenza
8.Pulmonary rehabilitation
9.Activity pacing
Complications of COPD: Cor Pulmonale-> Manifestations & Interventions
-right-sided heart failure caused by pulmonary disease
Manifestations:
1.Hypoxia and hypoxemia
2.Extreme dyspnea
3.Cyanotic lips
4.JVD
5.Dependent edema
6.Hepatomegaly
7.Pulmonary hypertension
Interventions:
1.Monitor respiratory status.
2.Monitor cardiac status and assess for indications of right-sided heart failure.
3.Administer oxygen therapy as prescribed.
4.Ensure adequate rest periods.
5.Encourage low-sodium diet.
6.Maintain fluid balance; possible fluid restriction.
7.Administer medications as prescribed.
a.)Diuretics
b.)Digoxin
Therapeutic Measures:
Mechanical ventilation
Complications of COPD-Pneumonia: Contributing Factors, Manifestations, Diagnostic Procedures, Interventions
-an inflammatory process in the lungs that produces excess fluid and exudate that fill the alveoli; classified as bacterial, viral, fungal, or chemical.
Contributing Factors:
1.Advanced age
2.No pneumococcal vaccination within the last 5 years
3.No influenza vaccine within the last year
4.Chronic lung disease
5.Immunocompromised
6.Mechanical ventilation
7.Postoperative
8.Sedation and opioid use
9.Prolonged immobility
10.Tobacco use
11.Enteral tube feeding
Manifestations:
1.Tachypnea and tachycardia
2.Sudden onset of chills, fever, flushing, diaphoresis
3.Productive cough
4.Dyspnea with pleuritic pain
5.Crackles
6.Elevated WBC
7.Decreased O 2 saturation
Diagnostic Procedures:
1.Chest x-ray
2.Pulse oximetry
3.Sputum culture and sensitivity
Nursing Interventions:
1.Assess respiratory status.
2.Administer oxygen.
3.Assess sputum.
4.Monitor vital signs.
5.Encourage 3 L of fluid per day.
6.Provide pulmonary hygiene.
7.Encourage mouth care.
8.Promote nutrition.
Medications:
1.Anti-infectives
2.Antipyretics
3.Bronchodilators
4.Anti-inflammatories
Client Education:
1.Medication administration
2.Preventive measures
3.Pneumonia and influenza vaccine
Complications of COPD-Tuberculosis: Contributing Factors, Manifestations, Diagnostic Procedures, Interventions
-an infectious disease caused by Mycobacterium tuberculosis and transmitted through aerosolization (i.e., an airborne route).
Contributing Factors:
1.Older populations and clients without housing
2.Lower socioeconomic status
3.Foreign immigrants
4.Those in frequent contact with untreated persons
5.Overcrowded living conditions
Manifestations:
1.Cough, hemoptysis
2.Positive sputum culture for acid-fast bacillus (AFB)
3.Low-grade fever with night sweats
4.Anorexia, weight loss
5.Malaise, fatigue
Diagnostic Procedures
1.Mantoux
2.Sputum culture and smear for AFB to confirm diagnosis
3.Serum analysis, QFT-G
4.Chest x-ray
Interventions:
1.Initiate airborne isolation precautions.
2.Obtain sputum sample before administering medications.
3.Maintain adequate nutritional status.
4.Teach the client to avoid foods containing tyramine when taking INH.
5.Inform the client that rifampin can alter the metabolism of certain other medications.
6.Monitor laboratory findings for liver and kidney function.
7.Administer medications on an empty stomach at the same time every day.
8.Medications should be taken for 6 to 12 months, as directed.
9.Instruct the client to watch for indications of hepatotoxicity, nephrotoxicity, and/or visual changes, and to notify a provider if any of these are noted.
Medications:
1.Rifampin
2.Isoniazid (INH)
3.Pyrazinamide
4. Ethambutol
5. Fluoroquinolones and aminoglycosides (if TB is resistant to anti-TB drugs)
Client Education and Referral:
1. Instruct client to follow infection control measures.
2. Ensure medication compliance and follow- up care.
Cases of diagnosed TB are reported to local or state health department.
Refer all high-risk clients to local health department for testing and prophylactic treatment regimen.
Complications of COPD- Laryngeal Cancer: Contributing Factors, Manifestations, Diagnostic Procedures, Interventions, Therapeutic Measures, Education & Referral
-malignant cells occurring in the mucosal tissue of the larynx; more common in men between the ages of 55 and 70
Contributing Factors:
1.Smoking
2.Radiation exposure
3.Chronic laryngitis and/or straining of vocal cords
Manifestations:
1.Hoarseness extending longer than 2 weeks
2.Dysphagia
3.Dyspnea
4.Cough
5.Persistent sore throat
6.Hard, immobile lymph nodes in neck
7.Weight loss, anorexia
Diagnostic Procedures:
1.MRI
2.Direct laryngoscopy with biopsy
3.X-ray and CT
4.Bone scan and positron emission tomography (PET) scan
Nursing Interventions:
1.Maintain patent airway.
2.Swallowing precautions
3.Emotional support
4.Nutrition
5.Pain management
6.Administer medications as elixir when possible.
Therapeutic Measures:
1.Partial or total laryngectomy
2.Radiation therapy
Client Education and Referral:
1.Communication method
2.Stoma care
3.Swallowing maneuvers
4.Speech therapy
Lung Cancer
-leading cause of cancer-related deaths for both men and women in the U.S.; primary or metastatic disease; most commonly occurs between the ages of 45 and 70 years
Contributing Factors:
1.Smoking (first- and second- hand smoke)
2.Radiation exposure
3.Chronic exposure to inhaled irritants
4.Older adult
Manifestations:
1.Chronic cough
2.Chronic dyspnea
3.Hemoptysis
4.Hoarseness
5.Fatigue, weight loss, anorexia
6.Clubbing of fingers
7.Chest wall pain
Diagnostic Procedures:
1.Chest x-ray and CT scan
2.CT-guided needle aspiration
3. Bronchoscopy with biopsy
4.TNM system for staging
a.)T – Tumor
b.)N – Nodes
c.)M – Metastasis
Nursing Interventions:
1.Maintain patent airway.
2.Suction as indicated by assessment.
3.Monitor vital signs and pulse oximetry.
4.Monitor nutritional status.
5.Position in high-Fowler’s.
6.Provide emotional support.
7.Assess and treat stomatitis.
8.Ensure protection for immunocompromised client.
Medications:
1.Chemotherapeutic agents
2.Opioid narcotics
Therapeutic Measures:
1.Palliative Care
a.)Medication
b.)Thoracentesis
2.Surgical
a.)Tumor excision
b.)Pneumonectomy, lobectomy, wedge resection
c.)Radiation
Client Education and Referral:
1.Medications
2.Constipation prevention and management
3.Mouth and skin care
4.Nutrition
5.Respiratory services
6.Radiology
7.Rehabilitation
8.Hospice
Pulmonary Embolism: Contributing Factors, Manifestations, Diagnostic Procedures, Interventions, Therapeutic Measures, Education & Referral
-a life-threatening hypoxic condition caused by a collection of particulate matter (solid, gas, or liquid) that enters venous circulation and lodges in the pulmonary vessels causing pulmonary blood flow obstruction
Contributing Factors:
1.Chronic atrial fibrillation
2.Hypercoagulability
3.Long bone fracture
4.Long-term immobility
5.Oral contraceptive or estrogen therapy
6.Obesity
7.Postoperative
8.PVD, DVT
9.Sickle cell anemia
10.Central venous catheters
Manifestations:
1.Dyspnea, tachypnea
2.Sharp, stabbing pain on inspiration
3.Tachycardia, hypotension
4.Sense of impending doom
5.Diaphoresis
6.Decreased SaO2
7.Pleural effusion
8.Crackles and cough
9.NOTE: Petechiae over chest and axilla are present with fat emboli.
Diagnostic Procedures:
1.ABGs
2.D-dimer
3.Chest x-ray
4.V/Q scan
5.Pulmonary angiography
Nursing Interventions:
1.Assess respiratory status and vital signs.
2.Provide respiratory support.
3.Provide oxygen therapy.
4.Position in high-Fowler’s.
5.Initiate IV access.
6.Provide emotional support.
Medications:
1.Thrombolytics
2.Anticoagulants
Therapeutic Measures:
1.Embolectomy
2.Vena cava filter
Client Education and Referral:
1.Preventive measures
2.Dietary precautions with vitamin K
3.Follow-up for PT or INR
4.Bleeding precautions
5.Home oxygen therapy
6.Cardiology and Pulmonary Services
7.Respiratory care
Pneumothorax
a collection of air or gas in the chest or pleural space that causes part or all of a lung to collapse due to a loss of negative pressure
Tension pneumothorax
occurs when air enters the pleural space during inspiration through a one-way valve and is not able to exit upon expiration. The trapped air causes pressure on the heart and the lung. As a result, the increase in pressure compresses blood vessels and limits venous return, leading to a decrease in cardiac output. Death can result if not treated immediately.
