Respiratory system care Flashcards
1
Q
where can a blood specimen come from?
A
Vein
Fingerstick
Artery
2
Q
types of labs and diagnostic test
A
Blood specimen
Urine, stool, sputum
X-ray and scans
3
Q
Oximetry
A
The amount of hemoglobin, carrying oxygen
Commonly used to titrate oxygen levels in hospitalized patients
4
Q
normal value of oxygen
A
Greater than or equal to 95%
5
Q
What can decreased oxygen levels indicate?
A
hypoventilation
Atelectasis
Pneumothorax
6
Q
how can oxygen be measured?
A
Intermittent or continuous
7
Q
sputum studies
A
Culture and sensitivity
Cytology – cancer
Acid fast bacillus – active TB
8
Q
when collecting a sputum
A
Sterile container
Send to lab ASAP
Sputum not saliva
9
Q
what time is best to collect a sputum specimen?
A
Morning
10
Q
Chest x-ray
A
remove metal between neck and waist
Common views are PA and lateral
2D picture of lung
11
Q
CT scan
A
Shows structures in cross-section
With or without contrast
May require sedation, if can’t lie still
Hard table, scanner will revolve around body
12
Q
CT contrast
A
Fills hollow organs and blood vessels
Highlights internal structures
Can be iodine based
13
Q
contrast nursing care
A
Address allergy to iodine, shellfish
Assess BUN/CR – can cause kidney damage
Tell patient they will feel a warm flush with injection
Force, fluids afterward
14
Q
MRI
A
Assesses lesions difficult to see in CT - lung apex
Distinguishes, vascular and nonvascular structures
Remove metal
15
Q
MRI nursing care
A
Is closed MRI – notify patient and may need to sedate
16
Q
is MRI contrast iodine based?
A
No
17
Q
PET scan
A
uses radioactive tracer injected into IV to look for disease/cancer
18
Q
difference between PET scan and others
A
PET scan – looks at function not structure
Blood flow, oxygen use, sugar uptake
19
Q
TB test
A
Skin test
Interferon – gamma, release assay blood test (IGRA)
20
Q
how is TB injected?
A
Intradermally
10 to 15°
Look for bleb under skin
21
Q
Bronchoscopy
A
bronchi are visualized
Obtains biopsy specimen for treatment
Nasopharynx is anesthetized
no dressing needed
22
Q
nursing care of before bronchoscopy
A
Sign consent
NPO for 6–12 hours before test
Give sedative
23
Q
nursing care after bronchoscopy
A
Keep NPO until gag reflex returns
Expected finding – blood tinged mucus, document and monitor
Is biopsy done, monitor for hemorrhage, or a pneumothorax
24
Q
What is a sign of a hemorrhage or a pneumothorax?
A
Unexplained increased heart rate
25
where is a bronchoscopy done in?
Endoscopy suite
26
Where is a transthoracic needle aspiration done?
With CT guidance in radiology
27
Where is an open lung biopsy done?
OR
28
where is a video assisted thoracic surgery done?
OR
29
Thoracentesis
Large bore needle into pleural space
Obtain fluid for diagnostic
Remove pleural fluid
Install meds
30
nursing care of before thoracentesis
Sign consent
Keep patient upright with elbows on overhead table
Instruct not to talk/move
31
nursing care after thoracentesis
X-ray of chest
Assess for hypoxia and/or pneumothorax
32
pulmonary function test
Measures lung function with respect to time – seconds
Nose pinched, mouth surrounds device
33
forced expiratory volume (1 sec)
FEV1
Maximum amount of there expired forcefully in one second
34
Peak flow meter
Device for asthma patients
Portable
Patience can check their FEV1
Accessibilities to exhale forcefully
know your personal best
35
epistaxis
Nosebleed
36
causes of epistaxis
Irritation, trauma, foreign bodies, tumors
Systemic disease – HTN, blood dyscrasias
Systemic treatment – chemo/anticoagulaters
37
Anterior care
position upright, and lean forward
reassure/calm
Vasoconstriction – lateral pressure/ice
Nasal tampon
38
what should you avoid doing?
Blowing your nose
petroleum jelly in nares
39
posterior care
Emergency/hospitalization
Posterior packing – balloon catheter
Assess respiratory status
Humidification, oxygen, bedrest, oral care, pain control
40
what to teach with posterior care
Saline spray/humidifier
Avoid aspirins, NSAIDs, strenuous activity
41
Where should you pinch the nose for a nose bleed?
below bony prominence
42
obstructive sleep apnea
Disorder of obstructive apnea, hypopneas and/or respiratory efforts
Related arousal is caused by repetitive collapse of upper airway during sleep
43
What structure drops down in OSA?
Mandible
44
risk factors for OSA
Increased age
Male
Obesity
Nasopharyngeal, structure abnormalities
Smoking – less
45
how does obesity affect OSA?
High visceral fat
large next circumference impedes airway
46
s/sx OSA
Daytime Sleepiness
Snoring, choking, gasping during sleep
Morning headache
wheezing, tachycardia, restlessness
47
physical exam of OSA
Obesity
Large neck, and or waist circumference
48
Signs associated with complications of OSA
Motor vehicle accidents
Neuropsychiatric dysfunction
Hypertension
Heart failure
Metabolic syndrome
49
what is the diagnostic test for OSA?
Polysomnography
50
CPAP
Continuous positive airway pressure
Mask, simplest, cheapest
Most often used
51
what do patients use a CPAP for?
Spontaneous breathing to improve oxygenation
Nocturnal ventilation to prevent upper airway obstruction
52
Noninvasive BiPAP
2 pressures – one during inhalation, one during exhalation
For nocturnal ventilation in patients with neuromuscular disease, chest wall, deformity, OSA and COPD
53
OSA treatment
Weight reduction and exercise
avoid alcohol and smoking
Sleep on side
Improved sleep hygiene
Oral devices
54
Surgical treatment for OSA
tissue removal or shrinking
Jaw repositioning
Implant
Tracheostomy
55
types of trachs
Shiley – disposable, inner cannula, cuff, obturator
Jackson – reusable, inner cannula, metal, no cuff, obturator
56
Tube dislodgment/decannulation
keep obturator taped at bedside
Insert obturator into outer cannula
Straighten neck, insert outer cannula/obturator
Remove obturator immediately
Check bilateral breath sounds
Secure a trach
57
viral pharyngitis
Most common
58
Fungal pharyngitis
“ thrush”
Caused by candida albicans
59
Bacterial pharyngitis
10% adult
30% child
A strep
60
strep pharyngitis
Sudden onset of sore throat with tonsillar hypertrophy and erythema
Tender lymph nodes, and fever
61
should you give antibiotics for viral pharyngitis?
No, only bacterial
62
treatment for candida infection
Nystatin, swish and swallow or spit
63
mainstay of symptoms care
Local soothing treatments
Warm or cool fluids
Analgesics/antipyretics
64
Head and neck cancer treatment
First line – surgery
Radiation
Chemo
Or combo of all
65
Head and neck cancer risk factors
tobacco use
More common in men
>50 years old
66
if a patient is younger than 50
Often associated with HPV infection
67
-ectomy
Removal of
68
-ostomy
Opening
69
Total laryngectomy
surgical removal of larynx
still able to eat, G.I. intact
No more air through nose or mouth, now, through stoma
70
artificial larynx
Electro larynx
Device, vibration
Most common
71
Tracheoesophageal voice restoration procedure
Valve
Surgically placed
72
esophageal speech
Vibratory source is pharyngeal esophageal segment
Oral air by esophagus, and expelled past pharyngeal esophageal segment
73
advantages of esophageal speech
Hands-free
No extra devices
74
disadvantage of esophageal speech
Oldest
Length of time to learn
Low quality of speech
75
Radical neck dissection
removal of all tissue on side of neck from mandible to clavicle
Includes muscle, nerve, salivary, gland, major blood vessels
76
nursing care for neck dissection
Nutrition– trach and tube feeding, may start before surgery
Jackson-Pratt drain
Maintain airway
Pulmonary toilet
Stoma care
Pain management
PT, speech therapy
77
Is blood tinged sputum normal secretions after neck dissection
Yes, after first one to two days
78
pneumonia
Acute infection of the lung parenchyma
79
Risk factors for pneumonia
>65
altered LOC
Weakened cough
bedrest, prolonged immobility
debilitating illness
Malnutrition
Smoking
Tracheal intubation
80
Community acquired pneumonia
Patients who have not been hospitalized or lived in a long-term care facility within 14 days of symptom onset
81
Hospital acquired pneumonia
non-intubated patients that begins 48 hours or longer after admission
Symptoms not present at admission
Type: ventilator associated pneumonia
82
viral pneumonia
Most common
Maybe mild, or self limiting or life-threatening
Usually resolves within 3 to 4 days
83
Bacterial pneumonia
May require hospitalization
84
Aspiration/opportunistic pneumonia
Abnormal entry of material from mouth or stomach into trachea/lungs
85
Risk factors for pneumonia
decreased LOC
Dysphasia
NG tubes
Immuno compromised
86
s/sx pneumonia
Starts with upper respiratory infection
Leads to fever, chills, cough, fatigue, chest pain with inspiration, myalgia
87
what is a common symptom in elderly for pneumonia?
Confusion
88
bacterial pneumonia cough
productive
Purulant
89
viral pneumonia cough
Nonproductive/scanty
90
dx pneumonia
s/sx physical assessment
Chest x-ray
WBC with diff
Sputum for C & S
91
WBC with diff – pneumonia
Leukocytosis with bacterial
Shift to left
92
prevention care for pneumonia
Pneumococcal vaccine
Stop smoking
Adequate rest, sleep, diet
93
in hospital care pneumonia
know who is at risk
Pulmonary toilet
Early ambulation
Strict adherence to standard precautions and hand hygiene
94
Acute interventions for pneumonia
VS/pulse ox, trends
Lung auscultation
supplemental oxygen as needed
Incentive spirometer
Increase fluids
Ambulation
Energy conservation
95
COPD
Includes asthma chronic bronchitis
Preventable and treatable
96
what is the most common cause of exacerbation?
Respiratory infection
97
Is the problem getting air in or out of the body?
Out
98
Characteristics of COPD
barrel chest
Diminished breath, sounds – wheezing, rhonchi, crackles
Prolonged expiration
99
signs of advanced disease
Pursed lip breathing
Neck vein, distention
Peripheral edema
Excessively malnourished
100
Cachexia
Excessively malnourished
101
nursing care for COPD
#1– smoking cessation
teach influenza and pneumonia vaccine adherence
Oxygen administration
Teach needing extra calories
102
What is the target SPO2 for COPD patients?
88-92%
103
Should oxygen ever be held with acute exacerbations?
No
104
CO2 narcosis
COPD patients retain CO2 for a long period of time
Low oxygen stimulus to breathe
Check ABG to confirm
105
Tuberculosis
Infectious disease caused by mycobacterium tuberculosis
106
MDR – TB
if resistant to INH and rifampin
107
Risk factors for tuberculosis
disproportionately poor, underserved minorities
IV. Drug users.
Low sanitation
Overcrowded, living conditions
Immunosuppression
108
primary TB
Bacteria are inhaled and start inflammatory reaction
Patient usually asymptomatic, not infectious
109
Latent TB
persistent state of immune response to bacterium
Asymptomatic and non-contagious
Positive TB test, cannot transmit
110
reactivated TB
develops after latent TB
Transmissible
111
Who is at a higher risk of reactivated TB?
Elderly and immuno suppressed
112
ghon nodule
Encapsulated nodule on chest x-ray, indicating positive TB
113
Active TB s/sx
positive sputum
Fever, night sweats, weight loss, productive cough
purulent, bloody sputum >3 weeks
hemoptysis*
Contagious
114
Another name for TB skin test
mantoux test
115
TB skin test
Intradermal injection
Inner surface of forearm
Desired: bleb
116
When are the results read for a TB skin test?
48-72 hours after
117
Risk groups of TB
HIV
Organ transplants
Immigrants
IV. Drug users.
Children <4
118
if positive result?
Obtain chest x-ray
If negative=latent TB
119
Direct observational therapy
Supervision of taking meds, if patient is unable to adhere
120
prevention of transmission
Airborne precautions
Negative pressure room
N95 mask
Monitor healthcare worker TB status annually
121
Homecare prevention
Drug therapy for high-risk contact
Cover nose and mouth
Wear a mask in crowds
sputum test for acid fast bacillus every two weeks
122
when is a patient no longer considered contagious with TB
After three negative cultures
123
sx lung cancer
Persistent, productive, cough
124
What is a definitive diagnostic test for lung cancer?
biopsy
Percutaneous, fine needle
Bronchoscopy
Video assisted thoracoscopy
125
surgical therapy for lung cancer
Pneumonectomy
Lobectomy
Segmental or wedge resection
126
right lung lobes
3
127
left lung lobes
2
128
airborne precautions
N95 mask
negative air return
129
hepatic
liver
130
renal
kidney
131
what kind of TB is resistant to rifampin and isoniazid (INH)?
MDR TB
