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NUR 334 > Respiratory system care > Flashcards

Respiratory system care Flashcards

1
Q

where can a blood specimen come from?

A

Vein
Fingerstick
Artery

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2
Q

types of labs and diagnostic test

A

Blood specimen
Urine, stool, sputum
X-ray and scans

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3
Q

Oximetry

A

The amount of hemoglobin, carrying oxygen

Commonly used to titrate oxygen levels in hospitalized patients

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4
Q

normal value of oxygen

A

Greater than or equal to 95%

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5
Q

What can decreased oxygen levels indicate?

A

hypoventilation
Atelectasis
Pneumothorax

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6
Q

how can oxygen be measured?

A

Intermittent or continuous

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7
Q

sputum studies

A

Culture and sensitivity
Cytology – cancer
Acid fast bacillus – active TB

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8
Q

when collecting a sputum

A

Sterile container
Send to lab ASAP

Sputum not saliva

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9
Q

what time is best to collect a sputum specimen?

A

Morning

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10
Q

Chest x-ray

A

remove metal between neck and waist

Common views are PA and lateral

2D picture of lung

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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

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12
Q

CT contrast

A

Fills hollow organs and blood vessels
Highlights internal structures
Can be iodine based

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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

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14
Q

MRI

A

Assesses lesions difficult to see in CT - lung apex

Distinguishes, vascular and nonvascular structures

Remove metal

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15
Q

MRI nursing care

A

Is closed MRI – notify patient and may need to sedate

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16
Q

is MRI contrast iodine based?

A

No

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17
Q

PET scan

A

uses radioactive tracer injected into IV to look for disease/cancer

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18
Q

difference between PET scan and others

A

PET scan – looks at function not structure
Blood flow, oxygen use, sugar uptake

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19
Q

TB test

A

Skin test
Interferon – gamma, release assay blood test (IGRA)

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20
Q

how is TB injected?

A

Intradermally
10 to 15°

Look for bleb under skin

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21
Q

Bronchoscopy

A

bronchi are visualized

Obtains biopsy specimen for treatment

Nasopharynx is anesthetized

no dressing needed

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22
Q

nursing care of before bronchoscopy

A

Sign consent
NPO for 6–12 hours before test
Give sedative

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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

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24
Q

What is a sign of a hemorrhage or a pneumothorax?

A

Unexplained increased heart rate

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25
Q

where is a bronchoscopy done in?

A

Endoscopy suite

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26
Q

Where is a transthoracic needle aspiration done?

A

With CT guidance in radiology

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27
Q

Where is an open lung biopsy done?

A

OR

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28
Q

where is a video assisted thoracic surgery done?

A

OR

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29
Q

Thoracentesis

A

Large bore needle into pleural space

Obtain fluid for diagnostic

Remove pleural fluid

Install meds

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30
Q

nursing care of before thoracentesis

A

Sign consent
Keep patient upright with elbows on overhead table
Instruct not to talk/move

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31
Q

nursing care after thoracentesis

A

X-ray of chest
Assess for hypoxia and/or pneumothorax

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32
Q

pulmonary function test

A

Measures lung function with respect to time – seconds

Nose pinched, mouth surrounds device

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33
Q

forced expiratory volume (1 sec)
FEV1

A

Maximum amount of there expired forcefully in one second

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34
Q

Peak flow meter

A

Device for asthma patients
Portable
Patience can check their FEV1
Accessibilities to exhale forcefully
know your personal best

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35
Q

epistaxis

A

Nosebleed

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36
Q

causes of epistaxis

A

Irritation, trauma, foreign bodies, tumors

Systemic disease – HTN, blood dyscrasias

Systemic treatment – chemo/anticoagulaters

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37
Q

Anterior care

A

position upright, and lean forward
reassure/calm
Vasoconstriction – lateral pressure/ice
Nasal tampon

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38
Q

what should you avoid doing?

A

Blowing your nose

petroleum jelly in nares

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39
Q

posterior care

A

Emergency/hospitalization
Posterior packing – balloon catheter
Assess respiratory status
Humidification, oxygen, bedrest, oral care, pain control

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40
Q

what to teach with posterior care

A

Saline spray/humidifier
Avoid aspirins, NSAIDs, strenuous activity

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41
Q

Where should you pinch the nose for a nose bleed?

A

below bony prominence

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42
Q

obstructive sleep apnea

A

Disorder of obstructive apnea, hypopneas and/or respiratory efforts

Related arousal is caused by repetitive collapse of upper airway during sleep

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43
Q

What structure drops down in OSA?

A

Mandible

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44
Q

risk factors for OSA

A

Increased age
Male
Obesity
Nasopharyngeal, structure abnormalities
Smoking – less

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45
Q

how does obesity affect OSA?

A

High visceral fat
large next circumference impedes airway

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46
Q

s/sx OSA

A

Daytime Sleepiness
Snoring, choking, gasping during sleep
Morning headache

wheezing, tachycardia, restlessness

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47
Q

physical exam of OSA

A

Obesity
Large neck, and or waist circumference

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48
Q

Signs associated with complications of OSA

A

Motor vehicle accidents
Neuropsychiatric dysfunction
Hypertension
Heart failure
Metabolic syndrome

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49
Q

what is the diagnostic test for OSA?

A

Polysomnography

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50
Q

CPAP

A

Continuous positive airway pressure
Mask, simplest, cheapest
Most often used

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51
Q

what do patients use a CPAP for?

A

Spontaneous breathing to improve oxygenation

Nocturnal ventilation to prevent upper airway obstruction

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52
Q

Noninvasive BiPAP

A

2 pressures – one during inhalation, one during exhalation

For nocturnal ventilation in patients with neuromuscular disease, chest wall, deformity, OSA and COPD

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53
Q

OSA treatment

A

Weight reduction and exercise
avoid alcohol and smoking
Sleep on side
Improved sleep hygiene
Oral devices

54
Q

Surgical treatment for OSA

A

tissue removal or shrinking
Jaw repositioning
Implant
Tracheostomy

55
Q

types of trachs

A

Shiley – disposable, inner cannula, cuff, obturator

Jackson – reusable, inner cannula, metal, no cuff, obturator

56
Q

Tube dislodgment/decannulation

A

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
Q

viral pharyngitis

A

Most common

58
Q

Fungal pharyngitis

A

“ thrush”

Caused by candida albicans

59
Q

Bacterial pharyngitis

A

10% adult
30% child
A strep

60
Q

strep pharyngitis

A

Sudden onset of sore throat with tonsillar hypertrophy and erythema

Tender lymph nodes, and fever

61
Q

should you give antibiotics for viral pharyngitis?

A

No, only bacterial

62
Q

treatment for candida infection

A

Nystatin, swish and swallow or spit

63
Q

mainstay of symptoms care

A

Local soothing treatments
Warm or cool fluids
Analgesics/antipyretics

64
Q

Head and neck cancer treatment

A

First line – surgery
Radiation
Chemo
Or combo of all

65
Q

Head and neck cancer risk factors

A

tobacco use
More common in men
>50 years old

66
Q

if a patient is younger than 50

A

Often associated with HPV infection

67
Q

-ectomy

A

Removal of

68
Q

-ostomy

A

Opening

69
Q

Total laryngectomy

A

surgical removal of larynx

still able to eat, G.I. intact

No more air through nose or mouth, now, through stoma

70
Q

artificial larynx

A

Electro larynx
Device, vibration
Most common

71
Q

Tracheoesophageal voice restoration procedure

A

Valve
Surgically placed

72
Q

esophageal speech

A

Vibratory source is pharyngeal esophageal segment

Oral air by esophagus, and expelled past pharyngeal esophageal segment

73
Q

advantages of esophageal speech

A

Hands-free
No extra devices

74
Q

disadvantage of esophageal speech

A

Oldest
Length of time to learn
Low quality of speech

75
Q

Radical neck dissection

A

removal of all tissue on side of neck from mandible to clavicle

Includes muscle, nerve, salivary, gland, major blood vessels

76
Q

nursing care for neck dissection

A

Nutrition– trach and tube feeding, may start before surgery

Jackson-Pratt drain

Maintain airway

Pulmonary toilet

Stoma care

Pain management

PT, speech therapy

77
Q

Is blood tinged sputum normal secretions after neck dissection

A

Yes, after first one to two days

78
Q

pneumonia

A

Acute infection of the lung parenchyma

79
Q

Risk factors for pneumonia

A

> 65
altered LOC
Weakened cough
bedrest, prolonged immobility
debilitating illness
Malnutrition
Smoking
Tracheal intubation

80
Q

Community acquired pneumonia

A

Patients who have not been hospitalized or lived in a long-term care facility within 14 days of symptom onset

81
Q

Hospital acquired pneumonia

A

non-intubated patients that begins 48 hours or longer after admission
Symptoms not present at admission

Type: ventilator associated pneumonia

82
Q

viral pneumonia

A

Most common
Maybe mild, or self limiting or life-threatening
Usually resolves within 3 to 4 days

83
Q

Bacterial pneumonia

A

May require hospitalization

84
Q

Aspiration/opportunistic pneumonia

A

Abnormal entry of material from mouth or stomach into trachea/lungs

85
Q

Risk factors for pneumonia

A

decreased LOC
Dysphasia
NG tubes
Immuno compromised

86
Q

s/sx pneumonia

A

Starts with upper respiratory infection
Leads to fever, chills, cough, fatigue, chest pain with inspiration, myalgia

87
Q

what is a common symptom in elderly for pneumonia?

A

Confusion

88
Q

bacterial pneumonia cough

A

productive
Purulant

89
Q

viral pneumonia cough

A

Nonproductive/scanty

90
Q

dx pneumonia

A

s/sx physical assessment
Chest x-ray
WBC with diff
Sputum for C & S

91
Q

WBC with diff – pneumonia

A

Leukocytosis with bacterial
Shift to left

92
Q

prevention care for pneumonia

A

Pneumococcal vaccine
Stop smoking
Adequate rest, sleep, diet

93
Q

in hospital care pneumonia

A

know who is at risk
Pulmonary toilet
Early ambulation
Strict adherence to standard precautions and hand hygiene

94
Q

Acute interventions for pneumonia

A

VS/pulse ox, trends
Lung auscultation
supplemental oxygen as needed
Incentive spirometer
Increase fluids
Ambulation
Energy conservation

95
Q

COPD

A

Includes asthma chronic bronchitis

Preventable and treatable

96
Q

what is the most common cause of exacerbation?

A

Respiratory infection

97
Q

Is the problem getting air in or out of the body?

A

Out

98
Q

Characteristics of COPD

A

barrel chest
Diminished breath, sounds – wheezing, rhonchi, crackles
Prolonged expiration

99
Q

signs of advanced disease

A

Pursed lip breathing
Neck vein, distention
Peripheral edema
Excessively malnourished

100
Q

Cachexia

A

Excessively malnourished

101
Q

nursing care for COPD

A

1– smoking cessation

teach influenza and pneumonia vaccine adherence
Oxygen administration
Teach needing extra calories

102
Q

What is the target SPO2 for COPD patients?

A

88-92%

103
Q

Should oxygen ever be held with acute exacerbations?

A

No

104
Q

CO2 narcosis

A

COPD patients retain CO2 for a long period of time

Low oxygen stimulus to breathe

Check ABG to confirm

105
Q

Tuberculosis

A

Infectious disease caused by mycobacterium tuberculosis

106
Q

MDR – TB

A

if resistant to INH and rifampin

107
Q

Risk factors for tuberculosis

A

disproportionately poor, underserved minorities
IV. Drug users.
Low sanitation
Overcrowded, living conditions
Immunosuppression

108
Q

primary TB

A

Bacteria are inhaled and start inflammatory reaction

Patient usually asymptomatic, not infectious

109
Q

Latent TB

A

persistent state of immune response to bacterium

Asymptomatic and non-contagious

Positive TB test, cannot transmit

110
Q

reactivated TB

A

develops after latent TB
Transmissible

111
Q

Who is at a higher risk of reactivated TB?

A

Elderly and immuno suppressed

112
Q

ghon nodule

A

Encapsulated nodule on chest x-ray, indicating positive TB

113
Q

Active TB s/sx

A

positive sputum
Fever, night sweats, weight loss, productive cough
purulent, bloody sputum >3 weeks
hemoptysis*
Contagious

114
Q

Another name for TB skin test

A

mantoux test

115
Q

TB skin test

A

Intradermal injection
Inner surface of forearm
Desired: bleb

116
Q

When are the results read for a TB skin test?

A

48-72 hours after

117
Q

Risk groups of TB

A

HIV
Organ transplants
Immigrants
IV. Drug users.
Children <4

118
Q

if positive result?

A

Obtain chest x-ray
If negative=latent TB

119
Q

Direct observational therapy

A

Supervision of taking meds, if patient is unable to adhere

120
Q

prevention of transmission

A

Airborne precautions
Negative pressure room
N95 mask
Monitor healthcare worker TB status annually

121
Q

Homecare prevention

A

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
Q

when is a patient no longer considered contagious with TB

A

After three negative cultures

123
Q

sx lung cancer

A

Persistent, productive, cough

124
Q

What is a definitive diagnostic test for lung cancer?

A

biopsy
Percutaneous, fine needle
Bronchoscopy
Video assisted thoracoscopy

125
Q

surgical therapy for lung cancer

A

Pneumonectomy
Lobectomy
Segmental or wedge resection

126
Q

right lung lobes

A

3

127
Q

left lung lobes

A

2

128
Q

airborne precautions

A

N95 mask
negative air return

129
Q

hepatic

A

liver

130
Q

renal

A

kidney

131
Q

what kind of TB is resistant to rifampin and isoniazid (INH)?

A

MDR TB

NUR 334 (4 decks)

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