Respiratory System Diseases Flashcards

Question

Pulmonary HTN and Cor Pulmonale: Treatment

Answer 1

- Treat w/ low flow O2 - arterial O2 to >60mmHg - Bronchodilators on a routine schedule - Diuretics for fluid removal (monitor electrolytes!) - Vasodiltors: require cardiac monitoring - Cardiac cath - AVOID sedatives/respiratory depressants

Answer 2

Pleural effusion = fluid in the pleural space - always caused by underlying disease TRANSUDATE = fluid with low protein (high hydrostatic pressure or low osmotic pressure) - most common cause is incr. pulmonary venous pressure from HF - Alveoli and pleura filled with fluid squished out of the capillaries - Low serum albumin d/t loss of osmotic pressure EXUDATE = fluid high in protein and cellular content - inflammatory (pneumnia, TB) or malignant process - gross bloody effusion: malignancy or chest trauma - cellular content: WBCs or cancer cells - Presence of air: bronchopleural fistula d/t TB, pneumonia, malignancy - --- air at apex, fluid at base - fluid = usually pus (empyema) - High fibrin content means pleural adhesions, which restricts ventilation - Chylothorax - d/t lymphatic obstruction (Lymph fluids in the pleural space)

Answer 3

PE varies based on rapidity of collection and volume (ie HF = slow, stab wound = quick) - Pain: initially most common sx - pleural friction rub - effusion can move between pleural and pericardial space (to test, hold breath during auscultation) - Dyspnea: effusion compresses normal lung, esp if developed rapidly/large quantity - Tachypnea - Cough, hemoptysis - Breath sounds: reduced, absent, only bronchial - Mediastinal shift: trachea and mediastinum shift away from large, one-sided PE

Answer 4

*treat underlying factors - Thoracentesis: performed at bedside - needle inserted for analysis (may need to be repeated to prevent fibrosis/ provide symptomatic relief) - Cone Biopsy: extract pleural tissue to test for TB or malignancy - Chest tube (continuous drainage) esp w/ empyema - Decortication/ peeling of pleural layers: may be necessary to avoid scarring if fibrous adhesions have occured - Pleurodesis: purposeful scarring, adheres lungs; late stage response.

Answer 5

Rapid accumulation of intrapleural air and collapse of lung Caused by any opening into pleural space through the visceral pleura, chest wall, mediastinum

Answer 6

Unexpected; caused by rupture of blebs - primary or congenital (mostly tall and thin males) - secondary to emphysema w/ the blebs - air gains access to pleural cavity through defect in bronchus or alveoli - Primary Sx: chest or shoulder pain worse with inspo/cough - Dyspnea: from pain/ lung collapse - decreased resp excursions/ asymmetry - decr breath and voice sounds

Answer 7

Leak closes quickly - if small can heal itself - closes immediately leaving only a partial collapse - interferes least w/ resp (other lung unaffected) - Leak in visceral pleura closes quickly - Symptoms more when fxn compromised by other disease - up to 30% heal w/o chest tube - watch for resolution

Answer 8

* lethal - medical emergency* - Valve-like opening in visceral pleura allows inspiration, closes for expiration - air accumulated under positive pressure completely collapsing lung and compressing contents of mediastinum (DEVIATION of other lung, aorta, vena cava, heart, trachea to other side) - prevents respiration => cyanosis, shock, death - Cardiac tamponade: parietal pleura continuous w/ pericardium

Answer 9

Penetrating injury - opening remains w/ collapse of lung - No negative pressure = affected lung does not expand at all - Postive pressure in trachea on expiration - expand on expiration - Air in trachea is rebreathed by unaffected lung - paradoxical/ see-saw breathing: chest rises on expirations and falls on inspiration (affected side)

Answer 10

Accompanied by transudate air moves to the top of lung and fluid at base - could be caused by a misplaced IV cath in sublcavian v. - punctures pleura and infuses IV into it

Answer 11

accompanied by blood | Mostly with chest trauma or surgery where blood vessels are cut

Answer 12

Thoracotomy tubes, called "trochar" - remove air/ fluid from space and reexpand lung - after chest srugery - inserted b/w ribs (6th-7th ICS for fluid) - Trochar in the pleural space has small openings - For air & fluid: need two tubes joined by a connector to a drain

Answer 13

(all chest drainage systems have this component) - allows bubbling of air through it; air can't return - bubbling = air leak, fistula has not closed - tidaling = up and down movement, should occur until lung is fully expanded then no movement - rolling boil = leak

Answer 14

**Pleurevac/thoraklex must be below level of chest tube at all times***** works with gravity*** - fluid drainage facilitated by semi-Fowler's position/ turning toward side of tube - avoid dependent loops of tubing - cause change in pressure - do not milk tuing - causes increased negative pressure - Check for respiratory distress (any kinks? all connections good? any leaking at insertion site?) Don't change dressing

Answer 15

They need to move - otherwise can get pneumonia/ frozen shoulder - encourage full ROM on affected side - deep breathing and coughing ESSENTIAL to prevent atelectasis - Deep inspo expands lung and pushes air and fluid into tube - Pt can ambulate... disconnect from wall!!!! Carry tube

Answer 16

NEVER clamp unless it's been opened by damage, then change quickly - clamping will result in a tension pneumothorax

Answer 17

amt ordered by physician via pleuravac - gentle continuous bubbling is all that's necessary - use wall unit/devide to regulate pressure - always check fluid levels, record, sign off - usually stops in 3-4 days - Check VS and make assessment if bloody drainage occurs - Auscultate lungs

Answer 18

(RN assists, done by MD, PA, NP) CXR first: is lung re-expanded? Give pain meds first - suture clipped - patient takes deep breath and bears down - regular gause and occlusive tape to prevent air entry - CXR done after - has pneumothorax reoccured? - check VS and breath regularly

Answer 19

Developmental: loss of self esteem, fear of dying, physical changes Economic: disruption/ loss of employment, cost of care OCcupational/ Recreational: loss of opportunities, restriction of activities Social: Change in sexual fxn, social isolation, change in role performance.