Test1

Question 1

Elderly

Answer 1

• RR 16-25 is normal
• decreased breath sounds are normal

Question 2

Lungs

Answer 2

• if punctured-no breath sounds, SOB, look at O2 sats, get VS, give 2L O2-CXR
• collapsed lung-not necessarily painful but O2 sats drop
• pleural effusion-complication of pneumonia
• PFT-no albuterol before; meas in/out/tidal

Question 3

Supplemental Oxygen

Answer 3

• nasal prongs: 2-6 L
• >6-12 L-green (high flow) tubing
• Venti mask-adjustable on mask itself 10-12 L
• non-re-breather (bag) 12-15 L
• continuous-bipap or cpap
• intubate-ET tube forces air into lungs

Question 4

Diagnostics

Answer 4

• Pulmonary Angiogram = dye to see blockages
• PFT-no albuterol before; meas in/out/tidal
• PET-3D picture, shows “hot spots” = CA
• Pulmonary angiogram-dye to see blockages in pulmonary vessels
• Bronchoscopy-NPO prior, assess gag relex before eating
• Biopsy-only way to confirm malignancy
• Thorocentesis-pull fluid from the lungs (bedside)-after assess RR, O2 sats, auscultate for lung puncture.
• V/Q scan (ventilation/perfusion)-a spiral CT scan-evaluates circulation of air and blood–for PE’s

Question 5

Rhinitis

Answer 5

• Allergic-clear
• Viral-clear, yellow, green, nose swollen inside, red, inflamed

Question 6

Anti-virals for Flu

Answer 6

• Tamiflu
• Relenza
• fluid and electrolyte imbalance is biggest concern

Question 7

Nasal Polyps

Answer 7

• fleshy
• in turbinates
• associated with Afrin use (3 day max)
• remove with laser
• form slowly in response to repeated inflammation of sinuses and nasal mucosa
• steroids may slow growth

Question 8

Polysomnography

Answer 8

• sleep study
• O2 sats must drop below 90% 10x in an hour
• C-pap
• bi-pap-forces air in then pressure drops to allow exhale
• sleep apnea-UP3 is surgical procedure

Question 9

Upper Airway Obstruction

Answer 9

• (asthma is lower)
• SOB, struggle to breath, stridor, diaphoretic
• Partial vs complet
• anaphylaxis-Epi, call code
• ET tube, tracheotomy
• sit them up, give O2

Question 10

Trach Care

Answer 10

• suction as needed-sterile procedure
• in-line suction (on vent) is clean procedure
• inner canula changed q8 h
• jackson cleaned q8h
• can eat if they pass swallow study-speech therapy
• passy-muir valve to speak, cuff must be deflated

Question 11

Lower Respiratory

Answer 11

• CXR won’t show inflammation
• Bronchitis-90-95% viral-SOB, cough, wheezing rales that clear on coughing, less chance of fever
• Pneumonia-CXR shows solid patches-can have hemoptysis, fever; increased tactile fremitus “99”, egophony (eee sounds like aaa), percuss=dull, auscultate decreased breath sounds. Complications-pleural effusion (bottom) = crackles, atelectasis=absence of breath sounds, pleurisy
• incentive spirometry
• TB-air droplets, close contact, prisons, nursing homes, immunocompromised; neg presure room, need 3 negative sputum cultures to go off isolation, CXR shows consolidation, 4 drug cocktail for 6 months-isonazide (liver toxic), rifampin (orange secretions, supresses contraception), ethambutol, INH (peripheral neuropathye), pyrazinamide DOT (direct observed therapy), N-95 mask; will test + if they’ve had the BCG vaccine, airborn precautions

Question 12

Pneumonia Vaccine

Answer 12

• over age 65, second one in 5 years
• kids-for ear infections

Question 13

Lung CA

Answer 13

• CXR, MRI or CT scan-1 cm is smallest
• cough, SOB
• small cell is bad=oat cell
• non-small cell-adenocarcinoma (associated with chronic interstitial fibrosis), squamous cell carcinoma, large cell carcinoma
• persistent cough and sputum

Question 14

Pneumothorax

Answer 14

• open (from outside-trauma, GSW)
• closed- spontaneous (males 20-30 y.o., smokers) or tension (pt has another dx)-injury allows air into the pleural space but prevents it from escaping from the pleural space.
• can be a complication of mechanical ventilation
• assess: dyspnea, RD, rapid shallow breaths, air hunger, cyanosis, poor cap refill, tracheal deviation-to opposite side, audible air escaping from wound, decreased O2 sats, tachy, hypotension, distended neck veins, chest pain, dysrhythmias, use of accessory muscles
• Interventions-resuscitate, ensure airway, O2, prep for chest tube, pain mgt (morphine!), monitor vitals

Question 15

Pleural Effusion

Answer 15

• XS fluid-HF, ascites, cirrhosis, rib fx, lung CA, TB, pneumonia
• crackles if thin, no sound if thick
• no sound at base bc fluid accumulates there
• CXR-needs 250 mL to show up
• Tx-diuretics, antibiotics, drain it-thorocentesis

Question 16

Vascular Lung Disorders

Answer 16

• Pulmonary edema-alveoli-pink, frothy sputum, SOB, crackles–diuretics, decr fluids
• PE-if in trunk-big deal, risk factors = BCP, DVT, sed lifestyle, long trips, post op, SOB, pain, low O2 sats, VQ scan, RA clot goes to lungs, INR 2-3 is therapeutic for coumadin, PTT for heparin q6-8 h until therapeutic (58-78), d-dimer (fibrin degradation product).
• Cor Pulmonale-right sided HF caused by a pulmonary problem-high BP in pulmonary arteries caused by chronic lung disease, can be caused by COPD, see JVD, systemic congestion, enlarged spleen, edema, Dx-US, echo Tx-diuretics, decr fluid intake, low Na diet, ACE inhibs, monitor BP
• Pulmonary HTN: SOB, everything else is fine (PFT, CXR) Tx-Flolan continuous drip

Question 17

Obstructive Lung Disease

Answer 17

• Asthma-airway remodelling is bad-triggers-stress, GERD; mucous from inflammatory response, wheezing, chest tightness, cough, breathness, family Hx, PFTs, CXR will be normal, ABGs; peak flow meter; status asthmaticus=unresponsive to tx
• COPD-preventable and treatable; includes chronic bronchitis and emphysema, keep O2 sats 90-92%

Question 18

Meds for Asthma

Answer 18

• Bronchodilators– beta adrengergic agonist=sympathomimetic-opposite of BBs-smooth muscle relaxation, contraction of cardiac tissue = albuterol, anticholinergics (atrovent, spiriva)
• combos - Advair=corticosteriod/long acting bronchodilator, Combivent (anticholinergic/short acting bronchodilator)
• Antiinflammatory drugs-corticosteroids (solumedrol, pulmocort), mast-cell stabilizers (cromolyn), leukotriene modifiers (Singulair)

Question 19

Smoking

Answer 19

• increased HR
• Peripheral vascular constriction
• increased BP
• increased cardiac workload
• decreased functional Hgb
• increased platelet aggregation
• decreased cilliary action

Question 20

COPD

Answer 20

• cigarette smoking, occupational chems/dust, air pollution, infection, aging
• SOB is first sign
• pursed lip breathing to prevent alveoli collapse
• Dx-PFTs, walk test
• prolonged expiratory phase, barrel chest,wheezes, decreased breath sounds, skin bluish, clubbing
• drugs=bronchodilators, corticosteroids
• can lead to cor pulmonale
• increased CO2-acidemia
• acute resp failure-ventilate, hard to wean

Question 21

Bronchitis

Answer 21

• rales, ronchi
• deep breath, cough
• wheezes
• not seen on CXR
• no fremitis, no consolidation
• no crackles (pneumonia has crackles)

Question 22

Pneumonia

Answer 22

• increased tactile fremitus
• egophony
• percuss=dullness
• fever
• hemoptysis
• crackles
• complications=pleural effusion, pleurisy, atelectasis
• Cefotan=antibiotic for pneumonia
• bronchial breath sounds (pulmonary consolidation

Question 23

Heart Failure

Answer 23

• RIGHT sided=lung problem, systemic edema
• LEFT sided=pulmonary edema