Unit VIII unit 2 Flashcards
What is the most preventable cause of death in society
Smoking
Second hand smoke contains more than ? chemicals
7,000
Do e-cigarettes help smokers quit
No
Nicotine stimulates the release of multiple neurotransmitterd such as dopamine which is
The pleasure & reward area of the brain
Physical effects of nicotine
Increased
Arousal, alertness, hr, b/p, cardiac output
Decreased
Anti diuretic effect, performance enhancement
Smoking —— airway diameter, ——-ciliary activity and ——–of distal airways
Decreased
Decreased
Abnormal dilation
Are light or ultra light cigarettes safer
No
5 A’s of quitting smoking
Ask Advise Assess Assist Arrange
What forms of nicotine replacements are there
Patch Gum Lozenge Spray Inhaler
Name withdraw symptoms
Anxiety Irritability Increased appetite Restlessness Cough Dry mouth Insomnia
Is a relapse a sign of failure
No
Name non nicotine prescriptions
Zyban (bupropion) start 2 weeks prior to quit date
Chantix (varenicline) start 1 week prior to quit date, do not use with replacement nicotine products) blocks receptors in brain
What type of nicotine replacement products are prescription
Spray
Inhaler
Goal of oxygen use
Decrease work of breathing
Decrease workload of heart
Keep SaP2 over 90
Oxygen therapy improves
Survival
Exercise capacity
Cognitive function
Sleep
Indications for use of supplemental oxygen
PaO2 less than 60mm Hg
SaO2 less than 90%
PaO2 is
Pressure of oxygen dissolved in plasma
SaO2 is
How much O2 in hemoglobin
What is the O2 protocol
Less than 90%, put on oxygen
Maintain O2 saturation above 90%
What is the % of oxygen in room air
21%
Normal SaO2 is above
94% without oxygen
If O2 falls below 90%, PaO2 is below 60mm Hg what would you do
Oxygenate
Oxygen therapy requires
A physicians order
Signs/symptoms of hypoxemia
Tachypnea Dyspnea Change in skin color Tachycardia HTN Restlessness Disorientation
Safety precaution of O2 therapy
No smoking
What helps with diffusion
PaO2
When do you humidify O2
Over 2 L/min
Minimum mask flow rates
6 L/min, except venti masks
When medulla loses sensitivity to CO2 & no longer has drive to breathe
CO2 necrosis
If patient is on O2 and dyspnea increases what needs to be done
Need to lower O2
Prolonged exposure to high O2 level, dyspnea increases even though pt is on oxygen
Oxygen toxicity
High O2 washes out nitrogen and causes alveoli to collapse
Absorption atelectasis
What can happen when you have oxygen toxicity
Absorption atelectasis
Nasal canula
Low concentration
1-6 L/min
Simple face mask
Used only short periods
5-8L/min (40-60%)
Minimum 5L/min
How often should you wash and dry under a mask
Q2h
Non rebreather mask
10-15L/min (95-100%)
Valve that prevents room air and expired air from flowing back in bag
Partial rebreather mask
Reservoir bag allows pt to breathe first 1/3 exhaled air with O2
6-10 L/min (60-90%)
Cannot use with humidity
Can you use a partial rebreather mask on a COPD pt?
No because they would breathe too much CO2
Venturi mask
Delivers precise, high flow O2
Make sure there is no blockage of ports
Tracheostomy collar
Delivers high humidity and oxygen
Need to check secretions in tubing
How often should you assess patients on O2
15-30 minutes then prn
Monitors saturation of hemoglobin with O2 and HR
Pulse Ox
Where can a pulse Ox be placed
Fingers Toes Forehead Nose Earlobe
What can cause an abnormal reading in pulse Ox
Hypothermia
Goal of chronic oxygen therapy
SaO2 at least 90% or greater at rest, sleep, exertion
Need to teach the family & patient what with oxygen therapy
Safety measures
Creates air passage between mouth and posterior pharyngeal
Oral airway
Creates air passage between nose and nasopharynx
Nasal airway
Used on conscious pt’s
Ideal position for promoting oxygenating
Standing
Semi or high fowlers
HOB elevated
Good lung down
Fluid intake of about —– a day helps thins secretions
3 liters
Pursed lip breathing
COPD or dyspnea patients
Strengthens diaphragm
Decrease working of breathing, RR and O2 demand
Diaphragmatic breathing
How to purse lip breathe
In through nose
Out through mouth slowly
What is closely related to breathing
Anxiety level
Effective and controlled coughs come from where in the lungs
Deep
Lower lobes
What cough is used for those who can’t cough effectively
Quad cough
What cough is used after bronchodilator and airways stay open while moving secretions
Huff cough
IS is done when
Inhalation
10 x’s hour
Vibrates airway and loosens mucus from airway walls
Flutter device
Measures air expelled by the lungs
Used for asthma
Peak flow meter
HHN
Hand held nebulizer
MDI
Metered dose inhaler
DPI
Dry powder inhaler
Nebulizer medications
Reach lower airways
Fine mist
Can be done at home
Disadvantage of HHN
Bacterial growth in machine
What must be done before use of MDI
Shake bc of suspension
What is the most common delivery of respiratory medications
MDI’s
When using MDI how long must you wait between puffs and why
1 minute, so 2nd dose can get deeper in the lungs
What should be done after use of MDI
Rinse mouth to avoid thrush
HFA inhaler requires
Slower longer inhale
Warm mist with taste
Wash weekly
Why are MDI with spacers used
Used with patients with poor coordination
Do not shake prior to use
Rinse only mouth piece
DRy powder inhaler
Solid particles in air
Over age 5
Do not keep in humid place
What is used for the patient with excessive bronchial secretions using positioning with percussion and vibration
Chest physiotherapy
When should chest physiotherapy (CPT) be done
One hour before or 1-3 hours after meals to avoid aspiration
Forceful striking of skin with cupped hands
Percussion, never do over spine or kidneys, always over clothes
What is used on long term ventilatior patients
Inflatable vest connected to high frequency pulse generator
High frequency chest compression vest
CPAP
Continuous positive airway pressure
BiPAP
Bi-level positive airway pressure
CPAP is used during
Inspiration and expiration
For severe apnea
Lung remodeling
Ongoing process of lung repair from long term inflammation
Permanent structural changes
Assists in changing airway responsiveness to prevent attacks
Preventative therapy drugs
long term
Stops attacks once started
Immediate relief
Rescue drugs
Short acting beta 2 adrenergic agonist
Bronchodilators
Stimulate beta 2 adrenergic receptors in bronchioles, prevents release of inflammatory mediators from mast cells
SABA
decreases bronchi spasms
Side effects of SABA’s
Tremors
Anxiety
Tachycardia
Palpations
SABA’s are what kind of inhalers
Rescue
Common SABA’s
Albuterol
what is used to treat the tobacco which allows nicotine to be absorbed 100x more readily than tobacoo in its natural state
ammonia
do males or females have a higher % of lung cancer deaths related to smoking
males
postural drainage
positioning pt to drain secretions from smaller to later airways
what is important to teach pts about SABA inhalers
to always carry the rescue inhaler, make sure it is full
LABA
long acting beta 2 adrenergic agonist
what does a LABA do
used for long term control, dilates bronchioles to increase airflow,
what is a common LABA
formoterol
blocks bronchoconstricting effects of parasympathetic nervous system (vagal nerve)
anti-cholinergic (anti muscarinic)
what is the most common side effect of anticholinergic
dry mouth
what is the most common anticholinergic
atrovent (ipratropium)
are methylxanthines a first line conrtoller medicatoin
no, they are used when other treatments are ineffective
prevents synthesis of inflammaroty mediators, reduces inflammation
corticosteroids
what does a corticosteroid do
decreases airway inflammation and may mask signs of infection, increase risk of thrush
most corticosteroids have what in the name
-one
prednisone
hydrocortisone
methylprednisolone
what should you teach the patient about corticosteroids
never stop abruptly, taper doses until prescription is completed, can result in adrenal crisis
leukotrienes
inflammatory mediators, potent bronchoconstrictors
produces airway inflammation and edema
give an example of a leukotrine receptor blocker
singulair (montelukast)
enzyme breaks bonds in mucus (thins secretions) decreases viscosity and enhances mobilization of secretions
mucolytics
how often should you get the flu shot? the pnumonia shot
every year
every 5 years
is COPD reversible
no
COPD is a combinatgion of which two respiratory diseases
chronic bronchitis
emphysema
what is the primiary cause of COPD
smoking
what is the pulmonary vascular changes in COPD
surface area for diffusion of O2 decreases
what produces mucous
goblet cells
COPD is
the inflammatio nof airways, pulmonary blood vessels and lung tissues
S/S of hypoxia
restlessness
dyspnea
confusion
anxious
wha tis a physical change of COD
barrel chest
abnormal permanent enlargement of the air space distal to the terminal bronchioles (alveoli)
emphysema
what does emphysema result in
increased work of breathing, decrased area for gas exchange, air trapping in lungs
panlobular
whole lobe
what does smoke relese in the lungs and what does it do
proteases, breaks down elastin found in alveoli
what is the genetic factor identified for COPD
AAT
alpha 1 antitrypsin deficiency
what is the earliest symptom of COPD
chronic intermittent cough
what are some signs of COPD
wheezing, chest tightness weight loss fatigue prolonged expiratory phase polycythemia (increased RBC) canosis
Blue bloaters
chronic bronchitis
pink puffers
emphysema
right sided heart failure
obese
cough with sputum
accessory muscle use
chronic bronchitis
think barrel chest little or no sputum pursed lip breathing accessory muscle use tripod position
emphysema
cor pulmonale
results from pulmoary HTN, increasepressure makes R heart pump harder and eventually fails
what leads to right sided heart failure
cor pulmonale
S/S of cor pulmonale
weight fain (fluid)
ascites
crackles in lung bases
extra heart sounds
exacerbations
flair up
chronic retention of CO2, increase hyper secretins of gastric acid
commonly in duodenum
peptic ulcer disease
what are the primary causes of COPD exacerbation
bacterial infection
viral infection
air pollution
how is COPD confirmed
pulmonary function test
low PaO2
increase PaCO2
decrease pH
increase bicarbonare
respiratory acidosis
what is the most common SABA
albuterol inhaler
what does corticosteroid therapy do
decreases airway inflammatio nby blocking eosinophils and macrophages
what does methylxanthines do
relaxes bronchial smooth muscle and enhances ciliary finctioning
what dos pursed lip breathing do
prevents bronchiolar collapse and air trapping
what is the purpose of a chest tube
remove fluid or air
where is a chest tube inserted
between 2nd and 9th ICS
is the drainage collection chamber emptied at the end of shift?
no it is marked at the end of shift
in the wet system what kind of bubbling is done in the water seal chamber
intermittent bubbling, with exhalation, coughing, sneezing until lung is re expanded (24-48 hours)
if you incraese the wall suctio nin a wet system does it incrase the negative pressure
no
in the wet system in the suctoin control chamber what kind of bubbling occurs
continuous bubbling occurs while unit is in use
does the wall suction effect suction in the device
no
what wil you report to the MD about the drainage
if greater than or equal to 100 mL an hour
where is the unit/device placed for a chest tube
below the level of the chest
how often should you assess lung sounds on a patient with a chest tube
q4h
do you have to have a dr’s order for milking the chest tube
yes
what is a common comlication of a chest tube
frozen shoulder, infection, pneumoina
what is put around the chest tube
occlusive dressing
idopathhic
unknown cause
what is the end result of intersitial lung disease
pulmonary fibrosis
what happens with pulmonary fibrosis
decrease of elastic recoil
gas exchange impaired
dyspnea
scarring of tissue
DOE
dyspnea on exertion
clubbing of fingers is a sign of
cgronic hypoxia
VQ scan
measures perfusion in lungs
what is the survival rate of idiopathic pulmonary fibrosis
less than 5 years
what is the biggest risk factor with lung cancer
cigaretts
what is the leading cause of cancer related death in the US
cigaretts
where are the common sites of metastsis of lung cancer
brain and bone
what is the primary type of lung cancer
non small cell lung cancer
how does lung cancer metastasize by
direct extension
blood
lymph
what type of lung cancer is caught earlier because of obstruction to the airway
squamous cell carcinoma
what is the most malignant form of lung cancer
small cel lung cancer, spreads early
how do we diagnois lung cancer
biopsy
staging of lung cancer
T-tumor
N-nodes (lymph)
M-metastases
is staging useful in SCLC
no because it is aggressive
how is SCLC classified
limited
extensive
treatment for Lung cancer
surgery
chemo
radiation
usually a combination of the above
removal of entire lung
pnumonectomy
removal of one or more lobes
lobectomy
how does chemo help with getting rid of cancer
disrupts cancer cell division
chemo is
systemic
radiation is
localized
does chemo cross the BBB
no, why radiation is used
if lung cancer has metastisized to the brain what are some symptoms
altered gait and speech
if lung cancer has metastisized to the bone what are some symptoms
increased bone pain (back)
is the care for lung cancer curative or palliative
palliative
surgical opening into thoracic cavity
thoracotomy
VATS (video-assisted thoracic surgery)
minimally invasive approach,
what is the post op position of a pnumonectomy patient
on the operative side
removal or stripping of thick, fibrous membrane from visceral pleura
decorticatoin
empyema
pus
remove diseased tissue so healty tissue can perform better, for severe COPD
lung volume reduction srgery
damaged aveoli due to COPD, decreased surface area
bullea
what is the most commoon type of lung transplant
single lung
remove and prevent pleural effusion
pleurodesis
what is the most commmon complaint after a chest surgery
intense pain for up to 24 hours
post op care for a chest surgery
VS
pulse ox
pain scale
preventing frozen shoulder
chronic inflammatory disorder of the airways
asthma
characteristic clinical manifestations of asthma
wheezing
cough
dyspnea
chest tightness
who has the most issues with asthma
african americans and male children
what is affected in asthma
bronhioles not aveoli
what triggers an asthma attack
allergens or irritants initiates inflammaory response
how long can a response take for an asthma attack
minutes to 4-10 hours after exposure
what happens to the airways in asthma
constrictio nof airway
airway edema
increase of secretions
cough variant asthma
cough is only symptom, nonproduction or thinck white sputum
what can cause asthma
seasonal foods exercise air pollutants occupational hazards gerd psychological
treatment of asthma
SABA
measures air expelled by the lungs, aides asthma control and determines treatment needs
peak flow meter
in asthma a silent chest is a sign of what
an emergency
red flags of asthma
HR greater than 120 RR greater than 30 silent chest speaks words not sentences SpO2 less than 90 agitation
severe life threatening respiratory emergency
status asthmaticus
signs of status asthmaticus
altered LOC
arrhythmia
low blood pressure
decrease RR
pneumothorax
collapsed lung
oxygen use
no open flames
Dysphagia
Difficulty swallowing
Proteases
Breaks down elastin in alveoli
Earliest symptom of copd
Chronic intermittent cough
Cor pulmonale results from
Pulmonary HTN
Normal pH PaCO2 HCO3 PaO2 SaO2
•Normal Ranges –pH 7.35 – 7.45 –PaCO2 35 – 45 mmHg –HCO3 22 – 26 mEq/L –PaO2 80 – 100 mmHg –SaO2 96 – 100%
Hemoptysis
Blood in sputum
