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► Med Misc 49 > Unit VIII unit 2 > Flashcards

Unit VIII unit 2 Flashcards

1
Q

What is the most preventable cause of death in society

A

Smoking

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2
Q

Second hand smoke contains more than ? chemicals

A

7,000

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3
Q

Do e-cigarettes help smokers quit

A

No

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4
Q

Nicotine stimulates the release of multiple neurotransmitterd such as dopamine which is

A

The pleasure & reward area of the brain

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5
Q

Physical effects of nicotine

A

Increased
Arousal, alertness, hr, b/p, cardiac output
Decreased
Anti diuretic effect, performance enhancement

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6
Q

Smoking —— airway diameter, ——-ciliary activity and ——–of distal airways

A

Decreased
Decreased
Abnormal dilation

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7
Q

Are light or ultra light cigarettes safer

A

No

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8
Q

5 A’s of quitting smoking

A 
Ask
Advise
Assess
Assist
Arrange
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9
Q

What forms of nicotine replacements are there

A 
Patch
Gum
Lozenge
Spray
Inhaler
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10
Q

Name withdraw symptoms

A 
Anxiety
Irritability
Increased appetite
Restlessness 
Cough
Dry mouth
Insomnia
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11
Q

Is a relapse a sign of failure

A

No

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12
Q

Name non nicotine prescriptions

A

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

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13
Q

What type of nicotine replacement products are prescription

A

Spray

Inhaler

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14
Q

Goal of oxygen use

A

Decrease work of breathing
Decrease workload of heart
Keep SaP2 over 90

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15
Q

Oxygen therapy improves

A

Survival
Exercise capacity
Cognitive function
Sleep

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16
Q

Indications for use of supplemental oxygen

A

PaO2 less than 60mm Hg

SaO2 less than 90%

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17
Q

PaO2 is

A

Pressure of oxygen dissolved in plasma

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18
Q

SaO2 is

A

How much O2 in hemoglobin

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19
Q

What is the O2 protocol

A

Less than 90%, put on oxygen

Maintain O2 saturation above 90%

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20
Q

What is the % of oxygen in room air

A

21%

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21
Q

Normal SaO2 is above

A

94% without oxygen

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22
Q

If O2 falls below 90%, PaO2 is below 60mm Hg what would you do

A

Oxygenate

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23
Q

Oxygen therapy requires

A

A physicians order

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24
Q

Signs/symptoms of hypoxemia

A 
Tachypnea
Dyspnea
Change in skin color
Tachycardia 
HTN
Restlessness
Disorientation
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25
Q

Safety precaution of O2 therapy

A

No smoking

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26
Q

What helps with diffusion

A

PaO2

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27
Q

When do you humidify O2

A

Over 2 L/min

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28
Q

Minimum mask flow rates

A

6 L/min, except venti masks

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29
Q

When medulla loses sensitivity to CO2 & no longer has drive to breathe

A

CO2 necrosis

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30
Q

If patient is on O2 and dyspnea increases what needs to be done

A

Need to lower O2

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31
Q

Prolonged exposure to high O2 level, dyspnea increases even though pt is on oxygen

A

Oxygen toxicity

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32
Q

High O2 washes out nitrogen and causes alveoli to collapse

A

Absorption atelectasis

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33
Q

What can happen when you have oxygen toxicity

A

Absorption atelectasis

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34
Q

Nasal canula

A

Low concentration

1-6 L/min

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35
Q

Simple face mask

A

Used only short periods
5-8L/min (40-60%)
Minimum 5L/min

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36
Q

How often should you wash and dry under a mask

A

Q2h

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37
Q

Non rebreather mask

A

10-15L/min (95-100%)

Valve that prevents room air and expired air from flowing back in bag

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38
Q

Partial rebreather mask

A

Reservoir bag allows pt to breathe first 1/3 exhaled air with O2
6-10 L/min (60-90%)
Cannot use with humidity

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39
Q

Can you use a partial rebreather mask on a COPD pt?

A

No because they would breathe too much CO2

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40
Q

Venturi mask

A

Delivers precise, high flow O2

Make sure there is no blockage of ports

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41
Q

Tracheostomy collar

A

Delivers high humidity and oxygen

Need to check secretions in tubing

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42
Q

How often should you assess patients on O2

A

15-30 minutes then prn

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43
Q

Monitors saturation of hemoglobin with O2 and HR

A

Pulse Ox

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44
Q

Where can a pulse Ox be placed

A 
Fingers
Toes
Forehead
Nose
Earlobe
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45
Q

What can cause an abnormal reading in pulse Ox

A

Hypothermia

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46
Q

Goal of chronic oxygen therapy

A

SaO2 at least 90% or greater at rest, sleep, exertion

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47
Q

Need to teach the family & patient what with oxygen therapy

A

Safety measures

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48
Q

Creates air passage between mouth and posterior pharyngeal

A

Oral airway

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49
Q

Creates air passage between nose and nasopharynx

A

Nasal airway

Used on conscious pt’s

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50
Q

Ideal position for promoting oxygenating

A

Standing
Semi or high fowlers
HOB elevated
Good lung down

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51
Q

Fluid intake of about —– a day helps thins secretions

A

3 liters

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52
Q

Pursed lip breathing

A

COPD or dyspnea patients

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53
Q

Strengthens diaphragm

Decrease working of breathing, RR and O2 demand

A

Diaphragmatic breathing

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54
Q

How to purse lip breathe

A

In through nose

Out through mouth slowly

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55
Q

What is closely related to breathing

A

Anxiety level

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56
Q

Effective and controlled coughs come from where in the lungs

A

Deep

Lower lobes

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57
Q

What cough is used for those who can’t cough effectively

A

Quad cough

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58
Q

What cough is used after bronchodilator and airways stay open while moving secretions

A

Huff cough

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59
Q

IS is done when

A

Inhalation

10 x’s hour

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60
Q

Vibrates airway and loosens mucus from airway walls

A

Flutter device

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61
Q

Measures air expelled by the lungs

Used for asthma

A

Peak flow meter

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62
Q

HHN

A

Hand held nebulizer

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63
Q

MDI

A

Metered dose inhaler

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64
Q

DPI

A

Dry powder inhaler

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65
Q

Nebulizer medications

A

Reach lower airways
Fine mist
Can be done at home

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66
Q

Disadvantage of HHN

A

Bacterial growth in machine

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67
Q

What must be done before use of MDI

A

Shake bc of suspension

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68
Q

What is the most common delivery of respiratory medications

A

MDI’s

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69
Q

When using MDI how long must you wait between puffs and why

A

1 minute, so 2nd dose can get deeper in the lungs

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70
Q

What should be done after use of MDI

A

Rinse mouth to avoid thrush

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71
Q

HFA inhaler requires

A

Slower longer inhale
Warm mist with taste
Wash weekly

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72
Q

Why are MDI with spacers used

A

Used with patients with poor coordination
Do not shake prior to use
Rinse only mouth piece

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73
Q

DRy powder inhaler

A

Solid particles in air
Over age 5
Do not keep in humid place

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74
Q

What is used for the patient with excessive bronchial secretions using positioning with percussion and vibration

A

Chest physiotherapy

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75
Q

When should chest physiotherapy (CPT) be done

A

One hour before or 1-3 hours after meals to avoid aspiration

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76
Q

Forceful striking of skin with cupped hands

A

Percussion, never do over spine or kidneys, always over clothes

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77
Q

What is used on long term ventilatior patients

Inflatable vest connected to high frequency pulse generator

A

High frequency chest compression vest

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78
Q

CPAP

A

Continuous positive airway pressure

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79
Q

BiPAP

A

Bi-level positive airway pressure

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80
Q

CPAP is used during

A

Inspiration and expiration

For severe apnea

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81
Q

Lung remodeling

A

Ongoing process of lung repair from long term inflammation

Permanent structural changes

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82
Q

Assists in changing airway responsiveness to prevent attacks

A

Preventative therapy drugs

long term

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83
Q

Stops attacks once started

Immediate relief

A

Rescue drugs

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84
Q

Short acting beta 2 adrenergic agonist

A

Bronchodilators

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85
Q

Stimulate beta 2 adrenergic receptors in bronchioles, prevents release of inflammatory mediators from mast cells

A

SABA

decreases bronchi spasms

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86
Q

Side effects of SABA’s

A

Tremors
Anxiety
Tachycardia
Palpations

87
Q

SABA’s are what kind of inhalers

A

Rescue

88
Q

Common SABA’s

A

Albuterol

89
Q

what is used to treat the tobacco which allows nicotine to be absorbed 100x more readily than tobacoo in its natural state

A

ammonia

90
Q

do males or females have a higher % of lung cancer deaths related to smoking

A

males

91
Q

postural drainage

A

positioning pt to drain secretions from smaller to later airways

92
Q

what is important to teach pts about SABA inhalers

A

to always carry the rescue inhaler, make sure it is full

93
Q

LABA

A

long acting beta 2 adrenergic agonist

94
Q

what does a LABA do

A

used for long term control, dilates bronchioles to increase airflow,

95
Q

what is a common LABA

A

formoterol

96
Q

blocks bronchoconstricting effects of parasympathetic nervous system (vagal nerve)

A

anti-cholinergic (anti muscarinic)

97
Q

what is the most common side effect of anticholinergic

A

dry mouth

98
Q

what is the most common anticholinergic

A

atrovent (ipratropium)

99
Q

are methylxanthines a first line conrtoller medicatoin

A

no, they are used when other treatments are ineffective

100
Q

prevents synthesis of inflammaroty mediators, reduces inflammation

A

corticosteroids

101
Q

what does a corticosteroid do

A

decreases airway inflammation and may mask signs of infection, increase risk of thrush

102
Q

most corticosteroids have what in the name

A

-one
prednisone
hydrocortisone
methylprednisolone

103
Q

what should you teach the patient about corticosteroids

A

never stop abruptly, taper doses until prescription is completed, can result in adrenal crisis

104
Q

leukotrienes

A

inflammatory mediators, potent bronchoconstrictors

produces airway inflammation and edema

105
Q

give an example of a leukotrine receptor blocker

A

singulair (montelukast)

106
Q

enzyme breaks bonds in mucus (thins secretions) decreases viscosity and enhances mobilization of secretions

A

mucolytics

107
Q

how often should you get the flu shot? the pnumonia shot

A

every year

every 5 years

108
Q

is COPD reversible

A

no

109
Q

COPD is a combinatgion of which two respiratory diseases

A

chronic bronchitis

emphysema

110
Q

what is the primiary cause of COPD

A

smoking

111
Q

what is the pulmonary vascular changes in COPD

A

surface area for diffusion of O2 decreases

112
Q

what produces mucous

A

goblet cells

113
Q

COPD is

A

the inflammatio nof airways, pulmonary blood vessels and lung tissues

114
Q

S/S of hypoxia

A

restlessness
dyspnea
confusion
anxious

115
Q

wha tis a physical change of COD

A

barrel chest

116
Q

abnormal permanent enlargement of the air space distal to the terminal bronchioles (alveoli)

A

emphysema

117
Q

what does emphysema result in

A

increased work of breathing, decrased area for gas exchange, air trapping in lungs

118
Q

panlobular

A

whole lobe

119
Q

what does smoke relese in the lungs and what does it do

A

proteases, breaks down elastin found in alveoli

120
Q

what is the genetic factor identified for COPD

A

AAT

alpha 1 antitrypsin deficiency

121
Q

what is the earliest symptom of COPD

A

chronic intermittent cough

122
Q

what are some signs of COPD

A 
wheezing, chest tightness
weight loss
fatigue
prolonged expiratory phase
polycythemia (increased RBC)
canosis
123
Q

Blue bloaters

A

chronic bronchitis

124
Q

pink puffers

A

emphysema

125
Q

right sided heart failure
obese
cough with sputum
accessory muscle use

A

chronic bronchitis

126
Q 
think barrel chest
little or no sputum
pursed lip breathing
accessory muscle use
tripod position
A

emphysema

127
Q

cor pulmonale

A

results from pulmoary HTN, increasepressure makes R heart pump harder and eventually fails

128
Q

what leads to right sided heart failure

A

cor pulmonale

129
Q

S/S of cor pulmonale

A

weight fain (fluid)
ascites
crackles in lung bases
extra heart sounds

130
Q

exacerbations

A

flair up

131
Q

chronic retention of CO2, increase hyper secretins of gastric acid
commonly in duodenum

A

peptic ulcer disease

132
Q

what are the primary causes of COPD exacerbation

A

bacterial infection
viral infection
air pollution

133
Q

how is COPD confirmed

A

pulmonary function test

134
Q

low PaO2
increase PaCO2
decrease pH
increase bicarbonare

A

respiratory acidosis

135
Q

what is the most common SABA

A

albuterol inhaler

136
Q

what does corticosteroid therapy do

A

decreases airway inflammatio nby blocking eosinophils and macrophages

137
Q

what does methylxanthines do

A

relaxes bronchial smooth muscle and enhances ciliary finctioning

138
Q

what dos pursed lip breathing do

A

prevents bronchiolar collapse and air trapping

139
Q

what is the purpose of a chest tube

A

remove fluid or air

140
Q

where is a chest tube inserted

A

between 2nd and 9th ICS

141
Q

is the drainage collection chamber emptied at the end of shift?

A

no it is marked at the end of shift

142
Q

in the wet system what kind of bubbling is done in the water seal chamber

A

intermittent bubbling, with exhalation, coughing, sneezing until lung is re expanded (24-48 hours)

143
Q

if you incraese the wall suctio nin a wet system does it incrase the negative pressure

A

no

144
Q

in the wet system in the suctoin control chamber what kind of bubbling occurs

A

continuous bubbling occurs while unit is in use

145
Q

does the wall suction effect suction in the device

A

no

146
Q

what wil you report to the MD about the drainage

A

if greater than or equal to 100 mL an hour

147
Q

where is the unit/device placed for a chest tube

A

below the level of the chest

148
Q

how often should you assess lung sounds on a patient with a chest tube

A

q4h

149
Q

do you have to have a dr’s order for milking the chest tube

A

yes

150
Q

what is a common comlication of a chest tube

A

frozen shoulder, infection, pneumoina

151
Q

what is put around the chest tube

A

occlusive dressing

152
Q

idopathhic

A

unknown cause

153
Q

what is the end result of intersitial lung disease

A

pulmonary fibrosis

154
Q

what happens with pulmonary fibrosis

A

decrease of elastic recoil
gas exchange impaired
dyspnea
scarring of tissue

155
Q

DOE

A

dyspnea on exertion

156
Q

clubbing of fingers is a sign of

A

cgronic hypoxia

157
Q

VQ scan

A

measures perfusion in lungs

158
Q

what is the survival rate of idiopathic pulmonary fibrosis

A

less than 5 years

159
Q

what is the biggest risk factor with lung cancer

A

cigaretts

160
Q

what is the leading cause of cancer related death in the US

A

cigaretts

161
Q

where are the common sites of metastsis of lung cancer

A

brain and bone

162
Q

what is the primary type of lung cancer

A

non small cell lung cancer

163
Q

how does lung cancer metastasize by

A

direct extension
blood
lymph

164
Q

what type of lung cancer is caught earlier because of obstruction to the airway

A

squamous cell carcinoma

165
Q

what is the most malignant form of lung cancer

A

small cel lung cancer, spreads early

166
Q

how do we diagnois lung cancer

A

biopsy

167
Q

staging of lung cancer

A

T-tumor
N-nodes (lymph)
M-metastases

168
Q

is staging useful in SCLC

A

no because it is aggressive

169
Q

how is SCLC classified

A

limited

extensive

170
Q

treatment for Lung cancer

A

surgery
chemo
radiation
usually a combination of the above

171
Q

removal of entire lung

A

pnumonectomy

172
Q

removal of one or more lobes

A

lobectomy

173
Q

how does chemo help with getting rid of cancer

A

disrupts cancer cell division

174
Q

chemo is

A

systemic

175
Q

radiation is

A

localized

176
Q

does chemo cross the BBB

A

no, why radiation is used

177
Q

if lung cancer has metastisized to the brain what are some symptoms

A

altered gait and speech

178
Q

if lung cancer has metastisized to the bone what are some symptoms

A

increased bone pain (back)

179
Q

is the care for lung cancer curative or palliative

A

palliative

180
Q

surgical opening into thoracic cavity

A

thoracotomy

181
Q

VATS (video-assisted thoracic surgery)

A

minimally invasive approach,

182
Q

what is the post op position of a pnumonectomy patient

A

on the operative side

183
Q

removal or stripping of thick, fibrous membrane from visceral pleura

A

decorticatoin

184
Q

empyema

A

pus

185
Q

remove diseased tissue so healty tissue can perform better, for severe COPD

A

lung volume reduction srgery

186
Q

damaged aveoli due to COPD, decreased surface area

A

bullea

187
Q

what is the most commoon type of lung transplant

A

single lung

188
Q

remove and prevent pleural effusion

A

pleurodesis

189
Q

what is the most commmon complaint after a chest surgery

A

intense pain for up to 24 hours

190
Q

post op care for a chest surgery

A

VS
pulse ox
pain scale
preventing frozen shoulder

191
Q

chronic inflammatory disorder of the airways

A

asthma

192
Q

characteristic clinical manifestations of asthma

A

wheezing
cough
dyspnea
chest tightness

193
Q

who has the most issues with asthma

A

african americans and male children

194
Q

what is affected in asthma

A

bronhioles not aveoli

195
Q

what triggers an asthma attack

A

allergens or irritants initiates inflammaory response

196
Q

how long can a response take for an asthma attack

A

minutes to 4-10 hours after exposure

197
Q

what happens to the airways in asthma

A

constrictio nof airway
airway edema
increase of secretions

198
Q

cough variant asthma

A

cough is only symptom, nonproduction or thinck white sputum

199
Q

what can cause asthma

A 
seasonal 
foods
exercise
air pollutants
occupational hazards
gerd
psychological
200
Q

treatment of asthma

A

SABA

201
Q

measures air expelled by the lungs, aides asthma control and determines treatment needs

A

peak flow meter

202
Q

in asthma a silent chest is a sign of what

A

an emergency

203
Q

red flags of asthma

A 
HR greater than 120
RR greater than 30
silent chest
speaks words not sentences
SpO2 less than 90
agitation
204
Q

severe life threatening respiratory emergency

A

status asthmaticus

205
Q

signs of status asthmaticus

A

altered LOC
arrhythmia
low blood pressure
decrease RR

206
Q

pneumothorax

A

collapsed lung

207
Q

oxygen use

A

no open flames

208
Q

Dysphagia

A

Difficulty swallowing

209
Q

Proteases

A

Breaks down elastin in alveoli

210
Q

Earliest symptom of copd

A

Chronic intermittent cough

211
Q

Cor pulmonale results from

A

Pulmonary HTN

212
Q 
Normal
pH
PaCO2
HCO3
PaO2
SaO2
A 
•Normal Ranges
–pH        7.35 – 7.45
–PaCO2    35 – 45 mmHg
–HCO3        22 – 26 mEq/L
–PaO2        80 – 100 mmHg
–SaO2        96 – 100%
213
Q

Hemoptysis

A

Blood in sputum

► Med Misc 49 (29 decks)

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