week 1 content Flashcards
___________oscopy
- Scope bronchi via mouth
- Visualize bronchi
- Can obtain biopsy specimen or provide treatment (remove secretions)
- Nasopharynx or oropharynx is anesthetized
Bronchoscopy
Head and neck cancers
Treatment
- Surgery
- Radiation therapy
- Chemotherapy
which one is first line?
surgery
TB Skin test reaction - positive or negative?
patient is an
- Immigrant
- IV drug users
- High risk work/living conditions
- Children <4
reaction size is 10 mm or bigger
positive
PNU Classifications: Community acquired (CAP) or Hospital acquired (HAP)
- Happens to people that haven’t been in a hospital or LTC facility within 14 days of s/s onset
- Non-intubated patients - Happens to people that were admitted to hospital without PNU and begins 48 hours or more after admission
- Intubated patients – ventilator associated pneumonia (VAP)
Community acquired (CAP)
- Happens to people that haven’t been in a hospital or LTC facility within 14 days of s/s onset
Hospital acquired (HAP)
- Non-intubated patients - Happens to people that were admitted to hospital without PNU and begins 48 hours or more after admission
- Intubated patients – ventilator associated pneumonia (VAP
Lung biopsy can be done: T/F
- Bronchoscope – uses scope to perform biopsy
- Transthoracic needle aspiration - needle to lung
- Open lung biopsy – incision over site, lung tissue removed
- Video assisted thoracic surgery/VATS – uses camera and forceps
true
TB diagnosis - Tb skin test/Mantoux test, CXR, Interferon gamma release assay blood test, Sputum?
- ___________ – evaluate cell mediated immunity
- ___________ – evaluate cell mediated immunity
- __________ – looking for nodule
- ___________ – looking for acid fast bacillus
- Tb skin test/Mantoux test – evaluate cell mediated immunity
- Interferon gamma release assay blood test – evaluate cell mediated immunity
- CXR – looking for nodule
- Sputum – looking for acid fast bacillus
which of these could you place Pulse ox on
- Finger – no nail polish
- Finger - nail polish
- Earlobe
- Toe
- Finger – no nail polish
X- Finger - nail polish - Earlobe
- Toe
COPD = emphysema + chronic bronchitis
is it Preventable and treatable?
is Chronic CPOD hospitalized?
is COPD exacerbations hospitalized?
what is the Most common cause of COPD exacerbations?
COPD = emphysema + chronic bronchitis
- Preventable and treatable
- Chronic CPOD = non hospitalized
- COPD exacerbations = hospitalized
- Most common cause is Respiratory infections
labs or diagnostic tools?
- Xray
- CT/MRI Scans
diagnostic tools
TB latent or active?
- Sputum C&S test positive
- Fever
- Night sweats
- Weight loss
- Productive cough with purulent or bloody sputum for longer than 3 weeks
active
latent = asymptomatic
s/s
- see mass on CXR
- Asymptomatic early
- Nonspecific s/s late
- Masked by chronic underlying cough
- Persistent productive cough
lung cancer
TB Transmission prevention in hospital
- ____________ precautions
- Private room with __________ pressure ventilation
- ___________ mask
- Monitor HC workers TB status – annual
- Preventative drug therapy to high risk contacts
Transmission prevention in hospital
- Airborne precautions
- Private room with negative pressure ventilation
- HEPA mask – high efficiency particulate air
- Monitor HC workers TB status – annual
- Preventative drug therapy to high risk contacts
TB resistant to INH and rifampin is called
- Multi-drug resistant tb =
CPAP or bipap
- Inhalation and exhalation pressure
- Kind of like last step to prevent intubation
- Used in more than just treatment for OSA pts – neuromuscular disease, chest wall deformity, COPD
bipap
diagnosis for lung cancer with Biopsy would be used to
examples of lung cancer biopsy methods:
- Percutaneous fine needle biopsy – takes tissue from nodule cancer cell
- bronchoscopy biopsy – scope through mouth
- video assisted thoracoscopy VAT – scope through thorax incision
– looks for cancer cells in tissue (definitive dx test)
Risk factors for OSA
- Increased age
- Female
- Obese
- Nasopharyngeal structural abnormalities
- Smoking
- Increased age
X- Male - Obese
- Nasopharyngeal structural abnormalities
- Smoking
PNU nursing care: illness prevention
- Education
- Pneumococcal vaccine
- Stop smoking
- Sleep and diet
- Know who is at risk
- Pulmonary toilet
- Early ambulation
- Standard precautions
- Hand hygiene
getting an incentive spirometer for my patient that has
- Altered LOC = weakened cough
- Bed rest/prolonged immobility
- Debilitating illness
- Malnutrition
is an example of which PNU prevention tactic?
- Know who is at risk
- Pulmonary toilet
s/s of COPD exacerbations
- __________ chest – from hyperinflation, problem with getting air out of body
- ___________ Breath sounds
- adventitious lung sounds = _______, _______, ________
- __________ respiration
Late signs
- ________ lip breathing
- Neck vein ________/_________ edema (may indicate pulmonary hypertension)
- Cachexia – excessive ___________
s/s
- Barrell chest – from hyperinflation, problem with getting air out of body
- Decreased Breath sounds
- Wheezing, rales, rhonchi
- Prolonged respiration
- Late signs
- Pursed lip breathing
- Neck vein distention/peripheral edema (may indicate pulmonary hypertension)
- Cachexia – excessive malnourished
Differentiate Pharyngitis type via:
- rapid streptococcal antigen testing
- based on s/s
- no test exists
- rapid streptococcal antigen testing
s/s
- Daytime sleepiness
- Morning headache
- Obese
- Large neck/waist circumference
- partner c/o patient is Snoring, choking, gasping during sleep
OSA
the gold standard Diagnostic test for ___________ is polysomnography
OSA
Treatment pharyngitis: viral, bacterial, fungal
- __________ – antibiotics
- __________– treat symptoms – warm/cool fluids, analgesics, antipyretics
- ___________– nystatin swish and swallow
- Bacterial – antibiotics
- Viral – treat symptoms – warm/cool fluids, analgesics, antipyretics
- Fungal – nystatin swish and swallow
Treatment - Posterior or Anterior epistaxis?
- Emergency
- Balloon cath
- Assess resp status
- Saline spray/Humidification
- Oxygen
- Bed rest
- Pain control – avoid ASA/NSAIDS
- Oral care
- Avoid strenuous activity
posterior
- Emergency bc location makes it hard to pinch to stop bleeding
TB Transmission prevention at home
- Preventative drug therapy to high risk contacts
- Cover mouth/nose
- Wear mask in crowd
- Sputum for _______ every 2 weeks
how many negative cultures until they are considered not contagious?
Transmission prevention at home
- Preventative drug therapy to high risk contacts
- Cover mouth/nose
- Wear mask in crowd
- Sputum for AFB every 2 weeks and after 3 negative cultures = not contagious
Chronic Obstructive pulmonary disease is when which 2 conditions occur together?
- Emphysema – alveolar damage
- Chronic bronchitis - excessive secretion production
Nursing care: COPD
- Stop smoking
- Influenza and PNU vaccine
- Early detection of respiratory infection
- Inhaler therapy
- Long acting beta agonist – main
- Long acting muscarinic antagonist
- Inhaled corticosteroids
- O2 therapy – target o2 sat 88-92%
- Tripod position and pursed lip breathing
- Cough techniques
- Energy conservation
- Extra calories bc of increased work of breathing
- Support
why is Early detection of respiratory infection important for COPD patients?
Most common cause of COPD exacerbations
Pre nursing care or Post nursing care: bronchoscopy
Pre nursing care
- Consent – invasive procedure
- NPO ___ - ___ hours
- Sedative
Post nursing care
- NPO until ______
- Blood tinged mucus – ________ finding
- If biopsy done – monitor for
_________ (look for increased HR) and Pneumothorax (look for SOA)
Pre nursing care
- Consent – invasive procedure
- NPO 6-12 hours
- Sedative
Post nursing care
- NPO until gag reflex returns
- Blood tinged mucus – expected finding
- If biopsy done – monitor for
- Hemorrhage – increased HR
- Pneumothorax – SOA
CXR, CT, MRI, and PET scan?
- Uses radioactive substance – tracer, to look for lung disease/cancer
- Looks at body function (CT/MRI looks at structure)
- Blood flow
- Use of O2
- Uptake of sugar
PET scan
TB latent or active?
- Asymptomatic
- Positive tb skin test
- CXR may have ghon nodule
latent
active = symptoms
PNU Types
_______________=
- Abnormal entry of material from mouth or stomach into trachea/lungs
- Risk factors – loss of consciousness, dysphagia, NG tubes
- May be silent (not always gagging, throwing up)
_______________=
- In immunocompromised pts
Aspiration
- Abnormal entry of material from mouth or stomach into trachea/lungs
- Risk factors – loss of consciousness, dysphagia, HG tubes
- May be silently aspirating (not always gagging, throwing up)
Opportunistic
- In immunocompromised pts
Nursing care for ________ includes
- Health promotion
- Interpret dx study results
- Identify contacts
- Drug therapy
TB
s/e of antimicrobials - Rifampin (rifadin), Isoniazid (INH), Ethambutol (myambutol)?
- ___________ – hepatoxicity (liver), peripheral neuropathy (numb fingers)
- ___________ – red/orange colored excretions
- ____________ – visual acuity, color blind to red and green
- Isoniazid (INH) – hepatoxicity (liver), peripheral neuropathy (numb fingers)
- Rifampin (rifadin) – red/orange colored excretions
- Ethambutol (myambutol) – visual acuity, color blind to red and green
- nose Irritation
- nose Trauma
- nose Infection
- Foreign bodies in nose
- Tumors in nose
- Systemic disease – hypertension
- Systemic treatment – chemo, anticoagulants
all causes of _________
Epistaxis
nose bleed
Lower respiratory: Pneumonia, TB, Obstructive pulmonary disease, COPD?
_______________ = contagious bacterial infection that primarily affects the lungs.
_________________ = Acute infection of the lung parenchyma (alveoli)
_____________ = includes Asthma, Emphysema, Chronic bronchitis
_____________ = includes Emphysema and Chronic bronchitis
TB = contagious bacterial infection that primarily affects the lungs.
PNU = Acute infection of the lung parenchyma (alveoli)
OPD = includes Asthma, Emphysema, Chronic bronchitis
COPD = includes Emphysema and Chronic bronchitis