WK 5: Respiratory Disorders B Flashcards
1
Q
What is a pleural effusion?
A
Characterised by an abnormal collection of fluid in the pleural space
2
Q
Describe the pathophysiology of a pleural effusion
A
Build up of excess fluid in the pleural space due to migration of fluids and other blood components through the walls of intact capillaries bordering the pleura
3
Q
List 3 ways excess fluid can develop in a pleural effusion
A
- Increased capillary pressure
- Decreased oncotic pressure
- Increased pleural membrane permeability
4
Q
Identify 3 clinical manifestations of a pleural effusion
A
Dyspnoea
Cough
Sharp non-radiating chest pain
5
Q
Identify 3 forms of acute management of a pleural effusion
A
Oxygen therapy PRN
Regular patient assessment
Thoracentesis
6
Q
What is a thoracentesis?
A
Used to remove air and fluid from the lungs via needle decompression
7
Q
Describe the pathophysiology of a pneumothorax
A
Presence of air or gas in the pleural space caused by a rupture in the visceral pleura (surrounding the lungs) or the parietal pleura and the chest wall causing a separation between the visceral and parietal pleura
8
Q
What is a haemothorax?
A
Bleeding into the pleural space
9
Q
Identify the 2 types of a pneumothorax
A
Open: When air enters through an external wound
Closed: When air does not enter through an external wound
10
Q
What is a tension pneumothorax?
A
When pressure in the pleural space caused by a one way valve in the parietal pleura pushes against an already collapsed lung, pushing against the mediastinum and the heart and other lung
11
Q
What is tracheal deviation?
A
In a tension pneumothorax there is so much pressure in one lung that the trachea is pushed to the other side
12
Q
Identify the 6 types of a pneumothorax
A
Spontaneous Iatrogenic Traumatic Tension Haemothorax Chylothorax
13
Q
Describe a spontaneous pneumothorax
A
“Bullae” (air pocket on the surface of the visceral pleura pops creating a big hole either due to
- Primary: No underlying cause
- Secondary: Due to an underlying lung disease
14
Q
Describe a iatrogenic pneumothorax
A
Occurs when air enters into the pleural space from a medical treatment or procedure
15
Q
Describe a traumatic pneumothorax
A
Occurs when air enters the pleural space due to trauma e.g. gun shot wound, stabbing
16
Q
Describe a chlyothorax
A
Occurs when lymphatic fluid (Chyle) leaks into the pleural space
17
Q
What is chyle?
A
Milky fluid consisting of lymph and emulsified fats
18
Q
Describe an empyema
A
Is a collection of pus in the pleural space
19
Q
Identify 3 clinical manifestations of a pneumothorax
A
Dyspnoea
Tachypneoa
Chest pain
Nil breath sounds over affected area
20
Q
Identify a clinical manifestation of a tension pneumothorax
A
Severe hypoxaemia
Tracheal deviaton
21
Q
Identify 3 forms of acute management for pneumothorax
A
Monitor vital signs
Oxygen therapy PRN
Do not remove impaled objects
22
Q
Identify 2 forms of acute management for thoracic emergencies
A
ICC insertion
Needle decompression
23
Q
Identify 3 nursing considerations of a pneumothorax
A
Hourly observations
Regular chest physio
Pt support and education
24
Q
What is lung cancer?
A
Uncontrolled growth of abnormal cells in the epithelium of one or both lungs
25
Describe the pathophysiology of lung cancer
Mutated epithelial cells occurring within the segmental bronchi and upper lobes of lung. Tumour invades surface tissues and form metastasises
26
What are metastasises
When malignant cells in ling cancer spread to other sides of the body
27
Identify the characteristics of Grade 1 lung cancer
Low: Cancer cells like slightly different from normal cells, usually slow growing
28
Identify the characteristics of Grade 2 lung cancer
Intermediate: Cancer cells don't look like normal cells, faster growing than grade 1 cells
29
Identify the characteristics of Grade 3 lung cancer
High: Cancer cells look very different to normal, fast growing
30
Identify 3 clinical manifestations of early lung cancer
Persistent cough
Haemoptysis (blood tinged sputum)
Dyspnoea
31
What is haemoptysis
Blood tinged sputum
32
Identify 3 clinical manifestations of late lung cancer
Anorexia
Fatigue
Dysphagia (difficulty swallowing)
Dysphonia (Hoarse voice)
33
Describe a pleural tap
Procuedure used to drain the pleural effusion by using a catheter to drain fluid. When it is left in situ it is called an indwelling pleural catheter
34
What is pleurodesis
To close the pleural cavity and prevent fluid buildup in the future. A tiny camera and instruments are inserted to guide sterile talc which adheres together the pleura, preventing fluid collection
35
What is talc?
Talc is a rubbery powder inserted sterile, to cause inflammation and close up the space to prevent future fluid collection
36
Identify 3 diagnostics which can be used to diagnose lung cancer
```
CT scan (Presence of tumours)
PET scan (Used to stage cancers)
Chest Xray: For large tumours
```
37
Identify 3 forms of treatment for lung cancer
Chemotherapy
Radiation therapy
Targeted therapy drugs
38
Identify 3 nursing considerations in lung cancer
Provide support/education
Regular pain assessment/ADL assistance
Holistic care
39
Identify the 4 areas of assessment in lung diseases
1. Primary assessment
2. Nursing assessment (History, clinical findings)
3. Secondary assessment
4. Respiratory focused assessment
40
What is a tracheostomy?
Is a surgical opening into a persons trachea, into which an indwelling tube is placed temporarily or permanently depending on the reason
41
Describe a surgical tracheostomy
Is formed in the operation theatre under general
42
Describe a percutaneous tracheostomy
Performed at the bedside using local
43
Identify the 4 indications for a tracheostomy
To overcome upper airway obstruction
To facilitate mechanical ventilatory support
To enable removal of trachea-bronchial secretions
To provide a comfortable and secure long term airway
44
Identify 3 areas of tracheostomy care
DRSABCDE (Ensure emergency equipment is available
Focused respiratory assessment
Assess skin integrity, colour of surrounding skin, dressing tapes
45
Identify the 3 indications for suctioning
Cannot cough effectively to clear secretions
Cannot maintain airway potency due to vomit/blood
Sudden respiratory distress (SpO2 falls)
46
Identify 3 potential side effects if suctioning
Hypoxia (10-15 seconds!)
Raised ICP
Tracheal mucosal damage
47
Describe the need for humidification in a tracheostomy
Upper airway is usually responsible for humidification, as the tracheostomy bypasses this, the patient receives hymifided air to compensate
48
Identify 3 potential complications of a tracheostomy
Subcutaneous emphysema
Airway leak
Tube displacement
49
What is subcutaneous/surgical emphysema
Occurs when air escapes into the subcutaneous tissue
50
Identify the 5 major complications of a tracheostomy
```
Haemorrhage (stomach ulceration)
Respiratory distress (Decreased spo2)
Obstructed tracheostomy (sputum plugging)
Partially dislodged tracheostomy
Completely dislodged tracheostomy
```
51
What is an Inter costal catheter (ICC)
Drain tube that is inserted between the ribs and into the chest of patients to remove air, fluid, pus or blood from the pleural space
52
How do you determine a presence/type of fluid in the pleural space (pleural effusion)?
Chest xray confirms id air or fluid is present, CT scan or US evaluates the fluid
53
What Is an Under Water Seal Drain? (UWSD)
Used to collect air or fluid from the ICC and restore normal respiratory function
54
Identify an indication for an ICC
To drain fluid as a result of an external or internal injury
55
Identify an indication of an UWSD
Mostly during an emergency or after surgery
56
Identify 5 potential complications of ICC/UWSD
```
Haemorrhage
Infection
Pain (parietal pleura sensitive)
No drainage
Surgical emphysema
```
57
What is haemorrhage in ICC/UWSD?
Bleeding that results from damage to blood vessels or internal structures e.g. lung when chest tube inserted
58
How often should vital signs assessments/drainage assessments be undertaken in ICC/UWSD
Every 15 mins for 2 hours after insertion, every hour after that
59
Identify 5 nursing considerations of ICC/UWSD
1. Always ensure the ICC/UWSD is below the patients chest
2. Ensure there are no kinks/air leak in tube
3. Do not clamp unless advised by medical team
4. Observe for S&S of infection on ICC and ensure sutures are intact
5. Air can re-enter if water seal is not maintained
60
Identify when a chest drain may be removed
Medical team will instruct based on:
<100 ml drainage in 24 hours
Minimal swing
Chest Xray indicates full lung expansion
61
What the importance of a water seal in an UWSD
The water seal ensure that when air comes out, it can not go back in. Intermittent bubbling will be seen, bubbling on expiration, usually none on inspiration, keeping the air out. If there is constant bubbling, this indicates an air leak or kink etc.
62
What is swing in an UWSD?
Reflects the changes in the pleural pressure on breathing. This will lessen as the lung re expands
63
List the 3 types of bronchodilators
Beta2 Adrenoreceptor Agonists
Xanthine Derivatives
Anticholinergics/Antimuscurinics
64
List the two types of Beta2 adrenoreceptor agonists
Short Acting Beta2 Agonists
| Long Acting Beta2 Agonists
65
What are the indications for Short Acting Beta2 Agonist
Symptom relief of asthma and COPD
| Prevention of exercise induced bronchoconstriction
66
Identify 2 examples of SABA's
Salbutamol
| Terbutaline
67
What are the indications for Long Acting Beta2 Agonists
Maintenance treatment of asthma in patients receiving inhaled or oral corticosteroids
COPD
68
Identify 2 examples of LABA's
Salmeterol
| Formoterol
69
Beta2 Adrenoreceptor Agonists
- Class
- Indication
- Action
- Adverse effects
- Nursing Consideration
- Beta2 agonist
- Manage respiratory conditions e.g. asthma, COPD
- Relaxes bronchial smooth muscle by stimulating B2 receptors to dilate and open airways
- Palpitations, tachycardia
- Check inhaler technique
70
Xanthine Derivatives
- Class
- Indication
- Action
- Adverse effects
- Nursing Consideration
- Theophyllines
- Severe acute asthma, maintenance therapy, COPD
- Bronchial smooth muscle relaxation, relax smooth muscle in BV = Decreased PVR
- Headache, palpitations
- Do not take excessive caffeine amounts
71
Anticholinergics/Antimuscarinics
- Class
- Indication
- Action
- Adverse effects
- Nursing Consideration
- Anticholinergic
- Acute, severe asthma, chronic asthma, bronchospasm, rhinorrhea
- Blocks vagal tone and the reflexes that induce bronconcstriciton
- Dry mouth, headache
- Check inhaler technique
72
What are 2 examples of xanthine derivatives?
Theophylline
| Aminophylline
73
What are 2 examples of anticholinergics
Ipratropium bromide
| Tiotropium
74
Identify the 2 types of corticosteroids
Local and systemic corticosteroids
75
Local Corticosteroids
- Class
- Indication
- Action
- Adverse effects
- Nursing Consideration
- Corticosteroids (inhaled)
- Asthma prophylaxis, allergic rhinitis
- Decreasing generation of prostaglandins, histamines, substances that lead to bronchospasm, immunoglobulins, mast cells and mucus production
- Dysphonia, dry mouth
- Check inhaler technique
76
What are 2 examples of local corticosteroids
Beclomethasone
Budesonide
Fluticasone
77
Systemic corticosteroids
- Class
- Indication
- Action
- Adverse effects
- Nursing Consideration
- Corticosteroids
- Supresses undesirable inflammatory or immune responses
- Supresses inflammatory response by inhibiting inflammatory mediators
- HTN, osteoporosis
- Monitor electrolytes, BGL, fluid balance regularly
78
What are 2 examples of systemic corticosteroids
Betamethasone
Hydrocortisone
Prednisolone
79
Mast cell stabilisers
- Class
- Indication
- Action
- Adverse effects
- Nursing Consideration
- Preventer medication
- Mild to moderate asthma prophylaxis, prevent bronchospasm
- Anti inflammatory that inhibits release of histamine, leukotriene and other mediators of inflammation
- Headache, vomiting
- Inhaler to be used with spacer
80
What are 2 examples of mast cell stabilisers
Sodium cromoglycate
| Nedocromilsodium
81
Leukotriene Receptor Antagonists
- Class
- Indication
- Action
- Adverse effects
- Nursing Consideration
- Leukotriene receptor antagonists
- Prophylaxis and treatment of chronic asthma
- Blocks leukotriene receptors to reduce inflammation, mucus secretion and bronchoconstriciton
- headache, abdominal pain
- Not used as a reliver during asthma
82
What is an example of a leukotriene receptor antagonist
Montelukast
83
Antihistamines
- Class
- Indication
- Action
- Adverse effects
- Nursing Consideration
- H1 Receptor antagonist
- Seasonal allergic rhinitis (hay fever), allergic skin reactions, anaphylactic shock
- Antiemetic, sedative, antimuscuarinic, local anaesthetic effects
- Sedation, dizziness
- Advise against driving if drowsiness
84
What are 2 examples of antihistamines
Promethazine
| Cetirizine
85
Mucolytics
- Class
- Indication
- Action
- Adverse effects
- Nursing Consideration
- Mucolytics
- Break down mucus in conditions with excessive mucus production, CF
- Thinning of respiratory secretions so that ciliary action can allow them to move, alter the structure of mucus by breaking down chains to aid in removal
- Headache, vomiting
- Avoid for those with fructose intolerance
86
What are 2 examples of mucolytics
Bromhexine
| Dornasealpha
87
What are the 3 forms of antibiotics
Penicillins
Cephalosporins
Tetracyclines
88
What are 2 examples of penicillins
Amoxicillin
Ampicillin
Flucloxacillin
89
What are 2 examples of cephalosporins
Cefazolin
Cefalexin
Cefaclor
90
What are 2 examples of tetracyclines
Doxycycline
Tetracycline
Minocycline
91
Penicillins
- Class
- Indication
- Action
- Adverse effects
- Nursing Consideration
- Antibacterial drugs
- Respiratory tract infection, exacerbation of chronic bronchitis
- Weaken the bacterial cell by binding to penicillin binding proteins = cell lysis death
- Vomtiing, diarrhoea
- Rapid IV administration
92
Cephalosporins
- Class
- Indication
- Action
- Adverse effects
- Nursing Consideration
- Antibacterial drugs
- Resp tract infection, penicillin allergy
- Inhibit bacterial wall synthesis by binding to penicillin binding protein = cell lysis and death
- Vomiting, diarrhoea
- Monitor for GI upset
93
Tetracyclines
- Class
- Indication
- Action
- Adverse effects
- Nursing Consideration
- Antibacterial drugs
- Resp tract infection. Community acquired pneumonia, exacerbation chronic bronchitis
- Inhibit bacterial protein synthesis by reversibly binding to subunits of ribosome
- Vomiting , diarrhoea
- Take with food to reduce GI upset
