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NUR2226 > WK 5: Respiratory Disorders B > Flashcards

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

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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

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3
Q

List 3 ways excess fluid can develop in a pleural effusion

A
  1. Increased capillary pressure
  2. Decreased oncotic pressure
  3. Increased pleural membrane permeability
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4
Q

Identify 3 clinical manifestations of a pleural effusion

A

Dyspnoea
Cough
Sharp non-radiating chest pain

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5
Q

Identify 3 forms of acute management of a pleural effusion

A

Oxygen therapy PRN
Regular patient assessment
Thoracentesis

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6
Q

What is a thoracentesis?

A

Used to remove air and fluid from the lungs via needle decompression

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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

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8
Q

What is a haemothorax?

A

Bleeding into the pleural space

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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

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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

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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

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12
Q

Identify the 6 types of a pneumothorax

A 
Spontaneous 
Iatrogenic 
Traumatic 
Tension 
Haemothorax 
Chylothorax
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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

  1. Primary: No underlying cause
  2. Secondary: Due to an underlying lung disease
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14
Q

Describe a iatrogenic pneumothorax

A

Occurs when air enters into the pleural space from a medical treatment or procedure

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15
Q

Describe a traumatic pneumothorax

A

Occurs when air enters the pleural space due to trauma e.g. gun shot wound, stabbing

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16
Q

Describe a chlyothorax

A

Occurs when lymphatic fluid (Chyle) leaks into the pleural space

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17
Q

What is chyle?

A

Milky fluid consisting of lymph and emulsified fats

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18
Q

Describe an empyema

A

Is a collection of pus in the pleural space

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19
Q

Identify 3 clinical manifestations of a pneumothorax

A

Dyspnoea
Tachypneoa
Chest pain
Nil breath sounds over affected area

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20
Q

Identify a clinical manifestation of a tension pneumothorax

A

Severe hypoxaemia

Tracheal deviaton

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21
Q

Identify 3 forms of acute management for pneumothorax

A

Monitor vital signs
Oxygen therapy PRN
Do not remove impaled objects

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22
Q

Identify 2 forms of acute management for thoracic emergencies

A

ICC insertion

Needle decompression

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23
Q

Identify 3 nursing considerations of a pneumothorax

A

Hourly observations
Regular chest physio
Pt support and education

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24
Q

What is lung cancer?

A

Uncontrolled growth of abnormal cells in the epithelium of one or both lungs

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25
Q

Describe the pathophysiology of lung cancer

A

Mutated epithelial cells occurring within the segmental bronchi and upper lobes of lung. Tumour invades surface tissues and form metastasises

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26
Q

What are metastasises

A

When malignant cells in ling cancer spread to other sides of the body

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27
Q

Identify the characteristics of Grade 1 lung cancer

A

Low: Cancer cells like slightly different from normal cells, usually slow growing

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28
Q

Identify the characteristics of Grade 2 lung cancer

A

Intermediate: Cancer cells don’t look like normal cells, faster growing than grade 1 cells

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29
Q

Identify the characteristics of Grade 3 lung cancer

A

High: Cancer cells look very different to normal, fast growing

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30
Q

Identify 3 clinical manifestations of early lung cancer

A

Persistent cough
Haemoptysis (blood tinged sputum)
Dyspnoea

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31
Q

What is haemoptysis

A

Blood tinged sputum

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32
Q

Identify 3 clinical manifestations of late lung cancer

A

Anorexia
Fatigue
Dysphagia (difficulty swallowing)
Dysphonia (Hoarse voice)

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33
Q

Describe a pleural tap

A

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

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34
Q

What is pleurodesis

A

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

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35
Q

What is talc?

A

Talc is a rubbery powder inserted sterile, to cause inflammation and close up the space to prevent future fluid collection

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36
Q

Identify 3 diagnostics which can be used to diagnose lung cancer

A 
CT scan (Presence of tumours)
PET scan (Used to stage cancers)
Chest Xray: For large tumours
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37
Q

Identify 3 forms of treatment for lung cancer

A

Chemotherapy
Radiation therapy
Targeted therapy drugs

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38
Q

Identify 3 nursing considerations in lung cancer

A

Provide support/education
Regular pain assessment/ADL assistance
Holistic care

39
Q

Identify the 4 areas of assessment in lung diseases

A
  1. Primary assessment
  2. Nursing assessment (History, clinical findings)
  3. Secondary assessment
  4. Respiratory focused assessment
40
Q

What is a tracheostomy?

A

Is a surgical opening into a persons trachea, into which an indwelling tube is placed temporarily or permanently depending on the reason

41
Q

Describe a surgical tracheostomy

A

Is formed in the operation theatre under general

42
Q

Describe a percutaneous tracheostomy

A

Performed at the bedside using local

43
Q

Identify the 4 indications for a tracheostomy

A

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
Q

Identify 3 areas of tracheostomy care

A

DRSABCDE (Ensure emergency equipment is available
Focused respiratory assessment
Assess skin integrity, colour of surrounding skin, dressing tapes

45
Q

Identify the 3 indications for suctioning

A

Cannot cough effectively to clear secretions
Cannot maintain airway potency due to vomit/blood
Sudden respiratory distress (SpO2 falls)

46
Q

Identify 3 potential side effects if suctioning

A

Hypoxia (10-15 seconds!)
Raised ICP
Tracheal mucosal damage

47
Q

Describe the need for humidification in a tracheostomy

A

Upper airway is usually responsible for humidification, as the tracheostomy bypasses this, the patient receives hymifided air to compensate

48
Q

Identify 3 potential complications of a tracheostomy

A

Subcutaneous emphysema
Airway leak
Tube displacement

49
Q

What is subcutaneous/surgical emphysema

A

Occurs when air escapes into the subcutaneous tissue

50
Q

Identify the 5 major complications of a tracheostomy

A 
Haemorrhage (stomach ulceration) 
Respiratory distress (Decreased spo2)
Obstructed tracheostomy (sputum plugging)
Partially dislodged tracheostomy 
Completely dislodged tracheostomy
51
Q

What is an Inter costal catheter (ICC)

A

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
Q

How do you determine a presence/type of fluid in the pleural space (pleural effusion)?

A

Chest xray confirms id air or fluid is present, CT scan or US evaluates the fluid

53
Q

What Is an Under Water Seal Drain? (UWSD)

A

Used to collect air or fluid from the ICC and restore normal respiratory function

54
Q

Identify an indication for an ICC

A

To drain fluid as a result of an external or internal injury

55
Q

Identify an indication of an UWSD

A

Mostly during an emergency or after surgery

56
Q

Identify 5 potential complications of ICC/UWSD

A 
Haemorrhage 
Infection 
Pain (parietal pleura sensitive)
No drainage 
Surgical emphysema
57
Q

What is haemorrhage in ICC/UWSD?

A

Bleeding that results from damage to blood vessels or internal structures e.g. lung when chest tube inserted

58
Q

How often should vital signs assessments/drainage assessments be undertaken in ICC/UWSD

A

Every 15 mins for 2 hours after insertion, every hour after that

59
Q

Identify 5 nursing considerations of ICC/UWSD

A
  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
Q

Identify when a chest drain may be removed

A

Medical team will instruct based on:
<100 ml drainage in 24 hours
Minimal swing
Chest Xray indicates full lung expansion

61
Q

What the importance of a water seal in an UWSD

A

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
Q

What is swing in an UWSD?

A

Reflects the changes in the pleural pressure on breathing. This will lessen as the lung re expands

63
Q

List the 3 types of bronchodilators

A

Beta2 Adrenoreceptor Agonists
Xanthine Derivatives
Anticholinergics/Antimuscurinics

64
Q

List the two types of Beta2 adrenoreceptor agonists

A

Short Acting Beta2 Agonists

Long Acting Beta2 Agonists

65
Q

What are the indications for Short Acting Beta2 Agonist

A

Symptom relief of asthma and COPD

Prevention of exercise induced bronchoconstriction

66
Q

Identify 2 examples of SABA’s

A

Salbutamol

Terbutaline

67
Q

What are the indications for Long Acting Beta2 Agonists

A

Maintenance treatment of asthma in patients receiving inhaled or oral corticosteroids
COPD

68
Q

Identify 2 examples of LABA’s

A

Salmeterol

Formoterol

69
Q

Beta2 Adrenoreceptor Agonists

  • Class
  • Indication
  • Action
  • Adverse effects
  • Nursing Consideration
A
  • 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
Q

Xanthine Derivatives

  • Class
  • Indication
  • Action
  • Adverse effects
  • Nursing Consideration
A
  • 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
Q

Anticholinergics/Antimuscarinics

  • Class
  • Indication
  • Action
  • Adverse effects
  • Nursing Consideration
A
  • Anticholinergic
  • Acute, severe asthma, chronic asthma, bronchospasm, rhinorrhea
  • Blocks vagal tone and the reflexes that induce bronconcstriciton
  • Dry mouth, headache
  • Check inhaler technique
72
Q

What are 2 examples of xanthine derivatives?

A

Theophylline

Aminophylline

73
Q

What are 2 examples of anticholinergics

A

Ipratropium bromide

Tiotropium

74
Q

Identify the 2 types of corticosteroids

A

Local and systemic corticosteroids

75
Q

Local Corticosteroids

  • Class
  • Indication
  • Action
  • Adverse effects
  • Nursing Consideration
A
  • 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
Q

What are 2 examples of local corticosteroids

A

Beclomethasone
Budesonide
Fluticasone

77
Q

Systemic corticosteroids

  • Class
  • Indication
  • Action
  • Adverse effects
  • Nursing Consideration
A
  • Corticosteroids
  • Supresses undesirable inflammatory or immune responses
  • Supresses inflammatory response by inhibiting inflammatory mediators
  • HTN, osteoporosis
  • Monitor electrolytes, BGL, fluid balance regularly
78
Q

What are 2 examples of systemic corticosteroids

A

Betamethasone
Hydrocortisone
Prednisolone

79
Q

Mast cell stabilisers

  • Class
  • Indication
  • Action
  • Adverse effects
  • Nursing Consideration
A
  • 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
Q

What are 2 examples of mast cell stabilisers

A

Sodium cromoglycate

Nedocromilsodium

81
Q

Leukotriene Receptor Antagonists

  • Class
  • Indication
  • Action
  • Adverse effects
  • Nursing Consideration
A
  • 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
Q

What is an example of a leukotriene receptor antagonist

A

Montelukast

83
Q

Antihistamines

  • Class
  • Indication
  • Action
  • Adverse effects
  • Nursing Consideration
A
  • 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
Q

What are 2 examples of antihistamines

A

Promethazine

Cetirizine

85
Q

Mucolytics

  • Class
  • Indication
  • Action
  • Adverse effects
  • Nursing Consideration
A
  • 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
Q

What are 2 examples of mucolytics

A

Bromhexine

Dornasealpha

87
Q

What are the 3 forms of antibiotics

A

Penicillins
Cephalosporins
Tetracyclines

88
Q

What are 2 examples of penicillins

A

Amoxicillin
Ampicillin
Flucloxacillin

89
Q

What are 2 examples of cephalosporins

A

Cefazolin
Cefalexin
Cefaclor

90
Q

What are 2 examples of tetracyclines

A

Doxycycline
Tetracycline
Minocycline

91
Q

Penicillins

  • Class
  • Indication
  • Action
  • Adverse effects
  • Nursing Consideration
A
  • 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
Q

Cephalosporins

  • Class
  • Indication
  • Action
  • Adverse effects
  • Nursing Consideration
A
  • 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
Q

Tetracyclines

  • Class
  • Indication
  • Action
  • Adverse effects
  • Nursing Consideration
A
  • 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

NUR2226 (8 decks)

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