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Nursing, LPN, Year 2 > X RESPIRATION - Preview Review (Grant) > Flashcards

X RESPIRATION - Preview Review (Grant) Flashcards

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1
Q

How to Collect Sputum

A
  • rinse mouth
  • collect before meals (avoid vomit)
  • deep cough from lungs
  • spit into cup
  • send to lab ASAP
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2
Q

Larynx

A

Voice box

  • connects to pharynx w trachea
  • made of 9 areas of cartilage
  • largest area (Thyroid, adams apple)
  • same side in men/women until puberty when boys grow and become larger.
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3
Q

Laryngoscopy

A
  • Direct visualization of Larynx to detect lesions and evaluate laryngal functioning and any inflammation
  • can use for biopsy or to remove polyps.
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4
Q

CA of Larynx (Voice Box)

A
  • squamous cell carcinoma
  • majority of malignancies develop from lining of larynx
  • heavy smoking, ETOH (chewing tobacco, pipes, cigars)
  • vocal abuse (singers, actioneers)
  • family Hx
  • CA usually located on Glottis (true vocal chord)
  • slow growing d/t low lymphatic blood supply
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5
Q

CA of Larynx (Voice Box): Prognosis

A
  • If tumor limited to Glottis, 80-90% cure rate.

- If OUT of Glottis area, NOT GOOD

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6
Q

CA of Larynx (Voice Box): SS

A
  • prgressive/persisitent hoarseness
  • Pain radiating to ear (Otalgia, ear pain)
  • Difficulty swallowing
  • Hemoptysis (blood in sputum)
  • persistant burning throat
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7
Q

CA of Larynx (Voice Box): NI

A

-Radiation (shrink cells)
-Sx
..Partial Laryngectomy:Partial w get temp teach.
..Total Laryngectomy removing diseased vocal chords and.or portion of thyroid cartilage. PERM Trach. loose sense of smell, lose voice
..Radical neck dissection

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8
Q

CA of Larynx (Voice Box): NI (cont)

A
  • Airway maintenance (suctioning)
  • skin care around teach
  • monitory I+O
  • tube feedings (temp)
  • facial /neck disfigurement (psych support)
  • support group
  • communicating (white board, hand gestures)
  • cover stoma in cold weather
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9
Q

Epistaxis

A

Nose bleed

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10
Q

Epistaxis: Cause

A
  • congestion of nasal membrane leading to capillary rupture
  • primary or secondary
  • pick nose
  • menstruation
  • severe dryness (use humidifier)
  • foreign body in nose
  • excessive nose blowing
  • deviated septum
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11
Q

Epistaxis: Subjective Data

A

-Deviation, severity

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12
Q

Epistaxis: Objective Data

A

1 nostril or both

anterior or posterior

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13
Q

Epistaxis Types

A

-90%, constant oozePosterior- farther back in nasal cavity. Profuse, arterial originRSK- airway compromise, aspiration of blood, difficulty controlling bleeding

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14
Q

Epistaxis can contribute to HTN

A

anxiety of bleed causes HTN

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15
Q

Epistaxis: Assess

A
  • bright red bleeding from one or both nostrils
  • can lose as much as 1L/hr
  • women, menstruation d/t hormones fluctuating Estrogen
  • BP, TP, Resp
  • evidence of hypovolemic shock (LO BP, if low enough, can stop bleeding
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16
Q

Epistaxis: NI

A
  • sitting position,leaning forward
  • direct pressure by pinching nose
  • ice compress to nose
  • nasal packing (saturated)
  • cautery using silver nitrate
  • balloon tamponada (foley like catheter inserted in nose, inflate balloon to put presssure against vessel to stop bleeding
  • Rhinoscopy w lighted speculum to look into nasal passageway
  • ABX profilactically to LO risk for infect
  • saline spray
  • humidifier
  • vaseline on nostrils to prevent dryness
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17
Q

Acute Follicular Tonsillitis

A
  • Inflammation of tonsils
  • Bacterial (strep most common) or Viral
  • most common in school aged children
  • tonsils help ward off infection
  • sometimes adenoids removed as well
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18
Q

Acute Follicular Tonsillitis: SS

A
  • Enlarged, tender, cervical lymph nodes
  • sore throat / Otolgia
  • Fever, Chills
  • Enlarged, purulent tonsils
  • Elevated WBC
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19
Q

Acute Follicular Tonsillitis: DX

A
  • Throat culture
  • CBC (UP WBC)
  • ABx ( based on pathogen)
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20
Q

Acute Follicular Tonsillitis: MM/NI

A
  • Abx, Analgesics, Antipyretics
  • warm saline gargles (temporary)
  • Tonsillectomy and adenoidectomy (for chronic tonsillitis)
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21
Q

Acute Follicular Tonsillitis: Tonsilectomy POST OP

A

Tonsillectomy and adenoidectomy (for chronic tonsillitis)

  • monitor for hemorrhage (excessive swallowing)
  • IV fluids until nausea subsides
  • ice cold liquid, ice cream
  • ice collar (vasoconstrictor, min bleed)
  • avoid coughing, sneezing, vigorous nose blowing
  • sponge soaked w epinephrine sol to help w minor bleeding.
  • meticulous oral care
  • normal diet after couple days
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22
Q

Acute Rhinitis (common cold)

A

Inflammation of the mucous membranes of the nose and accessory sinuses

  • Rhinovirus (most common, ~100 strains)
  • Droplet transmission
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23
Q

Acute Rhinitis (common cold): SS

A
  • thin, serous nasal exudate
  • productive cough
  • sore throat
  • fever
  • sinus congestion
  • nasal drip (throat irritation, HA, Otogia)
  • 24-48hrs after exposure
  • contagious first 3 days
  • Bacterial w last longer, worse
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24
Q

TB: Dx

A

PRESUMPTIVE Dx

  • Mantoux tuberculin skin test (w 2-10wks exposure). read test 2-3 days later. read area of INDURATION (hard, raised). Redness is normal.
  • Chest Xray
  • Acid fast bacilli smear x3 (bacteria can’t be washed away after using acid to stain it)
  • NAA (Nuclei Acid Amplification, Newer test, using Sputum, result in few hours,)
  • QFT-G: blood test more reliable than PPD. Detects protein antigen from Mycobacterium. Approved in 2004, FDA

CONFIRMED Dx
-Sputum Cx, pos for TB bacilli

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25
Q

TB: Risk

A
  • HIV
  • LO Immune System
  • Elderly
  • fatal if un Rx
  • can kill tissue of affected organ
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26
Q

TB: Types

A

Chronic Pulmonary: in lung

Extra Pulmonary: outside lung

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27
Q

TB: SS

A

-Asymtomatic-Fever-Weight Loss, weakness-productive cough, hemoptysis, dry cough—-chills, night sweats — (Active TB)Effects- Extra Pulmonary (Outside of Lung)-Respiratory-GI-Kidneys-Urinary Tract-Bones-Joints-Nervous Syst-Lympth Nodes-Skin-TB Arthiritis (in large bearing weight joints)

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28
Q

TB: Prognosis

A
  • good w Tx
  • Death w no Tx
  • requires long Tx
  • 50% DO NOT complete therapy
  • resistant TB cases reported among HIV pt w rapid disease progression
  • 75-90% mortality rate in HIV
  • Bacterium can survive more than 50yrs in human tissue. can become active when you are elderly
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29
Q

TB: MM/NI

A
  • Tuberculosis isolation (acid fast bacilli AB)
  • Multiple meds
  • prevent complications and illness transmission
  • Isolation for LARYNGEAL and PULMONARY TB
  • children w Pulmonary DON’T need Isolation because their sputum has low bacteria count and they rarely cough it up.
  • Tx 6-9mos, longer if Extra Pulmonary
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30
Q

PNA

A
  • cause of 10% hospital admissions
  • most common cause of death from an infection
  • inflammatory process of bronchioles and the alveolar spaces d/t infection
  • *Bacteria, Virus, mycoplasma, fungi, parasites
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31
Q

PNA: SS

A
  • productive cough
  • severe chills, UP temp
  • UP Heart Rate
  • UP Respiration
  • Dyspnea
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32
Q

PNA: Risk

A
  • Oversedation, inadequate ventilation, aspiration
  • common Winter/Early Spring
  • infants, elderly
  • recent anestesia
  • ETOH (aspirate w drunk)
  • Damaged resp defense mechanisms (COPD, Influenza, Trach)
  • Any disease affecting antibody response
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33
Q

PNA: Transmission

A
  • aspiration of infected materials into distal bronchioles and alveolar
  • direct and indirect contact
34
Q

Necrotizing PNA

A

Death of lung tissue d/t pathological changes in lung. usually d/t aspiration of vomitus. Usually altered state of consciousness (Sz, ETOH, Anestesia, Shock)

35
Q

VAP (Ventilation Assoc PNA)

A

type of aspiration PNA in pt w intubation, mech vent, endotracheal tube keeps glottis open, introducing bacteria aspiration to lungs

36
Q

Aspiration PNA

A

UP risk , bacterial PNA

37
Q

Types of PNA

A
  • Bacterial PNA: pus formation exudate, SS: lung consolidation
  • Mycoplasmal/Viral: produces interstitial inflam SS: NO Lungh Consolidation
  • Fungal/Mycobacterial: patchy distribution d/t necrosis. dev of cavities in lung. (fungi, candida/aspergillus)
  • StreptococcalPneumococcal: SS, sudden onset, 90% of bacterial, chest pain, chills, F/HA, cyanosis, cough w rust sputum, crackles, friction rub, hypoxemia (as blood shunted away from area of consolidation)
  • Stapholococcal: similar SS, to strep BUT Sputum is Copius and Salmon colored
  • Klebsiella:
  • Haemophilus
  • Mycoplasmal
38
Q

Klebsiella PNA

A
  • gram neg bacteria
  • common in sick pt on vents, IV catheters, Wounds, LT Abx

SS: similar to STREP BUT

  • onset more gradual
  • mortality UP if not Rx by second day of onset
39
Q

Haemophilus PNA

A
  • often follows URI
  • Elderly, HIV, COPD

SS:

  • low grade fever
  • croupy cough
  • SOB
  • arthralgia (joint pain)
  • yellow/green sputum
40
Q

Mycoplasmal aka Walking PNA

A

Influenza virus

  • HA, F
  • Malaise
  • Chills
  • severe cough, non productive
  • LO breath sounds, Crackles
  • WBC (normal)
  • Chest Xray (clear)

SS: Mild

  • patient in general less ill than bacterial
  • irritating cough –> bloody sputum
  • Myalgia
  • Anorexia
  • WBC (normal)
41
Q

PNA Assessment

A

Subjective Data

  • what are symptoms?
  • F, nights sweats?

Objective Data

  • VS q 2h-sputum (amount, color, consistenc)
  • Dyspnea
  • Cyanosis
  • use of accessory muscles
  • on inspiration: crackles
  • pleural effusion
42
Q

PNA DX

A
  • Blood/Sputum Culture
  • Chest Xray
  • WBC (leukocytosis in bacterial PNA)
  • PFTs (lung volume LO)
  • ABG (altered gas exchange)
  • Pulse Ox
43
Q

PNA: MM/NI

A
  • Oxygen (nasal canula/face mask)
  • **Chest percussion (am, before breakfast)
  • Encourage cough, deep breath
  • Abx (penivillin, erythromycin, tetracycline)
  • Analgesics (chest pain, sore)
  • **Expectorants
  • **Bronchodilators
  • Humidifier (drain/loosen)
  • Hi Fowlers
  • GOOD lung side down
  • suction prn
  • Percussion
  • encourage rest
  • limit visitors
  • pt conserving energy
  • hydrate
  • at least 1500cal per day
44
Q

PNA: Complications

A
  • pleurisy
  • Atalectasis
  • pleural effusion
45
Q

PNA: NI

A

-assist in pt conserving energy

46
Q

OSA, Obstructive Sleep Apnea

A
  • cessation of spontaneous respiration
  • partial or complete obstruction during sleep, causing apnea
  • can cause hypopnea (shallow/slow resp)
  • occurs when tongue and soft palate fall back and completely or partially obstruct pharynx
  • lasts 15-90 sec. during period pt can experience hypoxemia LO PAO2
47
Q

OSA: SS

A
  • snorts and loud gasps, grunts
  • causes soft palate to move out of the way?
  • about 2-400 x per night per 6-8hr sleep
  • frequent waking
  • insomnia
  • tired, sleepy during day d/t bad sleep
  • loud snoring
  • am HAs d/t hyprcapnea (CO2 retention) —> vasodilation of cerebral bv
  • personality changes —> stroke
  • systemic HTN
  • cardiac dysrythmia
48
Q

Chronic Sleep Loss: SS

A
  • cardiovascular disease
  • inability to concentrate
  • impaired mem
  • failure to comp daily tasks
  • interpersonal difficulties
  • male (Impotence)
  • driving accidents
  • severe depression
49
Q

OSA: Obstructive SLeep Apnea, RSK factors

A
  • 2ce MEN
  • risk UP w Age
  • weight gain/obesity
  • loss of pharyngeal muscle strength
  • obesity (larangyl fat, tongue/soft pallet enlarged)
  • Naso allergies
  • polyps
  • septal deviation (DEC diameter of Pharynx)
  • Pharangeal structural abnormalities (enlarged tonsils, long tongue, elongated uvula)
50
Q

OSA: Dx tests

A 
Polysomnography: 
monitor chest/abd mvmt, 
oral nasal air flow
SPO2
Ocular movement
HR rhythm
51
Q

OSA: NI

A
  • avoid sedatives, ETOH, 3-4hrs before sleep
  • weight loss if obese
  • teach use oforal appliances that bring mandible and tongue forward to enlarge airway space
  • support groups
  • CPAP machine use (attached high floater for continuous pos sir pressure, poor compliance)
  • BYPAP machines (bi level pos airway pressure)
  • Sx
52
Q

Acute Bronchitis

Lower Airway

A
  • inflammation of trachea and bronchial tree
  • usually secondary to URI
  • exposure to inhalted irritants
  • caused: Rhinivirus
53
Q

Acute Bronchitis: SS

A
  • Productive cough, wheezes, crackles (clear, white, yellow, green sputum)
  • dyspnea, chest pain, tightness
  • low grade fever, chills
  • malaise, HA
  • fatigue
  • residual cough for weeks post bronchitis
54
Q

Acute Bronchitis: Cause

A
  • most common cause
  • Smoking
  • Air Pollution
  • Dust/Toxic gases
  • repeated bouts can lead to chronic bronchitis –> COPD/ASTHMA
55
Q

Acute Bronchitis: MM/NI

A
  • Cough Suppressants
  • antitussives
  • antipyretics, tyenol
  • bronchodilators (open narrow passageway)
  • Abx, if bac
  • Vaporizer (moisture/loosen mucos)
  • encourage fluids (hydrate, loosen fluids)
  • breathing excer.
56
Q

Acute Bronchitis: Dx

A
  • Chest xray
  • sputum test
  • PFTs’
57
Q

Acute Bronchitis: Rsk Factors

A
  • smoking
  • LO immune system
  • air pollucon/dust/toxicg gas
  • elderly/very young
  • exp to irritantas (@work)
  • gastric reflux
  • cold weather can trigger
58
Q

Legionnaires’ disease

A

legionella pneumophila bacteria

  • thrives in water reservoirs
  • causes life threatening pneumonia –>Lung Consolidation and Alveolar Necrosis (lungs become firm and inelastic)
  • leads to resp failure, renal failure, cateremic shock and ultimately death
  • rapid progress, 2-10days
  • some don’t show simp for 10 days
  • NOT CONTAGIOUS, not transmitted by infected ppl. need to breath in thru lungs
59
Q

Legionnaires’ disease: Contract

A
  • aspiration
  • pt w abnormal gag reflux (smokers, lung disease, LO immune system)
  • drink contaminated water
  • bacteria found on plastic, rubber, wood
60
Q

Lung Consolidation

A

lungs become firm and in-elastic (Legionnaires disease)

61
Q

Legionnaires’ disease: SS

A
  • elevated temp
  • HA
  • non productive cough / productive
  • difficult and rapid respirations, crackles or wheezes upon auscultation
  • tachycardia
  • signs of shock
  • hematuria (blood in urine d/t renal failure)
  • GI symptoms (diarrhea)
62
Q

Legionnaires’ disease: Dx

A
  • specialized cultures w legionella medium (test sputum to see if it grows)
  • antibody testing
63
Q

Legionnaires’ disease: Rsk

A

Lung Disease

Smokers

64
Q

Legionnaires’ disease: MM/NI

A
  • Oxygen
  • Mech vent, intubation if necc
  • IV therapy (maintain E balance, hydration)
  • Abx (Erythromycin, Macrolides type, Quinolone type, Tetracyclin, Doxycyclin
  • Antipyretics
  • Vasopressors (if sings of shock)
  • Temp Dialysis (acute renal failure)
  • Analgesics (comfort)
65
Q

Legionnaires’ disease: Prognosis

A
  • 80-90% recover w/in first year
  • death rate UP w pre-existing problems (COPD)
  • smokers need to quit for life
  • 10-20% develop breathing probs (mech ventilation)
  • reported to health dept
66
Q

Thoracentesis ***

A
  • insert needle thru chest wall, pleural space for aspiration of fluid
  • for Dx or therapeutic purposes
  • Removed fluid w be examined (WBC, RBC, Glucose, Protein Culture for abnormal cells.
  • can detect malignant cells.
  • color of fluid ,amount
  • insertion site
67
Q

***Thoracentesis: NI

A
  • explain to pt (really Dr’s job but nurse should know)
  • need written consent
  • pt anxious, provide support
  • asst pt w position
  • 30* HOB raised
  • check VS, Resp (through out procedure)
  • no more than 1300ml removed w/in 30 min to prevent intra vascular shift
  • could lead to pulmonary edema
  • after procedure, place pt on unaffected side
  • specimen sent to lab ASAP
68
Q

Lab & DX Tests

A
  • Chest Roentgenogram (xrays)
  • Computed tomoraphy (CT)
  • Mediastinoscopy
  • Laryngoscopy
  • Bronchoscopy **
  • Sputum Specimen
  • Cytological Studies
  • Thoracentesis
  • Arterial Blood Gasses (ABG)
  • Pulse Oximetry
69
Q

Bronchoscopy ***

A
  • direct vis larynx, trachea, bronchi
  • introduced thru nose or mouth using flexible fiberoptic scope.
  • sometimes direct into trachea
  • used to treat lung disease, obtain biopsy, remove foreign objects
  • collect sputum
70
Q

Bronchoscopy: NI

A
  • NPO until gag reflex returns
  • semi fowler
  • lie on side to help w secretions
  • monitor for laryngal edema or spasms
  • stridor d/t obstruction
  • scope could cause inflammation
  • UP Dyspnea
  • monitor SS of Hemorrhage
71
Q

Administration of Steroid Inhalers

A
  • Sit or Stand
  • shake canister several times thorough mix
  • breath out thru mouth –> empty lungs
  • breath in slowly thru mouth, w canister to mouth. Less canister to allow med to be released while inhaling.
  • hold breath, keep mowh closed for 20s
72
Q

SARS, Severe Acute Respiratory Syndrome

A

-Conglomeration of different symptoms etc. Not directly specific.

CAUSE: **Corona Virus, Rhino Virus (common cold)

Corona Virus: from family of virus’ that cause many acute respiratory illness

73
Q

SARS: Spread

A
  • close contact
  • droplet
  • touching contaminated objects
74
Q

SARS: SS

A
  • Fever UP 101*
  • HA
  • Malaise
  • Muscle aches
  • dry cough (sometimes leads to SOB)
  • Dyspnea
  • Hypoxia
  • 20% need intubation/mech ventilation
  • lungs look patchy upon X-ray (fluid in space)
75
Q

SARS: Dx

A
  • lung xray (normal at first –> patch, fluid in space)
  • tissue cultures (serum antibodies)
  • nasal pharangeal swabs (antibodies)
  • bronchoalveolar lavage (wash out deeper secretions)
  • been to Asia? Toronto recently?
76
Q

SARS: MM/NI

A
  • no definitive Tx
  • Treat symptoms
  • ABX if bacterial
  • Ribaviran (antiviral)
  • Resp Isolation (if SARS suspected)
  • Corticosteroids
  • infection control nurse w notify healt dept on Dx. pt on isolation
  • return back to work once fever resolved and resp symps better
77
Q

Allergic Rhinitis (runny nose) and Allergic Conjunctivitis

A

antigen/antibody reactions in nasal membranes, nasopharynx and conjuctiva d/t allergies

78
Q

Allergic Rhinitis/Conjunctivitis: Causes

A

-pollen
-trees/grass
-weeds
-mold spores
-fungi
-dust
common among adults/children. can result in loss work/school
-seasonal mostly sometimes perennial

79
Q

Allergic Rhinitis/Conjunctivitis: SS

A
  • edema
  • photophobia
  • excessive tearing
  • blurring of visa
  • pruritis
  • excessive nasal secretions and/or congestion
  • sneezing
  • cough
  • HA
80
Q

Allergic Rhinitis/Conjunctivitis: NI

A
  • avoid allergen
  • antihistamines (rotate when intolerance)
  • Decongestants (actifed/sudafed)
  • Analgesics (HAs, Sinuses)
  • Hot packs over facial sinuses
  • Arizona/NM better climate for allergies

Nursing, LPN, Year 2 (27 decks)

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