X RESPIRATION - Preview Review (Grant) Flashcards
How to Collect Sputum
- rinse mouth
- collect before meals (avoid vomit)
- deep cough from lungs
- spit into cup
- send to lab ASAP
Larynx
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.
Laryngoscopy
- Direct visualization of Larynx to detect lesions and evaluate laryngal functioning and any inflammation
- can use for biopsy or to remove polyps.
CA of Larynx (Voice Box)
- 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
CA of Larynx (Voice Box): Prognosis
- If tumor limited to Glottis, 80-90% cure rate.
- If OUT of Glottis area, NOT GOOD
CA of Larynx (Voice Box): SS
- prgressive/persisitent hoarseness
- Pain radiating to ear (Otalgia, ear pain)
- Difficulty swallowing
- Hemoptysis (blood in sputum)
- persistant burning throat
CA of Larynx (Voice Box): NI
-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
CA of Larynx (Voice Box): NI (cont)
- 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
Epistaxis
Nose bleed
Epistaxis: Cause
- 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
Epistaxis: Subjective Data
-Deviation, severity
Epistaxis: Objective Data
1 nostril or both
anterior or posterior
Epistaxis Types
-90%, constant oozePosterior- farther back in nasal cavity. Profuse, arterial originRSK- airway compromise, aspiration of blood, difficulty controlling bleeding
Epistaxis can contribute to HTN
anxiety of bleed causes HTN
Epistaxis: Assess
- 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
Epistaxis: NI
- 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
Acute Follicular Tonsillitis
- 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
Acute Follicular Tonsillitis: SS
- Enlarged, tender, cervical lymph nodes
- sore throat / Otolgia
- Fever, Chills
- Enlarged, purulent tonsils
- Elevated WBC
Acute Follicular Tonsillitis: DX
- Throat culture
- CBC (UP WBC)
- ABx ( based on pathogen)
Acute Follicular Tonsillitis: MM/NI
- Abx, Analgesics, Antipyretics
- warm saline gargles (temporary)
- Tonsillectomy and adenoidectomy (for chronic tonsillitis)
Acute Follicular Tonsillitis: Tonsilectomy POST OP
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
Acute Rhinitis (common cold)
Inflammation of the mucous membranes of the nose and accessory sinuses
- Rhinovirus (most common, ~100 strains)
- Droplet transmission
Acute Rhinitis (common cold): SS
- 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
TB: Dx
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
TB: Risk
- HIV
- LO Immune System
- Elderly
- fatal if un Rx
- can kill tissue of affected organ
TB: Types
Chronic Pulmonary: in lung
Extra Pulmonary: outside lung
TB: SS
-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)
TB: Prognosis
- 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
TB: MM/NI
- 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
PNA
- 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
PNA: SS
- productive cough
- severe chills, UP temp
- UP Heart Rate
- UP Respiration
- Dyspnea
PNA: Risk
- 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
PNA: Transmission
- aspiration of infected materials into distal bronchioles and alveolar
- direct and indirect contact
Necrotizing PNA
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)
VAP (Ventilation Assoc PNA)
type of aspiration PNA in pt w intubation, mech vent, endotracheal tube keeps glottis open, introducing bacteria aspiration to lungs
Aspiration PNA
UP risk , bacterial PNA
Types of PNA
- 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
Klebsiella PNA
- 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
Haemophilus PNA
- often follows URI
- Elderly, HIV, COPD
SS:
- low grade fever
- croupy cough
- SOB
- arthralgia (joint pain)
- yellow/green sputum
Mycoplasmal aka Walking PNA
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)
PNA Assessment
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
PNA DX
- Blood/Sputum Culture
- Chest Xray
- WBC (leukocytosis in bacterial PNA)
- PFTs (lung volume LO)
- ABG (altered gas exchange)
- Pulse Ox
PNA: MM/NI
- 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
PNA: Complications
- pleurisy
- Atalectasis
- pleural effusion
PNA: NI
-assist in pt conserving energy
OSA, Obstructive Sleep Apnea
- 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
OSA: SS
- 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
Chronic Sleep Loss: SS
- cardiovascular disease
- inability to concentrate
- impaired mem
- failure to comp daily tasks
- interpersonal difficulties
- male (Impotence)
- driving accidents
- severe depression
OSA: Obstructive SLeep Apnea, RSK factors
- 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)
OSA: Dx tests
Polysomnography: monitor chest/abd mvmt, oral nasal air flow SPO2 Ocular movement HR rhythm
OSA: NI
- 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
Acute Bronchitis
Lower Airway
- inflammation of trachea and bronchial tree
- usually secondary to URI
- exposure to inhalted irritants
- caused: Rhinivirus
Acute Bronchitis: SS
- 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
Acute Bronchitis: Cause
- most common cause
- Smoking
- Air Pollution
- Dust/Toxic gases
- repeated bouts can lead to chronic bronchitis –> COPD/ASTHMA
Acute Bronchitis: MM/NI
- Cough Suppressants
- antitussives
- antipyretics, tyenol
- bronchodilators (open narrow passageway)
- Abx, if bac
- Vaporizer (moisture/loosen mucos)
- encourage fluids (hydrate, loosen fluids)
- breathing excer.
Acute Bronchitis: Dx
- Chest xray
- sputum test
- PFTs’
Acute Bronchitis: Rsk Factors
- smoking
- LO immune system
- air pollucon/dust/toxicg gas
- elderly/very young
- exp to irritantas (@work)
- gastric reflux
- cold weather can trigger
Legionnaires’ disease
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
Legionnaires’ disease: Contract
- aspiration
- pt w abnormal gag reflux (smokers, lung disease, LO immune system)
- drink contaminated water
- bacteria found on plastic, rubber, wood
Lung Consolidation
lungs become firm and in-elastic (Legionnaires disease)
Legionnaires’ disease: SS
- 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)
Legionnaires’ disease: Dx
- specialized cultures w legionella medium (test sputum to see if it grows)
- antibody testing
Legionnaires’ disease: Rsk
Lung Disease
Smokers
Legionnaires’ disease: MM/NI
- 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)
Legionnaires’ disease: Prognosis
- 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
Thoracentesis ***
- 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
***Thoracentesis: NI
- 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
Lab & DX Tests
- Chest Roentgenogram (xrays)
- Computed tomoraphy (CT)
- Mediastinoscopy
- Laryngoscopy
- Bronchoscopy **
- Sputum Specimen
- Cytological Studies
- Thoracentesis
- Arterial Blood Gasses (ABG)
- Pulse Oximetry
Bronchoscopy ***
- 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
Bronchoscopy: NI
- 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
Administration of Steroid Inhalers
- 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
SARS, Severe Acute Respiratory Syndrome
-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
SARS: Spread
- close contact
- droplet
- touching contaminated objects
SARS: SS
- 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)
SARS: Dx
- 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?
SARS: MM/NI
- 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
Allergic Rhinitis (runny nose) and Allergic Conjunctivitis
antigen/antibody reactions in nasal membranes, nasopharynx and conjuctiva d/t allergies
Allergic Rhinitis/Conjunctivitis: Causes
-pollen
-trees/grass
-weeds
-mold spores
-fungi
-dust
common among adults/children. can result in loss work/school
-seasonal mostly sometimes perennial
Allergic Rhinitis/Conjunctivitis: SS
- edema
- photophobia
- excessive tearing
- blurring of visa
- pruritis
- excessive nasal secretions and/or congestion
- sneezing
- cough
- HA
Allergic Rhinitis/Conjunctivitis: NI
- avoid allergen
- antihistamines (rotate when intolerance)
- Decongestants (actifed/sudafed)
- Analgesics (HAs, Sinuses)
- Hot packs over facial sinuses
- Arizona/NM better climate for allergies
