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M/S 2 > Exam 1 - Respiratory > Flashcards

Exam 1 - Respiratory Flashcards

1
Q

narrowest portion of the upper airway

A

laryngeal

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2
Q

frequent location of airway obstruction

A

laryngeal

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3
Q

laryngeal obstruction is a ___-___ _____

A

life-threatening emergency

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4
Q

most common cause of laryngeal obstruction in adults

A

ingested meat

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5
Q

s/sx of laryngeal obstruction

A 
subq emphysema/crepitus
voice changes
dysphagia
pain with swallowing
inspiratory stridor
hemoptysis
cough
asphyxia
anxiety/wide eyes
abdominal contraction (late s/sx)
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6
Q

being deprived from O2

A

asphyxia

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7
Q

s/sx of asphyxia

A 
coughing
choking
gagging
obvious difficulty breathing
AMU
inspiratory stridor
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8
Q

when an individual is choking and stops breathing, what do you initiate?

A

CPR

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9
Q

how can the airway become obstructed with laryngeal trauma?

A

edema
fracture of laryngeal structures
hematoma

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10
Q

treatment goal with laryngeal injury

A

maintaining an open airway

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11
Q

laryngeal injury diagnostic test

A

CT
fiber optic laryngoscopy
flexible bronchoscopy

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12
Q

cerebral anoxia

A

when the brain does not get enough O2

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13
Q

hypoxemia

A

inadequate oxygenation

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14
Q

atelectasis

A

alveoli collapse

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15
Q

pulmonary edema

A

fluid in lungs or pleural space

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16
Q

hypoventilation

A

slow RR

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17
Q

how often to cough-turn-deep breathe

A

q2h

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18
Q

what is removed with a total laryngectomy?

A 
larynx
hyoid bone
epiglottis
cricoid cartilage
several tracheal rings
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19
Q

can a pt speak with a laryngectomy tube is closed?

A

No

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20
Q

what to monitor for with trach/laryngectomy tubes

A

airway
breathing
infection control

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21
Q

surgically created stoma in the trachea to establish an airway

A

tracheostomy

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22
Q

3 resons for a tracheostomy

A

bypass airway obstruction

facilitate removal of secretions

permit long-term mechanical vent

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23
Q

preferred tracheostomy method

A

minimally invasive percutaneous tracheostomy

use of local sedation and analgesia

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24
Q

better option for long term mechanical ventilation

A

tracheostomy

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25
Q

when is a pt able to eat and/or speak with a tracheostomy

A

when the cuff is deflated

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26
Q

be familiar with the different parts of a trach

A

be familiar with the different parts of a trach - slide 21

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27
Q

how often are nondisposable inner cannula trachs cleaned?

A

q8h

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28
Q

trach suction time should be limited to how many seconds?

A

10 seconds

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29
Q

d/c trach suctioning if HR decreases __ bpm or increases by ___ bpm

A

decrease: 20 bpm
increase: 10 bpm

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30
Q

do you suction if pt is able to clear secretions on their own by coughing

A

No

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31
Q

how often to reoxygenate after trach suctioning?

A

30 seconds

5-6 breaths/vent

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32
Q

trach cuff should not exceed

A

20 mmHg or 25 cm H2O

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33
Q

how often to monitor cuff pressure?

A

q8h

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34
Q

if the trach becomes dislodged, what can be inserted?

A

obturator

suction catheter

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35
Q

if the trach tube can not be replaced, what should be done?

A

level of respiratory distress
place in semi-Fowler’s
cover stoma with a sterile dressing
ventilate with a bag-mask

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36
Q

3 C’s to trouble-shoot potential trach problems

A

cannula
cuff
call for help/code

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37
Q

if using an ambubag and the pt has a trach, what do you do with the stoma?

A

cover with a sterile gauze

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38
Q

spontaneous breathing can do what to the trach cuff?

A

deflate

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39
Q

how long to trach a cap before removal to ensure the pt can breathe on their own without complications

A

24 hours

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40
Q

how soon after trach removal does epithelial tissue form? how soon will the stoma close?

A

24-48 hours

4-5 days

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41
Q

___ TB is when TB is in other parts of the body

A

miliary

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42
Q

leading cause of death in HIV/AIDs

A

TB

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43
Q

highest risk for TB

A 
homeless
inner city neighborhoods
IV injection users
LTC facilities
prisions
working in a healthcare facility
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44
Q

TB occurs more frequently in these individuals

A

poor, under-serviced and minorities

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45
Q

how is TB spread?

A

person-person via airborne particles

requires close, frequent, or prolonged exposure

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46
Q

hallmark sign of TB

A

granuloma

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47
Q

long term granuloma can lead to ___ and/or ___

A

calcification; fibrosis

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48
Q

granuloma in latent TB

A

walled off

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49
Q

granuloma in active TB

A

liquify, pour contents into lungs

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50
Q

develops within the first 2 years of TB infection

A

active TB disease

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51
Q

TB disease occurring 2 or more years after the initial infection

A

reactivation TB (post-primary)

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52
Q

is reactivation TB considered dormant?

A

no

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53
Q

NCLEX TB trigger words

A 
blood tinged sputum
night sweats
fever
fatigue
anorexia
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54
Q

with latent TB, will a pt be symptomatic?

A

asymptomatic with a (+) TB skin test

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55
Q

pleural effusion lung sounds

A

crackles

rales

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56
Q

the time from TB exposure to infection can take how long?

A

a couple of weeks

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57
Q

TB test is aka

A

Mantoux test

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58
Q

when to assess for TB induration

A

48-72 hours

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59
Q

(+) TB in any person

A

15 mm induration

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60
Q

(+) TB with chronic disease, recent immigration, IV drug users

A

10 mm induration

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61
Q

(+) TB in immunocompromise

A

5 mm induration

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62
Q

does a positive reaction mean active TB?

A

No

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63
Q

where is the Mantoux test performed?

A

forearm; 4” below the elbow

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64
Q

where are TB vaccines administered?

A

UK

Latin American

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65
Q

When is the QuantiFERON-TB and T.SPOT.TB test performed?

A

when an individual has been vaccinated against TB

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66
Q

how often are sputum samples obtained for TB testing?

A

3 consecutive days

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67
Q

how long can it take for TB sputum tests to result

A

6-8 weeks

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68
Q

what can be present in older individuals who have TB?

A

AMS

69
Q

how long can TB treatment last?

A

6-12 weeks

70
Q

when is a person considered MDRTB?

A

resistant to INH and Rifampid

71
Q

initial TB treatment last how long and continues for…

A

8 weeks; 18 weeks - 1 year

72
Q

Isoniazid labs

A

LFT

73
Q

Isoniazid education

A

take 1 hour before meals or on an empty stomach

74
Q

Rifampin education

A

will change bodily fluids orange

75
Q

Ethambutol education

A

ocular-toxicity

color discrimination

76
Q

what is directly observed therapy (DOT)?

A

requires watching a TB pt swallow their meds

77
Q

how is latent TB treated?

A

Isoniazid for 6-9 months unless HIV +, take for 9 months

78
Q

Isoniazid can lead to what deficiency?

A

vitamin b

79
Q

TB isolation

A

airborne

negative pressure room

80
Q

nutrition needed for TB

A 
proteins
vitamins
calorie replacement
adequate hydration
remain active
81
Q

most common cause of lung abscess

A

aspiration

PNA

82
Q

where are lung abscesses typically found?

A

upper lobe

83
Q

risk factors for lung abscess

A

aspiration
TB
substance abuse
immunocompromised

84
Q

localized area of lung destruction or necrosis and pus formation

A

lung abscess

85
Q

s/sx lung abscess

A 
productive cough
chills, fever
pleurtic chest pain
malaise
anorexia
temperature elevation
purulent sputum (foul-smelling, bad tasting, dark brow or blood streaked)
86
Q

what breath sound will be heard if a lung abscess is in the pleural cavity?

A

friction rub

87
Q

CXR will show an area greater than __cm if there is a lung abscess

A

2cm

88
Q

large dose of abx therapy will be taken for __ weeks and then PO for __ weeks for a lung abscess

A

IV: 3 weeks

PO: 12 weeks

89
Q

what may be needed for prior to dental procedures for lung abscess

A

abx

90
Q

pneumothorax

A

air in the pleural cavity

91
Q

what kind of pressure space should the chest cavity be?

A

negative

92
Q

what kind of pressure space is the chest cavity with pneumothorax?

A

positive

93
Q

open vs. closed pneumothorax

A

O: external wound

C: no external wound

94
Q

closed pneumothorax increases the risk for ___ ____

A

tension pneumothorax

95
Q

what are the 5 types of pneumothorax?

A 
traumatic - open
traumatic - closed
Iatrogenic
tension
hemothorax
96
Q

cause of iatrogenic pneumothorax

A

puncture, laceration that occurs during a procedure/heath care associated

97
Q

open pneumothorax will have what type of chest wound?

A

sunken

98
Q

spontaneous pneumothorax occurs in which individuals?

A

tall, skinny, males

99
Q

spontaneous pneumothorax risk factors

A

smoking
family hx
high-altitude flying
previous hx of spontaneous pneumothorax

100
Q

s/sx of spontaneous pneumothorax

A 
pleuritic chest pain
SOB
tachycardia
tachypnea
asymmetrical chest wall movement
diminished, absent breath sounds
hyperresonant tone
unequal lung expansion
101
Q

tension pneumothorax is a medical emergency that affects the ___ and ___ systems

A

respiratory; cardiovascular

102
Q

s/sx of tension pneumothorax

A 
dyspnea
tachycardia
**tracheal deviation**
decreased, absent breath sounds
neck vein distension
cyanosis
profuse diaphoresis
103
Q

how to tx tension pneumothorax

A

needle decompression; chest tube insertion

104
Q

what type of pneumothorax can lead to tension pneumothorax?

A

closed

105
Q

cause of hemothorax

A

chest trauma
tumors (most common)
pulmonary infarction
infections (ex: TB)

106
Q

hemothorax treatment

A

thoracentesis

thoracostomy with chest tube

107
Q

how to proceed with a penetrating chest wound

A

cover with an occlusive dressing that is secured on 3 sides

108
Q

when is a partial pleurectomy, stapling, or pleurodesis needed?

A

repeated spontaneous pneumothorax

109
Q

proper chest tube placement is confirmed by ….

A

CXR

110
Q

chest tube placement/location for pneumo and hemothorax

A

p: 2nd intercostal space
h: 5th intercostal space

111
Q

when is a flutter/heimlich valve used

A

emergency transport

small-to-moderate pneumothorax

112
Q

what are you looking when managing a chest tube

A

tidal
continuous bubbling
nothing

113
Q

continuous bubbling with a chest tube system indicates…

A

air leak

114
Q

nothing happening with a chest tube system indicates…

A

potential blockage

115
Q

normal fluctuation of the water within the water-seal chamber

A

tidaling

116
Q

chest tube systems are usually filled with how much water?

A

20 cm

117
Q

removing too much fluid too quickly (1-1.5L) from a chest tube can potentially lead to which complications?

A

re-expansion pulmonary edema

vasovagal response with symptomatic hypotension

118
Q

how to mark chest tube output

A

mark the line on the chamber

119
Q

what to do when the chest tube is disconnected

A

submerge in 2cm sterile water

do not clamp

120
Q

most common rib fractures occur with ribs __ - __

A

5-9

121
Q

do you strap or bind the chest with a rib fracture?

A

No

122
Q

rib fracture treatment

A

NSAIDs
opioids
nerve block
pt education: deep breathing, coughing, IS

123
Q

when does flail chest occur?

A

fracture of several consecutive ribs, in 2 or more separate places

124
Q

when will flail chest bulge out?

A

during expiration

125
Q

the underlying lung of a flail chest may have what?

A

pulmonary contusion

aggravating hypoxemia

126
Q

flail chest s/sx

A

rapid, shallow respirations
tachycardia
asymmetric, uncoordinated chest movement

127
Q

paradoxic movement

A

occurs with flail chest

chest wall sinks in during inspiration, expands during expiration

128
Q

first thing a nurse should do with respiratory distress

A

assess the pt!

129
Q

pleural effusion

A

collection of fluid in the pleural space

130
Q

is pleural effusion a symptom or diagnosis?

A

symptom

131
Q

2 fluid types with pleural effusion

A

transudative

exudative

132
Q

how much fluid should be in the pleural space?

A

5-15 mL

133
Q

transudative pleural effusion color and indication

A

clear, pale yellow

increased hydrostatic pressure in HF
decreased oncotic pressure in liver, renal failure

134
Q

exudative pleural effusion color and indication

A

protein-rich fluid

cancer

135
Q

empyema is aka

A

pus

136
Q

what is chylothorax?

A

when lymph is found in the chest cavity

137
Q

s/sx of pleural effusion

A 
dyspnea
cough
may have pain
decreased, absent breath sounds
limited chest wall movement
dull percussion

**fever + chills if systemic

138
Q

less than 1.5 L of fluid is removed during a thoracentesis to prevent what kind of response?

A

vasovagal response

139
Q

pt positioning for a throancentesis

A

tripod

140
Q

how should a pt be positioned after a throancentesis and for how long?

A

lying on the unaffected side x1 hour

141
Q

pleuritis

A

inflammation of the pleura

142
Q

s/sx of pleuritis

A 
pain aggravated by deep breathing, coughing, movement
rapid, shallow respirations
limit chest wall movement
diminished breath sounds
pleural friction rub
143
Q

pleuritis treatment

A

analgesics
NSAIDs
codeine: relieve pain, suppress cough
positioning, splinting chest while coughing

144
Q

___ ___ can be a complication of pleuritis

A

pleural effusion

145
Q

pleuritis s/sx to report to HCP

A

increased fever
productive cough
difficulty breathing
SOB

146
Q

pleurodesis

A

creating of adhesions between parietal and visceral pleura

catheter inserted into pleural space, then a chemical is inserted

147
Q

why would a pt have a pleurodesis performed?

A

prevent recurrent pneumothorax

148
Q

chest tightness and pain associated with pleurodesis is __ __

A

short term

149
Q

what f/u diagnostic test is performed to ensure pleurodesis is holding

A

CXR

150
Q

mobile clot

A

embolis

151
Q

clot

A

thrombus

152
Q

blockage of one or more pulmonary arteries by a thrombus, fat or air embolus, or tumor

A

PE

153
Q

PE risk factors

A 
immobility
sx within last 3 months
hx of DVT
oral contraceptives
smokers
prolonged travel
hx of afib
154
Q

most common presenting symptom of PE

A

dyspnea

155
Q

s/sx of PE mimic s/sx of

A

R sided HF

156
Q

can a d-dimer result be definitive of a PE or clot?

A

No

157
Q

most common used test to Dx PE

A

spiral (helical) CT scan

aka CT angiography or CTA

158
Q

if a pt can not have contract, which test is used to Dx PE

A

ventilation-perfusion (VQ) scan

159
Q

what are the 2 components to a VQ scan?

A

perfusion: pulmonary circulation
ventilation: distribution of gas throughout the lung

160
Q

PE drug of choice

A

heparin

161
Q

PE prevention

A 
early ambulation
SCD
elevate lower extremities
active, passive ROM exercises
prophylactic anticoags
162
Q

is you suspect a PE, what positioning should a pt be in?

A

bedrest, semi-Fowler’s

163
Q

pulmonary hypertension

A

elevated pulmonary artery pressure resulting from an increase in resistance to blood flow through pulmonary circulation

164
Q

normal pulmonary wedge pressure

A

12-16

165
Q

wedge pressure with pulmonary hypertension

A

> 25 at rest

> 30 with exercise

166
Q

is there a cure for pulmonary hypertension

A

no, meds given to increase survival rate

may become a transplant canidate

167
Q

causes of pulmonary hypertnesion

A

primary: idopathic
secondary: complication r/t respiratory, cardiac, autoimmune, hepatic or connective tissue disorder

168
Q

pulmonary hypertension s/sx

A 
SOB
dyspnea on exertion
chest pain on exertion
fatigue
dizzy
snycope

*R sided HF s/sx as progresses

169
Q

meds for pulmonary hypertension

A 
Diuretics (PRN)
O2
Digoxin
anticoags
possibly CCB

M/S 2 (10 decks)

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