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Med Surg Exam 2 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

what is included in the upper airways

A

nose, sinuses, pharynx, larynx , lungs

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2
Q

what is included in the lower airways

A

trachea, bronchi, segmental bronchi, bronchioles, alveolar ducts, alveolar sacs

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3
Q

what happens in the alveoli

A

where gas exchange actually occurs also secrete surfactant to reduce surface tension and prevent alveolar collapse

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4
Q

what is the function of the respiratory tract

A

: Gas exchange (alveoli oxygen transport to the cells and Co2 away from the cells), Ventilation (atmospheric air – higher in O2 into lungs and removal of CO2), respiratory diffusion (movement of air across alveolar) , perfusion (blood flow – by the heart = central perfusion)

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5
Q

what changes happen to respiratory system with age

A

structure chest stiffness, decrease muscle mass (harder to expand lungs, less elasticity, alveolar are enlarged) a lifetime exposure to environmental pollutants could also harm the body over time

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6
Q

how can you prevent respiratory problems

A

Minimize exposure to inhalation irritants, stop smoking (including 2nd/3rd hand smoke),

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7
Q

what does the IPREPARE assessment stand for

A

Investigate, presenting work, resident, environment, past work, activity, resources/referral, educate

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8
Q

what should you ask when talking about family history

A

allergies, current health problems, current meds, genetic risk, smoking, drug use, travel, veterans (deployment location)

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9
Q

what is included on the physical assessment on the nose and sinuses

A

External nose – deformities or tumors, Septum – perforation or deviation, Nares – symmetry, size, shape, Nasal Cavity/Sinuses – color, swelling, drainage, bleeding, Mucous membranes- color, abnormalities

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10
Q

what is included on the assessment on pharync, trachea and larynx

A

– Mouth- can show early cyanosis (pale blue lips and mouth = central cyanosis = bad), Posterior pharynx, Neck – symmetry, alignment, masses, swelling, bruises, use of accessory muscles, lymph nodes, Trachea- palpate for position, mobility, tenderness, masses, Larynx – voice abnormality, hoarseness

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11
Q

what is included on the assessment of the lungs

A

Have them sit look at front and back, observe the chest and compare both sides while breathing and a rest, Assess breathing and respirations – rate rhythm, depth, effort, if retractions show remove shirt and get a better look, Percussion for pulmonary resonace, organ boundaries, diaphragmatic excursion, dull (pneumonia), Palpate – for movement, symmetry, tenderness, tactile fremitus and Auscultate

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12
Q

what does hemoglobin tell you and what doe low levels mean

A

low means less O2 to body = hypoxemia can also help identify deficiencies that may lead to hypoxemia

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13
Q

what do sputum specimens (culture and sensitivity) tell you

A

Identify the causative organism and the specific antibody to treat it

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14
Q

what does cytologic examination tell you

A

identifies cancer cells, allergic conditions

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15
Q

what do low/high levels of CBC tell you

A

could be increases in chronic disease r/t increased production of erythropoietin, decrease seen in anemia, hemorrhage, hemolysis

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16
Q

what does high/low levels in WBC tell you

A

elevation in acute infections or inflammation, Decrease in overwhelming infection, autoimmune disorder, immunosuppressant therapy

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17
Q

what does high levels of differential WBC tell you

A

can be decreased in sepsis, autoimmune and immunosuppressant therapy

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18
Q

what do low/high levels of neutrophils tell you

A

elevated in acute bacterial infection, COPD, or smoking, Decreased in viral infections

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19
Q

what do high levels of eosinophils tell you

A

elevated in COPD, asthma, allergies

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20
Q

what do high/low levels of basophils tell you

A

elevated could mean chronic infections, decreased in acute infection

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21
Q

what does high/low levels of lymphocytes tell you

A

elevated in viral infections, pertussis, and mononucleosis, decreased in corticosteroid therapy

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22
Q

what does a chest x-ray show you

A

Assess lung pathology (pneumonia, atelectasis, pneumothorax, tumor), Detects (pleural fluid, ETT placement, invasive line placement, chest tube placement

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23
Q

what position should the pt be in for chest x ray

A

position= posteroaneterior and left lateral (so air will rise),

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24
Q

what is the limitation for chest xray

A

may appear normal even with severe disease present

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25
Q

what does a CT show you

A

assess soft tissue, consecutive cross section of the chest, identifies lesions or clots, IV contrast to enhance,

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26
Q

what are the nursing considerations for CT

A

considerations allergies to IV contrast, iodine, shellfish, renal function, stop taking metformin 24 hours before, restart when renal function is good

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27
Q

what does a pulse ox do

A

infrared light is used to identify the percentage of hemoglobin saturated with oxygen, placement on finger, toe, earlobe, or forehead

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28
Q

what does a Capnometry/capnography do

A

measures carbon dioxide in exhaled air, provides info about: Co2 production, pulmonary perfusion, alveolar ventilation, respiratory patters, ventilator effectiveness, rebreathing of exhaled air, it is a more sensitive indicator of gas exchange then pulse ox

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29
Q

what does a pulmonary function test do

A

determines lung function/breathing diffuclties, compare data to expected findings, screen for lung disease or guide management, preoperative testing to identify patient’s at risk for lung complications

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30
Q

what does an exercise pulmonary function test do

A

identifies cause of dyspnea (cardiac, lung or muscle weakness)

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31
Q

what are the considerations for pulmonary function test

A

: explain the procedure of the test, no smoking 6-8 hours before, assess patient for dyspnea and bronchospasms after, doc meds administered during

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32
Q

what is exercise testing

A

– assesses the patient ability to work and perform ADLs, differentiates reasons for exercise limitations, evaluated influence of disease on exercise capacity, self paced 12 min walk/treadmill/bike, pulmonary patient’s limited by breathing capacity, gas exchange compromise or both

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33
Q

what should be considered for exercise testing

A

explain the test, assure the patient, monitor closely

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34
Q

what is a laryngoscopy

A

visualize the vocal cords, remove foreign objects, obtain tissue samples

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35
Q

what is a mediastiniscopy

A

insertion above the sternum to the area between the lungs, visualize tumors, obtain tissue samples

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36
Q

what is a bronchoscopy

A

diagnose and manage pulmonary disease, evaluate the airway, placement of ETT tube, collect specimen, remove secretions, stent to open airways, rigid scope – general anesthesia, flexiable scope – low dose sedations

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37
Q

what are the complications of bronchoscopy

A

bleeding, hypoxia, pneumothorax

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38
Q

what are the considerations for bronchoscopy

A

explain procedure, obtain pre procedure diagnostics like CBC, PT, platelet count, NPO for 4-8 hours,

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39
Q

what are the indications for a throcentesis

A

needle aspiration of pleural fluid or air , to diagnosis, manage, exam, relieve pressure on blood vessel or lung compression, relieve respiratory distress, instill meds

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40
Q

what are the considerations for thoracentesis

A

explain procedure, get consent, assess for allergies to anesthetic, do not cough/move/deep breath to avoid puncturing lung, provider should wear goggles, remove no more then 1000ml, apply pressure to site, follow up chest xray, assess for bleeding/drainage, doc everything

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41
Q

what are the complications of thoracentesis

A

fluid accumulation, subcutaneous emphysema, infection, tension, pneumothorax (crunchy

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42
Q

when would you see ss of pneumothorax after thoracentesis

A

may occur up to 24 hours after procedure

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43
Q

what are the indications for lung biopsy

A

obtain tissue for histological analysis, culture, or cytology, differential diagnosis of cancer, infection, inflammation, or lung disease

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44
Q

what are the different types of lung biopsies

A

transbrochial biopsy, transbrochial needle aspiration, thansthoracic needle aspiration

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45
Q

what are the considerations of lung biopsy

A

explain procedure, assess allergies, may need chest tube

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46
Q

what is the post op monitoring for lung biopsy

A

VS, respiratory assessment q4 for 24 hours, pneumothorax, respiratory distress, hemoptysis

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47
Q

why is ABG used

A

monitor blood Ph level, monitor the effectiveness of various treatments

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48
Q

how is an ABG taken

A

heparinized syringe, allens test to confirm radial/ulnar circulation, explain and reinforce procedure, use surgical asepsis, place specimen on ice (to keep Ph from changing), hold pressure on site for 5 mins (20 mins if patient on anticoagulants), monitor for swelling/bleeding/ change in color or temp, document, report results, administer O2 or change vent settings as prescribed

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49
Q

what are the complications of ABG

A

Arterial occlusion (on the artery you stuck) – monitor for changes in color temo, swelling, loss of pulse, or pain – tell doc of persistent findings, Hematoma – apply pressure to the site, call doc, Air embolism – place on left side trendleburg, monitor for sudden onset of SOB, decrease O2 sats, chest pain, anxiety, air hunger, call doc ASAP, get ABG from diff site, continue to assess respiratory status

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50
Q

what is normal Ph level of ABG and what do high/low levels mean

A

Ph= 7.35-7.45 ( increased= metabolic aklalosis, loss of gastric fluids, decreased K intake, diuretics, fever, sailcyte tocicity, repiratory alkalosis- hyperventilation Decreased = metabolic/respiratory acidosis, ketosis, renal failure, starvation, diarrhea, hyperthyroidism),

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51
Q

what is a normal Pao2 level for ABG and what do high/low levels mean

A

80-100 ( increased= increased ventilation, oxygen therapy, Decreased= respiratory depression, high altitude, carbon monoxide poisoning, decreased cardiac output decreased perfusion

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52
Q

what is a normal PaCO2 level in ABG and what do high/low levels mean

A

35-45 (Increased= respiratory acidosis, emphysema, pneumonia, cardiac failure, respiratory depression, Decreased = respiratory alkalosis, hyperventilation, diarrhea

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53
Q

what is a normal HcO3 level

A

21-28

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54
Q

what is a normal SaO2 level

A

95-100%

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55
Q

what is a normal bicarbonate level and what do high/low levels mean

A

Bicarbonate = 21-28 (increased = metabolic alkalosis, bicarb therapy, metabolic compensation for respiratory acidosis Decreased= metabolis acidosis, diarrhea, pancreatitis

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56
Q

what are the characteristics of metabolic acidosis

A

decrease Ph, Decrease HCo3, decrease PaCo2

57
Q

what are the characteristics of metabolic alkalosis

A

increase Ph, Increase HCo3 and Increase PaCo2

58
Q

what are the characteristics of respiratory acidosis

A

decrease Ph, Increase PaCo2, Increase HCo3,

59
Q

what are the characteristics of respiratory alkalosis

A

= increase Ph, decrease PACo2, Decrease HCo3

60
Q

what are some ss of acidosis

A

Cardiovascular: heart rhythm changes, Tall T waves, widened QRS complex, prolonged PR interval, hypotension, thready peripheral pulses, CNS (bc Ph is low): depressed activity (lethargy, confusion, stupor, coma), Neuromuscular: hyporeflexia, skeletal muscle weakness, flaccid paralysis, Respiratory: Kussumal respirations (metabolic), variable respirations (respiratory), Integumentary: warm, flushed, dry skin in metabolic, pale to cyanotic and dry skin in respiratory

61
Q

what are some ss of alkalosis

A

Cardiovascular- increased HR, normal to low BP, increased digoxin toxicity, CNS (Ph is high): increased activity, positive Chvostek’s and trousseau, paresthesia, Neuromuscular: hyperlexia, skeletal muscle weakness, muscle cramping and twitching, Respiratory: hyperventilation in respiratory, and decreases respiratory effort with skeletal muscle weakness in metabolic

62
Q

what is allergic rhinitis

A

inflammation r/t exposure to allergens (plant pollen, animal dander, molds, foods)

63
Q

what are the ss of allergic rhinitis

A

sneezing, itchy nose, rhinorrhea, watery eyes, congestion

64
Q

what is the treatment for allergic rhinitis

A

nasal corticosteroid spray (non-systemic – flonase), second generation antihistamines (non-sedating = loratadine, cetirizine, fexofendadine), allergy shots

65
Q

what are the interventions for allergic rhinitis

A

avoid triggers, med as prescribed, supportive care

66
Q

what is an upper respiratory infection

A

inflammation of the nasal mucosea and sinuses, common cold cause by a virus spread by droplets, allergic or non allergic, cute or chronic, coexists with other disorders (asthma, allergies)

67
Q

what are the risks for upper respiratory infection

A

extremely young/advanced age, recent exposure, lack of current immunization, smoker, chronic lung disease immunocompromised

68
Q

what are the ss of upper respiratory infection

A

rhinorrhea, purulent nasal drainage, sneezing, itchy nose, dry sore throat, redden, swollen nasal mucosa, low-grade fever, watery eyes, congestion

69
Q

what are the interventions/education for upper respiratory infection

A

encourage 6-8 hours rest, humidified air, cough etiquate, hand hygiene, vaccination, limit exposure espically is immunocompromised

70
Q

what is the treatment for upper respiratory infection

A

– decongestants (phenylephrine – constricts blood vessels and decrease edema), antipyretics for fever, antibiotics for bacterial infection

71
Q

what are some complementary options for upper respiratory infection

A

echinacea, large dose of vitamin c, zinc preparations, improve immune response

72
Q

what is sinusitis

A

inflammation of the mucous membrane of one or more of the sinuses, swelling and inflammation block drainage and lead to infection occurs after rhinitis

73
Q

what are the risk factors for sinusitis

A

deviates septum, nasal polyps, inhaled air pollutants or cocaine, facial trauma, dental infection, immunocompromised

74
Q

what are the ss of sinusitits

A

nasal congestion, headache, facial pressure/pain, cough, bloody or purulent nasal drainage, tenderness on palpation of sinuses, low-grade fever

75
Q

what are the interventions/education for sinusitis

A

encourage rest, humidified air, increased fluid intake, cough etiquate, hand hygiene, decrease swimming, driving, air travel, smoking cessation, sinus irrigation

76
Q

what is the treatment for sinusitits

A

decongestants (phenylephrine), antipyretics for fever, broad spectrum antibiotics for bacterial infection (amoxicillin, antibiotic stewardship) Pain relievers (NSAIDs, Acetaminophen, Asprin)

77
Q

what are some complications of sinusitis

A

meningitis – report suspected findings to provider

78
Q

what is seasonal and pandemic influenza

A

fall/winter, highly contagious acute viral infection, contagious from 24 hours before symptoms manifest to 5 days after onset, pandemic influenza – viral infection in birds or animals that has mutated and is highly infectious to humas (swine and avian flu)

79
Q

what are the risk factors for seasonal and pandemic influenza

A

history of pneumonia, over 65, pregnant women, health care workers

80
Q

what are the ss of seasonal and pandemic influenza

A

severe headache, muscle aches, chills, fatigue, weakness, severe diarrhea, fever, cough (avian flu) hypoxia (avian flu)

81
Q

what are some antivirals used for seasonal and pandemic influenza

A

amantadine, rimatadine, ribavirin, zanamivir, oseltamivir, begin antiviral treatment within 24-48 hours of symptoms onset

82
Q

what are some vaccines used for seasonal and pandemic influenza

A

trivalent vaccines prepared annually, IM injection, vaccines encouraged for everyone 6 mths and older

83
Q

what are the interventions for seasonal and pandemic influenza

A

encourage rest, droplet precautions, saline gargles, monitor hydration status, administer fluids, monitor respiratory status, encourage vaccination, avoid personal contact, avoid identified areas of pandemic flu

84
Q

how do you diagnosis seasonal and pandemic influenza

A

AV advantage A/H5N1 flu test

85
Q

what are the complications of seasonal and pandemic influenza

A

pneumonia in older adults and immunocompromised

86
Q

what is covid

A

caused by SARS-CoV-2 virus, spreads quickly through droplets

87
Q

what are the risks for covid

A

older adults, immunocompromised, people with certain medical conditions – asthma, cancer, chronic lung/kidney/liver disease, diabetes, dementia, cystic fibrosis

88
Q

what are the ss of covid

A

fever, chills, cough, SOB, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestions or runny nose, nausea, vomiting, diarrhea

89
Q

how do you diagnosis covid

A

PCR (most reliable), rapid antigen test, home/self test (antigen)

90
Q

what is the education for covid

A

follow CDC guidelines, testing, isolation, seek higher level of care

91
Q

how are you considered up to date for covid vaccine

A

based on – age, first vaccine date, length of time since last dose

92
Q

what are some approved vaccines for covid

A

Pfizer-BioNTech, Moderna, Novavax, J&J

93
Q

what is bronchitis

A

inflammation of the bronchi

94
Q

what are the risks for bronchitis

A

viral, air pollution, dust, chemical inhalation, smoking, sinuisitis, asthma

95
Q

what are the ss of bronchitis

A

cough up to 3 weeks, clear sputum, headache, fever, hoarseness, myalgia, chest pain, dyspnea

96
Q

how do you diagnose bronchitis

A

chest x-ray

97
Q

what is the treatment for bronchitis

A

cough suppressants/expectorants, antipyretic, beta2 agonist for wheezing (albuterol), Antibiotics (if prolonged over 3 weeks with purulent sputum)

98
Q

what should be considered for bronchitis

A

encourage increased fluid intake, cough etiquette, hand hygiene, stop smoking, encourage ambulation, prevent pneumonia

99
Q

what is pneumonia result in

A

in reduced gas exchange (aspiration, inhalation, hematogenous), excess fluid in the lungs, acute infection of lung parenchyma

100
Q

what are the risks for getting pneumonia

A

older adult, smoking, recent respiratory infection, immunocompromised, tracheal intubation, decreased LOC, immobility, lack of vaccines, smoking, chronic disease

101
Q

what is community acquired pneumonia

A

contracted outside the healthcare system,

102
Q

what is healthcare associated pneumonia

A

occurs less then 48 hours of hospital admission

103
Q

what is hospital acquired pneumonia

A

onset/diagnosis over 48 hours of hospital admission

104
Q

what is ventilator associated pneumonia

A

onset/diagnosis within 48-72 hours after ETT intubation

105
Q

what is aspiration pneumonia

A

chemical pneumonitis of gastric contents

106
Q

what is necrotizing pneumonia

A

rare, cavitation of lungs and abcess

107
Q

what is opprotunistic pnumonia

A

immunocompromised leading to pneumocystis, jiroveci and cytomegalovirus

108
Q

what are some ss of pneumonia

A

: anxiety, fear, weakness, chest discomfort r/t to coughing, confusion, fever, chills, flushing, diaphoresis, dyspnea, tachypnea, pleuritic chest pain, yellow tinged sputum, crackles, wheezes, dull chest percussion, decrease O2 sats, purelent, blood tinged sputum

109
Q

how do you diagnosis pneumonia

A
  • sputum culture/sensitivity, CBC, ABG, Blood culture, serum electrolytes, chest xray, pulse ox
110
Q

what are some interventions for pneumonia

A

– high fowlers, encourage cough and deep breathing, incentive spirometer, give breathing treatments and meds, oxygen therapy, cluster care, promote adequate nutrition, increase fluid intake, provide rest periods, reassure client experiencing respiratory distress

111
Q

what are some antibiotics prescribed for pneumonia

A

– pencillin and cephalosporins mostly used, sputum culture and sensitivity FIRST, start with IV then oral as condition improves, monitor renal function, observe for diarrhea with cephalosporins, encourage to take with food, some PNC must be taken 1 hour before or 2 hours after meals

112
Q

what do bronchodilators do

A

reduce bronchospasm and irritation, short acting beta 2 agonist (albuterol – rapid relief), Anticholinergics (ipratropium – allow for increase bronchodilation – suck on hard candy, rinse mouth, increase fluid intake), Methylxanthines (theophylline – requires close monitoring for therapeutic range

113
Q

what do glucocorticoids do for pneumonia

A

– fluticasone and prednisone – reduces airway inflammation

114
Q

what are some complications of pneumonia

A

atelectasis, bacteremia (sepsis), acute respiratory distress syndrome

115
Q

what is tuberculosis

A

caused by mycobacterium tb, airborne transmission, lodges in bronchioles and alveoli, primary infection, reactivated infection, latent (exposed not infected)

116
Q

what are the risks for TB

A

low seriocomic status, homeless, foreign born, travel to endemic area, immigration from Mexico, Philippines, Vietnam, china, Japan, easter Mediterranean countries, employed of living in prisons, long-term facilities shelters or healthcare, IV drug users, immunocompromised

117
Q

what are some ss of TB

A

persistent cough over 3 weeks, purulent blood tinged sputum, fatigue, lethargy, weight loss, anorexia, night sweats, low- grade fever in the afternoon

118
Q

what test show an active phase of TB

A

QuantiFERON-TB, Chest Xray, Acid-fast bacilli smear and culture

119
Q

what tests show a latent phase of TB

A

QuantiFERON, Mantoux

120
Q

what are some considerations/education for TB

A

heated/humidified o2, prevent infecition, promote adequate nutrition, encourage adequate fluid intake, encourage foods rish in protein, iron, and vitamins B and C, provide emotional support, airborne precautions not required at home

121
Q

why are some pts non compliant to TB treatment

A

duration of therapy being 6-12 months, follow up for 1 year

122
Q

how can you prevent TB

A
  • wear N95 mask, negative air flow room, barrier protection, have patient wear surgical mask when transported, cough etiquette
123
Q

what is Histoplasmosis

A

fungal infection inhalation of spores, not trasnmitttable

124
Q

what are the risks for getting Histoplasmosis

A

immunocompromised

125
Q

what are some ss of Histoplasmosis

A

similar to pneumonia but very ill

126
Q

what is the treatment of choice for Histoplasmosis

A

Amphotericin B-IV

127
Q

what is epitaxis

A

nose bleed

128
Q

what are the risks for epitaxis

A

hypertension, low humidity, allergies, sinusitis, upper respiratory infection

129
Q

how do you diagnosis epitaxis

A

ENT-scope

130
Q

what is the treatment for epitaxis

A

sit with head forward apply uninterrupted pressure for 5-15 minutes

131
Q

what are some differnt types of epitaxis

A

anterior bleeds pledget placed for 48-72 hours, posterior- rapid rhino-balloon or packing (prophylactic antibiotic if left in place over 48-72 hours)

132
Q

what is the teaching involved for epitaxis

A

sneeze with mouth open, saline nasal spray daily, avoid straining 4-6 weeks, afrin for no more then 3 days

133
Q

what is obstructive sleep apnea

A

obstruction or narrowing of air passages r/t relaxation, tongue/soft palate fell back, results in hypoxemis and hypercapnia, central – cessation of breathing- neuro cause

134
Q

what are the risks for obstructive sleep apnea

A

BMI over 30, over 65 years, neck circumference over 17cm, craniofacial abnormalities, acromegaly (over production of growth hormone), smoking, male

135
Q

what are some ss of obstructive sleep apnea

A

insomnia, frequent arousal, daytime sleepiness, snoring, headaches, irritability, observation of apnea over 10 seconds

136
Q

how do you diagnosis obstructive sleep apnea

A

questonaire and polysomnography = positive if over 5 apnea episodes per hour with a decrease of SPO2 3-4%

137
Q

what is the treatment for obstructive sleep apnea

A

side sleeping, HOB elevated, avoid alcohol, weight loss, mouth guard, CPAP or BiPAP with severe apnea (over 15 episodes in an hour)

138
Q

what are some complications of obstructive sleep apnea

A

untreated can lead to cardiac dysrhythmias, heart failure, and pulmonary hypertension

Med Surg Exam 2 (8 decks)

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