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NURS 313R > Exam 2: Respiratory Disorders > Flashcards

Exam 2: Respiratory Disorders Flashcards

1
Q

Pleural Effusion

A

Collection of fluids in the pleural space.

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2
Q

Causes of Pleural Effusion

A
  • Imbalance of hydrostatic pressure

- Exudate and extravasated of fluids

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3
Q

Clinical Manifestations of Respiratory Disorders

A

Symptoms of underlying disease process

- Fever, chills, chest pain
- Orthopnea
- Absent breath sounds
- Dull, flat percussion
- Tracheal deviation
- X-ray showing fluid accumulation
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4
Q

Goal for Medical Management of Pleural Effusion

A

Prevent accumulation of fluid to relieve discomfort.

  • Thoracentesis
  • Chest Tube Insertion
  • Pleurodesis
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5
Q

Nursing Management of Pleural Effusion

A
  • Assist in thoracentesis
  • Monitoring/care of chest tube
  • Pain management
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6
Q

Pneumothorax

A

Presence of air in the pleural space causing restriction of lung expansion and collapse.
ANY TRAUMA TO CHEST WALL.

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7
Q

What are the six types of pneumothorax?

A
    1. Simple (Spontaneous)
    1. Traumatic
    1. Tension
      1. Hemothorax
      2. Latrogenic
      3. Chylothorax
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8
Q

Hemopneumothorax

A

Presence of blood and air

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9
Q

Clinical Manifestations of Pneumothorax

A 
Pain
Tachycardia
Anxiety
Dyspnea
Use of accessory muscles
Central Cyanosis
Diminished breath sounds
Tracheal deviation/shift
Agitation
Hypotension
Profuse diaphoresis
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10
Q

Goal for management of a pneumothorax

A

To evacuate the air or blood from the pleural space.

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11
Q

Pneumothorax: Nursing Management

A 
Chest tube
Autotransfusion
Emergency care
Thoracentesis
Thoracotomy
Care for tension pneumothorax
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12
Q

Chest Tube/Pleural Drainage

A

Purpose is to remove air and fluid from the pleural space and restore normal intrapleural pressure

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13
Q

Chest Tube insertion

A

Can be inserted in ER, bedside or O.R.; can be inserted in ant. 2 ICS or post 8-9th ICS.
Site is covered with airtight dressing

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14
Q

3 Basic Components of Pleural Drainage

A
  1. Collection Chamber
  2. Second Chamber/Water- seal Chamber- contain 2 cm of water which act as a one way valve.
    a. Air fluctuates in this chamber called “tidaling”
  3. Third Chamber/Suction control chamber
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15
Q

Third Chamber/Suction Control Chamber

A

a. Applies suction to the chest tube drainage
b. Filled with 20 cm of water
c. Bubbling occurs when negative suction pressure exceeds 20 cm, it controls too much suctioning pressure.

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16
Q

Pneumothorax: Nursing Management

A
  • Keep all tubing straight as much as possible below chest level
  • Keep all connections tight and sealed
  • Keep appropriate water level, use sterile water
  • Mark the time of measurement and fluid level
  • Observe air bubbling/ tidaling in water seal chamber
  • Bubbling is intermittent in water seal, if continuous determine leakage by momentary clamping tube distal from the patient until bubbling stops.
  • Monitor Vital Signs and chest Movement
  • Never elevate drainage to the level of patient’s chest
  • Encourage deep breathing and ROM to affected side
  • Do not strip or milk chest tubes
  • If drainage tube breaks place the distal end of the drainage tube in a sterile water at 2 cm level
  • Clamp with rubber stopper a bed side
  • Always have a vaselinize gauze at bedside to reinforce dressing if leakage is present.
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17
Q

Two mechanisms of injury causing chest trauma

A
  1. Blunt Trauma

2. Penetrating Trauma

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18
Q

Blunt Trauma

A

Chest strikes or is struck by an object.

Impact damages thoracic structures. (Internal structures such as ribs -> laceration on lung tissue)

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19
Q

Penetrating Trauma

A

Open injury from a foreign body like a knife or gun shot.

Impulse or passes through the body tissues, creating an open wound.

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20
Q

Pneumothorax Classification

A

Open: air entering through an opening in chest.
Closed: no external wound

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21
Q

What happens when air enters the pleural space?

A

Increases positive pressure -> partial/complete lung collapse

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22
Q

An increase in volume of air in pleural space causes a

A

Decrease in lung volume

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23
Q

Intrapleural Pressure

A

Negative pressure between the pleural cavity.

Allows the lung to be passively filled during chest expansions. (Inhalation)

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24
Q

Actions of elastic fibers in the lung

A

Constantly pull against the pleura and keeps the intrapleural pressure below atmospheric pressure for passive inhalation (P outside > P inside)

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25
Q

Spontaneous Pneumothorax (Simple) can be d/t

A

Rupture of small blebs on apex of lungs “over distended alveoli”.

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26
Q

Spontaneous Pneumothorax (Simple): Primary

A

Blebs occurring in young healthy people

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27
Q

Spontaneous Pneumothorax (Simple): Secondary

A

Blebs occurring as a result of COPD, asthma, cystic fibrosis and pneumonia.

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28
Q

Spontaneous Pneumothorax (Simple): Risk Factors

A

Smoking, tall/thin, male, family has and previous sp.

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29
Q

Latrogenic Pneumothorax: Caused by

A

Laceration/puncture of lung during medical procedures

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30
Q

Barotrauma

A

Increased ventilator pressure rupturing alveoli or bronchioles

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31
Q

Traumatic Pneumothorax: Caused by

A

Penetrating (open) or non penetrating chest trauma (closed)

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32
Q

Tension Pneumothorax

A

Rapid accumulation of air/fluid into pleural space that doesn’t escape

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33
Q

Tension Pneumothorax: Caused by

A

Open/closed pneumothorax
Mechanical Ventilation
CPR
Clamped/blocked chest tubes

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34
Q

Tension Pneumothorax Affect on the Lungs and Heart

A
  • Compression of the lung on the affected side puts pressure on the heart and great vessels -> decreases venous return and CO
  • Tracheal shift to the unaffected side -> compresses the good lung -> effects O2
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35
Q

Clinical Manifestations of Tension Pneumothorax

A
  • Dyspnea (use of accessory muscles for breathing nostril flaring & sternocleidomastoid)
  • Cyanosis
  • Air hunger
  • Increased HR and decreased breath sounds
  • Agitation/restlessness (sign of hypoxia)
  • Tracheal deviation
  • Subcutaneous emphysema
  • JVD
  • Hyperresonance to percussion
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36
Q

Treatment for Tension Pneumothroax

A

Medical emergency!

Needle decompression followed by chest tube insertion with chest drainage system.

37
Q

Hemothorax

A

Blood in the pleural space.

May or may not occur in conjunction with pneumothorax.

38
Q

Clinical Manifestations of Hemothorax

A
  • Dyspnea
  • Diminished/absent breath sounds
  • Dullness to percussion
  • Decreased Hgb
  • Shock depending on blood vol lost
39
Q

Treatment for Hemothorax

A
  • Chest tube insertion with chest drainage system

- Autotransfusion of collected blood (what was evacuated out will be re filtered and given back to the patient)

40
Q

Chylothorax

A

Lymphatic fluid in pleural space

Traumatic or malignant disruption of thoracic duct.

41
Q

Chylothorax Treatment

A

Conservative treatment (chest drainage, bowel rest & parenteral nutrition)
Octreotide: decreased flow of lymph fluid
Pleurodesis: artificial adhesions between parietal & visceral pleura
(chemical scerolising agent: talc or doxycycline

42
Q

Repeated spontaneous pneumothorax treatment

A

Partial pleurectomy, stapling or pleurodesis

43
Q

Restrictive pulmonary disorders

A

Disorders that impair the ability of the chest wall and diaphragm to move with respiration’s.

44
Q

2 Types of Restrictive Respiratory Disorders

A
  1. Extrapulmonary: Lung it’sue is normal (i.e CNS, neuromuscular system, chest wall trauma)
  2. Intrapulmonary: problems with lung or pleura (i.e pneumothorax, pleural effusion, pleurisy, atelectasis, pneumonia)
45
Q

Pleural Effusion

A

Abnormal accumulation of fluid in the pleural space (indication of a disease).

46
Q

Types of Pleural Effusion

A

Transudative and Exudative

47
Q

Pleural Effusion Definition

A

Need to add information below “Balance Between: hydrostatic pressure: pushing fluids…”

48
Q

Clinical Manifestations: Pleural Effusion

A 
Dyspnea, Orthopnea
Cough 
Pleuritic chest pain: sharp, radiating chest pain
Worse on inhalation
Not substernal, it could occur right or left 
Decreased chest expansion 
Dull percussion 
Diminished breath sounds
49
Q

Why is there an absence of breath sounds in patients with pleural effusion?

A
  • NO CRACKLES because its not in the lung tissue its in the pleural space
  • ABSENCE OF BREATH SOUNDS because lung tissue is being pushed by the fluid
50
Q

Why is orthopnea a clinical manifestation of pleural effusion?

A

If you lay the head down, fluid will go up and cause less lung expansion

51
Q

Transudative Effusion

A

Non-inflammatory reaction: accumulation of protein-poor fluid
Clear, pale and yellow

52
Q

Transudative Effusion can be caused by

A
  • Increased hydrostatic pressure found in heart failure.

- Decreased oncotic pressure in liver/renal disease (hypoalbuminemia)

53
Q

Transudative Effusion in HF: Pathophysiology

A
  1. In LFH, fluid backs up into the LV -> LA -> Pulmonary Veins -> alveolar capillaries.
  2. Volume increases = increased hydrostatic pressure -> capillary distention.
  3. Fluid then pushes out into the pleural space creating transudative pleural effusion.
54
Q

Exudative Effusion

A

Characteristic of an inflammatory reaction.

Associated w/ infection and malignancies.

55
Q

Exudative Effusion results from

A

Increased capillary permeability.

56
Q

Empyema

A

Type of pleural effusion: collection of purulent fluid d/t pneumonia, TB, lung abscess, and infection of surgical wounds

57
Q

Clinical Manifestations of Empyema

A

Fever
Night Sweats
Cough
Weight loss

58
Q

Medical Management of Pleural Effusion: Goal

A

Prevent accumulation of fluid to relieve discomfort.

59
Q

Removal of fluid in patients with pleural effusion

A
  • usually only 1000-1200 mL is removed at one time.

- rapid removal can result in hypotension, hypoxemia, pulmonary edema.

60
Q

Thoracentesis

A

Removal of fluid using a large bore needle.

Local anesthetic is used and thoracentesis needle is inserted into intercostal space. Fluid is then aspirated.

61
Q

How do you position a patient undergoing thoracentesis?

A

Bent forward for maximum lung expansion (TRIPAD)

62
Q

Pleurodecesis

A

Injection of inflammatory agent into Intra pleural space -> irritates visceral and parietal pleura (give analgesic to decrease pain) so once they heal it can form a scar tissue so they can stick to each other thus preventing fluid to accumulate.

63
Q

Nursing Responsibilities in patients with Pleural Effusion

A

PAPOD
Obtain specimens with proper ID, labeling post-procedure.
Monitor VS and SpO2 during and after
Observe for respiratory distress

64
Q

PAPOD

A 
Preparation
Assisting 
Positioning
Obtaining Specimen
Documentation
65
Q

Collaborative Care

A

Treat underlying cause

66
Q

Chemical Pleurodesis

A

Obliterate pleural space and prevent accumulation of fluid in pleural space.
Used only if recurrent pleural effusion occurs.

67
Q

Empyema Treatment

A

chest tube drainage, AB therapy, intrapleural fibrinolytic therapy (dissolves fibrous adhesions), and decortication (removes pleural peel)

68
Q

Pleurisy Treatment

A

Treat underlying disease and providing pain relief.
NSAIDs: commonly aspirin is choice
Splint rib cage when coughing

69
Q

Tracheostomy

A

A surgical incision into the trachea for the purpose of establishing an airway

70
Q

Indications for a Tracheostomy Tube

A
  • bypass an upper airway obstruction
  • facilitate removal of secretions
  • permit long-tern mechanical ventilations
  • permit oral intake and sppech with long term mech-vent.
71
Q

Nursing Therapeutics Providing Tracheostomy Care

A
  • Educate pt/ family prior to procedure
  • Explain to patient the type of tracheostomy tube being used.
  • Suction to remove secretions
  • Cleaning around the stoma
  • Change tracheostomy tie
  • Check cuff inflation (use minimal leak technique)
  • Tape free ends of retention suture to pt’s skin
  • Replacement tube of equal or smaller size should be kept at the bedside so that it is easily accessible for emergency reinsertion.
72
Q

Tracheostomy: Cuff inflation Care

A
  • Know the dangers of an over inflated cuff.
  • Deflate cuff during exhalation, re inflate cuff during inspiration
  • Monitor cuff pressure daily
73
Q

In some cases, the cuff is deflated to remove secretion, the nurse should

A

Let the patient cough out secretions and then suction to prevent aspirations.

74
Q

A trach tube should not be dislodged from the stoma during

A

during the first few days when stoma is not mature (healed)

75
Q

When should trach tubes be changed?

A
  • Do not change trach. Tapes for at least 24 hours post insertion procedure.
  • First tube change is done by MD7 days post trach.
76
Q

If tube is accidentally dislodged the RN should

A

Attempt to reinsert, use hemostat to spread the opening to facilitate the insertion of the tube; use obturator to replace, lubricate with saline.

77
Q

What position should the patient be in if they have dyspnea and a trach?

A

Position semi flowler’s if patient have mild dyspnea

78
Q

If a patient with a trach undergoes respiratory arrest, what should you do?

A

If patient has respiratory arrest, cover trach with sterile dressing and use bag-mask ventilation ‘til help arrives.

79
Q

The spontaneously breathing patient may be able to talk by

A

deflating the cuff, can be enhance by occluding the tube

80
Q

Pneumonia

A

Inflammation of the lung parenchyma, consultation of the lung tissue/lubes

81
Q

Pneumonitis

A

Inflammation of the lung tissue

82
Q

Classifications of Pneumonia

A
  • Community acquired
  • Hospital Acquired
  • Pneumonia in the immunocompromised Host: patients using corticosteroids, those with chronic illnesses such as diabetes, those on chemotherapy
  • Aspiration Pneumonia: stroke patients, patients with nasal or tracheal tube (NG, J tube placement), (those with difficulty swallowing)
83
Q

Risk Factors for Pneumonia

A
  • Conditions that increase mucus or bronchial secretions
  • Immunosuppressive patients
  • Smoking
  • Prolong immobility
  • Depressed cough reflex
  • NPO with placement of NGT, ET
  • Supine position
  • Antibiotic therapy
  • Alcohol intoxication
  • Anesthetic agent
  • Advancing age
  • Nosocomial
84
Q

Pathophysiology of Pneumonia

A

Risk factors -> decreased immunologic defenses -> infectious agent entering the sterile lung field ->systemic microorganism from blood -> trapped in the alveoli-capillary bed -> inflammation of the alveoli -> exudate formation -> interfere with diffusion of O2 and CO2 -> edema of lung tissue causing obstruction -> inflammation of exudate + edema -> hardening of lung tissue/lubes

85
Q

Clinical Manifestations of Pneumonia

A
  • Sudden onset of fever/chills
  • Chest pain (pleuritic)
  • Tachypnea
  • Headache
  • Mucous or mucopurulent sputum
  • Central cyanosis (includes lips and not only the periphery)
  • Poor appetite (difficulty breathing during eating)
  • Increased tactile fremitus, dullness
86
Q

Complications of Pneumonia

A
  • Shock and respiratory failure
  • Atelectasis and pleural effusion
  • Super infection
87
Q

Nursing Interventions for Patients with Pneumonia

A

• Improve airway potency by:
o Encourage hydration (loosens secretions)
o Humidification (loosens secretions)
o Coughing/deep breathing/incentive spirometer (deep breathing/incentive spirometer helps with lung expansion)
o Chest physiotherapy
• Promote rest and conserve energy
• Promote fluid intake
• Maintain nutrition (d/t decreased appetite)
• Promoting patient knowledge

88
Q

Monitoring/Managing of Potential Complications

A

o Shock/respiratory failure
o Atelectasis/pleural effusion
o Superinfection
o Confusion

NURS 313R (18 decks)

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