Exam 1 - Respiratory Flashcards
(169 cards)
1
Q
narrowest portion of the upper airway
A
laryngeal
2
Q
frequent location of airway obstruction
A
laryngeal
3
Q
laryngeal obstruction is a ___-___ _____
A
life-threatening emergency
4
Q
most common cause of laryngeal obstruction in adults
A
ingested meat
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)
6
Q
being deprived from O2
A
asphyxia
7
Q
s/sx of asphyxia
A
coughing choking gagging obvious difficulty breathing AMU inspiratory stridor
8
Q
when an individual is choking and stops breathing, what do you initiate?
A
CPR
9
Q
how can the airway become obstructed with laryngeal trauma?
A
edema
fracture of laryngeal structures
hematoma
10
Q
treatment goal with laryngeal injury
A
maintaining an open airway
11
Q
laryngeal injury diagnostic test
A
CT
fiber optic laryngoscopy
flexible bronchoscopy
12
Q
cerebral anoxia
A
when the brain does not get enough O2
13
Q
hypoxemia
A
inadequate oxygenation
14
Q
atelectasis
A
alveoli collapse
15
Q
pulmonary edema
A
fluid in lungs or pleural space
16
Q
hypoventilation
A
slow RR
17
Q
how often to cough-turn-deep breathe
A
q2h
18
Q
what is removed with a total laryngectomy?
A
larynx hyoid bone epiglottis cricoid cartilage several tracheal rings
19
Q
can a pt speak with a laryngectomy tube is closed?
A
No
20
Q
what to monitor for with trach/laryngectomy tubes
A
airway
breathing
infection control
21
Q
surgically created stoma in the trachea to establish an airway
A
tracheostomy
22
Q
3 resons for a tracheostomy
A
bypass airway obstruction
facilitate removal of secretions
permit long-term mechanical vent
23
Q
preferred tracheostomy method
A
minimally invasive percutaneous tracheostomy
use of local sedation and analgesia
24
Q
better option for long term mechanical ventilation
A
tracheostomy
25
when is a pt able to eat and/or speak with a tracheostomy
when the cuff is deflated
26
be familiar with the different parts of a trach
be familiar with the different parts of a trach - slide 21
27
how often are nondisposable inner cannula trachs cleaned?
q8h
28
trach suction time should be limited to how many seconds?
10 seconds
29
d/c trach suctioning if HR decreases __ bpm or increases by ___ bpm
decrease: 20 bpm
increase: 10 bpm
30
do you suction if pt is able to clear secretions on their own by coughing
No
31
how often to reoxygenate after trach suctioning?
30 seconds
| 5-6 breaths/vent
32
trach cuff should not exceed
20 mmHg or 25 cm H2O
33
how often to monitor cuff pressure?
q8h
34
if the trach becomes dislodged, what can be inserted?
obturator
| suction catheter
35
if the trach tube can not be replaced, what should be done?
level of respiratory distress
place in semi-Fowler's
cover stoma with a sterile dressing
ventilate with a bag-mask
36
3 C's to trouble-shoot potential trach problems
cannula
cuff
call for help/code
37
if using an ambubag and the pt has a trach, what do you do with the stoma?
cover with a sterile gauze
38
spontaneous breathing can do what to the trach cuff?
deflate
39
how long to trach a cap before removal to ensure the pt can breathe on their own without complications
24 hours
40
how soon after trach removal does epithelial tissue form? how soon will the stoma close?
24-48 hours
4-5 days
41
___ TB is when TB is in other parts of the body
miliary
42
leading cause of death in HIV/AIDs
TB
43
highest risk for TB
```
homeless
inner city neighborhoods
IV injection users
LTC facilities
prisions
working in a healthcare facility
```
44
TB occurs more frequently in these individuals
poor, under-serviced and minorities
45
how is TB spread?
person-person via airborne particles
requires close, frequent, or prolonged exposure
46
hallmark sign of TB
granuloma
47
long term granuloma can lead to ___ and/or ___
calcification; fibrosis
48
granuloma in latent TB
walled off
49
granuloma in active TB
liquify, pour contents into lungs
50
develops within the first 2 years of TB infection
active TB disease
51
TB disease occurring 2 or more years after the initial infection
reactivation TB (post-primary)
52
is reactivation TB considered dormant?
no
53
NCLEX TB trigger words
```
blood tinged sputum
night sweats
fever
fatigue
anorexia
```
54
with latent TB, will a pt be symptomatic?
asymptomatic with a (+) TB skin test
55
pleural effusion lung sounds
crackles
| rales
56
the time from TB exposure to infection can take how long?
a couple of weeks
57
TB test is aka
Mantoux test
58
when to assess for TB induration
48-72 hours
59
(+) TB in any person
15 mm induration
60
(+) TB with chronic disease, recent immigration, IV drug users
10 mm induration
61
(+) TB in immunocompromise
5 mm induration
62
does a positive reaction mean active TB?
No
63
where is the Mantoux test performed?
forearm; 4" below the elbow
64
where are TB vaccines administered?
UK
| Latin American
65
When is the QuantiFERON-TB and T.SPOT.TB test performed?
when an individual has been vaccinated against TB
66
how often are sputum samples obtained for TB testing?
3 consecutive days
67
how long can it take for TB sputum tests to result
6-8 weeks
68
what can be present in older individuals who have TB?
AMS
69
how long can TB treatment last?
6-12 weeks
70
when is a person considered MDRTB?
resistant to INH and Rifampid
71
initial TB treatment last how long and continues for...
8 weeks; 18 weeks - 1 year
72
Isoniazid labs
LFT
73
Isoniazid education
take 1 hour before meals or on an empty stomach
74
Rifampin education
will change bodily fluids orange
75
Ethambutol education
ocular-toxicity
| color discrimination
76
what is directly observed therapy (DOT)?
requires watching a TB pt swallow their meds
77
how is latent TB treated?
Isoniazid for 6-9 months unless HIV +, take for 9 months
78
Isoniazid can lead to what deficiency?
vitamin b
79
TB isolation
airborne
| negative pressure room
80
nutrition needed for TB
```
proteins
vitamins
calorie replacement
adequate hydration
remain active
```
81
most common cause of lung abscess
aspiration
| PNA
82
where are lung abscesses typically found?
upper lobe
83
risk factors for lung abscess
aspiration
TB
substance abuse
immunocompromised
84
localized area of lung destruction or necrosis and pus formation
lung abscess
85
s/sx lung abscess
```
productive cough
chills, fever
pleurtic chest pain
malaise
anorexia
temperature elevation
purulent sputum (foul-smelling, bad tasting, dark brow or blood streaked)
```
86
what breath sound will be heard if a lung abscess is in the pleural cavity?
friction rub
87
CXR will show an area greater than __cm if there is a lung abscess
2cm
88
large dose of abx therapy will be taken for __ weeks and then PO for __ weeks for a lung abscess
IV: 3 weeks
PO: 12 weeks
89
what may be needed for prior to dental procedures for lung abscess
abx
90
pneumothorax
air in the pleural cavity
91
what kind of pressure space should the chest cavity be?
negative
92
what kind of pressure space is the chest cavity with pneumothorax?
positive
93
open vs. closed pneumothorax
O: external wound
C: no external wound
94
closed pneumothorax increases the risk for ___ ____
tension pneumothorax
95
what are the 5 types of pneumothorax?
```
traumatic - open
traumatic - closed
Iatrogenic
tension
hemothorax
```
96
cause of iatrogenic pneumothorax
puncture, laceration that occurs during a procedure/heath care associated
97
open pneumothorax will have what type of chest wound?
sunken
98
spontaneous pneumothorax occurs in which individuals?
tall, skinny, males
99
spontaneous pneumothorax risk factors
smoking
family hx
high-altitude flying
previous hx of spontaneous pneumothorax
100
s/sx of spontaneous pneumothorax
```
pleuritic chest pain
SOB
tachycardia
tachypnea
asymmetrical chest wall movement
diminished, absent breath sounds
hyperresonant tone
unequal lung expansion
```
101
tension pneumothorax is a medical emergency that affects the ___ and ___ systems
respiratory; cardiovascular
102
s/sx of tension pneumothorax
```
dyspnea
tachycardia
**tracheal deviation**
decreased, absent breath sounds
neck vein distension
cyanosis
profuse diaphoresis
```
103
how to tx tension pneumothorax
needle decompression; chest tube insertion
104
what type of pneumothorax can lead to tension pneumothorax?
closed
105
cause of hemothorax
chest trauma
tumors (most common)
pulmonary infarction
infections (ex: TB)
106
hemothorax treatment
thoracentesis
| thoracostomy with chest tube
107
how to proceed with a penetrating chest wound
cover with an occlusive dressing that is secured on 3 sides
108
when is a partial pleurectomy, stapling, or pleurodesis needed?
repeated spontaneous pneumothorax
109
proper chest tube placement is confirmed by ....
CXR
110
chest tube placement/location for pneumo and hemothorax
p: 2nd intercostal space
h: 5th intercostal space
111
when is a flutter/heimlich valve used
emergency transport
| small-to-moderate pneumothorax
112
what are you looking when managing a chest tube
tidal
continuous bubbling
nothing
113
continuous bubbling with a chest tube system indicates...
air leak
114
nothing happening with a chest tube system indicates...
potential blockage
115
normal fluctuation of the water within the water-seal chamber
tidaling
116
chest tube systems are usually filled with how much water?
20 cm
117
removing too much fluid too quickly (1-1.5L) from a chest tube can potentially lead to which complications?
re-expansion pulmonary edema
| vasovagal response with symptomatic hypotension
118
how to mark chest tube output
mark the line on the chamber
119
what to do when the chest tube is disconnected
submerge in 2cm sterile water
**do not clamp**
120
most common rib fractures occur with ribs __ - __
5-9
121
do you strap or bind the chest with a rib fracture?
No
122
rib fracture treatment
NSAIDs
opioids
nerve block
pt education: deep breathing, coughing, IS
123
when does flail chest occur?
fracture of several consecutive ribs, in 2 or more separate places
124
when will flail chest bulge out?
during expiration
125
the underlying lung of a flail chest may have what?
pulmonary contusion
| aggravating hypoxemia
126
flail chest s/sx
rapid, shallow respirations
tachycardia
asymmetric, uncoordinated chest movement
127
paradoxic movement
occurs with flail chest
chest wall sinks in during inspiration, expands during expiration
128
first thing a nurse should do with respiratory distress
assess the pt!
129
pleural effusion
collection of fluid in the pleural space
130
is pleural effusion a symptom or diagnosis?
symptom
131
2 fluid types with pleural effusion
transudative
| exudative
132
how much fluid should be in the pleural space?
5-15 mL
133
transudative pleural effusion color and indication
clear, pale yellow
increased hydrostatic pressure in HF
decreased oncotic pressure in liver, renal failure
134
exudative pleural effusion color and indication
protein-rich fluid
cancer
135
empyema is aka
pus
136
what is chylothorax?
when lymph is found in the chest cavity
137
s/sx of pleural effusion
```
dyspnea
cough
may have pain
decreased, absent breath sounds
limited chest wall movement
dull percussion
```
**fever + chills if systemic
138
less than 1.5 L of fluid is removed during a thoracentesis to prevent what kind of response?
vasovagal response
139
pt positioning for a throancentesis
tripod
140
how should a pt be positioned after a throancentesis and for how long?
lying on the unaffected side x1 hour
141
pleuritis
inflammation of the pleura
142
s/sx of pleuritis
```
pain aggravated by deep breathing, coughing, movement
rapid, shallow respirations
limit chest wall movement
diminished breath sounds
pleural friction rub
```
143
pleuritis treatment
analgesics
NSAIDs
codeine: relieve pain, suppress cough
positioning, splinting chest while coughing
144
___ ___ can be a complication of pleuritis
pleural effusion
145
pleuritis s/sx to report to HCP
increased fever
productive cough
difficulty breathing
SOB
146
pleurodesis
creating of adhesions between parietal and visceral pleura
catheter inserted into pleural space, then a chemical is inserted
147
why would a pt have a pleurodesis performed?
prevent recurrent pneumothorax
148
chest tightness and pain associated with pleurodesis is __ __
short term
149
what f/u diagnostic test is performed to ensure pleurodesis is holding
CXR
150
mobile clot
embolis
151
clot
thrombus
152
blockage of one or more pulmonary arteries by a thrombus, fat or air embolus, or tumor
PE
153
PE risk factors
```
immobility
sx within last 3 months
hx of DVT
oral contraceptives
smokers
prolonged travel
hx of afib
```
154
most common presenting symptom of PE
dyspnea
155
s/sx of PE mimic s/sx of
R sided HF
156
can a d-dimer result be definitive of a PE or clot?
No
157
most common used test to Dx PE
spiral (helical) CT scan
aka CT angiography or CTA
158
if a pt can not have contract, which test is used to Dx PE
ventilation-perfusion (VQ) scan
159
what are the 2 components to a VQ scan?
perfusion: pulmonary circulation
ventilation: distribution of gas throughout the lung
160
PE drug of choice
heparin
161
PE prevention
```
early ambulation
SCD
elevate lower extremities
active, passive ROM exercises
prophylactic anticoags
```
162
is you suspect a PE, what positioning should a pt be in?
bedrest, semi-Fowler's
163
pulmonary hypertension
elevated pulmonary artery pressure resulting from an increase in resistance to blood flow through pulmonary circulation
164
normal pulmonary wedge pressure
12-16
165
wedge pressure with pulmonary hypertension
> 25 at rest
> 30 with exercise
166
is there a cure for pulmonary hypertension
no, meds given to increase survival rate
may become a transplant canidate
167
causes of pulmonary hypertnesion
primary: idopathic
secondary: complication r/t respiratory, cardiac, autoimmune, hepatic or connective tissue disorder
168
pulmonary hypertension s/sx
```
SOB
dyspnea on exertion
chest pain on exertion
fatigue
dizzy
snycope
```
*R sided HF s/sx as progresses
169
meds for pulmonary hypertension
```
Diuretics (PRN)
O2
Digoxin
anticoags
possibly CCB
```
