Exam 1; Week 3 Flashcards
(85 cards)
1
Q
define ventilation
A
the process of moving gases into and out of the lungs,
- requires muscular and elastic properties of the lungs and thorax to be coordinated
2
Q
define perfusion
A
the cardiovascular system must have the ability to pump oxygenated blood to the tissues and then return it to the lungs.
3
Q
define diffusion
A
the movement of respiratory gases from one area to another by concentration gradients
4
Q
Contraction of WHAT pumps blood to lungs via pulmonary arteries?
A
rt. ventricle
5
Q
Oxygenated blood returns from lungs via WHAT to left arteries of heart?
A
pulmonary veins
6
Q
What is the condition where normal exchange of oxygen and carbon is altered by a collapse in the alveoli?
A
atelectasis
7
Q
Is atelectasis a disease or a condition that results from disease or abnormalities?
A
condition that results…
8
Q
What are 5 causes of atelectasis?
A
- infection
- blockage of airways (mucus, tumor, or foreign body)
- compression
- scarring from radiation
- pneumothorax or immature lungs
9
Q
What are 7 risk factors for atelectasis>
A
- advanced age
- immaturity
- smoking
- immobility
- CHF
- trauma
- obesity
- lung disease
10
Q
What are 4 clinical manifestations of atelectasis?
A
- dyspnea
- diminished lung sounds
- rales
- decreased O2 sat
11
Q
What are 4 treatment options for atelectasis?
A
- IS
- TCDB
- Adequate pain relief
- pulmonary hygiene
12
Q
What is inflammation of the lung parenchyma (alveolar spaces) creating a build up of fluid and excitement in the alveoli; decreasing gas exchange:
A
pneumonia
13
Q
What can cause pneumonia
A
- bacteria
- virus
- fungus
- gastric contents
- chemical
14
Q
What are 5 types of pneumonia?
A
- community-acquired
- hospital acquired
- ventilator-associated
- aspiration
- opportunistic
15
Q
What are 7 clinical manifestations of pneumonia?
A
- dry or productive cough
- colorful sputum
- fever
- pleuritic CP
- SOB
- increased heart rate
- adventitious lung sounds - rhonchi, crackles
16
Q
What are ways to diagnose pneumonia?
A
- CXR
- CBC
- sputum culture
- gram stain
- blood cultures - obtain cultures prior to antibiotic admin
17
Q
What are 5 treatment options for pneumonia?
A
- oxygen therapy as indicated
- antibiotics
- rest
- fluids
- antipyretics
- nutrition
18
Q
What do you want to encourage with pneumonia?
A
adequate pulmonary toilet
19
Q
What are ways to prevent pneumonia?
A
- good hand washing
- vaccinations
- avoid exposure and aspiration precautions
20
Q
What is a blockage of one or more pulmonary arteries by fat or thrombus, amniotic fluid or tumor tissue.
A
Pulmonary embolism
21
Q
Why are the lungs an ideal place for a PE?
A
due to its extensive vascular network.
22
Q
What part of the lungs are most often affected by PE?
A
lower lobes
23
Q
the majority of fatalities occur within how many hours after onset of a PE?
A
1-2 hours
24
Q
What does a PE often present as?
A
code arrest
25
A thrombosis is triggered by what 3 things?
1. venostasis
2. hypercoagulability
3. vessel wall inflammation
26
What is the patho of a PE?
Obstruction of pulmonary blood flow causes:
1. Reflex broncho-constriction in the affected region
2. Impaired gas exchange
3. Loss of alveolar surfactant
4. V/Q mismatch- ventilation without perfusion
5. RVF, Pulmonary HTN, tricuspid regurgitation
6. Compression of RCA
7. Elevated BNP and troponins
8. Necrosis of lung parenchyma
27
How is PE diagnosed?
1. CT scan
2. ventilation perfusion scen
3. D-dimes appear within 1 hour after thrombus
4. EKG may show tachycardia and RV involvement
28
How is PE treated?
1. fibronolytics
2. anticoags (heparin, lovenox, Coumadin)
3. embolectomy
29
clinical manifestations of PE are dependent on what?
the size of the emboli
30
How does a small emboli feel?
1. Pleuritic chest pain
2. cough
3. fever
4. wheezing
5. crackles
6. dyspnea
7. hemoptysis
8. hypoxia
31
How does a massive emboli feel?
1. change in mental status
2. a sense of pending doom
3. hypotension
4. pallor
5. sudden cardiac arrest
32
What is early thrombus prevention?
1. early ambulation
| 2. SCDs
33
What is supportive therapy for PE?
1. IV fluids
2. med admin
3. monitor lab values for safe admin of anticoagulant (PTT, PT, INR)
34
What is tuberculosis caused by?
mycobacterium tuberculosis; and is infectious
35
What type of precaution spreads tuberculosis?
airborne droplets
36
What does tuberculosis mostly affect? Where can it spread?
a. the lungs
b. can travel through lymph system and settle in the cerebral cortex, spine, bone, liver, kidneys, lymph nodes and adrenal glands
37
Who is most at risk for TB:
1. homeless
2. inner city neighborhoods
3. those living or working in institutions - prisons, long term care, psychiatric facilities
4. immunosuppressed
5. foreign-born
6. Poor and IV drug users
38
What is a Latent TB infection?
TB germs are in the body, but not enough to cause sickness or spread germs to others
39
What are other illnesses that are put in airborne precautions?
1. measles
2. varicella - chicken pox
3. Severe acute respiratory. syndrome (SARS).
40
What are signs and symptoms of TB?
1. A bad cough that lasts longer than three weeks.
2. Chest Pain
3. Coughing up blood or
4. tenacious sputum
5. Fatigue or weakness
6. Weight loss / no appetite
7. Chills and Fever
8. Night sweats
9. Lungs may sound normal or have crackles or other adventitious sounds
41
How long is treatment for TB?
6 to 9 months
42
What are the 4 most common meds to treat TB?
1. Isoniazid
2. Rifampin
3. Ethambutol
4. Pyrazinamide
43
What are the 3 things that make up COPD?
1. Emphysema
2. Bronchitis
3. Asthma
44
What is a preventable disease with persistent airflow limitation that is usually progressive?
COPD
45
What are the primary sources of illness in COPD patients?
1. cigarette smoking
2. recurrent rasp infections
3. alpha-1 antitrypsin deficiency or exposure to other noxious particles
46
What is the 3rd leading cause of death in the U.S.?
COPD
47
What are clinical manifestations of COPD?
1. Cough
2. sputum production
3. progressive dyspnea first with exertion then later with rest
4. use of accessory muscles,
5. barrel chest
6. fatigue
7. polycythemia
8. CO2 retention.
48
People with COPD generally have a history of what 4 things?
1. smoking
2. chem exposure
3. GERD
4. Infection
49
What are lab tests used for COPD?
1. strep pneumonia
| 2. Haemophilus influenzae
50
What is there an increase in with COPD patients?
increase in residual volume because of air trapping
51
What are the 4 parts of pulmonary rehabilitation for COPD?
1. exercise program
2. disease management training
3. nutrition counseling
4. psychological counseling
52
Important nursing education for COPD:
1. What is COPD?
2. Breathing and Airway Clearance 3. Exercises
4. Energy conservation Techniques
5. Medications (including correct use of inhalers, spacers or nebulizers).
6. Home Oxygen
7. Psychosocial/Emotional Support
8. COPD management Plan
9. Healthy Nutrition
53
What is a persistent but variable inflammation of the airways
asthma
54
What is the inflammation result in-in asthma?
results in edema of the airways, bronchoconstriction, and airway hyperactivity
55
What are 2 treatment options for asthma?
1. bronchodilators
2. anti-inflammatory meds
3. O2 admin and monitoring
4. IV fluid admin
5. pt. education regarding drug therapy and med adherence. Also teach pt. to identify triggers and eliminate them if possible
56
What are symptoms of asthma?
1. Wheezing
2. diminished lung sounds
3. paroxysmal coughing
4. chest tightness
5. dyspnea
6. tachycardia
7. tachypnea
57
What are diagnostics for asthma?
1. H & P
2. PFTS
3. peak flow meter
4. eosinophil count
5. IgE levels (allergic propensity)
6. allergy skin testing
58
define enteral nutrition/tube feeding
nutrition delivered in the GI tract through a surgically placed tube in the stomach.
59
What are 3 reasons why a child might use a GI tube?
1. child has functioning GI tract but cannot take any or enough oral nourishment OR it is unsafe to do so.
2. When passage of a tube through the mouth, pharynx, esophagus or cardiac sphincter of the stomach is contraindicated.
3. To avoid the constant irritation of NG tube in children who require tube feeding over an extended period of time.
60
Who gets G-tubes?
1. neurologic impairment
2. prematurity with poor suck/swallow
3. GI anomalies
4. craniofacial anomalies
5. cystic fibrosis
6. genetic disorders
7. metabolic disorders
8. malignancy
9. inflammatory bowel disease
10. burns/trauma
61
How is a G-tube placed? with what?
under general anesthesia
62
What does PEG stand for?
percutaneous endoscopic gastrostomy
63
What is the state of patient when they are getting a PEG?
Pt. sedated and local anesthesia for placement with an endoscope
64
What is a gastrostomy feeding button?
MIC
65
What is a MIC
a flexible silicone device
66
When is a MIC used?
in children who require long term enteral feedings
67
What is nice about a MIC?
allows extension tubing to be put on and taken off, easy to care for, cosmetically pleasing, extension tubing has med port and washable with soap and water.
68
What kind of device bypasses the stomach?
GJ-tube (gastric jejunum)
69
Why would someone use a GJ-tube?
1. recurrent aspiration
2. pneumonia
3. severe gastroesophageal reflux
4. gastric outlet obstruction
5. poor gastric emptying
70
What are 4 sources of nutrition for someone who has a G-tube?
1. breast milk
2. formula
3. H2O
4. special ordered formula
71
What are 2 methods of feeding with a G-tube?
1. Bolus - by gravity in a syringe
| 2. intermittent or continuous - feeding pump
72
How do you want to take care of a site where there is a G tube?
1. keep clean and dry
2. use soap and water
3. avoid dressings
4. avoid ointments unless prescribed
5. prevent pulling on tube
73
What can pulling on a tube do?
granulation tissue may develop around site
74
A child with a G-tube can bathe, swim, or lay on abdomen how many weeks after placement?
1 week
75
What are 4 complications that can come with a G-tube?
1. feeding intolerance - nausea and diarrhea
2. tube placement, breakage, occlusion, or migration
3. excessive granular tissue from pulling
4. site infection
76
What are some things to remember when administering a med through a G-tube?
1. use correct port
2. do not add med to the formula in the feeding bag
3. give each med separately, using a syringe
4. always flush with water before, during, and after
5. use liquid form of med whenever possible; dilute med if needed
6. Crush immediate release tablets and mix with water
7. do not crush extended release, enteric coated or capsules
8. always follow facility protocol and consult pharmacy as needed
77
Define gavage feeding:
feeding by gravity
78
Why would a child use gavage feeding tube?
1. If they are unable to feed orally
2. unable to coordinate suck, swallow, and breathing
3. too weak to suck effectively
4. lack of a gag reflex
79
Why are feeding tubes utilized?
to instill the feeding for infants as well as other children
80
Where are feeding tubes placed?
1. nose
| 2. mouth
81
When inserting a feeding tube, what point is the second marker?
between diploid and umbilicus
82
How can you check the placement of a feeding tube? (hint: 3 ways)
1. auscultate small amount of air given through the tube using a syringe.
- Listen to air pop with stethoscope
2. x-ray
3. aspirate stomach contents
83
When administering NG/OG feedings, what do you need to remember to check?
placement
84
Gavage feeding is by what?
gravity/bolus
85
Intermittent feeding is by what?
syringe of kangaroo pump
