exam 2 Flashcards
(178 cards)
1
Q
What is bronchoscopy?
A
Direct inspection of the larynx, trachea, and bronchi using a flexible or rigid fiberoptic bronchoscope.
2
Q
What are the purposes of bronchoscopy?
A
Tissue visualization to determine location and extent of patho process, secretion selection, biopsy, determine where tumor can be surgically resected, and diagnose source of hemoptysis.
3
Q
What are the pre-bronchoscopy procedures?
A
Informed consent, NPO 10-12 hours, local anesthetic throat spray, upright position, and may give atropine to dry up secretions.
4
Q
What are the post-bronchoscopy procedures?
A
Keep NPO, assess for gag reflex, ice chips once gag reflex returns, monitor respiratory rate, and monitor for hypoxia, hypotension, tachycardia, and dysrhythmia.
5
Q
What are common complications of bronchoscopy?
A
Fresh blood, prolonged fever, infection, aspiration, laryngospasm, bronchospasm, and hypoxemia.
6
Q
What are Pulmonary Function Tests (PFTs) used for?
A
Used in patients with chronic respiratory disorders to aid diagnosis and evaluate airflow obstruction.
7
Q
What is the percentage of atmospheric O2?
A
21%.
8
Q
What are noninvasive O2 therapies?
A
O2, nebulizer, and CPT.
9
Q
What are invasive O2 therapies?
A
Intubation, mechanical ventilation, and surgery.
10
Q
What is the flow rate and percentage of a simple mask?
A
5-8 L/min, 40-60%.
Fits over nose and mouth; need to do mouth care.
11
Q
What is the percentage of a non-rebreather mask?
A
60-100%.
Both valves on.
12
Q
What is the flow rate and percentage range for a Venturi mask?
A
4-10 L/min, 24-55%.
Interchangeable percentage dials.
13
Q
What is the flow rate and percentage for a partial rebreather mask?
A
6-15 L/min, 70-90%.
Patient rebreathes CO2; keep reservoir bag 2/3 full; 1 valve off.
14
Q
What is incentive spirometry?
A
A device encouraging deep breathing for maximum lung expansion to prevent or reduce atelectasis.
10-25 breaths an hour.
15
Q
What is a nebulizer?
A
A handheld device that delivers medication in mist form, driven by air.
Used for asthma or COPD patients with difficulty clearing secretions.
16
Q
What is a spacer used for?
A
To prevent medication from getting stuck in the nebulizer.
17
Q
What is chest physiotherapy (CPT)?
A
Techniques to improve lung function and loosen secretions.
Usually done by respiratory therapist.
18
Q
What is the purpose of chest tubes?
A
To remove excess air, fluid, or blood and to re-expand the involved lung.
19
Q
What is required for chest tube management?
A
CXR every morning.
20
Q
What should you notify the HCP about regarding a chest tube?
A
If it is bright red or draining over 100ml/hr.
21
Q
What does a chest tube drainage system include?
A
Suction source, collection chamber, and mechanism to prevent air from reentering the chest.
22
Q
What should you do when transferring a patient with a chest tube?
A
Place the tube below the patient so it can drain by gravity.
23
Q
What does a normal air leak monitor look like?
A
Tidaling.
24
Q
What does an abnormal air leak monitor look like?
A
Lots of bubbles or no movement.
25
What do you need at the bedside for a chest tube patient?
Vaseline gauze and padded clamp.
26
What should you monitor for a chest tube?
Respiratory status and check for crepitus.
27
If a patient's chest tube gets dislodged, what should you do?
Have the patient cough and exhale to prevent air from entering the pleural cavity; plug with Vaseline gauze.
28
If a patient's chest tube disconnects from the chamber tube, what should you do?
If not contaminated, reconnect quickly with antiseptic swab and monitor for respiratory problems.
29
What should you do if the air chamber is broken?
Put the distal end in 250ml of sterile saline and get a new one.
30
What should you NEVER do with a chest tube?
Milk it.
31
What are the respiratory labs?
ABG, blood cultures, and sputum cultures.
32
What is tuberculosis (TB)?
An infectious disease affecting lung parenchyma, meninges, kidneys, bones, and lymph nodes.
33
What precautions are needed for TB?
Airborne.
34
What precautions are needed for suspected TB?
N95 mask and negative isolation room.
35
What are the manifestations of TB?
Low-grade fever, cough, night sweats, fatigue, weight loss, and hemoptysis.
36
What are the diagnostics for TB?
TB skin test, chest X-ray, QuantiFERON-TB Gold Test, sputum culture (+ AFB), and Mantoux testing.
37
What is the gold standard for TB diagnosis?
3 positive AFBs.
38
What is Mantoux testing?
PPD test, dermal, checked 48-72 hours after.
39
What is involved in TB nursing management?
Promote airway clearance, adherence to treatment, adequate activity/nutrition, and prevent TB transmission.
40
What are the classifications of lung cancer?
1. Small Cell Lung Cancer (SCLC): 10–15%
2. Non-Small Cell Lung Cancer (NSCLC): 85–95%
Survival depends on type/stage.
41
What are common manifestations of lung cancer?
**Often asymptomatic until late. **
- Cough (± sputum, ± blood)
- Change in cough
- Dyspnea
- Chest pain
- Persistent 'infections'
- **Hoarseness, dysphagia **
- Weakness, anorexia, weight loss.
42
What are the diagnostics for lung cancer?
- Chest X-ray
- CT/MRI
- Fine-needle biopsy
- PET scan.
43
What are the treatment options for lung cancer?
- Surgery
- Chemotherapy
- Radiation
- Palliative care.
44
What conditions are included in COPD?
- Chronic bronchitis
- Emphysema.
45
How is chronic bronchitis diagnosed?
Cough and sputum for ≥3 months in each of 2 consecutive years.
46
What are the risk factors for COPD?
- Tobacco exposure
- Age
- Occupation
- Alpha antitrypsin-genetic disorder
- Passive smoking.
47
What are the manifestations of COPD?
- Chronic cough
- Sputum
- Dyspnea
- Increased work of breathing
- Chronic hyperinflation
- Abdominal breathing
- Shoulder heaving/retractions.
48
What are the complications of COPD?
- Respiratory insufficiency/failure
- Pneumonia
- Pneumothorax
- Pulmonary hypertension (cor pulmonale).
49
What is involved in nursing management for COPD?
- Airway clearance
- Improved breathing
- Activity tolerance.
50
What causes asthma?
Airway hyperresponsiveness, mucosal edema, and mucus production.
51
How is asthma characterized?
Chronic condition characterized by airway inflammation.
52
What are the manifestations of asthma?
- Cough
- Dyspnea
- Wheezing
- Prolonged expiration
- Diaphoresis
- Tachycardia
- Life-threatening hypoxemia.
53
What are the diagnostics for asthma?
- Episodic airflow obstruction
- Partial reversibility
- Exclude other causes
- Sputum culture & sensitivity
- Blood: eosinophilia, ↑ IgE
- ABG: Initially: hypocapnia, resp. alkalosis; Later: hypercapnia
- ↓ FEV₁ and FVC.
54
How to manage asthma exacerbations?
- Written action plans
- Quick-acting β2-agonists
- Systemic corticosteroids
- Oxygen
- Antibiotics (if comorbidities)
- Peak flow monitoring.
55
What is involved in nursing management for asthma?
- Assess respiratory status
- Take full history
- Identify current medications
- Administer and monitor response to meds
- IV fluids
- Patient education: Asthma Action Plan.
56
What is the normal pH range?
7.35-7.45
57
What is the normal PCO2 range?
35-45
58
What is the normal HCO3 range?
22-26
59
What is the normal PAO2 range?
80-100
60
What is pneumonia?
Inflammation of the lung parenchyma caused by many microorganisms.
61
What is Community Acquired Pneumonia (CAP)?
Occurring in the community or within < 48 hours of hospital admission.
62
What is Hospital-Acquired Pneumonia (HAP)?
Occurring > 48 hours after hospital admission that did not appear to be present at time of admission.
63
What is Ventilator Acquired Pneumonia (VAP)?
Type of HAP that develops > 48 hours after endotracheal intubation.
64
What are some reasons a patient might get VAP?
- Lack of suction
- HOB not elevated
- Daily sedation vacations
- Prophylactic pepsin
- DVT prevention
- Oral care
65
What is Health-Care Acquired Pneumonia (HCAP)?
- Hospitalization for > 2 days in an acute care facility within 90 days
- Residence in nursing home or LTAC
- Antibiotic therapy, chemotherapy, or wound care within 30 days of current infection
- Hemodialysis treatment in a hospital or clinic or home infusion therapy
- Family member with infection due to MDR bacteria
66
What is aspiration pneumonia?
Happens in patients who have feedings and are lying flat.
67
How do you prevent aspiration pneumonia?
- Hold feed when patient needs to be moved
- Keep HOB elevated
- Check residual every couple of hours
68
What are the pneumonia risk factors?
- Age > 65 years
- Alcoholism
- Multiple medical comorbidities
- Residency in LTAC
- Underlying cardiopulmonary disease
- Structural lung disease
- Corticosteroid therapy
- Malnutrition
- Encourage pneumococcal vaccination for all patients > 65 years
69
What is the gold standard for pneumonia diagnostic?
Chest x-ray with inflammation and infiltration in the lungs.
70
How often is the pneumonia vaccine given?
- After 65 years old
- 2nd booster by 70
71
How do you get rid of crackles?
Diuretics.
72
What is musculoskeletal pain?
- Dull, deep ache, boring in nature
- Can interfere with sleep.
73
What is fracture pain?
Sharp due to muscle spasms or pressure.
74
What is the timing of RA pain?
Morning.
75
What is the timing of Osteoarthritis pain?
Evening.
76
What is the timing of tendinitis pain?
Worse in the morning and gets better throughout the day.
77
What is included in a nutrition assessment of the musculoskeletal system?
Dietary considerations for calcium and phosphate intake.
78
What is paresthesia?
Abnormal sensations due to nerve compression.
79
How do you assess gait?
Have patient walk a short distance.
80
What are diagnostic tests for the musculoskeletal system?
- Bone scan
- Bone density
- Arthrocentesis
- X-ray
81
What are X-ray studies for the musculoskeletal system?
- Bone density
- Texture or erosion
82
What is MRI used for in the musculoskeletal system?
- Torn muscle, ligament, cartilage
- Herniated discs
- NO metal!
83
What is arthrography used for in the musculoskeletal system?
- Identifies cause of joint pain and progression of joint disease
- Uses contrast! --> If it starts leaking, they know there's a tear.
84
What are nursing interventions for Bone Densitometry?
- Assess for allergies (if contrast agent used)
- Assess for contraindications (e.g., pregnancy, claustrophobia, debility, metal implants)
- Post-procedure teaching
- Pain management
- Activity restrictions
- Joint mobility
- Tests for osteoporosis
- 'DEXA'
- Must lay flat.
85
What are nursing interventions for a bone scan?
- Assess for allergies to radioisotope
- Assess contraindications (pregnancy, breastfeeding)
- Empty bladder
- Pre-procedure teaching (discomfort from isotope)
- Post-procedure teaching; Encourage fluid intake.
86
What are the pre-procedure steps for arthrocentesis?
- Prepare patient
- Hair removal
- Teaching
- Analgesic use.
87
What are the post-procedure steps for arthrocentesis?
- Ice application
- Possible antibiotics
- Teach signs of complications: Fever, Excessive bleeding, Swelling, Numbness.
88
What is the pathophysiology of osteoporosis?
- Degenerative bone disease
- Reduced bone mass
- Creation of new bone doesn't keep up the loss of old bone
- Porous brittle fragile bones --> easy fractures.
89
What are the risk factors for osteoporosis?
- Small frame older women
- Post menopausal women due to loss of estrogen
- Nutrition - adequate calcium and vitamin D
- Gastric bypass patients - due to duodenal bypass.
90
What are the diagnostic findings for osteoporosis?
- DEXA scan Bone densitometry (anyone with risk factors should have a baseline)
- Bone density test
- T-score < 2.
91
What is the pharmacologic therapy for osteoporosis?
- Calcium Daily dose for women – 1200mg; Daily dose for men – 1000mg
- Biophosphonate; Binds to surface of bone to slow down reabsorption of the osteoclasts
- Vitamin D
- Hormones.
92
What are the nursing diagnoses for osteoporosis?
- Deficient knowledge
- Acute pain
- Risk for constipation or injury: Due to increased calcium in diet.
93
What is the pathophysiology of osteoarthritis?
- Non-inflammatory degenerative disorder of the joint
- Cartilage wears down over time
- Bone spurs protrude into bone space.
94
What are the risk factors for osteoarthritis?
Older people, athletic people, female, obesity
95
What is the purpose of osteoarthritis pharmacological therapy?
Decreases pain and stiffness, maintains and improves mobility
96
What are common medications used in osteoarthritis therapy?
NSAIDs, Tylenol
97
What is a cast?
A rigid, external immobilizing device
98
What are the functions of a cast?
Immobilize a reduced fracture, correct or prevent a deformity, apply uniform pressure to soft tissue, molded to contour of the body, stabilize a weakened joint, allows bones to heal
99
What are splints and braces used for?
Simple, stable fractures, tendon injuries, non-circumferential (no circulation compromise)
100
What is the role of braces?
Custom fit by orthopedic technicians
101
What are the 5 P's to monitor for musculoskeletal care?
Pain, pallor, pulselessness, paresthesia, paralysis
102
What nursing management is required before application of cast/splint/braces?
Neurovascular assessment, patient education
103
What nursing management is required after application of cast/splint/braces?
Assess every 4 hours for the first 24 hours, then every 1-4 hours for neurovascular compromise, elevate limb above heart for 24-48 hours
104
What are the pain management strategies for cast/splint/braces?
Immobilize, ice or cold packs (do not wet cast)
105
What extra considerations should be taken for cast/splint/braces?
Tetanus booster, monitor for systemic infection (especially with open wounds)
106
What are the complications of cast/splint/brace application?
Compartment syndrome, pressure ulcer
107
What should be included in patient education before cast application?
Explain condition and purpose of cast, what to expect during casting (e.g., heat from hardening), cast care: keep dry, do not cover with plastic, positioning: elevation, use of slings, hygiene, mobility
108
What should be included in patient education after cast application?
Prevent disuse syndrome with exercises, do not scratch or insert objects under cast, cushion rough edges, report signs: persistent pain/swelling, changes in sensation, movement, color/temp, signs of infection or pressure, follow-up care, cast removal
109
What is compartment syndrome?
Increased pressure → ischemia → neuromuscular damage, usually in long limbs
110
What are the signs of compartment syndrome?
Dusky/pale color, cool limb, delayed cap refill, paresthesia, unrelenting pain
111
What is the treatment for compartment syndrome?
Loosen or bivalve cast, fasciotomy (release the skin), emergent – call the doctor; must be loosened or cut
112
What causes a pressure ulcer?
Pressure → tissue anoxia
113
What are the signs of a pressure ulcer?
Painful 'hot spot', tightness, warmth, odor
114
What is the treatment for a pressure ulcer?
Bivalve or cut a window in cast
115
What are external fixators used for?
They are used for complex open fractures with soft tissue damage, fractures of humerus, forearm, femur, tibia, and pelvis.
116
What are the benefits of external fixators?
They provide external stability with wound access, allow early mobilization, and result in less blood loss.
117
What are the risks associated with external fixators?
There is a risk of infection at the pin site.
118
What are the pros of external fixators?
They can immediately stabilize fractures, result in minimal blood loss, provide comfort, and allow patients to weight bear.
119
What are the cons of external fixators?
Pins can get loose and there is a risk of infection.
120
What are the signs of inflammation/infection at the pin site?
Warmth, redness, swelling, and purulent drainage.
121
What is considered normal drainage for external fixators?
Serous drainage is normal for the first 48-72 hours.
122
What is the recommended cleaning technique for external fixators?
Aseptic technique using chlorhexidine.
123
What nursing management is needed for external fixators?
Patient education before application, elevate limb to heart level, and perform neurovascular assessments.
124
What is traction?
A pulling force to align a body part.
125
What are the goals of traction?
To reduce muscle spasms/pain, realign fractures, and prevent/correct deformities.
126
What are the types of traction?
Buck's extension traction, skin traction, skeletal traction, and manual traction.
127
What is an important consideration for traction?
Never remove weight unless in a life-threatening situation.
128
What is a contusion?
A soft tissue injury characterized by hematoma and bruising.
129
What is a strain?
An injury to muscle or tendon from overuse, often referred to as a 'muscle pull'.
130
What can chronic strain result from?
Improper management of an acute strain.
131
What is a sprain?
An injury to ligaments/tendons from twisting or hyperextension of a joint.
132
What characterizes a Grade 1 sprain?
Stretching and small tears; mild hematoma may form.
133
What characterizes a Grade 2 sprain?
More severe with partial tearing of the ligament; tenderness and ecchymosis.
134
What characterizes a Grade 3 sprain?
A complete tear of the ligament.
135
What does RICE stand for in injury management?
Rest, Ice, Compression, Elevation.
136
What is the nursing management for contusions, strains, and sprains?
Protection from further injury, ice intermittently for 1st 24-72 hours, NSAIDs for pain, neuro assessments, and motor sensory and vascular function.
137
What is a greenstick fracture?
A common fracture in kids characterized by a partial break.
138
What is a comminuted fracture?
A fracture where the bone has splintered into several fragments, possibly requiring pins and rods.
139
What is a closed/simple fracture?
A fracture with no break in the skin.
140
What is an open/compound fracture?
A fracture that involves the skin or mucous membrane.
141
What is fat embolism syndrome?
A condition associated with pelvic fractures, long bone fractures, and crush injuries where fat globules diffuse into the vascular compartment.
142
What is the classic triad of fat embolism syndrome?
Hypoxemia, neurologic changes, and petechial rash.
143
What is the treatment for fracture complications?
Respiratory support due to ARDS risk and corticosteroids.
144
What is shock in the context of fractures?
Hypovolemic shock from hemorrhage, particularly in pelvic and femoral fractures.
145
What is the management for shock?
Stabilize the fracture and restore blood volume.
146
What are the indications for joint replacement?
Severe joint pain/disability due to osteoarthritis, RA, trauma, congenital deformity, or AVN.
147
What are the most common joint replacements?
Hip and knee.
148
What is joint arthroplasty?
Replacement with metal or synthetic parts aimed at pain relief, improved function, and mobility.
149
What is the post-operative care for hip/knee replacement?
Begin ambulation ~1 day after surgery, follow weight-bearing precautions, assess for bleeding, prevent infection, and educate on rehab.
150
What are the post-operative complications for hip/knee replacement?
**Hypovolemic shock**, atelectasis, pneumonia, urinary retention, infection, **DVT/PE**, and constipation/fecal impaction.
151
What interventions are recommended for hip/knee replacement?
Use an abduction pillow, perform muscle setting and ankle/calf pumps, ensure nutrition & hydration, skin care, and follow rehab/PT programs.
152
What are the indications for amputation?
Circulatory disorders, trauma, malignancy, infection, and deformity.
153
What are the objectives of amputation?
Relieve pain, promote healing, restore mobility, and prevent complications.
154
What is the primary goal of positioning post-amputation?
Prevent contractures
155
What should be done with the limb immediately after surgery?
Keep limb extended briefly after surgery
156
What movements should be avoided in post-amputation positioning?
Abduction, External rotation, Flexion
157
What technique should be encouraged for post-amputation patients?
Encourage side-to-side turning
158
What positioning technique can be used for post-amputation patients?
Use prone positioning
159
What type of exercises should be incorporated post-amputation?
ROM exercises
160
What tool can be used for repositioning post-amputation?
Overhead trapeze for repositioning
161
What are signs of a respiratory problem?
Restlessness and confusion; check vital signs and oxygen levels.
162
How much oxygen can COPD patients receive?
1 to 2 L O2.
163
What is COPD characterized by?
Gas exchange problem, hyperinflation of lungs, alveoli obstruction.
164
What does the access fraction assessment include?
6 P's: inspection, distal pulses, color (pallor).
165
What is a key symptom of Fat emboli syndrome?
Fever.
166
What indicates compartment syndrome after surgery?
The patient has a fracture, 6 P's, leg pale, decreased pulses.
167
What symptoms alert someone with a circulatory problem when with a cast?
Tingling, no feeling in the arm.
168
When does a RA patient typically feel better?
In the morning.
169
How does pain present in osteoarthritis?
Pain gets worse as the day goes on; they must rest to relieve the pain.
170
What is a potential risk for knee replacement?
DVT is the main issue, along with emboli.
171
What does 'itis' indicate?
Infection.
172
Who is at risk for osteoporosis?
Gastric bypass patients.
173
What is bronchoscopy?
A procedure to view the airways.
174
What should be done if a chest tube is pulled out from a patient?
Apply Vaseline gauze, cough, and exhale.
175
What indicates a positive result in bronchoscopy?
3 positive sputum cultures AFB.
176
What should you not do and look for with a pelvic fracture?
do not add a foley, look for suprapubic distention
177
How is a hip fracture diagnosed?
x-ray
178
what is the hip fracture protocol?
adduct and externally rotated, use abduct pillow to abduct the legs and prevent leg crossing
