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adults exam 1 > management of pts with chest and lower respiratory > Flashcards

management of pts with chest and lower respiratory Flashcards

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1
Q

atelectasis

A

complete or partial collapse of the entire lung or area of the lung. When tiny alveoli within the lung become deflated

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2
Q

pneumonia

A

fluid in the lungs, one of the most common causes of death in U.S.

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3
Q

aspiration

A

something going down the wrong pip (ex. fluid into lung)

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4
Q

tracheobronchitis

A

inflammation of the trachea and bronchi (purulent sputum) classified as respiratory tract infection

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5
Q

pulmonary tuberculosis

A

serious infection caused by bacterium mycobacterium tuberculosis that involves the lungs but may spread to other organs, highly contagious (put in negative pressure room)

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6
Q

acute atelectasis

A

when the lung recently collapsed and is primarily notable only for airlessness (take care of right away)

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7
Q

chronic atelectasis

A

the affected area characterized by a complex mixture of airlessness, infection, widening of the bronchi, destruction, and scarring (maintenance)

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8
Q

who’s at risk for atelectasis

A

surgical patients, immobilized patients, increased age

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9
Q

symptoms of atelectasis

A

increasing dyspnea, cough, sputum production, respiratory distress, tachycardia, tachypnea, central cyanosis (late sign)

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10
Q

prevention for atelectasis

A

early mobilization, frequent turns, manage secretions, IS, deep breathing, fluids

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11
Q

before and after breathing treatment, what do you assess

A

pulse ox

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12
Q

types of pneumonia: community acquired

A

get it when out in public, symptoms can occur less than 48 hours after admitted

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13
Q

types of pneumonia: health care associated

A

non hospital areas (nursing homes, rehab) occurred in another health care setting

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14
Q

types of pneumonia: hospital acquired

A

more than 48 hours after admitted they develop pneumonia (hospitals fault)

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15
Q

types of pneumonia: ventilator associated

A

48 hours after intubated (ex. came into hospital had brain bleed and needed to be intubated, 48 hours after admitted on a ventilator)

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16
Q

types of pneumonia: immunocompromised

A

HIV/ AIDS/ cancer pts

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17
Q

types of pneumonia: aspiration pneumonia

A

water down into lungs and can’t cough it up (risk are stroke pts/ babies/ older population with weakness in swallowing muscles)

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18
Q

pneumonia can be

A

viral, fungal, or bacterial

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19
Q

path-physiology of pneumonia

A

presence of bacterial, mycobacterial, viral, or fungal in the lung -> causes inflammation in the lung tissues (alveoli) -> affects ventilation and diffusion -> decrease in alveolar oxygen tension mismatched ventilation & perfusion -> arterial hypoxemia

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20
Q

risk factors for pneumonia

A

age, exposure, immune state, nutritional state/ impaired swallowing, prolonged mobility, smoking

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21
Q

what types of patients may have pneumonia onto of another disease

A

COPD pts, cystic fibrosis pts, cancer pts

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22
Q

s/sx of pneumonia

A

hypoxia, fever, orthopnea, tires easily, sputum production (green/ blood tinged)

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23
Q

how to diagnose pneumonia

A

initial assessment (check BUN & creatinine before giving dye), sputum culture, chest xray, bronchoscopy, tissue biopsy

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24
Q

for pneumonia, when checking the CBC what might you see

A

high WBC, decrease in hemoglobin (all protein is going to make WBC to fight infection and leaves hemoglobin on back burner -> oxygen level will go down)

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25
Tx for pneumonia
check cultures (need deep mucus, not just spit), start with broad spectrum antibiotic and later change as needed, oral or IV
26
prevention of pneumonia
flu shot, pneumococcal vaccine (older adults or chronic illness pt), avoid pollutants, avoid infectious situations, maintain hydration, physical activity, isolate if infected, hand hygiene
27
pleural effusion
extra fluid in the pleural space between the visceral and parietal membrane (doesn't allow lungs to expand)
28
if WBC is low you can indicate
viral infection or chronic stress
29
if WBC is high you can indicate
bacterial infection or acute stress
30
complications if covid 19
pleural effusion, shock & respiratory failure
31
covid 19 is what type of transmission
viral, air borne, droplet
32
TB is transmited by
airborne, droplet (coughing, sneezing laughing)
33
TB can spread to
lungs, meninges (in brain), kidneys, bones, lymph nodes
34
s/sx of pulmonary TB
low grade fever, cough, night sweats, fatigue, weight loss
35
how to diagnose pulmonary TB
being suspicious, pt history, rust colored sputum, acid fast bacillus smear, sputum culture, skin testing, chest xray, TB blood tests
36
CDC recommended TB test
quantiferon TB gold test instead of Mantoux
37
if you get the Mantoux TB test (intradermal injection of PPD), if it comes back positive what does that mean
it does not mean you have active TB, just means you may have been exposed
38
positive result of Mantoux testing will look like what
induration at site (hardening)
39
TB treatment
combination of 4 drugs (INH, rifampin, ethambutol, pyrazinamide
40
with TB to prevent neuropathy what do you treat with
INH & vit B6
41
2 phases when treating TB
initial phase: INH, rifampin, pyrazinamide, ethambutol for 8 weeks continuation phase: INH & rifampin for 4-7 months more (risk or transmission decreases after 2-3 weeks of therapy)
42
side effect of INH
polyneuropathy (treat with vitamin B6)(monitor liver function)
43
side effect of rifampin
orange urine, secretions, strains contacts & clothes & skin (monitor AST/ALT & liver function)
44
side effects of ethambutol
optic neuritis (monitor vision changes, renal function, liver function)
45
side effects of pyrazinamide
joint pain (monitor uric acid/ can get hyperuricemia, AST/ALT, liver function)
46
pt education when treating for TB
liver function must be monitored, assure that meds are being taken, no alcohol intake, teach prevention of transmission, staff be fit tested for N95
47
with a pleural effusion what can be done to tx
thoracentesis
48
pleurisy
inflammation of the pleural space, when you take a deep breath since there is not enough surfactant in between the two membranes, it tears, sharp stabbing pain on inspiration
49
pneumothorax
occurs when the pleural space is exposed to positive atmosphere pressure (air in thoracic cavity)
50
pneumothorax can occur from
a stabbing, gun shot, punctured lung from the ribs, chest surgery, putting a central line in place
51
symptoms of a pneumothorax
SOB, acute chest pain, decreased blood pressure, decreased blood O2, increased HR/ acute distress, pain, tachypnea, respiratory discomfort, absent breath sounds, will be gasping for air, cyanosis
52
pneumothorax is what type of diagnosis
an emergency
53
tx for pneumothorax
chest tube (so positive air pressure doesn't go into cheat cavity)
54
thoracotomy
creation of a surgical opening into the thoracic cavity (may be for diagnose of lung or chest disease, obtain biopsy)
55
lung wedge resection
takes a small chunk of lung, will heal and be fine
56
lobectomy
takes the upper lobe of lung
57
pneumonectomy
takes the whole lung out (whole one side)
58
segmentectomy
takes part of a lobe (part of one lobe of three on one side)
59
decortication
removing scar tisse
60
chest tubes are placed
in pleural space to drain fluid, air, or blood/ keep chest tubes machine below chest level
61
placement of chest tube on upper chest for
air removal
62
placement of chest tube on lower chest for
fluid, blood removal
63
chest tubes are
one way system to allow air or fluid out of cavity and non back in
64
with chest tubes you want to look for
redness, drainage, crepitus (bubble wrap looking under skin) DO NOT WANT
65
ocean chest tube: chamber A
chamber A: suction chamber, where the water level should be, water up to ml of suction
66
ocean chest tube: chamber B
water seal, should see water go up and back down (tidaling)
67
ocean chest tube: chamber C
should not see any bubbling in chamber C- if you see bubbling then you have a leak somewhere
68
ocean chest tube: chamber D
drainage: will go from sangious to serous sanguineous to serous (at the end of each shift mark and initial drainage mark)
69
if tidaling has stopped in chamber B that means
lung have reexpanded or if fluctuation has stopped that could mean a blockage
70
when to assess chest tubes
every hour for the first 8 hours after placement then every 8 after that (if see bright red blood over 100ml/hr notify provider/ dark red drainage is normal: old blood just document if drainage stops assess pt first (auscultate lungs- you do not want to hear diminished lung sounds)
71
what never to do with chest tubes
never strip or milk chest tube, never want to see continuous bubbling in water seal/ air leak (only want to see in A), never clamp a chest tube during transport
72
if a chest tube becomes disconnected
cough and exhale immediately (you don't want air rushing in) apply occlusive dressing (petroleum gauze) secured on 3 side (not 4, one side needs to be open to allow air out)
73
lung cancer is the leading cause of
death and 2 most common cancer in both men and women
74
risks factors for lung cancer
smoking, genetic, environmental exposures (radon gas, 2nd hand smoke, asbestos, workplace)
75
classification of lung cancer
small cell (SCLC) 10-15%, non small cell large cell (NSCLC) 80-85%/ squamous- adenocarcinoma (most prevalent)
76
symptoms of lung cancer
cough, voice changes, hemoptysis, dyspnea, weight loss, pain (depends on location, existence of metastases, site)
77
90% of lung cancers start where
bronchial epithelium
78
tx for lung cancer
radiation, surgery, chemotherapy, palliative
79
pulmonary embolism
obstruction of the pulmonary artery or one of its branches by a clot from the venous system (blood clot in circulation of the lung, comes from a DVT through vein coming back to R side through pulmonary artery into either lung)
80
what medication to give with PE/ treatment
heparin/ enoxaparon/ tPA, surgery (IVC filter), anticoagulation therapy, IV lines
81
s/sx of PE
dyspnea, chest pain, anxiety, fear, diaphoresis, hemoptysis (coughing up blood), syncope, tachypnea, sudden death
82
prevention of PE
active leg exercises, early ambulation, SCDs/ ted hose
83
diagnoses if PE
blood tests (ABGs), chest xray, ultrasound (check for DVT), CT, V/Q scan (measures perfusion and ventilation), pulmonary angiogram, MRI

adults exam 1 (9 decks)

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