Respiratory 1 Flashcards
(145 cards)
1
Q
What is important to note about older adults when it comes to PNA (presentation)?
A
Older adults often lack the classic signs and symptoms of pneumonia
2
Q
What assessment method would the nurse use to determine the areas of the lungs that need draining?
A
Auscultation
3
Q
For a client with an endotracheal (ET) tube, what nursing action is the most important?
A
Auscultating the lungs for bilateral breath sounds
4
Q
For a PT with TB, what vitamin is likely to be given with isoniazid(INH) to prevent INH-associated peripheral neuropathy?
A
Vitamin B6
5
Q
What is the most common early sign of acute respiratory distress syndrome (ARDS)?
A
Rapid onset of severe dyspnea
6
Q
Bacterial pneumonia presents with?
A
Dyspnea and wheezing
7
Q
Why are chest tubes inserted?
A
To remove air/fluid from the pleural space
8
Q
What is a cardinal sign of lung cancer?
A
Cough or change in chronic cough
9
Q
Post thoracotomy what is important to teach the patient to do when coughing?
A
How to splint the incision
10
Q
When there is fluid in the pleural space this is known as?
A
Pleural effusion
11
Q
Paradoxical chest movement is seen with?
A
Flail chest
12
Q
Besides death, what is the most serious complication of influenza?
A
Staphylococcal pneumonia
13
Q
What is monitored to tell if a PT is Hypoxemic?
A
Oxygen saturation level
14
Q
What nursing diagnosis takes the highest priority with chest trauma?
A
Impaired gas exchange
15
Q
When weaning a PT off the ventilator, what is the order of steps taken?
A
Removal from the Ventilator > Tube > Oxygen
16
Q
Which complication may occur if the chest tube is clamped during transportation?
A
Tension pneumothorax
17
Q
The mortality rate is high in lung cancer clients due to which factor?
A
Few early symptoms
18
Q
A mediastinal shift occurs in which type of chest disorder?
A
Tension Pneumothorax
19
Q
What is the antibiotic of choice used to treat acute bacterial rhinosinusitis (ABRS)?
A
Amoxicillin
20
Q
What can be done for Atelectasis Prevention?
A
Frequent turning
Early mobilization
Use of incentive spirometer
Secretion management
21
Q
How does PNA present?
A
Cough, Low grade fever/chills, Dyspnea, Pleuritic chest pain, Orthopnea, Crackles, Sputum
22
Q
What is commonly seen in older adults with PNA?
A
Change in mentation with aggression
23
Q
Goals for patients with PNA include?
A
Improved airway patency
Increased activity
Normal CXR’s
Absence of complications
24
Q
What continuous monitoring is done for someone with a Tracheostomy?
A
Bilateral lung sounds and SpO2
25
What do we always want to provide to those with a tracheostomy?
Humidity
26
What is the time frame for a high chance of dislogement of a tracheostomy?
5-7 days post implant
27
What are the 2 phases of treatment for TB?
Initial (8 weeks)
Continuation (18 weeks)
28
What 4 drugs are used for TB?
Isoniazid
Rifampin
Pyrazinamide
Ethambutol
29
Lethargy and somnolence are suggestive of retaining what?
CO2
30
What are the common risk factors for Atelectasis?
Old age, Bedrest, Recent surgery, Lung disease
31
How does Atelectasis present?
Increased WOB, hypoxemia and decreased breath sounds
32
Which is the most common Influenza type?
Influenza A
33
True or False: Influenza A is zoonotic?
True
34
What are the subtypes of Influenza A
H & N
35
True or False: Influenza B is zoonotic?
False, only spreads human to human
36
Which Influenza can be spread throughout the year?
Influenza B
37
What is the mildest version of Influenza
Influenza C
38
What is the most common type of Influenza?
Influenza A at 75%
39
What is the incubation period for Influenza?
1-4 days
40
What is the peak transmission period of Influenza?
5-7 days
41
How does Influenza present?
Abrupt, fever and chills, muscle/joint pain, HA, fatigue
42
How is Influenza diagnosed?
Reverse transcription polymerase chain reaction (RT-PCR)
43
Who can get the Influenza vaccine?
Anyone over 6mo, Pregnant women, Immunocompromised persons
44
What is different between the Influenza shot and nasal vaccines?
Nasal vaccines contain LIVE virus while shots do not
45
What are Influenza complications?
PNA, Ear/Sinus infections, Dehydration
46
PNA is an acute infection of what part of the lungs?
Parenchyma, the function part where gas exchange occurs
47
What are the different types of acquired PNA?
Community acquired
Hospital acquired (Ventilator-associated)
COVID PNA
48
Hospital acquired PNA presents how soon after admission?
48 hours or longer
49
How is PNA caused usually?
Aspiration caused by abnormal entry of secretions/fluid into airway
50
Who's at greatest risk for Aspiration PNA?
Patients post stroke/CVA, those with decreased LOC, those with dysphagia, patients with NGT's
51
What are the S/S of Streptococcal PNA?
Sudden chills
Pleuritic chest pain
Tachypnea/Respiratory distress
52
What are the S/S of Legionella PNA?
Bradycardia
53
What are the Diagnostics for PNA?
CXR, CBC w/ diff, Sputum analysis
54
What Biomarkers are looked at for diagnosing PNA?
C-reactive protein (CRP): measures inflammation
Procalcitonin: tells if viral or bacterial
55
What 2 items are used as both diagnostic tools and treatment tools?
Thoracentesis and Bronchoscopy
56
Physicians uses what tool to aide if a patient requires hospitalization with PNA?
CURB-65
57
CURB-65 looks at what?
Confusion
BUN
Respiratory Rate
Systolic BP
Age
58
What are complications of PNA?
Atelectasis
Pleurisy (inflammation of pleura)
Pleural effusion (fluid in pleural cavity)
Pneumothorax (air in pleural cavity)
Meningitis
Acute respiratory failure
Sepsis/shock
Lung abcess
59
How soon after starting drug therapy for PNA should improvements been seen?
3-5 days
60
What are the indications for a Trachestomy?
Laryngeal cancer
Prolonged ventilator dependence
Upper airway obstruction
Neuromuscular Disease
61
TB is what type of bacterium?
Aerophilic
62
TB requires what type of isolation precautions?
Airborne
63
Pulmonary TB presents how?
Initial dry cough that becomes productive
Constitutional symptoms (fatigue, malaise, weight loss, fever)
Dyspnea and hemoptysis
64
What is important to know about Latent TB infections?
They are often asymptomatic
65
Isoniazid is taken for how long?
6-9 months
66
Rifampin is taken for how long?
4 months
67
What combination of drugs is taken for 3 months with TB?
Isoniazid and Rifapentine
68
What does PaO2 tell us?
Is the patient is experiencing hypoxemia
69
What 3 things are seen in acute respiratory failure?
Hypercapnia
Hypoventilation
Hypoxemia
70
What are common side effects of TB medications?
Reddish-brown urine, sweat, saliva, or tears
Liver toxicity
71
What is a common side effect of Ethambutol?
Vision changes/disturbances
72
How do TB medications work?
They're bactericidal and alter DNA to reduce growth of bacteria
73
What is Hypoxia?
A decrease in O2 supply to the tissues/cells
74
What is Hypoxemia?
An abnormally low concentration of oxygen (arterial oxygen tension) in the blood
75
Due to patients sitting upright what can occur?
Accumulation of secretions in the lower parts of the lungs
76
How often do patients need to use their Incentive Spirometer?
10x's an hour
77
What type of Trache allows ease of speaking with valves?
Passy Muir
78
What type of room are TB positive patients in?
Negative pressure rooms
79
What test is ran for TB?
Acid-Fast Bacillus (AFB)
80
Absent breath sounds over lung fields is indicative of what?
Pneumothorax
81
If pleural effusion is forming what is expected on auscultation?
Localized decreased breath sounds
82
When a patient has PNA what nurse teaching is important to do?
Education on splinting the chest while coughing to reduce pain
83
What is Chronic bronchitis defined as?
The presence of a chronic cough with excessive sputum production for at least 3 months
84
What is Emphysema defined as?
Abnormal distention of the airspaces beyond the terminal bronchioles due to destruction of the alveoli causing an increase in dead space
85
What is COPD defined as?
Chronic inflammation of the airways with air trapping
86
What causes COPD?
Cigarette smoking
Exposure to noxious particles and gases
Recurring respiratory infections
87
What happens in the lungs with COPD?
Loss of elastic recoil in alveoli
Mucous hypersecretion
Bronchospasm
88
If someone has not been exposed to cigarette smoke but has COPD what is suspected?
Alpha 1 antitrypsin deficiency
89
What does Nicotine do to the body?
Decreases amount of functional Hgb
Increases platelet aggregation
Makes CAD worse
90
How does smoking affect the respiratory tract?
Hyperplasia of goblet cells
Loss of ciliary activity
Abnormal dilation and destruction of alveoli
Chronic inflammation
Decreased O2 carry capacity of Hgb
91
COPD rates are higher in what demographic?
Females
92
What are the effects of aging on the respiratory system?
Loss of elastic recoil in lungs
Stiffening of chest wall (age-related kyphosis)
Decreased exercise tolerance
Rounder and smaller lungs
Decrease in functional alveoli
93
How does COPD present?
Chronic cough
Sputum production
Dyspnea
Use of accessory muscles
Inefficient breathing pattern
Weight loss
Exercise intolerance
Decreased breath sounds & crackles
Prolonged expiratory phase
94
In COPD how does dyspnea manifest?
Progressive and present daily
Exertion in early stages
Present at rest as COPD worsens
95
What diagnostic studies are done for COPD?
H&P
ABG
CXR (shows flat diaphragm)
CT
Alpha 1-antitrypsin screening < 45
96
How are COPD diagnoses confirmed?
Spirometry and Pulmonary function tests
97
What FEV1FVC ratio is considered COPD?
< 70%
98
What complications come from COPD?
Exacerbation
Respiratory insufficiency leading to Respiratory failure
Pulmonary HTN
PNA
99
What is Cor pulmonale?
The hypertrophy or dilation of the R side heart caused by pulmonary HTN
100
What causes enlargement and failure of the R ventricle?
Increased ventricular resistance
High BP in lungs
101
When does Cor pulmonale appear in COPD?
Late in their diagnosis
102
How does Cor pulmonale present?
Dyspnea / Lung crackles
JVD
Weight gain
Peripheral edema
Hepatomegaly w/ upper right quadrant tenderness
103
What diagnostics are done for Cor pulmonale?
CXR
R-sided cardiac catheterization (best)
Echocardiogram
BNP levels
104
What is the treatment for Cor pulmonale?
Treating the underlying cause (COPD)
Medications to lower BP and encourage O2 back to lungs
Diuretics to reduce fluid retention
Continuous low-flow O2
105
What is COPD exacerbation?
A sudden/worsening of COPD symptoms due to poor outcomes that can last several days
106
How does COPD exacerbation present?
Increased dyspnea / SOB
Increased cough
Increases sputum volume and/or purulence
Use of accessory muscles
Central cyanosis
107
What causes COPD exacerbation?
Bacterial or Viral infections
108
What are treatments for COPD exacerbation?
Short-acting bronchodilators
Oral systemic corticosteroids
ABX if infection present
109
What causes COPD Acute Respiratory Failure?
Exacerbations
Overuse of sedatives (benzos and opiods)
Surgery or severe painfull illness R/T chest/abd
110
What 2 mental issues come up from COPD?
Depression and Anxiety
111
What medication can be used to treat anxiety in COPD?
Buspirone
112
What O2 saturation is wanted for COPD?
> 90%
113
COPD O2 therapy includes what?
Low-flow mixed with room air
High-flow
Humidification
114
CO2 narcosis causes what?
Depression of LOC
115
What respiratory training is done for COPD?
Pursed lip and Diaphragmatic breathing
Effective coughing
Use of Airway clearance devices
116
What diet is recommended for COPD patients?
High protein and High calorie
117
What is Lung volume reduction surgery?
Removal of diseased lung to allow O2 to flow to only healthy lung
118
What is Bronchoscopic lung volume reduction surgery?
Placement of a one-way valve that only allows air to exit the diseased part of the lung it is placed in
119
What is a Bullectomy?
Removal of one or more enlarged air sacs that are no longer useful
120
How long does it take a tumor to reach 1 cm typically?
8-10 years
121
Lung tumors occupy what part of the lungs typically?
Segmental bronchi and upper lobes
122
What are the causes of Lung cancer?
Cigarette smoking
Pollution
Radon
Asbestos
Radiation
123
What prompts screening for Lung cancer?
Age 55-80 with history of smoking
30 year pack history
Current smoker
Quit < 15 years ago
124
What diagnostic studies are done to DX Lung cancer?
CT scans
CXR
Fiberoptic bronchoscopy
PET scan
Lung biopsy
125
What are the 2 types of lung cancer classes?
Small-cell (13%)
Non-small-cell (84%)
126
What are the 3 types of Non-small-cell lung cancer?
Squamous cell carcinoma
Adenocarcinoma
Large-cell carcinoma
127
How does Squamous cell carcinoma present?
With early symptoms but slow growth
128
How does Adenocarcinoma present?
As the most common in non-smokers and moderate growth
129
How does Large-cell carcinoma present?
As fast growing and highly metastatic
130
How does Small-cell lung cancer present?
Rapid growing
Most malignant
Metastasis early and to the brain first
Poor prognosis
131
What are the ways Lung cancer metastasizes?
Direct extension
Blood circulation
Lymph system
132
Where does Lung cancer metastasize?
Brain first
Lymphnodes
Liver
Bones
Adrenal glands
133
What are the clinical manifestations of Lung cancer?
Dyspnea
Hemoptysis
Chest/Shoulder pain
Pneumonitis
Persistent cough with sputum
134
The symptoms of Lung cancer are usually what?
Non-specific and appear late in the disease
135
What is the TNM system?
The way to stage Non-small-cell lung cancer (1-4)
136
What does TNM stand for?
T: tumor size/location
N: extent of lymph node invasion
M: presence/absence of metastases
137
How is Small-cell lung cancer staged?
Limited or Extensive
138
What is a Pneumonectomy?
The removal of an entire lung
139
What is a Lobectomy?
The removal of one or more lobes of a lung
140
What are Segmental/ Wedge procedures?
Removal of a section of a lobe
141
What is VATS?
Video-assisted thoracoscopic surgery
142
What is Lung cancer radiation therapy used for?
Treatment of both NSCLC and SCLC
Palliative therapy
Adjuvant therapy
143
Stereotactic Radiotherapy is given over what time frame?
1-3 days
144
Chemotherapy is the primary treatment for what Lung cancer?
Small-cell lung cancer
Nonresectable tumors
Adjuvant to surgery in Non-small-cell lung cancer
145
What is included in possible palliative care for Lung cancer?
Radiation therapy
Bronchoscopic interventions to place stents
Pain management
