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Flashcards in Respiratory 1 Deck (214):
1

Bronchodialators that relax the smooth muscles of the bronchial tree and decrease airway resistance

Short Acting Beta Agonists

2

Medication for short term relief for asthma attacks, or premedication when attacks are likely

Albuterol

3

What are the side effects of Albuterol?

Tachycardia

4

How should Albuterol be used?

Before other inhaled drugs to better enable penetration of other medications

5

Group of medications that relaxes bronchospasms and increases ciliary motility

Long Acting Beta Agonists

6

Medication for the maintenance of asthma or bronchospasms

Salmeterol

7

How long before exercise should Salmeterol be taken?

30-60 minutes

8

What is the therapeutic range of Theophylline?

10-20 mcg/mL

9

Name a Cholinergic antagonist

Ipratropium

10

If a patient has over 20 mcg/mL of Theophylline, what will happen?

Adverse reactions of the nervous system

11

Bronchodialators that are xanthine derivatives and are given via PO or IV drip

Theophylline and Aminophylline

12

What is Ipratropium used for?

Maintenance therapy for chronic bronchitis and emphysema

13

What is a side effect of Aminophylline?

Rash

14

What are the side effects of Theophylline?

Nausea, vomiting, diarrhea, tachycardia, dysrhythmias, restlessness

15

How should Ipratropium be taken?

Wait 30-60 seconds between puffs and 5 minutes between this and other inhaled meds and rinse mouth after taking to get rid of the bitter taste

16

What is the action of Theophylline?

Relieves broncho spasms of bronchitis, emphysema, and asthma

17

Medications that block the parasympathetic nervous system and are bronchodialators

Anticholinergic agents

18

If a patient has over 35 mcg/mL of Theophylline, what will happen?

Seizure and cardiac arrhythmias

19

Name the 5 types of Bronchodialators

Short acting Beta agonists, long acting Beta agonists, Methylxanthines, Cholinergic antagonists, and Leukotriene antagonists

20

Inhaler, nebulizer, or nasal spray that inhibits acetylcholine, blocking cholinergic bronchomotor tones and therefore stops vagally mediated bronchospasms

Ipratropium

21

What is the nasal spray form of Ipratropium used to treat?

Rhinitis and the common cold

22

Name examples of Methylxanthines

Theophylline and Aminophylline

23

Name Leukotriene antagonists

Accolate and Singulair

24

What are the types of Anti-Inflammatories?

Corticosteroids and Inhaled or Nasal Sprays

25

Bronchodialator that inhibits leukotriene and therefore inhibits inflammation and bronchoconstricition

Leukotriene Antagonists

26

What are side effects of Leukotriene antagonists?

Headache and increased incidence of URI if given with corticosteriods

27

What are the side effects of Ipratropium?

Blurred vision, eye pain, headache, palpitations, nervousness

28

Name a corticosteroid

Prednisone

29

What do Leukotriene antagonists do?

Prevents airway edema, smooth muscle constriction, altered cell activity due to inflammation

30

Which side effect of Ipratropium is an overdoes symptom?

Nervousness

31

At what point is the maximum effectiveness of an inhaled anti-inflammatory obtained?

2-3 days after initiation

32

Medications with anti-inflammatory properties used for severe respiratory symptoms

Corticosteroids

33

Which drug, when taken with Leukotriene antagonists, increases plasma concentration of Accolate?

Aspirin

34

Name types of inhaled anti-inflammatories

Budesonide, Veramyst, Flonase, and Beclomethasone

35

What are Singulair and Accolate used for?

Prophylaxis and chronic treatment of asthma associated with increased leukotriene production

36

What are the side effects of inhaled anti-inflammatories

Predisposition towards oral infection, dry mouth, hoarseness, sore throat, transient nasal irritation, epistaxis, nasalpharyngeal itching, dryness, crusting, headache, nausea, and vomiting

37

What are inhaled anti-inflammatories used for?

Steriod dependent asthma, and seasonal rhinitis

38

When giving Prednisone, what education should be completed?

Dose should be tapered off and never abruptly stopped, should be taken with food to decrease GI irritation

39

Which drug do mucolytics bind with?

Aspirin

40

Systemic mucolytic that reduces surface tension and adhesiveness of secretions for easier expectoration

Guaifenisin (Mucinex)

41

Reduces viscosity of mucus in patients with COPD, cystic fibrosis, and acetylcysteine

Mucolytics

42

In what forms does Guaifenisin come in?

Capsules and syrup

43

Name a mucolytic

Mucomyst

44

What effect does Prednisone have on electrolytes?

It causes sodium retention and potassium excretion

45

When taking Mucinex, what should the patient incease?

Fluids

46

What forms are mucolytics given in?

Nebulized, PO, IV

47

Combines Serevent, a long-lasting Beta agonist, and Flovent, a steroid

Advair

48

Which type of infection can occur while using inhaled anti-inflammatories if the patient does not rinse out their mouth?

Candidiasis

49

What are the side effects of Mucinex?

Stimulates sympathetic nervous system, elevates blood pressure, and causes tachycardia

50

Which type of medication smells like sulfur?

Mucolytics

51

How should inhalers be used?

Shake before use, inhale slowing while activating inhaler, hold breath for 5-10 seconds and exhale slowly

52

How long should a patient wait between puffs from an inhaler with the same medication?

1 minute

53

How often should inhalers be cleaned?

Daily

54

After taking an inhaled steroid, how can the patient prevent thrush?

Rinse mouth and gargle with warm water

55

What are the side effects of all inhaled steroids?

Irritation, dryness, and thrush

56

How should nasal inhalants be given?

Blow nose, shake medication well, instill medication, wash nose piece with warm water and dry

57

If two sprays of nasal inhalants are ordered, how should they be aimed?

One towards the upper part of the nostil and one towards the lower part

58

How often should the nasal inhalant nose peice be washed?

Daily

59

Oxygen exchange in tissues

Perfusion

60

What should you look for when examining the external nose?

Deformities or tumors

61

If a patient is using accessory muscles to breath, what lung sounds will generally be heard?

Stridor

62

Why do patients with sleep apnea have increased hemoglobin levels?

To have more places for oxygen to join up

63

What history should you aquire when are assessing the respiratory system?

Family and personal data, smoking (pack-years), drugs, allergies, travel, nutritional status, cough, sputum production, chest pain, dyspnea, PND, orthopnea, occupation and hobbies

64

Oxygen exchange in lungs

Oxygenation

65

Why do people have sinus issues in the winter?

Because heaters make sinuses very dry

66

Everything above the alveoli in the lungs

Dead space

67

What should you look for when examining the mucous membranes?

Abnormalities

68

What should you look for when examining the nares?

Symmetry of size and shape

69

What respiratory diseases should you assess a patient for when getting a health history?

Respiratory failure, asthma, COPD, abnormal blood tests, sleep apnea, and exercise endurance

70

In what position will the patient be if they are using accessory muscles to breath

Tripod

71

What is the purpose of turbinates?

To force inhaled air to flow in a steady, regular patter around the largest possible surface of cilia and climate controlling tissue

72

What population is likely to have mucous membrane abnormalities?

Drug abusers

73

Taking in lots of oxygen but not much goes to tissues

Shunting

74

What should you look for when examining the nasal cavity?

Color, swelling, drainage, and bleeding

75

What are considered accessory muscles for breathing?

Face muscles, sternoclidomastoid, intercostals, and stomach muscles

76

When assessing the neck, what are you looking for?

Symmetry, alignment, masses, swelling, bruises, and the use of accessory muscles for breathing

77

Which respiratory organ reflects the heart?

The mouth

78

Patients with sleep apnea will have high levels of what?

Hemoglobin

79

Long, narrow, and curled bone shelves that protrude into breathing passages of the nose

Turbinates

80

Which patients are generally barrel chested?

Patients with COPD and pregnant women

81

Where are bronchial lung sounds normal?

Over the trachea

82

When assessing the trachea, what are you looking for?

Palpate for position, mobility, tenderness, and masses

83

What population is most likely to have septal deviations?

Athletes

84

Cracking air in muscles

Crepitus

85

Where are bonchocesicular lung sounds normal?

Over the mid lungs

86

When assessing the mouth, what are you looking for?

Ulcerations and the presence of pink mucous membranes

87

What would cause a patient to have wheezing?

Inflammation, mucus, asthma, or excess secretions

88

Chest is wider than it is long

Barrel chest

89

How should the thorax be assessed?

With the patient sitting up, observe the chest and compare for symmetry; check the rate, rhythm, and depth of inspiration; examine the AP diameter and the distance between the ribs

90

When assessing respiratory function, what specifically are you looking for in the blood?

Abnormal hemoglobin levels

91

When is weight loss a bad sign?

When 10% of teh body fat is lost without trying

92

Where can crackles be heard?

Over the bases of the lungs or in the right upper lobes

93

When preparing to administer pulmonary function tests, what teaching should take place?

No smoking six hours before the test, no inhalers or medications during the test, and notify the testers if SOB or chest pain develops

94

Aspiration of pleural fluid or air from pleural space

Thoracentesis

95

When is wheezing very bad?

On expiration

96

What does the end tidal of CO2 value tell you?

Whether the patient has good oxygen exchange or not

97

Where are vesicular lung sounds normal?

Over the lower lobes

98

What laboratory tests should be performed on patients during a respiratory assessment?

Blood, sputum, CXR, CT, V/Q scan, and pulse ox

99

What are the strongest bones in the body?

The scapula and first rib

100

What is the normal pressure of PETCO2?

20-40 mmHg

101

Obtain tissue for histological analysis, culture, and cytologic examination

Lung biopsy

102

Which medications put a patient into twilight sedation?

Versed and fentanyl

103

Evaluates lung volume and capacities, flow rates, diffusion capacity, gas exchange, airway resistance, and distribution of ventilation

Pulmonary function tests

104

What psychosocial aspect worsens respiratory problems?

Stress

105

What are the signs and symptoms of pneumothorax?

Sudden and severe shortness of breath

106

Measures the amount of carbon dioxide present in exhaled air

Capnometry and Capnography

107

After a lung biopsy, how often do vital signs and breath sounds need to be assessed?

At least every 4 hours for 24 hours

108

Type of medical imaging using scintigrapy and meidcal isotopes to evaluate the circulation of air and blood within a patient's lungs

V/Q Scan

109

What is the purpose of a biopsy?

Diagnosis

110

Which medications wake a patient from twilight sedation?

Narcan and benzodiazepam

111

What should be reported immediately if found on a patient after a lung biopsy?

Reduced or absent breath sounds

112

Coughing blood

Hemoptysis

113

Nose bleed

Epistaxis

114

What are the clinical manifestations of respiratory distress?

Dyspnea, nasal flaring, use of accessory muscles, pursed-lips or diaphragmatic breathing, decreased endurance, and skin and mucous membrane changes

115

Low levels of oxygen in the blood

Hypoxemia

116

What systems work together to provide sufficient tissue perfusion to the body?

Respiratory, cardiovascular, and hematologic systems

117

What are the hazards and complications of oxygen therapy?

Combustion, oxygen-induced hypoventilation, oxygen toxicity, absorption atelectasis, drying of the mucous membranes, and infection

118

What is the best way to determine the need for oxygen therapy?

Arterial Blood Gas analysis

119

What patient population is most susceptible to oxygen toxicity?

Premature babies

120

Loss of senstivity to high levels of CO2

CO2 Narcosis

121

What are the late signs of respiratory distress?

Pallor and cyanosis

122

Why are COPD patients most susceptable to CO2 Narcosis?

Because their drive to breath is based on low O2 levels and raising the level of O2 only decreases this drive

123

Why do we need oxygen?

It is essential for life and function of cells and tissues

124

Decreased tissue oxygenation

Hypoxia

125

Does not provide enough flow to meet total oxygen and air volume

Low flow oxygen delivery systems

126

What is the purpose of oxygen therapy?

To improve oxygenation and, hopefully, tissue perfusion; to treat hypoxemia

127

Retention of CO2

Hypercarbia

128

What is the most important value in arterial blood gases?

pH of the blood

129

What is the goal of oxygen therapy?

To use the lowest fraction of inspired oxygen to obtain acceptable blood oxygen levels without causing harmful side effects

130

What does the type of oxygen delivery system used depend on?

Oxygen concentration required, the importance of accuracy and control of oxygen concentration, patient comfort, the importance of humidity and patient mobility

131

What is the flow rate of a nasal cannula?

1-6 L/min

132

How can oxygen tubing be made safer for mobile patients?

Duct tape the oxygen extention to the floor

133

New onset of crackles and decreased breath sounds while on oxygen therapy

Absorption atelectasis

134

Why does a flow rate of greater than 6 L/min on a nasal cannula not increase oxygen saturation?

Because the anatomical dead space is full

135

Which patients are most susceptable to CO2 narcosis?

Patients with COPD

136

What should be assessed before placing a patient on a nasal cannula?

Patency of the nostrils and changes in respiratory rate and depth

137

What are the types of low flow oxygen delivery systems?

Nasal cannual, simple facemasks, partial rebreather facemasks, and non-rebreather facemasks

138

How much oxygen requires humidification?

If the patient is on any amount of oxygen for more than 15 minutes or if the patient is on 4 liters or more

139

What is the oxygen concentration of a nasal cannula?

24%-44%

140

What is the oxygen concentration of a partial rebreather?

60%-75%

141

How should the rate of a partial rebreather be adjusted?

To keep the reservoir bag inflated

142

Which patients are non-rebreathers used for?

Unstable patients requiring intubation

143

What is the oxygen concentration of a simple facemask?

40%-60%

144

What is the flow rate of a non-rebreather?

10-15 L/min

145

What is the flow rate of high flow oxygen delivery systems?

8-15 L/min

146

What are the types of high-flow oxygen delivery systems?

Venturi masks, face tent, aerosol masks, tracheostomy collar and T-piece

147

What should be added to simple facemasks?

Humidity

148

Where is a Venturi facemask titrated?

At the bottom of the mask

149

What is the oxygen concentration of high-flow delivery systems?

24%-100%

150

How much tidal volume is exhaled with each breath when using a partial rebreather?

1/3

151

What should be assessed before putting a patient on a non-rebreather mask?

Ensure that the valves are patent and functional

152

What is the minimum amount of oxygen a simple facemask delivers?

5 L/min

153

What is the oxygen concentration of a non-rebreather mask?

Greater than 90%

154

What is the flow rate of a partial rebreather?

6-11 L/min

155

When a patient has a simple facemask, what should they be closely monitored for?

Aspiration

156

When are CPAPs used?

For patients with sleep apnea, cardiac-induced pulmonary edema, and for atelectasis after surgery

157

What does the T-piece do?

Ensures humidifier creates enough mist

158

What are the types of Pressure Ventilation?

BiPAP and CPAP

159

How does a patient using a Venturi facemask eat?

By switching to a nasal cannula

160

How are TTO systems set up?

A small, flexible catheter is passed into the trachea through a small incision

161

Fits over the chin, with the top extending halfway across the face

Face tent

162

Why are TTO systems not used?

Probability of infection

163

What is the best oxygen delivery system for patients with chronic lung disease?

Venturi Masks

164

Uses positive pressure to keep alveoli open, improving gas exchange without airway intubation

Pressure Ventilation

165

Long term delivery of oxygen directly into lungs

Transtracheal oxygen delivery

166

What patients are face tents used for?

Patients with facial trauma or burns

167

Delivers desired FIO2 for tracheostomy, laryngectomy, and ET tube patients

T-Piece

168

Why are transtracheal oxygen delivery systems used?

To avoid the irritation that nasal prongs cause

169

Delivers set positive airway pressure throughout each cyle of inhalation and exhalation

CPAP

170

How do you know that a T-piece is working?

Mist should be seen during inspiration and expiration

171

How much oxygen do face tents deliver?

10 L/min

172

Used when high humidity is needed after extubation or upper airway surgery or for thick secretions

Aerosol Masks

173

What is the oxygen concentration of a Venturi facemask?

24%-50%

174

How much oxygen does a Trach collar deliver?

10 L/min

175

What patient education needs to take place before there can be home oxygen therapy?

Safety, tripping hazards, fire hazards, humidification, don't self-diagnose and treat with increased oxygen

176

What is the oxygen concentration of an aerosol mask?

24%-100%

177

Surgical incision into the trachea for the purpose of establishing an airway

Tracheotomy

178

What is the oxygen concentration for face tents?

24%-100%

179

What are the priority problems for tracheostomy patients?

Reduced oxygenation, inadequate communication, inadequte nutrition, potential for infection, and damaged oral mucosa

180

What is the most important post-operative care to give to tracheostomy patients?

Ensure the airway is patent

181

What is the concentration of a Trach collar?

24%-100%

182

If a post-operative tracheostomy patient has a constant, non-productive cough, what does this indicate?

Tube dislodgement

183

How much oxygen does a Venturi mask deliver?

4-10 L/min

184

How much oxygen does a aerosol mask deliver?

10 L/min

185

Used to deliver high humidity and the desired oxygen to the patient with a tracheostomy

Trach collar

186

How should oxygen be weened?

0.5-1.0 liters at a time over 15-30 minutes with ambulation

187

Stoma that results from a tracheotomy

Tracheostomy

188

What is the oxygen concentration of a T-piece?

24%-100%

189

Why are tracheostomy patients at risk for damaged oral mucosa?

Because the mouth is bipassed and dried out, making it an infection breeding ground

190

How much oxygen does a T-piece deliver?

10 L/min

191

What assessments should be done on a post-operative tracheostomy patient?

Tube obstruction or dislodgement, assess for crepitus, excessive bleeding, and constant non-productive cough

192

What nursing interventions should be done with a patient who has a tracheostomy?

Check cuff pressure often, keep extras at the bedside, make sure suction equipment works, prevent tube friction and movement, and prevent malnurtition, hemodynamic instability and hypoxia

193

Why is suctioning so important for tracheostomy patients?

To maintain patent aitways and promote adequate gas exchange

194

What does over inflation of the tracheostomy cuff do?

Causes damage to the trachea and mucosal ischemia

195

How can hypoxia be prevented during the suctioning of a patient with a tracheostomy?

Apply suction on the way out and only suction 10-15 seconds at a time

196

What possible complications accompany a tracheotomy?

Pneumothorax, subcutaneous emphysema (crepitus), bleeding, and infection

197

How can a nurse prevent friction and movement of a tracheostomy?

Secure trach ties

198

Why would a patient have a fenestrated tracheostomy?

To talk

199

What does under inflation of the tracheostomy tube do?

Causes the patient to not be able to talk

200

How should tracheostomy patients be suctioned?

Through their nose and mouths

201

Why must air be humidified for tracheostomy patients?

Because the air they are breathing bypasses the nose and mouth, which normally warms, humidifies, and filters it

202

If a patient has vagal stimulation during suctioning, what will happen to their heartrate?

It will drop dramatically

203

What are some side effects of suctioning?

Hypoxia, tissue and mucosal trauma, infection, vagal stimulation and bronchospasms, and cardiac dysrhythmias

204

How should a tracheostomy tube be weaned?

Gradually decrease tube size until you ultimately remove the tube

205

How can you encourage good bronchial and oral hygeine of a tracheostomy patient?

Turn and repostion every 1-2 hours, support out of bed activities, encourage early ambulation, encourage coughing and deep breathing, chest percussion, postural drainage, and avoid glycerin swabs

206

How should a client who has a tracheostomy be positioned when they are eating?

Tuck chin down and forward when swallowing

207

What should you do if a patient's tracheostomy accidentally dislodges?

Check for breathing, get a pulse ox, and call someone to recannulate as you are staying with them

208

When can a tracheostomy cuff be deflated?

When the patient can manage their secretions and they don't need assissted ventilation

209

What should you do when feeding a patient with a tracheostomy?

Elevate head of bed for at least 30 minutes after eating to prevent aspiration, and use thickening

210

Breath sounds that E>I

Bronchial

211

Breath sounds that I>E

Vesicular

212

Breath sounds that I=E

Bronchial vesicular

213

High pitched breath sounds

Bronchial

214

Low pitched and breezy breath sounds

Vesicular