Respiratory 1 Flashcards
(214 cards)
1
Q
Bronchodialators that relax the smooth muscles of the bronchial tree and decrease airway resistance
A
Short Acting Beta Agonists
2
Q
Medication for short term relief for asthma attacks, or premedication when attacks are likely
A
Albuterol
3
Q
What are the side effects of Albuterol?
A
Tachycardia
4
Q
How should Albuterol be used?
A
Before other inhaled drugs to better enable penetration of other medications
5
Q
Group of medications that relaxes bronchospasms and increases ciliary motility
A
Long Acting Beta Agonists
6
Q
Medication for the maintenance of asthma or bronchospasms
A
Salmeterol
7
Q
How long before exercise should Salmeterol be taken?
A
30-60 minutes
8
Q
What is the therapeutic range of Theophylline?
A
10-20 mcg/mL
9
Q
Name a Cholinergic antagonist
A
Ipratropium
10
Q
If a patient has over 20 mcg/mL of Theophylline, what will happen?
A
Adverse reactions of the nervous system
11
Q
Bronchodialators that are xanthine derivatives and are given via PO or IV drip
A
Theophylline and Aminophylline
12
Q
What is Ipratropium used for?
A
Maintenance therapy for chronic bronchitis and emphysema
13
Q
What is a side effect of Aminophylline?
A
Rash
14
Q
What are the side effects of Theophylline?
A
Nausea, vomiting, diarrhea, tachycardia, dysrhythmias, restlessness
15
Q
How should Ipratropium be taken?
A
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
Q
What is the action of Theophylline?
A
Relieves broncho spasms of bronchitis, emphysema, and asthma
17
Q
Medications that block the parasympathetic nervous system and are bronchodialators
A
Anticholinergic agents
18
Q
If a patient has over 35 mcg/mL of Theophylline, what will happen?
A
Seizure and cardiac arrhythmias
19
Q
Name the 5 types of Bronchodialators
A
Short acting Beta agonists, long acting Beta agonists, Methylxanthines, Cholinergic antagonists, and Leukotriene antagonists
20
Q
Inhaler, nebulizer, or nasal spray that inhibits acetylcholine, blocking cholinergic bronchomotor tones and therefore stops vagally mediated bronchospasms
A
Ipratropium
21
Q
What is the nasal spray form of Ipratropium used to treat?
A
Rhinitis and the common cold
22
Q
Name examples of Methylxanthines
A
Theophylline and Aminophylline
23
Q
Name Leukotriene antagonists
A
Accolate and Singulair
24
Q
What are the types of Anti-Inflammatories?
A
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
