Respiratory

Question 1

lwr respir system structures

Answer 1

left lung- 2 lobes
right lung- 3 lobes (upper, middle, lower)
pleura
mediastinum
bronchi and bronchioles
alveoli

Question 2

oxygen transport

Answer 2

diffuses across alveolar mem into arterial blood, oxygenated blood carried to tissues (o2 bind w/ hgb= oxyhemoglobin)
*diffuses frm areas of higher partial p to lower partial p

Question 3

c02 transport

Answer 3

end product metabolic combustion
diffuses across alveolar cap mem into venous blood, deoxygenated blood perfuses back to lungs
co2 diffuses easier than o2

Question 4

respiration def

Answer 4

process of gas exchange btw atm air and the blood and blood and cells of the body
removes co2 from airway and oxygenates the blood

Question 5

oxygen concen in lungs v alveoli

Answer 5

lower conc in cap of lungs than alveoli

= o2 diffueses from alveoli into blood (remember o2 goes frm high to low pressure)

Question 6

ventilation-perfusion inequality or mismatch

Answer 6

v/q
air in alveoli/ blood flow in cap
normal = 1-1

Question 7

shunting

Answer 7

low v/q, dec vent to well perfused areas
blood passes alveoli w/out exchange
results- dec o2 sat, dyspnea
causes- pneumonia, atelectasis, respir depression

Question 8

alveolar dead space

Answer 8

high v/q, poor perfusion
cause- inc residual co2, pulmonary emboli
inhaled air not participate in gas exchange= alv damage`

Question 9

gerontologic considerations

Answer 9

dec surface are available for O2
dec elasticity
dead space inc
dec cough reflex, inc mucus
peak lung function-middle age

Question 10

s/s and cause (shortness of breath, cough, sputum production)

Answer 10

SOB- inc airway resistance, dec lung compliance, bronchospasms, anemia (dec 02 carrying capacity)
cough- irritation mucus mem (dry)- ACE inhib (lisinopril)
sputum- yellow-infection
white/pink and frothy- pulm edema

Question 11

s/s in physical assessment- chronic respir dis (COPD)

Answer 11

clubbing fingers, cyanotiic skin color

retraction, use acces musces, tripod position

Question 12

lung sounds

Answer 12

crackles (fluid) pneumonia, heart failure (if gone w/ cough= atelectasis (IS/ mobility important))
wheezing- asthma, COPD (inc airway resistance)
rhonchi- course crackle- bronchitis, pneumonia

Question 13

diagnostic tests

Answer 13

abg
sputum (id malignant cells, rinse mouth and obtain before eat/antib)
chest x-ray
CT
MRI
Radioisotope (lung scan, inject tracer tags specific tissue)
Thoracentesis (remove fluid frm lungs w/ needle)
biopses

Question 14

purpose of supplemental o2

Answer 14

dec work of breathing, reduce stress on the myocardium

Question 15

risks assoc w/ supp o2

Answer 15

oxygen toxicity, dry muc mem, (trt w/ wtr based lubricant), pressure sores frm tubing

Question 16

COPD supp O2 considertions

Answer 16

88-92%

Question 17

hypoxemia

Answer 17

not enough o2 avaliable
cause- abnorm v/q, inc mem thickness, edema, dec surface area
dec in arterial o2 tension in blood

Question 18

hypoxia

Answer 18

dec o2 supply to tissues/ cells

can be lifethreatening

Question 19

supp o2 admin

Answer 19

low v high flow
low- nasal can (variable performance bc breath in RA too
simple mask and non-rebreather mask
high- venturi (COPD) specific inspired control 4-8L

Question 20

chest tube drainage

Answer 20

suction or gravity-powered
collects pleural drainage (position changing can = dumping)
prevents air from re-entering chest w/ inhalation
removes fluid/air from pleural space
wet water seal or dry suction

Question 21

pneumonia def

Answer 21

inflamm lung parenchyma caused by microo (bac, mycobac, fungi and virus)
alveoli fill w/ fluid

Question 22

pneumonia- community-acquired

Answer 22

viral/bac
<48h after admission
incubating before
trt w/ antib

Question 23

pneumonia- nosocomial (healthcare assoc)

Answer 23

non-hospitalzied ppl w/ extensive healthcare contact
pts been in hospital >2 days within last 3 mon, nursing home res, pt on chronic antib, chemo pt, wound care, hemodialysis, pt w/ family member of MDR (mult drug resistant)

Question 24

hospital aquired pneumon/ ventilator-associated

Answer 24

greater than 48 h after admission (not icubating)

Question 25

pneumonia risk factors

Answer 25

Occurs in patients with certain underlying disorders and diseases Heart failure, diabetes, alcoholism, COPD, and AIDS Influenza, COVID-19shallow breathing, smoking, immobilization, NG tube (aspiration (good oral care, head bed elevated >30°)) Cystic fibrosis (lrg amnt mucus, inc risk bacterial infection= pneumonia)

Question 26

pneumonia clinical manifestations- general, strep, viral, other, orthopnea

Answer 26

Varies depending on type, causal organism, and presence of underlying disease general- dyspneic, sputum production, chest painsystemic-cough, fever, chills Streptococcal:-Sudden onset of chills, fever, pleuritic chest pain, tachypnea, and respiratory distress Viral- mycoplasma, or Legionella: relative bradycardia Other-Respiratory tract infection, headache, low-grade fever, pleuritic pain, myalgia, rash, and pharyngitis Orthopnea- crackles, increased tactile fremitus, purulent sputum

Question 27

pneumonia- hx questions

Answer 27

recent respir tract infection

Question 28

pneumonia- what to look for in physical exam

Answer 28

signs respir distress, vitals, IV v Po antibiotics, immed need for help= determine if treated outpatientdec lung sounds, rhonchi, crackles

Question 29

pneumonia- purpose blood culture

Answer 29

Blood culture (assess for risk bacteremia) blood 2 opposite sites (rule out contamination) 2-3 days for results

Question 30

pneumonia diagnostic tests-

Answer 30

blood culture chest x-ray sputum exam physical exam

Question 31

pneumonia- care plan goals (incl complications)

Answer 31

Improved airway patency interv- bronchodil, steroids (dec inflamm), fluid bal, humidif O2 etc… Increased activity Maintenance of proper fluid volume 1000-1200mL Maintenance of adequate nutrition Understanding of the treatment protocol and preventive measures Absence of complications pleural effusion shock, respir failure, bacteremia

Question 32

pneumonia- care plan interventions

Answer 32

``` Oxygen with humidification to loosen secretions Face mask or nasal cannula Coughing techniques Chest physiotherapy postural drainage (vibration- cystic fibrosis) Position changes Incentive spirometry Nutrition Hydration Rest Activity as tolerated Patient teaching Self-care ```

Question 33

pneumonia- drug therapy

Answer 33

Administration of the appropriate antibiotic as determined by the results of a culture and sensitivity Supportive treatment includes fluids, oxygen for hypoxia, antipyretics, antitussives, decongestants, and antihistamines Antibiotics not indicated for viral infections but are used for secondary bacterial infection

Question 34

pneumonia- education

Answer 34

Educate about pneumococcal vaccine (23+ Prevnar 15) reduce incidence pneumon. Reccom. +65 yr even if infected- risk for severe complications much less

Question 35

pnemonia- goals contin/ expected outcomes

Answer 35

Demonstrates improved airway patency (assessed w/ lung sounds, improved pulse ox) Rests and conserves energy and then slowly increasing activities Maintains adequate hydration; adequate dietary intake (assessed w/ I&O/ daily weight) Verbalizes increased knowledge about management strategies Complies with management strategies Exhibits no complications

Question 36

risk factors aspiration

Answer 36

``` Decreased LOC Seizure Stroke Swallowing disorder Flat positioning ```

Question 37

aspiration in relation to pneumonia

Answer 37

complication that can cause pneumonia | *can be silent

Question 38

aspiration def

Answer 38

inhalation foreign material into the lungs

Question 39

s/s aspiration

Answer 39

tachycardia, dyspnea, central cyanosis, hypertension, hypotension, and potential death

Question 40

aspiration- nursing interventions

Answer 40

``` Keep HOB elevated >30 degrees Avoid stimulation of gag reflex with suctioning or other procedures Check for placement before tube feedings Thickened fluids for swallowing problems Oral care ```

Question 41

Pulmonary emboli

Answer 41

Obstruction of the pulmonary artery or one of its branches by a thrombus (or thrombi) that originates somewhere in the venous system or in the right side of the heart

Question 42

surgeries assoc w/ PE

Answer 42

multi-trauma, shortness of breath, long bone surgeries, no mvmnt

Question 43

PE patho

Answer 43

Inflammatory process obstructs area, results in diminished or absent blood flow Bronchioles constrict, further increasing pulmonary vascular resistance, pulmonary arterial pressure, and right ventricular workload

Question 44

PE diagnosed via

Answer 44

diagnosed w/ v/q scan and d-dimer lab (measure fibrin lvl from clot lysis) abg’s (show respir alkalosis early on and acidosis later due to low O2 anaerobic metab)

Question 45

immediate bed side interventions for PE

Answer 45

ex. 84% on 28rr- respir physical assessment, start O2 suppl therapy, sit upright, anticipate EKG (test IV function)

Question 46

risks for PE

Answer 46

``` Trauma Surgery Pregnancy (hormone- inc risk clotting) Heart failure Hypercoagulability- (birth control inc risk) Immobility, venous stasis (DVT) ```

Question 47

prevention/treatment PE

Answer 47

Exercises to avoid venous stasis Early ambulation Anti-embolism stockings Treatment Measures to improve respiratory and vascular status Anticoagulation and thrombolytic (prevent new clots forming) therapy Surgical interventions embolectomy- remove clotreassurance- use inferior vena cava filter (stops clots frm lwr extremities) temporary, long term anti-coagulant

Question 48

COPD def

Answer 48

COPD is a slowly progressive respiratory disease of airflow obstruction Emphysema, & chronic bronchitis Preventable and treatable but not fully reversible smoking #1 cause Involving the airways, pulmonary parenchyma, or both

Question 49

COPD patho

Answer 49

Airflow limitation is progressive, associated with abnormal inflammatory response to noxious particles or gases Chronic inflammation damages tissue Scar tissue in airways results in narrowing Scar tissue in the parenchyma decreases elastic recoil (compliance) Scar tissue in pulmonary vasculature causes thickened vessel lining and hypertrophy of smooth muscle (pulmonary hypertension)

Question 50

chronic bronchitis def

Answer 50

Cough and sputum production for at least 3 months in each of 2 consecutive years Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucous may plug airways Alveoli become damaged, fibrosed, and alveolar macrophage function diminishes The patient is more susceptible to respiratory infections Poor lung function @ baseline w/ exacerbation (accompanied w/ components COPD)

Question 51

emphysema def

Answer 51

Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli alveoli chronically expanded Decreased alveolar surface area increases in “dead space,” impaired oxygen diffusion Hypoxemia results *Increased pulmonary artery pressure (frm resistance) may cause right-sided heart failure (cor pulmonale) Elevated CO2 lvl ”pink puffers”

Question 52

COPD manif

Answer 52

``` Four primary symptoms Chronic cough Sputum production Dyspnea Wheezing Weight loss due to dyspnea specifically in emphysema “Barrel chest” A/P diameter 1:1 v 1:2 retraction supraclavicular fossa and abdomen ```

Question 53

how to diagnose COPD

Answer 53

``` Pulmonary function tests Spirometry Arterial blood gas Chest x-ray Note ability talk and complete sentences, use of accessory muscles, R sided-heart failure, enlarged neck veins, LOC (hypercapnia), tripod position ```

Question 54

COPD complications

Answer 54

``` Respiratory insufficiency and failure acute nonchronic respir failure= O2 @ home Pneumonia Chronic atelectasis Pneumothorax Cor pulmonale ```

Question 55

COPD nursing interventions

Answer 55

Promote smoking cessation Reducing risk factors hygiene, avoid lrg crowds Managing exacerbations SABA, ICS, LABA etc Providing supplemental oxygen therapy Pneumococcal vaccine Influenza vaccine Pulmonary rehabilitation

Question 56

COPD drug therapy

Answer 56

Bronchodilators, MDIs Beta-adrenergic agonists Muscarinic antagonists (anticholinergics) Combination agents Shake, use spacer, inhale, wait 5 sec then use again Prioritize bronchodil before corticosteroid Corticosteroids- rinse after use, dec risk thrush Antibiotics Mucolytics Antitussives

Question 57

COPD patient education

Answer 57

COPD- diaphragmatic breathing (blow out w/ pursed lip breathing), 88-92% O2 metered dose inhaler- check physical/ cog ability to use

Question 58

COPD goals

Answer 58

Achieving airway clearance Improving breathing pattern Improving activity tolerance

Question 59

asthma def

Answer 59

Chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucus production- reversable Inflammation leads to cough, chest tightness, wheezing, and dyspnea (Fig. 24-6) Asthma is largely reversible; spontaneously or with treatment Allergy is the strongest predisposing factor

Question 60

asthma clinical manif

Answer 60

``` Cough, dyspnea, wheezing Exacerbations Cough, productive or not Generalized wheezing Chest tightness and dyspnea Diaphoresis Tachycardia Hypoxemia and central cyanosis ```

Question 61

asthma- drug therapy

Answer 61

``` Quick-relief medications Beta2-adrenergic agonists Anticholinergics Long-acting medications Corticosteroids Long-acting beta2-adrenergic agonists Leukotriene modifiers ```

Question 62

asthma- patient ed

Answer 62

``` How to identify and avoid triggers Proper inhalation techniques How to perform peak flow monitoring How to implement an action plan When and how to seek assistance ```