respiratory Flashcards
(49 cards)
1
Q
what are oxygen administration devices?
A
- nasal cannula
- simple face mask
- venturi mask
- partial re-breather
- non re-breather
- ambu bag
- tracheostomy collar
2
Q
how do you care for a patient with a tracheostomy?
A
- determine if it is temporary or permanent
- assess breath sounds
- suction
- provide tracheostomy care
- assess skin integrity
- stabilization
3
Q
what is the primary goal with tracheostomy
A
maintain patent airway
4
Q
what are potential complications of trachs
A
- risk for infection
- risk for tissue damage
- stabilization
- cuff inflation
- suction only when needed
- importance of humidity, fluid balance, and nutrition
5
Q
what are some communication issues
A
- patients can not talk if they have a tracheostomy
- patient and family experience frustration
- use white boards, ipads, paper/pen
6
Q
what is the purpose of chest tubes
A
- removing air and fluid
- preventing drained air/fluid from returning to the pleural space
- restoring negative pressure within the pleural space to re-expand the lung
7
Q
what are parts of the chest tube drainage systems
A
- water seal chamber
- fluctuates as pressure changes with inspiration and expiration; has a 1 way-valve for air out but not in
- collection chamber
- reservoir for draining fluid
- suction control chamber
- usually at -20 cm H2O adding more fluid increases suction
8
Q
what are nursing cares of patient with chest tubes
A
- meticulous respiratory assessment
- assess position of trachea
- assess for pain control
- monitor for signs of cardiac shift/compression
- observe for signs of infection
- prevent atelectasis
- assess drainage output
- monitor for crepitus
- assess chest tube dressing
9
Q
things to keep in mind with chest tubes
A
- verify connections
- keep drainage system below level of chest
- avoid kinks in chest tube
- secure chest tube
- monitor water level and water seal
- maintain suction as presecribed
- recognize when emergency assistance is needed
10
Q
how do you manage someone with obstructive sleep apnea
A
- weight loss
- avoid alcohol consumption
- CPAP
- BiPAP
- surgical repair
11
Q
what is the most common type of larynx cancer
A
squamous cell cancer
12
Q
what are clinical manifestions and diagnostics of larynx cancer
A
- often no early sign
- hoarseness
- voice changes
- persistent cough
- unilateral throat pain or ear pain
- sensation of foreign body in throat
- neck masses
- late signs
13
Q
diagnostics of larynx cancer include
A
- history and physical
- laryngoscopy
- biopsy
- barium swallow
- CT/MRI
14
Q
medical management for patients with laryngeal cancer
A
- treatment depends on type of tumor
- staged using TNM classification
- radiation therapy
- chemotherapy or targeted therapy as an adjunct with radiation and surgery
- surgical treatment
- laser surgery
- partial laryngectomy
- total laryngectomy with or without radical neck dissection
15
Q
surgical treatment for partial laryngectomy
A
- airway remains intact
- temporary tracheostomy
- may have altered voice
- assess swallowing
16
Q
surgical treatment for total laryngectomy
A
- permanent loss of voice
- permanent tracheostomy
- risk of aspiration
- potential for stricture
17
Q
nursing care of patient with a laryngectomy… preoperative care
A
- respiratory assessment
- nutritional assessment
- expectations for voice after surgery
- planning for addressing alcoholism, nicotine withdrawal
- financial and work concern
18
Q
nursing care of patient with a laryngectomy… postoperative care
A
- decrease risk for aspiration
- maintain patent airway
- prevent infective airway clearance
- assess for impaired gas exchange
- provide nutritional therapy
- decrease infection
- promote communication
19
Q
discharge education: teaching self care
A
- tracheostomy care at home
- humidification
- stoma bib for warmth and protection
- bathing practice and water sports
- medical alert bracelet
- emergency resuscitation
- stop smoking
- psychosocial support
20
Q
what is atelectasis
A
- collapse of alveoli
- acute or chronic
- can be segmental, lobar or whole lung
- prevention is key
21
Q
preventive measures for atelectasis
A
- TCDB
- early mobilization
- incentive spirometry
- CPT
- pain management
- monitor opioid use
22
Q
what is pneumonia
A
- inflammation of the lungs
- can be bacterial, viral, or fungal
23
Q
types of pneumonia
A
- community acquired
- develops within first 48 hours of admission
- healthcare associated
- multi-drug resistance, immunocompromised, aspiration
- hospital acquired
- ventilator acquired
- occurs >48 hours after intubation
- prevention is key
24
Q
pneumococcal pneumonia
A
- approx. 18,000 older adults die each year from pneumococcal disease in the usa
- the vaccine should be administered routinely
- adults 65 and older
- anyone 2 years or older with certain chronic illnesses
25
aspiration pneumonia-which lung is more likely to be affected and why
right lung because right lower lung lobe is the most common site of infiltrate formation due to the larger caliber and more vertical orientation of the right mainstem bronchus.
26
collaborative care for patients with pneumonia-testing/diagnosis
* history and physical
* high priority-sputum and blood cultures
* obtain prior to antibiotic therapy
* chest x-ray
* CBC
* ABG
* bronchoscopy
27
management of pneumonia
* specific antibiotic therapy
* oxygenation
* nutritional support
* small, frequent meals
* nutritional supplements
* hydration-IV or PO
* fluid and electrolyte balances
* PPD to rule out TB
* analgesics
* antipyretics
* rest
* other respiratory support
* suctioning
* chest PT
* bronchodilators
28
health promotion of pneumonia
* patient education
* stop smoking
* hand washing
* identify patients at increased risk
* prevent pneumonia in hospitalized patient
* turn every 2 hours, HOB elevated, bundles for VAP, oral care
* sterile technique when suctioning
* administer antibiotics on time
* vaccinations
29
TB-mode of transmission and type of onset
* airborne
* gradual, very slow onset
30
TB symptoms
* weight loss
* persistent cough
* fever
* chills
* night sweats
* anorexia
* hemoptysis
* fatigue
31
who is at risk for tb
* immunosuppressed
* aging adults
* living in a crowded environment
* abuse of drugs and/or alcohol
* immigrants
* health care workers
32
testing/diagnosis for tb
* mantoux method
* skin test injection of purified protein derivative
* bacille calmette-guerin (BCG) injection
* will cause a positive skin test
* if have a positive TB skin test, repeated ones will also have positive though the person may not have current disease
* interferon gamma release assay (IGRA)
* blood test looking for an immune response
* quantiFERON-tb gold in tube test (QFT-GIT) and T SPOT -TB test
33
more types of testing for tb
* sputum culture (AFB smear and culture)
* confirms active tb
* need to collect 3 different sputum samples
* final culture results may take 4-6 weeks
* culture should include multi-resistant organisms
* can have false positive and false negative results
* determine latent tb from active tb
34
latent tb
* exposed to tb bacteria but not sick
* may never develop the disease
* no transmission
* positive PPD indicating exposure to tb
* normal CXR and negative sputum
* treat for latent tb and prevent active tb disease
35
medication for treatment of active tb
* initial phase or induction 1st 8 weeks
* isoniazid (INH)
* rifampin
* pyrazinamide and ethambutol
* combination meds may be prescribed
* treatment last form 6-12 months
* adherence with treatment is a major issue
* patient education
36
monitoring and follow up with tb
* must be reported to the dept. of health
* patient education
* monitor for side effects
* monitor/counsel on nutrition
* increase activity and muscle strength
* identifying community resources
* prophylactic therapy for person at risk for significant disease
37
what is COPD
* chronic obstructive pulmonary disease
* chronic bronchitis
* airway problem
* pulmonary emphysema
* alveolar problem
* other diseases
38
etiology and risk factors
* smoking causes
* stimulates excess mucus production
* coughing
* destroys ciliary function
* inflammation damages bronchiolar and alveolar walls
* other risk factors include
* second hand smoke
* air pollution
* genetics a1 antitrypsin deficiency
* leads to early onset emphysema
* aging
39
chronic obstructive bronchitis
* chronic coughing
* increased mucus production-increase in number of goblet cells
* scarring of bronchial lining-impairs ciliary function
* symptoms continue for 3 months at a time in consecutive 2 years
40
emphysema
* alveolar walls destroyed
* difficulty with expiration due to damaged alveolar
* damages causes
* blebs-pockets of air in alveolar spaces
* bullae-pockets of air in lung parenchyma
* ventilation dead space
41
COPD physical assessment findings
* increase AP diameter
* barrel chest
* decreased muscle mass in extremities
* increased muscle mass in neck
* poor hygiene, fatigue, weight loss
* wheezes
* retraction
* decreased breath sounds
* hyperinflation, trapped air
* clubbing
* color changes
* sputum production
* cor pulmonale
42
complications with COPD
* respiratory tract infections
* lead to hospitalization
* respiratory failure
* spontaneous pneumothorax
* dyspnea at night
* hypoventilation and V/Q mismatch leads to chronic hypoxia
43
goals and outcomes for copd
* improve ventilation
* facilitate removal of secretions
* treat infection
* reduce complications
* slow progression of symptoms
* promote health maintenance and client management of disease
44
management of copd multidisciplinary approach
* #1 stop smoking - improves survival
* breathing techniques
* upright position/tripod positioning
* effective coughing
* airway clearance (CPT)
* nutritional support
* pulmonary rehab-with goal to improve QOL, improve physical and emotional health
45
improve ventilation
* bronchodilators
* beta 2 adrenergic agonist
* anticholinergic agents
* combination agents
* inhaled corticosteroids
* inhaled corticosteroids with beta 2 adrenergic agonist
46
oxygen therapy
* oxygen therapy sufficient to produce a resting PaO2 of at least 60 or SaO2 90
* oxygen administration-start low and go slow
* teach safety
* no smoking
* safe storage
47
airway clearance
* bronchodilators
* pulmonary hygiene
* huff cough
* chest PT with postural drainage
48
reduce complications
* monitor for signs of acute respiratory failure, and/or pneumothorax
* DVT prophylaxis for clients who are immobile, polycythemic or dehydrated
* vaccinations
* influenza and pneumococcal
49
promote activity tolerance
* strengthen respiratory muscles
