1
Q
What is atelectasis?
A
Closure or collapse of alveoli or possibly filled with alveolar fluid.
One of the most common respiratory complications after surgery.
2
Q
What are the clinical manifestations of acute atelectasis?
A
- Tachycardia
- Tachypnea
- Pleural pain
- Central cyanosis if large areas of the lung are affected
Most common in the postoperative setting.
3
Q
What are the clinical manifestations of chronic atelectasis?
A
- Similar to acute
- Gradual onset of increasing dyspnea, cough, and sputum production
4
Q
What are common risk factors for atelectasis?
A
- Older age
- Bedrest without frequent position changes
- Recent surgery
- Lung diseases (e.g., COPD, asthma)
These factors increase the risk of developing atelectasis.
5
Q
How is atelectasis assessed and diagnosed?
A
- Increased work of breathing (WOB)
- Hypoxemia
- Decreased breath sounds and crackles over the affected area
- Chest x-ray may suggest atelectasis before clinical symptoms appear
- Pulse oximetry may be less than 90%
Assessment focuses on respiratory function.
6
Q
What is the primary goal in managing atelectasis?
A
To improve ventilation and remove secretions.
Management includes multidisciplinary approaches.
7
Q
What are the first-line measures for managing atelectasis?
A
- Frequent turning
- Early ambulation
- Lung volume expansion maneuvers
- Coughing
These interventions help to prevent and manage atelectasis.
8
Q
What does ICOUGH stand for?
A
- Incentive spirometry
- Coughing and deep breathing
- Oral care
- Understanding
- Getting out of bed x3/day
- Head-of-bed elevation
9
Q
What are management strategies for treating Atelectasis?
A
- Chest physiotherapy (CPT)
- Thoracentesis to relieve compression
- Endotracheal intubation and mechanical ventilation
10
Q
What is hypoxemia?
A
Decrease in the arterial oxygen tension in the blood.
It can lead to severe hypoxia, which is life-threatening.
11
Q
What is hypoxia?
A
decrease in oxygen supply to the tissues and cells that can also be caused by problems outside the respiratory system
12
Q
What is chest percussion?
A
carried out by cupping the hands and lightly striking the chest wall in a rhythmic fashion over the lung segment to be drained
13
Q
What is chest vibration?
A
technique of applying manual compression and tremor to the chest wall during the exhalation phase of respiration
14
Q
What does postural drainage do?
A
Allows the force of gravity to assist in the removal of bronchial secretions.
Helps prevent or relieve bronchial obstruction caused by secretions.
15
Q
How does posterior drainage prevent or relieve bronchial obstruction?
A
Secretions drain from the affected bronchioles into the bronchi and trachea and are removed by coughing or suctioning to relieve bronchial obstruction
16
Q
What is influenza?
A
Highly contagious respiratory illness caused by a virus.
Flu season typically peaks from September to April.
17
Q
What are the three serotypes of influenza?
A
- A
- B
- C
Only types A and B cause significant illness in humans.
18
Q
What is the most common and virulent serotype of influenza?
A
Influenza A.
It is the most virulent and can cause pandemics.
19
Q
What are the two types of subtypes of Influenza A?
A
(H) Hemagglutinin: Allows virus to enter cell
(N) Neuraminidase: Facilities cell to cell transmission
20
Q
What is the incubation period for influenza?
A
1-4 days.
Peak transmission occurs one day before symptoms appear.
21
Q
What is the peak transmission period for influenza?
A
One day before symptoms appear and continues for 5-7 days after first appearing ill
22
Q
What is CURB-65 used for?
A
To aid in the decision to hospitalize pneumonia patients.
Each item on the scale is worth one point.
23
Q
What does CURB-65 stand for?
A
- Confusion
- BUN > 19 mg/dL (> 7 mmol/L)
- Respiratory Rate ≥ 30
- Systolic BP < 90 or Diastolic BP ≤ 60
- Age ≥ 65
24
Q
What are common clinical manifestations of influenza?
A
- Abrupt onset
- Fever/chills
- Myalgia (general aches)
- Headache
- Sore throat
- Fatigue
Symptoms typically subside within 7 days.
25
What diagnostic tests are used for influenza?
* Health history
* Viral cultures
* RT-PCR
* Rapid influenza diagnostic test
## Footnote
RT-PCR is more accurate but takes longer to process.
26
What is the best strategy for preventing influenza?
Influenza vaccine.
## Footnote
Best received before exposure.
27
Who is the Trivalent Inactivated Influenza vaccine (TIV) approved for?
* Anyone over 6 months of age
* Pregnant women
* Immunocompromised persons
* Residents of nursing homes
28
What are common side effects of the Trivalent Inactivated Influenza vaccine (TIV)?
* Fatigue
* Low-grade fever
* Headache
* Injection site reactions
## Footnote
Approved for anyone over 6 months of age.
29
How is the live attenuated influenza vaccines (LSIV) administered?
Nasally
30
Who is the live attenuated influenza vaccines (LSIV) NOT given to?
* Persons known to be immunocompromised
* Children/adolescents receiving ASA or salicylates
31
What are common side effects of the live attenuated influenza vaccines (LSIV)?
* Runny nose/congestion
* Sore throat in adults
* Fever in children (2-6 y/o)
32
What are common complications of Influenza?
* Pneumonia (PNA)
* Ear or sinus infection
* Dehydration (particularly in older adults)
33
What is pneumonia?
Acute infection of lung parenchyma associated with significant morbidity and mortality rates.
## Footnote
Pneumonia and influenza are leading causes of death from infectious diseases.
34
What causes pneumonia?
Mucociliary mechanism impaired by:
* Pollution
* Cigarette smoking
* Upper respiratory infections
* Tracheal intubation
* Aging
35
What are common risk factors for pneumonia?
* Smoking/ETOH
* Immunosuppression
* HF, COPD, DM, flu
* Prolonged immobility
* NGT, OGT, or ETT placement
* Older
## Footnote
These factors increase susceptibility to pneumonia.
36
What are the types of pneumonia?
* Community-acquired pneumonia (CAP)
* Hospital-acquired pneumonia (HAP)
* Ventilator-associated pneumonia (VAP)
* Aspiration pneumonia
* COVID pneumonia
## Footnote
Classification is based on where the infection was acquired.
37
What are clinical manifestations of pneumonia?
Sudden onset of chills, fever, pleuritic chest pain, tachypnea, respiratory distress
38
What are diagnostic tools for pneumonia?
* H&P
* Chest X-ray
* CBC (WBC > 15,00 with presence of bands)
* Sputum analysis
* Bronchoscopy
39
What are possible complications of pneumonia?
* Atelectasis
* Pleurisy (inflammation of lining of the lungs)
* Pleural effusion
* Pneumothorax
* Meningitis
* Acute respiratory failure
* Sepsis
## Footnote
These complications can arise from pneumonia.
40
What is tracheostomy?
Surgically created stoma used to establish a patent airway, bypass airway obstruction, facilitate secretion removal, or permit long-term mechanical ventilation.
## Footnote
It is a critical procedure in respiratory management.
41
What are the advantages of a tracheostomy over an endotracheal tube?
* Easier to keep clean
* Better oral and bronchial hygiene
* Increased patient comfort
* Less risk of long-term damage to vocal cords
## Footnote
These benefits make tracheostomy preferable in certain situations.
42
What are the indications for a Tracheostomy?
* Laryngeal Cancer
* Prolonged ventilator dependence
* Upper airway obstruction
* Neuromuscular Disease
43
Techniques to promote speech with a tracheostomy
* Spontaneously breathing patient may deflate cuff, allowing exhaled air to flow over vocal cords
* Specialized tracheostomy tubes (Fenestrated)
* Speaking valves (Passy Muir)
44
What do you do for accidental dislodgement of a tracheostomy?
* Call for help
* Use a bag-valve mask device to ventilate patient through the upper airway.
* Ventilate gently to prevent air escaping through the stoma
* Provider or specially trained RT will likely intubate the patient orally unless the stoma is mature and easily visualized (rare)
45
What is upper airway obstruction?
A blockage that prevents airflow through the upper respiratory tract.
46
What is a possible complication of neuromuscular disease?
Swallowing dysfunction.
47
What is the purpose of an inflated cuff in tracheostomy?
To prevent aspiration and maintain ventilation.
48
What is the clinical assessment for swallowing ability and aspiration risk?
Evaluation of patient’s ability to swallow safely and avoid aspiration.
49
What dietary modifications may be necessary for patients with swallowing dysfunction?
May require soft food initially or ADAT (as tolerated).
50
What is the primary care provider's decision regarding cuff management?
Leave cuff deflated or replace with a cuffless tube if no aspiration risk.
51
When should a tracheostomy tube be removed?
When the patient no longer requires ventilatory support and can protect their airway.
52
What happens after the tracheostomy tube is removed?
An occlusive dressing is placed over the stoma, which self heals over time.
53
What is NPO until swallowing is evaluated?
Patients are not allowed to eat or drink until their swallowing ability is assessed.
54
What should be encouraged hourly after tracheostomy tube removal?
Turn, cough, deep breathe (T,C, DB) and use of the incentive spirometer (IS).
55
What is involved in nursing management of tracheostomy?
Frequent monitoring of lung sounds, SpO2, suctioning, cuff pressure, humidification, and patient education.
56
What are the nursing management goals for a tracheostomy patient?
Maintain patency, provide communication means, and educate on daily care.
57
What is a spontaneous breathing trial (SBT)?
A test for ventilatory weaning from mechanical support.
58
What are the dangers of accidental dislodgement of a tracheostomy tube?
Most dangerous in the first 5-7 days; requires immediate action.
59
What should be at the bedside in case of accidental dislodgement?
A complete replacement tube.
60
What is tuberculosis (TB)?
An infectious disease caused by Mycobacterium tuberculosis.
61
What are common risk factors for TB?
* Homeless
* Residents of inner-city neighborhoods
* Foreign-born persons
* Health care workers
* IV drug users
* Immunosuppressed individuals
62
What are the clinical manifestations of pulmonary TB?
Initial dry cough, fatigue, malaise, anorexia, weight loss, low-grade fever, night sweats
63
How is TB transmitted?
* Requires close, frequent, or prolonged exposure
* NOT spread by touching, sharing food, kissing, or other physical contact
64
What is the Tuberculin Skin Test (TST) also known as?
Mantoux test.
65
What indicates a positive TST result?
Induration at the injection site.
66
What are the four-drug regimen components for active TB treatment?
* Isoniazid
* Rifampin
* Pyrazinamide
* Ethambutol
67
What are common side effects of Isoniazid?
Peripheral neuritis, hepatic enzyme elevation, hepatitis, hypersensitivity
68
Nursing considerations for Isoniazid
Monitor AST and ALT
69
What are common side effects of Rifampin?
Hepatitis, febrile reaction, purpura (rare), nausea, vomiting
70
Nursing considerations for Rifampin
* Bactericidal
* Orange urine and other body secretions
* Discoloring of contact lenses
* Monitor AST and ALT
71
What are common side effects of Pyrazinamide?
Hyperuricemia, hepatotoxicity, skin rash, arthralgias, GI distress
72
What are nursing considerations for Pyrazinamide?
* Bactericidal
* Monitor uric acid, AST, and ALT
73
What are common side effects Ethambutol?
Optic neuritis (may lead to blindness; very rare at 15 mg/kg), skin rash
74
What are nursing considerations for Ethambutol?
* Bacteriostatic
* Use with caution with renal disease or when eye testing is not feasible. Monitor visual acuity, color, and discrimination
75
What is directly observed therapy (DOT)?
A strategy to ensure adherence to TB medication by observing the patient swallow their drugs.
76
What is the significance of compliance in TB treatment?
Noncompliance leads to multidrug resistance and treatment failures.
77
What should patients with latent TB infection be treated with?
Isoniazid for 6 to 9 months.
78
What are the two phases of treatment for active TB disease?
* Initial phase (8 weeks)
* Continuation phase (18 weeks)
79
What are common nursing implementations for patients with TB?
* Airborne isolation
* Teaching prevention techniques
* Emphasizing medication compliance
80
How is Chronic Obstructive Pulmonary Disease
(COPD) defined?
Chronic inflammation found in the airways, lung parenchyma, & pulmonary blood vessels causing airflow limitation (air trapping) that is not fully reversible
81
What are the clinical manifestations of COPD?
* Chronic cough
* Sputum production
* Dyspnea
* Wheezing
* Weight loss
82
What are common risk factors of COPD?
* Cigarette smoking
* Occupational chemicals & dust
* Air pollution
* Severe recurring respiratory infections
* α1-antitrypsin deficiency (suspected cause for non-smoke exposure development)
* Low socioeconomic status
83
How does nicotine affect COPD?
* Stimulates SNS
* Decreases amount of functional hemoglobin
* Increases platelet aggregation
* Compounds problems in CAD
84
How does smoking affect the respiratory tract?
* Hyperplasia of goblet cells
* Lost or decreased ciliary activity
* Abnormal distal dilation & destruction of alveoli
* Chronic, enhanced inflammation
* Increased carbon monoxide levels
85
What is the effect of increased carbon monoxide levels caused by smoking?
* Decreases O2 carrying capacity
* Increases HR
* Impaired psychomotor performance and judgement
* Hgb has a high affinity for CO
86
What is the primary cause of COPD?
Cigarette smoking and exposure to noxious particles.
87
What are the two main components of COPD?
* Chronic bronchitis
* Emphysema
88
What is chronic bronchitis defined by?
Presence of cough with sputum production for at least 3 months in each of 2 consecutive years.
89
What is chronic bronchitis?
Excessive mucous production resulting in chronic productive cough
90
What causes chronic bronchitis?
* increased number of mucus-secreting goblet cells
* enlarged submucosal glands
* dysfunction of cilia
* stimulation from inflammatory mediators
91
What is emphysema characterized by?
Abnormal distention of airspaces and destruction of alveolar walls results in an increase in dead space, impaired oxygen diffusion, leading to hypoxemia and hypercapnia
92
What is the significance of FEV1/FVC ratio in COPD diagnosis?
A ratio of less than 70% indicates airflow limitation.
93
What are the effects of aging on the respiratory system?
* Loss of elastic recoil
* Stiffening of chest wall
* Decreased exercise tolerance
* Lungs become rounder and smaller
* Number of functional alveoli decreases
94
What is the treatment for patients with primary emphysema?
Focus on managing airflow limitations and improving oxygenation.
95
What is the treatment for patients with primary bronchitis?
Focus on managing mucus production and improving airflow.
96
What is the VC Ratio formula?
VC Ratio = FEV1 / FVC
## Footnote
Where FVC = Forced Vital Capacity and FEV1 = Forced Expiratory Volume in 1 second.
97
What are the grades of Chronic Obstructive Pulmonary Disease (COPD)?
* Grade I: Mild
* Grade II: Moderate
* Grade III: Severe
* Grade IV: Very severe
98
What defines Grade I COPD?
FEV1/FVC < 70% and FEV1 ≥ 80% predicted
99
What defines Grade II COPD?
FEV1/FVC < 70% and FEV1 50–80% predicted
100
What defines Grade III COPD?
FEV1/FVC < 70% and FEV1 < 30–50% predicted
101
What defines Grade IV COPD?
FEV1/FVC < 70% and FEV1 < 30% predicted
102
List some complications of COPD.
* Exacerbations
* Respiratory Insufficiency
* Respiratory Failure
* Pulmonary Hypertension (PH)
* Cor Pulmonale
* Pneumonia (PNA)
103
What is Cor Pulmonale?
Hypertrophy/dilation of the right side of the heart due to pulmonary arterial hypertension (PAH)
104
What are clinical manifestations of Cor Pulmonale?
* Dyspnea
* JVD
* Hepatomegaly (enlarged liver)
* Peripheral edema
* Weight gain
105
What are the diagnostics for Cor Pulmonale?
* CXR
* Right-sided cardiac catheterization (gold standard)
* Echocardiogram
* BNP levels
106
What is the treatment for Cor Pulmonale?
* Treat underlying cause
* Prescription medications to decrease BP
* Diuretics
* Continuous low-flow oxygen
107
What characterizes COPD exacerbations?
Sudden worsening of COPD symptoms typically lasting several days
108
What are primary causes of COPD exacerbations?
* Bacterial infections
* Viral infections
109
What are signs of severity in COPD exacerbations?
* Use of accessory muscles
* Central cyanosis
110
What treatments are used for COPD exacerbations?
* Short-acting bronchodilators
* Oral systemic corticosteroids
* Antibiotics
* Supplemental oxygen therapy
111
What can cause Acute Respiratory Failure in COPD?
* Exacerbations
* Delays in contacting healthcare
* Discontinuing bronchodilator or corticosteroid medication
* Overuse of sedatives
112
What should be assessed in COPD patients regarding mental health?
Assess feelings, ADLs, and family coping
113
What drugs are used to treat COPD?
Bronchodilators and Corticosteroids
114
What is the recommended dietary approach for COPD patients?
* High-calorie, high-protein diet
* Eat five to six small meals
* Avoid foods that require a lot of chewing
115
What is the goal of COPD oxygen therapy?
Keep O2 saturation > 90% during rest, sleep, and exertion
116
What are the two types of oxygen delivery systems?
* High-flow
* Low-flow
117
What complications can arise from oxygen therapy?
* Combustion
* CO2 narcosis
* O2 toxicity
* Absorption atelectasis
* Infection
118
What is the purpose of respiratory and physical therapy in COPD?
* Breathing retraining
* Airway clearance devices
* Chest physiotherapy
119
What is the purpose of airway clearance devices for COPD?
* Provide positive expiratory pressure (PEP) treatment
* Produces vibration in lungs to loosen mucus for expectoration
120
How is a Flutter airway clearance devices used?
Patient must be upright, and the angle at which the Flutter is held is critical
121
How is an Acapella airway clearance device used?
can be used in virtually any setting, as patients are free to sit, stand, or recline. The patient may also inhale through it, and nebulizers can be attached to the Acapella
122
What is Lung Volume Reduction Surgery (LVRS)?
Surgical removal of diseased lung to enhance performance of remaining healthy lung tissue
123
What is Bronchoscopic lung volume reduction surgery (BLVR)?
One-way valves are placed in the airways leading to the diseased parts of the lung
124
What is a Bullectomy?
one or more large bullae (large air sacs that form from destroyed alveoli) are removed to improve lung function
125
What is noninvasive positive-pressure ventilation?
Can be given via facemasks that cover the nose and mouth, nasal masks, or other oral or nasal devices
126
What is positive end-expiratory pressure (PEEP)?
pressure in the alveoli above atmospheric pressure at the end of expiration
127
What is Continuous positive airway pressure (CPAP)?
way of delivering PEEP but also maintains the set pressure throughout the respiratory cycle, during both inspiration and expiration
128
What is Bilevel positive airway pressure (BiPAP)?
On inspiration, machines deliver more air pressure. On expiration, the machine reduces the air pressure.
129
What is the primary cause of lung cancer?
Smoking is the most important risk factor in 85% to 90% of lung cancers
130
What is the classification of primary lung cancers?
* Small-cell lung cancer (SCLC)
* Non-small-cell lung cancer (NSCLC)
131
What are the types of Non-Small-Cell Lung Cancer (NSCLC)?
* Squamous cell carcinoma
* Adenocarcinoma
* Large-cell carcinoma
132
What are common clinical manifestations of lung cancer?
* Dyspnea
* Hemoptysis
* Chest or shoulder pain
* Pneumonia that does not respond to treatment
* Persistent cough with sputum
133
What are diagnostic tests for lung cancer?
* Chest x-ray (initial)
* CT (location and extent)
* Fiberoptic bronchoscopy
* PET scan
* Lung biopsy
134
What does the TNM system stand for in non-small cell lung cancer staging?
* T: Tumor size and location
* N: Extent of lymph node invasion
* M: Presence/absence of metastases
135
Why is the TNM scale not useful for small-cell lung cancer?
* Aggressive cancer that is always considered systemic
* Staged as limited or extensive
136
What are the surgical procedures used in lung cancer treatment?
* Pneumonectomy
* Lobectomy
* Segmental or wedge resection
* VATS (video assisted thoracic surgery)
137
What is pneumoectomy?
removal of one entire lung
138
What is a lobectomy?
Removal of one or more lobes of the lung
139
What is the prognosis for Small-Cell Lung Cancer (SCLC)?
Poor prognosis due to rapid growth and early metastasis
140
What is video-assisted thoracoscopy surgery used for?
To treat lung cancers near the outside of the lung
## Footnote
This minimally invasive procedure allows for better recovery and less pain.
141
What are the purposes of radiation therapy?
* Curative therapy
* Palliative therapy
* Adjuvant therapy
* Preoperative therapy to reduce tumor mass
## Footnote
Radiation therapy can be used to alleviate symptoms such as dyspnea and pain.
142
What is Stereotactic Radiotherapy (SBRT)?
High dose of radiation accurately delivered to tumor
## Footnote
It involves focused radiation beams targeting a well-defined tumor with minimal exposure to healthy lung tissue.
143
What is the primary treatment for small cell lung cancer?
Chemotherapy
144
What does immunotherapy target?
* Programmed cell death proteins such as PD-1 or PD-L1 on T cells
* Prevent T cells from attacking other cells in the body
* T cells are able to mount a better immune response against the tumor cells
## Footnote
This helps T cells mount a better immune response against tumor cells.
145
What are some components of palliative care?
* Radiation therapy to shrink tumors
* Bronchoscopic interventions
* Pain management
* Hospice care evaluation
## Footnote
The goal is to provide comfort and improve the quality of life.
146
What is important in planning for end-of-life care?
Evaluation and referral for hospice care
## Footnote
This ensures a dignified end-of-life experience for patients and families.
147
What psychological aspect is important in lung cancer treatment?
Psychological support
## Footnote
This is crucial due to the poor prognosis and rapid progression of the disease.
148
What is a key consideration in post-operative management?
Frequent VS monitoring
## Footnote
VS stands for vital signs, which need to be monitored closely after surgery.
149
What are some respiratory related post-operative complications?
* Respiratory failure
* Pulmonary edema
* Arrhythmias
* Shock
* Infection
* Pneumothorax
* Hemothorax
## Footnote
Monitoring for these complications is critical for patient recovery.
150
What are the overall goals of lung cancer treatment?
* Effective breathing pattern
* Adequate airway clearance
* Adequate oxygenation of tissues
* Minimal to no discomfort
* Realistic attitude about treatment and prognosis
## Footnote
These goals help improve the patient's quality of life.
MedSurg
flashcards
Decks in class (16)
# Cards
-
Gastrointestinal50
-
Infectious Disease41
-
Perioperative Care46
-
Fluid and Electrolytes57
-
Cardiovascular105
-
Genitourinary64
-
Diabetes Management51
-
Endocrine62
-
Substance Use Disorders50
-
Respiratory150
-
Obesity51
-
Hepatic58
-
Hearing and Vision Disorders69
-
Musculoskeletal108
-
Oncologic Disorders65
-
Neurologic106
