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Flashcards in Respiratory 2 Deck (220):
1

What are the five top priorities of a patient with a broken nose?

Airway, halo test, vision test, facial xray, and crepitus

2

Why are fractured noses so dangerous?

The airway could be obstructed and it can be a potential source of infection

3

Which type of epistaxis is more serious?

Posterior bleed

4

Which patient populations are more likely to develop epistaxis?

Patients with hypertension, leukemia, and those who snort cocaine

5

Why are sinus infections so painful?

Sinus infections are accompanied by pressure because they are very small spaces to begin with

6

What is battle's sign?

A bruise behind the ear

7

Benign, grapelike clusters of mucous membranes and connective tissue

Nasal Polyps

8

How is CSF identified?

Glucose and halo tests

9

After a rhinoplasty, how often should vitals be taken?

Every 4 hours

10

What is the treatment of choice for nasal polyps?

Polypectomy

11

What is the nursing priority for patients with non-infectious URI?

Promote oxygenation by ensuring a patent airway

12

What would a posterior epistaxis look like?

Frank blood emesis

13

What interventions should be done for a patient with a broken nose?

Closed reduction, rhinoplasty, and nasosetoplasty

14

If giving two units of blood, what should also be administered?

FFP

15

What does CSF dripping from a broken nose indicate?

A skull fracture

16

What are carcinogens for nose and sinus cancer?

Wood dust, textiles, leather, flour, nickel, chromium, mustard gas and radium

17

What is dangerous about large nasal polyps?

They may obstruct the patient's airway

18

What can a bruise behand the ear signify?

A fractured skull

19

What are cancers of the nose and sinuses so rare?

Because their cells are very fast growing

20

After a rhinoplasty, what should be observed?

Edema and bleeding

21

How are cancers of the nose and sinuses usually diagnosed?

Local lymph node enlargement on the side of the tumor often alerts doctors to the problem

22

What is done for a patient with epitaxis?

Pack the nose and possible cauterization of the affected capillaries

23

What is the priority action for a patient with facial trauma?

Airway assessment

24

What are cancers of the sinuses and nose so hard to diagnose?

Because they have a slow onset and their manifestations resemble sinusitis

25

How much fluid should a patient who has just had a rhinoplasy drink?

2500 mL/day

26

If giving blood rapidly, what extra step must be taken?

Warm the blood

27

What are the priority nursing intervention for patients with epistaxis?

Make sure the airway is patent, assess for respiratory distress and tolerance of packing or tubes, humidification, oxygen, bedrest, antibiotics, and pain medication

28

What are the clinical manifestations of nasal polyps?

Obstructed nasal breathing, increased nasal discharge, and a change in voice quality

29

How should a patient who has had a rhinoplasty be positioned?

WIth the head elevated

30

How are nasal polyps managed?

Inhaled steroids

31

What are the other names of the Le Fort III fractures?

Craniofacial disjunction or floating face fracture

32

Maxillary and nasoethmoid complex fracture

Le Fort II

33

What are the manifestations of facial trauma?

Stridor, dyspnea, anxiety, hypoxia and hypercarbia, decreased O2 saturation, cyanosis, LOC, sternal retractions, and echymosis behind the ear

34

Why are wire cutters so important to have for patients with facial trauma?

Incase of vomiting

35

How are cancers of the sinuses and nose treated?

Surgical removal generally, and that may be combined with radiation

36

Breathing disruption during sleep

Obstructive sleep apnea

37

What should the diet of a patient with a facial fracture be?

High calorie, proteins, and lipids

38

What are the signs and symptoms of obstructive sleep apnea?

Excessive daytime sleepiness, inability to concentrate, and irritability

39

What interventions should be done for patients with facial fractures?

Airway assessment, anticipate need for emergency intubation, tracheotomy, cricothyroidotomy, fixed occlusion, and debridement

40

What should be assessed for patients with facial trauma?

The mechanism of injury and any injuries occuring due to bracing the fall

41

Nasoethmoid complex fracture

Le Fort I

42

What is the nonsurgical management for obstructive sleep apnea?

Change of sleep position, weight loss, and positive pressure ventilaiton

43

What are the common disorders of the larynx?

Vocal cord paralysis, vocal cord nodules and polyps, and laryngeal trauma

44

What teaching should be done for patients with facial trauma?

Use of wire cutters, sleeping with the head of the bed elevated, nutrition, and appearance

45

Interruption in airflow through the nose, mouth, pharynx, or larynx

Upper airway obstruction

46

What are the intervention for upper airway obstruction?

Assess cause and mainatain a patent airway and ventilation

47

What is the surgical management for obstructive sleep apnea?

Adenoidectomy, uvulectomy or uvulopalatopharyngoplasty

48

Why is a high protein diet so important for patients with facial trauma?

They need albumin to heal

49

What is the clinical sign of aspiraction?

Coughing after swallowing

50

Facial fracture in which the bones are completely lifted off the face and no longer attached

Le Fort III

51

What is the priority for patients with neck trauma?

Assess for and maintain patent airway

52

If a patient has a neck injury, what should immediately be done?

Stabilize the neck

53

If a patient's upper airway is obstructed, how can a patient airway be maintained?

Cricothyroidotomy, endotracheal intubation, or tracheotomy

54

What can obstruction occur from in a patient with neck trauma?

The initial injury or resultant swelling

55

What are the inital signs of head and neck cancer?

Mucous that is chronically irritated, becoming tougher, thicker, and harder to expectorate

56

What is the number one way upper airway obstruction occurs?

Foreign objects

57

What kind of lesions are seen in patients with head and neck cancer?

Leukoplakia and erythroplakia

58

What are the clinical manifestations of head and neck cancer?

lumps in the mouth, throat and neck that cause difficulty swallowing, color changes in the mouth or tongue, oral lesions, persistent, unilateral ear pain, unexplained oral bleeding, numbness of the mourth, lips, or face, change in the fit of the dentures, a burning senstation when drinking citrus or hot liquids, hoarseness or change in voice quality, persistent sore throat, SOB, and anorexia and unexplained weight loss

59

After airway, what should be assessed for a patient with neck trauma?

Carotid artery and esophagus and cervical spine injury

60

What kind of cancer cell is usually seen in head and neck injury?

Squamous cell carcinoma

61

After a laryngectomy, how can a patient communicate?

With a white board

62

What teaching should be done for a patient post laryngectomy?

Stoma care, communication, and smoking cessation

63

What should the diet of a patient post laryngectomy not include?

Spicy foods, citrus, or acidic foods

64

How is head and neck cancer treated?

Radiation therapy, chemotherapy, cordectomy, and laryngectomy

65

How can aspiration be prevented in a patient with head and neck cancer?

Sit up in chair for meals

66

Why do the signs and symptoms of head and neck cancer not appear until late?

Because there is a lot of potential space

67

What should a nurse give to a patient with radiation therapy of the throat to aleviate discomforts?

Vicous zylocaine

68

In older patients with dementia, what can be done to prevent airway obstruction?

Maintain head of bed at or above 45 degrees

69

What post operative care should be done for a patient who had a laryngectomy?

Airway maintenance and ventilation, hemorrhage, wound breakdown, pain management, nutrition, speech and language rehabilitation, and dopplar pulses on wound and reconstructed tissue

70

What causes an asthma attack?

Specific allergens, general irritants, microorganisms, aspirin, NSAIDs, exercise, and URIs

71

What are the clinical manifestations of asthma?

Audible wheezes, increased respiratory rate, increased cough, use of accessory muscles, barrel chest, long breathing cycles, cyanosis, and hypoxemia

72

In what ways does asthma occur?

Inflammation and airway hyper-responsiveness leading to bronchoconstriction

73

What laboratory assessments should be done on a patient with asthma?

ABGs

74

What would blood assessments show in a patient who had an allergic asthma attack?

There would be elevated serum eosinophil and IgE levels

75

What happens to the arterial CO2 levels of an asthma patient?

They decrease early in asthma attacks and increase later

76

Airway hyper-responsiveness leads to and over production of what?

Mucus

77

Where do the airway obstructions occur in asthma patients?

Lumen

78

What race is asthma more prevalent in?

African American

79

What is the hyper-responsiveness of asthma is cause by?

Exercise and URIs

80

What would the sputum assessment show in a patient who had an allergic asthma attack?

The sputum would have eosinophils, mucous plugs, and shed epithelial cells

81

The processes of asthma affect what part of the respiratory anatomy?

Airways only

82

When are pulmonary function tests most accurate?

When used with spirometry

83

What would happen to the arterial O2 levels of asthma levels?

They decrease during acute asthma attacks

84

What sex is asthma more common in?

Women

85

What does a yellow peak flow meter indicate?

50-79% of normal peak flow, indicates caution, may mean that respiratory airways are narrowing and additional measures may be required

86

Maximum amount of lung expansion

Forced vital capacity

87

How can a patient tell if their inhaler is full?

Float it in water

88

What do the arterial CO2 levels of an asthma patient indicate?

Poor gas exchange

89

What is the drug therapy for asthmatics based on?

It is a step category for severity and treatment

90

In what patient population does asthma increase the odds of health care use?

Obese patients

91

What interventions should be done for a patient with asthma?

Teaching for self management, use of peak flow meter twice daily, and a personal drug therapy

92

What does a green peak flow meter value indicate?

80-100% of normal peak flow, asthma is under good control

93

Drugs for asthma that change airway responsiveness to prevent asthma attacks

Preventative therapy or controller drugs

94

What three tests are done in a pulmonary function test?

Forced vital capacity, forced expiratory volume in the first second, and peak expiratory flow rate

95

Drugs used by asthmatics to stop attacks once they've started

Rescue drugs

96

Why is finding a personal drug therapy for an asthmatic patient so difficult?

Because the symptoms are not consistent

97

Besides drug therapy, what other treatments can be used for asthma?

Exercise and activity and oxygen therapy

98

How often should controller drugs be used by asthmatic patients?

Everyday, regardless of symptoms

99

What does a red peak flow meter value indicate?

Less than 50% of normal peak flow, indicates a medical emergency and severe airway narrowing may be occurring, immediate action needs to be taken

100

Why is it important that asthmatics exercise?

To promote ventilation and perfusion

101

What types of oxygen therapy are used for asthmatics?

Masks, nasal cannula, or ET Tubes

102

Why are ET tubes sometimes useless for some asthmatics?

Because even though you can intubate, you can't force the oxygen into constricted airways

103

Why is status asthmaticus so dangerous?

Because it is unrelenting, intensifies once it begins, and does not respond to common therapy

104

What is the treatment for status asthmaticus?

IV fluids, potent systemic bronchodilator, steriods, epinephrine, and oxygen

105

Severe, life-threatening, acute episode of airway obstruction

Status Asthmaticus

106

What complications can arise from stats asthmaticus?

Patient can develop pneumothorax amd cardiac/respiratory arrest

107

What part of the lung does emphysema affect?

Alveoli

108

Inflammation of the bronchi and bronchioles caused by chronic exposure to irritants

Chronic Bronchitis

109

What is COPD characterized by?

Bronchospasms and dyspnea

110

What are the clinical signs of emphysema?

Dyspnea and the need for an increased respiratory rate

111

Why does air get trapped in the lungs of a patient with emphysema?

Because of the loss of elastic recoil in the alveolar walls

112

What is the goal of COPD management?

To minimize the damage that takes place

113

What diseases does COPD include?

Emphysema and chronic bronchitis

114

What complications can arise with chronic bronchitis?

Hypoxemia, tissue anoxia, ACIDOSIS, RESPIRATORY INFECTIONS, cardia failure, cardiac dysrhythmias

115

What are the clinical signs of chronic bronchitis?

Inflammation, vasodilation, congestion, mucosal edema, and bronchospasms

116

Loss of lung elasticity and hyperinflation of the lung

Emphysema

117

What is the end result of COPD?

Respiratory failure

118

What lab studies should be done to confirm a COPD diagnosis?

ABG, sputum samples, CBC, H&H, serum electrolytes, serum AAT, chest x-ray, and PFT

119

Cor Pulmonale

Right sided CHF

120

A bubble of air in a weak area of the lung that may pop and collapse that lung

Bleb

121

What is important to teach patients with COPD about mucolytics?

They have to drink water every time they cough

122

Which type of oxygen mask is best for patients with COPD?

Venturi mask

123

What is the purpose of a serum AAT for COPD patients?

It looks for a hereditary component

124

What types of drugs can be used to treat COPD?

Beta-adrenergic agents, cholinergic antagonists, methylxanthines, corticosteroids, NSAIDs, and mucolytics

125

What interventions should be done for patients with COPD?

Improve oxygenation and reduce carbon dioxide retention, prevent weight loss, minimize anxiety, improve activity tolerance, and prevent respiratory infections

126

What serum electrolytes will be raised in a patient with COPD?

Potassium and Magnesium

127

Occurs in the absence of other lung disorders; cause unknown

Pulmonary Arterial Hypertension

128

Genetic disease affecting many organs, lethally impairing pulmonary function

Cystic Fibrosis

129

How can patients with COPD manage their dyspnea?

By resting before meals and eating 4-6 small meals a day

130

What should the diet of a patient with CF include?

High fat and protein with low carbs

131

What is the nonsurgical preventative therapy for patients with CF?

Chest physiotherapy, positive expiratory pressure, active cycle breathing technique, and exercise

132

How can COPD be managed surgically?

Lung reduction surgery

133

How does CF affect breathing?

There is an error of chloride transport, producing thick mucus with low water content; the mucus plugs up glands and leads to atrophy and organ dysfunction

134

What are the home care needs for a patient with COPD?

Long term use of oxygen and pulmonary rehabilitation

135

How can CF be prevented?

Genetic counseling

136

What breathing techniques can a patient with COPD be taught?

Pursed lip breathing to maximize the amount of air in their alveoli

137

What is the nonsurgical management for COPD?

Weight management, vitamin supplement, diabetes management, and pancreatic enzyme replacement

138

What types of surgical management are available for patients with CF?

Lung and/or pancreatic transplantation

139

What is the nonsurgical management for exacerbation therapy?

Avoid mechanical ventilation, supplemental oxygen, heliox, airway clearance techniques, drug therapy and prevention

140

What are the clinical manifestations of CF?

Malnutrition, abdominal distention, GERD, rectal prolapse, steatorrhea, DM, osteoporosis, respiratory infections, chest congestion, cough and sputum production, use of accessory muscles, increased AP diameter

141

How long does surgical management extend the life of a patients with CF?

10 to 20 years

142

Restrictive disease in which the alveoli, blood vessels, and surrounding support lung tissue thickens and stiffens, reducing gas exchange

Interstitial pulmonary diseases

143

Granulomatous disorder of unknown causes that most often affects lungs in which normally protective T-lymphocytes increase and damage lung tissue

Sarcoidosis

144

High lethal, common restrictive lung disease in which there is extensive fibrosis and scarring

Idiopathic pulmonary fibrosis

145

Caused by occupational or environmental exposure

Occupational pulmonary disease

146

What do patients with pulmonary arterial hypertension die of?

Heart failure within 2 years

147

What is the main therapy for sarcoidosis?

Corticosteroids

148

What are pharmacological interventions for patients with CF?

Warfarin therapy, calcium channel blockers, endothelin-receptor antagonists, natural and synthetic prostacyclin agents, digoxin, diuretics, and oxygen therapy

149

What is the most common manifestation in patients with interstitial pulmonary diseases?

Dyspnea

150

What are the clinical manifestations of pulmonary arterial hypertension?

Blood vessel constriction with increasing vascular resistance in the lungs

151

How can occupational pulmonary disease be prevented?

Through special respirators and adequate ventilation

152

What is the therapy for idiopathic pulmonary fibrosis?

Corticosteroids and other immunosuppressants

153

Who is pulmonary arterial hypertension more common in?

Young women

154

What exposures causes occupational pulmonary disease?

Fumes, dust, vapors, gases, bacterial/fungal antigens, allergens, and cigarette smoke

155

Leading cause of cancer deaths worldwide, this disease is caused by bronchogenic carcinomas and paraneoplastic syndromes

Lung cancer

156

What are palliative interventions for patients with lung cancer?

Oxygen therapy, drug therapy, radiation therapy, thoracentesis and pleurodesis, dyspnea, pain management, and hospice care

157

What is the first chest tube chamber for?

Collects fluid draining from the patient

158

What is the nonsurgical management for lung cancer?

Chemotherapy, targeted therapy, radiation therapy, and photodynamic therapy

159

What are the nursing interventions for after a thoractomy?

Pain management, respiratory management, and pneumonectomy care

160

Inflammation of nasal mucosa

Rhinitis

161

Why is lung cancer staged?

To assess size and extent of the disease

162

What are the clinical manifestations of rhinitis?

Headache, nasal irritation, sneezing, nasal congestion, and rhinorrhea

163

What is the second chest tube chamber for?

Water seal to prevent air from re-entering the patient's pleural space

164

What is the surgical management for lung cancer?

Lobectomy, pneumonectomy, segmentectomy, and wedge resection

165

What is the third chest tube chamber for?

Suction control of the system

166

What kind of supportive therapy can be used for patients with rhinitis?

Drinking fluids, humidification, elevate the head of the bed, and staying away from the allergen

167

Common inflammation of pharyngeal mucous membranes

Pharyngitis

168

What are the nonsurgical interventions for sinusitis?

Broad spectrum antibiotics, analgesics, decongestants, steam humidification, hot/wet packs over sinus areas, nasal saline irritants, and increased fluids

169

Screening process for group A bet-hemolytic streptococcal antigen

Rapid Antigen Test

170

What complementary therapies can be used for patients with rhinitis?

Vitamin C ad zinc

171

Inflammation/infection of tonsils and lymphatic tissues caused by contagious, airborne bacteria

Tonsillitis

172

What are the symptoms of pharyngitis?

Odynophagia, dysphagia, fever, and hyperemia

173

Inflammation of sinus mucous membranes usually caused by streptococcus pneumoniae

Sinusitis

174

What drugs are used for patients with rhinitis?

Antihistamines, leukotriene inhibitors, mast cell stabilizers, decongestants, antipyretics, and antibiotics

175

Complication of acute tonsillitis in which pus causes one-sided swelling with deviation of the uvula

Peritonsillar Abscess

176

What is the problem with using decongestants for sinusitis?

A rebound effect

177

What are the symptoms of peritonsillar abscess?

Trismus, difficulty breathing, bad breath, and swollen lymph nodes

178

How long do the results from a rapid antigen test take?

15 minutes

179

What is the surgical management for sinusitis?

Functional endoscopic sinus surgery

180

How many days are antibiotics used for patients with tonsillitis?

7-10 days

181

What is the treatment for laryngitis?

Voice rest, steam inhalation, increased fluid intake, throat lozenges, and reduce use of tobacco and alcohol

182

Inflammation of mucous membranes lining the larynx with possible edema of the vocal cords

Laryngitis

183

What are the symptoms of influenza?

Severe headache, muscle ache, fever, chills, fatigue, weakness, and anorexia

184

What type of infection is laryngitis?

Viral

185

When are antiviral agents effective?

Within 24 hours of flu symptoms

186

What is the treatment for peritonsillar abscesses?

Percutaneous needle aspiration of the abscess, antibiotics, and IV fluids

187

Which antiviral drugs treat influenza?

Oseltamivir and zanamivir

188

Highly contagious acute viral respiratory infection

Influenza

189

What are the symptoms of laryngitis?

Acute hoarseness, dry cough, difficulty swallowing, and temporary voice loss

190

What types of precautions are used for patients with pandemic influenza?

Strict isolation

191

What is the only way to differentiate between viral and bacteria pneumonia?

Chest x-rays

192

What is pneumonia triggered by?

Infectious organisms or the inhalation of irritants

193

What does the chest x-ray of bacterial pneumonia look like?

Consolidation

194

How can Ventilator-Associated Pneumonia be prevented?

Hand hygiene, oral care, and head of bed elevation

195

Excess fluid in lungs resulting from inflammatory process

Pneumonia

196

Virus infection of respiratory tract cells, triggering the inflammatory response

Severe Acute Respiratory Syndrome (SARS)

197

What are the symptoms of pneumonia?

Atelectasis, hypoxemia, a harsh, productive cough, pleuresy, and lung fractures

198

What type of pneumonia is the most common?

Nosocomial

199

What does the chest x-ray of viral pneumonia look like?

Mucus

200

What type of isolation should a patients with SARS be in?

Strict airborne isolation

201

How can the spread of SARS be prevented?

Hand washing

202

What types of isolation should a TB patient have?

Negative airflow and droplet precautions

203

What are the drug interventions for TB?

Isoniazid, rifampin, pyrazinamide, and ethambutol

204

Localized area of lung destruction caused by liquefaction necrosis, usually relate to pyogenic bacteria?

Lung Abscess

205

How is TB transmitted?

Aerosolization

206

What does a positive PPD indicate?

Exposure to TB

207

What are the clinical manifestations of TB?

Progressive fatigue, lethargy, nausea, anorexia, weight loss, irregular menses, low grade fever, night sweats, and cough with mucopurulent sputum and blood streaks

208

How is TB ruled out?

Three negative morning sputum cultures

209

Highly communicable disease caused by a mycobacterium

Pulmonary Tuberculosis

210

What is the sign of a lung abscess?

Pleuritic chest pain

211

What should the diet of a TB patient consist of?

Lots of protein

212

Why is TB incidence increased in patients with HIV?

Because they have reduced T lymphocytes

213

What does a positive PPD look at?

Induration of 10 mm or greater

214

Why is there a recent upswing of TB?

Immigration

215

What are the interventions for patients with lung abscess?

Antibiotics, drainage of abscess, and frequent mouth care

216

Collection of pus in the pleural space commonly caused by pulmonary infection, lung abscesses, and infected pleural effusions

Pulmonary Empyema

217

What interventions can be done for patients with pulmonary empyema?

Empty the empyema cavity, re-expand the lung, and control the infection

218

Bacterial infection caused by contaminated soil

Inhalation anthrax

219

What are the two stages of inhalation anthrax?

Prodromal stage and fulminant stage

220

What drugs are used for inhalation anthrax?

Ciprofloxacin, doxycycline, and amoxicillin