Respiratory

Question 1

Pharynx and larynx issues

Answer 1

Acute pharyngitis: Inflammation of pharyngeal walls(tonsils, palate, uvula)

Peritonsillar abscess: Group A Strep

Laryngeal polyps: On vocal cords- overuse and abuse

Question 2

Acute bronchitis

Answer 2

Mainly viral cause
Can also be irritants in air, asthma

Usual assessment: Cough

Mangement: symptom relief, prevent pneumonia

High Fowler’s or whatever position is comfortable

Question 3

Pneumonia

Answer 3

Infection that inflames alveoli- may fill with liquid

Risk factors: over 65, bedrest/immobility, debilitating illness, chronic disease.

Prevention: immunization over 65\

HAP, CAP, necrotizing, aspiration, opportunistic

Viral most common

Complications: ARDS, septic shock, atelectasis

Question 4

ARDS

Answer 4

Acute Respiratory Distress Syndrome

Widespread rapid infection of lungs- commonly caused by sepsis/systemic inflammation

Shortness of breath, tachypnea, cyanosis

alveoli collapse

Question 5

Tuberculosis

Answer 5

Primary: Bacteria inhaled, get infected, inflammatory reaction

Reactivation: 2+ yrs. after initial infection

Latent: Positive skin test, asymptomatic

Assessment: Dry cough leads to productive cough, fatigue, anorexia, weight loss, night sweats.

Question 6

12 dose regimen for latent tb infection

Answer 6

Once weekly for 12 weeks

Directly observed therapy

Question 7

Directly observed therapy

Answer 7

Intensive phase: 2-3months
Medication taken under direct supervision of staff

Continuation phase: 4-6 months: blisterpack given, first dose taken under supervision

Question 8

Rib fracture treatment

Answer 8

Pain meds
Deep breathing
Coughing when you can

Question 9

Tension pneumothorax

Answer 9

Poke with needle
Chest tube

PT will be short of breath, blue and low 02 sat

Question 10

Flail chest treatment

Answer 10

Splint w/pillow on flail side

Question 11

Assessment of chest tubes

Answer 11

FOCA

Fluctuation of water seal chamber

Output

Color

Air leak

Question 12

Chest tube troubleshooting

Answer 12

DOPE

Dislodgement

Obstruction

Pneumothorax

Equipment

Question 13

Pleural drainage w/chest tubes

Answer 13

Tidal bubbling expected w/pneumothorax

Check connections for leaks

5th intercostal space, mid axillary line.

Sterile technique

Question 14

Pulmonary edema

Answer 14

Most common cause L side HF

Hear crackles-can have sudden onset

Low spO2
Dyspnea

Question 15

Asthma

Answer 15

Assessment:
Wheezing, anxiety

Risks: allergens, respiratory infection, air pollution

Asthma triad

beta blockers can trigger->bronchospasm
ACE inhibitors can cause cough

Sulfites can trigger (can be in fruits, beer, wine, vegetables)

Watch for silent chest

Question 16

Asthma triad

Answer 16

Nasal polyps

Asthma

Sensitivity to NSAIDS and aspirin

Question 17

Silent chest

Answer 17

If pt was wheezing, then sudden absence of wheeze- very bad, cannot breathe.

Life threatening, may need mechanical ventilation

Question 18

Status asthmaticus

Answer 18

Most extreme asthma attack

Hypoxia, hypercapnia, acute respiratory failure.

Unresponsive to corticosteroids and bronchodilators

Must be immediately intubated, mechanical ventilation.

Question 19

Asthma treatment

Answer 19

Main: short acting beta adrenergic (SABA- rescue drugs) bronchodilators- albuterol

Moderate to severe attack: ipratroprium (atrovent) w/SABA: AKA combivent

Frequent attacks also have to be on long term med: Inhaled corticosteroid (ICS)

Question 20

Combivent

Answer 20

SABA and irpratroprium combined.

Question 21

What asthma meds are quick relief

Answer 21

SABA, anticholinergic (ipratroprium)

Question 22

Long term asthma meds

Answer 22

Corticosteroids
Inhaled (fluticasone)
Singulair
Xolair

Question 23

Which asthma med is easiest to use and most effective

Answer 23

Nebulizers transfer more meds than MDI w/spacer

Easy to use

ex. albuterol, ipratroprium

Question 24

COPD

Answer 24

Chronic inflammation of lungs and airway.

Question 25

Chronic bronchitis

Answer 25

Couch and sputum production for at least 3 months/year in 2 consecutive years

Question 26

Emphysema

Answer 26

Destruction of alveoli w/o fibrosis. Mucus hypersecretion Air becomes trapped on inspiration=barrel shape (hyperinflation of lungs) Pulmonary HTN

Question 27

Long acting beta agonist bronchodilators

Answer 27

Symbicort(combo w/corticosteroid) Salmeterol

Question 28

Anticholinergic bronchodilators

Answer 28

Short acting: Ipratroprium Long acting: Tiotropium

Question 29

Anti inflammatory corticosteroids

Answer 29

LONG TERM: Beclomethasone Budesonide Fluticasone

Question 30

If you have meds to give for airway clearance which do you give first?

Answer 30

Bronchodilator first THEN Corticosteroid etc. Cant work if they can't get into lungs.

Question 31

Leukotriene modifiers

Answer 31

Montelukast Not for acute attack

Question 32

Cystic Fibrosis

Answer 32

Assessments/findings: Cough w/thick sputum Complications: resp failure, pneumothorax Management: Mobilize mucous, Chest physical therapy, postural drainage, nebulized saline.

Question 33

Cor pulmonale

Answer 33

Pulmonary HTN from lung disease->alveoli shrivel, blood doesnt flow to them->backs up, too much volume causes HTN Pulmonary HTN leads to R side cardiac hypertrophy due to it being harder to push.