Respiratory diseases Flashcards

Question

Pulmonary Angiography post procedure

Answer 1

-Monitor vital signs -Avoid taking blood pressures in extremity used for injection for 24 hours -Monitor peripheral neurovascular status -Assess insertion site for bleeding -Monitor for delayed reaction to dye

Answer 2

Description Removal of fluid or air from pleural space via transthoracic aspiration

Answer 3

Pre-procedure: -Informed consent -Baseline vital signs -Ultrasound or CXR if prescribed prior to procedure -Assess coagulation studies -Positioned sitting upright, with arms & head supported by table at bedside during procedure -If client cannot sit up, client is placed lying in bed on unaffected side with HOB elevated 45 degrees -Inform client not to cough, breathe deeply, or move during the procedure

Answer 4

Monitor vital signs (check lung sounds to ensure damage to lung did not occur) Monitor respiratory status Apply a pressure dressing and assess puncture site for bleeding and crepitus (escape of air flow into tissues from lung punctured hole) Monitor for signs of pneumothorax, air embolism, and pulmonary edema

Answer 5

Include a number of different tests used to evaluate lung mechanics, gas exchange, and acid-base disturbance through spirometric measurements, lung volumes, & arterial blood gases (ABGs) ex: spirometry

Answer 6

Determine if an analgesic that may depress respiratory function is being administered Consult with physician regarding holding bronchodilators prior to testing Instruct client: -Void prior to procedure -Wear loose clothing -Remove dentures -Refrain from smoking or eating a heavy meal for 4 to 6 hours prior to the test

Answer 7

Resume normal diet & any bronchodilators and respiratory treatments that were held prior to procedure

Answer 8

Normal breath (500ml) tidal volume (volume of normal breath) inspiratory reserve volume (maximum volume you can take in past normal breath) Expiratory reserve volume (maximum volume of air you can exhale past resting expiratory level) residual volume: the amount of air remaining in the lungs after you exhale as forcefully as possible Inspiratory capacity: tidal volume +inspiratory reserve volume functional residual capacity (FRC) =expiratory reserve volume + residual volume Vital capacity VC= IRV + tidal volume + Expiratory reserve volume total lung capacity = IRV + ERV + Tidal volume + RV

Answer 9

Obstructive: normal Vital capacity (VC) but decrease in forced expiratory volume (FEV1) (air exhaled in 1 second) Restrictive: decreased Vital capacity and normal FEV1 note: FEV1 is normaly= 75- 80% of vital capacity tidal volume normall= 500ml

Answer 10

Description A percutaneous lung biopsy is performed to obtain tissue for analysis by culture or cytologic examination A needle biopsy is done to identify pulmonary lesions, changes in lung tissue, and the cause of pleural effusion

Answer 11

Informed consent NPO prior to procedure Inform client that local anesthetic will be used but that sensation of pressure during needle insertion & aspiration may be felt Administer analgesics & sedatives as prescribed

Answer 12

Monitor vital signs Apply a dressing to the biopsy site and monitor for drainage or bleeding Monitor for signs of respiratory distress, and notify physician if they occur Monitor for signs of pneumothorax and air emboli, and notify physician if they occur Prepare client for chest x-ray if prescribed

Answer 13

In the perfusion scan, blood flow to the lungs is evaluated The ventilation scan determines the patency of the pulmonary airways and detects abnormalities in ventilation you maping the airways and pulmonary structure. takes a long time, stay in a machine A radionuclide may be injected for the procedure

Answer 14

Informed consent Assess for allergies to dye, iodine, or seafood Remove jewelry from chest area Review breathing methods, which may be required during testing Establish IV access Administer sedation if prescribed Emergency resuscitation equipment available post procedure: monitor for reaction to radionuclide

Answer 15

Description: An intradermal injection used to assist in diagnosing various infectious diseases Procedure : -Use test site free of excessive body hair, dermatitis, & blemishes -Apply at upper one third of inner surface of left arm -Circle & mark injection test site -Document date, time, & test site

Answer 16

pre procedure: Determine hypersensitivity or previous reactions to skin tests Post procedure: -Instruct client Do not to scratch test site to prevent infection & abscess formation -Avoid scrubbing test site Interpret reaction at injection site 24-72 hours after Assess test site for : -Amount of induration (hard swelling) in millimeters -Presence of erythema & vesiculation (small blister-like elevations)

Answer 17

-Measures the dissolved oxygen and carbon dioxide in the arterial blood and reveals the acid-base state and how well the oxygen is being carried to the body ex: Allen Test: done before abg blood draw to ensure adequate collateral circulation in the hand if the radial artery is punctured (checks the ulnar artery ability to supply blood to the hand to make sure ABG is not getting blood from site of does not compromise flow) ended on slide 39

Answer 18

Pre-procedure: Perform Allen’s test on both wrists prior to drawing specimens Have client rest for 30 minutes prior to specimen collection Avoid suctioning prior to drawing blood gases Do not turn off oxygen unless blood gases are ordered to be drawn at room air Post-procedure: Place specimen on ice Note client’s temperature on laboratory form Note O2 & type of ventilation client is receiving on form Apply pressure to puncture site for 5-10 minutes; Longer if client on anticoagulant therapy or has bleeding disorder Transport the specimen to laboratory w/in 15 min.

Answer 19

Noninvasive test that registers oxygen saturation of client’s hemoglobin Normal = 95% - l00% After a hypoxic client uses up the readily available O2 (PaO2 on ABG testing), reserve O2 attached to the hemoglobin (SaO2), is drawn on to provide oxygen to tissues Pulse oximeter reading alerts hypoxemia before clinical signs occur, but not all the time. makes sure to still assess the patient note: Carbon monoxide can also saturate hemoglobin, its affinity is higher than 02 which can read sp02 levels as normal but the patient has hypoxic symptoms nail polish can prevent SP02 reading, cold extremities can also affect levels (reduced perfusion). COPD patients low readings are normal must have a good wave form ECG along with SP02 reading to fully asses intervention

Answer 20

Procedure: A sensor is placed on the client’s finger, toe, nose, earlobe, or forehead to measure oxygen saturation, which is then displayed on a monitor Maintain transducer at heart level Do not select an extremity with an impediment to blood flow Results lower than 9l% necessitate immediate treatment (COPD normal) If the SaO2 is below 85%, the body’s tissues have a difficult time becoming oxygenated; An SaO2 of less than 70% is life-threatening

Answer 21

Acute inflammation of parenchymal tissues functional parts = alveoli (where gas exchange occurs) & bronchioles (carry airflow) Affects 1% of population each year 4 million cases each year 12 cases per 1,000 persons per year 6th leading cause of death Most common cause of death from infectious disease

Answer 22

Most susceptible: Age: Very young & elderly Antibiotic therapy Chronic diseases: Diabetes, cardiac, respiratory, ETOHism Smoking Post-operative patients Immunosuppressed: AIDS, organ transplant, chemo Complications: Bacteremia / septicemia: May spread to brain, heart, peritoneum Empyema: Pus in pleural cavity Lung abscess: (macrophage walling) May need Incision & Drainage

Answer 23

Infectious agents by droplet inhalation Bacterial: MOST COMMON: streptococcus pneumoniaG(+), diplococcus pneumoniae G(+) Gram (+): Staphylococcus aureus, Streptococcus pyogenes gram(-): Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Haemophilus influenzae, Legionella pneumophila Viral: influenza viruses; parainfluenza; RSV; CMV (= 90% mortality) Other: Mycoplasma pneumoniae Fungal: Candida, Mucor, Aspergillus histoplasmosis, Coccidiomycosis, blastomycosis Protozoal / fungal?: Pneumocystis carinii Smoke inhalation Aspiration: food or gastric contents

Answer 24

Sicker you are and the more co morbidities you have you are more at risk and will require more medical attention Persons < 60 without co-morbidity who can be treated outpatient Persons ≥ 60 with co-morbidity who can be treated outpatient Persons with community-acquired pneumonia who require hospitalization but not ICU Persons with community-acquired pneumonia who require ICU

Answer 25

SUBJECTIVE: Lassitude & severe malaise chest pain that ↑ with inspiration, dyspnea OBJECTIVE: ↑ T (106) & shaking chills ↑ RR, use of accessory muscles, orthopnea Cough & sputum color and characteristics: Pneumococcal: purulent, rusty Staphylococcal: yellow, blood streaked Klebsiella: red gelatinous Mycoplasma: non-productive that advances to mucoid

Answer 26

Gray complexion - toxic Rales = fine insp. crackles (fluid in alveoli) Rhonchi = coarse insp/exp crackles (mucus in bronchi) ↓ breath sounds over consolidation Friction rub (pleuritic pain) Dull to percussion E🡪 A changes ↑ HR

Answer 27

Congestion: stage1) 4-24 hours Serous exudate from initial inflammatory response pours into alveoli stage 2) Red hepatization: 48 hours Extravasation of RBCs, fibrin, PMNs (WBC) into alveoli; Tissue firm & red stage 3) Gray hepatization: 72 hours – 1 week Fibrin accumulates & granulates, RBCs & PMNs start disintegrating stage 4) Resolution: 1 week – 12 days; With antibiotics resolution starts in 48 hours Enzymes lyse consolidation; Macrophages phagocytize inflammatory cells; exudate also expectorated

Answer 28

Culture & sensitivity tests (blood & sputum): To determine organism & appropriate antibiotic therapy No culture results for 48 hrs – treat empirically often with Rocephin (ceftriaxone) Pneumococcal: penicillin & cephalosporins Gram (-): gentamycin or tobramycin

Answer 29

Monitor VS: T, RR, HR Medications: Antipyretics Antibiotics Bronchodilators Observe for signs of respiratory distress Encourage cough & deep breathing Splint as needed – incentive spirometry Observe sputum Color, consistency, amount Chest PT, postural drainage, suction Oxygen therapy Pulse oximetry Position: semi-Fowler’s Activity: plan rest periods Diet: high calorie, high protein Fluids: PO 3-4 l/day & IV fluids Anxiety: encourage expression of feelings Cover nose & mouth when coughing Oral care Monitor lab studies Evaluate client responses to treatment PREVENTION: pneumococcal vaccine & stop smoking

Answer 30

Hyper-responsive, reversible form of airway disease caused by restriction in airway size from bronchospasm, chronic inflammation, and increased airway secretions Bronchial & bronchiolar narrowing from ↑ smooth muscle tone mucosal edema hypersecretion of mucus 9-12 million people in US Increasing incidence, prevalence, and mortality Most common cause of chronic illness in children < 17 years

Answer 31

EXTRINSIC ATOPIC (type I) Immediate hypersensitivity response mediated by IgE Mast cells release histamine & prostaglandins on exposure to allergens Usually have family Hx of allergies, uticaria, hay fever Usually affects children Good prognosis – complete remission in adolescence ↑ IgE, ↑ eosinophils

Answer 32

EXERCISE-INDUCED ASTHMA (EIA) 40-90% TRIGGERS: Hypocapnia, cool air with less water vapor ASA TRIAD: Delayed hypersensitivity several hours after aspirin or NSAID ingestion

Answer 33

Cold air Loss of heat & water Exercise Cause unclear Emotional upset Vagal pathways Exposure to bronchial irritants such as cigarette smoke, pollutants, gases, dust & strong odors Irritant receptors & vagal reflex

Answer 34

Exert effects through inflammatory response IgE mediated response to allergens: Dust mite & cockroach excrement Molds & mildew Animal dander

Answer 35

Early response: Immediate bronchoconstriction on exposure to inhaled irritant or antigen. Sx’s w/in 10-20 min. Recovery 60-90 min. Caused by release of chemical mediators from IgE coated mast cells on mucosa.

Answer 36

3-5 hours later, after exposure and can last to days-weeks (steroids prevent long term effects) Involves inflammation and increased airway responsiveness Caused by release of chemical mediators from mast cells, macrophages, & epithelial cells (induce migration & activation of other inflammatory cells) Produces epithelial edema and injury, changes in mucociliary function, reduced clearance of secretions, ↑ airway responsiveness

Answer 37

signs and syptoms V/Q : ventilation and perfusion mismatch Asthma: silent chest is very concerning (pending respiratory arrest) wheezing is better as at least some air is flowing

Answer 38

most frequent admitting to the hospital are kids onset by age 1, most by 4 or 5 hereditary and environmental

Answer 39

Very similar to pneumonia care pursed lip breathing : peep, keeps the alveoli open evaluate breathing, lung sounds after treatment

Answer 40

aka chronic obstructive lung disease (COLD) or chronic airway obstruction (CAO) Group of diseases that result in obstruction of airflow Includes: Chronic bronchitis: inflammation of bronchial walls Emphysema: distended, inelastic, destroyed alveoli with bronchiolar obstruction & collapse Etiologies: Air pollution, smoking, chronic respiratory infections, exposure to molds & fungi, allergic reactions

Answer 41

Inflammation of the bronchial walls with hypertrophy of the mucous goblet cells Characterized by a chronic productive cough (copious mucus) Present for at least 3 months out of year OR 2 mo/yr for 2 successive years Often have frequent and recurrent respiratory infections “Blue Bloater”

Answer 42

Cigarette smoking Inhalation of industrial gases & other toxic substances Effects: Inhibits cilia & macrophages Inflammation of major & small airways Hypertrophy of mucosal glands Excessive secretion Narrowing and smooth muscle constriction

Answer 43

Destruction of walls of alveoli Dilatation & loss of elasticity of airspaces distal to terminal bronchioles & loss of normal elastic recoil Results in air trapping with ↑ AP diameter “barrel chest” Larger airways become thinned and atrophied 🡪 become more collapsible Less prone to acute bronchitis or pneumonia but is very serious or fatal when they do get it “Pink Puffer”

Answer 44

Dyspnea even at rest Tachypnea V/Q mismatch NOT prominent d/t loss of capillaries with alveoli Cyanosis & heart failure less prominent “Pink Puffers” Usually little cough or sputum ABGs usu. normal or respiratory alkalosis d/t hyperventilation May be unable to eat – marked weight loss Hyperinflation of the lungs “barrel chest” Slowly debilitating

Respiratory diseases Flashcards

(77 cards)