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Flashcards in Respiratory Disorders Deck (105):
1

Airway Resistance

Constriction -- Wheezing

Thickening of mucosa -- Inflammation

Obstruction of the airway -- Mucus

Loss of lung elasticity -- food, tumor, emphysema

2

Pulmonary Function Testing Purpose

Determine the function of the respiratory system

3

Pulmonary Function Testing Assessment

Flow of inspiration/expiration, medical diagnoses, how much air the lungs can hold

4

Pulmonary Function Testing Patient Preparation

Assess for analgesic use, assess for bronchodilators, tell patient not to smoke, have patient empty bladder, remove dentures, do not eat a heavy meal 4-6 hours prior

5

Total Lung Capacity

Volume in lungs after maximal inhalation

6

Normal pH of Human Blood

7.35-7.45

7

Respiratory Alkalosis

pH is increased

Headache, lightheadedness, vertigo, mental status changes, paresthesia, hypokalemia, hypocalcemia, tetany, convulsions

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Nursing Interventions of Respiratory Alkalosis

Maintain airway

Emotional support

Encourage appropriate breathing pattern

Monitor ventilator

Monitor potassium and calcium medications

9

Respiratory Acidosis

pH is decreased

More common

Post-op, atelectasis, depression of respiratory status, brain trauma

10

Respiratory Acidosis Signs and Symptoms

Visual disturbances, diaphoresis, cyanosis, hyperkalemia, rapid pulse, dysrhythmia, hypoventilation, mental status change

11

Nursing Interventions of Respiratory Acidosis

Airway, monitor for respiratory distress

Oxygen administration, Semi-Fowlers, TCDB

Hydration, suction

Monitor for electrolytes (especially potassium)

Antibiotics, bronchodilators

12

Pulse Oximetry

SpO2 less than 70% is life-threatening

13

FiO2

Fraction of inspired oxygen

14

Nasal Cannula

Low to moderate concentration (1-6 L) of oxygen, safe and simple, easy to control, allows mobility

Easily dislodged, skin breakdown, mouth breathing makes it useless

15

Face Mask

40-60% FiO2, 5-8 L

High skin breakdown potential, unable to eat, hot, good for mouth breathers

16

CPAP

Continuous positive airway pressure

Used for sleep apnea

17

BiPap-Bilevel Therapy

Low pressure on exhalation, high pressure on inhalation

Adjusts the pressure

18

Postural Drainage

Do not perform if they are bleeding

19

Allergic Rhinitis and Allergic Conjunctivitis

Hay Fever

Caused by antigen/antibody reactions --> increased secretions, decreased ciliary response, and increased capillary permeability

Can lead to secondary bacterial infection

20

Diagnostic Testing of Hay Fever

Interview, observation

21

Signs and Symptoms of Hay Fever

Similar to a cold, photophobia, tearing, blurry vision, itchy eyes, swelling of the eyes, inflammation and clear colorless drainage, can't breathe through the nose, ears full, sneezing, coughing, headache, nosebleeds

22

Treatment of Hay Fever

Antihistamines, decongestants (not long term), corticosteroids, analgesics

Avoid the allergen

Hot packs over facial sinuses

23

Acute Rhinitis

Common cold

Characterized by edema, swelling of the nasal mucosa

Viral in origin

24

Signs and Symptoms of Acute Rhinitis

Thin, serous nasal exudates

Productive cough

Sore throat, fever

Muscle aches, fatigue and loss of appetite

Dyspnea, congestion

Red and swollen throat

25

Treatment of Acute Rhinitis

Monitor vital signs, especially temperature

Analgesics, antipyretics, cough suppressants, expectorants, antibiotics (if infection is present)

Encourage fluids and rest

Humidification

26

Sinusitis

Upper respiratory infection, drainage occlusion

Can be viral, bacterial, or fungal

27

Signs and Symptoms of Sinusitis

Constant, severe headache

Purulent exudate

Malaise, fatigue

Fever

Anorexia due to decreased sense of smell

Facial congestion with edematous eyelids

Throat irritation due to postnasal drip

28

Treatment of Sinusitis

Saline and nasal irrigation to rinse irritants

Nasal corticosteroids to fight inflammation

Oral or injected corticosteroids (only if severe)

Decongestants (only for a few days)

Antibiotics

Analgesics

Surgery (polypectomy)

Vaporizers, moist pack, increase the head of the bed, rest, fluids

29

Complications of Sinusitis

Can spread to cause meningitis, osteomyelitis, septicemia

30

Acute Pharyngitis

Pharynx is inflamed

May be viral or bacterial

31

Signs and Symptoms of Acute Pharyngitis

Fever

Dry cough

Tender, enlarged tonsils with exudate

Enlarged cervical lymph glands

Red, sore throat (scratchy --> severe)

Dysphagia due to severe pain

32

Diagnosis of Pharyngitis

Rapid strep screen (2 swabs)

33

Treatment of Pharyngitis

Antibiotics, analgesics, antipyretics

Educate on antibiotics, gargle with salt water, encourage fluids, popsicles, rest, vaporizer, oral hygiene, monitor input and output and temperature

34

Complications of Pharyngitis

Can lead to rheumatic fever, otitis media, sinusitis, and/or glomerulonephritis

35

Chronic Pharyngitis

Caused by irritants, smoking, chronic alcohol ingestion, respiratory/cardio diseases

36

Signs and Symptoms of Chronic Pharyngitis

Irritated throat, increased mucus, cough, dysphagia

37

Treatment of Chronic Pharyngitis

Avoid irritant, treat underlying conditions, antihistamines, analgesics, lozenges, hydration

38

Acute Follicular Tonsillitis

Inflammation of the tonsils caused by airborne, foodborne, viral, or bacterial (strep) means

39

Signs and Symptoms of Acute Follicular Tonsillitis

Sore throat

Fever, chills, anorexia

Hypertrophied, purulent tonsils

Enlarged, tender cervical lymph nodes

Muscle aches, malaise

Elevated WBCs

40

Diagnosis of Tonsillitis

Throat swab, observation

41

Treatment of Tonsillitis

Warm saline gargles

Tonsillectomy for recurrent tonsillitis

Oral care to decrease risk of infection

42

Complications of Tonsillitis

Peritonsillar abscess

Nephritis

Rheumatic fever

Carditis

43

Peritonsillar Abscess

Caused by tonsillitis

44

Signs and Symptoms for Peritonsillar Abscess

Increasing pain

Difficulty swallowing

Thick secretions

Swollen soft palate

45

Treatment of Peritonsillar Abscess

Surgery and antibiotics

46

Tonsillectomy and Adenoidectomy

Performed on patients with repeated infections

Performed 4-6 weeks after acute infection

Screen for recent illnesses during Pre-Op

47

Postoperative Tonsillectomy and Adenoidectomy

Hemostasis is most important

Assess swallowing of blood, dripping of blood

Keep head up and slightly tilted to the side

Ice to vasoconstrict and decrease pain impulses

Nutrition should consist of cold liquids, IV, and avoid spicy foods

Avoid coughing, sneezing, nose blowing, and overexertion

Call if increased pain, fever, or bleeding

Hematemesis should be dark, not bright red

48

Laryngitis

Secondary to respiratory infection, may lead to respiratory distress

Caused by infection, abuse of vocal cords, inhalation of irritating fumes

49

Signs and Symptoms of Laryngitis

Hoarseness, voice loss

Scratchy and irritated throat

Persistent cough

50

Diagnosis of Laryngitis

Laryngoscope, edema, drainage, redness

51

Treatment of Laryngitis

If viral, wait it out

If bacterial, use antibiotics

Limit use of voice

Warm or cool mist vaporizer

Analgesics

Limit causes

Rest voice

Increase humidity and fluids

52

Acute Bronchitis

Inflammation of the trachea/bronchial tree

53

Signs and Symptoms of Acute Bronchitis

Productive cough, wheezes

Dyspnea and chest pain

Low-grade fever

Malaise, headache

54

Treatment of Acute Bronchitis

Cough suppressants, antipyretics, analgesics, bronchodilators

Vaporizers

Encourage fluids and bedrest

Monitor vital signs

55

Severe Acute Respiratory Syndrome (SARS)

Infection caused by the coronavirus

Spread through contact or airborne

56

Signs and Symptoms of SARS

Temperature above 100.4 degrees, headache, aches

After 2-7 days: cough, shortness of breath, difficulty breathing, hypoxia

57

Diagnostic Tests for SARS

Chest radiograph

Serum antibody testing, tissue cultures

Nasopharyngeal and oropharyngeal swabs

History of travel within 10 days of onset

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Treatment of SARS

Oxygen, respiratory isolation, corticosteroids, antiviral medications

MUST NOTIFY THE PUBLIC HEALTH DEPARTMENT

59

Causes of Pneumonia

Infection (viral, bacterial, fungal)

Oversedation (hypostatic pneumonia, TCDB to prevent, get them up or into sitting position)

Aspiration (stroke, impaired swallowing, alcoholics, GERD)

60

Classifications of Pneumonia

Lobar

Bronchopneumonia

Interstitial

61

Signs and Symptoms of Pneumonia

Productive cough, chest pain (bacterial), painful cough (bacterial), rusty sputum (bacterial), fever, chills, increased HR and RR, shallow breaths, cyanosis

Viral is less severe, "walking"

Bacterial is acute and serious

62

Diagnosis of Pneumonia

Sputum culture, chest x-ray, WBC

63

Treatment of Pneumonia

Antibiotics, codeine, analgesics, bronchodilators, TCDB, Semi-Fowler's position, splinting, vaccinations

64

Complications of Pneumonia

Death, atelectasis, pleural effusion, pericarditis, meningitis, heart failure

65

Atelectasis

Collapse of the lung tissue related to occlusion of airways

Ventilation/Perfusion mismatch, pressure on the lungs, shallow breathing, abdominal pressure

66

Treatment of Atelectasis

Bronchodilators, mucolytic agents, antibiotics, analgesics

TCDB, early ambulation

Respiratory treatments (incentive spirometry, intermittent positive-pressure breathing, oxygen, chest percussion and postural drainage)

Chest tube

67

Pneumothorax

Air in the thoracic cavity that affects the lungs' normal negative-pressure breathing

Caused by trauma, rupture

68

Signs and Symptoms of Pneumothorax

Decreased breath sounds, sharp chest pain with dyspnea, diaphoresis, tachycardia, tachypnea, no chest movement on affected side, sucking chest wound

69

Diagnosis of Pneumothorax

Signs and symptoms, chest x-ray

70

Treatment of Pneumothorax

Chest tube to water-seal drainage system, oxygen, analgesics

71

Chest Tube Purpose

Continuously drains fluid, blood, or air in the chest cavity

Sutured in place

72

Nursing Interventions for Chest Tubes

Monitor VS, pain, lung sounds

Assess for subcutaneous emphysema (crunchy on palpation)

Monitor patency of tube, keep below the level of the chest

TCDB, tape connections

73

Lung Cancer

Malignant tumor/tumors anywhere inside the lung

Caused by smoking, occupational hazards, genetics

74

Signs and Symptoms of Lung Cancer

Cough, hemoptysis

Dyspnea, wheezing, hoarseness

Chest pain

Fever, chills, repeated URI

Pleural effusion

Fatigue, anorexia, weight loss

75

Diagnosis of Lung Cancer

Biopsy, CT scan, bronchoscopy

76

Treatment of Lung Cancer

Depends on the stage

Surgery, thoracotomy, segmental resection, lobectomy, pneumonectomy (no chest tube afterwards)

Radiation, chemotherapy

77

Pre-Op Interventions for Lung Cancer

Encourage, educate, VS, monitor tracheal deviation, pain meds

78

Post-Op Interventions for Lung Cancer

Pain meds, education, bronchodilators, clears to high calorie meals, high protein, high vitamins

79

Pulmonary Embolism

Embolism in the lungs from a DVT, leads to a perfusion problem

80

Signs and Symptoms of Pulmonary Embolism

Sudden dyspnea, tachypnea, tachycardia, shock, chest pain, cyanosis, cough, hemoptysis, elevated temperature, increased WBCs, can be fatal

81

Predisposing Factors of Pulmonary Embolism

Inactivity, recent surgery, stroke, birth control pills, pregnancy

82

Diagnosis of Pulmonary Embolism

Gold-standard pulmonary ateriography

83

Treatment of Pulmonary Embolism

Anticoagulants, fibrinolytic agents, oxygen, HOB up 30 degrees, surgery, umbrella filter

84

Prevention of Pulmonary Embolism

TED hose, sequential compression devices, measure peripheral pulses, heparin therapy

85

Sarcoidosis

Inflammatory, autoimmune disease in the lung

T-Cells accumulate and lead to granulomas

86

Signs and Symptoms of Sarcoidosis

Night sweats, fever, weight loss, cough, skin nodules, polyarthritis, weakness, SOB, wheezing, suffocation, erythema nodosum, blurred vision, photophobia

87

Treatment of Sarcoidosis

Systematic monitoring, steroids

88

Diagnosis of Sarcoidosis

Chest x-rays, blood test, biopsy

89

Occupational Lung Disease

Caused by exposure to environmental or occupational fumes, dust, vapors, gases, bacterial or fungal antigens, and allergens

90

COPD includes...

Chronic bronchitis and emphysema

91

Pathophysiology of COPD

Goblet cells increase --> hypersecretion

Submucosal glands enlarge --> hypersecretion

Airway walls thicken --> airway narrowing

Fibrotic changes --> airway narrowing

Exudate --> airway narrowing

92

Chronic Bronchitis

Cough, sputum production for at least 3 months out of the year for at least 2 years

Caused by irritants, smoking, flare-ups in the winter

93

Acute Bronchitis

More sudden and severe symptoms

Related to a pathogen

94

Emphysema Pathophysiology

Impaired oxygen and carbon dioxide exchange

Alveolar wall destruction --> increased dead space, impaired oxygen diffusion, impaired carbon dioxide elimination --> hypercapnia and respiratory acidosis

Chronic inflammation

Pulmonary capillary bed reduced --> Cor pulmonale (right sided heart failure)

95

COPD Risk Factors

Exposure to tobacco smoke (damages cilia, distends alveoli, carbon monoxide piles up in the blood)

Increased age

Irritant exposure

Genetic abnormalities (Alpha 1-Antitrypsin; treat with IV infusion)

96

Primary Symptoms of COPD

Chronic cough, sputum production, dyspnea

97

Other Signs and Symptoms of COPD

Tachycardia (early), cyanosis (late), wheezing, barrel chest (related to air trapping), clubbing of fingers (long-term hypoxia)

98

Complications of COPD

Risk for respiratory infections leading to respiratory failure

Cor pulmonale/heart failure

Spontaneous pneumothorax

Cardiac dysrhythmias (atrial fibrillation --> high risk for blood clots)

Depression

99

Diagnosis of COPD

Spirometry, chest x-ray, CT scan, serum (CBC, WBCs, hematocrit and hemoglobin), sputum culture

100

Treatment of COPD

Bronchodilators (inhalers), corticosteroids (first line of defense), antibiotics, mucolytics, antitussives, vasodilators, narcotics, vaccines

Low-flow oxygen

Bullectomy, lung volume resection surgery, lung transplant

101

Long Term Continuous Oxygen

Used if there is evidence of PaO2 < 55 mmHg, tissue hypoxia, organ damage, polycythemia, edema from heart failure, mental status changes

102

Blebs

Air bubbles on the lungs that can rupture and lead to a pneumothorax

103

Pulmonary Rehabilitation

Goal is to reduce symptoms, improve quality of life, increase physical and emotional participation in activities

Benefits include increased exercise capacity and decreased perceived breathlessness

Includes assessment, education, smoking cessation, physical conditioning, and nutrition counseling

104

COPD Nursing Interventions

Education

Low-flow oxygen

Activity pacing

Nutrition (high protein, high calories, easy to chew, small and frequent meals)

Increased fluids (to thin secretions)

No smoking

105

Pursed Lip Breathing

Releases trapped air, decreases carbon dioxide buildup, keeps airways open, good for relaxation