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Nur 3010 exams > Respiratory pt. 2 > Flashcards

Respiratory pt. 2 Flashcards

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1
Q

what is restrictive lung disease

A

impair ability to fully expand lungs
- atelectatsis
- pleural conditions (pleurisy, empyema)
- ARDS
- pneumoconoises
- lung cancer
- chest wall injuries

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2
Q

what is obstructive lung disease

A

prevent exhalation
- asthma
- COPD (chronic bronchitis, emphysema)
- bronchietasis
- cystic fibrosis

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3
Q

what are vascular diseases we learned

A
  • pulmonary HTN
  • pulmonary embolisms
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4
Q

describe atelectasis (r/t, sx)

A
  • closure or collapse of alveoli
  • most common is acute atelectasis (d/t post anesthesia)
  • symptoms: increasing dyspnea, cough, sputum production
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5
Q

acute symptoms of atelectasis

A

tachycardia (decrease O2)
tachypynea (decrease O2)
pleural pain
central cyanosis if large areas of lung affected

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6
Q

chronic symptoms of atelectasis

A

similar to acute, pulmonary infection may be present
- can’t expand lungs
- vent dependent
-non ambulatory
- functional or development ds.

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7
Q

how to identify atelectasis

A

auscultation posterior base of lungs

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8
Q

assessment / diagnosis of atelectasis 3

A
  • increased work of breathing and hypoxemia
  • increased temp
  • decreased breath sounds/crackles over affected area (base)
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9
Q

what may suggest atelectasis before clinical sysmptoms appear

A

chest x-ray
pulse ox low O2 sat (less than 90%)

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10
Q

prevention of atelectasis

A

strategies to expand lungs and manage secretions
- q2 turning
- early mobilization post op
- IS
- voluntary deep breathing
- secretion management (coughing)
- CPT
- MDI
- thoracentesis (pleural effusions)

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11
Q

4 types of pleural conditions

A

visceral pleura (pleura covering lungs) and parietal pleura (pleura covering chest wall)
- pleurisy
- pleural effusion
- empyema
- pulmonary edema

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12
Q

describe pleuritis/diagnosis/sound on stethoscope

A

inflammation of both layers of pleurae
- pleuritic pain is associated with respiratory movement (rubbing of pleural layers together, sharp inspiratory pain)
- pleural friction rub = heard in stethoscope
- diagnostics: chest xray, sputum analysis, thoracentesis (used for infectious etiology)

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13
Q

nursing role in pleuritis

A
  • treat underlying cause
  • provide analgesia (allows for more appropriate expansion)
  • splint rib cage when coughing (hold pillow while coughing to clear airways)
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14
Q

describe pleural effusion (s/sx, diagnostic, sound on stethoscope)

A

fluid collection in pleural space usually secondary to heart failure, TB, pulmonary infections, cancer (recurrent)
- s/sx: fever, chills, pleuritic pain, dyspnea
- decreased/absent breath sounds, decreased fremitus, dull sound on percussion
-diagnostic: chest RX, chest CT, thoracentesis

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15
Q

which pleural condition has tracheal deviation away from affected side

A

pleural effusion (more common with tension pneumonia)

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16
Q

describe empyema (s/sx, diagnostic, sounds on stethoscope)

A

accumulation of thick, purulent fluid in pleural space (pleural effusion with thick fluid/pus)
- (S/D) complication of bacterial pneumonia or lung abscess
- acutely ill
- s/sx: similar to acute respiratory infection/pneumonia
- decreased breath sounds over affected area, dull sound on percussion
- diagnostic: chest CT, thoracentesis

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17
Q

how to relieve empyema

A

drain fluid via thoracentesis
- antibiotics for 4-6 weeks

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18
Q

describe ARDS (acute respiratory distress syndrome) - NOT ON EXAM

A

sudden, progressive pulmonary edema
- increased B/L lung infiltrates visible on chest XR (white opacities = decreased airflow)
- absence of an elevated left atrial pressure (independent of HF)
- worsening PaO2/FiO2 ratios (untreatable)
- rapid onset of severe dyspnea

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19
Q

ARDS management

A
  • identification/treatment of underlying cause
  • intubation, mechanical vent with PEEP to keep alveoli open
  • hypovolemia treated
  • prone positioning (BEST FOR OXYGENATION)
  • nutritional support, enteral feeding preferred
  • reduce anxiety
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20
Q

describe pulmonary hypertension (cause, s/sx, diagnosis, management)

A

HTN isolated to pulmonary arteries (running flight of stairs and taking break after to catch breath)
causes: vascular ds., congenital heart disease, HIV, illicit drug use
s/sx: exertional dyspnea (exercise), SOB, weakness, fatigue
diagnosis: right sided heart Cath/pulmonary artery catherization
mangement: anti-hypertensives, selective PA vasodilators (remodulin, sildenafil)

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21
Q

what are the s/sx of right sided heart failure in pulmonary HTN

A

peripheral edema, ascites, distended neck veins (JVD)

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22
Q

describe pulmonary embolism (PE)

A

blocked pulmonary artery or one of its branches by a clot (thrombus) in the venous system or in the right side of the heart -> lungs
- inflammatory process further obstructs area, results in diminished or absent blood flow (tissue perfusion abnormalities)
- bronchioles constrict, increasing pulmonary vascular RESISTANCE, pulmonary arterial pressure, and right ventricular workload (extra workload of heart)

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23
Q

what does PE result in (3)

A
  • ventilation perfusion imbalance (vent > perf)
  • right ventricular failure
  • obstructive shock
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24
Q

risk factors of PE

A

trauma, surgery, pregnancy, HF, hyper coagulability, immobility, venous stasis (sitting still for hours)

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25
s/sx of PE
concomitant DVT, SOB, chest pain, coughing, anxiety, dizziness, cyanosis, hypoxemia, low O2 sat
26
prevention of PE
- exercises to avoid venous stasis (early ambulation, antiembolism stockings) treatments: - measures to improve respiratory and vascular status (low flow to mechanical vent, fluids/pressors (increase BP) - anticoagulation ad thrombolytic therapy (bolus heparin IVP followed by IV drip and subsequent direct oral anti coagulation (DOAC) or Coumadin therapy) - eliquis - thrombolytics: TPA, altepase when hemodynamically unstable (dangerous, breaks clots in path) - surgical interventions (mechanical/percutaneous clot removal/embolectomy)
27
what happens if patient is contraindicated to anticoagulations
IVC filters that sit in IVS -> Catch potential clots that break off to prevent going into lungs
28
describe pneumoconioses
occupational lung ds. and includes asbestosis, silicosis, coal workers pneumoconiosis - nonneoplastic alt. of lung resulting from inhalation of mineral/inorganic dust (may lead to neoplasms) - preventable but NOT TREATABLE (reduce exposure, wear gear) - role of nurse: advocate and education patient
29
describe lung cancer
leading causes of cancer deaths in US - 85% contributed cigarette smoke (1st or 2nd hand) - classicification: SCLC/NSCLC tumors treatment: surgery (wedge resection (remove part lung), lobectomy (remove whole lobe), pneumonectomy (remove one side of lung), radiation/chemo
30
what is the nursing care for lung cancer
- drain rangement - airway clearance - track or oral airway - dyspnea - fatigue, pain, psychosocial support (end of life) - palliative care/end of life goals - risk reduction: SMOKING CESSATION - screening: adults 50+ w/ 20+ pack per year (annual CA screening, CT screen)
31
describe chest injuries causes
- blunt trauma - sternal, rib fractures - flail chest (sucked in when inspiration) - pulmonary contusion (supp. O2) - penetrating trauma (surgical correction) - pneumothorax (collapse lung) (spontaneous or simple, traumatic, tension pneumothorax)
32
what is tension pneumothorax
one way valve air leaks occurs from lung or through the chest wall/lung itself
33
treatment of chest injuries (tension pneumothorax)
- chest tube 2nd intercostal space
34
iclicker: an initial characteristic symptom of a simple pneumothorax is sudden onset of chest pain (t/f)
true
35
describe asthma
chronic inflammatory disease of the airways that cause (1) hyper responsiveness, (2) bronchial, mucosal edema, (3) mucus production - inflammation leads to cough, chest tightness, wheezing, dyspnea - largely reversible (spontaneously with/without treatment - very uncontrolled in US - can cause scarring
36
what part of the lung does asthma only affect?
bronchi and bronchioles -> bronchoconstriction - goblet cells in bronchioles produce mucus - lack of oxygen, build up of CO2 -> acidosis (hypercapnia resp. failure)
37
asthma triggers and meds
- allergy (eosinophilia) is a strong predisposing factor - triggers: stress, smoke, URIs/infections, cold weather, exercise drugs: - NSAIDS (naproxen, ketorolax) - beta blockers (nonselective specifically bc it prevents bronchodilation & cause bronchospasm (if allergic to metoprolol)
38
clinical manifestations of asthma
- cough (productive/nonproductive) - diaphoresis - tachycardia - hypoxemia/cyanosis
39
what does ASTHMA stand for
A - accessory muscle use (paradoxical breathing (with whole thorax) or diaphragmatic fatigue (CRITICAL) S - SOB/dyspnea (single word dyspnea..say one word per breath) T - tightness in chest/tachycardia (increased RR, shallow breaths) H - high pitched wheezing (d/t narrowed airways) M - minimal diminished breath sounds A - absent breath sounds, acidosis, air trapping (prolonged exhalation)
40
what is the hallmark of asthma
wheezing
41
iclicker: what ABGs would you expect to see in a patient with acute asthma attack?
pH: low PaCO2: high PaO2: low
42
sx of hypoxia
agitation restlessness drowsiness
43
describe status asthmatics
asthma attack that is refractory to medication (r/t resp. acidosis) - primary intervention: endotracheal intubation (however, still difficult d/t distal bronchioles still constricted) - demand > supply
44
what are the quick relief medications for asthma (rescue)
beta 2 adrenergic agonists - bronchodilator, improve airflow - ADR: tachycardia, insomnia, tremors - ex: ALBUTEROL (rescue drug) Anticholinergics - dries secretions, dilates airways, inhaled - ex: IPRATROPUM BROMIDE (duoneb - albuterol + anticholinergic) methylxanthines (not common) - bronchodilator - ex: theophylline 10-20 mg/dl
45
what re the long acting medications for asthma (maintenance)
corticosteroids - causes oral thrush, decreases immune response (decrease airway edema), increases glucose - ex: prednisolone, solumedrol (inhaled, PO, IV) - WASH MOUTH/INHALER AFTER USE long acting beta 2 adrenergic agonists - LABA - ex: salmeterol
46
MDI use
during acute asthma attack - albuterol 2-4 puffs Q20m x3 times - if not relieved, ER - wash inhalers 2x/week - steroid inhaler: wash after each use to prevent infection - efficacy: improved O2 sat, reduced RR, patient states relief, palpitations d/t beta sympathetic stimulant - other expected findings: increased productive cough (sputum
47
what is peak flow expiratory rate
how fast to get air out of airway (3 zones) - green (no worsening symptoms) - yellow (SABA Q4 for 1-2 days, follow up with MD) -red (emergency tx)
48
describer COPD (chronic obstructive pulmonary disease) & associated respiratory diseases
slowly progressive respiratory disease of airflow obstruction - emphysema (pink puffer) - chronic bronchitis ( blue bloater) - preventable and treatable, NOT REVERSIBLE - involves airways, pulmonary parenchyma, or both
49
other associated respiratory diseases
cystic fibrosis, bronchiectasis, asthma (uncontrolled -> COPD)
50
describe pathophysiology of COPD
- airflow limitation is progressive, associated with an inflammatory response to noxious particles or gases (chronic inflammation damages tissue) - scar tissue -> narrowing airway - scar tissue in parenchyma -> decreases elastic recoil (stiff lungs, hard time expand) - scar tissue in pulmonary vasculature -> thickens vessel lining and hypertrophy of smooth muscles (pul. HTN, RHF(for pulmonale)
51
risk factors of COPD 4
- smoking (primary) - fume inhalation - wood dust - chemical exposure
52
chronic bronchitis - blue bloater (indication, what occurs, susceptibility)
inflammation of bronchioles - cough & sputum production 3 months x2years - ciliary function reduced, bronchial walls thicken, bronchial airways narrow, mucus plus airways - alveoli damaged, fibrosed, alveolar macrophage function diminishes -> right HF - MORE susceptible to respiratory infections (can't get stuff out)
53
s/sx of chronic bronchitis
- cyanosis (blue bloater) - long term chronic cough - sputum production (some) - crackles + wheezes (distal alveoli collapses, increases mucous production) - edema/bloating (S/D right HF) - decreased O2 expected
54
describe emphysema - pink puffer
abnormal distention of air spaces beyond the terminal bronchioles with destruction of walls of alveoli - decreased alveolar surface area increases in "dead space" (large alveolar sacs) -> impaired oxygen diffusion (trapped air) - hypoxemia results - increased pulmonary artery pressure -> right sided heart failure (for pulmonale)
55
emphysema s/sx
- pursed lipped breathing: prolonged exhalation phase -> relapses O2 - barrel chest (A/P ratio 1:1) - NO CHRONIC COUGH - hyper resonant percussion (air trapping) - tripodingto improve air exchange (lean forward, brings cardiac tissues off lungs)
56
COPD s/sx overal (emphysema & bronchitis)
- O2 sat 88-90% - dyspnea/ SOB - weight loss - barrel chest - clubbing fingernails - restlessness, decreased ms, confusion (hypoxia) labs: - increased WBCs, RBCs (r/t hypoxia to circulate gas) - low paO2, high paCO2, normal pH (due to compensation)
57
assessment/diagnosis COPD
- health hx - pulmonary function tests - spirometry - arterial blood gas (elevated paCO2, decreased paO2, decreased/normal pH, elevated pHCO3) - chest XR (barrel chest, pneumonia)
58
complications of COPD 5
- respiratory insufficiency and failure (no abx unless long term COPD) - pneumonia - chronic atelectasis - pneumothorax - cor pulmonale
59
medical management of COPD
- BiPAP (acute exacerbations esp w/ high PaCO2) *AVOID SEDATION/RESP DEPRESSANT (benzos, narcs) - promote smoking cessation - reducing risk factors - providing supp. O2 (caution d/t CO2 retention) - vaccines: pneumococcal, influenza, covid) - pulmonary rehabilitation (exercise regimen, intermittent PFTs) - managing exacerbations
60
surgical management of COPD
- bullectomy ( remove large alveolar sacs) - lung volume reduction - lung transplant
61
pharmacological mangement of COPD
*bronchodilators, MDI (rescue)* - beta adrenergic agonists: ALBUTEROL - muscarinic antagonists (anticholinergics): ipratropium bromide (SABA), tiotroprium bromide (LABA) - combination agents: DUONEB (ipratroprim + salbutamol) *corticosteroids (maintenance) (decrease rate exacerbation, improve response to bronchodilators, decrease dyspnea)* - inhaled: beclomethasone (QVR), budesonide (pulmicort), fluticasone (Flovent) - PO: prednisone, medrol dose pack: regime to dose down medication - IV: solumedrol TIP: no difference PO vs. IV meds *long acting beta agonists* - formotreol, cilantro, salmeterol *combos (LABA + ICS)* - Symbicort (formotreol + budesonide) - breo (vilanterol + fluticasone) - Advair (salmeterol + fluticasone) *other* - antibiotics - mucolytics (mucinex) - antitussives (AVOID unless bronchitis) - pulmonary vasodilators (remodeling, sildenafil)
62
nursing management of COPD
- history - diagnostics test review - achieve/maintain airway clearance (BIGGEST) - improve breathing pattern (exercise) - improve activity tolerance - MDI patient education (wash out everything w/ steroids) - nursing care plan - oral care BEFORE meals - secretion clearance: coughing, sitting upright, deep slow inhalation, hold breath, forceful exhale - pursed lip breathing education: inhale through nose (3s), exhale (7s) through mouth (prevent air trapping)
63
describe bronchiectasis
chronic, irreversible dilation of bronchi and bronchioles
64
what is bronchiectasis caused by:
- airway obstruction, pulmonary infections - diffuse airway injury - genetic disorders - abnormal host defenses - idiopathic causes
65
bronchiectasis clinical manifestations and medical management
- chronic cough - purulent sputum in copious amounts - clubbing fingers (hypoxemia) - postural drainage Medical management - chest physiotherapy - smoking cessation (IMPORTANT) - antimicrobial therapy - bronchodilators and mucolytics
66
bronchiectasis nursing management
focus on ALLEVIATING symptoms and clearing pulmonary sections patient teaching: - smoking cessation - postural drainage - early s/sx respiratory infections - conserving energy
67
describe cystic fibrosis
- autosomal recessive disease among caucasian population - genetic screening to detect carrier - genetic counseling for couples at risk - genetic mutation changes chloride transport, leading to thick vicious secretions in lungs, pancreas, liver, intestines, reproductive tract - respiratory infections are leading cause of MORBIDITY and MORTALITY
68
medical management of CF (meds)
- chronic: control infections via abx - acute: aggressive therapy involves airway clearance and abx. - anti inflammatory agents - corticosteroids: inhaled, oral, IV during exacerbations - inhaled bronchodilators - oral pancreatic enzymes supplementation with meals
69
nursing management of CF
- promote removal of pulmonary secretions (CPT, deep breathing exercises, vibrating vest) - remind patient to reduce risk factors for respiratory infection - adequate fluid and electrolyte intake - palliative care (short life span) - discuss end of life issues and concerns - diabetes mangement (CF r/t diabetes -> increase glucose)

Nur 3010 exams (13 decks)

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