Respiratory system

Question 1

Tiotropium(Spiriva) Inhaler

Answer 1

A long acting24 hours,
anticholinergic,
inhaled medication used to control chronic obstructive pulmonary disease COPD
administered most commonly using your capsule inhaler system call them HandyHaler.
the capsule should not swallow and then the button pressed on the inhaler must be pushed to allow for medication this dispersion

Question 2

Status Asthmaticus(priority)

Answer 2

This is your life threatening ,episode of airway obstruction that is often unresponsive to common treatment.
It involves extreme wheezing, labored breathing, use of accessory muscles, distended neck veins, and create a risk for cardiac and/or respiratory arrest.

Question 3

Status Asthmaticus

Answer 3

nursing action: prepare for emergency intubation. As prescribed, administer oxygen bronchodilators, epinephrine, and initiate systemic steroid therapy.

Question 4

COPD emphysema(inflamed Airway and-collapsed air sacs)

Answer 4

progressive destruction of alveoli due to chronic inflammation-
decreased surface area for gas exchange –lose of elasticity of lung tissue-airway collapse.
primary cause smoking.

Question 5

COPD emphysema causes

Answer 5

primary cause:smoking
CXR- hyperinflated lungs, heart small or normal
pink puffer – barrel chest+,pursued lip+, accessory muscle breathing+, underweight.
Persistent tachycardia- inadequate oxygen, wheezing, diminished breath sounds, hyper resonance on percussion due to trapped air.
Difficulty with exhalation due to obstructed airway and Mucosa

Question 6

COPD emphysema

Answer 6

pursued lip breathing: instruct the client to:from the mouth as if preparing to whistle.
take a deep breath in through the nose and out through the lips/mouth
do not puff the cheeks. Take breaths deep and slow.

Question 7

COPD bronchitis(bluish blue blotter)

Answer 7

Chronic airway inflammation with chronic productive cough lasting at least three months in2years.
Blue blotter:-bluish- red skin (cyanosis+ polycythemia), obesity.
CXR- congested lung, heart enlarged. Chronic productive cough-thick mucosa-foul smelling.
Celia disappear-Ineffective airway clearance.
Frequent pulmonary infection, dyspnea,increase the AP diameter (anterior posterior)

Question 8

 COPD bronchitis

Answer 8

 ideal weight- nutritious food. Meds medication‘s, oxygen, avoid irritants,IZ.
Mucolytic agent(Break down Mucosa): These agents help thin secretions making it easier for the Client. 
Example: acetylcysteineMucomyst),guaifenesin( Mucinex)

Question 9

COPD bronchitis

Answer 9

Nursing care: position the client to minimize ventilation (highfowelers is 90)
encourage effective coughing or suctioning to remove secretions
encourage deep breathing exercise and use incentive spirometer 
Administer breathing treatment and medication as prescribed
administer oxygen as prescribed,
monitor for skin breakdown around the nose and mouth from the oxygen device. Promote adequate nutrition.

Question 10

Complication of COPD( cor pulmonale)

Answer 10

Air trapping, airway collapse,stiff alveoli lead to increased pulmonary pressures.
Right side heart failure and increased workload for heart.
Blood flow through lung tissue is difficult.
Enlargement and thickening of right atrium and right ventricle.
Lowoxygen levels, cyanotic lips. Enlarged tender liver.
distended neck ,veins and dependent edema.
nursing care::
monitor respiratory status and administer oxygen
monitor heart rate and rhythm, meds, I/v fluids

Question 11

COPD-Care after the change

Answer 11

Reference to assistance programs,such as food delivery services, home care services such as portable oxygen.
Client education: high calorie foods to promote energy. Encourage rest periods as needed. promote hand hygiene to prevent infection.
Reinforce the importance of taking medication (inhalers oral medication)as prescribed. Promote smoking cessation if the client smoker.
Encourage immunizations, such as influenza and pneumonia, to decrease the risk of infection. Client should use oxygen as prescribed. Inform other caregivers not to smoke around oxygen due to flammability. Provide support to the client and family and if needed respite care.

Question 12

Legionaries disease

Answer 12

Form of pneumonia caused by legionella pneumoPhila.which grows and multiplies in a building water system. (Steam/ hot tubs).

Question 13

legionaries disease

Answer 13

Assessment: 1 to 2 days of prodromal symptoms followed by high fever, dyspnea,vomiting, diarrhea, confusion, elevated WBC count.
Interventions:administer antibiotics as prescribed. Supportive care, including respiratory support, nutritional support, fluids and electrolyte management.

Question 14

Pneumothorax, hemothorax

Answer 14

A Pneumothorax is the presence of air or gas in the pleural space that causes lung collapse.
A hemothorax Is an accumulation of blood in the pleural space.

Question 15

Pneumothorax, hemothorax symptoms

Answer 15

A Tension pneumothorax occurs when air enters the pleural space during a inspiration and is not able to exit upon expiration. The trapped air causes pressure on the heart and the lungs leading to a decrease in cardiac out put.
A flail chest occurs when several rib’s , usually on the one side of the chest, sustain multiple fractures. 

Question 16

pneumothorax, hemothorax:signs

Answer 16

Dyspnea(first sign), crepitus, tracheal deviation, towards unaffected side
diminished of breath sounds in affected side – late sign.
Unequal chest expansion (reduce on affected side)
care:vitals vitals, oxygen, chest tube care, nutrition prevent infection, respiratory failure.
Medicines: analgesic, antibiotics

Question 17

Pleural effusion

Answer 17

Collection of fluid in plural space. Sharp pleuritic pain; increases with inspiration,
dry ,nonproductive cough.Decreased breath sounds over affected area,
Chest x-ray shows plural effusion, mediastinal shift.

Question 18

Pleural effusion interventions:

Answer 18

Identify, treat underlay causes, placed client in highfowelers position. Increased coughing, deep breathing, surgical intervention.

Question 19

Cystic fibrosis

Answer 19

Multisystem thick mucus, stetorrea,sweat test- more NaCl a
newborn – meconium ileus(first sign)
Affects-Bronchioles – infection
small intestine-unable to observe fats and proteins
retarded growth and puberty,
pancreatic and bile duct- clogged-prevent digestive enzymes from reaching Duodenum-Digestion and absorption issues
Management —respiratory hygiene, avoid infection, supportive care

Question 20

Tuberculosis

Answer 20

Highly communicable disease caused by mycobacterium tuberculosis improper, noncompliant use of treatment programs

Question 21

tuberculosisus risk factors

Answer 21

alcoholism, drinking unpasteurized milk from infected cow; younger and older clients; clients who are homeless and from lower socioeconomic group; crowded living conditions; intravenous drug user; malnutrition.
Transmission:airborne route by droplet infection
After infected individuals has received TBmedication’s for 2 to 3 weeks, risk of transmission reduced greatly

Question 22

Mantoux test and other test

Answer 22

Mantoux test:Results 48 to 72hrs.(skin test )redness,wheel area-Diameter bubble like .
PPD:purified protein Derivatives
Chest X-ray,not definitive presences of multimodal are infiltrate
Sputum AFB(Acid Fast Bacilli)
Blood test:TB Quantiferon blood test-measure a person immune reactivity to mycobacteriumTB.

Question 23

Mantoux test

Answer 23

An induration 05 MM and is considered a positive test,for immuno compromised client,
example HIV patient, oncology patient, long-term corticosteroids (more than 6weeks organ transplant recipient)
Depositing Mentax test indicates that the client has developed an immune response to TB– NOT confirmation of active decease
An Induration (palpable, raised, hardened area)of 10 MM or greater in diameter indicates the positive skin test
10 MM Or more positive in:: recent arrivals less than five years from high- prevalent countries, injectable drug users,resident and employee of high risk congregate settings (exampleprisons,nursing homes, hospitals, homeless shelters etc)
Mycobacteriology lab personnel , persons with the clinical condition that place them at high risk example diabetes, leukemia,end stage renal disease, chronic malabsorption syndromes, low body weight.
Children less than 40 years of age, our children and adolescents exposed to adults in high-risk categories, infants children, and adults exposed to adults high risk it categories

Question 24

Tuberculosis medication

Answer 24

Combination therapy – 6 to 12 months
isoniazid(Nydrazid):(IN-H)
This medication should be taken on an empty stomach. Monitor for hepatotoxicity and Neurotoxicity,such as tingling of the hands and feet. Vitamin B6 (pyridoxine) is used to prevent neurotoxicity from isoniazid.
Rifampin(Rifadin): infrom the client that urine and other secretions will be orange. Inform the client this medication may interfere with the efficacy of oral contraceptives.
Pyrazinamide: Take with a glass of water
Ethambutol: suppress RNA synthesis. Optic neuritis:can affect vision need a eye check up.
Streptomycin:nephrotoxic and ototoxic.report Olegaria, KFT, tinnitus,drink lots of fluids


Question 25

Pulmonary embolism: risk factors

Answer 25

``` Immobility , DVT,oral contraceptive use on the eastrogen therapy pregnancy, platelets problem, tobacco use, heart failure or chronic Atrial fibrillation, autoimmune hemolytic anemia(sickle cell),long bone fractures,surgery. Pulmonary embolism(PE) any substance (solid, gaseous, or liquid ) enters venous circulation and froms blockage in the pulmonary vasculature. ```

Question 26

Health promotions and disease prevention

Answer 26

Promote smoking cessation. Encourage maintenance of appropriate weight for height and body frame. Encourage a healthy diet and physical activity. Prevent deep vein thrombosis(DVT) encourage client to do leg exercise, where compression stockings, and avoid sitting for long periods of time.

Question 27

Health promotions and disease prevention

Answer 27

Signs and symptoms: anxiety, feelings of impending doom, pressure in chest, pain Upon inspiration and the chest wall tenderness, dyspnea and air hunger. Adventitious breath sounds (crackles) and cough, pleurisy, pleural friction, Rub,pleural effusion, (find in the lungs),tachycardia, tachypnea, hypertension, heart murmur S3 and S4 S3 , diaphoresis, decreased the oxygen saturation levels, low-grade fever, low saturation, cyanosis 

Question 28

 Health promotions and prevent diseases blood tests

Answer 28

Diagnostics: CT scan, ventilation perfusion V/Q scan, D dimer: 0.432 2.3mcg/ml

Question 29

Health promotions and prevent disease nursing care

Answer 29

Oxygen therapy, semi Fowlers, I/v access, vitals. Provided emotional support and comfort, monitor changes in LOC and mental status. Medications:watch for bleeding anticoagulant prevent clots from getting bigger, thrombolytic -dissolve clots Assess contraindication:active bleeding ,peptic ulcer disease, history of stroke, recent trauma.

Question 30

PE discharge education (pulmonary embolism)

Answer 30

Provide education to the client for the treatment and prevention of pulmonary embolism promote smoking cessation if client a smoker. Encourage client to avoid long periods of immobility Encourage physical activity such as walking. Encourage client to wear compression stockings to promote circulation .Encourage the client to avoid crossing his legs.remind the client of increased risk for bruising and bleeding. Encourage the client to avoid taking aspirin products, unless specified by the provider. Encourage the client to check his mouth and skin daily for bleeding and bruising. Encourage the client to use electric shavers on South Bristol toothbrushes. Instruct the client avoid blowing his nose hard, and to gently apply pressure if nosebleed occur. Encourage client who is traveling about measures to prevent PE. Instruct the client to arise from sitting position for 5minutes out of every hour.advice client to wear support stockings. inform the client to remain hydrated by drinking plenty of water. Instruct client to perform range of motion exercises when sitting. Advise the client to monitor intake of foods high in vitamin K (green, leafy vegetables)if taking warfarin. 

Question 31

Vitamin K

Answer 31

Vitamin K can reduce the anticoagulant effects of warfarin. Advise the client to adhere to a schedule for monitoring PT and INR, following instructions regarding medication dosage adjustments (for clients on warfarin),And adhere to weekly blood draws.

Question 32

Mechanical ventilation

Answer 32

Three types of ventilation alarms: volume, pressure, apnea alarms. Volume (low pressure)alarm indicate a-low exhaled volume due to a disconnection, cuff leak,and/or tube displacement. Pressure (high pressure)alarm indicates excess secretions exists, client biting the Tube, kinks in the tubing, client coughing, pulmonary edema, bronchospasm, and/or pneumothorax. Apnea Alarms indicate that the ventilator does not detect spontaneous respiration in the present time Period.

Question 33

respiratory medication Bronchodilators inhaler

Answer 33

Inhalers:Albuterol (Proventil, Ventolin): provide rapid relief of acute symptoms and prevent exercise- induced Asthma  Watch the client For tremors and tachycardia. short acting Prevention of Asthma episode (exercise – induced), Inhaled,short acting one is used for prevention of asthma episode.

Question 34

Asthma medication anticholinergic medication

Answer 34

Ipratropium(Atrovent): Decreases pulmonary secretions. Advise client to rinse the mouth after inhalation to decrease unpleasant taste. observe the client for dry mouth.hard candies, more fluids can be given to patients Salimeterol primarily used for asthma attack prevention in long-term. Not used to abort an asthma attack and not at the onset of an attack.it is Long acting.

Question 35

Steroids medication

Answer 35

Steroids to relieve inflammation. example:Fluticasone (Flovent)and prednisone(Deltazone). client education – encourage the client to drink plenty of fluids to promote hydration. Encourage the client to take prednisone with food. Decrease immune function,weight gain, fluid retention, risk of bleeding, hyperglycemia, reduced height growth in children. Increase Cline client to a one person with respiratory infections.good mouth care,Rinse mouth after use(prevent infection) Monitor the clients throat and mouth aphthous lesions (cancer sores) Do not stop the use of this type of medication suddenly. Boneless boneless: take vitamin D.

Question 36

Xanthine: Theophylline (Theo-24) Anti-bronchodilator

Answer 36

Narrow therapeutic range (5 to 15 MCG per ML)Mild toxicity: G.I. distress, restlessness,. Severe toxicity: tachycardia, dysrhythmias and seizures. If America station certain occur, stop the medication. Activated charcoal is used to decrease absorption. Lidocaine is used to treat dysrhythmias. Diazepam is used to control seizures. caffeine can increase theophylline levels. Avoid cola, coffee, chocolate, which contain xanthine. Phenobarbital and phenytoin decrease theophylline levels.

Question 37

Antitussives

Answer 37

Suppresses Cough: opioids:Codeine:suppress cough through its action on the central nervous system. For chronic nonreproductive cough. Safety precautions: G.I. distress-take with food. None opioid:dextromethorphan (found in many different products for cough,such as Robitussin),Benzoate(Tessalon),diphenhydramine (Benadryl),, mild nausea, dizziness and sedation may occur.

Question 38

Antitussives (suppressive cough)

Answer 38

``` Expectorants:Guaifensin(Mucinex): allow clients to decrease chest congestion by coughing out secretions. G.I. upset: take with food GI upset occurs. drowsiness dizziness: do not take prior to driving or activities if these reactions occur. Allergic reaction(rash): stop taking guiafenesin and obtain medical care if rash or other symptoms of allergy occur. increase intake of fluids:thin secretions. mucolytics :acetylcysteine (Mucomyst, Acetadote). ```

Question 39

Mucolytics: Acetylcysteine, (Mucomyst, Acetadote)

Answer 39

Mucolytics enhance the flow of secretions in the respiratory passages. S/E; Respiration and bronchospasm when administered orally. Advice clients that acetylcysteine has an odor that smells like rotten eggs. Mucolitis are used in clients who have cystic fibrosis. acetylcysteine is the antidote for the acetaminophen poisoning. Should not be used in client at risk for G.I. hemorrhage .

Question 40

Decongestants

Answer 40

Example: Phenylephrine:- to treat allergic or -non-allergic rhinitis by relieving near nasal stuffiness. S/E: vasoconstriction avoid in CAD. Rebound congestion secondary to prolonged use of topical agents. Advise clients to use for short term therapy, no more than 3 to 5 days. Taper use and discontinue medication using one nostril At a time.