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NUR 120 > Unit 3 > Flashcards

Unit 3 Flashcards

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1
Q

What are the 3 types of alveolar cells?

A

Type 1-majority-serve as barrier between air and alveolar surface area
Type 2-very little but important-produce type 1 and surfactant (reduces surface tension)
Alveolar macrophages-phagocytic, ingest foreign matter (defense mech)

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2
Q

Diff resp vs ventilation.

A

Gas exchange
Vs
Movement to breathe (req. air pressure variance, airway resistance, and lung compliance)

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3
Q

Explain air pressure variances.

A

On inspiration, diaphragm opens thoracic cavity lowering pressure inside thorax below atmospheric press. Air in.

Expiration, relaxation, passive, recoil, decrease thoracic cavity size, exceeds atmospheric pressure, air out.

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4
Q

What is airway resistance and some causes?

A

Any process changing the radius or size of bronchioles alters rate of airflow. Inc resis more effort is needed to maintain normal vent levels.
Asthma(bronchioles smooth muscle contraction)
Chronic bronchitis (thick mucosa)
Obstruction (tumor, foreign body)
Emphysema (loss of lung elasticity)

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5
Q

What is compliance?

What are factors that determine compliance?

A

Elasticity and expand ability of the lungs. Which is needed to create pressure gradient as in air pressure variances.

Alveolar surface tension, connective tissue and water content of lungs, and compliance of thoracic cavity.

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6
Q

What are the neurological controls of respiration?

A

Medulla controls rate/depth. Also has chemoreceptors that respond to changes in PH in CSF, and make changes to compensate.
Pons-pneumotaxic center-controls pattern
Peripheral chemoreceptors-aortic arch/carotid-respond to pao2, paco2, then ph.
Baroreceptors in aorta/carotid- detect changes in BP and compensate with either hyper/hypoventilation.

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7
Q

What is the desired outcome with partial pressures of o2 and co2, ph and note their normal ranges.

A

O2 pressure in blood equal to o2 pressure in alveoli.
Co2 is the major determinate of PH balance.
PH-7.35-7.45
Paco2-35-45
O2 sat-95-100
Pao2 80-100

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8
Q

What is V/Q ratio? Goal? And the 4 types of v/q states? What alterations can cause imbalances?

A

Ventilation perfusion ratio. Equal to one another (1:1)
Normal
Low:shunting, perf exceeds vent, blood bypass alveoli w/o exchange. (Lung tissue issue)causes:pneumonia, atelectasis, mucous plug.
High:dead space, good vent, no blood flow to alveoli. Causes:pulm emboli, cardiogenic shock.
Absent: absence of both. Causes:pneumothorax, ARDS

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9
Q

Explain the oxyhemoglobin dissociation curve. What occurs with left and right shifts?

A

Shows the relationship of partial pressure of o2 and percentage of o2 saturation.
Increases in co2, H, and temp (inc HR, metab) will shift curve to R, decreasing hemoglobin and oxygen affinity.(unloading, using more o2)
Decreases shift to L, inc Hemo/Oxy affinity (couch potato)

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10
Q

What are the general risks for respiratory d/o?

A 
Malnourished
Smoking
Obesity
Occupational hazard
Family hx
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11
Q

What are common complaints for those with resp d/o?

A 
Dyspnea
Cough 
Sputum production
Chest pain
Wheezing/crackles
Hemoptysis
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12
Q

What are the general physical assessments to perform on the respiratory d/o pt?

A

Gen appear:skin cond, color, clubbed fingernails, altered Mental status
Upper resp:nose, sinuses, mouth, pharynx, trachea
Lower resp:thorax (inspection, auscultation, palpation, percussion), positioning

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13
Q

What are the adventitious breath sounds? What is the reasoning behind these?

A

Crackles:discontinuous, indicates fluid, can be fine or coarse (louder). Pneumonia, pulm edema
Wheezes:continuous, indicates constriction. Bronchitis, emphysema.
Rhonchi-fluid/constriction mix (inc. secretions) coarse
Pleural rub-only during breath

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14
Q

When palpating and per cussing thorax in resp d/o, what are you looking for?

A 
Masses
Excursion (expansion)-dec indicates fibrotic dz, rib fx, pelurisy/uniobstruction

Dull-fluid
Fremitus- (vibration during speech is normal) dec-emphysema inc-pneumonia, lung constriction

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15
Q

What are the severe abnormal resp patterns?

A

Kussmaul-fruity acetone breath, shallow, then deep
Cheyne-stokes-near death breathing pattern. Rate and depth inc then dec w/ apnea reaching 20 secs
Biots-ataxic, CNS d/o, irregular

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16
Q

Define the TV, VC, Ins. Force, Minute vent.

A

tv-amount of air normally inspired and expired
Vital capacity-amount fully expired
MV-TVxRR. Amount air exchanged per minute
Ins. Force-insp efforts

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17
Q

What are the culture studies done in the respiratory pt?

A 
Sputum:
CandS-dx for drug sensativety
Cytology-malignant cell 
AFB-causes TB (check 3 days in row)
Throat:
Rapid strep(15 min)
Pathogen ID
Nasal swab/wash
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18
Q 
What is the purpose of using the following diagnostic assessment exams?
PFT
ABG
SpO2
CBC
A

PFT:Evals gas exchange, lung volume, diffusion (chronic resp d/o-see if tx working.)*no smoke, inhaler, eat 6hrs pre-test
ABG-status of oxygenation, acid/base balance (blood gases, ph, co2)
SpO2-o2 binding to hemoglobin
CBC:WBC-infection RBC-O2 transport

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19
Q

What are some useful imaging studies for the resp pt?

A

CXR:pneumonia, pneumothorax
CT:PE, aortic dissection
Fluoro:aspiration, MOVEMENT:lung, chest wall, heart diaphragm. lung masses, chest needle bx
Angiography:thromboembolic d/o’s (lung vessels and patency)
MRI:abnormal lesion/tumor

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20
Q

What are the 3 useful lung scans and how do these help?

A

V/Q-PE probability, measures lung blood perfusion
Gallium-inflam d/o’s abscesses, source of infection. Measures gallium uptake over lapsed time w/ mult images.
PET-Malignancy takes up dye, regional blood flow, necrotic tissues

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21
Q 
Discuss the following procedures:
Bronchoscopy
Thoracoscopy
Thoracentesis 
Biopsy
A

Bronch-inspect upper airway, examine tissue, obtain tissue/secretions. Risks:infection, aspiration, bronchospams, hypoxia, pneumothorax.
Thorac-chronic pleural effusions
Thoracen-needle aspirate blood/air.s/p proc. X-ray, equal breath sounds, bleeding/dressing
Bx-excision of tissue

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22
Q

Describe the diff methods of o2 delivery and their suggested flow rate and percentage setting.

A 
Cannula 1-6L 23-42FiO2
Simple mask 6-8L 40-60Fio2
Partial rebreather 8-11L 50-75FiO2
Non rebreather 12-15L 80-100FiO2
Venturi:4-6L 24-28FiO2
Trach collar, Tpiece, Face Tent:8-10L 30-100FiO2
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23
Q

What is the peak flow meter for?

A

Used after nebulizer tax. Highest air flow for exp.

Mod. Asthma

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24
Q

How many ml of chest tube drainage should you report to the provider?
What occurs in the water seal chamber?
Suction control chamber?

A

70mls or greater per hour

Tidaling (inspiration) w/ intermittent bubbling (expiration)

Cont bubbling

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25
What are some nursing care measures for the pt w/ a chest tube?
``` Mon. Rest rate/rhythm BP Apical Pulse Temp Hypoxia CO2 retention HOB up 30 deg. EKG mon. Turn q2hr, C and DB q 1-2 HR Excessive drainage/ system monitoring Tube connections/clearance ```
26
What are the common d/o of the upper airway?
``` D/O of Nose and Sinuses -Rhinosinusitis -epistaxis D/O of the larynx -laryngitis -laryngeal obstruction -ca of the larynx ```
27
What is Rhinosinustis? And the different types? Symptoms? Tx? Complications?
Inflammation of sinuses/nasal cavity. Acute:starts rapidly, resolves w/tx (hard to differ from cold, usually follows URI or cold) bacterial infection. Chronic:pt has 12 weeks of 2 or more episodes. Symps:facial pain/pressure/tenderness, fever, HA, ear pain, fullness in ear/nose. Worse when laying down at night. Comps:cavernous sinus thrombosis, meningitis, brain abscess, ischemic brain infarction, orbital cellulitis. Avoid travel, swimming, smoking. Tx:antibiotics (Amox/doxy)
28
What is an epistaxis? Where does it occur? | Nurse tx?
Nose bleed in anterior septum due to rupture of vessel (there major ones). Tilt head.pinch outer mid septum 5-10 min. Vasoconstrictor nasal decongestant may be used (phenylephrine), keep emesis near. More serious: rhino rocket w/ antibiotic for days. Cauterize do w/silver nitrate.
29
What is laryngitis? S/S? Nurse management?
Inflamed larynx s/p voice abuse, inhaled irritants, or w/ URI. Hoarseness or aphonia, sudden onset made worse by cold air, worse in am, better indoors, dry cough/sore throat. Common in immunosuppresed. Resting the voice, avoid irritants, expectorants, inc. fluid intake. Pt to call dr when:difficult to swallow, Hemoptysis, strider.
30
What can occur in laryngeal edema? | Tx?
Fatal. Laryngeal obstruction, anaphalaxis due to angioedema. Croupy cough due to aspirated contents falling down the bronchi.diff swallowing. Patent airway-emergent maneuver (no blind sweep). If from allergy:corticosteroid, epinephrine. Tracheotomy. Ice pack to neck.pulse ox.
31
What is the most common laryngeal cancer? Risk factors? S/S? What surgical management is available.
Squamous cell (epithelium). Carcinogens:smoking, asbestos, fumes, dusts, chemicals, tar, Vit. Def., age, race, gender, immunosuppresed. Need riboflavin in diet. 2 weeks hoarseness/cough/sore throat.lump. Later:dysphasia, dyspnea, nasal obstruction. Stage 1 and 2:surg/rad Stage 3 and 4:add chemo No voice box
32
What are 12 general types of lower airway conditions?
``` Atelectasis Resp. Infect:acute bronchitis, pneumonia, TB, lung abscess Pleural condition:pleurisy, pleural effusion, empyema COPD:chronic bronchitis, emphysema Asthma Pulm Embo Pulm Edema Sarcoidosis Anthrax Lung Ca Chest trauma:rib fx, flail chest, pneumo/hemothorax, tension pneumo Aspiration ```
33
Describe the patho of atelectasis-non obstruct/obstruc
Non-reduced ventilation (common w/post op-shallow breathing) Obstructive-blockage. Trapped alveolar air is absorbed into blood stream.lung becomes airless and alveoli collapse:excess secretions/mucous plugs, foreign body, tumor/growth compressing airway, chronic airway obstruction.
34
What are some causes (etiology) of atelectasis?
``` Altered breathing Pain Supine positioning (dec v/q) Increased abd pressure (lack of expansion) Reduced lung volumes Retained secretions (blockage) Post op (dec breaths v/q, immobile) ```
35
What factors elicit compressive atelectasis?
``` Pleural effusion Pneumo/Hemo thorax Pericardial effusion Tumor growth Elevated diaphragm ```
36
Describe the manifestations of atelectasis.
``` Dyspnea, cough, sputum production Tachypnea Tachycardia Pleural pain Anxiety Central cyanosis Dec Pao2 ( ```
37
What are some preventions of atelectasis? 1st line
``` Change position Early ambulatory DB and C Incentive Spirometry Secretion management:auctioning, nebulizer/MDI, post. Drainage/chest percussion Raise HOB ```
38
What are some preventions of atelectasis? 2nd line
PEEP Bronch Endotrach/mech vent Thoracentesis/chest tube
39
Describe acute tracheobronchitis patho.
Inflammation of mucous membranes (trachea/bronchi tree) w/ purulent sputum. Infection (viral, bacterial, fungal). Can occur s/p URI. Inhaled irritants Vent associated
40
What are the clinical manifestations of bronchitis (acute), and symptoms upon infection worsening?
Dry irritating cough, scanty mucoid sputum, sternal soreness, fever, chills, night sweats, HA, malaise. SOB Ins. Stridor, exp. wheeze Purulent sputum
41
What tx is necessary for acute bronchitis?
``` Antibiotics Fluids Mild analgesics Suction/bronch Rest Cough Moist heat to chest Cool vapor therapy/steam inhaler ```
42
What is pneumonia and the 4 classifications.
``` Inflammation of the parenchyma (lung cells) by microorganisms. Community Acquired Health care associated Hospital acquired Vent associated ```
43
What is the cause (patho) pneumonia?
Failure of upper resp protection:normal flora/aspiration in pt w/ altered resistance, blood borne organism enter pul circ and trapped. Vent/diff affected:inflam alveoli producing exudate, neutrophils fill air filled sacs. Dec alveolar o2 tension:secretions/mucosa edema occlude bronchi/alveoli. V/Q mismatch:hypoventilation, venous blood pass thru undervent alveoli. Arterial hypoxemia.
44
What are risk factors of pneumonia?
Comorbidity, immuno suppressed (low neutrophil) Any condition that produces mucus/bronchial obstruction (ca, smoking, COPD) Smoking Sedentary, shallow breathing Depress cough reflex(meds)aspiration into lungs(unconscious) dysphasia. NPO Supine position Antibiotic therapy Alcohol intox Anesthesia (resp dep, shallow breath) Old age
45
What are the s/s of pneumonia?
Productive cough:green-yel:strep, yel-blood:staph Fever, chills, malaise Tachycardia, tachypnea, dyspnea, resp distress, dec breath sounds Pleural pain
46
What are pneumonia preventions?
PPSV: age 65 over, chronic dz, asplenia, bad living conditions, immuno compromised. Education.
47
Pneumonia tx?
Antibiotic therapy (culture and sensa)-ineffective on viral pneumonia (Use antitussive). IV to oral when stable
48
What is the airborne infectious dz that affects the LUNGS, meninges, kidneys, bones, and lymph nodes?
TB
49
What is TB and best prevention?
Ghon tubercule. Necrosis, Cheesy mass of dead and living bacteria surrounded by macrophages multiplying in lung. (Can travel, miliary) Gram pos slow growing. Sensa to heat/UV light. Early ID and tx. TB skin testing.
50
What is used to dx TB?
Hand P TB skin test/blood test(sim to ELISA) CXR Acid fast bacillus smear/sputum culture
51
What are s/s of TB?
``` Fatigue/Malaise Wt loss/anorexia Chronic cough (non prod or mucopurulent), hemoptysis Night sweats Fever (late afternoon) ```
52
What are the 1st line meds for active TB?
Isoniazid Rifampin Pyrazinamide Ethambutol
53
What are the precautions for the TB patient?
``` Isolation until neg sputum culture. HEPA filter mask in pt room Take all meds full course Pt/fam teach Diet/activity ```
54
What is a lung abscess?
Necrotic lesion (localized)-lung parenchyma, microbial infection. Contains purulent material. Collapse and form cavity (2cm) #1 cause-aspiration
55
How is a lung abscess dx? Risk factors? Tx?
CXR, sputum culture, fiber optic bronch. Impaired cough reflex, swallowing difficulty, CNS d/o (drug/lac addicts) Antibiotic, oral care, c and DB, postural drainage, diet (inc. prot/cal)
56
What are the clinical manifestations and assessment findings of the pt w/ a lung abscess?
Fever Prod. Cough, sputum Anorexia Dullness, dec breath sounds, intermittent friction rub.
57
Diff what each of the 3 pleural conditions are. Pleurisy Pleural effusion Empyema
Ple-inflammation of both layers of the pleura Effusion-collection of fluid in the pleural space (2ndary dz usually) Empyema-collection of thick purulent fluid in pleural space, w/ fibrin development and loculated (walled off)where the infection is.
58
How is pleurisy dx'd and what interventions can the nurse provide?
CXR, sputum, thoracentesis Lay on effected side to splint (reduce pleural stretch).analgesic for pain. Topical heat or cold.anti inflam (nonsteroid)
59
What s/s and assessment findings are associated w/ pleurisy?
``` Pleural pain (sharp knife like: nerve endings on the parietal pleural rub), dec. as fluid builds up. Friction rub. ```
60
What are clinical manifestations, assessment findings and tx for pleural effusion?
More than 5-15 ml of fluid. Dyspnea, difficulty lying flat, and coughing. Dull, a scent breath sounds. Thoracentesis, culture, chest tube, pleurodesis w/ talc and change positions to spread.
61
What are some causes (patho) of empyema? S/S? Assessment data, and tax.
Complication of bacterial pneumonia, lung abscess, penetrating chest trauma. Fever, night sweats, pleural pain, cough, dyspnea, anorexia, wgt loss. Dec breath sounds, dullness. Dx: CT thoracentesis. Tx: antibiotics, thoracentesis, chest tube
62
COPD is defined as? | What are the 3 primary symptoms?
Airflow limitation or obstruction. Overlapping s/s of emphysema (loss of alveolar surface area)and chronic bronchitis (bronchi narrowing). Preventable/treatable/not reversible, chronic, progressive. Cough Sputum Dyspnea on exertion.
63
What are the COPD patho,
Inflammation (releases damaging subs) Thickening/narrowing of airway wall Hyper trophy of pulm vasculature-pulm hypertension(dec. lung ves inc pressure) Hyper secretion of mucus Loss of elastic fibers/decrease in alveolar elastic recoil Impaired exp. flow Increased air trapping Airway collapse/decreased surface area for gas exchange Damage to lung parenchyma/alveolar wall
64
What s/s of COPD? Risk factors?
``` Easily fatigued Frequent resp. Infections Accessory muscles use/barrel chest Orthopneic/dyspneic Cor pulmonale Thin frame/clubbed nails Wheezing/pursed lip/inc. exp. time. Risks:smoking, age, occupational exposures, air pollution, genetics (def in alpha antitrypsin) ```
65
What are the effects of chronic bronchitis in COPD? S/S
Dz of airways Cough and sputum production for at least 3 months in 2 consecutive years. Exacerbation during winter. Obesity, freq. cough/expect., acces. Muscles, rhonchi/wheeze, cor pulmonale
66
What are effects of emphysema in COPD? S/S?
Impaired O2 and CO2 exchange. Alveolar wall destruction. Chronic inflam, dec surface area.dead space. Impair diffusion(hypoxia), hypercapnea Pul blood flow resistance, inc. pulm arterial pressure. Cor pulmonale(r side HF) S/s:thin frame/barrel chest, no cough/exportation. Dypsnea and on exertion. Pursed lip/access. Muscle breathing. Orthopneic, anxious, short sentence speaking, r side HF.
67
What are the diagnostics for COPD?
``` PFT CXR ABG Serum electrolytes CBC Blood/sputum culture Alpha antitrypsin assay ```
68
What is asthma? S/S?
Rever obstructive lung dz. chronic inflam dz of airways: Hyper responsiveness Mucosal edema and production Bronchospasm (common AM or HS), bronchoconstriction Mast cells release mediators (inflam response), alpha adrenergic rec. stim w/ constriction. Cough, chest tightness, wheezing and Dyspnea. Retractions, inc. co2 retention, inc mucous
69
What are the triggers to asthma?
#1 allergy (seasonal, perennial) Irritants:pollution, cold, heat, smoke Foods:shellfish, nuts Exercise, meds, hormones, stress, RTI, GERD
70
What is used in dx of asthma?
Serum and sputum eosinophils (inc. w/ allerg resonse) Serum IgE ABG (dec o2), SpO2 (inc co2) PFT/Peak flow/Spirometry (tests improvement)
71
What is status asthmaticus? S/S? Lab eval?
(Ventilation issue) Attack Rapid onset, severe, persistent, doesn't respond to conventional therapy. Patho: severe bronchospams w/ mucous plug. Bronchi inflam/constriction w/thick secretions. V/q abnormal PaCO2 increase Labored breathing, inc exp, JVD, wheeze PFT (most accurate of airway obstruction)
72
What is the clinical management of status asthmaticus?
Short acting beta 2 adrenergic agonist Short course systemic corticosteroid High flow o2 (nonrebreath) IV fluid Mag sulfate Bronchial thermoplastic (heat up bronchi) REST Inhibit resp irritants in room (flowers, smoke, perfume, etc)
73
What is pulm embolism?
(Per issue) obstruction of pulm artery or one of its branches by either thrombus, air or fat. Dec blood flow to alveoli, dead space, lack of gas exchange, clot releasing subs that cause vasoconstriction. Inc pulm vas resis(dec size of vessel and beds), inc pressure, v/q imbalance, r ventricular HF. All leads to: dec card output, dec Oxy of organs, shock, death.
74
What are s/s of pulm embolism?
``` *Dyspnea Tachypnea Chest pain Apprehension Cough Shock Syncope Sudden death ```
75
What are the diagnosic testing for PE?
Pulm angio-invasive *best CXR, ABG, EKG, CT V/q scan D-Dimer assay (blood test for evidence of clot)
76
What is pulm edema? Patho?
Abnormal accumulation of fluid in lung tissue/alveolar space L side heart failure. Inc microvascular pressure, cell wall permeability. Fluid leak across membrane into interstitial space and alveoli.
77
What are s/s for pulm edema? Tx?
``` Restlessness Labored breathing:air hunger/tachypnea Intercostal and supra sternal retractions Tachycardia B ins. Crackles Pink, frothy sputum Low SpO2 Elevate HOB, 100% O2 mask, V/S SpO2, IV access, meds:furosemide, NTG, urinary Cath. ```
78
Define sarcoidosis. s/s?
Multi system. (Unknown Origin) Thought to be immune response. Granulomatous dz (develop clumps of macrophages) If to lungs-dec lung compliance from granuloma infiltrates and fibrosis. Lack of s/s-fatigue, anorexia, wgt loss, joint pain LUNG:Dyspnea, congestion, hemoptysis, lesions. Need to BX. Corticosteroid systemic tx.
79
What is anthrax? How can acquire? | TX?
Biological agent, in spore, odorless/invisible. Inhalation(dangerous), ingestion(GI symps), skin contact(lesions). PCN sensitive, standard precautions.
80
What are the types of lung ca? #1 cancer killer in US
Squamous cell(nonsmall)-slow growth Adenocarcinoma-rapid Undifferentiated large cell carcinoma Small cell/oat carcinoma-fast metas
81
What are risk factors for lung ca?
Smoking Occupation/environment (radon, asbestos) Genetics (2-3 X more likely) Dietary
82
What are s/s of lung ca?
Chronic cough Dyspnea, hoarseness, hemoptysis, shoulder/chest pain, Bronchitis/pneumonia, SVCS
83
What are the s/s, dx, and management of chest trauma:rib fx?
Pain, point tenderness, muscle spasm, bruising, shallow breathing. CXR, ECG, SpO2, ABG Control pain, medications Heals in 3-6 weeks
84
What occurs in flail chest? Management?
Paradoxical action: Inc dead space, dec alveolar vent/compliance Supportive-vent, clear secretions, pain control
85
Diff the 3 types of pneumothorax.
Simple (spontaneous)-can occur from pre existing condition Bleb rupture Trauma (open/closed)-air escapes from laceration in lung and enters pleural space OR wound in chest wall Tension-air trapped, unable to escape, pushes mediastinum
86
What are s/s of pneumothorax?
``` Pain Cough/hemoptysis Tachycardia, tachypnea, dyspnea Dec. breath sounds on affected side Anxiety/air hunger Asymmetrical chest wall expansion ```
87
Explain the secondary condition that arises from pneumothorax: subcutaneous emphysema.
``` Air enters the sub cut tissue Neck shoulder chest, etc. Palpate crackling sensation Assess area and monitor Spontaneously absorbed ```
88
What are nursing managements of pneumothorax?
``` Oxygen V/s and SpO2 Pain management, pain level Monitor color, work of breathing Breath sounds Chest tube ```
89
What is hemothorax?
Part/complete lung collapse due to blood accumulation in pleural space.

NUR 120 (6 decks)

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