Unit VIII unit 2 Flashcards Preview

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Flashcards in Unit VIII unit 2 Deck (213)
1

What is the most preventable cause of death in society

Smoking

2

Second hand smoke contains more than ? chemicals

7,000

3

Do e-cigarettes help smokers quit

No

4

Nicotine stimulates the release of multiple neurotransmitterd such as dopamine which is

The pleasure & reward area of the brain

5

Physical effects of nicotine

Increased
Arousal, alertness, hr, b/p, cardiac output
Decreased
Anti diuretic effect, performance enhancement

6

Smoking ------ airway diameter, -------ciliary activity and --------of distal airways

Decreased
Decreased
Abnormal dilation

7

Are light or ultra light cigarettes safer

No

8

5 A's of quitting smoking

Ask
Advise
Assess
Assist
Arrange

9

What forms of nicotine replacements are there

Patch
Gum
Lozenge
Spray
Inhaler

10

Name withdraw symptoms

Anxiety
Irritability
Increased appetite
Restlessness
Cough
Dry mouth
Insomnia

11

Is a relapse a sign of failure

No

12

Name non nicotine prescriptions

Zyban (bupropion) start 2 weeks prior to quit date
Chantix (varenicline) start 1 week prior to quit date, do not use with replacement nicotine products) blocks receptors in brain

13

What type of nicotine replacement products are prescription

Spray
Inhaler

14

Goal of oxygen use

Decrease work of breathing
Decrease workload of heart
Keep SaP2 over 90

15

Oxygen therapy improves

Survival
Exercise capacity
Cognitive function
Sleep

16

Indications for use of supplemental oxygen

PaO2 less than 60mm Hg
SaO2 less than 90%

17

PaO2 is

Pressure of oxygen dissolved in plasma

18

SaO2 is

How much O2 in hemoglobin

19

What is the O2 protocol

Less than 90%, put on oxygen
Maintain O2 saturation above 90%

20

What is the % of oxygen in room air

21%

21

Normal SaO2 is above

94% without oxygen

22

If O2 falls below 90%, PaO2 is below 60mm Hg what would you do

Oxygenate

23

Oxygen therapy requires

A physicians order

24

Signs/symptoms of hypoxemia

Tachypnea
Dyspnea
Change in skin color
Tachycardia
HTN
Restlessness
Disorientation

25

Safety precaution of O2 therapy

No smoking

26

What helps with diffusion

PaO2

27

When do you humidify O2

Over 2 L/min

28

Minimum mask flow rates

6 L/min, except venti masks

29

When medulla loses sensitivity to CO2 & no longer has drive to breathe

CO2 necrosis

30

If patient is on O2 and dyspnea increases what needs to be done

Need to lower O2

31

Prolonged exposure to high O2 level, dyspnea increases even though pt is on oxygen

Oxygen toxicity

32

High O2 washes out nitrogen and causes alveoli to collapse

Absorption atelectasis

33

What can happen when you have oxygen toxicity

Absorption atelectasis

34

Nasal canula

Low concentration
1-6 L/min

35

Simple face mask

Used only short periods
5-8L/min (40-60%)
Minimum 5L/min

36

How often should you wash and dry under a mask

Q2h

37

Non rebreather mask

10-15L/min (95-100%)
Valve that prevents room air and expired air from flowing back in bag

38

Partial rebreather mask

Reservoir bag allows pt to breathe first 1/3 exhaled air with O2
6-10 L/min (60-90%)
Cannot use with humidity

39

Can you use a partial rebreather mask on a COPD pt?

No because they would breathe too much CO2

40

Venturi mask

Delivers precise, high flow O2
Make sure there is no blockage of ports

41

Tracheostomy collar

Delivers high humidity and oxygen
Need to check secretions in tubing

42

How often should you assess patients on O2

15-30 minutes then prn

43

Monitors saturation of hemoglobin with O2 and HR

Pulse Ox

44

Where can a pulse Ox be placed

Fingers
Toes
Forehead
Nose
Earlobe

45

What can cause an abnormal reading in pulse Ox

Hypothermia

46

Goal of chronic oxygen therapy

SaO2 at least 90% or greater at rest, sleep, exertion

47

Need to teach the family & patient what with oxygen therapy

Safety measures

48

Creates air passage between mouth and posterior pharyngeal

Oral airway

49

Creates air passage between nose and nasopharynx

Nasal airway
Used on conscious pt's

50

Ideal position for promoting oxygenating

Standing
Semi or high fowlers
HOB elevated
Good lung down

51

Fluid intake of about ----- a day helps thins secretions

3 liters

52

Pursed lip breathing

COPD or dyspnea patients

53

Strengthens diaphragm
Decrease working of breathing, RR and O2 demand

Diaphragmatic breathing

54

How to purse lip breathe

In through nose
Out through mouth slowly

55

What is closely related to breathing

Anxiety level

56

Effective and controlled coughs come from where in the lungs

Deep
Lower lobes

57

What cough is used for those who can't cough effectively

Quad cough

58

What cough is used after bronchodilator and airways stay open while moving secretions

Huff cough

59

IS is done when

Inhalation
10 x's hour

60

Vibrates airway and loosens mucus from airway walls

Flutter device

61

Measures air expelled by the lungs
Used for asthma

Peak flow meter

62

HHN

Hand held nebulizer

63

MDI

Metered dose inhaler

64

DPI

Dry powder inhaler

65

Nebulizer medications

Reach lower airways
Fine mist
Can be done at home

66

Disadvantage of HHN

Bacterial growth in machine

67

What must be done before use of MDI

Shake bc of suspension

68

What is the most common delivery of respiratory medications

MDI's

69

When using MDI how long must you wait between puffs and why

1 minute, so 2nd dose can get deeper in the lungs

70

What should be done after use of MDI

Rinse mouth to avoid thrush

71

HFA inhaler requires

Slower longer inhale
Warm mist with taste
Wash weekly

72

Why are MDI with spacers used

Used with patients with poor coordination
Do not shake prior to use
Rinse only mouth piece

73

DRy powder inhaler

Solid particles in air
Over age 5
Do not keep in humid place

74

What is used for the patient with excessive bronchial secretions using positioning with percussion and vibration

Chest physiotherapy

75

When should chest physiotherapy (CPT) be done

One hour before or 1-3 hours after meals to avoid aspiration

76

Forceful striking of skin with cupped hands

Percussion, never do over spine or kidneys, always over clothes

77

What is used on long term ventilatior patients
Inflatable vest connected to high frequency pulse generator

High frequency chest compression vest

78

CPAP

Continuous positive airway pressure

79

BiPAP

Bi-level positive airway pressure

80

CPAP is used during

Inspiration and expiration
For severe apnea

81

Lung remodeling

Ongoing process of lung repair from long term inflammation
Permanent structural changes

82

Assists in changing airway responsiveness to prevent attacks

Preventative therapy drugs
(long term)

83

Stops attacks once started
Immediate relief

Rescue drugs

84

Short acting beta 2 adrenergic agonist

Bronchodilators

85

Stimulate beta 2 adrenergic receptors in bronchioles, prevents release of inflammatory mediators from mast cells

SABA
(decreases bronchi spasms)

86

Side effects of SABA's

Tremors
Anxiety
Tachycardia
Palpations

87

SABA's are what kind of inhalers

Rescue

88

Common SABA's

Albuterol

89

what is used to treat the tobacco which allows nicotine to be absorbed 100x more readily than tobacoo in its natural state

ammonia

90

do males or females have a higher % of lung cancer deaths related to smoking

males

91

postural drainage

positioning pt to drain secretions from smaller to later airways

92

what is important to teach pts about SABA inhalers

to always carry the rescue inhaler, make sure it is full

93

LABA

long acting beta 2 adrenergic agonist

94

what does a LABA do

used for long term control, dilates bronchioles to increase airflow,

95

what is a common LABA

formoterol

96

blocks bronchoconstricting effects of parasympathetic nervous system (vagal nerve)

anti-cholinergic (anti muscarinic)

97

what is the most common side effect of anticholinergic

dry mouth

98

what is the most common anticholinergic

atrovent (ipratropium)

99

are methylxanthines a first line conrtoller medicatoin

no, they are used when other treatments are ineffective

100

prevents synthesis of inflammaroty mediators, reduces inflammation

corticosteroids

101

what does a corticosteroid do

decreases airway inflammation and may mask signs of infection, increase risk of thrush

102

most corticosteroids have what in the name

-one
prednisone
hydrocortisone
methylprednisolone

103

what should you teach the patient about corticosteroids

never stop abruptly, taper doses until prescription is completed, can result in adrenal crisis

104

leukotrienes

inflammatory mediators, potent bronchoconstrictors
produces airway inflammation and edema

105

give an example of a leukotrine receptor blocker

singulair (montelukast)

106

enzyme breaks bonds in mucus (thins secretions) decreases viscosity and enhances mobilization of secretions

mucolytics

107

how often should you get the flu shot? the pnumonia shot

every year
every 5 years

108

is COPD reversible

no

109

COPD is a combinatgion of which two respiratory diseases

chronic bronchitis
emphysema

110

what is the primiary cause of COPD

smoking

111

what is the pulmonary vascular changes in COPD

surface area for diffusion of O2 decreases

112

what produces mucous

goblet cells

113

COPD is

the inflammatio nof airways, pulmonary blood vessels and lung tissues

114

S/S of hypoxia

restlessness
dyspnea
confusion
anxious

115

wha tis a physical change of COD

barrel chest

116

abnormal permanent enlargement of the air space distal to the terminal bronchioles (alveoli)

emphysema

117

what does emphysema result in

increased work of breathing, decrased area for gas exchange, air trapping in lungs

118

panlobular

whole lobe

119

what does smoke relese in the lungs and what does it do

proteases, breaks down elastin found in alveoli

120

what is the genetic factor identified for COPD

AAT
alpha 1 antitrypsin deficiency

121

what is the earliest symptom of COPD

chronic intermittent cough

122

what are some signs of COPD

wheezing, chest tightness
weight loss
fatigue
prolonged expiratory phase
polycythemia (increased RBC)
canosis

123

Blue bloaters

chronic bronchitis

124

pink puffers

emphysema

125

right sided heart failure
obese
cough with sputum
accessory muscle use

chronic bronchitis

126

think barrel chest
little or no sputum
pursed lip breathing
accessory muscle use
tripod position

emphysema

127

cor pulmonale

results from pulmoary HTN, increasepressure makes R heart pump harder and eventually fails

128

what leads to right sided heart failure

cor pulmonale

129

S/S of cor pulmonale

weight fain (fluid)
ascites
crackles in lung bases
extra heart sounds

130

exacerbations

flair up

131

chronic retention of CO2, increase hyper secretins of gastric acid
commonly in duodenum

peptic ulcer disease

132

what are the primary causes of COPD exacerbation

bacterial infection
viral infection
air pollution

133

how is COPD confirmed

pulmonary function test

134

low PaO2
increase PaCO2
decrease pH
increase bicarbonare

respiratory acidosis

135

what is the most common SABA

albuterol inhaler

136

what does corticosteroid therapy do

decreases airway inflammatio nby blocking eosinophils and macrophages

137

what does methylxanthines do

relaxes bronchial smooth muscle and enhances ciliary finctioning

138

what dos pursed lip breathing do

prevents bronchiolar collapse and air trapping

139

what is the purpose of a chest tube

remove fluid or air

140

where is a chest tube inserted

between 2nd and 9th ICS

141

is the drainage collection chamber emptied at the end of shift?

no it is marked at the end of shift

142

in the wet system what kind of bubbling is done in the water seal chamber

intermittent bubbling, with exhalation, coughing, sneezing until lung is re expanded (24-48 hours)

143

if you incraese the wall suctio nin a wet system does it incrase the negative pressure

no

144

in the wet system in the suctoin control chamber what kind of bubbling occurs

continuous bubbling occurs while unit is in use

145

does the wall suction effect suction in the device

no

146

what wil you report to the MD about the drainage

if greater than or equal to 100 mL an hour

147

where is the unit/device placed for a chest tube

below the level of the chest

148

how often should you assess lung sounds on a patient with a chest tube

q4h

149

do you have to have a dr's order for milking the chest tube

yes

150

what is a common comlication of a chest tube

frozen shoulder, infection, pneumoina

151

what is put around the chest tube

occlusive dressing

152

idopathhic

unknown cause

153

what is the end result of intersitial lung disease

pulmonary fibrosis

154

what happens with pulmonary fibrosis

decrease of elastic recoil
gas exchange impaired
dyspnea
scarring of tissue

155

DOE

dyspnea on exertion

156

clubbing of fingers is a sign of

cgronic hypoxia

157

VQ scan

measures perfusion in lungs

158

what is the survival rate of idiopathic pulmonary fibrosis

less than 5 years

159

what is the biggest risk factor with lung cancer

cigaretts

160

what is the leading cause of cancer related death in the US

cigaretts

161

where are the common sites of metastsis of lung cancer

brain and bone

162

what is the primary type of lung cancer

non small cell lung cancer

163

how does lung cancer metastasize by

direct extension
blood
lymph

164

what type of lung cancer is caught earlier because of obstruction to the airway

squamous cell carcinoma

165

what is the most malignant form of lung cancer

small cel lung cancer, spreads early

166

how do we diagnois lung cancer

biopsy

167

staging of lung cancer

T-tumor
N-nodes (lymph)
M-metastases

168

is staging useful in SCLC

no because it is aggressive

169

how is SCLC classified

limited
extensive

170

treatment for Lung cancer

surgery
chemo
radiation
usually a combination of the above

171

removal of entire lung

pnumonectomy

172

removal of one or more lobes

lobectomy

173

how does chemo help with getting rid of cancer

disrupts cancer cell division

174

chemo is

systemic

175

radiation is

localized

176

does chemo cross the BBB

no, why radiation is used

177

if lung cancer has metastisized to the brain what are some symptoms

altered gait and speech

178

if lung cancer has metastisized to the bone what are some symptoms

increased bone pain (back)

179

is the care for lung cancer curative or palliative

palliative

180

surgical opening into thoracic cavity

thoracotomy

181

VATS (video-assisted thoracic surgery)

minimally invasive approach,

182

what is the post op position of a pnumonectomy patient

on the operative side

183

removal or stripping of thick, fibrous membrane from visceral pleura

decorticatoin

184

empyema

pus

185

remove diseased tissue so healty tissue can perform better, for severe COPD

lung volume reduction srgery

186

damaged aveoli due to COPD, decreased surface area

bullea

187

what is the most commoon type of lung transplant

single lung

188

remove and prevent pleural effusion

pleurodesis

189

what is the most commmon complaint after a chest surgery

intense pain for up to 24 hours

190

post op care for a chest surgery

VS
pulse ox
pain scale
preventing frozen shoulder

191

chronic inflammatory disorder of the airways

asthma

192

characteristic clinical manifestations of asthma

wheezing
cough
dyspnea
chest tightness

193

who has the most issues with asthma

african americans and male children

194

what is affected in asthma

bronhioles not aveoli

195

what triggers an asthma attack

allergens or irritants initiates inflammaory response

196

how long can a response take for an asthma attack

minutes to 4-10 hours after exposure

197

what happens to the airways in asthma

constrictio nof airway
airway edema
increase of secretions

198

cough variant asthma

cough is only symptom, nonproduction or thinck white sputum

199

what can cause asthma

seasonal
foods
exercise
air pollutants
occupational hazards
gerd
psychological

200

treatment of asthma

SABA

201

measures air expelled by the lungs, aides asthma control and determines treatment needs

peak flow meter

202

in asthma a silent chest is a sign of what

an emergency

203

red flags of asthma

HR greater than 120
RR greater than 30
silent chest
speaks words not sentences
SpO2 less than 90
agitation

204

severe life threatening respiratory emergency

status asthmaticus

205

signs of status asthmaticus

altered LOC
arrhythmia
low blood pressure
decrease RR

206

pneumothorax

collapsed lung

207

oxygen use

no open flames

208

Dysphagia

Difficulty swallowing

209

Proteases

Breaks down elastin in alveoli

210

Earliest symptom of copd

Chronic intermittent cough

211

Cor pulmonale results from

Pulmonary HTN

212

Normal
pH
PaCO2
HCO3
PaO2
SaO2

•Normal Ranges
–pH 7.35 – 7.45
–PaCO2 35 – 45 mmHg
–HCO3 22 – 26 mEq/L
–PaO2 80 – 100 mmHg
–SaO2 96 – 100%

213

Hemoptysis

Blood in sputum