Unit VIII unit 2 Flashcards
(213 cards)
1
Q
What is the most preventable cause of death in society
A
Smoking
2
Q
Second hand smoke contains more than ? chemicals
A
7,000
3
Q
Do e-cigarettes help smokers quit
A
No
4
Q
Nicotine stimulates the release of multiple neurotransmitterd such as dopamine which is
A
The pleasure & reward area of the brain
5
Q
Physical effects of nicotine
A
Increased
Arousal, alertness, hr, b/p, cardiac output
Decreased
Anti diuretic effect, performance enhancement
6
Q
Smoking —— airway diameter, ——-ciliary activity and ——–of distal airways
A
Decreased
Decreased
Abnormal dilation
7
Q
Are light or ultra light cigarettes safer
A
No
8
Q
5 A’s of quitting smoking
A
Ask Advise Assess Assist Arrange
9
Q
What forms of nicotine replacements are there
A
Patch Gum Lozenge Spray Inhaler
10
Q
Name withdraw symptoms
A
Anxiety Irritability Increased appetite Restlessness Cough Dry mouth Insomnia
11
Q
Is a relapse a sign of failure
A
No
12
Q
Name non nicotine prescriptions
A
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
Q
What type of nicotine replacement products are prescription
A
Spray
Inhaler
14
Q
Goal of oxygen use
A
Decrease work of breathing
Decrease workload of heart
Keep SaP2 over 90
15
Q
Oxygen therapy improves
A
Survival
Exercise capacity
Cognitive function
Sleep
16
Q
Indications for use of supplemental oxygen
A
PaO2 less than 60mm Hg
SaO2 less than 90%
17
Q
PaO2 is
A
Pressure of oxygen dissolved in plasma
18
Q
SaO2 is
A
How much O2 in hemoglobin
19
Q
What is the O2 protocol
A
Less than 90%, put on oxygen
Maintain O2 saturation above 90%
20
Q
What is the % of oxygen in room air
A
21%
21
Q
Normal SaO2 is above
A
94% without oxygen
22
Q
If O2 falls below 90%, PaO2 is below 60mm Hg what would you do
A
Oxygenate
23
Q
Oxygen therapy requires
A
A physicians order
24
Q
Signs/symptoms of hypoxemia
A
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
