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resp 3 test
Apnea, Atelectasis, Pneumonia, Fungal Infections, TB, Pulmonary Edema
| Question | Answer |
|---|---|
| Describe Apnea | The cessation of spontaneous respirations that lasts longer than 20 seconds. |
| Describe Hypopnea | Condition characterized by shallow respirations with a 30-50% reduction in airflow. |
| Describe the pathophysiology of OSA (apnea) (Include length of obstruction, hypo/hyper-gas levels, avg.# of times a night) | Apnea occurs when the tongue falls backwards and obstructs the pharynx. Obstruction can last from 15-90 seconds and causes severe hypoxemia and hypercapnia. It can occur as often as 200-400 times a night. |
| What are the risk factors for forming sleep apnea? | increased body weight, age, neck circumference, craniofacial abnormalities More common in men than women |
| How is apnea manifested? | frequent awakening at night, excessive daytime sleepiness, witnessed apneic episodes, snoring, morning headache, irritability |
| What are some complications that can occur r/t apnea? | hypertension, right-sided heart failure, diminished ability to concentrate, impaired memory, interpersonal difficulites, depression, impotence |
| Describe polysomnography. | The patient's chest and abdominal movement, oral airflow, nasal airflow, SpO2, ocular movement, and heart rate and rhythm and monitored |
| What monitors are used during a sleep study? | polysomnography and pulse oximetry |
| What nursing and collaborative management should be done for a patient that has mild apnea? | avoiding sedatives before sleep & weight loss are the most effective. oral appliances to bring the mandible and tongue forward and support groups are also helpful |
| What does CPAP stand for and who would it benefit the most? | CPAP- continuous positive airway pressure used for patients with more severe symptoms of apnea |
| Describe how CPAP works. | The pt. applies a nasal mask that is attached to a high-flow blower that is adjusted to maintain a positive pressure to the airway during ventilation to prevent airway collapse. (Lewis 543) |
| What does BiPAP stand for and who would it benefit the most? | Bilevel positive airway pressure Best used for people with severe apnea that have a cardiac problem or have difficulty with the continuous pressure of the CPAP. |
| Describe how BiPAP works. | BiPAP delivers a higher pressure during inspiration and a lower pressure during expiration |
| During patient teaching r/t use of CPAP or BiPAP you would tell them that: Irritation of eyes and nose can be controlled with ________________ | Humidification This irritation is one reason that people do not comply with use of their masks, teaching them how to avoid it will help with compliance. |
| Describe Uvulopalatopharyngoplasty (UPPP) | It is a surgical measure done to manage sleep apnea. It has a 60% success rate. It is removal of the tonsillar pillars, uvula, and posterior soft palate (removes obstructing tissue) |
| Describe Genioglossal Advancement and Hyoid Myotomy (GAHM) | It is a surgical procedure done to manage sleep apnea. It has a 60% success rate. It involves advancing the attachment of the muscular part of the tongue on the mandible. (This keeps the tongue from falling back) UPPP is also often performed as well. |
| What are the available surgical procedures available for patients with apnea? | UPPP GAHM Tracheostomy |
| What are the manifestations of atelectasis? | Low-grade fever, diminished or absent breath sounds in affected area, diminished rate and depth of respiration, physical inactivity caused by immobility or pain |
| What are the diagnostic and labatory test finding r/t atelectasis? | Chest X-ray will reveal the area of collapse |
| What is the collaborative management r/t atelectasis? | Chest physical therapy and pulmonary hygiene measures are used. Resp. therapy use intermittent positive breathing treatments (IPPB) & O2 as ordered. Meds given are analgesics, antipyretics, bronchodilators |
| What are the priority nursing diagnosis for a patient with atelectasis? | Ineffective airway clearance Ineffective breathing pattern Impaired gas exchange |
| What nursing actions are done with a pt. with atelectasis? | Monitor respiratory and oxygenation status, pulmonary hygiene (assist w/splinting), ambulation, adequate hydration and nutrition |
| What patient and family education must be done for a pt. with atelectasis? | Disease process, diaphragmatic and abdominal breathing techniques, nonpharmacologic pain control measures |
| What are some expected outcomes for a pt. w/atelectasis? | Prevention; maintenance of airways; effective cough w/clear and thin secretions; Afebrile; absence/resolution of dyspnea; RR normalized; bilaterally clear and equal breath sounds; pt. participates in ADL's |
| Describe pneumonia. | acute inflammation of lung parenchyma (alveoli and respiratory bronchioles) from pathogens |
| What are the manifestations of a bacterial cause of pneumonia? | high-fever; productive cough; elevated WBC's; chest x-ray w/obvious infiltrates; clinical course more-severe |
| What are the manifestations of a viral cause of pneumonia? | low grade fever; non-productive cough; normal WBC; chest x-ray w/minimal changes; clinical course less-severe |
| What are the diagnostic tests done for pneumonia? | Chest x-ray; CBC; sputum culture/gram-stain |
| What is the significance between beginning treatment for pneumonia and the time it takes to get a sputum culture results? | Pneumonia has a high mortality rate- the faster it is treated the better (best with in 4 hours). Sputum cultures take 72 hours to get back. Therapy is empiric, and begin on the basis of the symptoms presented. |
| What is the collaborative management done for patients w/pneumonia? | Antibiotic and other antimicrobial therapy; analgesics; antipyretics; oxygen therapy |
| What are the priority nursing diagnoses for pneumonia? | Impaired gas exchange; Ineffective airway clearance; Ineffective breathing pattern; Imbalanced nutrition (less); Activity intolerance; Anxiety; Pain; Hyperthermia |
| What nursing actions should be done for a pt. w/ pneumonia? | Monitor respiratory and oxygenation status; Maintain patent airway; Provide supplemental oxygen as indicated; Be prepared to initiate mechanical ventilatory support |
| What preventative measures can nurses take to avoid causing/spreading pneumonia? | Identify high-risk patients, Maintain infection control measures, Maintain adequate nutrition and fluid intake, Aspiration precautions, Provide frequent oral hygiene, Encourage activity and mobility |
| What are aspiration precautions? | HOB at least 45* when eating, at least 30* for tube feeding |
| What patient/family education must be done r/t pneumonia? | Immunization, Activity limitations and the importance of rest, Proper medication management, Avoid pollutants and irritants |
| After a pneumonia patient is released from the hospital, what signs and symptoms would warrant a trip back to the hospital? | Family should be taught to bring the pt. back if there is a return of fever or worsening of respiratory status |
| What are the expected outcomes for a patient of pneumonia? | Absence of resp. distress; Clear breath sounds; Effective coughing w/expectoration of sputum; Decreased or absent chest pain; Resolution of fever; Maint. of normal body weight; Return to baseline activity; Return to baseline ADL's |
| Who is at risk of having a fungal infection of the lung? What drugs are used? | immunocompromised, those on anitbiotics run a risk; amphotericin B IV, Nizoral, and Diflucan |
| What is a lung abcess? | a pus containing lesion of the lung parenchyma that forms a cavity |
| What are the manifestations of a lung abscess? | cough w/purulent sputum; hemopytsis; fever; chills; pleurtic pain; decreased breath sounds; crackles in later stages |
| What diagnostic studies are done for a lung abscess? | Chest x-ray; CT scan; sputum cultures |
| What nursing and collaborative care is done for a pt. w/lung abscess? | antibiotics (clindamycin 2-4 months); patient education (take ALL drugs); chest physiotherapy; surgical intervention (lobectomy or pneumonectomy) |
| What is pulmonary tuberculosis? | lung infection caused by Mycobacterium tuberculosis |
| What are the assessments/manifestations of TB? | non-productive cough in the morning is an early sign; frequent cough w/copious frothy pink sputum; night sweats; anorexia; weight loss; history may indicate recent exposure to infected individuals |
| What are the diagnostics for TB? | Skin test; Ghon tubercle on chest X-ray; Positive acid-fast bacillus sputum cultures (definitive diagnosis) |
| When is a sputum culture best done? | Early in the morning |
| What collaborative management is done for TB? | Medical management is dependent on level of exposure/disease presentation. (Table 28-10 Lewis) |
| What if I have a positive PPD, but no clinical evidence of the disease? | INH is the drug of choice, with a minimum use of 6 months |
| What do I do if I know I will be exposed to TB? | a prophylactic antibiotic will be administered |
| What are the nursing diagnosis for TB? | Ineffective breathing pattern; Ineffective health maintenance; Imbalanced nutrition, less; Hyperthermia; pain; activity intolerance |
| What type of precautions should be done for TB? | Standard and Airborne |
| If a family member were to visit a pt. w/ TB what would they expect to see? | Private room w/negative air pressure that has 6-12 full air exchanges per hour; visitors will be asked to put on a mask |
| What type of precautions should a nurse use when entering the room of a TB patient? | N95 mask and a gown if the patient doesn't cover his mouth when coughing |
| What type of mask does a TB patient need before exiting their room? | surgical mask |
| What nursing actions would be done for a TB patient? | Monitor respiratory/O2 status; provide adequate nutrition and hydration; antimicrobial therapy; supplemental oxygen |
| Why is it important to take all of the drugs prescribed? | Prevents recurrence and/or the development of drug resistant organisms. Pts. who have to take a medication for a long period time and/or are taking a medication with bad side effects need to be taught this |
| Does a pt. with TB need to wash and/or throw away books, eating utensils, and other objects that were touched? | No...inanimate objects do no easily spread the bacteria. Infection control includes hand-washing and coughing into a tissue and disposing of the tissue in a tied-up plastic bag. |
| What pt/family education needs to be done for a pt. w/TB? | Mechanism of transmission, Infection control, treatment plan, and the importance of good nutrition and adequate rest |
| What are the 4 main drugs that a TB patient must take? | INH, Rifampin (RIF), Pyrazinamide (PZA), Ethambutol |
| What are the adverse effects of INH? | Hepatotoxicity, peripheral neuritis, anemia, agranulocyrosis, bleeding, hypersenstivity |
| What are the nursing actions for someone at risk of developing hepatotoxicity? | Assessment for the onset of jaundice and periodic monitoring of LFT's (liver function tests) |
| What are the nursing actions for someone with peripheral neuritis? | it can be minimized with the intake of Vitamin B6 |
| What are the adverse effects of Rifampin (RIF)? | It has a relatively low toxicity, but monitor CBC, LFT's, and renal status. There will be an orange-discoloration of body fluids. |
| What is the mechanism of action that most of the TB drugs have? | bacteriocidal against rapidly dividing cells |
| What are the adverse effects of Pyrazinamide? (PZA) | Causes hepatotoxity and elevates uric acid levels (gout). |
| What are the adverse effects of Ethanmutol? | Causes optic neuritis (change can include loss of visual acuity and red/green color discrimination) |
| If taking ethambutol, what assessments must be done to monitor it's adverse side effect? | Obtain a baseline vision screening and periodic eye exams |
| What are the expected outcomes for a pt. w/TB? | Adherence to medication therapy; Resolution of productive cough; Afebrile; RR normalized; pulse oximetry or ABG w/in normal range (baseline); Maint. of appropriate body weight; resolution of active disease; Prevention of spread to contacts |
| What is Pneumoconiosis? | a group of lung diseases caused by inhalation and retention of dust particles (i.e. asbestosis and berylliosis, hantavirus) |
| What happens to the lungs if dust particles are retained? | Pneumoconiosis eventually results in pulmonary fibrosis from the development of excess connective tissue from the chronic inflamation. |
| What is Pneumonitis? | Inhalation of a CHEMICAL or hypersensitivity reaction. |
| What are the manifestations of Pneumonitis? | Diffuse lung injury that presents as pulmonary edema with dyspnea and cough |
| What are the diagnostics for pneumonitis? | Chest x-ray; CT scan |
| What is the collaborative care for pneumonitis? | Prevention, stop exposure, symptom management |
| What is pulmonary edema? | abnormal accumulation of fluid in the alveoli and interstitial spaces of the lungs, it is a medical emergency |
| What are the manifestations of pulmonary edema? | severe SOB, elevated jugular venous distension, crackles in BOTH lungs, frothy pink sputum, restlessness, anxiety, decreased oxygen saturations |
| What is the collaborative treatment for pulmonary edema? | optimize oxygenation, prepare for possible intubation, use of medications |
| What medications are used to for pulmonary edema? | diuretics (decrease heart flow,**beware of K+ levels), morphine (decrease anxiety and pain, vasodilation), vasodilators, beta blockers (slow HR), inotropes (increase contractibility) |
| What nursing interventions should be done for a patient with pulmonary edema? | optimize breathing (elevate head, leaning forward a little); administer oxygen; administer medications; be a calming presence |
| What is pulmonary hypertension? | severe progressive disease of elevated blood pulmonary pressure (chronic disease) |
| What are the causes of pulmonary hypertension? | left-sided heart failure, COPD |
| What are the manifestations of pulmonary hypertension? | dyspnea on exertion advancing to at rest; fatigue; exertional chest pain; dizziness; exertional syncope |
| What are the diagnostics for pulmonary hypertension? | Chest x-ray; EKC; echocardiogram; cardiac catherization; PFT's |
| What is the collaborative management for pulmonary hypertension? | early diagnosis is vital; diuretic therapy; anticoagulation |
| What is the surgical intervention for pulmonary hypertension? | transplantation |
| What are the medications given for pulmonary hypertension? | Flolan IV, Remodulin, Bosentan PO |
| What nursing precautions need to be done with administration of Flolan IV? | there is a 1/2 life of 2-3 minutes; if there is a rebound pulmonary hypertension it could be fatal. pt. needs to be on a 1:1 because you only have 2 minutes to fix the problem |
| What information should a nurse know about Remodulin? | it is a continuous SQ infusion, the 1/2 life of the drug is 3 hours; there will be pain and erythema at the infusion site |
| What information should a nurse know about Bosentan PO? | it can cause serious liver injury |
| What are the nursing diagnosis for pulmonary hypertension? | Impaired gas exchange; decreased cardiac output; ineffective breathing pattern; ineffective health maintenance; imbalanced nutrition, less than; activity intolerance; anxiety |
| What nursing actions should be done for a patient with pulmonary hypertension? | monitor resp/O2 status; maintain patent airway; provide O2 as needed; emergency preparedness; administer meds; emotional support; nutritional support; provide for rest; patient and family education |
| What patient/family education should be done for pulmonary hypertension? | Medication adminstration; signs and symptoms of decompensation; improved quality of life; symptom management; energy saving techniques |
| What are the expected outcomes for a pt w/pulmonary hypertension? | Improvement in activity tolerance; symptom management |
| What is cor-pulmonale? | enlargement of the right ventricle; r-sided heart failure |
| What are the manifestations of cor-pulmonale? | dyspnea; wheezing; chronic productive cough; retrosternal or susternal pain; fatigue; polycythemia; cardiac complications: peripheral edema, weight gain, JUGULAR VENOUS DISTENSION, enlarged liver |
| What are the diagnostics for cor-pulmonale? | ABG's; chest x-ray; PFT's; cardiac catherization; BMP (basic metabolic profile); BNP (brain natriuretic peptide) |
| What is the function of the cardiac catherization? | measure the pressure and O2 sats in the heart chambers |
| What does BNP tell you? | tells if the ventricle is under strain; increase in the peptide indicates signs of heart failure |
| What is collaborative care/nursing diagnosis and actions? | treatment of underlying pulmonary problems; see COPD treatment plan |
| What is a pulmonary embolism? | emboli lodged in pulmonary vasculature and obstruct adequate blood flow |
| What are the assessments/manifestions of pulmonanry embolism? | restlessness, anxiety, and agitation; VS:tachycardia, tachypnea, hypotension, and fever; chest pain; hemoptysis (coughing up blood); mental status changes; cyanosis; lung crackles (if there is an inflammatory repsonse) |
| What would cause pulmonary embolism? | history thromboembolism (DVT); or long bone fractures; atrial fibrillation |
| What are the diagnostics for pulmonary embolism? | spiral or helical CT scan; EKG for a-fib; normal chest x-ray; pulmonary angiogram; ventilation-perfusion scan; ABG's |
| What is the collaborative management for pulmonary embolism? | oxygen therapy; anticoagulant; embolectomy; throbolytic therapy (most used); intracaval filter |
| What are the priority nursing diagnosis for pulmonary embolism? | ineffective breathing pattern; pain; impaired gas exchange; anxiety; impaired physical mobility |
| What are the nursing actions for pulmonary embolism? | Maintain airway; supplemental O2; preparation for emergency; IV access; circulatory support as needed; pre/post vena cava filter care; pain; surgical care |
| What client education should be done for a patient regarding pulmonary embolism? | prevention of thromboembolism; avoid immobility; signs and symptoms of venous occlusion (unilateral redness and swelling); anticoagulant therapy |
| What are the expected outcomes for a patient with pulmonary embolism? | RR normalized; back to baseline (O2 sats, ABG's, mental status, and orientation); absence/resolution of chest pain and anxiety; prevention of further thromboembolic phenomena |
| What is the difference in epistaxis for older adults and children? | Children: the bleed is usually anterior and stops spontaneously Adults: posterior nasal bleeding that may require medical treatment |
| What are the causes of epistaxis? | trauma; foreign bodies; inhaled topical corticosteroid use; nasal spray abuse; street drug use; anatomic malformation; allergic rhinitis; tumors; and condition that prolongs bleeding time or alters platelet counts (coumadin, ASA) |
| What is the basic treatment for epistaxis? | keep pt. quiet; have them sitting and leaning forward; apply direct pressure by pinching entire soft lower portion of nose; apply ice compress; insert a small gauze into bleeding portion & apply pressure if bleeding continues; get help if doesn't stop |
| If a nose bleed doesn't stop, what further treatment is done? | direct identification of bleeding site and application of vasoconstrictive agents; cauterization; and packing |
| Describe the types of nasal packing. | ribbon gauze, inflatable balloons, gauze rolls (tampons) |
| How long is nasal packing left in? | 3 days for a posterior and 24-48 hours for an anterior |
| __________________is a high priority when there is use of a nasal packing. | pain management |
| What will a patient who has a gauze roll look like? | a string will be coming out of their nose with a string taped to their cheek; a nasal sling can be used under the nares for drainage |
| What are the complications with the use of a nasal packing? | predisposes the patient to infection; can alter respiratory status; risk for aspiration; if the packing doesn't work they made need to do surgery |
| What patient/family teaching should be done regarding precautions after treatment of epistaxis? | Avoid (lifting, nose blowing, straining, and vigorous/strenuous activity) for 4-6 weeks. Sneeze with an open mouth. Avoid the use of ASA or NSAIDS |
| Describe thermal injury. | Results from the inhalation of hot air or noxious chemicals and can damage the tissues of the respiratory tract |
| What do you know/expect to see from a thermal injury above the glottis? | usually thermally produced; mucosal burns of the oropharynx, larynx and results in injury and swelling; look for blistering and edema; high risk for airway obstruction; remove pt. from toxic environment and maintain airway |
| What do you know/expect to see from a thermal injury below the glottis? | Frequently from a chemical; exposure to toxic fumes or smoke can lead to ARDS. Toxins damage type II pneumocytes and decrease surfactant production. Epithelial sloughing with bronchitis occurs 6-72 hours after burn |
| What are the signs and symptoms of a thermal injury to the lung? | mucosal burns w/swelling; blistering and edema; carbonaceous sputum; hemoptosis; resp. distress; dyspnea; decreased lung compliance; hypoxemia; V/P imbalances |
| What are warning signs that a nurse should be on the look out for when dealing w/a thermal injury patient? | respiratory distress, dyspnea, decreased lung compliance, hypoxemia, V/P imbalances |
| What is the treatment of thermal injury? | (similar to ARDs) early intubation before airway compromise occurs (thus avoiding an emergency trach) (should happen 1-2 hours after injury) |
| What would determine the amount of oxygen that should be delievered after a thermal injury? | ABG interputation |
| When should a fiberoptic bronchoscopy be done? | in the first 6-12 hours |
| What is a fiberoptic bronchoscopy assessing? (r/t thermal injury of the lung) | looking at the lower respiratory tract for cabonaceous sputum, mucosal edema, vesicles, erythema, hemorrhage, ulceration |
| How is carbon monoxide poisoning treated? | It is treated with 100% O2 until carboxyhemoglobin levels return to normal. (DO NOT BASE O2 levels on oximetry!!) |
| What does a unilateral nose fracture look like? | little or no displacement of the nose |
| What does a bilateral fractured nose look like? | it's the most common, gives the nose a flat look (black eyes) |
| What does a complex fractured nose look like? | caused by powerful frontal blows that usually involve damage to adjacent facial structures (teeth, eyes) swollen across the whole face |
| What nursing assessments/manifestation are r/t a fracture? | epistaxis may be only sign- assess the ability to breath; presence of edema, bleeding, or hematoma; clear drainage from nose suggests CSF leak |
| What nursing management is done for a fractured nose? | maintain airway (upright); reduce edema (apply ice); prevent complications (i.e. infection and respiratory compromise); provide emotional support (surgery, having a different looking face) |
Created by:
erachuy23
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