Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
resp lecture 3
G. Mcgregor lecture 3 respiratory
| Question | Answer |
|---|---|
| Lower Respiratory Problems | COPD, Pulmonary Hypertension, Fibrosis, Cancer of the Lung, Pulmonary Embolism, Tuberculosis |
| Chronic Obstructive Pulmonary Disease (COPD) | Refers to both chronic bronchitis and emphysema. Fourth leading cause of death for women and fifth leading cause of death for men |
| The single most common risk factor for COPD is | cigarette smoking |
| Blue Bloaters: Patient with | chronic bronchitis. Persistent cough and sputum production. airways always inflamed, inflammation causes mucus |
| Pink Puffers: | Patient with emphysema. Exertional dyspnea, inability to perform ADLs. Pt have less surface area to deal with |
| Blue Bloaters | Bronchitis inflamed primary and secondary bronchi. A problem of the airway |
| S/S of bronchitis | Peripheral edema, Cyanosis, Right heart failure symptoms, cough w/sputum, Coarse crackles/rhonchi, Exp wheezes. No respiratory distress, Pulm. HTN, Increased R V (traping aire) |
| Tests for bronchitis | ABG mild to severe hypercapnia & hypoxemia,compesory respiratory acidosis |
| In bronchitis, CBC shows increased | hemogloblin & RBC (polycythemia) |
| Cor pulmonali | rt sided heart failure caused by lungs |
| Emphysema | Pink Puffers – Emphysema holes cause less surface area for transfer of O2 |
| Emphysema is a problem of | the alveoli |
| S/S of emphysema-SOB, Pink color, Barrel chest, Thin, Prolonged expiration, pursed lip breathing (Accessory muscles), Unproductive cough, ↓breath sounds, Exp wheezes/crackles | the alveoli |
| Tests for emphysema show | ↑residual cap, ↓exp vol, ↓lung recoil, BG can be normal, mild hypercapnea (hi C02), norm/mild hypoximea |
| Chest x-ray of pt with emphysema will show | hyper ext of lungs w/a flat diagph. Widening of rib spaces, |
| Position most comfortable for pt with emphysema | Maintains position sitting upright with arms resting in front on table |
| In emphysema, inflammation for irritants causes release of proteases. The overactive proteases | destroy the alveoli |
| Alpha1-antitrypsin usually | protects the lung tissue from the inflammation CHRONIC EXPOSURE TO INFLAMMATORY PRODUCT |
| Emphysema results in | carbon dioxide retention and chronic respiratory acidosis |
| Inflammation damages lung tissue and | less surface area is available for gas exchange |
| Changes to airways, alveoli is | Progressive, chronic |
| Patho of emphysema | Air-trapping, lung over-expansion, alveoli breaks, O2 not getting to alveolar caps. for exchange |
| Using Harmonicas to | Improve PFTs (pulmonary function tests) in Emphysema |
| Exacerbation COPD | Infection is the most common cause |
| Exacerbation of COPD is defined as a | recent deterioration of a previously stable patient’s clinical state due to worsening of their COPD, |
| Symptoms of Acute Exacerbation COPD | ↑dyspnea, Tachycardia, ↑cough, ↑ sputum production, Ϫ sputum color, Accs muscle use, Peripheral edema, ↑wheeze, ↓LOC, ↓energy, Fever,↑resp rate, ↓FEV or PEF (expiratory), ↓ABGs, Chest tightness |
| Management of Exacerbation COPD | Oxygen – keep O2 saturation > 90% paCo2 55-65 |
| Medication | same as asthma |
| Secretion management | suctioning, physiotherapy |
| Support nutrition | suctioning, physiotherapy |
| Bi-level positive airway pressure (BiPAP) provides noninvasive pressure support ventilation by | nasal mask or facemask. |
| Although BiPAP is used for patients with | respiratory muscle fatigue to avoid more invasive ventilation methods. |
| Mechanical Ventilation | increasing fatigue, PaCO2> 65 mm Hg, hypoxemia, acidosis and hypercapnia, Hemodynamic monitoring |
| Medications for COPD Exacerbation | Oxygen – keep O2 Sat > 90%, wean down when patient improves, |
| Antibiotics | in case of suspected infection. Identify the organism, |
| Short acting Beta agonists – | MDI, nebulized., |
| Anti-cholinergics - MDI | MDI, nebulized., |
| Corticosteroids | inhaled or oral, IV for first 24 hours. Tapering doses for 10-14 days. Addision’s crisis |
| Theophylline | sends HR up!! bronchodilator, improves secretion clearance and diaphragm contractility |
| Goals of Therapy | Prevent progression, Relieve symptoms, Improve exercise tolerance, Improve health status, Prevent/treat exacerbation, Prevent/treat complications, ↓mortality, Minimize side effects from treatment |
| Pulmonary Vasculature | (HTN), Low pressure system – 20/10 mm Hg compared to 120/80 of arterial BP |
| Pulm HTN | Many branches to increase gas exchange at the alveolar-capillary membrane |
| Pulmonary vessels very compliant, able to stretch 5X for increased blood flow during exertion without increasing pressure | Many branches to increase gas exchange at the alveolar-capillary membrane |
| High pressures in this system will | affect gas exchange |
| Pulmonary Hypertension Pathophysiology | Pressures ↑in the pulmonary vessels, RT ventricle pumps blood against ↑pressure, rt ventricular hypertrophy, ↑hypertrophy →↑O2 need, O2 need exceeds O2 available, rt heart failure →Cor Pulmonale→↓O2 to other organs |
| Primary Pulmonary Hypertension Patho | Vasoconstriction, ↑vascular resistance of pulmonary blood vessels, Pulmonary blood pressure ↑, Blood flow↓ ,Poor perfusion→Hypoxemia→rt heart failure (Cor Pulmonale) |
| In pulmonary htn death usually occurs within | 2 years |
| Symptoms of Pulmonary HTN | dyspnea at rest, Fatigue, Exercise intolerance, Light-headed, syncope, JVD, peripheral edema, ascites, Cough, hemoptysis, Anorexia, Peripheral pulses weak/ thread. Chest pain |
| Early manifestations of PPHTN | The most common early manifestations are dyspnea and fatigue in an otherwise healthy adult. Some patients also have angina-like chest pain |
| Functional Assessment of PPHTN | stages 1-4 |
| Class I | Have pulmonary hypertension but no limitation of physical activity. Ordinary activity does not cause fatigue, chest pain or near-syncope |
| Class II | Slight limitation. Comfortable at rest but ordinary activity causes dyspnea, fatigue, chest pain or near-syncope |
| Class III | Marked limitation of physical activity. Comfortable at rest but any activity causes dyspnea, fatigue, chest pain or near-syncope |
| Class IV | Inability to perform any physical activity without symptoms. Symptoms of rt heart failure. Dyspnea or fatigue present at rest and discomfort is increased by any activity |
| Diagnosis PPHTN | History of symptoms: dyspnea and fatigue in an otherwise healthy adult, RT-sided heart catheterization. Pulmonary function tests show ↓functional volume and ↓capacity, CT |
| Meds for PPHTN | Coumadin, Calcium Channel Blockers, Epoprostanol, Digoxin, diuretics |
| Surgical management involves whole | lung transplant, if cor pulmonale may need heart-lung transplant |
| The two nursing priorities before surgery are teaching the patient the | expected regimen of pulmonary hygiene to be used in the period immediately after surgery and assisting the patient in a pulmonary muscle strengthening/conditioning regimen. |
| Major problem areas after lung transplantation are | bleeding, infection, and transplant rejection. |
| Bleeding is most common in transplant patients who had | cardiopulmonary bypass with anticoagulation. Usually the patient remains in the ICU for several days after transplantation. |
| Post-transplant drugs used | immunosuppressant’s and corticosteroids (after 10-14 days) |
| Primary pulmonary hypertension (PPH) occurs in the absence of other | lung disorders, and its cause is unknown although exposure to some drugs increases the risk. This disorder is rare and occurs mostly in women between the ages of 20 and 40 years (50% genetic) |
| INTERSTITIAL PULMONARY DISEASES | Pulmonary Fibrosis, scaring of lung tissue/thickens causes problems |
| Fibrosis | Disease of the interstitial, alveoli, blood vessels (gas exchange unit), |
| Restrictive disease that | Lung tissue thickens, Reduced gas exchange, Lung is “stiff” and does not expand well, Loss of compliance, Restrictive pulmonary disease |
| Risk Factors for Pulmonary Fibrosis | Occupational exposure to asbestos, toxins, sarcoidosis, Silicosis, Asbestosis, Cigarette smoking, Scar tissue formation in the lung tissue, can be occupational or idiopathic |
| Symptoms of Pulmonary Fibrosis | Cough, Dyspnea, Enlarged hilar lymph nodes, Onset is slow, insidious, Cough and dysmia, PFTs ↓FVC and TLC, scarring on the chest x-ray |
| Interventions for Pulmonary Fibrosis | Maximize oxyg, ↓symptoms, Slow the fibrotic process |
| Oxygen, Corticosteroids, Immunosuppressants, Lung Transplant | Maximize oxyg, ↓symptoms, Slow the fibrotic process |
| Pulmonary Embolism | Can be solid, liquid or gas, obstructs the pulmonary vessels, decreased systemic oxygenation, hypoxia, potential death, most common embolism is a blood clot |
| Pathophysiology of PE | Sudden obstruction of pulmonary vasculature, Altered ventilation/perfusion – mismatch, ↑alveolar dead space, Hypoxemia and vasoconstriction |
| ↓CO and tachycardia, Inflammation, Loss of surfactant, Atelectasis, Edema | Sudden obstruction of pulmonary vasculature, Altered ventilation/perfusion – mismatch, ↑alveolar dead space, Hypoxemia and vasoconstriction |
| PE Earliest symptom is | tackycardia |
| Risk Factors for Pulmonary Emboli | tackycardia |
| Virchow’s Triad | damage to the vessel wall (injury during surgical procedures), alterations of blood flow (slow blood flow in calf veins associated with bed rest), and alterations in blood constituents (change in clotting factors or increased platelet activity). |
| Venous Stasis | Sitting, bedrest – can happen in as little as 12 hours/ exercise |
| Endothelial Injury | Trauma, surgery, sepsis, atherosclerosis |
| Alterations in Coagulation | Trauma, surgery, sepsis |
| Symptoms of Pulmonary Embolus | Dyspnea (79%) ,Tachycardia (70%),Tachypnea (70%), Pleuritic Chest Pain (66%), Rales, late sign (51%), Cough (37%), Restlessness, apprehension (<25%), Calf pain, Homan’s sign (<25%), Hypotension, Death |
| Diagnostic for PE | Clinical correlation: Virchow’s triad & symptoms, D-Dimer: positive means a clot somewhere; negative means no clots, Ultrasound of thigh and pelvic vessels |
| VQ scan, CT- where and how big the emboli, Angiography – Invasive, expensive; considered positive proof but not always done, Autopsy | Clinical correlation: Virchow’s triad & symptoms, D-Dimer: positive means a clot somewhere; negative means no clots, Ultrasound of thigh and pelvic vessels |
| Interventions for Pulmonary Embolus | Conservative, preventative, Prophylactic , anticoagulation, TED hose, SCDs, Ambulation, Heparin/Coumadin, Invasive, Thrombolytics |
| Angiography, Embolectomy | Conservative, preventative, Prophylactic , anticoagulation, TED hose, SCDs, Ambulation, Heparin/Coumadin, Invasive, Thrombolytics |
| Cancer of the Lung | Leading cause of cancer-related deaths world wide |
| Overall survival rate for all clients with lung cancer is | 14% |
| Cancers are classified by their | histologic cell type |
| Lung cancer is staged at | diagnosis, the higher the number the more advanced |
| Metastasis is common through the | lymph system |
| Risks for Lung Cancer | Tobacco smoking – 85%, Second hand (passive) tobacco smoke, Chronic exposure to asbestos, beryllium, chromium, coal, distillates, Radiation exposure, Air pollution |
| Most primary lung cancers arise from the | bronchial epithelium. These cancers are collectively called bronchogenic carcinomas |
| Types of Lung Cancer | non-small cell cancer,squamous, adenocarcinoma, large cell |
| Small cell lung cancer | 15% of all lung cancers. Strongly linked to smoking. Also called oat cell cancer. Grows quickly. Don’t want |
| Non-small cell lung cancer | Most lung cancers. Grows more slowly. |
| Squamous cell | 25-30%, linked to smoking. Grows slowly, usually found near bronchus. |
| Adenocarcinoma | 40%, usually found in women and non-smokers |
| Large cell carcinoma | 10-15%. Often found in bronchioles or surface. Metastasizes quickly.don’t want |
| Warning Signs of Lung Cancer | Hoarseness, Ϫ in respiratory pattern, cough lasting > 2 wks, Blood-streaked, rust colored or purulent sputum, Chest px/tightness, Shoulder/arm/chest wall px, |
| Late stage SS of lung cancer | Recurring pleural effusion, pneumonia or bronchitis, Dyspnea |
| Wheezing, Weight loss, loss of appetite, Bone pain, aching joints | Recurring pleural effusion, pneumonia or bronchitis, Dyspnea |
| Diagnostics for Lung Cancer Less Invasive | Chest x-ray, Spiral CT, FDG-PET fluorine-18-deoxyglucose positron emission tomography), Ultrasound, MRI,Sputum cytology |
| More Invasive Dx of lung cancer | Bronchoscopy, Mediastinoscopy- gold standard for staging cancer, Needle biopsy |
| Most commonly, lung lesions are first identified on | chest x-rays. |
| Interventions for Lung Cancer | Staging guides the treatment plan. |
| SCLC is staged only as | limited or extensive |
| NSCLC is staged by extent of | primary tumor, involvement of lymph nodes and metastasis |
| Tx for lung cancer | Surgery, Radiation, Chemotherapy |
| Removal of all visible tumor offers the best chance for | NSCLC |
| Type of resection depends on type of | lesion, location, patient age & overall health |
| Minimally invasive | Open thoracotomy |
| Goal is to open just enough to | see and correct the problem |
| Radiation can | shrink a tumor prior to surgery |
| Radiation Can be used in combination with | chemotherapy |
| Ionizing radiation shrinks tumors by damaging their | DNA while limiting the destruction of healthy tissue |
| Can specifically target the tumor via external | beam radiation, intensity modulated or proton beam |
| Brachytherapy | implanting radioactive “seeds” in the tumor itself |
| Chemotherapy | Can help to slow tumor growth |
| Chemo is the most common treatment for | SCLC to slow the metastasis of the quick growing cells. Can be used in conjunction with radiation |
| Chemo may also be used in advanced stages of | NSCLC |
| Better survival rates with combination of | chemotherapy drugs administered simultaneously or sequentially |
| Infectious Lower Respiratory Problems | Tuberculosis, Pneumonia, Pleural Effusion, Empyema |
| Tuberculosis preys on those who are | immunocompromized. Highly communicable, airborne |
| Caused by | Mycobacterium tuberculosis, an acid-fast rod bacillus |
| Persons infected are those living in | close contact with an infectious person |
| TB has a slow | onset and persons with TB may not be aware they are infected |
| At-Risk Populations for TB | frequent, close contact with infected untreated persons, immunocompromised, (long term care, prisons, mental hospitals), Elderly and homeless, Abusers of injected drugs/alcohol, ↓socioeconomic groups |
| TB is prevalent among | Foreign immigrants from underdeveloped countries |
| Tuberculosis Pathophysiology | Exposure, Bacillus x’s in bronchus/alveoli, Exudate develops causing a pneumonitis (inflammation), body kills most of the bacillus but turns the TB test positive |
| After infection | Can be seen as granular mass in the lung |
| Person’s own immune system can suppress the initial infection but disease can be reactivated | when defenses are lowered |
| TB is GRAM | NEGTIVE RODS |
| Symptoms of Tuberculosis | Progressive fatigue, Lethargy, Nausea, Anorexia, weight loss, Low-grade fever, Night sweats, Cough with chest tightness, Blood-streaked sputum |
| Diagnostics for Tuberculosis | Positive Mantoux skin test – may not rule out infection in the very elderly or those who are severely immunocompromised |
| Diagnosis for TB Sputum gram stain for | acid-fast bacillus |
| Sputum positive for | Mycobacterium tuberculosis |
| Polymerase chain reaction (PCR) can give a result | more quickly but is very expensive |
| Common diagnosis for TB | Chest x-ray |
| Treatment for Tuberculosis | Combination drug therapy |
| Drugs for TB | Isoniazid (INH) + Rifampin for 6 to 12 months, Pyrazinamide can be added the first 2 months to decrease treatment time to 6 months |
| Strict adherence to the drug regimen is | crucial for suppressing the disease |
| Treatment of other | members of the household should be considered |
| Hospitalized patients are placed in | airborne precautions in a negative pressure room |
| Airborne Precautions | Negative Pressure room, Protective equipment includes self-contained breathing hood for nurse, Gown, gloves, Good handwashing, If patient needs to be transferred, he will wear a face mask |
| Top Nursing Diagnoses for TB | Impaired Gas Exchange related to disease progression, Ineffective Airway Clearance related to increased secretions or fatigue, Knowledge deficit |
| Other nursing diagnosis for TB | Fatigue related to poor tissue oxygenation and increased metabolism, Imbalanced Nutrition: Less than body requires, Social isolation related to altered state of wellness or changed appearance |
| Pneumonia | Excess fluid in the lungs as a result of an inflammatory process |
| Pneumonia is most often caused by | infective organisms but can result from inhalation of irritating agents |
| Two forms of contraction | community-acquired (CAP) or hospital-acquired nosocomial) |
| Pneumonia can be | (consolidated) in a lobe of the lung or in diffuse patches around the bronchi (broncholar) |
| Severity depends on type of | organism and the immune defenses of the host |
| Pathophysiology of Pneumonia | Infectious organism →airway mucosa & multiply in alveolar spaces, Inflammation/WBCs migrate to infection→capillary leak/edema/exudate, Fluid collects, alveolar walls thicken, ↓compliance, ↓Gas exchange→ hypoxemia |
| The fibrin and edema of inflammation | stiffen the lung, reducing compliance and decreasing the vital capacity. |
| EMPYEMA (ABSESS) | a collection of pus in the pleural space. |
| The most common cause of empyema is | pulmonary infection, lung abscess, or infected pleural effusion. Pneumonia or lung abscess can spread across the pleura. |
| Lymph node obstruction can cause a | retrograde (backward) flood of infected lymph into the pleural space. |
| Sepsis | a liver abscess or abdominal abscess can spread through the lymphatic system into the lung area. |
| Thoracic surgery and chest trauma can introduce | bacteria directly into the pleural space, leading to empyema. Blood from trauma may collect in the pleural space. Poor drainage of this blood promotes infection. |
| Empyema fluid is | thick, opaque, exudative, and foul smelling. |
| Treatment for empyema | emptying the empyema cavity, re-expanding the lung, and controlling the infection. Chest tube to closed drainage, Antibiotics, May need surgical excision of that area of the pleura |
| Diagnostics for Pneumonia | CBC – ↑WBC, may not elevate in older adults (ϪIN LOC) |
| Sputum for Cult & Sensitv, gram stain, ABGs, Electrolytes, BUN, Creatinine (dehydration), Radiographic – CXR, Thoracentesis, bronchoscopy, needle aspiration | CBC – ↑WBC, may not elevate in older adults (ϪIN LOC) |
| Treatment for Pneumonia | IV or oral antibiotics – best if organism specific, Fluids – keeps hydrated, keeps secretions thin, Fever control, Oxygen if hypoxemia is a factor |
| Why are CORTICOIDSTERIOS rarely used | B/C IT CAN INC INFECTION |
| Top Nursing Diagnoses for Pneumonia | Impaired Gas Exchange, Ineffective Airway Clearance, Potential for Sepsis |
| Pleural Effusion can be caused by | Abscss under the diaph, Cirrhosis, Coccidiodomycosis and other fungal |
| Drugs for pneumonia | hydraiazine, procainamide, sionaizid |
| Drugs for pneumonia | hydraiazine, procainamide, sionaizid |
Created by:
Jillzs
Popular Nursing sets