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TT2 NHCC Resp
TT2 NHCC Respiratory
| Question | Answer |
|---|---|
| What are common causes of bronchospasms? | Asthma, Chronic Bronchitis, Pulmonary Emphysema, Foreign body asp |
| Where is cyanosis seen? | in digits, circumoral, mucous membranes, conjuctiva |
| Where does Central Cyanosis occur? | arterial |
| What causes Peripheral cyanosis? | usually vasoconstriction |
| What is Polycythemia? | Bone marrow disease – dehydration, high altitude for long time |
| How does Polycythemia affect blood cells? | increase in total erythrocyte & Hgb |
| What happens when Increased RBC thickens blood? | embolism, thrombosis and make it difficult for heart to pump blood |
| What is the treatment for Polycythemia? | Phlebotomy; Myelosuppressive agents |
| What is Clubbing? | Bulbous digital tip of fingernails |
| What causes Clubbing? | increased vascularity in response to chronic hypoxia |
| What does Clubbing look like? | Fingers are swollen, spongy & loose the 160 degree angle (goes to 180) |
| What causes exertional Dyspnea? | COPD |
| What causes cardiac Dyspnea? | heart disease |
| What causes Dyspnea at rest? | CHF, COPD |
| What is in Sputum? | mucus, leukocytes, epithelial cells, bacteria from lungs |
| What is normal Sputum Color? | clear |
| What does Rusty Sputum indicate? | infection |
| What does Green or yellow Sputum indicate? | blood, TB |
| What does Pinkish Sputum indicate? | pulmonary emboli |
| What does Pinkish & Foamy Sputum indicate? | pulmonary edema |
| What is Hemoptysis? | blood tinged sputum |
| What is the Cause of Hemoptysis? | anything that causes inflammation of the tracheobronchial tree or erosion of the blood vessels & lung parenchyma |
| what are examples of diseases that cause Hemoptysis? | active TB, Cancer, Pulm. Edema, Pulm. Embolism |
| What type of patient would have Stiff Lungs? | Elderly |
| What type of patient would have Weakened respiratory muscles? | smoking, age, chest injury |
| What type of patient would have Decreased number of functional alveoli ? | COPD |
| What conditions cause Narrowed airways? | allergic reaction, bronchospasm, edema, foreign object, tumor, abnorm growth |
| What can interfere with normal defense mechanisms of the lungs? | Smoking, pneumonia, spinal cord injury, large amounts of alcohol, medications, infectious process |
| What Controls of Respiration? | Pons Medulla and Chemoreceptors |
| What role does the Pons Medulla play in respiration? | central processor |
| What are the two types of Chemoreceptors? | Central and Peripheral |
| Where is the Central Chemoreceptor located? | medulla |
| Where are the two Peripheral Chemoreceptors located? | aortic arch & carotid arteries |
| What is the cause of Bacteria pneumonia? | Group A streptococcus |
| What is the cause of Fungi pneumonia? | Pseudomonas, candida |
| What is the cause of Viral pneumonia? | influenza |
| What is the cause of Protozoapneumonia? | aids, cystic pyrene |
| What respiratory illness can Aspiration cause? | pneumonia |
| What is walking pneumonia called? | Mycoplasma |
| Apx. how many Americans have Chronic Obstructive pulmonary disease? | over 15 million |
| Is Asthma considered COPD? | No, it's reversable |
| COPD and Emphysema reversable? | No |
| What are the causes of Chronic Bronchitis? | continuous exposure to infections or noninfectious irritants, pollution, toxic fumes, dust |
| How long can a productive cough last with Chronic Bronchitis? | 3 months to a year |
| What are some of the manifestations of Chronic Bronchitis? | productive cough, Dyspnea with exertion, Low pO2; high pCO2 ,Peripheral edema and Cyanosis from chronic hypoxia |
| How is Chronic Bronchitis dx? | Repeated lingering URI , pulmonary function test, chest x-ray, ABG’s |
| What is the basic problem with Pulmonary emphysema? | imbalance between two substances: proteases & alpha 1-antitrypsin. Protease breaks down lung tissue and Alpha 1-antitirypsin inhibits breakdown. |
| Define Pulmonary emphysema? | abnormal condition of the pulmonary system characterized by overinflation and destructive changes of alveolar walls. |
| What structural changes does Pulmonary emphysema cause? | Hyperinflation ofalveoli, desctruciton of alveolar ducts and walls and also the bronchioles. Desctruction of alveoli capillary walls. narrowed torturous small airways and loss of lung elasticity |
| What causes the loss of lung elasticity in Pulmonary emphysema? | destruction of elastin and collagen |
| What are the two Types of b. Pulmonary emphysema? | Centrilobular and Panlobular |
| What is the most common type of Pulmonary emphysema? | Centrilobular |
| Describe Centrilobular emphysema | affects the bronchioles. Openings develop in walls causeing enlargement and one open space |
| Describe Panlobular emphysema | destruction of alveoli distal to bronchioles. Uniform enlargement |
| What change in function does Pulmonary emphysema cause? | decreased ventilation and decreased perfusion of oxygen |
| What is an early sypmtom of emphysema that progressively becomes severe? | Dyspnea |
| Describe the chest structure of someone with emphysema | Barrel chest |
| What are some signs and sypmtoms you would see with emphysema? | Use of accessory and intercostal muscles for breathing, thin and underweight, barrel shaped chest, diminished breath sounds, dyspnea |
| What results would you see on a pulmonary function test when dx ulmonary emphysema? | increased total lung capacity, increased residual vol,. decreased tidal vol, and vital capacity |
| What was the first sucessful drug developed to treat c. Tuberculosis? | streptomycin |
| What pathogen causes Tuberculosis? | acid fast bacilli |
| What type of infection is Tuberculosis? | chronic granulomatous infection |
| How is Tuberculotransmittedsis transmitted? | by inhalation or ingestion of infected droplets |
| How long is the incubation period for Tuberculosis? | 6 – 12 weeks incubation |
| What is the hallmark sypmtom of TB? | elevated temp & night sweats |
| Where can TB Occur incur in? | lungs, bone, blood, spine |
| What type of cough is seen in TB? | Dry at first, then more frequent and produces mucoid or mucopurulent sputem that becomes blood tinged in advanced cases |
| What symptoms of TB can affect nutritional status? | anorexia and weight loss |
| How does TB affect premenopausal women? | irregular menses |
| How can TB affect the exercise need area? | fatigue and malaise |
| What type of chest pain is experienced with TB? | dull or tight |
| What symptoms are seen in acute cases of TB? | high fever, chills, generalized flu-like symptoms, pleuritic pain and a productive cough |
| After the tubercle bacillus implants in the bronchioles or alveoli what happens? | organisms are engulfed by phagocytes and continue to multiple within the phyagocytes |
| What is a "Ghon's focus"? | a single gray-white circumscribed granulomatous lesion that contains the tubercle bacillus |
| What are the lesions visible on chest x-rays? | the lesions become calcified |
| When is the best time to get a Sputum culture to dx TB? | 1st AM culture daily for 3 days. NPO, get before brushing |
| nucleic acid amplification is used to diagnos what disease? | Tuberculosis |
| What technique is used to dx Nasal polyps? | inspection |
| What technique is used to dx 2. Limited chest expansion? | palpitation |
| What technique is used to dx Hyper resonance? | percuss |
| What technique is used to dx Increased tactile fremitus? | palpitation – 99 normal is not clear |
| What technique is used to dx Pleural friction rub? | auscultate |
| What technique is used to dx Crackles, wheezes? | auscultate |
| What technique is used to dx 8. Use of accessory muscles? | inspection |
| What technique is used to dx Tracheal deviation ? | palpitation, pneumothorax has occurred |
| What technique is used to dx Absence of sounds ? | auscultate |
| What technique is used to dx Stridor? | auscultate |
| What is the purpose of a chest x-ray? | 1 Screening 2.Diagnosing 3.Evaluating |
| what is the ratio of a barrel chest | 2 to 2 vs. 2 to 1 |
| What does an lung scan dx? | poor circulation |
| The first phase of a lung scan dye is injected to see what? | blood perfusion |
| The 2nd stage of a lung scan radioactive gas is inhaled to see what? | ventilation |
| What respiratory problems can a MRI detect? | PE, Pulm. Edema, differentiates abnormalities |
| What can a f. CT scan Differentiates between? | calcified lesions from tumors |
| How do you know when the gag reflex is present following a Bronchoscopy? | Feel them swallow, put finger in throat |
| What are 4 invasive lung dx tests? | Lung Scan, Bronchoscopy, Thoracentesis, Thoracoscopy – endoscope exam w/ video |
| What is the purpose of an Thoracoscopy endoscope exam w/ video? | a. Evaluates pleural effusion, stage tumors |
| What is the procedure for performing an Thoracoscopy? | small incision made into pleural cavity thru intercostal space |
| What is a complication of Thoracoscopy that needs to be monitored for? | pneumothorax |
| What are 3 purposes of Thoracentesis | 1. Remove fluid or air 2. Make diagnosis 3. Instill medications |
| What position should the pt be in for Thoracentesis? | lean over table to open up rib – don’t move or cough. If can’t sit up – 45 ° lay in bed, raise arm over head – hold w/ other hand |
| What is LDH3? | coenzyme in lunges |
| What does an increase in LDH3 indicate? | destruction/injury of cells (PE,PULM. INRARCTION) |
| What is LDH? | f. Lactic acid dehydrogenase, 1. Consist of 5 intracellular enzymes |
| What is a normal LDH value? | 100 – 210 mU/ml |
| What is the purpose of a Mantoux Test? | = id exposure to antigen, does NOT differentiate between active & dormant TB |
| How is a Mantoux Test performed? | 0.1ml of 5 tuberculin units is injected intradermally. Results read w/in 48 –72 hours. |
| What should be done next if the Mantoux Test is positive? | follow w/ sputum test & chest x-raySputum most positive way to ID active bacillus |
| How does a BCG vaccine affect a Mantoux Test? | e. Person who received BCG vaccine will always test positive for antibody |
| What is the purpose of a i. Pulmonary Function Test (PFT)? | lung volumes, mechanics & airflow. Clamp nose and blow into bellow |
| Why is a i. Pulmonary Function Test used? | 1. Screening 2. Evaluation 3.Disease progression |
| What are some Nursing Interventions to treat Pneumonia ? | O2 and rest, Check allergies, Administer drugs on schedule,I & O daily weight, TCDB, Health Promotion: Vaccine – Pneumovax, Fluids, Mouth care, Teaching hand washing |
| What kind of antibiotic is used to treat viral Pneumonia ? | Symadine |
| What are some Nursing Interventions to treat Pulmonary Emphysema? | O2 therapy, Fluids, Physiotherapy |
| What interventions are used with oxygen therapy for Emphysema? | 1 –2 liters - monitor often, don’t turn up O2. COPD = low O2 is stimulus to breath |
| How are Fluids used to treat Emphysema? | up to 3,00 cc ml/day - mucous – prevent dehydration, increase fluid intake |
| What is an example of Physiotherapy to treat Emphysema? | breathing ex., conditioning ex., I.S., aerosols |
| What are the 3 step interventions for treating TB? | 1st identify, 2nd isolate, 3rd treat |
| How would you isolate a TB patient? | negative pressure room; particulate respirator; confine to room @ home |
| How long does a TB patient need to be treated with meds? | at least 6months to 1 yr |
| TB 1st Line Drugs - what is INH? | bactericidal |
| TB 1st Line Drugs - what is Rifampin? | bacteriocidal |
| TB 1st Line Drugs- what is PZA? | bacteriostatic / cidal |
| TB 1st Line Drugs- what is EMB? | bacteriostatic |
| TB 1st Line Drugs- what is Streptomycin? | bacteriocidal |
| What are the 3 TB drugs that are bacteriocidal? | Streptomycin, INH, Rifampin |
| What is theTB drug that is bacteriostatic? | EMB |
| What is the TB drug that is both bacteriostatic and cidal ? | PZA |
| What is the major side effect of Streptomycin ? | hearing loss (ototoxicity) & nephrotoxicity can effect acranial nerve – tinnitus |
| What is the major side effect of EMB? | optic neuritis |
| Why should alchohol consumption be avoided while being treated with TB drugs? | Hepatitis is a side effect with Rifampin and INH. PZA can cause heptotoxicity |
| What precautions should you take when treating a TB patient? | Cover mouth &nose with double tissue, use HEPA mask, mask client when take out of room |
| What are the nutritional considerations when treating a TB patient? | high carb, protein, B6, lots fluid, sun light, vitamin c |
| What does the accronym BASS refer to when remembering the Proper order for inhaler medications? | B = bronchodilator - A = Anticholinergic - S = Steroid - S = Swiss & spit after steroid administration |
| What is an example of a bronchodilator? | Ventolin |
| What is an example of a Anticholinergic? | Atrovent |
| What is an example of a steroid? | Azmacort |
| What does caffine do to respiratory secretions? | dries secretions |
| What does alcohol do to respiratory secretions? | suppresses cleansing action of cilia |
| When should you avoid pushing fluids for respiratory problems? | cardiac and kidney problems and with mouth breathing |
| What is the rationale for Abdominal diaphragmatic breathing? | Deep breath can open collapsed alveoli - Stimulate type II cells to produce surfactant (reduces surface tension & prevent collapse) - Strengthens the cough & helps move mucus in the TB tree |
| What is the rationale for Purse Lip Breathing? | Purse lip during exhalation creates resistance against out flowing air so, prevents collapse or narrowing of small airways & helps to evenly distribute air throughout lungs. (prolong exhalation & increase airway pressure) |
| How is Purse Lip Breathing done? | Sit up right, hand on thigh, inhale through nose, slow release in whistle cup. Blow ping-pong ball across table. |
| What is the rationale for Incentive spirometry? | sustained maximal inspiration stimulates surfactant, strengthens normal & accessory muscles & open collapsed alveoli |
| How does Incentive spirometry work? | Measures roughly the inspired volume and offers incentive of measuring progress |
| How often should Incentive spirometry be done? | Use x 10 per hour while awake (put in plan of care) |
| What is the rationale for Postural drainage? | clears lungs of secretion by using gravity. Position depends on area of lung involved |
| What is the goal of Postural drainage? | Goal is to drain secretins toward th large airway = easier to cough/suction |
| When is the ideal time to do Postural drainage? | AM 45-60 mis B/4 meals and 2 hrs. after, bedtime |
| What is the purpose of Nebulization? | Add humidity to O2 system - Hydrate thick sputum - Relax bronchioles (spasm?) - Adm. Drugs |
| What is the purpose of Humidification? | add vapor to inspired air. a. Keeps secretions thin/liquid since dryness of airways impairs ciliary action & thickens mucus |
| What is the goal of oxygen therapy? | Reverse hypoxia! by Improve tissue oxygenation; decrease work of breathing and Decrease work of heart |
| What is the purpose of suctioning | 1. Remove secretions form nose, mouth & tracheobronchial tree Stimulate productive coughing |
| What are 3 important considerations when suctioning? | Give O2 b4 and after 2. Limit suction time (5-10 sec) 3. Keep pressure below 100 mmHg (80-100) |
Created by:
2007Nurse
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