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Ch 23 Respiratory
Management of Patients with Chest and Lower Resp Tract Disorders
| Question | Answer |
|---|---|
| Refers to closure or collapse of alveoli and often is described in relation to x-ray findings and clinical signs and symptoms | Atelectasis |
| fluid accumulating within the pleural space? | pleural effusion |
| air in the pleural space? | pneumothorax |
| blood in the pleural space? | hemothorax |
| Excessive pressure on the lung tissue, which restricts normal lung expansion on inspiration can cause? | Atelectasis |
| What are the hallmarks of the severity of atelectasis? | Tachypnea, dyspnea, and mild to moderate hypoxemia |
| What are signs and symptoms of atelectasis? | increasing dyspnea, cough, and sputum production |
| What are nursing measures to prevent atelectasis? | frequent turning, early mobilization, and strategies to expand the lungs and to manage secretions (Voluntary deep-breathing maneuvers at least q2hrs and incentive spirometry) |
| What is PEEP? | positive end-expiratory pressure |
| What is CPPB | continuous positive pressure breathing |
| In patients who do not respond to first line measures for atelectasis or who cannot perform deep-breathing exercises, what are three other treatments that can be used? | PEEP, CPPB, and bronchoscopy |
| If the cause of atelectasis is bronchial obstruction from secretions what must be done? | secretions must be removed by coughing or suctioning to allow air to reenter that portion of the lung. |
| With a large pleural effusion that is compressing lung tissue and causing alveolar collapse, what type of treatment may be included? | thoracentesis or insertion of a chest tube. |
| What is thoracentesis? | insertion of a needle into the pleural space to remove fluid that has accumulated and decrease pressure on the lung tissue; may also be used diagnostically to identify potential causes of pleural effusion. |
| An acute inflammation of the mucous membranes of the trachea and the bronchial tree, often follows infection of the upper respiratory tract? | Acute tracheobronchitis |
| What are the main causes of acute tracheobronchitis? | Streptococcus pneumoniae, Haemophilus influenza, Mycoplasma pneumoniae, and fungal infections (Aspergillus) |
| Inhalation of physical and chemical irritants, gases, or other air contaminants can also cause (blank) | bronchial irritation |
| What are the clinical manifestations of acute tracheobronchitis? | Initially, the patient has a dry, irritating cough and expectorates a scanty amount of mucoid sputum. The patient may report sternal soreness from coughing and have fever or chills, night sweats, headache, and general malaise. |
| What is the medical management for acute tracheobronchitis? | Antibiotics, Expectorants, and increased fluid intake. |
| What medication is usually not prescribed for acute tracheobronchitis? | Antihistamines |
| What is the nursing management for acute tracheobronchitis? | Encourage increased fluid intake and directed coughing to remove secretions. Completion of antibiotics, and cautions against overexertion. |
| (blank) is an inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses? | Pneumonia |
| What are the most common causes of death from infectious diseases in the United States? | Pneumonia and influenza |
| How is pneumonia classified? | Community-acquired pneumonia(CAP), hospital-acquired pneumonia (HAP), pneumonia in the immunocompromised host, and aspiration pneumonia. |
| What is the most common cause of CAP in people younger than 60 years of age? | S. pneumoniae (pneumococcus) |
| What causes CAP that frequently affects elderly people and those with comorbid illnesses? | H. Influezae |
| How is mycoplasma pneumonia spread? | by infected respiratory droplets through person to person contact. |
| What is the most common cause of pneumonia in infants and children? | Viruses |
| (blank) is associated with a high mortality rate, in part because of the virulence of the organisms, their resistance to antibiotics, and the patient's underlying disorder? | HAP |
| What are the common organisms responsible for HAP? | Enterobacter species, E.coli, H.influenza, Klebsiella species, Proteus, Serratia marcescens, P. aeruginosa, MRSA, and S.pneumoniae. |
| Pneumonia in the immunocompromised host occurs with.....? | use of of corticosteroids, chemotherapy, nutritional depletion, use of broadspectrum antimicrobial agents, AIDS, genetic immune disorders, and long term advanced life support technology (mechanical vents) |
| (blank) refers to the pulmonary consequences resulting from entry of endogenous or exogenous substances into the lower airway? | Aspiration pneumonia |
| What is the most common form of aspiration pneumonia? | bacterial infection from aspiration of bacteria that normally reside in the upper airways. |
| Pnuemonia affects both (blank) and (blank) | ventilation and diffusion |
| If a substantial portion of one or more lobes of the lung is involved, the disease is referred to as (blank) | lobar pneumonia |
| What term is used that describes pneumonia that is distributed in a patchy fashion? | bronchopneumonia |
| What is more common, bronchopneumonia or lobar pneumonia? | bronchopneumonia |
| What are the clinical manifestations for sreptococcal pneumonia? | sudden onset of chills, rapidly rising fever (101 to 105F), and pleuritic chest pain that is aggravated by deep breathing and coughing. Other signs are tachypnea, rapid and bounding pulse. |
| What are the predominate symptoms of pneumonia? | headache, low grade fever, pleuritic pain, myalgia, rash, and pharyngitis. |
| What is usually seen with sever pneumonia? | flushed cheeks and lips and nail beds demonstrate central cyanosis |
| What is orthopnea? | shortness of breath when reclining |
| How is the diagnosis of pneumonia made? | by history, physical examination, chest x-ray, blood culture, and sputum examination. |
| Is there a vaccine for pneumococcal pneumonia? | Yes |
| What is the treatment for pneumonia? | appropriate antibiotics |
| What is the criteria for hospital admission for patients with CAP? | age, home environment/caregiver support, severity of illness, and presence of comorbid conditions. |
| What are the signs and symptoms that may signal the onset of pneumonia in the elderly? | General deterioration, weakness, abdominal symptoms, anorexia, confusion, tachycardia, and tachypnea. |
| Why is the diagnosis of pneumonia often times missed in the elderly? | because the classic symptoms of cough, chest pain, sputum production, and fever may be absent or masked. |
| What are severe complications of pneumonia? | hypotension and shock and respiratory failure (especially with gram negative bacterial disease in elderly patients). |
| A (blank) is any pleural effusion associated with bacterial pneumonia, lung abscess, or bronchiectasis? | A parapneumonic effusion |
| Accumulation of purulent material in the pleural space? | empyema |
| How many stages are there of parapneumonic pleural effusion? | 3...uncomplicated, complicated, and thoracic empyema. |
| Sterilization of an empyema requires how much length of time? | 4 to 6 weeks of antibiotics |
| What are nursing interventions for pneumonia? | Removing secretions, encouraging hydration (2 to 3L/day), humidification to loosen secretions, turn deep breath and cough, incentive spirometry, chest physiotherapy, promoting rest, maintaining nutrion, and patient education, encourage to quit smoking. |
| When a nonfunctioning nasogastric tube allows the gastric contents to accumulate in the stomach, a condition known as (blank) may result | silent aspiration |
| The primary factors responsible for death and complications after aspiration of gastric contents are the (blank)? | volume and character of the aspirated gastric contents. |
| Aspiration pneumonitis may develop from aspiration of (blank) | substances with a low pH. |
| What does the aspiration of gastric contents cause? | A chemical burn to the tracheobronchial tree and pulmonary parenchyma, and an inflammatory response. |
| What is the primary goal when caring for patients at risk for aspiration? | Prevention |
| What does SARS stand for? | Severe acute respiratory syndrome |
| What is SARS? | a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus. |
| How does SARS develop? | It develops in people who either have close contact with a person who has been diagnosed with the disease or a history of travel or residence in an area with known cases. |
| How is SARS transmitted? | by respiratory droplets. |
| What are the symptoms of SARS? | fever, coughing, and difficulty breathing |
| What is the treatment for SARS? | treatment is solely supportive |
| (blank) is an infectious disease that primarily affects the lung parenchyma? | Tuberculosis (TB) |
| What is the main infectious agent of TB? | M. tuberculosis |
| How is TB spread? | by airborne transmission |
| What are the clinical manifestations of TB? | The s/s of pulmonary TB are insidious. Most patients have a low grade fever, cough, night sweats, fatigue, and weight loss. Hemoptysis also may occur. |
| What is used to diagnose TB? | A complete history, physical exam, tuberculin skin test, chest x-ray, acid fast bacillus smear, and sputum culture. |
| If a person is infected with TB, what will the x-ray look like? | it usually reveals lesions in the upper lobes. |
| What method is used to determine whether a person has been infected with the TB bacillus? | The Mantoux method |
| What does induration mean? | hardening |
| What does PPD stand for? | purified protein derivative |
| What is used in the TB skin test? | Tubercle bacillus extract (PPD), 26 or 27 gauge needle |
| When should the test be read? | 48 to 72 hours after the injection |
| What determines the significance of the reaction to the TB skin test? | The size of the induration |
| A reaction of 0 to 4mm is considered (blank)? | not significant |
| What does a reaction of 5mm or greater mean? | It is significant to people who are considered at risk. |
| What is the outcome for HIV patients who take the TB skin test? | The results will be positive |
| What does an induration of 10mm mean? | Significant in people who have normal or mildly impaired immunity. |
| What vaccine is given to produce a greater resistance to the development of TB? | The BCG vaccine. |
| Does a significant (positive) reaction from a TB skin test mean you have the active disease? | No |
| How many classes are used to classify TB? | 5 |
| What does class 0 refer to? | no exposure, no infection |
| What does class 1 refer to? | exposure;no evidence of infection |
| What does class 2 refer to? | latent infection; no disease |
| What does class 3 refer to? | disease; clinically active |
| What does class 4 refer to? | disease; not clinically active |
| What does class 5 refer to? | suspected disease; diagnosis pending |
| What kind of manifestations does TB have on elderly patients? | atypical |
| How is pulmonary TB treated? | antituberculosis agents for 6 to 12 months |
| What are the four first line medications for TB? | INH, rifampin, pyrazinamide, and ethambutol. |
| How many parts are there for a recommended treatment guideline for newly diagnosed pulmonary TB? | 2 parts; an initial treatment phase and a continuation phase. |
| What does the initial phase consist of? | A multiple medication regimen of INH, rifampin, pyrazinamide, and ethambutol for 8 weeks. |
| What does the continuation phase consist of? | INH and rifampin or INH and rifapentine for 4 to 7 months. |
| What is the nursing management for patients with TB? | promoting airway clearance, advocating treatment regimen, promoting acitivity and nutrition, and preventing transmission. |
| What is the main reason treatment fails for active TB? | Patients do not take their medications regularly and for the prescribed duration. |
| When should patients take their TB medications? | On an empty stomach or 1 hour before meals. |
| What is the outcome for HIV patients who take the TB skin test? | The results will be positive |
| What does an induration of 10mm mean? | Significant in people who have normal or mildly impaired immunity. |
| What vaccine is given to produce a greater resistance to the development of TB? | The BCG vaccine. |
| Does a significant (positive) reaction from a TB skin test mean you have the active disease? | No |
| How many classes are used to classify TB? | 5 |
| What does class 0 refer to? | no exposure, no infection |
| What does class 1 refer to? | exposure;no evidence of infection |
| What does class 2 refer to? | latent infection; no disease |
| What does class 3 refer to? | disease; clinically active |
| What does class 4 refer to? | disease; not clinically active |
| What does class 5 refer to? | suspected disease; diagnosis pending |
| What kind of manifestations does TB have on elderly patients? | atypical |
| How is pulmonary TB treated? | antituberculosis agents for 6 to 12 months |
| What are the four first line medications for TB? | INH, rifampin, pyrazinamide, and ethambutol. |
| How many parts are there for a recommended treatment guideline for newly diagnosed pulmonary TB? | 2 parts; an initial treatment phase and a continuation phase. |
| What does the initial phase consist of? | A multiple medication regimen of INH, rifampin, pyrazinamide, and ethambutol for 8 weeks. |
| What does the continuation phase consist of? | INH and rifampin or INH and rifapentine for 4 to 7 months. |
| What is the nursing management for patients with TB? | promoting airway clearance, advocating treatment regimen, promoting acitivity and nutrition, and preventing transmission. |
| What is the main reason treatment fails for active TB? | Patients do not take their medications regularly and for the prescribed duration. |
| When should patients take their TB medications? | On an empty stomach or 1 hour before meals. |
| Patients taking INH should avoid what type of foods? | foods that contain tyramine and histamine (tuna, aged cheese, red wine, soy sauce, yeast extracts) |
| What effect does rifampin have on other medications? | It can alter their metabolism, making them less effective. (beta blockers, warfarine, digoxin, quinidine, corticosteroids, oral hypoglycemic agents, oral contraceptives, theophylline, and verampamil |
| What should the nurse inform the patient who is taking rifampin about? | Rifampin may discolor contact lenses and that the patient may want to wear eyeglasses during treatment. |
| What does the nurse carefully monitor for with patients being treated for TB? | v/s, and observes for spikes in temp or changes in the patients status. |
| What must the patient do if they have contacted TB? | Contact their local Health Department |
| Spread or dissemination of TB infection to nonpulmonary sites of the body is known as (blank) | Miliary TB |
| A (blank) is necrosis of the pulmonary parenchyma caused by microbial infection? | Lung Abscess |
| Most lung abscesses are a complication of (blank)? | bacterial pneumonia or by aspiration of oral anaerobes into the lung. |
| The organisms frequently associated with lung abscesses are.....? | S.aureus, Klebsiella |
| What are the clinical manifestations of a lung abscess? | Mild productive cough with moderate to copious amounts of foul-smelling, sometimes bloody, sputum, fever, pleurisy, dyspnea, weakness, anorexia, and weight loss. |
| What are preventions for Lung Abscesses? | Appropriate antibiotic therpay before dental procedures, Adequate dental and oral hygiene, and appropriate antimicrobial therapy for patients with pneumonia. |
| What is the medical management for a lung abscess? | Drainage of the lung abscess, a high protein diet. |
| What is the pharmacologic treatment for anaerobic lung infection? | IV Clindamycin and then PO antibiotics for 4 to 8 weeks. |
| What is the nursing management for Lung Abcesses? | Teach patient to deep breath and cough, ensure proper nutritional intake, offer emotional support. |
| (blank) refers to inflammation of both layers of the pleurae (parietal and visceral) | Pleurisy |
| When the inflamed pleural membranes rub together during respiration, what is the result? | severe, sharp, knifelike pain. |
| Where is pleuritic pain limited to? | usually to one side, it may be localized or radiate to the shoulder or abdomen. |
| What is the objective of treatment for pleurisy? | To discover the underlying cause (pneumonia, infection) |
| What is the medical management for pleurisy? | Analgesic agents and topical applications of heat or cold. Indomethacin may be prescribed. |
| What is the nursing management for pleurisy? | The nurse teaches the patient to turn frequently onto the affected side to splint the chest wall and use hands or a pillow to splint the rib cage while coughing. |
| (blank) is defined as abnormal accumulation of fluid in the lung tissue, the alveolar space, or both? | Pulmonary edema |
| What is the clinical manifestations for pulmonary edema? | Dyspnea, air hunger, central cyanosis, hemoptysis, anxiousness,confusion and irritability. |
| What is the medical management for pulmonary edema? | Correcting the underlying cause (CHF, Hypervolemia) Administering oxygen, morphine to reduce anxiety and control pain. |
| What is the nursing management for pulmonary edema? | assisting with management of oxygen and intubation and mechanical ventilation if respiratory failure occurs. Also administering meds as prescribed. |
| (blank) is defined as a decrease in arterial oxygen tension to less than 50mmHg and an increase in arterial carbon dioxide tension to greater than 50mmHg, with an arterial pH of less than 7.35? | Acute respiratory failure |
| What are two causes of Chronic Respiratory Failure? | COPD and Neuromuscular diseases |
| What is the major cause of respiratory failure after major abdominal, cardiac, or thoracic surgery? | A ventilation-perfusion mismatch |
| What are early signs of impaired oxygenation? | restlessness, fatigue, headache, dyspnea, air hunger, tachycardia, and increased blood pressure. |
| As hypoxemia progresses what are more obvious signs? | confusion, lethargy, tachycardia, tachypnea, central cynosis, diaphoresis, and finally respiratory arrest. |
| What is the Medical Management for acute respiratory failure? | To correct the underlying cause and to restore adequate gas exchange in the lung. |
| What is the nursing management for acute respiratory failure? | Patients are usually managed in the ICU, the nurse assesses the respiratory status-responsiveness, ABG's, pulse ox, and v/s. |
| (blank) is a severe form of acute lung injury? | Acute Respiratory Distress Syndrome (ARDS) |
| (blank) occurs as a result of diffuse alveolar damage? | ARDS |
| (blank) is marked by a rapid onset of severe dyspnea that usually occurs 12 to 48 hours after the initiating event? | The acute phase of ARDS |
| What are assessment findings for ARDS? | Intercostal retractions and crackles may be present as the fluid begins to leak into the alveolar interstitial space. |
| What are common diagnostic test for ARDS? | BNP levels, echocardiography, and PAC |
| What is the definitive method to distinguish between heart failure and ARDS? | PAC |
| What is supportive therapy for ARDS | Most always intubation and mechanical ventilation. |
| What is a critical part of the treatment of ARDS? | PEEP (positive end expiratory pressure) |
| (blank) exists when the mean pulmonary artery pressure exceeds 25mmHg with a pulmonary capillary wedge pressure of less than 15mmHg ? | Pulmonary arterial hypertension |
| What are the two types of pulmonary arterial hypertension? | idiopathic(or primary) and pulmonary arterial hypertension due to a known cause. |
| Who does pulmonary arterial hypertension occur most often with? | Women ages 20-40 years of age. |
| What meds are used to treat pulmonary arterial hypertension? | calcium channel blockers, phophodiesterase-5 inhibitors, endothelin antagonists, and prostanoids. |
| (blank) is a condition in which the right ventricle of the heart enlarges as a result of diseases that affect the structure or function of the lung or its vasculature? | Cor Pulmonale |
| What is the frequent cause of Cor Pulmonale? | severe COPD |
| (blank) refers to the obstruction of the pulmonary artery or one of its branches by a thrombus or thrombi that originates somewhere in the venous system or in the right side of the heart? | Pulmonary embolism(PE) |
| What are other types of pulmonary emboli? | air, fat, amniotic fluid, and septic |
| What dysrhythmia can cause a PE? | Atrial Fibrillation |
| What are symptoms of a PE? | dyspnea, chest pain, anxiety, fever, tachycardia, apprehension, cough, diaphoresis, hemoptysis, and syncope |
| Death from PE commonly occurs in how much time after the onset of symptoms? | 1 hour |
| What is considered the best method to diagnose PE? | Pulmonary angiography |
| What is a blood test to help rule out a PE? | d-dimer |
| For patients at risk for PE, the most effective approach for prevention is to prevent (blank) | DVT |
| What are some preventive measures to prevent DVT? | Active leg exercises, early ambulation, anti-embolism stockings and sequential compression devices (SCDs) |
| In regard to a patient whom has a PE, once stabilized, what is the goal of treatment? | dissolove (lyse) the existing emboli and prevent new ones from forming. |
| What drugs are used for anticoagulant therapy? | Heparin and Warfarin |
| What are unfractionated and low molecular weight heparins used for? | To prevent recurrence of emboli (they have no effect on emboli that are already present). |
| Which anticoagulant is recommended for patients who have been diagnosed with PE? | Heparin |
| What is a risk of long term Heparin use? | Antibody formation and bleeding |
| Heparin must be continued until the INR is within a therapeutic range of......? | 2.0-2.5 |
| Once a patient starts on an oral regimen of(warfarin), what is to be remembered about drug brands? | The patient should stick to the same brand because the bioavailability may vary greatly among brand. |
| Which drugs are used for Thrombolytic Therapy? | Urokinase, Streptokinase, Aleplase |
| Before thrombolytic therapy is started, which labs are obtained? | INR, PTT, hematocrit, and platelet counts |
| Which drug therapy is stopped prior to giving thrombolytic agents? | Anticoagulant therapy |
| What are some nursing measures that help prevent thrombus formation? | Encourage ambulation and active and passive leg exercises (ankle pumps), do not cross legs, and do not wear constrictive clothing. |
| During thrombolytic infusion, while the patient remains on bed rest, how often are v/s assessed? | every 2 hours and invasive procedures are avoided. |
| When are labs drawn after a thrombolytic infusion is started? | 3 to 4 hours after infusion is started. |
| Because of prolonged clotting time, how long should manuel pressure be applied to puncture sites (arterial or venipuntures) | 30 minutes |
| (blank) is a multisystem, granulomatous disease of unknown etiology? | Sarcoidosis |
| (refers) to a nonneoplastic alteration of the lung resulting from inhalation of mineral or inorganic dust? | Pneumoconiosis |
| What are the most common pneumoconioses? | silicosis, asbestosis, and coal worker's pneumoconiosis. |
| Is there effective treatment for Pneumoconiosis? | No because the damage is irreversible |
| (blank) is the leading cancer killer among men and women in the United States? | Lung Cancer |
| What is the most common cause of lung cancer? | Smoking |
| What are the two major categories lung cancer is classified as? | small cell lung cancer and non-small cell lung cancer. |
| Which category of lung cancer is more prevalent? | non-small cell lung carcinoma (NSCLC) |
| The stage of a tumor refers to....? | size of the tumor, its location, whether lymph nodes are involved, and whether the caner has spread. |
| Which stage is the earlies stage and has the highest cure rate? | Stage I |
| What does stage IV represent? | Metastatic sread |
| What is the most frequent symptom of lung cancer? | Cough or change in a chronic cough. |
| The most common sites of metastases from lung cancer are....? | lymph nodes, bone, brain, contralateral lung, adrenal glands, and liver |
| What is a lobectomy? | Removal of a lobe of the lung |
| What is a pneumonectomy? | Removal of an entire lung |
| What are the two ways chest trauma is classified? | blunt or penetrating |
| What type of chest trauma results from sudden compression or positive pressure inflicted to the chest wall? | Blunt chest trauma |
| What type of chest trauma occurs when a foreign object penetrates the chest wall? | Penetrating trauma |
| What are the most common causes of blunt chest trauma? | motor vehicle crashes, falls, and bicycle crashes. |
| In regard to trauma, agitation and irrational and combative behavior are signs of....? | decreased oxygen delivery to the cerebral cortex. |
| Which sets of ribs are the most common sites of injuries? | The fifth through the ninth |
| Most rib fracutes heal within how much time? | 3 to 6 weeks |
| What usually occurs when three or more adjacent ribs are fractured at two or more sites, resulting in free floating rib segments? | Flail Chest |
| What is the medical management for Flail Chest? | Treatment is usually supportive, providing ventilatory support, clearing secretions, and controlling pain. |
| (blank) is defined as damage to the lung tissues resulting in hemorrhage and localized edema? | Pulmonary contusion. |
| Is pulmonary contusion evident initially after injury? | No, it develops most of the time posttraumatically. |
| The primary pathologic defect with a pulmonary contusion is....? | accumulation of fluid in the interstitial and intra alveolar spaces. |
| Occasionally, a contused lung occurs on the other side of the point of body impact; this is called....? | contrecoup contusion |
| In patients with moderate pulmonary contusions, what may be required? | bronchoscopy |
| What are the most common causes of penetrating chest trauma? | Gunshot and stab wounds |
| (blank) occurs when the parietal or visceral pleura is breached and pleural space is exposed to positive atmospheric pressure? | Pneumothorax |
| What are the different types of pneumothorax? | simple, traumatic, and tension pneumothorax |
| What are sucking chest wounds? | An open pneumothorax when the rush of air through the wound in the chest wall produces a sucking sound |
| What is medistinal flutter or swing? | Structures of the mediastinum (heart and great vessels) shift toward the uninjured side with each inspiration and in the opposite direction with expiration. |
| In regard to an open pneumothorax, what is a lifesaving measure? | Stopping the flow of air through the opening |
| A (blank) occurs when air is drawn into the pleural space from a lacerated lung or through a small opening or wound in the chest wall? | tension pneumothorax |
| T or F; Relief orf tension pnuemothorax is considered an emergency measure? | True |
| What does the nurse assess for in regard to any type of pneumothorax? | tracheal alignment, expansion of the chest, breath sounds, and percussion of the chest. |
| In a (blank), the trachea is shifted away from the affected side, chest expansion may be decreased or fixed in a hyperexpansion state, breath sounds are diminished or absent, and percussion to the affected side is hyperresonant? | Tension pnuemothorax |
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