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Ch 23 Respiratory

Management of Patients with Chest and Lower Resp Tract Disorders

QuestionAnswer
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
Created by: cgetsi