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210 Ch. 23
Lower Resp Tract Disorders
| Question | Answer |
|---|---|
| Atelectasis? How it develops? | At: closure or collapse of alveoli Dev: acute in postop/immobile/decr ventilation/blockage/xtra pressure on lung |
| Diff b/n pleural effusion? pneumothorax? hemothorax? | eff: fluid in pleural space(bn parietal and visceral pleurae) pneu: air in space hemo: blood in space |
| s/s of atelectasis? | dyspnea, cough, sputnum acute: resp distress showing tachyc/tachyp/pleural pain/central cyanosis(late sign of hypoxia) |
| Nsg preventions for atelectasis | turn, mobilization, deep breathing(q2h), incentive spir. Mgmt secretions: cough/suction/nebulizer/CPT |
| Other nsg mgmt when first line measures fail | PEEP(+ end-expiratory pressure)- mask that provides exp resistance CPPB(continuous pos press breathing) |
| Tx for pleural effusion? | thoracentesis - needle aspiration of fluid, or chest tube |
| what is acute tracheobronchitis? | inflammation of mucous membranes of trachea/bronchial tree. |
| Manifestations of tracheobronchitis? TX? | scanty sputum at first, fever, chills, insp stridor, exp wheeze, purulent sputum tx: fluids to thin secretions, moisture |
| Two classifications of pneumonia | CAP-community-acquired: w/in 1st 48h after hospitalization. HAP- hospital-acquired/nosocomial: More than 48h after admission |
| CAP types Steptococcal pneumonia 14% mortality rate | winter/Af Am/elderly/COPD, heart failure, alcoholism, asplenia, DM s/s: pain, quick onset tx: penicillin |
| Haemophilus influenza 30% mortality rate | alcoholics/elderly/DM/COPD/child<5y s/s: assoc with URI tx: amoxicillin |
| Legionnaires' Disease 15-50% mortality rate | summer/fall, older men/smokers/excavation sites s/s: flu like tx: fluoroquinolone,azithromycin |
| Mycoplasma pneumonia Viral Chlamydial | tx: macrolie, tetracycline oseltamivir/zanamivir fluoroquinolone |
| HAP Pseudomonas Pn 40-60% mortality | cancer/burns/lung disease s/s: productive cough, fever, chill tx: betalactam + cipro, levofloxin, aminoglycoside |
| Staphylococcal pn 25-60% mortality | drug users/hiv/MRSA s/s: hypoxemia, cyanosis, necrotizing inf tx: vancomycin, linezolid |
| Klebsiella pn 40-50% mortality | alcoholic/COPD/elderly s/s: tissue necrosis, cough, fever tx: levofloxacin, piperacillin/tazobactam + amikacin |
| Pneumonia in Immunocompromised PCP, fungal, mycobacterium(TB) | from corticosteroids, chemo, AIDS |
| Aspiration Pn | aspirate GI contents, gases, chemical contents |
| Who should get pnue vaccine? | >65, immunocompetent, asplenia(w/o spleen) |
| Complications of pneumonia | hypotension, shock, resp failure, heart failure, dysrhythmias, pericarditis, pleural effusion |
| what is silent aspiration | non-fx nasogastric tube allows gastric contents to accumulate in stomach Placement is key to prevention |
| When is residual volume checked in tube feedings? | q4h and if >200-250ml residual volume, then pt shows intolerance to feedings |
| what is SARS | viral resp illness caused by coronavirus. s/s: fever >100.4, coughing, trouble breathing tx: droplet/contact/airborne |
| TB preventions | negative pressure private room, fitted respirators, standard precautions |
| What is the Mantuox test for TB | Dx of TB How: deposit purified protein PPD subq w/ bevel of needle facing up to create bleb/wheal. Results in 48/72h Reaction pos: induration(hardening) and erythema |
| Induratino measurements for pos TB | 0-4mm- not signuficant >5mm- sig for at risk(HIV+, contact, + chest xray) >10mm- sig with impaired immunity Pos not mean active TB, immunocompromised may be + and not show = anergy |
| What may be diff for elderly wtih TB tests | s/s of confusion, fever, anorexia, wt. loss. TB test can show no reaction or delay up to wk(recall phenomenon), need 2nd test |
| TB tx? | antifubercolosis agents 6-12mos with 3-4 or more meds INH, Rifampin, pyrazinamidem, ethambutol Nsg Intv: compliance |
| contraindications for IHH and rifampin | INH avoid tyramine(tuna, aged cheese) (Vit B given with INH) Rifampin: alter metabolism and make less effecitve of BB, warfarin, dig, corticosteroids, oral contraceptives |
| Lung abscess s/s? tx? | necrosis of pulmonary parenchyma by inf s/s: pleural friction rub, crackles tx: clindamycin(Cleocin) |
| Peurisy s/s? tx? nsg mgmt? | inflamm both layers of pleurae s/s: knifelike pain, maybe one side s/s effusion: sob, pain, decr chest wall excursion tx: indomethacin(anti-inflamm) nsg: splinting, thoracentesis |
| Empyema s/s? tx? nsg? | thick, purulent fluid in space w/ walled off area s/s: like pneumonia dx: chest CT tx: drainage, abx nsg: breathing excercises |
| Pulmonary Edema s/s? tx? | fluid in alveolar space/lung tissue from heart prob(LV), pneumonectomy, pneumothorax dx: crackles, frothy secretion tx: fix problem |
| Acute Resp Failure vs chronic | acute: ventilation/perfusion impaired..PaO2<50, PaCO2>50, pH<7.35 chronic: long period, by COPD, neuromuscular diseases |
| ARDS Acute Resp Distress Syndrome | from acute lung injury 4-48h leading to hypoxemia tx: PEEP, nutritional support 35-45kcal/kg/day nsg: turning(prone), decr anxiety, sedate(ativan/versed/propofol/precedex), paralytics(pavulon/norcuron/tracrium/zemuron |
| pulmonary arterial hypertension two types? | MAP>25, wedge press <15mmHg 1.idiopathic,primary from known cause: women, 20-40y, death in 5y 2.From known cause |
| Pulmonary arterial htn s/s? tx? | s/s: dyspnea(exertion/rest), chest pain, weakness, fatigue, syncope, Rside heart failure tx: viagra/tracleer/thelin/letairis |
| Pulmonary Heart Disease-Cor Pulmmonale | RV enlarges of heart from diseases(COPD, pulmonary htn) tx: treat cause |
| Pulmonary Embolism | obstruction of pulmonary art or branch by thrombus from venous sys or Rside of heart. |
| risk factors for PE | venous stasis, injury, tumor, polycythemia, splenectomy, vascular dis, DM, COPD, HF, obesity, preg, elderly, oral contraceptives |
| Emergency mgmt for PE | O2, ABGs, CT, ECG, catheter if suffered embolism, stockings |
| anticoagulation therapy for PE | heparin continued til INR is 2.0-2.5 then need to take same kind of warfarin PO |
| Thrombolytic therapy for PE | urokinase, streptokinase, alteplase |
| Sarcoidosis | mostly of lung w/ s/s dyspnea, cough, hemoptysis, congestion |
| Lung Cancer Staging and types | 1.sm cell cancer 2. non-sm cell cancer sqaumous cell, lg cell, adenocarcinoma Stage 1 to IV(metastatic) Cough that changes can mean cancer |
| Rib fractures 1-3 means? 5-9? lower? | 1-3: high mortality bc subcl aa/vv 5-9: most common lower: spleen/liver injury tx: control pain |
| Flail chest? | 3 or more adjacent ribs fractured at 2 or more sites..free floating rib segments tx: airway/secretions/pain |
| what is a contrecoup contusion | contused lung occurs on other side of pt of body impact |
| Gunshot wounds classified by 3 types of velocity? Factors to determine? | low, med, high factor: distance from which gun was fired, caliber of gun, size of bullet |
| Nsg intv to mgmt gunshot wound to chest | maintain cardiopulmonary fx, assess further injuries, type blood for transfusion, peripheral pulses, lg bore IV line, catheter, NG tube, chest tube |
| What causes a pneumothorax? | pleural space exposed to pos atmospheric pressure. Normal is neg or subatmospheric simple/traumatic |
| tension pneumothorax? | air pulled into pleural space from lacerated lung or chest wall wound and gets trapped, not expelled. Lung collapse, heart/trachea shift to unaffected side(mediastinal shift). Incr press so decr circulation. tx: chest tube in 2nd intercostal space |
| When is a thoracotomy needed in open pneumothorax? | If >1500ml blood aspirated by thoracentesis or >200ml/h from chest tube |
Created by:
palmerag
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