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Nurs 332 - Test #5

Nursing in Health & Illness I: Respiratory

What are the two functions of respiration? -Transfer O2 from external air to blood for transport through body. - Rid the body of CO2
What gas controls breathing? Carbon Dioxide
How should a nurse treat epistaxis? -Pt in sitting position -apply pressure by pinching entire soft lower portion -insert gauze in nose and continue pressure - pledget's may be helpful with severe bleeding
What would a concern of the nurse be if Jason has clear fluid running out of the nose after being punched by John? Cerebral spinal fluid... better perform a glucose test on the fluid. High glucose = CSF
After Jake sustained a large facial trauma, what two medications should he avoid taking for two weeks? ASA and NSAIDS; also, he should gross everyone out and sneeze with his mouth open...ew!
What are the two contraindications for the flu vaccine? hypersensitivity to eggs Guillain-Barre syndrome
What antiviral medication should Scott take to avoid getting the flu after falsifying his flu vaccination record? oseltamivir (Tamiflu)
How will the dr tx the pt diagnosed with Sinusitis? antibiotics and saline nasal spray
How lengthy of a recovery should a patient with Sinusitis expect? 4 - 6 weeks, if doesn't heal may require surgery
What two complications may result from acute streptococcal pharyngitis? rheumatic heart disease or glomerulonephritis
What signs and symptoms should Scott look for when Jason starts to choke on the olive in his martini? stridor (use of accessory muscles), intercostal retractions and cyanosis
When suctioning a tracheotomy, would a new nursing graduate use clean or sterile technique? Good question... hopefully sterile.
What type of speaking device can be used in conjunction with a tracheostomy valve? Passy-Muir: one way valve, air goes into lungs, then moves up out over the larynx on expiration.
What should Jake do to protect his healing trachea stoma when he has to cough, swallow or speak? splint the stoma with his fingers
How is a tracheostomy repaired after it is no longer needed? No surgery required... use steri-strips.
What is the biggest risk factor for head and neck cancer? Tobacco use: cigarettes, cigars, chewing, snuff
What is one of the most common side effects of radiation to treat neck cancer? Xerostomia (dry mouth)
What is pilocarpine hydrochloride (salagen) used for? Increases saliva
What illness has a fun whooping cough sound? Pertussis... caused by paroxysms of cough followed by inspiratory that may last 6 - 8 weeks
In what part of the lung/circulation is the extra fluid that causes the crackling sound heard during pulmonary edema? pulmonary capillaries
What are early signs of hypoxemia/hypoxia? Tachycardia, increased respiration/BP/anxiety
What is a late sign of hypoxemia/hypoxia Cyanosis
Which bronchus has a higher risk of aspiration? Right bronchus... it is more of a straight shot. This means aspiration pneumonia is most common on the right side.
What is the composition of air before inhalation? After expiration? Room air: 79% Nitrogen, 20% oxygen, and trace carbon dioxide. Expired air: 79% Nitrogen, 16% oxygen, 4% carbon dioxide
There are two pleural membranes... which is closet to the lungs and which is the outer most membrane? Visceral pleura in closest to the lungs, Parietal pleura is the outer membrane.
What is the space between the pleural membranes called? Intrapleural space: it should have a negative pressure
List the structures of the airway in order from Trachea to Alveoli: Trachea, segmental bronchi (bronchi), sub-segmental bronchi, bronchioles (non-respiratory), bronchioles (respiratory), alveolar ducts, alveolar sacs, alveoli
What two types of alveoli cells are there and what are their functions? Type I: make up integrity of alveoli (gas exchange) Type II: makes surfactant which decreases surface tension and helps prevent alveolar collapse
define normal ventilation movement of air into and out of the lungs
define distribution air is brought in and distributed to all 300 million alveoli appropriately
define perfusion The movement of blood through though the pulmonary capillaries.
define diffusion gas exchange occurs across alveolar capillary membrane and should be normal matching of air and blood across the membrane
What are four factors that affect the rate and depth of breathing? - CO2 concentration: most powerful - H+ ion concentration: 2nd most powerful - O2 concentration - Exercise
What are 5 defense mechanisms of the respiratory tract? - Breathing through the nose - Cough reflex - Mucous & ciliary action - Macrophages in alveoli - pores of Kohn
What are the pores of Kohn? Pores between adjacent alveoli, or interalveolar connections. Allow collateral ventilation; (if the lung is partially deflated, ventilation can occur to some extent through these pores.) Fluid and bacteria can also pass through these pores.
What are the normal ranges for Arterial Blood Gases? pH: 7.35-7.45 PO2: 80-100 mm Hg PCO2: 35 - 45 mm HG HCO3: 22 - 26 mEq/L SaO2: 95 - 100% Hgb 12 - 18 g/dL
define hypercapnia increase in PCO2
What is the difference between hypoxemia and hypoxia? hypoxemia is a decrease of O2 in the blood and hypoxia is a decrease of O2 in the tissues
What 3 factors does O2 content depend on? - Hgb concentration: amount of hgb available to bind with O2 - O2 sat: % of available Hgb actualy bond to O2 - Max amount of O2 that can be transported/gm of Hgb (1.34 ml O2/Gm Hgb)
What is the most common cause of hypoxemia and what can relieve it? Ventilation/Perfusion (V/Q)abnormalities; can be fixed with O2
Low V/Q (ventilation/perfusion) is caused by poor ventilation of the well-perfused segment of the lung. What might cause this to happen? Mucous plugging of the bronchus, or asthma. The O2 is available at the site but the exchange is blocked from happening.
High V/Q is poor perfusion of well-ventilated portion of the lung. What might cause this to happen? A pulmonary embolism which has impaired blood flow to the lung segment and decreased cardiac output.
What is the second most common cause of hypoxemia? Alveolar hypoventilation: decreased PO2 and increased CO2
What are some causes of Alveolar hypoventilation? Can O2 relieve it? Caused by interference with respiratory center such as the pons & medualla, restrictive lung diseases, reduced thoracic expansion, obesity, and neuromusculuar disease. O2 will relieve hypoxemia, but won't restore adequate ventilation or remove excess CO2
What is a 3rd cause of hypoxemia? Diffusion defects: area between alveoli and capillary is thickened/scarred/decreased. O2 can relieve this. Also caused by pulmonary edema due to fluid interference, sarcoidosis, radiation pneumonitis and interstitial fibrous.
What are the 7 most common lung tests? Chest X-ray, sputum specimen, bronchoscopy, pulmonary angiography, thoracentesis, lung biopsy, and ventilation perfusion lung scan (V/Q scan).
When is the best time to get a sputum specimen and how should it be done? Morning, tell patient to rinse mouth with water, take a few deep breathes and obtain before admin antibiotics.
What should a nurse do to get a pt ready for a bronchoscopy? Pt in semi-fowlers, have suction, baseline and monitor vitals, contrasedation, lidocaine spray, IV (saline), check gag reflex after, NPO from midnight, consent form, remove dentures/glasses, have bite block, and INR.
What are two complications of bronchoscopy? hemorrhage and pneumothorax
Is it ok for a patient to cough up a little bloody sputum after a bronchoscopy? Yes, that is normal. However, a lot would be bad.
Is dye used in a pulmonary angiography? Yes, ask the pt if allergic to iodine/shellfish. Also check creatitine/kidney function
What are nursing considerations for the pulmonary angiography? Consent form, vitals, IV, sedation, INR, check IV site, immobilize pt.
What is a pulmonary angiography used to detect? pulmonary embolism
Where is the fluid or air being removed from during a thoracentesis? The plural space
What should a nurse monitor for after a patient has a thoracentesis? Crepitus: air trapping Also, the site should be covered with a pressure dressing.
Is it important to ask the patient about shellfish/iodine allergy before a ventilation/perfusion scan? No, the dye used it radioactive and not iodine related. However, gloves should be used for 24 hours when handling the patient's urine.
What are the flow rates for the devices and the percent of O2 administered with each one? 24% @ 1L NC; 28% @ 2L NC; 44% @ 6L NC; 55 - 60 % @ 8L simple face mask; 90% non-rebreather; 24 - 100% @ 8-15 L High-flow; Venturi Mask (dial a percent)
What is restrictive lung disease? restrict lung volume: lungs are unable to expand normally and there is decreased gas inspiration.
What is obstructive lung disease? Affects gas flow: air flow in and out of lungs is obstructed.
Some examples of extra pulmonary conditions leading to restrictive lung diseases are? Kyphosis, scoliosis, pectus excavatum, and flail chest. Also neuro and neuromuscular disorders like alveolar hypoventilation, Guillan Barre, polio, Lou Gehrig's, and myasthenia gravis.
What is pectus excavatum? Lower end of sternum is attached to thoracic spine by fibromuscular bands.
What happens when a person with flail chest breathes? Paradoxical breathing: in with inspiration and out with expiration.
What makes it difficult to treat mycoplasmal pneumonia? Mycoplasmal organisms are the smallest free living agent and do not have a cell wall which makes it completely resistant to antibiotics with that mechanism of action (penicillins/beta lactam).
What is used to treat mycoplasmal pneumonia? Tetracycline or erthromycin
What is the most common cause of viral pneumonia? Influenza A
What are s/s of viral pneumonia? HA, low-grade fever, generalized aching of muscles, fatigue, dry cough. Usually mild although can be lethal in children.
What is the major cause of aspiration pneumonia? GERD
What determines the severity of damage following aspiration of gastric juices? The pH of those gastric juices.
What kind of pneumonia is ventilator acquired pneumonia (VAP)? Categorized as aspiration pneumonia: happens because bacteria travels along trach or endotracheal tube. Usually hospital acquired.
Why is TB on the rise in the US? Happened after HIV became widespread in the 80's and with the increase of multi-drug resistant TB. Also immigrants a factor.
S/S of TB? Fever, fatigue, night sweats, flu-like symptoms, anorexia, malaise, a cough that lasts 3 weeks or longer. Hemoptysis is a late sign
How is TB diagnosed? A tuberculin skin test (TST/Mantoux) using PPD (purified protein derivative), 3 sputum tests (AFB test, a chest x-ray or QuantiFERON-TB rapid blood test.
What precautions must a nurse take with a TB patient? Pt should be placed on airborne isolation in a negative pressure room, nurse should wear HEPA mask, if pt is transported must wear surgical mask. Cough into tissues which should be disposed of properly.
How is a TB test administered and how is it read? Inject 0.1 mL of PPD intradermally on dorsal surface of forearm. Read 48 - 72 hrs later, induration of at least 10 mm = positive result and more testing is needed. Redness does not indicate positive.
What are common antibiotics a person with Tb may be treated with? Isoniazid (INH), rifampin, pyrazinamide (PZA), and ethambutol. Sometimes also streptomycin.
What are common ADR of isoniazid? heptotoxicity (no ETOH with use), monitor for signs of liver damage during treatment
What are common ADR of rifampin? Orange discoloration of all body fluids. Can also diminish high from opioids or other drugs.
What is pneumonia? Acute inflammation of the lung (including parenchyma, alveoli, and supportive structures).
What causes pneumonia? Pathogens introduced by aspiration, inhalation and circulation spread.
What are s/s of bacterial pneumonia? Fever, cough, pleuritic pain, rusty colored or blood streaked sputum
Treatments for bacterial pneumonia? Antibiotics, 02, turn/cough/deep breath. Complications can include: empyema, pleutitis, lung abscess and bacteremia.
What ADR should a pt with TB report to a healthcare worker? Rash, nausea, loss of appetite, persistently dark urine, fatigue/weakness, numbness/neuropathy of hands and feet.
What are barriers to effective TB treatment? Drugs are expensive, treatment is long-term, immigrants are afraid of being deported.
What are the two conditions that are called COPD? Chronic bronchitis and Emphysema (may also have asthma)
What causes COPD? Smoking (major risk factor), lung infections, genetics (alpha 1 antitrypsin defeciency).
When do symptoms usually begin for patients with COPD? Around age 50 after 20 years of cig smoking.
What are s/s of COPD? Dyspnea that is progressive/exertional. Late stages s/s include: dyspnea at rest, weight loss and anorexia, prolonged expiratory phase, and barrel chest.
In a person with COPD, why does pursed lip breathing improves ventilation? It increases small airway pressures during expiration as a means of preventing collapse.
What may cause exacerbations in a person with COPD? Bacterial or viral infections: this makes all their present COPD symptoms much worse.
What should a pt with COPD use to treat exacerbations? Bronchodilators and oral corticosteriods, CPAP
In COPD pts with depressed respiration, will increasing O2 diminish or stop their breathing? No, this is a common myth. It is vital to provide adequate O2 while assessing the ABGs, rather than not providing O2 because of fear of Co2 narcosis. However, the pt's heart could fall out. ;)
What are the 6 goals of the nurse when treating patients with COPD? Prevent disease progression (stop smoking), relieve symptoms and improve exercise tolerance, prevent and tx complications, promote pt participation in care, prevent and tx exacerbations, and improve quality of life and reduce mortality risk.
T/F Patients may become addicted to O2 and should not use it at home. False: O2 is not addictive (then again maybe it is and we all are: withdrawal symptoms include death...haha) Some pts do fear addiction.
What are two breathing techniques COPD pts should use? Pursed-lip breathing and effective coughing: huff coughing.
What most often causes a pulmonary embolish? Usually a blood clot but can also be a fat or air embolism or debris from the vein after a traumatic accident. The embolism travels from the lower limbs into the right side of the heart and lodges in the main pulmonary artery or its branches.
What is another location an embolism can form besides the lower extremities? In the right atria or right ventricle from atrial fib or flutter.
What percent of clots form in the deep veins of the leg? 90%, the others form in the pelvic veins and right side of the heart.
How does pulmonary hypertension develop? A large embolus or multiple emboli reduce the pulmonary vascular bed.
What are s/s of pulmonary embolism? chest pain of sudden onset, dyspnea, cough, rapid respirations, fever, occasional hemoptysis, pain usually pleuritic with a pleural friction rub, tachycardia.
How is a PE diagnosed? ABG's, pulmonary angiography, lung scans, V/Q studies
Treatments for PE? O2, anticoagulants, heparin (IV), filtering device in vena cava, thrombolytic drugs.
When might a fat embolus be common? After a severe trauma that causes fracture of the long bones (femur and tibia) and when fat coats the capillary walls and becomes leak increasing permeability.
What might lead a nurse to believe his patient is suffering from a PE caused by a fat embolism? 24-48 hrs after injury the pt has progressive respiratory distress with dyspnea,cyanosis, hypoxemia, rales (crackles) and rhonchi, fever, and tachycardia.
What other symptoms may present when a patient has a fat embolism that has reached the neck, trunk, conjunctivae and brain? Petechiae (fat alters the capillary membrane causing bleeding into the skin); Mental changes like confusion, stupor, delirium and coma (when the fat reaches the brain).
How should a nurse try to prevent a fat embolus PE? Fracture management, pulmonary support and steroids.
Name two factors that lead to pulmonary edema? Excess water in the lungs, results from Left Ventricular Failure or valvular disorder, excess fluid and HF.
What are s/s of pulmonary Edema? Anxiety, dyspnea, orthopnea, wheezing, pallor and rales, hypoxemia, increased work of breathing. Also copious amounts of pink frothy suptum, cough at night, rales and tachypnea.
Treatment options for pulmonary edema include? Morphine, bronchodilators, diuretics, digitalis, and O2.
What part of the heart does Cor pulmonale affect and what causes it? Right ventricular hypertrophy which is caused by lung disease.
What is a prerequisite for cor pulmonale? Pulmonary hypertension
What are common diseases that cause cor pulmonale? All pulmonary diseases, kyphoscoliosis, Pickwickian, neuromuscular disease, and extreme obesity.
What is the most common cause of Cor Pulmonale? 75% caused by COPD, 2nd place recurrent multiple pulmonary embolism.
What are s/s of cor pulmonale? enlarged RH, signs of RHF (increased neck vein distension, enlarged liver, and peripheral edema)
What would the focus of treatment be with a patient with Cor pulmonale? Improve alveolar ventrilation, digitalis to strengthen the heart, and control edema.
What is the major cause of Chronic Respiratory disease in children? Cystic Fibrosis
What causes cystic fibrosis? Autosomal recessive: both parent must be carriers.
How is cystic fibrosis diagnosed? A sweat test: with disease there is an increase of sodium chloride in the sweat. Also can use a gene study and history.
What type of glands are affected by cystic fibrosis? Exocrine glands in the epithelial lining of the respiratory, gastrointestinal and reproductive tracts.
S/s of cystic fibrosis? viscous mucus in the bronchi, steatorrhea, and abdominal pain. Pancreatic function is abnormal in 80-90% of pts so they must add enzymes to food.
What teaching will a nurse provide for a pt with cystic fibrosis? how to take meds, nutrition, airway clearance, avoid infection, delayed development of sex characteristics, development of barrel chest.
What treatment should a cystic fibrosis pt receive? Chest physiotherapy (cupping on back/chest), proper nutrition, hydrate to reduce viscosity of mucus, flu shot to reduce infection potential. Lucky pts get lung transplant.
What is the treatment of choice for a pulmonary embolism? Anticoagulants
T/F: most lung tumors are non-malignant? False: over 90% are malignant and 95% of these are bronchogenic CA which arise from the mucosa of the bronchial tree.
What is the biggest risk factor for lung cancer? Smoking--20x's more common than non-smokers; other risk factors are industrial hazards and air pollution, passive smoking.
Why are the lungs a common site for CA metastases? The tumor particles become lodged int he pulmonary capillaries.
What are the four types of bronchogenic cancer? Squamous cell, small cell, adenocarcinoma, and large cell.
Which type of cancer does not have smoking as a risk factor? Adenocarcinoma (alveolar cell CA)
What is the life expectancy of someone diagnosed with small cell CA? Prognosis is poor (9-10) months and death a few months after discovery.
What is the most common type of cancer in men and cigarette smokers? Squamous cell: s/s are cough and hemoptysis as a result of irritation.
What are manifestations of lung cancer? imitates other pulmonary disease so difficult to dx. no typical mode of onset. masquerades as pneumonitits that fails to resolve, cough and hemoptysis common, localized wheeze and mild dyspnea, rapid dev of dig clubbing. Late s/s: anorexia, weight loss
Treatment for lung cancer? surgery, chemotherapy, and radiation
What are causes of adult respiratory distress syndrome (ARDS)? Can be caused by aspiration of gastric contents, sepsis, and trauma, O2 toxicity, infection, micro emboli, drug OD, blood transfusion, near drowning, smoke or chemical inhalation, etc. Basically anything that damages the lungs.
T/F Patients recovering from ARDS have little to no permanent lung damage. True, although it is sometimes fatal.
What is adult respiratory distress syndrome (ARDS)? Results from increased permeability of the alveolocapillary membrane. Fluid accumulates in the lung interstitium, aveolar ventilation and reduces oxygenation of pulmonary capillary blood.
S/s of ARDS? Rapid, shallow breathing, dyspnea, hypoxemia, tachycardia, crackels/rhonchi, restlessness/anxiety, mental sluggishness, motor dysfunction.
What tests are used to diagnosis ARDS? ABG's, pulmonary artery catheterization, x-ray
TX of ARDS? Prevent progression, humidified O2 through tight fitting mask/CPAP, PEEP, fluid restrictions or hydration, sedation, narcotics or neuromuscular blocking agents, sodium bicarb to reverse metabolic acidosis, sometimes antibiotic therapy.
What causes obstructive sleep apnea? The tongue and soft palate fall backward and partially or completely obstruct the pharnyx for 15-20 seconds which causes hypxemia or hypercapnia.
What are risk factors for OSA? Obesity (bm > 28), age (>65), neck circumference (>17), more common in men
S/s of OSA? frequently waking up at night, insomnia, excessive daytime sleepiness, loud snoring, morning headaches (hypercapnia), irritability, HTN, pulmonary HTN
How is OSA diagnosed? polysomnography (sleep study): 10 events an hour with O2 below 90% is a positive OSA
Treatments for OSA? Avoid sedatives, alcohol before sleep, weight loss, oral appliance, and CPAP (5-20 cm H2O in airway during insp.exp)
What is the difference between BiPap and CPAP? CPAP has one pressure on inspiration and expiration and BiPap has higher inspiration and lower inspiration pressure.
Can OSA be treated with surgery? Yes, but Eldon didn't seem too positive about the outcomes.
Exocrine secretion of thick, tenacious mucous in the repiratory tract is characteristic of what disorder? Cystic Fibrosis
A one year old child with Cystic Fibrosis would demonstrate elevated levels of what? Sodium Chloride
The lung receives parasympathetic innervation by the _________ nerve? Vagus
What characterizes a "pink puffer"? A person with emphysema who will develop a barrel chest caused by accessory muscle use to breath. The person works harder to breath, but is able to maintain adequate O2 levels in the tissues.
What characterizes a "blue bloater"? Insufficient O2 which occurs with chronic bronchitis and leads to generalized cyanosis and often right-sided heart failure (cor pulmonale). They are cyanotic and develop clubbing.
What stimulate a COPD patient to breathe? Hypoxia driven instead of hypercapnia in healthy people.
What is the pathophysiology of emphysema? Reduced gas exchange surface area, increased air trapping, decreased capillary network.
What are the risk factors for emphysema? Smoking and environmental/occupational exposure.
S/s of emphysema? Pink puffers, barrel chest, pursed-lip breathers, distant/quiet breath sounds, wheezes, pulmonary blebs on radiograph.
Tx of emphysema? Lowest FlO2 possible to prevent CO2 retention, monitor for s/s of fluid overload, maintain PaO2 between 55 and 60, baseline ABG, teach pursed-lip breathing, sometimes diaphragmatic breathing (not used much anymore), and tripod position.
Pathophysiology of asthma? narrowing or closure of the airway due to a variety of stimulants.
S/S of asthma? Sudden dyspnea--devote all energy to breathing, very difficult expiration, air trapping leading to hyperinflation of lungs, prolonged wheezing on expiration, cough with lots of white sputum.
Tx for asthma attack? Epinephrine, bronchodialators, decrease pt's panic, recognize triggers and avoidance, long-term desensitization, O2, and steroids.
What are the 3 categories of asthma? Extrinsic/Allergic (least common), Intrinsic/Idiopathic, and mixed asthma (most common).
Characteristics of Extrinsic Asthma? Caused by allergens 40%, begins in childhood, family history of hay fever, eczema, and dermatitis, usually complete recovery by teenage years.
Characteristics of Intrinsic Asthma? Can be triggered by common cold, exercise, or emotions-not clearly defined, develops after age 40 with attack after a resp. infection, more severe as time goes on and can merge into COPD.
What group is most likely to develop mixed asthma-- extrinsic or intrinsic? Intrinsic... most extrinsic pts have complete recovery when teens.
What intervention should a nurse caring for a pt with right middle lung pneumonia perform to mobilize secretions? Assist client to use incentive spirometer hourly.
What priority outcome must a pt achieve prior to discharge after conscious sedation during a bronchoscopy? Demonstrate an intact gag reflex
What is the likelihood that anyone makes it to this slide? < 0.00036%...if you did I'm impressed and if you know all these slides it means you know all the notes which means you should do phenomenal on the test... at least that's the hope.
Created by: ewooda05