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Adult Hlth 2 Test 1
Respiratory Chs 33-35 & cdc.gov on influenza & pneumoccoccal vac
| Question | Answer |
|---|---|
| Define chronic airflow limitation (CAL) | Group of chronic lung disease that includes asthma, chronic bronchitis, and pulmonary emphysema. |
| _____ comes and goes depending on pt. reversible inflimation | Asthma-Intermittant |
| What are two ways airway obstruction can occur with asthma. | 1. Inflammation 2. Airway hyperresponsiveness |
| What is a bronchospasm? | o Narrowing of the bronchial tubes through the constriction of the smooth muscle around and within the bronchial walls. Airway is contracting and constricting. |
| • What is the most common manifestation of an acute episode of asthma? | Audible wheeze, Increased respiratory rate |
| What are PFTs? (NOT ON TEST) | Pulmonary Function Test |
| ____-Volume of air exhaled from full inhalation to full exhalation | FVC: Forced vital Capacity |
| ___-is the volume of air blown out as hard and fast as possible during the first second of the most forceful exhalation after the greatest full inhalation | FEV1: Forced Expiratory Volume in the first second |
| _____- Fastes airflow rate reached at anytime during exhalation | PERF: Peak Expiratory Rate Flow |
| ___ is fast acting for acute asthma attacks. | Albuerol |
| For maintaining asthma, what do you want to take? | Mantance-Adviar, Carvent-taken daily to help decrease exasperations |
| T/F o Avoid potential environmental asthma triggers, such as smoke, fireplaces, dust, mold, and weather changes (especially warm to cold or sudden barometric changes). | True |
| T/F Never avoid medications that could trigger asthma (e.g., aspirin, nonsteroidal anti-inflammatory drugs [NSAIDs], and beta blockers). | False Avoid them |
| What type of foods should you avoid if you have asthma? | o Avoid food that has been prepared with monosodium glutamate (MSG) or metabisulfite. |
| o If you experience symptoms of exercise-induced asthma, use your ____ inhaler 30 minutes before exercise to prevent or reduce ____. | Bronchodilator; bronchospasm |
| T/F Be sure you know the proper technique and correct sequence when you use metered dose inhalers. | True |
| T/F Getting adequate rest and sleep is not important for people with asthma? | False it is important |
| What are 3 things that will help an asthma pt adapt? | o Reduce stress and anxiety; learn relaxation techniques; adopt coping mechanisms that have worked for you in the past. |
| How should bedding be washed for an asthma pt? | o Wash all bedding with hot water to destroy dust mites. |
| What should you monitor as an asthma pt? | Monitor your peak expiratory flow rates as you were instructed. |
| When should you seek immediate emergency care as an asthma pt? | Gray or blue fingertips or lips; Difficulty breathing, walking/talking; Retractions of the neck, chest, or ribs; Nasal flaring; Failure of meds control worse symptoms; Peak expiratory rate flow decline steadily after treatmnt/flow rate 50% below your norm |
| What is status asthmaticus? | o Severe life threatening acute episode of airway obstruction that intensifies once it begins and often does not respond to common therapy |
| o IV fluids, potent systemic bronchodilators, steroids, epinephrine, and O2 are given immediately in _____? | status asthmaticus |
| T/F Status asthmaticus may require emergency intubation. | True |
| • What two disease processes occur with Chronic Obstructive Pulmonary Disease (COPD)? | Emphysema and chronic bronchitis |
| Emphysema is a ____ problem? | alveolar problem |
| Chronic bronchitis is a ____ problem? | airway problem |
| T/F COPD is NOT reversible or intermittant...progressively gets worse. What do you teach the pt? | True; Teach pt pursed lip breathing |
| What are three risk factors for COPD? | Smoking (most important); AAT enzyme deficiency; and Air pollution (small role mostly additive to tobacco exposure). |
| Wt. loss occurs with increasingly severe ____? | COPD |
| Loss of muscle mass in extremities, enlarged neck muscles, slow moving, slightly stooped posture and rapid shallow breaths with use of accessory muscles are all manifestations of _____? | COPD |
| Limited diaphragmatic excursion, decreased fremitus, crackles in lungs, Barrel chest, Chronic bronchitis and dependent edema with R sided HF occurs in _____ pts? | COPD |
| In COPD _____ manifests with cyanotic, excessive sputum production. | Chronic Bronchitis |
| What type of assessment is reduced socilization r/t annoying coughs, excessive sputum, dyspnea; crowded living situations/smoking in home; and Economic status may be affected by what disease? | Psychosocial Assessment of COPD |
| What Laporatory assessments should be done for COPD patients? | ABG baselines are drawn; Hypoxemia & hypercarbia; Sputum cultures; H&H to determine polycythemia; Lytes are drawn because of hypophosphatemia, hyperkalemia, hypocalcemia, & hypoMg+ reduce muscle strength, AAT levels may be drawn |
| The following Radiographic Assessment is done for COPD pts...._____: to rule out other chest diseases and to check progress with respiratory infections or chronic disease. What is the radiographic assessment? | CXR |
| What are the four complications of COPD and what they cause? | Hypoxemia-causes decreased tissue function; Acidosis-decreased tissue function; Respiratory infection-mostly caused by bacteria; Cardiac failure-R sided HF; and Dysrythmias-may result from hypoxemia, drugs, acidosis, other cardio diseases |
| What is Cor Pulmonale? | Right sided HF |
| What is a long term side effect of COPD? | Cor Pulmonale |
| Hypoxia & hypoxemia, increasing dyspnea, fatigue, weakness, enlarged & tender liver, warm, cyanotic extremities with bounding pulse, cyanotic lips, JVD, R ventricular enlargement, Lower sternal or epigastric pulsations are all manifestations of ____? | Cor Pulmonale |
| Cyanotic lips, JVD, R ventricular enlargement, lower sternal/epigastric pulsations, GI disturbances i.e Nausea/anorexia, dependent edema, Pulmonary HTN, Metabolic & respiratory acidosis, Liver congestion are all manifestaions of ___? | cor Pulmonale |
| What are some interventions for clients with COPD? | Pursed lip breathing, bed at 45 or above, Airway management-incentive spirometer, breath sounds, secretions...Cough Enhancement: breath hold 2 secs and cough 2-3xs inhale deeply; O2 Therapy: placement, skin breakdown, liters per min, need for it. |
| Should you monitor Energy level of a COPD pt and why? | Yes, monitor nutrition as well because you want the pt to have adiquate circulation and avoid necrosis. |
| What is a COPD client's primary drive for breathing? | o High levels of CO2 are a COPD patients drive to breath |
| Will they require higher or lower levels of oxygen delivery? | o They require lower levels of oxygen because higher levels of oxygen will reduce their drive to breath |
| • What types of medications will a client with COPD be prescribed? | Beta-andrenergic agents; Cholinergic antagonist; Methylxanthines; Corticosteroids; Cromolyn sodium/nedocromil; Leukotriene modifiers; Mucolytics (thin secretions) |
| Are breathing treatments very important? | Yes becuase you will need to know this in order to do client teaching |
| _____ breathing: Patient consciously increases the movement of the diaphragm; Lying on back allow abdomen to ____? | Diaphragmatic/Abdominal breathing...Lying on back allow abdomen to relax |
| ____ Breathing: Uses resistance of partially closed lips to prolong exhalation and increase airway pressure | Pursed-lip breathing |
| T/F COPD pts have excessive mucus? | True |
| What can you do to help with airway clearance? | Controlled Coughing; Chest Physiotherapy/Postural Drainage; Suctioning; Positioning; Hydration; |
| When should you perform controlled coughing? | Caughing at specific times of the day i.e. upon rising in the AM, before meal times, & before bed |
| How should you perform Controlled coughing? | Sit in chair or side of bed w/ feet planted, turn shoulders inward and bend head slightly downward, hug pillow to stomach, take a few deep breaths using pursed lips, then cough 2-3 times in same breath. Repeat 2x |
| What does Chest physiotherapy/Postural Drainage do? | It moves secretions into central airways, reexpand lung tissue, and promotes efficient use of ventilartory muscles; Chest percussion with vibration to loosen secretions; postural drainage uses specific positions and gravity to move secretions |
| Is Chest Phsyiotherapy/Postural Drainage routinely used with all COPD clients? | NO |
| Perform suctioning only with ____ breath sounds? | abnormal |
| Is suctioning a routine scheduled procedure and assess for what? | No it is not a routine scheduled procedure; assess for dyspnea, tachycardia, and dysrhythmias during procedure |
| Sitting in chair for 1 hour periods 2-3 times a day helps move ____ and keeps diaphragm in better position for ventilaiton. | secretions |
| A COPD pt should have how much hydration and why? | 2-3L/day unless contraindicated; hydrations helps keep secretions thinned |
| • What is a chest tube? What does it do? | o Drain placed in the pleural space to restore intrapleural pressure, allowing re-expansion of the lung AIR BUBBLES IN LINE THERE IS A LEAK VACINES ARE IMPORTANT FOR TEST |
| • A three-bottle system is used to explain the principles of the water-seal chest drainage. What does bottle one do? | Does not at first have fluid in it; Collects the fluid draining from the cl-measure hourly in 1st 24hrs; FLUID MUST NEVER COME INTO DIRECT CONTACT W/ THE TUBE DRAINING FROM CL OR THE CONNECTING TUBE TO BOTTLE 2 DRAINING WILL STOP |
| • A three-bottle system is used to explain the principles of the water-seal chest drainage. What does Bottle TWO do? | Water seal that prevents air from entering the client's pleural space |
| • A three-bottle system is used to explain the principles of the water-seal chest drainage. What does Bottle THREE do? | Suction control bottle of the system; Three connections: Short tube from the second bottle, Long open tube dipped into the water and Short tube conected to suction unit |
| What is rhinitis? | o Inflammation of the nasal mucosa, ie common cold |
| • How long will a “common cold” last? When is this client most contagious? | Most contagious in the first 2-3 days of symptoms; Usually lasts 7-10 days |
| Decongestants, Antihistamines (if allergic ___); Antipyretics if fever present, Antibiotics only if bacterial ___ are perscribed for what____? | RHINITIS, rhinitis, rhinitis |
| What are some supportive therapy people with Rhinitis could do? | Importance of rest 8-10hrs per day; Fluid intake of 2 L/day; Humidifying air helps to relieve congestion (use humidifier, inhaling steam from pan of boild water, steamy air in bathroom after running shower |
| What is sinusitis? | Inflammation of the mucous membranes of one or more of the sinuses. |
| Where does sinusitis most often develop? | Most often in the frontal and maxillary sinuses |
| Broad spectrum antibtiotics; analgesics for pain & fever; Decongestants; Steam humidification; Hot & wet packs over sinus area; Nasal saline irrigations; Increase fluid intake to more than 10 glasses of H20/juice per day are all non-surgical means treat _ | Rhinitis |
| What are the two surgical interventions for rhinitis? | Antral irrigation and Endoscopic sinus surgery |
| In ____ a large gauge needle is inserted into maxillary sinus on affected side; fluid or pus is drained from sinus; irrigated with saline, antibiotic or both | Antral irrigation |
| In ____ surgery is used to diagnose and treat sinus disorders; general anesthesia; procedure only takes minutes but takes mucosa 4-6 WEEKS TO HEAL!!! | Endoscopic Sinus Surgery |
| What is pharyngitis? | Sore throat, inflammation of mucous membranes of the pharynx |
| What is the main cause of pharyngitis? | Main cause is Group A streptococcus in bacterial cases Most adult cases are viral |
| What is Odynophagia? | pain on swallowing |
| What is dysphagia? | Difficulty swallowing |
| How do you determine if the infection is viral or bacterail? | Temperature w/ bacteria is high, Lab test are abnormal and onset abrupt. if Viral low grade/no fever, lab test and onset is gradual |
| How do you manage viral infections? | rest, increased fluid intake, humidifying the air, analgesics for pain, warn salines gargles, throat lozenges |
| How do you manage bacterial infections? | antibiotics are required as well as the interventions for the viral form |
| What is tonsillitis? | o Inflammation and infection of the tonsils and lymphatic tissues located on each side of the throat |
| What antibiotics will be prescribed with tonsillitis? | Penicillin or azithromycin |
| What is term to describe the surgical removal of the tonsils? | Tonsillectomy |
| Is the flu viral or bacterial? | viral |
| Vacinations should be taken w/in ___ of onset? CAN YOU GET THE FLU FROM VACINATION & WHY? | 24-48hrs of onset; No you can not get the flu from it because flu shot is inactivated-killed. Injection shot is > 6 months old |
| Severe HA; Muscle aches; Fever; Chills; Fatigue; Weakness; Anorexia; Sore throat, cough, rhinorrhea follow after initial symptoms are manifestations of ____? | flu |
| How often should one get the influenza vaccine? | once a yr in the fall |
| Who should be vaccinated? | Older than 50; People with chronic illness or immune compromise; Living in institutions; Health care personnel providing direct care to clients |
| Will antibiotics be prescribed for the flu? | NO its viral not bacterial |
| What are the antiviral agents given for the flu? | A: Amantadine (symmetrel) & rimantadine (Flumadine); B: ribavirin (Virazole) A&B withing 48hrs of onset: zanamivir (Relenza) & oseltamivir (Tamiflu) |
| What are some pt teachings that you can do for supportive measures of getting over the flu? | Stay in bed for several days; Drink large amounts of fluids; Saline gargles may ease sore throat pain; Antihistamines may reduce rhinorrhea |
| What is pneumonia? | Excess of fluid in the lungs reslting from an inflammatory process |
| What is the term used to describe a hospital-acquired pneumonia? | Nosocomial |
| What are 5 risk factors for Community Aquired Pneumonia (CAP)? | 1. older adult 2. No Hx of pneumococcal vaccination 3. No Hx of received flu vaccine previous yr 4. Chronic/other coexisting condition 5. Recent Hx/exposure to vial/flu infection 6. Hx of tobacco/ETOH use |
| What are 5 risk factors for Hospital Aquired Pneumonia (HAP)? | Older adult; Chronic lung disease; Gram-colonization of the oropharynx & stomach; altered LOC, Aspiration; ET tube, trach, NG tube, Poor nutrition, Immunocomprimised, Medication that increases Gastric pH, mech vent. |
| Flushed checks, bright eyes, anxious expression are physical manifestations of ____? | pneumonia |
| Chest or pleuritic pain, myalgia, HA, chills, fever, cough, tachycardia, dyspnea, tachypnea, sputum production are manifestations of ____? | pneumonia |
| Chest muscle weakness, cracles or wheezing; Tactile fremitus is increased over areas of ___, percussion is dulled; weak rapid pulse, hypotensive are all manifestations of ____? | pneumonia, pneumonia |
| Sputum gram stained, culture & sensitivity; CBC, Blood cultures to assess for sepsis; HIV may be performed; ABG, Lytes, BUN, Creatinine are all lab assessments for _____? | pneumonia |
| In a ____ radiographic assessment pneumonia shows up as an area of increased ____? | CXR; pneumonia shows up as an area of increased density |
| What are the 3 interventions for clients with pneumonia? | Cough Enhancement; Oxygen Therapy; REspiratory Monitoring- review notes on how to teach and help pt do this (2 pgs in notes reviewing this). |
| What is pulmonary tuberculosis? | highly communicable disease caused by M. Tuberculosis |
| How is pulmonary tuberculosis transmitted? | Aerosolization (airborne route) |
| What is the percentage of those initially infected will develop active TB? | 5-15% |
| T/F Assist cl to a sitting position w/ neck slightly flexed, shoulders relaxed, and knees flexed when the client has pneumonia | True |
| T/F Encourage cl to take several deep breaths, hold it for 2 secs, & cough 2-3x in succession with pneumonia | True |
| T/F Instruct client to inhale deeply, bend forward slightly, and perform three or four huffs (against an open glottis) in pts with pneumonia | True |
| T/F Instruct cl to inhale deeply several times, to exhale slowly, and to cough at the end of exhalation if they have pnuemonia | True |
| T/F Do not instruct client to follow coughing with several maximal inhalation breaths if they have pneumonia? | False Do instruct them to do it |
| Should you incurage use of incentive spirometery, as appropriate for a pneumonia pt? | Yes |
| If a person has pneumonia should fluid restriction occur all the time? | NO promote systemic fluid hydration as appropriate |
| During Oxygent Thearpy what should you monitor? | Administration of oxygen and monitor its effectiveness |
| In oxygen therapy for pneumonia what do you do? | clear secreations, restrict smoking, maintain airway patency, Set up O2 equipment & admin through heated, humidified system, Monitor Liter flow-position-perscribed concentration in O2 delivering device-anxiety-skin breakdown... |
| In monitoring the respirations of a pneumonia pt how do you determine the need for suctioning? | Determine the need for suctioning by auscultating for crackles and rhonchi over major airways. |
| What is secondary TB? | Reactivation of the disease in previously infected person |
| Who is at greatest risk for development of TB? | Older adults; HIV positive; Immunoompermised; Close proximitys; Foreign imagrents |
| Cough, Afternoon fever, Night sweats, hemoxisis (bloody sputum); progressive fatigue; lethargy; N & anorexia; wt loss; irregular menses; low grade fever; cough w/ mucopurulent sputum, may be blood streaked all are manifestations of ___? | TB |
| How is TB diagnosed? | Diagnosis suggested by manifestations & positive smear for acid fast bacillus; sputum culture confirms diagnosis; polymerase chain reaction (PCR) is used for rapid identification (expensive not common); TB skin test-most commonly used reliable test |
| • Does a positive reaction to the Mantoux test mean that active TB disease is present? What does it mean? | NO it indicated exposure to TB or the presence of inactive disease |
| Once a skin test is positive for TB, what is needed to detective active vs. dormant disease? | Chest x-ray is needed to detect clinically active TB or old, heald lesions |
| How long must a TB pt be on drugs? | Compliance is essential 6-12 months |
| What are some of the TB drugs? | Combination Isoniazid (INH)-throughout; Rifampin-throughout; Pyrazinamide-1st 2 months; Ethambutol or streptomycin-4th drug... |
| What are the TB precautions in the hospital? | well ventilated room; don't shake sheets (airborne pathogen); health care workers wear N95 or HEPA respirator; and hand hygiene |
| When is a TB pt no longer infectious? | When the results of 3 sputum cultures are negative, the cl is no longer infectious |
| What kind of precaustions is a hospitalized cl with TB placed under? | Airborne precautions-6 fresh air exchanges per minute & ventilated to the outside if possible; All entering the room must wear a N95 respirator and implement standard precautions |
| T/F A TB pt on community-based care is no longer contagious after 2-3 weeks of continous weeks and clinical improvement is seen? | True |
| T/F It is not important that proper nutrition is maintained in TB care? | FALSE it is important |
| T/F Make sure you as a nurse provide client information about TB and how to prevent transmission | True |
| What is acute respiratory distress syndrome? | Acute respiratory failure w/ the following indicators: Hypoxemia that persists even when 100% O2 is given; Decreased pulmonary compliance; Dyspnea; Noncardiac-associated bilateral pulmonary edema; Dense pulmonary infiltrates on x-ray |
| What is the mortality rate of acute respiratory distress syndrome? | 50-60% |
| What is the major site of injury in the lung in the acute respiratory distress syndrome (ARDS)? | Alveolar-capillary membrane |
| Shock, Trauma, Pancreatitis, Sepsis, Pulmonary infection, Serious nervous system injury, and aspiration are all common causes of ____? | ARDS |
| How will ABGs and CXR in ARDS pt manifest? | ABGs: lowered partial pressure arterial oxygen (PaO2)----CXR: Shows diffuse haziness or "whited-out" appearance of the lung |
| What will the ARDS patient need? | ET intubation and mechanical vent with positive end-expiratory pressure or CPAP |
| A major indication for intubation in pts with____ is airway protection when the client loses reflexes because of anesthesia, medications, disease or decreased LOC. | ARDS |
| A major indication for _____ is to provide positive pressure or high O2 concentration or to bypass airway obstruction | intubation |
| Facilitating pulmonary hygiene & suctioning of secretions when the client cannot handle secretions are major indications for ____? | intubation |
| What are the goals for mechanical ventilation? | Improve oxygenation and ventilation; decrease the work need for an effective breathing pattern |
| What are the 2 thypes of ventilators? | Negative Pressure Ventilators and Positive Pressure Ventilators |
| _____ Ventilators works by chaning pressures in the chest cavity rather than by forcing air directly into the lungs; "Iron Lung" Artificial airway is not required. | Negative Pressure Ventilators |
| When is Negative Pressure ventilators used? | used for pts with neuromuscular disease, CNS problems, spinal cord injuries, COPD |
| _____ ventilators: during inspiration, pressure is generated that pushes air into the lungs and expands the chest. ET tube or trach is needed. | Positive Pressure Ventilators |
| What is Assist Control ventilation? | Resting mode; Ventilator takes over work of breathing for the client; Tidal volume and ventilatory rate are present |
| What is synchronized intermittent mandatory ventilation? | Tidal volume & ventilartory rate are present; If cl doesn't breathe, miniual ventialtor pattern is established; It allows spontaneous breathing at the client's own rate & tidal volume between the ventilator breaths |
| What is Bi-level Positive Airway Pressure? | Provides non-invasive pressure support ventilation by nasal or face mask; Used most often for cl w/ sleep apnea-Never feels rested, chokes, breathing disruption during sleep for at least 10 seecs. Short neck, obeses, large ovula |
| T/F Regardless of the brand of ventilators, the controls and settings are universal? | True |
| What is Tidal volume and the ventilator settings? | Volume of air the cl receives with each breath; Average between 7-10 ml/kg of body weight |
| What is Rate and ventilator setting? | Breaths per minute; Usually set between 10-14 breaths/minute |
| FIO2 is oxygen level delivered to the client. How is the prescribed FIO2 determined? | The prescribed FiO2 is determined by ABG |
| What does Mode on the ventilator mean? | The way the client receives breaths from the ventilator |
| What is PIP on the Ventilator? | Indicates the pressure needed by the ventilator to deliver a set tidal volume at a given dynamic compliance |
| What is PEEP on the ventilator? | Positive Pressure Exerted during the expiratory phase of ventilation |
| What does PEEP on the ventilator prevent? | Prevents atelectasis |
| What is the FLOW on the ventilator and setting? | How fast the ventilator delivers each breath; usually set at 40 L/min |
| What are three nursing goals in caring for the mechanically ventilated client? | Monitor & evaluate the response to the ventilator; Manage the ventilator system safely; Prevent complications |
| In monitoring and evaluating the response to the ventilator what do you assess? | Asses VS & listen to breath sounds every 30-60 mins at 1st; Assess breathing pattern in reation to the vent cycle; Assess area around the ET tube or Trach site every 4 hrs |
| What are the 2 alarms on the ventilator? | High pressure and Low exhaled volume |
| What is weaning? | Weaning is the process of going form vent dependence to spontaneous breathing |
| What is pneumothorax? | air in the pleural space |
| What is tension pneumothorax? | air leak in the lung or chest wall. Air is forced into the chest cavity causing complete collaps of affected lung. Air cannot escape causing increasing tension with each breath |
| What is Hemothorax? | Blood in the pleural space |
| How is pneumothorax, Tension pneumothorax, and Hemothorax diagnosed? | Chest X-ray |
| _____ is the drug of choice because it decreases the inflammation in the airway? | Prednisone |
| If we give COPDs too much O2 what can happen? | They can lose their drive to breathe |
| What pt is likely to have flattened diaphragm? | COPD pts |
Created by:
cgwayland
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