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med-Surg chap 29

Ignativicius, Med-Surg, Respiratory

QuestionAnswer
What is the purpose of breathing (name two) (1) - to provide oxygen for tissue perfusion so that cells have enough oxygen to metabolize and generate energy 2) - to remove carbon dioxide, the waste product of metabolism
What does the upper respiratory tract consist of
(What does the lower respiratory tract consist of
What does the lower respiratory tract do
Where does gas exchange take place
How many alveoli do a pair of healthy adult lungs have
What is acinus
What is surfactant
What would happen without surfactant
What occurs during atelectasis
Which lung is larger than the other
How many lobes does the right lung have
How many lobes does the left lung have
Which lung effects oxygenation more
Name the accessory muscles that help during breathing
What do the scalene muscles do
What does the sternocleidomastoid muscles do
What do the trapezius and pectoralis muscles do
What changes in the alveoli are related to aging Surface area decreases, diffusion capacity decreases,elastic recoil decreases, bronchioles and alveolar ducts dilate, ability to cough decreases, airways close early
What nursing interventions should you use because of the changes in the alveoli
Why are interventions needed for the change in alveoli Potential for mechanical or infectious respiratory complications is increased in these situations.The upright position minimizes ventilation perfusion mismatching
What physiologic changes occur in the lungs that are related to aging Residual volume increases,vital capacity decreases, efficiency of oxygen and carbon dioxide exchange decreases, elasticity decreases
What interventions would you use because of the changes in lungs due to aging Include inspection, palpation, percussion and auscultation in lung assessments,help patient actively maintain health and fitness, assess patients respirations for abnormal breathing patterns, encourage frequent oral hygiene
What are the rationales for using these interventions for the changes in lungs due to aging The focused lung assessments are needed to detect normal age-related changes,health and fitness keep losses of respiratory functioning to a minimum, periodic breathing patterns (e.g. Cheyne Stokes) can occur, oral hygiene aids in the removal of secretions
What are the physiologic changes in the pharynx and the larynx that are related to aging Muscles atrophy,vocal cords becomes slack, laryngeal muscles lose elasticity airways lose Cartilage
What intervention would you use because of changes in the pharynx and larynx r/t aging and what is the rationale
What Physiologic changes occur in the pulmonary vasculature that are related to aging pulmonary vascular system increases, pulmonary capillary blood volume decreases, the risk for hypoxia increases, vascular resistance to blood flow through
What interventions should you use due to the pulmonary vascular to change r/t aging and why
What kind of physiologic change occurs to the elderly's exercise tolerance, What intervention should you use and why Body's response to hypoxia and hypercarbia decreases, assess for subtle manifestations of hypoxia because early assessment helps prevent complications
What physiologic changes do you notice in the elderly's muscle strength Respiratory muscle strength, especially the diaphragm and the intercostals decrease,
What interventions can you use r/t changes in elderly and what are the rationales Encourage pulmonary hygiene and help patient actively maintain health and fitness, Because regular hygiene and overall fitness help maintain maximal functioning of the respiratory system and prevent illness
what intervention could you use to prevent infection and why Encourage pulmonary hygiene and help patient actively maintain health and fitness, Because regular hygiene and overall fitness help maintain maximal functioning of the respiratory system and prevent illness
What changes occur to the elderly's chest wall Anteroposterior diameter increases, thorax becomes shorter, progressive kyphoscoliosis occurs chest wall compliance (elasticity) decreases, mobility may decrease, osteoporosis is possible
Discuss the normal changes of aging - patients may be anxious because they must work harder to breathe, Discuss the need for increased rest periods during exercise
Women have greater bronchial responsiveness and larger airways, this factor increases the risk for a more rapid decline in lung function as the woman ages
Patients with dark skin usually show a lower oxygen saturation because of the deeper coloration of the nail bed and this does not reflect the true oxygenation
Why are the elderly more susceptible to infection, what intervention could you use and why The effectiveness of the cilia decreases, Immunoglobulin A decreases, alveolar macrophages are altered
Interventions and rationales are the same as for muscle strength
What type of information is important to collect for identifying the type and severity of breathing problems
What are some home conditions that can affect respiratory
In smokers, how would you document their smoking history In pack years...
How does smoking effect the lungs
Name some occupations that may have environmental factors that could cause or worsen lung disease Baker's, coal miners, stonemasons, cotton handlers, woodworkers, welders, Potters, plastic and rubber Manufacturers, printers, asbestos workers, farmworkers,
What teaching opportunities would a nurse have with these patients Teach patients about the use of masks and adequate ventilation to protect the respiratory system from inhalation irritants
What type of information is important to collect for identifying the type and severity of breathing problems Work history, home conditions, respiratory history, hobbies, smoking history, drug use, travel, allergies
What are some home conditions that can affect respiratory Type of heat (gas heater, wood-burning stove, fireplace, kerosene heater) hobbies and pets-- exposure to irritants (fumes, chemicals, animals, birds, air pollutants)
In smokers, how would you document their smoking history In pack years... (Number of packs smoked per day multiplied by number of years the patient has smoked)
How does smoking effect the lungs Induces changes in the airways that lead to some airway obstruction, as a result smokers have a more rapid age-related decline in pulmonary function.
Cough is a sign of lung disease, it's also a side effect of what Some antihypertensive drugs (angiotensin - converting enzyme[ACE] inhibitors)
Why is a patient's history of travel or area of residence significant in determining source of respiratory issues Histoplasmosis a fungal disease caused by inhalation of contaminated dust are found in the central part of the US and Canada.Coccidioidom
Excessive pink, frothy sputum is common with...
What information should we gather about coughing How long the cough is been present, when it occurs (for example specific time of day or specific activity), what type of cough (e.g. wet with sputum, or dry, tickling or hacking)
What information about sputum production should be gathered Duration, color, consistency, odor and amount
what patients are often seen with hemoptysis
Chest pain caused by cardiac issues are described as
What kind of sputum does bacterial pneumonia cause Rust colored Pulmonary pain, may appear only on deep inhalation or at the end of inhalation and the end of exhalation. Pulmonary pain is not made worse by touching or pressing over the area
Excessive pink, frothy sputum is common with Pulmonary edema Type of onset (slow or abrupt)duration (number of hours, time of day)relieving factors (position changes, drug use, activity cessation)whether wheezing, crackles, or stridor occur with breathes
What condition often produces foul-smelling sputum Lung abscess
What is hemoptysis,(Often seen in patients with chronic bronchitis, lung cancer, TB, pulmonary infarction, bronchial adenoma or lung abscesses) Blood in the sputum
Chest pain caused by cardiac issues are described as Intense and "crushing"; may also radiate to the arm, shoulder or neck
How does the mucous membrane of the nose appear with allergic rhinitis
What information regarding dyspnea should be gathered Type of onset (slow or abrupt)duration (number of hours, time of day)relieving factors (position changes, drug use, activity cessation)whether wheezing, crackles, or stridor occurs with bre The light shines through the perforation into the opposite side of the nares- - this condition is often found in cocaine users
What do nasal polyps look like
When palpating lymph nodes, what do tender nodes that are movable suggest
PND and orthopnea often occur with what issues Chronic lung disease and left-sided heart failure
List lung disorders that cause the trachea to push AWAY from the affected area Tension pneumothorax, large pleural effusion, mediastinal mass neck tumors
Name some disorders that pull the trachea TOWARD the affected area
What do nasal polyps look like Pale, shiny, gelatinous lumps or "bags" attached to the turbinates
When palpating lymph nodes what do tender nodes that are movable suggest Inflammation
What kind of nodes are often hard and do not move with palpation Malignant
What is fremitus
Name some disorders that pull the trachea TOWARD the affected area Pneumonectomy, fibrosis and atelectasis
What does decreased tracheal mobility sometimes occur with Cancer or fibrosis of the mediastinum
Patients with emphysema usually present what type of chest appearance,And why Barrel chest: because emphysema is a disorder that causes air trapping
When is fremitus increased
What is fremitus Vibration
What is crepitus Air trapped in and under the skin, also known as subcutaneous emphysema. Felt as a crackling sensation beneath the fingertips Resonance, hyperresonance, flatness, dullness, tympany
What is tactile fremitus The vibration of the chest wall produced when the patient speaks, this vibration can be felt on the chest wall Pitch - low, intensity - moderate to loud, quality- hollow, duration - long, findings -resonance is characteristic of normal lung tissue
When might fremitus be decreased When the transmission of sound waves is slowed Such as when the pleural space is filled with air (pneumothorax) or fluid (pleural effusion) or when the bronchus is obstructed Pitch - higher than resonance, intensity - very loud, quality - booming, duration - longer than resonance, findings - hyperresonance indicates the presence of tra
Describe the pitch, intensity, quality, duration and findings of the flatness note, Where might an example be found Pitch - high, intensity - soft, quality- extreme dullness, duration - short, findings Flatness percussed over
Describe the pitch, intensity, quality, duration and findings of the tympany note. Where might you find an example of this sound
Name the five percussion notes Resonancehyper resonanceflatnessdullnesstympany
Describe the pitch, intensity, quality, duration and findings of the resonance note Pitch - lowintensity - moderate to loudquality - hollowduration - longfindings - resonance is characteristic of normal lung tissue
Describe pitch, intensity, quality, duration and findings of the hyperresonance note Pitch - higher than resonanceintensity - very loudquality - boomingduration - longer than resonancefindings - hyperresonance indicates the presence of tra
Describe the pitch, intensity, quality, duration and findings of the flatness noteWhere might an example be found Pitch - highintensity - softquality - extreme dullnessduration - shortfindings - . Flatness percussed over
Describe the pitch, intensity, quality, duration and findings of the tympany note.Where might you find an example of this sound Pitch - highintensity - loudquality - musical, drum likeduration - shortfindings - over the lung, a tymp
How are breath sounds identified (described) Breath sounds are identified by their location, intensity, pitch, and duration within the respiratory cycle
Examples of the way breath sounds are identified ,E.g., early or late, inspiration and expiration, bronchial or tubular (harsh hollow sounds heard over the trachea and mainstream bronchi), bronchovesicular (heard over the branching bronchi) and vesicular
What are adventitious sounds Additional breath sounds superimposed on normal sounds and they indicate pathologic changes in the lungs
Name the five different discontinuous adventitious sounds Fine cracklesfine raleshigh pitched ralescoarse crackleslow pitched crackles
When do fine crackles, fine rales, high-pitched rales occur Either early or late inspiration
Describe the character of fine crackles, fine rales, high-pitched rales Popping discontinuous sounds caused by air moving into previously deflated airways; Sounds like hair being rolled between fingers near the ear. "Velcro"sounds late in inspiration usua
What disorders are associated with the first three discontinuous adventitious sounds Asbestosis,atelectasisinterstitial fibrosisbronchitis pneumoniachronic pulmonary diseases
When do coarse crackles and low pitched crackles occur in the respiratory cycle More common on expiration but may be present early in inspiration
What is the character of coarse crackles,and low pitched crackles (describe) Lower pitched, coarse, discontinuous rattling sounds caused by fluid or secretions in large airways; likely to change with coughing or suctioning
Name some disorders associated with coarse crackles and low pitched crackles Bronchitispneumoniatumorspulmonary edema
Name the 2 types of continuous, adventitious sounds Wheezerhonchus [rhonchi]
When is wheezing audible During either inspiration, expiration or both
Characterize wheezing Squeakymusicalcontinuous sounds associated with air rushing through narrowed Airways; may be heard without a stethoscopearise from the small airways usually does not clear with coughing
What disorders are associated with the wheezing sound Inflammation
bronchospasm
edema
secretions
pulmonary vessel engorgement (as in cardiac "asthma")
When does rhonchi occur Audible during both inspiration and expiration but commonly more prominent on expiration
Characterize rhonchi Lower pitched coarse, continuous snoring soundarise from the large airways
With what disorders is rhonchi associated Thick, tenacious secretionssputum productionobstruction by foreign bodytumors
When is a pleural friction rub heard Her during both inspiration and expiration, generally at the end of inspiration and the beginning of expiration
Characterize pleural friction rub Loud, rough, grating, scratching sounds caused by the inflamed surfaces of the plural rubbing together; often associated with pain on deep inspirationsheard in lateral lung fields
With what disorders are pleural friction rubs associated Pleurisytuberculosispulmonary infarctionpneumonialung cancer
Gas exchange affects all body systems, name an indicator that would suggest immediate oxygenation problems Cyanosis
What are some changes that would reflect long-term oxygenation problems Clubbing of the fingernails indicates long-term hypoxia weight loss - arms and legs may appear then or poorly muscled, and chest muscles may be hypertrophied especially in the pat
What information does the RBC provide Information about the transport of oxygen. Hemoglobin, found in RBCs transports oxygen to the tissuesa hemoglobin deficiency could cause hypoxemia
What do ABGs assess OxygenationAnd acid-base balance
What would sputum specimens identify Organisms or abnormal cells, such as cancer or an allergy
What are chest x-rays used for To evaluate the status of the chest and provide a baseline for comparison with future changes
What is the nurse's role during the CT test Provide information to the patientdetermine whether the patient has any sensitivity to the contrast materialasked the patient whether he or she has a known allergy to iodine or shellfishkeep the pati
What pulse oximetry results indicate an emergency and require immediate assessment and treatment Any result lower than 91%
Body tissues have a difficult time becoming oxygenated below what pulse oximetry level Below 85%
What pulse oximetry result is usually life-threatening Below 70% (occasionally below 80%
What does Capnometry and Capnography measure the amount of carbon dioxide present in exhaled air, which is an indirect measurement of arterial carbon dioxide levels
What is the normal pressure of end tidal carbon dioxide (PETCO2) Ranges between 20 and 40 mm HG
What do changes in PETCO2 reflect Reflects changes in breathing effectiveness and may occur before hypoxia can be detected using pulse oximetry which is good for directing early intervention with critically ill patients and those with respiratory problems
What are factors that can increase PETCO2 above normal levels Does that reflect inadequate oxygenation, such as fever, hypoventilation, partial airway obstruction, and re-breathing exhaled air
What factors decrease PETCO2 below normal levels Factors that reflect poor ventilation, such as hypothermia, poor cardiac output, hypotension, hypovolemia, pulmonary embolism, apnea, total airway obstruction and tracheal extubation
What are PFTs and what do they do Pulmonary function tests, Most common reason for performing a PFT is to determine the cause of dyspnea
A PFT done before surgery may identify what The patient at risk for lung complications after surgery
When performed while patient exercises PFT's help determine what Determines whether dyspnea is caused by lung or cardiac dysfunction or by muscle weakness
How do you prepare the patient before a PFT test Advise the patient not to smoke for 6 to 8 hoursbronchodilator drugs may be withheld for 4 to 6 hours before handhelp reduce anxiety by describing what will happen during and after the testing
What do you do during follow-up care for PFTs Observe patient for increased dyspnea or bronchospasm, document any drugs given during testing
What is exercise testing for To assess the patient's ability to work and perform ADLs, differentiates reasons for exercise limitation, evaluates disease influence on exercise capacity and determines whether supplemental oxygen is needed during exercise
What are skin tests used for To identify various infectious diseases (e.g. tuberculosis), viral diseases (e.g. mononucleosis, more), and fungal diseases (e.g. coccidioidomycosis,histoplasmosis)
Name some endoscopic examinations Bronchoscopy, laryngoscopy, mediastinoscopy
How is laryngoscopy performed A tube for visualization is inserted into the larynx to assess the function of the vocal cords, remove foreign bodies caught in the larynx, or obtain tissue samples for biopsy or culture
How is a mediastinoscopy performed Insertion of a flexible tube through the chest wall just above the sternal into the area of the upper chest between the lungs. This is performed in the operating room with the patient under general anesthesia to examine
What is a bronchoscopy The insertion of a two in the airways, usually as far as the secondary bronchi, for the purpose of viewing airway structures and obtaining tissue samples for biopsy or culture
How do you prepare patient for bronchoscopy Patient should be NPO for 4 to 8 hours before procedure to reduce the risk of aspiration. Explain the procedure, verify the consent, document allergies, premedication with one of the benzodiazepines may be used
What is methemoglobin An altered iron state (conversion of normal hemoglobin to methemoglobin) that does not carry oxygen, resulting in tissue hypoxia
What causes methemoglobin Topical anesthetic such as benzocaine spray
What is the normal blood level of methemoglobin Less than 1%
What happens when the level of methemoglobin increases Tissue oxygenation is reduced
What occurs when methemoglobin levels are between 10 and 20% Cyanosis
What happens when methemoglobin levels are between 20 and 50% Anxiety, tachycardia and lethargy develop
What happens when methemoglobin reaches 50 to 70% Death can occur
When should methemoglobinemia be suspected If patient becomes cyanotic after receiving a topical anesthetic, does not respond to supplemental oxygen, and if blood is a characteristic chocolate - brown in color
How can methemoglobinemia be reversed Oxygen and IV injection of 1% methylene blue (1 to 2 mg/kg)
What immediate intervention should be done if the patient has any symptoms of methemoglobinemia Notify the rapid response team
What laboratory tests may be required before bronchoscopy CBC, platelet count, prothrombin time, electrolytes, chest x-ray
What does the follow-up care of a bronchoscopy consist of Monitor patient until effects of sedation have resolved and gag reflex has returned. Monitor vital signs including oxygen saturation and assess breath sounds every 15 minutes for first two hours
What are potential complications of a bronchoscopy Bleeding, infection or hypoxemia (possibly related to a pneumothorax or methemoglobinemia
What is thoracentesis Aspiration of pleural fluid or air from the pleural space
What is a thoracentesis used for Drain fluid to relieve blood vessel or lung compression, relieve respiratory distress caused by cancer emphysema pleurisy or tuberculosis. Drugs can be instilled into the pleural space
How do we prepare patient for thoracentesis Tell patient to expect stinging sensation from anesthetic agent, a feeling of pressure when needleless push through the tissue of the posterior chest. Stress the importance of not moving.
Why should a patient not move during a thoracentesis Coughing, Deep breathing, or sudden movements should be avoided to avoid puncture of the pleura or lung
What is a pneumothorax Partial or complete collapse of lung
What are the manifestations of a pneumothorax Pain on affected side that is worse at the end of inhalation and end of exhalation
rapid heart rate
rapid shallow respirations
feeling of air hunger
prominence of the affected side that does not move in and out with respiratory effort
trachea slanted more to the unaffected side instead of being in the center of the neck
new onset of nagging cough
cyanosis
What is a mediastinal shift Shift of central thoracic structures toward one side
During a thoracentesis what should the nurse observe for Observe patient for shock, pain, nausea, pallor: diaphoresis, cyanosis, tachypnea and dyspnea
What should the nurse to do for follow-up care after thoracentesis Monitor vital signs, auscultate breath sounds for absent or reduce sounds on affected side, check puncture site and dressing for leakage or bleeding, assessment complications, birds patien
What complications can occur From a thoracentesis Re-accumulation of fluid and pleural space, subcutaneous emphysema, infection, and tension pneumothorax
What should be documented after thoracentesis Procedure, (include patient's response, volume and character of fluid removed, any specimen sent to the lab, location of puncture site, and respiratory assessment findings before during and after procedure)
What is a lung biopsy performed for Obtain tissue for histologic analysis, culture, or cytologic examination
What does follow up care consist of after lung biopsy Monitor vital signs, breath sounds - every four hours for 24 hours, assess for respiratory distress (e.g. dyspnea, pallor, diaphoresis, tachypnea) assess for pneumothorax. Report reduced or absent brea
Created by: bethwebb