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Chapter 49
PT 52 Exam #4 Study Guide
| Term | Definition |
|---|---|
| Number of lobes the left lung contains | two lobes |
| Number of lobes the right lung contains | three lobes |
| Anthrax (know the 3 types) | 1.Cutaneous- the most common type.Bacteria or spores enter the skin through cut or abrasion 2. Gastrointestinal- the least common type.Ingestion of the organism in contaminated food. 3. Inhalational- seen in global warfare. Most deadly type. |
| Epistaxis | bleeding from the nose. Underlying cause is congestion of the nasal membranes, leading to capillary rupture. |
| Allergic rhinitis and allergic conjunctivitis( hay fever) | Atopic allergic conditions that result from antigen-antibody reactions in the nasal membranes, nasopharynx and conjunctiva from inhaled or contact allergens. |
| *Which type of anthrax is usually non fatal? | *cutaneous anthrax. |
| #Which type of anthrax resembles an insect bite after several days , until black eschar appears at the center of the lesion and the site becomes edematous | #cutaneous anthrax |
| What type of anthrax is most deadly? | Inhalational. Seen in global germ warfare. It develops when spores are inhaled deeply into the lungs Immune cells fight to fight lung infection carrying some bacteria into the lymph system, which spreads the infection to the other organs. |
| Which type of anthrax is the least common type? | Gastrointestinal is the least common type. Occurs after ingestion of the organism is contaminated or under cooked food. Spores generate in the mouth, the esophagus, the stomach or the small and large intestines causing ulcers. |
| Medical Management for anthrax? | Antibiotic treatment. (Cipro) CDC recommends a 60 day course of therapy to ensure eradication of inactive spores and bacteria. |
| Turberculosis | Chronic pulmonary and extrapulmonary (outside the lung) infectious disease acquired by inhalation of a dried droplet nucleuscontaining a turbercle bacillus, coughed or sneezed into the air by a person who contains virulent tubercle bacilli, and inhaled. |
| Clinical Manifestations of TB are? | NIGHT SWEATS, daily recurring fever with chills, hemoptysis, weight loss, weakness, productive cough. |
| Nursing Interventions and Patient Teaching for TB are? | AFB isolation and precautions. Room with negative air pressure. Air flowing in, no air flowing out.Develop supporting relationship with patient. Teach patient proper disposal and hand washing, coughing, sneezing techniques. Adhere to medication regimen. |
| Medical Management :Active TB requires what course of drug ingestion? | 6- 9 months minimum and often longer to stop the disease. Drug therapy. Treatment usually consists of at least three or four drugs to avoid resistancy. Ionized drugs(INH). Rifampin(rifampicin). |
| High risk groups for TB are? | Individuals with incompetent immune systems, such as HIV-infected people , older adults,people receiving immunosuppressive therapy, and the malnourished, Residents of long-term care facilities, nursing homes, prisons, low-income, health care workers exc. |
| What is the difference between TB infection and active disease? | TB infection is characterized by mycobacteria( not micro) in the tissue of a host who is free of clinical signs and symptoms and who demonstrates the presence of antibodies against the mycobacteria. 10% of infections progress into active disease. |
| Clinical manifestations of inhalational anthrax resemble? | The common cold or influenza, except that the patient usually does not develop an increased amount of thing, clear, nasal exudate. Susequent breathing problems may be mistaken for pneumonia. |
| INH Isoniazid (Nydrazid, others) | Action :antitubercular agent. |
| Rifampin( Rifadin, Rimactane) | Antitubercular agent. |
| Pneumonia | Inflammatory process of the respiratory bronchioles and the alveolar spaces that is caused by an infection.Can also be caused by oversedation, inadequate ventilation, or aspiration. Often winter and early spring. Most common in infants and older adults. |
| High risk groups for Pneumonia are? | Whose normal respiratory defense mechanisms are damaged or altered,COPD, influenza, recent tracheostomy, recent anesthesia, diseases affecting antibody response. Alcoholics( increased danger of spiration).Delayed white blood cell response to infection |
| Clinical Manifestations of Pneumonia are? | Severe chills, elevated temperature, increased heart and respiratory rates may accompany the painful, productive cough, Color and consistency of sputum depends on the type present. |
| Pneumonia type :Streptococcal, pneumoncoccal signs and symtoms | Sudden onset. Rust colored sputum, fever like symptoms, crackles friction rub, hypoxemia, syanosis. Sputum culture needed to determine causative agent. |
| Pneumonia type:Staphylococcal: | Many of the same signs as streptococcal except salmon colored sputum. |
| Pneumonia type: Klebsiella: | Many same signs and symptoms as streptococcal; onset more gradual; more bronchopneumonia( inflammation of the terminal bronchioles and alveoli). If treatment delayed beyond second day after onset patient becomes critically ill and mortality rate is high. |
| Pneumonia type: Haemophilus | Commonly follows upper respiratory tract infection; low -grade fever; croupy cough; malaise; arthralgias; yellow or green sputum. |
| Pneumonia type: Mycoplasmal | Gradual onset; headache; fever; malaise, chills cough, severe and nonproductive cough; decreased breath sounds and crackles; chest radiograph clear; white blood cell count normal. |
| Pneumonia type: Viral | Signs and symptoms generally mild; cold symptoms, headache; anorexia; myalgia( tenderness or pain in muscles); irritating cough that produces mucopurulent or bloody sputum. |
| In older adults symptoms of pneumonia are often | Atypical , fever cough and purulent sputum may be absent. Lethargy, disorientation, dyspnea, tachypnea, chills, chest pain and vomiting as well as unexpected exacerbation of coexisting conditions should be viewed with suspicion. |
| Pseumonia and adequate hydration: | Go hand in hand because it helps liquefy secretions and promotes expectoration. |
| The most common bacterial pneumonia? | Streptococal |
| Bronchiectasis | Is a disease characterized by abnormal permanent dilation of one or more large bronchi. This dilation eventually destroys muscular elements and bronchial elastic that supports bronchial wall. |
| Clinical manifestations of Bronchiectasis | Dyspnea, cyanosis, clubbing of fingers. Paroxysms of coughing in the morning. Foul smelling sputum. Fatigue weakness. Loss of appetite. |
| Medical management of Bronchiectasis | Antibiotics. Oxygen may be ordered at a low flow volume. Mucolytic agents( acetycysteine)Surgical removal of patients lung is the only cure. |
| Nursing interventions for Bronchiectasis | Cool mist vaporizer to provide humidity. Increase oral intake of fluids to aid in secretion or removal. Assess vital signs every 2-4 hours . Suction patient as needed. Assist with chest physiotherapy. |
| SARS is caused by what virus? | The corona virus |
| The proper medical method to prevent spread of infection with SARS is to.. | Place infected patients in isolation including use of appropriate disposable particulate respirator to protect other patients and care workers. |
| Pneumothorax | is a collection of air or gas in the pleural space causing the lung to collapse. It can be secondary to a ruptured bleb on the lung surface( as in emphysema or a severe coughing episode. |
| Anatomy of the lung | Trachea-->right/left bronchus--->Bronchioles-->right and left-->superior, middle and inferior lobe-->terminal bronchioles/alveolar ducts-->alveoli(alveolus) |
| Function of respiratory system | Performs external respiration to exchange 02/c02 with environment. Performs internal respiration to exchange 02/c02 for the cardiovascular system to transport to and from the cells. |
| Pleural Effusion/ Empyema Etiology/ Pathophysiology | Once pleural lining inflamed, fluid can accumulate in plural space. Usually a secondary problem. Occurs when physiologic pressure in the lungs and pleurae are disturbed. |
| Clinical Manifestations of Pleural Effusion/empyema | Associated with Pancreatitis, cirrhosis of the liver, pulmonary edema, CHF, Kidney disease. Usually a result of bacterial infection. Persistent fever despite antibiotics. |
| Medical Management for Pleural Effusion/empyema | Thorancentesis. Fluid removal less than 1300 to 1500 mL at one time. Tubes, closed system, water seal drainage, antibiotics. |
| Nursing Interventions for Pleural Effusion Empyema | Frequent oral care. Keep mucous membranes moist. Encourage coughing, deep breathing, ensure patency of chest tube system maintained. Sterile dressings for thorancentesis. |
| COPD can lead to which abnormal condition characterized by hypertrophy of the right ventricle of the heart as a result of hypertension of the pulmonary circulation? | Cor pulmonale can be caused by this condition. |
| Results of cor pulmonale are... | Edema in the lower extremities, sacral and perineal areas, distended neck veins and enlargement of liver ascites. |
| COPD -Chronic Obstructive Pulmonary Disease | Is a chronic respiratory condition that obstructs the flow of air to or from patients bronchioles. |
| With Emphysema the walls of | alveoli are torn and can not be repaired. Alveoli fuse into large air spaces. |
| With Chronic bronchitis | Air tubes narrow as a result of swollen tissues and excessive mucus production. |
| With Asthma | Edema of respiratory mucosa and excessive mucus production obstruct airways. |
| Cigarette smoking is the most common cause of what condition? | Emphysema and Chronic Bronchitis. |
| Heredity Emphysema | Caused by deficiency of alpha antitrypsin( ATT). Lung protective protein produced by liver which inhibits neutrophil elastase in lungs. |
| Normal PH of blood is | 7.35 to 7.45. Deviation from this range causes patient to develop acidosis or alkalosis. |
| The more carbon dioxide is in the blood | the more acidic the blood becomes. After exhalation blood becomes more alkaline. |
| Signs of Hypoxia and Symptoms( page 1616 table in text) | apprehension, anxiety, decreased ability to concentrate, disorientation, decreased LOC, vertigo, behavioral changes, elevated blood pressure, pallor, clubbing, dysrhythmias. |
| Blood gas analysis | essential test in diagnosing and monitoring patients with respiratory disorders. |
| Clinical Manifestations of Emphysema | Little sputum production , but later it becomes copious. Barrel chested( an increased anteroposterior diameter caused by overinflation) and begins using accessory muscles for breathing. |
| An Outstanding Feature of Emphysema | Clubbing of the fingers as well as lateral and longitudinal curvature of the nails accompanied by soft tissue enlargement, presenting a bulbous, shiny appearance. |
| A therapeutic position for the patient with COPD | to lean the head forward, with the head tilted and the arms resting on the patients legs or table. Expiration is prolonged as the patient forces breath through obstructed airways. |
| Some medical management of Emphysema or COPD | oxygen therapy, bronchodilators, beta-adrenergic agoniists, short acting albuterol, long acting salmeterol or theophyllines. Anticholinergics, corticosteroids( with antibiotic) Diuretics. |
| COPD diet | High calories and protein. 5-6 meals a day. Oral fluid intake 2-3 L/day. Encourage patient to drink fluid between means instead of during to reduce gastric ditention and pressure on diaphragm. |
| How often should a patient with COPD have specific vaccinations? | Yearly influenza vaccine. Pneumococcal revaccination every 5 years. |
| Chronic Bronchitis | Is characterized by recurrent chronic productive cough for a minimum of 3 months a year for at least 2 years. Caused by physical or chemical irritants and recurrent infections. |
| Impairment of cilia not being able to move secretions is a good indication of what condition? | Chronic Bronchitis. |
| Hypercapnia( greater than normal amounts of carbon dioxide in the blood) is common in what condition, due to increased airway resistance and bronchospasm? | Bronchitis |
| A common Characteristic of Bronchitis is | Reddish Blue skin |
| Medical Management of Bronchitis | Bronchodilators, beta adrenergic agonists, short acting albuterol, long acting salmeterol, corticosteroids, theophyllines, anticholinergics, erythromycin. |
| Pulmonary embolism usually occurs in patients who | have had prior thrombophlebitis, who have recently had surgery, been pregnant, , given birth, who are taking contraceptives on a long- term basis; and those with a history of CHF obesity, or immobilization from fracture. |
| Deviated Septum and Nasal Polyps | Common conditions that cause nasal obstruction caused by congenital abnormality, or more likely injury. The septum deviates from the midline and can partially obstruct the nasal passageway. |
| Clinical manifestations of nasal septal deviations are | polyps and stertorous( charecterized by a harsh snoring sound( respirations, dyspnea , and sometimes postnasal drip. |
| Medical management of Deviated Septum and Nasal Polyps | Often needs surgical correction. Nasoseptoplasty is the operation of choice, to reconstruct, align and straighten the deviated nasal septum. Nasal packing to control bleeding for 24 hours. Light layer of petroleum jelly or nasal irrigation of saline. |
| Nursing Interventions for Deviated Septum | Maintain airway patency and prevent infection, hemorrhage and maintaining patient comfort. |
| Clinical manifestations of Antigen Antibody Allergic Rhinitis and Hay Fever include | edema, photophobia, excessive tearing, blurring of vision, pruritus. Excessive secretions or inability to breathe through the nose because of congestion or edema. Otitis media symptoms can occur if eustachain tubes are occluded. |
| Medical Management of Antigen Antibody Allergic Rhinitis and Hay Fever include | Corticosteroids, antihistamines, leukotriene receptor antagonists like zafirlukast( Accolate) or montelukast( Singulair),. Decongestants for 3 to 5 days like Phenylephrine, pseduoephedrine, chlorpheniramine and phenylpropanolamine. |
| Nursing interventions for Antigen- Antibody Allergic Rhinitis and Hay Fever. | These illnesses are self limiting so focus on health promotion and maintenance teaching to provide for self-care management. Include ways to avoid allergens, self- care management through symptom control, and medication action and usage. |
| Obstructive Sleep Apnea(OSA) | Is characterized by partial or complete upper airway obstruction during sleep, causing apnea and hypopnea. Apnea is the cessation of spontaneous respirations; hypopnea is abnormally shallow and slow respirations. |
| What exactly happens with (OSA) Obstructive Sleep Apnea? | Airflow obstruction occurs when the tongue and soft pallet fall backward and partially or completely obstruct the pharynx. The obstruction may last from 15 to 90 seconds. During the apneic period, the patient experiences severe hypoxemia and hypercapnia. |
| Clinical manifestations of Sleep Apnea Include | Frequent awakening at night, insomnia, excessive daytime sleepiness, and witnessed apneic episodes. Patients bed partner complains of snoring so they both can't sleep in the same room, headache, personality changes, hypertension, right sided heart failure |
| Apnea arousal cycles occur | As many as 200 to 400 times during 6 to 8 hours of sleep. |
| Risk Factors for Sleep Apnea Include | Older age( more common men 65 and up), obesity when the pharynx infiltrated with fat and the tongue and soft palate enlarged, crowding air passages. Short thick neck(17 inches) Nasal conditions, Pharngeal structural abnormalities, Receding chin. |
| Medical Management and nursing Intervetions for Sleep Apnea | avoid alcoholic beverages 3-4 hours before sleep, weight loss, nCPAP machine, biPAP machine. Surgical procedures like uvulopalatosplasty, pharynogoplasty or UPPP( yes three ps's) |
| Cancer of the Larynx | Squamous cell carcinoma is caused by prolonged tobacco use, heavy alcohol use, chronic laryngitis, vocal abuse, and family history. |
| Medical Management of Cancer of the Larynx | determined by the extent of tumor growth. If the tumor is confined to the true cord without limitations of cord movement than radiation therapy is the best course of treatment. Full or partial laryngectomy to remove diseased vocal cord. |
| Acute Rhinitis | ( or acute coryza), known as the common cold. Is an immflammatory condition of the mucous membranes. Caused by one or more viruses; may become complicated by bacterial infection. signs and symptoms occur 24 to 48 hours after exposure. |
| SARS is spread by | touching contaminated objects and droplets in the air. |
| Clinical manifestation of SARS | Fever greater than 100.4 F, headache , overall feeling of discomfort and muscle ages. After 2-7 days , SARS patients may develop a dry cough, shortness of breath, difficulty breathing and hypoxia. |
| Nursing interventions for SARS | Respiratory isolation with meticulous hand hygiene. When patients respiratory status returns to baseline, he or she is discharged home. The patient can go out in public and return to work 10 days after fever has resolved and respiratory symptoms are gone |
| Legionnaries Disease | Legionella pneumophila is a gram negative bacillus previously not recognized as agent of human disease. It causes a life threatening pneumonia. progresses less than 1 week. Results in resp failure, rental failure, bacteremic shock and death. |
| The bacterial legionella pneumophila organism that causes a severe pneumonia can thrive in | Water reservoirs like air conditioners, humidifiers, whirlpool spas. It is transmitted through airborne routes. |
| Medical management of Legionnaries disease | Assisted ventilation requiring intubation through oral or nasal airway. Possible temporary renal dialysis, oxygen therapy, IV fluid therapy, Antibiotic agents( erythromycin IV admin.,Rifampin. Antipyretics, vasopressors and analgesics. |
Created by:
Nursegirl29