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Med Surg 1
Respiratory
| Question | Answer |
|---|---|
| What are the tiny hairs that act as filters in the respiratory tract called? | Cilia |
| What connects to the nasal cavity? | Sinuses |
| What spreads to the sinuses? | Nasal infections |
| What lines the nose and sinuses? | Mucous membranes |
| How much fluid do you encourage a patient to drink when they have a respiratory infection? | 2-3L/day |
| What are the three divisions of the Pharynx (throat)? | Nasopharynx, Oropharynx, Laryngopharynx |
| Where is the Nasopharynx located? | Back of nasal passages above the throat |
| What structures make up the oropharynx? | Mouth and throat |
| Where is the Laryngopharynx located? | Above the larynx (voice box) |
| The trachea is lined with cilia, what is the purpose of the cilia? | Sweep mucous toward the throat |
| Why can't a patient speak when they have a tracheostomy? | No air flows over the vocal cords to emit vibrations |
| What must you have at the patients bed side when they have a tracheostomy? | Pen & paper |
| What position should a patient with a tracheostomy be in? | Mid-fowlers |
| How many lobes does the right lung have? | Three |
| How many lobes does the left lung have? | Two |
| Where is the cardiac notch located? | Left lung |
| What is the purpose of the cardiac notch? | Allows heart to sit in thoracic cavity without impeding lung function |
| Where does gas exchange occur? | Alveolar |
| What gases are exchanged in the alveoli? | Oxygen & carbon dioxide |
| What lines the surface of the lungs? | Visceral pleura |
| What lines the chest cavity? | Parietal pleura |
| Where is the diaphragm located? | Below the lungs, attached to the lowest rib |
| What happens when the diaphragm and intercostal muscles contract? | Inspiration (inhalation) |
| What happens when the diaphragm and intercostal muscles relax? | Expiration (exhalation) |
| What type of pressure is created when the diaphragm and intercostal muscles contract? | Negative, allowing air to be pulled in |
| What happens to the air when the diaphragm and intercostal muscles relax? | Air is forced out |
| What are respirations driven by? | CO2 |
| Where are the chemoreceptors located? | Carotid arteries |
| What do the chemoreceptors do? | Sense changes in oxygen, carbon dioxide, and pH levels in blood |
| Where do the chemoreceptors send messages to? | Brain |
| How do chemoreceptors maintain homeostasis? | Send messages to the brain to change the rate and depth of respirations as needed |
| What are external respirations? | Exchange of oxygen and carbon dioxide between the lungs and environment |
| What is the % of oxygen in the atmosphere that we breathe? | 21 |
| What do the alveoli do to the oxygen and carbon dioxide? | Diffuse |
| What is the waste product that we breathe out called? | Carbon dioxide |
| What is internal respiration? | Exchange of oxygen and carbon dioxide at the cellular level |
| What type of concentrations are the gases exchanged in the capillaries | Equalized |
| What happens to the patient when pH levels fall below 7.4? | Become acidotic |
| When a patient is acidotic, what do they do to maintain homeostasis? | Breathe faster because CO2 levels increase |
| What are the causes of acidosis? | Hypoventilation, drug overdose, pulmonary edema, mechanical ventilation, neuromuscular disease, or airway obstruction |
| What happens to the patient when pH levels increase above 7.4? | Become alkolodic |
| What are the causes of alkalosis? | Anxiety, hyperventilation, initial stages of acute pulmonary problems, mechanical ventilation, or high altitude |
| What is the quickest way to assess oxygenation? | Pulse oximetry |
| What is the normal pulse ox range? | 95%-100% |
| What must you do first when the pulse ox alarm sounds? | Assess patient (never assume it's the equipment) |
| What is the most accurate way to assess oxygenation? | Arterial Blood Gas (ABG's) |
| What is epitaxis? | Nose bleed |
| What is the treatment for epitaxis? | Have patient sit leaning forward with head and shoulders elevated, pinch nose, and monitor blood pressure |
| What type of packing does the physician order for epitaxis? | Ratio of 1:1000 of epinephrine (causes vasoconstriction to reduce bleeding), balloon tamponade, or cautery |
| What is tonsillitis? | Infection of tonsils |
| What is the treatment for tonsillitis? | Tonsillectomy & adenoidectomy (T&A) |
| What is patient care for a patient who has T&A? | Do not give red jello, watch for frequent swallowing, no straws, and no coughing/clearing throat for at least 1 week |
| What are the signs/symptoms of epiglottitis? | Cherry red epiglottis, high fever, and drooling |
| Epiglottitis is considered to be what? | True medical emergency |
| What is the first sign of cancer in the larynx? | Progressive or persistent hoarseness < 2 weeks |
| What is Acute laryngotracheobronchitis also known as? | Croup |
| What is the treatment for croup? | Cool, moist air humidifier |
| What is secondary to Upper Respiratory Infection (URI)? | Bronchitis |
| What are the signs/symptoms of bronchitis? | Narrowed airways, low grade fever, and chest pain |
| What helps thin secretions? | Forcing fluids (2-3L/day) |
| What is COPD? | Chronic Obstructive Pulmonary Disorder |
| What are the names of COPD disorders? | Emphysema, chronic bronchitis, asthma, bronchiectasis, and acute respiratory distress syndrome (ARDS) |
| What are the characteristic of patients with COPD? | Easily fatigued, frequent URI's, and use accessory muscles to breathe |
| What is another name for emphysema? | Pink Buffer |
| What breathing technique do you encourage patients with emphysema to use? | Pursed lip |
| What is the cause of barrel chest? | Trapped air and over inflation of alveoli |
| What is emphysema? | Loss of elasticity and destruction of alveolar walls which decreases area for gas exchange |
| What happens when the bronchioles narrow and trapped air enlarges the air sacs (alveoli) during expiration? | Retention of CO2 |
| What is dyspnea? | Trapped air in alveoli that makes it difficult to breathe |
| What is secondary to air trapping causing the barrel chest appearance? | Hyperinflation |
| What are assessment questions to ask an emphysema patient? | Do you smoke? How many packs/day? How long? Are you exposed to second hand smoke? |
| What are the physical assessments for an emphysema patient? | General appearance, airway/breathing, PFT (pulmonary function test), circulation |
| What drives the COPD disorders? | Oxygen - COPD has high retention of CO2 |
| What oxygen therapy is used in COPD patients? | No more than 2L/nasal cannula |
| Why can't a COPD patient have high flow oxygen? | Will cause respiratory arrest (CO2 necrosis) |
| What knocks out the drive to breathe in a patient with COPD? | Too much oxygen |
| What is patient teaching for a COPD patient? | Diaphragmatic or abdominal breathing, encourage fluids, and conserve energy |
| Describe pursed lip breathing | Inhaling through the nose, then exhale slowly through pursed lips |
| What is the best way for a patient to conserve energy? | Rest 30 minutes before eating, drink between meals, eat 5-6 meals/day that are high in protein (nutrient dense) |
| What is another name for chronic bronchitis? | Blue bloater |
| What type of coloring does a patient with chronic bronchitis have? | Dusky to cyanotic |
| What is the most common cause of chronic bronchitis? | Smoking |
| What is an elevated temperature a sign of? | Acute bronchitis |
| What do you teach bronchitis patients to avoid? | Milk |
| What is asthma? | Reactive airway disease |
| Where does a intrinsic trigger come from in asthma? | Within the body (stress, respiratory infection, fatigue) |
| Where does a extrinsic trigger come from in asthma? | External factors such as allergens (dust, foods, pollen) |
| What is a bronchospasm? | Narrowing of air passages |
| What is asthma? | Obstruction of bronchioles caused by swelling in the lining; increased mucous production which gets trapped in airways |
| What cromolyn sodium is used to prevent the release of substances in the body that cause inflammation? | Inhaled corticosteroids |
| How do steroids work? | Decrease swelling in the airways; always take with foods, an monitor for infections |
| What is theophylline? | Bronchodilator |
| Why must you monitor blood levels when a patient is taking theophylline? | Excessive levels can be toxic |
| What does not responds to usual treatment and is considered a medical emergency? | Status asthmaticus |
| What do you monitor in a patient with status asthmaticus? | Airway, breathing, and circulation (ABC's) |
| What position do you have a patient with status asthmaticus sit in? | Orthopneic |
| What is the treatment(s) for status asthmaticus? | Aggressively and possible ventilator |
| What is a peak flow meter? | Measures air in forced exhalation, good indicator of how lungs are moving |
| What can indicate early signs of a asthma attack? | Peak flow meter |
| What do you teach a patient with asthma to avoid? | Milk/milk products; and to recognize what triggers an attack, avoid those as well |
| What is bronchiectasis? | Obstruction-dilating bronchi and loss of elasticity |
| What are the signs/symptoms of bronchiectasis? | Coughing when laying down, coughing when first rising in the morning, and large amounts of foul smelling sputum |
| What can a patient with bronchiectasis benefit from? | Postural drainage |
| What are interventions for a patient with bronchiectasis? | Cool mist vaporizer, force fluids (2-3L/day), TCDB q 2hrs, and suction as needed |
| What causes Acute Respiratory Distress Syndrome (ARDS)? | Aspiration |
| What occurs as a result of other disease processes? | ARDS |
| ARDS occurs after what specific other disease processes? | Lung damage, hypovolemic shock, sepsis, intubation, and mechanical ventilation |
| What is the supportive treatment for ARDS? | Adequate oxygenation as well as treating the underlying cause |
| What are the factors that affect lung perfusion and expansion? | Pulmonary embolus (PE), lung cancer, atelectasis, pneumothorax, and hemothorax |
| What is a pulmonary embolus (PE)? | Clot that has moved to the lung |
| What are the nursing interventions for PE? | Elevating HOB 30 degrees or more, and position patient on left side |
| What are the medications used to treat PE? | Anticoagulants and thrombolytics |
| What are the nursing observations for PE? | Epitaxis, hemoptysis, and bruising or bleeding |
| What are the top priorities to watch for in PE? | Blood in urine or stool |
| What is a pneumothorax? | Air gets into the pleural cavity and causes the lung to collapse |
| What happens to a patients v/s when they are experiencing a pneumothorax? | Heart rate increases, blood pressure decreases, and they will have no lungs sounds on the affected side |
| What is the main goal when treating a pneumothorax? | Re-expand the lung |
| What is the treatment for pneumothorax? | Chest tube that is attached an underwater seal system |
| What is pleurisy? | Inflammation of the visceral and parietal pleura |
| What are the nursing interventions for pleurisy? | Medications, splint the affected side, and lay on affected side |
| Who are the high risk patients for pneumonia? | Very old and very young |
| What is pneumonia? | Pooling of secretions in lungs, infection spreads from lobe to lobe |
| What are the objective signs in pneumonia? | Crackles on inspiration, diminished breath sounds in bases, and wheezes due to narrow airways |
| What is a pleural effusion? | Accumulation of fluid in the pleural space |
| What is the treatment for pleural effusion? | Thoracentesis to remove fluid and possible chest tube placement |
| What is tuberculosis (TB)? | Chronic pulmonary and extra-pulmonary infectious disease |
| What is the AFB test? | Acid fast bacilli test is a sputum collection that requires the collection of 10 mL of sputum |
| How is TB diagnosed? | Positive chest x-ray, positive MANTOUX, and three positive AFB sputum cultures |
| What are early symptoms of TB? | Fever in the afternoon and slight cough |
| What are the late symptoms of TB? | Night sweats and hemoptysis |
| What is hemoptysis? | Coughing up blood due to eroding blood vessels |
| Why cant you use a standard mask when treating patient with TB? | Bacilli is micro-small and can travel through a standard mask |
| What is the proper mask to wear for TB? | N95 respirator |
| What kind of room is a TB patient placed in? | Negative pressure room that filters air directly outside and not back into facility air circulation |
| What kind of precautions do you use for TB? | Droplet precautions |
| What is the patient teaching for a patient with TB? | Cover nose and mouth, especially when coughing or sneezing; properly dispose of tissues, and to take all medications during treatment period |
| If a patients chest tube is accidentally removed, what do you do? | Immediately place an occlusive sterile petroleum based dressing at incision site, and notify charge nurse/physician |
| How do you know that a chest tube is working correctly? | Water in drainage system will move up and down as the patients inhales and exhales |
| What does it mean if there is no fluctuation of water in the drainage system of chest tube? | Obstruction |
| How do you prevent chest tube reflux? | Never raise the drainage system above the level of patients chest |
| How do you calculate the drainage in chest tube? | Mark level of drainage with date & time, then subtract cumulative total from amount of drainage; this is counted as output |
| Why is mechanical ventilation used? | Overcome a patient's inability to oxygenate adequately |
| What can be intermittent, continuous, short-term, or long-term? | Mechanical ventilation |
| How do you monitor chest expansion? | Watch to make sure it is symmetrical |
| What are ventilator complications? | Hypotension, pneumothorax, subcutaneous emphysema, stress ulcers, muscular deconditioning, and ventilator dependence |
| What is ventilator dependency? | Inability to wean patient from ventilator |
| What are the different medication classes used for the respiratory system? | Antihistamines, bronchodilators, decongestants, mucolytics, corticosteroids, and antitubercular |
| What is an example of a antihistamine? | Benadryl |
| What are the side effects of Benadryl? | Dry mouth and drowsiness |
| What is an example of a bronchodilator? | Theophylline |
| What is the desired effects of bronchodilators? | Relax the smooth muscles in bronchioles |
| What are the nursing actions for Theophylline? | Monitor Theophylline levels in the blood, as too much can be toxic |
| What are examples of decongestants? | Sudafed or Pseudoephedrine |
| What are the desire effects of decongestants? | Decrease nasal congestion and swelling of mucous membranes |
| What are the desire effects of mucolytics/expectorants? | Thin and break up mucous in order to make it easier to cough up secretions |
| What are examples of mucolytics/expectorants? | Guaifenesin, Mucomyst, or Potassium iodide |
| What are antitussives? | Cough medicines |
| What are the desired effects of corticosteroids? | Decrease swelling (anti-inflammatory) |
| What are side effects of corticosteroids? | Sodium and water retention, weight gain, poor wound healing, bruising, and immediate hyperglycemia |
| What do corticosteroids mask signs of? | Infection |
| What are the nursing interventions for corticosteroids? | Taper off slowly, give with food/milk |
| What are examples of antitubercular medicines? | Isoniazid (INH), Rifampin, and Ethambutol |
| What are the desired effects of antitubercular medicines? | Decrease bacilli ability to reproduce |
| What are the nursing actions for antibubercular's? | Assess blood work, avoid alcohol, and give antiemetic's as ordered |
Created by:
tandkhopkins
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