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Med Surg 1


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