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Adventitious abnormal sounds superimposed on breath sounds.
Atelectasis collapse of alveoli, preventing the respiratory exchange of carbon dioxide and oxygen.
Bronchoscopy visual examination of the larynx, trachea, and bronchi, using a standard rigid, tubular flexible fiberoptic bronchoscope.
Coryza acute inflammation of the mucous membranes of the nose and accessory sinuses, usually accompanied by edema of the mucous membranes and nasal discharge
Crackles short, discrete, interrupted crackling or bubbling sounds; most commonly heard upon inspiration.
Cyanosis slightly bluish, gray, or dark purple discoloration of the skin, resulting from the presence of abnormally reduced amounts of oxygenated hemoglobin in the blood.
Dyspnea shortness of breath or difficulty in breathing; may be caused by disturbances in the lungs, certain heart conditions, and hemoglobin deficiency
Embolism obstruction of blood vessel by a foreign substance; blood clot, fat, or air.
Empyema accumulation of pus in a body cavity, especially the pleural space, as a result of an infection
Epistaxis hemorrhage of the nose; nosebleed.
Exacerbation an increase in the severity of a disease or disorder, marked by an increase in signs and symptoms
Extrinsic caused by external factors
Hypercapnia greater than normal amounts of carbon dioxide in the blood.
Hypoventilation an abnormal condition of the respiratory system that occurs when the volume of air inhaled is not adequate for the metabolic needs of the body
Hypoxia an inadequate, reduced tension of cellular oxygen
Intrinsic caused by internal factors
Orthopnea an abnormal condition in which a person must sit or stand in order to breathe comfortably or deeply (often measured by how many pillows a patient needs to sleep at night).
Pleural Friction Rub low-pitched, grating or creaking lung sounds that occur when inflamed pleural surfaces rub together during respiration
Pneumothorax collection of air or gas in the pleural cavity which causes the lung to collapse.
Sibilant wheeze musical, high-pitched, squeaking or whistle-like sound caused by rapid movement of air through narrowed bronchioles
Sonorous wheeze low-pitched, loud, coarse, snoring sound
Stertorous pertaining to respiratory effort that is strenuous and struggling, this creates a snoring sound
Tachypnea an abnormal rapid rate of breathing
Thoracentesis surgical perforation of the chest wall and pleural space with a needle for the aspiration of fluid for diagnostic or therapeutic purposes.
Virulent power of microorganism to produce disease
What is an empyema? Accumulation of pus in a body cavity, especially the pleural space, as a result of an infection
Pharynx-Three subdivisions Nasopharynx Oropharynx Laryngopharnx
External Respiration Exchange of oxygen and carbon dioxide between the lungs and the environment
Internal Respiration Exchange of oxygen and carbon dioxide at the cellular level
Upper Respiratory Tract Nasolacrimal ducts (tear ducts) Turbinates Sinuses Smell Receptors Nose
Pharynx 1)Nasopharynx: most superior portion and contains the adenoids. 2) Oropharynx: posterior to mouth and contains the tonsils. 3)Laryngopharynx: directly superior to larynx. Eustachian Tubes
Larynx: voicebox Connects the pharynx with the trachea and contains the vocal cords: opening between the vocal cords is the glottis.* Supported by nine rings of cartilage
Nasopharynx most superior portion and contains the adenoids
Oropharynx Posterior to mouth and contains the tonsils
Laryngopharnx Directly superior to larynx
Eustachian tubes Inner lining of the pharynx continuous with the eustachian tube A common area of infection in children
Trachea: windpipe. Tubelike structure, containing C-shaped cartilaginous rings, that extends to the midchest where it divides into the right and left bronchi
Bronchial Tree: Left Bronchus Right Bronchus
Bronchioles smaller branches of the bronchi
Epiglottis Protects the larynx when swallowing Covers the larynx tightly to prevent food from entering the trachea
What is part of the upper respiratory tract? Pharynx Larynx Nose Bronchi Trachea Bronchi: located in the lower respiratory tract
What would be subjective respiratory data? Shortness of Breath (SOB). Dyspnea on Exertion (DOE). Cough
Objective Data Chest movement and expansion Clues of distress Flaring nostrils Retractions of chest wall between the ribs and under the clavicle during inspiration. Auscultation Orthopnea
Oxygen Element of oxygen is colorless, odorless, and tasteless gas that will not burn or explode
Hypoxia Inadequate oxygen at the cellular level
Hypoxia S/S Apprehension, Anxiety, restlessness Decreased ability to concentrate Disorientation, decreased LOC Increased fatigue, vertigo
Hypoxia, Hypoxemia, Cyanosis Behavioral changes Tachy/Bradycardia Respirations increased if not corrected shallow & slowed B/P up, if 02 deficiency is not corrected, blood pressure will decress Cardiac dysrhythmias Pallor, cyanosis, dyspnea Clubbing (chronic hpoxia) Dyspnea
Hypoxemia Decreased O2 in the blood Signs and symptoms Pallor, cyanosis, dyspnea Anxiety Decreased level of consciousness
Cyanosis a blue discoloration caused by O2 defieciency
Cyanosis-Signs and symptoms Pallor Dark skinned individuals may have a grayish skin color
Identify Precautions for Oxygen Therapy Precautions Fire Smoking Advice patient not to smoke while receiving any form of oxygen Avoid open flames and smoking areas Turn off O2 when not in use Post sign oxygen in use No lighters, matches, candles, wool blankets or nylon
Precaution of Oxygen Fire/smoking signs,Precaution of Oxygen,Drying of tissue
Define hypoxia Hypoxia is inadequate oxygen at the cellular level
Safty precautions for the use of oxygen Advoid use of electrical appliances * Administer oxygen as ordered by the physician Increased pulse then brady Elevated B/P then drop
symptoms of hypoxia. Signs and symptoms Apprehension, anxiety, restlesslessness Decreased ability to concentrate Disorientation, decreased level of consciousness Increased fatigue, vertigo Behavioral changes
Define bronchitis: Inflammation of the mucous membranes of the major bronchi and their branches
Bronchitis is usually secondary to what? Upper respiratory infections
List 3 clinical manifistations of bronchitis *Productive cough *Low grade fever *Diffuse rhonchi/wheezes, dyspnea *Chest pain *Generalized malaise, and headache
What causes legionnaires disease? Legionella Pneumophilia (Gram-negative)
Legionaires disease progresses on what two courses? Influenza *Legionella disease (results in life threatening pneumonia)
List 3 clinical manifistations of legionaires disease Significantly elevated temperature 102f - 105f (38.8c - 40.5c) *Headache *Diarrhea *General malaise *NONPRODUCTIVE cough with tachypnea *crackles and wheezing *Signs of shock *HEMATURIA indicating renal failure
Antagonist Any drug that exerts an action opposite to that of another or competes for the same receptor.
Anticholinergic (parasympatholytics Drugs that block the action of acetylcholine and similar substances at acetylcholine receptors, resulting in inhibition of the transmission of parasympatheric nerve impulse
Acetylcholine controls what? Acetylcholine controls many bodily functions not under voluntarily control, including sweating, balancing, pupil dilation, contraction of bladder muscles, digestion and salivation.
Acetylcholine drug uses? allergies, motion sickness, coughs and colds, nausea, overactive bladder, diarrhea and overactive bladder
Antihistamines Substance capable of reducing the physiologic and pharmacologic effects of histamine, including a wide variety of drugs that block histamine receptors.
Antihistamines control (manageage) Antihistamines refer to a type of medication used to manage such allergy manifestations as a runny nose, itchy or watery eyes, nasal congestion, chest congestion, itching, a rash and sneezing.
Antitussive A dug that reduces couhing, often inhibiting neural activity in the cough center of the Central Nervous System.
Corticosteroids Any of the hormones produced by the adrenal cortex, either in natural or synthetic drug form
Decongestants Decongestants open nasal passages regardless of the cause by shrinking blood vessels.
Expectorants Drugs that aid in the expectoration (i.e., coughing up and spitting out) of excessive mucus accumulated in the respiratory tract by breaking down and thinning out the secretions.
EPISTAXIS Bright red bleeding from the nose caused by congestion of the nasal membranes
Epistaxis:Etiology/Pathophysiology *Frequently caused by injury *Occurs more frequently in men *Either primary or secondary disorder to other conditions *Related to menstrual flow in women *Hypertension
Epistaxis: Clinical Manifestations *Severe nasal hemorrhage, adults can lose up to one liter of blood per hour *Irritation of nasal mucosa, dryness, chronic infection *Vigorous nose blowing
How do antitussives differ from expectorants? *Antitussives work by suppressing cough *Expectorants work by breaking down and thinning secretions, relying on coughs to expel mucus
How do the s/s of pneumonia differ in older adults? s/s of pneumonia often atypical (fever, sputum, cough often absent)
What form of pneumonia carries a poor prognosis? Bacterial aspiration
Your patient informs you that she cannot breathe while lying flat and must sleep with two pillows. You would describe this condition as: Orthopnea
The most definitive method of diagnosing a pulmonary embolism is by performing:____ A pulmonary angiogram
An atopic allergic reaction caused by an antigen-antibody reaction that occurs in the conjunctiva, usually resulting from a contact allergen is called: Allergic conjunctivitis
Which of the following infections is usually bacterial in origin? Acute follicular tonsillitis
Acute follicular tonsillitis, or inflammation of the tonsils is caused by what? airborne or foodborne bacterial infection, often Streptococcus. It can be viral, but this occurs less often.
True or False: Pneumonia os the most common cause of death in North America True
True or False: Deep breathing exercises are discouraged for pneumonia PTs due to the inflammation to the lungs and pleural rub False. Deep breathing/coughing exercises are encouraged to open the airways and clear the lungs of mucous.( it's for increasing lung air volume)
List 2 antibiotics used to treat pneumonia *penicilin *e-mycin *cephalosporin *tetracycline
You are caring for a patient who has been diagnosed with severe acute respiratory syndrome (SARS). Which of the following assessment and/or laboratory data would you expect to see for this patient? A. xx Positive bacterial cultures indicating a serious bacterial infection B. xx Elevated white blood cell count in the early stages of the illness C. **Fever, headache, discomfort, and muscle aches** D. xx Decreased creatinine phosphokinase (CPK) leve
Appropriate nursing care for a patient with pneumonia includes which of the following interventions? *Educate the patient about the importance of handwashing. *Implement interventions to foster the patient's ability to move secretions. *Assist the patient to conserve energy.
What are manifistations of mycoplasmal pneumonia? *Severe, non-productive cough *Crackles *Decreased breath sounds
The presence of infected fluid that accumulated in the pleural space is called: Empyema
While the physician is inserting a central line, the patient suddenly develops acute dyspnea and tachypnea. The physician quickly directs you to "get me a chest tube tray, STAT!" What happening to the patient? Development of a pneumothorax
Appropriate nursing interventions for a patient with chronic obstructive pulmonary disease (COPD) includes D.Encouraging the patient to get the flu vaccination each year and pneumococcal revaccination every 5 years
Pneumonia is a major cause of disease and death in who? Critically ill PTs
What are the manifistations of viral pneumonia? *generally mild s/s *Cold symtoms *Irrating cough that produces mucopurulent or bloody sputm
What form of pneumonia commonly follows a URI? Hemophilus
What are manifistations of Streptoccocal /pneumococcal pneumonia? Rust colored sputum; possible friction rub
What are manifistations of Hemophilus pneumonia? *Croupy cough *Arthralgias (joint pain) *Yellow or green sputum
List 3 causes of pneumonia *Bacterial pneumonia *Aspiration pneumonia *Viral pneumonia *Fungal *Chemical
list 3 clinical manifistations of pneumonia *Sudden onset of pleurisy *Severe chills *Elevated temperature and night sweats *Painful productive cough *Increased heart rate *Tachypnea with difficult expiration
Epistaxis:Medical Management Nasal packing with cotton saturated with Epinephrine 1:1000 Cautery (electrical or chemical) Posterior packing
A patient with a history of nosebleeds is admitted to the emergency room. The nursing interventions to attempt to stop the nose bleeds are: Have patient sit with head forward monitor color and amount of blood monitor vital signs and apply ice pack and pressure to the nose.
Deviated Septum & Nasal Polyps:Clinical Manifestations Stertorous breathing Dyspnea Postnasal drip
Deviated Septum & Nasal Polyps: Assessment Subjective Data History of: previous injuries Infections Sinus congestion allergies Dyspnea
Deviated Septum & Nasal Polyps: Objective Data Identification and location Rate and character of respirations
Deviated Septum & Nasal Polyps: Diagnostic Tests Sinus x-rays Visual examination
Deviated Septum & Nasal Polyps: Surgical correction: Nasoseptoplasty: reconstruct, align and straighten the nasal septum Nasal polypectomy: remove polys Nasal packing: control bleeding for 24 hours Nasal mucosa hydration: irrigation or application of petroleum
Nursing care for a patient after surgery for a deviated septum would include? Elevate HOB, apply ice compresses to the nose to decrease edema, discoloration, discomfort, and bleeding
Lung Cancer:Diagnostic tests Chest X-Ray CT MRI Bronchoscopy Needle aspiration Biopsy Mediastinoscopy Scalene lymph node biopsy
Lung Cancer:Medical management- depends on type and stage of lung cancer Estimated 1/3 of patients inoperable when first diagnosed Another 1/3 found inop during exploratory thoracotomy Surgical treatment-1/3 experience tumor spread
Lung Cancer: Surgical treatment Pneumonectomy Lobectomy Segmental resection Video assisted thorascopic surgery Radiation and chemotherapy SCLC chemotherapy
Lung Cancer: Nursing diagnosis and interventions Airway clearence ineffective r/t lung surgery Facilitate optimal breathing Encourage ambulation Position changes Cough deep breathe Assess breath sounds
Lung Cancer:Nursing diagnosis and interventions(cont) Fear r/t cancer treatment and prognosis*Explain treatments and procedures Listen to the pt, accept feelings of anger Encourage verbalization of feelings Supportive services Monitor for s/s of worthlessness, anxiety, powerlessness
Pulmonary Edema: Etiology/Pathophysiology Accumulation of serous fluid in interstitial lung tissue and alveoli Results from Severe left ventricular failure Inhalation of irritating gases Rapid administration of I.V. fluids Barbiturate and opiate overdose
Pulmonary Edema Serous fluid forced into alveoli Gas diffusion severely affected Acute Can lead to death if untreated. (forced in < 2hrs it's medical emergency)
Pulmonary Edema:Clinical manifestations Dyspnea Tachypnea Tachycardia Hypoxia, cyanosis Pink frothy sputum Restlessness, agitation
Pulmonary Edema: Assessment Note c/o dyspnea May express feeling of impending death Assess for signs and symptoms of resp distress Wheezing and crackles Weight gain Decreased urinary output Productive cough with frothy pink sputum
Pulmonary Edema:Diagnostic tests CXR, ABG (respiritory acidosis)
Pulmonary Edema: Medications Oxygen therapy Lasix Morfine sulfate Nipride (Nitroprusside) Digoxin
Pulmonary Edema: Nursing interventions Assess respiratory status frequently O2 therapy Volume status Patient teaching Prognosis
Pulmonary Embolus: Clinical manifestations Chest pain(sever&sudden) Dyspnea Tachypnea Hemoptosis Diminished lung sounds Elevated temperature Hypotension Regional bronchoconstriction, Atelectasis Pulmonary edema, decreased surfactant
Pulmonary Embolus: Assessment Note degree of dyspnea and chest pain Identify risk factors Observe for: Plueritic chest pain Nature of cough Tachypnea, tachycardia, hypotension Crackles, decreased breath sounds Plueral friction rub, anxiety, air hunger
Pulmonary Embolus: Diagnostic tests ABG’s CXR CT angiogram V/Q scan Pulmonary arteriogram D-dimer Venous ultrasound
Pulmonary Embolus: Medical management Medications Anticoagulants Thrombolytics Filter device Embolectomy
Pulmonary Embolus: Nursing interventions Assess sensorium Monitor cardiorespiratory status DVT treatment Assess for signs of bleeding Patient teaching Prognosis- 30% mortality rate if untreated. 5% mortality with early diagnosis and treatment
ARDS (acute respiratory distress syndrome):Etiology/Pathophysiology Also called non-cardiogenic pulmonary edema Secondary to an acute disease process, a syndrome of pulmonary shunting , hypoxemia, reduced lung compliance and parenchymal lung damage (functional part of lung)
ARDS:Causes Pneumonia Chest trauma Aspiration Inhalation injury Near drowning Fat emboli Sepsis (most common cause) Shock Overdoses, renal failure, pancreatitis
ARDS: Pathophysiology Surface of alveolar capillary membrane becomes altered Fluid leaks into the interstitial space and alveoli Results in pulmonary edema and hypoxia Alveoli lose elasticity and collapse Pulmonary artery hypertension
ARDS:Clinical manifestations Usually manifests in 12-24 hours post surgery Respiratory distress with altered breath sounds within 5-10 days Altered sensorium Tachycardia
ARDS: Assessment Obtain background information Observe changes in patients condition Assess respiratory rate rhythm and effort Assess for nasal flaring, retractions, or cyanosis Assess for crackles and wheezing Assess level of consciousness
ARDS:Diagnostic tests Pulmonary functions tests ABG’s CXR
ARDS: Medical management focuses on supportave treatment by maintaining adequate oxygenation and treating the cause
ARDS: Medications Diuretics Morphine sulfate Digoxin Antibiotics Ventilatory support Nitric oxide
ARDS: Nursing interventions and patient teaching Goal: Provide adequate oxygenation and ventilation and treat multi system response to ARDS Monitor respiratory status Assess vital signs Position patient to facilitate optimal ventilation Turn cough deep breath
ARDS: Nursing diagnosis Gas exchange impaired r/t tachypnea Breathing pattern, ineffective r/t respiratory distress
ARDS: Nursing interventions Monitor ABG’s Monitor for restlessness Administer oxygen Report v/s changes and L.O.C. Assess respiratory rate rhythm and effort Proper positioning Maintain airway patency and promote C/DB
Mucolytics A mucolytic is a drug that loosens respiratory secreations. Use: Bronchitis. Cystic Fibrosis. COPD. Atelectasis. Acetaminophen toxicity.
Mucolytics:Actions: Decreases viscosity of secretions by breaking disulfide links of mucoproteins. Serves as a substrate in place of glutathione, which is necessary to inactivate toxic metabolites in acetaminophen overdose. Example: acetylcysteine (Acetadote, Mucomyst).
Mucolytics Contraindications: Hypersensitivity. Increased intracranial pressure. Status asthmaticus.
Mucolytics Precautions: Pregnancy. Hypothyroidism. Addison’s Disease.
Mucolytics Precautions Con’t CNS depression. Brain tumor. Asthma. Renal / heptic disease. COPD. Psychosis. Alcoholism. Convulsive disorders. Breastfeeding.
Mucolytics Side Effects CNS: dizziness, drowsiness. CV: hypotension. EENT: rhinorrhea. GI: nausea, stomatitis, constipation, vomiting, anorexia, hepatotoxicity. Integ: urticaria, rash, fever, clamminess, pruritus. Resp: bronchospasm, hemoptysis, chest tightness.
Mucolytics:Interactions Do not use with iron, copper, rubber. Do not mix with antibiotics. Increases the effects of nitrates
Mucolytics Nursing Implications Assessment: Cough: type, frequency, character, including sputum. VS: resp rate, rhythm, increased dyspnea. CV: dysrthythmias. Lab Tests: ABGs (increased CO2: asthma).
Mucolytics Nursing Implementation Administration (PO): Mix with soft drinks to disguise taste. (Give within one hour). Give ½ - 1 hour before meals for better absorption and to decrease nausea. Assistance with inhaled dose: bronchodilator if bronchospasm occurs.
Mucolytics Nursing Implementation Antidotal: within 24 hours. Store in refrigerator (up to 96 hours after opening). Gum, hard candy, frequent rinsing of mouth for dryness of oral cavity
Mucolytics Patient Teaching About mucolytic use. Unpleasant odor will decrease after repeated use. Discoloration of solution after opening, does not affect effectiveness of medication. Report vomiting, since dose may need to be repeated.
Mucolytics Evaluation Absence of purulent secretions. Absence of hepatic damage in acetaminophen toxicity.
What is the action of Mucolytics? Loosens respiratory secretions. Reduces the viscosity of respiratory secretions by direct action on the mucus.
Emphysema;Etiology (1) Symptoms develop when a patient is in their 40s progressing to disability in the 50s and 60s. (2) Characterized by changes in alveolar walls and capillaries (See p. 1692 Figure 49-15, C).
Emphysema: Pathophysiology Aveolar distention Alveoli losing their elasticity Blebs Capillary beds replaced with scarring Hypoxia and hypercarbia
Emphysema:Causes Primarily cigarette smoking Air pollution Age May lead to cor pulmonale
Emphysema: Clinical Manifesta Exertional dyspnea Sputum Use of accessory muscles Spontaneous pursed-lip breathing Development of barrel-chest Wheezing Chronic weight loss
Assessment History Tachycardia Tachypnea Peripheral cyanosis Clubbing of fingers Lung examination
Emphysema Medical Management Medications Bronchodilators Antibiotics Corticosteroids Diuretics Oxygen therapy Anti-anxiety agents
Emphysema: NURSING INTERVENTIONS Activity intolerance, related to imbalance between oxygen demand, secondary to inefficient work of breathing
Emphysema: NURSING INTERVENTIONS ) Organize care so patient can have periods of uninterrupted rest 2) Advise patient to rest 30 minutes before meals 3) Assist patient with ADLs and exercises to increase stamina 4) Asses patient’s respiratory response to activity
Emphysema:Patient teaching Focus on optimizing nutrition and smoking cessation Nutrition Smoking cessation Infection control Relaxation techniques*COPD is usually irreversible and is the fourth leading cause of death in the US
Chronic Bronchitis Recurrent chronic productive cough for a minimum of three months for at least two years Chemical irritants or bacterial or viral infection Smoking is the most common cause
Chronic Bronchitis Clinical Manifestations Dyspnea Cyanosis and right ventricle failure Polycythemia Cyanosis Dependant edema Productive cough (mostly morning)
Chronic Bronchitis Assessment Assess cough Assess severity of dyspnea Auscultation for presence of wheezing Asses patient’s anxiety/restlessness level Vital signs
What are indications for spirometry? Asymetric chest wall movement, increased resp* Rate, increased production of sputum, diminished lung expansion postoperatively
What is called procedure in which a device (spirometer) is used at the bedside at regular intervals to encourage the patient to breath deeply? Incentive spirometry
How many ml is tidal capacity of inspired air at rest? 500 ml
Three common types of bronchialdilators Anticholinergics Beta- Adrengeric Angonist (Sympathomimetics)- Xanthines (zanthines)
What organ do Beta-1 blockers primarily effect? The heart
What organ do Beta-2 blockers primarily effect? The lungs
Acetylcysteine (Mucomyst): Action- Mucolytic agent; also used as antidiote in acetaminophen overdose
Acetylcysteine (Mucomyst): Side Effects Nausea* vomiting *rhinorrea* mucorrhea* bronchospasm
What are non-selective adrengerics? effect beta-1 and beta-2
What is the most severe of the pneumoconioses? Asbestosis
When teaching the patient about albuterol sulfate (Proventil), the nurse should explain that it may cause______ Nervousness
In a acute rhinitis, nasal drainage normally is______ Clear
Created by: ninja3lake