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Respiration ch 21
| Question | Answer |
|---|---|
| In bronchitis what happens to the lower respiratory tract? | It has compromised function |
| What happens when you leave your bronchitis untreated? | Respiratory failure; chronic respiratory disease |
| When you have inflammation and infection in the alveoli and bronchioles what is the outcome? | Impaired gas exchange |
| What is acute bronchitis? | Inflammation of the mucous membranes |
| What is tracheobronchitis? | Inflammatory process involving the trachea |
| What could cause bronchitis? | Viral infection (URI) secondary to bacterial or funagal infection |
| Where are gases exchanged in bronchitis? | Lower respiratory tract |
| What could cause bronchitis? | Chemical reaction |
| What is a better term for pus? | purulent |
| Assessment findings of bronchitis are? | Initially dry cough, fever, chills, malaise, HA |
| Assessment findings later in bronchitis are? | blood streaked sputum, mucopurulent sputum (yellow/green), paroxysmal coughing attacks/possibly wheezing, moist inspiratory crackles |
| How might you diagnosis bronchitis? | sputum sample (culture)to rule out bacteria and chest xray to rule out pneumonia |
| Medical Management of bronchitis is? | promote comfort,rest, increase fluids, use a humidifier and medications |
| What medications would be best utilized for bronchitis? | Antipyretics - fever Expectorants - loosens secretions Antitussives - cough Bronchodilators If secondary bacterial infection occurs use broad spectrum antibiotic |
| As a nurse, what will you do for this patient with bronchitis? | Ascultate breath sounds every 4 hours Use humidification w vaporizer Encourage cough, deep breathe |
| How would a humidifier work for bronchitis? | loosens secretions and decreases cough |
| What would coughing and deep breathing do to help bronchitis patients? | Help expectorate (spit out) sputum |
| What could you teach your client regarding bronchitis? | wash hands frequently cover your cough discard soiled tissues in plastic bag avoid sharing personal articles w others |
| What would happen if you suppressed the cough? | may cause pooling of secretions and lead to further problems |
| Pneumonia is? | inflammatory process affecting the bronchioles and alveoli. Is the 8th leading cause of death in the USA when combined with influenza |
| Pneumonia can result from what other problems? | radiation therapy chemical ingestion or inhalation, aspiration of foreign bodies or gastric contents |
| Atypical pneumonias | radiation pneumonia, chemical pneumonia; aspiration pneumonia |
| Hypoventilation of lung tissue? | Over a prolonged period can occur when a client is bedridden and breathing with only part of the lungs |
| Hypostatic pneumonia is the outcome of? | Bronchial secretions subsequently accumulating |
| Bronchopneumonia | Infeciton is patchy, diffuse, and scattered across both lungs |
| Lobar pneumonia is? | inflammation confined to one or more lobes of the lung |
| Community-Acquired Pneumoia (CAP) | illness acquired in community setting and evident within 48° of admission |
| Hospital-Acquired Pneumonia (HAP)or nosocomial pneumonia | Nosocomial acquired 48° after admission |
| Pneumonia in the Immunocompromised host | pneumocystis carinli fungal pneumonia - tuberculosis |
| Aspiration pneumonia | is when a client inhales a foreign body or gastric content during vomiting or regurgitation |
| How do the organisms that cause pneumonia reach the alveoli? | by inhalation of droplets, aspiration of organisms from the upper airway, or seeding from the bloodstream (less common) |
| Hypoxemia | results from the inability of the lungs to oxygenate blood from the heart |
| Atypical pneumonia | the exudate infiltrates the interstitial spaces rather than the alveoli directly. |
| Atypical pneumonia | is more scattered and increasingly interferes with gas exchange between the bloodstream and lungs. |
| Atypical pneumonia | increases carbon dioxide in the blood stimulates the respiratory center causing more rapid and shallow breathing. |
| Complications of pneumonia include | Congestive heart failure, empyema, pleurisy and septicemia,atelectasis, hypotension and shock |
| empyema | collection of pus in the pleural cavity |
| pleurisy | inflammation of the pleura |
| septicemia | infective microorganisms in the blood |
| When organisms reach the alveoli what happens next? | the inflammatory reaction is intense, produces and exudate that impairs gas exchange. Capillaries surrounding the alveoli become engorged and cause collapse further interfering with ventilation. |
| If this is atypical pneumonia and goes untreated | consolidation occurs as the inflammation and exudate increase. Hypoxemia results from the inability of the lungs to oxygenation blood form the heart. |
| Most pneumonia | has exudate, infiltrate interstitial; scattered infiltrates to impaired gas exchange |
| Potential complications of pneumonia | Hypoxemia, bronchitis, tracheitis necrosis; circulation system compensates then falls r/t hypoxemia (heart rate speeds up then falls)leading to heart failure |
| Potential complications of pneumonia | Empyema, pleurisy, septicemia; endocarditis (travels to the heart), Otitis, bronchitis, sinusitis and death in the elderly and very young due to the weakened immune system |
| Signs and symptoms of bacterial pneumonia | Sudden onset - fever, chills, cough, malaise; productive cough; chest discomfort (muscle) with respiration's; sputum - rust (bacteria) colored |
| Signs and symptoms of Viral pneumonia | Less severe; blood cultures sterile (no growth), sputum is copious; slow pulse and repirations; wekness lasting longer than bacterial up to 2-3 mos; may have secondary bacterial pneumonia |
| What are the diagnostic findings with pneumonia? | wheezing and cyanosis;sputum culture and sensativity; chest film-infiltrates/consolidation; WBC; blood cultures |
| Medical Management for Pneumonia | Hydration to thin secretions; oxygen - Chest physio therapy (CPT; medications; fluid and electrolyte replacements; intubation to mechanical ventilation; if bacterial you need antibiotics |
| Medications for pneumonia | Bronchodilator; antipyretics and analgesics; cough expectorants/suppressants |
| Nursing Management for pneumonia | Monitor lung sounds, arterial blood gases; cough and sputum production, fluid intake and out put, skin turgor, serum electrolytes, oxygenation status |
| Nursing Management for pneumonia | Encourage elderly and at-risk clients to get pneumococcal and flu shots; turn, cough, deep breath, inspirometer use |
| Pleurisy or pleuritis definition | An acute inflammation of the parietal and visceral pleurae. |
| Pleurisy | in the acute phase the pleurae are inflamed, thick and swollen eventually becoming ridgid. |
| Pleurisy what happens on inspiration? | the pleurae rub together causing severe, sharp pain |
| Pleurisy usually is a consequence of a primary condition such as | pneumonia, other pulmonary infections; lung cancer; pulmonary embolism; cardiac and renal disease; systemic infections |
| Assessment findings of pleurisy are | shallow respirations r/t pain; pleural fld increases and pain decreases; friction rubs heard early in dx process disappears as fluid builds up |
| Assessment findings of pleurisy are | dry cough; fatigues easily, dyspnea,Decreased ventilation resulting in atelectasis, hypoxemia and hypercapnia |
| Assessment findings of pleurisy are | Chest xray; sputum culture; thoracentesis for fluid specimen or pleural biopsy |
| Medical Management for Pleurisy | the goal is to comfort; treat underlying condition and meds |
| Medicines for pleurisy | analgesics; antipyretic drugs; non-steroidal anti-inflammatory drug and procaine intercostal nerve block |
| Hypercapnia | an increased amount of carbon dioxide, the waste product of respiration, in the blood. |
| Nursing Management of pleurisy | heat or cold applications for comfort (collaborative need an order for this); client teaching in splint chest wall with pillow; anxiety r/t pain and underlying illness - client needs reassurance |
| Pleural Effusion | abnormal fluid collection between visceral and parietal pleurae |
| Pleural Effusion is a complication of | pneumonia; lung cancer; pulmonary embolism; partial lung collapse r/t pressure from fluid |
| Pleural effusion assessment findings are | fever,pain, dyspnea, with chest compression the sound is dull; auscultation is diminished or absent and friction rub; CXR &CT show fluid;thoracentesis may reveal malignant cells |
| Medical Management for pleural effusion is | eliminate cause; medications; thoracentesis; and surgery poss if cancerous |
| Medications for plueral effusion are | antibiotics; analgesics; cardiotonic drugs if CHF |
| Nursing management for pleural effusion | nurse prepares client for thoracentesis and supports client; if chest tube monitor function of drainage system; amount & nature of drainage (bubbling or not) (serous, etc) |
| chest tube care per fundamentals book | assess respirations; presence of chest pain, breath sounds over affect lung area;vitals and SpO2; increased Resp distress/chest pain, dec breath sounds;cyanosis,asymmtrical chest movement;hypotension and tachycardia |
| chest tube care per fundamentals book | Observe chest tube dressing and surrounding tube tissue; kinks, loops or clots in tube; chest drainage system remains upright and below level of insertion site;note amount of drainage |
| chest tube care per fundamentals book | 2 rubber tiped hemostats for ea chest tube @ top of bed attached w tape. Only clamp tubing per MD under special circumstances |
| chest tube care per fundamentals book | Assess for air leak; quickly empty or change disposable systems; performed by nurse w training;if accidental disconnection of drainage tube from collection device; assess if client is ready to have tube removed removed by MD's order |
| if chest tube is clamped watch client for | tension pneumothorax |
| Position client in Semi-Fowler's | to evacuate air (pneumothorax) |
| Position client in High-Fowler's position to | drain fluid (hemothorax, effusion) |
| chest tube care per fundamentals book | avoid excess tubing and keep tube horizontal b4 dropping vertical into drainage bottle. If client is sitting lift tubing q15min;doc time of drainage |
| chest tube care per fundamentals book | observe water seal for fluctuations w client's inspiration and expiration |
| chest tube care per fundamentals book | waterless system the float ball indicates amount/suction the intrapleural space is receiving |
| chest tube care per fundamentals book | Observe water seal sys bubbling in water seal chamber; bubling in the suction-control chamber upon suctioning |
| chest tube care per fundamentals book | observe type of fluid and measure;color; VS;skin color |
| chest tube care per fundamentals book | mediastinal ch tube adult 50-200ml/hr -500ml/24°;100-300 pleural ch tube 1st 3°500-1000ml/24° grossly bloody postop |
| chest tube care per fundamentals book | sudden gushes of drainage is usually due to client repositioning |
| Lung abscess has a | localized area of pus formation in parenchyma (lung tissue); tissue necrosis as abscess increases |
| Lung abscesses affected area later | collapses forming a cavity infecting bronchi @ pleural cavity |
| Lung abscess may develop from | |
| Lung abscess Assessment findings | wt loss; ch pain;productive cough,sputum,finger clubbing if chronic;dull or absent breath sounds; CXR or CT scan 4 loc ation of abscess;bld and sputum cultures identifies pathogens;thoracentesis Culture and Sensitivities |
| Medical and Surgical Management of lung abscess | postural drainage - change position; antibiotics;last resort lobectomy removes abscess and surrounding lung tissue |
| Nursing management of lung abscess | monitor adverse effects of antibiotics; admin chest physical therapy; deep breaht/cough;diet high proteint & calories;emotional support |
| Empyema definition of | pus in a body cavity (general)//usually refers to pleural cavity (thoracic empyema) |
| Empyema is usually caused by | chest trauma;pneumonia;TB |
| Empyema is a | pus filled area that becomes walled off enclosed by thick membrane |
| Assessment findings of Empyema | dyspnea; anorexia; malaise; breath sounds diminished or absent; CXR or CT scan |
| Medical and surgical management of Empyema | Thoracentesis aspiration of fluid; closed drainage (ch tube)empties cavity; Thoracotomy open procedure placing several tubes to drain into underwater seal drainage. |
| Chronic Empyema if adequately treated | thick coating over lung; decortication and evacuation of pleural space |
| Nursing Management of Empyema | requires long treatment, provide emotional support; teach client breathing exercises as prescribed |
| Influenza is an | acute respiratory disease of relatively short duration. |
| Influenza is transmitted through | droplet through the respiratory tract |
| Influenza is transmitted | easily and it becomes an epidemic quickly |
| is Influenza viral or bacterial? | Viral and the strains are A, B, C; subtypes are swine and avian(bird) |
| swine and avian are subtypes what do these types do? | mutate and produce variants |
| Prevention of influenza | annual flue shot, hand washing, cover mouth |
| Signs and symptoms of influenza | incubation 1-3 days; without symptoms but contagious |
| what is the onset of influenza? | sudden, fever, chills, HA, muscle ache accept elderly immune system won't generate those symptoms |
| what is the progression of influenza? | 7-10 days; fever 3days;anorexia, weakness, apathy, malaise; conjunctival irritation; respitoratory sneezing, pharyngitis, laryngitis, rhinitis, cough |
| complications of influenza are | tracheobronchitis; cardiovascular disease;2° bacterial pneumonia, staphylococcal pneumonia |
| Can you die from pneumonia? | yes, bacterial complications, pregnant women; elderly or debilitated clients; chronic cardiac disease or emphysema |
| Diagnostic studies for influenza | CXR or sputum analysis to r/o other disease; annual flue vaccinations |
| who should get flu shots? | elderly, young, healthcare workers, people at high risk |
| Nursing care for influenza | isolation of clients;airborne or droplet precautions; mask, door closed; private room or pneumonia together;antivirals for those not affected (collaborative) |
| Who should stay home? | those with symptoms should stay home staff and visitors! |
| What are the different Immunizations for influenza? | Standard injection; flu-mist - live attenuated influenza vaccine for ages 5-50; administered intranasally |
| Who should not be immunized for influenza? | x-husbands; allergy to eggs; immunosupressed, pregnant; history of Gillian-Barre |
| Pulmonary Tuberculosis aka | TB; consumption |
| Tuberculosis is a | bacterial infectious disease; may affect lungs, kidneys, bones, and other organs; world wide health problem |
| Tuberculosis as a bacterial infection disease is | a mycrobacterium tuberculosis; gram positive,rod shaped; acid fast; aerobic; can live for months in dried sputum (who keeps their sputum that long?);destroyed by UV light in a couple of hours, heat, pastuerization |
| What is the leading cause of death with pts w HIV? | tuberculosis; vaccination is in its 1st phase of human testing |
| How is TB transmitted? | by droplet; coughing, sneezing, spitting;many who are infected never become ill |
| what are the predisposing factors of TB? | inadequate health care; malnutrition; over crowding; classification of TB |
| TB is older adults is | twice that of the general population; most prevalent in 65 or older in long term care facilities |
| What did she mean by TB classification? | TB is classified in a systemic way to monitor the epidemiology and treatment. Based on Clients history, physical exam;skin test,CXR, mcirobiologic test |
| TB is characterized by | stages of early infection, latency, & potential for recurrence after the primary disease then becoming secondary TB. Bacilli may remain dormant for years and then reactivates producing clinical symptoms |
| Early onset of TB is | asymptomatic then fatigue & wt loss |
| Immune activation occurs within two weeks which is when | a tissue reaction results in formation of a granuloma, which then through the dx process is eaten from the inside out causing a cavity and could be spreading through pts breath to others making it airborne, |
| Healing of the primary lesion of TB | occurs through resolution, fibrosis and calcification. This is called Ghon complex and is visible on xray |
| Latent Period of TB | you can be in latent period for years or a lifetime w/o symptoms. Depending upon immune status if the pt develops clinical disease. |
| Clients at high risk are | those with HIV; diabetes; on chemotherapy or long-term steroids. Only a small % of infected ppl actually develop clinical symptoms |
| Progressive stage of TB | you have a low fever; night sweats; cough w blood streaked sputum |
| Later stage of TB | pts are weak; hemoptysis; dyspnea |
| Secondary TB is | reactivation of initial infection, then immune response, lesions form in lungs and the process begins again of eating inside out etc; spreading to other areas via the lymph system; exacerbation and remission |
| Diagnostic findings of TB | TB screening test; CT scan, MRI;analysis of sputum & other body fluids 4 bacilli & confirm diagnosis;gastric lavage:gastric aspiration;bronchoscopy |
| Med and Surg Management of TB | drug therapy - controls pathogen & allow immune sys to overcome;combined therapy w drugs-toxicity & resistance;C&S - 2-3 wks to grow;segmental resection;surgery of wedge resection, lobectomy,pneumonectomy |
| Nursing process of TB | asses breath sounds, breathing patterns,overall resp status;assess pain/discomfort experienced w breathing;inspect sputum color, viscosity; amount; signs of blood |
| Diagnosis/planning & interventions | ineffective airway clearance - encourage fluids, discontinue smoking,eat light balanced diet; notify physician w sudden chest pain & dyspnea; activity intolerance |
| Medications for TB | INH, rifampin, pyrazinamide are ALWAYS related to TB; take meds for many months |
| Chronic Obstructive Pulmonary disease aka | COPD is an umbrella term for bronchiectasis;emphysema; chronic bronchitis |
| COPD IS.... | obstructive airflow in lungs, resistance to inspiration is decreased, where as resistance to expiration is increased prolonged expiratory phase of respiration |
| COPD is . . . | chronic cough and expectoration, dyspnea, impaired exp flow; bronchiectasis, chronic bronchitis, emphysema |
| other diseases associated w COPD | asthma- episodic and acute; sleep apnea syndrome; cystic fibrosis - genetic; all these get progressively worse |
| Bronchiectasis assessment | chronic infection; characterized by irreversible dilation of airways; chronic cough;fatigue, wt loss, anorexia, dyspnea;CXR, bronchoscopy reveal bronchioles size;sputum C & S test; PFT |
| Bronchiectasis chronic cough | purulent sputum, possibly hemoptysis; sputum - frothy, clear saliva, purulent |
| Medical Management of bronchiectasis | goal improve breathing; help raise secretions to improve drainage of purulent material; meds; surgical removal if small area is involved |
| Meds for bronchiectasis | bronchodilators, mucolytics; humidification loosens secretions(nebulizers) |
| Nursing management for bronchiectasis | client eduation postural drainage techniques - positions promote drainage specific lobe must keep position for 10-15 min ea; client coughs & expectorates secretions; provide oral care after treatment |
| Clients with COPD are at greater risk for | Atelectasis - collapse of alveoli r/t obstruction of bronchi or lower air passages r/t mucous plug, foreign body obstruction; fluid or air in thoracic cavity; enlarged heart, aneurysm |
| Atelectasis | air is trapped in lung- gradually absorbed into blood stream leaves collapsed area of lung |
| Atelectasis risk factors | supine position w limited turning; splinting the chest; respiratory depression, muscle weakness |
| Atelectasis assessment | basilar crackles posteriorly; dyspnea, cyanosis, cough, increased TPR, dec sat; chest discomfort |
| Atelectasis diagnosed by | CXR, decreased breath sounds, bronchoscopy |
| Atelectasis treatment | incentive spirometer, turn cough deep breath; removal of secretions; other dependent upon cause; meds; bronchodilators, humidification; oxygen admin |
| Nursing management of Atelectasis | focus on prevention of Atelectasis; post operative: TCDB; use of incentive spirometer |
| Chronic bronchitis is | chronic inflammation caused by continuous exposure to infectious or non infectious irritants |
| What are chronic irritants to bronchitis? | Asthma, tobacco smoke, 2nd hand smoke; air pollution, toxic fumes, dust |
| Chronic bronchitis is defined as | excess production of mucous and chronic cough lasting 3 mos/year for 2 consecutive years; more evident in winter months |
| Pathophysiology and Etiology of chronic bronchitis | hyper-secretion of mucus w recurrent infections and altered ability of cilia; mucus plugs with focal tissue death; factors associated w chronic bronchitis diagnosis |
| Signs and symptoms of ch bronchitis | chronic dough; bronchospasm; respiratory infections; progressive stage - yellow sputum prolonged expiration, cyanosis; dyspnea,right sided heart failure w edema |
| Diagnostic findings w ch bronchitis | physical exam; pulmonary fucntion test; CXR; consolidation; bronchoscopy; sputum examination; lung scan |
| Medical Management of ch bronchitis | prevent recurrent irritation - bronchial mucosa; removal of secretions; smokking cessation; bronchodilators; increase fluid intake; postural drainage; steroid therapy |
| Nursing management of ch bronchitis | education clients to manage the disease; eliminate irritants; pneumonia and flu immunizations; measures to improve health - diet, rest and activity |
| Nursing management of ch bronchitis continued | instruct use of aerosolized, metered dose inhaler, corticosteroids; bronchodilators; postural drainage techniques; determine amnt of aerobic activity - dyspnea |
| Importance of aerobic activity in ch bronchitis | is so that don't loose the volume that they already have |
| Pulmonary emphysema is a | chronic disease characterized by abnormal distention of the alveoli, destruction and occurs over many yrs; major cause of disability in US |
| Pathophysiology and etiology of pulmonary emphysema | alveoli lose elasticity and trap air; destruction causes large air sacs over lung surface and capillaries are destroyed and fibrous scars replace normal tissue |
| Symptoms of pulmonary emphysema | first symptom is exertional dyspnea; progressive stage chronic cough; diff inspiration r/t barrel shaped chest, expiration prolonged, difficult, wheeze; |
| Assessment of pulmonary emphysema | client leans forward, purse lip breathing, anxious, pale, short, jerky communications; O2 sats begin to fall low 90s into 80s |
| Advanced stage of COPD | dyspnea @ rest; impaired respiratory function; memory loss; carbon dioxide narcosis |
| COPD advanced stage Assessment | diminished breath sounds, wheezing, crackles, muffled heart sounds; fan for comfort |
| Diagnostic findings of COPD advanced stage | xray;fluoroscopy;PFT; ABG analysis - blood gases acute problems interventions working or not working |
| Medical Management of COPD advanced stage | smoking cessation, meds - bronchodilators, Nebulizers; antibiotics; corticosteroids; inc fluids; postural drainage w CPT aerosol therapy |
| Nursing management of COPD advanced stage | id environmental irritants cold air, wind (cause broncho spasms) |
| Prevening infections w COPD advanced stage | monitor sputum and treat infection early;diet exercise, rest; pneumovax; annual flu shot;avoid ppl w resp disease (avoid crowded areas, peak times) |
| Hypoxic drive w COPD advanced stage | chronic CO2 elevation medulla becomes less sensitive to CO2; O2 level drives respiration - hypoxic drive; O2 admin too much causes resp arrest; never admin O2> 2 or 3L/min may cause them to stop breathing |
| Diagnosis, plan, and interventions w COPD advanced stage | ineffective airway clearance; impaired gas exchange teach pursed lip breath & abd breathing; risk for atelectasis; eval of expect outcomes |
| Asthma is an | obstructive disease of lower airway |
| Asthma is | caused by inflammation; hyper responsiveness of airway to stimuli |
| 3 types of asthma | allergic (extrinsic) idiopathic instrinsic mixed |
| Pathophysiology & Etiology of acute asthma | obstruction r/t bronchospasms & constriction r/t reactive airways; inflammation & edema; thick mucus |
| Pathophysiology & Etiology of allergic asthma | causes immunoglobulin E(Igf)inflammatory response,antibodies attach to mast cells in lung/reexposure to antigen causes release of mast cell histamine |
| Pathophysiology and Etiology of asthma | alveoli hpyerinflate and trap air in lungs causing wheezing; poor perfusion; poor gas exchange poss Atelectasis or resp failure |
| Assessment findings of asthma | shortness of breath; wheezing; coughing; thick sputum; fear & anxiety; duration hours to weeks; orthopnea-classic sitting position |
| Assessment findings of Asthma onset | prolonged expiration; coughing initially unproductive; as attack subsides thick stringy mucus |
| Severe Asthma attack assessment findings | cyanosis, perspiration; status asthmaticus - persistent & life threatening |
| Diagnostic findings of asthma | breath sounds - expiratory wheezing may have inspiratory wheeze; diminished breath sounds; hypoxemia; decreased forced expiratory volume and vital capacity |
| classic sitting position for ppl w breathing problems | body leaning slightly forward and the arms at shoulder height. position facilitates chest expansion and more effective excursions of the diaphragm |
| ABG's related to asthma show | O2 stable r/t hyperventilation; CO2 varies w stage of attack. Early PaCO2 levels decrease due 2 resp increase; later you might have a normal PaCO2 which indicates impending respiratory failure |
| Medical Management of Asthma is | prevention - avoid allergens; desensitization allergy shots/antihistamine therapy; AC;humidification of air; O2 if cyanosis or hypoxia |
| Meds for Asthma | Bronchodialators; anticholinergis;corticosteroids |
| Beta agonist | albuterol SE palpitations theophyline epinephrine SE nervousness |
| Anticholinergics | Ipratropium SE pallor |
| Corticosteriods | SE insomnia and decreases or prevent inflammation |
| Mast cell inhibitors | cromolyn |
| Nursing Management of asthma | nursing dx - anxiety and restlessness |
| Nursing Management of asthma | nursing dx - anxiety and restlessness |
| Nursing intervention of asthma | O2 administration; high Fowler's; rest & fluids; check IV site for extravasation |
| Nursing intervention of asthma | O2 administration; high Fowler's; rest & fluids; check IV site for extravasation |
| Client education re asthma | teach use of flow meter; instruct asthma action plan; use of inhalers; id triggering events; relax & breath techniques |
| Cystic fibrosis definition | Exocrine gland dysfunction |
| Cystic fibrosis definition | Exocrine gland dysfunction and multi-system disorder - eventually becomes fibrontic |
| Exocrine gland dysfunction | Faulti transport of NaCl; thick sticky mucus; altered electrolyte balance |
| multi-system disorder | respiratory skin GI - pancreas, intestines |
| Assessment findings for Cystic Fibrosis | newborns meconium ileus and salty tasting skin Children- failure to thrive;finger clubbing;frequent respiratory infection/hemoptysis;malabsorption of fats and fat soluble vit - foul smell/greasy stool;risk for bowel obstruction; clubbing finger tips |
| diagnostic findings of CF | sweat test; CXR sonsolidation, fibrotic changes over aerated; GI system - fibrotic changes; Feces- steatorrhea; PFT's |
| Medical Management of CF Respiratory | postural drainage, CPT Bronchodilator meds Nebulized mist treatments |
| Medical Management of CF Digestive system | Pancreatic enzyme replacement (Pancrease) fat-soluble vitamin supplements High-calorie diet |
| Medical Management of CF | Respiratory digestive system Mucus-thinning drugs; nSAIDS' Gene therapy - experimental |
| Surgical Management CF | for end stage disease liver and lung transplants |
| Nursing Management of CF | Teach 2 prevent respiratory inf -prompt treatment Strict adherence - pulmonary toilet(cleansing) CPT,DB&C, suction, nebulize treatments |
| Nursing Management of CF | Chest wall oscillation prophylactic antibiotics-teach adm home IV ABX to prevent hospitalization; diet high cal & balanced, enzyme meds |
| Cause of Occupational lung disease Esposure | organic and inorganic dusts noxious gases |
| Cause of Occupational lung disease Pneumoconiosis | fibrous inflammation of lungs after prolonged exposure |
| Cause of Occupational lung disease examples | silicosis, asbestosis,black lung disease |
| Occupational lung disease symptoms | dyspnea cough coal dust- black streaked sputum YUMMO |
| Occupational lung disease DIAGNOSIS | CXR PFT - abnormal conservative treatment O2 therapy- severe dyspnea |
| Occupational lung disease Nursing Management | Prevent by using protective equipment avoid smoking care is as for clients w emphysema |
| Pulmonary Hypertension definition is | continuous high pressure in the pulmonary arteries and results from heart disease, lung disease or both |
| Primary Pulmonary Hypertension | is rare and has a familial tendency most often in women 20-40 yr old and fatal within 5 yrs |
| Secondary Pulmonary Hypertension | accompanied by other heart and lung conditions most commonly COPD |
| Pulmonary Hypertension patients have | difficulty breathing pt presents very ill |
| Pulmonary vessel normal | Pulmonary arteriole is normally thin and distensible |
| Pulmonary Hypertension early vessel looks like | thickening of the medial muscular layer |
| Pulmonary Hypertension late vessel resembles | extensive intimal fibrosis and medial thickening |
| Pulmonary Hypertension Assessment findings reveals | dyspnea on exertion, weakness; right ventricular failure distended neck veins; peripheral edema; EKG rt vent hypertrophy |
| Diagnostic exams for Pulmonary Hypertension | Cardiac cath pulmonary function studies Echocardiography ventilation-perfusion scan pulmonary angiography |
| Medical management for Pulmonary Hypertension | Right sided failure - digitalis; diuretics Vasodilators, anticoagulants Primary disease - heart lung transplant secondary dx - management of underlying disease, O2 |
| Nursing Management for Pulmonary Hypertension | Observe for resp distress Administer O2 prevent fatigue - ADL's Reduce need for O2 |
| PULMONARY EMBOLISM DEFINITION | OBSTRUCTION OF PULMONARY ARTERIES OR BRANCHES; CAUSE THROMBUS IN HEART |
| Pathophysiology and Etiology of PULMONARY EMBOLISM | Embolus travels to lungs; occludes pulmonary artery; causes infarction and then scar tissue |
| PULMONARY EMBOLISM examples | Clots formed in venous system Endocardium - endocarditis, MI Fat embolus- fx of long bone Bed rest, recent child birth Virchow's triad - venostasis, hypercoagulability, disruption of venous lining |
| Signs and symptoms of PULMONARY EMBOLISM | Vary w size of affected area Pain, tachycardia, dyspnea, petechiae Fever, cough, bld streaked sputum cyanosis, restlessness, shock sudden death |
| Assessment findings of PULMONARY EMBOLISM | CXR - atelectasis ECG to r/o MI Lung and CT scan Pulmonary angiography Ultrasonography Impedance plethysmography VQ scan |
| Medical and Surgical Management of PULMONARY EMBOLISM | IV heparin - monitor coag studies; IV thrombolytic drug; Anticogulants-long term Pulmonary embolectomy; Inferior vena cava device - umbrella filter device - greenfield filter |
| Nursing Management of PULMONARY EMBOLISM | Assess - Homan's sign, petechia, O2sat, ABGs, cough, hemoptysis, diaphoresis, dyspnea |
| Nursing Intervention for PULMONARY EMBOLISM | activate rapid response team Administer Vasopressors; ECK monitoring I & O |
| cause of Pulmonary edema | right side of heartdelivers more flood to pulmonary circulation; fluid accumulation in interstitium and alveoli of lungs |
| Signs and symptoms of PULMONARY EMBOLISM | dyspnea, feeling of suffocation; skin cool, moist, cyanotic; Continual blood tinged, frothy sputum cough; medical treatment discussed in CV unit |
| Respiratory failure definition of | Inability to exchange sufficient amounts of O2 and C02; Expected ABD values pO2<50, pCO2>50, pH<7.25; Maybe acute or chronic |
| Pathophysiology and Etiology PULMONARY EMBOLISM acute | Life-threatening condition; Alveoli cannot expand; Impaired neuro control of respiratory; trauma to chest wall |
| Pathophysiology and Etiology PULMONARY EMBOLISM CHRONIC | copd; neuromuscular disorders; gas exchange dysfunction; chronic resp acidosis |
| Assessment findings of PULMONARY EMBOLISM | use of accessory muscles, dec sat -S&S of underlying disorder; Restlessness; wheezing;cyanosis, fatigue,HA; MENTAL STATUS CHANGE, DYSRHYTHMIAS, RESP ARREST; CXR; Serum electrolyte determinations (venous CO2) |
| Medical Management of PULMONARY EMBOLISM | Venturi and rebreather masks; Humidified O2; Endotracheal entubation or tracheostomy tube; Mechanical ventilation; treat underlying cause |
| Nursing management of PULMONARY EMBOLISM | Assess respirations, breath sounds, cyanosis, pulse ox; Emergent resuscitative eequip & rapid resp team; notify MD if symptoms occur suddently; ABG results; prevent complications; reduce anxiety |
| ACUTE RESPIRATORY DISTRESS SYMDROME ARDS | Adult respiratory distress syndrome Non cardiogenic pulmonary edema; high mortality rate |
| Non cardiogenic pulmonary edema | no left sided heart failure; sudden; Progressive loss of lung compliance |
| Pathophysiology of ACUTE RESPIRATORY DISTRESS SYMDROME | Injury related to platelet clumping and inflammation which increases permeability of cap membrane and alveolar collapse |
| Etiology of ACUTE RESPIRATORY DISTRESS SYMDROME | aspiration, near drowning; drug overdose; DIC massive transfusion |
| Assessment findings of ACUTE RESPIRATORY DISTRESS SYMDROME | Severe respiratory distess w/in 8-48°; Inc respiratory rate causing distress; hypoxemia unrelieved by O2 adm; CXR- bilateral infiltrates- no evidence of left sided heart failure; Inc pulmonary artaery pressure |
| Medical Management of ACUTE RESPIRATORY DISTRESS SYMDROME | HUMIDIFIED OXYGEN - endotracheal or tracheostomy tube Mechanical ventilation using PEEP TREAT SHOCK-administration of IV fluids; colloids; NUTRITIONAL suppoft is essential once stabilized tube feedings |
| Nursing Management of ACUTE RESPIRATORY DISTRESS SYMDROME | provide explanations and support Provied alternative methods to communicate if on vent |
| LUNG CANCER | Common cancer and #1 cause of cancer death in US - breast, prostate and colon less than lung cancer; |
| LUNG CANCER Risk factors | Smoking and second hand smoke |
| LUNG CANCER Incidence | greater in men than women >49 year olds |
| Pathophysiology and Etiology of LUNG CANCER cause | long term exposure to irritants |
| Pathophysiology and Etiology of LUNG CANCER cells | Large- undifferentiated small- oat cell Epidermod - squamous Adenocarcinoma |
| Lung Cancer begins | in bronchus then invades and spreads blocking lumen of bronchus; tumor may bleed causing hemoptysis |
| Assessment Findings of LUNG CANCER Early sign | blood streaked sputum |
| Assessment Findings of LUNG CANCER Progressive stage | Fatique, anorexia - wt loss; dyspnea and pain at site |
| Assessment Findings of LUNG CANCER Indicating Mets | Head and neck edema pericardial effusion vocal cord paralysis |
| Diagnostic findings of LUNG CANCER | Sputum for cells; CT scan or MRI; CXR; Bronchoscopy; Fine-needle aspiration; Lung and bone scan; lymph node biopsy; Mediastinoscopy |
| Medical and surgical management of lung cancer | Tumor removal via lung resection; Radiation therapy - slows spread, shrinks tumor palliative ; Chemo - palliative |
| Metastasis of lung Cancer | Mediastinum, cervical lymph nodes; Liver, brain, spinal cord; bone, other lung |
| Nursing Management of Lung cancer | Same as that for Malignant disease and lung disease |
| Mediastinal tumors usually | are malignant and metastatic |
| Mediastinal tumors cause is | unknown, initially asymptomatic |
| Mediastinal tumors symptoms | chest pain; dysphagia; dyspnea; Orthopnea; Dx - Mediastinoscopy w biopsy of the lesion |
| Medical Management of Mediastinal tumors | Malignant - inoperable; Benign - usually operable |
| Chest trauma - fractured ribs | Common injury; Causes are due to fall; blunt chest trauma - MVA-airbag; Assault; contact sports |
| Pathophysiology and Etiology of fractured ribs causes | painful but not life threatening unless broken rib punctures a lung; chest wall become unstable ie multi rib fx |
| Pathophysiology and Etiology of fractured ribs FLAIL CHEST | IMPAIRMENT OF CHEST WALL MOVEMENT creating ineffective movement of air in and out of thoracic cavity (paradoxical) |
| Assessment findings of fractured ribs | Pain-severe, inspirations and expiration Shortness of breath; Flail chest symptoms-impaired gas exchange, inc CO, hypotension -Respiratory acidosis - hypercapnia; -Radiographs sometimes difficult to visualize |
| Medical Management of rib fractures | Analgesics - regional nerve block; Elastic bandage-rib belt-complications-atelectasis, PNE; Flail chest-mechanical ventilation, suctioning, ABX |
| Nursing Managment of rib fractures | Apply immobilization device and instruct: applicationand removal of rib belt; deep breath; care based on respiratory needs; Monitor for signs of respiratory distress, infection and increased pain |
| CHEST TRAUMA - BLAST INJURIES | COMPRESSION OF CHEST BY EXPLOSION RUPTURES ALVEOLI SUBCUTANEOUS EMPHYSEMA-CREPITATION, SLIGHT SWELLING; TX-BEDREST, VERY CLOSE OBSERVATION, RESP SUPPORT, THORACENTESIS, CHEST TUBE; DEATH-hemorrhage --asphyxiation |
| CHEST TRAUMA PENETRATING WOUNDS | Types- gunshot-usually high velocity; stab wounds-low velocity |
| Consequences of CHEST TRAUMA PENETRATING WOUNDS | Often life threatening; Pneumothorax; Hemopneumothorax; Subcutaneous emphysema; Injury to chest tissue and organs |
| Assessment findings of CHEST TRAUMA PENETRATING WOUNDS | Dyspnea; bleeding - trachea shifts away from affected side; Respiratory distress/shock; radiographs; ABG; Pulse Ox; ECGs |
| Emergency treatment of CHEST TRAUMA PENETRATING WOUNDS | Do not remove foreign body b4 victim is hospitalized - may prevent entry of air;may stabilize blood vessels; Emergency treatment of pneumothorax-application of a tight pressure dressing-prevents entry of air;-O2 adm, establish IV |
| medical and Surgical Management of CHEST TRAUMA PENETRATING WOUNDS | Airway management; Thoracentesis & chest tube insertion; Thoracotomy prn to repair injury; Indwelling catheter; nasogastric tube |
| Nursing management of CHEST TRAUMA PENETRATING WOUNDS | similar to that of a client who has thoracic surgery |
| Thoracic surgery | Thoracotomy-surgical opening of chest wall; Reasons removal of fluid, blood, tumor, foreign body; Open heart surgery; repair trauma, |
| Preoperative nursing management of thoracic surgery | prepare for surgery; obtain as much history as possible support resp |
| Postoperative nursing management of thoracic surgery | assess client's neurologic status, heart rate, lung sounds; drain thoracic cavity - air & fluid,chest tubes-more note drainage-bloody or serous;record output frequently |
| Post op nursing for thoracic surgery | Dressings-minimal draining; report subcutaneous emphysema; Impaired mobility-shoulder on affected side assess lateral ROM Passive ROM qid; Encourage client to use arm in ADL's |
| Underwater seal drainage system | Secure all connections - tube coming from pt must always be under water; Maintain wall suction as ordered (<20cmH2O pressure); |
| Underwater seal drainage system | Record fluctuation w/resp-normal initially, cease when lung is expanded bubbling-NI initally, cease when pneumo is resolved; excess bubbling-check for leaks/notify physician |
| Chest tube troubleshooting | Patency must be immediatly addressed; do not allow kinking; clogging- milk; strip |
| GENERAL CONSIDERATIONS NUTRITIONAL EMPHYSEMA | mALNUTRITION-SMALL FREQ FEEDINGS PREVENT DYSPNEA WHILE EATING; ENCOURAGE FLUIDS R/T SLOWED PERISTALSIS |
| GENERAL CONSIDERATIONS NUTRITIONAL EMPHYSEMA | dietary RECOMMENDATIONS INCREASE CALORIE NEEDS 40% FAT, 40% PROTEIN, 20% CHO |
| GENERAL CONSIDERATIONS NUTRITIONAL ASTHMA | FOOD ALLERGENS MAY INCLUDE EGGS, SEAFOOD, FISH; SUPPORT IMMUNE SYSTEM ENCOURAGE ADEQUATE CALORIES AND PROTEIN; ENCOURAGE VIT A, C, B6 AND ZINC |
| GENERAL CONSIDERATIONS NUTRITIONAL ASTHMA CONT | Obese CLIENTS WITH EMPHYSEMA - LOOSE WEIGHT!; SPECIAL ENTERAL FEEDING FORMULAS CONTINUOUS |
| pharmacologic GENERAL CONSIDERATIONS NUTRITIONAL asthma | respiratory tract infection:culture and ABX; COUGH MEDICINES -SUPPRESSING COUGH MAY LEAD TO INFECTION; BRONCHODILATORS OFTEN PRESCRIBED; THEOPHYLLINE THERAPEUTIC LEVELS - 10-20ug; TB-INH is prophylactic for family; Narcotics - monitor resp closely |
| GENERAL CONSIDERATIONS GERONTOLOGIC | prone to PNE after riB FRACTURE AND URI; Flu vaccine-annual; Vaccination-once pneumococcal pneumonia>50yrsold;nursing home residents; debilitated clients; Post op period-may be confused protect tubes; include family in teaching |
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