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Rhinitis is also known as:
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The three types of rhinitis are:
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Ch. 20 & NCLEX-?
| Question | Answer |
|---|---|
| Rhinitis is also known as: | common cold, coryza, rhinovirus |
| The three types of rhinitis are: | acute, chronic, and allergic |
| Rhinitis is spread by: | droplet inhalation and direct contact |
| What is a possible complication of rhinitis? | pneumonia |
| Symptoms of rhinitis: | sneezing, nasal congestion, rhinorrhea, sore throat, watery eyes, cough, low–grade fever, headache, aching muscles, malaise |
| Treatment and prevention of rhinitis: | treatment is minimal; prevention is a healthy lifestyle |
| Pathophysiology and etiology of sinusitis: | spread of infection to sinuses; blockage of normal sinus drainage |
| Assessment findings for sinusitis: | headache, fever, and pain over affected sinus area and around eyes; nasal congestion and discharge; malaise; nasal smear (culture and sensitivity testing); transillumination, xrays, and allergy history |
| Medical and surgical management of sinusitis: | conservative treatment: saline irrigation, antibiotic therapy, vasoconstrictors; surgical: endoscopic sinus surgery, Caldwell-Luc procedure, external sphenethmoidectomy |
| Nursing management for sinusitis: | medication and supportive treatment measures; postop care: assess visual acuity and pain |
| Client teaching for sinusitis: | treatment, oral hygiene, avoid blowing nose, lifting objects, Valsalva maneuver, and poor ventilation |
| What causes pharyngitis? | viruses, bacteria: Group A streptococci |
| How contagious is pharyngitis? (low, medium, high) | Highly |
| What are the complications of strep throat? | cardiac and renal |
| Symptoms of pharyngitis: | sore throat, dysphagia, fever, chills, headache, malaise, white patch over tonsillar area, and swollen glands |
| **How is pharyngitis diagnosed? | throat culture, Biostar, strep A optical immunoassay (OIA): standard 24hr throat culture and sensitivity tests |
| How is pharyngitis treated? | antibiotic therapy |
| What is the pathophysiology and etiology of tonsillitis and adenoiditis: | Group A streptococcus |
| Assessment findings for tonsillitis and adenoiditis: | sore throat, swallowing is difficult and/or painful; fever, malaise, nasal obstruction; noisy breathing, snoring, nasal voice; visual exam; throat culture and sensitivity test |
| Medical and surgical management of tonsillitis and adenoiditis: | medical: antibiotics, analgesics, and saline gargles; surgical: tonsillectomy and/or adenoidectomy |
| Assessment for a patient receiving a tonsillectomy and/or adenoidectomy: | client’s understanding of procedure; eval bleeding tendencies (recent use of medications that prolong bleeding time); obtain baseline vitals; need to know if patient and NPO status |
| Nursing diagnoses for patients receiving a tonsillectomy and/or adenoidectomy: | risks for: aspiration, impaired tissue integrity, and pain |
| Expected outcomes for patients receiving a tonsillectomy and/or adenoidectomy: | clear airway; minimal bleeding; intact suture line; pain relief; swallowing |
| When does a peritonsillar abscess occur? | follows severe streptococcal or staphylococcal tonsillar infection |
| Symptoms of peritonsillar abscess: | swallowing difficulty and pain; fever, malaise, ear pain; difficulty talking |
| Treatment of peritonsillar abscess: | antibiotics, surgical incision, drainage of abscess, tonsillectomy |
| Nursing management of peritonsillar abscess: | Semi-Fowler’s position, ice collar, fluids, observe signs of respiratory obstruction and bleeding |
| What is laryngitis and what is its etiology? | spread of infection to the larynx, vocal cord edema, allergies, smoking, excessive or improper voice use |
| What are the symptoms of laryngitis? | hoarseness, whispered speech, aphonia, throat irritation, dry cough |
| How is the diagnosis of laryngitis made? | symptoms or laryngoscopy |
| Persistent hoarseness is a sign of what? | laryngeal cancer |
| What is the treatment for laryngitis? | voice rest, antibiotic therapy, smoking cessation |
| Pathophysiology and etiology of epistaxis: | rupture of tiny capillaries in the nasal mucous membrane (nosebleed), most often occurs in the anterior septum (referred to as Kiesselbach’s plexus) |
| Assessment findings for epistaxis: | bleeding, assessment of nares, back of throat, area above and behind the uvula |
| Medical and surgical management of epistaxis: | medical: direct continuous pressure to the nares, ice packs, cauterization, electrocautery, topical vasoconstrictor, nasal packing; surgical: balloon inflated catheter |
| Nursing management for epistaxis: | monitor vital signs, assess for signs of continued bleeding, use bleeding control measures (humidification, nasal lubricant), reassurance |
| Client teaching for a patient with epistaxis: | avoid vigorous nose blowing, nose picking, and nose trauma |
| Pathophysiology and etiology for nasal obstruction: | deviated septum, nasal polyps, hypertrophied turbinates |
| Assessment findings for a patient with a nasal obstruction: | sinusitis, breathing difficulty, nosebleeds, nasal discharge, inspection with nasal speculum |
| Medical and surgical management for a patient with a nasal obstruction: | medical: steroids (nasal spray, injection); surgical: septoplasty, rhinoplasty, polypectomy, turbinectomy |
| Nursing management for patients with nasal obstructions: | client preparation and teaching: surgical procedure, postop nasal packing, ice pack |
| What are the postsurgical nursing interventions for a patient with a nasal obstruction: | Semi-Fowler’s position, monitor bleeding and vitals, provide oral hygiene and saline mouth rinses |
| Medical and surgical management for fractures of the nose: | lateral displacement: pressure to the convex portion of the nose; bleeding: apply cold compress and surgery |
| Client teaching for patients with fractures of the nose: | elevated head, ice, analgesics |
| Nursing management for patients with fractures of the nose: | assess airway obstruction, respiratory difficulty, dysphagia, signs of infection, papillary responses, level of consciousness, periorbital edema, test clear drainage for glucose, answer questions, provide reassurance |
| Pathophysiology and etiology of laryngeal trauma: | vehicle accident, endoscopic and endotracheal intubation, thyroid cartilage fracture |
| Pathophysiology and etiology of laryngeal obstruction: | edema, throat inflammation, aspiration of foreign bodies |
| Signs and symptoms of laryngeal trauma and obstruction: | neck swelling, bruising, tenderness, stridor, dysphagia, hoarseness, cyanosis, possible hemoptysis |
| Diagnostic findings of laryngeal trauma and obstruction: | laryngoscopy, radiographs, oxygenation studies |
| Medical and surgical management of laryngeal trauma and laryngeal obstruction: | maintain patent airway, Heimlich maneuver, corticosteroids, intubation; allergic reactions may require epinephrine; severe obstructions may require tracheostomy |
| Trauma to the upper airway assessment: | air movement, lung sounds, respiratory patterns, signs of increased nasal swelling, bleeding, symptoms of laryngeal edema |
| Nursing diagnoses applicable to trauma to the upper airway: | risks: ineffective breathing pattern, pain, anxiety |
| Expected outcomes for trauma to the upper airway: | unobstructed airway, improved breathing patterns, decreased anxiety, pain relief |
| Pathophysiology and etiology for sleep apnea syndrome: | frequent, brief episodes of respiratory standstill during sleep |
| Classification for sleep apnea syndrome: | central, obstructive (most common), mixed |
| What is central sleep apnea? | air movement is absent secondary to absence of ventilator efforts; the brain malfunctions in its normal signal to breathe |
| What is obstructive sleep apnea? | air movement is absent secondary to pharyngeal obstruction; chest and abdominal movements are present; most common form of sleep apnea |
| What is mixed sleep apnea? | combination of central and obstructive sleep apnea in one apneic episode |
| Assessment findings for sleep apnea: | progressivly worsening snoring, brief breathing cessation, sudden awakening with loud snort, daytime fatigue, morning headache, sore throat, enuresis, erectile dysfunction, behavioral differences |
| How is the diagnosis for sleep apnea made? | patient’s reported symptoms and/or polysomnography (monitors the respiratory and cardiac status while sleeping) |
| Surgical management for sleep apnea: | uvulopalatopharyngoplasty (removes tissues in the throat, including the uvula, palate, and pharynx to relieve obstruction) or tracheostomy |
| Medical treatment for sleep apnea: | noninvasive positive pressure ventilation (NPPV): CPAP (continuous pressure), Bi-PAP (varying pressures), APAP (automatically adjusts airway pressure PRN) |
| Nursing management for sleep apnea: | anxiety reduction , referral to self-help groups or counselors |
| Client teaching for patients with sleep apnea: | disease process, polysomnography, implications if untreated, collaboration with respiratory therapists |
| What kind of cancer is laryngeal cancer? | squamous cell carcinoma |
| Pathophysiology and etiology of laryngeal cancer: | carcinogens, chronic laryngitis, habitual voice overuse, heredity |
| Signs and symptoms of laryngeal cancer: | persistent hoarseness, swelling or lump in the throat, dysphagia, pain, burning in the throat (late onset symptom); advancing carcinoma: dyspnea, weakness, weight loss, enlarged cervical lymph nodes, pain, anemia |
| Diagnostic findings for laryngeal cancer: | laryngoscopy, biopsy, CT, chest XR, vocal cord mobility assessment |
| Medical and surgical management for laryngeal cancer: | medical: chemo and radiation therapy; surgical: laser surgery, total laryngectomy, radical neck dissection |
| What methods are used for alaryngeal speech: | esophageal speech, artificial larynx, tracheoesophageal puncture (TEP) with Blom-Singer device; also speech therapy |
| Assessment for a patient undergoing laryngeal surgery: | level of understanding, diagnosis,reason for surgery,probable outcome;hoarseness;sore throat;dyspnea/dysphagia;pain;burning in the throat;assess level of anxiety;identify coping strategies;assess alternate ways of communication;pre-op teaching; expression |
| Nursing diagnoses applicable to patients undergoing laryngeal surgery: | risks: ineffective airway clearance, impaired verbal communication, imbalanced nutrition, social isolation |
| Expected outcomes for the patient undergoing laryngeal surgery: | clear airway, effective alternative communication methods, adequate caloric and fluid intake, social interactions, coping with changes |
| General considerations for tracheostomy and tracheotomy: | temporary or permanent opening, suctioning, humidification, complications |
| Nursing management for client with tracheostomy and tracheotomy: | monitor vitals, complications and breath sounds; assess skin color, level of consciousness, and mental status; check airway patency |
| Postop care for a client with tracheostomy and tracheotomy: | positioning, inspect tracheostomy, tracheal dilator, precautions, suctioning, routine care |
| Client teaching for a client with tracheostomy and tracheotomy: | procedure (care) |
| General considerations for patients with endotracheal intubation and mechanical ventilation: | negative-pressure and positive-pressure ventilators; hospital policy: preparation, procedure, removal, reinsertion, complications; precautions; consequences (laryngospasm, respiratory arrest) |
| Nursing management for patients with endotracheal intubation and mechanical ventilation: | monitor vital signs, blood gas studies, and pulse ox; observe complications, mental status, lung auscultation, humidification, position change, oral care, suctioning; provide reassurance |
| Major goals for patients with endotracheal intubation and mechanical ventilation: | improve respirations, patent airway, communication |
| A client comes to the doctor’s office describing shortness of breath and strange breath sounds when inhaling deeply. Upon auscultation of the lung fields, sibilant wheezes are noted. What causes wheezing? | air passing through narrowed passages |
| The nurse is giving instructions to a pt having pulmonary angiography. What statements would show that the client understands the instructions about what will take place during the procedure? | “I may feel some pressure at the site”, “I may have bleeding at the site following the procedure”, “I will sense a warm, flushed feeling and an urge to cough when the dye is injected” |
| A client has undergone a thoracentesis and has been ordered to undergo a chest x-ray. Why is a chest radiograph being done? | to check for pneumothorax |
| Which of the following nursing interventions is most important during a lung scan: reassure the client about the amount of radiation from the test,coach the client to hold their breath at times during the procedure,admin sedative or narcotic as ordered | coach the client to hold his or her breath at times during the procedure |
| A nurse is auscultating the lung sounds of a client who came to the clinic for a physical exam. There is not any history of lung disease. What would the nurse expect to hear? | vesicular breath sounds |
| What is most important for the nurse to teach the client to help loosen secretions and increase comfort during medical treatment for sinusitis? | increase fluid intake |
| A client is seen in a clinic for possible laryngeal cancer. In reviewing the client’s record, the nurse will most likely hear which early complaint expressed by the client? | persistant hoarseness for the last month |
| The nurse is providing postop care for a client who has undergone tonsillectomy. In which position will the nurse place the head of the bed when the client is fully awake? | raised at a 45° angle |
| A client was in the ER with severe epistaxis. After the nasal packing is placed, the bleeding is controlled. What should be included with d/c instructions? | keep nasal packing in place until seen for follow up appointment, do not blow the nose, and call the physician if bleeding persists or becomes worse |
| A client comes to the doctor’s office stating that he has a lump in this throat and is afraid it is cancer. What is the earliest symptom is laryngeal cancer? | persistent cough (or hoarseness) |
| An elderly client is brought to the ER with the following vitals: T 102°F, P 88, R 32, and BP 160/86. Upon exam, the client is having difficulty breathing. What would be the nurse do next? | apply a pulse oximeter to check the blood’s oxygen status |
| A client comes to an urgent care clinic with pleurisy. What is the most common complaint from these clients? | pain with each breath |
| The nurse is caring for a client with tuberculosis. A sputum sample is ordered for the next 3 consecutive days. What time should the nurse schedule sputum collection? | upon arising in the morning |
| A client with moderately controlled asthma needs to use a peak flow meter. The nurse instructing this client correctly tells the patient that the peak flow meter is used to measure the: | peak expiratory flow rate (the highest flow during forced expiration) |
| The nurse notes the care plan for a pt moved from ICU 2 days postop thoracic surgery has “Impaired gas exchange r/t decreased lung expansion, impaired lung function,& surgical procedure.” Which interventions are priorities in the care of this client? | monitor client’s temp at least every 4hrs, remind the client to deep breathe and cough at least every 2hrs, and reposition the client so that the head is elevated 30°-40° |
| Jessica,13, is a client at the pulmonary clinic. She has a long history of asthma and is seeing the pulmonologist for her monthly appt. What are the primary functions of the lungs? Select all: destroying CO2, ventilation, oxygen production, gas exchange. | ventilation and gas exchange |
| 2mo before Eric’s tonsillectomy, he had a peritonsillar abscess r/t severe strep infection. The MD immediately prescribed a potent antibiotic after culturing the area and before receiving the results. Why did the MD prescribe a strong antibiotic? | to prevent septicemia (to prevent the spread of the causative microorganism to the bloodstream or adjacent structures) |
| What is the primary function of the larynx? | produces sound |
| Annual flu vaccines are recommended for healthcare workers, populations at high-risk for developing complications, and for those exposed to many different people daily. Who are some of the conditions for which the flu vaccine is not recommended? | patients with renal disease, patients undergoing chemo treatment, and diabetics |
| During the cold and flu season each winter, rhinoviruses run rampant infecting those susceptible. What is an important preventative factor to reduce the spread of this viral infection? | frequent handwashing |
| Pete has an appt your office for his cough. States he has been coughing for a month; nothing helps. Uses the same cough med as he has for 50yrs & doesn’t understand why it won't work. You tell Pete to talk to the MD before using non-Rx antitussives. Why? | sensitivity to antitussives needs to be determined |
| Opal is a pt on your hospital unit. The pulmonologist has sched a procedure to get a sample of pleural fluid or a biopsy specimen from the pleural wall for dx purposes. Why should you provide pertinent info and explanations of the dx procedure to her? | to manage her decreased energy levels (complete explanations of procedures should be brief and may need to be repeated later after a rest period) |
| Rosella is presenting at the ED with her 4th major nosebleed of the day. The MD does a physical exam & orders blood tests. She has no history of HTN, trauma, or cocaine use. What could be the cause of her nosebleeds which are so difficult to control? | blood dyscrasias |
| Bill, a 93 y.o., is having a pulmonary angiography performed in the radiology department. Which sign would indicate an allergic reaction to the contrast medium? | difficulty breathing |
| Influenza, an annual epidemic in the US, creates a significant increase in hospitalizations and an increase in the death rates of pneumonia and cardiovascular disease. Besides death, what is the most serious complication of influenza? | staphylococcal pneumonia |
| Where are the olfactory sensory cells located? | within the nasal mucosa |
| Terence has just been admitted to your hospital unit due to dyspnea and hypoxia. Understanding pulmonary physiology, which of the following would you expect to result in decreased gas exchange in older adults? | alveolar walls contain fewer capillaries |
| Over the winter months, Sam has seen her MD for bronchitis. She spends a lot of time outdoors, enjoying the snow; breathes mostly through her mouth. You offer client ed that helps to decrease episodes of bronchitis. What suggestion do you give? | help Samantha to learn to breathe through her nose (the vascular and ciliated mucous lining of the nasal cavities warms and humidifies inspired air) |
| Helen is recovering on your hospital unit from a bout with empyema. Because of her condition, you implement an intervention to promote healing and oxygenation. What intervention do you implement? | encourage breathing exercises |
| Bob, a 43 y.o., has had a laryngectomy as treatment for laryngeal cancer. After extensive client education to Bob and his wife regarding stoma and site care, what would you tell them would be most important to avoid? | swimming |
| Alice, a 49 y.o., has entered your post-anesthesia care unit directly following her sinus surgery. What should you monitor closely during the postop period? | repeated swallowing (could indicate possible hemorrhage) |
| How much fluid is typically present between the pleurae, which surround the lungs, to prevent friction rub? | 5-15mL |
| Knowing respiratory physiology is important to understand how the disease process can work within that system. Which hollow tube transports air from the laryngeal pharynx to the bronchi? | trachea |
| What is not a recommended lifestyle change for those diagnosed with severe sleep apnea? | drink alcohol in moderation |
| What are the signs of respiratory obstruction? Select all that apply: restlessness, dyspnea, pyrexia, eupnea | restlessness and dyspnea |
| The symptoms of bacterial and viral pneumonia differ. Which of the following symptoms are more indicative of viral pneumonia. Select all that apply: copious sputum, chills, sterile blood cultures, rapid pulse | copious sputum and sterile blood cultures |
| Wilbur has acute bronchitis and is visiting your primary care group to find relief. He reports a low grade fever, chills, headache, and a productive cough. What is the primary treatment modality for acute bronchitis? | relieving symptoms |
| Not every structure in the upper airway has a purpose in respiration. Some structures' role is immunological. Which structures protect against infection? Select all: epiglottis, nasopharynx, pharyngeal tonsils, palantine tonsils | pharyngeal tonsils and palantine tonsils |
| How many deaths were attributed to influenza in 2008? | 36,000 deaths (over 200,000 hospitalizations) |
| Client education is important in preventing the development of sinus infections? What event predisposes clients to sinusitis? | interference with sinus drainage (trapped secretions readily become infected) |
| Bob has had a laryngectomy as treatment for laryngeal cancer. Which of the following nutritional interventions should be implemented for Bob? | use enteral feedings after the procedure (used 10-14 days after procedure to avoid irritation to the sutures and reduce the risk of aspiration) |
| What are complications that can result from pneumonia? Select all that apply: shock, septicemia, chronic bronchitis, CHF | shock, septicemia, CHF |
| Pharyngitis can be caused by viruses and bacteria. Serious complications can result from bacterial pharyngitis, specifically group A streptococci. Diagnosis and treatment of strep throat is important to prevent what serious complications? | glomerulonephritis, rheumatic fever, endocarditis |
| During the winter, increased instances of acute bronchitis cause a backlog of physician appointments that spill over into ED visits. What is the most common cause of acute bronchitis infections? | viral infections |
| “Swallowing down the wrong pipe” has happened to all of us. After a significant coughing spasm and gasping for air, we typically recover. Which upper airway structure malfunctions to cause this event? | epiglottis |
| Edward, a 48 y.o., has just undergone surgery for a nasal obstruction. Which nursing interventions should you perform to promote Ed’s safety and recuperation? | ensure mouth breathing (nasal passage will be packed post op) |
| Preventing falls in older adults directly correlates to preventing bone fractures. If an older adult falls and fractures one or more ribs, what is a possible complication that could develop after the fracture? | pneumonia |
| Lula is a client in the hospital unit. She was admitted with a diagnosis of pleurisy; you perform frequent client ed for pain and symptom management. Which techniques do you suggest to Lula while teaching her about splinting her chest wall? | turn onto affected side |
| What practice should you encourage in these women, who are at risk of pneumococcal and influenza infections? Select all that apply: using prescribed opioids, receiving vaccination, technique for incentive spirometry, hand antisepsis | receiving vaccination and hand antisepsis |
| How many strains of this virus cause coryza? | over 100 |
| Austin & his brother Matt are being seen by the MD for their 3rd middle ear infection of this winter season. Mom reports they develop an upper respiratory infection & an ear infection seems quick to follow. What contributes to this event? | eustachian tubes |
| MaryAnn has a 60-pack-year history and is diagnosed with emphysema. She is 100lbs overweight and is having significant problems with fatigue and oxygenation. As her nurse, why would you encourage her to lose weight? | to improve breathing |
| Eric is recovering from his tonsillectomy. After his overnight stay r/t increased secretions and vomiting, you give his client ed. What indicates need for further teaching? | “If I’m vomiting, I’ll drink 7-Up to keep myself hydrated” (clients are instructed to avoid carbonated fluids and fluids high in citrus content) |
| Patsy is admitted to the ICU as the result of an MVA. She was intubated at the site. The pulmonologist is in the process of weaning, but she remains on the vent, for 16hrs a day. Which nursing interventions should you perform when caring for her? | clean Patsy’s teeth with applicators |
| Dorothy is admitted to the pulmonology unit of the hospital. She was admitted with a pleural effusion and was “tapped” to drain the fluid to reduce her mediastinal pressure. What primary condition could have caused the pleural effusion? | CHF |
| In performing your head-to-toe assessment of Samantha, what are you assessing by inspecting and palpating her trachea? | deviation from the midline |
| Bob is your client in the hospital. He is usually homeless and will remain in your unit until his lung abscess is healed to make his return to the streets safer. You encourage him to eat foods to promote healing.What suggestions do you make? | diet rich in protein |
| Opal is a client on your hospital unit. The pulmonologist has scheduled a thoracentesis to obtain a sample of pleural fluid or a biopsy specimen from the pleural wall for diagnostic purposes. What does serous fluid indicate? | inflammation |
| Willy has been brought to the ED. Willy and friends were having a contest to see who could throw a Skittle the highest and catch it in their open mouth. Willy aspirated a Skittle. Where would be the most likely place to find the aspirated Skittle? | right mainstem bronchus or right upper lung |
| The respiratory system provides _______ , for cellular metabolic needs and removes ________. | O2;CO2 |
| What are the external openings of the nose? | nares |
| What is the nasal cavity lined with? | mucous membranes & cilia |
| What do sinuses do? | lighten skull weight and resonance |
| What are the two frontal sinuses? | ethmoidal & sphenoidal |
| What are the largest and easies to treat sinuses? | maxillary sinuses |
| Where is the criboform plate located? | roof of nose & floor of skull |
| What protects the lower airways from infection? | immunoglobulin A (IgA) |
| What do the turbinate bones (conchae) do? | change flow of inspired air (moisturize and warm inspired air) |
| What does mucous membrane surface of the turbinate bones do? | trap dust and microorganisms |
| What is the purpose of the olfactory nerves? | detect odors and induce sneezing to remove dust |
| What does the pharynx do? | carries air from nose to larynx and food from mouth to esophagus |
| What are the three areas of the pharynx? | nasopharynx, oropharynx, laryngeal pharynx |
| The adenoids, Eustachian tubes, and soft palate make up what? | nasopharynx |
| The tongue attachment and tonsils are part of what? | oropharynx |
| What closes during swallowing? | epiglottis |
| What are tonsils and adenoids? | lymph tissue |
| What is the voice box? | cartialaginous framework between pharynx and trachea; part of larynx |
| What is the function of the voice box? | produce sound, protect lower airway |
| What are the structures of the larynx? | epiglottis, glottis, vocal cords |
| What does the trachea do? | transport air from pharynx to bronchi |
| The trachea is made up of: | c shaped cartilage (except cricoid, just below thyroid) |
| What structure protects the lungs? | rib cage |
| What does the trachea do at the carina? | bifurcates |
| Which branch of the bronchi is shorter and straighter, thus making aspiration more likely? | right |
| What are the bronchi lined with? | mucous membranes and cilia |
| What is the entrance of bronchi into the lungs called? | hilus |
| Where are the alveoli located? | end of bronchioles |
| What is the site of gas exchange? | alveoli |
| What prevents the collapse of alveoli? | surfactant |
| Where does the exchange of O2 and CO2 happen? | alveoli (epithelial tissue and capillaries) |
| What is the dome shaped muscle that separates the thoracic and abd cavities? | diaphragm |
| What happens when the diaphragm contracts to flatten? | creates negative pressure and air rushes into the lungs |
| What divides the thoracic cavity into 2 halves? | mediastinum wall |
| What is the visceral layer on the outside of the lungs? | pleural cavity |
| What lubricates membranes during respiration? | serous fluid |
| The parietal pleura lines what? | the thoracic wall |
| Movement of air in and out of the lungs is: | ventilation |
| What requires patent airway and functioning resp muscles? | ventilation |
| What is the transfer of substance from higher concentration to lower concentration called? | diffusion |
| What is movement of oxygen into the lungs called? | inspiration |
| What is the removal of carbon dioxide from the lungs called? | expiration |
| Where in the brain are the respiratory centers located? | medulla oblongata and pons |
| What responds to CO2 and hydrogen in cerebral spinal fluid, then sends message to the lungs? | central chemoreceptors |
| What measures BP? | baroreceptors |
| Where are proprioceptors located? | joints and skeletal muscles |
| Where are peripheral chemoreceptors located? | aortic arch & carotid arteries |
| What determines the amount of CO2 in the body? | alveolar respiration |
| Is CO2 an acid or base? | acid |
| What happens to pH if CO2 increases? | pH decreases |
| What happens to pH if CO2 decreases? | pH increases |
| What monitors pH? | medulla oblongata |
| How does pH effect respiratory rate and depth? | pH is monitored by the medulla oblongata, which then controls resp rate and depth (lungs blow off excess CO2) |
| How do the kidneys effect respiration? | maintain normal pH by managing H+ and HCO3 |
| What is made up of RBC & O2? | oxyhemoglobin |
| What happens to CO2 combined with HgB? | eliminated by lungs |
| CO2 +H2O=bicarbonate ions (HCO3). How is it eliminated from the body? | kidneys |
| What happens if the primary problem of acid-base imbalance occurs in the lungs? | the kidneys compensate |
| What happens if the primary problem of acid-base imbalance occurs in the kidneys? | the lungs compensate |
| What is bronchial circulation? | blood supply to the lungs (supply the actual resp structures/tissues |
| What is pulmonary circulation? | gases are exchanged between the lungs and the atmosphere |
| The pulmonary artery transports venous blood from ________to _______. | right ventricle to right and left lungs |
| Blood circulates through the pulmonary capillary bed where what occurs? | diffusion |
| Blood returns to atrium through what? | pulmonary veins |
| How does an upright position effect pulmonary circulation? | less perfusion to the upper lobes |
| How does a side lying position effect pulmonary circulation? | best perfusion is in dependent lung (lung closest to the mattress) |
| What is V/Q ratio? | ventilation/perfusion |
| What must the lungs have in order to have enough O2 available to the cells? | adequate ventilation and adequate perfusion |
| What is perfusion? | blood circulating through pulmonary capillary bed |
| Ventilation and perfusion must both be working well for _______ ___________. | optimum oxygenation |
| What is hypercapnia? | too much CO2 |
| What is hypocapnia? | not enough CO2 |
| Respiratory insufficiency develops r/t: | impaired diffusion, ventilation, perfusion |
| What factors influence breathing? | airway resistance, lung compliance |
| What is airway resistance determined by? | rate of air flow (inc rate=inc resistance), airway diameter |
| What is lung compliance? | stiffness of lungs r/t surfactant, fibrosis, edema, atelectasis |
| What can dec the diameter of the airway? | mucus, edema, bronchospasm, chronic bronchitis, emphysema, tumor |
| During a physical exam, what do you look for in respiration? | rate, depth, effort, rhythm |
| During a physical exam, what do you look for in the chest? | shape, movements, inspect nose |
| Physical exam of the nose includes looking for: | injury, inflammation, symmetry, lesions |
| What do you look for with the trachea during a physical exam? | is it midline (tugging = collapsed lung) |
| What does a flat-high pitch indicate when percussing the chest? | solid mass or effusion |
| What does a dull sound indicate when percussing the chest? | atelectasis, pneumonia |
| What does a tympanic (hollow sound) when percussing the chest indicate? | pneumothorax |
| What does a hyperresonant sound when percussing the chest indicate? | emphysema, pneumothorax |
| Which lung sounds sound like static, may clear with cough, and indicate fluid in alveoli? | crackles |
| Which lung sound is musical or sonorous? | wheezes |
| Which lung sound is grating or crackling? | friction rubs |
| What is the purpose of ABGs? | determine blood’s pH levels |
| What does ABGs measure? | O2 levels, CO2, bicarbonate ion |
| Where can ABGs be drawn? | radial, brachial, femoral, arterial line (if in ICU) |
| What is a normal pulse ox reading? | >95% |
| ABGs-pH level: | 7.35-7.45 |
| ABGs-CO2 level | 35-45 |
| ABGs-pp level | 80-100 |
| The mantoux test detects antibodies to what? | mycobacterium tuberculosis |
| How do you measure pulmonary function? | spirometer, tidal volume (useful in determining when to extubate pt) |
| What is the purpose of pulmonary function studies? | assess the functional ability of the lungs |
| What are sputum specimens examined for? | pathogenic microorganisms and cancer cells |
| Methods of sputum sample collection: | expectoration, suctioning, bronchoscopy |
| What test is used to assess the arterial circulation of the lungs and will dx pulmonary emboli? | pulmonary angiography |
| What should a nurse assess on a patient who will be having pulmonary angiography? | level of anxiety and knowledge |
| How will clients feel when having pulmonary angiogram? | warm, flushed, urge to cough r/t contrast infusion |
| What allergies should be assessed prior to pulmonary angiography? | iodine, shellfish, contrast material |
| Post pulmonary angiography, what kind of dressing should be in place? | pressure dressing |
| Post pulmonary angiography, what should the puncture site be assessed for? | swelling, discoloration, bleeding, hematoma, distal circulation and sensation |
| Post pulmonary angiography, what needs to be reported to the physician? | dim pulses, cool skin, dec cap refill, numbness, tingling, bleeding, hematoma |
| What scan detects patterns of blood flow through the lung and patterns of air movement and distribution in the lungs? | VQ lung scan |
| What can a VQ lung scan dx? | pulmonary emboli, lung cancer, COPD, pulmonary edema |
| What gives direct visualization of the larynx, trachea, and bronchi? | bronchoscopy |
| What can a bronchoscopy be used for? | dx, tx, bx, sputum specimen, remove foreign body, pulmonary cleansing |
| What is the prep for a bronchoscopy? | fasting 6 hours (local anesthesia), atropine to dry up secretions, sedative/narcotic to prevent depression of vagus nerve to prevent hypotension, dysrhythmias |
| What test gives direct visualization of the larynx? | laryngoscopy |
| What can laryngoscopy diagnose? | lesions (bx) laryngeal, function, inflammation |
| How do you prevent aspiration post bronchoscopy and laryngoscopy? | Maintain NPO for 6 hour prior to exam and 2-8 hours post procedure, suction available post, offer sips or chips after confirming gag reflex has returned (tickle pharynx w/cottons swab) |
| What test us used to visualize the mediastinum? | mediastinoscopy |
| The purpose of mediastinoscopy: | visualize lymph nodes, bx |
| Possible complications post mediastinoscopy: | dysrhythmias, MI, bleeding, pneumothorax |
| What is a thoracoscopy? | exam of pleural cavity |
| Where are the incisions for a thoracoscopy? | intercostal spaces |
| What will a patient need post thoracoscopy? | chest tube |
| What is insertion of needle into the pleural space under local anesthetic? | thoracentesis |
| What is the purpose of a thoracentesis? | obtain sample of pleural fluid, removal of fluid, instillation of medicine |
| Where can a thoracentesis be done? | at bedside or treatment room |
| How do you position a client for a thoracentesis? | leanind over bedside table, head on pillow or side lying, affected side up |
| What do you monitor during a thoracentesis? | pulse ox and VS |
| What should you asses for during a thoracentesis? | resp distress, dyspnea, tachypnea, hypotension |
| What should be recorded regarding the fluid removed during a thoracentesis? | amount, color, character of fluid |
| What should be done post a thoracentesis? | small pressure dressing, chest x-ray to r/o pneumothorax, bedrest 1 hour lying on unaffected side |
| How do you assess for a pneumothorax post procedure? | asymmetric chest expansion, subcutaneous emphysema (feels and sounds like rice crispies) |
| Why can a pneumothorax occur post thoracentesis/thoracoscopy? | air enters the pleural space and the lungs cannot expand properly |
| What should you do if contrast will be used? | assess allergies to seafoods and iodine, notify physician |
| What happens when aleveolar walls become thinner and contain fewer capillaries? | de gas exchange |
| Dec elasticity in the elderly increases the risk for what? | resp disease |
Created by:
kthoma