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Adult 1 Respiratory

Respiratory Review

Tidal Volume (TV) how much? 500mL
Tidal Volume is? The amount of air moved in and out with each normal, quiet respiration
Inspiratory reserve volume (IRV) how much? 2100 - 3100mL
Inspiratory reserve volume is? Amount of air that can be inhaled forcibly above the TV
Expiratory reserve volume (ERV) how much? 1000mL
Expiratory reserve volume (ERV) is? the amound of air that can be forcibly exhaled over the the tidal volume
The residual volume ois the volume of air that? Remains in the lungs after a forced expiration
Residual volume is how much? 1100mL
vital capacity is the sum of? VC = TV + IRV + ERV
Vital capacity of adult is? 4500mL
normal PO2 of arterial blood = 97.4%
normal PO2 of venous blood = 75%
Each hemoglobin molecule can carry up to how many oxygen molecules? Four
As temperature goes up, the affinity of hemoglobin for oxygen? Decreases -- so oxygen unloading is enhanced
As blood becomes acidic, the oxygen-hemoglobin bond is? weakend -- oxygen unloading to the tissues is enhanced
As the PCO2 of blood increases the pH _________ and oxygen unloading is _________? As the PCO2 of blood increases the pH _DECREASED_ and oxygen unloading is _ENHANCED_?
As hydrogen ion concentration in the blood increase, the oxygen-hemoglobin bonds are _________? Weakened -- enhancing oxygen unloading to the tissues
the organic chemical _________ is formed in RBCs during times of increased metabolism? 2,3-DPG
The organic chemical 2-3-DPG _________ the release of oxygen from hemoglobin by binding to it when increased metabolism? enhances
Active cells produce about _____mL of carbon dioxide each minute and this is the _________ _______ that is excreted by the lungs each minute? Active cells produce about _200_mL of carbon dioxide each minute and this is the _EXACT_ _AMOUNT_ that is excreted by the lungs each minute?
Carbon dioxide is transported in the blood in three forms, the largest amount is transported as __________? HCO3 (bicarbonate ions)
Carbon dioxide is transported in the blood in three forms. What are they? Dissolved in plasma, bound to hemoglobin, and as bicarbonate ions (HCO3)
In the systemic circulation, CO2 entering the blood causes ____ _________ to dissociate from hemoglobin, allowing more _____ to combine with hemoglobin and more __________ ____ to be generated? n, CO2 entering the blood causes _MORE_ _OXYGEN_ to dissociate from hemoglobin, allowing more _CO2_ to combine with hemoglobin and more _BICARBONATE _ _IONS_ to be generated?
During one pass through the body, about ___% of hemoglobin bound oxygen is unloaded to the tissues? 25%
The nose may be asymmetrical as a result of ? previous surgery or trauma
Allergies may cause the skin around a client's nose to be ______ and _____? red and swollen
Chronic cocaine abuse might cause? the septum to be perforated
Red mucosa in the nares indicates? Infection
________ drainage indicates ____ or _____ infection? _PURURLENT_ drainage indicates _NASAL_ or _SINUS_ infection?
Watery nasal drainage, pale turbinates, and polyps on the turbinates may indicate? Allergies
Three things may cause changes in the ability to smell. What are they? 1. Damage to olfactory nerve 2. Chronic inflammation of the nose 3. Zinc deficiency
Tachypnea is ? a rapid respiratory rate
Tachypnea is seen with 6 conditions. List them. 1. atelectasis 2. pneumonia 3. asthma 4. pleural effusion 5. pneumothorax 6. CHF
atelectasis is ? collapse of lung tissue following obstruction of the bronchus or bronchioles, inadequate TV, hypoventilation secondary to pain, etc.
Damage to the brainstem may causes either ___________ or ___________? tachypnea or bradypnea
pleural effusion is? fluid between the visceral and parietal pleura
bradypnea is ? a low respiratory rate, seen with some circulatory disorders, side effects of meds, response to pain
apnea is? cessation of breathing lasting from a few seconds to a few minutes -- stroke, head trauma, side effect of medications, following airway obstruction
eupnea is? normal breathing
the anteroposterio diameter of the chest should be _____ than the transverse diameter? Less than
The normal ratio of anteroposterior diameter to transvers diameter of the chest is from __:___ to __:____? 1:2 to 5:7
A ratio of 1:1 (equal) anteroposterior to transverse diameter of the chest typically occurs with? Emphysema
With asthma you may see ___________ of the intercostal spaces retraction
With pneumothorax you may see ___________ of the intercosatl spaces bulging
Pneumothorax is? a collection of air or gas in the pleural cavity (collapsing the lung) usually d/t perforation of the chest wall sometimes from rupture of emphysematous bleb or superficial lung abs
The trachea shifts to the _______ side with pleural effusion and to the ________ side in atlectasis? The trachea shifts to the _UNAFFECTED_ side with pleural effusion and to the _AFFECTED_ side in atlectasis?
Percussion of dullness is heard with? atelectasis, lobar pneumonia, pleural effusion (filled up)
Percussion of hyperresonance is heard with? chronic asthma, pneumothorax (hollow)
Vesicular sounds are heard where? all areas except major bronchi
Bronchovesicular sounds are heard where? anteriorly over primary bronchi and posteriorly between the scapulae
Bronchial sounds are heard where? Heard over the manubrium
Vesicular sounds are soft, medium or loud? soft
Bronchovesicular sounds are soft, medium or loud? medium in intensity
bronchial sounds are soft, medium, or loud? loud
vesicular sounds are low, medium, or high pitched? low pitched
bronchovesicular soundsa are low, medium or high pitiched? medium pitched
bronchial sounds are low, medium, or high pitched? high pitched
Vesicular sounds last longer during _____ than _______? inspiration than expiration
Vesicular sounds have a inspiration to expiration ratio of __:__ 3:1
Bronchovesicular sounds have an inspiration to expiration ratio of __:__? 1:1
Bronchial sounds have an inspiration to expiration ratio of __:__? 2:3
Inspiration and Expiration are __________ in duration with __________ sounds? n are _EQUAL_ in duration with _BRONCHOVESICULAR_ sounds?
With bronchail sounds the expiration is ________ than the inspiration? longer
Breath sounds are _________ over atelectasis? decreased
Breath sounds are _________ over emphysema? decreased
Breath sounds are _________ over asthma ? decreased
Breath sounds are _________ over lobar pneumonia? increased
Breath sounds are _________ or ________ over pleural effusion? decreased or absent
Breath sounds are _________ over pneumothorax? decreased
bronchial and bronchovesicular sounds are hear over ? lunges filled with fluid or solid tissue
auscultate the lungs for breath sounds by having the client __________________________? take slow, deep breaths through the mouth
voice sounds and tactile fremitus is decreased in (voice sounds may be absent)? atelectasis, emphysema, asthma, pleural effusion, and pneumothorax
voice sounds and tactile fremitus "99" are increased in? pneumonia if the bronchus is patent
"voice sounds" include ________, __________, ___________? bronchophony "99", egophony "whisper 1-2-3", whispered pectoriloquy "ee"
Where is the apex of each lung located? a. in the mediastinum b. resting on the diaphragm c. within the parietal pleuar d. just below the clavicle d. just below the clavicle
what physiological process is involved in gas exhange at the respiratory membrane? a. facilitates transport b. active transport c. simple diffusion d. hydrostatic pressure c. simple diffusion
While auscultating your client's breath sounds, you not continuous musical sounds. You document these as? a. Murmurs b. Wheezes, c. Crackles d. Rales b. wheezes
Your client has had a lung removed. What type of breath sound would you expect to assess over this area? a. hyperresonance b. crackles c. broncovesicular d. absent d. absent
What would you ask your client to do as you auscultate the lungs? a. hold your breath b. repeat the nubmers 99 several times c. take slow deep breaths through your mouth d take slow deep breaths through your nose c take slow deep breaths through your mouth
short, discrete, crackling noises are called? crackles
continous, musical sounds are called wheezes
a loud, dry, creaking sound indicating pleural inflammation is called? friction rub
pleuritis is a _____________ and you might auscultate a ___________? INFLAMMATIO OF THE PLEURAL__ and you might auscultate a _friction rub_?
You might hear ________ with pneumonia? crackles
You might hear ________ with CHF? crackles
You might hear ________ with emphysema? wheezes
You might hear ________ with asthma? wheezes
You might hear ___________ or _________ with bronchitis? crackles or wheezes
the purpose of the surfacant that is secreted by cells in alveolar walls is? to maintain moisture reducing the surface tension of the alveolar fluid to help prevetn collapse of the lungs
The right lung has __ lobes? 3, the RUL, RML, and RLL
The left lung has ___ lobes? two, the LUL and LLL
the base of the lungs rests on the _________? diaphragm
During inspiration the diaphragm __________ , it ________, the sternum moves _______ and air_____________? During inspiration the diaphragm _CONTRACT_, it _FLATTENS_ the sternum moves _OUTWARD_ and air _RUSHES IN_.
Each breath consists of ? Two phases, inspiration and expiration
a single inspiration lasts about? 1 - 15. sec
a single expiration lasts about ? 2 -3 sec
breaths normally occur how many times per minute? 12 to 20 / min
Expiration is primarily a _______ process as a result of the ________ of the lungs? Expiration is primarily a _PASSIVE_ process as a result of the _ELASTICITY_ of the lungs?
The distensibility of the lungs is called? compliance
The nasopharynx serves as a passageway only for ____? air
air moving into and out of the lungs is called? pulmonary ventilation
The exchange of oxygen and carbon dioxide that occurs between the alveoli and the blood is called? external respiration
The transportation of oxygen and carbon dioxide to and from the lungs and the cells of the body is called? gas transport
The exchange of oxygen and carbon dioxide between the blood and the cells is called? internal respiration
the lower respiratory system includes the ? bronchi and lungs
the upper respiratory system includes the ? nose, sinuses, pharynx, larynx, and trachea
The three sections of the larynx are? from top to bottom naso-, oro- laryngo-
The most common upper respiratory disorder is? rhinitis
Rhinitis is? inflammation of the nasal cavity
acute viral rhinitis is also know as? the common cold or viral URI (upper respiratory infection)
the incidence of URI peaks between what months? September and January
viral URIs are highly? contagious
URIs are spread by? aerosolized droplets during sneezing or coughing or through direct contact
coryza is what? profuse nasal discharge (aka rinorrhea), a symptom of URI
the initial symptom of the viral URI is often? sore throat
phenylephrine (neo-Synephrine) is a? decongestant
phyenlyporpanolamine (Comtrex, Triaminic) is a? decongestant
Pseudoephedrine (Sudafed, Actifed) is a decongestant
Decongestants stimulate the ____________________ and so the contraindications include ______________ or ___________? Decongestants stimulate the _SYMPATHETIC NERVOUS SYSTEM___ and so the contraindications include _HYPERTENSION_ or _CHRONIC HEART DISEASE_?
Decongestants work by? promote vasoconstriction, reducing the inflammation and edema of nasal mucosa and relieving nasal congestion
Decongestants have a _______ onset and ________ duration? rapid, short (may be habit forming)
rhinitis medicamentosa is? a rebound phenomenom of drug-induced nasal irritaion and inflrammation from chronic use of decongestants
Decongestants may interact with which two types of drugs? antihypertensives and MAOIs
Use nasal spray decongestants for no more than? 3 - 5 days
Grompheniramine, Chlorpheniramine, Clesmastine, Dexchlopheniramine, Trirolidine are ? antihistamines (sedating)
Three nonsedating antihitanmines are? cetirizine (Zyrtec), fexofenadine (Allegra), loratadine (Claritin)
antihistamines dry respiratory secrestion through an ______________ effect? anticholinergic
Caution clients not to ________ when taking OTC _________? drive, antihistamines
some contraindications to antihistamines include? acute asthma or lower respiratory disease (too drying, may aggravate), glaucoma, impaired GI motiliy, prostatic hypertrophy, heart disease, concurrent alcohol or CNS depressants
herbal remedies for acute viral URIs include garlic, echinaccea (no longer than two weeks, not during pregnacy or lactation), aromatherapy (don't ingest)
risks for URI are increased by stress, exposure to crowds, poor hand hygiene
blowing the nose with both nostrils open is recommended because? to prevent infected matter from being forced into the eustachian tubes
reccomend ____, ____, and ____ for acute URI? additional rest, additional fluid intake, well-balanced diet to support immune system
a hyighlycontagious viral respiratory diease characterized by coryza, fever, cough, and systemic symptorms such as headache and malaise is ? influenza (the flu)
a global epidemic is also know as a ? pandemic
which categories are at risk for higher incidence of complications or higher risk of moratlity from influenza? older adults, people with chronic heart or pulmonary disease
influenza is transmitted by? airborne droplet and direct contact
There are three major strains of influenza viruses, A, B, and C. Which is reponstible for the most infections and the most severe outbreaks? influenza A
A/Tiawan/90 means? an influenza A strain, originating in Tiawan, in 1990
Chilling or going out in the rain do or do not cause colds? Do not
influenza is linked to increased risk of _________ in older adults pneumonia, viral pneumonia progresses rapidly and may be fatal
reye's syndrome is? a rare but potentially fatal complication of influenza, mostly in children, associated with the use of aspirin, 30% mortality rate, symptoms inclue hepatic failure and encephalopathy
infection with influenza virus produces one of three syndromes, what are they? 1. uncomplicated nasopharyngeal inflammation, 2. viral upper respiratory infection followed by bacterial infection, or 3. viral pneumonia
repiratory manifestations of influenza include? coryza, cough (initially dry becoming productive), substernal burning, sore throat
systemic manifestations of influenza include? fever and chills, mailaise, muscle aches, fatigue
vaccination is ___% effective in preventing influenza? 85%
80% to 90% of all influenza related deaths are in people who are ? >65 years old
WBC is commonly __________ in influenza? decreased
Amantadine (Symmetrel) or rimantadine (Flumadine) are given as a prophylaxis for? exposure to influenza
Which class of drugs can be given to reduce the duration and severity of influenza symptoms? antivirals
inflammation of the mucous membranes of one or more of the sinus is? sinusitis
pharmacological treatment of sinusitis includes? antibiotics (if bacterial), oral or topical decongestants, systemic mucolytic agents like guaifenesin
antral irrigation, caldwell-luc procedure, external sphenoethmoidectomy are all surgical treatments for? sinusitis
pharyngitis is usually _____ in origin? viral
the most common cause of bacterial pharyngitis is? strep throat (Group A beta-hemolytic streptococcus)
tonsillitis is usually due to a ____________ infection? streptococcal
viral tonsillitis may occur under what kind of conditions? crowded living conditons (ex. military recruits)
pharyngitis and tonsillitis are spread by? droplet nuclei
epiglottitis is a ________ ________? medical emergency (airway compromised)
aphonia is a common manifestation of ? laryngitis
Toxins are relased that inflame the tisssues and exudate from inflammed tissues forms a thick, grayish, rubbery, pseudomembrane over the posterior pharynx with this disease... diptheria
Pertussis is an _________ respiratory disease upper
whooping cough is also known as pertussis
classic pertussis has three phases, name them ctarrhal phase, paroxysmal phase, convalescent phase
adolescents and adults with pertussis often have these symptoms severe prolonged (>7 days) cough, vomiting with cough, worse at night
a nosebleed is also known as? epstaxis
Kiesselbach's area is? where 90% of all nosebleeds arise from this area (in the anterior nasal septum)
which is more severe, anterior or posterior epistaxis? posterior
what is the priority assessment with nasal packing? O2 saturation and airway, next most important is probably assessing for hemorrhage
nursing dx for epstaxis? anxiety, risk for aspiration (esp. with packing -- must breath through mouth)
There are unilateral, bilateral, and complex fractures of the nose. Complex fractures may involve which structures? septum, ascending processes of maxilla, frontal bones of face
surgical reconstruction of the nose is called? rhinoplasty
What are the two common surgery to repair a deviated septum? septoplasty and submuous resection (SMR)
nursing dx for broken nose include? ineffective airway clearance, risk for infection
The narrowest portion of the upper airway is the? larynx
Laryngeal obstruction is __ _________ ________? a medical emergency
The most common cause of laryngeal obstruction in adults is _____________ _____ and is know as the ______ __________? The most common cause of laryngeal obstruction in adults is _INGESTED _ _MEAT_ and is know as the _CAFE'_ _CORONARY_?
You might hear ___________ _________ with laryngeal obstruction? inspiratory stridor
If laryngeal obstruction is caused by anaphlaxis, __________ may be administered? epinephrine
When airway obstruction is complete a _____________ ___________ is performed Heimlich maneuver (wrap arms around victim from behind, one fist between umbilicus and xiphoid process, cover fist with other hand, forcefully thrust upwards)
If the victim is unconcious, instead of the Heimlich maneuver, ______________ ______ are adminstered? abdominal thrusts (straddle client's thighs, deliver thrusts upward and inward to upper abdomen)
dyspnea, nasal flaring, tachypnea, anxiety, wheezing, inspiratory stridor following neck trauma may indicate? laryngeal obstruction
the intermittent absence of airflow through the mouth and nose during sleep is called? sleep apnea
the more commone type of sleep apnea is? obstructive sleep apnea -- involves occlusion of the oropharyngeal airway
a less common type of sleep apnea involving transient impairment of the neurologic drive to respiratory muscles is called? central sleep apnea
polysomnography is? an overnight sleep study used to diagnose sleep apnea
Name a conservative treatment for mild to moderate sleep apnea. Weight reduction, alcohol abstinence, and avoiding supine postion during sleep
uvulopalatopharngoplasty (UPPP) is a treatment for? obstructive sleep apnea
Chronic shouters and singers are at risk for? developing benign laryngeal tumors
__________ _________ is the major risk factor for cancer of the larynx? cigarette smoking (5-35 x more likely)
_____ are 3 times as likely as _____ to develop laryngeal cancer? men 3x more than women
Cancer of the larynx develops betweens the ages of ___ and ___? 50 and 70
When combined with smoking, what can increase the risk of developing laryngeal cancer as much as 100 times? alchohol consumption
Laryngeal cancer is more common in which group of people? African Americans
white, patchy, precancerous lesions appearing on the laryngeal mucosa are called? leukoplasia
Red, velvety patches, appearing on the laryngeal mucosa, thought to be a later stage in carcinoma development are called? erythroplakia
CIS stands for? Carcinoma in situ
Carcinoma in situ (CIS) is what stage? stage 0
Laryngeal cancer may metastasize to the _____? lungs (this would be stage IV)
Where to most lesions form with laryngeal cancer? along the edges of the glottis or true vocal cords
Hoarsnss, change in voice, painful swallowing, dyspnea, foul breath, palpable lump in nec, earache are all signs of ? Laryngeal cancer
Benign vocal cord polyps might be treated with? inhaled steroid spray
Early laryngeal cancers are often treated with ___________ therapy? radiation
Radiation therapy for laryngeal cancer preserves the _____? voice
The combination of radiation and chemo therapy can reduce the need for total laryngectomy by ? two-thirds
The most common druges used to treat laryngeal cancer are? cisplatin (Patinol) and 5-fluorourcil (5-FU)
Besides cisplating and 5-FU, what chemo drugs are used to tread laryngeal cancer? methotextrate (Mexate), bleomycin sulfate (Blenoxane), and carboplatin (Paraplatin)
What type of surgery can be used with CIS and early vocal cord cancers, that preserve the voice? laser surgery
In a partial laryngectomy, ___% or more of the larynx is removed? 50% or more
Will the client lose his/her voice with a partial laryngectomy? normal speaking, breathing and swallowing are restored
What kind of surgery is needed if a cancer extends beyond the vocal cords? total laryngectomy
what is removed with a total laryngectomy? entire larynx, epiglottis, thyroid cartilage, several tracheal rings, and the hyoid bone
Will the client be able to speak after a total laryngectomy? Normal voice is lost
f cervical lymph nodes are involved but no distal metastasis, what kind of surgery might be included with a total laryngectomy? radical or modified neck dissection -- radical = remove all soft tissue from lower edge of mandible to the clavicle -- YIKES!!
Will the client breath through his or her mouth after a total larynectomy? No, breathing will be through stoma
No, breathing will be through stoma anxiety assessment and reduction, teaching loss of voice/breating through neck stoma; establishing postop communications technique (magic slate, hand signals, etc.); taste and smell will be affected
post op care for total laryngectomy includes? monitor airway and resp. status; encourage deep breathing/ coughing; elevate hob; humidify gases; adequate fluids; suction via trachostomy; teach stoma protection; head support when repostioning; call light easy reach; encourage family presence
tracheoesophageal puncture (TEP) is? creation of a passage between the trachea and the esophagus to provide aire to the esophagus; the usual method to restore speech after total laryngectomy; a small one-way valve is installed (requires manual dexterity)
using controlled belching of swallowed air to create sound is called? esophageal speech (only 30% master this)
Three methods of vocal rehab are? Valve placement, esophageal speech, speech generators (teach use preop)
nursing dx for laryngeal cancer? risk for impaired airway clearance; impaired verbal communcation; impaired swallowing; imbalanced nutrition: less than body requirements; anticipatory grieving
While in the hospital trach care is a _____ procedure, it is a _______ procedure? sterile; clean
How long will client have tracheostomy tube in place post partial laryngectomy? approximately 1 week
Laryngeal cancer is associated with _________, _________, _____________________, and ____ smoking, drinking, exposure to industrial irritants, and HPV
Laryngeal cancers are ______ growing? slow
Which health promotion activity for community-dwelling seniors would be most likely to prevent influenza and pneumonia? a. wintertime indoor exercise b. flu vaccine clinics c. teaching handwashing d. teaching crowd avoidance b.
Most appropriate Tx for ER client following facial trauma who complains 'nose keeps dripping"; drainage appears like watery blood? a. provide box of tissues b. reassure client this is expected c. suction the nasopharynx d. obtain specimen for glucose test d
An expected finding with obstructive sleep apnea is? a. confusion and signs of dementia b. enlarged tongue c. complaints of daytime sleepiness d. decreased oxygen saturation levels while awake c.
Hoarse voice is change from previous noted by RN during office visit. Most appropriate to ask? a. How long hoarse? b. Do you smoke? c. Do you have a sore throat? d. Would you like a prescription for throat lozenges? a.
Teaching is effective when client with stage I laryngeal cancer states? a.I'm glad I can delay Tx b. I hate to think about losing speech, but I'd rather Tx aggressively now c. Glad it caught early so I won't lose my voice d. Thank God this never spreads c.
Local effects of lower respiratory tract disorders include? cough, excess mucus production, shortness of breath, dyspnea, hemoptysis, chest pain
dyspnea = difficult or labored breathing
hemoptysis = bloody sputum
cyanosis = gray to blue or purple skin color caused by deoxygenated hemoglobin
clubbing = enlargement and blunting of terminal digits
Systemic effects of lower respiratory disorders include? fever, anorexia, malaise, cyanois, clubbing
Acute bronchitis = an inflammation of the upper airways,commonly folllowing a URI, the cause is usually a viral infection
the most common symptom of acute bronchitis is cough with or without fever and/or sputum production, sometimes with substernal chest pain
Acute bronchites is differentiated from? pneumonia, sinusitis, and chronic bronchitis (COPD)
Treatment for acute bronchitis is ____________? if otherwise healty, symptomatic -- rest, fluids, mild analgesics (acetominophen), expectorants (guaifenesin) daytime, antitussives (cough suppressants) --dextromethorphan or nightime -- hold the antibiotics unless client has COPD or other underlying!!
Inflammation of the lung parenchyma (the respiratory bronchioles and alveoli) is called? pnuemonia
Pneumonia is the ______ leading cause of death in the U.S. sixth
Pneumonia accounts for ___% of the hospital admission in U.S./ 10%
Pneumonia may be either __________ or _____________; or classified as __________, _________, or ____________? Pneumonia may be either INFECTIOUS or NONINFECTIOUS; or classisfied as COMMUNITY ACQUIRED, NOSOCOMIAL, or OPPORTUNISTIC
Noninfectious causes of pneumonia include? aspiration of gastric contents and inhalation of toxic or irritating gases
The most common cause of community acquried pneumonia is the _________ organism, accounting for __% of all diagnosed cases of pneumonia? Streptococcus pneumoniae (aka pnumococcus), 75%
Pnumononcystis carinii usually only causes pneumonia in ____? immunocompromised people
Defenses to pneumonia include ? sneezing, trapping in mucous, reflex closure of epiglottis, cough reflex, cilia and mucus of resp tract, alveolar macrophages, inflammatory and immune responses
The most common means of entry of pathogens into the lung is ? aspiration of oropharyngeal secretions (also through inhaling cough,sneeze, or breath of infected person; contaminated aerolized water; from blood stream from other infection)
consolidation = in pneumonia, the filling of alveoli with serous exudate, blood cells, fibrin, and bacteria -- usually in bases
lobar pneumonia = consolidation of a large portion of an entire lung lobe -- typical for pnumococcal pneumonia
patchy consolidation involving several lobules = bronchopneumonia
Signs for pulmonary consolidation are: Dullness on percussion; increased fremitus; CRACKLES (RALES)/RONCHI; limited breath sounds
risk factors for pneumonia include? Immune compromise, Advanced age, Decrease mobility, Decreased consciousness, Smoking
Sudden onset; fever with chills;Productive cough with purulent sputum or rust-colored sputum; pleuritic pain = bacterial pneumonia
sharp, localized chest pain that increases with breathing and coughing = pleuritic pain
which client position for trach care? semi-Fowler's or Fowler's to facilitate ventilation
what is used to remove crusted secrections hydorgen peroxide, but rinse with gauze moistened with NS to prevent skin irritation
True or False. It is okay to cut the dressing to shape for a trach dressing? False. Do not cut or use a cotton-filled dressing to prevent aspiration of foreign material. Use commerical dressing or fold 4x4
Bacterial pneumonia has a ______ onset with ___________ cough with ________ ________, while atypical (mycoplasma) pneumonia and viral pneumonias have _____ onsets with a _________ cough and _______. Bacterial pneumonia has a _RAPID_ onset with _PRODUCTIVE_ cough with _PURULENT_ _SPUTUM_, while atypical (mycoplasma) pneumonia and viral pneumonias have _GRADUAL_ onsets with a _DRY_ cough and _DYSPNEA_.
rapid onset, productive cough, purulent sputum, fever and chills is what type of pneumonia? bacterial pneumonia (pneumoncoccal or lobar)
gradual onset, dry cough, dyspnea, flu-like symptoms is what types of pneumonia? viral pnuemonia and primary atypical pneumonia (mycoplasma)
ABGs -- an arterial oxygent tension (PO2) less than ____ indicates impaired gas exhange or alveolar ventilation? less than 75-80 mmHG
Alveolar gas exchange impairment may be indicated by a SaO2 value less than _____? 95%
The percentage of arterial hemoglobin that is saturated or combined with oxygen as measured by a pulse oximeter is _______? SpO2
Collect baseline/initial sputum specimens before _____? antibiotic and/or oxygen therapy
Collect sputums specimens at what time of day? early in the morning, just after awakening -- secretions pool overnight
provide ______ care before obtaining sputum speciment? oral care -- reduces contamination from oral flora
when obtaining a sputum specimen via suctioning, apply suction for no longer than ____ seconds? 10 sec
Treatments for pneumonia include _________, _________, and __________? antibiotics, O2 therapy, and Chest PT (percussion, postural drainage,and vibration) -- also increase fluids to 2500-3000ml/day, incentive spirometer
Nasal cannula FiO2 and flow rate? 24-45% 2-6L/min
FiO2 of room air =? 21%
FiO2 = Fraction of inspired oxygen -- the concentration of oxygen in the inspired air
Rebreather maske FiO2 and flow rates? 40-60% 5-8L/min
Maximum FiO2 with non-rebreather mask? up to 100%
What are the three low-flow oxygen delivery devices? nasal cannula, simple face mask, nonrebreather mask
What is a high-flow, precisely regulated device that can deliver 24-50% FiO2? Venturi mask
Oxygen therapy is indicated for those patients who are _________ or __________? hypoxemic or tachypneic
Increasing the FiO2 enhances the __________ of Oxygen into the _________? diffusion of Oxygen into the capillaries
rhythmically striking or clapping the chest wall with cupped hands using rapid wrist flexion and extension = percussion
repeatedly tensing the arm and hand muscles while maintaing frim but gentle pressure over the affected area whyt the flat of the hand = vibration
using gravity to facilitate removal of secretions from a lung segment = postural drainage
administer _______ before postural drainage? bronchodilators or nebulizer treatments
Nursing Dx for pneumonia are? Ineffective Airway Clearance, Ineffective Breathing Pattern, Activity Intolerance, Knowledge deficit
Transmission of TB is by _________ _________? droplet nuclei (airborne droplets produced when infected person sneezes, coughs, speaks, or sings. Droplets can remain suspended for hours.
a sealed off colony of bacilli forms a granulomatous lesion called a __________? tubercle
the process of the center of a tubercle dying and forming a cheeslike, necrotic center is called __________ _______? ceseation necrosis
the screening test for TB is ____? Intradermal PPD (Mantoux test)
PPD is? purified protein derivative of tuberculin
read mantoux in _____ hours? 48-72 hours
<5 mm on Mantoux means? negative response, does not rule out infection
5-9 mm on Mantoux means? postive for people who 1. in close contact with infected 2. abnormal CXR 3. HIV
10-15 mm on Mantoux means? Postive for people with other risk factors 1. birth in high-incidence country 2. low SES 3. African, Hispanic, American Asian American, IV drug use, live in long-term-care
> 15 mm on Mantoux means? Positive for all people
An acid fast smear of a series of ___ early morning sputum specimens is used to verify the presence of M. tuberculosis 3
The positive diagnosis of TB is made by a _____ _____ sputum culture -- takes 4-8 weeks for results
A positve Mantoux test is usually followed by which diagnostic tests? Followed by X-ray or CT, acid-fast staining of sputum, culturing bacteria
isoniazid (INH) is used for? Drug of choice for tuberculosis prophylaxis and first-line drug for active disease
What test should be performed before initiating therapy with isoniazid (INH)? liver tests -- isoniazid (INH) is hepatotoxic
what is the regimen for TB meds? pyrazinamide for 1st 2 months plus isoniazid (INH) and rifampin for first 4 months (9 months if HIV)
what med is added if INH resistance is suspected? add ethambutol(myambutol)
what are the three drugs used for initial TB therapy? isoniazid(INH), rifampin, pyrazinamide
bacilli Calmette-Guerin (BCG) vaccine is for ? TB vaccination -- widely used in developing countries
why are more than one antibacterial drug used in TB therapy? The TB bacillus readily mutates to resistant form if only one is used
Why is TB medication therapy so lenghty? Bacillus are encapulated and can survive for a long time -- min of 6 months to ensure complete eradication
What change to the urine can be assessed for compliance with TB medication regimen? Ethambutal turns body fluids orange-red
Most TB meds have what side effect? hepatotoxicity, so avoid concurrent alcohol and acetominophen use
Fatigue, Weight loss, Anorexia Low grade fever and night sweats, Cough, initially dry, later purulent and/or blood stained = TB
HIV is particulary high risk factor for TB because? It suppresses cell mediated immunity which is what defends against TB
dry cough, eventually productive along with night sweats? TB
chronic, progressive infection with a period of latency following initial infection, occuring most often in the lungs? TB
leading infectious cause of mortality worldwide? TB -- kills approx. 2 million /year
Nursing Dx for TB? Fatigue, Knowledge deficit,Ineffective therapeutic regimen management, Risk for infection
Polymerase Chain Reaction (PCR) test is for? TB (rapid DNA detection)
pre medication testing for TB? liver function, vision exam (ethambutol side effects), audiometric (streptomycin side effects)
How effective is influenza vaccine? 40-50% effective at preventing hospitalization, 80% efffective at preventing death
How effective is pneumoncoccal vaccine? 75% effective at preventing invasive disease
what ages should get influenza vaccination? flu > 50yrs (all ages if immunocompromised)
what ages should get pneumoncoccal vaccination? pneumonia >65 (>2 if immunocompromised)
a preventable chronic inflammatory condition of the lungs that results in a tightening or narrowing of the airways =? Asthma
dyspnea, chest tightness, coughing, and wheezing with tachypnea, tachycardia, anxiety and apprehension? could be asthma attack
#1 cause of school absenteeism? Asthma
Cause of Asthma? largely unknown, but attacks are usually attributed to an allergic reaction from one or more of a variety of “triggers,” such as cigarette smoke, pollen, mold, animal dander, feathers, dust, air pollution, food, exercise or emotional stress.
the airways narrow, the lining of the lungs begins to swell, the muscles tighten and mucus is secreted into the airway, producing a “wheezing” sound. The individual may feel as though he/she is suffocating, possibly generating fear and panic = Asthma "atttack"
Cholinergic (parasympathetic) stimulation leads to broncho___________? bronchoconstriction
Sympathetic Beta-2-adrenergic receptors cause broncho__________? bronchodilation
Inflammatory mediators such as histamine released during antigen-antibody response act on bronchial smooth muscle to cause broncho_________? bronchoconstriction
triggers for asthma include? allergens, respiratory tract infections, inhaled irritants, emotional upsets
loud diffuse wheezing? asthma
severe, prolonged asthma that does not respond to routine treatment = __________ ___________? status asthmasticus -- a medical emergency -- treat agressively, prepare for intubation, mech. vent, etc.
The onset of respiratory failure with asthma is marked by ____________ breath sounds? inaudible
PEFR = Peak Expiratory Flow Rate
FEV1= forced expiratory volume
PEFR and FEV1 are the most valuable PFTs to evaluate? the severity of an asthma attack and effectiveness of treatments
What is "Challenge" or "Bronchial provocation testing"? Tests used to confirm diagnosis of asthma, inhaled substance such as histamine is used to detect hypersensitive airway response
ABGs duing initial asthma attach show? mild respiratory alkalosis d/t tachypnea and hypoxemia (low PO2)
Severe airflow obstruction during asthma attack cause what in ABGs? respiratory acidosis and significant hypoxemia (PO2 < 42mmHg)
The three primary classes of bronchodilators used in asthma are ? adrenergic stimulants, methylxanthines, anticholinergics
What is the treatment of choice for quick relief of allergy symptoms? short-acting beta-adrenergic agonists like albuterol, biolterol, perbuterol, terbutaline by metered-dose inhaler
no _____ blockers with asthma beta-blockers
Ipratropium (Atrovent) is an ______________ used as a __________________ for asthma anticholinergic, bronchodilator -- it acts more slowly than the beta agonists like albuterol (60-90 min onset
Albuterol is a _______________ which acts as a _________________ for the treatment of ___________? beta-adrenergic stimulant, bronchodilator, asthma
Theophylline is a __________________ used as an adjunctive treatment for ____________? methylxanthine, asthma -- it is a bronchodilator, increases cAMP levels
when using theophylline as a bronchodilator you must monitor and assess what? serum theophylline levels -- 10-20ug/mL is thereapeutic
Theophylline is a ______-term bronchodilator long-term
Anti-inflammatory agents given to suppress airway inflammation in asthma are ___________, _________, and ___________ (blank)
Name the six classes of medications used to treat asthma. 1. adrenergic stimulants 2. methylxanthines 3. anticholinergics 4. coritcosteroids 5. mast cell stabilizers 6. leukotriene modifiers
What are a few examples of adrenergic stimulators for bronchodilation? epinephrine, albuterol (Proventil, Ventolin), salmeterol (Serevent)
adrenergic stimulants result in smooth muscke __________ and ___________________? relaxation, bronchodilation
which class of asthma medication is used and by what route for quick relief of acute asthma attack? adrenergic stimulant, inhaler
Which class of asthma medication are now used primarily for preventing noctunal asthma in adults? methylxanthines
Ipratroprium bromide (Atrovent) and atropine are examples of which class of medications? anticholinergics
when using inhaled corticosteroids, there is an increased risk of __________ infections fungal
What is the action of the leukotriene modifiers lkie zafirlukast (Accolate) and zileuton (Zyflo) Leukotriene modifiers interfere with the inflammatory process in the airways, improving airflow, decreasing symptoms, and reducing the need for short-acting bronchodilators
Theophylline is a ___________? mehylxanthine
Nursing Dx for asthma? Ineffective Airway Clearance, Ineffective Breathing Pattern, Anxiety, Ineffective Therapeutic Regimen Management
With asthma an ineffective cough or a quiet chest may signal impending __________ __________? respiratory failure
There are currently three classes of medications used for asthma: corticosteroid anti-inflammatory agents, which interrupt the development of bronchial inflammation bronchodilators, which relax the bronchial muscle by dilating the airways; mast cell stablizers that inhibit inflammatory response by blocking early and lat
In early asthma attack, the client responds by _______ventilating and they exhibit ____________ _______osis? In early asthma attack, the client responds by _HYPER_ventilating and they exhibit __RESPIRATORY__ _ALKAL_osis?
Late in an asthma attack, the person's respiratory muscles fatigue, they begin to retain _____ and exhibit ____________ ________osis? Late in an asthma attack, the person's respiratory muscles fatigue, they begin to retain _CO2_ and exhibit _RESPIRATORY_ _ACID_osis?
The peak of the early phase of asthma attack is ____ to _____ min 30 to 60 min
During the early phase of asthma attack the primary physiological response of the lungs is _____________ (symptom) and which is responsive to _________________ (type of medication) During the early phase of asthma attack the primary physiological response of the lungs is _BRONCHSPASM_ (symptom) and which is responsive to _BRONCHODILATORS_ (type of medication)
Early phase Peaks 30-60 min. Primary response is bronchospasm Responsive to bronchodialator (blank)
During the LATE phase of asthma attack the primary physiological response of the lungs is ______________________ and which is responsive to _______________ (type of medication) During the early phase of asthma attack the primary physiological response of the lungs is _MUCOSA SWELLS (INFLAMMATION)_ and which is responsive to _CORTICOSTEROIDS_ (type of medication)
What is the leading cause of cancer deaths in the U.S.? Lung cancer
Most people diagnosed with lung cancer die within ____? 1 year
More than ____% of lung cancers are caused by smoking? 80%
The number one cause of lung cancer is _________? smoking
Besides smoking what are risk factors for lung cancer? ionizing radiation, inhaled irritants especially asbestos
tumors of the airway epithelium are called ? bronchogenic carcinomas
the vast majority of primary lung lesions are ? bronchogenic carcinoma
bronchogenic carcinomas are categorized by cell type, what are the four categories? small-cell carinoma; adenocarcinoma; squamous cell carcinoma, adn large-cell carcinoma ( the last three are categorized as non-small cell)
non-small cell carcinomas account for ___% of lung cancers? 75%
small cell carcinomas account for ___% of lung cancers? 25%
what is the fastest growing type of lung cancer? small cell carcinoma
T or F. All bronchogenic cancer tends to be aggressive, locally invasive and have widespread metastatic lesions True
Lung cancer -- central lesion wht hilar mass common, early mediastinal involvment, no cavitation, SIADH, Cushing's syndrom, thrombophlebis = ? small cell carcinoma
Peripheral mass involving bronchi; few local symptoms; hypertrophic pulmonary osteoarthropathy = ? adenocarcinoma
central lesion located in large bronchi; client presents with cough, dyspnea, atelectasis, and wheezing; hypercalcemia is common == ? squamous cell carcinoma
Usually perphral leasion that is larger than adenocarcinoma and tends to cavitate; gynecomastia, thrombophlebitis = ? large-cell carcinoma
Superior Vena Cava Syndrome is ? partial or complete obstruction of teh superior vena cava; a potential complicaton of lung cancer
Created by: hwk