Management of Patients with Chest and Lower Resp Tract Disorders
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| Refers to closure or collapse of alveoli and often is described in relation to x-ray findings and clinical signs and symptoms | Atelectasis
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| fluid accumulating within the pleural space? | pleural effusion
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| air in the pleural space? | pneumothorax
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| blood in the pleural space? | hemothorax
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| Excessive pressure on the lung tissue, which restricts normal lung expansion on inspiration can cause? | Atelectasis
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| What are the hallmarks of the severity of atelectasis? | Tachypnea, dyspnea, and mild to moderate hypoxemia
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| What are signs and symptoms of atelectasis? | increasing dyspnea, cough, and sputum production
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| What are nursing measures to prevent atelectasis? | frequent turning, early mobilization, and strategies to expand the lungs and to manage secretions (Voluntary deep-breathing maneuvers at least q2hrs and incentive spirometry)
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| What is PEEP? | positive end-expiratory pressure
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| What is CPPB | continuous positive pressure breathing
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| In patients who do not respond to first line measures for atelectasis or who cannot perform deep-breathing exercises, what are three other treatments that can be used? | PEEP, CPPB, and bronchoscopy
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| If the cause of atelectasis is bronchial obstruction from secretions what must be done? | secretions must be removed by coughing or suctioning to allow air to reenter that portion of the lung.
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| With a large pleural effusion that is compressing lung tissue and causing alveolar collapse, what type of treatment may be included? | thoracentesis or insertion of a chest tube.
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| What is thoracentesis? | insertion of a needle into the pleural space to remove fluid that has accumulated and decrease pressure on the lung tissue; may also be used diagnostically to identify potential causes of pleural effusion.
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| An acute inflammation of the mucous membranes of the trachea and the bronchial tree, often follows infection of the upper respiratory tract? | Acute tracheobronchitis
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| What are the main causes of acute tracheobronchitis? | Streptococcus pneumoniae, Haemophilus influenza, Mycoplasma pneumoniae, and fungal infections (Aspergillus)
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| Inhalation of physical and chemical irritants, gases, or other air contaminants can also cause (blank) | bronchial irritation
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| What are the clinical manifestations of acute tracheobronchitis? | Initially, the patient has a dry, irritating cough and expectorates a scanty amount of mucoid sputum. The patient may report sternal soreness from coughing and have fever or chills, night sweats, headache, and general malaise.
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| What is the medical management for acute tracheobronchitis? | Antibiotics, Expectorants, and increased fluid intake.
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| What medication is usually not prescribed for acute tracheobronchitis? | Antihistamines
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| What is the nursing management for acute tracheobronchitis? | Encourage increased fluid intake and directed coughing to remove secretions. Completion of antibiotics, and cautions against overexertion.
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| (blank) is an inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses? | Pneumonia
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| What are the most common causes of death from infectious diseases in the United States? | Pneumonia and influenza
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| How is pneumonia classified? | Community-acquired pneumonia(CAP), hospital-acquired pneumonia (HAP), pneumonia in the immunocompromised host, and aspiration pneumonia.
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| What is the most common cause of CAP in people younger than 60 years of age? | S. pneumoniae (pneumococcus)
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| What causes CAP that frequently affects elderly people and those with comorbid illnesses? | H. Influezae
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| How is mycoplasma pneumonia spread? | by infected respiratory droplets through person to person contact.
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| What is the most common cause of pneumonia in infants and children? | Viruses
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| (blank) is associated with a high mortality rate, in part because of the virulence of the organisms, their resistance to antibiotics, and the patient's underlying disorder? | HAP
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| What are the common organisms responsible for HAP? | Enterobacter species, E.coli, H.influenza, Klebsiella species, Proteus, Serratia marcescens, P. aeruginosa, MRSA, and S.pneumoniae.
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| Pneumonia in the immunocompromised host occurs with.....? | use of of corticosteroids, chemotherapy, nutritional depletion, use of broadspectrum antimicrobial agents, AIDS, genetic immune disorders, and long term advanced life support technology (mechanical vents)
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| (blank) refers to the pulmonary consequences resulting from entry of endogenous or exogenous substances into the lower airway? | Aspiration pneumonia
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| What is the most common form of aspiration pneumonia? | bacterial infection from aspiration of bacteria that normally reside in the upper airways.
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| Pnuemonia affects both (blank) and (blank) | ventilation and diffusion
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| If a substantial portion of one or more lobes of the lung is involved, the disease is referred to as (blank) | lobar pneumonia
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| What term is used that describes pneumonia that is distributed in a patchy fashion? | bronchopneumonia
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| What is more common, bronchopneumonia or lobar pneumonia? | bronchopneumonia
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| What are the clinical manifestations for sreptococcal pneumonia? | sudden onset of chills, rapidly rising fever (101 to 105F), and pleuritic chest pain that is aggravated by deep breathing and coughing. Other signs are tachypnea, rapid and bounding pulse.
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| What are the predominate symptoms of pneumonia? | headache, low grade fever, pleuritic pain, myalgia, rash, and pharyngitis.
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| What is usually seen with sever pneumonia? | flushed cheeks and lips and nail beds demonstrate central cyanosis
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| What is orthopnea? | shortness of breath when reclining
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| How is the diagnosis of pneumonia made? | by history, physical examination, chest x-ray, blood culture, and sputum examination.
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| Is there a vaccine for pneumococcal pneumonia? | Yes
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| What is the treatment for pneumonia? | appropriate antibiotics
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| What is the criteria for hospital admission for patients with CAP? | age, home environment/caregiver support, severity of illness, and presence of comorbid conditions.
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| What are the signs and symptoms that may signal the onset of pneumonia in the elderly? | General deterioration, weakness, abdominal symptoms, anorexia, confusion, tachycardia, and tachypnea.
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| Why is the diagnosis of pneumonia often times missed in the elderly? | because the classic symptoms of cough, chest pain, sputum production, and fever may be absent or masked.
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| What are severe complications of pneumonia? | hypotension and shock and respiratory failure (especially with gram negative bacterial disease in elderly patients).
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| A (blank) is any pleural effusion associated with bacterial pneumonia, lung abscess, or bronchiectasis? | A parapneumonic effusion
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| Accumulation of purulent material in the pleural space? | empyema
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| How many stages are there of parapneumonic pleural effusion? | 3...uncomplicated, complicated, and thoracic empyema.
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| Sterilization of an empyema requires how much length of time? | 4 to 6 weeks of antibiotics
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| What are nursing interventions for pneumonia? | Removing secretions, encouraging hydration (2 to 3L/day), humidification to loosen secretions, turn deep breath and cough, incentive spirometry, chest physiotherapy, promoting rest, maintaining nutrion, and patient education, encourage to quit smoking.
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| When a nonfunctioning nasogastric tube allows the gastric contents to accumulate in the stomach, a condition known as (blank) may result | silent aspiration
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| The primary factors responsible for death and complications after aspiration of gastric contents are the (blank)? | volume and character of the aspirated gastric contents.
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| Aspiration pneumonitis may develop from aspiration of (blank) | substances with a low pH.
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| What does the aspiration of gastric contents cause? | A chemical burn to the tracheobronchial tree and pulmonary parenchyma, and an inflammatory response.
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| What is the primary goal when caring for patients at risk for aspiration? | Prevention
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| What does SARS stand for? | Severe acute respiratory syndrome
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| What is SARS? | a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus.
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| How does SARS develop? | It develops in people who either have close contact with a person who has been diagnosed with the disease or a history of travel or residence in an area with known cases.
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| How is SARS transmitted? | by respiratory droplets.
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| What are the symptoms of SARS? | fever, coughing, and difficulty breathing
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| What is the treatment for SARS? | treatment is solely supportive
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| (blank) is an infectious disease that primarily affects the lung parenchyma? | Tuberculosis (TB)
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| What is the main infectious agent of TB? | M. tuberculosis
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| How is TB spread? | by airborne transmission
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| What are the clinical manifestations of TB? | The s/s of pulmonary TB are insidious. Most patients have a low grade fever, cough, night sweats, fatigue, and weight loss. Hemoptysis also may occur.
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| What is used to diagnose TB? | A complete history, physical exam, tuberculin skin test, chest x-ray, acid fast bacillus smear, and sputum culture.
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| If a person is infected with TB, what will the x-ray look like? | it usually reveals lesions in the upper lobes.
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| What method is used to determine whether a person has been infected with the TB bacillus? | The Mantoux method
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| What does induration mean? | hardening
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| What does PPD stand for? | purified protein derivative
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| What is used in the TB skin test? | Tubercle bacillus extract (PPD), 26 or 27 gauge needle
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| When should the test be read? | 48 to 72 hours after the injection
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| What determines the significance of the reaction to the TB skin test? | The size of the induration
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| A reaction of 0 to 4mm is considered (blank)? | not significant
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| What does a reaction of 5mm or greater mean? | It is significant to people who are considered at risk.
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| What is the outcome for HIV patients who take the TB skin test? | The results will be positive
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| What does an induration of 10mm mean? | Significant in people who have normal or mildly impaired immunity.
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| What vaccine is given to produce a greater resistance to the development of TB? | The BCG vaccine.
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| Does a significant (positive) reaction from a TB skin test mean you have the active disease? | No
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| How many classes are used to classify TB? | 5
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| What does class 0 refer to? | no exposure, no infection
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| What does class 1 refer to? | exposure;no evidence of infection
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| What does class 2 refer to? | latent infection; no disease
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| What does class 3 refer to? | disease; clinically active
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| What does class 4 refer to? | disease; not clinically active
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| What does class 5 refer to? | suspected disease; diagnosis pending
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| What kind of manifestations does TB have on elderly patients? | atypical
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| How is pulmonary TB treated? | antituberculosis agents for 6 to 12 months
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| What are the four first line medications for TB? | INH, rifampin, pyrazinamide, and ethambutol.
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| How many parts are there for a recommended treatment guideline for newly diagnosed pulmonary TB? | 2 parts; an initial treatment phase and a continuation phase.
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| What does the initial phase consist of? | A multiple medication regimen of INH, rifampin, pyrazinamide, and ethambutol for 8 weeks.
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| What does the continuation phase consist of? | INH and rifampin or INH and rifapentine for 4 to 7 months.
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| What is the nursing management for patients with TB? | promoting airway clearance, advocating treatment regimen, promoting acitivity and nutrition, and preventing transmission.
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| What is the main reason treatment fails for active TB? | Patients do not take their medications regularly and for the prescribed duration.
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| When should patients take their TB medications? | On an empty stomach or 1 hour before meals.
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| What is the outcome for HIV patients who take the TB skin test? | The results will be positive
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| What does an induration of 10mm mean? | Significant in people who have normal or mildly impaired immunity.
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| What vaccine is given to produce a greater resistance to the development of TB? | The BCG vaccine.
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| Does a significant (positive) reaction from a TB skin test mean you have the active disease? | No
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| How many classes are used to classify TB? | 5
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| What does class 0 refer to? | no exposure, no infection
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| What does class 1 refer to? | exposure;no evidence of infection
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| What does class 2 refer to? | latent infection; no disease
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| What does class 3 refer to? | disease; clinically active
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| What does class 4 refer to? | disease; not clinically active
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| What does class 5 refer to? | suspected disease; diagnosis pending
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| What kind of manifestations does TB have on elderly patients? | atypical
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| How is pulmonary TB treated? | antituberculosis agents for 6 to 12 months
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| What are the four first line medications for TB? | INH, rifampin, pyrazinamide, and ethambutol.
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| How many parts are there for a recommended treatment guideline for newly diagnosed pulmonary TB? | 2 parts; an initial treatment phase and a continuation phase.
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| What does the initial phase consist of? | A multiple medication regimen of INH, rifampin, pyrazinamide, and ethambutol for 8 weeks.
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| What does the continuation phase consist of? | INH and rifampin or INH and rifapentine for 4 to 7 months.
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| What is the nursing management for patients with TB? | promoting airway clearance, advocating treatment regimen, promoting acitivity and nutrition, and preventing transmission.
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| What is the main reason treatment fails for active TB? | Patients do not take their medications regularly and for the prescribed duration.
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| When should patients take their TB medications? | On an empty stomach or 1 hour before meals.
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| Patients taking INH should avoid what type of foods? | foods that contain tyramine and histamine (tuna, aged cheese, red wine, soy sauce, yeast extracts)
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| What effect does rifampin have on other medications? | It can alter their metabolism, making them less effective. (beta blockers, warfarine, digoxin, quinidine, corticosteroids, oral hypoglycemic agents, oral contraceptives, theophylline, and verampamil
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| What should the nurse inform the patient who is taking rifampin about? | Rifampin may discolor contact lenses and that the patient may want to wear eyeglasses during treatment.
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| What does the nurse carefully monitor for with patients being treated for TB? | v/s, and observes for spikes in temp or changes in the patients status.
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| What must the patient do if they have contacted TB? | Contact their local Health Department
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| Spread or dissemination of TB infection to nonpulmonary sites of the body is known as (blank) | Miliary TB
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| A (blank) is necrosis of the pulmonary parenchyma caused by microbial infection? | Lung Abscess
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| Most lung abscesses are a complication of (blank)? | bacterial pneumonia or by aspiration of oral anaerobes into the lung.
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| The organisms frequently associated with lung abscesses are.....? | S.aureus, Klebsiella
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| What are the clinical manifestations of a lung abscess? | Mild productive cough with moderate to copious amounts of foul-smelling, sometimes bloody, sputum, fever, pleurisy, dyspnea, weakness, anorexia, and weight loss.
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| What are preventions for Lung Abscesses? | Appropriate antibiotic therpay before dental procedures, Adequate dental and oral hygiene, and appropriate antimicrobial therapy for patients with pneumonia.
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| What is the medical management for a lung abscess? | Drainage of the lung abscess, a high protein diet.
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| What is the pharmacologic treatment for anaerobic lung infection? | IV Clindamycin and then PO antibiotics for 4 to 8 weeks.
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| What is the nursing management for Lung Abcesses? | Teach patient to deep breath and cough, ensure proper nutritional intake, offer emotional support.
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| (blank) refers to inflammation of both layers of the pleurae (parietal and visceral) | Pleurisy
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| When the inflamed pleural membranes rub together during respiration, what is the result? | severe, sharp, knifelike pain.
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| Where is pleuritic pain limited to? | usually to one side, it may be localized or radiate to the shoulder or abdomen.
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| What is the objective of treatment for pleurisy? | To discover the underlying cause (pneumonia, infection)
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| What is the medical management for pleurisy? | Analgesic agents and topical applications of heat or cold. Indomethacin may be prescribed.
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| What is the nursing management for pleurisy? | The nurse teaches the patient to turn frequently onto the affected side to splint the chest wall and use hands or a pillow to splint the rib cage while coughing.
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| (blank) is defined as abnormal accumulation of fluid in the lung tissue, the alveolar space, or both? | Pulmonary edema
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| What is the clinical manifestations for pulmonary edema? | Dyspnea, air hunger, central cyanosis, hemoptysis, anxiousness,confusion and irritability.
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| What is the medical management for pulmonary edema? | Correcting the underlying cause (CHF, Hypervolemia) Administering oxygen, morphine to reduce anxiety and control pain.
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| What is the nursing management for pulmonary edema? | assisting with management of oxygen and intubation and mechanical ventilation if respiratory failure occurs. Also administering meds as prescribed.
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| (blank) is defined as a decrease in arterial oxygen tension to less than 50mmHg and an increase in arterial carbon dioxide tension to greater than 50mmHg, with an arterial pH of less than 7.35? | Acute respiratory failure
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| What are two causes of Chronic Respiratory Failure? | COPD and Neuromuscular diseases
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| What is the major cause of respiratory failure after major abdominal, cardiac, or thoracic surgery? | A ventilation-perfusion mismatch
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| What are early signs of impaired oxygenation? | restlessness, fatigue, headache, dyspnea, air hunger, tachycardia, and increased blood pressure.
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| As hypoxemia progresses what are more obvious signs? | confusion, lethargy, tachycardia, tachypnea, central cynosis, diaphoresis, and finally respiratory arrest.
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| What is the Medical Management for acute respiratory failure? | To correct the underlying cause and to restore adequate gas exchange in the lung.
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| What is the nursing management for acute respiratory failure? | Patients are usually managed in the ICU, the nurse assesses the respiratory status-responsiveness, ABG's, pulse ox, and v/s.
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| (blank) is a severe form of acute lung injury? | Acute Respiratory Distress Syndrome (ARDS)
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| (blank) occurs as a result of diffuse alveolar damage? | ARDS
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| (blank) is marked by a rapid onset of severe dyspnea that usually occurs 12 to 48 hours after the initiating event? | The acute phase of ARDS
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| What are assessment findings for ARDS? | Intercostal retractions and crackles may be present as the fluid begins to leak into the alveolar interstitial space.
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| What are common diagnostic test for ARDS? | BNP levels, echocardiography, and PAC
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| What is the definitive method to distinguish between heart failure and ARDS? | PAC
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| What is supportive therapy for ARDS | Most always intubation and mechanical ventilation.
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| What is a critical part of the treatment of ARDS? | PEEP (positive end expiratory pressure)
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| (blank) exists when the mean pulmonary artery pressure exceeds 25mmHg with a pulmonary capillary wedge pressure of less than 15mmHg ? | Pulmonary arterial hypertension
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| What are the two types of pulmonary arterial hypertension? | idiopathic(or primary) and pulmonary arterial hypertension due to a known cause.
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| Who does pulmonary arterial hypertension occur most often with? | Women ages 20-40 years of age.
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| What meds are used to treat pulmonary arterial hypertension? | calcium channel blockers, phophodiesterase-5 inhibitors, endothelin antagonists, and prostanoids.
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| (blank) is a condition in which the right ventricle of the heart enlarges as a result of diseases that affect the structure or function of the lung or its vasculature? | Cor Pulmonale
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| What is the frequent cause of Cor Pulmonale? | severe COPD
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| (blank) refers to the obstruction of the pulmonary artery or one of its branches by a thrombus or thrombi that originates somewhere in the venous system or in the right side of the heart? | Pulmonary embolism(PE)
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| What are other types of pulmonary emboli? | air, fat, amniotic fluid, and septic
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| What dysrhythmia can cause a PE? | Atrial Fibrillation
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| What are symptoms of a PE? | dyspnea, chest pain, anxiety, fever, tachycardia, apprehension, cough, diaphoresis, hemoptysis, and syncope
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| Death from PE commonly occurs in how much time after the onset of symptoms? | 1 hour
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| What is considered the best method to diagnose PE? | Pulmonary angiography
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| What is a blood test to help rule out a PE? | d-dimer
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| For patients at risk for PE, the most effective approach for prevention is to prevent (blank) | DVT
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| What are some preventive measures to prevent DVT? | Active leg exercises, early ambulation, anti-embolism stockings and sequential compression devices (SCDs)
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| In regard to a patient whom has a PE, once stabilized, what is the goal of treatment? | dissolove (lyse) the existing emboli and prevent new ones from forming.
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| What drugs are used for anticoagulant therapy? | Heparin and Warfarin
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| What are unfractionated and low molecular weight heparins used for? | To prevent recurrence of emboli (they have no effect on emboli that are already present).
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| Which anticoagulant is recommended for patients who have been diagnosed with PE? | Heparin
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| What is a risk of long term Heparin use? | Antibody formation and bleeding
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| Heparin must be continued until the INR is within a therapeutic range of......? | 2.0-2.5
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| Once a patient starts on an oral regimen of(warfarin), what is to be remembered about drug brands? | The patient should stick to the same brand because the bioavailability may vary greatly among brand.
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| Which drugs are used for Thrombolytic Therapy? | Urokinase, Streptokinase, Aleplase
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| Before thrombolytic therapy is started, which labs are obtained? | INR, PTT, hematocrit, and platelet counts
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| Which drug therapy is stopped prior to giving thrombolytic agents? | Anticoagulant therapy
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| What are some nursing measures that help prevent thrombus formation? | Encourage ambulation and active and passive leg exercises (ankle pumps), do not cross legs, and do not wear constrictive clothing.
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| During thrombolytic infusion, while the patient remains on bed rest, how often are v/s assessed? | every 2 hours and invasive procedures are avoided.
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| When are labs drawn after a thrombolytic infusion is started? | 3 to 4 hours after infusion is started.
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| Because of prolonged clotting time, how long should manuel pressure be applied to puncture sites (arterial or venipuntures) | 30 minutes
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| (blank) is a multisystem, granulomatous disease of unknown etiology? | Sarcoidosis
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| (refers) to a nonneoplastic alteration of the lung resulting from inhalation of mineral or inorganic dust? | Pneumoconiosis
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| What are the most common pneumoconioses? | silicosis, asbestosis, and coal worker's pneumoconiosis.
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| Is there effective treatment for Pneumoconiosis? | No because the damage is irreversible
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| (blank) is the leading cancer killer among men and women in the United States? | Lung Cancer
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| What is the most common cause of lung cancer? | Smoking
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| What are the two major categories lung cancer is classified as? | small cell lung cancer and non-small cell lung cancer.
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| Which category of lung cancer is more prevalent? | non-small cell lung carcinoma (NSCLC)
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| The stage of a tumor refers to....? | size of the tumor, its location, whether lymph nodes are involved, and whether the caner has spread.
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| Which stage is the earlies stage and has the highest cure rate? | Stage I
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| What does stage IV represent? | Metastatic sread
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| What is the most frequent symptom of lung cancer? | Cough or change in a chronic cough.
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| The most common sites of metastases from lung cancer are....? | lymph nodes, bone, brain, contralateral lung, adrenal glands, and liver
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| What is a lobectomy? | Removal of a lobe of the lung
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| What is a pneumonectomy? | Removal of an entire lung
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| What are the two ways chest trauma is classified? | blunt or penetrating
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| What type of chest trauma results from sudden compression or positive pressure inflicted to the chest wall? | Blunt chest trauma
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| What type of chest trauma occurs when a foreign object penetrates the chest wall? | Penetrating trauma
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| What are the most common causes of blunt chest trauma? | motor vehicle crashes, falls, and bicycle crashes.
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| In regard to trauma, agitation and irrational and combative behavior are signs of....? | decreased oxygen delivery to the cerebral cortex.
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| Which sets of ribs are the most common sites of injuries? | The fifth through the ninth
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| Most rib fracutes heal within how much time? | 3 to 6 weeks
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| What usually occurs when three or more adjacent ribs are fractured at two or more sites, resulting in free floating rib segments? | Flail Chest
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| What is the medical management for Flail Chest? | Treatment is usually supportive, providing ventilatory support, clearing secretions, and controlling pain.
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| (blank) is defined as damage to the lung tissues resulting in hemorrhage and localized edema? | Pulmonary contusion.
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| Is pulmonary contusion evident initially after injury? | No, it develops most of the time posttraumatically.
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| The primary pathologic defect with a pulmonary contusion is....? | accumulation of fluid in the interstitial and intra alveolar spaces.
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| Occasionally, a contused lung occurs on the other side of the point of body impact; this is called....? | contrecoup contusion
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| In patients with moderate pulmonary contusions, what may be required? | bronchoscopy
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| What are the most common causes of penetrating chest trauma? | Gunshot and stab wounds
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| (blank) occurs when the parietal or visceral pleura is breached and pleural space is exposed to positive atmospheric pressure? | Pneumothorax
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| What are the different types of pneumothorax? | simple, traumatic, and tension pneumothorax
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| What are sucking chest wounds? | An open pneumothorax when the rush of air through the wound in the chest wall produces a sucking sound
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| What is medistinal flutter or swing? | Structures of the mediastinum (heart and great vessels) shift toward the uninjured side with each inspiration and in the opposite direction with expiration.
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| In regard to an open pneumothorax, what is a lifesaving measure? | Stopping the flow of air through the opening
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| A (blank) occurs when air is drawn into the pleural space from a lacerated lung or through a small opening or wound in the chest wall? | tension pneumothorax
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| T or F; Relief orf tension pnuemothorax is considered an emergency measure? | True
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| What does the nurse assess for in regard to any type of pneumothorax? | tracheal alignment, expansion of the chest, breath sounds, and percussion of the chest.
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| In a (blank), the trachea is shifted away from the affected side, chest expansion may be decreased or fixed in a hyperexpansion state, breath sounds are diminished or absent, and percussion to the affected side is hyperresonant? | Tension pnuemothorax
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