respiratory lecture for mtc 265
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| Bronchography is | radiopaque dye covers the bronchial mucosa. It enables visualization of the tracheobronchial tree It is used to identify bronchiectasis
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| Angiography is | IV radiopaque dye, visualize the pulmonary vessels. Pulmonary angiography may be done on patients with suspected pulmonary embolism when the lung scan is inconclusive.
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| What diagnostic test is used to identify bronchiectasis? | bronchography
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| What diagnostic test is helpful in making the diagnosis of pulmonary embolism? | lung scan
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| Lung scan is performed, how? | by injecting technetium IV (nuclear tracer dose)
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| Lung perfusion scan- is use to | visualize clots and check if circulation to carry oxygen to the cells is present
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| Sputum cytology | -cell studies that identify malignancy in cell structure
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| signs and symptoms of hypoxia | restlessness, increased pulse and respiration
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| signs and symptoms of hypercapnia | headache, confusion, bounding pulse, warm sweaty extremities
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| Signs of increased work of breathing | accessory muscles, flaring nostrils, sternal retraction, increased respirations, expiratory grunt
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| risk factors for COPD | cigarette smoke, environmental, genetic factors, secondhand smoke, infection
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| COPD pathology | chronic bronchitis and Emphysema
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| Emphysema is | destruction of the walls of the overdistended alveoli which results in impaired gas exchange
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| Chronic bronchitis is | xcessive accumulation of mucous secretions block the airway
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| Primary Symptoms of COPD: include | dyspnea, chronic cough, and sputum production
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| Auscultation of a COPD patient; would be what? | Dry crackles may be heard at the bases and wheezes may be heard with forced expiration
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| Typical clinical picture of a COPD patient | increased respiratory rate, rapid shallow respirations, use of accessory muscles (in abdomen or neck), limited diaphragmatic excursion (the diaphragm is flattened)
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| What is the typical oxygen therapy for a COPD patient? | oxygen flow of 2-4 liters via nasal cannula or 40% Venture mask
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| What type of diet does a COPD patient have? | high calories and high protien
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| Bronchodilators Medications for COPD | Albuterol (Proventil,Ventolin)
Theophyllines-reduces smooth muscle bronchospasm (Aminophylline by IV infusion, elixophylline PO).
Theodur
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| How is tuberculosis transferred (route)? | airborne
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| what are some of the ways you can transfer Tuberculosis (TB)? | by laughing, coughing, sneezing, whistling or singing
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| what is the percent of people that actually become infected from TB? | 5-15 percent
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| What are the factors that influence TB disease after exposure? | Virulence of the strain, health of the individual, and the lenght of exposure
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| what type of people body's resistance is low with TB? | malnutrition, aging, and people with infectious diseases (HIV)
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| Why does Bacillus calmette guerin (BCG) vaccines cause a false positive? | Live virus vaccine
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| what type of TB test is used for first screening of healthcare workers 2 step TB | TB skin test
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| What type of mask does healthcare workers wear when entering a respiratory isolation room? | HEPA filter mask
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| Where can TB spread to within the body? | Brain, meninges, liver, kidney or Bone marrow
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| When does infected people, become infectious? | when the manifestations of disease occurs
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| What are the symptoms of TB? | cough with hemoptosis, weight loss, anorexia, night sweats, fever, chills, shortness of breath, progressive fatigue and dulling aching chest pain.
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| What confirms the diagnosis of TB? | sputum culture
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| What does it mean when the TB skin test measures 10 mm in diameter or more? | Exposure the TB
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| What is a positive skin test measurement for a HIV patient? | 5mm or more
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| How long should a patient with TB be on medication? | 6 months
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| How many sputum test for TB needs to be done before patient is no longer infectious? | 3 negative sputum specimens
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| How can TB grow and spread within the chest cavity? | tracheobronchial lymph nodes
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| What other parts of the body can TB spread too? | brain, meninges, liver, kidney or bone marrow
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| How long is the treatment for a TB patient? | 6 month to 12 month
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| How many negative sputum test a TB patient need to have in order to be no longer infectious? | 3 negative sputum specimens
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| What are the first line of medication for TB patients? | Isoniazid (INH), Rifampin, Ethambutol, Pyrazinamide
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| Which TB medication will turn your urine red or orange? | Rifampin
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| What TB medication causes problems with visual acuity? | Ethambutol
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| When does a TB patient become non-infectious on medication? | after 2-3 weeks
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| what population should be treated with a nine month course of NH (Isoniazid)? | HIV
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| Bronchiectasis means | A disorder characterized by permanent, abnormal dilation of one or more of the large bronchi
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| What are the predisposing factors for bronchiectasis? | obstructive processes such as lung masses, thick secretions found in cystic fibrosis or bronchitis, and aspirated foreign bodies
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| S/sx bronchiectasis | chronic cough and production of thick (copious mucopurulent) sputum, hemoptysis recurrent pneumonia accompanied by crackles, rhonchi, and wheezing
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| Treatment for bronchiectasis | Antibiotics, bronchodilators, and expectorants
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| TB skin test: indicates exposure, when it measures? | "10 mm or more
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| What is the next test given, when you have a positive TB skin test? | chest x-ray, to determine active lesions
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| Symptoms of TB | cough with sputum that may be streaked with blood, weight loss, anorexia, night sweats, fever, chills, shortness of breath, crackles or wheezes, progressive fatigue, dull aching chest pain
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| Why can't a patient with total laryngectomy aspirate | because the airway has been completely separated from the esophagus
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| What are the risk factor for TB? | close contact with someone who has not been
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| Major risk factors for cancer of the larynx? | smoking and alcohol
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| What are the diagnostic test to determine laryngeal cancer? | CAT for location or MRI for invasion
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| What is the purpose of a biopsy using a panendoscopy? | to confirm the diagnoses and stage the cancer by the TNM method
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| What are the early S/S of laryngeal cancer? | Hoarseness pain or burning in the throat when drinking hot liquids or citrus juices, lump in the neck
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| What are the later S/S of laryngeal cancer? | difficulty swallowing or breathing (dyspnea), unilateral nasal obstruction or discharge, persistent hoarseness, or foul breath, weight loss, general debilitated state, and pain radiating to the ear
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| What is the major health problems of laryngeal cancer? | risk for ineffective breathing patter related to impaired airway
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| What are the side effects of radiation for cancer of the larynx? | hoarseness, sore throat, and difficulty swallowing, skin may get red and tender,
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| What is the partial laryngectomy? | only one vocal cord is involved
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| Why is the Total laryngectomy done? | performed for cancer that extends beyond that vocal cords or cancer that persists after radiation therapy
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| Nodal neck dissection is | removal of the tumor, lymph nodes, the sternocleidomastoid muscle, the jugular vein, 11th craninal nerve and surrounding soft tissue
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| What is the affect of nodal neck dissection on the 11th cranial nerve? | causes the shoulder to drop
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| What causes you to have a permanent tracheal stoma? | total laryngectomy
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| What are the three types of communication after laryngectomy? | esophageal speech, electric larynx, and tracheoesophageal
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| what is used to cleanse a stoma of a laryngectomy? | saline
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| How long does a tracheal stoma heal? | 3-6 weeks
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| What is the initial nutritional treatment for a laryngectomy patient? | may have IV fluids, enteral feedings by PEG or NG or TPN
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| What should nurses assess frequently for, when new nutritional things are introduce for a laryngectomy patient? | swallowing difficulties
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| What are the complications of laryngectomy surgery? | hemorrhage, infection or wound breakdown
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| Why can't a total laryngectomy patient aspirate? | airway has been completely separated from the esophagus
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| How long is the initial nutritional treatment for a laryngectomy patient | 10-14 days
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| What are the risk factors for lung cancer? | smoking, passive smoke and occupational exposure
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| What are the four types of lung cancer? | small cell (oat cell), non- small cell (squamous cell), adenocarcinoma and large cell carcinoma
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| How is lung cancer spread? | direct extension, the lymph system, or blood
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| Symptoms of lung cancer? | Hoarseness, cough, sputum production, hemoptysis (later finding), shortness of breath or change in endurance, purulent or rust colored sputum
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| What is a late symptom of lung cancer? | pleural effusion which is fluid in the pleural space
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| what are the Diagnostic tests for lung cancer? | Chest x-ray, CAT scans, bronchoscopy, needle biopsy, and direct surgical biopsy, MRI
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| What is the purpose of radiation treatment in lung cancer patients? | to shrink the tumor
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| After radiation treatment, how long should they avoid sun exposure? | at least a year
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| How many chest tubes would be inserted after a Pneumonectomy? | two
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| When a pleuravac is in place, how much drainage is to much? | 100 ml/hr
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| What does it mean when there is no fluctuation in the second chamber of pleuravac? | may indicate the chest tube is obstructed or no more air is leaking into the pleural space
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| What supplies are keep at the bedside, when a patient has a chest tube? | sterile gauze and padded clamps
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| in a Pneumonectomy, what is a tissue flap used for? | no air can leak through the stump.
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| what will happen with a pneumonectomy patient, if they lay on the operative side? | erous fluid can go into the remaining lung and drown the patient
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| What is the best position for a pneumoectomy patient post op? | supine and semi fowlers
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| When is the best to implement ambulation for a pneumoectomy patient post op? | second or third postop day
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| When a lung scan is inconclusive at diagnosis of pulmonary embolism, what else can be used? | pulmonary angiography
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| hypoxic patient PO2 level is consistently below, what? | 50
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| What is the best delivery of oxygen? | non rebreather
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| what is the most important things a nurse can impliment for a patient schedules for a bronchoscopy? | pt is NPO
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| what does a pulmonary function study indicate | evaulates lung function and breathing problems
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| what is the most accurate test for asthma | pulmonary function test
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| what conditions is a COPD patient more at risk for? | respiratory infections, hypoxemia, acidosis, and cardiac failure
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| what is the ratio of FEV/FCV need to be defined as a obstructive disease (COPD) | less than 70%
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| what is hemoptysis | blood in the sputum
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| crepitus is | air trapped in and under the skin
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| what is the first nursing interventation for a COPD patient? | improve gas exchange
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| how is smoking history expressed | packs per day times the number of years
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| what do ronchodilators do? | relieve bronchospasm, reduce airway obstruction and aid in secretion clearance
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| what is the purpose of mucolytics? | liquefy and loosen thick mucous secretions so they can be expectorated.
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| what side effect can Theophylline cause for a COPD patient? | lower BP and cause arrythmias
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| what is the therapeutic range for Theophylline? | 10-20 ug/ml
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| cor pulmonale is | right sided heart failure caused by pulmonary disease
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| what are the risk factors for a TB exposure? | close contact with TB patient, immunocompromised people, living in crowded conditions, low socioeconomic group, foreign immigrats, older or homeless, IV drug abusers
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| what is the biggest nursing interventions for a TB patient on medications? | patient teaching for drug therapy adherence and infection control
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| leukotriene antagonists used of COPD | montelukast
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| what are the side effects of Isoniazid(INH) | hepatitis, neurotoxicity, and peripheral neuropathy
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| what can be given to a TB patient on isoniazid to reduce peripheral neuropathy? | vitamin B6
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