Respiratory
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| What are the tiny hairs that act as filters in the respiratory tract called? | Cilia
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| What connects to the nasal cavity? | Sinuses
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| What spreads to the sinuses? | Nasal infections
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| What lines the nose and sinuses? | Mucous membranes
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| How much fluid do you encourage a patient to drink when they have a respiratory infection? | 2-3L/day
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| What are the three divisions of the Pharynx (throat)? | Nasopharynx, Oropharynx, Laryngopharynx
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| Where is the Nasopharynx located? | Back of nasal passages above the throat
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| What structures make up the oropharynx? | Mouth and throat
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| Where is the Laryngopharynx located? | Above the larynx (voice box)
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| The trachea is lined with cilia, what is the purpose of the cilia? | Sweep mucous toward the throat
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| Why can't a patient speak when they have a tracheostomy? | No air flows over the vocal cords to emit vibrations
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| What must you have at the patients bed side when they have a tracheostomy? | Pen & paper
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| What position should a patient with a tracheostomy be in? | Mid-fowlers
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| How many lobes does the right lung have? | Three
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| How many lobes does the left lung have? | Two
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| Where is the cardiac notch located? | Left lung
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| What is the purpose of the cardiac notch? | Allows heart to sit in thoracic cavity without impeding lung function
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| Where does gas exchange occur? | Alveolar
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| What gases are exchanged in the alveoli? | Oxygen & carbon dioxide
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| What lines the surface of the lungs? | Visceral pleura
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| What lines the chest cavity? | Parietal pleura
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| Where is the diaphragm located? | Below the lungs, attached to the lowest rib
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| What happens when the diaphragm and intercostal muscles contract? | Inspiration (inhalation)
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| What happens when the diaphragm and intercostal muscles relax? | Expiration (exhalation)
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| What type of pressure is created when the diaphragm and intercostal muscles contract? | Negative, allowing air to be pulled in
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| What happens to the air when the diaphragm and intercostal muscles relax? | Air is forced out
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| What are respirations driven by? | CO2
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| Where are the chemoreceptors located? | Carotid arteries
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| What do the chemoreceptors do? | Sense changes in oxygen, carbon dioxide, and pH levels in blood
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| Where do the chemoreceptors send messages to? | Brain
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| How do chemoreceptors maintain homeostasis? | Send messages to the brain to change the rate and depth of respirations as needed
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| What are external respirations? | Exchange of oxygen and carbon dioxide between the lungs and environment
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| What is the % of oxygen in the atmosphere that we breathe? | 21
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| What do the alveoli do to the oxygen and carbon dioxide? | Diffuse
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| What is the waste product that we breathe out called? | Carbon dioxide
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| What is internal respiration? | Exchange of oxygen and carbon dioxide at the cellular level
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| What type of concentrations are the gases exchanged in the capillaries | Equalized
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| What happens to the patient when pH levels fall below 7.4? | Become acidotic
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| When a patient is acidotic, what do they do to maintain homeostasis? | Breathe faster because CO2 levels increase
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| What are the causes of acidosis? | Hypoventilation, drug overdose, pulmonary edema, mechanical ventilation, neuromuscular disease, or airway obstruction
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| What happens to the patient when pH levels increase above 7.4? | Become alkolodic
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| What are the causes of alkalosis? | Anxiety, hyperventilation, initial stages of acute pulmonary problems, mechanical ventilation, or high altitude
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| What is the quickest way to assess oxygenation? | Pulse oximetry
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| What is the normal pulse ox range? | 95%-100%
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| What must you do first when the pulse ox alarm sounds? | Assess patient (never assume it's the equipment)
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| What is the most accurate way to assess oxygenation? | Arterial Blood Gas (ABG's)
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| What is epitaxis? | Nose bleed
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| What is the treatment for epitaxis? | Have patient sit leaning forward with head and shoulders elevated, pinch nose, and monitor blood pressure
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| What type of packing does the physician order for epitaxis? | Ratio of 1:1000 of epinephrine (causes vasoconstriction to reduce bleeding), balloon tamponade, or cautery
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| What is tonsillitis? | Infection of tonsils
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| What is the treatment for tonsillitis? | Tonsillectomy & adenoidectomy (T&A)
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| What is patient care for a patient who has T&A? | Do not give red jello, watch for frequent swallowing, no straws, and no coughing/clearing throat for at least 1 week
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| What are the signs/symptoms of epiglottitis? | Cherry red epiglottis, high fever, and drooling
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| Epiglottitis is considered to be what? | True medical emergency
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| What is the first sign of cancer in the larynx? | Progressive or persistent hoarseness < 2 weeks
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| What is Acute laryngotracheobronchitis also known as? | Croup
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| What is the treatment for croup? | Cool, moist air humidifier
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| What is secondary to Upper Respiratory Infection (URI)? | Bronchitis
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| What are the signs/symptoms of bronchitis? | Narrowed airways, low grade fever, and chest pain
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| What helps thin secretions? | Forcing fluids (2-3L/day)
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| What is COPD? | Chronic Obstructive Pulmonary Disorder
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| What are the names of COPD disorders? | Emphysema, chronic bronchitis, asthma, bronchiectasis, and acute respiratory distress syndrome (ARDS)
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| What are the characteristic of patients with COPD? | Easily fatigued, frequent URI's, and use accessory muscles to breathe
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| What is another name for emphysema? | Pink Buffer
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| What breathing technique do you encourage patients with emphysema to use? | Pursed lip
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| What is the cause of barrel chest? | Trapped air and over inflation of alveoli
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| What is emphysema? | Loss of elasticity and destruction of alveolar walls which decreases area for gas exchange
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| What happens when the bronchioles narrow and trapped air enlarges the air sacs (alveoli) during expiration? | Retention of CO2
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| What is dyspnea? | Trapped air in alveoli that makes it difficult to breathe
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| What is secondary to air trapping causing the barrel chest appearance? | Hyperinflation
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| What are assessment questions to ask an emphysema patient? | Do you smoke? How many packs/day? How long? Are you exposed to second hand smoke?
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| What are the physical assessments for an emphysema patient? | General appearance, airway/breathing, PFT (pulmonary function test), circulation
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| What drives the COPD disorders? | Oxygen - COPD has high retention of CO2
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| What oxygen therapy is used in COPD patients? | No more than 2L/nasal cannula
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| Why can't a COPD patient have high flow oxygen? | Will cause respiratory arrest (CO2 necrosis)
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| What knocks out the drive to breathe in a patient with COPD? | Too much oxygen
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| What is patient teaching for a COPD patient? | Diaphragmatic or abdominal breathing, encourage fluids, and conserve energy
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| Describe pursed lip breathing | Inhaling through the nose, then exhale slowly through pursed lips
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| What is the best way for a patient to conserve energy? | Rest 30 minutes before eating, drink between meals, eat 5-6 meals/day that are high in protein (nutrient dense)
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| What is another name for chronic bronchitis? | Blue bloater
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| What type of coloring does a patient with chronic bronchitis have? | Dusky to cyanotic
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| What is the most common cause of chronic bronchitis? | Smoking
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| What is an elevated temperature a sign of? | Acute bronchitis
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| What do you teach bronchitis patients to avoid? | Milk
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| What is asthma? | Reactive airway disease
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| Where does a intrinsic trigger come from in asthma? | Within the body (stress, respiratory infection, fatigue)
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| Where does a extrinsic trigger come from in asthma? | External factors such as allergens (dust, foods, pollen)
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| What is a bronchospasm? | Narrowing of air passages
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| What is asthma? | Obstruction of bronchioles caused by swelling in the lining; increased mucous production which gets trapped in airways
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| What cromolyn sodium is used to prevent the release of substances in the body that cause inflammation? | Inhaled corticosteroids
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| How do steroids work? | Decrease swelling in the airways; always take with foods, an monitor for infections
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| What is theophylline? | Bronchodilator
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| Why must you monitor blood levels when a patient is taking theophylline? | Excessive levels can be toxic
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| What does not responds to usual treatment and is considered a medical emergency? | Status asthmaticus
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| What do you monitor in a patient with status asthmaticus? | Airway, breathing, and circulation (ABC's)
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| What position do you have a patient with status asthmaticus sit in? | Orthopneic
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| What is the treatment(s) for status asthmaticus? | Aggressively and possible ventilator
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| What is a peak flow meter? | Measures air in forced exhalation, good indicator of how lungs are moving
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| What can indicate early signs of a asthma attack? | Peak flow meter
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| What do you teach a patient with asthma to avoid? | Milk/milk products; and to recognize what triggers an attack, avoid those as well
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| What is bronchiectasis? | Obstruction-dilating bronchi and loss of elasticity
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| What are the signs/symptoms of bronchiectasis? | Coughing when laying down, coughing when first rising in the morning, and large amounts of foul smelling sputum
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| What can a patient with bronchiectasis benefit from? | Postural drainage
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| What are interventions for a patient with bronchiectasis? | Cool mist vaporizer, force fluids (2-3L/day), TCDB q 2hrs, and suction as needed
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| What causes Acute Respiratory Distress Syndrome (ARDS)? | Aspiration
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| What occurs as a result of other disease processes? | ARDS
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| ARDS occurs after what specific other disease processes? | Lung damage, hypovolemic shock, sepsis, intubation, and mechanical ventilation
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| What is the supportive treatment for ARDS? | Adequate oxygenation as well as treating the underlying cause
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| What are the factors that affect lung perfusion and expansion? | Pulmonary embolus (PE), lung cancer, atelectasis, pneumothorax, and hemothorax
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| What is a pulmonary embolus (PE)? | Clot that has moved to the lung
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| What are the nursing interventions for PE? | Elevating HOB 30 degrees or more, and position patient on left side
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| What are the medications used to treat PE? | Anticoagulants and thrombolytics
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| What are the nursing observations for PE? | Epitaxis, hemoptysis, and bruising or bleeding
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| What are the top priorities to watch for in PE? | Blood in urine or stool
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| What is a pneumothorax? | Air gets into the pleural cavity and causes the lung to collapse
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| What happens to a patients v/s when they are experiencing a pneumothorax? | Heart rate increases, blood pressure decreases, and they will have no lungs sounds on the affected side
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| What is the main goal when treating a pneumothorax? | Re-expand the lung
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| What is the treatment for pneumothorax? | Chest tube that is attached an underwater seal system
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| What is pleurisy? | Inflammation of the visceral and parietal pleura
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| What are the nursing interventions for pleurisy? | Medications, splint the affected side, and lay on affected side
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| Who are the high risk patients for pneumonia? | Very old and very young
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| What is pneumonia? | Pooling of secretions in lungs, infection spreads from lobe to lobe
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| What are the objective signs in pneumonia? | Crackles on inspiration, diminished breath sounds in bases, and wheezes due to narrow airways
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| What is a pleural effusion? | Accumulation of fluid in the pleural space
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| What is the treatment for pleural effusion? | Thoracentesis to remove fluid and possible chest tube placement
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| What is tuberculosis (TB)? | Chronic pulmonary and extra-pulmonary infectious disease
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| What is the AFB test? | Acid fast bacilli test is a sputum collection that requires the collection of 10 mL of sputum
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| How is TB diagnosed? | Positive chest x-ray, positive MANTOUX, and three positive AFB sputum cultures
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| What are early symptoms of TB? | Fever in the afternoon and slight cough
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| What are the late symptoms of TB? | Night sweats and hemoptysis
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| What is hemoptysis? | Coughing up blood due to eroding blood vessels
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| Why cant you use a standard mask when treating patient with TB? | Bacilli is micro-small and can travel through a standard mask
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| What is the proper mask to wear for TB? | N95 respirator
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| What kind of room is a TB patient placed in? | Negative pressure room that filters air directly outside and not back into facility air circulation
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| What kind of precautions do you use for TB? | Droplet precautions
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| What is the patient teaching for a patient with TB? | Cover nose and mouth, especially when coughing or sneezing; properly dispose of tissues, and to take all medications during treatment period
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| If a patients chest tube is accidentally removed, what do you do? | Immediately place an occlusive sterile petroleum based dressing at incision site, and notify charge nurse/physician
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| How do you know that a chest tube is working correctly? | Water in drainage system will move up and down as the patients inhales and exhales
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| What does it mean if there is no fluctuation of water in the drainage system of chest tube? | Obstruction
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| How do you prevent chest tube reflux? | Never raise the drainage system above the level of patients chest
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| How do you calculate the drainage in chest tube? | Mark level of drainage with date & time, then subtract cumulative total from amount of drainage; this is counted as output
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| Why is mechanical ventilation used? | Overcome a patient's inability to oxygenate adequately
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| What can be intermittent, continuous, short-term, or long-term? | Mechanical ventilation
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| How do you monitor chest expansion? | Watch to make sure it is symmetrical
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| What are ventilator complications? | Hypotension, pneumothorax, subcutaneous emphysema, stress ulcers, muscular deconditioning, and ventilator dependence
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| What is ventilator dependency? | Inability to wean patient from ventilator
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| What are the different medication classes used for the respiratory system? | Antihistamines, bronchodilators, decongestants, mucolytics, corticosteroids, and antitubercular
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| What is an example of a antihistamine? | Benadryl
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| What are the side effects of Benadryl? | Dry mouth and drowsiness
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| What is an example of a bronchodilator? | Theophylline
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| What is the desired effects of bronchodilators? | Relax the smooth muscles in bronchioles
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| What are the nursing actions for Theophylline? | Monitor Theophylline levels in the blood, as too much can be toxic
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| What are examples of decongestants? | Sudafed or Pseudoephedrine
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| What are the desire effects of decongestants? | Decrease nasal congestion and swelling of mucous membranes
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| What are the desire effects of mucolytics/expectorants? | Thin and break up mucous in order to make it easier to cough up secretions
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| What are examples of mucolytics/expectorants? | Guaifenesin, Mucomyst, or Potassium iodide
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| What are antitussives? | Cough medicines
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| What are the desired effects of corticosteroids? | Decrease swelling (anti-inflammatory)
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| What are side effects of corticosteroids? | Sodium and water retention, weight gain, poor wound healing, bruising, and immediate hyperglycemia
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| What do corticosteroids mask signs of? | Infection
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| What are the nursing interventions for corticosteroids? | Taper off slowly, give with food/milk
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| What are examples of antitubercular medicines? | Isoniazid (INH), Rifampin, and Ethambutol
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| What are the desired effects of antitubercular medicines? | Decrease bacilli ability to reproduce
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| What are the nursing actions for antibubercular's? | Assess blood work, avoid alcohol, and give antiemetic's as ordered
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