AH II Word Scramble
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| Question | Answer |
| Atelectasis | collapse of lung tissue at any structural level (segmental,lobar, basilar, microscopic) |
| Who is at risk for atelectasis | post-op, elderly, obese, bedridden, chronic critically ill |
| assessment of atelectasis | x-ray, hypoxemia, dyspnea, tachypnea, tachycardia, cyanosis, diminished breathsounds or crackles in lower lobes |
| severe atelectasis | tracheal shift toward affected side, decrease in tactile fremitus over affected side,dull percussion over affected side, decreased chest movement over affected side |
| prevention of atelectasis | position changes, early ambulation, cough, deap breath, IS |
| teatment of atelectasis | O2, postural drainage, suctioning, bronchoscopy |
| risk factors for pnuemonia | advanced age, smoker, URI, immobility, immunosuppression,malnutrition, dehydration, chronic disease,tracheal intubation |
| pathophys of pnuemonia | inflammation, loss of defense mechanisms (cilia, cough, immunoglobulins A), Alveolar exudate (mucous), bacterial pneumonia is usually more virulent than viral |
| pnuemonia assessment | fever, chills/sweats, pleuritic chest pain, cough,sputum, hemoptysis,fatigue, crackles, increased whispered pectroliloquy(e sounds like a) |
| diagnosis of pnuemonia | sputum culture, x-ray, blood/urine cultures, ABG's, bronchoscopy |
| Tx of pneumonia | antibiotics (penecillin,levoquin),O2, postural drainage, resp.tx, suctioning, bronchodilators (beta 1 agonist) |
| nursing interventions for pneumonia | increase fluid intake, antibiotics, C&DB w/ IS, positioning, suctioning, monitor O2 |
| preventing pneumonia | handwashing, protective equipt., fluid intake, control pain, C&DB w/ IS, prevent aspiration, monitor tube feed residual |
| Tuberculosis | common in underdeveloped countries, Mycobacterium TB, increased in HIV, multiple resistant strains, spread by air droplet |
| TB latent infection | causes no symptoms and is not contagious, positive skin test, can become active later |
| TB active infection | display symptoms, contagious, positive skin test |
| extrapulmonary TB | occurs outside the lung, kidneys, growth plates, lymphatics, bone marrow, widespread dissemination is known as miliary TB |
| TB assessment | cough (initial sx), fatigue, anorexia, wt loss, night sweats, low-grade fever, dyspnea, hemoptysis,dull or pleuritic chest pain,chest tightness, crackles |
| TB screen & diagnosis | mantoux (purified protien derivative), QFT, MODS |
| mantoux test | read in 48-72 hrs, > 5mm of induration positive for HIV & IV drug abusers, >10mm positive for all other high-risk groups, >15mm positive for low-risk groups |
| QFT (quantiferon-TB Gold | blood test, detects bacteria in the blood |
| MODS (microscopic-observation drug-susceptibility | sputum test very reliable in detecting MDR-TB |
| TB diagnosis after a positive skin test | acid-fast Bacillus smear (sputum), 3 sputum collections for 3 mornings, chest x-ray |
| TB induction phase meds (1st 2-4 months) | isniazid (on empty stomache), rifampin(orange pee) |
| TB continuation phase meds (4-8 months after) | isoniazid, rifampin |
| new TB drug | rifater, combo of isoniazid, rifampin & pyrazinamide |
| prevention of transmission of TB | early ID, private negative airflow room, UVlamp/hepa filter, TB mask, monitoring hc workers |
| Main risk factor of lung cancer | smoking |
| small cell cancer | rapid growth considered metastatic upon diagnosis |
| squamous cell cancer | slower growth, can metastasize, smokers, cental bronchus causing air obstruction, esophagus, more infectious, does develop symtoms |
| adenocarcinoma | slow growth, can metastasize, secondhand smoke, periphery of the lung, glandular often no symptoms, diagnosed later than SCCA |
| large cell cancer | slow growth, can metastasize |
| signs & symptoms of lung cancer | persistent cough, hemoptysis, rust-colored/purulent sputum, wt loss, fatigue, chest sholder back or arm pain, recurring pleural effusion, pnuemonia, bronchitis, dyspnea |
| metastasis of lung cancer | laryngeal nerve involvement (change quality of voice), lymph node involvement (palpable), dysphagia, suppression of vena cava |
| diagnosis of lung cancer | x-ray, CT scan, bone scan, PET scan, MRI |
| tx of lung cancer | radiation, chemotherapy |
| what lab is noted for CT & bone scans | creatinine |
| surgical procedures for lung cancer | pulmonary resection, pneumonectomy |
| wedge resection | remove small localized section of tissue |
| segmental resection | remove one or more segments of lung |
| lobectomy | removal of entire lobe, remaining lung over expands to fill empty space |
| pneumonectomy | remove entire lung, serous fluid fills empty thoracic cavity |
| post-op thoracotomy care | pain is priority, altered gas exchange, ineffective airway clearance |
| at risk for what after thoracotomy | tension pneumothorax, shock, post-op infection |
| chest tube | closed to the atmospheric pressure,negative pressure system, remove air, serosanguineuos or blood fluid from plueral space, re-expand lung tissue, prevent mediastinal shift (which can compress the heart & blood vessels) |
| why are chest tubes inserted | pneumothorax, hemothorax, pleural effusion, post thoracotomy, post CABG, chylothorax |
| chlylothorax | occurs after surgical procedures when lymphatics are nicked & large amounts of milky/serous drainage |
| types of chest drainage systems | bottle, pluer-evac, atriaseal, thora-seal |
| whater seal chamber | tidaling, bubbling, suction control: 10-20cm H2O (> 50 cm dangerous) |
| tidaling | normal, rises with inspiration, falls with expiration |
| bubbling | intermittent-common after thoracotomy & clears with time, continuous is not normal (may be air leak) |
| wall suction | more than 20, 30-40 cm H2O pressure |
| chest tube drainage | must always be below clients chest |
| milking/stripping | creates pressure of -100cm H2O, can strip w/ MD orders |
| drainage volume | > 100 cc/hr is surgical emergency, call MD, can be discontinued if drainage stops after 24 hrs |
| chest tube air leaks | inspect insertion site, check dressing, briefly clamp tube & ask client to cough, if air leak still in chamber its the system if not its the pt |
| nursing management of chest tube | positioning, dressing change, activity, monitor, assess pain |
| penetrating chest injuries | open sucking wound, hemothorax, hemoneumothorax, combined w/ abdomen, diaphragm, trachea & great vessel injuries |
| blunt chest injuries | pneumothorax (tracheal shift away), hemothorax, diaphragm injury, aortic rupture, trachea/bronchus rupture, cardiac injury, fracture sternum, rib fracture |
| pneumothorax | presence of air in the plueral space, impairs complete lung expansion, |
| closed pneumothorax | puncture or tare internal respiratory structures, fractured rib most common cause, spontaneous rupture of internal structures |
| open pneumothorax | sucking chest wound, accidents, surgical trauma |
| tension pneumothorax | emergency, with each inspiration air trapped in pleural space, medialstinum shift |
| hemothorax | blood in pleural space, >300cc for sx to occur |
| flail chest | consists of 2 or more adjacent ribs on same side broken, flail section floats moving paradoxical w/ inspiration/expiration (see saw movement) |
| assessment of chest injuries | tachypnea, dyspnea, abrasions, burns, asymmetrical chest expansion, accessory muscles, shallow breathing, pain w/inspiration, see saw movement |
| palpation of chest injury | chest expansion, subq emphysema (rice crispies) decrease fremitus (movement of air) trachea displacement |
| trachea displacement for pneumothorax | away from injured side |
| trachea displacement for hemothorax | toward injured side |
| percussion of chest injury | tympany= pneumothorax, dull= hemothorax or rupture diaphragm |
| auscultation of chest injury | decrease breath sounds, absent breath sounds, bowel sounds heard in chest |
| nursing intervention for chest trauma | cough, deep breath, IS, pain meds, splinting, chest tube maintenance |
| ARDS (acute respiratory distress syndrome) | ischemia, toxins, sepsis, inflammation |
| patho of ARDS | inflammation, increased capilary permeability, decreased lung surfactant, alceolar collapse, fibrosis |
| pulmonary edema | abnormal accumulation of fluid in the interstitial spaces in lungs, cardiogenic |
| most common cause of pulmonary edema | heart failure (red frothy sputum) |
| clinical manifestatins of ARDS | severe hypoxia, tachypnea, dyspnea, lung sound may be normal or abnormal (from inflammation not fluid overload) |
| medical management of ARDs | mechanical ventilation, prone position (1 hr to promote profusion), diuretics don't work |
| needs for emergency intubation | anesthesia, suction, ambu bag, O2, intubation kit, sedation, tape or ties, chest x-ray |
| care of intubated patient | reassurance, sedation, comfort, assess lung sounds (q 2-4 hrs), oral care, suction, SaO2 monitoring, ABGs, maintain placement, monitor for skin breakdown, monitor cuff inflation, position changes |
| indication for tracheostomy | airway obstruction, chronic resp failure, prevent aspiration, promote pulmonary hygiene |
| fenestrated trach | speaking valves |
| when to change cannula | every shift, maintain dry dressing |
| tracheomalacia | softening of trach |
| decannulation | dislodgement of trach |
| suctioning trachs | saline, hyperoxygenate, monitor SpO2, HR, VS, insert catheter until you elicit a cough, suction for 10-15 sec |
| risk factors for cancer of the larynx | smoking, drinking |
| cardinal syptom of larynx cancer | hoarseness, > 2 weeks w/ no symptoms of URI see MD |
| larynx cancer diagnosis | laryngoscopy, CT, tissue biopsy |
| tx for larynx cancer | chemo/radiation 1st to shrink, then surgery |
| larynx cancer post-op concerns | bleeding, infection, aspiration, loss of voice, trach will be converted to stoma |
| epiglottis | inflammation of epiglottis = emergency |
| causes of epiglottis | H. influenza, recent URI |
| symptoms of epiglottis | stridor, painful sore throat, inability to swallow, DROOLING |
| tx of epiglottis | IV steroids, antibiotics |
Created by:
aclelan
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