321 -Final Study Guide Exam P. 20-38

Front 1

Diagnostic Studies for TB
•TB skin testing (TST) (formerly PPD)

Positive reaction occurs when?

Positive reaction indicates what?

Back 1

–Positive reaction occurs 2-12 weeks after initial infection

–Positive reaction indicates presence of TB but not if dormant or active

Front 2

Diagnostic Studies for TB

TB skin testing (TST) (formerly PPD)

how long should you wait to have your TB test read?

Back 2

48-72 hours is how long you should wait to have your TB test read

Front 3

CXR is used for diagnosis of TB

True or False

Back 3

FALSE-- it does NOT confirm..

sputum confirms!

Front 4

Diagnostic studies to confirm for ACTIVE TB

-Bacteriologic studies (look at sputum for what?

Back 4

– to see if it has acid fast bacilli)

Front 5

Diagnostic studies to confirm for ACTIVE TB

Sputum
-what is the process?

Back 5

– 3 specimens on 3 different days

Front 6

-TB can take up to 3 months before your TB skin test is positive, indicating that you did have a positive exposure

true or false

Back 6

true

Front 7

With regards to TB testing, you are getting tested for the past, no today.

T or F

Back 7

True

-TB can take up to 3 months before your TB skin test is positive, indicating that you did have a positive exposure

Front 8

-a positive TB test doesn’t mean you have TB, it just means

Back 8

you were exposed to it

Front 9

-CXR doesn’t confirm active TB, it just confirms what

Back 9

that you may have a lesion in your lung

Front 10

When reading a TB skin test, what is the only thing that matters?

Back 10

induration

redness doesn’t matter, it’s induration only – raised, bumpy, hard)

Front 11

Positive TB Skin Test – 5 mm

who would be positive? 4

Back 11

–Recent close contact with person newly diagnosed with TB

or if you fall in the highest risk groups:
–HIV
–Organ transplants
-Immunouppressed

Front 12

Positive TB Skin Test – 10 mm

who would be positive? 7

Back 12

–Chronic illness
–Recent immigrants (within 5 years) from high-prevalance countries
–Medically underserved, homeless
–Residents of LTC facilities, prisons
–IV drug users
–Health care workers
–children younger than 4 years of age

Front 13

Positive TB Skin Test – 15 mm

Back 13

–All other persons who are at low risk

(if you are relatively healthy)

Front 14

Thoracentesis is what?

Back 14

-aspiration of pleural fluid or air from the pleural space

Front 15

Thoracentesis
-who may have to get this done?

Back 15

-pleural fluid may be drained to relieve blood vessel or lung compression and the respiratory distress caused by cancer, empyema, pleurisy, or TB

Front 16

Thoracentesis
-what do you tell the pt to expect when getting this procedure done?

Back 16

-tell the pt to expect a stinging sensation from the local anesthetic and a feeling of pressure when the needle is inserted & stress the importance of not moving during the procedure

Front 17

Thoracentesis
-how much fluid is withdraw?

Back 17

-to prevent re-expansion pulmonary edema, no more than 1000mL of fluid is removed at one time

Front 18

-after a thoracentesis, a chest x ray is performed to rule out what?

Back 18

possible pneumothoroax and mediastinal shift (shift of central thoracic structures toward one side)

-monitor VS and auscultate breath sounds for absent or reduced sounds on the affected side

Front 19

Thoracentesis

-assess for complications, such as:

Back 19

-reaccumulation of fluid in the pleural space,
-subcutaneous emphysema,
-infection,
-tension pneumothoroax

Front 20

-teach pt CM of a pneumothoroax which can occur within 24 hrs after a thoracentesis, such as: (6)

Back 20

-pain on the affected side that is worse at the end of inhalation and the end of exhalation
-rapid HR
-rapid shallow respirations
-feeling of air hunger
-trachea slanted more to the unaffected side
-shortness of breath and chest pain

Front 21

Sputum culture

-when should you collect this?
-how much sputum should you obtain?
-what do you have them to before obtaining the specimen?

Back 21

-collect in AM
-15mL of sputum
-brush teeth before collecting specimen

Front 22

Asthma
HR
RR
BS
O2

metabolic imbalance?

Back 22

-tachycardia
-tachypnea
-wheeze
-hypoxemia


-respiratory acidosis

Front 23

Thoracotomy
-incision into the thorax

tell me about oxygen after surgery

Back 23

the lungs have increased functional reserve so they will have enough oxygen after surgery

Front 24

Thoracotomy

-position changes?

Back 24

frequent to prevent fluid accumulation

Front 25

Thoracotomy
-Routine post-op care
Assess for hemorrhage, how?

Back 25

monitor the CT drainage (anything over 100mL per hour is bad)

Front 26

Nursing Care – Postop Thoracotomy/Thorascopic
•Ineffective breathing pattern


assess:

Back 26

–Assess BS every 2-3 hours
–Assess need for tracheal suctioning (restlessness may be a first sign)
–Assess for complications - pneumothorax or hemothorax
–DB&C every 2 – 3 hours
–Position (usually out of bed the night of surgery)
–Use IS every 2 – 3 hours

Front 27

Bronchoscopy is used when?

Back 27

-to view airway structure, get tissue sample

Front 28

Bronchoscopy
-tell pt numbness in throat from anesthetic will go away
---what do you need to do to prevent aspiration?

Back 28

(limit fluids until gag reflex returns)

Front 29

Bronchoscopy
-expect what color sputum?

Back 29

-expect pink sputum, not bloody

-blood streaked sputum is expected for several hours

Front 30

Bronchoscopy

-NPO status?
-mouth care when?

Back 30

4-8 hours before

mouth care prior

Front 31

Bronchoscopy
-complications are: 7

Back 31

cyanosis,
dyspnea,
stridor,
bronchospasms,
hemoptysis,
hypotenstion,
tachycardia

Front 32

Croup refers to what?

Back 32

a group of upper airway illnesses that result from swelling of the epiglottis and larynx

Front 33

Croup
-symptoms for all include 3 common clinical manifestations?

Back 33

inspiratory stridor
seal like barking cough
hoarseness

Front 34

Croup
-throat cultures and visual inspection of the inner mouth and throat are contraindicated in children with LTB and epiglottits. WHY????

Back 34

These procedures can cause laryngospasms (vibrations that close the larynx) and a complete airway obstruction may result

Front 35

Croup
-interventions the parent can do to help reduce mucosal edema?

Back 35

-steam from hot running water in a closed bathroom and cool mist from a beside humidifier are effective in reducing mucosal edema
-cold air outside will help too

Front 36

Trach
-How do you know if you need to do a better job at preoxygenation??

Back 36

--HR increase 40 beats above baseline or 20 beats below when suctioning

Front 37

Pneumonectomy is what?

Back 37

-removal of entire lung and the pleural cavity on the affected side is now empty

Front 38

Pneumonectomy
-do they have a chest tube?

Back 38

-no CT, want fluid to accumulate in the empty space and create adhesions which reduce mediastinal shift

Front 39

Pneumonectomy
--complications (2)

Back 39

empyema and development of bronchopleural fistula

Front 40

Pneumonectomy

-what do you make sure to cover this with?

Back 40

-cover with occlusive dressing so air doesn’t accumulate in the space

Front 41

Laryngeal cancer

C/M: very few early signs (3)

Back 41

-hoarseness (earliest sign)
-discomfort
-lump in throat (earliest sign)

Front 42

Laryngeal cancer

C/M - Late:

Back 42

-pain
-dysphagia
-air way obstruction
-decreased tongue movement
-otalgia (ear pain)

Front 43

Thoracotomy
-3 complications:

Back 43

-impaired gas exchange
-ineffective breathing pattern
-hypoxia

Front 44

Pneumothorax
-what is it?

-BS upon auscultation?
-percussion?

Back 44

collapse of a lung caused by air in pleural space

-reduced breath sounds on auscultation
-hyperresonance on percussion

Front 45

Pneumothorax

-prominence of the involved side of the chest which moves poorly with respirations

True or False

Back 45

True

Front 46

Pneumothorax
-where do they experience pain?

-HR?

Back 46

-pain with respiration
-tachycardia

Front 47

Pneumothorax
-BS on the affected side:

Back 47

-diminished or absent breath sounds on the affected side

Front 48

Pneumothorax
-how are there respirations?

-metabolic imbalance?

Back 48

-rapid, shallow respirations


-respiratory acidosis

Front 49

Pneumothorax
-where is the trachea slanted towards?

Back 49

-trachea is slanted more to the unaffected side instead of being in the center of the neck

Front 50

Pneumothorax
-diagnosed how?

Back 50

-an ultrasound or chest x ray is used for diagnosis

Front 51

Pulmonary Emphysema
--2 major changes are

Back 51

loss of lung elasticity and hyperinflation of the lung which result in dyspnea and the need for an increased RR

Front 52

Pulmonary Emphysema
-in a healthy lung, enzymes called proteases are present to destroy and eliminate organisms inhaled during breathing.

Back 52

-if these protease levels are high, they damage the alveoli and the small airways by breaking down elastin.
-high protease levels cause the alveolar sacs to lose their elasticity and the small airways to collapse or narrow.

Front 53

Pulmonary Emphysema
--some alveoli are destroyed, others become large and flabby, with a decreased area for effective gas exchange

Back 53

-an increased amount of air becomes trapped in the lungs and the work of breathing is increased

Front 54

Pulmonary Emphysema
-what happens to the lung and diaphragm?

Back 54

-the hyperinflated lung flatters the diaphragm, weakening the effect of the muscle so the pt needs to use accessory muscle in the neck, chest, and abdomen to inhale and exhale. this increased effort increases the need for O2

Front 55

Pulmonary Emphysema

-metabolic imbalance?

Back 55

carbon dioxide retention and respiratory acidosis are seen

Front 56

Pulmonary Emphysema
-why are they called pink puffers?

Back 56

-hyperventilation keeps PaO2 WNL, “pink puffer” (as a result of air becoming trapped they have hyperventilation, they breathe faster trying to get the air out but that breathing helps them maintain their PaO2 and that’s why they are called pink puffers, they are pink. they can get oxygen in, but they have problem blowing it out)

Front 57

barrel chest appearance is seen with what COPD?

Back 57

Pulmonary Emphysema

Front 58

Chronic Bronchitis
-excessive mucous production obstructs the small airways

Back 58

the irritants trigger inflammation with vasodilation, congestion, mucosal edema, and bronchospasms.

Front 59

Which COPD? an inflammation of the bronchi and bronchioles caused by chronic exposure to irritants

Back 59

Chronic Bronchitis

Front 60

which COPD?
-alveoli are only affected

Back 60

emphysema

Front 61

Which COPD

-chronic inflammation causes an increase in the # and size of mucous glands, which produce thick mucous
-the bronchial walls thicken and impair airflow

Back 61

chronic bronchitis

• chronic bronchitis hinders airflow and gas exchange because of mucous plugs and infection narrowing the airways

Front 62

Chronic Bronchitis
-why are they called blue bloaters?

Back 62

-unable to increase breathing effort to maintain PaO2 = blue bloater

Front 63

Chronic Bronchitis
-chronic hypoxemia causes what?

Back 63

kidneys increase production of RBC to increase oxygen (polycythemia)

clubbing (angle > 160) result of chronic hypoxia

Front 64

Emphysemia OR Chronic bronchitis

Body build: thin with weight loss

Back 64

Emphysemia

Front 65

Emphysemia OR Chronic bronchitis

Body build: tendency toward obesity

Back 65

Chronic bronchitis

Front 66

Emphysemia OR Chronic bronchitis

Age: 30-40 onset; 60-70 disabling

Back 66

Emphysemia

Front 67

Emphysemia OR Chronic bronchitis

Age: 20-30 onset, 40-50 disabling

Back 67

Chronic bronchitis

Front 68

Emphysemia OR Chronic bronchitis

Dyspnea: slow and progressive

Back 68

Emphysemia

Front 69

Emphysemia OR Chronic bronchitis

Dyspnea: variable, relatively late

Back 69

Chronic bronchitis

Front 70

Emphysemia OR Chronic bronchitis

Sputum: scanty, mucoid

Back 70

Emphysemia

Front 71

Emphysemia OR Chronic bronchitis

Sputum: copious,mucopurulent

Back 71

Chronic bronchitis

Front 72

Emphysemia OR Chronic bronchitis

Cough: negligible

Back 72

Emphysemia

Front 73

Emphysemia OR Chronic bronchitis

Cough: considerable

Back 73

Chronic bronchitis

Front 74

Emphysemia OR Chronic bronchitis

Chest: increase in AP diameter

Back 74

Emphysemia

Front 75

Emphysemia OR Chronic bronchitis

Chest: slight to marked increase in AP diameter

Back 75

Chronic bronchitis

Front 76

Emphysemia OR Chronic bronchitis

scattered crackles, rhonci, wheezing

Back 76

Chronic bronchitis

Front 77

Emphysemia OR Chronic bronchitis

-limited diaphragmatic excursion
-quite or diminished breath sounds

Back 77

Emphysemia

Front 78

Emphysemia OR Chronic bronchitis

Cor Pulmonale: frequent with many episodes

Back 78

Chronic bronchitis

Front 79

Epiglotitis is what?

viral or bacterial?

Back 79

-severe rapid swelling of epiglottis

-bacterial

Front 80

Epiglotitis
-CM

Back 80

-thick muffled sounds
-drooling
-dysphagia
-inspratory stridor
-increase fever
-cherry red epiglottis

Front 81

Bacterial Croup Syndrome - Epiglottis
•Etiology

Back 81

–haemophilius influenza type B
–strep
–staph

Front 82

Bacterial Croup Syndrome - Epiglottis

•CM – severe and rapid swelling of epiglottis

4 D's

Back 82

–Dyspnea
–Dysphagia – trouble swallowing (history from parents)
–drolling *1st sign that should tell you* don’t want to lay flat
–dysphonia – muffled voice

Front 83

Bacterial Croup Syndrome - Epiglottis

•it is confirmed by

Back 83

an x-ray (upper airway looking for swollen epiglottis and narrowed airway)

Front 84

Bacterial Croup Syndrome - Epiglottis

–Do not visualize and DO NOT put anything in their throat
–don’t stress them (do not look at them if it causes stress)

Back 84

–Support airway
–May need intubation 24 – 48 hours
–IV antibiotics
-IV corticosteriods (Solu-Cortef)

Front 85

Asthma

-asthma, unlike COPD is an intermittent disease with reversible airflow obstruction and wheezing that affects only the airways, NOT the alveoli
T or F

Back 85

True

Front 86

What disease
-muscle surrounding the bronchial tubes tighten (bronchospasms), narrowing the air passage and interrupting the normal flow of air into and out of the lungs. airflow is further interrupted by an increase in mucous secretion, forming mucous plugs, and the swelling of bronchial tubes.

Back 86

asthma

Front 87

Asthma:
airway obstruction can occur in 2 ways

Back 87

1) inflammation (obstructs the inside of the airways)

2) airway hyperresponsiveness ( bronchial linings overreact to various triggers, causing smooth muscle spasms that severely constrict the airway. mucosal edema and thickened secretions further block the airways)

Front 88

Asthma

inflammation of the mucous membranes lining the airways is a key event in triggering an asthma attack. inflammation occurs in response to the presence of specific allergens (examples)

Back 88

cold or dry air, microorganisms, aspirin

Front 89

airway hyperresponsiveness can occur with :

Back 89

exercise, upper respiratory illness

Front 90

what disease

-the patient usually has a pattern of episodes of dyspnea (SOB), chest tightness, coughing, wheezing, and increased mucous production

Back 90

asthma

Front 91

Asthma

-during an acute episode, the most common s/s are

Back 91

an audible wheeze and increased RR. the wheeze is loud on exhalation.

Front 92

Metabolic imbalance?

headache, drowsiness, tachycardia, cyanosis, shallow respirations

Back 92

Respiratory acidosis:

Front 93

Metabolic imbalance?


dizziness, anxiety, paresthesia, muscle cramps, tetani, seizures, tachycardia, tachypnea, N/V

Back 93

Respiratory alkalosis:

(hypokalemia, hypocalcemia)

Front 94

Metabolic imbalance

hyperkalemic, mental dullness, kussmauls respirations (fast and shallow)

Back 94

Metabolic acidosis:

Front 95

Metabolic imbalance

expected findings is decreased RR and depth, numbness and tingling in fingers and toes, tetani, convulsions, dizziness, confusion, hypokalemia and hypocalcemia

Back 95

Metabolic alkalosis:

Front 96

LTB (larygotracheobronchitis)


when are symptoms worse?

Back 96

-symptoms worse at night

Front 97

LTB (larygotracheobronchitis)

Early CM:

Back 97

-mild fever
-barking seal
-cough
-hoarseness
-runny nose
-sore throat
-inspiratory stridor
-restless/irritable
-tachypnea

Front 98

Atelectasis - is defined as what:

Back 98

-a lack of gas exchange within alveoli, due to alveolar collapse or fluid consolidation

-collapse of lung or alveoli

Front 99

Atelectasis
CM:

Back 99

dyspnea, tachypenia, tachycardia, hypoxemia, fever, coughing

Front 100

Atelectasis
Breath sounds:

Back 100

diminished, crackles, gurgles

Front 101

-Pneumonia is an excess of what

Back 101

fluid in the lungs resulting from an inflammatory process

Front 102

Pneumonia
--The inflammation is triggered by many infectious organisms and by inhalation or irritating agents

Back 102

-organisms penetrate the airway mucosa and multiply in the alveolar spaces. there is an inflammatory process that occurs and WBCs migrate to the area of infection, causing capillary leak, edema, and exudates reducing gas exchange and lead to hypoxemia. the capillary leak spreads the infection to other areas of the lung

Front 103

Pneumonia
-clinical manifestations

Back 103

coughing
fatigue
pleuritic pain
dyspnea
fever/chills
elevated WBC
rust colored or purulent sputum

Front 104

Pneumonia
-BS

Back 104

crackles, pleural rub
tachypnea

Front 105

PFT
-evalutes?

-looks at what?

Back 105

-evaluate lung function and breathing problems
-looks at lung mechanics, gas exchange, acid base disturbance through spirometric measurements, lung volumes, and ABGs

Front 106

PFT

-RV residual volume

Back 106

(remaining air after expiration)


-increases in emphysema and chronic bronchitis pts

Front 107

PFT

-FEV1 forced expiratory volume

Back 107

(amount of air exhaled in 1 second)

-should be 1:1
-decrease in Emphysemia pt and in chronic bronchitis

Front 108

PFT

TLC total lung capacity

Back 108

(amount of air remaining in the lungs at the end of inhalation)

-increased TLC indicates air trapping
-emphysemia: increased
-chronic bronchitis: normal or slightly increased

Front 109

PFT

-VC Vital capacity

Back 109

- max amount of air that can be exhaled as quickly as possible after inspiration

-indication of respiratory muscle strength
-decreased in emphysema and chronic bronchitis