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291 Cards in this Set

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The effect of stress may be due to its effect on the
sympathetic and parasympathetic release of catecholamines and an acute rise in blood pressure (ig 729)
Three basic types of diuretics are used to decrease blood volume and lower blood pressure (ig 739)
1) Thiazide diuretics
2) Loop (high-ceiling) diuretics
3) Potassium-sparing diuretics
The primary purposes for surgery may be divided into five general subcategories (ig 237)
1) Diagnostic
2) Curative
3) Restorative
4) Palliative
5) Cosmetic
A subtle early indication of infection is
an increase in the band cells (immature neutrophils) in the WBC differential count (left-shift) (ig 293)
Potassium-sparing diuretics -
act on the distal tubule to inhibit reabsorption of sodium ions in exchange for potassium, thereby retaining potassium
Advantages of Balanced General Anesthesia (ig 269)
1) Minimal disturbance to physiologic function
2) Minimal side effects
3) Can be used with older and high-risk patients
Foundation of Hypertension Control (ig 737)
* Sodium restriction
* Weight reduction
* Moderation of alcohol intake
* Exercise
* Relaxation techniques
* Tobacco avoidance
The clean surgical wound heals itself at skin level in (how long)?
appx. two weeks (ig 291)
Dysfunction of the adrenal medulla or the adrenal cortex can cause
secondary hypertension (ig 735)
Test for the return of sympathetic nervous system tone by gradually elevating the pt. head and monitoring for Hypotension (ig 289)
The preoperative period begins when
the client is scheduled for surgery and ends at the time of transfer to the surgical suite (ig 237)
LDL value of 100 to 129 mg/dL are
near or above optimal (ig 730)
Warm antibody anemia is usually associated with _____ antibody excess (ig 842)
IgG
Thiazide diuretics -
prevent sodium and water reabsorption in the distal tubules while promoting potassium excretion
Renal and urinary function affects the filtration and eventual excretion of waste products, including anesthetic and analgesic agents (ig 243)
Usually, sickeled cells resume a normal shape when
the precipitating condition is removed and proper oxygenation occurs (ig 838)
Atherosclerosis =
type of arteriosclerosis; involves the formation of plaque within the arterial wall (ig 728)
The process of vascular autoregulation, which keeps perfusion of tissues in the body relatively constant, appears to be important in
causing hypertension accompanying salt and water overload (ig 735)
Splinting of the surgical incision (ig 253)
1) Unless coughing is contraindicated, place a pillow, towel, or folded blanket over your surgical incision and hold the item firmly in place
2) Take three slow, deep breaths to stimulate your cough reflex
3) Inhale through your nose, then exhale through your mouth
4) On your third deep breath, couth to clear secretions from your lungs while firmly holding the pillow, towel, or folded blanket against your incision
Ways of assessing for undermedication (ig 299)
* questioning the client about the effects of the mediation
* observe for nonverbal cues that indicate pain or discomfort
- restlessness
- increased confusion
- picking at bedcovers
- aggressive behaviors
Factors indirectly related to atherosclerosis include (ig 729)
* Obesity
* Sedentary lifestyle
* Stress
Disadvantages or Regional or Local Anesthesia (ig 269)
1) Difficult to administer to an uncooperative or upset patient
2) No way to control agent after administration
3) Absorbs rapidly into the blood and causes cardiac depression (Hypotension) or overdose
4) Increased nervous system stimulation (overdose)
5) Not practical for extensive procedures because of the amount of drug that would be required to maintain anesthesia
An extremity in a person with significant atherosclerotic disease may be
cool or cold, with a diminished or absent pulse (ig 730)
Hypercholesterolemia =
an elevated total blood cholesterol level (ig 730)
When a diagnosis of hypertension is made, most clients have
no symptoms (ig 736)
Emergence =
recovery from anesthesia (ig 269)
Intraoperative =
during surgery (ig 237)
stop
Renin, angiotensin, and aldosterone also regulate
blood pressure (ig 734)
Having an LDL value less than _____ is optimal (ig 730)
100 mg/dL
Clients at risk for DVT (Deep vein thrombosis) (ig 253)
* obese
* older than 40
* concurrent dx of cancer
* decreased mobility or immobility
* fracture or leg trauma
* history of DVT, PE, varicose veins, or edema
* taking estrogen or oral contraceptives
*( smoke
* decreased cardiac output
* undergoing pelvic surgery
Advantages of Intravenous General Anesthesia (ig 269)
1) Rapid and pleasant induction
2) Low incidence of postoperative nausea and vomiting
3) Requires little equipment
Common NDx and Collaborative Problems R/T Hypertension (ig 737)
1) Deficient Knowledge r/t information misinterpretation or unfamiliarity with information resources
2) Risk for Ineffective Therapeutic Regimen Management r/t noncompliance with treatment
Some drainage of the wound, changing from sanguineous (bloody) to serosanguineous to serous (serum-like, or yellow) is normal during the first few days following surgery (ig 291)
Increased rigidity of the thoracic cavity and loss of lung elasticity reduce
the efficiency of anesthesia excretion (ig 240)
Disadvantages of Inhalation GENERAL Anesthesia (ig 269)
1) Must be used in combination with other agents for painful or prolonged procedures
2) Limited muscle relaxant effects
3) Postoperative nausea and shivering common
4) Explosive
Changes in fluid volume also affect the
systemic arterial pressure (ig 734)
General Anesthesia =
a reversible state in which the client loses consciousness as a result of the inhibition of neuronal impulses in the several areas of the central nervous system (ig 269)
Advantages of Inhalation GENERAL Anesthesia (ig 269)
1) Most controllable method
2) Induction and reversal accomplished with pulmonary ventilation
3) Few side effects
Evisceration =
total separation of the layers and extrusion of internal organs or viscera (usually abdominal) through the open wound (ig 291)
Low or normal HDL cholesterol levels also indicate
an increased risk for atherosclerosis (ig 730)
A diet high in protein, calories, and vitamin C promotes wound healing (ig 300)
Benefits of Mobility soon after surgery (early ambulation) (ig 253)
1) Stimulates GI motility
2) Enhances lung expansion
3) Mobilizes secretions
4) Promotes venous return
5) Prevents rigidity of joints
6) Relieves pressure
Dehiscence =
partial or complete separation on the outer layers of the wound; splitting open of the wound (ig 291)
Iron deficiency anemia is the most common type of anemia and can result from
blood loss
increased energy demands
GI malabsorption
dietary inadequacy (ig 843)
Fluid volume deficit or fluid volume overload may occur after surgery (ig 289)
Palliative surgery makes the pt. more
comfortable (ig 237)
LDL value of _____ mg/dL (borderline high) are advised to follow a fat-modified diet (ig 730)
130 to 159
Appx. two-thirds of the body's iron is contained in hemoglobin; one third is stored in the bone marrow, spleen, liver, and muscle (ig 842)
Cholesterol is found only in animal sources, such as meat and eggs, which are also high
in saturated fats (ig 731)
Preoperative =
before surgery (ig 237)
Physical and Emotional Signs of Pain (p 292)
* increased pulse
* increased blood pressure
* increased respiratory rate (hyperventialation)
* diaphoresis (profuse perspiration)
* restlessness
* increased confusion
* wincing
* moaning
* crying
Sickle cell disease is a condition in which
chronic anemia is one of many problems causing pain, disability, increased risk for disease, and death (ig 837)
Stages of General Anesthesia (ig 270)
1) Stage 1 = analgesia and sedation, relaxation
2) Stage 2 = Excitement, delirium
3) Stage 3 = operative anesthesia, surgical anesthesia
4) Stage 4 = danger
Smoking increases the level of circulating
carboxyhemoglobin (carbon monoxide in the oxygen-binding sites of the hemoglobin molecule)
Homan's Sign =
calf pain on dorsiflexion of the foot (ig 288)
Elevated LDL cholesterol levels indicate that
a person is at an increased risk for atherosclerosis (ig 730)
Disadvantages of Intravenous General Anesthesia (ig 269)
1) Must be metabolized and excreted from the body for complete reversal
2) Contraindicated in presence of hepatic or renal disease
3) Increased cardiac and respiratory depression
4) Retained by fat cells
Atelectasis =
collapse of alveoli (ig 240)
Physical signs indicating anxiety (ig 293)
* restlessness
* increased pulse
* increased blood pressure
* increased respiratory rate
* crying
A level of 200mg/dL or above indicates
hypertriglyceridemia (ig 730)
All DNA synthesis requires adequate amounts of
folic acid to ensure the availability of thymidine (ig 843)
Obesity increases risk for poor or incomplete wound healing because
of excessive adipose tissue. Fatty tissue has poor vasculature, little collagen, and decreased nutrients, all of which are important for wound healing (ig 244)
Disadvantages of Balanced General Anesthesia (ig 269)
1) Drug interactions can occur
2) Pharmacologic effects on the body may be unpredictable
Pathophysiology of Sickle cell disease =
formation of abnormal beta chains in the hemoglobin molecule (ig 837)
Ineffective wound healing may be caused by (ig 291)
* wound infection
* distention from edema or paralytic ileus
* stress at the surgical site
* conditions that delay wound healing
Surgical procedures are usually categorized according to (ig 237)
1) The reason for the surgery
2) The urgency of the procedure
3) The degree of risk
4) The anatomic location
5) The extent of surgery required
Opioid analgesics are routinely given during the first 24 to 48 hours after surgery (ig 297)
Typical dysrhythmias for the patient with an inferior MI are
bradycardias and second-degree AV blocks resulting from Ischemia of the AV node (ig 803)
Anesthesia =
an artificially induced state of partial or total loss of sensation, occurring with or without loss of consciousness (ig 267)
Postoperative =
after surgery (ig 237)
Advantages or Regional or Local Anesthesia (ig 269)
1) Gag and cough reflexes stay intact
2) Allows participation and cooperation by the patient
3) Less disruption of physical and emotional body functions
4) Decreased chance of sensitivity to the agent
Agranulocytopenia =
a reduction in leukocytes (ig 844)
Complications from General Anesthesia or Anesthesia Management (ig 274)
1) Malignant Hypothermia
2) Overdose
3) Unrecognized Hypoventilation
Cosmetic surgery reconstructs
the skin and underlying structures (ig 237)
Disorders of the hematologic system can occur as a result of problems in the
production
function
normal destruction of any type of blood cell (ig 836)
Common NDx R/T CAD (ig 796)
1) Acute Pain r/t imbalance between myocardial oxygen supply and demand
2) Ineffective Tissue Perfusion (Cardiopulmonary) r/t interruption of blood flow
3) Activity Intolerance r/t imbalance between oxygen supply and demand
4) Ineffective Coping r/t effects of acute illness, major changes in lifestyle, or loss of control over a body part
Four control systems play a major role in maintaining blood pressure (ig 734)
1) Arterial baroreceptor system
2) Regulation of body fluid volume
3) Renin-Angiotensin-Aldosterone system
4) Vascular autoregulation
carboxyhemoglobin decreases
oxygen delivery (ig 240)
The significance of hypertension is that it is a major risk factor for
coronary, cerebral, renal, and peripheral vascular disease (ig 732)
The total WBC count is usually _____ the normal among patients with sickle cell disease (ig 839)
above
Hyperplasia =
thickening (ig 735)
Atelectasis prevents the exchange of oxygen and carbon dioxide and causes
intolerance of anesthesia (ig 240)
Hypertension is generally defined as
a systolic blood pressure greater than or equal to 140 mm Hg and/or a diastolic blood pressure great than or equal to 90 mm Hg in individuals who do not have diabetes (ig 732)
Physical inactivity may be the most important risk factor for the general population for MIs (ig 792)
stop
A bruit is described as
a turbulent, swishing sound, which can be soft or loud in pitch (ig 730)
Pernicious anemia =
failure to absorb vitamin B12 (ig 843)
The patient with an anterior MI is likely to exhibit
ventricular irritability (ig 803)
Loop (high-ceiling) diuretics -
depress sodium reabsorption in the ascending loop of Henle and promote potassium excretion
Hematocrit =
percentage of packed RBCs per deciliter of blood (ig 836)
Beta-Adrenergic Blocking Agents lower blood pressure by
blocking beta receptors in the heart and peripheral vessels, reducing the cardiac rate and output. By blocking beta-adrenergic receptors in the heart, these drugs cause a decrease in the heart rate and decrease contractility (ig 740)
S3 gallop often
indicates heart failure (ig 794)
Angiotensin-converting enzyme (ACE) inhibitors are also used as
single or combination agents in the treatment of hypertension (ig 741)
Anemia is a reduction in either the number of RBCs, the quantity of hemoglobin, or the hematocrit (ig 836)
Malignant hypertension is a severe type of elevated blood pressure that is
rapidly progressive (ig 735)
Patients with obstruction of the left anterior descending (LAD) artery usually have _____ or _____ MIs because the LAD artery perfuses the anterior wall and most of the septal wall of the left ventricle (ig 791)
anterior, septal
The patient receiving an ACE inhibitor for the first time is instructed to stay in bed for 3 to 4 hours to avoid
the severe hypotensive effect that can occur with initial use (ig 741)
The adult body contains between 2 and 6g of iron (ig 842)
Calcium Channel-Blocking Agents reduce
vasoconstriction (ig 741)
Common Health Problems with Sickle cell disease (ig 840)
* Pain
* Potential complications of sepsis
* Multiple organ dysfunction
The arterial baroreceptors are found primarily in
the carotid sinus but also in the aorta and the wall of the left ventricle (ig 734)
Polycythemia =
excess of RBCs (ig 836)
Renal vascular and renal parenchymal disease are two of the most common cause of
secondary hypertension (ig 735)
A major objective in treating the patient with sickle cell disease is preventing _____ (ig 840)
infection
Arteriosclerosis =
thickening, o hardening, of the arterial wall (ig 728)
The patient with MI may experience a _____ elevation for several days after infarction (ig 794)
temperature
Secondary hypertension =
when specific disease states and medications may increase a person's susceptibility to hypertension (ig 735)
Sickle cell disease is a genetic disorder. A mutation in genes leads to the formation of HbS instead of HbA (ig 838)
In immunohemolytic anemia, immune system components attack a person's own RBCs (ig 842)
Sustained blood pressure elevation in clients with essential (primary) hypertension result in damage to blood vessels in
vital organs (ig 735)
G6PD =
Glucose-6-Phosphate Dehydrogenase
Ejection fraction =
the percentage of blood ejected from the heart during systole
The circumflex artery supplies the
lateral wall of the left ventricle and possibly portions of the posterior wall or the SA and AV nodes (ig 791)
If a patient's body mass index (BMI) is _____ or higher, the nurse and dietitian encourages weight loss (ig 737)
27
The absence of _____ problems is an important diagnostic finding to differentiate folic acid deficiency from B12 deficiency (ig 844)
neurologic
Preload =
increase stretch of the myocardial fibers (ig 699)
The development of left ventricular failure and pulmonary edema is assessed by
auscultating fro crackles and identifying their location in the lung fields (ig 803)
Crackles and wheezes my be present on auscultation in _____ ventricular failure (ig 702)
left
Thrombocytopenia =
a reduction in platelets (ig 844)
Compensatory mechanisms when cardiac output is insufficient to meet the demands of the body (ig 699)
1) Increased heart rate
2) Improved stroke volume
3) Arterial vasoconstriction
4) Sodium and water retention
5) Myocardial hypertrophy
The pluripotent stem cell is the precursor of the
hematopoietic cell (ig 844)
As afterload increases, the left ventricle requires more energy to eject its contents, and stroke volume may decline (ig 699)
Class IV heart failure is cardiogenic shock (ig 804)
Systolic dysfunction results when
the ventricle is unable to contract forcefully enough during systole to eject adequate amounts of blood into the circulation. The ejection fraction drops from a normal of 50% to 70% to below 40% (ig 699)
Fibrinolytics are used to
dissolve thrombi in the coronary arteries and restore myocardial blood flow (ig 798)
The primary treatment of patients with iron deficiency anemia is to
increase the oral intake of iron form common food (ig 843)
Hypertension increases the workload of the heart, which increases the risk of MI (ig 792)
Right ventricular failure may be caused by (ig 699)
* left ventricular failure
* right ventricular myocardial infraction
* pulmonary hypertension
Patients with class I heart failure often respond well to
reduction in preload with IV diuretics (ig 803)
Sympathetic stimulation increases _____ return to the heart, which further stretches the myocardial fibers (ig 699)
venous
Clients with class II and class III heart failure may require
diuresis and more aggressive medical intervention, such as reduction of afterload or enhancement of contractility (ig 803)
Afterload =
the resistance against which the heart must pump (ig 699)
The primary lab finding associated with sickle cell disease is
the large percentage of HbS (ig 839)
Orthopnea =
dyspnea at rest in the recumbent position (ig 702)
Blood transfusions are the mainstay of treatment for clients with
aplastic anemia (ig 844)
Diastolic failure occurs when the left ventricle is unable to
relax adequately during diastole (ig 699)
Nitroglycerin, a nitrate, increases
collateral blood flow, redistributes blood flow toward the subendocardium, and causes dilation of the coronary arteries (ig 796)
In heart failure, stimulation of the sympathetic nervous system represents the most immediate
compensatory mechanism (ig 699)
Manifestations of cardiogenic shock include (ig 804)
* Tachycardia
* Hypotension
* Blood pressure less than 90 mm Hg, or 30 mmHg less than the clients baseline
* Urine output less than 30 mL/hr
* Cold, clammy skin with poor peripheral pulses
* Agitation, restlessness, or confusion
* Pulmonary congestion
* Tachypnea
* Continuing chest discomfort
As the amount of blood ejected from the left ventricle diminishes, pressure builds in the
pulmonary venous system and results in fluid-filled alveoli and pulmonary congestion (ig 701)
Aplastic anemia is a deficiency of circulating erythrocytes resulting from arrested development of RBCs within the bone marrow (ig 844)
The volume of blood returning to the left ventricle is further increased by activation of the
renin-angiotensin-aldosterone mechanism (ig 699)
Myocardial infarction occurs when myocardial tissue is abruptly and severely deprived of
oxygen (ig 790)
Common NDx and collaborative problems regarding heart failure (ig 703)
1) Impaired Gas Exchange r/t inadequate cardiac pump function
2) Decreased Cardiac Output r/t a reduction in stroke volume as a result of mechanical malfunctions
3) Activity Intolerance r/t an imbalance between oxygen supply and demand, fatigue, or an electrolyte imbalance
Abdominal organs are usually the first to be damaged as a result of multiple episodes of hypoxia and Ischemia during sickle cell disease (ig 839)
Aldosterone secretion causes
sodium and water retention (ig 699)
The presence of chest, epigastric, jaw, back, or arm discomfort is noted during physical assessment (ig 793)
Constriction of the arteries has the benefit of
maintaining blood pressure and improving tissue perfusion in low-output states. However, constriction of the arteries increases afterload (ig 699)
stop
Homocysteine is derived from dietary methionine and metabolized either by remethylation or transsulfuration (ig 730)
In cardiogenic shock, necrosis of more than 40% of the left ventricle has occurred (ig 804)
Left ventricular failure is associated with
decreased cardiac output (ig 702
Morphine Sulfate is sometimes prescribed to relieve chest discomfort that is unresponsive to
nitroglycerin (ig 796)
In sickle cell disease at least 40% of the total hemoglobin contains an abnormality of the beta chains. The abnormality is known as hemoglobin S (HbS) (ig 837)
Changes in CNS function may occur directly or indirectly in sickle cell disease. During crises, patients may have a low-grade fever (ig 839)
In right ventricular failure, the right ventricle is unable
to empty completely. Increased volume and pressure develop in the systemic veins, and systemic venous congestion and peripheral edema develop (ig 699)
RBCs contain no mitochondria, so active glycolysis is essential for energy metabolism (ig 841)
Right ventricular failure is associated with
increased systemic venous pressure and congestion (ig 702)
stop
Left vs. Right Ventricular Failure (ig 699)
Typical causes of left ventricular failure include
* hypertensive diseases
* coronary artery disease
* valvular disease involving mitral or aortic valve
G6PD stimulates critical reactions in the _____ pathway (ig 841)
glycolytic
High-Output syndrome is present when
cardiac output remains normal or above normal but the metabolic needs of the body are not met
Gram-negative bacteria are most often the cause of
infection (ig 849)
Low-Output syndrome occurs when the heart fails as a pump, resulting in
impaired peripheral circulation and peripheral vasoconstriction (ig 699)
When anemia is caused by a dietary deficiency, the client must increase
the intake of foods rich in vitamin B12 (ig 843)
Classifications of Heart Failure (ig 699-700)
1) Systolic vs. Diastolic Dysfunction
2) Left vs. Right Ventricular Failure
3) Low-Output vs. High-Output Syndrome
4) Functional Status
Unstable angina =
chest discomfort that occurs at rest or with minimal exertion and causes marked limitation of activity (ig 790)
Proper production of RBCs depends on adequate
DNA synthesis in the precursor cells so the cell division and maturation into functional RBCs can occur (ig 843)
Assessing fluid and electrolyte balance is a high priority in the early _____ period (ig 808)
postoperative
Any medication that increases the workload of the failing heart also increases its _____ requirement (ig 708)
oxygen
Hypotension =
systolic blood pressure less than 90 mmHg (ig 809)
stop
Most MIs are the result of
atherosclerosis (ig 790)
The primary collaborative problem surrounding heart failure is
Potential for Pulmonary Edema (ig 703)
In spite of the anemia, patients with sickle cell disease usually are not deficient in
iron (ig 839)
Chest x-ray studies can be helpful in diagnosing left ventricular failure.
Typically, the heart is enlarged, representing hypertrophy or dilation, during left ventricular failure (ig 703)
In sickle cell disease the heart rate may be _____ and the BP _____ (ig 839)
rapid
low to average
HbS is sensitive to change in the oxygen content of the RBC. When RBCs containing large amount of HbS are exposed to conditions of decreased oxygen, the abnormal beta chains contract and pile together within the cell ... distorting the overall shape of the RBC (ig 837)
Angina does not cause permanent damage of myocardial tissue (ig 790)
The kidney produces renin, an enzyme that acts on plasma protein substrate to split of angiotensin I, which is converted by an enzyme in the lung to form angiotensin II. Angiotensin II has strong vasoconstrictor action on blood vessels and is the controlling mechanism for aldosterone release. The significance of aldosterone in hypertension is most evident in primary aldosteronism. By increasing the activity of the sympathetic nervous system, angiotensin II also appears to inhibit sodium excretion, resulting in an elevation in blood pressure (ig 734-735)
Beta-adrenergic blocking agents decrease
the size of the infarct, ventricular dysrhythmias, and mortality rates in clients with MI (ig 801)
Signs of systemic congestion occur as the right ventricle fails, fluid is retained, and pressure build in the venous system (ig 702)
Angina pectoris =
a temporary imbalance between the coronary arteries' ability to supply oxygen and the cardiac muscle's demand for oxygen (ig 790)
Paroxysmal nocturnal dyspnea (PND) =
sudden awakening with a feeling of breathlessness 2 to 5 hours after falling asleep (ig 702)
Stable angina =
chest discomfort that occurs with moderate to prolonged exertion in a pattern that is familiar to the patient; frequency, duration, and intensity of symptoms have not increased over the past several months (ig 790)
Three basic processes occur in atherosclerosis (ig 789)
1) Overgrowth of intimal smooth muscle cells with accumulation of macrophages and T cells
2) Formation of a connective tissue matrix in the vessel intima
3) Accumulation of lipids, especially cholesterol, in the connective tissue
Pain is the most common symptom experienced during sickle cell crisis. Jaundice may also be present as a result of increased RBC destruction and release of bilirubin (ig 839)
Interventions for asthma
* Goals of therapy are
- to improve airflow
- relieve symptoms
- prevent future episodes
* Patient education
* Medication
The hematocrit of clients with sickle cell disease is usually _____ (ig 839)
low
Anemia =
insufficient number or insufficient function of RBCs (ig 836)
Anger may represent an attempt to regain control of life (ig 802)
With Larynx cancer sometimes radiation is done pre-operatively to reduce the size of the tumor and to lessen the surgery
A person who has surgery will have a permanent trach and feeding tube ... LOTS OF SECRETIONS
The danger of rewarming a patient too quickly is
that he or she may begin shivering, resulting in metabolic acidosis and hypoxia (ig 809)
Cold antibody anemia is associated with fixation of complement proteins on _____ (ig 842)
IgM
Puomonary TB - People most commonly infected are those having repeated exposure with an infected person who has not yet been Dx
* Immune compromised individuals especially HIV or AIDS
* Living in crowded areas
* Homeless
* Foreign immigrants
Ischemia occurs when
insufficient oxygen is supplied to meet the requirements of the myocardium (ig 789)
Aspiration pneumonia -
something goes down wrong pipe and enters the lungs.
Septicemia = when the infecting organism gets to the bloodstream. VERY DANGEROUS DECREASES BP
INCREASES FEVER
INCREASES PULSE
PATEINT GETS HYPOXIC
Septicemia is Dxed by blood cultures, usually do high doses of several antibiotics, often in ICU, Blood Draw x 2 = draw blood from two sites
Sleep Apnea
Disruption of breathing that lasts at least 10 seconds and occurs a minimum of five times an hour
Assessment for Pneumonia
* Risk factors
- often include older individuals
- individuals w/o pneumococcal vaccines
- COPDers
- smokers
- aspiration
- trachs (because of aspiration risk)
- people on ventilators
* Past illness
* Living, work arrangements
* Chest x-ray
* CBC
* CT Scan if necessary
* Sputum for C & S (Culture and sensitivity)
* Pulse Ox
Interventions of Pharyngitis
* Will depend on bacterial vs. viral
* Rest
* Increased fluid intake
* Analgesics
* Humidification of air
* Warm saline throat irrigations
* Antibiotics (penicillin, cephalosporins, erythromycin)
Cancer of the Nose and Sinuses
* Relatively uncommon
* Onset is slow, symptoms resemble sinusitis and therefore disease may be advanced at Dx.
* Treatment is radiation or possible surgery
CHEMOTHERAPY DOES NOT WORK ON THIS CANCER
Assessment for Asthma
* Diagnosed based on the frequency and the severity of the symptoms
* Patient response to treatment
Dx of COPD
* Impaired gas exchange
* Ineffective Breathing Pattern
* Anxiety
* Activity intolerance
* Ineffective Airway Clearance
COPDers do NOT get anemic ... they have too many RBCs
Interventions for Sinusitis
* Antibiotics
* Analgesics
* Decongestants
* Humidified air
* Nasal saline irrigations
* Increased fluid intake
Peak flow meters are able to help pt. measure air flow and somewhat predict how their breathing is doing relative to an asthma attack
Problem with Trans-trach is patient must be able to self-care
Symptoms of Influenza
* Severe headaches
* Muscle aches
* Fever
* Chills
* Fatigue
* Weakness
* Anorexia
Facial Trauma
Often due to auto accidents.
Defined by the specific bones involved = LeFort I, LeFort II, LeFort III
Priority is assessment for patent airway.
Watch for cranial or spinal injuries as well.
Look for CSF drainage from nose or ear.
Treatment is stabilization of the fracture ... DIETARY INSTRUCTIONS.
If they vomit and mouth is wired ... cut wires.
Do NEURO checks
Asthma
* Condition of intermittent, reversible airflow obstruction affecting only the airways, not the alveoli ...
ASTHMA DOES NOT AFFECT THE ALVEOLI
* Inflammation of the mucous membranes lining the airways is a key event in precipitating an asthma attack
* Inflammation
* Hyper responsive airways
- hyper active - causing bronchoconstriction
A lot of allergy testing is done to determine what triggers the asthma attack
May be brought on by exercise, infections in upper respiratory, and know known reasons
Nursing interventions for Influenza
* Bed rest
* Increase fluid intake
* Analgesics
* Antihistamines
* Antiviral agents
Symmetral (take 24-48 hours after symptoms start)
Virazole (take 24-48 hours after symptoms start)
Zanamivir (take 24-48 hours after symptoms start)
Symptoms of Pneumonia
* Chills
* Fever
* Persistent cough
* Dyspnea
* Wheezing
* Hemoptysis
* Increase sputum
* Fatigue
* Use of accessory muscles
Nursing Interventions for Pulmonary TB
* Combination drug therapy
* Proper nutrition
* Rest
* Increased fluid intake
* Oxygen
* Respiratory treatments
* Patient education
Assessment for Pharyngitis
* Redness of throat
* Enlarged tonsils
* Exudates
* Enlarged cervical lymph nodes
* Throat culture
* CBC
Functions of Nose
* Filters air
* Heats air
* Humidifies air
When people have trachs they don't have the benefit of the nose
About the Trachea
windpipe, how air enters body
REVIEW PAGE 520 OF IG TABLE 29-2
COPDers have difficulty eating because Oxygen goes to stomach and they get SOB
Frequent small meals
Medications Used for Asthma
1) Bronchodilators
* Adrenergics stimulate beta 2 adrenergics receptors in the smooth muscle of the bronchi and bronchioles, these receptors in turn stimulate the enzyme AMP producing bronchodilation
ALBUTEROL is most common (inhaled or PO, pill)
- Epinephrine
- Terbutaline
2) Anti-inflammatory (Prednisone is the primary used drug)
* Decrease the general and allergic inflammatory responses in the airways
* Not recommended unless symptoms are severe
* Multiple side effects
* Can be administered PO or inhaled
Influenza
* Epidemics are common
* Influenza often leads to pneumonia
* Highly contagious, acute viral respiratory infection
* Complications can occur
Pharyngitis
* Inflammation of the mucous membranes of the pharynx
* Most common cause is group A beta-hemolytic streptococcus
Interventions with COPD
* Airway management
* Oxygen therapy
* Energy management
* Medications
* Patient education
* Home care
* Drugs to thin secretions
* Usually on Prednisone for rest of life
* Pursed lip breathing
* Lots of skin problems because they don't like to move; because moving causes exhaustion
* SUPPORT SYSTEMS ARE VERY IMPORTANT
Lung Cancer
* Leading cause of cancer related deaths
* Prognosis is poor
* 85% of lung cancers might be prevented through the elimination of cigarette smoking
Speech Therapy
* Communication - lip reading, boards, etc.
* Alaryngeal communication
- esophageal speech
- artificial larynx (electrolarynx)
- tracheosophageal puncture
* training with speech therapist when approved by physician
Symptoms of Pharyngitis
* Soreness and dryness of the throat
* Pain on swallowing
* Fever
* Purulent nasal drainage
* Voice changes
Interventions for Rhinitis
* symptomatic relief
* antihistamines and decongestants
* patient education
* increase fluid intake and rest
* humidified air
Symptoms of Rhinitis
* Headache
* Nasal irritation
* Sneezing
* Nasal congestion
* Watery drainage from the nose
* Itchy, watery eyes
* At times a low grade fever and chills
Symptoms of Sinusitis
* Nasal swelling
* Congestion
* Headache
* Facial pressure
* Pain
* Low grade fever
* Cough
* Purulent of bloody nasal drainage
Head and Neck Cancer
* Interferes with breathing, eating, self-image, speech
* Most often it is nasal cancer
Respiratory System Functions -
1) Provide a source of oxygen for tissue metabolism
2) Remove CO2 the major waste product of metabolism
Assessment for Influenza
* Diagnosed by symptoms
During Pneumonia White blood cells invade the alveoli and cause thickening of the alveolar wall
RBCs and fibrin move into the alveoli, fluid fill the alveoli, which protects the organism from phagocytosis and facilitates the movement of organisms to other alveoli, and the infection spreads
Treatment of Sleep Apnea
may be as simple as weight loss, CPAP, BiPAP, or surgery.
Sleep apnea is more common in obese people.
CPAP = Naso Continuous Positive Airway Pressure
BiPAP = Cyclic machine delivering a set inspiratory airway pressure.
May do surgery on Adenoids or Uvula to address sleep apnea
Emphysema
* Shortness of breath
* EMPHYSEMA AFFECTS THE ALVEOLI
* Two primary changes occurring are loss of lung elasticity and hyperinflation of the lung
* Resulting in dyspnea and increased respiratory rate
* An increased amount of air becomes trapped in the lungs due to loss of elastic recoil in the alveolar walls, overstretching of alveoli and collapse of the small airways
Surgical Interventions for Sinusitis
* Antral irrigation - outpatient procedure, irrigation of the sinuses
* Caldwell-Luc procedure - removal of infected mucosa
* Endoscopic sinus surgery - outpatient, direct inspection of the sinuses through a endoscope
Symptoms of Asthma
* Shortness of breath
* Chest tightness
* Coughing
* Wheezing
* Excessive mucous production
About the Bronchioles
* break into smaller and smaller tunnels
Nasal Polyps
1) Benign grape-like clusters of mucous membranes and loose connective tissue in nose
2) Can cause obstructed nasal breathing, change in nasal discharge character
3) May cause a change in speech quality
Symptoms of Pulmonary TB
* Progressive fatigue
* Lethargy
* Nausea
* Anorexia
* Weight Loss
* Low grade fever
* Night sweats
* Cough/sputum production
S/S of Asthma
Key symptom of asthma is WHEEZING.
Increased respiratory rate
Use of accessory muscles
Dx on severity of symptoms.
Dx additionally bases on pt. response to treatment
COPDers tend to be undernourished
They have high levels of anxiety
Functions of Larynx
voicebox; mostly cartilage
With a total laryngectomy there is permanent loss of voice, and a permanent trach is put in place
Assessment for Lung Cancer
* History
* Physical assessment
* Psychosocial
* Diagnostic
* Exposure to carcinogen
* Farmers (dusting of crops)
* May hear wheezing
* SOB
* Psychosocial
When a person with lung cancer coughs blood, the blood is frothy because the blood is coming up from the lungs
Chronic Bronchitis
ONLY AFFECTS MAINSTEM BRONCHIs and BRONCHIOLEs
Risk factors for Chronic Bronchitis
Smoking
Upper respiratory infection
Asbestos
* An inflammation of the bronchi and bronchioles caused by continuous exposure to infectious and noninfectious irritants
* Affects only the small and large airways
* Chronic inflammation results in mucous gland hypertrophy and Hyperplasia
Empyema =
pus in pleural cavity; pus is usually removed by using chest tubes
REVIEW IG 533 - SYMPTOMS
Nasal cancer usually requires surgery and usually involves removing the nose
Interventions for Pneumonia
* Antibiotics
* Airway management - Oxygen and C&DB (Cough and Deep Breathing)
* Respiratory treatments
* Community acquired
* Hospital acquired (nosocomial)
The goal is to identify and eradicate organism causing the infection.
Broad spectrum drugs are given (antibiotics)
C&S ought to be done before antibiotics are given.
Cough and Deep Breathing
Sinusitis
* Inflammation of the mucous membranes of one or more of the sinuses
* Swelling can obstruct the flow of secretions
* Causative organism is usually streptococcus pneumonia hemophilus influenza
diplococcus
bacteriodes
* Most often develops in the maxillary and frontal sinuses
Assessment for Sinusitis
* Sinus x-rays
* CT scan of the sinuses
* Palpation
Diagnostic Assessment of Respiratory System
1) Blood
RBC; carry O2; Hemoglobin and Hct
Shows how much blood you have to transport the oxygen.
WBC count = indicates infection if it is elevated
ABGs = used to identify oxygenation when used for respiratory system
2) Sputum test
Need to know what the test is being done for in order to determine which test is to be done
May have to suction to get sputum
C & S test = culture and sensitivity test
Culture indicates what's growing
Sensitivity indicates what antibiotics to use
Cancer MAY be diagnosed in sputum test
Test for TB
3) Chest X-ray
indicates pneumonia
atelectasis = collapse of alveoli
Used to indicate pneumothorax (collapse of lung)
Indicates presence of tumor(s)
Types of chest x-ray -
1) PA (posterior - anterior)
2) Lateral

4) CT Scans
Cross sectional and spiral view
3-D assessment
Contrast may be used
Dye is hard on kidneys and liver (only doctor may order - nurse may not order)
5) Ventilation and Perfusion Scanning (VQ Scan)
Identifies areas of lung being ventilated
Indicates distribution of blood
(Done to rule out pulmonary embolism)
6) Pulse Oximetry
Measures Oxygen concentration
7) Pulmonary Function Test (PFT)
Respiratory therapists perform this test
Evaluates lung function and dysfunction
Lung capacity
Gas Exchange
Distribution of ventilation
Screening tool for lung damage

Review chart on IG 484
8) MRI
Uses magnets
May not be done if patient has metal on or in them
Shows more than a CT scan
COPD often get a trans-trachea which requires less Oxygen and is covered with shirt
Pneumonia
* Inflammatory process that results in edema of lung tissue and movement of fluid into the alveoli, causing hypoxemia
* Causes include infectious or noninfectious irritants
* Inflammation occurs in the interstitial spaces, the alveoli, and often the bronchioles
Assessment of Pulmonary TB
* Early detection
* PPD (Purified Protein Derivative)
* Chest X-ray
* Sputum for AFB (Acid fast bacillus)
S/S of Cancer of the Nose and Sinuses =
Drainage
Sinusitis
Orthopnea =
unable to sleep laying down
Diagnostic Tests for Lung Cancer
* Chest x-ray
* Early morning sputum
* CT Scan
* MRI
* Bronchoscopy
* Open lung biopsy (thoractomy) = patient will have chest tubes following a thoractomy
The process of pneumonia begins when pathogens successfully penetrate the airway mucus and multiply in the alveolar spaces
Fluid and exudates form as the organism multiply, and other evidence of inflammation become apparent
About the Right and Left Mainstem Bronchi
* Right is wider, more vertical, and shorter
When we intubate sometimes we only get into the right side - this is not what we want, we want both sides of lungs to get air
Pulmonary TB
* Highly communicable disease caused by Mycobacterium TB
* Transmitted via airborne routes
* Multiplies freely when it reaches a susceptible site
* The granulmatous inflammation created by the tubercle bacillus in the lung becomes surrounded by collage, fibroblasts, and lymphocytes
* Necrotic tissue forms

3 Positive AFBs is the sign that a person has TB.
Reverse airflow rooms are used for TB patients - air does not come into the room; the air is exchanged several times during the hour.

Nurse must wear a HEPA - mask
Assessment for COPD
* Hx
* Physical Assessment
* Respiratory Assessment
* Psychosocial Assessment
* Occupational Hx
Cancer of the Larynx
Curable if detected early
Affects more men ages 50-70, increasing in women
* two thirds affect glottic area (vocal cords)
* one-third affects supraglottic (epiglottis and false cords)
* < 1% affects subglottis
Interventions for Lung Cancer
* Chemotherapy
* Radiation - attempts to decrease tumor size
- usually five to six weeks
* Surgery depends on location and tumor size
Chest tube dressings are never changed by nurse, only reinforced ... DOCTOR CHANGES DRESSINGS
Risk Factors for Larynx Cancer
* Carcinogens - tobacco (smoke and smokeless)
* Combined effects of alcohol and tobacco
* Exposure to asbestos, mustard gas, wood dust, cement dust, tar products, leather and metal products
* Straining voice, chronic laryngitis
* Deficiency of riboflavin
* Family history
S/S of Cancer of the Larynx
* Hoarseness
* Pain
* Burning
* Lump
* Dysphagia (trouble swallowing)
* Dyspnea (trouble breathing)
* Obstructions
* Weight loss
Be careful about early evaluations of hoarseness.
If they've had symptoms for 3-4 weeks they ought be investigated
Lower Respiratory Tract
1) Trachea
2) Right and Left Mainstem Bronchi
3) Lobar, Segmental, Subsegmental Bronchi
4) Bronchioles
5) Alveolar Ducts
Trachs result in a lot of sputum production
Do not do well in cold weather
* no heating of air
* no filtering of air
Bacterial Pharyngitis can lead to acute complications -
- glomerular nephritis (after 7 days) - inflammation of kidneys
- Rheumatic Fever (3-5 weeks after pharyngitis)
- Rarely causes epiglottitis (epiglottis can swell up and closes off airway)
Epiglottitis is treated with steroids; intubation
Assessment for Rhinitis
The presence of the offending substance causes a release of natural biochemicals from basophiles and mast cells in the nasal mucosa (histamine, serotonin, bradykinin, and prostaglandins)

This causes changed in the blood vessels inducing dilation and increase capillary permeability, causing edema and swelling
Page 573; chart 31-1 (Ig)
COPD =
Emphysema + Chronic Bronchitis
Risk factors for COPD include
* Smoking
* Air Pollution
* Repeated exposure to harmful inhaled chemicals
Classifications of Lung Cancer
* Small Cell (Oat cell)
- survival rate of about 2 years
- combination chemotherapy
- high rate of metastasis
- radiation not recommended
* Non-small cell
- Strong association with cigarette smoking
- slower growing than small cell lung cancer
- less invasive than small cell
- usually do surgery - lobectomy
- associated with obstructive symptoms and pneumonias
* Adenocarcinoma
- tumors are located peripherally in lungs
- slow growing
- high frequency of metastasis to the brain
- usually direct extension of the primary tumor
* Large cell
- often form larger tumor masses than adenocarcinoma
- slow growing
- METS is similar to that for adenocarcinoma with addition of the GI tract
- poor prognosis
Consolidation =
part of lung is solid with pneumonia, or fluid; alveoli are unable to exchange air
Keep Oxygen levels at _____ on COPDers
88-89%
Diagnostic Assessment of Respiratory system
1) Thoracentesis
Drawing of fluid from pleural cavity
May be used to Dx cancer
Empyema = pus-like fluid
2) Lung Biopsy
Done in surgery
Done during a bronchioscopy (when tube is inserted into longs)
Bronchioscopy = doctor looks into lungs with tube
During a bronchioscopy the GAG reflex must be paralyzed
May not drink for an hour after the test
Functions of Sinuses
help to decrease the weight of the skull
Upper Respiratory Tract
1) Nose
2) Sinuses help to decrease the weight of the skull.
3) Pharynx (throat) - passageway for respiratory and GI tract.
4) Larynx - voicebox; mostly cartilage
Voice and airway changes post-op Laryngeal Cancer
* Partial laryngectomy -
airway maintained, voice hoarse, quality may change
* Supraglottic
temporary trach,
radical neck dissection
voice quality changes
speech therapy
temporary feeding tube
dysphagia
* Hemilaryngectomy -
temporary trach
feeding tube (10-14 days)
airway and swallowing intact
voice changes
Total Laryngectomy -
Permanent G-tube
Often dye is put in food in order to determine if patient is aspirating
Wound infections are common
Permanent loss of voice
Change in airway
Permanent tracheal stoma
Usually radical neck dissection
Dysphagia
Fistulas
Stenosis
Strictures
Accessory Muscles
1) Scalene Muscles
* Elevate first two ribs
2) Sternocleidomastoid
* raises sternum
3) Trapezius and Pectoralis Muscles
* Shoulders
* Allows for deep breaths
4) Diaphragm
* Main muscle for breathing
* Underneath the lungs
* Partition between abdomen and thoracic cavities
* Contracts with inspiration - flattens out and goes down
* Relaxes and elevates during expiration - lowers with inspiration, rises with expiration
Risk factors include for Head and Neck Cancer
* Alcohol and Tobaccos
Assessment and Dx of Larynx Cancer
* During assessment palpate for lumps in neck
* Hx and PE of head and neck
* Laryngoscopy indirect - office, direct with local or general anesthesia, specimens for evaluation, CT, MRI, PET
* Biopsy or CO2 laser
(Pulmonary TB) Once the patient has 3 negative sputum test the may return to regular schedule
Medical Management of Larynx Cancer
* Depends on location, size, tumor type, node
* Radiation therapy
- reduce tumor size
- eradicate cancer
* Chemotherapy - in combination with radiation
* Surgery-Partial laryngectomy, supraglottic laryngectomy, hemilaryngectomy, total laryngectomy, (dental fix first)
- Hemilaryngectomy - beyond vocal cord, less than 1cm
Rhinitis
* Inflammation of the nasal mucosa
* Most common problem that affects the nose and sinuses of adults
* Can be infectious (viral or bacterial)
* Can be caused by contact with allergens
* Acute viral rhinitis is the common cold and can be caused by any one of 200 viruses
About the Lobar, Segmental, Subsegmental Bronchi
* Each enters into 5 lobes of lung
* Mostly connective tissue and blood vessels
Functions of Pharynx (throat)
passageway for respiratory and GI tract
About the Alveolar Ducts
* Clusters of alveoli
* Basic units of gas exchange