Med/surg Exam #3 - Respiratory System & Drugs, Older Adult & Health Promotion

Front 1

Moving air in & out of the airways is called

Back 1

ventilation

Front 2

Upper respiratory system does what?

Back 2

warms & filters the air;
traps particulate matter in the mucus of the airways and propels it toward mouth for elimination

Front 3

Lower respiratory system has what function?

Back 3

gas exchange

Front 4

Lungs and circulatory system deliver?

Back 4

O2 to & expel CO2 from the cells of the body

Front 5

Structures of Upper Respiratory Tract

Back 5

Nose
Sinuses & nasal passages
Pharynx
tonsils & adenoids
Larynx (epiglottis

Front 6

Functions of Respiratory System

Back 6

Ventilation
O2 transport (02 from blood to the cells and CO2 from cells to the blood)
Respiration
diffusion
ventilation & perfusion balance
gas exchange
CO2 transport
Neurological control of ventilation

Front 7

Lungs work at the ______ level to control ventilation

Back 7

neurological

Front 8

Respiration is the…?

Back 8

process of gas exchange between ATMOSPHERIC AIR and the blood at the ALVEOLI and between the blood cells and the cells of the body

Front 9

Exchange of gases occurs bc of differences in….?

Back 9

Partial pressures and to match the elimination of CO2 and supply of O2 to meet metabolic needs

Front 10

Respiration is controlled by the CNS; specifically, the ?

Back 10

Medulla and Pons

Front 11

Stimulation of receptors from inhaled irritants and mucus stimulates the…?

Back 11

Cough reflex

Front 12

Changes in _________ __________ of O2 & CO2 affect respiration

Back 12

partial pressures

Front 13

The thoracic cavity is an

Back 13

airtight chamber

Front 14

The floor of the thoracic cavity is the

Back 14

diaphragm

Front 15

Things that affect ventilation:

Back 15

1. compliance
2. surface tension
3. muscle effort
4.airway resistance

Front 16

Inspiration

Back 16

contraction of the diaphragm (movement of this chamber floor downward) & contraction of the external intercostal muscles increases the space in this chamber
Lowered intrathoracic pressure causes air to enter through the airways & inflate the lungs

Front 17

Expiration

Back 17

Diaphragm relaxes and moves up

Front 18

Expiration requires the

Back 18

elastic recoil of the lungs

Front 19

Inspiration normally is ____ of the respiratory cycle and expiration is _____

Back 19

1/3 and 2/3

Front 20

Perfusion is the

Back 20

filling of the pulmonary capillaries with blood

Front 21

Adequate gas exchange depends upon

Back 21

an adequate V/Q ratio

Front 22

Shunting occurs when

Back 22

there is an imbalance of ventilation & perfusion
This results in cyanosis or hypoxia

Front 23

Gas exchange helps maintain

Back 23

the acid-base balance of the body

Front 24

Changes in the CO2 level in the blood result in

Back 24

either respiratory acidosis or alkalosis

Front 25

Respiratory acidemia is called

Back 25

hypercapnia

Front 26

Respiratory alkalemia is called

Back 26

hypocapnia

Front 27

Normal PCO2 is

Back 27

35-45 mm Hg

Front 28

If the PCO2 is >45, this indicates the patient is...?

Back 28

Hypoventilating and hypercapneic

Front 29

The _______ nerve stimulates respiratory cells?

Back 29

phrenic

Front 30

The __________ and _______ control the rate & depth of ventilation

Back 30

medulla and pons

Front 31

The apneustic center is responsible for

Back 31

deep, prolonged inspirations

Front 32

The pneumotaxic center

Back 32

controls the patterns of respiration

Front 33

Tidal volume (TV)

Back 33

air volume of each breath

Front 34

Peak flow rate reflects

Back 34

max expiratory flow

Front 35

Inspiratory force is measured by a

Back 35

manometer

Front 36

Normal inspiratory pressure is approximately

Back 36

100

Front 37

Force of less than 25

Back 37

usually requires mechanical ventilation

Front 38

With the effects of aging, do changes occur more in the upper or lower airway?

Back 38

Lower

Front 39

What are some of the effects of aging on respiratory system?

Back 39

Movement of cilia slows & becomes less effective
Lungs become rounder & alveolar air decreases
Alveolar walls lose elasticity (this decreases lung function)
Increased incidence of true emphysema and greater prevalence of chronic cough & sputum production

Front 40

Symptom analysis method?

Back 40

OLDCART
Onset
Location
Duration
Correlating Factors
Aggravating Factors
Remitting Factors
Treatment

Front 41

In inspiration/expiration ratio, normal length of inspiration is

Back 41

1:2

Front 42

The earliest signs of respiratory distress are?

Back 42

Restlessness
Confused
Irritable

Front 43

The trachea is best palpated from?

Back 43

Behind

Front 44

Percussion Sounds

Back 44

Flatness (ex. Large pleural effusion)
Dullness (ex. Lobar pneumonia)
Resonance (ex. Simple chronic bronchitis)
Hyperresonance (ex. Emphysema

Front 45

Vesicular breath sounds

Back 45

Inspiratory sounds last longer than expiratory ones (soft intensity; low pitch) entire lung field

Front 46

Bronchovesicular breath sounds

Back 46

Inspiratory and expiratory sounds are about equal (intermediate intensity; intermediate pitch) 1st and 2nd interspaces anteriorly and between the scapulae (over the main bronchus)

Front 47

Bronchial breath sounds

Back 47

Expiratory sounds last longer than inspiratory ones (Loud intensity; relatively high pitch) Over the manubrium

Front 48

Tracheal breath sounds

Back 48

Inspiratory and expiratory sounds are about equal (Very loud intensity; relatively high pitch) Over the trachea in the neck

Front 49

Crackles

Back 49

Soft; high-pitched; discontinuous popping sounds that occur during inspiration (secondary to fluid in the airways or alveoli or to opening of collapsed alveoli

Front 50

Coarse crackles

Back 50

Discontinuous popping sounds heard in early inspiration; harsh moist sound originating in the large bronchi (assoc. w/ COPD)

Front 51

Fine crackles

Back 51

Discontinuous popping sounds heard in late inspiration; sounds like hair rubbing together; originates in the alveoli (assoc. w/ interstitial pneumonia

Front 52

Sonorous wheezes (rhonchi)

Back 52

Deep low-pitched rumbling sounds heard primarily during expiration

Front 53

Sibilant wheezes

Back 53

Continuous musical high-pitched whistle-like sounds hearing during inspiration and expiration caused by air passing through narrowed or partially obstructed airways (bronchospasm; asthma and buildup of secretions)

Front 54

Pleural friction rub

Back 54

Harsh crackling sound – like 2 pieces of leather being rubbed together. Heard during inspiration alone or during both inspiration and expiration (secondary to inflammation and loss of lubricating pleural fluid)

Front 55

In the nursing care of upper airway disorders what is an important aspect of care?

Back 55

Patient teaching

Front 56

Upper Airway Infection is most common cause of

Back 56

patient illness

Front 57

Upper Airway Infection is also known as

Back 57

Upper Respiratory Infection

Front 58

About 90% are

Back 58

viral

Front 59

Typical length of viral upper respiratory infection is?

Back 59

7-14 days

Front 60

Rhinitis is

Back 60

inflammation and irritation of nasal mucous membranes

Front 61

Rhinitis may be

Back 61

acute or chronic and nonallergic or allergic

Front 62

Pathophys of nonallergic rhinitis

Back 62

environmental; temp; odors; foods; infection; drugs; foreign body.
Most commonly associated with antihypertensive agents

Front 63

Viral rhinitis a/k/a

Back 63

COMMON COLD
Most frequent viral infection in the general population

Front 64

Viral rhinitis is highly contagious because virus is shed for about

Back 64

2 days before symptoms appear.

Front 65

What group is more susceptible to the common cold?

Back 65

Adult women

Front 66

Why the symptom of scratchy/sore throat with common cold?

Back 66

Because of drainage going down the naso oropharynx

Front 67

Common cold symptoms tend to last?

Back 67

1-2 weeks

Front 68

Can only treat the __________ of rhinitis if viral in nature

Back 68

symptoms

Front 69

Meds given for rhinitis are?

Back 69

Antihistamines; decongestants; nasal spray; intranasal corticosteroids; ophthalmic meds.
Antibiotics if evidence of BACTERIAL INFECTION.

Front 70

Nursing Management for Rhinitis

Back 70

Help reduce allergen & irritant exposure; teach pt to read drug label and about OTC meds; teach HAND HYGIENE; encourage appropriate IMMUNIZATIONS.

Front 71

Sinusitis affects

Back 71

35 millions people a year

Front 72

Sinuses are normally protected from infection by

Back 72

mucociliary action
If cilia action is impaired or mucus openings are obstructed mucus can accumulate and thus become an infection

Front 73

In sinusitis blockage of mucus openings may be due to

Back 73

a deviated septum, bony malformations, infections or allergies

Front 74

S/S of sinusitis

Back 74

fever & chills; HA and facial pain exacerbated w/ bending; pain or numbness in the upper teeth or discolored nasal discharge; pt may also have fatigue; ear pain; sore throat; cough and periorbital edema

Front 75

In sinusitis xrays will show

Back 75

opacification of the sinuses; thickened mucous membranes; and an air-fluid level

Front 76

How is sinusitis diagnosed?

Back 76

Pain w/ palpation and decreased transillumination; cultures via aspiration/swabbing

Front 77

Medical management of sinusitis

Back 77

Antibiotics; decongestants; corticosteroid nasal spray; humidification; sinus lavage or surgical procedures such as functional endoscopic sinus surgery (FESS)

Front 78

Nursing Management for Sinusitis

Back 78

Teach pts to HUMIDIFY air; use steam inhalation or warm compresses; avoid tobacco; swimming; diving; and air travel because they increase the pressure; teach concerning meds and REBOUND CONGESTION with nasal sprays

Front 79

Teach S/S of complications of sinusitis (untreated sinus infections can spread to the brain)

Back 79

Fever; severe HA; and nuchal rigidity

Front 80

Nursing Management following sinus surgery

Back 80

Assess post op pt for profuse nasal bleeding; respiratory distress; ecchymosis; and orbital and facial edema FOR THE FIRST 24 HOURS
Apply ice compresses to the nose and cheek to minimize edema and control bleeding; place pt in Semi or High Fowler’s position FOR 24-48 HOURS

Front 81

Pharyngitis

Back 81

Inflammation of pharynx.
More common in pts younger than 25 years; Primary symptom is sore throat
Pathophys – usu caused by viral infection; may be bacterial (strep); body triggers an inflammatory response to the invading organism

Front 82

Manifestations of Pharyngitis

Back 82

Pain; fever; edema; redness and swelling of the pharynx and surrounding structures; “white patches” of exudate; enlarged tender lymph nodes; malaise; occasional GI symptoms and scarletina rash w/ strep throat

Front 83

Medical Management of Pharyngitis

Back 83

Viral=supportive measures only; Tylenol or aspirin; antitussives; cool/warm drinks; increase fluid intake to AT LEAST 2-3 L/day
Bacterial=antibiotic agents (usu. Penicillin)

Front 84

Nursing Management of Pharyngitis

Back 84

Teach pt when to contact physician: with dyspnea; drooling; inability to swallow and inability to fully open mouth; rest during febrile stage of illness; frequent handwashing and proper disposal of tissues; warm saline gargles

Front 85

Tonsillitis and Adenoiditis most commonly caused by

Back 85

Group A beta hem. Strep

Front 86

Tonsilitis and Adenoiditis S/S

Back 86

Sore throat; fever; snoring; difficulty swallowing; earaches; bronchitis; bad breath; voice impairment; noisy respiration

Front 87

How is tonsillitis and adenoiditis diagnosed?

Back 87

By culturing the tonsils

Front 88

Medical Management of tonsillitis and adenoiditis?

Back 88

Supportive measures; increase fluid intake; analgesics; saltwater gargles & rest;IF BACTERIAL, tx w/ penicillin for 7-10 DAYS

Front 89

With Tonsillitis and Adenoiditis, consider surgical removal if pt has had

Back 89

repeated infections (ex. frequent ear infections), hypertrophy causing obstruction & sleep apnea NOT JUST IF THEY ARE ENLARGED (will usu decrease w/ age)

Front 90

Tonsillitis and Adenoiditis – Nursing Management for postop pts

Back 90

Continuous observations as pt is at increased risk for airway obstruction; PRONE w/ head to side

Front 91

Tonsillitis and Adenoiditis – Nurse does not remove oral airway until?

Back 91

Pt’s gag and swallowing reflexes have returned

Front 92

Tonsillitis and Adenoiditis – Post op

Back 92

if pt vomits large amounts of dark blood or bright red blood at frequent intervals or if the pulse rate and temp rise & pt is restless NURSE NOTIFIES SURGEON IMMEDIATELY!!

Front 93

Home teaching for the pt after surgery for tonsillitis/adenoiditis?

Back 93

Teach s/s hemorrhage; liquid or semiliquid diet for several days; avoid SPICY HOT ACIDIC OR ROUGH FOODS; limited MILK products; avoid vigorous tooth brushing or gargling

Front 94

Laryngitis

Back 94

An inflammation of the larynx that often occurs as a result of voice abuse; exposure to irritants such as dust; chemicals; smoke and other pollutants or as part of an URI

Front 95

Laryngitis most commonly caused by

Back 95

a virus – usually in the winter; and easily transmitted to others

Front 96

S/S of laryngitis?

Back 96

hoarseness and severe cough

Front 97

Management of Laryngitis

Back 97

Voice rest; avoid irritants; inhaling cool steam or aerosol meds; antibiotics if assoc. w/ another bacterial infection; increase PO fluids

Front 98

With laryngitis, contact MD with

Back 98

difficulty swallowing
hemoptysis
noisy respirations
continued HOARSENESS greater THAN 5 DAYS AFTER TREATMENT - VERY IMP!!

Front 99

Potential complications of upper airway infections

Back 99

sepsis; meningitis; peritonsillar abscess; otitis media; sinusitis

Front 100

Nursing care of laryngitis

Back 100

interventions to maintain a patent airway; promote comfort w/ analgesics; gargles for sore throat; use of hot packs for sinus congestion or ice collar to reduce swelling and also bleeding post tonsillectomy and adenoidectomy; rest; refrain from speaking; encourage liquids 2-3 L/day and appropriate foods

Front 101

Epistaxis

Back 101

Hemorrhage from the nose

Front 102

Most common site of bleeding in epistaxis?

Back 102

Anterior septum

Front 103

Treatment of epistaxis?

Back 103

Initially apply direct pressure w/ pt sitting upright with head tilted FORWARD pinching the nose for 5-10 MINUTES

Front 104

With epistaxis packing may stay in place for

Back 104

48 hrs or up to 6 days to control bleeding
Antibiotics may be prescribed d/t the risk of infection and toxic shock syndrome

Front 105

Nursing care of pts w/ epistaxis

Back 105

Assessment of bleeding; monitor airway and breathing; vital signs; reduce anxiety; teach pt to avoid nasal trauma; nose picking and nose blowing; air humidification; pressure on the nose to stop bleeding
If bleeding does not stop IN 15 MINUTES

Front 106

Tumors of the larynx may be either

Back 106

benign or malignant

Front 107

Larynx – Benign tumors

Back 107

Papillomas – one type of benign tumor of the larynx that are small wart-like growths believed to be viral in origin
Nodules or polyps – usu in people who abuse or overuse their voice

Front 108

Larynx – Cancerous tumors

Back 108

2-3% of all malignancies. Treatment depends of stage of the disease

Front 109

Cancer of the larynx – primary etiologic agent

Back 109

cigarette smoking

Front 110

Chronic laryngitis and voice abuse may also contribute to

Back 110

cancer of the larynx

Front 111

Cancer of the larynx is a possible mutation of

Back 111

gene p53

Front 112

Cancer of the larynx – pathophys

Back 112

squamous cell is the most common malignant tumor of the larynx

Front 113

With exception of cancer of the glottis cancers elsewhere in the larynx spread rather quickly because of the

Back 113

abundant lymphatic vessels

Front 114

Cancer of the larynx usually spreads

Back 114

quickly

Front 115

Cancer of the larynx – supraglottic

Back 115

false vocal cords above the vocal cords

Front 116

Cancer of the larynx – glottic

Back 116

true vocal cords; interferes w/ normal closure and vibration of the cords

Front 117

Cancer of the larynx –subglottic

Back 117

below the vocal cords; usu no manifestations until late in the disease process

Front 118

Symptoms of cancer of the larynx

Back 118

Hoarseness (> 2 weeks); voice change; persistent cough; sore throat or pain and burning in the throat; lump in the neck; sensation of a foreign body in the throat
Later symptoms: dysphagia; dyspnea; unilateral nasal obstruction; persistent hoarseness; persistent ulceration; foul breath
Generalized symptoms: weight loss; debilitation; lymphadenopathy; and radiation of pain to the ear

Front 119

Cancer of the larynx – Diagnosis is made by direct visual examination of the larynx using

Back 119

laryngoscopy

Front 120

Lab work to dx cancer of the larynx?

Back 120

CBC; electrolytes; kidney and liver function tests

Front 121

Cancer of the larynx – radiation therapy cure rates of

Back 121

85-95% if limited to true vocal cords

Front 122

Partial laryngectomy

Back 122

usually combined with radiation for SUPRAGLOTTIC tumors

Front 123

Supraglottic laryngectomy

Back 123

for CA of the supraglottis

Front 124

Total laryngectomy

Back 124

usually for SUBGLOTTIC tumors or large tumors that are fixated on the vocal cords

Front 125

Cancer of the larynx – Possible complications of surgery

Back 125

airway obstruction from edema; bleeding; or loss of airway from a plugged trach; hemorrhage from inadequate hemostasis durding surgery; fistula formation between the hypopharynx and the skin

Front 126

Carotid artery rupture is

Back 126

a LATE COMPLICATION and a LIFE-THREATENING EMERGENCY. Mild bleeding from the oral cavity, neck or trachea may precede rupture by 24 TO 48 HOURS.
A PULSATING TRACH TUBE is a sign that the tip of the tube is resting on the innominate artery and may result in injury!!

Front 127

Potential for Aspiration in Laryngectomy

Back 127

Keep HOB elevated during and after tube feedings; check GASTRIC RESIDUAL when administering tube feedings; when pt begins oral feedings maintain upright bed position during and after feedings; swallowing maneuvers to prevent aspiration; use of thickened liquids

Front 128

How to check for proper placement of feeding tube?

Back 128

1.check pH of aspirate; 2. auscultate for air; 3. x-ray

Front 129

Maintaining a patent airway in pt w/ laryngectomy

Back 129

Assess for edema and bleeding; auscultate every 2 hours for the first 24 hours; semi fowlers or high fowler’s position to decrease edema; care of the stoma; humidification of air

Front 130

Additional post op consideration for pt w/ laryngectomy

Back 130

Radical neck dissection may result in decreased shoulder ROM and decreased muscle strength. Exercises to prevent/minimize these are encouraged
Avoid HEATING PADS or exposure to temp extremes due to lack of sensation following neck dissection

Front 131

Post op teaching of trach care

Back 131

Include written instructions for the pt concerning: wound care to the stoma site; use of a humidifier; administration of tube feedings; progression of the diet; communication techniques; potential use of an artificial larynx; use of a medic alert bracelet and s/s to report to physician

Front 132

Atelectasis

Back 132

The collapse or airless condition of the ALVEOLI caused by hypoventilation; obstruction to the airways or compression
causes include bronchial obstruction by secretions due to impaired cough mechanism or conditions that restrict normal lung expansion on inspirations
Postoperative pts are at HIGH RISK FOR atelectasis

Front 133

With atelectasis, symptoms are

Back 133

Insidious and vague

Front 134

Symptoms of Atelectasis

Back 134

Cough
Sputum production
Low-grade fever

Front 135

If severe, physical assessment findings with atelectasis are...

Back 135

a tracheal shift toward the AFFECTED SIDE;
Decreased tactile fremitus
Dull percussion over affected area;
Decreased chest movement toward the involved side (b/c alveoli are collapsed);
Respiratory distress, anxiety and symptoms of hypoxia occur if large areas of the lung are affected

Front 136

Clinical picture of atelectasis ?

Back 136

Dyspnea
tachycardia
tachypnea
pleural pain
central cyanosis
decreased breath sounds
difficulty breathing in supine position
anxiety

Front 137

Nursing management to prevent atelectasis ?

Back 137

Frequent turn & early mobilization;
Strategies to improve ventilation (deep-breathing exercises at least every 2 HOURS & incentive spirometry); coughing exercises, suctioning, aerosol nebulizer treatments and chest physical therapy

Front 138

Treatment of Atelectasis

Back 138

Strategies to improve ventilation & remove secretions; treatments may include PEEP (positive end-expiratory pressure and IPPB (intermittent positive-pressure breathing). BRONCHOSCOPY may also be used to remove obstruction. May require THORACENTESIS d/t compression & pleural effusion

Front 139

Types of respiratory infections

Back 139

influenza
acute tracheobronchitis
pneumonia
pulmonary tuberculosis

Front 140

Influenza is ?

Back 140

an acute VIRAL infection of the respiratory tract. Usually occurs seasonally in epidemic form

Front 141

Who is at highest risk for influenza?

Back 141

Young children;
Older adults;
People living in institutional settings;
People w/ chronic disease
Health care personnel ARE MOST AT RISK

Front 142

Influenza is identified as types

Back 142

A, B, or C;

With A being the MOST PREVALENT AND MOST SERIOUS

Front 143

Manifestations of Influenza

Back 143

Fever
Muscle pain
cough

Predisposes to complications such as viral bronchitis or pneumonia; bacterial pneumonia; and super infections

Front 144

The flu differs from a common cold how primarily?

Back 144

by its SUDDEN ONSET and widespread occurrence within the population. Colds have a slower onset and usu do not cause fever have malaise as major manifestation and cause nasal manifestations

Front 145

Newer drugs such as Zanamivir, Oseltamivir and Rimantadine MUST BE TAKEN when?

Back 145

WITHIN 24 to 48 HOURS of onset and do not replace need for immunization

Front 146

No influenza immunization for client who have.....?

Back 146

egg allergy or a history of Guillain-Barre syndrome

Front 147

How is influenza spread?

Back 147

Airborne by droplets

Front 148

Pneumonia is

Back 148

an inflammatory process w/ an increase in interstitial and alveolar fluid

Front 149

Pneumonia is the _____ ______ ____________ nosocomial infection with the highest mortality rate

Back 149

2nd most common

Front 150

Pathophys of Pneumonia

Back 150

It is an inflammatory response to the offending organism or agent; disruption of the mechanical defenses of cough and ciliary motility leads to colonization of lungs and subsequent infection, THUS inflammed and fluid-filled alveolar sacs do not exchange CO2 effectively

Front 151

Pneumonia - Etiology

Back 151

bacteria
viruses
mycoplasmas
fungal agents
protozoa
aspiration

Front 152

Pneumonia - Risk factors

Back 152

Advanced age
History of smoking
URI
intubation
immobility
immunosuppressive therapy
nonfunctional immune system
malnutrition
dehydration
Chronic disease states

Front 153

Manifestations of Pneumonia

Back 153

Fever, chills, sweats, pleuritic chest pain, cough, sputum production, hemoptysis, dyspnea, orthopnea, HA, poor appetite, diaphoretic, malaise, bronchial breath sounds over areas of consolidation, crackes, whispered pectoriloquy, increased tactile fremitus, dulled percussion sounds, unequal chest expansion and fatigue.

**OLDER clients may have altered mental status and dehydration

Front 154

Medical management of pneumonia

Back 154

Antibiotic therapy if identified organism. If viral, only supportive therapy. Respiratory support, nutritional support, fluid and electrolyte management

Front 155

Supportive treatment for pneumonia includes....

Back 155

Fluids / 2-3 L/day
Ox for hypoxia
antipyretics
antitussives
decongestants
antihistamines

Front 156

Administration of antibiotics in pneumonia is determined how?

Back 156

by Gram stain results

Front 157

Assessment for pneumonia includes

Back 157

Changes in temp & pulse; secretions; cough; tachypnea; SOB; changes in inspection and auscultation of chest; changes in chest xray, and IN ELDERLY changes in MENTAL STATUS, fatigue, dehydration and concomitant heart failure

Front 158

What is tuberculosis?

Back 158

A communicable disease caused by M. tuberculosis, an aerobic, acid-fast bacillus. It is an AIRBORNE infection. Acquired by inhalation of a particle small enough to reach the alveolus. DROPLETS are emitted during coughing, talking, laughing, sneezing or singing.

Front 159

In TB, how long of exposure to be infected?

Back 159

Brief exposure usu does not result in disease, but after REPEATED close contact with an infected person.
INITIAL INFECTION USU OCCURS 2-10 WEEKS AFTER EXPOSURE

Front 160

Treatment for TB?

Back 160

Long term process. Clients w/ active TB are started on a minimum of 4 MEDS. Primarily chemotherapy agents for 6-12 MONTHS

Front 161

If a TB medication regimen is not working....

Back 161

at least TWO meds (never just one) are added.

Treatment is measured by NUMBER OF DOSES, NOT TIME FRAME

Front 162

Individuals are considered noninfectious after how long of therapy for TB?

Back 162

After 2-3 WEEKS OF CONTINUOUS MED THERAPY

Front 163

Nursing consideration for clients with TB?

Back 163

High-risk clients and clients with clinical manifestations should be IMMEDIATELY ISOLATED until results are obtained.
NEGATIVE PRESSURE ROOMS; PPE; semi-annual for high-risk populations

Front 164

Pleurisy

Back 164

An inflammation of both layers of the pleurae. Inflamed surfaces rub together with respirations and cause SHARP PAIN that is INTENSIFIED WITH INSPIRATION

Front 165

Pleural effusion

Back 165

A collection of FLUID in the pleural space, usu secondary to another disease process. Large effusions impair lung expansion and cause dyspnea; decreased/absent breath sounds; DECREASED tactile fremitus, dull/flat sounds on perc. Treat the cause and remove with thoracentesis or chest tube

Front 166

Empyema

Back 166

Accumulation of thick, purulent fluid in the pleural space. Pt is usually acutely ill. Fluid, fibrin development and loculation (walled off area) will impair lung expansion. Resolution is a prolonged process. Tx is drainage and prolonged antibiotics

Front 167

Pulmonary Edema

Back 167

The accumulation of fluid in the lung tissue, alveolar space, or bth. Usually a result of poor heart function which causes blood to back up in the heart and lungs increasing pressure and eventually leaking into the interstitial space and alveoli

Front 168

Pulmonary Edema

Back 168

Severe, life-threatening condition.

MANIFESTATIONS: Respiratory distress, dyspnea, central cyanosis, anxiety, agitation, FROTHY, BLOOD-TINGED SECRETIONS, crackles and tachycardia

Front 169

What is especially important in nursing management for a pt with pulmonary edema?

Back 169

Baseline wt and lung assessment. Keep legs in dependent position

Front 170

Pulmonary hypertension

Back 170

May be idiopathic or of known cause (usu heart or lung dz).

IDIOPATHIC IS VERY RARE.

Pulmonary vascular bed cannot handle the blood volume delivered by the right ventricle causing increased pressure and ultimately leading to RIGHT-SIDED HEART FAILURE (cor pulmonale)

Front 171

Cor pulmonale

Back 171

a/k/a right-sided heart failure, is an enlargement of the right ventricle due to high blood pressure in the lungs usu caused by chronic lung dz

Front 172

Manifestations of pulmonary hypertension

Back 172

Dyspnea with FIRST EXERTION and then AT REST, substernal chest pain, weakness, fatigue, SYNCOPE, hemoptysis and signs of right-sided heart failure (peripheral edema, ascites, distended neck veins, crackles and a heart murmur

Front 173

Respiratory failure is

Back 173

when one or more of the needed systems or organs fail to maintain optimal functioning

Front 174

Respiratory failure is an

Back 174

ARF-PaO2 of 50 mm Hg or less on room air or PaO2 of 50 mm Hg or more (ph < 7.35)

Classified as acute or chronic failure and as (1) hypoxemic or (2) ventilatory

Front 175

Hypoxemic respiratory failure

Back 175

is in clients with NORMAL LUNGS but respiratory status is impaired by drugs or diseases that affect respiration

Front 176

Ventilatory respiratory failure

Back 176

is in clients who have INTRINSIC lung diseases such as COPD or pneumonia with significant lung damage that increases the amount of nonfunctional lung tissue for ventilation

Front 177

S/S of Respiratory Failure

Back 177

Restlessness
Fatigue
HA
Dyspnea
Tachycardia
Increased B/P
Confusion
Lethargy
Tachypnea
Cyanosis
Diaphoresis
Use of accessory muscles, decreased breath sounds

Front 178

Pulmonary Emboli

Back 178

The obstruction of a pulmonary artery or branch by BLOOD CLOT, AIR, FAT, AMNIOTIC FLUID or SEPTIC THROMBUS

Front 179

Most thrombi are blood clots from the.....

Back 179

veins of legs

Front 180

Risk factors for Pulmonary Emboli

Back 180

Venous stasis
Hypercoagulability
Venous endothelial dz
heart dz
trauma
postop/postpartum
diabetes mellitus
COPD
Other: pregnancy, obesity, oral contraceptive use, constrictive clothing

Front 181

Manifestations of Pulmonary Emboli

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Dyspnea and tachypnea, SUDDEN, PLEURITIC chest pain, anxiety, fever, tachycardia, cough, diaphoresis, syncope

Development often assoc w/ DVT

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If pulmonary emboli is left untreated, death commonly occurs....

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within 1 hour

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Prevention and treatment of pulmonary emboli

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exercises to avoid venous stasis; early ambulation; anticoagulant therapy (Coumadin, Heparin)

Diagnosis by CXR, ECG, peripheral vascular studies, ABG, VG scan, Doppler studies

Treatment: improve resp and CV status, anticoagulation and thrombolytic therapy, compression devices, UMBRELLA FILTER placement

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Flail chest

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3 or more ribs are fractured at 2 or more sites, resulting in free-floating rib segments.

WILL HAVE SEVERE PAIN

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Pneumothorax

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The presence of air in the pleural space that prohibits complete lung expansion. Lung expansion occurs when there is NEGATIVE Pressure in the pleural space. If this is lost, the lung collapses and results in a pneumothorax. May be open or closed, spontaneous or traumatic

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Manifestations of pneumothorax

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Moderate: tachypnea, dyspnea, sudden sharp pain on the AFFECTED SIDE w/ chest movement, breathing or coughing, asymmetrical chest, hyperresonance to percussion on the affected side, restlessness, anxiety

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Tracheal deviation to which side with pneumothorax?

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Unaffected side

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Tracheal deviation to which side with atelectasis?

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Affected side

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Prevention of aspiration

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Elevate HOB; turn pt to the side when vomiting; prevention of stimulation of gag reflex with suctioning or other procedures; assessment and proper admin of tube feeding; rehab tx for swallowing; assurance of functioning feeding tubes

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Risk factors for aspiration

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Seizure activity
Decreased LOC from trauma, drug or alcohol intox, excessive sedation or general anesthesia
N/V
Stroke
Swallowing disorders
Cardiac arrest
silent aspiration

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COPD: reversible or irreversible?

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Not fully reversible

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COPD

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A disease state characterized by airflow limitation that is not fully reversible

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COPD includes what diseases?

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Emphysema, chronic bronchitis

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Asthma is now considered

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a separate disorder but can coexist with COPD

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COPD - pathophys

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Airflow limitation is progressive and is assoc w/ abnormal inflammatory response of lungs to noxious agents. Occurs throughout airways, lung parenchyma and pulmonary vasculature. AFFECTS PERFUSION. Scar tissue and narrowing occur in airways. Causes changes in VQ ratio

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Chronic bronchitis is

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Presence of a cough and sputum production for at least 3 months in each of 2 consecutive years.

Irritation of airways results in inflammation and hypersecretion of mucus.
Mucus-secreting glands and goblet cells increase in number. Ciliary function is REDUCED, bronchial walls thicken, bronchial airways narrow and mucus may plug airways. ALVEOLI become damaged and fibrosed and alveolar macrophage function diminishes

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Emphysema

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Floppy lungs, walls of alveoli are destructed. Decreased alveolar surface area causes an increase in DEAD SPACE and impaired oxygen diffusion

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Normal A-P diameter is

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ratio of 1/2 and abnormal ratio (in emphysema) is 2/1.

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Tobacco smoke causes

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80-90% of COPD cases

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Asthma

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a chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, mucus production

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What is strongest predisposing factor in asthma?

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Allergy

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Normal concentration of O2 in room air is

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21%

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Normal respiratory drive is from

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increased CO2

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In COPD, respiratory drive is from

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increased blood O2