Nc 4- Respiratory Problems (25%)

Front 1

ACID-BASE IMBALANCES of ___ may depress the respiratory system

Back 1

less than 7.15 or greater than 7.45

Front 2

What portions of the neuro system deals with respiratory functioning?

Back 2

The medulla oblongata is the inspiratory and expiratory center of the brain than controls the rate and depth of respiration. The apneustic center of the lower pons may also contribute to inspiration and the pneumotaxic center may assist in expiration.

Front 3

RESPIRATORY FAILURE is

Back 3

respiratory system can’t adequately supply the body with the O2 it needs or adequately remove CO

Front 4

PO2 value of ______ indicates respiratory failure

Back 4

PO2 less than or equal to 50 mm Hg

PCO2 greater than 50 mm Hg with a pH of less than or equal to 7.25

Front 5

RESPIRATORY FAILURE may be confirmed by

Back 5

ABG levels show hypoxemia, acidosis, alkalosis, and hypercapnia.

Front 6

RESPIRATORY FAILURE tx includes

Back 6

O2 therapy, intubation, and mechanical ventilation (PEEP)

Front 7

RESPIRATORY FAILURE interventions include

Back 7

include early detection of signs of hypoxemia and tx with O2. Provide suctioning, assist with turning, coughing and deep breathing. Maintain bed rest to reduce O2 requirement.

Front 8

CROUP is

Back 8

severe inflammation of the upper airway, usually caused by a virus

Front 9

GROUP s/s are

Back 9

- bark-like cough, inspiratory stridor and laryngeal obstruction to varying degrees.

Front 10

GROUP

Back 10

related to symptoms and can include aerosolized epinephrine, decadron, and application of cool mist. Antipyretics can control fever if present. Frequently affects children up to three years of age

Front 11

CHRONIC BRONCHITIS is a form of

Back 11

COPD

Front 12

COPD results from

Back 12

results from irritants and infections that increase mucus production, impair airway clearance, and cause irreversible narrowing of the small airways leading to hypoxemia and CO2 retention

Front 13

CHRONIC BRONCHITIS s/s are

Back 13

dyspnea, increased sputum production, productive cough, prolonged expiration, rhonchi and wheezes

Front 14

CHRONIC BRONCHITIS maybe confirmed by which test, what does each test reveal

Back 14

chest x-ray shows hyperinflation and increased bronchovasicular markings. PFTs may reveal increased residual volume, decreased vital capacity and forced expiratory volumes, and normal static compliance and diffusion capacity.

Front 15

CHRONIC BRONCHITIS tx includes

Back 15

increase fluid intake to 3000 ml/day, CPT, IS, increase protein and vitamin C, calories and nitrogen in the diet. Intubate and ventilate if respiratory status deteriorates

Front 16

What should be noted about FiO2 as it relates to nsg interventions of CHRONIC BRONCHITIS

Back 16

administer low FiO2 because COPD patients use their hypoxic drive to breathe and increased FiO2 shuts that drive system down, they will stop breathing and become hypercapnic, somnolent and obtunded

Front 17

LARYNGEAL EDEMA is

Back 17

edema of the mucous membranes that surround the larynx (voice box

Front 18

LARYNGEAL EDEMA s/s are

Back 18

acute anaphylaxis, scarlet fever and severe inflammations of the throat

Front 19

LARYNGEAL EDEMA tx includes

Back 19

epinephrine, and an icepack to the throat

Front 20

Provide a general overview of MUCOID SECRETIONS

Back 20

Fluid imbalances that result in dehydration can severely impact airway clearance. Thick, sticky, tenacious secretions are harder to remove. Infection can also change the consistency of secretions and make them harder to remove

Front 21

ASTHMA is

Back 21

chronic reactive airway disease. Bronchial linings overreact to various intrinsic and extrinsic stimuli, causing episodic spasms and inflammation that can severely restrict the airways

Front 22

ASTHMA s/s are

Back 22

chest tightness, dyspnea, wheezing, primarily on expiration, tachypnea, tachycardia, and use of accessory muscle

Front 23

ASTHMA tx includes

Back 23

- Increased fluid intake to prevent thickened secretions, beta-adrenergic drugs (serevent), bronchodilators (albuterol, ipratropium bromide), mast cell stabilizer (intal).

Front 24

Provide an overview of EMPHYSEMA

Back 24

recurrent pulmonary inflammation damages and eventually destroys alveolar wall, creating large air spaces and reducing the area available to exchange O2 and CO2. Lungs are less able to recoil after expanding, air trapping and overdistention are characteristic of this disorder

Front 25

EMPHYSEMA s/s are

Back 25

barrel chest, dyspnea, pursed-lip breathing, increased use of accessory muscles for breathing

Front 26

EMPHYSEMA maybe confirmed by

Back 26

chest x-ray reveals a flattened diaphragm, reduced vascular markings, enlarged antero-posterior chest diameter and a vertical heart. PFT’s show increased residual volume, total lung capacity and compliance and decreased vital capacity, diffusing capacity and expiratory volumes

Front 27

EMPHYSEMA tx includes

Back 27

bronchodilators, steroids (hydrocortisone, solu-medrol), aerosolized steroids, diaphragmatic and pursed-lip breathing to strengthen respiratory muscles, high-fowler’s position to improve ventilation, smoking cessation, and avoidance of people with respiratory infections.

Front 28

FLAIL CHEST s/s are

Back 28

fractured ribs on both the left and right can lead to paradoxical movement of the chest wall. During inspiration a portion of the chest wall deflates instead of expands giving a see-saw appearance to breathing.

Front 29

FLAIL CHESTunusual treatment maybe

Back 29

Usual treatment is mechanical ventilation to stabilize the ribs and give them time to heal

Front 30

What should be noted about Paradoxical movement

Back 30

movement is not an effective breathing pattern and carries the increased risk of broken rib bones puncturing lung tissue and causing further damage

Front 31

Provide an overview of DIAPHRAGM PARALYSIS excluding tx

Back 31

as result of damage to the phrenic nerve. Intercostal and accessory muscles take over the role of breathing and can quickly lead to fatigue and respiratory failure

Front 32

DIAPHRAGM PARALYSIS tx includes

Back 32

upright position and frequent use of mechanical ventilation especially at night.

Front 33

PLEURAL EFFUSION is

Back 33

excess fluid in the pleural space (between the lung and the protective layer around it. Usually this area contains a small amount of extracellular fluid that lubricates the pleural surfaces. Increased production or inadequate removal of this fluid results in pleural effusion.

Front 34

PLEURAL EFFUSION s/s are

Back 34

decreased breath sounds, dyspnea, fever, pleuritic chest

Front 35

PLEURAL EFFUSION maybe confirmed by

Back 35

chest x-ray shows radiopaque fluid in dependent regions

Front 36

PLEURAL EFFUSION tx may include

Back 36

Thoracentesis to remove fluid and antibiotics according to the sensitivity of causative organism. Use of chest tube to drain fluid from the pleural space.

Front 37

Explain how altitudes may affect O2 supply

Back 37

the ambient pressure in high altitude areas is less than at sea level. This decreases the pressure gradient between the lungs and the environment, so that there is less being “pushed” into the lungs.

Front 38

Living in high altiitudes may result in

Back 38

in polycythemia to improve oxygen carrying capacity.

Front 39

Polycythemia is

Back 39

A condition marked by an abnormally large number of red blood cells in the circulatory system.

Front 40

Provide an overview of SMOKE INHALATION INJURY

Back 40

loss of ciliary action, mucosal edema and decrease in surfactant leading to atelectasis, alveolar collapse. Mucosa sloughing can cause expectoration of mucopurulent material and carbon particles. Pt’s should be watched for 24-48 hours to access for extent of edema and risk of problem from exudates in the lung

Front 41

PERIPHERAL VASCULAR DISEASE IS

Back 41

chronic inadequate blood flow in the lower extremities

Front 42

PERIPHERAL VASCULAR DISEASE S/S ARE

Back 42

moderate edema, burning, itching, prominent superficial veins, ulcers and skin changes

Front 43

PERIPHERAL VASCULAR DISEASE TX includes

Back 43

Aimed at vasodilation, pain relief, and maintaining skin integrity. Do NOT use a heating pad to keep extremities warm

Front 44

PERIPHERAL VASCULAR DISEASE

Back 44

Encourage walking and other leg exercise, watch for signs of decreased peripheral circulation.

Avoid temperature extremes, prolonged standing, constrictive clothing or crossing the legs at the knee when seated.

Front 45

PERIPHERAL VASCULAR DISEASE Complications include

Back 45

include gangrene, and pressure sores

Increased incidence of peripheral vascular disease in older adults.

Front 46

Nsg interventions for PERIPHERAL VASCULAR DISEASE

Back 46

Provide instruction about foot care and exercise programs. Develop a plan for smoking cessation

Front 47

PULMONARY EMBOLISM is

Back 47

fat, air or thrombus in the pulmonary vessels that obstructs blood flow. Obstruction may result in pulmonary hypertension and possible infarction

Front 48

PULMONARY EMBOLISM includes

Back 48

surgery, flat, long bone fractures, obesity, oral contraceptive use, pregnancy, prolonged bed rest, venous stasis

Front 49

PULMONARY EMBOLISM s/s are

Back 49

sudden onset of dyspnea, tachypnea, crackles, chest pain, cough, hemoptysis, tachycardia, anxiety

Front 50

PULMONARY EMBOLISM dx confirmed by

Back 50

ABG shows respiratory alkalosis and hypoxemia and elevated A-a gradient. Lung scan shows V/Q mismatch

Front 51

PULMONARY EMBOLISM tx is

Back 51

bed rest, anticoagulants (heparin), diuretics (lasix), fibrinolytics (streptokinase), and in recurrent cases the insertion of a vena cava filter.

Front 52

PULMONARY HYPERTENSION is

Back 52

when the blood pressure in the pulmonary arteries (the vessels that carry blood from the heart to the lungs) becomes higher than normal. This puts strain on the right side of the heart

Front 53

PULMONARY HYPERTENSION maybe classified by

Back 53

When the cause of pulmonary hypertension isn't known, the disorder is called "primary" pulmonary hypertension

Secondary" pulmonary hypertension has a known cause. Common causes are emphysema and chronic bronchitis (breathing problems).

Front 54

PULMONARY HYPERTENSION maybe treated by

Back 54

medicines called calcium-channel blockers, breathing oxygen from a tank, or a blood-thinning medicine may help. In primary pulmonary hypertension, a medicine that is given through a vein, called prostacyclin (brand name: Flolan), may lower the blood pressure in your pulmonary arteries.

Front 55

TUBERCULOSIS is

Back 55

Airborne, infectious, communicable disease. Alveoli become infected from inhaled droplets containing tubercle bacilli

Front 56

TUBERCULOSIS s/s are

Back 56

fever, night sweats, cough with yellow mucoid sputum, anorexia, weight loss

Front 57

TUBERCULOSIS maybe confirmed by

Back 57

mantoux skin test is positive. Sputum study is positive for acid-fast bacillus and M. tuberculosis.

Front 58

TUBERCULOSIS tx includes

Back 58

standard/airborne precautions, antituberculars (isoniazid, rifamping),

Front 59

TUBERCULOSIS nsg interventions include

Back 59

Instruct the patient to cover nose and mouth when sneezing to reduce transmission by droplet.

Front 60

ADULT RESPIRATORY DISTRESS SYNDROME is

Back 60

Assault to the pulmonary system (aspiration, decreased surfactant production, fat emboli, fluid overload, neurologic injuries O2 toxicity, respiratory infection, sepsis, shock, trauma). Respiratory distress. Decreased lung compliance. Severe respiratory failure

Front 61

ADULT RESPIRATORY DISTRESS SYNDROME s/s are

Back 61

Anxiety, restlessness, crackles, rhonchi, decreased breath sounds, dyspnea, tachypnea

Front 62

ADULT RESPIRATORY DISTRESS SYNDROME maybe confirmed by

Back 62

ABG shows respiratory acidosis, metabolic acidosis and hypoxemia that doesn’t respond to increased O2. Chest x-ray shows bilateral infiltrates and lung fields with a ground-glass appearance

Front 63

ADULT RESPIRATORY DISTRESS SYNDROME tx includes

Back 63

intubation and mechanical ventilation, O2 therapy, analgesics (morphine), antibiotic ( according to infectious organism sensitivity), diuretics, neuromuscular blocking agents (Norcuron), and steroids.

Front 64

ADULT RESPIRATORY DISTRESS SYNDROME nsg interventions include

Back 64

turning and CPT to promote drainage and keep airways clear. Position in high-fowler’s to promote chest expansion. Maintain bed rest to promote oxygenation.

Front 65

PULMONARY EDEMA is

Back 65

complication of L sided heart failure. Increased pressure in the capillaries of the lungs causes acute transudation of fluid. Creates impaired oxygenation and hypoxia.

Front 66

PULMONARY EDEMA s/s are

Back 66

dyspnea, orthopnea, tachypnea, blood-tinged, frothy sputum, agitation, restlessness, intense fear

Front 67

PNEUMOTHORAX is

Back 67

loss of negative intrapleural pressure results in collapse of the lung. The surface area of gas exchange is reduced, resulting in hypoxia and hypercapnia

Front 68

PULMONARY EDEMA maybe confirmed by

Back 68

hemodynamic monitoring shows increased PAP, PAWP, and CVP. Decreased cardiac output

Front 69

PULMONARY EDEMA nsg interventions are

Back 69

assessing cardiovascular status, etc to detect changes in fluid blance, tachycardia, S3 heart sound, hypotension, increased respiratory rate and crackles which can indicate increases fluid volume.

Keep the head of the bed in high fowler’s if tolerated to reduce venous return to the heart and promote chest expansion

Front 70

PNEUMOTHORAX causes are

Back 70

blunt chest trauma, penetrating chest injuries, rupture of a bleb, and thoracic surgeries

Front 71

PNEUMOTHORAX s/s are

Back 71

diminished or absent breath sounds, dyspnea, tachypnea, subcutaneous emphysema, cough, sharp pain that increases with exertion

Front 72

PNEUMOTHORAX maybe confirmed by

Back 72

chest x-ray

Front 73

PNEUMOTHORAX tx includes

Back 73

chest tube to water-seal drainage

Front 74

Black lung diease is

Back 74

condition of the lungs caused by inhalation of coal dust

Front 75

Provide an overview of CHEST TUBES are assessed by

Back 75

Assess by palpating chest around the tube for subcutaneous emphysema, notify dr. of any increase. Assess function of chest tube. Bubbling in the water seal chamber should decrease as the pneumothorax is resolved. Constant bubbling may indicate a loose connection, promptly correct any loose connections. If the tube becomes dislodged, cover the opening immediately with petroleum gauze and apply pressure. Call the doctor and continue to keep the opening closed, prepare to reinsert chest tube. If the tubing becomes cracked insert the distal end into sterile water and call the doctor.

Front 76

PNEUMONIA is

Back 76

bacterial, viral, parasitic, or fungal infection that causes inflammation of the alveolar spaces. Droplet inhalation causes inflammation and an increase in alveolar fluid, secretions thicken making ventilation more difficult

Front 77

PNEUMONIA s/s are

Back 77

chills, fever, crackles, rhonchi, pleural friction rub on auscultation, SOB, dyspnea, tachypnea, used of accessory muscles, sputum production

Front 78

PNEUMONIA maybe confirmed

Back 78

chest x-ray shows pulmonary infiltrates, sputum study to identify specific organism

Front 79

PNEUMONIA tx includes

Back 79

symptomatic and antibiotics

Front 80

PNEUMONIA nsg interventions are

Back 80

monitoring for dehydration due to insensible water loss secondary to fever, monitor respiratory status to detect early signs of compromise

Front 81

ATELECTASIS is

Back 81

localized alveolar collapse that reduces the gas exchange surface of the lungs.

Front 82

ATELECTASIS is caused by

Back 82

include mucous plugs, decreased expansion due to pain, and anesthesia

Front 83

ATELECTASIS s/s are

Back 83

diminished or bronchial breath sounds, dyspnea, anxiety, cyanosis, diaphoresis, tachycardia, substernal or intercostal retraction

Front 84

ATELECTASIS tx is

Back 84

bronchodilators, deep breathing and coughing, administer adequate analgesics.

Front 85

COPD s/s are

Back 85

Exertional dyspnea, weakness, fatigue and chronic, productive cough

Front 86

COPD tx may inclue

Back 86

correcting hypoxemia and administration of digitalis, antibiotics, vasodilators, anticoagulants and oxygen

Front 87

COPD maybe confirmed by

Back 87

increased pulmonary artery pressure measurements