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50 Cards in this Set

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  • Back
What is dyspnea, and s/s?
(page 752) Dyspnea is the subjective sensation of uncomfortable breathing, the feeling of being unable to get enough air. It is often described as breathlessness, air hunger, shortness of breath (SOB), labored breathing, and preoccupation with breathing...The signs of dyspnea include nasal flaring of the nostrils, use of accessory muscles of respiration, and retraction (pulling back) of intercostal spaces.
What is orthopnea?
(page 752) Pulmonary congestion tends to cause dyspnea when the individual is lying down (orthopnea). The horizontal position redistributes body water, causes the abdominal contents to exert pressure on the diaphragm, or decreases the efficiency of the respiratory muscles. Orthopnea generally is relieved by sitting up in a forward-leaning posture or supporting the upper body on several pillows.
What is paroxysmal nocturnal dyspnea?
(page 752) Some individuals with left ventricular failure wake up at night gasping for air and have to sit up or stand to relieve the dyspnea (paroxysmal nocutrnal dyspnea [PND]). PND results from fluid in the lungs caused by the redistribution of body water while the individual is recumbent.
What are Kussmal respirations?
(page 752) Strenuous exercise or metabolic acidosis induces Kussmaul respirations (hyperpnea), which is characterized by a slightly increased ventilatory rate, very large tidal volumes and no expiratory pause.
What are Cheyne stokes respirations?
(page 752) Cheyne-Stokes respirations are characterized by alternating periods of deep and shallow breathing. Apnea lasting from 15 to 60 seconds is followed by ventilations that increase in volume until a peak is reached; then ventilation (tidal volume) decreases again to apnea. Cheyne-Stokes respirations result from any condition that slows the blood flow to the brain stem, which in turn slows impulses sending information to the respiratory centers of the brain stem. Neurologic impairment above the brain stem is also a contributing factor.
What is hypercapnia?
(page 752) With hypoventilation, CO2 removal does not keep up with CO2 production and PaCO2 increases, causing hypercapnia (PaCO2 more than 44mm Hg.)
What is hemoptysis?
(page 753) Hemoptysis is the coughing up of blood or bloody secretions. This is sometimes confused with hematemesis, which is the vomiting of blood. Blood that is coughed up is usually bright red, has an alkaline pH, and is mixed with frothy sputum, whereas blood that is vomited is dark, has an acidic pH and is mixed with food particles.
What is pulmonary embolism?
(page 775) Pulmonary embolism is occlusion of a portion of the pulmonary vascular bed by an embolus, which can be a thrombus (blood clot), tissue fragment, lipids (fats), or an air bubble. The most common emboli are thrombi dislodged from deep veins in the thigh. (and pelvis) They also can originate in the pelvis, particularly in pregnant women.
What is COPD?
(page 768) Chronic obstructive pulmonary disease (COPD) has been defined as pathologic lung changes consistent with emphysema or chronic bronchitis and is syndrome characterized by abnormal tests of expiratory airflow that do not change markedly over time, nor exhibit major reversibility in response to pharmacologic agents.
What is asthma?
(page 764) Asthma is defined as, "a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role, in particular, mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells. In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning.
What is a cough?
(page 753) A cough is a protective reflex that cleanses the lower airways by an explosive expiration. Inhaled particles, accumulated mucus, inflammation, or the presence of a foreign body initiates the cough reflex by stimulating the irritant receptors in the airway.
What is a wheeze?
(page ???) with asthma
What is stridor?
(page ???) Upper airway obstruction
What is ARDS?
(page 762) Acute respiratory distress syndrome (ARDS) is a fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury with noncardiogenic pulmonary edema.
What is community acquired pneumonia?
(page 772) The most common community-acquired pneumonia is caused by Streptococcus pneumoniae (also known as the pneumococcus) which has a relatively low overall mortalily, although it is higher in the elderly…Community-acquired pneumonia (CAP) tends to be caused by different microorganisms as compared with those infections acquired in the hospital (nosocomial).
What is cyanosis?
(page 753) Cyanosis is a bluish discoloration of the skin and mucous membranes caused by increasing amounts of desaturated or reduced hemoglobin (which is bluish) in the blood.
What is clubbing?
(page 753) Clubbing is the selective bulbous enlargement of the end (distal segment) of a digit (finger or toe). Usually is is painless. Clubbing is commonly associated with diseases that interfere with oxygenation, such as lung cancer, bronchiectasis, cystic fibrosis, pulmonary fibrosis, lung abscess, and congenital heart disease.
When would you see pink frothy sputum?
(page???) Either pulmonary edema or TB (MILKSHAKE ANYONE?)
What is hypoxemia?
(page 754-755) Hypoexmia, or reduced oxygenation of arterial blood (reduced PaO2), is caused by respiratory alterations, whereas hypoxia, or reduced oxygenation of cells in tissues, may be caused by alterations of other systems as well.
What is atelectasis and some causes?
(page 757) Atelectasis is the collapse of the lung tissue. There are two types of atelectasis: (1) Compression atelectasis caused by external pressure exerted by tumor, fluid, or air in pleural space or by abdominal distention pressing on a portion of lung, causing alveoli to collapse. (2) Absorption atelectasis results from removal of air from obstructed or hypoventilated alveoli or from inhalation of concentrated oxygen or anesthetic agents.
What is pneumothorax, name the different kinds and s/s?
(page 758-759) Pneumothorax is the presence of air or gas in the pleural space caused by a rupture in the visceral pleura (which surrounds the lungs) or the parietal pleura and chest wall. As air separates the visceral and parietal pleurae, it destroys the negative pressure of the pleural space and disrupts the equilibrium between elastic recoil forces of the lung and chest wall. The lung then tends to recoil by collapsing toward the hilus...In open pneumothorax, air pressure in the pleural space equals barometric pressure because air that is drawn into the pleural space during inspiration is forced back out during expiration. In tension pneumothorax, however, the site of pleural rupture acts as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing up during expiration.
What is pleural effusion?
(page 759) Pleural effusion is the presence of fluid in the pleural space. The source of the fluid is usually blood vessels or lymphatic vessels lying beneath either pleura, but occaionally an abscess or other lesion is draining into the pleural space.
What is aspiration pneumonia?
(page 756-757) Aspiration is the passage of fluid and solid particles into the lung…Aspiration of acidic gastric fluid (pH<2.5) may cause severe pneumonitis (localized lung inflammation). Bronchial damage includes inflammation, loss of ciliary function, and bronchospasm. In the alveoli, acidic fluid damages the alveolocapillary membrane, allowing plasma and blood cells to move from capillaries into the alveoli, resulting in hemorrhagi pneumonitis. The lung becomes stiff and noncompliant as surfactant production is disrupted, leading ot further edema and collapse...The rate of deaths resulting from aspiration-caused pneumonitis is greater than 50%.
What is pulmonary edema, include predisposing factors and s/s?
(page 756) Pulmonary edema is excess water in the lung. The normal lung is kept dry by lymphatic drainage and a balance among capillary hydrostatic pressure, capillary oncotic pressure and capillary permeability. In addition, surfactant lining the alveoli repels water, keeping fluid from entering the alveoli. Predisposing factors for pulmonary edema include heart disease, acute respiratory distress syndrome, and inhalation of toxic gases. (SEE FIGURE 26-3; page 756)
What is chronic bronchitis?
(page 768) Chronic bronchitisis defined as hypersecretion of mucus and chronic productive cough for at least 3 months of the year (usually the winter months) for at lest 2 consecutive years.
What is tuberculosis?
(page 773) Tuberculosis (TB) is an infection caused by Mycobacterium tuberculosis, an acid-fast bacillus that usually affects the lungs, but may invade other body systems. The major reason for the increase in TB up until the mid-nineties was the epidemic of the acquired immunodefiency syndrome (AIDS). Individuals with AIDS are highly susceptible to infection with multidrug resistant tuberculosis.
What is pleural friction rub?
(page 753) Infection and inflammation of the parietal pleura cause sharp or stabbing pain when the pleura stretches during inspiration. The pain is usually localized to a portion of the chest wall, where a unique breath sound called a pleural friction rub may be heard over the painful area. (sounds like leather being rubbed together)
What is lung cancer?
(page 779-782) Lung cancers (bronchogenic carcinomas) arise from the epithelium of the respiratory tract. Therefore the term lung cancer excludes other pulmonary tumors, including sacromas, lymphomas, blastomas, hematomas, and mesotheliomas…The most common cause of lung cancer is cigarette smoking...At least 12 different cell types of tumors are included under the broad heading of lung cancer.
What is laryngeal cancer?
(page 778) Carcinoma of the true vocal cords (glottis) is more common than that of the supraglottic structures (epiglottis, aryepiglottic folds, arytenoids, false cords)…The presenting symptoms of laryngeal cancer include hoarseness, dyspnea, and cough. Progressive hoarseness is the most significant symptom and can result in voice loss...
What is hypoventilation?
(page 752) Hypoventilation is inadequate alveolar ventialation in relation to metabolic demands. It is caused by alterations in pulmonary mechanics or in the neurologic control of breathing.
What is bronchiectasis?
(page 757) Bronchiectasis is persistent abnormal dilation of the bronchi. It usually occurs in conjunction with other respiratory conditions and can be caused by obstruction of an airbody, infection, cystic fibrosis, tuberculosis, congenital weakness of the bronchial wall, or impaired defense mechansims.
What is empyema?
(page 760) Empyema (infected pleural effusion), the presence of pus in the pleural space, is a complication of respiratory infection, usually pneumonia caused by Staphylococcus aureus, Escherichia coli, anaerobic bacteria, or Klebsiella pneumoniae. In children, community-acquired pneumonia caused by Streptococcus pneumoniae accounts for the increased incidence of pediatric empyema seen in the last decade.
What is flail chest?
(page 761) Flail chest results from the fracture of several consecutive ribs in more than one place or the fracture of the sternum plus several consecutive ribs. These multiple fractures result in instability of a portion of the chest wall, causing paradoxic movement of the chest with breathing.
What are normal ABG values?
Normal values: pH 7.35-7.45; pCO2 35-45mmHg; pO2 80-95 mmHg; HCO3- 18-23mEq/L; O2 sat 95-100%
Compare the structures of the lower airway as the generation of division move toward the alveoli.
(page 733) Trachea, segmental bronchi, subsegmental bronchi (bronchioles) [nonrespiratory, respiratory], alveolar ducts (alveoli)
List the purpose of CSF.
(page 809) Permits the exchange of nutrients and waste between the blood and the CNS neurons. acts as a cushion or shock absorber.
List the components of normal CSF. What substances found within CSF differentiate it from other non-bloody body fluids?
(page 809) Formed from blood plasma. Glucose and protein.
List characteristics/ components of CSF that indicate abnormal findings suggestive of bacterial infection.
(page 825) WBC (massive amounts), turbid or cloudy, decrease glucose levels, increase protein levels
Consider the nursing interventions/ implications, pre, during, and post lumbar puncture.
(page 818)PRE AND DURING:
-informed consent
-pt on side/lying position closest to the edge of the bed
-help pt. flex his/her knees up to the chest
-pt. needs to be bedrest with head of bed flat for 6-8 hours (yeah right)
-increase oral fluids
-check puncture site for leakage
-assess pt. for headaches (losing CSF can cause this)
-label and send specimens to the lab as ordered
Explain the Monroe-Kellie doctrine and its relationship to increase in ICP
(page 827)The skull is a rigid compartment containing three components: brain, blood, and CSF. If one component increases and is not accompanied by a decrease in one or both of the other components, the result is increased ICP.
List S/S of increased ICP.
(page 827;Box46-2)1st manifested by:
-Restlessness, irritability and decreased LOC
-diminished reactivity and dilation of the pupil
-pupil stops reacting to light
-pupils become fixed and dilated
-VS change (late indication)
-Cushing's response (classic late sign)
List potential etiologies of increased ICP.
(page 827) -Anybody with an intracranial pathological condition
-head trauma
-intracranial hemorrhage
-brain tumors
List the interventions (and rationale) to prevent increased ICP, decrease adaptive capacity R/T infectious process:
(page 829) Avoid valsalva's maneuver, rectal temps, and flexion of the neck when positioning the pt.
Pain related headache and nuchal rigidity.
-Opiods are avoided (mask neuro S/S)
-Assist pt. to whatever position is most comfortable
-Dark, quiet room with few distractions (reduce headache)
Hyperthermia R/T infectious process.
-control fever with acetaminophen or asprin (can increase temp??)
-cooling mattress and tepid sponge baths
-cooling pt. gradually and wrapping extremities (comfort)
Risk for injury R/T seizures or falls
-seizure precautions
-use of side rails
-reminders to pt. not to get up without help
-have a family member stay with pt. to provide comfort and prevent falls (when pts. ability to remember instructions are impaired)
Disturbed sensory perception
-Monitor pt. closely for changes in LOC
Impaired physical ability
Encourage pt. to move and turn in bed and ambulate if able. (reduces risk of weakness and immobility)
Most common causes of meningitis.
Meningococcus, pneumococcus, and haemophilus influenza
What are some S/S of meningitis?
-inital symptom: sever headache
-fever (101 to 103F) or higher
-petechial rash on skin and mucous membranes
-nuchal rigidity (pain and stiffness when the neck is moved)
-Kernigs sign (the examiner flexes the pt's hip to 90 degrees and tries to extend the knee. Positive if the there is pain and spasm of the hamstring)
-Brudzinski's sign (positive if flexion of pt's neck causes the hips and knees to flex)
-Encephelopathy (late sign)
-Lethargy and seizures (late sign)