Nursing Iii O2 Deprivation & Acute Respiratory Problems

Front 1

What happens at the alveoli?

Back 1

where gas exchange occurs

Front 2

Ventilation

Back 2

flow of gas in & out of lungs (will refer to O2 & CO2)

Front 3

Perfusion

Back 3

filling of the pulmonary capillaries in the blood

Front 4

Adequate gas exchange will depend on what?

Back 4

ventilation/perfusion ratio (V/Q ratio)

Front 5

Normal V/Q ratio

Back 5

healthy lungs, adequate gas exchange, adequate blood flow

Front 6

Low V/Q ratio

Back 6

SHUNT
where perfusion exceeds ventilation
-bloods passing thru but not getting oxygenated

Front 7

Low V/Q ratio commonly found in?

Back 7

pneumonia, atelectasis (collapse of part-or less commonly all, of lung), respiratory diseases

Front 8

High V/Q ratio

Back 8

DEAD SPACE
ventilation exceeds perfusion
-alveoli not getting enough blood for gas exchange to occur
-vessel is blocked

Front 9

High V/Q ratio commonly found in?

Back 9

pulmonary embolism (usually legs)

Front 10

Interventions for pulmonary embolism?

Back 10

heparin, lovanox, compression stockings, get them walking

Front 11

Silent Unit

Back 11

SILENT
worst, absense of ventilation & perfusion, no exchange whatsoever

Front 12

Silent Unit commonly found in?

Back 12

pneumothorax (collapsed lung)-needs chest tube

Front 13

V/Q imbalances

Back 13

-normal V/Q ratio
-low V/Q ratio (shunt)
-high V/Q ratio (dead space)
-silent unit

Front 14

Client with pneumonia--which V/Q ratio or perfusion mismatch exists?

Back 14

Physiological shunt

Front 15

In a blood clot/pulmonary embolism, which V/Q ratio or perfusion mismatch exists?

Back 15

Alveolar dead space

Front 16

In a client with pneumothorax, which V/Q ratio or perfusion mismatch exists?

Back 16

Silent unit

Front 17

Hypoxia

Back 17

deficiency of O2 (low O2 sat, using excessory muscles)

Front 18

Hypoxemia

Back 18

decreased O2 concentration in blood, measured by PaO2

Front 19

Pt with O2Sat of 89%..interventions?

Back 19

raise HOB, cough deep breathe, IS, O2 therapy, present in a CALM manner

Front 20

Ventilation Perfusion Scan

Back 20

scans to find V/Q ratio?

Front 21

Pulmonary Function Tests

Back 21

how someone is inhaling & exhaling
-will assess resp function
-measure lung volume

Front 22

Pulse Oximetry

Back 22

want > 92%

Front 23

Peripheral Vascular Studies

Back 23

see how blood is flowing
-if CO2 is up, resp rate will originally increase

Front 24

ABG's (arterial blood gases)

Back 24

will tell us if resp acidosis or alkalosis

Front 25

Cultures

Back 25

sputum culture (want to obtain & send to lab within 2 hours, cleanse mouth/rinse water) get good globber in a cup....find if bacterial or fungal (could also do blood cultures)

Front 26

Chest xray

Back 26

to see whats going on with resp status
-may show infiltrates, plueral perfusion, pneumonia

Front 27

Other image studying

Back 27

CT, MRI, Pulmonary Angiography, Lung scans

Front 28

Endoscopic Procedures

Back 28

1) Bronchoscopy
2) Thoracoscopy
3) Thoracentesis

Front 29

Endoscopic Procedures

Back 29

1) Bronchoscopy
2) Thoracoscopy
3) Thoracentesis

Front 30

Bronchoscopy

Back 30

scope goes down throat with light to look at bronchials (use local anesthetic)

Front 31

Endoscopic Procedures

Back 31

1) Bronchoscopy
2) Thoracoscopy
3) Thoracentesis

Front 32

Why would you do a bronchoscopy?

Back 32

common to do if pt has unexplained cough, blood in sputum, or to diagnose infected lungs

Front 33

Bronchoscopy

Back 33

scope goes down throat with light to look at bronchials (use local anesthetic)

Front 34

Bronchoscopy

Back 34

scope goes down throat with light to look at bronchials (use local anesthetic)

Front 35

Why would you do a bronchoscopy?

Back 35

common to do if pt has unexplained cough, blood in sputum, or to diagnose infected lungs

Front 36

Thoracoscopy

Back 36

goes down side, examines plueral cavity

Front 37

Why would you do a bronchoscopy?

Back 37

common to do if pt has unexplained cough, blood in sputum, or to diagnose infected lungs

Front 38

Thoracoscopy

Back 38

goes down side, examines plueral cavity

Front 39

Thoracentesis

Back 39

Can remove air, blood, do when insert chest tube.
-catheter will go in 2nd & 33rd space for air, and 4th & 5th for fluid (bc fluid is lower than the air)
-done at bedside

Front 40

Thoracoscopy

Back 40

goes down side, examines plueral cavity

Front 41

Interventions/activities surrounding a Thoracentesis

Back 41

lung assessment before & after
-ask if have dentures
-allergies
-baseline VS
xray should be obtained before & after-make sure placed correctly

Front 42

Thoracentesis

Back 42

Can remove air, blood, do when insert chest tube.
-catheter will go in 2nd & 33rd space for air, and 4th & 5th for fluid (bc fluid is lower than the air)
-done at bedside

Front 43

Thoracentesis

Back 43

Can remove air, blood, do when insert chest tube.
-catheter will go in 2nd & 33rd space for air, and 4th & 5th for fluid (bc fluid is lower than the air)
-done at bedside

Front 44

During Thoracentesis procedure nurse does what?

Back 44

-assess resp rate
-lightheadedness, shortness of breath, increased resp rate may signal punctured lung-pnuemothorax

Front 45

Interventions/activities surrounding a Thoracentesis

Back 45

lung assessment before & after
-ask if have dentures
-allergies
-baseline VS
xray should be obtained before & after-make sure placed correctly

Front 46

Interventions/activities surrounding a Thoracentesis

Back 46

lung assessment before & after
-ask if have dentures
-allergies
-baseline VS
xray should be obtained before & after-make sure placed correctly

Front 47

Pneumonia stats

Back 47

-most common cause of death in US from infectious disease
-8th leading cause of death in US

Front 48

During Thoracentesis procedure nurse does what?

Back 48

-assess resp rate
-lightheadedness, shortness of breath, increased resp rate may signal punctured lung-pnuemothorax

Front 49

During Thoracentesis procedure nurse does what?

Back 49

-assess resp rate
-lightheadedness, shortness of breath, increased resp rate may signal punctured lung-pnuemothorax

Front 50

Pneumonia results from...

Back 50

fluid/puss (exudate) build up in bronchioles & alveoli
-is an inflammatory process

Front 51

Pneumonia stats

Back 51

-most common cause of death in US from infectious disease
-8th leading cause of death in US

Front 52

Pneumonia stats

Back 52

-most common cause of death in US from infectious disease
-8th leading cause of death in US

Front 53

How to prevent pneumonia

Back 53

vaccinations & hand hygeine has lowered death rates in recent years

Front 54

Pneumonia results from...

Back 54

fluid/puss (exudate) build up in bronchioles & alveoli
-is an inflammatory process

Front 55

Pneumonia results from...

Back 55

fluid/puss (exudate) build up in bronchioles & alveoli
-is an inflammatory process

Front 56

How to prevent pneumonia

Back 56

vaccinations & hand hygeine has lowered death rates in recent years

Front 57

How to prevent pneumonia

Back 57

vaccinations & hand hygeine has lowered death rates in recent years

Front 58

2 Patterns of Pneumonia

Back 58

Lobar
Broncho

Front 59

Lobar Pneumonia

Back 59

usually starts in one area & may extend to fill an entire lobe

Front 60

Aspiration pneumonia is most likely to be what pneumonia pattern?

Back 60

Lobar pneumonia

Front 61

Why is patient NPO before surgery?

Back 61

To lower risk of aspiration pneumonia

Front 62

pseudomonas

Back 62

flem that smells, bacteria

Front 63

Smoking increases risk for pneumonia why?

Back 63

Bc smoking parallyzes the cilia

Front 64

Broncho Pneumonia

Back 64

most common
-clustered throughout lobes, more patchy

Front 65

Etiology of pneumonia

Back 65

can be bacterial, viral, or fungal

Front 66

Bacterial pneumonia

Back 66

streptococcus most common form

Front 67

Viral pneumonia

Back 67

microplasma & parasites most common

Front 68

Fungal pneumonia

Back 68

canditus, legionnaires, most common

Front 69

pneumonia spread by

Back 69

airborne

Front 70

Community acquired pneumonia

Back 70

refers to patient that ended up w/ pneumonia living in a community
-or in hospital & diagnosed w/in first 48 hours
50% of all diagnosed

Front 71

Hospital acquired pneumonia

Back 71

AKA nosocomial
-diagnosed while patient in hospital, when there more than 48 hours

Front 72

Immuno- compromised host getting pneumonia

Back 72

patient gets pneumonia bc they have an autoimmune disease

Front 73

Getting pneumonia by aspiration

Back 73

aspirating on food or water

Front 74

Risk factors for pneumonia

Back 74

-mechanical ventilation
-elderly
-chronic disease
-cigarette smoking
-immobility
-poor nutritional status

Front 75

Clinical manifestations of pneumonia

Back 75

crackles, chills, fever, pleuritic chest pain, tachypnea, SOB, chest percussion will be dull, nasal congestion, sore throat, poor appetite, uses exessory muscles for breathing

Front 76

Clinical manifestations of pneumonia, continued

Back 76

orthopnea, purulent blood-tinged rust colored sputum, diaphoretic

Front 77

Diagnostic Finding with pneumonia

Back 77

-history of URI
-chest xray
-physical exam
-blood cultures
-sputum
-WBC's elevated (normally 4-11K)(monitor once on antibiotics, if still elevated-need to try another treatment)

Front 78

Nursing Interventions

Back 78

HH, hydration (thin secretions), VS (O2sat <, pulse >, resp rate >), IS, turn cough deep breathe, chest pt, promote rest, nutrition, O2 therapy

Front 79

Incentive Spirometry does what?

Back 79

increases lung capacity, helps open alveoli

Front 80

Medications for pneumonia/resp

Back 80

Antitussives
Bronchodilators
Antihistamines
Nasal Decongestants
Antibiotics

Front 81

Antitussives

Back 81

robatussin, expectorant, helps loosen secretions so can spit out

Front 82

Bronchodilators

Back 82

opens bronchols

Front 83

Antihistamines

Back 83

use bronchodilators before these
-reduce inflammation

Front 84

Nasal Decongestants

Back 84

ex. sudafed, reduces nasal congestion

Front 85

Antibiotics

Back 85

will depend on if bac, or fungal
-z-pack (zithomas) used frequently, Levaquin IV, Penacillin

Front 86

If pt can't take penacillin

Back 86

amoxacillin, tetrocycline (will stain your teeth if kid)

Front 87

Ineffective Airway Clearance

Back 87

raise HOB, IS, turn cough deep breathe, chest pt, monitor O2sat, encourage fluids, suction PRN (10-15sec)

Front 88

Activity Intolerance

Back 88

walk/ambulate, IS, ROM exercises, rest periods, assess & monitor O2 sat before, after, & during walking

Front 89

Risk for Fluid Volume Deficit

Back 89

hydrate, monitor Is & Os, monitor F & E

Front 90

Knowledge Deficit

Back 90

educate pt, family, provide materials/referrals, about meds, vaccines, disease prevention
-also need to assess pt's readiness to learn

Front 91

Pleural Conditions

Back 91

-Pleurisy
-Pleural Effusion
-Empyema

Front 92

Pleurisy

Back 92

refers to inflamation of pleural space

Front 93

Pleural Effusion

Back 93

collection of fluid in pleural space, will be pain, see more w congestive heart failure, TB, pulm embolism

Front 94

Empyema

Back 94

puss, gunk, infection, exudate, usually occurs w bacterial pneumonias

Front 95

Pleurisy symptom of pain

Back 95

will complain of chest pain bc walls are inflammed & friction together-severe sharp pain, like a knife

Front 96

Pulmonary Embolism

Back 96

can be blood/clot/thrombus,
air (gets into circulatory system & embeds), or fat

Front 97

Pulmonary Embolism urgency

Back 97

EMERGENCY
needs immediate intervention or will be dead within the hour

Front 98

Pulmonary Embolism symptoms

Back 98

anxious, scared, foaming at mouth (pink tinged), tachycardic, lose level of consciousness, cyanotic

Front 99

How to treat pt with pulmonary embolism

Back 99

IV heparin, fluids, O2, maybe ventilator, try to maintain resp & circulatory system

Front 100

Risk factors for pulmonary embolism

Back 100

venous stasis (decreased mobility), trauma, surgery, pregnancy, age, obesity, oral contraceptive use, constrictive clothing

Front 101

Clinical manifestations of pulmonary embolism

Back 101

sudden onset of dyspnea, pleurtic chest pain, apprehension, feeling of impending doom, cough, hemoptysis (blood in sputum), tachypnea, crackles, friction rub, tachycardia, sweating, fever, petechiae over chest and axillae

Front 102

Prevention of pulmonary embolism

Back 102

-PROM
-ambulate
-anti embolism stockings & pneumatic compression stocking
-no constricting clothing
-prevent pressure under knees
-anti coagulation therapy

Front 103

Acute Laryngotracheobronchitis (LTB)

Back 103

most common croup syndrome
-affects children less than 5 years of age
-inflammation of the mucosa lining larynx & trachea

Front 104

Clinical manifestations of LTB

Back 104

barking or seal like cough, acute stridor, hypoxia, gradual onset of fever, hoarseness, restlessness, rapid respirations (acidosis)

Front 105

LTB responding to treatment

Back 105

can bottom out quickly when get it--but responds to treatment well

Front 106

Treatment for LTB

Back 106

-maintain patent airway
-high humidity with cool mist
-corticosteroids (solumedrol IV reduces inflamation), racemic epinephrine, encourage PO fluids unless rr > 60 breaths/min

Front 107

Treatment for LTB

Back 107

Racemic epinephrine (given in nebulizor treatment), ribavirin (anti viral agent, put kid in croup tent)(if pregnant, shoudln't handle this med-aerosauled)

Front 108

If child goes into full blown airway block, symptoms

Back 108

increased pulse, increased rr, flaring of nares, increased restlessness

Front 109

Early sign of hypoxemia?

Back 109

nasal flaring

Front 110

Early sign of O2 toxicity

Back 110

-non productive cough
-hypoventilation
-nasal stuffiness