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198 Cards in this Set
- Front
- Back
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What is the upper airway?
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at and above trachea
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What is the nose used for?
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filters and warms air we breath, very vascular
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What are the sinuses?
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frontal, maxillary, ethmoid, sphinoid
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What is the pharynx?
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throat
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What is the naso oro pharynx?
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branches into the larynx, soft cartilage
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What is the larynx?
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hard cartilage, less flexible
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What is the trachea?
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4-5 in long, hard, less flexible cartilage
divides into the R & L main stem bronchi |
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How many lobes are in the L lung? Right?
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2 L
3 R |
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What are the elastic fibers of the alveoli used for?
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wrap around them so they can expand but then return to normal
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What is the parietal lining?
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covers each lobe of lung
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What is the visceral lining?
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communicates with alveoli
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What does the fluid b/t the parietal and visceral lining do?
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Creates a negative pull and keeps alveoli from collapsing
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Where are chest tubes inserted?
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into the pleural lining
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What should be included in the resp hx?
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do you smoke? ppd x # yrs, sleeping pattern changes, cigars, illicit drugs, chemical exposure, work, hobbies, lifestyle chnages, 2nd hand smoke, TB, pnuemonia, cough-sputum, do you get light headed, change in activity
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What should be included in inspection?
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resp rate, labored breathing, symmetry, color, clubbing, position
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What should be included in palpation?
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lung expansion- hands on back while breathing, repeat 99 (any vibration is abnormal)
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What should be herd when doing percussion?
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hollow sounding
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What are crackles?
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collapsed alveoli are reopening
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What are wheezes?>
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bronchoconstriction or fluid volume
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What are rhonchi?
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secondary to an obstruction- thick, wet secretions
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What is a pleural rub?
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inflammation or fluid accumulation
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Why is O2 considered a med?
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b/c of complications
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What are some complications of O2?
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O2 induced hypoventilation
combustion/fire potentiating alteration in mucus membranes can cause staph toxicity causes irreversible alveolar damage |
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What is a nasal cannula?
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protect sensitive pressure points
24-44% 02 > 4L put on humidity |
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What is a simple face mask?
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30-60% 02
5-12 LPM < 5LPM increases risk for C02 inhalation |
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What is a venturi mask?
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most precise delivery device
24-70% long tube helps w/ C02 inhalation |
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What is a rebreather?
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apply to pt that need increased % of 02 w/o ventilation
about 80-90% 02 must keep reservoir inflated check one way vavles not rebreathing C02 or old air |
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What is a bypap?
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gives positive pressure when inhalation occurs
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What is a cpap?
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helps to inflate and take deeper breaths- ventilatory
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What is a tracheostomy?
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hold made in trachea
decreases dead space to make breathing easier air has less space to travel too many secretions-not able to get secretions all the way into mouth cannot get weaned from ventilators esophageal surgery |
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What is a fenestrated trach?
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allows them to talk
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What should the care for a pt with a trach include?
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cuff pressure
watch for bleeding trach collar is secure |
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What is intubation?
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laryngascope is used to visualize vocal chords
endotracheal tube placed b/t vocal chords confirmed with CXR |
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What should the care for a intubated pt include?
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cuff pressure
position |
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What are the manifestations of the flu?
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fever, lethargy, body aches, cough, sore throat
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How is the flu managed?
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neurominidase inhibitors- Tamiflu & relenza
expectorants, antipyretics, rest, fluids, symptom treatment |
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How can sinusitis be managed?
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OTC decongestants, warm compresses, steam inhalation, PCN
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What should be avoided with sinusitis?
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anti-histamines
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What are some complications to pharyngitis?
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acute glomerulorephritis, rheumatic fever
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What is used to treat pharyngitis?
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PCN
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What are the s/s of viral pharyngitis?
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low grade fever, HA, sore irritated throat, rhinorrhea- runny nose
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What are the s/s of bacterial pharyngitis?
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fever around 101
malaise, sore throat, arthralgia- pain in joints |
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What is laryngitis?
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inflammed vocal chords make it hard to talk
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What are some nursing diagnosis for URI?
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pain, acute
communication, impaired verbal nutrition, imbalanced airway clearance, ineffective |
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What is epistaxis?
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nose bleeds
usually r/t trauma to the nose mucous membranes get very dry and start to crack HTN, cocaine abuse |
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What is an anterior epistaxis?
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comes out of nose
use 5-10 min of pressure, ice, sitting forward |
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What is a posterior epistaxis?
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bleeding down throat
potential aspiration cause vomiting nasal packing surgery |
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What would you do for nasal trauma or surgery?
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consider abuse
check for presence of CSF- clear watery drainage check for glucose to r/o CSF airway management cervical spine stabilization |
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What is SQ ephysema or crepitus?
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air comes out of larynx and inflames SQ tissue
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What are the risk factors for sleep apnea?
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male, obese, age, increased neck circumference, ETOH or CNS depressants
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What is sleep apnea?
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soft pallete occludes airway, hypoxia awakes person but are usualy unaware
no breathing for atleast 10 sec/min atleast 5x an hr |
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What are the s/s of sleep apnea?
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snoring, sleepiness/fatigue, HA, irritability, decreased mental status, increased workload on heart
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What are the treatments for sleep apnea?
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ByPAP, CPAP
uvulopalatopharnyngoplasty- elimiates tissue from soft pallet |
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What is a polyp?
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generally beign, associated w/ chronic URI
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What is a papilloma?
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polyp that has become hardened usually after chronic viral infections
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What is nodule?
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secondary to voice abuse or tobacco abuse
outpouching of mucus membranes |
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Where is the primary site for cancer?
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laryngeal then can matastize to lung
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What is a laryngectomy?
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partial- 50% removal of larynx have temp. trach, can speak, swallow, increased risk for aspiration
total- larynx, epiglottis, thyroid cartilage, tracheal rings, and hyoid bone radical or modified neck dissection- mandible to clavicle |
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What would be a nursing diagnosis for someone having a laryngectomy?
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impaired verbal communication
risk for aspiration |
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What is bronchitis?
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inflammation of the bronchials
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What is the pathophysiology of bronchitis?
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viral or bacteria infection following URI
noxious inhalant smooth muscle constriction, increased secretions |
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What are the manifestations of bronchitis?
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infectious- fever, malaise, cough, wheezes, rhonchi
noninfectious- cough, wheezes, rhonchi |
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How can you manage bronchitis?
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antibiotics, cough suppresants, expectorants,
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What are some nursing diagnosis for bronchitis?
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airway clearance
impaired gas exchange pain sleep disturbance |
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What is pneumonia?
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inflammation of bronchioles and alveoli
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What is the pathophysiology of pneumonia?
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aspiration, viral/bacterial, parasitic, legionnaire's
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What causes CAP pneumonia?
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strep
mycoplasma |
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What causes nosocomial pneumonia?
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stap
pseudomonas klebisella e. coli |
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What are the s/s of pneumonia?
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cough, fever, crackles-mid lung
pleural rub d/t alveolar leakage can cause pleural effusion or empyema |
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How can you manage pneumonia?
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percussion and postural drainage, antibiotics, mucolytics, expectorants, fluids
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What are some nursing diagnosis for pneumonia?
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airway clearance, impaired gas exchange, activity intolerance
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Who are at a high risk for developing pneumonia?
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L HF, elderly, COPD, immunocomprimsed,
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What is SARS?
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mutation of corona virus
virus invades pnuemocytes and destroys them |
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What are the s/s of SARS?
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fever, malaise, cough, hypoxia
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What is the management for SARS?
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provide 02, no treatment
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What is a throactomy?
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surgical incision made into the chest
lungs, esophagus, trachae, heart |
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What is a pneumonectomy?
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removal of a total lung
staple or tie off main stem to prevent air from entering |
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What is a lobectomy?
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removal of a single lobe
may have chest tube to allow negative pressure so lung still fills w/ air |
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What is a segmentectomy?
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removal of a segment of a lobe
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What is a wedge resection?
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remove effected lung tissue by wedging
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What is a decortication?
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get access to pleural space to remove an empyema, may be too thick to drain
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What is a bullectomy?
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surgery on a bulla to allow functional tissue more room to expand
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What is a bulla?
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pocket of air inflated lung tissue that have no vascular supply
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What are the complications of chest surgery?
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pneumothorax
atlectisis bronchospasms pulmonary emboli pulmonary toilet pulmonary rehab |
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What is the pathophysiology of TB?
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mycotuberculosis
can be active or latent airborne transmission b.c bacteria is so small spreads to resp. tract takes 2-8 wks for bacteria to be killed in a healthy individual |
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What are the s/s of TB?
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fatigue
weight loss anorexia low-grade fever esp. in afternoon night sweats hemopytsis (bloddy sputu) pleuritic pain and cough |
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What is used to determine if someone has TB?
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man tox test
CXR acid fast bronchoscopy |
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What are the risk factors for getting TB?
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immunocomprimised
previous exposure Africa, Asia, Latin American, former Soviet Union, nursing home pts, prisons, jails, homeless, and substance abuse |
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How many drugs are taken the first 2 months after being diagnosed with TB? next 4 months?
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4
2 |
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What are airborne precautions?
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keep door closed- private room
surgical mask on pt negative flow room N95 respirator masks |
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What is the pathophysiology of anthrax?
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bacillus anthrax, toxin is produced, lodge in UR tract, can penetrate into lung and into alveoli
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What are the s/s of anthrax?
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fever > 100, dyspnea, stridor, cyanosis, spetic shock, cough, sore throat, enlarged lymph nodes, flu like symptoms w/o URI symptoms, chest tissue hemorrhaging
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What is histoplasmosis?
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found in bird or bat poop
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What are the s/s of histoplasmosis?
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flu like symptoms
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What is coccidioidomycosis?
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found in soil
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What are the s/s of coccidioidomycosis?
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fever, pleuritic pain cough with bloody purulent
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What is aspergillosis?
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mimics pnuemonia
hyphae cause irritation in bronchioles and upper alveoli which causes inflammation disseminated can cause blood clots |
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What is pleuritis?
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inflammation d/t infection or trauma
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What are the s/s of pleuritis?
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pleuritic pain, decreased lung sounds, pleural rub
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How can pleuritis be managed?
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pleural tap, chest tube, throancentesis
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What is a pleural effusion?
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something in pleural space usually liquid
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What is an empyema?
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d/t infectious process
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What is transudate?
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not infectious
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What is exudate?
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infectious
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What is a pneumothorax?
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air around or outside the lung
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What is a spontaneous pneumothroax?
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ruptured bleb/blister
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What is a secondary pnuemothroax?
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caused by COPD/ tibubation from over inflation
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What is an open peuemothroax?
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penetration trauma
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What is a closed penumothroax?
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line placement
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What are the s/s of a pneumothroax?
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SOB, asymmetrical chest expansion, diminished breath sounds
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What is a dry suction?
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put suction w/ dial
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What is wet suction?
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level of water=suction
watch for evaporation |
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What do bubbles on a suction indicate?
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an air leak
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What do suctions have to have?
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water seal
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How can you manage a pneumothorax?
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throcentesis
chest tube inserted depending on reason usually 4 and 5th rib mid axillary has to be connected to something like a pleuravac |
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What is hemothroax?
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effusion- blood in the pleural space
can comprimise ventilation |
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What is pulmonary contusion?
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bruise in pulmonary tissue
blood can leak into alveoli |
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What is a pleurodesis?
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instill something into lung
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What is a flail chest?
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trauma
segment of rib cage has been dettached comprimises breathing usually upper ribs |
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What is a tension pneumothroax?
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during inspiration air leaks in but during exhalation air cannot get out
pushes mediastenium and trachae over |
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How can you manage a tension pneumothroax?
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aspiration thorcentesis followed by a cehst tube
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What should you watch for with a tension pneumothroax?
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watch for movement of trachae
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What might cause a tension pneumothroax?
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blocked chest tube
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What is a thermal inhalation injury?
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closed blast injury
primarily from mucosal swelling early intubation but increased risk of alveolar rupture/pneumothroax |
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What is a smoke inhalation injury?
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less heat, more irritation
carbon monoxide binds more easily to hemoglobin than 02 |
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What is chemical inhalation injury?
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lead to interstitial or brribrtoic changes
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What does near death drowning cuase?
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pulomonary edema, pneumonia
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What is nonsmall cell lung cancer?
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squamoous cell
around bronchi may have to have lobes eremoved increased correlation with smoking |
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What is adenocarcinoma lung cancer?
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most common among non smokers
invades glaands |
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What is large cell undifferentitated lung cancer?
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very praid growing
on outer edges of lung tissue |
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What is small cell lung cancer?
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high association with somking
rapid grwoing starts in bronchi and forms larger tumors |
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What is the pathophysiology of asthma?
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inflammation
airways narrow too much..too easily in response to tot many non-harmful stimuli w/ an exacerbation of the inflammatory response |
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What is hyper-responsiveness?
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bronchospasm and parasympathetic smooth muscle constriction- eosionphils can cause damage
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What is inflammation?
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persistent inflammation
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What can phase 1 of asthma cause?
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structural and cellular damage
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What are the s/s of asthma?
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itchy/sneezing/runny nose, fatigue, HA
association with rhinitis decreased peak flow d/t bronchial constrictions chest tightness, SOB, wheezes, cough |
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How can asthma be managed?
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peak flow meters to help prevent phase I attacks
B2 agonist albuterol anticholinergics oral corticosteriods ICS B2 adrenergic leukotriene modifiers methylxanthines |
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What is the goal of asthma management?
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no loss of work, total participation in activites, no ER visits
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What is emphysema?
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alveolar d/s which leads to decreased in elastin and recoil which leads to air trapping
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What is the pathophysiology of emphysema?
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lose of elastin makes alveoli unalbe to reoil and air gets trapped in alveoli
may result in bulla enzyme in smoking breaks down elastin |
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What is primary alpha-antitrypsin deficiencey?
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enzyme that breaks down elastin is not regulated properly
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What are the s/s of emphysema?
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increased work of breathing, use accessory muscles, tripod positioning, brarrell chest d/t trapped air, SOB, dyspnea 0-5 scale
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How can you manage emphysema?
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tobacco ceasation
beta 2, anticholinergics bronchodilators inhaled corticosteriods lung reduction surgery-remove alveoli that are over stretcehd or not working anymore |
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What are some nursing diagnosis for emphysema?
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risk for infection d/t activity intolerance
impaired gas exchange d/t c02 retaining activity intolerance |
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What is chronic bronchitis?
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d/s of bronchiles
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What is the pathophysiology of chronic bronchitis?
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inflammation and thick mucus secretions
vasodilation which increases mucus production leading to edema chronic irritation exposure destorys cillia making it hard to clear airways |
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What are the s/s of chronic bronchitis?
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ocugh, thick sputum, cyanoick looking, clubbing
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How can you manage chronic bronchitis?
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same as emphysema
bronchidilation inhaled corticorsteriods mucolytics, expectorants percussion and psotural drainage if healthy |
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What is the pathophysiology of cystic fibrosis?
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gene that regulates CL is mutated not allowing CL to move in and out of cells resulting in a fluid blalance problem
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What are the s/s of cystic fibrosis?
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lung congestion and infection, obstruction d/ot secretions, inadequate ventilation, resp acidosis, c02 reention, hypoxemia, ecersie intolerance, nail bed clubbing, cyanosis, right sided HF
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How can you manage cystic fibrosis?
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lung transplant but cna come bakc, lots of lfuid, mucolytics, expectorants, PNPD
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What are some nursing diagnosis for cystic fibrosis?
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airway clearance
gas exchange risk for infection |
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What is atelectasis?
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deflated alveoli-inadequate tidal vol,
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What is the pathophysiology of atelectasis?
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post op, obstruction, compression-pnuemoathroax
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What are the s/s of atelectasis?
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resp acidosis, crackles, seondary infection-pneumonia
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How can you prevent atelectasis?
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IS, cough and deep breathing, posistive pressure-CPAP, BYPAP
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What are some nursing diagnosis for atelectaiss?
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gas exchange
risk for infection |
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What is bronchiectasis?
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usually secondary to some bacterial infection of bronchioles
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What is the pathophysiology of bronchietctasis?
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that causes inflammation- necrotizing bacteria, inflammation cuases weakness causing overflationg or colappose
common in late stage AIDS |
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How can you manage bronchiectasis?
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antibitoics, PNPD, bronchodilators
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What are some nursing diagnosis for bronchiectasis?
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gas exchange
risk for infection |
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What is the pathophysiology of interstitial d/o?
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damage to tissue surrounding alveoli- beocmes thick and hard, dimiinshed ventilation
d.s process to cronhic exposure to irritant, radiation exposure |
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What are the s/s of interstitial d/o?
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depends on level of d/s, ventilation problems, increased c02 levels, decreased gas exchange, oxygenation problems d/t dmaage of alveoli capillaires
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How can you manage interstitial d/o?
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transplant, anti-inflammatory therapy-steroids
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What are some nursing diagnosis for interstitial d/o?
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gash exchange ventilation
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What is sarcoidosis?
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exaggerated immune response
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What is the pathophysiology of sarcoidosis
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inflammatory phases in lung sarcoidosis going from alveolitis, to grnumloma formation to fibrosis
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What are the s/s of sarcoidosis?
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colume loss, pleuritic pain
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How can you manage sarcoidosis?
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can go away w/o treament, exacerbates
corticosteriods |
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What are some nursing diagnosis for sarcoidosis?
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ventilation
risk for infection |
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What is the pathophysiology of a pulmonary embolism?
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something blocking a blood essel in the pulmonary system usually d/t DVT in the lower legs
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What are the risk factors for DVT?
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venastasis, decreased mobility, CHF, post op, obesity, hypercoagulability, vessell wall inflammation/injury
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What are the risk factors for PE?
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recent DVT or PE
post surgery or post partum, immobiliation, maligancy |
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What is the treatment for a PE?
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heparin- PTT- 1.5-2.0x normal used to make sure thrombi doesn't get ibgger
coumadin/warfarin-INR- 2-3.5 x normal fibrinolytic-tpa, strptokinase |
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How can you detect a PE?
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venous doppler
D-Dimer Chest CT pulmonary angiogram V/Q scran emboletomy inferior vena cava interuption-green fill fillers catches clots |
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What is the prevention for PE?
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anticoagulation
SCDs/TEDS ambulation, ROM |
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What is the pathophysiology of pulmonary HTN?
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increased pressure in the pulmonary vasculaature
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What is idiopathic pulmonary HTN?
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20-40 yr old women, nonknown cuase
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What is secondary pulmonary HTN?
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to osmething else- recurrent PE, COPD, sleep apnea, L ventricular HF
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What are some nursing diagnosis for sarcoidosis?
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ventilation
risk for infection |
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What is the pathophysiology of a pulmonary embolism?
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something blocking a blood essel in the pulmonary system usually d/t DVT in the lower legs
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What are the risk factors for DVT?
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venastasis, decreased mobility, CHF, post op, obesity, hypercoagulability, vessell wall inflammation/injury
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What are the risk factors for PE?
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recent DVT or PE
post surgery or post partum, immobiliation, maligancy |
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What is the treatment for a PE?
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heparin- PTT- 1.5-2.0x normal used to make sure thrombi doesn't get ibgger
coumadin/warfarin-INR- 2-3.5 x normal fibrinolytic-tpa, strptokinase |
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How can you detect a PE?
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venous doppler
D-Dimer Chest CT pulmonary angiogram V/Q scran emboletomy inferior vena cava interuption-green fill fillers catches clots |
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What is the prevention for PE?
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anticoagulation
SCDs/TEDS ambulation, ROM |
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What is the pathophysiology of pulmonary HTN?
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increased pressure in the pulmonary vasculaature
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What is idiopathic pulmonary HTN?
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20-40 yr old women, nonknown cuase
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What is secondary pulmonary HTN?
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to osmething else- recurrent PE, COPD, sleep apnea, L ventricular HF
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What are the s/s of pulmonary HTN?
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dyspnea, SOB, righ sided fialure (cor pulmonale)
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How can you manage pulmonary HTN?
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Ca Channel blockers, heart or lung transplant, anticoagulants, prostacyclines
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What are some nursing diagnosis for pulmonary HTN?
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gas exchange
activity intolerance decreased CO |
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What is acute respiratory failure?
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Pa02 < 60
PaC02 < 50 pH < 7.3 |
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What is hypercapnic?
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ventilatory/pump fialure- obstructive airway d/s, COPD, central airway obstruction, asthma, resp. muslce fatigue, ascites
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What is hypoxemic respiratory failure?
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pnuemonia, atelectasis, pulmonary thromboembolism, pulmoar emedma- cardiogenic, non cardiogenic
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What is ARDS?
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adult resp. distress syndrome
non cardiogenic pulmonary deema- not r/t HF inflmaatory process that can be strarted form a lot of things damage to the capillary beds which start to leak into alveoli- alveoli start to collapse, cells that make surfactant are damaged gas exchange is lost |
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What are the s/s of ARDS?
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pink frothy sputum
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Why is it difficult to treat ARDS?
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b/c cause in unknown
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