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213 Cards in this Set
- Front
- Back
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These move mucus back to the larynx
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Cilia
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A pt with sinus congestion points to the area on the inside of the eye as the point of pain. The nurse knows that the pt is referring to which sinus
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Ethmoidal
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The lungs are enclosed in a serous membrane called the
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Pleura
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The left lung in contrast to the right lung has
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One less lobe
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The alveolar cells that secrete surfactant are
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Type II cells
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Gas exchange between the lungs and blood and between the blood and tissues is called
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Respiration
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When taking a resp. hx the nurse should assess?
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Previous Hx of lung disease
Occupational/environmental influences Smoking and exposure to allergies |
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Bacterial pneumonia can be indicated by the presence of
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Green purulent sputum
Thick yellow sputum or rusty sputum |
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Chest pain described as knifelike on inspiration would most likely indicate
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Pleurisy
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Hemoptysis a sx of cardiopulmonary disorders is characterized by
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An alkaline pH, sudden onset, bright red bleeding mixed w/sputum
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The nurse inspects the thorax of a pt with advanced emphysema. The nurse expects chest configuration change consistent w a deformity known as
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Barrel chest
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Breath sounds that originate in the smaller bronchi and bronchioles and are high pitched, sibilant and musical are called
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Wheezes
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Crackles, noncontinuous breath sounds, would be assessed for a pt with
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Collapsed alveoli
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When gathering a sputum sample from a pt you would direct them to
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Initially clear nose and throat
Take a few deep breaths before coughing Use diaphragmatic contractions to aid in the expulsion of sputum |
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A physician wants a study of diaphragmatic motion because of suspected pathology; he would most likely order a
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Fluoroscopy
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A pt getting ready for a lung scan would need to know
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A mask will be placed over his nose and mouth during test.
The imaging time will amt to 20-40 min. He will be expected to lie under the camera |
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The nurse should advise the pt who is scheduled for bronchoscopy that he or she will
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Have his/her nose sprayed with a toical anesthetic.
Be required to fast before the procedure Receive preop meds |
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Because a bronchoscopy was ordered the nurse knows that the suspected lesion was not in the
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Pharynx
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Nursing measures before the bronchoscopy include
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Obtaining an informed consent
Supplying info about procedure Withholding food/fluids for 6hrs prior to test |
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Possible complications of broncoscopy (3)
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Aspiration
Infection Pneumothorax |
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After a broncoscopy pt must be monitored for (3)
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Dyspnea
Tachycardia Hemoptysis |
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After broncoscopy pt may be given
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Ice chips and fluids after he demonstrates that he can perform the gag reflex
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Nursing responsibilities for the thoracenteses include (3)
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Inform the pt about pressure sensations that will be experienced during procedure. Making sure consent has been signed. Making sure chest xrays ordered in advance have been completed
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For thoracentesis the pt is assisted to what positions
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Lying on unaffected side with HOB elevated 30-40 deg.
Sitting on edge of bed with feet supported and arms and head on padded overbed table. Straddling a chair with arms and head resting on back of chair |
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The thoracentesis site is normally located in
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the second and third intercostal spaces
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Nursing observations after the thoracentesis include assessment for (3)
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Blood tinged mucus
Sx of hypoxemia Tachycardia |
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A CXR film is usually ordered after the thoracentesis to R/O ?
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Pneumothorax
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Pt teaching for the uncomplicated common cold include (3)
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Informing pt about sx of secondary infection.
Suggesting fluid intake and rest. Teaching that the virus is contagious for 2 days before sx appear and during the 1st part of the symptomatic phase |
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The herpes virus which remains latent in cells of the lips or nose usually subsides spontaneously in?
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10 to 14 days
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Acyclovir and antiviral agent is recommended for
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Herpes simplex infection
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About 60% of cases of acute sinusitis are caused by bacterial organisms. A second line antibiotic used is?
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Augmentin
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Nursing suggestions for a pt with acute or chronic sinusitis include (3)
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Adequate fluid intake
Increased humidity Local heat applications to promote drainage |
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An antibiotic that decreases nasal secretions and polyp size in chronic sinusitis is?
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Biaxin
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Acute pharyngitis of a bacterial nature is most commonly caused by
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Group A beta hemolytic streptococci
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A complication of acute pharyngitis can be
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Mastoiditis
Otitis media Peritonsillar abcess |
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Nursing mgmt for acute pharyngitis includes
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Applying ice collar for relief of sore throat
Encouraging bed rest during febrile stage of illness Suggesting liquid or soft diet during the acute stage of disease |
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The most common organism associated with tonsillitis and adenoiditis is
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Group A beta hemolytic streptococcus
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Potential complications of enlarged adenoids include
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Bronchitis
Nasal obstruction Acute otitis media |
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To assess for URI the nurse should palpate
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The frontal and maxillary sinuses
The trachea The neck and lymph nodes |
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To assess for URI the nurse should inspect the
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nasal mucosa
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Surgical reduction of nasal fractures is usually performed how long after the fx
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7-10 days
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Angioedema as a risk factor that leads to laryngeal obstruction is ususally caused by
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Hx of airway problems
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An early sx of cancer of the larynx in the glottic area (61% of cases) is
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Affected voice sounds
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A pt with a total laryngectomy would no longer have
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Natural vocalization
Normal effective cough Protection of the lower airway from foreign particles |
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Pt education for laryngectomy includes
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Advising that lg amts of mucus can be coughed up thru stoma
Caution to prevent water from entering stoma Telling the pt to expect diminished taste and smell |
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Emergency tx for epistaxis may include
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cotton pledget moistened with aqueous epinephrine
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Nasal packing used to control nose bleed can be left in place for
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anywhere from 2 to 6 days
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Position for epistaxis
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keep upright with head tilted forward to prevent swallowing and aspiration of blood
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The most common form of cancer of the larynx is
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Squamous cell carcinoma
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Pt teaching for laryngectomy
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There will be ways to communicate without voice
Pt will require permanent tracheal stoma Pt will not be able to sing, whistle or laugh |
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Oral feedings will begin when after laryngectomy?
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1 week
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Aspergillis is the causitive fungi in
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Acute tracheobronchitis
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Nursing mgmt for acute tracheobronchitis includes (3)
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Increase fluid to remove secretions
Encourage bedrest Using cool vapor therapy to relieve laryngeal and tracheal irritation |
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In the US the most common cause of death from infectious disease is
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Pneumonia
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S.pneumoniae is the organism most commonly responsible for
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Community acquired pneumonia
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This is acid fast
affects about 35% of the worlds population Is able to lie dormant within the body for years |
Mycobacterium tuberculosis
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A mantoux skin test is considered to be NOT significant if the size of the induration is
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3-4 MM
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Prophylactic INH drug tx is necessary for about how many months?
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6-12
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Dx confirmation of a lung abcess is made by
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Chest radiograph
Bronchoscopy Sputum culture |
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The most dx clinical symptoms of pleurisy is?
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Stabbing pain during respiratory movement
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Pleural effusion results when fluid accumulation in the pleural space is greater than
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20mL
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Auscultation can be used to dx the presence of pulmonary edema when what adventitous breath sounds are present
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Crackels in the posterior bases
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ARF is directly related to three things
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Decreased respiratory drive
Chest wall abnormalities Dysfunction of lung parenchyma |
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A key characteristic feature of ARDS is
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Arterial hypoxemia
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A nurse knows to assess a pt with pulmonary arterial hypertension for the primary symptom of
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Dyspnea
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Clinical manifestations directly related to cor pulmonale include three things
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Dyspnea and cough
Distended neck veins Edema of the feet and legs |
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The nurse assesses a pt for possible pulmonary embolism. The nurse looks for the most freq sx which is?
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Tachycardia
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As a cause of death among men in the US lung cancer ranks?
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1st
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More than 80% of all lung cancers are primarily caused by?
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Cigarette smoking
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The most prevalent lung ca that is peripherally located and freq metastasizes is?
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Adenocarcinoma
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The most freq symptom of lung cancer is?
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Coughing
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The nurse is aware that the most common surgical procedure for a small apparently curable tumor of the lung is a?
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Lobectomy
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Paradoxical chest movement is associated with?
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Flail chest
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An initial characteristic symptom of a simple pneumothorax is?
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Sudden onset of chest pain
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This refers to a closure or collapse of alveoli
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atelectasis
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Three severe complications of pneumonia are?
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Hypotension
Shock Respiratory failure |
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Three common paathogens that can cause aspiration pneumonia are
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streptococcus pneumoniae
hameohilus influenzae staphlococcus aureus |
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The mortality rate of ARDS is as high as ______% The cause of death is usually from
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60%
mutli system organ failure |
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A characteristic and dx feature of ARDS is
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hypoxemia that does not respond to supplemental oxygen
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The cause of cor pulmonale
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enlargement of the right ventricle of the heart
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Manifestations of bacterial pneumonia include these three things
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Fever
Tachypnea Stabbing or pleuritic chest pain |
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The antibiotic of choice for community acquired s. pneumoniae is?
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Penicillin G
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COPD ranks _____ in the cause of death in the US
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4th
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The current definition of COPD leaves only one disorder under its classification and that disorder is?
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Emphysema
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The underlying patho of COPD is?
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Inflamed airways that obstruct airflow
Mucus secretions that block airways Overinflated alveoli that impair gas exchange |
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Two diseases common to the etiology of COPD are
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Chronic bronchitis and emphysema
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For a pt with chronic bronchitis the nurse expects to see the major clinical symptom of
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sputum and a productive cough
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The major cause of emphysema is?
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smoking
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The primary presenting symptom of emphysema is?
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Dyspnea
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Bronchodilators are prescribed in emphysema primarily because they?
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reverse bronchospasm
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A nursing assessment of a pt with bronchospasm assoc with COPD would include assessment for three things
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Compromised gas exchange
Decreased airflow Wheezes |
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A commonly prescribed methylxanthine used as a bronchodilator is
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theophylline
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The physician orders a common bronchodilator that is only admin by inhaler, the nurse knows this would be
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Foradil
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The nurse should be alert for complication of bronchiectasis that results from a combination of retained secretions and obstruction. This complication is known as
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Atelectasis
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Histamine a mediator that supports the inflammatory process in asthma is secreted by
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Mast cells
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Obstruction of the airway in the pt with asthma is caused by ?
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Thick mucus
Swelling of bronchial membranes Contraction of muscles surrounding the bronchi |
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A commonly prescribed mast cell stabilizer used for asthma is
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cromolyn sodium
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The nurse understands that the pt with status asthmaticus will likely initially evidence symptoms of
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Respiratory alkalosis
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The nurse knows that the presence of a barrel chest is caused by?
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air trapping in the lungs
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The method of oxygen admin primarily used for COPD pt is
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Venturi mask
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To help a pt to use a mini nebulizer the nurse should encourage the pt to do what 3 things?
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Hold his breath at the end of inspiration for a few seconds
Cough frequently |
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To assist a pt with the use of an IS the nurse should?
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Encourage the pt to take approximately 10 breaths per hour between tx while awake
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When vibrating the pts chest the nurse applies vibration when?
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the pt is exhaling
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The purpose of pursed lips during exhalation is to
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prolong exhalation
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When suctioning secretions from a trach tube it is helpful to first instill
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3 to 5 mL of SS
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When suctioning a trach tube the nurse needs to remember that each aspiration should not exceed
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15 seconds
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When an entire lung is removed it is called a
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pneumonectomy
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This trach tube protect the lower airway by producing a seal between the upper and lower airway,freq used for clients receiving mechanical ventilation
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Cuffed
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This type of trach tube is used when the pt can protect the airway from aspiration and in children under 8 years old
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Uncuffed
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This type of trach tube is used for pts with extra thick necks
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Single lumen tube
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This type of trach tube distributes low pressure hign vol over a large area min pressure on trachea wall
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Trach tube with cuff and pilot balloon
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This trach tube has openings on the surface of the outer cannula that permit air from the lungs to flow over vocal cords
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Uncuffed fenestrated
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This trach tube is often used for pts w spinal cord injury or neuromuscular disease who require ventilation at all times
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Cuffed fenestrated trach tube
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This trach tube is used for a permanent tracheostomy
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Metal trach tube
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This trach tube has 2 pigtail tubings one is used to inflate and the other is connected to low air that moves up over the vocal cords to permit speech
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Talking/speaking trach tube
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This trach tube has a cuff filled with plastic foam
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Foam filled cuff
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Common cold also referred to as a
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URI
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Manifestations of a cold
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viral
nasal drainage fever headache sneezing sore throat cough |
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Interventions for a cold
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fluids
handwashing warm salt water gargles cover mouth apply local heat |
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What is the prominent symptom of sinusitis
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Nasal congestion
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Interventions for acute/chronic sinusitis
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increase fluids
local heat info on sx of sinus infection info on SE of nasal sprays(rebound congestion) |
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Chronic sinusitis is defined as
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inflammation of sinuses more than 8 weeks
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Sinusitis caused by
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chronic nasal obstruction
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Assessment for chronic sinusitis
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cough
headache hoarse decrease in smell and taste |
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Interventions for chronic sinusitis
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Warm soaks to face
eat proper diet exercise rest antimicrobial for 21 days (ceftin) |
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Rhinitis is defined as
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Group of disorders that cause inflammation and irritation of the mucus membranes of the nose
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Rhinitis is classified as 3 things
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Infectious
Allergic Non allergic |
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Interventions for rhinitis
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avoid allergens/irritants
Saline nasal spray Provide instructions for proper use of nasal sprays and aerosols Instructed to blow nose prior to admin meds in nose |
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Acute pharyngitis is defined as
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Febrile inflammation of the throat
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Pharyngitis causitive agent
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Group A strep
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Tx for acute pharyngitis
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PCN
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How is acute pharyngitis dx
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Strep test
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Pts with pneumonia need to stop smoking because
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Smoking destroys tracheobronchial ciliary action which is the 1st line of defense in the lungs
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Interventions for pneumonia
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Rest
nutrition stop smoking pt education |
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This disease is a world wide health disorder and the mortality and morbidity rates continue to increase
|
pulmonary tb
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TB is transmitted how
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Airborne droplets person to person
Talking coughing sneezing laughing |
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Agent in TB is
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AFB
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After TB is inhaled the body tries to destroy it by
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walling it off with fibrous tissue
if unsuccessful it becomes a cheesy mass that softens and flows into the bronchi causing a prod. cough |
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TB is usually in the lung parenchyma but can be transmitted to where else in the body
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bones
kidneys meninges lymph nodes |
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TB assessment would reveal
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Fever
loss of strength, appetite and weight productive cough more weak as day goes on |
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Dx of TB 3 things
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TB skin test
Sputum studies CXR |
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Does a positive tb skin test mean that the person has active tb?
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No
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Mantoux test how to admin
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Bevel up
0.1 of PPD injected (bleb,wheal) |
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What two things are indicators of a positive tb test
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induration
erythema |
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TB is primarily tx with what class of drugs and for how long
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chemotherapeutic
antituberculosis 6-12 months |
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This TB drug is bacteriocidal
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Isoniazid (INH)
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This TB drug turns tears,urine, sweat orange/red
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Rifampin (RIF)
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With this TB drug you want pt to have eye exams
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Ethambutol (EMB)
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This TB drug can cause hepatotoxicity monitor LFT's
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Pyrazinamide (PZA)
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This TB drug is for multi drug resistant TB
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MDR-TB (Cipro)
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The tx for TB initially starts out.....
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INH,RIF and EMB for 8 weeks
and INH,RIF for 4-7 more weeks |
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Pt education for TB
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Handwashing
Cover mouth Correct disposal of tissues Proper cleaning of eating utensils Avoid mouth to mouth contact |
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A pt with TB gets what kind of room
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Isolation
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This is defined as inflammation of both layers of the pleural (parietal and visceral pleura)
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Pleurisy
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Clinical manifestations of plurisy
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Severe sharp knife like pain on inspiration
Initially hear a pleural rub on assessment |
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Nursing mgmt for pleurisy
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Relieve pain
Analgesics Indomethacin Chest splinting Turn to affected side( relieves pain) |
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This is a collection of fluid 5-15mL in the pleural space, usually a secondary disease from CHF,TB, pneumonia
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Pleural effusion
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Assessment for pleural effusion
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Areas that contain fluid will have NO breath sounds
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Pleural effusion is confirmed with
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CXR or thoracentesis
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Tx for pleural effusion
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Tx underlying cause
Prevent reaccumulation of fluid Relieve discomfort and dyspnea Prepare pt for thoracentsis |
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This is a collection of purulent liquid (pus) in the pleural cavity
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Emphyema
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Characteristics of emphyema
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initially fluid is thin
Progresses to fibropurulent Then encloses lung with thick exudative membrane |
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Symptoms of emphyema
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Fever
night sweats pleural pain absence of breath sounds flatness of chest percussion |
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Tests to dx emphyema
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CXR
CT Thoracentesis |
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Medical mgmt of emphyema
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Drain pleural cavity
Full expansion of the lung Lg doses of antibiotics Care of the chest tube |
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This is defined as excessive secretions of mucous that block the airway
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Bronchitis
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This is impaired gas exch from destruction of the walls of the over extended alveoli
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Emphysema
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This is inflammed and constricted airwars that obstruct the airflow
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Asthma
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Diet for COPD
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High fat, low carb
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Medical mgmt of COPD
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O2
Resp tx Breathing exercises pursed lip Pacing activity Performing ADL's Physical conditioning Coping measures |
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Complications of COPD
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Respiratory insufficiency
Respiratory failure |
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Pt teaching for COPD
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Set realistic goals
Avoid extreme temps No smoking Lifestyle changes |
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Chronic bronchitis is defined as?
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Productive cough lasting 3mo, a year for 2 consecutive years
Assoc with smoking, air pollution |
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In time irreversable lung changes, leads to emphysema and bronchiectasis
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Chronic bronchitis
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Assessment findings in chronic bronchitis
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Chronic prod cough in winter
occurs in 5th decade Hx of cigarette smoking |
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Dx of bronchitis
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H and P
Exposure smoking habits ABG's, CXR, PFT's H and H |
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Medical mgmt for bronchitis
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Keep bronchioles open
Facilitate removal of secretions To prevent infection and disability |
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Tx for chronic bronchitis
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Bronchodilators
Postural drainage Fluids Corticosteroids Prevention |
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With chronic bronchitis you want to continuously monitor
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changes in sputum
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THis is defined as distention of the air spaces beyond the bronchioles with destruction of the wall of the alveoli. Secretions are increased and fluid retained so pt cant expel them
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Pulmonary emphysema
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Major cause of pulmonary emphysema
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Smoking
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Pulmonary emphysema is classified two ways
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Pink Puffers (pantilobular)
Pt remains pink until disease becomes terminal Blue bloaters (centrilobular) pt has cyanosis, peripheral edema and resp failure |
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Prolonged respirations are a sx in
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pulmonary emphysema
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Assessment findings in pulmonary emphysema
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SOB
Cough clubbed fingers exp wheezes wt loss weak secretions resp infections |
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Medical mgmt of pulmonary emphysema
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Improving quality of life
Slow progression Relieve hypoxia |
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Nursing interventions for pulmonary emphysema
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Bronchodilators(aminophylline,theo)
Aerosol tx Antibiotics Corticosteroids Continuous low flow o2 |
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This is described as intermittent reversible airway obstruction, caused by narrowing of airways swelling of bronchi
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Asthma
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Extrinsic asthma means
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caused by known allergen
family hx of allergies exposure to allergen |
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Intrinsic asthma means
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Not R/T specific allergens
Factors such as cold, resp infections, exercise, emotion and environmental pollutants |
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Mixed asthma
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Most common form
characteristics of both extrinsic and intrinsic |
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Three common symptoms for asthma
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Cough
Dyspnea Wheezing |
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For asthma beta agonists bronchodilators
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Proventil
Albuterol Epinephrine |
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For asthma methylxanthines
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Aminophylline
Theophylline |
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For asthma anticholinergics
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Atropine
Atrovent |
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Mast cell inhibitor med
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Chromolyn sodium
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This is a chronic dilation of the bronchi and the bronchioles
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Bronchiectasis
|
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Bronchiectasis sputum has?
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Three layers
Top layer is frothy Middle is clear Bottom is dense with particles |
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THis is freq mistaken for chronic bronchitis not readily diagnosed
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Bronchiectasis
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Mgmt of bronchiectasis
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Antibiotics
Postural drainage Bronchodilators Nebulizers Increased fluids No smoking face tent possible OR to remove segment or lobe |
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This is a collapse of the alveolus caused by and obstruction of a bronchus
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Atelectasis
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Dyspnea, cyanosis, cough, sputum prod., pleural pain, fever and difficulty breathing are all assoc with
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atelectasis
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Is the escape of air from an injured lung into the pleural cavity
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pneumothorax
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Three types of pneumothorax are
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Simple/open
Traumatic Tension |
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Pain is sudden and pleuritic, resp distress is minimal to severe
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Open pneumothorax
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Air hunger, hypotension, hypoxemia, central cyanosis, tachycardia
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Tension pneumothorax
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Calls for emergency interventions. Stopping the air flow through chest
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Open pneumothorax
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Requires a chest tube
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Open pneumothorax
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If this is suspected the pt should immediately be given a high concentration of O2 to tx the hypoxia
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Tension pneumothorax
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Can be decompressed by inserting a lg bore needle at the 2nd intercostal space, midclavicular line on the affected side
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Tension pneumothorax
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Severe asthma that is unresponsive to conventional therapy w epi and theophylline and lasts longer than 24 hrs
|
status asthmaticus
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This is known as self-perpetuating
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Status asthmaticus
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Decrease in the diameter of the bronchi
ventilation-perfusion abnormality from hypoxemia and resp alkalosis, followed by resp acidosis, death possible from resp failure |
Status asthmaticus
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Tx for status asthmaticus
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Short acting beta agonists such as albuterol and corticosteroids
O2 and IVF Mechanical vent is used when ot is in resp failure and cant breathe |
