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138 Cards in this Set
- Front
- Back
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Define Bronchial breath sounds.
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Sounds not heard in the normal lung but occurring in pulmonary disease, indicating infiltration and solidification of the lung
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Define Vesicular Breath Sound
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A normal breath sound heard over the entire lung during breathing.
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When are bronchial breath sounds abnormal?
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When heard over alveolar tissue. I can mean consolidation such as that of pneumonia.
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Describe the qualities of bronchial breath sounds.
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The sounds are loud and high pitched with a hollow/harsh quality.
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Define Egophony.
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An abnormal change in tone, somewhat like the bleat of a goat, heard in auscultation of the chest when the subject speaks normally.
Client says "E", but auscultation results in "A". |
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What is a treatment option when you hear egophony?
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Remove the secretions that are causing the consolidation.
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Whispered Pectoriliquay
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Transmission of the voice sound through the pulmonary structures so that it is unusually audible on auscultation of the chest, indicating either consolidation of the lung parenchyma or the presence of a large cavity.
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What is the other word for Crackles?
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Rales.
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When would you hear Crackles or Rales?
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At the end of the Inspiration.
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Do Crackles/Rales Clear with Coughing?
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Yes
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What causes Crackles/Rales?
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Delayed Opening of the Alveoli.
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Name 4 Reasons for Crackles/Rales.
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COPD // CHF // Pneumonia // Hypoventalation Problems.
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How can Crackles/Rales be treated?
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Clear with Cough or Suction//Avoid Fluid Overload//Use DB or IS// Increase Ambulation or Activity.
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What is another word for Gurgles?
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Rhonchi.
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When are Rhonchi heard?
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Inspiration or Expiration
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What does gurgles indicate?
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Mucous in larger airways.
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What can cause Gurgles/Rhales?
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Ineffective coughing or accumulation fo secretions in larger airways.
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Give three treatment options for Gurgles/Rhonchi.
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Encourage Coughing or suctioning. Give adequate analgesia to encourage coughing. Give expectorants.
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Name two major health related concerns of TB.
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-Multi Drug Resistant Strains
-TB Susceptibility with HIV Infection |
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How is TB Transmitted?
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Dropletts from talking or coughing.
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List High Risk TB Populations.
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Healthcare workers
Foreign Born HIV Positive Longterm Care Facility Residents Medically Underserved Homelessness IV Drug Abusers |
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Describe Primary TB Infection.
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First time person infected.
Small area of bronchopneumonia develops in lower lobe. Tubercles form with bacilli Bacilli spread through blood and Lympn Most Tubercles calcify into Ghons Tubercles which can be seen on CXR T Cells cause Positive PPD |
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How Long after wheal placement is the skin test read?
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48-72 Hours
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Name some factors that cause primary infection to progress to active disease.
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Advanced Age
HIV Immunosuppression Prolonged Corticosteroid Tx Malabsorption Dec Body Weight Substance Abuse DM // ESRD // Malignancy Genetic Predisposition |
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Describe Secondary Infection
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Reinfection from earlier primary infection
Areas with bacilli may be latent for years Reactivate when resistance is low. |
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Do primary TB Infections always have symptoms?
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No, they can go totally asymptomatic.
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Are the clinical manifestations of TB unique?
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No, they mimic other diseases which make it difficult to dx.
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What percent of primary infection progresses to active disease?
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About 10 Percent
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List some typical Sx of Active Pulmonary TB.
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Nonproductive or productive cough
Fatigue Anorexia Weight loss Low-grade fever Chill and night sweats Dyspnea Hemoptysis Pleuritic or dull chest pain and tightness |
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When is a Mantoux Test Contraindicated?
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If previous + test was not documented.
Persons with previous severe + skin text. |
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For whome is a 5mm Induration a positive skin test?
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IVDA
HIV Close proximity of infected Suspicious CXR |
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For whome is a 10mm Induration a positive skin test?
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Other High Risk Groups such as....
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What is the size necessary for a Positive PPD in a low risk person?
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15mm Induration.
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What can cause a False + PPD?
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THose with other mycobacterial infections.
Those who have had BCG vaccination. |
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What can cause a False - PPD?
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Immunosuppressed.
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How many days Sputum Tests are necessary for an AFB Series?
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Three different days.
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If the AFB is positive, what does that mean.
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Active disease present.
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If AFB is negative, what is next step?
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Culture which can take 2-12 weeks.
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What can cause a False + PPD?
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THose with other mycobacterial infections.
Those who have had BCG vaccination. |
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What can cause a False - PPD?
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Immunosuppressed.
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How many days Sputum Tests are necessary for an AFB Series?
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Three different days.
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If the AFB is positive, what does that mean.
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Active disease present.
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If AFB is negative, what is next step?
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Culture which can take 2-12 weeks.
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What two drugs are used to eliminate remaining TB for those without prevoius disease?
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INH and RIF
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Describe some Specifics of INH.
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Usually PO
Discontinue with: -Liver Enzymes x3 Normal -Hepatic Toxicity N/V * Anorexia * Fatigue * Jaundice AVOID ALCOHOL |
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Describe some Specficis of RIF.
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Usually PO but can be IV
-Colors body fluids orange. -GI Upset commong / Split Dose -Drug metabolized in Liver |
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Name three Medication Adjuncts for Pulmonary TB
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Pyrazinamide
Ethambutol Streptomycin. Accellerates Tx and Effecity. |
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When is TB Patient hospitalized?
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Acutely Ill
High Risk living situation Noncompliance Cocontaminant disease No improvement /p tx Highly resistant needing 2nd 3rd line drugs. |
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What are the two most common medications to treat TB?
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INH and RIF
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Name Four Factors that cause COPD.
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Smoking
Chronic Respirator Infections Aging Heredity. |
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Define FEV1 / FVC.
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The foreced expiratory volume in 1 second over the forced vital capacity.
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What is the progression of bronchitis?
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Its starts in the large airways and spreads to all airways.
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What happens when secretions block the airway in bronchitis?
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Airways are obstructed, and air is trapped. Alveolar ventilation is reduced.
Pa02 decreased, PCO2 increases. |
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Why is polycythemia seen in bronchitis?
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The chemo receptors sense the decreased O2 and try to make more red blood cells to carry more O2 to the tissues.
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Name some Sx of Chronic Bronchitis.
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Symptoms of chronic bronchitis include shortness of breath or wheezing, chest pain, and chronic productive cough.
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Define COPD (Chronic Obstructive Pulmonary Disorder)
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Chronic obstructive pulmonary disease (COPD) refers to chronic lung disorders that result in blocked air flow in the lungs. The two main COPD disorders are emphysema and chronic bronchitis, the most common causes of respiratory failure. Emphysema occurs when the walls between the lung's air sacs become weakened and collapse. Damage from COPD is usually permanent and irreversible.
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Define Emphysema
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Emphysema is a lung disease involving damage to the air sacs (alveoli).There is progressive destruction of alveoli and the surrounding tissue that supports the alveoli. With more advanced disease, large air cysts develop where normal lung tissue used to be. Air is trapped in the lungs due to lack of supportive tissue which decreases oxygenation.
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List some evidence of Emphysema.
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-Alveolar Wall Destruction
-Partial Airway Collapse -Loss of Elastic Recoil -Blebs and Bullae -Dead air space that cannot participate in gas or blood exchange -Destruction of pulmonary capillaries |
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What is AAT
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Alpha1-antitrypsin (AAT) deficiency, first described in 1963, is one of the most common inherited disorders among Caucasians. Its primary manifestation is early-onset panacinar emphysema.
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What is Dead Space?
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Areas of the lungs not participating in Gas or blood exchange.
TABERS The portion of the tidal volume not participating in gas exchange. |
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What are the three types of Emphysema?
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Centrilobular (Most Common)
Panlobular Paraseptal |
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Describe Centrilobular Emphysema
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Bronchoul Destruction in the Upper Lungs.
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Describe Panlobular Emphysema
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Bronchioles and Alveoli destruction
Lower lungs Seem more in smokers |
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Define Paraseptal Emphysemia.
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Alveoli destroyed.
Affects periphery of lower lungs. Blebs can cause pneumothoral AAT Deficiency or elderly |
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What are the three components of COPD?
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Asthma/bronchitis/emphysema. One is usually perdominante.
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Define Pulsus Paradoxous.
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paradoxical pulse A decrease in the strength of the pulse (and of systolic blood pressure) during inspiration, a condition that may be esp. prominent in severe asthma, cardiac tamponade, obstructive sleep apnea, croup, and other conditions that alter pressure relationships within the chest. SYN: Kussmaul's pulse ; pulsus paradoxus
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Define Cor Pulmonale
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cor pulmonale Hypertrophy or failure of the right ventricle resulting from disorders of the lungs, pulmonary vessels, or chest wall
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What is the most prominent age for Bronchitis?
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40-50 years old.
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What blood value will be increased with Bronchitis?
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HCT secondary to High RBC with Polycethemia.
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What is the maximum O2 for a COPD Patient.
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3L or Less
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What is the minimum P02 and SpO2?
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Po2 >60 SpO2>90
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What should the patient do after a Nebulized Bronchodilator Tx?
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Cough to remove secretions.
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How is polycythemia treated?
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Remove 1Unit of blood and replace with Chrystaloid.
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When would ABX be Rx in COPD?
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When sputum is colored indicating pneumonia.
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What type of foods should a client eat/avoid to help reduce CO2 production?
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Low Carb, High Fat in small frequent meals, earlier in the day if tired later.
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Should inhalers be used /ac or /pc?
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After meals to help reduce the bad taste.
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What are some nursing interventions to help manage anxiety in COPD?
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Fan in Room
Quite Open Curtains or Door Relaxation Techniques |
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Name some energy conservation techniques.
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Pace activities during day
Alternate High and Low Keep diet for RN Evaluation |
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How can the RN Promote Adequate Sleep?
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Avoid Stimulents
Have a High Protein Snack Drink a Warm Beverage. |
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What do chchexia and air trapping in blebs indicate?
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Emphysema
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Right Sided CHF that occurs with bronchitis patients and late in emphysema patients is called.
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Cor Pulmonale (Right Sided CHF)
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Ipatropium is a bronchodilating medication in the class called.
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Anticholinergic.
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Define TLC, VC, IC, FRC, FEV1
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Total Lung Capacity
Vital Capacity Inspiratory Capacity Functional Residual Capacity Forced Experatory Volume 1Sec |
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Should Bronchodilators be given before a PFT?
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Pulmonary Function Test baseline air volumes. Give the medication after the test to determine a baseline /s med, and an /p volume /c the med.
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What can cause a fols Normal on SpO2?
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Anemia.
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What are normal SpO2?
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97-100 in Healthy
>92 Respiratory Problems. |
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What information is sent along with an ABG sample?
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Temperature or Patient, O2 Amount and delivery type.
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What are the pH levels inconsistant /c life?
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<6.8 or >7.8
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What is the Henderson-Hasselbalch Relationship?
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1 Part of H2CO3 = 20 Parts HCO3
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What is a cause of Low Hc03?
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Renal disease which causes metabolic acidosis.
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What is normal P02 for someone /s respiratory problems?
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80-100
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What is acceptable P02 for someone /c respiratory problems?
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60+
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Name three reasons for Hypoxia/Hupoxemia.
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Hypoventilation
Low Diffusion Low Perfusion |
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If your assessment shows frothy liquid sputum what might that tell you?
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Patiet has fluid in lungs.
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Define Empyema
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A collection of inflamed, infected fluid in a body cavity, typically between the pleura.
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Define thoracentesis
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thoracentesis (thō″ră-sĕn-tē′sĭs) [″ + kentesis, a puncture] Inserting a needle through the chest wall and into the pleural space, usually to remove fluid for diagnostic or therapeutic purposes.
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Define pneumothorax
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A collection of air or gas in the pleural cavity.
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What is the patient position for a thoracentesis?
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Sit Upright, No Deep Breaths, Lean forward over table.
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Define pleural effusion
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pleural effusion Fluid in the thoracic cavity between the visceral and parietal pleura.
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Should the client take deep or shallow breaths during thoracentesis.
Why? |
Shallow. Deep breathing will inflate the lung, and allow greater chance for the needle to puncture the lung.
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Define Hemothorax
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hemothorax (hē″mō-thō′răks) [″ + thorax, chest] Blood or bloody fluid in the pleural cavity caused by rupture of blood vessels resulting from inflammation of the lungs in pneumonia or pulmonary tuberculosis, lung cancer, or trauma.
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Define Flail Chest
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A condition of the chest wall due to two or more fractures on each affected rib resulting in a segment of rib not attached on either end; the flail segment moves paradoxically in with inspiration and out during expiration.
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The chamber of a closed chest drainage system that holds the drainage is called the..
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Collection Chamber
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Tracheal shift, decreased breath sounds on the affected and unaffected sides, and hypotension with a sucking chest wound all point to...
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Tension Pneumothorax
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Another name for subcutaneous emphysema is..
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Crepitus.
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Define Induration
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A raised area or bump often seen after a mantoux TB Test.
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A positive reaction for an IV drug abuser, HIV, close contacts with TB infected person, or suspicious chest xray
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5mm
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Previous converters, those having received BCG or those with other myobacterial infections can have what?
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False Positive PPD
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What the most common first line antiobiotics for TB?
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INH and RIF
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What should you encourage your client to do when you hear egophony?
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Need to do more coughing, incentive spirometer, and activity.
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What are clinical manifestations of acute respiratory failure?
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Slow or fast respiratory rate, high pCO2, dyspnea, and confusion.
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What are nursing interventions for a patient on a ventilator?
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Frequent monitoring, vital signs, suctioning, and alarm management
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A disease that causes ventilary failure is...
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Myasthenia Gravis.
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What is the most common type of ventilator used in respiratory failure?
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Volume
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Name Seven complications of mechanical ventilation...
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Pneumothorax/infection/cerebral edema, decreased cardiac output, ischemic gastric mucosa, alveloar stretching, and oxygen toxicity.
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Is ARDS usually a frontline disease?
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No, it is the result of other underlying problems, either Direct Pulmonary or Indirect Pulmonary Traume.
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What is DIC?
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Disseminated intravascular coagulation.
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What is Lung Compliance?
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Elasticity of the Lung. It can become more stiff.
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What is the main pathophys of ARDS?
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A massive inflammatory response of vasoactive substances like histamine and serotonin cause leaking of fluid from blood into interstitial and alveolar areas impairing O2 transport.
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Name three phases of ARDS.
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Exudative 24 Hours Leaking
Poliferative 7-10 Days dec surfactant Fibrotic 2-3 Weeks Fibrin dec compliance |
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What is the presentation of an ARDS on CXR?
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White areas referred to as Snowstorm or Whiteout.
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Will an ARDS client have Acidosis or Alkilosis?
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Starts as Respiratory Alkalosis with hyperventilation in early stages, but cant continue to blow off and may change to acidosis.
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What might you suspect with thich frothy sputum?
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ARDS
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What is PEEP?
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Positive End Expiratory Pressure.
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What is the name of the type of drug to increase lung contractility?
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Positive Inotropic
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How does pleural or pleuritic chest pain differ from other chest pain?
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It increases with Inspiration.
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Why does a Pneumonectory not have any chest tubes?
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They want the fluid to build up to replace the MASS or the removed lung to prevent mediastinal shift, resulting in hypotension and shock.
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Name three types of Lung Surgery.
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Wedge resection
Segmental resection Lobectomy |
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Describe positional requirements /p pneumonectomy.
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No lying on affected side as the great vessels and heart shift. Lying on unaffected side puts too much pressure on the only surviving lung which increases profusion , but decreases ventillation.
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What type of dysrhythmias are especially seen in Lung Surgery.
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AFib.
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What is the term for the movement of air in the water seal chamber when the client breathes?
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Tidaling.
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What level of wall suction must always be set when attaching a Pluravaac?
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The lowest possible. The CT can be adjusted by the amount of water that is added to the Suction Control Chamber. The physician can change the water level here.
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Which chamber in a pluravaac would you expect to see constant bubbling in?
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The suction control chamber.
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What two assessments would you want to report when looking at a collecting chamber?
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Sudden Gushes, or >300ml in first two hours.
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How often do you need to check the water level in the Suction Control Chamber?
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Q4h
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What is Thrombocytopenia?
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A decrease in platlets which cause clotting/bleeding issues.
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Is Profound Dyspnea an Early or Late finding with ARDS?
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Early
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What does PEEP Stand for?
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Posive End Expiratory Pressure (Makes sure there is always air in the lungs).
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