Test 2 - Resp

Front 1

Respiratory Diagnostic Procedures

Back 1

Pulse Ox
ABGs
Bronchoscopy
Thoracentesis

Front 2

Pulse Ox routes

Back 2

Finger
toe
bridge of nose
earlobe
forehead

Front 3

When to use Pulse Ox

Back 3

During continuous opioid epidural infusion

Increased work of breathing

wheezing

coughing

cyanosis

Front 4

Pulse Ox Results

Back 4

95-100 (expected)
91-100 (acceptable)
85-89 (some illnesses permit)
<86 (Emergency)
<80 (Life threatening)

Front 5

Pulse Ox Low reading causes

Back 5

hypothermia
poor peripheral
too much light
Low Hgb
movement
edema
polish

Front 6

When is pulse ox unreliable

Back 6

during Cardiac arrest
Shock
low perfusion

Front 7

ABG pressure

Back 7

hold pressure for 5min
20min if on coagulant

Front 8

ABG complications

Back 8

hematoma
arterial occlusion

Front 9

Air embolism

Back 9

Sudden SOB
low O2
chest pain
anxiety

(Notify MD, give O2, check ABG)

Front 10

Bronchoscopy

Back 10

visualization of larynx, trachea, bronchi (flexible or rigid bronchoschope)

Front 11

Bronchoscopy
When can it be done

Back 11

During general, local, moderate sedation

Thru endotracheal tube

Front 12

Bronchoscopy Indications

Back 12

tumors
inflammation
strictures
lung cancer
aspiration of deep sputum
removal of foreign bodie
post op
atelecactasis
detroy/excise lesions

Front 13

Bronchoscopy Nurse Actions

Back 13

check for anticoagulants
consent form
NPO 8-12hrs
admin lidocaine
Sitting position
Atropine for secretion reduct.
VS
collect specimen
Gag reflex (2hrs)
oral hygeine
Pt gargle salt water

Front 14

Bronchoscopy Complications

Back 14

laryngospasm (vocal cords)
impede ability to inhale
use naropharyngeal airway
O2 w/ humid = lowers edema

Front 15

Thoracentesis

Back 15

Dx evaluation
Meds into pleural space
remove effusion/air

local anesthesia by MD
ultrasound for guidance

Front 16

Thoracentesis Indications

Back 16

Transudates (HF, Chirrhosis)

Exudates (Inflammatory, infections)

Empyema
Pneumonia
Trauma, invasive surgeries

Front 17

Thoracentesis Complications

Back 17

Pneumothorax

Bleeding (signs- hypotension, low hgb)

Infection

Front 18

Chest Tube Indications

Back 18

Pneumothorax
Hemothorax
Post Op chest Drainage
Pleural effusion
Lung abscess

Symptoms - Dyspnea, distended neck veins, poor circulation, cough

Front 19

Chest Tube Nursing actions

Back 19

prep insertion site w/ providone-iodine. Drape the site

Chest tube tip positioned up toward the shoulder (pneumothorax)

toward posterior (hemothorax/effusion)

Front 20

Nasal Cannula

Back 20

24-44%
1-6L

Flow rate depends on pt's breathing

Humidify for 4L+

Front 21

Simple face mask

Back 21

40-60%
1-6L/min

>5L can result in rebreathing CO2
High risk of aspiration

Front 22

Partial rebreather mask

Back 22

60-75%
6-11L/min

client rebreath 1/3 room air
Complete deflation = CO2 build up

Front 23

Nonrebreather mask

Back 23

80-95%
10-15L/min

highest O2 possible
valve/flap must be intanct

Front 24

Venturi Mask

Back 24

24-55%
2-10L/min

precise
no humidification needed
for chronic lung cancer
expensive

Front 25

Face tent

Back 25

24-100%

High humidification needed
Empty condensation tube often
Ensure for adequate water
ensure for mist
ensure tracheostomy safety

Front 26

T-piece

Back 26

24-100%
>10L/min

for tracheostomies, larygenectomies, endotracheal tubes
High humidification requires monitoring

Front 27

Hypoxemia Early findings

Back 27

Tachypnea
Tachycardia
Restleness
Pale skin
elevated BP
Resp distress

Front 28

Hypoxemia Late findings

Back 28

Confusion/stupor
Cyanotic
Bradypnea
Bradycardia
Hypotension
cardiac dysrythmia

Front 29

Symptoms of Hypercarbia

Back 29

Restleness
Hypertension
Headache

Front 30

Oxygen toxicity s/s

Back 30

nonproductive cough
substernal pain
nasal stuffiness
nausea
vomiting fatigue
headache
sore throat
hypoventilation

Front 31

Mechanical ventilation Indications

Back 31

hypoxemia/hypoventilation/resp acidosis
Airway trauma
Exacerbation of COPD
Acute pulmonary edema
head injuries
neuro disorders
obstructive sleep apnea

Front 32

3 types of ventilator alarms

Back 32

volume
pressure
apnea

Front 33

Mechanical ventilation complications

Back 33

Fluid retention
Oxygen toxicity
Hemodynamic compromise
Aspiration
GI ulcer

Front 34

Asthma

Back 34

Chronic inflammatory disorder of the airways that results in intermittent and reversable airflow obstruction of the bronchioles

Front 35

Asthma categories

Back 35

mild intermittent
mild persistent
moderate persistent
severe persistent

Front 36

Asthma - meds to avoid

Back 36

aspirin
NSAIDS
betablockers
cholinergics

Front 37

Pulmonary Function tests (PFTs)

Back 37

most accurate test for diagnosing asthma

Front 38

Forced vital capacity

Back 38

volume of air exhaled from full inhalation to full exhalation

15-20% lower for asthma

Front 39

Meds for Asthma

Back 39

Bronchodilators
Anti-inflammatory agents

Front 40

Bronchodilators

Back 40

albuterol
Atrovent
theophylline

Front 41

Anti-inflammatory agents

Back 41

Flovent
Deltasone
Intal
Xolair

Front 42

Combination of bronchodilators and anti-inflammatory

Back 42

Combivent
Advair

Front 43

Asthma complications

Back 43

Respiratory failure
Status asthmaticus

Front 44

COPD

Back 44

Emphyema
Chronic Bronchitis

Front 45

Emphysema

Back 45

Loss of lung elasticity and hyperinflation of lung tissue

Front 46

Chronic Bronchitis

Back 46

inflammation of bronchi and bronchioles

Front 47

COPD s/s

Back 47

Chronic dyspnea
productive cough
respiratory acidosis
crackles/wheezes
rapid and shallow resp
use of accessory muscles
barrel chet
more

Front 48

COPD complications

Back 48

Respiratory infection
Right-sided HF

Front 49

Pneumonia

Back 49

inflammatory disease that produces excess fluid

Front 50

Pneumonia complications

Back 50

Atelectasis
Bacteremia (sepsis)

Front 51

Diabetes meds

Back 51

Biguanides
Sulfonylureas
Meglitinides
Thiazolidinediones
Alpha-Glucosidase Inhibitors
Gliptins

Front 52

Biguanides

Back 52

Metformin HCL

Front 53

Sulfonylureas

Back 53

Tolbutamide
chlorpropamide
glyburide

Front 54

Meglitinides

Back 54

-glinide

Front 55

Alpha-Glucosidase Inhibitors

Back 55

Precose
Glyset

Front 56

Diabetes Complications

Back 56

Cardiovascular disease
Impaired vision/blindness
Foot injury
Renal failure

Front 57

Diabetic Ketoacidosis (DKA)

Back 57

acute, life threatening condition by hyperglycemia >300mg

mortality 1-10%

more common in type 1

Front 58

Hyperglycemic-hyperosmolar state (HHS)

Back 58

acute, life threatening condition by hyperglycemia >600mg

mortality >15%

Front 59

Albeturol

Back 59

Inhaled short acting
oral long acting

prevention of asthma

Front 60

Formoterol
Salmeterol

Back 60

Inhaled long acting

Long-term control of asthma

Front 61

Terbutaline

Back 61

Oral, long-acting

long-term control of asthma

Front 62

Oral diabetes agents
S/E

Back 62

tachycardia
angina
tremors

Front 63

Beta2-adrenergic agonists

Back 63

Albeturol
Formoterol
Salmeterol
Terbutaline

Front 64

Pneumonia
4 major classes

Back 64

Community acquired
Nosocomial
Immunocompromised Host
Aspiration

Front 65

Community Acquired Pneumonia (CAP)

Back 65

Usually follows an initial viral infection
Occurs in the community
Or
Within 48 hours of admission to the hospital
Most common bacteria:
Streptococcus pneumoniae (organism)
Mycoplasma pneumoniae (organism)
Haemophilus influenza (organism)
Viruses

Front 66

Hospital Acquired Pneumonia(HAP)

Back 66

Onset: > 48 hours after admission
No evidence of infection at time of admission

3 conditions exist:
Host defenses are impaired
Portions of a pathogen capable of causing infection overtake host’s defenses
Highly virulent organism is present

Front 67

VAP

Back 67

ventilator associated pneumonia
Patients with acute respiratory failure requiring mechanical ventilation > 48 hours

Front 68

Common Organisms for HAP

Back 68

Klebsiella
Serratia
Pseudomonas aeruginosa
Methicillin-resistant staph aureus (MRSA)

HIGH MORTALITY RATES

Front 69

Pneumonia in the Immunocompromised Host

Back 69

Pneumocystis pneumonia: PCP
Organisms:
Pneumocystis jiroveci
Fungal pneumonias
Mycobacterium tuberculosis

Front 70

Health Care-Associated Pneumonia

Back 70

Nonhospitalized patients who had extensive health care contact
Resident of nursing home or long term facility
Acute care hospitalization > 2 or more days within last 90 days
IV antibx
Wound care
Chemotherapy
Hospital or dialysis clinic with 30 days

Front 71

Pleurisy (pleuritis)

Back 71

Inflammation of both layers of pleura

Treat underlying cause
Pneumonia, infection
Analgesics such as NSAIDS; possibly opioids

Front 72

FEV1

Back 72

Forced Expiratory Volume in 1 sec
(The volume of air that can be exhaled during the first second of a forced exhalation.)

Front 73

FVC

Back 73

Forced Vital Capacity
Maximally forced expiratory volume of gas that can be expelled from the lungs
< 70% = COPD

Front 74

Alveolar Cells

Back 74

Type I: Epithelial


Type II: Metabolically active; secrete surfactant



Type III: alveolar cell macrophages

Front 75

Biots

Back 75

abnormal pattern of breathing characterized by groups of quick, shallow inspirations followed by regular or irregular periods of apnea

Front 76

Continuous positive Airway Pressure (CPAP)

Back 76

Continuous flow and demand system
Prevents the upper airway from collapsing during inspiration
Evidence:
BNP elevated with obstructive sleep apnea
Reduced once started on CPAP
Most effective treatment
Bipap: similar; used for COPD or sleep apnea

Front 77

Panlobular Emphysema

Back 77

Hereditary r/t deficiency of Alpha1 antitrypsin
Destroys bronchioles, alveolar ducts and alveoli
Airspaces within lobules are enlarged

Front 78

Centrilbular Emphysema

Back 78

r/t smoking
Pathological changes
occur in lobules of alveoli
whereas outer portions of
epithelial cells are preserved

Front 79

Drugs for smoking cessation

Back 79

Zyban (Bupropion SR, Wellbutrin)
Chantex (Chantix)

Front 80

Combivent

Back 80

Number one prescribed bronchodilators used in the treatment of COPD

Front 81

Atopy

Back 81

most common identifiable predisposing factor to asthma