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144 Cards in this Set

  • Front
  • Back
What makes up the upper respiratory tract?
-Nose
-Pharynx
-Adenoids
-Tonsils
-Epiglottis
-Larynx
-Trachea
What makes up the lower respiratory tract?
-Bronchi
-Bronchioles
-Alveolar ducts
-Alveoli
A tubular passageway that is subdivided from above downward into 3 parts
-Pharynx
-divided into nasopharynx, oropharynx, and laryngopharynx
Small masses of lymphatic tissue found in the nasopharynx and oropharynx:
-Adenoids and tonsils
During swallowing, this covers the larynx to prevent solids and liquids from entering the lungs:
-Epiglottis
The trachea bifurcates into the right and left _____ ______ at a point called the ______.
-mainstem bronchi
-carina (located at the angle of Louis)
The mainstem bronchi, pulmonary vessels, and nerves enter the lungs through a slit called the _____.
-Hilt
True or False:
Aspiration is more likely in the left lung than in the right lung.
-False: the right mainstem bronchus is shorter, wider, and straighter than the left; therefore aspiration is more likely in the right than left.
Mainstem bronchi then divide to form ______ which in returns divides into ______ and _____.
-Bronchioles
-Alveolar ducts
-Alveoli
The amount of air that is exchanged with each breath is called:
-Tidal volume (about 500 mL for adult)
-A lipoprotein that lowers the surface tension in the alveoli, reduces the amount of pressure needed to inflate the alveoli and decreases the tendency of the alveoli to collapse:
-Surfactant
Lungs receives deoxygenated blood from the _____ _____ from the ______ ventricle.
-Pulmonary artery
-right
Where does the O2-CO2 exchange take place?
-Alveoli
Oxygen is carried in the blood in 2 forms:
1. Dissolved O2
2. Hgb-bound O2
-Represents the amount of O2 dissolved in the plasma:
-PaO2
-The amount of O2 bound to Hgb in comparison with the amount of O2 the Hgb can carry:
-SaO2
O2 delivery to the tissues depend on 2 factors:
1. amount of O2 that can be carried from the lungs
2. the ease the Hgb gives up O2
What does a shift to the left in the O2-Hgb dissociation curve mean?
-Oxygen is more readily in the lungs but less readily to the tissue
What causes a shift to the left in the O2-Hgb dissociation curve?
-Increase pH (alkalosis)
-Decrease temp
-Decrease PaCO2 (increase O2 level)
What does a shift to the right in the O2-Hgb dissociation curve mean?
-O2 is less readily in the lungs and more readily to the tissues
What causes a shift to the right in the O2-Hgb dissociation curve?
-Decrease pH (acidosis)
-Increase Temp
-Increase of PaCO2
-Normal arterial pH value:
- 7.35-7.45
-Normal arterial PaO2:
-80-100 mmHg
-Normal arterial PaCO2:
-35-45 mmHg
-Normal HCO3 value:
-22-26 mEq/L
The reaction of the nasal mucosa to a specific allergen:
-Allergic rhinitis
-Rhinitis that the symptoms are present less than 4 days a week or less than 4 weeks per year:
-Intermittent rhinitis
-Rhinitis that the symptoms are present more than 4 days a week and for more than 4 weeks per year:
-Persistent rhinitis
-Describe treatment of chronic (allergic) rhinitis:
-Drug therapy including antihistamines, steroid nasal spray (if possible begin 2 wks prior the allergy season), sinus rinse
-Allergy shots if meds do not help
-Alternative therapies: echinacea and zinc (short-term use [10-14 days] and not exceed 8 wks)
-Describe treatment of acute rhinitis:
-sneezing; watery, itchy eyes and nose; altered sense of smell; and thin, watery nasal discharge
-headache, congestion, pressure, nasal polyps
A condition caused by the adenovirus that invades the upper respiratory tract and often accompanies an acute URI:
-Acute Viral Rhinitis (common cold)
How long can the adenovirus survive on an inanimate object?
-3 days
Describe s&s of acute viral rhinitis:
-first experience tickling, irritation, sneezing, or dryness of the nose or nasopharynx
-followed by copious nasal secretions, some nasal obstruction, watery eyes, elevated temp, general malaise, and headache
Name complications of acute viral rhinitis:
-pharyngitis
-sinusitis
-otitis media
-tonsillitis
-lung infections
Describe nursing interventions for a patient with acute viral rhinitis:
-rest, fluids, proper diet, antipyretics, and analgesics
-drug therapy: antibiotics not indicated unless complication arises; antihistamine or decongestant
-advised to avoid crowded, close situations and other persons who have obvious cold symptoms
-frequent hand washing and avoiding hand-to-face contact
What is the most common complication of flu?
-pneumonia
Describe the s&s of influenza:
-symptoms are typically abrupt: cough, fever, and myalgia, headache and sore throat
Name the 2 types of influenza vaccine available:
1. live, attenuated
2. inactivated
Describe nursing interventions for the influenza virus:
-Flu vaccine (70-90% effective)
-relief of symptoms and prevention of secondary infection
-antivirals can be given for chemoprophylaxis if an outbreak occurs; shorten the course of influenza
This condition develops when the exit from the sinuses are narrowed or blocked by inflammation or hypertrophy (swelling) of the mucosa:
-Sinusitis
This type of sinusitis is most commonly caused by Streptococcus pneumoniae, Haemophilus influenza, or Moraxella catarrhalis:
-Bacterial sinusitis
This type of sinusitis follows an upper respiratory infection in which the virus penetrates the mucous membrane and decreases ciliary transport:
-Viral sinusitis
-This type of sinusitis is uncommon and is usually found in pts who are debilitated or immunocompromised:
-Fungal sinusitis
-This usually results from an URI, allergic rhinitis, swimming, or dental manipulation; all of which cause inflammatory changes and retention of secretion:
-Acute sinusitis
This has symptoms lasting longer than 3 weeks and is a persistent infection usually associated with allergies and nasal polyps:
-Chronic sinusitis
Describe s&s of sinusitis:
-Significant pain over the affected sinus, purulent nasal drainage, nasal obstruction, congestion, fever, and malaise
-hyperemic and edematous mucosa, a discolored purulent nasal drainage, enlarged turbinates, an tenderness over the involved frontal and/or maxillary sinuses
Describe nursing interventions for a patient with sinusitis:
-Antibiotics to treat the infection if it persists longer than 7 days without treatment; usually lasts 10-14 days and will be changed with symptoms do not resolve
-drug therapy to resolve symptoms such as decongestants to promote drainage and nasal steroid to decrease inflammation
-alternative: hot showers, nasal rinse
Benign mucous membrane masses that form slowly in response to repeated inflammation of the sinus or nasal mucosa; appear bluish, glossy, and can become large:
-Nasal polyps
Describe s&s of nasal polyps:
-nasal obstruction, nasal discharge (usually clear), and speech distortion
Describe nursing interventions for a patient with nasal polyps:
-relieve fear (of malignancy)
-may be removed with endoscopic or laser surgery, but reoccurrence is common
-Nosebleed; occurs in a bimodal distribution, with children less than 10 years of age and adults of 50 years more affected:
-Epistaxis
-Describe 6 first aid measures taken to control/stop epistaxis:
1. keep the pt quiet
2. place in sitting position or high fowler's if needed
3. apply direct pressure by pinching the entire soft lower portion of the nose for 10-15 min
4. apply ice compresses
5. partially insert small gauze pad into the bleeding nostril
6. obtain medical asst if bleeding does not stop
-Describe medical management to be done if epistaxis cannot be controlled by first aid methods:
-Application of vasoconstrictive agent, cauterization, or anterior packing
-Describe nursing interventions for a patient with epistaxis:
-Monitor closely resp rate, HR and rhythm, O2 sat, LOC, and observe for signs of aspiration
-Admin mild opioid analgesic for pain and antibiotic as ordered
A condition characterized by partial or complete upper airway obstruction during sleep:
-Obstructive sleep apnea
The cessation of spontaneous respirations lasting longer than 20 seconds:
-Apnea
Describe s&s of sleep apnea:
-frequent awakenings at night, insomnia, excessive daytime sleepiness, and witnesses apneic episodes, loud snoring, am headaches, personality changes, irritability
Describe complications that can occur as a result of sleep apnea:
-HTN, right-sided heart failure from pulmonary HTN, and cardiac dysrhythmias
Describe nursing interventions of a patient with sleep apnea:
-Instruct to avoid sedatives and alcoholic beverages for 3-4 hours before sleep; encourage weight loss
-Instruct how to use CPAP, BiPAP (can deliver a higher inspiration pressure and a lower pressure during expiration)
-Nurse must be aware that the use of opioids may worsen symptoms
-Surgery (last resort)
Describe factors predisposing to pneumonia:
-Depressed cough and epiglottis reflex
-Tracheal intubation
-Certain diseases
-Aging
-Air pollution
-Bed rest and prolonged immobility
-Malnutrition
-Smoking
An acute inflammation of the lung caused by microbial organisms:
-Pneumonia
Pneumonia can be caused by:
-Bacteria
-Viruses
-Mycoplasma
-Fungi
-Parasites
-Chemicals
A lower respiratory tract infection of the lung parenchyma with onset in the community or during the first 2 days of hospitalization:
-Community-Acquired Pneumonia
What is the most common organism to cause community-acquired pneumonia?
-Streptococcus pneumoniae
Pneumonia occurring 48 hours or longer after hospital admission and not incubating at the time of hospitalization; second most common nosocomial infection; usually bacterial or viral and rarely fungal
-Hospital-Acquired Pneumonia
Refers to pneumonia that occurs more than 48-72 hours after endotracheal tubing:
-Ventilator-Acquired Pneumonia
Abnormal entry of secretions or substances (material from mouth or stomach) into the lower airway;
-Aspiration Pneumonia
Pneumonia that affects those with altered immune responses and are highly susceptible to respiratory infections:
-Opportunistic Pneumonia
Those at higher risk for developing opportunistic pneumonia include:
1. protein-calorie malnutrition
2. immune deficiencies (AIDS)
3. received transplants and treated with immunosuppressive drugs
4. treated with radiation therapy, chemo, and corticosteroids
In this stage of pneumonia, pneumococcus organisms reach the alveoli causing an outpouring of fluid; organisms multiply and damage the host by their overwhelming growth and interfere with lung function:
-Congestion
In this stage of pneumonia, massive dilation of capillaries causes the lungs to appear red and ganular similar to the liver; alveoli are filled with organisms, neutrophils, RBCs, and fibrin:
-Red Hepatization
In this stage of pneumonia, blood flow decreases, and leukocytes and fibrin consolidate in the affected part of the lung:
-Gray Hepatization
In this stage of pneumonia, resolution and healing occur if there are no complications:
-Resolution
Describe s&s of pneumonia:
-Sudden onset of fever, shaking, chills,SOB, cough
-Lung Sounds: diminished, crackles, increased fremitus
Describe treatment for a patient with pneumonia:
-Empiric anti-infectives: Zithromax
-Sputum culture may result in drug therapy change
-Supportive therapy: O2 therapy, analgesics to relieve chest pain, antipyretics
-Vaccination
-Increase of fluids to 3 L/day
-An infectious disease caused by Mycobacterium tuberculosis; involves the lungs, but also the larynx, kidneys, bones, adrenal glands, lymph nodes, and meninges; 2nd most common cause of death:
-Tuberculosis
True or False:
TB is seen in the poor, the underserved, and minorities
-True
True or False:
A brief exposure to a few TB bailli can cause an infection.
-False; TB is not highly infectious, and transmission usually requires close, frequent, or prolonged exposure
Describe s&s of TB:
-In early stages; asymptomatic
-Active TB: fatigue, malaise, anorexia, unexplained weight loss, low-grade fevers, and night sweats; cough with white, frothy sputum
Describe diagnostic testing for TB:
-Mantoux testing: best way to determine exposure to TB and the development of antibodies
-CXR: confirmation of a neg test result, but cannot diagnose TB
-Sputum Culture: the only way to diagnose TB
Describe treatment for TB:
-Drug Therapy: anti-infective; usually a 6 month regimen (INH, rifampin, pyrazinamide, and ethambutol)
-Vaccine (given in other parts of the world) this will cause a false positive Mantoux test
An abnormal accumulation of fluid in the alveoli and interstitial spaces of the lungs; considered a medical emergency and may be life threatening; most common cause is left-sided HF:
-Pulmonary Edema
Air in the pleural space; partial or complete collapse of the lung:
-Pneumothorax
When air enter the pleural space with no external association:
-Closed pneumothorax
When air enters the pleural space through an opening in the chest wall:
-Open pneumothorax
A pneumothorax with rapid accumulation of air in the pleural space, causing severely high intrapleural pressures with resultant tension on the heart and great vessels; either open or closed; intrathoracic pressure increases, the lung collapses, and the mediastinum shifts toward the unaffected side; CO is altered; medical emergency:
-Tension pneumothorax
Lymphatic fluid in the pleural space due to a leak in the thoracic duct; caused by trauma, surgical procedures, and malignancy:
-Chylothorax
A collection of fluid in the pleural space:
-Pleural effusion
Occurs primarily in noninflammatory conditions and is accumulation of protein-poor, cell-poor fluid:
-Transudate
An accumulations of fluid and cells in an area of inflammation:
-Exudate
A pleural effusion that contains pus:
-Empyema
Elevated pulmonary pressures resulting from an increase in pulmonary vascular resistance to blood flow:
-Pulmonary HTN
A severe and progressive disease; characterized by mean pulmonary arterial pressure greater than 25 mmHg; remain incurable; unknown etiology:
-Primary Pulmonary HTN
Occurs when a primary dz causes a chronic increase in pulmonary artery pressures; can develop as a result of parenchymal lung dz, LV dysfunction; intracardiac shunts, chronic pulmonary thromboembolism, or systemic connective tissue dz:
-Secondary Pulmonary HTN
Describe the pathophysiology of asthma:
-Exposure to allergens or irritants initiates the inflammatory cascade
-Mast cells degranulate and release multiple inflammatory mediators including: leukotrienes, histamine, cytokines, prostaglandins, and nitric oxide
-Results in vascular congestion; edema formation; production of thick, tenacious mucus; bronchial muscle spasm; thickening of airway walls; and increase bronchial hyperresponsiveness
Describe s&s of asthma:
-Unpredictable and variant
-Episodes of wheezing, breathlessness, chest tightness, and cough
-Expiration is prolonged
-Cough may be productive or nonproductive
-Creates a feeling of suffocation
-Restlessness, increased anxiety, inappropriate behavior, increased pulse and BP
-Diminished or absent breath sounds
Name the 4 classifications of asthma:
1. Mild intermittent
2. Mild persistent
3. Moderate persistent
4. Severe persistent
Give examples of anti-inflammatory agents (corticosteroids) used for asthma:
-methylprednisolone (Medrol, Solu-Medrol)
-prednisone
-triamcinolone (Azmacort)
-fluticasone (Flovent)
-budesonide (Pulmicort)
Give an example of short acting anticholinergic used for asthma:
-ipratropium (Atrovent)
Give an example of long acting anticholinergic used for asthma:
-tiotropium (Spiriva)
Give an example of leukotriene receptor blocker used for treatment of asthma:
-montelukast (Singulair)
Give an example of an inhaled, short acting B2-Adrenergic agonist:
-albuterol (Ventolin)
Give an example of an immediate-acting B2-Adrenergic used for treatment of asthma:
-epinephrine (Adrenalin)
Given examples of combination agents used for the treatment of asthma:
-budesonide/formoterol (Symbicort)
-fluticasone/salmerterol (Advair)
A preventable and treatable disease states characterized by airflow limitation that is not fully reversible:
-Chronic Obstructive Pulmonary Disease
The presence of chronic productive cough for 3 months in each of 2 consecutive years in a patient in whom other causes of chronic cough have been exhausted:
-Chronic Bronchitis
An abnormal permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis:
-Emphysema
Inflammatory process starts with inhalation of noxious particles and gases; macrophages and lymphocytes increase and release inflammatory factors causing damage to lung tissue; lungs undergo remodeling which increasing collgen and scar tissue formation (fibrosis):
-Pathophysiology of COPD
In COPD, the bronchioles tend to collapse (especially on expiration) and air is trapped in the distal alveoli, resulting in hyperinflation and overdistention of the alveoli resulting in this appearance:
-Barrel-chested
In COPD, the lungs can be easily inflated, but can be only partially _____.
-Deflated
Describe the s&s of COPD:
-Typically develop slowly around 50 years of age after 20 pack-years of smoking
-Cough, sputum production, or dyspnea
-Dyspnea is often progressive, and usually occurs with exertion progressing to dyspnea at rest for severe cases
-Barrel-chest
-Cough initially intermittent progressing to everyday occurrence, but seldom present during night
-Wheezing and tightness may be present
-Weight loss and anorexia
-Use of accessory muscles
-Edema
-Bluish-red color of the skin
Hypertrophy of the right side of the heart, with or without HF, resulting from pulmonary HTN;
-A late manifestation of chronic pulmonary heart disease:
-Cor pulmonale
-Describe s&s of cor pulmonale:
-Dyspnea; lung sounds are normal or crackles may be heard
-Right-sided ventricular distolic S3 gallop
-Hepatomegaly with right upper tenderness, ascites, epigastric distress, peripheral edema, and weight gain
An autosomal recessive, multisystem disease characterized by altered function of the exocrine glands primarily involving the lungs, pancreas, and sweat glands:
-Cystic Fibrosis
Describe the pathophysiology of Cystic Fibrosis:
-Cells that line the passageways of the lungs, pancreas, and other organs produce abnormally thick, sticky mucous causing destruction of the lung tissue; leads to air trapping and hyperinflation of the lungs; causing chronic airway infections
A glycoprotein growth factor synthesized and released by the kidneys:
-erythropoietin
-An immature erythrocyte; counting measures the rate at which new RBCs appear in the circulation; can develop into mature RBCs within 48 hours of release into circulation:
-reticulocyte
Where does Hemolysis take place in the body?
-bone marrow
-liver
-spleen
Name 2 benefits of a bone marrow examination:
1. a full evaluation of hemopoiesis
2. the ability to obtain specimens for cytopathology and chromosomal abnormalities
Where is the preferred site of a bone marrow aspiration and/or biopsy:
-Posterior iliac crest
(The anterior iliac crest and sturnum are alternative sites)
A deficiency in the number of RBCs, the quantity of Hgb, and/or the volume of packed RBCs (Hct):
-Anemia
How is anemia diagnosed?
-CBC, reticulocyte count, and peripheral blood smear
Name possible causes of anemia:
-Blood loss
-Impaired production of RBCs
-Increased destruction of RBCs
Describe s&s of anemia:
-Decreased Hgb levels
-Palpitations, dyspnea, diaphoresis
-Pallor, jaundice, pruritus
-CO is maintained by increasing the HR and SV
-Systolic murmurs and bruits
-Extreme cases: angina, MI, HF, cardiomegaly, pulmonary and systemic congestion, ascites, and peripheral edema
What is the normal lifespan of a RBC?
-120 days
One of the most common chronic hematologic disorders; effects the very young, those on poor diets, and women in their reproductive years:
-Iron-deficiency Anemia
Name some nutrients that aid in erythropoiesis:
-Cobalamin (B12)
-Folic acid
-Iron
-Vit B6
-Amino acids
-Vit C
Malabsorption of iron may occur in:
-GI surgery
-Malabsorption syndromes
Iron absorption occurs in the:
-duodenum
A disease in which the patient has peripheral blood pancytopenia (a decrease of all blood cell types [RBCs, WBCs, and platelets]) and hypocellular bone marrow:
-Aplastic anemia
A group of inherited, autosomal recessive disorders characterized by the presence of an abnormal form of Hgb in the erythrocyte; causes the erythrocyte to stiffen and elongate taking on a sickle shape in response to low O2 levels
-Sickle Cell Disease
Describe s&s of sickle cell anemia:
-vary greatly from person to person
-chronic health problems and pain because of organ tissue hypoxia and damage
-fatigue, decreased exercise tolerance, pallor
-jaundice, prone to gallstones, pain is severe because of ischemia of tissue
-fever, swelling, tenderness, tachypnea, HTN, nausea, vomiting
The production and presence of increased numbers of RBCs which is so great that blood circulation is impaired as a result of the increased blood viscosity (hyperviscosity) and volume (hypervolemia):
-Polycythemia
True or False:
-Polycythemia vera also includes an increase of WBCs and platelets.
-True
Describe s&s of polycythemia vera:
-Headache, vertigo, dizziness, tinnitus, and visual disturbances, generalize pruritus
-Angina, HF, intermittent claudication, and thrombophlebitis, stroke secondary to thrombosis
Treatment of polycythemia include:
-reducing blood volume and viscosity
and bone marrow activity
-phlebotomies (drains blood)
A sex-linked recessive genetic disorder caused by defective or deficient coagulation factor (factor VIII and factor IX):
-Hemophilia
Describe s&s of hemophilia:
-slow, persistent bleeding from minor trauma
-delayed bleeding after minor injuries
-uncontrollable hemorrhage
-GI bleeding
-epistaxis
-joint bleeding (hemarthrosis)
-ecchymosis
To directly visualize the trachea, bronchi, and bronchial tree, obtain biopsies and sputum samples or to wash-rinse area, instill medication
-Bronchoscopy
To remove fluid from the pleural space (pleural effusion) and obtain specimens:
-Thorocentesis
Diagnosis and monitoring of lung disease, monitor effectiveness of treatment:
-Pulmonary Function Tests
To monitor function of the respiratory, cardiac and renal system, to monitor pH and O2 levels; preferred arterial puncture of radial artery:
-Arterial Blood Gases (ABGs)
Normal Hgb value for women? Men?
-Men: 13.5-18 g/dl

-Women: 12-16 g/dl
Normal Hct level for women? Men?
Women: 38-47%

Men: 40-54%