• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/158

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

158 Cards in this Set

  • Front
  • Back
What are the structures of the upper respiratory tract? (there are 7)
nose
pharynx
adenoids
tonsils
epiglottis
larynx
trachea
What are the structures of the lower respiratory tract? (there are 4)
bronchi
bronchioles
alveolar ducts
alveoli
Lipoprotein secreted by the alveolar cells that decreases the surface tension on the alveoli making it easier to stay inflated
surfactant
collapsed alveoli (common in postop patients)
atelectasis
Function is protection- with the thoracic cage, pleura, and resp. muscles
chest wall
How many lobes does the R lung have? What are they called?
upper, middle, and lower lobes
How many lobes does the L lung have? what are they called?
2 lobes

upper and lower lobes
From the nose to the ____ _____ is dead space. It is just a conduction system- full of air but no gas exchange.
respiratory bronchioles
upper respiratory problem possibly due to a break or could be congenital. The air passage is altered- can lead to increased risk of sinusitis. the septum is not straight.
deviated septum.
What can be done to fix a deviated septum?
septoplasty
Upper respiratory problem involving a blow to the face that causes airway obstruction, epistaxis,or cosmetic deformity.
Nasal Fracture
What are interventions for nasal fracture?
-keep patient upright
- apply ice
- maintain airway
Surgical reconstruction of the nose. Is an outpatient procedure.
Rhinoplasty
What are some priorities in rhinoplasty?
- implants shape the nose
- nasal packing postop
- ecchymosis post surgery
- maintain airway
- pain management
- bleeding
- infection
- edema
What should a nurse NOT administer preop to a patient having a nasal surgery?
NSAIDs
A respiratory problem caused by trauma, foreign bodies, nasal spray abuse, street drug use, anatomic malformation, allergic rhinitis, and tumors. Is commonly called a nosebleed.
Epistaxis
Who is epistaxis more common in?
children and elderly
People taking which medications are more likely to develop epistaxis?
NSAIDs or aspirin, or other drugs that alter platelet counts
Posterior nasal bleeding occurs more commonly in _____. What is usually done to treat it?
1. older adults

2. medical attention
Anterior nasal bleeding is more common in ___ and ____. What is usually done to treat it?
1. children and young adults

2. self-treatment and it stops spontaneously.
What are the initial nursing management skills for epistaxis? (there are 6)
1. forst aid measures
2.quiet patient, sitting position
3. apply direct pressure- pinch entire lower nose 10-15 minutes
4. ice compress
5. partially insert gauze pad in to nostril, apply more pressure
6. obtain medical assistance if bleeding does not stop.
What are nursing measures for epistaxis that is persistant/prolonged? (there are 4)
1. localization of bleeding site
2. vasoconstrictive agents
3. cauterization
4. anterior packing of nose for 48-72h.
Posterior packing for epistaxis to control bleeding should be left in place for a minimum of ___ days.
3

*Patient should be hospitalized- monitor respiratory rate, heart rate, O2sat, LOC. Observe for s/s aspiration. give mild analgesics. give antibiotic.
If epistaxis is not controlled with posterior packing, _____ is indicated.
surgery
Postop epistaxis patients should avoid:
-vigorous nose blowing
-streuous activity
-lifting and straining for 4-6 weeks
The reaction of the nasal mucosa to a specific antigen. These attacks are usually seasonal, last for several weeks, and cause by allergens.
Allergic Rhinitis
Symptoms of this respiratory disorder resemble the common cold, are present intermittently or constantly, and are usually associated with pet dander, dust mites, or molds.
Allergic Rhinitis
Clinical manifestations of allergic rhinitis: (list 5)
-nasal congestion
- watery,itchy eyes
- sneezing
- watery, itchy nose
- thin, watery discharge from nose
- enlarged nasal turbinates
The most important step involved in managing allergic rhinitis is to______________
identify and avoid triggers of allergic reactions.
What drug therapy is used for allergic rhinitis?
- nasal sprays
- antihistamines
- decongestants
- nasal corticosteroids
How do nasal corticosteroid sprays work?
- they act to reduce systemic absroption
How does combination therapy work?
uses a nasal corticosteroid spray and an antihistamine to provide relief of symptoms
This generation of a certain type of drug causes sedation- teaching patient of side effects is important. Example is benadryl and tavist.
first generation antihistamines
This generation of a certain type of drug are nonsedating but expensive. Examples are claritin and zyrtec.
second generation antihistamines.
The most common infectious disease. Spread by droplets, caused by adenovirus. the "common cold".
Acute Viral Rhinitis
Signs and symptoms of acute viral rhinitis
- tickling, irritated sore throat
- sneezing
- possible fever
- s/s become worse
What are appropriate interventions for acute viral rhinitis.
-rest
-fluids
-treat the fever
-frequent handwashing, avoid crowds
What treatment is not indicated for acute viral rhinitis?
- antibiotics
What are some symptoms of influenza
-onset is abrupt with systemic symptoms:
- cough
- fever
- myalgia
- HA
- sore throat
Chest auscultation is normal with which respiratory disorder?
influenza
What is the most normal complication of influenza?
pneumonia

*tx with antibiotics is indicated when pneumonia develops
Who is most at risk for death from influenza? (and thus the most important to be immunized)
-primarily persons over 60 with underlying heart or lung disease.
What is the focus of nursing managment for influenza?
relief of symptoms

prevention of secondary infection
When should influenza vaccines be encouraged? Who should routinely be vaccinated?
mid october

persons over 50 and high risk groups (ex. health care workers)
A respiratory problem that develops when inflammation or swelling of the mucosa causes a narrowing or blockage of the exit from the sinuses. Blocked secretion accumulate, providing a medium for growth of bacteria, viruses, and fungi, which may result in infection of the sinuses.
sinusitis
What organisms are the most common causes of bacterial sinusitis?
Strep pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
What are the s/s of acute sinusitis? (there are 7)
- pain over affected sinus
- purulent nasal drainage
- nasal obstruction
- congestion
- fever
- malaise
- dental pain
What type of sinusitis is usually associated with allergies, facial pain, and nasal congestion?
chronic sinusitis
What are common treatments of acute sinusitis?
antibiotics (10-14 days)
decongestants
nasal corticosteroids
mucolytics
What are some dx/ treatmetns for chronic sinusitis?
- Xray or CT to confirm sinuses filled with fluid
- broad-spectrum antibiotics for 4-6 weeks
benign mucous membrane masses that form slowly in response to inflammation
polyps
What treatment is used for polyps? What is the problem with this treatment?
- surgical removal laproscopically
- they usually return
How should foreign bodies be removed from the resp. track?
- they can be removed in the direction in which they went in.
-sneezing
-blowing

*irrigation or pushing back is not indicated- could cause aspiration
Acute inflammation of the pharynx including the tonsils palate or uvula
acute pharyngitis
A patient presenting with a sore throat, pain with swallowing, and a red throat with pus and yellow exudate would be suspected to have ________.
Acute Pharyngitis
What can be done to determine the pathogen causing acute pharyngitis?
rapid strep
What are nursing management considerations for acute pharyngitis?
- infection control
- symptom relief
- antibiotic therapy
A respiratory problem where bacteria infect and invade both tonsils.
peritonsillar abscess
A patient presents to the hospital with enlarged tonsils, high fever, leukocytosis, and chills. What is the most likely problem?
peritonsillar abscess.
What are the treatments for peritonsilar abscess?
tonsillectomy after infection has subsided.
Partial or complete upper airway obstruction during sleep caused by the tongue and soft palate falling back and obstructing the pharynx.
obstructive sleep apnea
A patient comes to the hospital complaining of insomnia, daytime sleepiness, headaches, and irritability. Her husband says she has apenic episodes, snores, and seems to have personality changes. What problem is this patient experiencing?
obstructive sleep apnea.
What kind of airway obstruction is a medical emergency?
complete
S/S of airway obstruction: (there are 6)
stridor
use of accessory muscles
wheezings
restlessness
cyanosis
tachypnea
The stoma that resulys from a tracheotomy
tracheostomy
When is a tracheostomy indicated? (4 reasons)
1) to bypass an upper airway obstruction
2) facilitate removal of secretions
3) permit long-term mechanical ventilation
4) permit oral intake and speech in a patient who requires long-term mechanical ventilation
What are some advantages for long-term tracheostomy care? (4 advantages)
-less risk of long-term damage to airway
- increased patient comfort, b/c no tube in mouth
- allows the patient to eat b/c tube enters lower in airway
- mobility is increased, b/c tube is more secure
What is indicated when the patient is at risk for aspiration or needs mechanical ventilation?
a tracheostomy tube with an inflated cuff
1. How does a inflated tracheostomy cuff work?
2.How does a nurse know how much air should be inflated into a trach cuff?
3. An inflated cuff should not exceed _______mmHg, because higher pressures may compress tracheal capillaries, limit blood flow, and predispose to tracheal necrosis.
1.it exerts pressure on the tracheal mucosa
2. An inflated cuff should be inflated with the minimum volume of air required to obtain an airway seal
3. 20mmHg
What may need to be done to remove secretions that accumulate above the trach cuff?
deflate the cuff, then suction the mouth and trach tube to clear the airway.

*Deflate the cuff during exhalation because exhalation propels secretions into the mouth. Reinflating the cuff should be done during inhalation.
Nursing management of trach cuffs should include: (2)
1. daily monitoring of the volume of air required to inflate the cuff (increased volume may indicate tracheal dilation from cuff pressure)
2. assessment of the aptient's ability to protect the airway from aspiration.
When is a cuffless trach tube indicated?
when the patient no longer requires mechanical ventilation and can protect the airway from aspiration.
During the fist few days after tracheostomy is performed and the stoma is not healed, care should be taken not to dislodge the trach tube. Tube replacement is difficult. Precautions include: (there are 3)
1) a replacement tube of equal or smaller size should be kept at the bedside, ready for emergency reinsertion
2) tracheostomy tapes are not changed for at least 24 h after insertion procedure
3) the first tube change is performed by a physician no sooner than 7 days after tracheostomy
Problem that arises from mucosal surfaces.
head and neck cancer
What origin is most head and neck cancers?
squamous cell
Where can tumors occur in head and neck cancer?
paranasal sinuses
oral cavity
nasopharynx
oropharynx
larynx
Who is most at risk for head and neck cancer (90% of head and neck cancers affects this group).
individuals 50years or older after prolonged use of tobacco and alcohol.
What head and neck cancers are typically diagnosed in the late stages?
pharynx
supraglotticlaryx
What 2 s/s of pharyngeal and supraglotticlaryngeal cancer are indications for medical evaluation?
lump in the neck
hoarseness that persists >2weeks
Late stage symptoms of head and neck cancer include: (there are 5)
1. pain
2. dysphagia
3. decreased mobility of the tongue
4. airway obstruction
5.cranial nerve neuropathies
What is a white patch observed in the mouth that may be indicative of head and neck cancer called?
leukoplakia
What is a red patch observed in the mouth that may be indicative of head and neck cancer called?
erythroplakia
Inflammation of the bronchi in the lower tract r/t infection
acute bronchitis
what are the 3 types of pneumonia?
1. fungal pneumonia
2. aspiration pneumonia
3. opportunistic pneumonia
An accute inflammation of the lung parenchyma caused by a microbial agent. The leading cause of death from an infectious disease in the US.
pneumonia
What are the 3 methods that can cause pneumonia to reach the lung?
1. aspiration from the nasopharynx or oropharynx
2. inhalation of microbes present in the air (mycoplastic pneumoniae, fungal pneumonias for ex)
3. hematogenous spread from a primary infection elsewhere in the body (staph aureus for ex.)
Pneumonia is commonly classified into 2 categories besides causative agents. What are they?
1. community acquired pneumonia (CAP)
2. hospital-acquired pneumonia (HAP)
Why is it important to classify pneumonia?
becuase it can differentiate between probable causative organisms and help with selection of appropriate antibiotic therapy.
An infectious disease that usually involves the lungs, but may infect the larynx, kidneys, bones, adrenal glands, lymph nodes, and meninges, and can be disseminated throughout the body. It is caused by Mycobacterium tuberculosis.
Tuberculosis
What are the 2 factors contributing to the resurgence of Tuberculosis?
1. epidemic proportions of TB among HIV patients
2. Emergence of multidrug-resistant strains of M. tuberculosis.
Who is more likely to develop Tuberculosis?
Immunosuppressed persons:
- cancer chemo patients
- long-term corticosteroid therapy
- HIV
- diabetics
A patient presents to the hospital who is already immunosuppressed. The patient is having fatigue, malaise, anorexia, weight loss, low-grade fever, night sweats, frequent productive cough, pleuritic chest pain, and crackles over the apices of the lungs. What is the most likely disease the patient is experiencing?
Tuberculosis
What does the intradermal purified protein derivitive (PPD) test for?
antibody response to tubercle bacilus.
An induration of _____ (or _____ in a immunocompromised person) or greater present after 48-72 hours indicates a positive finding for exposure to TB.
10mm

5mm
What are the four primary drugs used for the treatment of TB?
1. isoniazid (INH)
2. rifampin
3. pyrazinamide
4. ethambutol
What should be done after symptoms of TB are detected in a patient?
1. put on airborne isolation
2. four-drug therapy
3. medical work-up: CXR, sputum smear and culture (acid-fast bacillus)
When is a TB patient considered noninfectious?
After 3 negative AFB smears, they are improving clinically, and are complient with medications and meds proving effective.
These infections are not transmitted from person to person, do not require isolation of the patient, and s/s are similar to bacterial pneumonia.
Pulmonary Fungal Infections
Resembles TB but not transmitted via airborne droplet. Does not grow out in bacterial culture.
Atypical mycoobacteria
How do you treat atypical mycobacteria?
use culture and sensitivity to determine appropriate antibiotics.
Pus-containing lesion that can create a cavity to form. usually caused by some sort of aspuration and an infectious agent. Often occurs as a result of another lung condition.
lung abscess
Cancer originating from the eithelium of the broncuhs. Over 90% of lung cancers.
Bronchogenic
What are common sites of metastatic spread for lung cancer?
liver
brain
bones
scalene lymph nodes
adrenal glands
Most s/s of lung cancer occur late. However, what is one significant early symptom of lung cancer?
-a persistent cough that may be productive of sputum
-also, perhaps localized unilateral chest pain and wheezes.
*it may or may not have blood- hemoptysis is not common in early stages
A patient presents to the hospital with anorexia, fatigue, weight lossm N/V, and hoarseness. They have palpable lymph nodes in the neck and axilla. The patient is a smoker. What is the most probably diagnosis?
lung cancer.
What symptoms of lung cancer may occur as a result of intrathoracic spread of malignancy?
unilateral paralysis of diaphragm
dysphagia
superior vena cava obstruction
What is usually the only successful treatment of lung cancer?
surgical resection

*it is for non small cell stages I and II
* potentially curable
* includes pneumonectomy (removal of one entire lung), lobectomy (removal of a lobe or lobes), resection or wedge.
*is very serious surgery-life threatening, very painful
What is used as an adjunct to surgery for lung cancer?
radiation
What can be done when there is no indication of surgical cure for lung cancer?
Chemotherapy
Lung cancer therapy aimed at using drugs to block the growth of molecules involved in tumor growth
biologic and targeted therapy
Air accumulation in the pleural space
pneumothorax
air accumulation in the pleural space not assocated with an external wound
closed pneumothorax
air enters the pleural space through an opening in the chest wall (ex. GSW, stab wound)
open pneumothorax
What is the most common form of closed pneumothorax?
spontaneous pneumothorax
What can happen due to the rupture of small blebs on the visceral pleural space causing air to enter the pleural space? (the cause of the blebs is unknown)
spontaneous pneumothorax
Who is most likely to develop a spontaneous pneumothorax?
20-40YO underweight male cigarrette smokers.

*there is a tendency for spontaneous pneumo to recur.
Besides spontaneous pneumothorax, how else can closed pneumothorax occur? (there are 5)
1. injury to the lungs from mechanical ventilation
2. injury to lungs from subclavian catheter insertion
3. perforation of the esophagus
4. injury to the lungs from broken ribs
5. ruptured blebs or bullae in a patient with COPD
What kind of dressing should be used on a patient with an open pneumothorax?
a vented dressing (one secured on 3 sides with tape and fourth side left untaped).

*this allows air to escape from the vent and decreases the likelihood of tension pneumothorax from developing.
If an impaled object is causing an open chest wound, what should the nurse do? (should the nurse remove it?)
Stabilize the object with a bulky dressing and NEVER remove without a physician present.
Postop thoracic surgery care centers on promoting ventilation and reexpansion by: (6)
1. maintaining a patent airway
2. promoting comfort by pain relief
3. coughing and deep breathing exercises
4. proper maintenance of a closed drainage system
5. promoting nutrition
6. monitoring for bleeding and subQ emphysema
If a chest tube is inserted in the OR, what kind of incision is used?
thoracotomy incision
If a chest tube is inserted in the ED/bedside, how should the patient be placed? (2 differet ways)
1. sitting position
2. lying down with affected side elevated
what is the most common form of chest injury?
fractured ribs
Results from multiple rib fractures, causing instability of the chest wall. The affected area will move paradoxically to the intact portion of the chest during respiration. On inspiration, a portion sinks in, on expiration, a portion bulges out. This prevents adequate ventilation of the lung in the injured area.
flail chest
A collection of fluid in the pleural space
pleural effusion
What is done to treat pleural effusion?
chest tubes
pleural drainage
An inflammation of the pleura, caused by pneumonia, TB, chest trauma, pulmonary infarctions, and neoplasms.
Pleurisy
A patient presents to the hospital with chest pain. It is sharp, and aggravated by inspiration. A pleural friction rub can be heard on auscultation. The patient also has a recent history of another respiratory problem. What is this patient's most likely secondary respiratory problem called?
Pleurisy
A condition of the lungs characteried by collapsed, airless alveoli. The comst common cause is airway obstruction that results from retained exudates and secretions.
Atelectasis
What is important to prevent and treat patients with atelectasis or at risk for atelectasis?
Deep breathing exercises

*this is necessary to open the pores of Kohn, that are responsible for providing collateral passage of air frmo one alveolus to another.
A respiratory complication that arises from thrombi in the venous circulation or R side of the heart (thromboembolism), or from other sources (ex. fat, air, bone marrow, and foreign IV material). This causes partial or complete occlusion of pulmonary arterial blood flow.
pulmonary embolism
What is the most common source of a pulmonary embolism?
DVT

*the thrombus breaks loose and travels as a clot until it lodges in the pulmonary vasculature. the result is a complete or partial occlusion of the pulmonary arterial blood flow to parts of the lung.
A patient comes to the hospital complaining of dyspnea, chest pain, hemoptysis, anxiety, tachypnea, and tachycardia. What is a probable cause of this patient's symptoms?
pulmonary embolism
What are some s/s of massive emboli when a patient has pulmonary embolism?
sudden collapse
shock
pallor
dyspnea
hypoxia
crushing chest pain

*mortality is high
What are some complications of pulmonary embolism?
pulmonary hypertension
bronchial ischemia
What are some diagnostic studies commonly ordered for a patient suspected of having pulmonary embolism?
VQ scan
ventilation perfusion
D dimer
CT scan
A nurse is caring for a patient at risk for a pulmonary embolism. What managment strategies is she going to implement?
prevention measures
bed rest-semi fowlers
IV therapy
O2 therapy
cardiac monitoring
labs (PTT, INR)
anticoagulant therapy
observe for anxiousness, inability to breathe,etc.
A chroni inflammatory disorder of the airways, or a reactive airway disease.
asthma
Common s/s of asthma that are recurring related to an increase in existing hyperresponsiveness to a varying of stimuli.
wheezing
breathlessness
chest tightness
cough
When are asthma symptoms most prevalent?
at night
early in the morning
Airway inflammation and hyperirritability of the tracheobronchial tree (the 2 hallmarks of asthma) are caused by___1__, ___2___, and __3___ agents.
1. physical
2. chemical
3. pharmacological
What disease is characterized by widespread spasms of the bronchial smooth muscle? (when this happens, excessive secretions ads to airway obstruction.
asthma
What air pollutants trigger asthma attacks?
cigarette or wood smoke
vehicle exhaust
elevated ozone levels
sulfur dioxide
List some triggers of asthma attacks. (9)
allergens
exercise
air pollutants
occupational factors
respiratory infections
nose and sinus problems
drugs and food additives
GERD
emotional stress
What drugs should patients with asthma avoid?
aspirin/NSAIDs
When a patient has a chronic productive cough for 3 or more months in each of 2 successive years and other causes of chronic cough are excluded the patient probably has...
chronic bronchitis
A form of COPD characterized by progressive destruction of alveoli from chronic inflammation, with decreased surface area of respiratory bronchioles, alveoli, and alveolar ducts available for gas exchange.
emphysema
Symptoms in ____ can be reversible.
asthma
symptoms of ______ are not reversible, but are typically progressive. More than 1/2 of patients with it die within 10 years of diagnosis.
emphysema
What is a complication of emphysema and COPD?
cor pulmonale

*hypertrophy of the right side of the heart with or without heart failure resulting from pulmonary hypertension
Name some risk factors of COPD.
cigarette smoking
occupational chemicals and dusts
air pollution
infection
heredity
aging
What are the clinical manifestations of COPD?
- cough
- sputum production
- dyspnea (on exertion and at rest)
- exposure to risk factors
- cyanosis
- polycythemia
- chronic fatigue
- underweight
*also, physical changes such as pulmonary vascular changes and supporting structures of the lungs are destroyed
What are the ABG typical findings?
Low PaO2
Increased PaCO2
Decreased pH
Increased bicarbonate level in late COPD
How is COPD diagnosed?
-pulmonary function tests
- CXR
- spirometry
- history & physical
- ABG
- 6-minute walk test (for O2sat with exercise)
- ECG (for cor pulmonale)
Is low or high flow O2 delivery used more?
low- it is mixed with room air and delivery is less precise than high flow
Why use humidification with oxygen therapy?
used because O2 has a drying effect on the mucosa

supplied by nebulizers, vapotherm, and bubble-through humidifiers
List some complications of O2 therapy
combustion
CO2 narcosis
absorption atelectasis
infection
In COPD, why should O2 therapy be used at home?
- improves prognosis
- improves mental acuity
- improves exercise intolerance.