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;
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% |