Med Surg - Respiratory

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created 5 years ago by lsokol04
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updated 5 years ago by lsokol04
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College: Third year, College: Fourth year, Professional
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1

Name the structures of the upper resp tract

nose, sinuses and nasal passages, pharynx, tonsils and adenoids, larnyx, and trachea

2

T/F
The purpose of the cilia is to move the mucus back to the larynx

True

3

Name the structures of the lower resp tract

lungs, pleura, mediastinum, lobes of the lungs (right has 3), bronchi, bronchioles, and alveoli

4

Place where gas exchange takes place

alveoli

5

Gas exchange takes place by ____________

diffusion

6

The movement of air in and out of the airways

ventilation

7

The floor of the thoracic cavity is the ___________

diaphragm

8

Contraction of the diaphragm and contraction of the external intercostal mm increases the space in this chamber. Lowered intrathroacic pressure causes air to enter through the airways and inflate the lungs. This process is known as ___________

Inspiration

9

The process that requires increased pressure that pushes air out of the lungs and involves elastic recoil is _________________

Expiration

10

Inspiration is normally ______ of the resp cycle and expiration is _______.

1/3rd ; 2/3rds -- you expire 2x as long as you inspire

11

The process of gas exchange between atm air and the blood at the alveoli, and between the blood cells and the cells of the body is ___________

Respiration

12

The filling of the pulmonary capillaries with blood is known as ____________

Perfusion

13

Shunting occurs when there is an imbalance of ventilation and perfusion. This results in _____________.

Hypoxia

14

Symptoms of hypoxia are:

Confused, dizzy, lack of o2

15

#1 risk factor for lung cancer

Exposure to/ smoking

16

Inspection should include:

1) Symmetry 2) Dyspnea 3) Use of accessory mm 4) Color - cyanosis? 5) Clubbed finger 6) Resp Rate and Rhythm 7) Chest shape - barrel shape?

17

Near death respiratory pattern is _____________

Cheyne Stokes

18

Characterized as 3-4 irregular breaths then a period of apnea is what breathing pattern?

Biots

19

Fruity acetone breath and an increase in rate and depth is known as what breathing pattern?

Kussmaul

20

Grating, crackling or popping sounds and sensations experienced under the skin and joints or a crackling sensation due to the presence of air in the subcutaneous tissue.

Crepitus "snap, crackle, pop - can happen with chest tubes"

21

When doing a resp assessment, palpate:

1) Sinuses 2) Diaphragmatic Excursion 3) Crepitus

22

When doing a resp assessment, auscultate for:

normal or adventitious breath sounds

23

Normal breath sounds:

Vesicular (inspiration > exp)
Bronchovesicular (=)
Bronchial (ins < exp)

24

Abnormal (adventitious) sounds:

Crackles - rales, discont. high pitch
Wheezes - heard with asthma - narrowing of airway
Friction Rubs - pleurisy

25

T/F
Wheezes are considered a normal breath sound.

False - they are considered an adventitious breath sound

26

Lung Capacity

air volume of each breath

Tidal Volume

27

Lung Capacity

max vol that can be inhaled after a normal inhalation

Insp reserve volume

28

Lung Capacity

max vol that is exhaled after a normal exhalation

Exp reserve volume

29

Lung Capacity

the max vol of air exhaled from a maximal inspiration

Vital Capacity VC = TV + IRV + ERV

30

This instrument measures vol of air exhaled and i used to assess lung capacities.

Spirometer

31

This rate reflects maximal expiratory flow and is frequently done by pt using a home spirometer

Peak Flow Rate

32

This force evaluates the effort of the pt in making an inspiration

Inspiratory Force

33

Normal inspiratory pressure is __________
Force less than ______ usually requires mechanical ventilation

100 cm H20 ; 25 cm

34

What does arterial blood gases measure?

Measurement of arterial oxygenation and co2 levels

35

What is an ABG used to assess?

The adequacy of alveolar ventilation and the ability of the lungs to provide oxygen and remove co2 --- it also assesses ACID BASE BALANCE

**Asthma, Copd

36

A noninvasive method to monitor the oxygen saturation of blood

Pulse Oximetry

37

T/F
Pulse oximetry can be used to replaced an ABG.

False

38

A mask is a form of oxygen therapy used for pt who need _____ concentrations of o2

high

39

A nasal cannula is a form of oxygen therapy that can deliver _______ L 02/minute.

1-6 L

40

When you are not sure, you should give no more than ____ L of o2.

2

41

When a pt is required to use an incentive spirometer, how often should he use it?

10 reps every hr while awake

42

Which diagnostic test should be done first thing in the morning after oral care?

Sputum tests/ throat culture

43

T/F

A consent must be signed before any invasive procedures.

True

44

What pt education should be given before undergoing a bronchoscopy?

NPO 6-8 hrs - no gastric contents

45

When caring for a pt who has a drainage system, where should it be kept?

Always keep on the floor below lvl of chest tube site w/no kinks in tubing

46

If you see air bubbles in the chest drainage system, what should you do?

Call the Dr.

47

A surgically created breathing hole in the neck

Tracheostomy

48

How often should a nurse do trach care?

Every 8 hrs

49

When would a pt receive a tracheostomy?

When the pt is not getting air flow from the UR to the LR

50

What are the three parts to a tracheostomy?

Outer cannula with flange (neck plate), inner cannula, and an obturator

51

Inflammation of the sinus mucosa

Sinusitis (Rhinosinusitis)

52

_____ and ______ are used to dx Sinusitis (Rhinosinusitis)

ct scan and xray

53

Signs and symptoms of Sinusitis

pain over affected sinus, fever/chills, nasal discharge

54

Inflammation of the nasal mucous membranes. The release of histamines cause vasodilation and edema which is what causes the symptoms of __________

Rhinitis

55

S/s of bacterial rhinitis

nasal congestion, itching, sneezing, and nasal discharge (typically cold)

56

S/s of viral rhinitis (common cold)

fever and malaise

57

Inflammation of the pharynx

Pharyngitis

58

S/s of Pharyngitis

red, swollen, sore throat; pus may be present, dysphagia, fever, chills, and malaise

59

Pharyngitis is commonly known as :

Strep Infection

60

Ppl who smoke and use ETOH habitually, use their voice a lot, and are around much dust are at risk for _________ pharyngitis

Chronic

61

Inflammation of the larynx caused by inflammation, vocal abuse, occasionally GERD

Laryngitis

62

S/s of laryngitis are

hoarseness and sore throat

63

T/F

Acute pharyngitis of a bacterial nature is most commonly caused by group A, beta hemolytic streptococci

True

64

Bacteria in the blood

Sepsis

65

When doing an assessment on someone with an upper resp infection, inspect the nose, neck, and throat and palpate what?

lymph nodes

66

Potential complications of someone with an upper respiratory infection are: (5)

Sepsis, meningitis, peritonsillar abscess, otitis media, and siusitis

67

What are 5 nursing dx that were mentioned in class for upper resp infections?

Ineffective airway clearance, acute pain, impaired verbal communication, deficient fluid volume, and deficit of knowledge related to prevention, treatment, surgical procedure, and post op care

68

How many L a day should be encouraged as an intervention for an upper resp infection?

2-3 L a day

69

The #1 prevention of upper airway infections is:

Hand washing

70

T/F

An early sign of cancer of the larynx in the glottic are enlarged lymph nodes.

False - hoarseness

71

Cancer of the larynx is most common in _______ of ages 60-70 yrs old.

males

72

Collapse or airless condition of alveoli caused by hypoventilation, obstruction to airways, or compression

Atelectasis

73

Who is at high risk for atelectasis?

post op pt

74

What type of breath sounds are common in pt who have atelectasis?

diminished or crackles over the area

75

T/F

Turning a pt once per shift will prevent atelectasis.

False - frequent turning and early mobilization

76

What strategies improve ventilation?

deep breathing exercises every 2 hrs and using an incentive spirometer

77

What strategies can be used to remove secretions?

coughing, suctioning, aerosol therapy, chest physiotherapy

78

T/F

A bronchoscopy may be used to remove obstruction of the airway

True

79

When diagnosing pneumonia, a sputum culture must be taken when?

prior to starting ATB and after oral care

80

If an etologic agent of pneumonia is not identified, utilize ___________ antibiotic therapy.

Empiric

81

What lung sound would a nurse expect to hear when listening to a pt who has pneumonia?

crackles

82

What coughing technique is encouraged to improve airway clearance of someone who has pneumonia?

Huffing cough

83

What medical position promotes breathing?

Semi-Fowlers (fowlers)

84

Seizure activity, brain injury, decreased lvl of consciousness, endotracheal intubation, flat body positioning, stroke, swallowing disorder, cardiac arres are ALL RISK FACTORS FOR _______________

Aspiration

85

Aspiration of stomach contents into the lungs is a serious complication that can cause _________

pneumonia

86

When a nonfunctioning nasogastric tube allows gastric contents to accumulate in the stomach, a condition known as _________ aspiration may result

Silent

87

What are some ways to prevent aspiration?

1) elevate HOB, turn pt to side when vomit 3) prevent stim of gag reflex with suctioning

88

S/s of TB

cough, **blood tinged sputum, night sweats, anorexia and weight loss, low grade fever, dyspnea and chest pain (late)

89

What is the difference between a purified protein derivitive (ppd) and quantiferon tb gold test are test?

PPD is intradermal and a positive test would indicate an induration at the site; whereas, a quantiferon tb gold test is a blood test.

90

If the PPD is positive, a person must do what type of test thereafter?

a chest xray

91

What type of room is a pt placed in and what type of mask must a nurse where when she enters the room for protection?

a Neg press rm; a N95 mask

92

Inflammation of both layers of pleurae caused by URI, TB, PE, Pneumonia, and Trauma to chest

Pleurisy

93

What happens during pleurisy?

inflamed surfaces rub together with respirations causing sharp pain that is intensified with each inspiration

94

Collection of fluid in pleural space - and is usually secondary to another disease. Caused by heart failure, TB, pneumonia, bronchogenic carncinoma

Pleural Effusion

95

Pt who are diagnosed with pleural effusion may have __________ deviation

tracheal

96

Accumulation of THICK, PURULENT fluid in pleural space

Emphysema

97

Emphysema usually occurs as a complication of ________ pneumonia or lung abcess

bacterial

98

Characterized by sudden, progressive pulmonary edema, increasing bilateral lung infiltrates on CXR, hypoxemia refractory to ox2 therapy, decreased lung compliance

Acute Respiratory Distress Syndrome (ARDS)

99

ARDS is severe form of acute lung injury and most pts are sent to __________

ICU and on a vent

100

What are the symptoms of ARDS

Rapid onset of SEVERE dyspnea, hypoemia that does not respond to supp oxygen

101

ARDS pts require ____________

Intubation

102

obstruction of pulmonary artery or branch by blood clot, air, fat, amniotic fluid, or septic thrombus

Pulmonary Embolism - most blood clots from leg veins

103

The first s/s of a pulmonary embolism is _________

sudden onset dyspnea

104

When diagnosing a pulmonary embolism, it should be confirmed with a ___________

lung scan

105

T/F

Bradypnea is the most common sign for a possible pulmonary embolism

False - sudden onset of dyspnea

106

Occupational lung disease that causes death to 124,846 ppl in the US

Pneumoconiosis - Prevention is key!

107

Lung Cancer

Small cell and large cell grow ________; whereas, adenocarcinoma does not.

rapidly

108

What is the most common surgery for a small apparently curable tumor of the lung?

Lobectomy

109

Spontaneous pneumothroax is most commonly seen in __________ pts

tall, thin

110

The trachea is not midline is this type of pneumothorax

traumatic

111

In this type of pneumothorax,air enters and can't leave so pressure is built up

Tension pneumothorax

112

Commons s/s of pneumothorax are:

sudden onset of chestpain (simple) asymmetrical chest expansion and tracheal deviation

113

Best treatment for pneumothorax is __________ and ___

chest tube and o2

114

Tension pneumothorax s/s are:

tracheal deviation to the unaffected side, cyanosis, shock, hypotension

115

T/F

An initial characteristic symptom of a simple pneumothorax is a sudden onset of chest pain

True

116

Characterized by airflow limitation that is not full reversible (GOLD)

COPD

117

T/F

COPD is currently the 4th leading cause of death and the 12th leading cause of disability

True

118

COPD includes what two diseases or a combo of ?

Emphysema and Chronic Bronchitis

119

Characterized by the presence of a cough and sputum production for at least 3 months in each of 2 consecutive years

Chronic Bronchitis

120

What types of respiratory sounds would a nurse expect to hear in a pt who has chronic bronchitis?

Crackles and Wheezing

121

T/F

For pt with chronic bronchitis, the nurse expects to see the major clinical symptoms of tachypnea and tachycardia

False - wheezes, sputum, cough, shortness of breath

122

Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli

Emphysema

123

Decreased alveolar surface area causes an increase in ______ and impaired oxygen diffusion

dead space

124

Increased pulmonary artery pressure may cause ____________ heart failure

right-sided

125

A pt with emphysema will present what type of chest due to air trapping?

barrel chest

126

What is the primary clinical symptom of emphysema?

Wheezing

127

Typical posture of someone who has COPD is

shoulders rising using sternocleidomastoid mm and leaning forward

128

Leading cause of COPD

Smoking

129

T/F

A commonly prescribed methyxanthinine is theophylline.

True

130

A chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucous production.

Asthma

131

The most chronic disease of childhood

Asthma

132

The strongest prediposing factor to asthma is ________

allergies

133

Severe, sustained asthma is called _________

Status Asthmaticus - may be life threatening

134

You must rinse your mouth after using this long acting medication for asthma to avoid getting thrush

Corticoteroids (Advair)

135

Singulair is this type of medication

Leukotriene

136

What type of breathing technique should a person with asthma use?

Purse lip breathing

137

The most common fatal autosomal recessive disease AMONG CAUCASIAN population

Cystic Fibrosis

138

Characterized by thick, viscous secretions of sputum making it hard to breathe, __________ is key!

airway clearance