Term
Air enters the ______ - to the bronchi - to the secondary bronchi which enter the __ lobes of the lungs. |
|
Definition
|
|
Term
once air is passed through the secondary bronchi where does thee air go next? |
|
Definition
bronchioles
which are less than a millimeter in diameter. |
|
|
Term
onece air has passes the bronchioles it goes to the _______ |
|
Definition
|
|
Term
_______ are the grape like structures, these have surfactant secreted to decrease surface tension. |
|
Definition
|
|
Term
what types of cells are at alveolus site |
|
Definition
|
|
Term
The respiratory system has high arterial compliance
which means |
|
Definition
it accommodates a blood flow equal to ALL other organs together |
|
|
Term
The alveoli have poor capillary bed exchange
True or Fales |
|
Definition
Fales
Richest capillary bed |
|
|
Term
how thick is it at the sight of gas exchange |
|
Definition
1 micron across-single cell transport |
|
|
Term
How much blood is in the pulmonary circuit compared to the body at one time? |
|
Definition
Less than 1/5 -(1Liter)-of blood the pulmonary circulation with 100cc in capillaries at one time |
|
|
Term
What system runs parallel to the blood vessels? |
|
Definition
|
|
Term
how might having the Lymphatics next to the blood vessels complicite health? |
|
Definition
may lead to the spread of CA's |
|
|
Term
What are visceral and parietal pleura held together by |
|
Definition
a thin layer of serous fluid |
|
|
Term
Visceral and parietal pleura are a _______ space? |
|
Definition
|
|
Term
What is the range of Intrapleural pressure |
|
Definition
754-757 mmHg
if it is out of this range it indicates a problem |
|
|
Term
What are ABG's reported as? |
|
Definition
Partial pressures O2 or CO2 |
|
|
Term
What oxygen transported by? |
|
Definition
|
|
Term
O2 transport-each 100 ml of blood contains
____ of O2 with __ % dissolved in plasma |
|
Definition
20ml of O2
3% dissolved in plasma |
|
|
Term
What receptors aid in respiration? |
|
Definition
chemo receptors, stretch receptors |
|
|
Term
What part of the brain (Central controller) controls respiration |
|
Definition
|
|
Term
What do Chemo-receptors sense |
|
Definition
Changes in PCO2 and ph sensed in anterior medulla
Changes in CSF H+ levels |
|
|
Term
How do Chemo-receptors sense changes in the body? |
|
Definition
H+ and HCO3 diffuse slowly across BBB |
|
|
Term
What do Carotid bodies and aortic bodies respond to? |
|
Definition
|
|
Term
What are the respiratory Lung Receptors
and where are they located? |
|
Definition
Proprioceptors in muscles and joints
Pulmonary airway smooth muscle
Irritant receptors |
|
|
Term
if any of the bodies receptors associated with respiration are damage what can result? |
|
Definition
|
|
Term
What should be included in a pt respitory history |
|
Definition
Medical History/Occupational Exposures Medications/Drugs
Cultural factors, Smoking history
Sputum, Cough, Chest Pain, Allergies |
|
|
Term
What test can show repository problems before a pt becomes symptomatic? |
|
Definition
Pulmonary Function Testing |
|
|
Term
What is the Tidal volume of the Pulmonary Function Testing |
|
Definition
amount of air inhaled and exhaled with each breath. |
|
|
Term
What is the normal range for the Tidal volume |
|
Definition
|
|
Term
What is the Minute volume of the Pulmonary Function Testing |
|
Definition
Tidal volume (TV) x RR or the amount of air that can be inhaled and exhaled from a person over one minute. |
|
|
Term
What is the Vital capacity of the Pulmonary Function Testing
|
|
Definition
amount of air that can be forcefully exhaled after a deep inspiration. |
|
|
Term
What is the Residual volume of the Pulmonary Function Testing
|
|
Definition
the amount of air left in the lungs after a full forced exhalation. |
|
|
Term
What is the Functional residual capacity of the Pulmonary Function Testing |
|
Definition
amount of air left in the lungs after a normal expiration. |
|
|
Term
A nurse is doing a respitory assassment what can the nurse do before starting to insure her assessment is done well? |
|
Definition
Good light
No clothes- LOOK at the chest, not the gown covering
Position pt for comfort |
|
|
Term
How would a nurse progress in an orderly fashion when doing a respiratory assessment |
|
Definition
Work from top down
anterior to posterior
move as little as possible
Do not to wear the patient out |
|
|
Term
A nurse is doing a respitory assessment and notices these things: Trachea midline, ↑ anterior Chest expansion, Tripoding.
What should the nurse report to the MD as an abnormality? |
|
Definition
↑ anterior Chest expansion, Tripoding |
|
|
Term
|
Definition
|
|
Term
What does Nasal flaring indicate? |
|
Definition
may indicate increased respiratory effort |
|
|
Term
How should a nurse observe the interior nose? |
|
Definition
ask the patient to tilt the head back for a penlight examination. Use a nasal speculum and nasopharyngeal mirror for a more thorough inspection of the nasal cavity. |
|
|
Term
What should a nurse be observing the interior nose |
|
Definition
color, swelling, drainage, and bleeding. |
|
|
Term
How would the nurse recognize a perforated septum
what may it indicate about ur pt |
|
Definition
present on pen light inspection: if the light shines through the perforation into the opposite nostril.
this condition is often found in cocaine users. |
|
|
Term
How do Nasal polyps appear to the viewer? |
|
Definition
are pale, shiny, gelatinous lumps or "bags" attached to the turbinates. |
|
|
Term
how should the nurse check for nasial unblockage? |
|
Definition
Block one naris at a time to check whether air moves through the unblocked side easily. |
|
|
Term
How should the nurse assess the pharynx |
|
Definition
use a tongue depressor to press down one side of the tongue at a time (to avoid stimulating the gag reflex). As the patient says "ah," |
|
|
Term
What should the nurse look for when assessing the pharynx |
|
Definition
observe the rise and fall of the soft palate and uvula and inspect for color and symmetry, evidence of discharge (postnasal drainage), edema or ulceration, and enlarged or inflamed tonsils. |
|
|
Term
What should the nurse inspect the neck for? |
|
Definition
symmetry, alignment, masses, swelling, bruises, and the use of accessory neck muscles in breathing. Palpate lymph nodes for size, shape, mobility, consistency, and tenderness. |
|
|
Term
Tender nodes are usually movable and suggest __________. |
|
Definition
|
|
Term
Malignant nodes are often ____ and are fixed to the surrounding tissue. |
|
Definition
|
|
Term
The space on each side of the trachea should be _____. |
|
Definition
|
|
Term
What lung disorders cause the trachea to deviate from the midline. |
|
Definition
push the trachea away from the affected area: Tension pneumothorax, large pleural effusion, mediastinal mass, and neck tumors
pull the trachea toward the affected area: Pneumonectomy, fibrosis, and atelectasis |
|
|
Term
How is the larynx usually examined? |
|
Definition
by a specialist with a laryngoscope. |
|
|
Term
What is the # 1 symptome that indicates a problem with the larynx |
|
Definition
An abnormal voice, especially hoarseness, may be heard when there are problems of the larynx. |
|
|
Term
When the nurse is inspecting the chest what should she be looking for? |
|
Definition
discoloration, scars, lesions, masses, and spinal deformities such as kyphosis, scoliosis, and lordosis. |
|
|
Term
Why should a nurse assess the lungs side to side? |
|
Definition
Assessing from side to side allows you to compare the assessment findings for each lung at the same level. |
|
|
Term
Impaired movement or unequal expansion may indicate: |
|
Definition
disease of the lung or the pleura |
|
|
Term
Observe the type of breathing:
What types may you see |
|
Definition
pursed-lip or diaphragmatic breathing and the use of accessory muscles. |
|
|
Term
What are Retractions and what do they indict |
|
Definition
Retractions are areas that get sucked inward when the patient inhales. This does not occur during normal respiratory effort.
occur when the patient is working hard to inhale around an obstruction. |
|
|
Term
Palpate the chest ____ inspection. |
|
Definition
|
|
Term
What is the nurse looking for when Palpating |
|
Definition
respiratory movement symmetry and observable abnormalities, to identify areas of tenderness, and to check vocal or tactile fremitus (vibration). |
|
|
Term
How should the nurse assess chest expansion |
|
Definition
by placing your thumbs on the patient's spine at the level of the ninth ribs and extending the fingers sideways around the rib cage. As the patient inhales, both sides of the chest should move upward and outward together in one symmetric movement and move your thumbs apart. On exhalation, the thumbs should come back together as they return to the midline. |
|
|
Term
If while assessing chest expansion there is decreased movement on one side what might this indicate? |
|
Definition
may be a result of pain, trauma, or pneumothorax (air in the pleural cavity). |
|
|
Term
|
Definition
slowed movement on one side
occurs with the presence of a pulmonary mass, pleural fibrosis, atelectasis, pneumonia, or a lung abscess. |
|
|
Term
|
Definition
air trapped in and under the skin, also known as subcutaneous emphysema |
|
|
Term
How will the nurse reconise Crepitus in a pt |
|
Definition
Palpate- is felt as a crackling sensation beneath the fingertips. Document this finding when it occurs around a wound site or a tracheostomy site or if a pneumothorax is suspected. |
|
|
Term
Why should the nurse instruct the patient to breathe slowly and deeply through an open mouth while Auscultation of the lungs? |
|
Definition
Breathing through the nose sets up turbulent sounds that are transmitted to the lungs |
|
|
Term
a nurse chart the breath sounds as being adventitious. what does this mean? |
|
Definition
describes the breath sounds as UNUSUAL |
|
|
Term
Where are Bronchial Breath Sounds heard over |
|
Definition
heard over trachea and larynx |
|
|
Term
Where are Bronchiovesicular Breath Sounds heard over |
|
Definition
heard over the major bronchi, posterior between the scapulae, anterior around the upper sternum and 1st &2nd intercostal spaces. |
|
|
Term
What aria are Vesicular Breath Sounds heard in |
|
Definition
heard in the peripheral lung fields |
|
|
Term
What are the two most common lung sounds you will hear |
|
Definition
|
|
Term
how would a nurse describe Crackles to a pt who asks what it means? |
|
Definition
these are short bubbling or popping sounds that can usually be heard on inspiration. Associated with several conditions |
|
|
Term
how would a nurse describe Wheezes to a pt who asks what it means?
|
|
Definition
these are high pitched or low pitched/moaning and can be heard during inspiration or expiration. Caused by narrowed airways |
|
|
Term
Chronic airflow limitation or CAL, includes:
3 |
|
Definition
asthma, chronic bronchitis and emphysema |
|
|
Term
What conditions are referred to as COPD or chronic obstructive pulmonary disorder.
2 |
|
Definition
Chronic bronchitis and emphysema |
|
|
Term
What is Pectus excavatum or Funnel chest |
|
Definition
the sternum is depressed from the second intercostal space, more pronounced with inspiration; a congenital anomaly |
|
|
Term
What is Pectus excavatum or Pigeon chest |
|
Definition
the sternum abnormally protrudes; the ribs are sloped backward; a congenital anomaly |
|
|
Term
What is the Criteria for Chronic Bronchitis
|
|
Definition
Inflammation of the bronchichronic cough with excessive mucous
3 months/yr. X 2 consecutive yrs.
Eventually constant |
|
|
Term
What is Chronic Bronchitis Disease Course |
|
Definition
Initially affects large airways then eventually affects all airways
Secretions are thick & tenacious ® booger balls ® air trapping (ball-valve effect) |
|
|
Term
What may proceed the Onset of Chronic Bronchitis
|
|
Definition
Insidious : May follow Asthma, Influenza, Pneumonia
Usu. seen in middle age Early s/s often attributed to aging |
|
|
Term
Chronic Bronchitis Clinical Manifestations Early |
|
Definition
l Cough with thick white mucus– Esp. in A.M./P.M.
l Bronchospasm during coughing episodes
l Freq. resp. infections in winter- May last several weeks |
|
|
Term
Chronic Bronchitis Clinical Manifestations: Disease Progression |
|
Definition
Orthopneic/tripod, (cor pulmonale) Sputum becomes: Purulent yellow, Copious, Blood streaked after severe coughing. Cyanosis/clubbing, confusion, photophobia. Course crackles/rhonchi/wheezing. Speaks in short choppy sentences. dyspnea at rest ¯ Mobility r/t SOB |
|
|
Term
Chronic Bronchitis Management Goals |
|
Definition
Prevent irritation & infection of bronchial mucosa Maintain resp. function, Remove secretions |
|
|
Term
In bronchitis what is the effect of chronic inflammation |
|
Definition
increase in number of mucous glands
• production of large amounts of thick mucus
• bronchial walls thicken
• impaired airflow. |
|
|
Term
Etiology of brochitis (in order of occurrence): |
|
Definition
cigarette smoking, alpha-antitrypsin deficiency-an autosomal recessive genetic disorder, air pollution. |
|
|
Term
What is the difference between emphysema and chronic bronchitis? |
|
Definition
in bronchitis only airway effected rather than alveoli. |
|
|
Term
|
Definition
Abnormal, permanent enlargement of the air spaces distal to the terminal bronchioles accompanied by destruction of alveolar walls |
|
|
Term
What is Emphysema caused by? |
|
Definition
Imbalance in proteolytic enzyme & protease ® alveoli ¯ elasticity → air trapped → over inflation → destruction of alveolar walls → one great big alveoli (blebs & bullae) |
|
|
Term
What is Emphysema r/t and when is the typica onset? |
|
Definition
– r/t smoking
– Onset between 30-40 y/o if AAT |
|
|
Term
How might a pt's chest apper who has Emphysema
Why? |
|
Definition
Increased A-P diameter (barrel shaped chest) Chest rigid ® inspiratory difficult
r/t hyper inflation & air trapping |
|
|
Term
What is the 1st S/S of Emphysema |
|
Definition
|
|
Term
Emphysema Clinical Manifestation Advanced disease |
|
Definition
Memory loss, Impaired judgment, Drowsy, confused Increased PCO2, Muffled sounds |
|
|
Term
How would a pt's PFT look if they have Emphysema |
|
Definition
¯ overall lung function
↑ Total lung capacity & residual volume
¯ Vital capacity & forced exp. volume |
|
|
Term
AP diameter
Like to sit leaning forward
Hypertrophy of accessory muscles of upper chest & neck
Which of these are you likely to observe in a pt with Emphysema |
|
Definition
All:
AP diameter
Like to sit leaning forward
Hypertrophy of accessory muscles of upper chest & neck |
|
|
Term
T/F
a pt with Emphysema will need a high flow of o2 |
|
Definition
Fales
Pt with Emphysema can be harmed by high o2 flow. Don’t turn up O2 without MD's ok |
|
|
Term
a pt is newly diagnosed with emphazema what might a nurse teah this pt |
|
Definition
– Monitor air quality before going out
– Avoid cold air & wind
l Causes bronchospasms
– Monitor & report sputum to MD |
|
|
Term
a nurse is taking care of a pt with COPD. the nurse should try to reduce ______, by teaching relaxation. |
|
Definition
|
|
Term
how might a nurse teach a pt energy conservation |
|
Definition
teach the pt to have pland rest
do activites in am when energy is high |
|
|
Term
A pt with COPD has loosed 20 lbs sinces his last visit to the Drs. What should the nurse teach the pt about his nutrition? |
|
Definition
Eat small frequent meals and nutritionally dense foods |
|
|
Term
What complications should a nurse plann for when taking care of a pt with COPD? |
|
Definition
|
|
Term
What types of Medications would you expect a pt with copd to be on? |
|
Definition
bronchodilators, steroids, non-steroidal agents |
|
|
Term
Examples of Bronchodilators |
|
Definition
Short acting Beta² agonist: Albuterol, Terbutaline
Long acting Beta² agonist: Serevent
Methylxanthines: Theophylline (Theo-Dur), Aminophylline
Cholinergic antagonists: Atrovent |
|
|
Term
What should the nurse know about the Xanthines? |
|
Definition
have a narrow therapeutic range and are potentiated by caffeine. Overstimulation can have effects on the heart |
|
|
Term
What Anti-inflammatories are used to treat COPD? |
|
Definition
Steroids: Prednisone
Leukotriene antagonists: Accolate
Mast cell stabilizers: Cromolyn
Inhaled anti-inflammatory: new-Tilade (non-steroidals inhibit the release of inflammatory mediators from the respiratory epithilium) |
|
|
Term
When should Steroids be used in a pt with COPD? |
|
Definition
are usually given in exacerbations rather than long term with a burst and taper regime. |
|
|
Term
With long term steroids you need to watch for:
7 |
|
Definition
GI ulceration, poor wound healing, decreased immune function, weight gain, hyperglycemia, personality changes and fluid retention. |
|
|
Term
What Surgeries are done for pts with COPD
Why? |
|
Definition
lung transplantation, lung reduction.
This improves gas exchange in the patient with COPD. This can improve the FEV by 75% and reduce the TLC and RV while increasing quality of life and activity tolerance. |
|
|
Term
|
Definition
An intermittent process
Reversible airflow obstruction and wheezing |
|
|
Term
What are the common Asthma triggers
4 |
|
Definition
1. Cold air, dry air
2. air borne particles such as dust and dander.
3. Microorganisms.
4. Exercise. |
|
|
Term
Asthma is caused by what Pathology? |
|
Definition
Inflammation → Bronchoconstriction |
|
|
Term
Asthma
Pulmonary function tests that are affected include:
• FVC (forced vital capacity) |
|
Definition
which is the air exhaled during a full exhalation phase,
goes down |
|
|
Term
Asthma
Pulmonary function tests that are affected include:
FEV1 (forced expiratory volume at 1 second) |
|
Definition
volume blown out as hard and fast as possible during 1 second of the most forceful exhalation
goes down |
|
|
Term
Asthma
Pulmonary function tests that are affected include:
PEF (peak expiratory flow) |
|
Definition
the fastest airflow rate reached at anytime during the FVC.
A decrease in either the FEV1 or the PEF of 15% to 20% below expected levels for age/gender is common in asthma |
|
|
Term
A increase in either the FEV1 or the PEF of 12%, after treatment with a bronchodilator is ________. |
|
Definition
|
|
Term
What are the Goals of Asthma-treatment
3 |
|
Definition
Goals-improve airflow, relieve symptoms,
prevent episodes |
|
|
Term
Asthma Diagnostic Findings |
|
Definition
PFT’s – ¯ Forced expiratory volume & forced vital capacity – Total lung capacity & functional residual volume ABGs (during attack) – ¯PO2 – ¯PCO2 (r/t ↑ resp. rate) – early – PCO2 ↑ late |
|
|
Term
Asthma Medical Management , Symptomatic during attack |
|
Definition
Bronchodilators – SVN
Terbutaline-a bronchodilator SQ
Aminophyline -Xanthine derivative IV gtt. |
|
|
Term
Asthma Medications, Maintenance – MDI/PO |
|
Definition
Steroids (prefer inhaler)
Mast cell inhibitors :Cromyln inhaler
Leukotriene inhibitors: Singulair, Accolate
Long acting bata agonist- Serevent
|
|
|
Term
What Client Teaching would a nurse do for a pt with Asthma 5
|
|
Definition
Peak flow meter, Correct use of meds & MDI, Help ID & avoid triggers, Relaxation techniques, Breathing exercises |
|
|
Term
When is Respiratory failure diagnosed |
|
Definition
when there are blood gas abnormal readings.
Specifically the PaO2 is less than 60mmHg, SaO2 is less than 90%, and PaCO2 is greater than 50mmHg with a pH <7.3. |
|
|
Term
What are the types of Respiratory Failure? |
|
Definition
oxygenation failure, ventilatory failure or a combination.
and Adult Respiratory Distress Syndrome |
|
|
Term
What are the Symptoms a nurse may see in a pt with Respiratory failure |
|
Definition
Dyspnea (difficulty breathing)
DOE (dyspnea on exertion)
Orthopnea-is shortness of breath changes in respiratory rate or pattern
Abnormal lung sounds-wheezing
Decreased oxygen saturation
Abnormal ABGs |
|
|
Term
In Respiratory failure how will ABGs be abnormal |
|
Definition
1. Hypercapnia- ↑ CO2
2. Hypoxemia- ↓ O2 |
|
|
Term
What is Ventilatory Failure |
|
Definition
Ventilation-perfusion (V/Q) mismatching
Perfusion is normal, ventilation is inadequate
Inappropriate air movement in and out of lungs
Insufficient oxygen reaches alveoli, carbon dioxide is retained |
|
|
Term
What Mechanisms can cause Ventilatory Failure
3 |
|
Definition
1. Abnormality of lungs or chest wall
2. Defect in respiratory control center in the brain
3. Impairment in function of the respiratory muscles |
|
|
Term
a pt in Ventilatory Failure, what will there PaCO2 look like? |
|
Definition
|
|
Term
What is Oxygenation Failure |
|
Definition
Thoracic pressure changes are normal
Lungs cannot oxygenate pulmonary blood
Result of V/Q mismatch
Ventilation is normal, perfusion is decreased |
|
|
Term
What is Combination Failure |
|
Definition
1. Hypoventilation: insufficient respiratory movement
2. Inadequate gas exchange at alveolar-capillary membrane |
|
|
Term
Acute respiratory distress syndrome (ARDS) is acute respiratory failure with these indicators:
5 |
|
Definition
• Hypoxemia that persists even when 100% oxygen is given
• Decreased pulmonary compliance
• Dyspnea
• Noncardiac-associated bilateral pulmonary edema
• Dense pulmonary infiltrates on x-ray (ground-glass appearance) |
|
|
Term
What does ARDS offten occurs after? |
|
Definition
ARDS occurs after an acute lung injury (ALI) as a traumatic event in people who have no previous pulmonary disease. |
|
|
Term
A nurses best action when a pt is diagnosed with ARDS is to tell the family that the pt has a very high chances of survival and not to worry.
T/F? |
|
Definition
False
The mortality rate is high even when intensive interventions are used. |
|
|
Term
When a family member of a pt asks what was the cause of the ARDS, what is the nurses best responce. |
|
Definition
an injury leading to a systemic inflammatory response, that damaged the lungs. |
|
|
Term
Lung tissue normally remains relatively dry.
How will the lungs appear in patients with ARDS? |
|
Definition
lung fluid increases and contains a high level of proteins |
|
|
Term
From the start of the respiratory distress/ injury how rapid is the onset of ARDS? |
|
Definition
Rapid onset-12-24 hours, within 72 hrs of injury |
|
|
Term
What is the nursing priority in the prevention of ARDS? |
|
Definition
early recognition of patients at high risk for the syndrome. |
|
|
Term
What patients are at high risk for ARDS? |
|
Definition
thoughs who have sustaind a Trauma
and or patients who have a hyper-inflammatory responses to injury (genetic) |
|
|
Term
Pts with ARDS have a widening alveolar oxygen gradient
What does this mean? |
|
Definition
increased fraction of inspired oxygen [Fio2] does not lead to increased Pao2 levels
They can not use the oxygen they are breathing in. |
|
|
Term
What is refractory hypoxemia |
|
Definition
Pt does not respond to high concentrations of oxygen
Pt is unable to use the oxygen that is inspired |
|
|
Term
What is the typical cores of action the nurse should expect for a pt experiencing refractory hypoxemia? |
|
Definition
The pt may need intubation and mechanical ventilation. |
|
|
Term
What will the chest x-ray of a pt with ARDS usually show |
|
Definition
diffuse haziness or a "whitedout" (ground-glass) appearance of the lung. |
|
|
Term
A nurse is doing an assessment on a pt with ARDS what should the nurse recognizes as a problem r/t breath sounds? |
|
Definition
Hyperpnea, grunting respirations,
BS may be initially normal
|
|
|
Term
A nurse is doing an assessment on a pt with ARDS what should the nurse recognizes as a problem r/t skin? |
|
Definition
Cyanosis, pallor
Diaphoresis
|
|
|
Term
A nurse is doing an assessment on a pt with ARDS what should the nurse recognizes as a problem r/t the movment of the breath? |
|
Definition
Retraction intercostally/suprasternally |
|
|
Term
A nurse is doing an assessment on a pt with ARDS what should the nurse recognizes as a problem r/t LOC? |
|
Definition
|
|
Term
A nurse is doing an assessment on a pt with ARDS what should the nurse recognizes as a problem r/t cardiovascular |
|
Definition
Hypotension
Tachycardia and tachypnea
Dysrhythmias
Decreased PaO2 |
|
|
Term
What Interventions should the nurse expect to see when a pt has ARDS? |
|
Definition
Treat underlying cause
Endotracheal intubation
Mechanical ventilation
Drug/fluid therapy
Steroids controversial-given early
Nutrition therapy- either tube feeding or TPN |
|
|
Term
The nurse knows that early intervention with ARDS crucial
so what should the nurse be assessing? |
|
Definition
Monitor ABG’s , lungs
Judicial fluid status, sepsis possible
Watch for oxygen toxicity
PEEP complications |
|
|
Term
What are the benefits of Mechanical Ventilation |
|
Definition
Improves oxygenation and ventilation
Decreases amount of work for effective breathing
Provides respiratory support until lung function is adequate |
|
|
Term
Complications of Mechanical Ventilation
Cardiac |
|
Definition
1. Hypotension
2. Fluid retention |
|
|
Term
Complications of Mechanical Ventilation
Lung |
|
Definition
1. Barotrauma
2. Volutrauma
3. Acid-base abnormalities |
|
|
Term
Complications of Mechanical Ventilation
GI and nutritional |
|
Definition
1. Stress ulcers
2. Paralytic ileus
3. Malnutrition
4. Carbohydrates increase CO2 production
5. Electrolyte imbalance |
|
|
Term
What is a pulmonary embolism (PE)? |
|
Definition
a collection of particulate matter (solids, liquids, or air) that enters venous circulation and lodges in the pulmonary vessels. |
|
|
Term
many patients die of a PE within 1 hour of the onset of symptoms or before the diagnosis has even been suspected.
T/F? |
|
Definition
|
|
Term
|
Definition
Nidus-sight of injury
Clotting cascade
Fibrin thrombus
Walls and valves inflammed
Attachment fragile- may break off |
|
|
Term
Is this a mismatch on the ventilatory or the perfusion side of the V/Q from a PE? |
|
Definition
perfusion
A PE will block pulmonary circulation |
|
|
Term
What will the PE lead to? |
|
Definition
Decreased systemic oxygenation
Pulmonary tissue hypoxia→ tissue damage |
|
|
Term
What are the Risk Factors for a PE |
|
Definition
Immobilization
Surgery
Obesity
Hypercoagulability
Smoking
Pregnancy
Estrogen Therapy (i.e birth control)
Trauma, certain diseases, central lines
Advancing age
History of embolus |
|
|
Term
Manifestations/Symptoms of a PE
Respiratory |
|
Definition
dyspnea
tachypnea
pleuretic chest pain
hemoptysis- expectoration (coughing up) of blood
ABG=hypoxemia |
|
|
Term
Manifestations/Symptoms of a PE
Cardiac |
|
Definition
tachycardia
syncope
cyanosis
S3, S4 possible |
|
|
Term
Manifestations/Symptoms of a PE
Miscellaneous |
|
Definition
low grade fever
petechiea
nausea, vomiting, malaise |
|
|
Term
|
Definition
CXR
V/Q scan
CT contrast (pulmonary angiogram) |
|
|
Term
What Nursing Diagnosis are apropret for a pt with a PE? |
|
Definition
Ineffective Gas Exchange
Decreased cardiac output
Anxiety (possible impending doom)
Risk for Injury
Activity Intolerance
|
|
|
Term
What is the nurses first intervention for a pt with a PE? |
|
Definition
1. Oxygen therapy-maintain airway |
|
|
Term
a nurse admits a pt to the ER with a PE. The nurse gives Oxygen therapy and has maintain airway. What should the nurse do next? |
|
Definition
Monitoring-pulse ox and draw labs- ABG’s, INR, PTT and PT |
|
|
Term
a nurse admits a pt to the ER with a PE. The nurse gives Oxygen therapy and has maintain airway, drawn labs. What should the nurse do next? |
|
Definition
Prepair to give Anticoagulation thrombolytic therapy |
|
|
Term
After a pt has recived the anti- thrombolytics, what is the next type of theripys the pt may recive? |
|
Definition
IV therapy
Drug therapy-Heparin, Lovenox, Coumadin |
|
|
Term
What is the surgical management for a pt with a PE? |
|
Definition
1. Embolectomy
2. Inferior vena caval interruption |
|
|
Term
What should the nurse know about Heparin and Lovenox before giving? |
|
Definition
Generally given IV
Blocks formation of thrombin to prothrombin
Prevents extension of clot, no lysis
Onset is 20-60 minutes, peak is within minutes
Duration is 2-6 hours
Half life is 90 minutes
|
|
|
Term
What is the antagonist to Heparin and Lovenox |
|
Definition
Reverse with protamine sulfate |
|
|
Term
Coumadin/warfarin
Labs drawn on Wednesday will reflect does taken on _________.
why? |
|
Definition
Monday
Onset is 2-5 days, peak is 1/2 to 3 days, half life is 3 days |
|
|
Term
What is the antagonist of Coumadin/warfarin |
|
Definition
Reverse with Vitamin K or (in emergencies may give FFP) |
|
|
Term
Coumadin/warfarin has less occurence with interactions with other medications this is why pts are swiched to it.
T/F? |
|
Definition
False
Coumadin Interactions with other medications
pt are swiched because it is an oral med and easier to take |
|
|
Term
Laryngeal Cancer is more prevalent in which sex? |
|
Definition
|
|
Term
What factors may predispos someone for Laryngeal Cancer |
|
Definition
Synergistic effect ETOH, smoking
chronic laryngitis, voice abuse
|
|
|
Term
What are the Symptoms/Manifestations of Laryngeal Cancer |
|
Definition
Horseness or lump in the neck for longer than 3-4 weeks.
Persistant or recurrent sore throat.
Short of breath.
Difficulty swallowing. |
|
|
Term
What is the Treatment Goal of Laryngeal Cancer |
|
Definition
preserve life, voice, swallow |
|
|
Term
How is Laryngeal Cancer diagnosed |
|
Definition
Dx-Hx, Xray, bronchoscopy, laryngoscopy, MRI, CT
TNM(tumor nodes metastases), requires biopsy |
|
|
Term
What is the cure rate of Laryngeal Cancer type 1
and type 2 |
|
Definition
T1, 90% curable with RT, 100% with Surgery
T2, 75-85 with RT, 90% with surgery |
|
|
Term
What type of Laryngeal Cancer can you use Radiation Therapy |
|
Definition
|
|
Term
What are the benifits of using Radiation Therapy to treat Laryngeal Cancer |
|
Definition
Client retains voice
•only 4-8 weeks of treatment
• Leaves with better voice quality
• Can be used with chemotherapy |
|
|
Term
What is a Laryngectomy Partial |
|
Definition
lesion on vocal cord, client has a serviceable voice. May need temporary trach and feeding tube |
|
|
Term
What is a Complete Laryngectomy |
|
Definition
no voice, permanent trach, loss of smell, can swallow,
removal of: epiglottis, thyroid cartilage, larynx, hypoid bone |
|
|
Term
What is a Radical Neck Dissection |
|
Definition
Removal of regional metastasis
May remove tongue, tonsil, lip, thyroid |
|
|
Term
what are the Complications of treating
Laryngeal Cancer
7 |
|
Definition
Esophageal stenosis- stricture is a narrowing or tightening
• Salivary fistula
• Laryngeal edema
• Rupture of carotid-hemorrhage
• Nutritional deficits
• Breakdown of suture line
• Chemo-stomatitis-inflammation of the mucous lining of any of the structures in the mouth, pul fibrosis-the formation or development of excess fibrous connective tissue in the lungs |
|
|
Term
What are the concerns for a pt who has Laryngeal Cancer |
|
Definition
Breathing, swallow, drainage, labs
Nutritional
Psych/social
Communication
Self-care
Rehabilitation
Altered body image |
|
|
Term
What is a blunt chest trauma? |
|
Definition
body struck by a blunt object, i.e. steering wheel |
|
|
Term
What is a penetrating chest trauma |
|
Definition
foreign body impales or passes through the body tissues |
|
|
Term
What are Simple rib fractures caused by and what are the complications that can occur? |
|
Definition
blunt trauma
Main problem is pneumothorax and PAIN. |
|
|
Term
|
Definition
no external wound. Spontaneous is the most common |
|
|
Term
|
Definition
air enters pleural space from an opening in the chest wall, “sucking chest wound” |
|
|
Term
What is a simple hemothorax |
|
Definition
is 1500ml or less of blood in the chest wall |
|
|
Term
What is a Massive hemothorax
|
|
Definition
is greater than 1500 ml of blood in the chest wall. |
|
|
Term
What causes a Hemothorax? |
|
Definition
Blood can come from damage to the lung tissue (contusion) or intrathoracic bleeding as in trauma to the great vessels. |
|
|
Term
Tension Pneumothorax Can result from: |
|
Definition
|
|
Term
Tension Pneumothorax causes: |
|
Definition
Inability of air to escape-in an open wound, a flap may prevent air movement
Intrathoracic pressure increases, CO altered, compression of great vessels |
|
|
Term
Tension Pneumothorax Can occur if chest tubes are left clamped.
T/F? |
|
Definition
|
|
Term
Tension Pneumothorax is expected to happen when chaning tubing it is not a medical emergency.
T/F? |
|
Definition
Fales
It is a medical emergency
only clamp tube for a brife time and only with an order. |
|
|
Term
A pt has Paradoxical movement when breathing, Crepitus, and Mediastinal shift. what should the nurse suspect is wrong? what tests should be done to conferm? |
|
Definition
Flail Chest- Fracture of 2 or more adjacent ribs in 2 or more places with loss of chest stability
chest Xray, ABG assessment |
|
|
Term
What are the treatments for Flail Chest? |
|
Definition
Ventilate, oxygenate, IV’s
Stabilize chest |
|
|
Term
What is the treatment of any lung or chest injury? |
|
Definition
Ensure airway
High flow O2
IV access
Assess for other significant injuries
Position in semi-fowlers if neck OK
May need chest tube placement. This is often placed at the bedside and you as the nurse may be assisting |
|
|