Respiratory test review

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Trap particles

Purpose of mucous

The goblet cells

Where is mucous produced?

Cilia

Propells mucous up toward the trachea

- The diaphram goes down
- The rib cage goes up and out

The mechanics of breathing

RBCs

Carries 02 to the tissues

Increase in RBCs to deliver more 02 (Polycythemia)

Compensatory mechanism in COPD pts not getting enough 02

- Deviated septum
- Polyps

Upper airway obstructive disorders

Nasoseptoplasty

Tx for deviated septum

- Polypectomy
- Decongestants or steroids

Tx for polyps

Cystic fibrosis

Heredity disorder involving the exocrine glands

Rales/crackles

Air moving through fluid

Wheezes

Air moving through narrowing airway

Kussmuls

Fast, deep respirations

Biots

Fast, deep respirations with periods of apnea

Obesity, deviated septum, enlarged tonsils and adnoids

Causes of sleep apnea

CPAP

Tx for sleep apnea

- Daytime fatigue d/t no REM sleep
- Personality change
- Loud snoring

S/S of sleep apnea

- Cold slow onset, contagious 3 days, treat the symptoms
- Flu - sudden onset, fever, body aches - tx symmetrel, tamiflu 1st 48 hrs

Difference between the cold and flu

To prevent secondary infection

Why would abt be given to a pt with a cold?

- Monitor for frequent swallowing
- HOB elevated
- Monitor VS
- Monitor I&O

Post op nursing interventions for nasal or throat surgery?

On stomach

Position of child after tonsilectomy?

Semi-fowler's on side

Position of older person after tonsilectomy?

Restlessness

First s/s of hypoxia

Digital clubbing caused by chronic hypoxemia

Late s/s of hypoxia

Toothache, HA, bad taste in mouth

S/S of sinusitis

Bronchiectisis pts or pts receiving mucomyst tx

What pts need good mouth care?

3 L

Max amount of 02 for COPD pts?

Venturi

High flow mask that delivers a precise percent of 02 used primarily in COPD pts?

Make sure the bag inflates - if it doesn't, increase the flow

What do you need to insure when a pt is on a non rebreather mask?

- Teach pursed lip breathing to prevent premature airway closure

Pt with chronic airflow limitation, what would you teach them?

Increase the flow until the bag inflates

What do you do when you switch from a NC to a non rebreather?

Cor polmonale

Complicatins of COPD?

Rt sided HF & pulmonary edema leading to pulmonary HTN causing increased pressure in the liver=acites, sacral edema, JVD

What is cor polmonale?

- Diuretics
- Digoxin

Tx for corpolmonale

Change in color of their sputum

COPD pts are told to monitor what that may indicate infection?

Pneumonia

COPD pts are prone to what?

Small frequent meals, supplements, oral care before meals, rest periods

What can you teach a COPD pt to increase appetite?

-02
- Abt
- Bronchodilators
- Diuretics
- Steroids

Tx for COPD

- Thin skin
- Decrease in immunity

Effects of long term steriod use?

C02

What drives respirations in a normal, healthy person?

02

What drives respirations in a COPD pt?

Depresses their respirations

What does too much 02 do to a COPD pt?

-Teach to avoid crowds during flu season
- hand washing
-02, TCDB, Chest PT
- Suction
- Increase fluids to 2-3 L/day

Nursing implications for COPD pts

Sitting up, leaning overside table

What is orthopnic position?

Orthopnea - progresses to nocturnal paroxymal dyspnea

Early s/s of pulmonary edema?

- Pink frothy sputum
- Tachypnea

Late s/s of pulmonary edema

- Morphine to decrease RR & anxiety
- Diuretics (Monitor I&O and lytes)

Tx for pulmonary edema

Avian

Flu caused by chickens

Histoplasmosis

Flu caused by birds

- Hyperflex head
-Pinch nose
- epi 1:1000
-Caulterizatin (Silver nitrate)

Tx for epitaxsis

Impaired communication d/t permanent trach

NANDA for pt with total larangectomy

Suction to prevent aspiration

Before deflating the cuff of a trach pt what do you do?

On the way out

When do you apply suction when suctionion a trach pt?

Until you meet resistance

How far to you insert the tube when suctioning a trach?

One way valve, prostesis, communication board

Ways for trach pts to communicate

hoarseness & sore throat

1st s/s of caancer of the larynx

Cover trach with a scarf when going out in the cold

Pt teaching for a pt with total laryngectomy

- 1/2 peroxide, 1/2 NS
- rinse with NS
- dry with pipe cleaner

How do you clean a double lumen trach?

- Need 2 people OR
- Put new ties on before removing the old ties

How do you change the ties of a trach?

Esophageal speech

Speech a pt can use if they don't have a total laryngealetomy

Flu and pnumovax

What vaccine should people > 65 get?

Booster needed in 6 yrs

Pt teaching about pnumovax vaccine?

Hypostatic pneumonia

What pneumonia are pts prone to post op?

Lay them on operative side to promote drainage and good lung expansion of the non operative lung

Pt has pneumoectomy. What does the nurse expect to do post op?

- Chest tube
- Occlusive dressing (don't change)

Pt has pneumoectomy. They will come to the floor post op with what?

Turn down the suction

Pt with chest tube, the water chamber is bubbling vigorously, what should the nurse do?

Check for kinks

The nurse suspects the chest tube is not draining enough. What should she do?

Milk the tube to break up the clots(Don't strip)

If the chest tube has clots, what should the nurse do?

Chamber 1 = Water
Chamber 2 = suction
Chamber 3 = Drainage (Connected to the pt)

What are the chambers of chest tube drainage system called?

- Trauma
- Pleural effusion

What other reason might someone need a chest tube?

- Large = chest tube
- Small= Thoracentesis

Tx for pleural effusion?

- Monitor respiratory status, breath sounds
- Lay on unoperative side

Nursing implications post op throracentesis

Diminished breath sounds on affected side

What will you hear with pneumothorax

Acid fast bacilli

Sputum culture for AFB, what are you testing for?

3 cultures on 3 separate days

How is sputum culture for AFB done?

Tuberculosis

This is a granulomatous bacterial infection that affects the lungs and other organs.

Tx with INH 6-9 months

Pt has + PPD but - chest x-ray. What is the treatment?

- 3 AFB sputum collections on 3 consecutive days
- Tx with ING and rifampin up to a year

Pt has + PPD and + chest x-ray

Dropplet precautions

Pt teaching for TB patient

5 mm at 48 hrs

What indicates + TB test in immunosuppresed pt?

10 mm at 48 hrs

What indicates + TB test in health care workers?

15 mm at 72 hrs

What indicates + TB test in healthy individuals?

Compliance d/t side effects of the medications

What is the biggest problem with TB pts?

LFTs

What do you monitor closely with pts taking INH and rifampin?

NC, simple mask, partial rebreather, non rebreather

Types of low flor 02 systems?

Double the rate

If you go from a NC to a simple mask what do you have to do?

Non rebreather

What mask delivers the highest concentration of 02

Venturi

What mask delivers a precise percentage of 02 and is used primarily in COPD pts?

By hyperventilating which can lead to respiratory alkalosis

How does the body compensate for metabolid acidosis?

The bag is inflated - if not, increase the flow

If the pt is on a non rebreather, what do you have to make sure?

- Exedutative drainage
- Empyema

Pt has pleural effusion and a thoracentesis is done. The drainage is milky and yellow. What is this called and what would the nurse suspect?

Orthopnea

1st s/s of pulmonary edema

Tachypnea, nocturnal paroxymal dyspnea

Late s/s of pulmonary edema

- Diuretics
- Morphine (to decrease RR and anxiety)
- Digoxin

Tx for pulmonary edema

Deviated septum & polyps

Pt has stenorous respirations, dyspnea, and post nasal drips. What is this s/s of?

Upper airway obstruction

Pt has stenorous respirations, apnea, altered RR and chacter. What is this s/s of?

-Head tild
- Jaw thrust
- Heimliche

Tx for upper airway obstruction?

Paper thin skin, barrel chest, digital clubbing

Characteristics of a pt with COPD?

Emphysema

Alveolar disease caused by overinflation and other destructive changes of alveolar walls resulting in decreased lung elasticity and gas exchange

Dyspnea on exertion

1st sign of emphysema

- pursed lipped breathing
- digital clubbing

Late signs of emphysema?

Bronchodilators, ABT, steroids

Meds to tx COPD

TCDB, 02, Rest, chest x-ray, stop smoking

Nursing implications for COPD

Chronic bronchitis

This is dx'd after a pt has had it for at least 3 months out of the year for 2 consecutive years

Asthma

This is caused by an increased reactivity of the trachea and bronchi to stimuli resullting in increased mucus production and mucosal swelling

Bronchiectasis

Caused b dilation of the bronchi and bronchioles that destroys bronchial elastic and muscular elements

- Chronic respiratory infections
- tuberculosis lesions
- CF
- Bronchial obstruction

Causes of bronchiectasis

Heart/lung transplant

Tx for CF

Acute coryza (cold)

Inflammatory process of the upper airway respiratory tract resulting in sneezing, post nasal drip, HA, sore throat

3 days

How long is a cold contagious?

Acute pharyngitis

May accompany a cold and be acute or bacterial?

Strep

Bacterial cause of pharyngitis?

Acute laryngitis

Usually caused by other URIs and in children it occurs at night and is called croup

Sinusitis

Sometimes mistaken for a tooth problem

Influenza

Acute viral respiratory infection accompanied by fever

- Symmetrel
- Tamiflu

Antivirals used to tx the flu in the first 48 hrs of symptoms

Pneumonia

Acute inflammation of the gas exchange units of the lungs

COPD, alcoholics, malnutrition, surgery patients

Pts who are predisposed to pneumonia?

Lung abcess

Infection of the lung characterized by localized accumulation of pus

Empyema

If an abcess ruptures and pus leaks into the pleural space?

Pleurisy

Inflammation of the pleura that is a complication of pneumonia, TB, or trauma

Pleuritic pain (Sharp, knife like pain on inspiration radiating to the shoulder or abd)

S/S of pleurisy?

Pleural friction rub

Pt has pleurisy and you auscultate the lungs. What will you hear?

Crepitus

Air escaping into tissue aka SQ empyhsema

PPD or Mantoux test

Test used to dx TB?

Do a PPD test

Pt comes in complains of cough, fatigue, wt loss, night swets, what is the first thing the nurse should do?

SARS

This disease is highly transmissible from person to person and person to object and is r/t travel

Pulmonary edema

This disorder is d/t an incease in pulmonary capillary pressure resulting from abnormal left heart function

Pulmonary embolism

Obstruction of the pulmonaray artery or one of its branches

Prevention: TED hose, scuds, early ambulation, no pillow under the knees, TCDB

Tx of pulmonary embolism?

PT = 1.5 - 2 x control
INR = 2-3

Theraputic lab values for anticoagulation therapy?

Pneumothorax

This d/o is d/t air in the pleural space

Hemothorax

This d/o is d/t blood in the pleural space

3rd & 4th ICS midauxillary

Placement of chest tube for pneumothorax

8th & 9th ICS midauxillary

Placement of chest tube for hemothorax

Pleural effusion

Caused d/t an imbalance between formation and absorption of fluid

02 < 50 and C02 > 50

What is respiratory failure defined as?

Adult respiratory distress syndrome (ARDS)

Diffuse lung injury in people with no previous pulmonary problems

- PEEP
- Ventilation

What is the tx of ARDS?

Atelectasis

Collaps of part of the lung that starts in the alveoli and progress to involve a lobe or lobes

Prevention: TCDB, early ambulation, postural drainage

TX of atelectasis?

Epistaxis

Caused by congestion, dryness, or trauma leading to capillary rupture.

- Cautery (Silver nitrate)
- Packing (epi 1:1000)

Tx of epistaxis?

Watch for frequent swallowing

Pt has nasal packing. What is nursing priority?

Laryngeal cancer

Males > 60 who smoke and drink are at higher risk for what?

Lung cancer

This cancer is usually dx in late stages because s/s are absent until it is too late?

Sleep apnea

30 or more episodes of apnea in a 6 hr period of sleep

Rhonci (sonorous wheezes)

Low pitched, loud caused by congestion d/t asthma, emphysema, mucous plugs

Tell pt to cough. It if clears, then it was rhonci. If it does not, it was rales

How can you tell the difference between rhonci and rales?

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