Exam 1 301 - respiratory

Term
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when getting a CT scan what do you want to monitor?

and what should you ask and tell them?

what should you do after?

How is contrast inserted?
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Terms in this set (57)
when getting a CT scan what do you want to monitor?

and what should you ask and tell them?

what should you do after?

How is contrast inserted?
BUN/Cr b/c can be nephrotoxic to kidneys

ask them if allergic to shellfish (iodine based)
and tell them they will feel a warm flush when contrasted inserted

force fluids after to get contrast out of kidneys

IV
how is a CT diff from an MRI?

MRI:
assesses.... what?
assess lesions difficult to see by CT (lung apex) and for distinguish vascular vs. nonvascular

the contrast is not iodine based
V/Q Scan

what is it?

how procedure done?
test used to identify areas not receiving airflow (ventilation) or blood flow (perfusion) indicating a pulmonary embolism

ventilation without perfusion --> called a mismatch = pulmonary embolus

radioactive inhaled (should distribute evenly = ventilation) and radioactive inserted into vein (travels to vessels)
if pulmonary embolus - no injected material reaches
PET scan

what it does?

how diff from CT/MRI?

examples:
Position Emission Tomography

uses a "tracer" to look for lung disease/ cancer, and when tracer is up-taken lights up called a "hotspot"

CT/MRI look at structure - PET looks at function

blood flow, use of oxygen, uptake of sugar

PET scans do not diagnose cancer; they only show areas of abnormal uptake of the tracer material. Other diseases can produce "hot spots," such as infection.
why would someone get a bronchoscopy?

NPO B4 and after?

what is an abnormal finding?
to obtain biopsy specimen or monitor treatment

b4 = consent, NPO 6-12 hours, give sedative

after: NPO till gag reflux returns and monitor sedation --> blood tinged mucous = not normal!!!
Types of lung biopsy: (4)
1. Transbronchially (bronchoscope)
2. Percutaneously or transthoracic needle aspiration (TTNA)
3. VATS - video assisted thoracic surgery
4. Open lung biopsy
TTNA:
what can it be used for?

where does needle go/ how does pt. sit/do?

what type of anesthesia?

what type of needle?

what to do after?
obtain fluid for diagnosis, remove pleural fluid, instill meds

needle goes through thorax and chest wall under CT guidance --> sit upright w/ elbows on table and feet supported (no talking or coughing)

local anesthesia

large bore

order CXR after to check for pneumothorax
what biopsy may require a chest tube?
VATS - until lung re-expands
TB skin test:

who is positive if 5 or more mm?

(5)
- HIV persons

- recent contact of a person with TB

-persons with fibrotic changes on chest radiograph consistent with prior TB

-patients with organ transplants

-persons who are immunosuppressed for other reasons (15 mg prednisone or TNF antagonists)

(all immunosuppressed people)
TB skin test:

who is positive for 10 or more mm?


(7)
- recent immigrants (<5 years) from high=prevalence countries

-IV drug users

-residents and employees of high risk settings

-mycobacteriology lab personnel

-persons w/ clinical condition that put them at high risk

-children < 4 years old

-infants, children, and adolescents exposed to adults in high risk categories


(all risk people)
TB skin test: who is positive for 15 or more mm?- any person with no known risk factors for TB TB skin test should be conducted on only high risk groupsdefine dyscrasiascoagulation/blood disorders (a cause of nose bleed)what treatment could cause epistaxis?chemotherapy/anitcoagulations (warfarin, NSAIDS, aspirin)what to do if posterior epistaxis? - done by? - how long? - discharge teaching: assess? then...posterior packing! done by physician - can be left 2-3 days -cleanse and no heavy lifting 4-6 weeks assess respiratory status b/c could affect then humidification (prevent drying!), o2, bedrest, pain control, oral careRhinitis: viral/bacterial vs. allergic sinusitis:viral = common cold allergic= allergies inflammation of sinuses (treat symptoms)Pharyngitis types? what happens if you don't treat bacterial?viral: most - no antibiotics so just rot self out fungal (candidas/thrush) bacterial: B-hemolytic streptococcus -serious medical complications: 1. acute glomerulonephritis 2. rheumatic fever - then heart probs if don't treat thosemain cause of strep?B-hemolytic streptococcus --> seeing if need antibiotics test right on spotwhat is candidiasis/thrush caused by? treat with?candida albicans nystatin S&S (know order for swish or swallow)obstructive sleep apnea: define: Lasts: results in: how many times/ hour?tongue/soft palate fall back and partial or complete obstruction lasts: 15-90 seconds hypoxemia/hypercapnia --> which triggers ventilation = startle and wake up to open airway (200-400 times in 8 hrs)risks of OSA:- obesity -neck circumference >17 inches -cranofacial abnormalities that impact airway -age > 65 - men > womenwhat are 2. complications of OSA?1. lack of sleep = irritability and decreased concentration 2. chronic hypoxemia and dysrhythmias = hypertension, heart failurehow to diagnose OSA?polysomnography also looking at: EKG (heart rhythm) EMG: (muscle tension w/ maxila and mandible) EEG: encephalogram/brainOSA: avoid what before bed? maintain/loose ________. how should you sleep? how many events/ hour is considered OSA?-alcohol, sedatives -loose weight -supine makes jaw relax so bad, side! - 5 events/ hourRND: post-op care: - BIG THING!!! -trach? - secretions? what to do? - pain? - nutrition? - speech?Radical Neck Dissection - airway maintenance! pulmonary toilet!!! - may or may not, if so collar with o2 and humidification - oral (tonsil tip/yankauer suction) and tracheal - pain management - feeding tube 7-10 days still can't swallow (once peristalsis resumes, not b4) - will need speech rehabilitation, esp if no larynxwhen is blood tinged sputum normal vs. not?not normal w/ bronchoscopy, normal for 1-2 post RND, but if goes and comes back = not normalwho gets a trach? (4)1. acute airway obstruction 2. airway protection (after RND surgery) 3. facilitate removal of secretions 4. prolonged intubation (can eat, less damage, more comfortable, more mobility)what is the most common cause of atelectasis?obstruction of small airway secretionsatelectasis: common causes: (2) clinical manifestations: (2) 5 nursing interventions:cause: secretions and dec. lung volumes CM: dec. breath sounds and signs of hypoxemia (pallor, restless, O2 stats dec.) 1. preventing! 2. pulm toliet 3. early ambulation 4. supplemental O2 5. addressing problem (ex: pain)Pleural effusion: causes: CM:causes: CHF, hypoalbuminia, pulmonary malignancies, and infections CM: >250 on CXR, <250 = dec. breath sounds and signs of hypoxemia (CXR will note volume/location of effusion)define empyemaempyema = infected effusionif compare sides and note different sounds/no sounds on lungs, what should nurse do?call HCP and try to get xray orderedways to treat a pleural effusion: (4)1. thoracenteses 2. pleurodesis 3. chest tube 4. address the cause (CHF, low albumin)what is used during pleurodesis? what happens? result?talc or bleomycin inject into pleural cavity, creates inflammation and tacks 2 pleura together result: no space for fluid to go b/c pleura stick togetherwhat is pneumonia? what 3 methods do organisms reach the lung?inflammation/infection of bronchioles and alveoli 1. aspiration (vomit, choke, etc) 2. inhalation (air) 3. blood sourceCM of pneumonia -fast or slow onset? -symptoms: (7) what are atypical signs?- usually sudden onset! - fever - shaking chills - SOA - purulent sputum - adventitious breath sounds - pleuritic chest pain - confusion w/ elderly atypical? - more gradual - dry cough - extrapulmonary symptoms (fever, HA, N/V)diagnosis of pneumonia:CXR and sputum culture/sensitivity3 main nursing diagnosis for pneumonia:1. ineffective breathing pattern 2. impaired gas exchange 3. ineffective airway clearancePneumonia: nursing management 1. what to educate? 2. what can nurse as do during hospitalizations? (4 things)1. stop smoking! adequate rest/sleep and balanced diet 2. - know who is at risk (aspiration) - keep them moving (pulm toilet and ambulation, - - good hand-washing - strict medical asepsisPneumonia: - what to monitor/assess? -what to intervene with? - what to teach?- V.S. - Pulse ox and supp o2 as ordered - lung auscultation -pulm toilet, chest physiotherapy (percussions and postural drainage) -FF, force fluids - ambulation -energy conservation -drug therapy -teaching needswhat type of drugs are used with pneumonia?antibiotics bronchodilators antipyretics (fever) cough suppressants/ expectorantswhat causes TB?mycobacterium tuberculosislatent vs. active TB: who's at risk for active?Latent: + TB skin test may or may not have ghon nodule on CXR asymptomatic/ not contagous Active: + sputum AFB (takes 8 weeks so treat empirically) symptoms: weight-loss, malaise, low-grade fever, night sweats immunosuppressed and elderlyTB nurse job: - ultimate goal? - interpret? -identify who? - main treatment? - so do what? - what happens if not adherent?- eradiction/gone! -interpret diagnostic study results -identify contacts - drug therapy is main treatment --> needs strict adherence = DOT prn, and watch for AE if not adherent - it could come back multidrug resistant = even harder to killDrugs used for TB and their side effects:isoniazid (INH) - hepatotoxicity; peripheral neuropathy (look at sclera for jaundice) rifampin (Rifadin) - red/orange discoloration of excretions ethambutol (myambutol) - dec. visual acuity and inability to differentiate b/w red and greenTB - prevention of transmission in hospital -what precautions? - what type of room? - what nurse wear when in room? - who should be monitored? - who else should receive drug therapy?- airborne precautions - private room w/ negative pressure ventilation - HEPA mask - monitor health care workers TB status annually - preventative drug therapy to high-risk contactsTB - prevention of transmission in home -who else should receive drug therapy? - what precautions? - what pt. should do to prevent? - how to tell if no longer infectious?- preventive drug therapy to high-risk contacts -airborne precautions not necessary -cover mouth/nose, and wear a mask in crowds -Sputum for AFB every 2 weeks --> once 3 negative cultures in a row b/w 2 week period = no longer infectiousemphysema vs. chronic bronchitisemphysema = alveolar damage (over inflation and air trapping) chronic bronchitis = excessive secretion productionCOPD: most common cause of exacerbations of COPD? what diagnostic tests are used for COPD? what is main nursing diagnosis for COPD patients? primary drug therapy? Nursing jobs to do (2)respiratory infections PFT and ABG's Activity intolerance (fatigue) bronchodilators!!!!! and O2 administration early detection of respiratory infection and smoking cessationWhat is O2 toxicity? what is considered potential toxicity?too much O2 for too long from supplemental O2 >50% O2 for > 24 hoursCOPD: nursing implications for respiratory therapy:- pursed lip breathing - effective coughing (huff cough) - chest physiotherapy (percuss, vibration, postural drainage) -flutter valve - nebs (bronchodilators)3 main nursing implications for COPD?1. respiratory therapy 2. Nutritional therapy 3. activity considerations - energy conservation -muscle strengthening -walking until SOA and baseline returns in 5 mins - sex and psychosocialLung cancer CM: - how is it found sometimes/rarely? -symptoms? - most common symptom?- 10% on CXR - usually silent! nonspecific and late in disease and is masked by underlying cough - persistent cough that produces sputumLung cancer diagnosis: (4)- CXR: mass/ infiltrate -CT/MRI looking for metastasis -sputum for cytology -biopsy -percutaneous fine need bx -bronchoscopy -VATS -surgicaldefine pneumonectomyremoval of entire lungKusmaul respirationsgetting rid of acid - hyperventilation specific for: DKA/ metabolic acidosisresp acidosis breathing pattern?hypoventilationantidote for warfarin (Coumadin) and heparinwarfarin = vit k (PT/INR) heparin = protamine sulfate (ptt)