Respiratory test review
Purpose of mucous
The goblet cells
Where is mucous produced?
Propells mucous up toward the trachea
- The diaphram goes down
- The rib cage goes up and out
The mechanics of breathing
Carries 02 to the tissues
Increase in RBCs to deliver more 02 (Polycythemia)
Compensatory mechanism in COPD pts not getting enough 02
- Deviated septum
Upper airway obstructive disorders
Tx for deviated septum
- Decongestants or steroids
Tx for polyps
Heredity disorder involving the exocrine glands
Air moving through fluid
Air moving through narrowing airway
Fast, deep respirations
Fast, deep respirations with periods of apnea
Obesity, deviated septum, enlarged tonsils and adnoids
Causes of sleep apnea
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?
Position of child after tonsilectomy?
Semi-fowler's on side
Position of older person after tonsilectomy?
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?
Max amount of 02 for COPD pts?
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?
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?
Tx for corpolmonale
Change in color of their sputum
COPD pts are told to monitor what that may indicate infection?
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?
Tx for COPD
- Thin skin
- Decrease in immunity
Effects of long term steriod use?
What drives respirations in a normal, healthy person?
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
- 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
Late s/s of pulmonary edema
- Morphine to decrease RR & anxiety
- Diuretics (Monitor I&O and lytes)
Tx for pulmonary edema
Flu caused by chickens
Flu caused by birds
- Hyperflex head
- 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?
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?
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?
- 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?
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
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?
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?
What mask delivers the highest concentration of 02
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
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?
1st s/s of pulmonary edema
Tachypnea, nocturnal paroxymal dyspnea
Late s/s of pulmonary edema
- Morphine (to decrease RR and anxiety)
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?
- Jaw thrust
Tx for upper airway obstruction?
Paper thin skin, barrel chest, digital clubbing
Characteristics of a pt with COPD?
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
This is dx'd after a pt has had it for at least 3 months out of the year for 2 consecutive years
This is caused by an increased reactivity of the trachea and bronchi to stimuli resullting in increased mucus production and mucosal swelling
Caused b dilation of the bronchi and bronchioles that destroys bronchial elastic and muscular elements
- Chronic respiratory infections
- tuberculosis lesions
- Bronchial obstruction
Causes of bronchiectasis
Tx for CF
Acute coryza (cold)
Inflammatory process of the upper airway respiratory tract resulting in sneezing, post nasal drip, HA, sore throat
How long is a cold contagious?
May accompany a cold and be acute or bacterial?
Bacterial cause of pharyngitis?
Usually caused by other URIs and in children it occurs at night and is called croup
Sometimes mistaken for a tooth problem
Acute viral respiratory infection accompanied by fever
Antivirals used to tx the flu in the first 48 hrs of symptoms
Acute inflammation of the gas exchange units of the lungs
COPD, alcoholics, malnutrition, surgery patients
Pts who are predisposed to pneumonia?
Infection of the lung characterized by localized accumulation of pus
If an abcess ruptures and pus leaks into the pleural space?
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?
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?
This disease is highly transmissible from person to person and person to object and is r/t travel
This disorder is d/t an incease in pulmonary capillary pressure resulting from abnormal left heart function
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?
This d/o is d/t air in the pleural space
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
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
What is the tx of ARDS?
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?
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?
Males > 60 who smoke and drink are at higher risk for what?
This cancer is usually dx in late stages because s/s are absent until it is too late?
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?
Kyphosis, lordosis, scoliosis, pigeon chest, barrel chest
Restrictive chest deformities?
Emphysema, chronic bronchitis, asthma, CF, bronchiectasis
Obstructive d/o of the lower airway