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Respiratory Pharm Test
Terms in this set (52)
performed by passing a bronchoscope into the trachea and bronchi.
using either a rigid bronchoscope or a flexible fiberoptic bronchoscope, this allows visualization of the larynx, trachea, and bronchi
The exam includes observing the tracheobronchial tree, abnormalities, tissue biopsy, collecting secretions for cell or bacteriologic exams.
Anesthesia may be used intravenously
1. Keep the patient on NPO until gag reflex returns, 2 hrs later
2. Keep patient in semi-fowlers position and turning on either side to promote removal of secretion
3. Monitoring patient for laryngeal edema or laryngospasm, stridor and increasing dyspnea
4. If lung tissue biopsy is taken, monitor sputum for hemorrhage,(blood sputum is expected after a few days after biopsy).
these can be for either direct or indirect visualization of the larynx.
Indirect laryngoscopy is most common for assessing respiratory difficulties.
indirect laryngoscopy procedure
The patient is awake, a laryngeal mirror is positioned in the mouth for visualization
direct laryngoscopy procedure
A laryngoscope can be used for biopsy or polyp excision. Requires local anesthesia and exposes the vocal chords as the laryngoscope is passed down over the tongue
pulmonary function test (PFT) defined
performed the assess severity of disease in small and large airways. They include various procedures to obtain information on lung volume, ventilation, pulmonary spirometry and gas exchange .
PFT Lung volume test
these refer to the volume of air that can be exhaled completely and slowly after a maximum inhalation(vital capacity) Require the use of a spirometer.
PFT Inspiratory capacity
this is the largest amount of air that can be inhaled in one breath from the resting expiratory level. Require the use of a spirometer.
PFT Total Lung Capacity
This is calculated to determine the volume of air in the lung after the maximal inhalation. Require the use of a spirometer.
PFT Ventilation test
these evaluate the volume of air inhaled or exhaled in each respiratory cycle. Require the use of a spirometer.
PFT Pulmonary spirometry test
these evaluate the amount of air that can be exhaled forcefully after maximum inhalation. Require the use of a spirometer.
PFT: DLCO (diffusing capacity of lungs for carbon monoxide)
these test determine how well oxygen diffusing from the alveoli is taken up by blood in the pulmonary capillary bed.
Oxygen is not used in this test, carbon monoxide is used. Small amounts are used, it is NOT harmful.
After these is performed the rate of oxygen can be determined.
use of body positioning to assist in removal of secretions from specific lobes of the lung, bronchi, or lung cavities
cancer of the lungs
often occurs in older patients
limited to true vocal chords; slow growing due to decreased lymphatic supply, spreads early to deep lymph nodes on neck
Larynx Cancer - Signs & Symptoms
• Early - Hoarseness, pain or burning in the throat when drinking hot liquids or citrus juices, lump in the neck
• Later - Difficulty swallowing or breathing, unilateral nasal obstruction or discharge, persistent hoarseness or foul breath
• Metastasis - Cervical lympahdenopathy, weight loss, general debilitated state, and pain radiating to the ear
Larynx Cancer - Tx
Endoscopic laser surgery
Rest the voice - no talking/no whispering
Treat underlying cause
larynx cancer nursing interventions
communicate through facial/hand gestures and writing
airway maintained and suctioning
asses hydration stats
Acute respiratory distress syndrome (ARDS)
obtained for microscopic evaluation for gram stain, and culture/sensitivity.
collecting a sputum specimen
1. Explain sputum must be brought from lungs, fluid intake
2. collect before antibiotics start
3. collect before meals
4. Instruct to inhale and exhale 3 times, then inhale swiftly, cough forcefully, then expectorate into container
5. hypertonic saline aerosol may help patient who cant raise sputum
6. rinse mouth with water before expectorating in bottle
7. label and send to lab
8.alternative: nontracheal suctioning
side effect of an anti-inflammatory drugs
1. Dry mouth, hoarseness: mild and resolve with continued therapy. Do not discontinue drugs.
2. Fungal infection, and thrush; risks for this include contaminated antibiotic use, diabetes, improper aerosol administration, large oral doses of corticosteroids, and poor dental hygiene.
a contraction of the smooth muscle in the walls of the bronchi and bronchioles that tighten and squeeze the airway shut
Inflammation of the visceral and parietal pleura. Can be caused by either bacterial or viral infection. Can happen spontaneously, or a complication of pneumonia, pulmonary infractions, viral infection, chest, rib, intercostal muscle trauma, or early stages of tb/lung tumor.
pleurisy signs and symptoms
severe inspiratory pain that radiates in the solders or abdomen of the affected side
pain caused by stretching inflamed pleura
pleurisy diagnostic testing
pleural friction rub is considered diagnostic.
Chest radiographic examination isn't valuable unless pleural effusion is present and fluid accumulates.
Nursing Interventions for pleurisy
1. Position patiently comfortable on affected side to splint chest, apply heat to area
2. instruct patient on signs and symptoms of exacerbation, purulent sputum production, increase in temp, increase in pain
3. Teach patient to cough effectively every 2 hours and to splint the affected side.
perscription for pleurisy
1. Anesthetic around the vertebrae to block the intercostal nerves, reliving pain
2. prescribed meds may include antibiotics(penicillin) to combat infection
3. Antipyretics(acetaminophen) used for fever
Follows Pleural effusion
when the fluid is infected and pus pus accumulates in a body cavity or pleural space, becomes ENPYEMA.
Pleural effusion defined
once plural lining is inflamed, fluid can accumulate in plural space. this is called PLEURL EFFUSION
this is a secondary problem with the psychologic pressure in the lungs and pleura is disturbed.
Pleural effusion signs and symptoms
cirrhosis of the liver
congestive heart failure
Empyema signs and symptoms
result of bacterial infection
Blunt chest trauma
persistent fever w antibiotics
Empyema /pleural effusion assessment
subjective data: patient complaints of dyspnea, air hunger, fear and anxiety related to decrease in oxygen.
objective data: respiratory distress, nasal flaring, tachypnea, decreased breath sounds, assess breath sounds and vitals, especially temp
Empyema /pleural effusion diagnostic test
effusions and pleural fluid are apparent in radiographic exams
thoracentesis(needle inserted ion pleural space) can be used to obtain specimen
Empyema /pleural effusion procedure thoracentesis
thoracentesis: remove fluid gradually, less than 1300 to 1500 ml at a time
chest tubes can be inserted for continuous drainage of fluids from the pleural cavity and med administration.
a closed drainage system is used to prevent lung collapse, maintaining neg pressure in the lung
Empyema /pleural effusion procedure thoracotomy
thoracotomy tubes: two tubes are inserted into the pleural space and are attached to a closed drainage water seal system. one catheter is used to remove air from the pleural space. The second tube is used for drainage of serosanguineous/ purulent exudate. Maintaining neg pressure in the thoracic cavity.
Empyema /pleural effusion nursing interventions
1. Patient on bed rest
2. Oral care for oxygen therapy patients
3. Encourage effective coughing/deep breathing
4. If the patient has thoracentesis, apply large sterile dressings.
5. Ensure the patency of the chest tube system
6. Potential atelectasis from hyperventilation; check for increased dyspnea,
7. Increased air in intrapleural space; observe air leaks in the system, ensure the tubing is secure and patent
8. infection; note increase in WBCs, elevated temp, and purulent drainage.
8. Never elevate the drainage system to the level of the patients chest, this causes backflow of drainage
The disease of areolar tissue destruction without fibrosis. Alveolar sacs lose elasticity and collapse during exhalation, trapping air in the lungs.
Dyspenic with shortness of breath
Breathes through pursed lips
scanty sputum collection
Obstructive Sleep Apnea defined
This is characterized by partial or complete upper airway obstruction during sleep. causing apnea and hypopnea.
Obstructive Sleep Apnea action
Airflow obstruction occurs when the tongue and the soft palate fall backwards and partially or completely obstruct the pharynx.
could last 15-90 seconds.
During this period, the patient experiences severe hypoxemia, and hypercapnia. These cause the patient to wake slightly.
When the patient reacts to this (snorts, gasps), this causes the tongue and the soft palate to move forward and the airway to open.
Obstructive Sleep Apnea Facts
Apnea and arousal cycles occur repeatedly as many as 200/400 times during 6-8 hrs sleep.
18 Million adults in the united states have Sleep apnea but 90% are undiagnosed.
Obstructive Sleep Apnea signs and symptoms
awakening at night
excessive daytime sleepiness
partner may complain of loud snoring'
morning headaches (from hypercapnia that causes vasodilation of cerebral blood vessels)
right sided heart failure
pulmonary hypertension caused by nocturnal hypoxemia
risk factors of Obstructive Sleep Apnea
twice as many men as women have OSA
pharyngeal structure abnormalities
Obstructive Sleep Apnea diagnostic testing
1. A polysomnography is used to diagnose OSA
a nasal cannula measures airflow and pulse ox
2. Documenting multiple episodes of apnea or hypopnea
done in a sleep lab or at home
Nursing interventions for Obstructive Sleep Apnea
1. Instruct patient to avoid sedatives and alcohol 3/4 hrs before sleep
2. referral to weight loss programs
3. Using oral appliances during sleep bring the mandible and tongue forward to enlarge airway space/preventing airway occlusion
5.finding support groups to express feelings/concerns
6. (nCPAP) machines help more sever patients; A nasal mask attached to a high blower. The blower is made to maintain positive pressure to the airway during inspiration and expiration to prevent airway collapse.
7. (BiPAP) machines are for patients who struggle inhaling high pressure. These machines deliver high pressure during inspiration (when the airway is often occluded) and lower pressure during expiration.
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