Shared Flashcard Set

Details

med surg II Unit 4
Respiratory
198
Nursing
Undergraduate 1
10/15/2011

Additional Nursing Flashcards

 


 

Cards

Term
Air enters the ______ - to the bronchi - to the secondary bronchi which enter the __ lobes of the lungs.
Definition

trachea 

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
alveoli
Term
_______ are the grape like structures, these have surfactant secreted to decrease surface tension.
Definition
alveoli
Term
what types of cells are at alveolus site
Definition

Macrophages

Mast cells

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
Lymphatics
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
Potential space
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
hemoglobin
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
pons and medulla
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
PO2-levels below 60
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
respiratory failure
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
8-10 ml/kg body weight
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
What is a norm RR
Definition
12-20
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
inflammation
Term
Malignant nodes are often ____ and are fixed to the surrounding tissue.
Definition
hard 
Term
The space on each side of the trachea should be _____.
Definition
equal
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
after 
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
What is Respiratory lag
Definition

slowed movement on one side

occurs with the presence of a pulmonary mass, pleural fibrosis, atelectasis, pneumonia, or a lung abscess.

Term
What is Crepitus
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
Crackles, Wheezes
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

What is Emphysema

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
DOE- dyspnea on exertion 
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
Anxiety
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
pneumonia, exacerbations
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
What is Asthma?
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
diagnostic (of Asthma)
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
PaCO2  > 45 mm Hg
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
 Changes in mental status
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
True
Term
How are PE formed?
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
How is a PE Diagnosed
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
men
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
Solo tumor (no mets)
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
Pneumothorax Closed:
Definition
no external wound. Spontaneous is the most common
Term
Pneumothorax open: 
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
closed or open wound
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
true
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

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