Shared Flashcard Set

Details

Ch. 10 - Patients With Chest and Lower Respiratory Tract Dis
TEST 1
93
Nursing
Undergraduate 4
09/12/2014

Additional Nursing Flashcards

 


 

Cards

Term
What is atelectasis?
Definition
The collapse of the alveoli, leading to the loss of lung volume.
Term
What are the 3 types of atelectasis?
Definition
1.) Absorptive
2.) Compressive
3.) Obstructive
Term
What is absorptive atelectasis?
Definition
Occurs by surfactant inactivation or when less than normal levels of inhaled nitrogen (WASHOUT) are preent in the alveoli.
Term
What are the most common causes of absorptive atlectasis?
Definition
ARDS -> loss or surfactant -> Nitrogen washout
Term
How does ARDS cause absorptive atelectasis?
Definition
Pulmonary edema fluid dilutes/reduces surfactant production.
Term
What is compressive atelectasis?
Definition
A result of external forces compressing pleural and/or lung tissues.
Term
What are the common causes of compressive atelectasis?
Definition
Pleural effusion, lung tumors, pneumothoraces, hemothoraces, abdominal distention
Term
What is obstructive atelectasis?
Definition
Mechanical obstruction of airways or from low tidal volume breathing
Term
What can cause obstructive atelectasis?
Definition
Secretions, airway tumors, foreign bodies
Term
What is the result of all 3 types of atelectasis?
Definition
Mismatching of lung ventilation to perfusion which results in deoxygenated blood reaching systemic circulation and lowering oxygen supply to tissues
Term
Of the 3 types of atelectasis, what is the most common?
Definition
Mechanical
Term
What are the risk factors associated w/ atelectasis?
Definition
-postoperative patients
-anesthetic/narcotic induced hypoventilation
-incisional pain
-abdominal distention
-immobility
-chronic lung disease
-morbid obesity
-tobacco use
-anesthesia time > 4 hrs
-prior CVA
-lung cancer
-pleural effusion
-NG tube placement
Term
What are the symptoms of atelectasis?
Definition
Dyspnea, cough, leukocytosis, and sputum prodction.
Term
What are the findings of atelectasis?
Definition
Crackles, decreased breath sounds, decreased tactile fremitus, tracheal deviation towards affected side, ego phony, asymmetry of chest
Term
How is atelectasis PREVENTED?
Definition
-Position changes
-Early mobilization
-Appropriate deep breathing/cough
-INcentive spirometry
-Prescribed opiods and sedatives judicially
-Perform postural drainage
-Suctioning to remove secretions
Term
What is the GOAL of atelectasis treatment?
Definition
to correct tissue hypoxia.
Term
How is atelectasis treated?
Definition
-PREVENTION IS KEY!
-The use of nebulizers, chest PT, and oxygen may be used
Term
What can you do for obstructive atelectasis?
Definition
-coughing
-suctioning
-mucolytic agents
-bronchoscopy
Term
What can you do for compressive atelectasis?
Definition
-Thoracentesis
-Chest tube
-PEEP
Term
What is pneumonia?
Definition
An infection of the LRT caused by a variety of microorganisms. The most common infectious cause of death
Term
What are the classifications of pneumonia?
Definition
Community-acquired pneumonia
Hospital-acquired pneumonia
Ventilator-associated pneumonia
Health-care associated pneumonia
Pneumonia in an immunocompromised patient
Term
What is community acquired pneumonia?
Definition
Occurs either in the community dwelling person or within the first 48 hours after hospitalization or institutionalization.
Term
What is hospital-acquired pneumonia?
Definition
The onset of pneumonia symptoms more than 48 hours after admission in patients with no evidence of infection at the time of admission
Term
When does HAP occur?
Definition
1.) Host defenses impaired
2.) Microorganisms reach LRT
3.) Highly virulent organism is present
Term
What is ventilator-associated pneumonia?
Definition
A type of HAP that is associated w/ endotracheal intubation and mechanical ventilation.

Pneumonia that develops in patients who have been receiving mechanical ventilate for at least 48 hours.
Term
What is health care associated pneumonia?
Definition
Occurs in nonhospitalized patients who have had extensive health care contact, as defined as one of the following:

Resident of a nursing home
Acute care hospitalization for 2 or more days within the last 90
Intravaneous antibiotic therapy
Wound care
Chemotherapy
Hospital hemodialysis within the last 30 days
Term
What is pneumonia in the immunocompromised host?
Definition
Pneumocystis pneumonia
Fungal pneumonias
mycobacterium tuberculosis
Term
When does pneumonia in the immunocompromised host occur?
Definition
-Steroid use
-chemotherapy
-nutritional deficit
-use of broad spectrum antibiotic
-AIDS
-genetic immune disorders
- long term life support technology
Term
What is the pathophysiolgy of pneumonia?
Definition
The presence of of microorganisms in the lower respiratory tract causes the inflammatory response to be activated. This causes WBC, plasma fluid, and immune complexes into the alveoli filling the normally air filled sac with fluid. This causes consolidation of lung tissue.
Term
What are the classic clinical manifestations of pneumonia?
Definition
Fever, cough, dyspnea, and leukocytosis.
Term
What are the physical exam findings of pneumonia?
Definition
Bronchial breath sounds, crackles, increased tactile fremitus, dullness of percussion, ego phony, whispered pec.,
Term
How is pneumonia diagnosed?
Definition
Physical exam, chest x-ray, blood culture, sputum examination, rapid bacterial antigen testing, uring or oropharyngeal swabs
Term
What is the pharmacological treatment of pneumonia?
Definition
appropriate antibiotic depending on classification of pneumonia
Term
What is oxygen inhalation therapy?
Definition
The administration of oxygen at a concentration greater than that found in the environmental atmosphere.
Term
What is the goal of oxygen inhalation therapy?
Definition
To prevent or correct tissue hypoxia
Term
What is hypoxemia?
Definition
Decrease in the arterial oxygen content that is measured by ABG

An oxygen level less than 60mm hb and or a pulse ox of less than 90
Term
What must the nurse keep in mind when administering oxygen?
Definition
Oxygen transport to the tissues is dependent not only on the arterial oxygen content but also cardiac output, hemoglobin concentration, and metabolic requirements.
Term
What are the clinical indicators for oxygen use?
Definition
Dyspnea, chest pain, ABG readings, POX, physical exam findings
Term
What needs to be done for high flow rate oxygen/
Definition
Must be humidified
Term
What is the flow rate for a nasal cannula?
Definition
1-6 L of oxygen at 23-42% o2
Term
What is the flow rate for a simple mask?
Definition
6-8 L of oxygen at 40-60% o2
Term
What is the flow rate for a partial rebreather mask?
Definition
8-11 L of oxygen at 50-75% o2
Term
What is the flow rate for a non rebreather mask?
Definition
12 L of oxygen at 80-100% o2
Term
What is the flow rate for a venturi mask?
Definition
4-8 L of oxygen at 24, 26, 28, 30, 35, 40% O2
Term
What is the flow rate for a tracheostomy collar and face tent?
Definition
8-10 L of oxygen at 30-100% O2
Term
A nurse is reviewing the epidemiology of pneumonia. The nurse should be aware of a seasonal pattern of incidence and prevalence in what type of pneumonia?

Community-acquired pneumonia
Hospital-acquired pneumonia
Ventilator-associated pneumonia
Health care–associated pneumonia
Definition
Community-acquired pneumonia
Most cases of CAP occur in the winter and early spring. The etiology of the other three major types of pneumonia does not include seasonal patterns of incidence and prevalence.
Term
What do the goals of pneumonia care address?
Definition
Improved airway patency
Conserving energy
Maintenance of proper fluid volume
Maintenance of adequate nutrition
Understanding of treatment and preventive measures
Absence of complications
Term
A nurse is administering tuberculin skin tests to a group of employees. What technique will the nurse utilize?

Intradermal injection into the workers’ forearms
Intramuscular injection into the vastus lateralis
Subcutaneous injection into the abdominal region
Insertion at a 90-degree angle into the deltoid
Definition
A. Intradermal injection into the workers’ forearms
Rationale: During the tuberculin skin test, tubercle bacillus extract is injected into the intradermal layer of the inner aspect of the forearm
Term
What is pleurisy?
Definition
Inflammation of both layers of the pleurae. May develop in conjunction w/ pneumonia, URTI, TV, collagen disease, trauma, pulmonary infarction, after a thoractomy.
Term
What are the clinical manifestations of pleurisy?
Definition
Pleuritic pain related to respiratory movement, limited in distribution, usually only occurs on 1 side
Term
How is pleurisy managed?
Definition
Discover the underlying cause of the pleurisy and treat it.
Can give analgesics, NSAIDS, narcotic/nerve block
Term
What is a pleural effusion?
Definition
A collection of fluid in the pleural space that usually occurs secondary to other diseases.
Term
What are pleural effusions sometimes a complication of?
Definition
Heart failure
TB
Pneumonia
Pulmonary infections
Nephrotic syndrome
connective tissue disoders
pulmonary embolus
neoplastic tumors
Term
What is an empyema?
Definition
Exudative pleural effusions
Term
What do most empyemas occur because of?
Definition
Bacterial pneumonia or lung abscesses
Term
What are the clinical manifestations of ARF?
Definition
Restlessness, fatigue, headache, dyspnea, air hunger, mild tachycardia, tachyapnea, central cyanosis, diaphoresis, respiratory arrest
Term
What are the physical exam findings of a ARF?
Definition
Use of accessory muscles, decreased breath sounds
Term
How is a ARF treated?
Definition
Correct underlying cause and to restore adequate gas exchange in the lungs.

Oxygen therapy, naloxone used to reverse narcotic caused resp. depression, mechanical ventilation
Term
What are the clinical manifestations of a pleural effusion?
Definition
Caused by the underlying disease so anything from pneumonia symptoms to tumor
Term
What are the assessment findings of pleural effusion?
Definition
Decreased/absent breath sounds, decreased fremitus, and a dull/flat sound on percussion.
Term
How is a pleural effusion diagnosed?
Definition
CXR ultrasound or thoracentesis
Term
How is a pleural effusion medically managed?
Definition
Discover the underlying cause of the problem and treat it

thoracentesis, chest tube
Term
What is the nurse's role in a pleural effusion?
Definition
Implement medical regimen, prepare and position client for thoracentisis and offer support, chest tube management, pain management
Term
What is acute respiratory failure?
Definition
Sudden life threatening deterioration of the gas exchange function of the lung. Exists when the exchange of oxygen for carbon dioxide in the lungs cannot keep up with the rate of oxygen consumption and carbon dioxide production by cells of the body.
Term
What is the classification of acute respiratory failure?
Definition
Hypoxemic (PAO2 <50) on room air)
Hypercapnic (PACO2 > 50 on room air)
ABG pH of < 7.35
Term
What is the pathophysiology of ARF?
Definition
1.) Alveolar hypoventilation
2.) Diffusion abnormalities
3.) Ventilation-perfusion mismatching
4.) Shunting
5.) Increased physiologic dead space
Term
What is alveolar hypotension? (ARF)
Definition
Inability to deliver oxygen to the alveoli and remove Co2 from the alveoli
Term
What is diffusion abnormalities? (ARF)
Definition
Related to problems with gas transfer across the alveolar-capillary membrane
Term
What is ventilation-perfusion mismatching? (ARF)
Definition
Alveolar ventilation bring oxygen to the lung and removes CO2 while blood brings CO2 to the alveoli and takes O2 from the alveoli. Thus 02 and Co2 levels are determined by the mismatching of ventilation with perfusion.
Term
What is shunting? (ARF)
Definition
Perfusion is adequate to the lung but ventilation is impaired, thus deoxygenated blood continues to the L side of heart
Term
What is dead space? (ARF)
Definition
Impaired perfusion.
Term
What are the 4 common causes of ARF?
Definition
1.) Decreased respiratory drive
2.) Dysfxn of chest wall
3.) Dysfxn of lung parenchyma
4.) Other
Term
What is the nursing management of ARF?
Definition
Assisting with intubation and maintaining mechanical ventilation, monitor ABG/POX, VS, assess entire respiratory system
Term
What is ARDS?
Definition
Severe form of acute lung injury. Sudden and progressive pulmonary edema, increasing bilateral infiltrates on CXR, hypoxemia refractory to supplemental O2, reduced lung compliance.
Term
What are the risk factors for ARDS?
Definition
-Aspiration
-Drug ingestion and overdose
-Hematologic disorders
-Prolonged inhalation of high concentrations of O2
-Localized infection
-Metabolic disoders
-Shock
-Trauma
-Major surgery
-Fat/air embolism
-Systemic sepsis
Term
What is PEEP?
Definition
Positive-end-expiratory pressure that is used to treat ARDS.
Term
What are the clinical manifestations of ARDS?
Definition
Onset of severe dyspnea that usually occurs 12-48 hours after the initiating event. Arterial hypoxemia that does not respond to supplemental O2. Increased alveolar dead space. Decreased pulmonary compliance. Intercostal retractions, crackles.
Term
How is ARDS managed?
Definition
Mechanical ventilation and intubation
Term
What does PEEP do?
Definition
Helps to increase FRC and reverse alveolar collapse by keeping the alveoli open, resulting in improved arterial oxygenation and a reduction in the severity of the ventilation-perfusion imbalance.
Term
What is the goal of PEEP?
Definition
PaO2 > 60 mm Hg or an oxygen saturation level of greater than 90% at the lowest possible FiO2.
Term
What does PEEP increase?
Definition
Intrathoracic pressure and causes a decrease in preload of the heart. THis drop in preload can result in a drop in cardiac output and hypotension.
Term
A patient has been admitted to the emergency department with signs and symptoms that are suggestive of ARDS. What action should the ED nurse prioritize?

Preparing to participate in intubation
Administering oxygen by nasal cannula
Administering bronchodilators by metered dose inhaler
Auscultating the patient’s chest
Definition
A. Preparing to participate in intubation
Rationale: In order to facilitate the priorities of airway and breathing, prompt intubation is imperative in the treatment of a patient with ARDS. This is a priority over other assessments and interventions.
Term
What is a pulmonary embolism?
Definition
Refers to the obstruction of the pulmonary artery or one of its branches by a thrombus that originates somewhere in the venous system or right side of the heart.
Term
How are pulmonary embolisms treated?
Definition
-General measures to improve respiratory and vascular status
-Anticoagulation therapy
-Thrombolytic therapy
-Surgical intervention
Term
What is the nurses' role in PE?
Definition
-Minimizing the risk of PE
-Preventing thrombus formation
-Assessing potential for pulmonary embolism
-Monitoring thrombolytic therapy
-Managing pain
-Managing oxygen therapy
-Relieving anxiety
-Monitoring for complications
-Providing post operative care
Term
What is a tension pneumothroax?
Definition
Occurs when air is drawn into the pleural space from a lacerated lung or through a small opening or wound in the chest wall. May be a complication of other types of pneumothorax. With each breath, positive pressure increases and causes the lung to collapse and the heart, vessels, and trachea to shift towards the UNAFFECTED side.
Term
What is the medical/nursing management of a tension pneumothroax?
Definition
A chest tube to create negative pressure and to reinflate the lungs
Term
Why are chest tubes used?
Definition
To drain fluid or air from any of the three compartments of the thorax (R, L, mediastinum)
Term
What complications can chest tubes fix?
Definition
Pneumothroax, hemothorax,
Term
What are the 2 types of chest drainage systems?
Definition
Wet or dry seal
Term
What nursing care is associated w/ chest tubes?
Definition
-Pain management
-Dry dressing
-No dependent loops
-Measure output
-Look for air/water leaks
Term
What is a pneumoectomy?
Definition
Removal of lung due to damage or cancer
Term
What is a lobectomy?
Definition
removal of a lobe of a lung due to damage or cancer
Supporting users have an ad free experience!