Term
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Definition
| The collapse of the alveoli, leading to the loss of lung volume. |
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Term
| What are the 3 types of atelectasis? |
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Definition
1.) Absorptive
2.) Compressive
3.) Obstructive |
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Term
| What is absorptive atelectasis? |
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Definition
| Occurs by surfactant inactivation or when less than normal levels of inhaled nitrogen (WASHOUT) are preent in the alveoli. |
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Term
| What are the most common causes of absorptive atlectasis? |
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Definition
| ARDS -> loss or surfactant -> Nitrogen washout |
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Term
| How does ARDS cause absorptive atelectasis? |
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Definition
| Pulmonary edema fluid dilutes/reduces surfactant production. |
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Term
| What is compressive atelectasis? |
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Definition
| A result of external forces compressing pleural and/or lung tissues. |
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Term
| What are the common causes of compressive atelectasis? |
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Definition
| Pleural effusion, lung tumors, pneumothoraces, hemothoraces, abdominal distention |
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Term
| What is obstructive atelectasis? |
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Definition
| Mechanical obstruction of airways or from low tidal volume breathing |
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Term
| What can cause obstructive atelectasis? |
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Definition
| Secretions, airway tumors, foreign bodies |
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Term
| What is the result of all 3 types of atelectasis? |
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Definition
| Mismatching of lung ventilation to perfusion which results in deoxygenated blood reaching systemic circulation and lowering oxygen supply to tissues |
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Term
| Of the 3 types of atelectasis, what is the most common? |
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Definition
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Term
| What are the risk factors associated w/ atelectasis? |
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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 |
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Term
| What are the symptoms of atelectasis? |
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Definition
| Dyspnea, cough, leukocytosis, and sputum prodction. |
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Term
| What are the findings of atelectasis? |
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Definition
| Crackles, decreased breath sounds, decreased tactile fremitus, tracheal deviation towards affected side, ego phony, asymmetry of chest |
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Term
| How is atelectasis PREVENTED? |
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Definition
-Position changes
-Early mobilization
-Appropriate deep breathing/cough
-INcentive spirometry
-Prescribed opiods and sedatives judicially
-Perform postural drainage
-Suctioning to remove secretions |
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Term
| What is the GOAL of atelectasis treatment? |
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Definition
| to correct tissue hypoxia. |
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Term
| How is atelectasis treated? |
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Definition
-PREVENTION IS KEY!
-The use of nebulizers, chest PT, and oxygen may be used |
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Term
| What can you do for obstructive atelectasis? |
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Definition
-coughing
-suctioning
-mucolytic agents
-bronchoscopy |
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Term
| What can you do for compressive atelectasis? |
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Definition
-Thoracentesis
-Chest tube
-PEEP |
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Term
|
Definition
| An infection of the LRT caused by a variety of microorganisms. The most common infectious cause of death |
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Term
| What are the classifications of pneumonia? |
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Definition
Community-acquired pneumonia
Hospital-acquired pneumonia
Ventilator-associated pneumonia
Health-care associated pneumonia
Pneumonia in an immunocompromised patient |
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Term
| What is community acquired pneumonia? |
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Definition
| Occurs either in the community dwelling person or within the first 48 hours after hospitalization or institutionalization. |
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Term
| What is hospital-acquired pneumonia? |
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Definition
| The onset of pneumonia symptoms more than 48 hours after admission in patients with no evidence of infection at the time of admission |
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Term
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Definition
1.) Host defenses impaired
2.) Microorganisms reach LRT
3.) Highly virulent organism is present |
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Term
| What is ventilator-associated pneumonia? |
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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. |
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Term
| What is health care associated pneumonia? |
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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 |
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Term
| What is pneumonia in the immunocompromised host? |
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Definition
Pneumocystis pneumonia
Fungal pneumonias
mycobacterium tuberculosis |
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Term
| When does pneumonia in the immunocompromised host occur? |
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Definition
-Steroid use
-chemotherapy
-nutritional deficit
-use of broad spectrum antibiotic
-AIDS
-genetic immune disorders
- long term life support technology |
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Term
| What is the pathophysiolgy of pneumonia? |
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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. |
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Term
| What are the classic clinical manifestations of pneumonia? |
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Definition
| Fever, cough, dyspnea, and leukocytosis. |
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Term
| What are the physical exam findings of pneumonia? |
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Definition
| Bronchial breath sounds, crackles, increased tactile fremitus, dullness of percussion, ego phony, whispered pec., |
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Term
| How is pneumonia diagnosed? |
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Definition
| Physical exam, chest x-ray, blood culture, sputum examination, rapid bacterial antigen testing, uring or oropharyngeal swabs |
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Term
| What is the pharmacological treatment of pneumonia? |
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Definition
| appropriate antibiotic depending on classification of pneumonia |
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Term
| What is oxygen inhalation therapy? |
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Definition
| The administration of oxygen at a concentration greater than that found in the environmental atmosphere. |
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Term
| What is the goal of oxygen inhalation therapy? |
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Definition
| To prevent or correct tissue hypoxia |
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Term
|
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 |
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Term
| What must the nurse keep in mind when administering oxygen? |
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Definition
| Oxygen transport to the tissues is dependent not only on the arterial oxygen content but also cardiac output, hemoglobin concentration, and metabolic requirements. |
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Term
| What are the clinical indicators for oxygen use? |
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Definition
| Dyspnea, chest pain, ABG readings, POX, physical exam findings |
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Term
| What needs to be done for high flow rate oxygen/ |
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Definition
|
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Term
| What is the flow rate for a nasal cannula? |
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Definition
| 1-6 L of oxygen at 23-42% o2 |
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Term
| What is the flow rate for a simple mask? |
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Definition
| 6-8 L of oxygen at 40-60% o2 |
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Term
| What is the flow rate for a partial rebreather mask? |
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Definition
| 8-11 L of oxygen at 50-75% o2 |
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Term
| What is the flow rate for a non rebreather mask? |
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Definition
| 12 L of oxygen at 80-100% o2 |
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Term
| What is the flow rate for a venturi mask? |
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Definition
| 4-8 L of oxygen at 24, 26, 28, 30, 35, 40% O2 |
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Term
| What is the flow rate for a tracheostomy collar and face tent? |
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Definition
| 8-10 L of oxygen at 30-100% O2 |
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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 |
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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. |
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Term
| What do the goals of pneumonia care address? |
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Definition
Improved airway patency
Conserving energy
Maintenance of proper fluid volume
Maintenance of adequate nutrition
Understanding of treatment and preventive measures
Absence of complications |
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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 |
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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 |
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Term
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Definition
| Inflammation of both layers of the pleurae. May develop in conjunction w/ pneumonia, URTI, TV, collagen disease, trauma, pulmonary infarction, after a thoractomy. |
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Term
| What are the clinical manifestations of pleurisy? |
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Definition
| Pleuritic pain related to respiratory movement, limited in distribution, usually only occurs on 1 side |
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Term
|
Definition
Discover the underlying cause of the pleurisy and treat it.
Can give analgesics, NSAIDS, narcotic/nerve block |
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Term
| What is a pleural effusion? |
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Definition
| A collection of fluid in the pleural space that usually occurs secondary to other diseases. |
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Term
| What are pleural effusions sometimes a complication of? |
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Definition
Heart failure
TB
Pneumonia
Pulmonary infections
Nephrotic syndrome
connective tissue disoders
pulmonary embolus
neoplastic tumors |
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Term
|
Definition
| Exudative pleural effusions |
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Term
| What do most empyemas occur because of? |
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Definition
| Bacterial pneumonia or lung abscesses |
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Term
| What are the clinical manifestations of ARF? |
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Definition
| Restlessness, fatigue, headache, dyspnea, air hunger, mild tachycardia, tachyapnea, central cyanosis, diaphoresis, respiratory arrest |
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Term
| What are the physical exam findings of a ARF? |
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Definition
| Use of accessory muscles, decreased breath sounds |
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Term
|
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 |
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Term
| What are the clinical manifestations of a pleural effusion? |
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Definition
| Caused by the underlying disease so anything from pneumonia symptoms to tumor |
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Term
| What are the assessment findings of pleural effusion? |
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Definition
| Decreased/absent breath sounds, decreased fremitus, and a dull/flat sound on percussion. |
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Term
| How is a pleural effusion diagnosed? |
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Definition
| CXR ultrasound or thoracentesis |
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Term
| How is a pleural effusion medically managed? |
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Definition
Discover the underlying cause of the problem and treat it
thoracentesis, chest tube |
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Term
| What is the nurse's role in a pleural effusion? |
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Definition
| Implement medical regimen, prepare and position client for thoracentisis and offer support, chest tube management, pain management |
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Term
| What is acute respiratory failure? |
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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. |
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Term
| What is the classification of acute respiratory failure? |
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Definition
Hypoxemic (PAO2 <50) on room air)
Hypercapnic (PACO2 > 50 on room air)
ABG pH of < 7.35 |
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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 |
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Term
| What is alveolar hypotension? (ARF) |
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Definition
| Inability to deliver oxygen to the alveoli and remove Co2 from the alveoli |
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Term
| What is diffusion abnormalities? (ARF) |
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Definition
| Related to problems with gas transfer across the alveolar-capillary membrane |
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Term
| What is ventilation-perfusion mismatching? (ARF) |
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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. |
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Term
|
Definition
| Perfusion is adequate to the lung but ventilation is impaired, thus deoxygenated blood continues to the L side of heart |
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Term
| What is dead space? (ARF) |
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Definition
|
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Term
| What are the 4 common causes of ARF? |
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Definition
1.) Decreased respiratory drive
2.) Dysfxn of chest wall
3.) Dysfxn of lung parenchyma
4.) Other |
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Term
| What is the nursing management of ARF? |
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Definition
| Assisting with intubation and maintaining mechanical ventilation, monitor ABG/POX, VS, assess entire respiratory system |
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Term
|
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. |
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Term
| What are the risk factors for ARDS? |
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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 |
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Term
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Definition
| Positive-end-expiratory pressure that is used to treat ARDS. |
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Term
| What are the clinical manifestations of ARDS? |
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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. |
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Term
|
Definition
| Mechanical ventilation and intubation |
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Term
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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. |
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Term
| What is the goal of PEEP? |
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Definition
| PaO2 > 60 mm Hg or an oxygen saturation level of greater than 90% at the lowest possible FiO2. |
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Term
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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. |
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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 |
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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. |
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Term
| What is a pulmonary embolism? |
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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. |
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Term
| How are pulmonary embolisms treated? |
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Definition
-General measures to improve respiratory and vascular status
-Anticoagulation therapy
-Thrombolytic therapy
-Surgical intervention |
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Term
| What is the nurses' role in PE? |
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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 |
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Term
| What is a tension pneumothroax? |
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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. |
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Term
| What is the medical/nursing management of a tension pneumothroax? |
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Definition
| A chest tube to create negative pressure and to reinflate the lungs |
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Term
| Why are chest tubes used? |
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Definition
| To drain fluid or air from any of the three compartments of the thorax (R, L, mediastinum) |
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|
Term
| What complications can chest tubes fix? |
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Definition
| Pneumothroax, hemothorax, |
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|
Term
| What are the 2 types of chest drainage systems? |
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Definition
|
|
Term
| What nursing care is associated w/ chest tubes? |
|
Definition
-Pain management
-Dry dressing
-No dependent loops
-Measure output
-Look for air/water leaks |
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Term
|
Definition
| Removal of lung due to damage or cancer |
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Term
|
Definition
| removal of a lobe of a lung due to damage or cancer |
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