health and illness test 2

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health and illness test 2
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respiratory health and illness test 2
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  1. •Acute pharyngitis of a bacterial nature is most commonly caused by group A, beta-hemolytic streptococci.
    True or False?
    •True.

    •Rationale: Acute pharyngitis of a bacterial nature is most commonly caused by group A, beta-hemolytic streptococci.
  2. •What should the nurse palpate when assessing for an upper respiratory tract infection?

    A.Neck lymph nodes
    B.Nasal mucosa
    C.Tracheal mucosa
    D.All of the above
    •A. Neck lymph nodes

    • •Rationale:The nurse should palpate the neck lymph nodes along with the trachea and the frontal and maxillary sinuses when assessing for an upper respiratory tract infection. The nurse should inspect the nasal and tracheal mucosa when
    • assessing for an upper respiratory tract infection.
  3. Epistaxis
    • •Hemorrhage from nose
    • •Risk factors
    • •Sites of bleeding
    • –Most common: anterior septum
    • •Can be serious problem resulting is significant blood loss or airway compromise
  4. Cancer of the Larynx
    • –Supraglottic: false vocal cords above vocal cords
    • –Glottic: true vocal cords
    • –Subglottic: below vocal cords
  5. Cancer of the Larynx
    • •Hoarseness
    • •Persistent cough
    • •Sore throat or pain, burning in throat
    • •Lump in neck
    • •Later symptoms: dysphagia, dyspnea, unilateral nasal obstruction, persistent hoarseness, persistent ulceration,
    • foul breath
    • •Generalized symptoms: weight loss, debilitation, lymphadenopathy, radiation of pain to ear
  6. •An early sign of cancer of the larynx in the glottic are is enlarged cervical nodes.
    True or False
    •False.

    • •Rationale:
    • An early sign of cancer of the larynx in the glottic are is affected voice sounds, not enlarged
    • cervical nodes.
  7. Atelectasis
    •Collapse or airless condition of alveoli caused by hypoventilation, obstruction to airways, or compression

    •Causes: bronchial obstruction by secretions due to impaired cough mechanism or conditions that restrict normal lung expansion on inspiration

    •Postoperative patients at high risk

    •Symptoms: insidious, include cough, sputum production, low-grade fever

    •Respiratory distress, anxiety, symptoms of hypoxia occur if large areas of lung are affected
  8. •Pleurisy:
    • inflammation of both layers of pleurae
    • –Inflamed surfaces rub together with respirations, cause sharp pain intensified with inspiration
  9. •Pleural effusion:
    •Pleural effusion: collection fluid in pleural space usually secondary to another disease process

    • –Large effusions impair lung
    • expansion, cause dyspnea
  10. •Empyema:
    • accumulation of thick, purulent fluid in
    • pleural space.

    –Patient usually acutely ill; fluid, fibrin development, loculation impair lung expansion

    –Resolution is a prolonged process
  11. Pulmonary Emboli
    • •Obstruction
    • of pulmonary artery or branch by blood clot, air, fat, amniotic fluid, or
    • septic thrombus

    • –Most thrombus are blood clots
    • from leg veins

    • •Obstructed
    • area has diminished or absent blood flow

    • –Although area is ventilated, no
    • gas exchange occurs

    • •Inflammatory
    • process causes regional blood vessels, bronchioles to constrict, further
    • increasing pulmonary vascular resistance, pulmonary arterial pressure, right
    • ventricular workload

    • •Ventilation-perfusion
    • imbalance, right ventricular failure, shock occur
  12. •Bradypnea is the most common sign for a possible
    pulmonary embolism.
    True or False
    •False.

    •Rationale: Tachypnea, not bradypnea, is the most common sign for a possible pulmonary embolism.
  13. •Which of the following is the most common surgery for a small apparently curable tumor of the lung?

    A.Lobectomy
    B.Pneumonectomy
    C.Segmentectomy
    D.Sleeve resection
    •A. Lobectomy

    • •Rationale: The most common surgical procedure for a small, apparently curable tumor of the lung is a lobectomy. A pneumonectomy is the removal an entire lung. Segmentectomy is not recommended as curative resection of
    • lung cancer and is a removal of a segment of the lung. A sleeve resection is removal of the cancerous lobes with a segment of the main bronchus resected.
  14. •An initial characteristic symptom of a simple pneumothorax is a sudden onset of chest pain.
    True or False
    •True.

    •Rationale: An initial characteristic symptom of a simple pneumonthorax is a sudden onset of chest pain.
  15. COPD:
    • •Chronic Obstructive Pulmonary Disease
    • •A disease state characterized by airflow limitation that is not full reversible (GOLD).
    • •COPD is the currently is 4th leading cause of death and the 12th leading cause of disability.
    • •COPD includes diseases that cause airflow obstruction (emphysema, chronic bronchitis) or a combination of these
    • disorders.
    • •Asthma is now considered a separate disorder but can coexist with COPD.
  16. Chronic Bronchitis
    • •The presence of a cough and sputum production
    • for at least 3 months in each of 2 consecutive years.

    • •Irritation of airways results in inflammation
    • and hypersecretion
    • of mucous.

    • •Mucous-secreting glands and goblet cells
    • increase in number.

    • •Ciliary
    • function is reduced, bronchial walls thicken, bronchial airways narrow, and
    • mucous may plug airways.

    • •Alveoli become damaged, fibrosed, and
    • alveolar macrophage function diminishes.

    • •The patient is more susceptible to
    • respiratory infections.
  17. For patients with chronic bronchitis, the nurse expects to see the major clinical symptoms of tachypnea and tachycardia.
    True or False
    False



    For patients with chronic bronchitis, the nurse expects to see the major clinical symptoms of sputum and productive cough, not tachypnea and tachycardia
  18. Emphysema:
    • •Abnormal distention of air spaces beyond the
    • terminal bronchioles with destruction of the walls of the alveoli.

    • •Decreased alveolar surface area causes an
    • increase in “dead space” and impaired oxygen diffusion.

    • •Reduction of the pulmonary capillary bed
    • increases pulmonary vascular resistance and pulmonary artery pressures.

    •Hypoxemia result of these pathologic changes.


    • •Increased pulmonary artery pressure may cause
    • right-sided heart failure (cor pulmonale).
  19. What is the primary clinical symptom of emphysema?

    A.Chest pain
    B.Productive cough
    C.Sputum
    D.Wheezing
    D

    The primary symptom of emphysema is wheezing. Sputum and productive cough are the primary symptoms of chronic bronchitis.
  20. Risk Factors for COPD
    • •Tobacco smoke causes 80-90% of COPD cases!
    • •Passive smoking
    • •Occupational exposure
    • •Ambient air pollution
    • •Genetic abnormalities
    • –Alpha1-antitrypsin
  21. A commonly prescribed methylxanthine is theophylline.
    True or False
    True
  22. A commonly prescribed methylxanthine is theophylline.
  23. Bronchiectasis
    •Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles.

    • •Caused by:
    • –Airway obstruction
    • –Diffuse airway injury
    • –Pulmonary infections and obstruction of the bronchus or complications of long-term pulmonary infections
    • –Genetic disorders such as cystic fibrosis
    • –Abnormal host defense (eg, ciliary dyskinesia or humoral immunodeficiency)
    • –Idiopathic causes
  24. Cystic Fibrosis
    •The most common fatal autosomal recessive disease among the Caucasian population.

    •Genetic screening is able to detect carriers of this disease.

    •Genetic counseling for couples at risk.

    •A mutation of a gene causes changes in chloride transport which leads to thick, viscous secretions in the lungs, pancreas, liver, intestines, and reproductive tract.

    •Pulmonary problems are the leading cause of morbidity and mortality.
  25. The primary oxygen administration method for
    a patient with COPD is a nasal cannula.
    True or False
    False
  26. The primary oxygen administration method for a patient with COPD is a Venturi mask, not a nasal cannula.
  27. A patient with hypoxemia will have an
    increase in the PaO2 level.
    • False
    • A patient with hypoxemia will have a decrease in the PaO2 level, not an increase in the PaO2 level.
  28. The patient should be encouraged to use an incentive spirometer approximately ten breaths per hour between treatments while awake.
    True or False
    True

    The patient should be encouraged to use an incentive spirometer approximately ten breaths per hour between treatments while awake.
  29. Tracheostomy
    • •Bypasses the upper airway to bypass an
    • obstruction, allow removal of secretions, permit long-term mechanical
    • ventilation, prevent aspirations of secretions, or to replace an endotracheal
    • tube.

    • •Complications include bleeding, pneumothorax,
    • aspiration, subcutaneous or mediastinal emphysema, laryngeal nerve damage, posterior
    • tracheal wall penetration.

    • •Long-term complications include airway
    • obstruction, infection, rupture of the innominate artery, dysphagia, fistula formation, tracheal dilatation, and
    • tracheal ischemia and necrosis.
  30. Chest Drainage
    • •Used to treat spontaneous and traumatic pneumothorax
    • •Used postoperatively to reexpand the lung and remove excess air, fluid, and blood.
    • •Types of drainage systems
    • •Traditional water seal
    • –Dry suction water seal
    • –Dry suction
    • •Management Prevention of cardiopulmonary complications
  31. Diagnostic test: blood normal levels
    • ABGs, CBC, H&H, hematocrit- male 40-50%, women 37-47%; WBC: 5000-10,000; RBC: male-4.5-6.2 million, female-4.2-5.4; Hemoglobin:male-13.5-18g/dl, female- 12-16
    • ·
    • ABGsnormal values: Pao2: 75-100 mmhg; PaCo2:
    • 35-45 mmhg; pH: 7.35-7.45; HCO3:22-26; O2: 95-100%
  32. alaryngeal communication:
    alternative modes of speaking that do not involve the normal larynx; used by patients whose larynx has been surgically removed
  33. aphonia:
    impaired ability to use one’s voice due to disease or injury to the larynx
  34. apnea:
    cessation of breathing
  35. carcinogen:
    agent that can cause cancer; carcinogens can be chemicals, viruses, hormones, ionizing radiation, or solid materials
  36. dysphagia:
    difficulties in swallowing
  37. epistaxis:
    • hemorrhage from the nose due to rupture of tiny,
    • distended vessels in the mucous membrane of any area of the nose
  38. laryngectomy:
    surgical removal of all or part of the larynx and surrounding structures
  39. laryngitis:
    inflammation of the larynx; may be caused by voice abuse, exposure to irritants, or infectious organisms
  40. medicamentosa:
    rebound nasal congestion commonly associated with overuse of over-the-counter nasal decongestants
  41. nuchal rigidity:
    stiffness of the neck or inability to bend the neck
  42. pharyngitis:
    inflammation of the throat; usually viral or bacterial in origin
  43. rhinitis:
    inflammation of the mucous membranes of the nose; may be infectious, allergic, or inflammatory in origin
  44. rhinorrhea:
    drainage of a large amount of fluid from the nose
  45. rhinosinusitis:
    inflammation of the nares and paranasal sinuses, including frontal, ethmoid, maxillary, and sphenoid sinuses; replaces the term “sinusitis”
  46. tonsillitis:
    inflammation of the tonsils, usually due to an acute infection
  47. xerostomia:
    dryness of the mouth from a variety of causes
  48. Epistaxis, a hemorrhage from the nose, is caused by the rupture of tiny, distended vessels in the mucous membrane of any area of the nose. Rarely does epistaxis originate in the densely vascular tissue over the turbinates. Most commonly, the site isthe anterior septum, where three major blood vessels enter thenasal cavity:
    (1) the anterior ethmoidal artery on the forward part of the roof (Kiesselbach’s plexus), (2) the sphenopalatineartery in the posterosuperior region, and (3)the internal max-illary branches (the plexus of veins located at the back of thelateral wall under the inferior turbinate).Several risk factors are associated with epistaxis.
  49. Be alert for the following signs and symptoms (apnea I think):
    •Excessive daytime sleepiness•Frequent nocturnal awakening•Insomnia•Loud snoring•Morning headaches •Intellectual deterioration •Personality changes, irritability •Impotence •Systemic hypertension •Dysrhythmias •Pulmonary hypertension, cor pulmonale •Polycythemia •Enuresis
  50. Assessing for ObstructiveSleep Apnea (OSA)
    • •Local infections (vestibulitis, rhinitis, sinusitis)•Systemic infections (scarlet fever, malaria)•Drying of nasal mucous
    • membranes•Nasal inhalation of illicit drugs (eg, cocaine) •Trauma (digital trauma as in picking the nose; blunttrauma; fracture; forceful nose blowing) •Arteriosclerosis •Hypertension •Tumor (sinus or nasopharynx) •Thrombocytopenia •Use of aspirin •Liver disease •Redu-Osler-Weber
    • syndrome (hereditary hemorrhagictelangiectasia)
  51. acute lung injury:
    an umbrella term for hypoxemic, respiratory fail-ure; acute respiratory distress syndrome is a severe form of acute lung injury
  52. acute respiratory distress syndrome:
    nonspecific pulmonary response to a variety of pulmonary and nonpulmonary insults to the lung; characterized by interstitial infiltrates, alveolar hemor-rhage, atelectasis, decreased compliance, and refractory hypox-emia
  53. asbestosis:
    diffuse lung fibrosis resulting from exposure toasbestos fibers
  54. atelectasis:
    collapse or airless condition of the alveoli caused by hypoventilation, obstruction to the airways, or compression
  55. central cyanosis:
    bluish discoloration of the skin or mucous mem-branes due to hemoglobin carrying reduced amounts of oxygen
  56. consolidation:
    lung tissue that has become more solid in naturedue to collapse of alveoli or infectious process (pneumonia)
  57. cor pulmonale:
    ”heart of the lungs”; enlargement of the right ventricle from hypertrophy or dilation or as a secondary response to disorders that affect the lungs
  58. empyema:
    accumulation of purulent material in the pleural space
  59. fine-needle aspiration:
    insertion of a needle through the chest wall to obtain cells of a mass or tumor; usually performed under fluoroscopy or chest computed tomography guidance
  60. hemoptysis:
    the coughing up of blood from the lower respiratory tract
  61. hemothorax:
    partial or complete collapse of the lung due to blood accumulating in the pleural space; may occur after surgery or trauma
  62. induration:
    an abnormally hard lesion or reaction, as in a positive tuberculin skin test
  63. nosocomial:
    pertaining to or originating from a hospitalization; not present at the time of hospital admission
  64. open lung biopsy:
    biopsy of lung tissue performed through a lim-ited thoracotomy incision
  65. orthopnea:
    shortness of breath when reclining or in the supine position
  66. pleural effusion:
    abnormal accumulation of fluid in the pleural space
  67. pleural friction rub:
    localized grating or creaking sound caused bythe rubbing together of inflamed parietal and visceral pleurae
  68. pleural space:
    the area between the parietal and visceral pleurae;a potential space
  69. pneumothorax:
    partial or complete collapse of the lung due topositive pressure in the pleural space
  70. pulmonary edema:
    increase in the amount of extravascular fluid inthe lung
  71. pulmonary embolism:
    obstruction of the pulmonary vasculature withan embolus; embolus may be due to blood clot, air bubbles, or fatdroplets
  72. purulent:
    consisting of, containing, or discharging pus
  73. restrictive lung disease:
    disease of the lung that causes adecrease in lung volumes
  74. tension pneumothorax:
    pneumothorax characterized by increasing positive pressure in the pleural space with each breath; this is an emergency situation and the positive pressure needs to be decompressed or released immediately
  75. thoracentesis:
    insertion of a needle into the pleural space to removefluid thathas accumulated and decrease pressure on the lung tis-sue; may also be used diagnostically to identify potential causesof a pleural effusion
  76. ventilation–
    • perfusion ratio: the ratio between ventilation and per-fusion in the lung; matching of ventilation to perfusion optimizes gas
    • exchange
  77. Pleurisy (pleuritis) refers to inflammation of both layersofthe pleurae (parietal and visceral).
    Pleurisy may develop inconjunction with pneumonia or an upper respiratory tract infection, TB, or collagen disease;after trauma to the chest, pulmonary infarction, or PE; in patients with primary or metastatic cancer; and after thoracotomy.
  78. An empyema
    is an accumulation of thick, purulent fluid within the pleural space, often with fibrin development and aloculated (walled-off) area where infection is located.
  79. air trapping:
    incomplete emptying of alveoli during expira-tion due to loss of lung tissue elasticity (emphysema),bronchospasm (asthma), or airway obstruction
  80. -antitrypsin deficiency:
    genetic disorder resulting from deficiency of alpha 1
  81. antitrypsin
    a protective agentfor the lung; increases patient’s risk for developing panacinar emphysema even in the absence of smoking
  82. asthma:
    • a disease with multiple precipitating mechanisms resulting
    • in a common clinical outcome of reversible air-flow obstruction; no longer considered a category of COPD
  83. bronchiectasis:
    • chronic dilation of a bronchus or bronchi; the dilated airways become saccular and are a mediumfor chronic infection; no
    • longer considered a category of COPD
  84. bronchitis:
    a disease of the airways defined as the presence of cough and sputum production for at least acombined total of 3 months in each of 2 consecutive years; a category of COPD
  85. chronic obstructive pulmonary disease:
    • disease statecharacterized by airflow limitation that is not fullyreversible; sometimes referred to as chronic airway
    • obstruction or chronic obstructive lung disease
  86. emphysema:
    a disease of the airways characterized by de-struction of the walls of overdistended alveoli; acategory of COPD
  87. metered-dose inhaler:
    patient-activated medication canister that provides aerosolized medication that the patientinhales into the lungs
  88. polycythemia:
    increase in the red blood cell concentrationin the blood; in COPD, the body attempts to improveoxygen carrying capacity by producing increasingamounts of red blood cells
  89. spirometry:
    pulmonary function tests that measurespecific lung volumes (eg, FEV 1 , FVC) and rates(FEF 25–75%); may be measured before and afterbronchodilator administration
  90. continuous positive airway pressure (CPAP):
    positive pressure applied throughout the respiratory cycle to a spontaneously breathing patient to promote alveolar and airway stability; may beadministered with endotracheal or tracheostomy tube or by mask
  91. controlled ventilation:
    • mode of mechanical ventilation in which the ventilator completely controls the patient’s ventilation according to
    • preset tidal volumes and respiratory rate; because of problems with synchrony, it is rarely used except in paralyzed or anesthetized patients
  92. endotracheal intubation:
    insertion of a breathing tube through the nose or mouth into the trachea
  93. fraction of inspired oxygen (FiO2):
    concentration of oxygen delivered (1.0100% oxygen)
  94. hypoxemia:
    decrease in arterial oxygen tension in the blood
  95. hypoxia:
    decrease in oxygen supply to the tissues and cells
  96. incentive spirometry:
    method of deep breathing that provides visual feedback to help the patient inhale deeply and slowly and achieve maximum lung inflation
  97. intermittent mandatory ventilation (IMV):
    mode of mechanical ventilation that provides a combination of mechanically assisted breaths and spontaneous breaths
  98. mechanical ventilator:
    • a positive- or negative-pressure
    • breathing device that supports ventilation and oxygenation
  99. pneumothorax:
    partial or complete collapse of the lung due to positive pressure in the pleural space
  100. positive end-expiratory pressure (PEEP):
    positive pressure maintained by the ventilator at the end of exhalation (instead of a normal zero pressure) to increase functional residual capacity and open collapsed alveoli; improves oxygenation with lower fraction of inspired oxygen
  101. postural drainage:
    positioning the patient to allow drainage from all the lobes of the lungs and airways
  102. pressuresupportventilation(PSV):
    modeofmechanical ventilation in which preset positive pressure is delivered with spontaneous breaths to decrease work of breathing
  103. proportional assist ventilation (PAV):
    mode of mechanical ventilation that provides partial ventilatory support in proportion to the patient’s inspiratory efforts; decreases the work of breathing
  104. respiratory weaning:
    process of gradual, systematic withdrawal or removal of ventilator, breathing tube, and oxygen
  105. synchronized intermittent mandatory ventilation (SIMV):
    mode of mechanical ventilation in which the ventilator allows the patient to breathe spontaneously while providing a preset number of breaths to ensure adequate ventilation; ventilated breaths are synchronized with spontaneous breathing
  106. thoracotomy:
    surgical opening into the chest cavity
  107. tracheostomy tube:
    indwelling tube inserted directly into the trachea to assist with ventilation
  108. tracheotomy:
    surgical opening into the trachea
  109. vibration:
    a type of massage administered by quickly tapping the chest with the finger tips or alternating the fingers in a rhythmic manner, or by using a mechanical device to assist in mobilizing lung secretions
  110. airway pressure release ventilation (APRV):
    • mode of mechanical ventilation that allows unrestricted, spontaneous breaths throughout the ventilatory cycle; on inspiration patient receives preset level of continuous positive airway pressure, and pressure is periodically released to
    • aid expiration
  111. assist–control ventilation (A/C):
    • mode of mechanical ventilation in which the patient’s breathing pattern may trigger the ventilator to deliver a preset tidal volume; in the absence of spontaneous breathing, the
    • machine delivers a controlled breath at a preset minimum rate and tidal volume
  112. chest drainage system:
    use of a chest tube and closed drainage system to reexpand the lung and to remove excess air, fluid, and blood
  113. chest percussion:
    manually cupping over the chest wall to mobilize secretions by mechanically dislodging viscous or adherent secretions in the lungs
  114. chest physiotherapy (CPT):
    • therapy used to remove bronchial secretions, improve ventilation, and increase the efficiency of the respiratory
    • muscles; types include postural drainage, chest percussion, and vibration
  115. Pneumonia
    • •Typical Pneumonia - Bacterial
    • •Atypical Pneumonia - Viral/Fungal
    • •Pneumocystis Carinii - HIV

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