Med Surg Exam 5 Respiratory

Card Set Information

Med Surg Exam 5 Respiratory
2014-11-01 15:17:14
Med Surg Nursing
Show Answers:

  1. What is a condition in which breathing is disrupted for at least 10 seconds and occurs at a minimum of five times in an hour?
    Sleep Apnea
  2. Pt comes in the clinical complaining of excessive day time sleepiness, unable to concentrate, often feels irritable, and wakes up with a severe headache, what do you suspect is wrong?
    The patient is suffering from sleep apnea
  3. What would you recommend for the patient to help improve his condition of sleep apnea?
    Weight loss and changing sleep positions
  4. If sleep apnea is severe enough, what non surgical intervention may be required?
    Positive pressure ventilation
  5. What are some surgical interventions for sleep apnea
    • Adenoidectomy
    • Uvulectomy
    • uvulopalatopharyngoplasty
  6. What is a life-threatening emergency in which an interruption of airflow through the nose, mouth, pharynx, or larynx occurs
    Upper airway obstruction
  7. What is the nurses first step in intervening with a person who has an upper airway obstruction?
    determine the cause
  8. Name 3 options for maintaining a patent airway and ventilation
    • Cricothyroidotomy
    • Endo/naso/orotracheal intubation
    • Tracheostomy
  9. In what structures do head and neck cancer occur?
    • Larynx
    • Trachea
    • Throat
    • Oral Cavity
    • Tongue
  10. Where does head and neck cancer usually arise from?
    skin or mucosa as squamous cell carcinoma
  11. What are the two greatest risk factors of head and neck cancer?
    • Alcohol
    • Tobacco
  12. What are risk factors other than alcohol and tobacco that cause head and neck cancer?
    • Voice abuse
    • Chronic laryngitis
    • exposure to industrial chemicals/hardware dust
    • Long-term/severe GERD
  13. What kind of history will the nurse want to know that could indicate head/neck cancer disease
    • Tobacco/Alcohol (how much)
    • Repeat Acute/Chronic laryngitis, pharyngitis
    • Oral sores, lumps in the neck
    • Exposure to pollutants
  14. What clinical manifestations are present for a person who has head/neck cancer
    • Weight loss
    • Hoarseness
    • Lumps in head/neck
    • mouth sores
    • laryngeal abnormalities
  15. What kind of psychosocial information would the nurse want to assess?
    • Pt/family feelings
    • Support system/coping mechanisms
    • Education level (teaching)
    • Pt use of speech for employment
  16. What labs will be performed when head and neck cancer is suspected?
    • CBC
    • PT, PTT (Bleeding times)
    • Protein levels (albumin)
    • Renal/Liver function tests (AST/ALT, Creatinine/BUN...)
  17. What other tests (besides labs) will be indicated for a person with head/neck cancer?
    • Urinalysis
    • Xray (skull/sinuses/neck/chest)
    • CT (head/neck)
    • MRI
    • brain/bone/liver scans
    • PET
    • Direct/Indirect laryngoscopy, nasopharyngoscopy, esophagoscopy, bronchosopy
    • Biopsy
  18. What is the goal for a person with Potential Respiratory Obstruction?
    Remove or eradicate the cancer while preserving as much normal function as possible.
  19. What are the side effects of radiation therapy for head/neck cancer?
    • halitosis
    • taste changes
    • risk for dental caries/infections
    • dry mouth
  20. What is a long-term complication of radiation therapy of head/neck that may be permanent and how can it be managed?
    • Dry mouth:
    • Heavy fluid intake (water)
    • Room humidification
    • Artificial Saliva (Salivart)
    • Saliva stimulants (Salagen/cevimeline)
    • Chewing gum/sucking hard candy
  21. What treatment can be used in addition to radiation of head and neck or used alone?
  22. What is TNM and what does it determine?
    • Tumor size and location classification:
    • Surgery type needed
  23. How are very small, early staged tumors of head and neck commonly treated?
    photodynamic therapy: Laser
  24. Name traditional surgical procedures for head/neck cancer
    • Laryngectomy
    • Tracheotomy
    • Oropharyngeal resection
    • chordectomy
    • radical neck dissection
    • composite resection
  25. What is the creation of a new artificial airway by opening the wall of the trachea
  26. What is the removal of vocal chords
  27. What is the removal of primary tumor along with lymph node dissection (could involve skin/muscle/bone/other structures)?
    Radical neck dissection
  28. What is the combination of surgical procedures including glossectomies, partial manibulectomies, and nodal neck dissections
    Composite resections
  29. What preoperative measures would the nurse take before surgery of head/neck when educating the patient?
    • Location of surgical incision
    • alternate forms of communication
    • self-care of airway
    • Critical care environment (ventilators/feeding tubes, nutrition, goals for discharge)
  30. What post-operative interventions would the nurse perform following head/neck surgery?
    • Airway maintenance/ventilation:
    • ventilator management
    • suctioning
    • oxygen therapy
    • humidification
    • coughing/deep breathing
    • laryngectomy/tracheotomy care
  31. What does wound management consist of following surgery
    • Evaluating grafts/flaps q hr for first 72 hrs
    • Monitor cap refill, drainage, doppler major feeding vessel
    • Position pt on side
    • Report changes to surgeon
  32. What results in large amounts of bright red blood spurting quickly after head/neck surgery?
    Carotid Artery rupture
  33. What action does the nurse take if she suspects carotid artery leak?
    • DON'T TOUCH (could cause rupture)
  34. What action does the nurse take if carotid rupture is suspected?
    • Transport pt to OR
  35. What results in bright red oozing blood following head/neck surgery?
    Carotid artery leakage
  36. How much Kcal should the pt receive daily following head/neck surgery?
    35-40 Kcal/kg of body weight
  37. How long is IV fluids or parental nutrition used after surgery of head/neck?
    Until intestinal tract is functioning
  38. How long does tube feeding by NG tube/gastrostomy/jejunostomy remain after head/neck surgery
    7-10 days
  39. What do you assess before removing the pts feeding tube
    swallowing ability
  40. What is a patient who has had a subtotal, vertical, or supraglottic laryngectomy at risk for?
  41. What precautions should be taken for a pt with a feeding tube in place?
    • Elevate HOB 30-40 degrees
    • strict adherence to tube feeding
    • check residual volume before each bolus
    • check residual volume q 4 hrs if continuous
    • Abdominal Assessment
    • Check pt tolerance
  42. What action should the nurse take if the residual volume for tube feeding is high for 2 hours? (>200=250mL)
    • Withhold feeding
    • Notify PCP
  43. When should a bolus not be given?
    • at night
    • when pt is flat/supine
  44. During feeding a pt or assisting, what precautions should be taken to avoid aspiration
    • upright position
    • completely/partially deflate tube cuff
    • Suction b4/after cuff deflation to clear airway
    • encourage pt to dry swallow
    • avoid consecutive drinks of water
    • have pt tuck chin down and forward when swallowing
    • Monitor tolerance by: resp rate, pulse ox, HR
  45. What steps do you teach the pt to take when performing supraglottic swallowing
    • Inhale/Hold breath
    • Place food in swallow position
    • Swallow while holding breath
    • cough after swallowing and before inhaling
  46. What could you recommend the pt to do following head/neck surgery that may have disturbed body image dx
    • wear loose-fitting clothes, high collar shirts, sweaters, scarves, and jewelry to cover stoma or tracheostomy
    • use cosmetics to cover scars
  47. What discharge education would the nurse teach the patient following head/neck surgery
    • stoma/tracheotomy care
    • incision/airway care
    • safety
    • wearing medical alert bracelet
    • smoking cessation
    • community support agencies
  48. What is intermittent and reversible airway obstruction affecting only airways and not alveoli
    bronchial asthma
  49. What two ways can cause airway obstruction
    • Inflammation (obstructing lumen)
    • Airway Hyperesponsiveness (contrict bronchioles)
  50. What can cause airway hyperesponsiveness
    • exercise
    • upper respiratory illness
  51. What key event can trigger an asthma attack
    inflammation of mucous membrane lining the airways
  52. What type of setting is asthma more common in
  53. A pt presents to the clinic with a history of specific patterns of dyspnea (night/exercise/seasonal), chest tightness, coughing, wheezing, and increased mucous production, what do you suspect is the problem?
  54. Pt presents to the clinic with audible wheezing (louder on exhalation), increased resp rate, longer breathing cycle, coughing, decreased oxygen sat, pallor, cyanotic, tachycardic, accessory muscle use, and changes of LOC. What do you suspect is occuring?
    Asthma attack
  55. What physical changes can be noticed caused by frequent asthma attacks
    • Increased AP chest diamater
    • Increased space in ribs
  56. What lab values will be noticed during a pt with an asthma attack
    • Decreased PaO2
    • Decreased PaCo2 (early)
    • Increased PaCo2 (late)
  57. If the asthma attack if triggered from allergies, what would the labs show?
    • Increased esinophils
    • Increased IgE
    • sputum with esinophils, mucus plugs, shed epithelial cells
  58. What dx tests could be used to determine asthma
    • pulmonary function test
    • chest xray
    • blood levels of theraputic drugs
  59. What is the goal of asthma therapy
    • Improve airflow
    • relieve symptoms
    • prevent episodes
  60. What does priority pt teaching include for asthma
    • assess sx severity 2x/day with peakflow meter
    • adjust drugs to manage inflammation and bronchospasms
    • Help pt establish personal best PEF (how to read)
    • When to use rescue inhaler
    • Keep sx/intervention diary
    • follow action plan
  61. What should a patient do if they have a PEF reading in the red zone
    • Use rescue meds
    • Seek emergency help
  62. When should a pt use their rescue inhaler
    when PEF is between 50-80% of personal best
  63. What two types of drug therapy is used to treat asthma
    • prevention
    • rescue
  64. What drugs are used to change airway responsiveness to keep asthma attacks from occurring and how often are they used
    • preventative
    • every day
  65. What do you teach the pt regarding preventative drugs
    take every day whether sx are present or not
  66. What do bronchodilators do and name 3 types
    • increase bronchiolar smooth muscle relaxation
    • bata2 agonist
    • cholinergic agonist
    • methylxanthines
  67. What asthma medication is delivered by inhaler directly to the bronchioles and what is the pro/con of its use?
    • Serevent
    • Need time to build up effect/lasts longer
  68. What is Serevent recommended to be co-administered with
    inhaled steroids
  69. What is a long-acting beta2 agonist
  70. What should the patient be warned about the use of Serevent
    It is not useful during an attack (its preventative)
  71. What drug is similar to atropine are used to block the PNS causing bronchodilation and decrease pulmonary secretions, name 2 examples
    • Cholingeric antagonist
    • Atrovent
    • Spirava
  72. What medication is used for asthma when other management hasn't been effective, give two examples
    • methylxanthines
    • Theophylline
    • Aminophylline
  73. What would you recommend the pt do when taking cholinergic antagonists drugs and why
    • Keep all appts for monitorting
    • narrow-safety range with dangerous side effects such as cardiac and CNS stimulation
  74. What drugs decrease inflammatory response in the airways, give 4 examples
    • Antihistamines
    • Inhaled corticosteroids: Flovent
    • NSAID: Tilade/Intal
    • Leukotriene antagonist: Singulair
    • Immunomodulators: Xolair
  75. What drugs are beneficial for rapid, short term treatment of active asthma attack, name an example
    • short-acting beta2 agonist
    • albuterol
  76. What other treatment may be used for acute asthma attack
    supplemental oxygen with high flow rate/concentration
  77. What two conditions are included in COPD
    • emphysema
    • Chronic Bronchitis
  78. What is COPD characterized by
    bronchospasm and dyspnea
  79. What is irreversible tissue damage that increases in severity leading to respiratory failure
  80. What are the two major changes that occurs with emphysema
    • loss of lung elasticity
    • hyperinflation of lung
  81. What is loss of elastic recoil in the alveolar walls, overstretching and enlargement of the alveoli into bullae, and collapse of small airways (bronchioles)
    Air trapping
  82. What is inflammation of the bronchioles caused by chronic exposure to irritants, especially tobacco smoke
    chronic bronchitis
  83. What are clinical manifestations of chronic bronchitis
    • Inflammation
    • vasodialation
    • mucosal edema
    • congestion
    • bronchospasm
    • large amounts of thick mucous
  84. What are risks of COPD
    • cigarettes
    • AAT deficiency
    • Air pollution
  85. Name 5 complications of COPD
    • Hypoxemia
    • Acidosis
    • Resp Infections
    • Cardiac Failure
    • Cardiac dysrhythmias
  86. What kind of questions would you ask about the person and their history that could have COPD
    • Age
    • Gender
    • Occupational hx
    • ethnic/culture
    • family hx
    • current breathing problems
  87. What clinical manifestations would be present with an individual who has COPD in the respiratory system
    • rapid, shallow breaths with accessory use
    • abnormal chest retractions/asymetric
    • Limited diaphragmatic excursion
    • Hypperesonant breath sounds
    • wheezing
    • dyspnea degree
  88. What clinical manifestations would be present with an individual who has COPD in the cardiovascular system
    • Heart rate, rythm
    • edema feet and ankles
    • cyanosis, blue-gray dusky appearance
    • delayed cap refill
    • clubbing of fingers
  89. What psychosocial issues may be present with an individual with COPD
    • Social isolation
    • work, family, social, sexual roles may change and affect self-esteem
    • Anxiety/ fear r/t dyspnea
  90. What economic issues may be present with an individual with COPD
    • May not be able to work
    • drugs are expensive (may use incorrectly to preserve)
  91. What dx tests will be performed to determine COPD
    • ABGs
    • O2 sat
    • Sputum
    • Hct, Hgb
    • Ca, Ph, Mg, and K
    • AAT
    • Chest xray
    • PFT
    • Peak expiratory flow rate
    • Carbon monoxide diffusion test
  92. What labs can monitor hypercarbia and hypoxemia
  93. What labs assess for polycythemia
    Hct and Hgb
  94. What is the expected findings of K, Ca, Ph, and Mg in a pt with COPD and what would the effect be of these values
    • HypoCa, HypoPh, HypoMg
    • HyperK
    • decreased muscle strength
  95. What are the primary interventions for a pt with Impaired gas exchange
    • Maintain Patent Airway
    • Oxygen Therapy
    • Drug Therapy
    • Pulmonary Rehabilitation
  96. What steps will a nurse take to ensure patent airway maintenance for impaired gas exchange
    • Monitor respiratory status q 2 hrs 
    • Enhance Coughing effectiveness: sit up, knees flexed, head slightly flexed, shoulders relaxed
    • Teach pt to follow coughing with several maximal inhalation breaths (hold 2 sec cough 2-3 times)
    • Assist pt to clear airway secretions
    • keep pt head, neck, chest aligned
  97. What steps will a nurse take when providing oxygen therapy for impaired gas exchange
    • Provide O2 (2-4L/min) nasal cannula or 40% with venturi mask
    • No open flames or combustion hazards where O2 is
    • Assess resp hrly for resp depression
    • Low arterial o2 level is primary drive for breathing
  98. What kind of drug therapy will be provided for a pt with impaired gas exchange
    • Inhaled bronchodilators (Proventil, ipratropium, spirava, theophylline, etc
    • Inhaled/systemic anti-inflammatory: fluticasone, prednisone
    • Mucolytic: acetylcysteine
  99. What education could you provide the pt about pulmonary rehabilitation
    • Need for exercise training
    • collaborate with pt/physical therapist for plan
    • Perform plan 2-3x/wk
    • Using walker, O2 when needed
  100. What do you assess for ineffective breathing patterns r/t COPD
    • breathing pattern
    • rate, rhythm, depth, accessory muscles use
    • risk factors contributing to effort
  101. What is the goal of managing ineffective breathing patterns
    Improve pt breathing effort and decrease work of breathing
  102. What breathing techniques would you teach the pt to help manage ineffective breathing patterns r/t COPD
    • Diaphragmatic Breathing
    • Pursed-lip breathing
    • Pt positioning (upright, elevate HOB)
    • Energy conservation
  103. When working with a pt's activity level for COPD what is important for the nurse to include
    frequent resting periods
  104. What teaching could you help the pt learn to help minimize discomfort r/t COPD
    • Avoid working with arms raised
    • adjust work heights to reduce back strain/fatigue
    • Keep arm motions smooth and flowing
    • use adoptive tools (long handled dustpans)
    • Organize work space so items are within reach
    • don't talk when engaging in activities
    • avoid breathholding when performing an activity
  105. What causes ineffective airway clearance r/t COPD
    excessive secretions leading to compromised breathing, poor oxygenation and tissue perfusion, and increases the risk for resp infections
  106. What do you assess for pt with ineffective airway clearance r/t COPD
    • assess breath sounds and O2 sat routinely/b4 and after interventions
    • dyspnea, tachycardia, dysrhythmias during coughing procedure
  107. How would you teach the pt to cough who has ineffective airway clearance? When should they perform these coughs?
    • Sit in chair or bed with feet on floor
    • Shoulders inward, bend head slightly down
    • Hug a pillow against stomach
    • Take a few deep breaths in through nose out through pursed lips
    • bend forward slowly when coughing 2-3x from the same breath
    • Observe color, consistency, odor, and amount
    • Repeat 2x
    • Morning, bedtime, before meals
  108. When should suctioning be performed during ineffective airway clearance r/t COPD
    only when abnormal breath sounds are present
  109. How often should you assess an individual who can tolerate sitting in a chair for 1 hr?
    2-3x daily
  110. How much should you educate the pt with COPD to drink per day
  111. The pt with COPD has imbalanced nutrition, describe their appetite and what effects are causing it
    food intolerance, loss of appetite r/t nausea and dyspnea
  112. What causes protein and calorie increase with COPD and what are the results of the deficit
    • increased work of breathing
    • reduced effective breathing due to loss of total body mass, ventilatory muscle mass and strength, lung elasticity, and alveolar capillary surface area
  113. What would you monitor for COPD pt with imbalanced nutrition
    • wt
    • skin condition
    • prealbumin levels
  114. What should you educate the client in regards to meals with COPD
    • eat 4-6 small meals/day
    • use bronchodilator 30 min b4 meals
    • Encourage easy to chew, high calorie, high protein
    • Avoid dry food, milk, chocolate, caffeine
    • Avoid fluids before/during meals
    • Suggest dietary supplements
  115. What nursing interventions can be provided for a pt with activity intolerance r/t COPD
    • Assist with ADLs based on assessment
    • Encourage pt to pace activities, dont rush
    • assess pt response to activity
    • Suggest O2 during high energy activities
  116. What surgery can be performed for end stage COPD
    • lung transplant
    • Lung reduction surgery
  117. What cancer is the leading cause of death worldwide
    lung cancer
  118. How does lung metastasis occur
    • extension
    • blood
    • lymph
  119. What are common sites of metastasis of lung cancer
    • bone
    • liver
    • brain
    • adrenal glands
  120. What is the major risk factor of lung cancer contributing to 85% of all lung cancer deaths
  121. What are some additional causes of lung cancer (besides smoking)
    • Asbestos
    • Chromium
    • Coal
    • Iron oxide
    • Petroleum
    • Radiation
    • Nickel
  122. What are manifestations of lung cancer in respiratory system
    • Dyspnea
    • Pallor/cyanosis
    • tachycardia
    • bloody sputum
    • cough
    • Pain (when lymph nodes press on nerves)
  123. What are manifestations of lung cancer in pulmonary systems?
    • hoarseness
    • wheezing
    • decreased/absent breath sounds
    • prolonged exhalation w/ periods of shallow breathing
    • rapid shallow breathing
    • areas of tenderness or masses on chest wall
    • increased fremitus in areas of tumor
    • decreased/absent fremitus on side with bronchial obstruction
    • tracheal deviation
    • pleural friction rub
    • asymmetry of diaphragm movement
    • accessory muscles
    • retraction between ribs or sternal notch
  124. nonpulmonary manifestations of lung cancer
    • wt loss
    • muffled heart sounds
    • dysrhythmias
    • cyanosis
    • clubbing
    • bone pain
  125. late manifestations of lung cancer
    • fatigue
    • wt loss
    • anorexia
    • dysphagia
    • n/v
    • lethargy
    • confusion
    • personality changes
  126. Tests to diagnose lung cancer
    • Biopsy
    • chest xray
    • ct scan
    • fiberoptic bronchoscopy
    • thoracoscopy/thoracentesis
    • MRI
    • Radionuclide
    • liver, spleen, bone scan
    • PET
  127. WHat is the treatment of choice for lung cancer
  128. Side effects of chemo
    • n/v
    • alopecia
    • mucositis
    • immunosuppression
    • anemia
    • throbocyopenia
    • peripheral neuropathy
  129. Side effects of radiation for lung cancer
    • chest skin irritation, peeling
    • fatigue
    • taste changes
    • wheezing
    • esophagitis
    • photodynamic therapy
  130. What is post-op intervention of lung cancer surgery
    • respiratory management with mechanical ventilation for first 24 hrs
    • Maintain patent airway
    • Assess resp status q 2 hrs
    • check alignment of trachea
    • Assess o2
    • Assess breath sounds, cyanosis signs
    • Oral suctioning prn
    • Semi-fowlers or chair ASAP
    • Use IS
    • Teach splinting when coughing
    • closed chest drainage
  131. What palliation care would you give for pt with lung cancer
    • O2, drug therapy, antibiotics (infections), and radiation to relieve hemoptysis, bronchial obstruction, dysphagia, and bone pain
    • Thoracentesis/Pleurodesis for pleural effusion
  132. Name 3 chest tube chambers and their job
    • 1: collect fluid draining from pt
    • 2: prevent air from entering pt pleural space
    • 3: suction control of system
  133. What are clinical manifestations of influenza
    • severe HA
    • Muscle ache
    • Fever
    • Chills
    • Fatigue
    • Weakness
    • Anorexia
  134. What is excess of fluid in the lungs resulting from inflammatory process triggered by infectious organisms and inhalation of irritants
  135. Name two complications of pneumonia
    • hypoxemia
    • atelectasis
  136. Risks for CAP pneumonia
    • old
    • no previous vaccination or >6 yrs ago
    • No influenza vaccine
    • chronic health problems
    • recent exposure
    • tobacco and alcohol
  137. Risks for HAP pneumonia
    • old
    • chronic lung disease
    • gram-neg colonization
    • Altered LOC
    • Recent aspiration event
    • ET, Trach, NG tube
    • Poor nutrition
    • Immunocompromised
    • Mechanical ventilation
  138. Pt hx for possible pneumonia
    • Age
    • live/work/school
    • diet/exercise/sleep
    • dysphagia
    • NG tube
    • tobacco/alcohol use
    • past/current drugs
    • Resp illness
    • exposure
    • skin rash/insect bites/animal exposure
    • home resp equipment and cleaning
  139. Assessment for sx of pneumonia
    • Tachycardia
    • difficulty breathing
    • chest/pleuritic pain/discomfort
    • chills/fever
    • cough
    • tachypnea
    • O2 sat
    • crackles/wheeze
    • Hypotension
    • Mental status change
    • Fatigue
    • Anxiety
  140. Older adult common manifestations of pneumonia
    confusion from hypoxia
  141. Diagnotic tests for pneumonia
    • Sputum
    • Gram Stain, culture
    • WBC
    • Chest xray
    • ABG
  142. Complications of pneumonia
    • Hypoxemia
    • Ventilatory failure
    • Atelectasis
    • Pleural Effusion
    • Pleurisy
  143. What prophylactic measures are taken to prevent sepsis secondary to pneumonia
    antibiotic therapy based on organism
  144. What is used to treat aspiration pneumonia
    Steroids and NSAIDS with antibiotics
  145. What would the nurse educate the pt on regarding pneumonia
    • Take all meds
    • Notify if sx fail to resolve or get worse
    • rest
  146. What should the nurse teach the pt to avoid for upper resp tract infections and viruses
    • Avoid crowds, sick people, irritants
    • Influenza and Pneumonia Vaccine
    • Balanced diet
    • Smoking cessation
  147. What is a highly communicable disease caused by Mycobacterium?
    Pulmonary TB
  148. Who is at risk for TB
    • Exposure from infected individual
    • Immune Dysfunction (HIV)
    • Crowded areas
    • Homeless people
    • old
    • drug abusers
    • poor people
    • foreign immigrants
  149. Clinical manifestations of TB
    • Progressive fatigue
    • lethargy
    • nausea
    • Anorexia
    • wt loss
    • irregular menses
    • low grade fever, night sweats
    • mucopurulent blood streaked cough
  150. What would you asses for TB aside from the clinical manifestations
    • Dullness over lung infected
    • Bronchial breath sounds
    • crackles
    • Wheezes
    • Enlarged lymph nodes
  151. How is TB diagnosed
    • AF bacillus smear
    • PPD 2 step test
    • GOLD test
    • Sputum culture
    • Chest Xray
  152. What does positive PPD reveal
    Pt has been exposed, not nessecarily that they have it
  153. What does a negative PPD test in the eldery or immunocompromised indicate
    does not rule out TB disease
  154. First line therapy for TB
    • Isoniazid (INH) for 6 months
    • Rifampin  for 6 months
    • Ethambutol for 6 months
    • Pyrazinamide for first 2 months
  155. What precaution should the nurse take in the hospital for a pt with TB
    Airborne precautions
  156. What should the pt be told to do when coughing or sneezing when they have TB
    cover mouth and nose with tissue and place in plastic bag when done
  157. How long is the pt contagious after treatment regimen has been started (have been on meds)
    2-3 consecutive weeks
  158. Two methods the government has put in place for containing individuals with TB
    • Institutionalize
    • DOT-force them to go to health dept
  159. What is a collection or particular matter-solid, liquid, air-enters venous circulation and lodges in the pulmonary vessels
    Pulmonary emobolism
  160. What usually causes pulmonary embolism
    blood clot from DVT from one of the veins in legs or pelvis
  161. Name some risks for PE
    • immobilization
    • CV catheters
    • Surgery
    • Obesity
    • Advanced Age
    • Conditions increasing blood clotting
    • Hx of Thromboembolism
    • Smoking
    • Pregnancy
    • Estrogen Therapy
  162. What would you educate the pt to prevent PE
    • smoking cessation
    • wt loss
    • increased activity
    • if sitting for long periods get up and move frequent and drink plenty of fluids
    • refrain from massaging leg muscles
  163. What do you assess in resp system for pt with possible PE
    • Dyspnea
    • Tachypnea
    • tachycardia
    • pleuritic chest pain
    • crackles
    • dry cough
    • hemoptysis
  164. What would you assess in cardiac system for pt with possible PE
    • JVD
    • Syncope
    • Cyanosis
    • Hypotension
    • Ab heart sounds
    • Abn ECG
  165. What non specific symptoms are present for pt with possible PE
    • low grade fever
    • petechiae
    • flu-like sx
  166. What would labs look like for possible PE
    • Low PaCo2 (early)
    • Low PaO2 (late)
    • High PaCo2 (late)
    • Low pH (late)
  167. Labs to test for PE
    • ABG
    • A-gradient increased
    • Pulse Ox
    • Imaging assessment
    • CT scan
  168. Nonsurgical management of PE
    • Oxygen
    • pt monitoring
    • anticoagulants
    • fibrinolytics
  169. Surgical management of PE
    • Embolectomy
    • Inferior vena cava interruption
  170. When is the pt with PE discharged
    • when hypoxemia and hemodynamic is resolved
    • adequate anticoagulation achieved
  171. What do you teach pt in regard to PE discharge
    • Bleeding precautions
    • Activities to reduce DVT and recurrent PE
    • Complications and follow up
  172. What is an accumulation of atmospheric air in the pleural space that results in chest pressure and a reduction in vital capacity
    Pneumothorax (Collapsed lung)
  173. What causes pneumothorax
    blunt chest trauma
  174. What do you assess for pneumothorax
    • reduced breath sounds
    • hyperresonance
    • prominence of chest side involved (moves poorly with respirations)
    • deviation from trachea away from (closed) or toward the affected side (open)
    • pleuritic chest pain
    • tachypnea
    • subcutaneous emphysema
  175. What diagnostic tests are performed for pneumothorax
    • US examination
    • Chest Xray
  176. What may be needed to help air escape and the lung to reflate for pneumothorax
    Chest tubes
  177. What is a rapidly developing and life-threatening complication of blunt chest trauma that results from an air leak in the lung or chest wall
    Tension Pneumothorax
  178. What other things can cause Tension pneumothorax (besides blunt chest trauma)
    • Mechanical ventilation w/ PEEP
    • closed chest drainage
    • insertion of central access catheters
  179. What does the nurse assess for tension pneumothorax
    • Asymmetry of thorax
    • tracheal movement from midline to uneffected side
    • resp distress
    • absence of breath sounds on one side
    • JVD
    • Cyanosis
    • Hypertympanic sound over affected side
  180. Initial management of tension pneumothorax
    insertion of large bore needle into second intercostal space in midclavicular line of affected side
  181. What follows initial management of tension pneumothorax
    chest tube placement in forth intercostal space then water seal drainage until lung reinflates
  182. Pt presents to the clinic c/o sudden dyspnea, sharp/stabbing pain in the chest, rapid HR, and has a dry cough. What do you suspect
  183. What does the nurse do if a pt that has PE begins to have JVD, syncope, cyanosis, and hypotension
    Call rapid response team
  184. Name 4 complications of PE
    • Hypoxemia
    • Hypotension
    • Anxiety
    • Hemorrhage
  185. Name 3 common meds given for PE
    • Milranine
    • Dobutamine
    • Nitroprusside
  186. What labs should be monitored for a pt with PE
    • PTT (1.5-2.5 x control value)
    • INR (2-3)
  187. What should the nurse keep with her when giving drugs during PE
    Anitdotes (vit k-Warfarin, (protamine sulfate-Heparin)
  188. What interventions should the nurse take when a pt has PE
    • O2 continually
    • Mechanical ventilation
    • Vitals, lungs, cardiac status hourly
    • Administer anticoagulants as prsecribed
  189. WHat intervention should the nurse anticipate for a pt who develops hypotension secondary to PE
    IV soln with crystallized soln to prevent shock
  190. What interventions should the nurse perform for risk of bleeding with a pt that has a PE
    • assess q 2 hrs (oozing, bruises that cluster, pupura, petechaie)
    • Measure abd girth q 8 hrs
    • use lift sheet when moving pt
    • Hold pressure for 10 min after puncture with smallest gauge possible needle
    • Apply ice over area of trauma
    • Observe IV q 4 hrs
  191. What labs should the nurse monitor for PE
    • Hct
    • Hgb
    • Platelet
    • PT
    • aPTT
    • INR
  192. When should antivirals for influenza be given to be effective in treating sx
    within 12-24 hrs after sx onset
  193. How is a pulmonary function test for asthma performed
    Incentive Spirometer
  194. When should a pt seek help during an asthma attack
    when PEF is 50% below personal best
  195. How often should resp status be assessed following lung surgery
    q 2 hr for first 12-20 hrs
  196. Name antiviral medications for influenza
    • Amantadine
    • Oseltamivir
  197. Who should be encouraged to get flu vaccine
    • old (>65)
    • young (>6 mo)
    • Pregnancy
    • Health care workers
  198. Name a complication of influenza
  199. Nursing care for influenza
    • saline gargles
    • monitor I&O, hydration status
    • administer fluids as prescribed
    • monitor resp status
  200. What will a chest xray look like for a person who has pneumonia
    consolidation/solidification, density (white) lungs
  201. How should clients be educated to take penicillins and cephalosporins?
    With food
  202. Adverse effects of thephylline
    • tachycardia
    • n/d
  203. Adverse effects of albuterol
    • tremors
    • tachycardia
  204. What adverse effect happens with ipratropium and how can it be managed
    • dry mouth
    • sucking hard candy, increase fluid intake
  205. Other adverse effects of ipratropium (besides dry mouth)
    • monitor HR
    • HA, blurred vision, palpitations
  206. What should be monitored for pt taking glucocorticosteroids (fluticasone)
    • immunosuppression
    • fluid retention (wt gain)
    • hyperglycemia
    • hypokalemia
    • poor wound healing
    • canker sores
  207. When taking antinflammatories what should the nurse instruct the patient to report
    black, tarry stools
  208. 3 complications of pneumonia
    • Atelectasis
    • Sepsis
    • ARDS
  209. What do the labs show pertaining to Co2 levels in ARDS
    increased levels (hypercarbia)
  210. What does a chest xray look like for a pt with ARDS
    area of density with "ground glass" appearance
  211. 3 manifestations of asthma
    • mucosal edema
    • bronchoconstriction
    • excessive mucous production
  212. Describe 4 categories of asthma
    • Mild intermittent: <2 x/wk
    • Mild persistent: >2x/wk but not daily
    • Moderate persistent: 2x/wk and daily
    • Severe persistent: Continually with frequent exacerbations
  213. What nursing actions should be taken for respiratory failure following an asthma attack
    • Monitor o2 and acid base balance
    • prepare for intubation and mechanical ventilation
  214. What nursing actions should be taken for the complication of status asthmaticus secondary to asthma
    • prepare for emergency intubation
    • Administer oxygen, bronchodilators, epinephrine, and initiate systemic steroid therapy
  215. When is productive cough most severe in COPD pts
  216. How do you teach the pt to perform diaphragmatic breathing
    • lie on back with knees bent
    • rest hand over abd to create tension
    • the hand should raise and lower when breathing
  217. How do you teach a client pursed lipped breathing
    • form the mouth like preparing to whistle
    • take deep breath through nose and out through mouth
    • dont puff cheeks
    • take deep and slow breaths
  218. How do you teach the pt to breathe with incentive spirometer
    • tight seal around mouth piece
    • inhale and hold breath 2-3 sec
  219. How often should a pt with COPD exercise
    20 min 2-3x/wk
  220. Sx of Right sided heart failure r/t copd
    • low O2
    • cyanotic lips
    • enlarged/tender liver
    • JVD
    • dependent edema
  221. How would TB look on an xray
    Ghons tubercle
  222. How can you tell if Mantoux test is positive
    Induration of 10mm or greater
  223. How should isoniazid for TB be taken and what should be monitored
    • on an empty stomach
    • hepatotoxicitiy and neurotoxicity
  224. What should you let the pt know when taken rifampin
    orange urine
  225. What is a side effect of ethambutol that should be reported immediately
    Vision changes