-
Decreased FEV-1 is indicative of what diseases?
-
Decreased vital capacity indicates what?
- Pulmonary Fibrosis
- Neuromuscular disorders
(restrictive lung disease)
-
What are common etiologies of epistaxis?
- Trauma
- Nasal sprays
- Street drugs
- Coagulopathy
-
What is the most effective medication for allergic rhinitis?
Nasal corticosteroid
-
What other medications help with allergic rhinitis?
- 1st generation antihistamine: Benadryl
- (highly sedating)
2nd generation non-sedating: Claritin
Leukotriene inhibitors: Singulair
-
Obstructive Sleep Apnea
Risk factors:
S/S:
- Snoring
- AM Headache
- Somnolence
- HTN
-
Obstructive Sleep Apnea
Diagnostic:
Managment:
Polysomnography (Sleep Study)
- Weight loss
- Avoid sedatives
- CPAP or BiPAP
-
Oxygen Delivery Methods
Nasal Canula:
Simple Mask:
Venturi Mask:
Non-Rebreather:
- NC
- Up to 6L
- Drying
- Fall risk, skin breakdown
- NR
- Up to 100%
- Intake valves
-
What are the two artificial airways?
- Endotracheal Intubation
- (short-term mechanical vent)
- Tracheostomy
- (long-term mechanical vent)
- (for upper airway obstruction)
-
Tracheostomy Management
What equipment should be at the bedside?
- Ambu Bag
- Suction
- Oxygen
- Obturator
- Trach Tube
-
Tracheostomy Management
Important things to consider when suctioning:
- Limit attempts
- 10 seconds per attempt
- Pre-oxygenate
- Assess vitals pre/post
-
Pneumonia
Risk Factors:
- Chronic lung disease
- Immunocompromised
- Immobility
- Altered LOC
- Intubation
- Tube Feeding
-
Community-Acquired Pneumonia
Typical vs. Atypical Organisms:
- Typical
- Strep Pneumoniae
- Haemophilus Influenzae
- Atypical
- Mycoplasma
- Chlamydia
- Legionella
-
Hospital-Acquired Pneumonia
Prevalence?
Associated with?
Second most common nosocomial infection
- Ventilator
- (prevention: Elevate HOB, Closed circuit, suction)
-
Antibiotics should be administered within ____ hours
4 hours
-
Why are blood cultures done for pneumonia?
To look for sepsis
-
Tuberculosis
S/S:
- Coughing hemoptosis
- Fever
- Chills
- Weight loss
-
Tuberculosis
Diagnostics:
-
Tuberculosis
Latent vs. Active:
Latent - patient has it but immune system has it under control...can be active later
Active - currently has it
-
What precautions must be taken with an active TB patient?
How long is the treatment?
- Respiratory isolation in a negative pressure room
- (air that won't be circulated out into the halls)
- 6 months - 2 years
- (compliance can be an issue)
-
TB Drugs and their risks:
- Isoniazid (INH)
- Hepatotoxicity
- Neuropathy
- Rifampin
- Hepatotoxicity
- Orange urine
- Pyrazinamide
- Hepatotoxicity
- Dermatitis
-
What is the leading cause of cancer death?
Lung Cancer
-
Lung Cancer
Risk Factors:
S/S:
Diagnostics:
- Smoking
- Radon
- Inhaled carcinogens
Chronic cough
-
Lung Cancer
Types:
Non-small cell
- Small cell
- (Influences SIADH = hyponatremic)
- (more aggressive with poor prognosis)
-
Lung Cancer
Treatment:
Nursing Care:
- Surgery
- Radiation
- Chemotherapy
- Oxygenation
- Symptoms management
- Nutrition
- Psychosocial
-
Chest Tube - 3 Chamber System
Water seal vs. Suction
WS - Let's air come out but not back in. Look for bubbles, if you see it check lines to find air leak
S - Draws off air and fluid
-
Restrictive Lung Disease
Etiologies:
S/S:
- Idiopathic
- Inhalation or dust
- Also amioderone
-
Asthma
S/S:
- Wheezing
- Cough
- Dyspnea
- Prolonged Expiration
- Decreased breath sounds
- Exercise-Induced
-
Asthma Medications: B-2 Agonists
Types:
Adverse Effects:
- Albuterol - short-acting
- Salmeterol - long-acting
- Tachycardia
- Angina
- Tremors
- Palpitations
- Anxiety
-
Asthma Medications: Corticosteroids
- For long-term use
- Less adverse effects
- Most effective
- NOT a rescue inhaler
- Rinse mouth after use
-
Asthma Medications: Anticholinergic
Types:
Atrovent
-
Asthma Medications: Leukotriene Inhibitors
Types:
Also used for:
Singulair
Allergies
-
Asthma Medications: Theophylline
Toxicities:
Therapeutic Range:
Cardio, Neuro, GI
5-15 mg/L
(Many drug interaction)
-
Asthma Medications: Combo Inhalers
- Advair (Flucticasone + Salmeterol)
- BID dosing
- NOT rescue
- Don't increase inhalations
- Combvient (Albuterol and Ipratropium)
- Can be QID prn dose
-
Status Asthmaticus
Silent chest?
Initial ABGs?
Late ABGs?
- Hear wheezing then nothing = BAD!
- (lung are not moving)
- PO2 decrease
- PCO2 decrease
- pH increase
- (resp. alkalosis = hyperventilating)
- PO2 decrease
- PCO2 increase
- pH decrease
- (resp. acidosis = not breathing)
-
How to manage asthma?
- Avoid triggers
- Reduce allergens
- Understand medication usage
- Peak flow meter
-
COPD
Reversible?
Risk Factors?
Not fully reversible
- Tobacco smoke - #1
- Occupational
-
COPD
Chronic Bronchitis vs. Emphysema
- CB
- Productive cough for 3 months in 2 consecutive years
- E
- Destruction of terminal bronchioles with air trapping
- Decreased surface area for gas exchange
-
What is the purpose of pursed lip breathing?
Prevents the airway from collapsing
-
COPD Treatments: Anticholinergic Inhalers
Types:
- Atrovent - short-acting
- Spiriva - long-acting
(bronchodilators)
-
Cystic Fibrosis
Genetics:
Diagnostic:
Autosomal recessive
Sweat chloride test
-
Cystic Fibrosis
Median survival age:
Treatment:
35
Lung transplant
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