-
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
-
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
-
What would you recommend for the patient to help improve his condition of sleep apnea?
Weight loss and changing sleep positions
-
If sleep apnea is severe enough, what non surgical intervention may be required?
Positive pressure ventilation
-
What are some surgical interventions for sleep apnea
- Adenoidectomy
- Uvulectomy
- uvulopalatopharyngoplasty
-
What is a life-threatening emergency in which an interruption of airflow through the nose, mouth, pharynx, or larynx occurs
Upper airway obstruction
-
What is the nurses first step in intervening with a person who has an upper airway obstruction?
determine the cause
-
Name 3 options for maintaining a patent airway and ventilation
- Cricothyroidotomy
- Endo/naso/orotracheal intubation
- Tracheostomy
-
In what structures do head and neck cancer occur?
- Larynx
- Trachea
- Throat
- Oral Cavity
- Tongue
-
Where does head and neck cancer usually arise from?
skin or mucosa as squamous cell carcinoma
-
What are the two greatest risk factors of head and neck cancer?
-
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
-
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
-
What clinical manifestations are present for a person who has head/neck cancer
- Weight loss
- Hoarseness
- Lumps in head/neck
- mouth sores
- laryngeal abnormalities
-
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
-
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...)
-
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
-
What is the goal for a person with Potential Respiratory Obstruction?
Remove or eradicate the cancer while preserving as much normal function as possible.
-
What are the side effects of radiation therapy for head/neck cancer?
- halitosis
- taste changes
- risk for dental caries/infections
- dry mouth
-
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
-
What treatment can be used in addition to radiation of head and neck or used alone?
Chemotherapy
-
What is TNM and what does it determine?
- Tumor size and location classification:
- Surgery type needed
-
How are very small, early staged tumors of head and neck commonly treated?
photodynamic therapy: Laser
-
Name traditional surgical procedures for head/neck cancer
- Laryngectomy
- Tracheotomy
- Oropharyngeal resection
- chordectomy
- radical neck dissection
- composite resection
-
What is the creation of a new artificial airway by opening the wall of the trachea
Tracheotomy
-
What is the removal of vocal chords
Cordectomy
-
What is the removal of primary tumor along with lymph node dissection (could involve skin/muscle/bone/other structures)?
Radical neck dissection
-
What is the combination of surgical procedures including glossectomies, partial manibulectomies, and nodal neck dissections
Composite resections
-
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)
-
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
-
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
-
What results in large amounts of bright red blood spurting quickly after head/neck surgery?
Carotid Artery rupture
-
What action does the nurse take if she suspects carotid artery leak?
- CALL RAPID RESPONSE TEAM
- DON'T TOUCH (could cause rupture)
-
What action does the nurse take if carotid rupture is suspected?
- CALL RAPID RESPONSE TEAM
- PLACE PRESSURE OVER SITE
- SECURE AIRWAY
- Transport pt to OR
- DONT LEAVE PT
-
What results in bright red oozing blood following head/neck surgery?
Carotid artery leakage
-
How much Kcal should the pt receive daily following head/neck surgery?
35-40 Kcal/kg of body weight
-
How long is IV fluids or parental nutrition used after surgery of head/neck?
Until intestinal tract is functioning
-
How long does tube feeding by NG tube/gastrostomy/jejunostomy remain after head/neck surgery
7-10 days
-
What do you assess before removing the pts feeding tube
swallowing ability
-
What is a patient who has had a subtotal, vertical, or supraglottic laryngectomy at risk for?
Aspiration
-
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
-
What action should the nurse take if the residual volume for tube feeding is high for 2 hours? (>200=250mL)
- Withhold feeding
- Notify PCP
-
When should a bolus not be given?
- at night
- when pt is flat/supine
-
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
-
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
-
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
-
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
-
What is intermittent and reversible airway obstruction affecting only airways and not alveoli
bronchial asthma
-
What two ways can cause airway obstruction
- Inflammation (obstructing lumen)
- Airway Hyperesponsiveness (contrict bronchioles)
-
What can cause airway hyperesponsiveness
- exercise
- upper respiratory illness
-
What key event can trigger an asthma attack
inflammation of mucous membrane lining the airways
-
What type of setting is asthma more common in
urban
-
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?
asthma
-
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
-
What physical changes can be noticed caused by frequent asthma attacks
- Increased AP chest diamater
- Increased space in ribs
-
What lab values will be noticed during a pt with an asthma attack
- Decreased PaO2
- Decreased PaCo2 (early)
- Increased PaCo2 (late)
-
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
-
What dx tests could be used to determine asthma
- pulmonary function test
- chest xray
- blood levels of theraputic drugs
-
What is the goal of asthma therapy
- Improve airflow
- relieve symptoms
- prevent episodes
-
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
-
What should a patient do if they have a PEF reading in the red zone
- Use rescue meds
- Seek emergency help
-
When should a pt use their rescue inhaler
when PEF is between 50-80% of personal best
-
What two types of drug therapy is used to treat asthma
-
What drugs are used to change airway responsiveness to keep asthma attacks from occurring and how often are they used
-
What do you teach the pt regarding preventative drugs
take every day whether sx are present or not
-
What do bronchodilators do and name 3 types
- increase bronchiolar smooth muscle relaxation
- bata2 agonist
- cholinergic agonist
- methylxanthines
-
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
-
What is Serevent recommended to be co-administered with
inhaled steroids
-
What is a long-acting beta2 agonist
Serevent
-
What should the patient be warned about the use of Serevent
It is not useful during an attack (its preventative)
-
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
-
What medication is used for asthma when other management hasn't been effective, give two examples
- methylxanthines
- Theophylline
- Aminophylline
-
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
-
What drugs decrease inflammatory response in the airways, give 4 examples
- Antihistamines
- Inhaled corticosteroids: Flovent
- NSAID: Tilade/Intal
- Leukotriene antagonist: Singulair
- Immunomodulators: Xolair
-
What drugs are beneficial for rapid, short term treatment of active asthma attack, name an example
- short-acting beta2 agonist
- albuterol
-
What other treatment may be used for acute asthma attack
supplemental oxygen with high flow rate/concentration
-
What two conditions are included in COPD
- emphysema
- Chronic Bronchitis
-
What is COPD characterized by
bronchospasm and dyspnea
-
What is irreversible tissue damage that increases in severity leading to respiratory failure
COPD
-
What are the two major changes that occurs with emphysema
- loss of lung elasticity
- hyperinflation of lung
-
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
-
What is inflammation of the bronchioles caused by chronic exposure to irritants, especially tobacco smoke
chronic bronchitis
-
What are clinical manifestations of chronic bronchitis
- Inflammation
- vasodialation
- mucosal edema
- congestion
- bronchospasm
- large amounts of thick mucous
-
What are risks of COPD
- cigarettes
- AAT deficiency
- Air pollution
-
Name 5 complications of COPD
- Hypoxemia
- Acidosis
- Resp Infections
- Cardiac Failure
- Cardiac dysrhythmias
-
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
-
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
-
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
-
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
-
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)
-
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
-
What labs can monitor hypercarbia and hypoxemia
ABGs
-
What labs assess for polycythemia
Hct and Hgb
-
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
-
What are the primary interventions for a pt with Impaired gas exchange
- Maintain Patent Airway
- Oxygen Therapy
- Drug Therapy
- Pulmonary Rehabilitation
-
What steps will a nurse take to ensure patent airway maintenance for impaired gas exchange
- Monitor respiratory status q 2 hrsÂ
- 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
-
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
-
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
-
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
-
What do you assess for ineffective breathing patterns r/t COPD
- breathing pattern
- rate, rhythm, depth, accessory muscles use
- risk factors contributing to effort
-
What is the goal of managing ineffective breathing patterns
Improve pt breathing effort and decrease work of breathing
-
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
-
When working with a pt's activity level for COPD what is important for the nurse to include
frequent resting periods
-
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
-
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
-
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
-
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
-
When should suctioning be performed during ineffective airway clearance r/t COPD
only when abnormal breath sounds are present
-
How often should you assess an individual who can tolerate sitting in a chair for 1 hr?
2-3x daily
-
How much should you educate the pt with COPD to drink per day
2-3L
-
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
-
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
-
What would you monitor for COPD pt with imbalanced nutrition
- wt
- skin condition
- prealbumin levels
-
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
-
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
-
What surgery can be performed for end stage COPD
- lung transplant
- Lung reduction surgery
-
What cancer is the leading cause of death worldwide
lung cancer
-
How does lung metastasis occur
-
What are common sites of metastasis of lung cancer
- bone
- liver
- brain
- adrenal glands
-
What is the major risk factor of lung cancer contributing to 85% of all lung cancer deaths
smoking
-
What are some additional causes of lung cancer (besides smoking)
- Asbestos
- Chromium
- Coal
- Iron oxide
- Petroleum
- Radiation
- Nickel
-
What are manifestations of lung cancer in respiratory system
- Dyspnea
- Pallor/cyanosis
- tachycardia
- bloody sputum
- cough
- Pain (when lymph nodes press on nerves)
-
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
-
nonpulmonary manifestations of lung cancer
- wt loss
- muffled heart sounds
- dysrhythmias
- cyanosis
- clubbing
- bone pain
-
late manifestations of lung cancer
- fatigue
- wt loss
- anorexia
- dysphagia
- n/v
- lethargy
- confusion
- personality changes
-
Tests to diagnose lung cancer
- Biopsy
- chest xray
- ct scan
- fiberoptic bronchoscopy
- thoracoscopy/thoracentesis
- MRI
- Radionuclide
- liver, spleen, bone scan
- PET
-
WHat is the treatment of choice for lung cancer
chemo
-
Side effects of chemo
- n/v
- alopecia
- mucositis
- immunosuppression
- anemia
- throbocyopenia
- peripheral neuropathy
-
Side effects of radiation for lung cancer
- chest skin irritation, peeling
- fatigue
- taste changes
- wheezing
- esophagitis
- photodynamic therapy
-
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
-
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
-
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
-
What are clinical manifestations of influenza
- severe HA
- Muscle ache
- Fever
- Chills
- Fatigue
- Weakness
- Anorexia
-
What is excess of fluid in the lungs resulting from inflammatory process triggered by infectious organisms and inhalation of irritants
pneumonia
-
Name two complications of pneumonia
-
Risks for CAP pneumonia
- old
- no previous vaccination or >6 yrs ago
- No influenza vaccine
- chronic health problems
- recent exposure
- tobacco and alcohol
-
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
-
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
-
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
-
Older adult common manifestations of pneumonia
confusion from hypoxia
-
Diagnotic tests for pneumonia
- Sputum
- Gram Stain, culture
- WBC
- Chest xray
- ABG
-
Complications of pneumonia
- Hypoxemia
- Ventilatory failure
- Atelectasis
- Pleural Effusion
- Pleurisy
-
What prophylactic measures are taken to prevent sepsis secondary to pneumonia
antibiotic therapy based on organism
-
What is used to treat aspiration pneumonia
Steroids and NSAIDS with antibiotics
-
What would the nurse educate the pt on regarding pneumonia
- Take all meds
- Notify if sx fail to resolve or get worse
- rest
-
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
-
What is a highly communicable disease caused by Mycobacterium?
Pulmonary TB
-
Who is at risk for TB
- Exposure from infected individual
- Immune Dysfunction (HIV)
- Crowded areas
- Homeless people
- old
- drug abusers
- poor people
- foreign immigrants
-
Clinical manifestations of TB
- Progressive fatigue
- lethargy
- nausea
- Anorexia
- wt loss
- irregular menses
- low grade fever, night sweats
- mucopurulent blood streaked cough
-
What would you asses for TB aside from the clinical manifestations
- Dullness over lung infected
- Bronchial breath sounds
- crackles
- Wheezes
- Enlarged lymph nodes
-
How is TB diagnosed
- AF bacillus smear
- PPD 2 step test
- GOLD test
- Sputum culture
- Chest Xray
-
What does positive PPD reveal
Pt has been exposed, not nessecarily that they have it
-
What does a negative PPD test in the eldery or immunocompromised indicate
does not rule out TB disease
-
First line therapy for TB
- Isoniazid (INH) for 6 months
- Rifampin for 6 months
- Ethambutol for 6 months
- Pyrazinamide for first 2 months
-
What precaution should the nurse take in the hospital for a pt with TB
Airborne precautions
-
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
-
How long is the pt contagious after treatment regimen has been started (have been on meds)
2-3 consecutive weeks
-
Two methods the government has put in place for containing individuals with TB
- Institutionalize
- DOT-force them to go to health dept
-
What is a collection or particular matter-solid, liquid, air-enters venous circulation and lodges in the pulmonary vessels
Pulmonary emobolism
-
What usually causes pulmonary embolism
blood clot from DVT from one of the veins in legs or pelvis
-
Name some risks for PE
- immobilization
- CV catheters
- Surgery
- Obesity
- Advanced Age
- Conditions increasing blood clotting
- Hx of Thromboembolism
- Smoking
- Pregnancy
- Estrogen Therapy
-
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
-
What do you assess in resp system for pt with possible PE
- Dyspnea
- Tachypnea
- tachycardia
- pleuritic chest pain
- crackles
- dry cough
- hemoptysis
-
What would you assess in cardiac system for pt with possible PE
- JVD
- Syncope
- Cyanosis
- Hypotension
- Ab heart sounds
- Abn ECG
-
What non specific symptoms are present for pt with possible PE
- low grade fever
- petechiae
- flu-like sx
-
What would labs look like for possible PE
- Low PaCo2 (early)
- Low PaO2 (late)
- High PaCo2 (late)
- Low pH (late)
-
Labs to test for PE
- ABG
- A-gradient increased
- Pulse Ox
- Imaging assessment
- CT scan
-
Nonsurgical management of PE
- Oxygen
- pt monitoring
- anticoagulants
- fibrinolytics
-
Surgical management of PE
- Embolectomy
- Inferior vena cava interruption
-
When is the pt with PE discharged
- when hypoxemia and hemodynamic is resolved
- adequate anticoagulation achieved
-
What do you teach pt in regard to PE discharge
- Bleeding precautions
- Activities to reduce DVT and recurrent PE
- Complications and follow up
-
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)
-
What causes pneumothorax
blunt chest trauma
-
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
-
What diagnostic tests are performed for pneumothorax
-
What may be needed to help air escape and the lung to reflate for pneumothorax
Chest tubes
-
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
-
What other things can cause Tension pneumothorax (besides blunt chest trauma)
- Mechanical ventilation w/ PEEP
- closed chest drainage
- insertion of central access catheters
-
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
-
Initial management of tension pneumothorax
insertion of large bore needle into second intercostal space in midclavicular line of affected side
-
What follows initial management of tension pneumothorax
chest tube placement in forth intercostal space then water seal drainage until lung reinflates
-
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
PE
-
What does the nurse do if a pt that has PE begins to have JVD, syncope, cyanosis, and hypotension
Call rapid response team
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Name 4 complications of PE
- Hypoxemia
- Hypotension
- Anxiety
- Hemorrhage
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Name 3 common meds given for PE
- Milranine
- Dobutamine
- Nitroprusside
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What labs should be monitored for a pt with PE
- PTT (1.5-2.5 x control value)
- INR (2-3)
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What should the nurse keep with her when giving drugs during PE
Anitdotes (vit k-Warfarin, (protamine sulfate-Heparin)
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What interventions should the nurse take when a pt has PE
- O2 continually
- Mechanical ventilation
- Vitals, lungs, cardiac status hourly
- Administer anticoagulants as prsecribed
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WHat intervention should the nurse anticipate for a pt who develops hypotension secondary to PE
IV soln with crystallized soln to prevent shock
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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
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What labs should the nurse monitor for PE
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When should antivirals for influenza be given to be effective in treating sx
within 12-24 hrs after sx onset
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How is a pulmonary function test for asthma performed
Incentive Spirometer
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When should a pt seek help during an asthma attack
when PEF is 50% below personal best
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How often should resp status be assessed following lung surgery
q 2 hr for first 12-20 hrs
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Name antiviral medications for influenza
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Who should be encouraged to get flu vaccine
- old (>65)
- young (>6 mo)
- Pregnancy
- Health care workers
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Name a complication of influenza
pneumonia
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Nursing care for influenza
- saline gargles
- monitor I&O, hydration status
- administer fluids as prescribed
- monitor resp status
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What will a chest xray look like for a person who has pneumonia
consolidation/solidification, density (white) lungs
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How should clients be educated to take penicillins and cephalosporins?
With food
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Adverse effects of thephylline
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Adverse effects of albuterol
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What adverse effect happens with ipratropium and how can it be managed
- dry mouth
- sucking hard candy, increase fluid intake
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Other adverse effects of ipratropium (besides dry mouth)
- monitor HR
- HA, blurred vision, palpitations
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What should be monitored for pt taking glucocorticosteroids (fluticasone)
- immunosuppression
- fluid retention (wt gain)
- hyperglycemia
- hypokalemia
- poor wound healing
- canker sores
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When taking antinflammatories what should the nurse instruct the patient to report
black, tarry stools
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3 complications of pneumonia
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What do the labs show pertaining to Co2 levels in ARDS
increased levels (hypercarbia)
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What does a chest xray look like for a pt with ARDS
area of density with "ground glass" appearance
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3 manifestations of asthma
- mucosal edema
- bronchoconstriction
- excessive mucous production
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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
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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
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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
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When is productive cough most severe in COPD pts
morning
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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
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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
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How do you teach the pt to breathe with incentive spirometer
- tight seal around mouth piece
- inhale and hold breath 2-3 sec
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How often should a pt with COPD exercise
20 min 2-3x/wk
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Sx of Right sided heart failure r/t copd
- low O2
- cyanotic lips
- enlarged/tender liver
- JVD
- dependent edema
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How would TB look on an xray
Ghons tubercle
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How can you tell if Mantoux test is positive
Induration of 10mm or greater
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How should isoniazid for TB be taken and what should be monitored
- on an empty stomach
- hepatotoxicitiy and neurotoxicity
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What should you let the pt know when taken rifampin
orange urine
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What is a side effect of ethambutol that should be reported immediately
Vision changes
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