respiratory EXAM 2

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what is asthma
- -chronic
- -hyper response to trigger
asthma is response to

immune
asthma attacks are

gradual
asthma triggers
- allergens
- air pollutants
- exercise
- occupational
- GERD
asthma symptoms of hypoxia
- restless
- cyanosis
- tachycardia
- increase bp
- increase RR
asthma clinical manisfestations
- prolonged expiration
- cough(dry or productiver)
- wheeze
- dyspnea
- hypoxia
asthma simplified
- inflammation, edema and mucos in the airway
- -constriction
start pt with asthma on

protonix
classes of asthma
- intermittent
- mild
- moderate
- severe
asthma intermitent

s/s less 2day/week
asthma mild

more 2day/week but not daily
asthma moderate

daily
asthma severe

continuous
severe asthma s/s of hypoxia
- -anxiety
- -pulse above 120 and increase bp
- -increase RR over 30
- -low o2
- -accessory muscle
- -dyspnea at rest
- -decrease breath sounds
asthma pt teaching
- disease process
- meds
- prevention
- action plan
what is PEFR(peak expiratory flow rate)
- measures the ability to expire air and thus the degree of obstruction
- -detects subtle change in breathing
peak flow meter

green
yellow
red
- green-80%-take meds
- yellow- 50-80% action plan
- red- 50% call dr
is COPD preventable

yes
what is COPD

airflow limitation that is not fully reversable
copd causes
- smoking
- aging
- hereditary(AAT deficiency)
AAT deficincy
- large air pockets that fill the lungs
- no co2 exchange
- bollue
- young ppl 20-40
COPD chest signs

barrel chest
what is bronchitis
- -inflamed airways
- -mucos hyper secretion
- -bad cilia
- air is trapped in distal bronchioles
important cells for bronchitis

increase goblet cells
dx of bronchitis

chronic cough for 3 consect months for 2 years in a row and all other dx ruled out
bronchitis s/s
- productive couch
- sob
- crackles or wheeze
- chest pain w cough
- fever
- hoarse
- malaise
what is emphasema
- loss of bronchi elastic recoil in aveoli
- hyperinflation of lungs
- flat diaphragm
- gas exchange problems
emphesema s/s
- sob on exertion progressing to continuous sob
- barrel chest
- anorexia
why would a pt with emphesema have barrel chest
- happens over time
- muscle structure changes b/c working harder to breathe
why would a pt with emphesema have annorexia

increased energy
COPD early clinical minisfestations
- chronic intermit cough
- dyspnea
- air hunger
- prolonged expiratory wheeze
COPD late stage clinical manisfestations
- barrel chest
- flat diaphragm
- cyanosis
- polycythemia(blue red color d/t hypoxemia)
- cachexia(malnurited)
- anxiety
- low o2
define polycythemia

red/blue color dt hypoxemia in COPD late s/s
define cachexia
- malnurited
- COPD late s/s
position that helps w COPD

tripod
what is cor pulmonale
- -right vent hypertrophy
- -hypoxia+pulmonary htn + cor pulmonale= right side heart failure
labs for COPD
- -anemic
- -increase RBC(body compensate for lack of o2)
- -low hbg and hct
cor pulmonale s/s
- exertional dyspnea
- tachypnea
- cough
- fatigue
right side heart failure s/s
- edema
- wt gain
- jvd
labs to check with COPD

ABG's
ABG labs and values with COPD
- ph-low acidic
- pao2-low(hypoxemia <60)
- paco2-high(hypercapnia >45)
- hco3(high-normal)
Acute exacerbation of COPDs cause
- -bacterial and viral
- -quit taking meds
Acute exacerbation of COPD is signaled by a change in
- dyspnea
- cough
- sputum
Acute exacerbation of COPDs sign of severity
- use of accessory muscles
- central cyanosis
Acute exacerbation of COPDs treatment
- -short acting bronchodialators
- corticosteroids
- antibiotics
- o2 therapy
- mechanical ventilation
what are the bronchodialators
- beta 2 agonist
- anticholenergenic
- theophylline
what type of pt responds better to bronchodialators

asthma
beta 2 short acting drug and why used
- -albuterol
- -mild or fewer s/s
- -asthma or exercising
beta 2 long acting drug and why used
- -salmeterol(lasts 12 hours)
- -moderate stage of copd
- -used with a short acting for rescue dyspena
anticholenergenic
short acting
long acting
- Atrovent
- spriva
theophylline what is it
- bronchodialator
- antiinflamatory
- long acting
if pt takes a theophylline what should you monitor for and what would normal lab be
- -s/s of toxicity
- -normal serum levels are 10-20mcg/ml
theophylline side effects
- tachy
- heart attak
- freq serum checks
se of steroids
- bone loss
- thin skin
steroid drugs
- slou-cortef/medrol
- prednisone
- Pulmicort
- po/iv/mdi
leukotrine

singulair
combo therapy
- Combivent(albuterol and Atrovent)
- Advair(salmetrol and floment)
what do anticholenergenics do
- -work on nervous system
- -decrease secretion in lung
- -act on larger muscles
- -dialate
inhaler how to use
- hold for 10 sec
- exhale slow
- wait 1 min b/t puff
- 5 min b/t diff meds
huff cough
- -ACT
- -"fogging up a windowa'
- -repeate huff several times while refraining from reg cough
- -
postural drainage
- ACT
- positioning and vibration to mobilize secretion
acapella
- ACT
- vibration device to mobilize secretions
COPD interventions
- hydration
- immunization
- stop smoking
- pursed lip breathing
the risk of developing lung cancer

is directly related to the total smoke and second hand smoke as well as inhaled carcinogens
vaping

cancer organization supports it lung organization does not
patho of lung cancer
- -arise from the mutated epithelial cells
- -takes 8-10yrs for theses cells to reach 1cm
- -metastasizes
non small cell lung cancers
- squamous cell
- adenocarcinoma
- large cell
squamous cell carcinoma
- centrally located
- slow groeing
- early s/s
adenocarcinoma
- moderate growth
- most common in non smokers
- grows in peripheral of lungs so more of mets
- does not respond well to chemo
large cell carcinoma
- -not as common
- large growing
- mets quickly
small cell lung cancer
- "oat cell carcinoma"
- most malignant
- highly correlated w smoking
- paraneoplastic properties
- chemo
what causes paraneoplastic syndrom
- -tumor cells start secreting factors
- -often associated with SCLC
s/s of paraneoplastic syndrom
- -endocrine disorders
- -hypercalcemia
- -SIADH(retain fluids)
- -adrenal hyper secretion
- cushing syndrome(increase cortisone levels)
S/S ARE AHEAD OF LUNG CANCER AND CAN BE TREATED
which cancer is not as likely to metastisize

NSCLC
lung cancer clinical manifestations
- -extensive mets before s/s or dx
- -cough
- chest pain
- "silent killer"
- sob/dyspnea
- hemoptysis
lung cancer diagnostics
- chest xray
- ct and mri(metastisis)
- sputum(early morning)(if not located next to tumor easy to miss)
- VAT(most often)
what is a bronchoscopy
- scope dwn pt
- into lungs
- biopsy tumor
- might do BAL
bronchoscopy pre and post op
- pre: npo 4-8hrs
- post: because of risk for laryngeal spasm check gag, cough and swallow
NSCLC staging
- 1-4
- small to large
- 1:no lymph
- 2:some lymph
- 3: spread
- 4: distal mets
lobectomy
- invasive
- removal of 1 or more lobes
pneumonectomy
- invasive
- removal of 1 entire side of lung
wedge ressection
- -non invasive
- -Ideal for medically frail pt who cant handle surgery
- -remove tumor and surrounding healthy tissue
- -VATS(video assisted)
nursing intervention for lung cancer surgical post op
- -airway and o2
- -turn q1 hr
- -TCDB(turn cough deep breath)
- -pain
- -emotional
- -xray
what is pleural effusion
- complication of lung cancer
- collection of fluid in the pleural space
- common
risk of having fluid in the pleural space

infection and pneumonia
s/s of pleura effusion
- dyspnea
- tachy/hypo
- decrease mvmt of chest wall on effected side
tx for pleural effusion
- thoracentesis
- chest tube
- tx cause
- AB
what is a thorencentisis
- -pt is set on side of bed
- -bent over table
- -lidocaine and large bore needle into pleural space
- -drainage bag or glass bottle
- -sterile
- -aspirate fluid
when performing a thorocentisis, how much fluid is removed and why would you not want to remove to much
- - 1000-1200ml
- -too much fluid removed could cause a shift in organs which could cause dysarythmias and make pt unstable
nursing interventions for a thorocentisis
- -cxr
- -vitals
- -respiratory distress
head and neck cancer risk factors
- tobacco
- HPV
- ETOH
head and neck cancer tumors can occur
- paranasal sinus
- oral cavity
- pharynx/larynx
oral cancer
- painless growth
- bleed easily and do not heal
pharynx cancer

rarely produces early s/s
larynx cancer
- hoarseness
- lump in throat
- dysphagia
diagnostic studies for head and neck cancer
- laryngoscopy(upper airway visual)
- CT/MRI(mets)
- PET(returned cancer)
- biopsy(definitive)
vocal cord stripping
- remove outter layer of vocal cord tissue
- no speech impairment
cordectomy
- partial removal of cord
- partial speech impairment
total laryngectomy
- larynx removed
- perm trach
what is a concern with the different approaches of surgery for neck cancer

different approachs alter the nursing interventions with pt
radical neck dissesction
- -multiple lymph nodes involved
- -major surgery
- -removes muscles, nerves and veins
- -decrease risk of lymph spread
nutritional concerns after throat surgery
- -swallow eval
- -parenteral fluids 24-48hrs
- tube feeds (DHT, PEG)
transesophogeal puncture
- popular
- one way valve
- push to speak
- occludes stoma
esophageal speech

swallow a bunch of air and belch out their words
electrolarynx
- box to throat with electronic voice
- vibrations from voice help them to speak
radiation therapy s/s
- decrease saliva
- soft bland diet
- no coffee
- stomatitis

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Author

ChelseaL

342667

Card Set

respiratory EXAM 2

Description

respiratory EXAM 2

Updated

2018-10-02T22:48:50Z

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