respiratory EXAM 2

  1. what is asthma
    • -chronic
    • -hyper response to trigger
  2. asthma is response to
    immune
  3. asthma attacks are
    gradual
  4. asthma triggers
    • allergens
    • air pollutants
    • exercise
    • occupational
    • GERD
  5. asthma symptoms of hypoxia
    • restless
    • cyanosis
    • tachycardia
    • increase bp
    • increase RR
  6. asthma clinical manisfestations
    • prolonged expiration
    • cough(dry or productiver)
    • wheeze
    • dyspnea
    • hypoxia
  7. asthma simplified
    • inflammation, edema and mucos in the airway
    • -constriction
  8. start pt with asthma on
    protonix
  9. classes of asthma
    • intermittent
    • mild 
    • moderate
    • severe
  10. asthma intermitent
    s/s less 2day/week
  11. asthma mild
    more 2day/week but not daily
  12. asthma moderate
    daily
  13. asthma severe
    continuous
  14. 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
  15. asthma pt teaching
    • disease process
    • meds
    • prevention
    • action plan
  16. what is PEFR(peak expiratory flow rate)
    • measures the ability to expire air and thus the degree of obstruction
    • -detects subtle change in breathing
  17. peak flow meter

    green
    yellow 
    red
    • green-80%-take meds
    • yellow- 50-80% action plan
    • red- 50% call dr
  18. is COPD preventable
    yes
  19. what is COPD
    airflow limitation that is not fully reversable
  20. copd causes
    • smoking
    • aging
    • hereditary(AAT deficiency)
  21. AAT deficincy
    • large air pockets that fill the lungs
    • no co2 exchange
    • bollue
    • young ppl 20-40
  22. COPD chest signs
    barrel chest
  23. what is bronchitis
    • -inflamed airways
    • -mucos hyper secretion
    • -bad cilia
    • air is trapped in distal bronchioles
  24. important cells for bronchitis
    increase goblet cells
  25. dx of bronchitis
    chronic cough for 3 consect months for 2 years in a row and all other dx ruled out
  26. bronchitis s/s
    • productive couch
    • sob
    • crackles or wheeze
    • chest pain w cough
    • fever
    • hoarse
    • malaise
  27. what is emphasema
    • loss of bronchi elastic recoil in aveoli
    • hyperinflation of lungs
    • flat diaphragm
    • gas exchange problems
  28. emphesema s/s
    • sob on exertion progressing to continuous sob
    • barrel chest
    • anorexia
  29. why would a pt with emphesema have barrel chest
    • happens over time
    • muscle structure changes b/c working harder to breathe
  30. why would a pt with emphesema have annorexia
    increased energy
  31. COPD early clinical minisfestations
    • chronic intermit cough
    • dyspnea
    • air hunger
    • prolonged expiratory wheeze
  32. COPD late stage clinical manisfestations
    • barrel chest
    • flat diaphragm
    • cyanosis
    • polycythemia(blue red color d/t hypoxemia)
    • cachexia(malnurited)
    • anxiety
    • low o2
  33. define polycythemia
    red/blue color dt hypoxemia in COPD late s/s
  34. define cachexia
    • malnurited 
    • COPD late s/s
  35. position that helps w COPD
    tripod
  36. what is cor pulmonale
    • -right vent hypertrophy
    • -hypoxia+pulmonary htn + cor pulmonale= right side heart failure
  37. labs for COPD
    • -anemic
    • -increase RBC(body compensate for lack of o2)
    • -low hbg and hct
  38. cor pulmonale s/s
    • exertional dyspnea
    • tachypnea
    • cough 
    • fatigue
  39. right side heart failure s/s
    • edema
    • wt gain
    • jvd
  40. labs to check with COPD
    ABG's
  41. ABG labs and values with COPD
    • ph-low acidic
    • pao2-low(hypoxemia <60)
    • paco2-high(hypercapnia >45)
    • hco3(high-normal)
  42. Acute exacerbation of COPDs cause
    • -bacterial and viral
    • -quit taking meds
  43. Acute exacerbation of COPD is signaled by a change in
    • dyspnea
    • cough
    • sputum
  44. Acute exacerbation of COPDs sign of severity
    • use of accessory muscles
    • central cyanosis
  45. Acute exacerbation of COPDs treatment
    • -short acting bronchodialators
    • corticosteroids
    • antibiotics
    • o2 therapy
    • mechanical ventilation
  46. what are the bronchodialators
    • beta 2 agonist
    • anticholenergenic
    • theophylline
  47. what type of pt responds better to bronchodialators
    asthma
  48. beta 2 short acting drug and why used
    • -albuterol
    • -mild or fewer s/s
    • -asthma or exercising
  49. beta 2 long acting drug and why used
    • -salmeterol(lasts 12 hours)
    • -moderate stage of copd
    • -used with a short acting for rescue dyspena
  50. anticholenergenic
    short acting
    long acting
    • Atrovent
    • spriva
  51. theophylline what is it
    • bronchodialator
    • antiinflamatory
    • long acting
  52. 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
  53. theophylline side effects
    • tachy
    • heart attak
    • freq serum checks
  54. se of steroids
    • bone loss
    • thin skin
  55. steroid drugs
    • slou-cortef/medrol
    • prednisone
    • Pulmicort
    • po/iv/mdi
  56. leukotrine
    singulair
  57. combo therapy
    • Combivent(albuterol and Atrovent)
    • Advair(salmetrol and floment)
  58. what do anticholenergenics do
    • -work on nervous system
    • -decrease secretion in lung
    • -act on larger muscles
    • -dialate
  59. inhaler how to use
    • hold for 10 sec
    • exhale slow
    • wait 1 min b/t puff
    • 5 min b/t diff meds
  60. huff cough
    • -ACT
    • -"fogging up a windowa'
    • -repeate huff several times  while refraining from reg cough
    • -
  61. postural drainage
    • ACT
    • positioning and vibration to mobilize secretion
  62. acapella
    • ACT
    • vibration device to mobilize secretions
  63. COPD interventions
    • hydration
    • immunization
    • stop smoking
    • pursed lip breathing
  64. the risk of developing lung cancer
    is directly related to the total smoke  and second hand smoke as well as inhaled carcinogens
  65. vaping
    cancer organization supports it lung organization does not
  66. patho of lung cancer
    • -arise from the mutated epithelial cells
    • -takes 8-10yrs for theses cells to reach 1cm
    • -metastasizes
  67. non small cell lung cancers
    • squamous cell
    • adenocarcinoma
    • large cell
  68. squamous cell carcinoma
    • centrally located
    • slow groeing
    • early s/s
  69. adenocarcinoma
    • moderate growth
    • most common in non smokers
    • grows in peripheral of lungs so more of mets
    • does not respond well to chemo
  70. large cell carcinoma
    • -not as common
    • large growing
    • mets quickly
  71. small cell lung cancer
    • "oat cell carcinoma"
    • most malignant
    • highly correlated w smoking
    • paraneoplastic properties
    • chemo
  72. what causes paraneoplastic syndrom
    • -tumor cells start secreting factors
    • -often associated with SCLC
  73. 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
  74. which cancer is not as likely to metastisize
    NSCLC
  75. lung cancer clinical manifestations
    • -extensive mets before s/s or dx
    • -cough
    • chest pain
    • "silent killer"
    • sob/dyspnea
    • hemoptysis
  76. lung cancer diagnostics
    • chest xray
    • ct and mri(metastisis)
    • sputum(early morning)(if not located next to tumor easy to miss)
    • VAT(most often)
  77. what is a bronchoscopy
    • scope dwn pt
    • into lungs
    • biopsy tumor
    • might do BAL
  78. bronchoscopy pre and post op
    • pre: npo 4-8hrs
    • post: because of risk for laryngeal spasm check gag, cough and swallow
  79. NSCLC staging
    • 1-4
    • small to large
    • 1:no lymph
    • 2:some lymph
    • 3: spread
    • 4: distal mets
  80. lobectomy
    • invasive
    • removal of 1 or more lobes
  81. pneumonectomy
    • invasive
    • removal of 1 entire side of lung
  82. wedge ressection
    • -non invasive
    • -Ideal for medically frail pt who cant handle surgery
    • -remove tumor and surrounding healthy tissue
    • -VATS(video assisted)
  83. nursing intervention for lung cancer surgical post op
    • -airway and o2
    • -turn q1 hr
    • -TCDB(turn cough deep breath)
    • -pain
    • -emotional
    • -xray
  84. what is pleural effusion
    • complication of lung cancer
    • collection of fluid in the pleural space
    • common
  85. risk of having fluid in the pleural space
    infection and pneumonia
  86. s/s of pleura effusion
    • dyspnea
    • tachy/hypo
    • decrease mvmt of chest wall on effected side
  87. tx for pleural effusion
    • thoracentesis
    • chest tube
    • tx cause
    • AB
  88. 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
  89. 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
  90. nursing interventions for a thorocentisis
    • -cxr
    • -vitals
    • -respiratory distress
  91. head and neck cancer risk factors
    • tobacco
    • HPV
    • ETOH
  92. head and neck cancer tumors can occur
    • paranasal sinus
    • oral cavity
    • pharynx/larynx
  93. oral cancer
    • painless growth
    • bleed easily and do not heal
  94. pharynx cancer
    rarely produces early s/s
  95. larynx cancer
    • hoarseness
    • lump in throat
    • dysphagia
  96. diagnostic studies for head and neck cancer
    • laryngoscopy(upper airway visual)
    • CT/MRI(mets)
    • PET(returned cancer)
    • biopsy(definitive)
  97. vocal cord stripping
    • remove outter layer of vocal cord tissue
    • no speech impairment
  98. cordectomy
    • partial removal of cord
    • partial speech impairment
  99. total laryngectomy
    • larynx removed
    • perm trach
  100. what is a concern with the different approaches of surgery for neck cancer
    different approachs alter the nursing interventions with pt
  101. radical neck dissesction
    • -multiple lymph nodes involved
    • -major surgery
    • -removes muscles, nerves and veins
    • -decrease risk of lymph spread
  102. nutritional concerns after throat surgery
    • -swallow eval
    • -parenteral fluids 24-48hrs
    • tube feeds (DHT, PEG)
  103. transesophogeal puncture
    • popular
    • one way valve
    • push to speak
    • occludes stoma
  104. esophageal speech
    swallow a bunch of air and belch out their words
  105. electrolarynx
    • box to throat with electronic voice
    • vibrations from voice help them to speak
  106. radiation therapy s/s
    • decrease saliva
    • soft bland diet
    • no coffee
    • stomatitis
Author
ChelseaL
ID
342667
Card Set
respiratory EXAM 2
Description
respiratory EXAM 2
Updated