1
Q
pulmonary function tests
A
- measures blood volume and flow
2
Q
dyspnea
A
- person’s perception of difficult breathing and their reaction to the sensation
- breathlessness and increased work of breathing
- flaring nostrils, retraction, use of accessory muscles
3
Q
types of dyspnea
A
- dyspnea on exertion
- orthopnea
-paroxymal nocturnal dyspnea
4
Q
hypoxemia
A
- reduction in arterial oxygen (PaO2)
- can be caused by inadequate about of O2, respiratory disease, dysfunction of the neurological system, and alterations in perfusion
- can lead to hypoxia
5
Q
hypoxia
A
- inadequate supply of O2 to tissues
- can be caused by inadequate about of O2, respiratory disease, dysfunction of the neurological system, and alterations in perfusion
6
Q
clinical manifestations of hypoxemia
A
- alterations in neurological and sensory function
- restlessness, agitation, impaired judgement, blurred vision
- cyanosis
- increase in respirations, tachycardia, increased production of erythropoietin
- uncoordinated muscle movement
7
Q
hypercapnia
A
- increase in arterial carbon dioxide content
- measured by PCO2
- can be caused by alterations in CO2 production, disturbance in gas exchange, abnormalities in chest wall or respiratory muscles, neurological control changes
- can lead to decreased levels of consciousness
8
Q
cyanosis
A
- blue tint due to increasing amounts of deoxygenated blood
- often a late sign of hypoxemia/hypoxia
- areas of body where cyanosis is most commonly seen are lips, nailbeds, ears, cheeks
- for central cyanosis, see buccal mucosa, tongue, and lips
- for peripheral cyanosis, see nail beds, tip of nose, ears
9
Q
influenza
A
- viral infection
- can affect upper and lower respiratory tract
- three types: A, B, C
- transmitted through droplet - sneeze, cough
- aren’t a lot of options for treatment
- prevention can include vaccinations, hand hygiene
10
Q
clubbing of fingers
A
- occurs in patients who have chronically low oxygen levels in the blood
- pathologica change of capillary, densirt of capillaries increase because of exposure to low oxygen levels over time
- see in patients with lung cancer, respiratory disorders, COPD
11
Q
pneumonia
A
- when entry of food/fluids into the airway cause inflammation in the lungs
- typical - bacterial
- atypical- viral, fungal
12
Q
lobar pneumonia
A
- when the inflammation is found in a single lobe of the lung
13
Q
bronchopneumonia
A
- see the inflammation of several lobes of the lung
14
Q
pneumococcal pneumonia patho
A
- caused by inhaled infectious particles and result in inflammation and edema
- red and gray hepatization
15
Q
red hepatization
A
- the lungs will be red, firm, and airless with a resemblance to the liver
16
Q
gray hepatization
A
- the lung appears gray with liver-like consistency due to fibrinopurulent exudate, progressive disintegration of red blood cells, and hemosiderin
17
Q
pneumococcal pneumonia symptoms
A
- fever, chills, malaise, fatigue
- dyspnea
- productive cough (watery sputum->blood-tinged->rust/purulent)
- crackles, rales on lung ascultation
- pleuritic pain (sharp pain that increases with respiration)
- older adults are less likely to show entirety of symptoms
18
Q
pneumococcla pneumonia diagnostics
A
- chest x ray
- elevated WBC count
- sputum - gram stain and culture
- ABG (early is respiratory alkolosis, later is hypoxemia, respiratory acidosis)
19
Q
pneumococcal pneumonia treatment
A
- antimacrobials
- oyxgen support
- ventilation support
- adequate support
- pulmonary hygiene (cough, deep breath, turning)
- prevention includes immunizations and vaccines
20
Q
tuberculosis
A
- infectious disease
- caused by myobacterium tuberculosis
- transmitted by inhalation of airborne droplets
- most commonly found in the pulmonary system, but can occur anywhere in the body
21
Q
tuberculosis patho
A
1) fail to register an infection
2) become infected but then clear the infection
3) successfully contain the infection but continue to harbour bacilli in the absence of symptomatic disease (latent TB infection), or 4) develop progressive TB disease
22
Q
tuberculosis symptoms
A
- asymptomatic
- fever, fatigue, weight loss, night sweats, dyspnea, hemoptysis, increasing cough, purulent sputum
23
Q
tuberculosis diagnosis
A
-TB skin test: screening test for exposure
- chest xray
- sputum (acid fast smears and culture)
- DNA techniques
- genotyping
24
Q
tuberculosis treatment
A
- drug resistance is a problem
- treat with multiple antibiotics
- successful treatment results in reduction of symptoms, radiological proof of improvement, absense of organism in culture
25
lung cancer
- leading cause of cancer death in men and women
- smoking linked as a large cause
- high mortality rate
- primary tumors arise from lung tissue (95%)
- aggressive, locally invasive, metastatic
26
small cell lung cancer
- strongest associated with cigarette smoking
- highly malignant
- infiltrate and disseminate early
- originate in the bronchiole epithelium
- make up 20-25% of lung cancer
27
squamous cell lung cancer
- common in men with smoking history
- originates in central bronchi
- 25-40%
28
adenocarcinoma lung cancer
- most common in north america in women and nonsmokers
- weaker association with cigarette smoking
- originate in bronchioles or aveolar tissue
29
large cell lung cancer
- highly anaplastic (divide rapidly)
- originate periphery
30
symptoms of lung cancer
- dyspnea, cough, wheezing, chest pain, hemoptosis, increased sputum, hoarseness, anorexia, weight loss, superior vena cava syndrome
31
lung cancer diagnostic tests
- history, physical, pulmonary function, positive cytologic/histologic findings, bronchoscopy, tissue biopsy, pleural fluid samples, CXR, CT, MRI, PET scans
32
lung cancer treatment
- staging and grading used to determine treatment
- surgery
- chemotherapy
- radiation
- laser therapy - airway lesions
- reducing risk - decrease carcinogens
33
asthma
- obstructive disorder
- chronic disease
- affects 25 million Americans
- airway obstruction, bronchial hyperresponsiveness, airway inflammation, airway remodeling
34
asthma symptoms
- cough, wheezing, chest tightness, prolonged exhale, tachycardia, tachypnea, dyspnea, hypoxemia, hypercapnia, anxiety
35
asthma diagnostic tests
- history, physical, clinial findings, ABGs, pulmonary function test, determination of allergens, skin testing, CBCs
36
stepwise approach to asthma
- prevent symptoms and reduce triggers
- maintain pulmonary function
- maintain normal activity
- prevent exacerbations
- meet patient and family expectations for care
37
two forms of COPD
emphysema and bronchitis
38
COPD
- inflammation and fibrosis of bronchial wall
- hypertrophied mucus glands leads to hypersecreation of mucus and chronic cough
- loss of aveolar tissue which leads to lower surface area available for gas exchange
- loss of elastic lung fibers which leads to airway collapse, obstructed exhalation, and air trapping
39
emphysema symptoms
- loss of lung elasticity
- enlargement of air spaces caused by destruction of aveolar walls and capillary beds
- airway collapse
- mismatch of ventilation and perfusion
- overventilate to maintain blood gases
- pink puffer
40
lung bleb
- a small gas-containing space within the visceral pleura or in the subpleural lung, not larger than 1 cm in diameter
41
chronic bronchitis symptoms
- airway obstruction of major and small airways caused by chronic inflammation and excessive bronchial secretions
- chronic productive cough for 3 months in 2 consecutive years
- hypertrophy of the submuccosal glands whcih leads to the hypersecretion of mucus in large airways
- increase in goblet cells and excess mucus production which leads to smaller airways
- mismatch of ventilation and perfusion
- bronchiolar wall fibrosis
blue bloater
42
COPD diagnosis
- history, physical, pulmonary function tests, CXR, labs
43
COPD treatment
- smoking cessation
- bronchodilators, antochodilators, anticholinergenics expectorants, steroids, O2 (low dose and if O2sat is under 90), nutrition, immunizations
44
emphysema patho
- increase respiration to maintain oxygen levels
- dyspnea, increased ventilatory effort
- use accessory muscles, pursed-lip breathing
45
bronchitis patho
- cannot increase respirations enough to maintain oxygen levels
- cyanosis and polycythemia (increased RBC production)
- cor pulmonale
46
cor pulmonale
- right sided heart failure from increased pulmonary pressures
- right heart has to work harders
- fluids back up venous system
- happens in bronchitis
47
pulmonary emboli
- blood borne substances lodge in the pulmonary artery and obstruct blood flow
- thrombus, fat globules, air, amniotic fluid, foreign material
48
thrombus
- blood clots that develop in thighs and legs (most common source of pumonary embolism)
49
fat globules
- secondary to fractures (long bones, pelvis)
50
air
- venous access devices open to air
51
amniotic fluid
- collections of fluid or debris related to a complicated labor
52
foreign material
- sutures, catheter tips, etc
53
pulmonary emboli risk factor
- development of deep vein thrombosis, immobility, trauma, spinal cord injury, fractures, surgery
54
virchow's triad
- venous stasis
- hypercoagulability
- damage to vessel wall (intimal injury)
55
pulmonary embolism patho
- emboli released
- travels toward the heart and lungs
- lodge in the pulmonary vasculature
- vasoconstriction with increases the pulmonary artery pressures
- increase workload for right ventricle which can result in right side heart failure
- hypotension from decreased cardiac output
- shockp
56
pulmonary embolism symptoms
- restlessness, anxiety, tachycardia, tachypnea, sudden dyspnea, chest pain, hemoptysis, heart failure, shock, respiratory arrest
57
pulmonary embolism diagnostic tests
- V/Q scan, ABG's, pulmonary arteriography, D-dimer, Lung scans
58
pulmonary embolism treatment
- prevention is the primary treatment
- stabalize patient condition
- dissolve existing emboli and prevent new ones from forming
- measures to improve respiratory and vascular status (oxygen, bedrest, ventilator)
- pharmacologic treatment (thrombolytic therapy, anticoagulants - heparin, coumadin - to prevent blood clots from forming)
- surgical intervention (embolectomy, IVC filter)
59
pleural effusion
- abnormal collection of fluid in the pleural cavity as a result of a disease process
- types: transudates, exudates, empyema (pus), blood, chyle (lymph fluid)
60
pleural effusion symptoms
- vary based on cause
- dullness to percusion
- absense of breath sounds over affected area
- dyspnea
- pleuritic pain
- hypoxemia
- fever
- infection
61
pleural effusion diagnostic studies
- CXR, Ct, ultrasound
- thoracentesis
- analysis of pleural fluid
- elevated WBC (infection)
62
pleural effusions treatment
- thoracentesis
- chest tube for drainage
63
pneumothorax patho
- accumulation of air in the pleural cavity
- normal pressure in the pleural space is negative
- negative pressure is required to keep the lung inflated
- breach in the lung or pleura, allows air to enter the pleural space and the lung or a portion of the lung collapses
64
penumothorax symptoms
- tachycardia
- decreased or absent breath sounds
- dyspnea
- tachypnea
- chest asymmetry
- hypoxemia
65
pneumothorax diagnostic tests
- CXR, CT scan, ABG's
66
pneumothorax treatment
- supplemental O2
- evacuation of the air from the pleural space
- chest tube insertion - placed to chest drainage system that provide water-seal and suction
67
tension pneumothorax symptoms
- tachycardia, hypotension, distended neck veins, tracheal shift
68
tension pneumothorax treatment
- immediate decompression of lung (needle compression followed by chest tube placement)
69
post-op atelectasis
- incomplete expansion of the lung or portion of
- cause: intra-op high does supplemental O2, and anesthesia, mucus plug, external compression by fluid, mass, exudate
-
Nursing
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