Med/surg Exam 2 Respiratory/pulmonary disorders

How to assess effectiveness of chest tube:

-Hear more breath/lung sounds -Daily chest x-ray -continuous pulse o2 -tidaling -water seal -output -air leak -ability to breath

wedge resection

a surgery in which a small wedge-shaped piece of cancerous lung tissue is removed, along with a margin of healthy tissue around the cancer

Traumatic pneumothorax manifestations

pain dyspnea tachypnea tachycardia decreased respiratory excursion absent breath sounds in affected area air movement through an open wound

What are drugs are administered for pain in PE?

-Analgesics (acetaminophen, Aspirin, NSAIDs) -Morphine (air hunger)

How are chest tubes measured?

"French"

IVC filter is used for

(Inferior vena cava filter) -filter placed for recurrence of clot -filter catches clot -keeps clot from entering heart and lungs

Post-procedure chest tube placement

- Assess resp every 4 hours -maintain closed system (tape all connections and secure chest tube) -keep collection apparatus below level of the chest -check tubes frequently for kinks/loops -check water seal frequently (water should fluctuate with respiratory effort, if it doesn't, system may not be intact, PERIODIC air bubbles in the water-seal chamber are normal and indicate air is being removed from chest) -measure drainage every 8 hours (report cloudy, excess of 70ml per hour, red, warm, and free flowing) -add water when needed -assist with frequent position changes and ambulation is allowed -when chest tube is removed immediately apply sterile petroleum jelly

What are hallmark signs of lung cancer your patient may display?

- Chronic cough, hemoptysis - Wheezing - SOB - Dull, aching chest pain - Pleuntic pain - Hoarseness and or dysphagia

What would you teach a patient who has been diagnosed with TB?

- Explain the disease and how its spread - Tx anad follow up procedures - Importance of eating well-balanced, high-protein, high carbohydrate; balance exercise with rest, and avoid crowds and people with upper resp infections - Importance of avoiding alcohol and other substances while taking chemo drugs - Fluid intake should be 2.5 to 3.0 quarts of fluid per day - Manifestations to report include chest pain, hemoptysis, difficult breathing, anorexia, N/V, yellow tint to skin or sclera, sudden wight gain, swollen feet, ankle, legs, or hands; hearing loss, tinnitus, or vertigo and vision changes - Promote adherence to treatment plan - Reduce risk for infection

Who is at risk for the flu?

- Highest at risk are under 5 y/o or adults older than 65 - Chronic illnesses (esp those with impaired immune or resp systems) - Pregnant and early postpartum women - Residents of nursing homes or other long-term facilities

How do we screen for TB

- Injecting small amount of purified protein derivative (PPD) of tuberculin anytime thereafter activates this response, attracting macrophages to the area and causing a pronounced local inflammatory response - Measurement is used (mm)

What is the nursing role in managing a patient with the flu?

- Monitor resp rate and pattern - Pace activities to provide for periods of rest - Elevate the HOB - Promote airway clearance and patency (remove secretions, maintain hydration, increase humidity with humidifier, teach cough techniques) - Promote sleep and rest -Reduce the risk for infection

What is reactivation TB?

- Occurs when the immune system is suppressed due to age, disease, or use of immunosuppressive drugs - Pts with HIV are at high risk of active TB -Pts don't finish medication regimen

When dx TB

- Positive TB tests (PPD >5 mm diameter) alone does NOT indicate active disease - Sputum tests for bacillus and chest x-rays are routinely used to dx and evaluate active pulmon disease - Sputum smear: resistance of decolorizing chemicals indicates positive tests - Sputum Culture - PCR takes DNA - Chest x-ray can show pulmon TB if lesions show

Review superior vena cava syndrome related to lung cancer

- SVC syndrome is partial or complete obstruction of SVC, a potential complication of lung cancer, when tumor involves the superior mediastinum or mediastinal lymph nodes - Obstructed venous flow from the head and neck produces sxs like edema of neck and face, headache, dizziness, vision probs and syncope - Veins in upper chest and neck are dilated; flushing occurs, followed by cyanosis - Cerebral edema may affect LOC, laryngeal edema may impair respirations

What precautions are in place for a patient with the flu?

- Transmitted by airborne droplet and direct contact - Incubation is only 18-72 hours - Use standard precautions and encourage all staff to wash hands, tell pts and visitors to control resp secretions by using tissues and to maintain a distance of atleast 3 feet from others when coughing or sneezing, provide masks -Use droplet precautions for patients with suspected or confirmed influenzas: private room, masks for caregivers and visitors and mask pt when transporting

Why do we do two tests?

- Two tests are used because false-negative responses are common in people who are immunosuppressed. If first test is negative, a 2nd PPD test is given a week later. If 2nd test is negative, pt is either free of infection or anergic (unable to react to common antigens) - 2 step procedure is recommended for long-term care residents and workers

What would you tell the people who live with person with TB?

- Use disposable tissues to contain resp secretions, esp during first 2 weeks - Screen close contacts for infection and possible prophylactic treatment -Disease is not spread by touching inanimate objects, so no special precautions are required for eating utensils, clothing, books, or other objects used

How does a nurse keep themselves safe while caring for a patient with TB?

- Use personal protective devices - OSHA required use of HEPA-filtered respirator to protect occupational exposure to TB - Surgical masks are ineffective to filter droplets - When collecting specimens, pt should collect specimen in room with airflow control devices, UV light or both - Wear a mask capable of filtering droplets - Aerosol therapy, percussion, and postural drainage may help pt produce drainage

What is extrapulmonary TB

- When primary disease or reactivations allows live bacilli to enter bronchi, disease may spread through the blood and lymph system or to other organs - Especially those with HIV - Miliary TB result from hematogenous spread (through the blood) - Genitourinary TB is kidney and genitourinary tract—it travels to kidneys through blood, and infection can affect urinary tract (ureters and bladder), in men, prostate, seminal vesicles, and epididymis and in women, fallopian tubes and ovaries - TB meningitis is when TB spreads to subarachnoid space - Skeletal TB affects bones and joints via blood to vertebrae ends of long bones and joints—kyphosis can develop, and spinal cord can be compressed (painful, warm, tender)

What medications are used to manage the flu?

- Yearly vaccine (watch for egg allergy) - Amatntadine (Symmetrel) or rimantadine (flumadine) used prophylactically in unvaxxed people - Antiviral drugs like zanamivir (Relenza), oseltamivir (Tamiflu), and peramivir (rapiva) reduce sxs - Zanamivir inhalation (not for hx of asthma or COPD) - OTC drugs like analgesics like aspirin, acetaminophen or NSAIDS - Antitussives and mucolytics decrease cough

Pre-procedure chest tube:

-Get consent, Explain procedure -local anesthesia will be used -reassure pt breathing will be easier once tube in place -gather supplies -position patients (upright or side lying) -can be performed at bedside, help as needed

Patho of pulmonary edema:

- contractility of the left ventricle is severely impaired -ejection fraction falls as the ventricle is unable to eject blood -causing rise in end-diastole volume and pressure—as a result, fluid leaning from pulmonary capillaries congest interstitial tissues, ventilation and gas exchange are disrupted and hypoxia worsens

The nurse is teaching a pt prescribed isoniazid (INH). Which pt statement would indicate additional teaching?

-"I will take INH immediately after eating breakfast."

Postive PPD test:

-15 mm or above, regardless of hx is POSITIVE

Priorities for TB

-ABC's (keep o2 above 90-92%) -Get cultures (before meds)

Rifampin (Rifadin, rimactane) nursing responsibilities

-Admin on empty stomach -Monitor CBC, liver, and renal function -This drug reduces the effect of oral contraceptives, quinidine, corticosteroids, warfarin, digoxin and hypoglycemia

Isoniazid nursing responsibilities

-Admin on empty stomach -Monitor adverse reactions: tingling, hepatoxicity, hypersensitivity

Pyrazinamide (Tebrazid) nursing responsibilities

-Admin with meals -Monitor liver function and uric acid levels (gout)

What education should you provide for family of patient with TB?

-Airborne isolation-- each fam member is required to wear a particulate respirator when in room with pt -Pt should not leave room -Keep pts door closed at all times

Assess for what allergy before giving the flu and pneumonia vaccine?

-Allergy to eggs

Thrombolytic agents

-Altepase -Streptokinase -Urokinase

Preventitive actions for DVT/PE

-Ambulate ASAP -Ensure pt is staying active -Move pt limbs -Stay well-hydrated -Wear compression socks -Pneumatic compression cuffs -Alternative to oral contraceptives

Which client has the highest risk for developing a pulmonary embolism?

-An obese client with leg trauma

Treatment for PE

-Anticoagulant -Thrombolytic agents -Analgesics -Preventative actions -Pneumatic compression cuffs -Surgical intervention

Ethambutol (Myambutol) nursing responsibilities

-Baseline visual exam (optic neuritis) -Admin with meals -Monitor liver/renal/neuro function

What diagnostic tests would be ordered for TB?

-CBC, blood cultures, sputum cultures -Quatiferon Gold is usually saved for when other tests are inconclusive (blood test) -Chest x-ray -Labs -PPD TB skin test

Manifestations of TB

-Calcified lesions (chest x-ray) -Fatigue -Weight loss -Anorexia -Low-grade fever -Night sweats -Dry cough that becomes purulent/bloody

Best/fastest way to dx pneumothorax:

-Chest x-ray

What methods are used to dx PE?

-Chest x-ray: consolidation in both lungs (wet lungs in pneumonia) -Chest CT with contrast -Lung scans -Pulmonary embolism (definitive test for PE) -ECG (rules out MI!) -ABGs -Coagulation (aPTT or PTT or INR)

If a pt has hypoxemia, why would oxygen therapy through a nasal cannula not improve o2 status?

-Clot blocking vessel -Blood exchange is not occurring (co2 not going out and o2 not coming in) -Gas exchange problem because of a perfusion problem

what should your first nursing action be when chest tube becomes dislodged?

-Cover site with occlusive dressing -Taped on 3 sides -Creating one way valve to prevent pt from developing a tension pneumothorax while waiting for provider -Make sure the opening of 3 sided dressing is toward the grand -Notify dr immediately, stay with pt and monitor respiratory and hemodynamic status

Effects of aging on respiratory system

-Decrease of elastic recoil of lungs during expiration because of less elastic collagen and elastin - Calcification of the coastal cartilage and weakening of the intercostal muscles - Loss of skeletal muscle strength in thorax and diaphragm; flattening of diaphragm - Alveoli are less elastic, more fibrotic and have fewer working capillaries - Cough is less effective - PO2 reduces as much as 15% by age 80 - Less mobility increases risk of pneumonia

Manifestations of PE

-Dyspnea -SOB -Pleuritic chest pain -Anxiety -Sense of impending doom -Diaphoresis (causing syncope/cyanosis) -Tachycardia and tachypnea -Crackles heard in lungs -Cardiac gallop (s3 and s4) -Fever -Slow of cap refill

When is the best time to obtain a sputum culture?

-First thing in the morning

S/S to report with TB

-Further hemoptysis -Difficulty breathing -Worsening cough -New cough -Fever -Chills -Night sweats

The nurse is assessing a pt recovering from a motor vehicle accident. Which assessment finding indicated the pt is experiencing a pneumothorax?

-Hyperresonance to percussion at the apex of the lungs

Other s/s of PE

-Hypoxemia -Bruising/tender/warm leg -Hemoptysis -Decreases percussion in lungs (indicates atelectasis)

Surgical interventions for PE:

-IVC filter -Pulmonary embolectomy

Pts prescribed thrombolytics should be monitored for:

-Increased risk of bleeding (esp when prescribed heparin alongside of throbolytic)

Rifampin education

-Increases sweating, urine, alive, tears -Urine may be orange -Don't wear soft contact lenses (permanent stain) -Dont take with aspirin -Report flu like sxs to Dr. and drug can cause hepatitis

PPD skin test for TB is what kind of injection?

-Intradermal

PPD testing: 2 types

-Intradermal PPD -Multiple puncture (tine) test

Multiple-puncture (tine) test

-Less accurate

What baselines labs should be taken before starting RIPE

-Liver tests -Vision exams -Audiometric testing

Who is at risk for TB

-Lower socioeconomic groups - Injection drug users - Homeless - People with alcoholism - People with HIV -Close contact with others that has TB

Patho of TB:

-M. TB is a rod-shaped aerobic bacterium and is spread via droplet -Transmitted by droplet nuclei, airborne droplets when person coughs, sneezes, speaks, or sings -Can remain in air for hours -Most inhaled bacilli are trapped in upper airways; those reaching distal airways implant in respiratory bronchioles and alveoli -Bacili multiply within macrophage, eventually killing macrophages - Cell-mediated immune response activate additional macrophages and lymphocytes, destroying bacilli - Most lesions calcify and are seen on x-ray but remain dormant until reactivated - Weak immune system: lesions grow - Enlarged lesions damages bronchial walls and blood vessels - Bacilli multiply and spread to airway and to blood and lymph nodes, and from there, many organs and tissues can be affected - Resulting extrapulmonary lesions evolve in the same sequence as pulmonary lesions

Risk factors for PE

-MI -HF -Obesity -Advanced age -Women using oral contraceptives or estrogen therapy -Women during pregnancy and childbirth

If patient on warfarin

-They will need to have their other medications, dietary supplements, and nutrition plan reviewed That is because medications, supplements, or food can impact the blood's ability to clot while potentially negatively impacting the drug

Ethambutol (Myambutol) education

-Monitor vision

What nursing actions should be taken when patient with suspected TB comes in?

-Move pt to negative pressure room -Notify provider to get dx tests ordered -Place patient in AIRborne isolation in a negative pressure room ASAP -Apply oxygen for SpO2 of at least 90% -Notify Dr and charge nurse immediately if TB suspected

What can happen if pt doesn't take entire prescribed medication for TB?

-Multi-drug resistant TB (could further her problems later)

Tubing of chest tube:

-NO dependent loops -Secure a loop of drainage tubing to the sheet or gown -Do not clamp chest tube (air can back up and cause tension pneumothorax)

Patho of pneumothorax

-Negative pressure is vital to breathing -Contraction of diaphragm and intercostal mules enlarge the thoracic space -Negative pressure draws lung outward, increasing volume so air rushes into fill expanded lung space

manifestations of pulmonary edema

-dyspnea -sob -labored resp -orthopnea -cant breathe when lying down -productive cough with pink/frothy sputum -crackles in lungs

pre-op thoracentesis

-fasting/sedation not required -local anesthesia is used -admin cough suppressant -supplies -position patient upright, leaning forward with arms and head supported or on over bed table

Sputum cultures for TB

-Not spit, should be sputum from the back of the pharynx -Aerosol therapy, percussion, and postural drainage may help the pt produce sputum -Tracheal suctioning, bronchoscopy, or gastric lavage is sometimes necessary to retrieve sputum -We want sputum to bypass the mouth to prevent contamination of mouth bacteria

Pyrazinamide education

-Notify dr for loss of appetite, n/v jaundice, gout sxs -Avoid alcohol

PATHO of PE cont

-Obstruction of pulmonary blood flow by an embolus affects both perfusion and ventilation -reflexes cause vasoconstriction, leading to: -Pulmonary htn -right-ventricular HF -hypotension -drop in CO -bronchoconstriction occurs in affected area of lung

Which prescribed intervention would the nurse question for a client who has just been dx with the flu after having sxs for 4 days?

-Oseltamivir (tamiflu)

Which finding for a client with pulmonary edema who received furosemide is the best indicator that the tx has been effective?

-Oxygen saturation per pulse ox is 99%

Pt has a chest tube inserted for a pneumothorax. What should the nurse expect when assessing the drain system?

-Periodic bubbling in the water seal chamber immediately after insertion

Hallmark symptoms of pneumothorax

-Pleuratic chest pain -SOB -Respiratory and HR increase -Affected side is hyper resonant to percussion, and breath sounds may be absent or diminished -Hypoxemia (more pronounced in secondary pneumothorax)

A young adult pt who is asking questions about smoking cessation plans to take a scuba diving class. Which health problem are they at risk for developing?

-Pneumothorax

Which is the function of the water-seal chamber on a closed chest drain system for client with hemothorax?

-Prevents reflux of air back into the pleural space

When suspecting patient has TB. What other personal and/or med hx questions do you need to ask to be sure?

-Recent travel -Symptoms -Hx of TB exposure to someone else with TB recently

Assessment for pt with suspected pneumothorax, what are priority assessments?

-Respiratory assessment -Full set of VS -Cardiac assessment

Pt is recovering from surgery for lung cancer. Which action would not be considered a part of the post-op plan of care?

-Restrict pain meds

Meds to administer for TB: RIPE

-Rifampin -Isoniazide -Pyrazinamide -Ethambutol

How do you manage a traumatic pneumothorax? What type of dressing would you use?

-Seal wound of open pneumothorax or from inadvertent tube removal as soon as possible with sterile occlusive dressing, such as gauze impregnated with petroleum jelly -If sterile dressing not available, use foil or plastic wrap -Tape the dressing on three sides ONLY -An occlusive dressing tapes on 3 sides prevents the development of tension pneumothorax by inhibiting air from entering the wound during inhalation but allowing it to escape during exhalation

3 types of pneumothorax

-Spontaneous -Traumatic -Tension

Risk factors for PE cont

-Stasis of blood flow -Vessel wall damage -Altered blood coagulation -Prolonged immobility -Trauma (hip/femer fracture) -Surgery (orthopedic, pelvic, gyno)

Isoniazid education

-Take FULL prescription -If n/v occurs when taking med, take with food -Notify dr for anorexia, n/v, jaundice -Avoid alcohol -Use measures to prevent pregnancy when taking this drug, it may harm fetus

What else can happen if pt doesn't finish medication?

-Tb infection could lay dormant in her body as Latent TB and could resurface later

Pneumatic compression cuffs:

-These should be placed on the patient's legs while they're bedridden to decrease the risk of more blood clots forming

Why is the patient's SpO2 and PaO2 unresponsive to receiving supplemental oxygen?

-This occurs because blood clots reduce or entirely prevent blood from flowing past a clot. Therefore, any alveoli distal to the clot will receive little to no perfusion. This decrease in perfusion prevents carbon dioxide and oxygen from effectively being exchanged at the alveolar-capillary membrane, even when the patient is ventilating normally -This prevention of effective gas exchange due to low perfusion is part of what causes patients with a pulmonary embolism to be unresponsive to supplemental oxygen. The development of atelectasis (alveoli death) due to pulmonary infarction secondary to a pulmonary embolism can further reduce the patient's responsiveness to oxygen

What are the most frequent cause of pulmonary embolism?

-Thromboboli, or blood clots that develop in venous system (DVT) or right side of the heart

Pt is dx with a tension pneumothorax. What should nurse expect to asses in this pt?

-Tracheal deviation toward unaffected side -Distended neck veins -Absent breath sounds on the affected side

secondary pneumothorax

-Underlying lung disease leads to weakened small airways which collapse with respirations (COPD, asthma, CF, pulmonary fibrosis, TB, and ARDS) -life-threatening

Pt dx with active TB is in a negative pressure room for respiratory airborne isolation. How long should the nurse maintain the pt in this type of isolation?

-Until sputum specimens for acid-fast bacilli are negative

Other methods for dx include

-V/Q scan (second most preferred test-- it shows disturbed gas distribution in pts lungs when thrombus is present) -Pulmonary angiogram (least preferred) -D-dimer (most often used when looking for blood clot) and Platelet count show clotting status

Nursing assessment for TB

-Vital signs -Full heart and lung assessment -Subjective assessment of sxs -Observe and documents any sputum from productive cough -Autoimmune disorders -Hx of alcoholism/smoking

A hospitalized pt is dx w/ influenza. What action should the nurse take to help this pt?

-Wear a ask when caring for the pt -Implement droplet precautions -Apply mask to pt when transporting out of room -Assign the pt to private room

Pt is prescribed isoniazid (INH) and rifampin for tx of TB. Which adverse effect should the nurse instruct pt to report?

-Yellow tent to skin

The nurse is preparing a pt for a thoracentesis to drain an empyema. Which statement by the nurse is incorrect?

-You will have general anesthesia for pain control during the procedure

Crepitus

-a crackling or grating sound found when a leakage is occurring out into the sub skin -felt when palpated

manifestations of spontaneous pneumothorax:

-abrupt onset -pleuritic chest pain -dyspnea -SOB -tachypnea -tachycardia -unequal lung excursion -decreased breath sounds and hyperresonant percussion tone on affected side

tension pneumothorax

-air enters pleural space thru chest wall or from airways but is unable to escape, resulting in rapid accuramulation

What is a tension pneumothorax?

-air is evident on affected side -mediastinal (heart) and trachea is shifted toward unaffected or opposite side-- away from the affected lung

Precautions for TB:

-airborne precautions: N95 mask (particulate masks), negative pressure room, gown, gloves, goggles -Limit visitors -Limit patient leaving room

What does an anticoagulant do?

-can help stop the existing clot from growing and to prevent new clots from forming. Patients who are prescribed

what should you do if you discover there is a hole in the drainage system tubing?

-change entire system and tubing -can be done without order -prepare new system, clamp chest tube -USE STERILE TECHNIQUE -document drainage in the old system before discarding

Tuberculosis is

-chronic, recurrent infectious disease that usually affects lungs, but any organ be affected

Hypoxemia occurs because of:

-decreased perfusion because PE gets lodges in chunk of lung and alveoli past clot are not getting blood blow (gas exchange halted and no perfusion)

spontaneous pneumothorax

-develops when an air-filled bleb, or blister on the lung surface ruptures

how do you know if the chest tube is closed?

-floater in window next to the pressure gage should be present (check connections/seals) -vigorous/continuous bubbling is indicating a leak

activities that can increase the risk of spontaneous (primary) pneumothorax:

-high-alltitude flying -rapid decompression during suba diving

Influenza is

-highly contagious viral respiratory disease characterized by coryza, fever, cough, and systemic symptoms such as headache and malaise

What are hallmark sign would you look for in a tension pneumothorax?

-hypotension -shock -distended neck veins -severe dyspnea -tachypnea -tachycardia -decreases respiratory excursion -absent breath sounds on affected side -tracheal deviation toward unaffected side

manifestations of tension pneumothorax

-hypotension -shock -distended neck veins -severe dyspnea -tachypnea -tachycardia -decreases respiratory excursion -absent breath sounds on affected side -tracheal deviation toward unaffected side

post-op thoracentesis

-monitor pulse, color, o2 sat -apply dressing over picture site -put pt on unaffected site for 1 hour -label specimen with date, name, source and dx -during first several hours freq assess vs -obtain chest x-ray -normal activities can resume after 1 hour if no evidence of pneumothorax

Fungal infections

-most fungi are opportunistic and affect immunocompromised (AIDS, renal failure, leukemia) -Resembles TB

what happens if tubing cracks?

-nurse can replace system and not need providers order

3 types of traumatic pneumothorax

-open -closed -iatrogenic

Other dx methods of pneumothorax include:

-oxygen saturation (gas exchange) -ABGs (gas exchange -MRI -CT scan

Pulmonary embolectomy

-performed to remove existing clot that is not dissolved by medications -pulls clot out

what could be the possible causes of an air leak?

-poor connections -cracks in tubing -dislodgment of the tube -equipment failure (hole in the tubing)

Intradermal PPD test:

-read 48-72 hours -response of 5mm or greater after 48hrs is considered positive

Patho of PE cont

-right side of heart receives deoxygenated blood from venous circulation -o2 and co2 diffuse across membrane -partial pressure of o2 in alveolus is greater than in the capillary and diffuses into blood -co2 diffuses from capillaries into alveoli, driven by higher pressure of dissolved co2 -a match of blood flow thru pulmonary system (perfusion) and lung ventilation gas exchange (respiration) is necessary -low alveolar PaO2 constricts alveolar capillaries, directing blood to better ventilated areas of the lungs -high alveolar paco2 cause bronchodilation, increasing airflow and eliminates excess co2

Safety of managing chest tubes:

-should be kept upright -don't knock it over -avoid placing tension on chest tubes during positioning, ambulation, and care activities (easily displaced)

Nursing interventions with pulmonary edema:

-sit pt up with legs dangling -ABGs -oxygen sat -chest x-ray -admin morphine and oxygen -loop diuretics -ABCs -Improve gas exchange -monitor CO -manage fear

at risk for primary pneumothorax

-smokers -fam hx

PE Anticoagulation

-standard treatment for PE -heparin (fast-acting anticoagulant) -warfarin (slow-acting anticoagulant)

What does a thrombolytic do?

-they can help break down the embolism -clot buster

Supplies needed for chest tube placement:

-thoracotomy tray -injectable lidocaine -sterile gloves -chest tube drainage system -sterile water -large sterile catheter-tipped syringe to use as a funnel or filling water-seal and suction chambers

Suctioning from a chest tube:

-used to expedite procedure -not necessary

Patho of pulmonary embolism

1) Thrombus formation in peripheral circulation 2) Thrombus dislodges 3) Thrombus travels to the pulmonary circulation 4) Partial or complete obstruction of the pulmonary artery occurs 5) Obstruction of blood flow in the pulmonary capillary bed results in ventilation/perfusion mismatch and worsening hypoxia

Goal of anticoagulant therapy is to achieve therapeutic range of:

2.0-3.0

Sputum cultures should be negative within how many months?

3 months

How long could pts expect to be on medication course for TB?

6-12 months

What does a chest tube do?

a tube is placed in the pleural cavity to remove air or fluid, it must be sealed to prevent air from entering the tube and, in essence, creating an open pneumothorax

laser bronchoscopy

guided laser that resects tumors localized in main bronchus

Types of lung surgery for lung cancer:

look at table 36.8 p. 1325 -Laser bronchoscopy -mediastinoscopy -thoracotomy -wedge resection segmental resection sleeve resection lobectomy pneumonectomy

What is the treatment of choice for pneumothorax?

Chest tube placement (closed-chest catheter to allow lung to expand)

Major method to dx PE

Computed tomography pulmonary angiogram (CTPA)

Isoniazid (INH)

Drug of choice for TB prophylaxis and first-line drug for tx of active disease

Pt had dx of: Pt c/o:

Dx: -left radius fracture -fractured ribs on left side C/o: -tight chest -cant take a deep breath -anxious

S3 heart sound sounds like what?

Lub-dub-dub

atelectasis

Partial or total collapse of lung tissue

Priority nursing action for PE

Prevent

Lobectomy of lung

Removal of a single lobe of a lung expect a chest tube. Extremely painful. Incision on the front of the chest under the nipple and wraps around the back under the shoulder blade.

segmental resection of the lung

Removal of an individual bronchovascular segment of a pulmonary lobe with ligation of segmental branches of pulmonary vessels and division of the segmental bronchus

Lung cancer TNM staging

Table 36.7 p. 1325

Computed tomography pulmonary angiogram (CTPA):

This is the preferred test for confirming a pulmonary embolism. The presence of a blood clot will show as a darkened area.

What occurs when chest tube placed on water seal?

Valve or water seal prevents air from entering the chest cavity during inspiration and allows air to escape during expiration

pleural effusion

abnormal accumulation of fluid in the pleural space -normally 10-20 ml of fluid

Pneumothorax

accumulation of air in the pleural space

primary pneumothorax

affects previously healthy people, usually 20-30y/o usually tall and slender

hemothorax

blood in the pleural cavity

Hemoptysis

bloody sputum; coughing up blood

traumatic pneumothorax

blunt or penetrating trauma of chest wall and pleura-- motor vehicle accident, fractured ribs

nursing care of patient receiving radiation therapy for lungs

box 36.5 p. 1327

pneumoconiosis

chronic fibrotic lung diseases caused by inhalation of inorganic dusts and particle matter -including silicosis, coal workers

What is the biggest risk factor for lung cancer

cigarette smoking

Atelectasis is

collapsed alveoli and alveoli become infarction (death)

Risk factors for pneumothorax:

concurrent rib fractures (ribs broken in sequence, usually 2 or more)

manifestations of atelectasis

diminished breath sounds for small (on affected side), for large lung affected: dyspnea, tachypnea, asymmetrical lung movement, anxiety, restlessness, tracheal deviation, and tachycardia

pulmonary hypertension

elevated pulmonary pressure resulting from an increase in pulmonary vascular resistance to blood flow through small arteries and arterioles.

mediastinoscopy

endoscopic visual examination of the mediastinum

thoracotomy

incision into the chest cavity to assess for surgery

pleuritis

inflammation of the pleural membranes, irritates fibers and causes pain

Iatrogenic traumatic pneumothorax

involves laceration of vesperal pleura during a procedure such as Thoracenteses, central-line insertion, lung biopsy

Pulmonary edema:

is abnormal accumulation of fluid in the interstitial tissue and alveoli of the lungs and is a medical emergency—it may be gradual or acute and progress to severe respiratory distress

Saddle embolus

large thrombus lodged at an arterial bifurcation (so big it can be shaped as the lungs)

Tidaling

level of water moves up/down with respiratory rate (NORMAL)

nursing care for patient undergoing lung surgery:

look at box 36.4 p. 1326 pre operative post operative

thoracentesis

p. 36.2 p. 1309

Fungal infections present as

lung lesions are slow to develop and sxs are mild, fungi can spread from lungs to other organs

water-seal

make sure the fluid level is appropriate (2cm) -add water

Lung cancer

malignant tumor arising from the lungs and bronchi

The chest cavity has what type of pressure

negative pressure (pulling air in, allows lungs to expand-- in pneumothorax, air gets brought up to atmosphere pressure, so when taking a deep breath, lungs don't expand all the way, this is because there is not enough negative pressure to pull lungs down to fill with air, results in lack of gas exchange (hypoxia))

What is a pulmonary embolism?

obstruction of blood flow in part if the pulmonary vascular system by an embolism (blood cot)

open traumatic pneumothorax

occurs when penetrating chest trauma allows air from environment to enter pleural space -examples are motor vehicle accident, fall, CPR

Closed traumatic penumothorax

occurs with blunt trauma that allows air from lung to enter pleural space -examples are car accident, crushing chest injury

Other causes of atelectasis

pneumothorax, pleural effusion, tumor, loss of pulmonary surfactant, inability to maintain open alveoli

2 types of spontaneous pneumothorax

primary and secondary

pneumonectomy

removal of a entire lung

cor pulmonale

right ventricular hypertrophy and heart failure due to pulmonary hypertension

thoracentesis

surgical puncture to remove fluid from the pleural space

in tension pneumothorax the lung collapses on which side?

the affected side

in tension pneumothorax, as intrapleural pressure increases.... what happens to heart, great vessels, trachea, and esophagus?

they shift toward the unaffected side