Respiratory Handout Part 2
Medical-Surgical Nursing
I.
Influenza: AKA _______________________
a. General Info
i. Highly __________________________
ii. Pathogen: _______________________
iii. ______________________: Rapid & extensive spreading infection & affecting
many individuals in an area or a population at the same time.
iv. H1N1: Newly identified strain  ____________ (_______-wide epidemic
b. Mode of transmission
i. ________________ droplet or Direct ___________________
c. Infection Control
i. Incubation period: ____________________
ii. Onset: _________________________
iii. Duration: _______________________
d. S&S
i. ________________ nose
ii. _____________ throat
iii. Cough: ______________, Non-productive  ____________________
iv. Substernal ____________________
v. _____________ & fever
vi. ______________
vii. _____________
viii. Muscle _______________
ix. ______________ & weakness
e. Older Adults
i. Higher risk of Complications: _________________________ & _______
ii. Why
1. Cilia ________________
2. Chest muscle strength _____________
3. Chest wall _____________________
4. Cough ________________________________
f.
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i. Most URI’s are self-limiting
1. ____________-care
2. Symptomatic ______________
3. ______________ complications
4. Prevent ___________________
g. Dx Test
i. _________________________ R/O streptococci
ii. CBC
1. WBC normal __________________________
2. WBC increased _________________________
iii. Chest __________________ R/O pneumonia
h. Prevention
i. Polyvalent influenza ________________ vaccine
1. _____________ effective
ii. Who should not be inoculated
1. Allergic to _____________________
Small Group Questions
1. What pathogen is assoc. with flu?
2. Identify 5 S&S of the flu
3. What type of isolation would you use for a client with the flu
4. Mary asks you if she should get the flu vaccine, how do you respond?
5. What priority nursing diagnosis would you give for a person with the flu?
II.
COPD
a. Overview
i. C______________O______________ P _______________ D_________
1. _________________ classification of diseases
b. Characterized by:
i. ________________ limitation
ii. ________________________
iii. Dyspnea on ___________________________
iv. ___________________________________
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v. Abnormal ___________________ response of the lungs to __________
particles or gases
c. Pathophysiology
i. Noxious particles of ____________  _________________ response 
___________________ of the airway  inflammation  ____________ of the
walls of the pulmonary _____________________
d. Includes:
i. ______________________ & chronic ____________________________
ii. Does not include: _______________________________
e. Risk Factors
i. #1 _______________________________
ii. __________________ smoking
iii. _______________________ exposure
iv. _________ pollution
f.
Effects of smoking
i. _______ phagocytes
ii. _______ cilia function
iii. _______ mucus production
g. Chronic Bronchitis
i. Disease of the ___________________
1. _________________ + ________________ production > 3 months
ii. Pathophysiology
1. Pollutant _____________________ airway  ____________ 
_______ secretions of ______________  Bronchial walls __________
 lumen _______________  PLUGS
2. “Plugs become areas for bacteria to grow and chronic infections which
increase mucus secretions and eventually, area of focal necrosis and
fibrosis”
3. ________________ & bronchioles become ______________ 
_______ susceptibility to LRI
iii. Exacerbation: ________________________
h. Emphysema
i. Affects _______________________ membrane
ii. Pathophysiology
1. Destruction of alveolar ________________ 
2. Loss of ___________________ recoil 
3. Over ____________________ alveoli 
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4. Damage to _____________________ pulmonary capillaries 
5. Impaired ____________________ expiration
6. ______ pulmonary pressure 
7. ___ Work load for the ____________ ventricle  _____ sided heart
failure
iii. Nursing Diagnosis: __________________________________
a.  _____________________  ____ CO2
i.
Compare & Contrast
i. Chronic bronchitis is a disease of the _________________________
ii. Emphysema is a disease affecting the _____________________
j.
Clinical manifestations
i. Primary
1. ___________________
2. ___________________ production
3. Dyspnea on ____________________
ii. Secondary
1. ______________ loss
2. Resp ______________________
3. ___________________ chest
k. Nursing Assessment
i. ______________ factors
ii. __________________ hx / ___________________ hx
iii. ____________________ of development
iv. Presence of ________________________________
v. Current ________________________
vi. _______________________
l.
Dx Test
i. A__________________B _____________________ G ___________
ii. _____________ scan
iii. _________________
m. Risk reduction
i. ____________________ cessation
n. Rx therapy
i. Primary
1. Bronchodilators
a. Action
i. _______________ the size of the ________
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ii. Relieve ____________________________*
iii. Reduce airway ______________________ 
iv. _________ ventilation
b. Example
i. Albuterol (Proventil)
2. Corticosteroids
a. Action
i. Potent _____________________________ agent
b. S/E
i. ________ & ___________ retention
ii. Never __________________________ abruptly
c. Examples
i. Prednisone
ii. Secondary
1. Antibiotics
2. Mucolytic agents
3. Anti-tussive agents
iii. Oxygen: ________________________________
iv. Pulmonary rehab
1. ______________________ exercises
2. Pulmonary _________________________
Small group Questions
1. What 2 diseases are assoc. with COPD?
2. Describe the pathophysiology of COPD.
3. What effect does smoking have on the resp. system?
4. Differentiate between chronic bronchitis and emphysema.
5. What are the 3 main S&S of COPD?
6. What 2 classifications of meds are used to treat clients with COPD (what are their actions)?
III.
Pneumonia
a. Definition
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i. An ____________________ process in which there is _____________________
In the ___________________spaces.
ii. ___________ exchange cannot take place in __________________area
iii. Primary nrs. Dxs based on the pathophysiology: ________________
iv. Components of respiration: ___________________________________
b. Causative agents
i. _______________________
ii. _______________________
1. Pneumocystis pneumonia: ______________________
iii. Aspiration pneumonia
c. Progression of events
i. Inflammation  ________ exudates  _______ movement of ______ &
_________  ___________ migrate into the alveoli  Fill _____ containing
spaces  ____ ventilation  _____ oxygen saturation
d. Risk factors
i. _________________________________
ii. ___________________
iii. Prolonged ______________________
iv. Depressed _____________ reflex
v. ____________
vi. ___________________ intoxication
vii. Gen _____________________ or opiod
viii. Advanced _______________
e. S&S Typical
i. Onset: ________________________
ii. ___________________________
iii. _______________ & Fever
iv. Cough: _______________________________
v. Sputum: _________________________________________________
vi. Pain: ___________________________________________________
vii. Breath sounds: ____________________________________________
f.
S&S Atypical: AKA ___________________________________
i. ____________________symptoms
ii. ____________________
iii. H./A
iv. ______________ aches
v. ____________________
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vi. Cough: _________________________________________________
vii. Self limited
g. S&S Elderly
i. General ____________________________
ii. ______________________
iii. _________________ symptoms: _______________________________
iv. Confusion
v. _____________ cardia
vi. _____________ pnea
vii. Do not C/O
1. ________________
2. ________________
3. ________________
4. ________________
h. Dx
i. Sputum ________________
ii. CBC
1. WBC Elevated _____________________
2. WBC Decreased/ normal ______________________
iii. ABG’s
iv. Pulse oximetry
v. Chest x-ray
i.
Rx
i. Primary
1. Antibiotics
a. Action: _______________________________________
b. Nrs Considerations:
i. Educate to _______________________________
ii. Not contagious after _______________________
2. Bronchodilators
a. _____________ bronchi
b. Reduce ____________________
c. ______________ ventilation
d.
3. Expectorant
a. Break up _____________________ (____ viscosity)
b. _____________________ mucus
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c. Easier to _____________________________
d. Take with lots of _____________________
ii. Secondary
1. Antibiotics
2. Antipyretic
3. Analgesic
iii. Oxygen Therapy
j.
Nursing interventions
i. Fluids:
ii. Chest physiotherapy __________________________________
iii. Assess resp status
iv. Position
v. Rest:_____________________________
vi. _____________________ per order
vii. Maintain nutrition: __________________________________
viii. Promote the patients ________________________________
k. Prevention
i. Vaccine
ii. Treat _______________________
iii. Avoid ______________________
Small Group Questions
1. Describe the pathophysiology of pneumonia.
2. What is the difference btw typical and atypical pneumonia?
3. What causes pneumocystis carinii?
4. What lab values are associated with bacterial pneumonia? / viral pneumonia?
5.
What is Nosocomial pneumonia
6. Identify 5 risk factors for developing pneumonia
7. What medications might be administered to treat a pt. with pneumonia?
8. What nursing education would you give to a patient with pneumonia?
9. What are the gerontological considerations of caring for the elderly in regards to pneumonia?
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IV.
Lung Cancer
a. Pathophysiology
i. ________________________ bind to the DNA and change it 
___________________ growth
ii. Usually develops on the _________ of the _______________ tree
b. Etiology / contributing factors
i. #1 _____________________________
ii. Carcinogens
1. Asbestos, Uranium, Arsenic, Nickel, Iron oxide, Radon, Coal dust
c. S&S
i. Early
1. Insidious & ________________________ until late stages
2. #1 ____________________
3. #2 Repeat resp. ______________________________
4. _____________________________
5. _____________________________
ii. Late
1. _____________________________
2. Chest _______________________
3. ________________ loss
4. _______________________
5. Anorexia
d. Dx exams
i. _____________________
ii. _____________ scan
iii. ___________________ via ________________________: cytology
e. Tx
i. ____________________________
ii. ____________________________: metastasis
iii. ____________________________ to shrink
f.
Assessment
i. Resp assess
ii. ___________________ hx
iii. Lab ______________________
iv. S&S of complications
1. ___________________
2. H/A
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3. ____________________
4. ______________________ changes
5. ______________________ breathing
6. C/O _______________________
g. Nursing Interventions
i. Assess :
ii. Position:
iii. Pulmonary hygiene
iv. ____________per order
v. _____________PRN
vi. Emotional ____________________
h. Activity intolerance
i. Document response to __________________
ii. Planned ______________periods
iii. Increase activities _________________
iv. Enc to ________________- as active as possible
v. Allow ____________to provide assist PRN
vi. Keep frequently used _________________nearby
i.
Pain
i. Assess
ii. Administer __________________ PRN
iii. Alternative pain relief: ______________________________________
iv. Provide ________________activities
v. Allow family to ______________
j.
Grieving
i. Spend ______________ with client & family
ii. Answer __________________ honestly
iii. Enc. Pt to express ___________________(fear, anxiety, concerns)
iv. Assist to understand the _______________ process
v. Enc other ________________systems
vi. Discuss ______________directives
k. Prevention: __________________________________
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