1-presentation/videos Flashcards
Upper respitaroty system
composed of
considered
Composed of:
nose,
sinuses,
pharnyx,
larynx,
trachea
Considered the Air movement passage way
lower respiratory system
composed of
largest component
pulm art/veins
Composed of:
lungs
,bornhi,
brochioles
Largest component- Lungs
pulmonary arteries-deliver deox blood to lungs
pulmonary veins -delvier ox blood to heart
why are lungs subdivide into lobes
alveoli are responsible for
lungs subdivided in lobes- right-3, left -2 ,so that if one is damges lungs cans till work
Alveoili are responsible for air supply.the air sacs fill up and passes through alveolar walls for co2 and o2 gas exchange
art of reparation
c02 travels from blood into alveolar cells and then exhaled
02 travels from alveolar cells into blood and is circulated into tissues
factors affecting respirations
Volume & Capacity-
Air Pressure –
O2, Carbon Dioxide & Hydrogen Ion Concentrations –
Surfactant-
Airway Resistance, lung compliance & elasticity-
volume and capacity are affected by
gender
age
weight
health
why is air pressure necessary
necessary to maintain expanded lungs
Inhalation- airflow into lungs -diaphragm contracts downwards
Exhalation- airflow out of lungs-diaphragm relaxes upward and intercostal spaces relax, reduces space forces air out
how does 02,co2 and hydrogen ion work
rate and depth is controlled by respiratory centers, brain detects changes in co2 and alters breathing accordingly
how does surfactant work
reduces surface tension in lung fields, helps expands lungs by keeping alveoli open
how does airway resistance
lung compliance
elsacticty
as resistance increases, gas flow decreases.
Compliance is the distenbiality and is reliant in the lungs .
Decrease elasticity impairs respirations (emphysema)
assessing repsitaroy function
ABG’s
Biopsy of Lung & Bronchoscopy
Chest X ray
CT/MRI
Pulse Oximetry
Sputum Studies
Thoracentesis
VQ Scan
Patient Assessment: Subjective
history
p and fh
d h
o/s f
current
History - respiratory changes with aging,genetic considerations,smoking history,mediacation usage,allergies,
Personal and Family History -
Diet History
Occupational/Soci-economic factors
Current Health Problems cough, chest pain, sputum production, charstictics of sputum. Dyspnea with rest or excerptions
Patient Assessment: Objective
physical assess
I and p
aus
perc
l v
v s
p o
Physical Assessment
Inspection & Palpate –bulgings or retrations
Auscultation –all fields listgen to anteriot and posterior, clear, diminished, rub,wheezes
Percussion –dullness could mean pneumonia,atalecasis
hypernemisis- emphanima or asthma/pnemothorax
Lab values low rbc= decreased tissue oxygenation-could be confused
Vital Signs
vital signs
what is spo2 measuring
Spo2 is measuring amont of hemoglobin that is carrying oxygen in the blood
Pulse ox measures using light sensors by measure how much blood is carrying o2
Viral Upper Respiratory Infections
known
peaks
Knowns as URIs or common cold-highly contagious-
peaks during sep to jan
viral uri
Patho
over__
spreds
contagious
inflammation
mucus
over 200 strains,
droplet spreads through sneezing coughing or direct contact. spreads when hands and fingers pick It up
Contagous prior to and after symptom devlopemnt.
Inflammation is when the body is trying to trap the organism and kill off-
mucus secretions trap invading organism by being hyperactive
viral uri manifesations
nasal mucus passway swells
, sneezing,
coughing-loose,wet or non productive,
sweating
fever,
sore throuat-initial symtpom
. Nasal mebranes red and swollen,
clear secretions leading to coryza(nasal inflammation and discharge)
viral uri diagnosis
self care
Diagnosis H&P, presentation of symptoms, wbc count, cultures of purulent discharge.
Self care is appropriate. Trearmetn is required when sinitus or ottitus media devlop
how to manage uri
nursing interventions
adequate Rest,
maintain high fluid intake ,
pain/fever meds
,cough managmaent, covering when coughing and sneezing
hygiene,
avoiding crowds,
washing hands,masks.
Nursing Interventions C&DB-prevents pneumonia-know of effective by listening to lung sounds, monitor pulse ox, assess repirory rate
Auscultate lung sounds, monitoring pulse ox, assessing respiratory rate
medications uri
other therapies
Decongestants, antihistamines, nasal sprays
Complementary Therapies
Herbal tea,
,essential oils,
vitamin c,
zinc
accumputure,
garlic,,
essential oils such as basil, cedarwood, eucalyptus, frankincense, lavender, marjoram, peppermint, or rosemary can reduce congestion and promote comfort and recovery.
health promotion and continuity of care uri
promotes-breathing,airways clearance,reduce infections
Avoid Crowds, rest, hand hygiene, stress
promots effective breathing-monitor rr , pace activies for rest,elevate hob,//
promote aireay clearance, cough and seceretions, hydration and increase humidity and inspired air,teach cough tehcniques//sleep qlait-sleep patters//
reduce risk of infection—standarg precatiuiins, control secretions by mainating distance,, droplet precations,mask and priv room
decongestants
Phenylephrine (Neo-synephrine),
pseudoephedrine (Sudafed),
oxymetazoline (Afrin)
decongestants
vasoconstriction
reducing inflammation and edema within head and relieves congestion. Habit forming and can cause rebound congestion. Can lead to chroninc congestion and inflammtion
what need to know as rn
decongestants
pt education
Cardiac contraindications asses for hypertion and heart disease. Will increase hr and bp
Medication interactions maoi inhibitors and antihypertensive drugs
pt education decongestants
safe dose,
cardiac history,
nasal spray–not to use for more then 5 days, can cause jittery and hyper and can cause insomnia/sleeplnesness
antihistamines
Diphenhydramine (Benadryl),
Cetirizine (Zyrtec),
Loratadine (Claritin)
antihistamines
what do
OTC allergy and cold medications
Relieve histamine dry secretions up.
what need to know as rn and pt education antihistamines
Assess for asthma or lower respiratory disease
Effects drying. Sedative some are more then others.
Activity tolerance and safety and sleepiness
Patient Education no alcohol due to sedation
respiratory syncytial virus
primary cause
who gets
Primary cause of respiratory illness In Young children and infants
Older children and adults more likely to present
Elderly and immunocompromised more susceptable
trasnmissopn of rsv
similar to ur. Can get through
droplet
object,
coughing and sneezing
via contaminated hands or objects
manifestations RSV
rhinorrhea,
common cold
,and cough
children can progres to pneumonia or brovnciolitis
treatment of rsv
supportive care, similar to ur.
Intubation only necessary when in lower lungs and hypoxia
develops hydration and mobilizing secreations.
diagnosis/meds for rsv
Diagnosis is
history/clinical findings,
wbc count
Meds-ribravian in older adults
nursing care rsv
promote effective breathing, airway,sleep,infections
promote effective breathing-monitor rr/ pace activities for rest/ elevate hob
promotes airway clearance –monitor cough and ability to remove secretions/ maintain hydration/ increase humidity in air/teach cough techniques
assess sleep quality,w/sleep patters..
Reduce risk of infection-standerd precautions/instruct patients to maintain distance of 3 feet/ droplet precautions/priv room and masks
influenza
transmission
strains
incubation period
high risk
Transmission-droplet and direct contact-masks
Three major strains
A most infections and large outbreaks
B less extensive and severe
C mild and unnoticed
18-72 hr incubation period
high risk in super young/old and chronic illness
manifestations influenza
resp
system
respiratory symtoms
coryza
dry cough
substernal during
sore throat
systemic symtoms
fever
malaise
muscle aches
fatigue
influenza
complications
Respiratory failure, increased risk of pneumonia –higher pevleance in chronic heart failure-exacerbation of copd,brinchtid,or asthma
prevention influenza
Prevention
Immunization
85% affective, eldergly served first
diagnosis influenza
history and physical,
nasal swab,
long term may need xray and chest work
WBC
medications influnza
anti
tam
otc
immunize
antiviral,before/within 48 hours of exposure-ends in ine.
tamiflue is given to reduce duration and severity if needed.
Otc is given to relieve fever/pain yearly
immunization –don’t igve to pts with egg allerg,, antitsuuives may decrease cough
health promotion/education for influenza
Vaccination, hygiene, handwashing, masks- patient & visitors and staff
Rest, encourage fluids
Care-protect vulnerable populatons
nursing care influenza
breathing
airway
sleep
infection
-promote effective breathing-monitor rr pace actvites for rest elevate hob
promotes airway cleanrce- monitor cough and ability to remove secretions, maintain hydration, increase humidity if air, teach cough techniques
assess sleep quality,w/sleep patterns..provide medications before bed
Reduce risk of infection-standerd precaution-instruct patients to maintain distance of 3 feet, droplet precautions, priv room and masks
sinitus
what is
any process
follows
inflammation of mucus membranes-develops when swell
Any process that impairs drainage from the sinuses may precipitate sinusitis. Examples include nasal polyps, deviated septum, rhinitis, tooth abscess, and swimming or diving trauma
Follows an URI, influenza-seceations collect in cavities. Draws serum and loekoctyes and causes increases swelling and pressure
manifestations and complications of sinitus
manifestions
Pain/Tenderness across infected sinus
Heachache
Fever
malaise
Pain in leaning forward and up teeth
Nasal congestion, discharge/bad breath
complications
menengitis,
brain abcess
Discomfort in neck may mean spreading issues
Periorbital Abcess,cellulitis,sepsis or intracranial pain
how diagnose sinitus
Presentation of symptoms h and p
Imaging x ray- normally translucent, cloudy and pink
Ct and mri may be needed to rule out chroninc sisues
how is sinitus treated
antibiotic therapy-10-14 days w/ amxocillan or ciroflaxon
steroids/decogestants-dry secretions, not as effective
saline-promotes drainage
no response = surgery
nursing care sinitus
manage pain scale, ice pack, elevate hob//
nutrition
clear liquid diet
I and o
elevate hob//
tonsillitis
what is
who at risk
diagnoes
Inflammation of tonsils-strep infections-spread by droplet-symptoms last 3-10 days
–risk factors immunocompromised,
Diagnosed w/ throwat swab,cbc
tonsillitis how present
Tonsils brigh red
white exudate
uvula swollen/red
lymph nodes swollen tender
sore throat
Difficulty swallwong
- Fever worse in adults
treatment of tonsillitis
antipyretics/pain releif-ibuprofen
Antibiotocs for 10 days-after 24 hrs-noncontagous
tonsilectamy
tonsillectomy nursing care
pt airway position
complications
Patent airway position allow secretion drainage –semi fowlers with head turned to side to allow drainage from mouth
Complications?
Excessive bleeding /hemorrage
Notify MD immediately
pain/swelling interventions
caution in children
‘
tonsillectomy
Ice collar, cool fluids, ice chips, warm saline, liquid diet/semi liquid,assess pain, adnminster analgesucs
Take caution with asprin in children. Don’t eat acidic or citrus foods/drinks. No forcful gagling. Can cause blleding—can only do gentle saline gargles
Laryngeal Infection: Epiglottitis
What does the larynx do?
includes
inflammation=
Located between upper airway and lungs and protects lower repertory tract from inhaled subatacnes and allows speach
Includes the epiglottis
Inflammation of these structures = epiglottis or laryngitis
epiglottitis
type of infection
presentation
H. influenzae infection
P- swelling and edema can threaten airway. Fever sore throat, painful swallowing, drooling and strider
diagnosis of epiglottis
never use
Epiglottis visualized with optic scope
never use a toungue bla dor tongur cultire due to laryngeal spasm and airway pbstruviotn
treatment of epiglottis
Antibiotics- Ceftriaxone cefuroxime (), or ampicillin/sulbactam
corticosteroids to decrease swelling/ inflammation
nursing care focus for epiglottis
monitor for
keep at bedside
airway management.
monitor spo2
monitor breathing difficulties
restlesses,
stridor,
keep airway supplies at bedside
laryngitis
what is
caused by
Inflammation of larynx –can occur with uri
caused by
uri,
changes in temp,
excessive usage of voice,
exposure to dusts//pollutants
manifestations of laryngitis
change in voice, hoarseness or loss of voice
how to treat laryngitis
No specific treatments,
elimination is key, voice rest and soothing measures like throat sprays
Try to identify potential irratants like fumes or checmicals
diphtheria
pathogen
uncommon
spread
Aerobic pathogen called Corynebacterium Diphtheriae
Uncommon is US due to immunization -tdap
Spread through droplet and contamination of objects – spreads in poor contaminated areas, lomted acces too heathcare and crosded areas
manifesaations of diphtheria
thoickgray exudate or membrane over laync- interferes w. eating drnkinf breathing
fever sore throat and bad breaht
immunization for diphtheria
TdAP- tetanus, diphtheria, & pertussis
treatment for diphtheria
complications
confirmedhow
care-monitor/promote/assess/precatuions
Treat infection, prevent spread, support respiratory status
10% die w treatment, 50 % die wout-
complications –airway occlusion,pulmonary infection that can led to resp falure, myocarditis, polyneuropathy
Confirmed w/ throat culture
Care- montor cough,maintain hydration, increase humidity/
prmote effective breathing, montor rr, pacae activies, elvate hob,//
assess sleep quality/
/use droplet precations –ISOLATION prequations, hugeine, masl, privater room
all visitors are screened and immunized -given antibiotics
pertussis
highly contagious-adults are resovoirs- starts as runny nose/snnezing, can lead to coughing fits, lad to brok ribs and pnemnia
patho pertussis
toxins damage mucosa and paralzye cilia
preventions for pertussis
immunization
diagnosis
////
treatment
pertussis
swabbing of nasal secretions , blood tests
erythromycin
manifestations and complications
pertussis
burst of rapid coughing, followed by whoop, whoop is les frequent in adults. 7-10 days of coryza,sneezing, low fever and mild cough, after 1 wek cough becomes frequent manifestions/
/ complications– hopsiaptazied die to hypoxia dns nireoglcan affects of not enough 02
nursing care for pertussis
bresthing
airway clearnance
sleep
infection
promote effective breathing,-montor rr ,periods of restr, elvate hob
/prmote airway cleanrece momnitor cough, maintain hydration, increase humiidty, teach cough techniqes/
/assess sleep waloty
/ reduce risk of incetion, standard precation, instruct pateints to maintain a distance of 3 feet, droplet preations
epistaxis
causes and goal
AKA nosebleeds-rich supply of blod
Causes trauma, dry nasal membanes, subrance abuse, irraition
Goal identify cause and stop it
May be indicative of a fracture
anterior bleeds epistaxis
how to help
pressure, lean forward, ice causing vasoconstriction
Topical vasoconstriction medication
posterior bleeds vasoconstriction
Nasal packing –w/ gauze left in place for 2-5 days –in pts woth cardio disease, hypertension,dysthrmia, acute mi and can cause toxic shock syndrome. Rubber gauze foes into nose w guazwe attached
Cautery
nursing priority for epistaxis
Respiratory status, risk for aspiration , anxiety
what to avoid w epistaxis
Avoid strnous exercise, don’t blow nose, , don’t pick nose
use petrolluem jelly, use humidifier
sleep apnea
linked w/
Intermittent absence of airflow through the mouth and nose during sleep-leading cause od daytime sleepiness
Linked w/ hypertension,heart failure
obstructive sleep apnea
common, reps drive remains intact, occlusion is causing hinderence of airpflw
central sleep apnea
rare nerloguic disosider that involves imaoriemnt of drive of msucles
patio for sleep apnea
airflow obstruction
po2,o2,ph fall
pco2 rises
brief arousal to restore airways
manifestations sleep apnea
Snoring
Daytime sleepiness
Headache, irritability
Period of apnea
Gasping
Contributes to daytime sleeptimess , memory loss and personality changes
risk factor for sleep apnea
Obesity, large neck circumference, alcohol and CNS depressants
diagnosis sleep apnea
Overnight sleep study
treatment sleep apnea
Losing weight,
CPAP (Continuous positive airway pressure),
surgery
no alchhol.
Avoiding supine position for sleep
Cpap Prevents collapse of small air sacs and airway obstruction
bronchitis
Inflammation of the bronchi –acute or chronic
Virus or bacteria that damage respiratory mucosa
risk for bronchitis
exposure,
no immunization,
exposure to smoke fumes or pollution
manifestations for bronchitis
nonproductive cough that becomes productive, aggravated by varying air.
chest pain/moderate fever/malagia
diagnosis for bronchitis
Chest X ray, H&P
how is bronchitis treated
Broad spectrum antibiotic –penicillin or erythromycin
Fluids, rest, fever relief
Secretions encourage fluids and cough/deep breath
pneumonia
Inflammation of bronchioles & alveoli
Hindrance to the gas exchange process
can be infectious or non
risk factors are pneumonia
whis at risk
underlying respiratory conditions,
smoking,
malnutrition ,
very young/old
manifestations pneumonia
chills-rigors
fever
cough w/ rust colored sputum
chest ache
plural friction rub
how to diagnose pneumonia
x ray
sputum
cbc/wbc
pulse ox
abg
nursing priority and nursinmg considerations for pneumonia
oxygen
increase fluids to help release sputum
use incentive spirometer
o2 therapy
chest physiotherapy
complications pneumonia
hypoxemia
oxygen
confusion dr hypoxema
respiratory failure
tb
Chronic-recurrent infectious disease affecting the lungs
Caused by mycobacterium tuberculosis
transmission of tb
airborne, breathing in infected air, remain suspended in air for several hours
manifestations of tb
Initial- few symptoms
Nonspecific; fatigue, weight loss, anorexia, night sweats ,dry cough that turns productive
who’s at risk for tb
imagrants,
pts with hiv,
disavataged population,
drug/alcohol absue
overcrowded area,
exposure
, drug usage
medical and treatment goals for tb
Make the disease non-communicable to others
reduce sympons of disease
Effect a cure in the shortest possible time
use of Antibacterial medications and Antitubercular drugs
diagnosis for tb
H&P,
Chest X ray,
sputum culture (definitive test)
, skin test (PPD Test-activates hypersencitvy response,does not mean ccitve disease is present 5mm or greater is opsitive)
,sputum smear, sputum culture,
senstuvty testing
ethambutol side effects/nursing considerations
Optic nuratis,
Color discitmatitoin and
visual acuity,
isoniazid side effects/nursing considerations
Nuerpathy and hepatitis, monitor liver function and sensation
rifampin side effects/nursing considerations
Urine can be yellow or orange, flu like sympotpms, monitor labs educations
pyrazinamide
side effects/nursing considerations
hepatotoxic , monitor liver functions
what diagnostic tests are utilized to evaluate effectiveness of medication therapy??
Chest x rays and sputium
tuberculosis preventaiton
Public health education
Best prevention: Early diagnosis and appropriate treatment to achieve cure
airborne precations, family screening , medications, follow up sputum testing, nutritional needs
vaccines tb
BCG Vaccine- infants where TB in prevalent
asthma
characteristic by
Reactive disorder; chronic inflammatory disorder of airway
wheezing, breathlessness , chest tightness and coughing
patio asthma
Airways are in constant state of inflammation; triggers worsen inflammatory state
triggers asthma
allergens
repository infections
excercise
emotional upsets
inhaled irratents
disgnosis asthma
Pulmonary Function Test (PFT):evaluate degree of airway obstructions
Skin Testing: specific allergens
ABGs: oxygenations
Challenge Testing: determain asthma by seeing airays hypersentivities
disease monitoring asthma and risk factors
Peak Flow Meter/Rate: Used for newly diagnosed, monitoring medication response
Recording daily, can help identify early changes treatment, seek medical attention
allergies/genetics
manifestations asthma
complicaitons
chest tightness, cough, dyspnea, wheezing, tachypnea, tachycardia, anxiety, and apprehension—
w.out treatment, resp failure, hypoxmia, hypercapnia and acidosis
asthma preventive measures
avoid triggers,
early treatment
long term asthma meds
Long-acting bronchodilators
Anti-inflammatory agents
Leukotriene Modifiers
quick relief meds asthma
Rapid
acting bronchodilators
Anticholinergic drugs
Methylxanthines
Nursing Diagnosis & Priorities in Care
asthma
Airway
Ineffective breathing
pattern
Anxiety
Education of therapeutic regimenheart racing and jittery, mouth rnising
inhaler
w/soacer—,check dose coutner, prime new inhaler by shaking 10 times and spray 2-4 times, shake inhaler ,tap cp off , clean spacer and puit in inhaler to sopacer, remove cap. Brethe out. Hold inhgaler and tilt head back, breath in while spraying meciation. Keep lips closed on spacer, hold breth for 10 seconds-rins mputh and spit out,store in cool dry space
copd
Narrow airways, resistance to airflow increased, expiration difficult
Smoking greatest risk factor
Emphysema & Chronic Bronchitis fall into this category
copd manifestations
Airway limitations
Dyspnea
Barrel chest- air trapping; hyperinflation; @ risk for high Co2 levels
Clubbing of fingers and toes- chronic hypoxemia
Tripod position for most effective breathing
Pursed lip breathing
copd diagnosis
PFTs,
ventilation/perfusion scan,
ABG’s
pulse ox
chest ray
treatment/goals copd
Immunization
Smoking cessation
Oxygen- fyi at risk for increased carbon dioxide levels
Clearing secretions fluids & C&DB activities/exercises
Pulmonary rehab- lifestyle modification
meds copd
Bronchodilators (albuterol); will help decrease constriction and improve SpO2; followed by steroid inhaler-reduce air trapping,promote air flow
Aminophylline- CNS Simulant; produce bronchodilation
must watch for toxicity increased resletness and agitation
Plan for medication administration for most benefit –before eat
Ling term oxygen thereapy,potential tranplatation
copd nursing care
resp stauts/nutrution/coping/smoking
Asses resp status every 1-2 hrs,report chages in 02 satuarion,mintor labs,weigh daily,high fluids, fowelrs position, coughing and db every 2 hours, provide tiisues and bag for sputuim, rep therapist, suctioning, provide supplemental oxygen /
/promote blanced nutrition,observing stauts,monitor labs,cosult diatition,oserve intake,place in high fowlers for meals,mouth acer prior ro meals,//
/family coping//
smoking cessation
copd priotires
Support of physical & psychologic responses
Ineffective airway
Nutrition
cystic fibrosis
Excessive gland secretion
Excessive mucous production
impared ability to clear secretions
pancreatin enxyme disease to impair digestion
Impaired digestion
High levels of sodium and chloride in sweat
cystic fibrosis manifestations
club fingers and toes dt hypoxemia,
increased fluid volume and abdomen distention,
distended neck veins,
edema
ab pain
and excess fat in stool
diagnosis cystic fibrosis
analysis of chloride level in sweat, overall shorter lifespan
Cystic Fibrosis Medications & Treatment
Immunization
Bronchodilators
Lung transplant- only definitive treatment
CF nursing cares
Difficulty clearing secretions; Promote airway clearance –asses rest status, assess cough, montor results, place in fowler postion, assist coughing, fluid intake pf 2000-2500//
promote healthy greif responses//
Chest Physiotherapy- aids in drainage, comleted on empty sdtomach
Percussion & postural drainage- completed on empty stomach
Atelectasis
Condition associated with many respiratory disorders
Partial or total lung collapse and airlessness –xray shows no air in lungs
results from trauma,acute or chrnic lung diseases, poor lung use,
atelectasis therapy
and assessments
prevention,
copd,smoking, prolonged bedrest//
assess repsitary status,including rate,breths ounds, spiromaty readinig
atelectasis manifestatioons
Diminished breath sounds, X ray- airless component of lungs
atelectasis nursing care
airway clearance, C&DB, increase fluids, pulmonary hygiene and exercise
Working as a TEAM with Respiratory Patients
Registered Nurse must complete primary and initial education, primary assessment
Licensed practical nurse (LPN) medication administration under their scope, reinforce education
Unlicensed personal able to assist with tasks and take vitals
