12 resp system, 13 disorders w/ upper resp system, 14 disorders w/ lower resp system Flashcards
pt is scheduled to have direct laryngoscopy for removal of polyps, advise the pt
room _
ice_
mild _
hoarseness _
-room will be darkened
-an ice collar may be applied after the procedure to decrease swelling
-mild sore throat
-hoarseness may occur
Order in which air flows 1-6
external nares
larynx
trachea
right upper lobe bronchus & left main bronchus
bronchiole
alveoli
Mucous membrane lining the many small branches of the bronchial tree contains these tiny hairlike projections: c_, trap and propel small inhaled foreign particles towards entrance of respiratory tract; this reflex works to expel secretions and particles
cilia; cough
signals of changing levels of hydrogen ions, CO2, and O2 trigger the r_ c_ to send signals through the s_ c_ and s_ n_ to the peripheral nervous system and to the phrenic and intercostal nerves that control the diaphragm and respiratory muscles
respiratory center
spinal cord
spinal nerves
Breaths are initiated based on p_
pH
-about how many mL of air move in and out of lungs with each breath
-primary respiratory muscle
500 mL
diaphragm
-diaphragm contracts, moving d_
-other chest muscles contract, pulling rib cage u_ and o_, expanding the lungs and creating an area of negative pressure
-air from the atmosphere, has p_ p_, flows into the lungs
downward
up and out
posititve pressure
-Surfactant secreted by cells in the a_;
-d_ surface tension on alveolar wall, allowing for diffusion to take place
-when surfactant levels are l_, alveoli cannot properly e_, O2 and CO2 cannot cross the membrane adequately
alveoli
decreases
low, expand
when interstitial edema occurs in the l_ t_, alveolar membrane is thickened and gases cannot diffuses across membrane as easily
lung tissue
major portion of O2 attaches to the h_ portion of the h_ molecule carried by the e_ and forms o_
heme
hemoglobin
erythrocytes
oxyhemoglobin
-aging results in decreased c_ reflex, and increased potential for a_
-O_ may cause kyphosis, which impinges on lung e_
-muscle atrophy may affect r_ m_, diminishing their strength
cough
aspiration
osteoporosis
expansion
respiratory muscles
the extent to which the lungs are able to return to their original position after being stretched or distended: e_
elastance
broad term referring to diminished availability of oxygen to the body tissues
hypoxia
ability of the lungs to distend in response to changes in volume and pressure of inhaled air. L_ c_ first increases and then decreases with age as the lungs become stiffer and the chest wall more rigid: l_ c_
lung compliance
delivery of fluid through the blood vessels to body tissues: p_
perfusion
methods used to clear secretions from the airways: p_ h_
pulmonary hygiene
the force working against the passage of air, major determinant is the radius of the airway: r_
resistance
an abnormality of gas exchange with either an excess of CO2 or a deficit of O2 or both: r_ f_
respiratory failure
intrapulmonary s_ is the diverting of blood so that it does not take part in the gas exchange at the alveolar sites. When this occurs, blood enters the left side of the heart without being oxygenated, a possible cause of hypoxemia
shunting
produced by lipoprotein produced by cells lining the alveoli, lowers surface tension within alveoli preventing the collapse of the lung by stabilizing the alveoli and decreasing capillary pressures: s_
surfactant
clinically measured by CO2, movement of air from external environment to the gas exchange units of the lung and back to the environment: v_
ventilation
-O_ p_ diseases are characterized by problems moving air into and out of the lungs
-narrowing of the openings in the tracheobronchial tree i_ resistance to the flow of air, making it difficult for O2 to enter and contributing to air trapping, making exhalation difficult; examples of obstructive lung diseases- a_, e_, c_ b_, t_
obstructive pulmonary
increases
asthma
emphysema
chronic bronchitis
tumors
Pulmonary disease classifications, obstructive or restrictive:
airway diseases-
a_
c_
b_
o_ s_ a_
c_ b_
e_
asthma - o
COPD - o
bronchiectasis - o
obstructive sleep apnea -o
chronic bronchitis - o and r
emphysema - o
Pulmonary disease classifications, obstructive or restrictive:
Lung tissue disease-
p_ f_
sarcoidosis - r and o
p_
c_ f_
ARDS - o
pulmonary fibrosis - r
pneumonitis - r
cystic fibrosis - r
Pulmonary disease classifications, obstructive or restrictive:
extrapulmonary causes:
neurologic disorders (ALS, MD, MD) - r
body habitus conditions (scoliosis, obesity, arthritis)-r
p_ e_
a_
pulmonary effusion - r
ascites - r
Pulmonary disease classifications, obstructive or restrictive:
Lung diseases-
p_ hypertension
p_ e_
pulmonary hypertension - constriction or obstruction of blood flow in the lungs
pulmonary embolism - obstruction of blood flow in the lungs
certain groups: o_ a_, c_ i_, immunization against influenza and pneumonia is effective against reducing incidence of r_ d_.
h_ w_, n_, should also be immunized
older adults
chronically ill
respiratory disease
healthcare workers
nurses
influenza vaccine prepared from c_ e_, screening pt’s for allergy to e_ is important
chicken embryos
eggs
assessing an older adult: important to obtain smoking and alcohol Hx. Approx _% of throat cancer occurs in people who both smoke and immoderately drink alcohol, _ times more common in men
90%
4 times
-bronchovesicular breath sounds:
found over the m_ b_ below the level of the clavicles, besides the sternum; posteriorly between the s_
-sounds: moderate to high p_ with a h_, muffled quality; equal time of inspiration and expiration
mainstem bronchi
scapulae
pitched
hollow
-c_ produced by air passing through moisture in the smaller airways
-f_ c_ are high pitched, can be heard in pt’s who have atelectasis, fibrosis, pneumonia, or early congestive heart failure
-c_ c_ are louder, low in pitch and are heard in pt’s with bronchitis, pulmonary edema, and resolving pneumonia
-if c_ are heard, have pt take a deep breath, c_, then listen again. If c_ are no longer present, atelectasis has been cleared
crackles
fine crackles
coarse crackles
crackles
cough
crackles
In pt’s with altered breathing patterns, coach the pt to perform this type of breathing p_-l_ and d_.
-the h_ f_ position is best for pt’s with dyspnea, this position supports and allows the respiratory muscles to function at maximum efficiency
pursed-lip
diaphragmatic
high fowlers
the measurement and display of CO2 levels: c_
capnography
retention of excessive amounts of CO2, result of hypoventilation, where the usual amount of CO2 is not eliminated by exhalation
hypercapnia (capina= CO2 in blood)
a deficit of CO2, occurs as a result off hyperventilation, can result in respiratory alkalosis.
Conditions include: those with increased metabolic rate like thyrotoxicosis, persistent fever, acute anxiety; salicylate overdose, and improper use of mechanical ventilation
hypocapnia
clinical signs of r_ a_:
hyperactive neuromuscular reflexes, tetany, carpopedal spasms, vertigo, blurred vision, and diaphoresis
respiratory alkalosis
r_ f_ defined by arterial blood gases: arterial oxygen below 50mm Hg, partial pressure of carbon dioxide equal or greater than 50mm Hg
respiratory failure
alterations in nutrition and hydration:
a_ and i_ n_ common in pt’s with respiratory disorders (particularly when the disorders are chronic. Pt may have an impaired sense of taste or smell, or sputum can leave a bad taste in the mouth or cause nausea. Pt may fear chewing or swallowing may bring on an attack of coughing or may be so tired that eating or preparing food is too exhausting
anorexia and inadequate nutrition
d_-b_ exercises and c_ t_ should be planned whenever the pt is able to do them w/ or w/out assistance. Should be followed by good mouth care and a short period of uninterrupted rest
deep-breathing
coughing techniques
-pt’s with a cold are contagious for about _ days after symptoms first appear
-colds are spread by d_ infection
3
droplet
b_ i_ is likely to present with a ‘cold’ persists for more than 7-10 days w/out improvement or if the pt begins to feel worse, has temp of 101 and develops chest pain or coughs up purulent sputum. This is a s_ i_
bacterial infection
secondary infection
What helps with epistaxis
sit forward
apply direct pressure just under the bone for 10-15 min
cold compress
-p_ (inflammation of the pharynx) also called a sore throat, may be caused by a v_, b_, or f_.
-acute pharyngitis (s_ t_) caused by beta-hemolytic streptococcal infection
-
pharyngitis
virus
bacteria
fungus
strep throat
post-op instructions for tonsillectomy
cold or warm liquids, progressing to semisolid foods for the first 24 hrs. Avoid red foods, citrus fruits, hot fluids, and rough foods until throat has completely healed. Do not use a straw, it may cause bleeding
sleep condition where person is making breathing effort, but there is no or extremely limited airflow
Obstructive sleep apnea
Obstructive sleep apnea:
what is the most common cause- m_ r_ at the back of the t_, which make the t_ fall back and block the airway
muscle relaxation at the back of the throat, tongue
Obstructive sleep apnea:
daytime symptoms include f_, m_ h_, and difficulty c_.
nighttime they w_ frequently
fatigue
morning headache
concentrating
wake
Obstructive sleep apnea:
physical examination revels o_, enlarged n_ c_, and hypert_
obesity
neck circumference
hypertension
Obstructive sleep apnea:
how to determine if one has condition, s_ s_
sleep study
Obstructive sleep apnea:
those with mild apnea may be treated with conservative measures- w_ l_, avoiding a_ 4-6 hrs before bed, and sleep p_ m_
weight loss
alcohol
position modification
Nasal fracture:
-pt is observed for frequent s_ postop, which could indicate posterior n_ b_
-vital signs monitored closely, amount of d_ on dressing observed
-pt should rest in s_-f_ position and cool compress used to decrease swelling
swallowing
nasal bleeding
drainage
semi-fowlers
Cancer of the Larynx:
-pt’s who use excessive amounts of a_ are at highest risk
-lack of f_ and v_, gastroesophageal reflux disease, i_, and infection with h_ p_ or h. pylori, have all been linked to increase in cancer of larynx
-exposure over long periods of time to environmental pollutants, a_, p_ or w_ or c_ dust has increased risk
-most common malignant tumor of the larynx is s_ c_ c_, growing from the mucous membrane lining the respiratory tract. Metastasis may occur in the l_
alcohol
fruits and vegetables
immunosuppression
human papillomavirus
asbestos
paint fumes
wood or coal
squamous cell carcinoma
lung
Tracheostomy tubes:
o_ is used during insertion as a guide to protect against scraping the sides of the trachea with the sharp edge of the tube
obturator
one-way tracheostomy valve box can be fitted into the tube opening, allowing air to be inhaled thorough the tracheostomy opening. Valve closes when pt exhales, diverting the air through the larynx enabling the pt to s_
speak
p_ support of the tracheostomy pt and family is essential. Pt must learn to breathe differently and cannot speak, or call out. Passy-Muir speaking tracheostomy valve may be used by some. Providing verbal r_ shows awareness of apprehension and readiness to help. E_ what is being done and why each time trach care is provided. T_ begins as soon as pt is alert after trach tube is placed. Pt may experience g_ over losing their natural voice and the change in eating
psychological
reassurance
explain
teaching
grief
Proper r_ is important in the acceptance of surgery and its consequences. A s_ t_ helps pt with e_ speech. First pt’s learn s_ air and then moving it forcibly back up through the esophagus
rehabilitation
speech therapist, esophageal
swallowing
Acute bronchitis:
treating the symptoms includes h_ using either warm or cool moist air. Cough suppressants or broncod_ are used to reduce coughing and soothe the irritated tracheal and bronchial mucosa. Maintain n_ and f_ balances. Rest is recommended to prevent progression from acute to c_. Antibiotics are used if s_ culture identifies s_ b_ o_
humidifier
bronchodilators
nutrition and fluid
chronic
sputum, specific bacterial organism
Influenza:
a prophylaxis with an antiviral agent (amatadine: Symmetrel, rimantadine: Flumadine, sanamivir: Relenza, oseltamivir: Tamiflu) may be given to a h_ r_ pt who is has been known to have come in contact with type A influenza.
Drugs must be started within __ hours of the start of symptoms
high risk
48
Influenza:
-children 6 - 59 months
-pregnant women
-people >50 yrs
-people of any age with certain chronic medical conditions (diabetes)
-nursing home residents
-people who live or care for persons of high risk
who is recommended for flu vaccine
Pneumonia:
-S. pneumoniae (pneumococcus) is the most c_ cause of bacterial pneumonia
-pathogenic m_ are always present in the upper respiratory tract; pneuonia can occur when resistance is lowered by some other factor such as c_ d_, a_, d_, p_ i_ or extremes in age
-pneumonia occurs after an i_ infection in many instances
common
microorganisms
chronic diseases
alcoholism
debilitation
physical inactivity
influenza
Pneumonia:
Pneumocystis jirovecii (PCP) infection associated with A_ and is treated with trimethoprim-sulfamethoxazole (Bactrim) give I_ or orally depending on the s_ of the infection
AIDS
IV
severity
-first signs of decreasing oxygenation: r_ or c_.
-pt may want to s_ u_ to allow for better chest excursion
-respiratory rate will i_ and later the nares will f_, then r_ of the intercostal muscles if the condition worsens
restlessness or confusion
sit up
increase
flare
retraction
Fungal infections:
h_ occurs in central and eastern portions of North America. The fungus lives in moist soil such as that in which mushrooms grow, on the floor of chicken houses and bat caves, and in bird droppings. Clinical signs are f_, f_, c_, dyspnea, and w_ l_ over 1 to _ months
histoplasmosis
fever
fatigue
cough
weight loss
2
TB:
-test is positive when the site of injection is >_ mm in diameter 48 to _ hours after injection for people who have had a history of contact with infectious TB or in immunocompromised pts
-i_ of >mm in diameter is positive in recent immigrants from countries where TB is prevalent, in medically underserved groups, and in the homeless
-those are low risk, and induration of >mm is considered positive
-Skin testing is contraindicated for those who have had a s reaction
-vaccination with bacillus Calmette-Guérin (BCG) is not a c but must be considered when i_ results
5
72
induration
10
15
severe
contraindication
interpreting
TB:
-pt’s and families should be e_ about the importance of medication compliance and the basic principles of i_ c_: covering mouth when c_ or s_, disposing of t_ in plastic bags, good h_ h_, wearing a m_ in c_ until medication effectively suppresses the infection
-s_ examinations are required monthly during treatment
-pt needs _ negative cultures to e_ e_ of medications and to be considered no longer infectious, may resume work etc.
educated
infection control
coughing or sneezing
tissues, hand hygiene
mask, crowds
sputum
3
evaluate effectiveness
Occupational lung disorders:
-occupational Hx is part of the r_ a_
-coal dust; dust from hemp, flax, and cotton processing; exposure to silica in the air can cause work-related l_ d_
-a_ exposure may cause mesothelioma, a rare cancer of the chest lining. a_ exposure also causes s_ of the lung tissues
-the other exposures cause o_ of small airways or s_ and l_ of e_ and c_
respiratory assessment
lung disorders
asbestos, asbestos, scarring
obstruction, scarring, loss of elasticity and compliance
Nutrition consideration for pts with COPD:
-drink _ to _ glasses of noncaffeinated fluids per day to keep m_ thin and easier to cough up (if pt is on f_ r_ they need to check with their hcp)
-rest before e_
-a d_ stomach will make it h_ to breathe, pts should avoid o_ and avoid foods that cause gas or bloating because
-to decrease stomach fullness and reduce f_, eat _ to _ small meals a day rather than 3 regular meals
-eat a well-balanced diet with adequate p_
-avoid l_ d_ an hour after eating
-if pt becomes short of breath while eating or right after meals:
~take s_ bites and chew s_
~choose food that are easy to s_
~use oxygen while eating
-steroid medications put pts at risk for o_, take in sufficient c_ via dairy, vegetables, and supplements
-cook when feeling most e_; make e_ portions and freeze them for easy, quick, reheatable dinners
6 to 8, mucous, fluid restrictions
eating
distended, harder, overeating
fatigue, 4 to 6,
protein
laying down
smaller, slowly
swallow
osteoporosis, calcium
energetic, easy
Emphysema:
-d_ is an early sign of emphysema
-c_ with small amounts of mucoid sputum is present and more common in the m_
-as disease progresses, d_ worsens and eventually interferes with ADLs
-the d_ becomes permanently f_ by o_ of the lungs, the muscles of the rib cage become r_, and the ribs f_ o_. pt can have a c_ skin tone
-pt develops a “b_ c_”
dyspnea
coughing, morning,
dyspnea
diaphragm, flattened, overdistention, rigid, flare outward, cyanotic
barrel chest
Montelukast (Singular):
-classified as a c_ a_
-action is providing both b_ and a_ effects
combination agent
bronchodilation, anti-inflammatory
Using peak flow meter:
-peak flow should be monitored d_
-if reading is % below pts best, treatment should be a
-“green zone” means airflow is n_
-“yellow zone” airflow has d_ and routine medications should be i_
-“red zone” rescue medications are needed and hcp should be notified
daily
60%, adjusted
normal
decreased, increased
Properly peak flow meter:
-set point to zero
-while s_, take a deep breath
-put mouthpiece in mouth and clamp the lips firmly around it for tight seal
-blow into meter as h_ and f_ as possible
-record the value and reset pointer
-rest for a couple breaths
-repeat procedure for a total of _ readings
-record the h_ reading on the peak flow sheet
standing
hard and fast
3
highest
Cor pulmonale:
-e_ of the r_ side of the heart as a complication of p_ h_ caused by constriction of the pulmonary vessels in response to hypoxia
-to overcome the increased p_ in the lungs, the r_ side of the heart must pump more f_, causing e_
enlargement
pulmonary hypertension
pressure
right
forcefully
enlargement
Cor pulmonale:
-c_ hypoxia stimulates e_, with resulting polycythemia (blood cancer) and increased v_ of blood
constant
erythropoiesis
viscosity
Cor pulmonale:
-eventually, right-sided heart failure causes s_ v_ congestion, which manifests as distended neck veins, r_ u_q_ tenderness from an e_ l_, peripheral edema, weight gain, gastrointestinal distress, and ascites
-treatment includes c_ l_ f_ o_, and medications to treat both the heart failure and f_ v_ o_
systemic venous congestion
right upper quadrant
engorged liver
continuous low flow oxygen
fluid volume overload
intrathoracic surgery (resection of lung tissue and other pulmonary structures requiring opening the chest wall and entering the pleural cavity) :
-positioning for comfort, optimal ventilation, and adequate drainage of the operative site is important during p_-t_ care.
-many surgeons do not permit lying on the u_ s_ because this position diminishes the e_ of the good lung
-if pt has a tube for draining, lying on o_ s_ will facilitate the flow of drainage
-taking care when positioning pt to prevent k_ of the chest tubes
post-thoracotomy
unaffected side, expansion
operative side
kinking
care of pts with chest tubes and closed drainage:
-persistent b_ in the water-seal chamber indicates an a_ l_
-fluid in the chamber s_ fluctuate with i_ and e_
-occasional b_ may appear with breathing, sneezing, or coughing
-if a p_ is present, b_ will occur with i_, as air is forced out of the area of the p_
bubbling, air leak
should, inhalation and exhalation
bubbling
pneumothorax, bubbles, inspiration, pneumothorax
pulmonary hygiene:
-because there is likely some g_ during coughing episodes that take place during p_ d_, it’s best to carry out procedure before meals, when stomach is relatively empty and v_ is less likely
-after p_ d_ is completed, g_ m_ c_ (including brushing the teeth, and using mouthwash) should be performed
gagging, postural drainage, vomiting
postural drainage
good mouth care
oxygen therapy:
-amount of O2 the pt receives depends on r_ and d_ of breathing
-n_ c_ provides low flow rates, should not exceed L/min flow
-higher flow rates cause d and c_ of n_ m_
-if a mask system is used, it’s important that the flow rate is at a minimum of _L/min; lesser flow rates are not adequate to wash out exhaled CO2 and will cause the pt to rebreathe the exhaled CO2
rate and depth
nasal cannula, 5
drying and cracking, nasal mucosa
6
mechanical ventilation, modes of ventilation:
-assist-mode ventilation d_ the work of breathing for the pt
-pt takes a breath, the machine delivers a set t_ v_
-assist-mode ventilation is combined with the control function to provide an assist-control mode. if pt’s respiratory rate f_, the machine will d_ a set number of breaths per min. if the pt i_ a breath, the machine f_ it at the s_ t_ v_
decreases
tidal volume
falls, deliver, initiates, finish, set tidal volume
mechanical ventilation, noninvasive positive-pressure ventilation:
-delivery device uses r_ a_ and not O2 for gas delivery
-primary function is to keep p_ p_ in the airway to prevent it from c_ during sleep
-delivery of supplemental O2 is n_ the goal of the therapy
room air
positive pressure, closing
not
throat cultures can test for:
p_
t_
m_
w_ c_
s_
pneumonia
tonsillitis
meningitis
whooping cough
strep
why would a lung ventilation and perfusion scan(VQ scan) be ordered
to assess lung ventilation and lung perfusion; to locate pulmonary embolism and diagnose tumor, emphysema, bronchiectasis, or fibrosis
why is a bronchoscopy/ laryngoscopy used
to inspect bronchi; and to remove foreign objects or mucous plugs, or to biopsy lesions
why would a thoracentesis be ordered
to remove pleural fluid, instill medication, or obtain fluid for diagnostic studies
-who would use a peak flow meter
-normal range, compared against what
-what does this assess
asthma or COPD pts
300-700 L/min; compares against pt’s baseline
peak expiratory flow
characteristics of sputum:
pneumococcal pneumonia
scant, sticky, rust colored
characteristics of sputum:
frothy, pinkish or blood-tinged
pulmonary edema
characteristics of sputum:
blood-tinged, bloody, or blood-streaked
TB, ulcerated pulmonary vessel, or bronchogenic carcinoma
characteristics of sputum:
large amounts
pneumonia or bronchitis
characteristics of sputum:
scanty
asthma
characteristics of sputum:
very thick and viscous
inadequate hydration
adventitious lung sounds:
wheeze; whistling, musical, high-pitched sound
occurs when air is forced through a narrowed airway
asthma
adventitious lung sounds:
rhonchi; coarse, low-pitched rattling
occurs with secretions in larger air passages
adventitious lung sounds:
crackles; fine: high-pitched or coarse: louder and low-pitched
occurs when air passes through moisture in smaller airways
fine- pneumonia, CHF
coarse- bronchitis, pulmonary edema
adventitious lung sounds:
pleural friction rub; grating/scratching sound- creaking shoe leather, opening squeaky door
occurs when visceral and parietal pleura rub against each other
adventitious lung sounds:
stridor; “croaking sound” heard without a stethoscope
occurs when there is partial obstruction of upper air passages
croup in children
upper airway obstruction
Nursing goals: (SMART)
promote o_
prevent i_
prevent f_ l_ d_
promote r_
(specific, measurable, achievable, realistic, timely)
oxygenation
infection
further lung damage
rehabilitation
s/s of resp. acidosis:
-first see n_ changes: d_, d_, c_, won’t answer questions appropriately (maybe nod off while you’re talking and fall asleep)
-complain of h_
-respiratory d_, have l_ bp
-watch p_ levels, this will i_ levels, see EKG changes of tall T waves, flat P waves or prolonged QRS and PR interval
neuro, decline, drowsy, confused
headache
distress, low
potassium, increase
