Cardiac & Resp. - Notes Flashcards
1
Q
Thoracic cavity
A
contains the lungs and the mediastinum
2
Q
mediastinum
A
contains the heart and the major blood vessels
3
Q
true ribs
A
- 1st seven pairs
- Attached to vertebral and sternum
4
Q
false ribs
A
- 8-10 ribs
- Attach to rib above
- No sternum attachment
5
Q
floating ribs
A
- 11-12 ribs
- No anterior attachment
6
Q
Intercostal spaces
A
spaces b/t ribs
7
Q
1st intercostal space
A
Count from collar bone and first rib is space 1
8
Q
where do you hood up leads EKG?
A
intercostal spaces
9
Q
Diaphragm
A
major muscle of respiration
10
Q
External intercostal muscles
A
Allow inspiration and lift ribs
11
Q
Internal intercostal muscles
A
Accessory muscles for exhalation
12
Q
Primary functions of the nasal cavity
A
warm, filter debris, and (moisture) the incoming air
13
Q
what transports air?
A
nasal cavity
14
Q
Sinuses
A
- Air filled cavities with in the bones surrounding the nose
- Provide resonance during speech and decrease the weight of the skull
15
Q
Pharynx
A
nasopharynx, oropharynx, and laryngopharynx
16
Q
Nasopharynx
A
contains the adenoids and the openings of the Eustachian tubes which connect the pharynx to the middle ear
17
Q
Oropharynx
A
contains the tongue and palatine tonsils.
18
Q
tonsils
A
- filter debris
- important part of immunity
19
Q
Laryngopharynx and larynx
A
- connect the pharynx to the trachea
- houses the epiglottis and the vocal cord
- Strong cough and spasm reflex to prevent aspiration
20
Q
Upper Respiratory Tract
A
Nasal cavity, sinuses, mouth, pharynx, and larynx
21
Q
Lower Respiratory Tract
A
Trachea, bronchi, and bronchioles.
22
Q
Carina
A
division where bronchi break off into rt and lt
23
Q
bronchi
A
Main stem
24
Q
Right main stem
A
shorter and wider, more likely to aspirate onto this side because of the angle, listen for crackles in rt lung
25
left main stem
can aspirate here but more likely to go to the rt side
26
Terminal bronchiole
last of pure conducting
27
Cilia in the Lungs
- Move debris out
- Make you cough
- Bring up sputum
28
Lower airways
- anatomical dead space
| - Lined with cilia and mucus - protectant
29
How much air is trapped here?
150 mL of air, never really goes anywhere, keeps lung in place
30
what paralyzes cilia?
Smoking, asthma, inhaled chem. exposure, pneumonia, anesthesia
31
bronchioles
Transition from conducting airways to respiratory zone
32
where does gas exchange begin?
with bronchioles which lead into the alveolar ducts, alveolar sacs and ultimately the alveoli
33
how many alveoli does an adult have?
300 million
34
what do type II cells produce?
surfactant
35
surfactant function
- Keep alveoli open
- Lubricates
- Reduces surface tension
- Prevent alveolar collapse
- Keep lungs inflated
- Limits expansion - prevents over inhalation
36
Lung compliance
lost ability to recoil, decreased surfactant
37
who has a barrel chest?
Emphazema and COPD
38
what is the chief organ of respiration?
lungs
39
which lung is thicker, wider, and shorter?
right
40
which lung has 3 lobes?
right
41
why does left lung have only 2 lobes?
placement of heart
42
3 parts to lungs
Apex, mid-lung (right side only), and base (lower)
43
how many layers are the lungs covered with?
2
44
names of the layers that surround the lungs
visceral pleura & parietal pleura
45
what is the inner layer to the lungs called?
visceral pleura
46
what is the outer layer to the lungs called?
parietal pleura
47
what is between the two layers around the lungs?
Small amount of lubricating fluid
48
what is the space between the two layers named?
pleural space
49
why is their lubricant between the two layers?
glide over each other without friction
50
should you be able to see the pleural space on x-ray?
no
51
when can you see the pleural space?
when their is pleural effusion
52
pleural effusion
the pleural space fills with fluid, blood, pus
53
what causes pleural effusion?
- Gun shot wound, car accident, trauma
| - Inflammation and infection
54
why would you insert a chest tube?
drain the fluid, blood or pus that has collected in the pleural space
55
what is an early sign of lung cancer?
Frequent pneumonia/fluid in pleural effusion
56
Functions of the Respiratory System
- Gas exchange
- Synthesis of surfactant and other chemicals
- Metabolism and detoxification of drugs and toxins
- Defense against infection
57
why do you want babies to be born at full term?
- Babies make surfactant closer to term
| - May give mom supplemental surfactant so that it goes to baby to develop lungs
58
what respiratory function is important to pharmacology?
Metabolism and detoxification of drugs and toxins
59
how does the respiratory system defend against infection?
- Nose tries to get rid of things
| - Cilia work against infections
60
External respiration
- Bringing in atmospheric air
- Most important, cant bring it in then you can't exchange it
- Much of interventions happen here
- Help people breathe better
- Mechanical ventilation
61
mechanical ventilation
Intubate and ventilator
62
Internal respiration
Cellular level
63
Ventilation
movement of gases into and out of the lungs. Ventilation is affected by lung compliance, elastic recoil, and airway resistance
64
what limits ventilation?
disease, infection, and inflammation
65
how is ventilation studied?
utilizing spirometry, peak flow meters, pulmonary function testing
66
Perfusion
refers to the blood flow thru the vessels of a specific organ or body part
67
Diffusion
movement of gases across the capillary membrane from areas of higher concentration to areas of lower concentration
68
Involuntary ventilation
- During sleep, coughing
| - Back up system
69
Factors that Influence Oxygenation
```
Triggers you to breathe
Hematology system
Lifespan and Development
Environment
Lifestyle
Medications
Pathophysiological Conditions
```
70
Factors that Influence Oxygenation - Triggers you to breathe
- CO2 levels builds up
| - Triggers you to take a breath (bring in oxygen)
71
Factors that Influence Oxygenation - Hematology system
- Enough hemoglobin to allow oxygen to bind
| - Anemic patients will sometime have respiratory issues
72
Factors that Influence Oxygenation - Lifespan and Development
- RDS (respiratory distress syndrome) - infant or adult
- ARDS - adult
- URI - upper respiratory infection
- Adolescent smoking
- How well you can oxygenate
73
Factors that Influence Oxygenation - Environment
Stress and allergies
74
Factors that Influence Oxygenation - Lifestyle
- Nutrition, exercise, substance abuse, etc.
- Nutrition - adequate diet of iron to make RBC
- Exercise - improves oxygen
75
Factors that Influence Oxygenation - Medications
- Can alter oxygen levels
| - Help them breathe or make it worse
76
Factors that Influence Oxygenation - Pathophysiological Conditions
- Alterations in oxygen and carbon dioxide levels
- Alterations in pulmonary system
- Pulmonary circulation
- Neuromuscular abnormalities
- Cardiovascular abnormalities
- Oxygen transport problems
- Metabolic problems
77
Pathophysiological Conditions - Alterations in oxygen and carbon dioxide levels
- Asthma
- Chronic bronchitis
- COPD
- Emphysema
78
asthma
harder time getting appropriate oxygen in
79
Emphysema
no problem with bringing oxygen in but struggle with getting CO2 out
80
Pathophysiological Conditions - Alterations in pulmonary system
structure, airways, and tissue
81
Pathophysiological Conditions - Pulmonary circulation
hypertension
82
Pathophysiological Conditions - Neuromuscular abnormalities
MS, Lou Gehrig's
83
Pathophysiological Conditions - Cardiovascular abnormalities
- heart disease/vessel disease
- Cardiac and respiratory go hand in hand
- If you have cardiac disease you are at risk for respiratory disease and vice versa
84
Pathophysiological Conditions - Metabolic problems
Endocrine disorder
85
how big is the heart?
Generally about the size of a fist and weighs less than one pound
86
how much blood does the heart pump in a lifetime?
80 million gallons
87
function of the circulatory system
1. Provide oxygen, nutrients, and hormones to the cells.
2. Remove CO2 and waste products from the cells.
3. Distribute heat throughout the body to maintain body temperature
88
If temp is too high
vasodilation occurs
89
If temp is too low
vasoconstriction, conserve heat, protect inner core
90
Layers of the Heart
- Endocardium
- Myocardium
- Epicardium
91
Endocardium
- inner lining of the heart
- made of endothelial cells
- line the heart chambers and valves
92
Myocardium
- thickest part of the heart that consists of cardiac muscle
- does the work
- muscle layer
93
Epicardium
consists of a visceral layer and parietal layer
94
Cardiac tamponade
heart stops because it can't pump, cardiac standstill, too much fluid between the two spaces, too much pressure
95
visceral epicardium
attaches to the myocardium and is the outer layer of the heart
96
parietal epicardium
forms the sac called the pericardium that surrounds the heart
97
how many chambers does the heart have?
4
98
what do the chambers do?
fill and empty of blood with each contraction and relaxation
99
Contraction
depolarization (no charge) of the cardiac muscle
100
relaxation
repolarization (get ready to take on new electrical charge) of the cardiac muscle
101
what are the upper chambers of the heart called?
atria
102
what are the lower chambers of the heart called?
ventricles
103
is the myocardium thicker on the left or right?
left
104
why does the left ventricle work the hardest?
needs to contract efficiently enough to get all of the blood into aorta which is a high pressure system
105
where does congestive heart failure occur?
left ventricle
106
where is the worst place to have a heart attack?
Posterior side of heart, don't have a lot of vessels but 2nd worst is lt ventricle
107
how many valves does the heart have?
4
108
name the heart valves
- tricuspid, pulmonic, mitral, and aortic
| - tissue paper my assets
109
chordae tendineae
- Valves have fibrous cords
| - Attached to the cusps of the mitral and tricuspid valves that attach to the papillary muscles
110
Valve dysfunction
- what does it affect: valve, chordae tendonae, papillary muscles
111
Mitral valve prolapse
- Graded or staged according to how much destruction into chordae tendonae or papillary muscle
- Grade 4 - entire anatomical structure is destroyed
112
how many arteries serve the heart?
2
113
Rt coronary artery
feeds rt side of heart has a little bit that goes back to the posterior side
114
Lt coronary artery
- Circumflex - left coronary artery that goes around to the posterior
- Patient presented in ER - doa, turn them over and have big bruise on their back (blood that is pooling), posterior side of heart blows out, no ability to revive them
115
how much blood is on the posterior side of the heart?
not a lot
116
Rt ventricle just contracted where must blood go next?
Pulmonic valve must open
117
Stroke volume
volume of blood pumped by the ventricles with each contraction
118
Cardiac output
volume of blood pumped by the left ventricle per minute
119
How does cardiac output impact pharmacology principles?
Medicine affects stroke volume and cardiac output
120
what happens to meds if cardiac output is too high?
- med goes out into circulation to quickly, go through liver for first past quickly, come back to liver
- meds do not get the half life that they expect
- benefit of med for shorter amount of time
121
what happens to meds if cardiac output is too low?
- half life too long, do not clear through liver in a timely manner, become toxic from meds
122
early sign of lenoxin toxicity
- Patient will ask if it looks hazy, blurry, smoky, halos
- Meals - play with food
- Next day don't want to eat, smell makes them nauseous
- Call physician
123
CHF
- extra fluid in heart
- lt ventricle is working harder already
- increased cardiac output to a point and then it starts to fall behind
124
where is the electrical impulse sent from?
SA node
125
what is the pacemaker of the heart?
SA node
126
where does the SA node send the impulse?
AV node
127
what happens when the impulse reaches the AV node?
the atria contracts creating a P wave on the EKG
128
where does the impulse go after the AV node?
Bundle of HIS
129
where does the impulse go after the bundle of HIS?
the message splits into the left and right bundle branches until it reaches the Purkinje Fibers
130
what happens when the impulse reaches the purkinje fibers?
the ventricles contract creating the QRS complex on the EKG
131
QRS complex
- ventricles have contracted
- got rid of electrical charge
- depolarized
132
Q
goes down
133
R
is the spike
134
S
is at the base line
135
T wave
ventricular repolarization, ventricles are ready to take another charge
136
Atrial repolarization
overcome by QRS complex so you don't see it, might see a U wave, most people don't have these
137
U wave
- may be normal for some but others might be an electrolyte imbalance most likely Potassium imbalance
- if all of a sudden present with P wave, notify dr
138
Nursing assessment
- Patient history
- Health history
- Last CXR, mantoux, and PFT
- Family history
- Smoking
- Occupation
- Military history
139
Nursing assessment - smoking
- How much, how long
| - Packs per day over the number of years
140
Nursing assessment - occupation
- Now and in past
| - May have worked in factory prior
141
Nursing assessment - military history
- Where did they serve
| - Exposed to? Ex. Agent orange
142
Nursing assessment - Health history
- Respiratory/cardiac illnesses
| - TB, asthma
143
Nursing assessment - family history
- TB, asthma
144
Cough, nasal secretions, pain, dyspnea, and fatigue
- Cough like
| - Kind of secretions
145
Physical exam
Chest - changes in diameter/structure
146
Auscultation of lung sounds
what is the rate, depth, effort
147
What is the expansion
- use of accessory muscles
| - flare nostrils
148
Crackles
- Discontinuous sounds
- High pitched popping sounds
- Low pitched bubbling sounds
- Caused by - fluid in alveoli
149
Wheezes
- High pitched, continuous musical sounds
| - Caused by - Narrowing of the airways
150
Rhonchi
- Low pitched continuous gurgling sounds
| - Caused by - Secretions in the large airways
151
Pleural rub
- Squeaking or grating sounds of the pleural linings rubbing together
- Caused by - layers are inflamed and have lost their lubrication
152
Stridor
- Piercing, high-pitched sound
- Primarily during inspiration
- Caused by - Experiencing respiratory distress or obstructed airway
153
Cough
protective mechanism for clearing the lower airways
154
Cough - Chronic
- Associate with some type of irritation
| - Experience for months or longer
155
Cough - Chronic - Common causes
- Smoking
- Allergies
- Chronic sinus infection
- Living in inner cities - pollution
156
Cough - Paroxysmal
- Spasmodic
| - Cough and cough and cough, feel terrible, hard to get it to stop, feel like you will pee your pants
157
Cough - Paroxysmal - Common Causes
- Asthma
| - Chronic bronchitis
158
Cough - Dry or nonproductive
- Not able to bring anything up
| - Hydrate to loosen up secretions
159
Cough - Productive
- Able to cough and bring up sputum
| - Color of sputum, describe sputum
160
Mucoid
white to clear
161
Purulent
- dark yellow green
- might be from smoker and not an infection
- sudden onset, feel pressure across face, chest tight, fever - can assume that their might be an infection
162
Mucopurulent
combination of more mucus than pus
163
Rusty
- traces of blood but not frank bright red
| - indication of TB
164
Bloody
hemoptysis - really bloody, frank blood
165
Frothy
- white might be pink/blood tinged
| - congestive heart failure or pulmonary edema
166
Nasal secretions/Expectoration of Sputum
- 95% water
- the more you drink the better
- harder to bring up when secretions get below 95% water
167
Pain
- Tissue in lungs doesn't have ability to feel pain
| - Likely from the muscles work (Coughing/Work hard at breathing)
168
Pleuritic pain
- Pleural space should only have enough fluid to allow the layers to glide over them
- Gets dry or fluid builds up
169
Pleurisis
point to side, hurts worse when they take in a deep breath
170
Intercostal pain
Cartilage between ribs, comes from coughing a lot
171
Generalized pain
Over all pain from coughing and fever or infection
172
Dyspnea
have two of these descriptors, rapid audible labored breathing, use of accessory muscles, dilated or flared nostrils, tachycardia, anxious, gasping, orthopnea, paroxysmal nocturnal dyspnea, conversational dyspnea, or cyanosis
173
Hypoxemia
low oxygen in blood, reflective in arterial blood gasses
174
Hypoxia
low oxygen in tissue
175
How do you know patient has hypoxia?
changes in color, cyanosis, modeling
176
ABG
arterial blood O2 stats
177
O2 stats
have margin of error of couple of percent
178
Hypnoxia
no oxygen; absence of oxygen
179
Hypercapnia
- too much co2, not ventilating proper
- pneumonia
- COPD live in hypercapnia all of the time, CO2 levels are always higher than they should be
180
Hypocapnia
- not enough co2, breathe too quickly, blow off to much CO2
- anxiety or panic attack
- numbness/tingling around mouth and extremities; look like they maybe having a stroke; get them to slow down breathing usually makes the symptoms subside
181
Respiratory Failure
not specific diagnosis, system as whole is not able to do job adequately, body not getting enough oxygen and not getting rid of co2
182
Respiratory Failure causes
Caused by COPD, asthma, airway obstruction, broken ribs, drug overdose, anesthesia, pneumonia, head trauma, pulmonary embolus
183
Carbon dioxide narcosis
people become comatose; CO2 goes so high that it starts to suppress respiratory center in brain; may turn around by putting them on a ventilator of some sort (bipap, mechanical vent)
184
Is it typical chest pain-patient needs to describe and when does the pain occur?
- Subjective Complaints
- Crushing, elephant standing on chest
- Feels like indigestion
- Atypical symptoms are harder to diagnosis
185
Does the patient have any complaints of dyspnea?
- Subjective Complaints
- Has it changed, if so how?
- Present over the course of time - 6 months ago, 3 months ago, recently
- Gradually onset vs sudden onset
- Different tests for gradual and sudden onset
186
Does the patient voice any concerns about edema?
- Subjective Complaints
- Patient points out obvious signs
- Does it resolve itself during the night or unrelently edema
- Can easily gain 10 pounds before you see edema
- 4+ pitting, 20 to 25 extra pounds of water
187
Do they ever experience any vertigo?
- Subjective Complaints
- Microvalve prolapse
- Connection between heart and vertigo
188
Do they ever have cardiac palpitations?
- Subjective Complaints
- Stress induced is pretty common
- Caused by caffeine
189
Do they ever become diaphoretic?
- Subjective Complaints
- Sweat really bad
- Indication of heart disease
- Come in to wipe themselves off when shoveling snow, heart attack waiting to happen
190
Do they fatigue easily?
- Subjective Complaints
- Develop over time, valve issues
- Develop over a course of time tend to be valve problems
191
Monitor skin
- Objective Complaints
| - Paleness, cyanosis
192
Assess the neck veins for distention
- Objective Complaints
| - Jugular vein distention
193
What are the vital signs?
- Objective Complaints
194
Examine the abdomen and check for ascites
- Objective Complaints
- Ascites is the build up of fluid in the space between the lining of the abdomen and abdominal organs (the peritoneal cavity)
195
What is their current weight and is this their usual weight?
- Objective Complaints
- Is this typical weight? Down or up
- Not everyone tells the truth
196
Do they have any edema?
- Objective Complaints
- Remember a patient can gain ten pounds before edema can be detected by sight
- 1+ Barely visible
- 2+ Obviously present
- 3+ Able to indent but rebounds
- 4+ Indentation remains
197
Pulmonary Function Studies
- Inhalation, exhalation
- Done by respiratory therapy or nurse
- Dr order to get an overall picture of respiratory condition
- Measure volume & capacity of lungs
- Use to make diagnosis and how effective is treatment
198
ABG’s
- pH, CO2, O2, bicarb level
- Go on O2 at home, need to meet criteria to have insurance cover the cost
- Nurses don’t generally do arterial blood draws
199
Pulse Oximetry
normal is 95-100%
200
Cultures and smears
- Nasal
| - Sputum
201
When is the best time to get a sputum sample?
First thing in morning, brush teeth, and then get sample
202
Smears
- cytology
| - cancer
203
X-ray
- Chest
- Common starting point for all people who have respiratory and cardiac disease
- What is size and shape of heart and lungs
- What position are they in
- Do the lungs look symmetrical
- Look at pleural spaces
- Pericardial sac
- Helps to decide on other tests they want to do
204
What should you ask a female before doing x-ray?
- ask if they are pregnant
| - if pregnant need to shield abdomen and pelvis
205
Fluoroscopy
- Chest xray
- Projected on a screen
- Dr is going to go into a mass in the lung with a needle and try to get biopsy
- Allows them to see where they are at
- Go directly into lesions that they are looking at
- Use fluoroscopy to place some needles or markers
206
Lung Scan
- Ventilation - air flow
- Perfusion - what is blood flow like in lungs
- Pulmonary embolism, pulmonary edema, lung cancer
207
Peak Flow Monitor
- Patients who have asthma
- Measures max expiratory flow rate
- Use everyday and record where they are at
- Dr uses this to treat patients more effectively
208
EKG
starting point, is it normal or abnormal
209
Stress
EKG is marginal, walk on tread mill, hooked up to monitors, increase speed and incline, stay on as long as possible, make sure to cool down on treadmill slowly, have them sit and watch them when they are done, make sure you have a dr there before you start
210
Thallium
- injection of dye, does the same thing to heart that exercise dose, increases heart rate and then brings it down, helpful if they can go on treadmill for a short time, see x-ray of rate
- Positive - heart disease, need some type of treatment
211
Holter or event monitor
leads on chest, 24 to 72 hours, takes the monitor home, diary of what you do, is there something in the day that triggers events, button to press when you feel symptoms, person reading the report can identify when the person felt the symptoms
212
Bronchoscopy
- Surgical procedure so you need consent
- Direct visualization of trachea, branches, lung tissue
- Complete for diagnosis
- Treat and evaluate disease
- Take biopsies
- Remove item from lungs (penny, peanuts, sunflower seeds)
213
Laryngoscopy
- Need consent
- Diagnostic or therapeutic
- Surgical - looks at larynx
- Done in DR office or ER bay
- Quick procedure
- Use local anesthesia
- Look at why patient is hoarse, polyps, lesions
- Tells dr if they should refer to ENT
214
Atropine
- Used prior to bronchoscopy/laryngoscopy
| - Medicine that dries up secretions, given before
215
Thoracentesis
- Consent form
- Aspirate fluid, air or pus
- Take out fluid from pleural space
- May need a chest tube
- Possibility of collapsing a lung during procedure
- Watch for hemorrhage, collapse, increased shortness of breath
216
Lung Biopsy
- Brush on lesion, needle, cut
| - Trying to know if lesion is cancerous or not
217
Promote Venous Return
- Feet up
- TEDS
- compression
- Leg exercises, movement, ambulation
218
Immunizations
- Prevent upper respiratory infection
- Flu shot - once per year
- Pneumonia vac - once per 10 years or as prescribed by DR
219
Positioning
Elevate head of bed
220
Pneumonia
- side to side, move around and don’t stay on back
| - more they reposition gives the fluid and infection less time to settle
221
Aspiration Precautions
- Any patient that you think will aspirate is RN level assessment, do not delegate
- Able to swallow/risk for aspiration - done by RN or speech therapy
222
Mobilizing secretions
- Deep breathing and cough
- Keep well hydrated
- Chest Physiotherapy
- Oxygen Therapy
223
Arterial blood gas measurement
- Measures the amount of CO2, O2, & pH
- CO2 is an acid
- pH falls if CO2 rises
- pO2 reflects O2 level in blood
- SaO2 (or SpO2) reflects % saturation
224
Nursing Interventions
- Cough and deep breath
- Incentive Spirometer
- Diaphragmatic breathing
225
Nursing Assessment
- Arterial blood gas measurement
- Pulmonary function studies
- Peak flow meter
226
Diaphragmatic Breathing
- Use diaphragm rather than accessory muscles.
- Lie down, left hand on ribcage, right hand just above navel, little finger on navel and thumb on sternum.
- Take a deep breath thru the nose and use pursed lip breathing on expiration. If done correctly left hand should not move.
- Use for CPOD, chronic bronchitis, issues post-op
- Enhance ability to bring O2 in and CO2 out
- Conserve energy and breathe better
- Improve CO2 and O2 in blood
227
Pursed-Lip Breathing
- Prolongs expiration and increases pressure in the lower airways preventing collapse of bronchioles.
- Moves CO2 out so more room for fresh O2.
- Inhale thru nose with relaxed abdominal muscles and exhale slowly with pursed lips and abdominal muscles contracted.
- Exhalation needs to be twice as long as inhalation.
- Patient can practice by using a straw to make small bubbles in a glass of water.
228
CPAP
provides pressure to the airways at the end of expiration to prevent airways from collapsing
229
BIPAP
provides end expiration pressure like CPAP plus pressure at the end of inhalation to assist greatest inhalation
230
Manual respiration
- Uses resuscitator bag (ambu); O2 source, tubing; face mask or airway adaptor (if intubated), 2 people if not intubated
- O2 to 15 L, position mask for a tight seal, compress bag until chest rises, allow exhalation, every 5 seconds (adult)
- Watch for gastric distension
231
Chest physiotherapy
- To assist in removal of secretions when large amounts are present
- Postural drainage, percussion, vibration
- Trendelenburg is the best position or modified - Trendelenburg
- Make sure that they haven't just eaten
- Listen to lungs before and after
232
Postural drainage
- Position downward angle, < = 25 degrees
- Remains in position 3-15 minutes • Side to side, then supine, repeat
- Cough in dependent position, deep breath between position changes
- Slowly return to sitting position, address sputum produced, hygiene, evaluate
233
Chest percussion
- Hands cupped, flex elbows and wrists
- Gently, rhythmically, clap over area to be drained
- Alternate hands, hollow sound, no pain
- Each area 3-5 minutes, not breasts or bones
- Cough after percussion
- Handle secretions, hygiene, evaluate
234
Chest vibration
- Follows percussion, postural drainage in each position
- Client to exhale slowly through pursed lips
- Hands flat, moderate pressure, contract and relax your arms and shoulders, 3-4 exhalations over each area, cough before position change
- Handle secretions, hygiene, evaluate
235
How much oxygen do you breathe in?
21%
236
How much oxygen do you breathe out?
15-16%
237
Nasal Cannula
- Delivers 24-44% oxygen at flow rates from 1-6 liters … dependent on rate and depth of respiration
- 24% oxygen at 1 L
- 44% oxygen closer to 6 L
238
Simple mask
- Provides 35-65% FIO2 at 8-12 Liter/min flow rate
| - Can run at 5 to 6L
239
Masks with reservoir bag
- Allow for higher FIO2 levels
| - Acute situation or near end of life
240
Masks with reservoir bag - Partial rebreathing
- Beginning of expiration mixes in the bag with inspired air, most escapes
- FIO2 40-60%, 6-10 L/min
- Exhales the O2 gets trapped in bag and rebreathe it
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Masks with reservoir bag - Non-rebreathing
- Valve closes during expiration so is not “rebreathed”, no inhalation of room air
- FIO2 60-100%, 6-15 L/min
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Venturi mask
- Uses adaptors, more precise FIO2 delivery with minimal CO2 buildup
- FIO2 24-50% depending on liter flow and adapter used
- Most precise
- Intensive care
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Bubblers
- Connected to concentrator/tank
- Get more humidify air
- Look at when it gets to 5L
- Use distilled water
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Oxygen hood
- Fits over a baby’s head
- Warms and humidifies the O2
- 28-85 % at 5-12 L
- OB, NICU
245
Why do you have to be careful when using an oxygen hood?
- Can cause child to go blind - oxygen toxicity
| - Deteriorates retina
246
Oxygen tent
- Encloses the child, canopy, provides O2, humidity, and cool environment
- FIO2 up to 50%, 10-15L/min.
- Also called “croup tent”
- Acute bronchitis, bronchio spasm
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What precautions do you need to take with the oxygen tent?
Make sure tent is well supported by crib, suffocation hazard
248
Oropharyngeal
- Use in OR, keep tongue in place, airway open
- Easier to use with ambu bag
- Side of mouth to ear to measure
- Insert upside down and rotate; patient can take out
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Nasopharyngeal
- Go in nose, lubricate with water soluble
- Variety of sizes
- Oral surgery, car accident
250
Endotracheal
- Use metal blade to guide - laryngoscope
- Hold tongue down
- Secure with strap or tape
- Balloon inflated to keep in place
- May come out of surgery with one
- Contemplating to hooking up to ventilator, short term
- Can use ambubag with this
- Short term use, 7-10 days
- Not usually put in by a nurse
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Tracheostomy
- May have an inner and outer cannula
- May have a cuff
- Change every 30 to 90 days
- Weaning process if it is going to be taken off, heal from inside out
- Need two people to change trach
- Sometimes when you try to put it back in the person will have a broncho spasm
- Sterile procedure
- Want the tube that goes into the patient to remain sterile
252
How often do you change an inner cannula?
every day
253
When would you deflate the cuff?
- Deflate at particular times of the day
- Can leave balloon deflated
- Vent full time, don't usually deflate balloon
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Mechanical Ventilation
- Used to overcome the patient’s inability to ventilate or oxygenate adequately
- Can be intermittent or continuous.
- Can be short-term or long-term
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Mechanical Ventilation - Negative pressure or positive pressure
- Most often see positive pressure
| - Exerts full pressure on alveoli
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Mechanical Ventilation - Assist
- Respiratory efforts trigger vent
| - Will come on when there is not enough thoracic pressure
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Mechanical Ventilation - Control
- Machine does all the work
- No breaths on own
- Head injury
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Mechanical Ventilation - assist-control
- Back up to make sure that there is control
- Triggered by each breath that is inadequate
- Based on tidal volume
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how often should you check a mechanical ventilator?
every 2 hours
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Mechanical Ventilation - high alarm
resistance to machine, something is wrong, something is occluding their airway
261
Mechanical Ventilation - low alarm
pressure has significantly dropped, something has come apart, often happens in suctioning
262
Chest Tubes
- Lungs are surrounded by the pleura which should have negative pressure within the pleural space which creates a vacuum that keeps the lungs expanded.
- Breaking this vacuum causes the lungs or lung to collapse.
- To recreate this a chest tube must be placed.
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How do you know if a chest tube is operating properly?
seeing normal tidaling
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How do you know if a chest tube is NOT operating properly?
- rapid bubbles
| - start at entry point, check for leaks and kinks all the way
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Nasopharyngitis (Common cold)
common in children can have 6 to 9 colds per year
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Pharyngitis
common in the 4-7 year old
267
influenza
common in school-age children
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Why would you deflate a balloon in an endotracheal patient?
- it damages trach and vocal cords
| - do not leave patient while it is deflated
