Exam 3 Study Guide: Leonard Flashcards
what is the respiratory system responsible for?
o ventilation
o vocalization
what occurs during ventilation respiration cycle?
o gas exchange
- occurs in the alveoli
- oxygen and carbon dioxide are exchanged
how does vocalization occur in the respiration cycle?
o air comes up from the lungs and into the voicebox
- air through lungs and vocal cords
- vibration of our vocal cords (how were able to vocalize)
- how were able to speak
normal pH level
7.35 - 7.45
acidosis pH level
< 7.35
alkalosis pH level
> 7.45
inflammation of an airway causing narrowing and production of mucous
asthma
is asthma genetic/related to family hx?
yes, genetics
what position should a patient be in when experiencing SOB?
High Fowler’s
- unless ordered by physician not to
what muscle is used to breath?
accessory muscle
expected findings of Asthma Exacerbation
o dyspnea
o chest tightness
o anxiety or stress
physical S/S of Asthma
o coughing
o wheezing
o mucous production
o use of accessory muscles
o prolonged exhalation
o poor oxygen saturation (low SaO2)
o barrel chest or increased chest diameter
what develops during asthma exacerbation
sputum
what do you hear from asthma patients?
expiratory wheezes
What is the normal O2 level
92 - 100
always make sure O2 is normal in asthma patients
anything on the exam that has a low O2 level, know the intervention is what?
Oxygen intervention
decreased PaO2
< than 80mmHg
Hypoxemia
decreased PaCO2
< than 35mmHg
o early in attack
Hypocarbia
increased PaCO2
> than 45mmHg
later in attack
Hypercarbia
what is the most commonly used bronchodilator?
albuterol
albuterol comes in what 2 types of form?
o Inhaler Form
- powder
o ambuel form
- used in nebulizer
- liquid form
- mist created that is inhaled
when do we administer bronchodilators?
during acute asthma attacks
what is considered a rescue inhaler?
albuterol
what are the steps for using an inhaler?
o patients must rinse their mouth out with mouthwash first
(to prevent thrush)
o breath out
o then seal lips around inhaler
o inhale 2-3 seconds
o press button
o hold breath for 5-10 seconds
o breath out for 20 - 60 seconds
o wait another 20 - 60 seconds in between each puff
does albuterol provide rapid relief?
yes
what are corticosteroids used for?
decrease inflammation
what do we teach diabetic patients who are on corticosteroids?
it increases blood sugars
when should a client take their corticosteroid medications?
in the mornings
how should corticosteroids be taken?
must be taken with food
damage to lung tissues due to emphysema and chronic bronchitis
COPD
o chronic obstructive pulmonary disease
S/S of COPD
o SOB
o wheezing
o chronic cough
risk factors of COPD
o obesity
o smoking
are CNA’s allowed to administer or adjust oxygen?
no, they are only allowed to take pulse ox
what types of foods/snacks should a patient with COPD consume?
o foods that are soft
o foods that have protein
- no overeating
what should we teach COPD patients?
conserve energy
what can a COPD patient do to ease breathing and enhance gas exchange?
sit up and lean forward to open lungs
the loss of lung elasticity and hyperinflation of lung tissue that causes destruction of the alveoli, leading to decreased surface are for gas exchange, carbon dioxide retention, and respiratory acidosis
Emphysema
inflammation of the bronchi and bronchioles due to chronic exposure to irritants
chronic bronchitis
can be latent for a long time in patients who have already had this disease
TB
tuberculosis
contributing factors that can reactivate TB
o chronic renal disease (kidney cant filter toxins which will reactivate TB)
o diabetes
o malnutrition related to loss of appetite
o noncompliance with medication regimen
how long do patients with TB need to take their medications for?
9 - 12 months
Mantoux
- 2 step PPD with results in 48-72 hrs
- skin test induration
> 10mm is positive for TB
TB blood test
Quantiferon
what is performed in TB patients to visualize lesions on lungs, gas filled spaces and gaps in lungs
chest x-ray
what are the 3 testing methods for TB?
o Manoux
o Quantiferon
o Chest X-ray
S/S of TB
o bacterial infection
o blood-tinged sputum or blood with cough
o weight loss
o night sweats
o chest pain
o fatigue
o low grade fever
what type of precaution for TB
Airborne precaution
what PPE should be used when caring for a TB patient
o N-95 mask
o gloves
what type of sputum is seen in patients with bacterial pneumonia (PNA)?
o thick, greenish, purulent sputum
we want to encourage our patients with pneumonia to do what?
o ambulate
o cough/take deep breaths
o use incentive spirometer
what is the proper way to use an incentive spirometer
o have client exhale
o then place mouth on spirometer
o inhale through incentive spirometer
teachings on antibiotic medications
o prescribed after a sputum culture
o must be taken as prescribed
o do not stop if feeling better
o must take until prescription says
why do we encourage fluid intake for pneumonia patients
o it will help liquify secretion for expectoration
o helps breakdown secretion
which elevated WBC indicate infection/pneumonia?
neutrophils
accumulation of excess mucous throughout the body
o impairs breathing, digestion, elimination, and GI function
Cystic Fibrosis
daily therapy of airway management for Cystic Fibrosis
o continuous chest percussion (vest)
o treat with mucolytics
- to thin and decrease amount of mucous
o pancreatic enzymes supplements
- pancreatic enzymes depleted and aren’t being produced because mucous is blocking so must replenish with supplements
o protein modulators (CFTR - cystic fibrosis transmembraneconductive regulator)
- protein replacement
what do Cystic Fibrosis patients suffer from
o malnutrition
o fatigue
- must conserve energy
Cystic Fibrosis Diet
o high in fat
o high calories
o salt (need to replenish salt and potassium)
o fluids to liquify mucous secretions
o highly contagious acute viral infection
o occurs as an epidemic (usually in fall and winter months)
seasonal influenza
viral infection among animals or birds that has mutated and is becoming highly infections in humans
pandemic influenza
Flu S/S
o severe headache and muscle aches
o chills
o fatigue, weakness
o severe diarrhea and cough (avian flu)
o fever
o hypoxia (avian flu)
contraindications for giving the flu vaccine
o age
- 68 yo or older must receive the live attenuated (weaker/lessened vaccine)
o allergies
- eggs
o Asthma can be exasperated by the flu vaccine
precautions implemented with flu patients
o maintain droplet and contact precautions (pandemic influenza)
o provide saline gargles
o monitor hydration status, intake, output
o administer fluid therapy as prescribed
o monitor respiratory status
home education for O2 use
o flammable (no smoking)
o DO NOT use vaseline for nasal dryness (water based lubricant only)
o humidify oxygen (keep from drying out)
o educate family members on importance of use and compliance (don’t ever leave oxygen tank at home away from patient)
what position should a patient be in for enhanced breathing?
High Fowler’s
method used to measure force of your exhalation
FEV (Forced Expiratory Volume)
FEV1
used for diagnosis as well as determining the effectiveness of the therapy
comparisons of forced expiratory volume (FEV) to forced vital capacity (FVC) are used to classify COPD as mild to severe
pulmonary function test
everything to know about FEV/FVC
o comparisons of forced expiratory volume (FEV) to forced vital capacity (FVC) are used to classify COPD as mild to severe
o as COPD advances, the FEV-to-FEV ratio decreases
- expected reference range is 100% for mild COPD, the FEV/FVC ratio is decreased to less than 70%
- as the disease progresses to moderate and severe, the ratio decreases to less than 50%
what is the pulmonary function test used for?
classify COPD as mild to severe
1-6L/min
Nasal Cannula
6-10L/min
Simple Mask
10-15L/min
Nonrebreather
15L/min or higher
Venturi Mask
what is the normal pulse ox waveform pattern
o normal signal = mountain peaks
o low perfusion = almost flat line
S/S of O2 toxicity
o lethargy
o difficult to arouse
minimum mmHg for trach suctioning
80mmHg
maximum mmHg for trach suctioning
120mmHg
how long do you wait in between each trach suctioning?
30 seconds
how long do you suction for during trach suctioning?
10 seconds
how long does a patient have to be at 100% hyperoxygenation before suctioning
10-15 seconds
o keep a tight mouth seal around the mouth piece
o inhale and hold breath for 3-5 seconds
o during inhalation, needle of spirometry machine will rise
proper use and technique of incentive spirometer
what is incentive spirometer used for
promotes lung expansion
o used to conserve energy
o looks like you are kissing someone or drinking through a straw
o for COPD patients
pursed lip breathing
how many blood cultures is needed for diagnosis?
2 blood cultures need from two different areas
can you collect a sputum sample from a trach?
no, only thing allowed to go in is for suction
when is the best time to collect a sputum specimen
mornings
what should a patient do before collecting specimen?
make sure patient rinses mouth out with mouthwash
low concentration of O2 in your blood
hypoxemia
S/S of hypoxemia
o agitation/anxiety
o cyanosis
o SOB
o wheezing
o cough
o confusion
not breathing properly during sleep
obstructive sleep apnea (OSA)
what causes OSA?
o tongue obstructs by moving to top or back of mouth when laying down
o respiration cycle is not being completed
- O2 being deprived
- oxygen not going down to alveoli and exchanging with carbon dioxide to complete cycle
what 2 treatments are used for OSA?
o CPAP
o Bi-PAP
o continuous pressure flow that opens airways
o must always take it with you if you will be sleeping away from home
CPAP
Continuous Positive Airway Pressure
o one level of exhalation and another level for inhalation
o two different types of pressure
Bi-PAP
Bi-Level Positive Airway Pressure
Anatomy of OSA
o airway narrows and collapses as the body relaxed during sleep, decreasing gas exchange and apnea occurs - meaning there is no air being moved in or out of the body and no alveolar gas exchange
risk factor for OSA
o obesity
o smoking
o ETOH use
o males age 40 - 65 yo
o menopause
o avoid sleeping pills
o heavy meals
benefits of OSA treatment (CPAP/BiPAP)
o sleep quality improves
o decreased or no snoring
o will help both yourself and your partners sleep quality
important teaching for CPAP/BiPAP users
o must clean devices and masks regularly
o change filters
inflammation of the nasal mucosa and often the mucosa in the sinuses that can be caused by infection (viral or bacterial) or allergens
Rhinitis
S/S of Rhinitis
o more severe than sinusitis
o excessive nasal drainage, runny nose (rhinorrhea), nasal congestion
o purulent nasal discharge
o sneezing and pruritus of the nose, throat, and ears
o watery/itchy eyes
o sore/dry throat
o red, inflamed, swollen nasal mucosa
o low-grade fever
o diagnostic testing can include allergy tests to identify possible allergens
an inflammation of the mucous membranes of one or more of the sinuses
sinusitis
where should you palpate when assessing sinusitis
orbital areas
S/S of sinusitis
o nasal congestion
o headache
o facial pressure or pain (worse when head is tilted forward)
o cough
o bloody or purulent nasal drainage
o tenderness to palpation of forehead, orbital, and facial areas
o low-grade fever
inflammation/infection of the mucous membranes of the voicebox (larynx)
laryngitis
what causes larryngitis
o upper respiratory infection
o environmental pollutants
o use of asthma inhalers
o singing
o talking (overuse)
o GERD - acidity - burns vocal chords
what should people with laryngitis avoid?
o acidic food
o alcohol
o smoking
o dry air
how to treat laryngitis/hoarseness
o rest
o rest vocal cords
o find other means to communicate
o humidify your air
o see Dr. if it lasts for a long period of time
risk factors of laryngeal cancer
o tobacco use
o alcohol use
o poor dietary habits
o compromised immune system
o genetic syndromes
o occupational hazards
o gender
o age
o race
o GERD
o 4x more common in men than in women
o occupations where workers have intense and long exposure to certain chemicals
o more common in people who have compromised immune status
CPAP Essay
CPAP prevents collapse of the upper airway through the use of pressure delivered through the use of a nasal, oral, or oronasal mask during sleep
CPAP machine delivers a continuous stream of positive pressure, keeping the airway open and providing an unobstructed airway
Weight management and loss are encouraged as a first-line intervention in conjunction with the use of CPAP
Positioning during sleep in a nonsupine position by using pillows in an effective secondary intervention
Avoid alcohol and sedatives before bedtime
You hear wheezing sounds in lungs of which 3 patients?
o CF
o Asthma
o Lung Cancer
