Exam #4 Flashcards
1
Q
Upper Resp System
A
- nose
- mouth
- pharynx
- epiglottis
- larynx (vocal chords)
- trachea
2
Q
lower resp system
A
- bronchi
- bronchioles
- alveolar ducts
- alveoli
- lung lobes
3
Q
alveoli and surfactant
A
- o2 and co2 exchange
- primary gas exchange site
- surfactant: lipoprotein that decreases surface pressure
4
Q
blood supply to the lungs
A
1) pulmonary: provides lungs with blood that participates in gas exchange
2) bronchial: provides oxygen to the bronchi and other pulmonary tissues
5
Q
chest wall
A
- ribs
- pleura
- parietal: lines chest cavity
- visceral: lines lungs
- space in between is called the intrapleural space: provides lubrication, facillitates expansion
- diaphragm: contraction decreases intrathoracic pressure allowing air to enter the lungs
6
Q
physiology of respiration
A
- ventilation involves inspiration
- expiration is passive and depends on elastic recoil
- compliance: ease of lung expansion
- diffusion: movement of gases from the area of higher concentration to area of lower
- arterial blood gases measure oxygen saturation and acid-base balance
- pulse oximetry is read as SpO2: less accurate when spo2 is less than 70, hemoglobin variants and other factors can give an inaccurate reading
7
Q
PaO2
A
- lung’s ability to oxygenate arterial blood = partial pressure oxygen
- PaO2 decreases with age and varies with distance above sea level
- for patients with impaired CO or hemodynamic instability, mixed venous blood gases obtained from a pulmonary artery catheter
8
Q
control of respiration
A
- chemoreceptors respond to changes in paco2 and ph
- mechanical receptors respond to a variety of physiologic factors
9
Q
respiratory defense mechanisms
A
- filtration of air
- mucociliary clearance system
- cough reflex
- reflex bronchoconstriction
- alveolar macrophages
10
Q
resp gerontologic considerations
A
- structural changes:
- stiffening of chest wall
- decrease in elastic recoil and compliance (hinders exhalation)
- AP diameter increases (barrel chested)
- chest is barrel-shape, may need accessory muscles to breathe
- less tolerance for exertion leading to dyspnea
- defense mechanisms: less effective, less forceful cough, fewer cilia, higher risk of aspiration
- respiratory control: more gradual response to changes in PaO2 and PaCo2
- SOB changes gradyally and can lead to severe hypoxia
11
Q
subjective resp assessment
A
- frequency of upper respiratory problems and seasonal effects
- meds
- cough - secretions, force, acute, chornic
- sputum: amount, color, consistency, odor
- wheezing
- travel
- smoking and tobacco products
- vaccination against influenza and pneumonia
- inhalers, demonstrate use
- weight loss (illness) and fluid intake (secretion thickness)
- ADLs, dyspnea
- sleep apnea signs: snoring, insomnia, daytime drowsiness, early am headaches
- night sweats
- neurologic symptoms
- pain with breathing
- anxiety: stress management
12
Q
objective resp assessment
A
- some nasal deviation is normal
- nasal discharge
- small, mobile, nontender nodes (shotty) are normal; tender, hard or fixed are not
- begin auscultation on posterior especially for females - better info on back if pt tires
- AP diameter should be less than 1:2
- inspiration should be half as long as expiration
- skin color
- clubbing
- femitus
13
Q
abnormal breath sounds
A
- adventitious sounds
- fine crackles
- coarse crackles
- rhonchi
- wheezes
- stridor
- pleural friction rub
14
Q
resp lab and diagnostic studies
A
- labs
- arterial blood gases
- hemoglobin: O2
- hematocrit: RBC vs plasma ratio
- pulse ox
- sputum studies: induced (given something to make them cough) vs exporated (cough)
- TB skin test
- allergy testing
- pulmonary function tests - spirometer used during different activities to evaluate air flow
15
Q
resp radiologic studies
A
- chest xray
- CT
- MRI
- ventilation perfusion VQ scan: identified areas of lungh not getting enough o2
- pulmonary angiogram: ask about idodine
- PET scan: radioisotope, benign vs. malignant lesions
16
Q
resp diagnostic procedures
A
- mediastinoscopy: OR biopsy
- lung biopsy
- bronchoscopy
- thoracentesis: aspirate or drain fluid
17
Q
bronchoscopy
A
- looks for tumors or abnormalitis
- NPO status prior to procedures
- blood tinged mucous is not abnormal
18
Q
trachesostomy
A
- surgically created stoma in trachea
- care: changes ties and dressings when soiled
- check for skin integrity
19
Q
rhinoplasty
A
- outpt procedure using regional anesthesia
- stop taking nsaids to reduce risk of bleeding
- internal nasal packing and or nasal septal splints may be removed by the surgeon the day after surgery
- external plastic splints are molded to the nose and removed 3-5 days after surgery
- keep head elevated to decrease nasal swelling
- will have edema and bruising for a short period before achieving the final cosmetic result
20
Q
epitaxis (nosebleed)
A
- anterior bleeding usually stops spontaneously, posterior bledding may require tx
- keep the pt quiet and in a sitting position
- apply direct pressure by pinching the lower part of the nose for 10-15 minutes
- partially insert a gauze pad into the nostril
- if bleeding doesnt stop, will ned a vasoconstrictor, cauterization, or packing
- packing can alter respiratorys status and increase risk of aspiration in older adults
- packing is painful because of the pressure and increase risk of infection
- may leave packing in for days
- painful to remove, premedicate
- no vigorous nose blowing, strenuous actibity, lifting, stratining for 4-6 weeks
21
Q
allergic rhinitis
A
- S/S: sneezing itchy eyes/nose, watery nasal discharge, nasal decongestion
- most important treatment is to identify and void triggers
- antihistamines (non-sedating) claratin, syrtex, need lots of fluids
- intranasal corticosteroids (rhinocort, flonase), decrease local inflammation w/o systemic effects, start 2-3 weeks before allergy season
- leukotriene receptor antagonists (singulair)
- allergy shots if nothing else works
22
Q
acute viral rhinitis (common cold)
A
- S/S: sneezing, nasal congestion, watery eyes, fever, malaise, headache
- rest
- increase fluids
- decongestant nasal sprays for no more than 3 days
- antipyretics and analgesics (tylenol)
- no abx unless complications (high fever, purulent nasal drainage, tender/swollen glands, sore/red throat, sputum changes, SOB, chest tightness) or it lasts longer than 7 days
23
Q
concerns with common illnesses
A
- dyspnea, crackles - pulmonary complications
- symptoms lasting longer than 7 days - bacterial infection
- purulent, foul smelling nasal drainage - foreign body
- inadequate treatment of strep - rheumatic heart disease or glomerulonephritis
- high fever, muffled “hot potato” voice - peritonsillar absceses (life threatening airway obstruction)
24
Q
tracheostomy
A
- indications: bypass an upper airway obstucton, facilitate removal of secretions, permit long term ventilation, permit oral intake and speech in pts who reuire long term mechanical ventilation
- Better than endotracheal tube: less risk of longer tem damage to airway, increased patient comfort, can eat with it b/c its lower in the airway, trach is more secure so mobility can be increased
25
Q
tracheostomy safety
A
- be very careful first 5-7 days of a new trach
- HCP performs first tube change after new trach
- keep replacement tube of equal or smaller size at bedside
- humidified air to warm and moisten secretions (trach collar)
- change tubes once a month
- review suction technique
- change trach
26
Q
cuffed tracheostomy tube
A
- use dif pt as risk for aspiration or needs mechanical ventilation
- cant speak while inflated
- inflate using minimal leak technique then verify pressure with manometer
- check cuff pressure q 8 hours
- before deflation: have pt cough, suction trach and mouth
- deflate during exhalation, reinflate during inspiration
27
Q
speaking with a trach tube
A
- fenestrated trach: when inner cannula is removed, cuff deflated, and decnnaulation plug inserted, air flows around the tube, through the fenestration in outer cannula and up over the vocal chors so pt can speak
- talking trach tube: allows speech while cuff is inflated by connecting a port to an ar source so air can flow up over the vocal chords
- speaking valves: must be cuffless trach or delate the cuff
28
Q
permanently removing a trach
A
- close stoma with steri strips and cover with an occlusive dressing
- keep dressng clean and dry
- have pt splint the stoma when coughing, swallowing, or speaking
- opening will close in several days
- no surgery is needed to close the trach opening
29
Q
head and neck cancers
A
- risk factors: tobacco and alcohol use, diet poor in fruits and veggies, HPV infection
- S/S: painless growth/ulcer that doesnt heal, persistent unilateral sore throat or ear pain, hoarseness; pain, dysphagia, airway obstruction are late symptoms
- tx: radiation, surgery, chemo; very difficult to treat; cordectomy (chricoid), hemilaryngectomy (hald larynx), supraglottic laryngectomy, radical neck dissection, modified neck dissection; not a good cure rate even with tx
- speaking anddisfigurement are biggest issues
- nutrition: enternal nutrition may be needed, closely observe for choking when taking by mouth, avoid thin liquids, thick it, bland foods, give antiemetics before meals, add calories by adding dry milk, add sauces and gravies to food
30
Q
head and neck cancer radiation therapy
A
- xerostomia: dry mouth, increased fluid intake, salagen to increase saliva production, chew sugarless gum or candy, use non-alcoholic mouth rinses, always keep a water bottle with them
- fatigue: take frequent rest periods, regular, light exercise
- stomatitis: soft, bland foods; sore mouth, oral sores, very sore, no mouthwash or spicy foods; use benadryl, maalox, lidociane swish/spit
- skin: no lotions within 2 hours of tx, avoid sun, call if moist skin reaction occurs
31
Q
head and neck cancer surgical care
A
- expect a change in speech
- # 1 priority is to maintain patent airway
- laryngectomy tube will be in place
- semi-fowler’s position decreases edema and stress on suture lines
- may have surgical drain
- trach secretions will be bloody changing to thicker secretions
- no saline to this secretions
- exercise neck and shoudlers to prevent limitation in motion
32
Q
laryngectomy stoma care
A
- wash around the stoma daily
- if pt has a laryngectmy tube, remove and clean daily
- can wear a scarf to shield the stoma
- cover the stoma when coughing and during actibities where something might be inhaled
- use a plastic collar when showering
- no swimming
- bedside humidifier
- wear a medic alert bracelet that says I am a neck breather - NEVER use mouth to mouth
- can’t smell smoke so need smoke detectors
33
Q
head and neck voice rehab
A
- voice prosthesis: device that is inserted into a fistula between esophagus and trachea; pt has to manually block the stoma with the finger unless they have a valve
- esophageal speech: involves swallowing air, trapping it in the esophogus and releasing it to create sound
- electrolarynx: handheld device that creates speech with sound waves, takes practice to learn how to use it
34
Q
lower respiratory problems
A
- acute bronchitis: occurs after an URI; persistent night time cough with clear sputum, self limiting, supportive tx, no abx
- pertusis: whooping cough, tdap; highly contageous, paroxysms of coughing followed by inspiratory gasps, vomiting; cough lasts 6-8 weeks; treat with zithromax (zpack); adolescents and adults need booster immunizations
35
Q
Pneumonia
A
- acute infection of the lung parenchyma (lung lining)
- associate with significant morbidity and mortality rates
- community aquired is 6th leading cause of eath in people 65+
36
Q
Pneumonia etiology
A
- results when defense mechanisms become incompetent or overwhelmed
- decreased cough and epiglottal reflexes may allow aspiration- mucociliary mechanisms impaited: pollution, smoking, upper resp infections, tracheal intubation, aging
- chronic diseases supress immune system
3 ways organisms reach lungs:
1) aspiration from nasopharynx or oropharynx
2) inhalation of microbes present in the air
3) hematogenous spread from primary infection elsewhere in body
37
Q
types of pneumonia
A
- Community aquired
- hospital aquired: 48 hours after hosp admint
- ventilator associated: 48 hours after endotracheal intubation
- health care associated: new onset of pt hospialized 2+ days, in long term care or attended a clinic
- aspiration
- opportunistic: immunocompromised, jiroveci, cytomegalovirus
38
Q
pneumonia tx
A
- based on: known risk factors, early versus late onset, probable organism
- multidrug resistant organisms are major problem in treating HCAP
- pneumocystis jiroveci: trimethoprim/sulfamethoxazole (bactrim, septra), IV or orally
- cytomegalovirus: antiviral medications and high dose immunoglobin
39
Q
pneumonia clinical manifestations
A
- sudden onset of fever, chills
- cough with purulent sputum
- may have pleuritic chest pain
- confusion or stupor
- breath sounds: increased fremitus, crackles, wheezing, dull to percussion (inflammation)
- viral pneumonia symptoms are highlt variable, self limiting
40
Q
pneumonia complications
A
- pleurisy = inflammation of the pleura, common
- pleural effusion = fluid in the pleural space resulting in decreased breath sounds
- atelectasis = collapsed alveoli
- bactremia: bacterial infection in the blood
- empyema: accumulation of purulent exudate in the pleural cavity
