final Flashcards
what is the difference between the right and left lung
right lung has 3 lobes
left lung has 2 lobes
lungs are large paired spongy cone shaped organs that receive their blood supply directly from the heart through the pulmonary arteries
why is the medulla oblongata important to the respiratory system
responsible for basic rhythm and depth of respiration
What is the alveoli’s roll in gas exchange
alveoli’s is the most important feature, it is here that the oxygen diffuses into the cardiovascular system
- diffusion of carbon dioxide and oxygen occures
- effective in gas exchange because they are extremely thinned walled
What is surfactant?
reduces surface tension and prevents the alveolus from collapsing after each breath
what is the airway passage from the nose down to the alveoli
nose throat (pharynx) voice box, or larynx. windpipe (trachea) the left and right bronch bronchioles alveoli
what contributes to increasing blood acidity
Body needs oxygen
increasing levels of carbon dioxide AND decreases levels of blood oxygen, leads to increasing blood acidity,
what is the inspiratory capacity
is the largest amount of air that can be inhaled in one breath from the resting expiratory level
respiratory acidosis
kidneys retain increased amounts of HCO3 (bicarb) to increase pH
respiratory alkalosis
kidneys excrete increased amounts of HCO3 to lower pH
metabolic acidosis
lungs “blow off” carbon dioxide to raise pH
metabolic alkalosis
lungs retain carbon dioxide to lower pH
ABG’s
essential in diagnosing and monitoring patients with respiratory disorders
normal values:
(pH) acidity { 7.35-7.45 } alkalinity
(PaCO2) acidity { 45-35 } alkalinity
(HCO3) acidity {21-28 } alkalinity
what is the anatomical location of the larynx
- located above trachea, just below the pharynx at the root of tongue
- connects the pharynx with the trachea
what is the purpose of the larynx
enable speech -> during expiration air rushes over the vocal cords, causes them to vibrate
“voice box” contains vocal cords
-Thyroid cartilage= Adam’s Apple
what is the purpose of cilia
Small hair like
Lines the entire structure of the trachea
Sweeps / dusts debris upward toward the
nasal cavity
what is the purpose of chemoreceptors in carotid bodies
called carotid and aortic bodies, specialized receptors that send nerve impulses to the respiratory centers, which in turn modify respiratory rates
what happens when the oxygen level in the blood decreases
1
what is the kidneys role in respiratory acidosis
the kidneys attempt to compensate by reabsorbing increased amounts of HCO3
how do you measure inspiratory capacity
pulmonary function tests-(ventilation tests)
what is the correct positioning of a pulse oximeter on the patients finger
do not attach the probe to an extremity that has a blood
pressure cuff or arterial catheter in place-these devices
reduce blood flow
place probe over a pulsating vascular bed
while on the pt protect probe from strong light
avoid excess pt movement
hypothermia, hypotension and vasoconstriction can
effect readings
pulse ox abnormal reading
less than 70% considered life threatening
under 90% abnormal
what is the proper technique in order to collect the sputum specimen
explain procedure to patient (sputum must be brought up
from the lungs)
collect specimen before prescribed abx are started
collect specimen before meals to avoid emesis
instruct pt to inhale and exhale deeply 3 times, then
swiftly cough forcefully, and expectorate into sterile
sputum container
usually early morning samples collected on 3
consecutive days
samples can also be obtained via nasotrach suction
what is a nursing intervention for a patient that starts coughing up blood tinged sputum
elevate head of bed
place pt in fowlers position
get oxygen readings
what is video assisted thorascopic surgery
is a surgical procedure used in the chest and lungs. It is a type of ‘keyhole’ surgery where only very small cuts (incisions) are made to the body.
VATS uses a special instrument called a thoracoscope. This is a thin, tube-like instrument which has a camera built into the end. The camera feeds pictures from the chest on to a screen. This allows your surgeon to look inside the chest and lungs.
VATS can be used to do a wide range of things, including take small samples of tissues (biopsies) from the lungs. These samples can then be examined in the laboratory.
what are the post procedural guidelines for bronchoscopy
NPO until gag reflex returns (usually about 2 hours)
semi-fowlers position and turning on either side to
facilitate removal of secretions
monitor for signs of laryngeal edema or laryngospasms
such as stridor or increase dyspnea
if lung tissue biopsy obtained-monitor sputum for signs
of hemorrhage
why pursed lip breathing is helpful
- causes backflow and opens airway
- Promote carbon dioxide elimination
what is the post procedural after care for a patient that undergoes thoracentesis
Monitor vital signs, Respiratory status Assess the site for bleeding or crepitus Apply a pressure dressing and Monitor client for signs of pneumothorax, air embolism, and pulmonary edema. lie the client on the unaffected side
identify the signs and symptoms of severe respiratory distress
the patients expression, chest movement and respirations, pt’s skin color and turgor all provide valuable visual clues.
at times pt unable to verbalize distress, but has a wide-eyed anxious look that reflects fear, and flaring nostrils
where is the anatomical location of the apex of the lungs
projects above the clavicle
located approximately 1 inch (2.5cm) above the first rib, is the narrow part. (the apex) of each lung
sibilant wheezes
musical, high- pitched, squeaking or whistling sounds, caused by rapid movement of air through narrowed bronchioles
crackles
short, discrete, interrupted crackling or bubbling sounds,
caused by fluid, mucous, or puss in the small airways and alveoli
- brief, not continuous, common in inspiration
interrupted crackling/bubbling sound
(ex)think of the sound of hairs being rolled btwn fingers close to the ear
-associated with inflammation or infection of the small bronchi, bronchioles and alveoli
pleural friction rubs
low pitched grating or crackling lung sounds that occur when inflammed pleural surfaces rub together during respiration-machine like quality
usually caused by inflammation
Why are antibiotics and antihistamines often used to treat sinusitis?
- Antihistamines for allergy signs and symptoms and to decrease congestion-blocks allergic response through histamine receptor blockade.
- Antibiotics to prevent infection
What are your nursing interventions for a patient with the pulmonary infection?
-maintain bed rest
-head elevated at least 30 degrees
monitor intake/out take
-signs and symptoms of shock
-administer vasopressor drugs as ordered
-maintain hydration
-cough and deep breath q2hrs if able
-note respiratory rate and rhythem
What is the difference between pharyngitis, bronchitis, and laryngitis?
LARYNGITIS
- secondary to other respiratory infections
- associated with inflammation of the laryngeal mucous or edematous vocal cords
- accompanies viral or bacterial infections
What is the difference between pharyngitis, bronchitis, and laryngitis?
PHARYNGITIS
- most common throat inflammation and accompanies the common cold
- usually viral but can also be bacterial
- strep throat common cause
- evidence of gonococcal pharyngitis
What is the difference between pharyngitis, bronchitis, and laryngitis?
BRONCHITIS
inflammation and irritation of bronchi caused by chronic exposure to irritants, especially tobacco smoke. There is excess mucous and a productive cough.
What is your patient teaching for a patient with a common cold ?
correct hand washing technique
proper disposal of used nasal tissues
limit exposure to others during the first 48 hours and then to check his or her temperature every 4 hours
netipot use to flush out the nasal passages
What are the common assessment findings in acute rhinitis?
-inflammatory condition of the mucous membranes of the nose and the accessory sinuses
-characterized by edema of the nasal mucous membrane
-caused by one or more viruses, can be complicated by a bacterial infection
-s/s how you 24-48 hours after exposure
thin serous, nasal exudate, productive cough, sore throat, fever, subsides in a week
sonorous wheezes
low-pitched, loud, coarse, snoring sounds.
- caused by air moving through narrowed tracheobronchial passages
- deep running sound may be continuous, loud low, course sound ( like a snore) heard at any point of inspiration or expiration
What are your nursing interventions for tonsillitis?
- provide meticulous oral care-promotes comfort and assists in combating infection
- observe/report if pt swallows frequently-often indication of excessive bleeding
What are the common diets for a patient with an upper respiratory tract infection?
spicy foods,and citrus juices should be avoided
offer fluids
ice pops/cream
carbonated drinks ok if tolerated
What are your nursing interventions to help a patient expectorate?
- assist with coughing, positioning, suctioning and liquidfying secretions
- administer bronchodilators, mucolytics and expectorants to dilate bronchioles, and remove sections
- provide hydration
What is your patient education regarding a patient taking an expectorant?
should not be used by pregnant women
-mix with fruit juice to mask taste
How do you know an expectorant is working effectively for a patient?
able to move secretions
**drugs that increase the bronchial secretion and enhance the expulsion of mucus by air passages of the lungs. This makes it is easier to cough up the phlegm or sputum. Expectorants are used in cough mixtures for chesty coughs.
Which side effects of antihistamines should be educated to a patient?
- changing from one antihistamine to another seasonally may help impede tolerance to any one medication.
- Drowsiness, confusion, dry mouth, constipation, urinary retention, blurred vision, increased viscosity of respiratory secretions.
Nursing Implications:
Avoid use with alcohol or other CNS depressants; avoid driving and other hazardous activities.
subjective data for upper respiratory infection
1
clinical manifestations of a patient with respiratory infections
1
nursing interventions if a chest tube is dislodged or removed
immediately cover the insertion site with dry sterile gauze and notify the provider.
This allows air to escape and reduces the risk for development of a tension pneumothorax.
risk for developing embolus
o Long-term immobility
o Oral contraceptive use and estrogen therapy
o Pregnancy
o Tobacco use
o Hypercoagulability (elevated platelet count)
o Obesity
TB
-chronic pulmonary and extrapulmonary infectious
disease acquired by inhalation of dried droplet nucleus
-only about 10% of infections become active disease
-occurs often in individuals with competent immune systems
-important to differentiate infection with TB from active disease
Clinical Manifestations: TB
fever, wt loss, weakness, productive cough
-later in disease: daily recurring fever with chills, night sweats, hemoptysis
- Assessment TB: Subjective -pt reports loss of muscle strength and weight loss
- Assessment TB: Objective -elevating and recording the amount, color, and characteristics of spututm
TB-diagnostic tests
TB skin test
- chest xray
- sputum specimens
Medical Management: Tb
- isolation
- negative pressure room
- tx is lengthy 6-9 months
- multiple drug therapy
- 1st line drugs are (INH)rifampin and isoniazid (rifamate)
- 2nd line drugs are ethionamide para-aminosalicylate sodium (PAS), cycloserine, capreomycin, kanamycin, amikacin, levofloxacin, ciprofloxacin
TB- N/I
- place in isolation-negative pressure room
- use of high efficiency particulate respiration mask
- instruct patient to cover mouth and nose to cough/sneeze, handwashing, proper disposal of used tissues
- must report sx of hemoptysis, dyspnea, vertigo or chest pain
- pt to maintain adequate fluids and nutrional intake
High-Risk Groups to scan for TB
- HIV pts
- Close contact with TB pts
- silicosis, diabetes, chronic renal failure, weight below 10% of ideal body weight, prolonged corticosteroids, hematologic disorders
- ppl born in country with a high prevalence of TB
- substance abusers
- residents in long-term care facilities
- medically underserved low-income population
- health care workers
QuantiFERON-TB Gold Test
- blood test to aid in the diagnosis of latent
- results 24 hours after blood is collected
asthma
- episodic increased tracheal and bronchial responsiveness to various stimuli, resulting in widespread narrowing of the airways.
- improves either spontaneously or with treatment
- can result from an altered immune response or increased airway resistance and altered air exchange
extrinsic asthma and intrinsic asthma
means it is caused by external factors, such as environmental allergens
intrinsic asthma -is from internal causes, not fully understood but often triggered by respiratory tract infection
NI/Pt. Edu.: Asthma
- administer prescribed medications
- adequate fluid intake
- optimal ventilation
- rest periods
- elevate HOB
- breathing techniques
- correct use of peak flowmeter
Medical Management: Asthma maintenance therapy
acute therapy
Maintenance–>Drugs that prevent attacks are used daily regardless of symptoms
OR- rescue drugs help stop an attack that has already started.
Clinical Manifestations: Asthma
- mild asthma- is manifested by dyspnea on exertion and wheezing, symptoms are usually controlled by medications
- acute asthma- attack usually occurs at night and includes tachypnea, tachycardia, diaphoresis, chest tightness, cough, wheezing, nasal flaring
- ^ anxiety, triggered by external factors
Assessment of Asthma: Objective and subjective
signs of hypoxia, restlessness, inappropriate behavior, increased pulse, ^BP, tachypnea, hunched forward position, wheezing, stringy mucous
Subjective anxiety, fear of suffocation, breathlessness, chest tightness, cough
Diagnostic Test: Asthma
ABGs PFTs Chest xrays Sputum culture CBC
Status Asthmaticus
- unrelenting, life-threatening attack that fails to respond to usual treatment and places the patient at risk for respiratory, failure
- trapped air leads to exhaustion and respiratory failure
proper techniques and eduation for asthma medication
spacers are used To help keep the inhaler further from the mouth and to get that medication into the lung where it needs to go.
- Encourage clients to drink plenty of fluids to promote hydration.
- Encourage clients to take prednisone with food.
- Instruct children to rinse mouth or gargle with warm saltwater after the use of an inhaler.
- Instruct children and their families to watch for redness, sores, or white patches in the mouth, and report them to the provider.
if taking 2 inhaled medications for asthma, how many minutes apart must they be
- Instruct clients to use a bronchodilator inhaler 5 min prior to using an anti-inflammatory inhaler to promote bronchodilation and increased absorption of medication.
side effects of asthma mediations
- Albuterol- Watch clients for tremors and tachycardia.
- Theophylline - Monitor the client’s serum levels for toxicity. Side effects will include tachycardia, nausea, and diarrhea.
- Ipratropium - Observe clients for dry mouth., - Advise clients to suck on hard candies to help relieve dry mouth.
- Teach clients to monitor heart rate.
- Increase water fluid intake to decrease dry mouth and throat irritation.
how does atelectasis lead to pneumonia
Airway inflammation and edema lead to alveolar collapse and increase hypoxemia
- Clients might report shortness of breath and exhibit sings of hypoxemia
- Client might have diminished or absent breath sounds over the affected area.
- A chest X-ray will show an area of density
what causes barrel chest
2- Advise clients to suck on hard candies to help relieve dry mouth.
- Teach clients to monitor heart rate.
- Increase water fluid intake to decrease dry mouth and throat irritation.
commonly used expectorants? nursing education?
1
What are corticosteroids used for?
PREVENTION of an asthma attack
Bronchodilators
- They relax bronchial smooth muscle. NO EFFECT ON INFLAMMATION
SABA (short acting beta agonists):
Albuterol (Proventil, Ventolin). Can stop or reduce life-threatening bronchoconstriction. May cause tachycardia. Via MDI or DPI
LABA (long acting beta agonists):
Salmeterol (Serevent). Slow onset, does not relieve or reverse symptoms. Via MDI or DPI
Cholinergic antagonist:
Iprtropium (Atrovent). Can stop or prevent life threatening bronchoconstriction. Via MDI or DPI
Methylxanthines
- mimics caffeine causing bronchodilation & relaxes smooth bronchial muscle. Used mostly to prevent attacks. NO CAFFEINATED BEVERAGES WHILE USING THIS DRUG.
Theophylline
(p.o). Loading dose to start therapy and achieve a certain level. Must monitor levels to ensure therapeutic. Narrow safe range. Severe side effects. Works similar to caffeine.
Anti-Inflammatories-
Corticosteriods improve bronchial airflow by decreasing inflammation of the mucous membranes in the airway.
NOT BRONCHODILATORS
Fluticasone (Flovent)
via MDI. Must use on a regular basis. Takes 48-72 hrs for effect. Slow onset. Does not relieve or reverse symptoms.
Prednisone (Deltasone)
p.o. Several possible side effects. Reduces all inflammatory responses increasing risk for infection. Possible GI ulcerations, thin skin, easy bruising,
Tuberculosis: Medications - Isoniazid
• Nursing considerations
Monitor for hepatotoxicity and neurotoxicity, such as tingling of the hands and feet.
Administer vitamin B6 (pyridoxine) to prevent neurotoxicity from isoniazid
• Client education
Instruct clients to take medication on an empty stomach.
Advise clients not to drink alcohol while taking isoniazid, because it may increase the risk for hepatotoxicity.
Tuberculosis: Medications - Rifampin
• Nursing considerations
Observe for hepatotoxicity.
• Client education
Inform clients that urine and other secretions will be orange.
Advise clients to report yellowing of the skin, pain or swelling of joints, loss of appetite, or malaise immediately. Inform clients that this medication may interfere with the efficacy of oral contraceptives.
