Fund 51 - ch 17 Flashcards
crackles (inhale crac, but not all at once)
nonmusical, discontinuous popping during inspiration
hemoptysis
hemoptysis - blood from respiratory
larnyx
watchdog of lungs. protects from foreign substances.
parietal pleura
parietal pleura - lines thoracic cavity, lateral wall of mediastinum, diaphragm, and inner aspects of ribs.
mediastinum
mediastinum - all thoracic tissue outside of lungs, ie heart, thymus, aorta and vena cava, esophagus.
3 types of alveoli
alveoli - 3 types. type 1 and 2 are the epithelium. type 1 is 95% of surves and is a barrier btw air and alveolar surface. type 2 is 5% and produces type 1 cells and surfactant. 3rd type is alveolar macrophages.
respiration
after capillary exchange, blood enters venous circulation and goes to pulmonary circulation. O2 in blood in capillaries is lower than in the alveoli. O2 then diffuses from alveoli to blood. Co2 the other direction.
respiration definition
gas exchange btw atmospheric air and blood and blood and cells.
inspiration during first
third of respiration cycle, expiration during latter 2/3.
tidal volume
500 mL - may not vary even with severe disease.
inspiratory reserve volume USE your reserve - (inspired but reserved by the movie 3000)
- 3000 mL. max volume of air that can be inhaled.
expiratory reserve volume (she expired at 11 and went to heaven)
- 1100 mL - max that can be forceably exhaled.
residual volume (cindella was just residual)
1200 mL - air remain gin in lungs after max exhalation
vital capacity (it is vital to take it all 46)
4600 mL - max exhaled from point of max inspiration.
inspiratory capacity (my inspiration maxed out at 35)
- Inspiratory capacity is the sum of tidal volume plus inspiratory reserve volume.
functional residual capacity (not functioning at 23)
2300 mL - air remaining in lungs after normal expiration
total lung capacity (totally inspiring at 58)
5800 mL - air in lungs after max inspiration.
pulmonary is considered low or high pressure?
low pressure
perfusion is influenced by
alveolar pressure.
severe hypoxia occurs when shunting exceeds
20%
PAO2 is
this pressure ensure diffusion of O2 access the alveolar.
he higher the PaO2, the greater the amount of
O2 dissolved. therefore the amount of dissolved O2 is directly proportional to the parietal pressure
patterns of perfusion are determined (the pattern of art, gravity and alveoli)
artery pressure, gravity and alveolar pressure.
oxygen saturation - 150 mm Hg
hemoglobin is 100% saturated.
VQ (and what are the states)
V/Q - ventilation perfusion ratio. different in different parts of the lungs.
V/Q states are: normal, low, high and silent.
oxyhemoglobin dissociation curve (is the curve oxygenated)
shows relationship btw partial pressure of oxygen and % of saturation of oxygen. % of sat. can be affected by CO2, hydrogen ions, temp.
oxyhemoglobin dissociation curve - shift to the right (right is less)
increase shifts curve to the right, thus less oxygen is picked up by lungs, but more is related to the tissues, if PaO2 is unchanged.
oxyhemoglobin dissociation curve - shift to the left (heme takes oxys then exits left)
a decrease causes a shift to the left, making bond btw oxygen and hemoglobin stronger.
advantage is if PaO2 decrease from 100 to 80, hemoglobin of arterial blood is still saturated at 94%.
breathing in and out controlled by
medulla oblongata and pons controls rate and depth of ventilation
central chemoreceptors in medulla respond to (chemo cerebro)
chemical changes in cerebrospinal fluid, which results from chemical changes in blood. the receptors respond to change in pH and then tell lungs to change depth and and then rate
peripheral chemoreceptors located in
aortic arch and carotid respond first to PaO2, then partial pressure of carbon dioxide and ph.
mechanoreceptors in lungs respond to changes in (the lungs are resistant to change)
resistance by altering breathing patterns.
at 50, alveoli lose elasticity. dead space increases.
acute lung disease causes
more sever grade of dyspnea than chronic diseases.
COPD = wheezing on expiratory or inspiratory? (COPD weezy out the door)
COPD = wheezing on expiratory. (out the door with COPD)
tumor - type of breathing (tumors are loud)
noisy breathing
laryngotracheitis - high or low cough (larry has a high pitched cough)
high pitched cough
sever or changing cough -
bronchogenic carcinoma
bad breath and foul smelling is (bad arms)
lung abscess
pleuritic pain is
sharp and seems to catch. tabbing. pt more comfortable with ethey all on affected side bc it splints the chest wall.
wheezing - heard on inspiration or expiration? You knew this one…
high pitched continous, heard on inspiration and expiration.
asthma - inspiration or expiration? (she expired from asthma)
expiration
bronchitis - inspiration or expiration? (inspired by bronchitis)
inspiration
hemoptyosis symptoms
initial symptoms include tickling in throat, salty taste, burnin or bulling in chest, and maybe chest pain. it has a pH higher than 7.
blood from stomach is
vomited and usually much darker, looks like coffee grounds. the pH is less than 7.
patients with anemia
early develop cyanosis, and pts with polycythemia (high RBCs) may appear to cyanotic but they have enough O2.
funnel chest
funnel chest - depression in lower sternum. may compress heart causing murmurs. occurs with rickets
kyphoscoliosis
kyphoscoliosis - elevation of scapula and corresponding S-shaped spine. occurs with osteoporosis.
cheyne-stokes (cheyenne - many mountains, and then nothing)
cheyne-stokes - rate and depth increase, then apnea. heart failure, drugs, tumor, trauma.
biot’s (don was normal, and then he stopped)
biot’s - normal breathing, 3-4 breaths, and periods of apnea. also called ataxic breathing. respiration depression from drug overdose and brain injury.
obstructive - (obstruct CABs)
obstructive - long expiratory - airway narrowing - asthma, COPD, and bronchitis.
tactile fremitis with emphysemia and also pneumonia (emphsyma is fizzled out)
pts with emphasema have no fremitus . pneumonia has fremitus over the whole lobe.
percussion - normal and also with fluid (fluid is dull)
percussion - normal lung sound should be resonance. dullness with fluid or solid tissue. usually start at posterior
bronchial sounds audible anywhere except over main broncus signifies
pathology.
pts with pneumonia or pulmonary edema may
cause bronco phony - more intense and clear, or egophony - distorted, ask patient to repeat the letter E.
vesicular (high to low)
vesicalur - inspiration sounds that last longer than expiration. low.
bronchiovesicular -
inspiration and expiration the same. sound is intermediate.
bronchial
bronchial - expiration longer. high and loud.
tracheal
tracheal - inspiration and expiration are equal. very loud and high.
coarse crackles (of course crac early but more in the evening)
coarse crackles - popping heard in early inspiration and throughout expiration. harsh.
fine crackles (fine hair in the morning) and what disease
fine crackles - soft, high pitched, disoncounous and heard in late inspiration. hair rubbing together. (fine hair) pneumonia.
left sided heart failure - what sound? (left failure cracks me up)
left sided heart failure - congestion and edema. inspiratory crackles.
atelectasis - lung sound
atelectasis - sounds absent.
tidal volume - can be measured with a
spirometer. measure several breaths for accuracy
tidal volume X respiratory rate =
minute ventilation, the volume of air exchanged per minute. can detect respiratory failure. measured using a spirometer.
vital capacity pt test - how fast?
vital capacity - have patient take in maximal breath and exhale through spirometer. most ppl can exhale 80% in 1 second and all in 3 seconds.
inspiratory force - measured how (man, my inspiratory is bad)
inspiratory force = effort the patient is making during inspiration. useful for unconscious patients. measured with a manometer.
pulmonary function tests (PFT)
pulmonary function tests (PFT) used in pts with chronic respiratory disorders. used for coal miners and exposure to asbestos. used prior to thoracic and upper abdominal surgery, obese.
forced vital capacity reduced in what disease? (think, can’t blow out)
forced vital capacity - reduced in COPD
forced expiratory volume -
forced expiratory volume - air exhaled during specific time - valuable clue to the severity of expiratory airway obstruction
ratio of timed forced expiratory volume to forced vital capacity -
ratio of timed forced expiratory volume to forced vital capacity - presence or absence of airway obstruction.
forced expiratory flow - the mean is between (blow out at 200)
200 and 1200 mL. indicates large airway obstruction.
forced midexpirtory flow - (mid is not full)
forced midexpirtory flow - slowed in small airway obstruction
forced-end expiratory flow - mean forced expiratory
forced-end expiratory flow - mean forced expiratory during terminal portion of FVC - slowed in obstruction of smallest airway
maximal voluntary ventilation (max exercises)
maximal voluntary ventilation - air expired in specific period during repetitive maximal effort - measures exercise tolerance
VBG (veggies take the 02 home)
VBG is the balance bwtn amount of oxygen used by tissues and organs and amount of oxygen returning to the right side of heart. obtained form venous circulation.
pulse oximetry - disadvantage
pulse oximetry - disadvantage - can’t detect hyperoxemia.
end tidal carbon dioxide -
end tidal carbon dioxide - measures partial pressure of CO2 at end exhalation. considered reliable. can indicate early respiratory depression and impaired airway function. antacids or sodium bicarbonate can give false results with ETCO2.
sputum samples usually taken at what time of day?
early morning before eating or drinking anything. if patient can’t cough, use nebulizer.
CT (CT is fine)
CT - provides cross sectional view of chest. X-ray shows contrast, while CT shows fine tissue density. can be used to show pulmonary nodules and small tumors. can’t use contrast dye if allergic to iodine or shellfish, kidney malfunctions, pregnant, clausterphobic, or obese.
CT Scan nursing interventions
will be less than 30 min. pt needs to stay 4 hours prior to exam if contrast is needed.
pulmonary angiography -
pulmonary angiography - used to find congenital abnormalities in pulmonary. it has replaced CT scan of chest. do not eat or dry for 4 hours, meds - anti anxiety, secretion reducing agents and antihistamines. may feel warm flush. after, monitor vital signs and bleeding.
MRI
MRI - can distinguish abnormal tissue better than CT. used for pulmonary nodules, can stage bronchogenic carcinoma, inflammatory activity, PE, pulmonary hypertension. contraindication, all and including metal implants.
radioisotope diagnostic procedure (lung scan) - (radio is radiation)
radioisotope diagnostic procedure (lung scan) - assesses lung functions. inject dye into veins. nursing interventions - requires radiation precautions, instruct pt to avoid caffeine, alcohol and tobacco 24 hrs prior. need an empty bladder, may insert catheter. encourage fluid after procedure to eliminate radioisotopes.
thoracoscopy
thoracoscopy - pleural cavity is examined and fluid and tissues obtained. done in operating room under anesthesia. used for pleural effusions and tumors.
inspiration or expiration shorter
inspiration shorter than expiration. 500 ml in a normal breath.
bronchi - right is
wider and shorter, it increases aspiration on right side.
bronchioles divide into
terminal bronchioles down to alveoli.
thorocentisis is done where in the body?
the pleural space.
what nerve stimulates diaphragm?
phrenic nerve
pursed lip breathing is what type of breathing? (forcing my pursed lips to expire)
forced expiration (which is usually passive)
concentration of O2 is always higher in
alveoli so it diffuses to RBC.
CO2 is always higher in
RBC.
decreased cardiac output -
perfusion problem
anaphalysis
anaphalysis - massive inflammation and leaking of capillaries into lung - pulmonary edema
sepsis
sepsis - distributive shock, pressure changes and capillaries leak, lungs fill with fluid
age related changes that are normal (mom driving)
age related changes: these are normal. structural changes - stiffening of thoracic, decrease in height, kyphosis, compliance is decreased. increased residual volume. muscle changes - decreased strength of diaphragm and intercostals. tissue changes - decrease in elasticity = decreased vital capacity. reactivity of airway - is increased - more reactive airway, they have a delayed reaction to bronchodilators. gas exchange - depressed cough reflex. immune changes - increase in nuetrophils (caused chronic inflammatory) and decrease in macrophages.
V/Q - if dead space, there
is high V/Q mismatch. air is getting in, but what is perfused doesn’t match. low V/Q with pneumonia.
cancer
cancer, short of breath lack of appetite
tactile fremitis. percussion - hyper resonance
the lung has collapsed.
how to document respiratory (CDFA - resp is a complete downer, FA)
normal, respiratory compromise, respiratory distress, respiratory failure, respiratory arrest.
how to document asthma (RRED)
asthmas - rate, rhythm, effort, depth.
PASTE
PASTE - provoking factors, associated chest pain, sputum production, tireness/time, exercise tolerance.
increase in total lung capacity
COPD. decrease = pulmonary fibrosis, sarcodosis.
decrease in forced vital capacity - and what about age????
decrease in forced vital capacity - COPD, pulmonary fibrosis, sarcodosis, gravis. aged related.
total lung capacity - number
6000
Normal inspiratory pressure is approximately
100 cm H2O. less than 25 cm usually requires mechanical ventilation minute ventilation (MV)
Volume of air moved in and out of the lungs in one minute.
Normal MV is 5-8 liter.
RR x tidal volume =
Minute Ventilation 12 X 500 mL – 6,000 mL (6 liters)
if volume goes up
rate goes down. if rate goes up, volume goes down
3 main components of respiratory assessment -
3 main components of respiratory assessment - airway, oxygenation, and ventilation
low oxygen concentration is
< 60 mmHg, or SaO2 < 90%.
signs of hypoxemia = (emia snores)
signs of hypoxemia = mental status most important and quick. SOB, difficultly breathing. audible snoring or stridor (narrow trachea) restless. cyanosis. nasal flaring. open mouth breathing, tripod, purse lips.
decreased O2 - causes - and what about the thyroid?
decrease O2 = Hypoventilation, hypothermia, sedation, neuromuscular blocking agents, anesthesia, hypothyroidism, inactivity.
heart beats faster when O2 level is
low, increased RR.
oxygen toxicity
doesn’t usually occur until its over 50% for 24 hours. frequent headaches, anxiety, cyanotic (blue) lips or fingernails, drowsiness, confusion, restlessness, slow, shallow, difficult, or irregular breathing
In cases of carbon monoxide inhalation
the oxygen saturation can be falsely elevated
nasal cannula (up by 4 with cannula)
nasal cannula - 1L = 24%
2L = 28%
3L = 31%
4L = 35%
5L = 40%
6L = 44%
if O2 is 92%, start with
2 liters
how much is shunting? (started shunting at 5, yikes)
5%
simple face mask - min and max L and what % (keep it simple at 5 and 30)
Creates an additional reservoir; delivers 30-50%, minimum liter flow is 5L/min and maximum is 10L/min.
low flow mask (stay low, don’t go above 10 or 60)
Face mask with reservoir/non-rebreather mask: delivers 60% oxygen at 10L/min flow and is the highest concentration of the low-flow systems. keep flaps patent.
low flow mask precautions
“close to 100% oxygen” contained therein Must have at least 10L flow ,reservoir bag must be 1/2 to 3/4 inflated
high flow mask - how many L minimum?
10 L minimum
positive pressure ventilation - bag valve mask (BVM) Bag-Valve Mask Indications. (bags are the highest)
Connect to oxygen source at 15L/min flow rate. Position patient supine. Perform basic airway maneuvers (head-tilt chin-lift or modified jaw thrust). Suction if necessary. I
positive pressure ventilation mask instructions - how often, breath sounds, and what tests?
Adult: one breath every 5-8 seconds . Do not hyperventilate. Assess breath sounds, skin, etc and ABG to determine effectiveness. you’re delivering 21% room air. we expire 17% o2. make sure to hear breath sounds on both sides. they will do a blood gas.
pneumothorax
pneumothorax - lung collapse
CPAP - don’t go above what? And RR needs to be what before we use it?
CPAP - we can open alveoli using CPAP and push fluid. this lowers the amount of O2 needed bc we’ve created more surface area. pt needs to be spontaneously breathing. need to be alert enough to protect airway. need to be able to take mask off. don’t go above 10. the higher the pressure, the less cardiac output. pt should have resp rate of greater than 25/min. should have signs of early respiratory failure.
CPAP used for
Congestive heart failure, Pulmonary edema, COPD, Asthma, Pneumonia
Sleep apnea, Hypercapnic respiratory failure
CPAP HOB
45%
O2 tank
make sure more than half full. replace tanks under 500 psi. under 200 psi is critical. tell pt not to smoke near them.
acute pharyngitis are caused by which of the following - viral or bacterial?
viral
