Lecture 3.1 - Respiratory System Flashcards
What is ventilation?
The mechanical movement of airflow between atmosphere and alveoli - dependent on compliance
Perfusion is the pumping or flow of blood into tissues and organs. What is it dependent on?
Cardiac output - MAP
Gravity
Pulmonary vascular resistance
When someone is intubated the air they breathe bypasses their nose and cilia, what is a danger of this?
Ventilator-associated pneumonia
What organs with be prioritized when perfusion or cardiac output is reduced?
Brain, heart, lungs, and kidneys
What sided-heart failure will lead to pulmonary congestion?
Left-sided
Edema and systemic congestion occurs with right-sided
What is MAP?
Mean arterial pressure - tells us how well the blood is circulating in vessels
S + 2xD / 3
What is the medical term for a nosebleed?
Epistaxis
Epistaxis is most common in which demographics? Why might a person need to go to the hospital for it?
Most common for older persons - especially posterior bleeding
Aspirin, NSAIDS, Warfarin and other blood thinners and any conditions that prolong bleeding time or alter platelet count predispose someone to nosebleeds
Non-humidified oxygen can cause…
Epistaxis
Why do we not humidify oxygen in open systems?
Chance of infection/contamination - droplets
O2 must be humidified in a closed system, like a vent
Why might a person be on Warfarin?
To prevent blood clot formation in atria d/t blood pooling in a-fib.
How can epistaxis be managed?
Place pt in sitting position, leaning forward.
Apply direct nasal compression by pinching entire soft lower portion of nose for 10-15 minutes.
Apply ice compresses to forehead and have pt suck on ice.
Further interventions:
Packing with lidocaine
Epinephrine for vasocontraction
Cauterization
Double-balloon device
What sound would you hear in a person with partial obstruction?
Stridor, wheezing - upper airway blockage
Why might someone develop stridor in the adult population?
Food bolus is most common reason.
Other reasons include: laryngeal edema following extubation, laryngeal or tracheal stenosis, CNS depression, or allergic reaction
What can be done for people with food bolus causing partial airway obstruction without stridor?
Coca-cola - acidic and breaks down food
OR
Nitroglycerin SL to open airway
What might cause abnormal bleeding of a tracheostomy? How can it be managed?
Causes:
Surgery
Erosion of BV
Management:
Monitor bleeding
Notify MD is excessive
What might cause tube dislodgement of a tracheostomy? How can it be managed?
Causes:
Suctioning
Manipulation
Management:
Ensure ties are secure
Obturator and new trach tube at bedside
What might cause an obstructed tubeof a tracheostomy? How can it be managed?
Caused by dried or excessive secretions
Management:
Assess resp status
Suction prn
Humification
trach care
Adequate hydration
What might cause subcutaneous emphysema of a tracheostomy? How can it be managed?
Caused by air escaped from incision to SQ tissues
Managed by monitoring air and reaasuring patient
What might cause tracheoesophageal fistula with a tracheostomy? How can it be managed?
Caused by tracheal wall necrosis
leading to fistula formation
Management:
Monitor cuff pressure
Monitor cough and choking while eating
What might cause tracheal stenosis with a tracheostomy? How can it be managed?
Caused by narrowing of the tracheal lumen d/t scarring
Managed by monitoring cuff pressure, treating infection, and ensuring ties are secure.
What is the maximum time you should suction a patient for during trach care?
Prof says no more than 10 seconds, book says 10-15 seconds.
What are restrictive pulmonary diseases?
Problem with inflow of air
What are obstructive pulmonary diseases?
Problem with outflow of air
What are some causes of restrictive pulmonary disorders?
decreased functioning alveoli, lung tissue loss d/t lobectomy or cancer, external issues such as morbid obesity.
What is hypoxemia?
Low oxygen in blood
What is hypoxia?
Low oxygen in tissue
What are some clinical manifestations of restrictive pulmonary disorders?
Tachypnea, decreased tidal volume, chest pain or discomfort (heaviness), fatigue, history of weight loss
Why might a history of weight loss be associated with restrictive pulmonary disorders?
The energy needed to breathe burns calories - rule out cancers first
What is TV or Vt?
Tidal volume is air volume of each breath
What is IRV?
Inspiratory reserve volume is the maximum volume that can be inhaled after a normal inhalation
What is ERV?
Expiratory reserve volume is the maximum volume exhaled after a normal exhalation
What is the VC?
Vital capacity is the maximum volume of air exhaled from a maximal inspiration, VC = TV + IRV + ERV
How are peak flow tests used?
3 times before puffer + 3 times after puffer in those with asthma
used to determine efficiency of bronchodilator/inhaler
What is hospital acquired pneumonia (HAP)? What kind of bacteria usually causes it?
Nosocomial infection
Pseudomonas, enterobacter staphaureus, MRSA
What is ventilator associate pneumonia (VAP)?
Pneumonia d/t ventilation
We can prevent this with a closed system, suction only when required. Brushing teeth/oral care every few hours while awake. Use sterile technique during care.
What is Health care-associated pneumonia?
Associated with LTC facilities
What is community-acquired pneumonia? What medication is given for it? What bacteria are associated with it?
Also called walking pneumonia, usually doesn’t require hospitalization.
Biaxin (clarithromycin) - regimen lasts 3 days and stays in system long term.
Streptococcus pneumoniae, MRSA
What is pneumonia?
Inflammation of lung tissue causing consolidation of exudate
Caused by bacteria, viral, or aspiration.
Who is at risk for pneumonia?
Age 65+, recent abd or thoracic surgery, altered LOC, prolonged immobility.
What are some signs of pneumonia?
Tachypnea, productive cough, pleuritic pain, crackles & decreased breath sounds, dullness on percussion mental status changes, abrupt onset fever, cyanosis, ABG analysis indicates hypoxemia.
