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MedSurg > Lecture 3.1 - Respiratory System > Flashcards

Lecture 3.1 - Respiratory System Flashcards

1
Q

What is ventilation?

A

The mechanical movement of airflow between atmosphere and alveoli - dependent on compliance

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2
Q

Perfusion is the pumping or flow of blood into tissues and organs. What is it dependent on?

A

Cardiac output - MAP
Gravity
Pulmonary vascular resistance

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3
Q

When someone is intubated the air they breathe bypasses their nose and cilia, what is a danger of this?

A

Ventilator-associated pneumonia

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4
Q

What organs with be prioritized when perfusion or cardiac output is reduced?

A

Brain, heart, lungs, and kidneys

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5
Q

What sided-heart failure will lead to pulmonary congestion?

A

Left-sided

Edema and systemic congestion occurs with right-sided

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6
Q

What is MAP?

A

Mean arterial pressure - tells us how well the blood is circulating in vessels

DP + 1/3 (PP)

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7
Q

What is the medical term for a nosebleed?

A

Epistaxis

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8
Q

Epistaxis is most common in which demographics? Why might a person need to go to the hospital for it?

A

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

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9
Q

Non-humidified oxygen can cause…

A

Epistaxis

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10
Q

Why do we not humidify oxygen in open systems?

A

Chance of infection/contamination - droplets

O2 must be humidified in a closed system, like a vent

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11
Q

Why might a person be on Warfarin?

A

To prevent blood clot formation in atria d/t blood pooling in a-fib.

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12
Q

How can epistaxis be managed?

A

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

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13
Q

What sound would you hear in a person with partial obstruction?

A

Stridor, wheezing - upper airway blockage

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14
Q

Why might someone develop stridor in the adult population?

A

Food bolus is most common reason.

Other reasons include: laryngeal edema following extubation, laryngeal or tracheal stenosis, CNS depression, or allergic reaction

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15
Q

What can be done for people with food bolus causing partial airway obstruction without stridor?

A

Coca-cola - acidic and breaks down food
OR
Nitroglycerin SL to open airway

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16
Q

What might cause abnormal bleeding of a tracheostomy? How can it be managed?

A

Causes:
Surgery
Erosion of BV

Management:
Monitor bleeding
Notify MD is excessive

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17
Q

What might cause tube dislodgement of a tracheostomy? How can it be managed?

A

Causes:
Suctioning
Manipulation

Management:
Ensure ties are secure
Obturator and new trach tube at bedside

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18
Q

What might cause an obstructed tubeof a tracheostomy? How can it be managed?

A

Caused by dried or excessive secretions

Management:
Assess resp status
Suction prn
Humification
trach care
Adequate hydration

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19
Q

What might cause subcutaneous emphysema of a tracheostomy? How can it be managed?

A

Caused by air escaped from incision to SQ tissues

Managed by monitoring air and reaasuring patient

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20
Q

What might cause tracheoesophageal fistula with a tracheostomy? How can it be managed?

A

Caused by tracheal wall necrosis
leading to fistula formation

Management:
Monitor cuff pressure
Monitor cough and choking while eating

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21
Q

What might cause tracheal stenosis with a tracheostomy? How can it be managed?

A

Caused by narrowing of the tracheal lumen d/t scarring

Managed by monitoring cuff pressure, treating infection, and ensuring ties are secure.

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22
Q

What is the maximum time you should suction a patient for during trach care?

A

Prof says no more than 10 seconds, book says 10-15 seconds.

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23
Q

What are restrictive pulmonary diseases?

A

Problem with inflow of air

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24
Q

What are obstructive pulmonary diseases?

A

Problem with outflow of air

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25
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.
26
What is hypoxemia?
Low oxygen in blood
27
What is hypoxia?
Low oxygen in tissue
28
What are some clinical manifestations of restrictive pulmonary disorders?
Tachypnea, decreased tidal volume, chest pain or discomfort (heaviness), fatigue, history of weight loss
29
Why might a history of weight loss be associated with restrictive pulmonary disorders?
The energy needed to breathe burns calories - rule out cancers first
30
What is TV or Vt?
Tidal volume is air volume of each breath
31
What is IRV?
Inspiratory reserve volume is the maximum volume that can be inhaled after a normal inhalation
32
What is ERV?
Expiratory reserve volume is the maximum volume exhaled after a normal exhalation
33
What is the VC?
Vital capacity is the maximum volume of air exhaled from a maximal inspiration, VC = TV + IRV + ERV
34
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
35
What is hospital acquired pneumonia (HAP)? What kind of bacteria usually causes it?
Nosocomial infection Pseudomonas, enterobacter staphaureus, MRSA
36
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.
37
What is Health care-associated pneumonia?
Associated with LTC facilities
38
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
39
What is pneumonia?
Inflammation of lung tissue causing consolidation of exudate Caused by bacteria, viral, or aspiration.
40
Who is at risk for pneumonia?
Age 65+, recent abd or thoracic surgery, altered LOC, prolonged immobility.
41
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.
42
What does white frothy sputum indicate?
pulmonary edema
43
What is the different between dyspnea and shortness of breathe?
Dyspnea is quantifiable - 1,2,3 words.
44
Why is viral pneumonia so hard to diagnose?
Absence of bacteria, harder to test for.
45
What might cause aspiration pneumonia? How soon after aspiration of gastric secretions leads to pneumonia how soon afterwards?
Inability to protect airway and prevent aspiration d/t OD, neuromuscular diseases, seizures, dysphagia, feeding tube Pneumonia presents 47-72 hours after aspiration
46
What causes opportunistic pneumonia?
P. jirocevi opportunistically attacks the lungs and is found in 70% of HIV-infected individuals. Most common opportunistic infection in Pts with AIDS Symptoms include non-productive cough, tachypnea, fever.
47
When is the best time of day to do a sputum culture?
First thing in the morning - before eating anything
48
Why is a WBC differential important?
Lymphocytes, neutrophiles, basophils. Tells us if its bacterial or viral, reason for WBC elevation
49
How much should a person with pneumonia be drinking?
More than 3L (8 glasses) a day.
50
How is pneumonia treated?
Increased fluid (at least 3L a day) Limited activity and rest Antipyretics Analgesics Oxygenation (if indicated) Antibiotic regimens --> Early intervention is key for favored patient outcomes --> Blood cultures first
51
What is chronic bronchitis?
Chronic sputum with cough production on a daily basis for a minimum of 3/months a year
52
What are some indications of chronic bronchitis?
Chronic hypoxemia/cor pulmonade Increased mucus production and bronchial wall thickness (obstructs air flow) CO2 retention leads to acidosis and therefore reduced responsiveness of respiratory center to hypoxemic stimuli.
53
What is emphysema?
Abnormal enlargement of the air spaces distal to the terminal alveolar walls (barrel chest) Causes reduced surface area for gas exchange, increased air trapping, decreased capillary network, and increased work for o2 consumption.
54
What are the restrictive pulmonary disorders?
Restrictive disorders prevent inflow of air --> pneumonia
55
What are the obstructive pulmonary disorders?
Prevents the outflow of air Characterized by air becoming trapped in alveoli or increased lung compliance with poor elastic recoil --> Asthma --> COPD
56
What are triggers for asthma?
Allergens, exercise, resp infection, cold dry air, GERD, medication
57
What are symptoms of asthma?
Wheezing, SOB, cough, chest tightness that is intermittent and worse at night and in the early morning
58
What nursing diagnoses are associated with asthma?
anxiety and inadequate airway clearance.
59
How is asthma managed?
Establishing a confirmed diagnoses and establish continuous assessment and monitoring of asthma control and severity.
60
What is the blue puffer for asthma?
Ventolin - short acting b2 agonist (Bronchodilator)
61
What is the green asthma puffer?
A combination inhaler (corticosteroid and long acting B2 agonist)
62
How long should you wait before puffs on inhalers?
30 seconds between puffs, 5 minutes between different medications
63
What is the orange asthma inhaler?
A corticosteroid --> can cause oral thrush (oral hygiene, spacer)
64
What order should asthma puffers be used in?
Blue, green, and then orange. (or just blue and orange)
65
What is obstructive asthma (Status asthmaticus)? What physiological changes are associated with it?
extreme episodic exacerbation, life threatening due to airway obstructions. Only asthma related complication that can result in permanent remodeling of airways. --> Inflammation causing narrowing of the airway --> Hyper-responsiveness to irritants: bronchospasm and mucous plugging)
66
What are the symptoms of status asthmaticus?
Pulses paradoxus of 25 mmHg or greater Significant lung hyperinflation Hypoxemia with or without hypercapnia Absence of breath sounds or sudden cessation of wheezing
67
What is COPD?
Respiratory disorder caused by smoking or other noxious particles and gases, characterized by persistent airflow limitation. Bronchioles lose their shape and become clogged with mucous. Usually progressive and associated with enhances chronic inflammatory response in the airways and the lung.
68
Bronchitis will look and sound like what?
Right-sided HF, cyanosis, distended neck veins Hear crackles on inhalation, rhonchi, expiratory wheezes
69
What does emphysema look and sound like?
Looks like pursed lip breathing, non cyanotic and thin Sounded like distant, quiet breath sounds, wheezes.
70
What are the steps on huff coughing? Who can it help?
1. Patient sits in chair with feet on floor and forearms supported by pillow 2. Patient drops head and bends forward while using slow pursed-lip breathing 3. Sit up again, pt uses diaphragmatic breathing to inhale slowly and deeply 4. Repeat steps 2,3 another three to four times to facilitate movement of secretions 5. Take deep abdominal breath, bend forward, then cough 3-4 times in exhalation. Helpful for pts with COPD or other obstructive disorders.
71
What are some priorities when caring for a pt with COPD?
Take care not to abolish hypoxic drive for effective breathing with O2 (titrate) Monitor for S/S of fluid overload Orthopneic position Teach pursed lip breathing
72
How many L of oxygen should you hook up to a bag mask?
10-12.
73
What surgical therapy is available for COPD?
Lung volume reduction surgery, lung transplant
74
What is the key therapy for COPD?
Nutrition --> High calorie, high protein Pulmonary rehab programs --> Pursed lip breathing & effective coughing
75
What causes TB? How is it spread?
Mycobacterium tuberculosis
76
Which populations are usually impacted by TB?
Underserved groups, minorities, first nations and Inuit people. Those living in close quarters.
77
What will be seen in an assessment of a TB patient?
Low grade fever, pallor, chills, night sweats, easily fatigued, anorexia, weight loss
78
Which drug used to treat TB causes GI disturbances and orange discoloration of body fluids?
Rifampin
79
What is CF?
An autosomal recessive, multisystem disease characterized by altered function of the exocrine glands involving primarily the lungs, pancreas, and sweat glands --> abnormally thick, abundant secretions lead to chronic diffuse obstructive pulmonary disorder in almost all patients (chronic sinus and lung infections, leading to progressive accumulation of damage) --> Exocrine pancreatic insufficiency (malnutrition, vitamin deficiency, secondary diabetes) --> Sweat glands excrete increased Na and Cl
80
What are the diagnostic tests for CF?
Sweat chloride tests, characteristic respiratory or GI symptoms
81
How long a day do CF patients require management and treatment?
2 hours a day performing chest physiotherapy, and 1 hour receiving nebulized medications.
82
What is a lobectomy?
Removal of a lobe in lung
82
What is a pneumonectomy?
Removal of a lung (12% risk of mortality)
83
What is a wedge resection?
Remove a triangle-shaped slice of tissue, used to remove tumors.
84
What is a segmentectomy?
Removal of part of the a lobe to remove tomor.
85
Which side do patients with a pneumonectomy have to lie on?
Must not be turned onto side of unaffected lung --> Can cause compromised respiratory status and build up of fluid in lungs
86
What is a pneumothorax?
Presence of air in the pleural lungs
87
Who is at risk for spontaneous pneumothorax?
Underweight male cigarette smokers between 20-40 years old.
88
How is pneumothorax tested for?
Chest x ray
89
What is the purpose of a chest tube?
They are inserted into the pleural space to remove air and fluid, allowing the lung to re-expand.
90
What are the three compartments of a chest collection drainage system?
Collection Chamber --> Air and fluid are collected from pleural or mediastinal space --> Fluid remains and air is vented to the second compartment Water Seal Chamber --> Contains 2 cm of water to prevent backflow (acts as a 2 way valve) --> Fluid should move upward with each inspiration and downward with each expiration (tidaling) Suction Control Chamber --> Water suction to aid in draining chest --> Dry suction provides effective level of vacuum
91
What are some important things to note when takin care of a patient with a chest tube?
Keep water level above 2cm. Keep unit lower than client's head Suction at 20mmHg
92
What is closed pneumothorax?
One with no associated external wound, most common kind of spontaneous pneumothorax
93
What is an open pneumothorax?
Air enters pleural space through opening in chest wall. Often called a sucking chest wound.
94
What is a tension pneumothorax?
Caused by rapid accumulation of air in pleural space causing high intrapleural pressure and tension of heart and great vessels. Can result from an open or closed pneumothorax.
95
What is a hemothorax?
Accumulation of blood in intrapleural space.
96
What are COPD risk factors?
Infection Smoking or other pollutants AAT deficiency Age - thoracic cage stiffens with age
97
What is cor pulmonade?
Hypertrophy of right side of heart, with or w/o HF Often seen in those w COPD
98
What medication for tuberculosis can cause red-green colour blindness, also known as retrobulbar neuritis?
Ethambutol hydrochloride
99
What does bubbling in a chest tube indicate?
Air still in the pneumothorax, or an air leak in the system.
100
What is terbutaline? Who is it used for? What else is it known as
Short acting bronchodilator (B-agonist) used in COPD aka Bricanyl and Brethine
101
Which bronchodilators are used in people with COPD?
Salbutamol --> Albuterol, Proventil, Apo-Salvent, Ventolin Terbutaline --> Bricanyl, Brethine Bitolterol --> Tornalate Salmeterol Xinafoate (long-acting) --> Serevent
102
What is the orthopneic position?
Tripod position

MedSurg (14 decks)

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