Lecture 4 Flashcards
Upper respiratory tract
Lower respiratory tract
Chest wall
Structures of the Respiratory System
________ reduces fluid accumulation and keeps the airways dry by reducing surface tension
Surfactant
Elastic recoil and compliance
Ventilation
Oxygen–hemoglobin dissociation curve
Diffusion
test measures the oxygen and carbon dioxide levels in your blood as well your blood’s pH balance
Arterial blood gases
Ability to carry oxygen in our body
Oxygen delivery
Captures blood from the superior and inferior vena cavae and the coronary sinus to reflect a true mixture of all of the venous blood coming back to the right side of the heart
Mixed venous blood gases
(PaCO2)
Partial Pressure of Carbon Dioxide
Oxygen saturation is a crucial measure of how well the lungs are working
Oximetry
Control of respiration
Chemoreceptors
Mechanical receptors
Filtration of air
Mucociliary clearance system
Cough reflex
Reflex bronchoconstriction
Alveolar macrophages
Respiratory defence mechanisms
↓ Response to hypoxemia
↓ Response to hypercapnia
Age Related Changes: Respiratory control
↓ Elastic recoil
↓ Chest wall compliance
↑ Anteroposterior diameter
↓ Functioning alveoli
Age Related Changes: Structure
↓ Cell-mediated immunity
↓ Specific antibodies
↓ Cilia function
↓ Cough force
↓ Alveolar macrophage function
Age Related Changes: Defense mechanisms
Blood studies
Oximetry
Sputum studies
Skin tests
Diagnostic studies of Respiratory System
Radiological studies:
Chest x-ray
Computed tomography (CT)
Magnetic resonance imaging (MRI)
Ventilation–perfusion scan
Pulmonary angiography
Positron emission tomography (PET)
Diagnostic studies of Respiratory System
Endoscopic examinations
Bronchoscopy
Mediastinoscopy
Lung biopsy
Thoracentesis
Pulmonary function tests
Exercise testing
Diagnostic studies of Respiratory System
__________ from birth or trauma can result in altered air flow through the nasal passage. Individuals can have troubles breathing through their nose which can result in mouth breathing and problems snoring at night. Individuals who have are prone to epistaxis and sinusitis ( caused form decreased or blocked mucus drainage from the sinus cavities).
Deviated septum
trauma
can result in complications such as a meningeal tear (causing a csf leak), airway obstruction, epistaxis and deformity.
Nasal Fracture
Nosebleed
Occurs in all age groups, especially in children (anterior bleeding) and older adults (most commonly posterior bleeding)
Causes: Trauma, foreign bodies, nasal spray abuse, street drug use, anatomical malformation, allergic rhinitis, dry air, tumours, alcohol use
Aspirin, NSAIDs, and conditions prolonging bleeding time or altering platelet counts predispose clients
Epistaxis
Keep the client quiet
Place in a sitting position, leaning forward - head and shoulders elevated
Apply direct pressure to entire lower portion of the nose (10-15 min)
Apply ice to forehead - have client suck on ice
Apply digital pressure if bleeding continues
Obtain medical assistance if bleeding doesn’t stop
Management of Epistaxis
Allergic rhinitis
Acute viral rhinitis
Influenza
Sinusitis
Inflammation and Infection of the Nose and Paranasal Sinuses
Reaction of the nasal mucosa to a specific allergen
Clinical manifestations
Nasal congestion; sneezing; watery, itchy eyes and nose; altered sense of smell; thin, watery nasal discharge
Nasal turbinates appear pale, boggy, and swollen
Chronic exposure to allergens: Headache, congestion, pressure, postnasal drip, nasal polyps
Patient may complain of cough, hoarseness, snoring, or recurrent need to clear the throat.
Allergic rhinitis
Identify and avoid triggers of allergic reactions.
Drug therapy: Nasal sprays, leukotriene receptor antagonists (LTRAs), antihistamines, and decongestants to manage symptoms
Intranasal corticosteroid and cromolyn sprays (decrease inflammation locally)
Provide instructions on proper use of nasal inhalers (they can cause rebound effect from prolonged use).
Immunotherapy (allergy injections) may be used if drugs are not tolerated or are ineffective.
Involves controlled exposure to small amounts of a known allergen through frequent (at least weekly) injections with the goal to decrease sensitivity
Management of allergic rhinitis
Common cold or acute coryza
Caused by viruses that invade the upper respiratory tract; spread by airborne droplet sprays emitted while breathing, talking, sneezing, or coughing or by direct hand contact
Nursing and collaborative management
Supportive therapy such as rest, fluids, proper diet, antipyretics, and analgesics
Acute Viral Rhinitis
Clinical manifestations
Onset abrupt; systemic symptoms of cough, fever, myalgia, headache, sore throat
In uncomplicated cases, symptoms subside within 7 days; older adults may experience persistent weakness or lassitude that persists for weeks
Most common complication: Pneumonia
Nursing and collaborative management
Hand hygiene
Influenza vaccination
Supportive measures
Influenza
Clinical manifestations
Acute: Significant pain, purulent nasal drainage, nasal obstruction, congestion, fever, malaise
Chronic: Facial pain, nasal congestion, increased drainage; severe pain and purulent drainage are often absent
Symptoms may mimic those seen with allergies.
Difficult to diagnose because symptoms may be nonspecific; client is rarely febrile
Nursing and collaborative management
Environmental control
Appropriate drug therapy
Client interventions
Increase fluid intake
Nasal cleaning techniques and irrigation
Persistent complaints may require endoscopic surgery.
Sinusitis
Polyps
Foreign bodies
Obstruction of the nose and paranasal sinuses
Benign mucous membrane masses
Clinical manifestations: Nasal obstruction, nasal discharge (usually clear mucus), speech distortion
Polyps
Inorganic may go undetected.
Organic produce local inflammation, nasal discharge, may be foul smelling.
Should be removed through route of entry.
Foreign bodies
Acute pharyngitis
Peritonsillar Abcess
Conditions related to the pharynx
Airway obstruction
Tracheostomy
Laryngeal Polyps
Conditions Related to the Trachea and Larynx
May include tonsils, palate, and uvula
Can be caused by a viral (most common), bacterial (strep throat), or fungal infection (candidiasis)
Acute Pharyngitis
A complication of acute pharyngitis or acute tonsillitis when bacterial infection invades one or both tonsils
Tonsils may enlarge sufficiently to threaten airway patency.
Patient experiences a high fever, leukocytosis, and chills.
Peritonsillar Abcess
May be complete or partial
Complete obstruction is a medical emergency.
Partial obstruction may occur as a result of aspiration of food or a foreign body; laryngeal edema following extubation; laryngeal or tracheal stenosis; CNS depression; or allergic reactions.
Symptoms: Stridor; use of accessory muscles; suprasternal and intercostal retractions; wheezing; restlessness; tachycardia; cyanosis
Airway obstruction
Surgical incision into the trachea for the purpose of establishing an airway
________ the stoma (opening) that results
Tracheotomy
Indications
To bypass an upper airway obstruction
To facilitate removal of secretions
To permit long-term mechanical ventilation
To permit oral intake and speech in the client requiring long-term mechanical ventilation
Tracheostomy
May develop on the vocal cords from vocal abuse or irritation
Most common symptom is hoarseness
Surgical removal may be indicated for large polyps.
Usually benign, but may become malignant
Laryngeal polyps
Brings oxygen into the body and removes carbon dioxide – __________ (process by which gas is exchanged)
respiration
________ the process of moving air into and out of the lungs. The rate is modified by a number of factors, including emotions, fever, stress, the PH of the blood, and certain medications.
Ventilation
Blood flow through the lungs is called
perfusion
Involves two main processes.
Ventilation moves air into and out of the lungs and perfusion allows for gas exchange across the capillaries.
Physiology of respiratory system
are lined with smooth muscle that controls the amount of air entering the lungs.
Bronchioles
Dilation and constriction of the airways are controlled by the ________ nervous system
autonomic
During fight or flight response, ___________ receptors of the sympathetic nervous sytem are stimulated, and the bronchiolar smooth muscle relaxes, and bronchodilations occurs
beta2-adrenergic
________ nervous system also increases the rate and depth of breathing.
Sympathetic
Pulmonary drugs are delivered to the respiratory system by _________ treatments.
aerosol
Can give immediate treatment for ___________ (bronchiolar smooth muscles contracts)
bronchospasms
For loosening viscous mucus in the bronchial tree
Pulmonary Drugs via inhalation
produce a fine mist to be inhaled by mask or a handheld device.
Nebulizers
delivers a fine powder
Dry powder inhaler (DPI)
use of a propellant to deliver a measured dose of drugs to the lungs during a breath.
Metered dose inhalers (MDI)
A chronic disease with inflammatory and bronchospasm components.
Typical causes of _______ attacks: allergens, air pollutants, chemicals and foods, respiratory infections, stress
Asthma
________ focuses either on the bronchial constriction and or the inflammation component of asthma.
Pharmacotherapy
- Achieve acceptable control of the disease.
- Treatment of asthma should focus on managing inflammation; inhaled glucocorticoids are the first- line - anti inflammatory therapy.
- Control the environment.
- A written action plan for guided self-management should be provided for all clients.
- If acceptable control is not obtained, other drugs can be used in addition to moderate doses of corticosteroids.
5 fundamentals aspects of asthma care accord to the canadian asthma consensus guidelines endorsed in 2003
Beta-adrenergic agonists and anticholinergics
Mucolytics
Expectorants
Glucocorticoids
Mast cell stabilizers
Antitussives
Drugs used to treat respiratory disorders
Dilate bronchi
Beta-adrenergic agonists and anticholinergics
Loosen mucus
Mucolytics
Produce thinner mucus
Expectorants
Suppress inflammation
Glucocorticoids
Inhibit histamine release
Mast cell stabilizers
Suppress cough
Antitussives
- drugs of choice in the treatment of acute bronchoconstriction
- relax bronchial smooth muscles resulting in lower airway resistance - easier breathing for patients.
-inhaled produce little systemic toxicity because only small amounts of the drugs are absorbed.
Beta-adrenergic agonists
Used to prevent and treat wheezing, difficulty breathing, chest tightness caused by lung diseases such as asthma, and COPD;
Side effects – irritability, nervousness, tachycardia, insomnia and anxiety are common side effects of beta adrenergic agonist bronchodilators that result from sympathetic nervous system stimulation.
Beta-adrenergic agonists
Ultra short acting
Immediate effect but lasts only 2-3 hours
Isoproterenol (Isuprel)
Short acting
Act quickly but last 5-6 hours
Metaproterenol
(Alupent, Orciprenaline)
Short acting
Act quickly but last 5-6 hours
Terbutaline
(Bricanyl)
Short acting
Act quickly but last 5-6 hours
Salbutamol (Ventolin)
Intermediate acting
8 hours
Pir(Maxair)
Up to 12 hours
Salmeterol
- patient should use an aero chamber and hold their breath for 10 seconds after inhaling the medication and wait for 2 full minutes before the second inhalation.
Limit the use of caffeine.
Report any difficulty breathing, change in eyesight, heart palpitations, tremor, nervousness, and vomiting.
Bronchodilator should be taken before other inhalers.
Educating patient
a rapidly acting bronchodilator and is the first line medication in rescue inhalers that reverses airway narrowing in acute asthma attacks
Beta2-adrenergic agonist that causes dilation of the bronchioles.
MDI, 1-2 inhalations tid-qid/day (max 8 inhalations/day) Can be given every 30 – 60 minutes until relief is obtained.
Nebulizer solution, 2.5mg tid-qid PRN
Salbutamol (Ventolin)
Acts by selectively binding to beta2 - adrenergic receptors in bronchial muscle to cause bronchodilations.
When taken 30 to 60 minutes prior to physical activity – helps to prevent exercise induced bronchospasm.
Asthma maintenace therapy drug because of long effect
Takes 15 to 25 minute to act so not good for acute symptoms.
Half life of 3 – 4 hours
Salmeterol (Serevent)
An older alternative to beta agonist for the treatment of asthma
The methylxanthines are older established drugs (Aminophylline, theophyline).Side effects include nausea and vomiting, and CNS stimulation and dysrythmias.
One anticholinergic (Atrovent) has widespread use.
Methylxanthines and anticholinergics
can dry mucous membranes.
Methylxanthines
should be used cautiously in elderly men with BPH and cllients with glaucoma.
Anticholinergics
can aggravate urine retention.
Anticolinergics
Anticholinergic (muscarinic antagonist), causes bronchodilation by blocking cholinergic receptors in bronchial smooth muscle.
Given via inhalation with effects peaking in 1 – 2 hours and continue up to 6 hours.
Half life of 2 hours.
Less effective then the beta2 agonist –or glucocorticoids for an additive effect.
Sometimes used for nasal congenstion and chronic bronchitis.
Atrovent (ipotropium)
Inhaled glucocorticoids used for the long term prevention of long term management.
Oral glucocorticoids may be used to the short term management of acute asthma.
Inhaled glucocorticoids are first line therapy for asthma – they suppress airway inflammation without major side effects and help to prevent acute asthma attacks. (Evidence-based therapy for asthma)
Glucocorticoids
Beclomethasone
Pulmicorte
Flovent
Inhaled glucorticoids
Methylprednisolone
Prednisone
Oral glucorticoids
