Lower Respiratory System Health Challanges Flashcards
Top signs of respiratory distress
-abnormal respirations
-Tachypnea
-Bradypnea
-Apnea
-retractions/accessory muscle use
-Head bobbing, position of comfort
-Nasal flaring
-Grunting
-Colour change (pale or cyanotic
-poor aeration
Respiratory distress definition
An inability to maintain gas exchange
Bronchiectasis
A chronic condition where the walls of the bronchi are thickened from inflammation and infection
Chest tube
A plastic tube that is inserted into the pleural space of the lung to
-Remove air or fluid
-to help lung re-expand
(Can also be inserted into mediastinum space (under sternum) to drain fluid from the heart after cardiac surgery).
Pulmonary edema
-often caused by congestive heart failure
-heart is not able to pump blood efficiently, blood backs up into the veins that take blood through the lungs, fluid is pushed into the alveoli
Pulmonary hypertension
The pressure in the blood vessels leading from the heart to the lungs is too high
Cor pulmonale
A condition that causes the right side of the heart to fail. Can be caused by long term high blood pressure in the arteries of the lung and right ventricle of the heart.
Acute bronchitis
An inflammation of the bronchi in the lower Respiratory tract usually cause by infection. Mostly viral.
Acute bronchitis symptoms
Most common symptom is a presistent cough.
Acute bronchitis TX
Fluids
Rest
Anti-inflammatory agents
Acute bronchitis; expectorants and mutolytic agents
Expectorants loosen bronchial secretions that can then be expelled by coughing.
Mucolytics this out bronchial mucus.
Expectorants and mucolytic agents; side effects
-gi irritant
-rash
-oropharyngeal irritation
Expectorants and mucolytic agents; interventions
-take with a full glass of water, maintain adequate fluid intake
-encourage client to cough and breathe deeply
-Acetylcystine should not be mixed with other meds if given via nebulizer
Acute bronchitis; antitussives
Act on cough Center in medulla to suppress cough reflex
Antitussives; side effects
Constipation
Respiratory depression
Antitussives; interventions
-notify HCP if cough last longer than a week
-maintain adequate fluid intake
-sleep with HOB elevated
Pneumonia
Infection and inflammation of the pulmonary tissue, including the interstitial spaces, the alveoli and the bronchioles caused by various microorganisms.
Pneumonia; classifications
-Community acquired
-Hospital acquired
-Fungal
-Opportunistic (immunocompromised)
-aspiration
Pneumonia; etiology
-normal defends mechanisms
-factors predisposing to pneumonia
-Acquisition of organisms
Pneumonia; diagnosis
-chest x-ray shows consolidation, pulmonary infiltrates or pleural effusions
-Positive sputum culture
-^WBC and sedimentation rate
Pneumonia; CM
-pyrexia and chills
-pleuritic pain
-tachypnea
-rhonchi/wheezes
-Accessory muscle use
-Mental status change
-Sputum production
Pneumonia; collaborative care
-oxygen therapy/chest physio
-pneumococcal vaccine
-drug therapy
-nutritional and fluid therapy
Pulmonary Tuberculosis
Infectious disease caused by mycobacterium tuberculosis (public health problem Canada and WW)
Pulmonary Tuberculosis; transmission
Airborne droplets
Tuberculosis; CM
-Asymptomatic
-fatigue, weightloss, feaver, chills, night sweats
-Mucus cough, hemoptysis
-Chest tightness and pain
-Enalrged and painful lymphnodes
-Egophony,fremitus
-finished bronchial sounds and crackles
Tuberculosis; diagnosis
-Tuberculin skin testing
-Chest radiography study
-Bacteriological studies
Asthma; risk factors and etiology
-allergens
-respritory infections
-Nose and sinus issues
-Drugs and food additives
-GERD
-Air pollutants
-Emotional stress
Asthma; treatment
-Avoid triggers
-rescue medication (fast acting B2 agonists, ex salbutamol)
-Short acting B2 agonists
-inhaled corticosteroids
-Longterm prednisone if asthma is difficult to control
-Anticholinergics (ex ipratropium)
Covid; common symptoms
-Fever
-Chills
-New or worsening cough
-Fatigue or myalgia
-Headache
-GI upset
Covid; less frequent symptoms
-SOB
-Sore throat
-painful/difficulty swallowing
-conjunctivitis
-Delirium
-Loss of appetite
-loss of smell or taste
Covid; rare symptoms
-Skin CM
-Confusion
-Runny/stuffy nose
-Eye CM
Current Covid variants of concern in Canada
-Alpha
-Beta
-Gamma
-Delta
Covid; urgent symptoms
-Trouble breathing or severe SOB
-Persistent pressure or pain in chest
-New confusion or altered level of consciousness
-inability to wake or stay awake
-Pale, gray, or blue coloured skin, lips, or nail beds
Covid; incubation period
2-14 days
Covid; key treatment
-Antibiotics
-Antivirals
-Monitoring and fluid
-Steroids
-O2
-Convalescent plasma
Blunt trauma
-Body struck by a blunt object
-External injury may appear minor but can mask life-threatening internal Injuries
-countercoup trauma
Penetrating trauma
Foreign body impales or passes through the body tissues
Pneumothorax
Presence of air in pleural space
Types of pneumothorax
-Closed pneumothorax
-Open pneumothorax
-tension pneumothorax
-hemothorax
-chylothorax
Pneumothorax CM
Small: mild tachycardia and Dyspnea
Large: Respritory distress, shallow and rapid respirations, Dyspnea, air hunger, decreased O2 sat
Pneumothorax; CC
-May resolve spontaneous
-Aspiration of pleural space
-Insertion of chest tube
Fractured ribs
-Most common type of chest injury resulting from trauma
-Ribs 5-10 are most commonly fractured since they are least protected by chest muscles.
Fractured ribs CM
-pain (especially on inspiration)
-Main treatment goal is to decrease pain so client can breathe adequately to promote good chest expansion.
Flail chest
Results from multiple rib fractures, causing instability of the chest wall. Prevent adequate ventilation of the lung in injured area.
The affected (flail) area will move paradoxically to the intact portion of the chest during respiration. During inspiration it’s sucked in and during expiration it bulges out.
Flail chest CC
-Adequate ventilation
-admin of humidified O2
-admin of crystalloid IV soloutions
-pain control
-definitive therapy to re-expand the lung and ensure adequate oxygenation
-Call a RT!
Chest Drainage; nursing management complications
-Routine milking or stripping of chest tubes to maintain patency is no longer recommended because it can cause dangerously high intrapleural pressure and damage to pleural tissue.
-Clamping of chest tubes during transport or when the tube is accidentally disconnected is no longer advocated; there is a danger of rapid accumulation of air in the pleural space, causing tension pneumothorax.
Chest tube complications
-chest tube malposition
-re-expansion pulmonary edema
-vasovagal response with symptomatic hypotension
-infection at skin site
-pneumonia
-shoulder disuse
Restrictive respiratory disorders
A restriction in lung volume, caused by decreased compliance of the lungs or chest wall.
Extrapulmonary disorders
Involve the CNS, NMS and chest wall.
Intrapulmonary disorders
Involve the pleura or the lung tissue.
Types of Pleural effusion
Transudative: pleural effusion is caused by fluid leaking Into the pleural space. This is from increased pressure in the blood vessels or a low blood protein count. Heart failure is the most common cause.
Exudative: pleural effusions occour when the pleura is damaged ex by trauma, infection, or malignancy
Epyema
Pleural effusion that contains pus
Pleural effusion CM
-progressive Dyspnea
-decreased movement of chest wall on effected side
-pleuritic pain from underlying disease
-dullness to percussion and absent or decreased breath sounds over affected area.
Empyema CM
Those of pleural effusion as well as:
-Fever
-Night sweats
-Cough
-Weight loss
Thoracentis
A procedure to remove fluid or air from the pleural space
Thoracentesis types
-diagnostic
-Theraputic
Thoracentesis procedure
-client sits on the edge of the bed and leans forward over bedside table
-1000-1200ml of pleural fluid is removed at a time
-Rapid removal can result in hypotension, hypoxemia, or pulmonary edema
Pleural effusions CC
Treat the underlying cause; treatment of pleural effusions secondary to malignant disease is difficult.
Pulmonary embolism
Blockage of pulmonary arteries by a thrombus, fat or air embolus, or tumor tissue
Pulmonary embolism risk factors
-Individuals at risk for VTE
-Following fracture of a long bone
-following child birth
-Malignancies
Pulmonary embolism CM
-Apprehension and restlessness
-Blood tinged sputum
-chest pain
-cough
-crackers and wheezes
-cyanosis
-distended neck veins
-Dyspnea, angina, pleuritic pain that’s worse on inspiration
-hypotension
-petechiae over chest and axilla
-Shallow restorations
-tachypnea
-tachycardia
Pulmonary embolism; complications
-pulmonary infarction
-pulmonary hypertension
Pulmonary embolism; CC
-Drug therapy
-Fibrinolytic
-anticoagulant therapy
-Surgical therapy
-Pulmonary embolectomy with placement of a vena cava filter
Pulmonary embolism prevention
-Early ambulation
-Anticoagulant therapy
-Sequential compression devices
Pulmonary embolism initial nursing management
-Notify HCP
-Elevate head of bed
-Apply o2
-Assesment: vital signs, lung sounds, ABGs
COPD impact in Canada
-affects 3million
-1.5 of those undiagnosed
-fourth leading cause of death in Canada
COPD; causes
-smoking is primary cause (25% have never smoked)
-Genetic disorders
-SH smoke
-Air pollution
-Repeated lung infections during childhood
-Severe asthma
-Asthma combined with smoking
COPD diseases
-chronic bronchitis
-emphysema
COPD; CM
-Copious sputum production
-Cough
-Cyanosis
-Volume overload
-Wheezes
-Rhonchi
COPD; common inhalers
-Atrovent
-Airomir
-bricanyl
-ventolin
COPD; CC
-Goals are to stop it from getting worse and alleviate symptoms.
-prompt treatment of exacerbations
-SMOKING CESSATION
-Pulmonary rehab programs
-Hydration
Nasal Cannula; system
-1-6L/m
-delivers 24-44% O2 (3% increase with each litre)
Nasal Cannula; advantages
-Safe and simple
-Good for low amounts of O2 delivery
-Allows eating / talking
Nasal cannula; disadvantages
-Drying of mucosa
-Can cause necrosis/breakdown at ears
-Contraindicate in nasal obstruction
Nasal Cannula; special notes
-Do not exceed 6L/min
-Gauze to protect ears
-Oral and nasal care for dryness
Simple face mask; system
-6-10L/min
-Delivers 40-60% O2
Simple face mask; Advantages
-Delivers high o2 conc
-Does not dry mucous membranes of nose and mouth
-Can be used with nasal obstruction
Simple face mask; disadvantages
-Hot, confining
-uncomfortable
-often poorly tolerated with dyspneic patients
-interferes with eating and talking
-potential for o2 toxicity
-Cannot deliver >40%
-not practical for long term use
-Anxiety
Simple face mask; special notes
-pads between face mask and bony parts of face
-Wash and dry every 4 hours
-Ensure flow rate of at least 6L/m
-Watch for signs of o2 toxicity
-Monitor ABGs
Partial rebreathing mask; system
-delivers 6-10L/m
-35-60% o2
Partial rebreathing mask; advantages
-delivers high o2 concentration
-does not dry mucous membranes
Partial rebreathing mask; disadvantages
May cause co2 retention if bag is not inflated
Partial rebreathing mask; special notes
-ensure bag is inflated
-keep mask snug
-monitor ABGs
-Watch for signs of O2 toxicity
Non-rebreathing mask; system
-6-12L/min
-Delivers 60-90%
Non-rebreathing mask; advantages
-One way valve prevents rebreathing of Co2
Non-rebreathing mask; disadvantages
-Same as other masks but does not cause co2 retention
Non-rebreathing mask; special notes
-Ensure bag is inflated
-keep mask snug
-Monitor ABGs
-Watch for signs of O2 toxicity
Venturi mask; system
-4L/min delivers 24-28%
-8L/min delivers 35-40%
Venturi Mask; advantages
-Delivers accurate o2 concentration
-o2 concentration can be changed
Venturi mask; disadvantages
-Relies on snug fitting mask
-Hot confining, uncomfortable
-Tight seal nessacary
Venturi mask; special notes
-Check ABGs frequently
-Watch for signs of o2 toxicity
Tracheostomy collar; system
-21-70% O2 delivery 10L or to provide visible mist
Tracheostomy collar; advantages
-does not pull on tracheostomy
-Elastic ties allow movement of collar away as needed
Tracheostomy collar; disadvantages
-02 diluted by room air
-Increased risk of infection and irritation at stoma
Tracheostomy collar; special notes
-Ensure o2 is warmed and humidified
-Empty condensation from tubes frequently
