medsurg 3 Flashcards
protective mechanisms of the respiratory system
-irritant receptors
-alveolar macrophages
-nasal hairs
-mucous membranes
-cilia
what do irritant receptors do
-trigger sneeze and cough
-project out particles or bacteria
what do alveolar macrophages do
attack foreign particles and bacteria
what do nasal hairs do
trap dust and microorganisms
what do mucous membranes do
-warm and moisten air
-trap inhaled particles in the mucous
what do cilia do
move particles to be swallowed or coughed
3 parts of the pharynx
-nasopharynx
-oropharynx
-laryngopharynx
airway between the pharynx and trachea contains the vocal chords
larynx
what protects the airway of the larynx
epiglottis at the top of the larynx
vestibular folds close the glottis
walls lines with ciliated epithelium
what closes the vocal cords when we swallow and open when we talk
vestibular folds
lined with ciliated epithelium mucosa and extends to the carina
trachea
parts of the bronchial tree
-primary bronchi
-secondary bronchi
-tertiary bronchi
-bronchioles
-alveolar ducts
-alveolar sacs
what is responsible for gas exchange
alveoli
problems with alveoli = ________ gas exchange and _______ SPO2
decreased
decreased
the exchange of air occurs through whaaht is called the ____________ which consists of the alveolar epithelium the capillary endothelium and their joined basement membrane
respiratory membranes
the alveoli are wrapped in a fine _____ of capillaries
mesh
the extremely _______ walls of the alveoli and the _________ of the capillaries allow for efficient gas exchange
thin
closeness
what is the most important muscle of the respiratory system
diaphragm
how many lobes does the right lung have
3
how many lobes does the left lung have
2
what fissures does the right lung contain
horizontal
oblique
what fissure does the left lung contain
oblique
primary muscles of the respiratory system
diaphragm
intercostal
muscles used during respiratory distress or exercise
accessory muscles
what accessory muscles are used during respiratory distress or exercise
shoulder muscles and abdominal muscles
when the diaphragm contracts what does it do to the lungs
fills lungs with air
when the diaphragm relaxes what does it do to the lungs
the air is pushed out of the lungs
what happens when the external intercostal muscles pull the ribs upward and outward widening the thoracic cavity
inspiration
what happens when the internal intercostal muscles pull the ribs downward as the external intercostals relax
expiration
what happens when the diaphragm relaxes bulging upward and pressing against the base of the lungs, reducing the size of the thoracic cavity
expiration
what happens when the diaphragm contracts flattens and drops pressing the abdominal organs downward and enlarging the thoracic cavity
inspiration
what happens when air rushes in to equalize pressure
inspiration
what happens when air is pushed out of the lungs
expiration
respiratory assessment involves:
health history
inspection
respiratory patterns
spo2
auscultation
what do you need to find out of a patients health history for a respiratory system
-conditions
-symptoms
-family history
-use whats up for complaints
whats up means:
where is it?
how does it feel?
aggravating/alleviating factors?
timing?
severity?
useful data?
patients perception?
when asking a patient the severity of their respiratory issues you should always use what
a scale
inspection on respiratory system involves:
symmetry
swelling
abnormalities
respirations rate pattern and depth
work of breathing
cyanosis
dyspnea
apnea
difficulty breathing is called what
dyspnea
absence of breathing is called what
apnea
work of breathing inspection involves
-labored or unlabored
-accessory muscle use
-retractions
soft tissue pulled inward during distressed inhalation
retractions
normal rate and rhythm respiratory pattern 12-20 breaths per minute
eupnea
deeper respirations
hyperventilation
increased rate >20 breaths per minute
tachypnea
decreased rate <12 breaths per minute
bradypnea
deep fast respirations which then slow down and a period of apnea occurs
cheyne-stokes
much faster and deeper without pauses seen with diabetic acidosis
kussmauls
gasping respirations due to brain stem reflux - not affecting breathing
agonal breathing
which respiratory pattern is a medical emergency
agonal breathing
what condition is usually seen when a patient has barrel chest
copd
o2 deprivation to the tissues causes:
clubbed fingers
what condition is usually seen with clubbed fingers
cardiac problems
if a patient has clubbed fingers what can you expect their normal o2 to be?
usually sats stay in the 80s
what is a respiratory assessment you don’t do from across the room
spo2
what does spo2 measure
percentage of hgb saturated with oxygen
when may spo2 readings be inaccurate
trembling or shivering
cold extremities
nail polish
how do you do auscultation of the lungs
-listen to anterior, lateral and posterior chest
-listen during inspiration and expiration
-compare sounds from side to side
air sounds with fluid in the airways
coarse crackles (rales)
air sounds caused by narrowed airways
wheezes
lung sounds caused by decreased air movement
diminished
lung sounds caused by alveoli popping open
fine crackles
lung sounds caused by airway obstruction
stridor
lung sounds caused by obstruction from secretions
rhonchi
lung sounds caused by no air movement
absent
lungs sounds that sound like high-pitched violin on expiration
wheezes
lung sounds that sound like moist bubbling sound
coarse crackles
lung sounds that sound like loud crowing without stethoscope
stridor
lung sounds that sound like faint lung sounds
diminished
lung sounds that sound like velcro being torn apart or hair between fingers
fine crackles
lung sounds that sound like low pitched rattling, snoring
rhonchi
no lung sounds
absent
lung sound you would hear if a patient has pulmonary edema or pneumonia
coarse
lung sounds you would hear if the patient has atelectasis
fine crackles
lung sounds you would hear if a patient has secretions, copd or pneumonia
rhonchi
lung sounds you would hear if a patient has asthma
wheezes
lung sounds you would hear if a patient had a tumor, foreign object, swelling
stridor
lung sounds you would hear when angela doesnt take her allergy medicine
stridor
lung sounds you would hear if a patient ahs emphysema, hypoventilation, pneumonia
diminished
lung sounds you would hear if a patient has pneumothorax, pneumectomy
absent
what are the lung sounds that are considered an emergency
stridor
absent
why would a patient have absent lung sounds
-they have had a lobectomy
-emergency
if you hear rhonchi lung sounds what should you have the patient do
cough
what tests can be done for respiratory issues not imaging
sputum
throat swab
nasal sample
arterial blood gases
what should you encourage to get a good sputum sample
deep breathing and coughing
a sputum sample will tell us what
if there is an infection within the lungs
what does arterial blood gases show
the amount of gas exchange present in the arterial blood o2 and co2
when is an arterial blood gas done
only in emergent settings because you have to get the sample from an artery
what specific lab tests will we run if a patient has respiratory issues
cbc
d-dimer
what will we look for on cbc
white blood cells will be increased if theres an infection
rbc, hemoglobin, hematocrit will be increased if they have copd pr something respiratory
d-dimer will be elevated if there is a possible blood clot present
diagnostic tests that will be done for respiratory problems
chest xray
ct scan of chest
ct angiogram
ventilation perfusion scan
if a patient has suspected pneumonia what diagnostic tests can be done
chest xray
ct scan of chest
if a patient has suspected pulmonary embolism what diagnostic tests can be done
ct angiogram
ventilation perfusion scan
if you want to evaluate the blood vessels what test should be done
ct angiogram
if you want to evaluate the circulation of air and blood within a patients lungs what test should be done
ventilation perfusion scan
interventions for respiratory concerns
-deep breathing
-coughing
-breathing exercises
-huff coughing
-turning/ambulation
-o2 therapy
-smoking cessation
-positioning to help with lung expansion
what are two types of breathing exercises
diaphragmatic breathing
pursed lip breathing
pursed lip breathing promotes co2 _______ by leaving airways open during exhalation
excretion
what positions help with lung expansion
-high fowlers
-tripod
-good lung down
how does good lung down work
gravity helps increase blood circulation in healthier lung promoting increased spo2
device that helps expand the lungs and encourages deep breathing
incentive spirometer
_______ on use of spirometer is important
education
when using a spirometer patient needs to breathe _____
in
a incentive spirometer helps prevent lung infections by preventing _______
atelectasis
use incentive spirometer ______ per hour while awake
10 times
respiratory distress interventions
hob up to expand lungs
Encourage deep breathing
Encourage coughing to clear secretions
Check SPO2
Focused respiratory assessment COMPARE TO LAST ASSESSMENT
Apply oxygen as needed to achieve appropriate SPO2
disorders of the lower respiratory tract
bronchitis
pneumonia
copd
asthma
pulmonary embolism
inflammation of the bronchi
bronchitis
bronchitis can progress into what condition
pneumonia
with bronchitis you have ______ mucus production from irritation
excess
excess mucus = what
congested airway
what is bronchitis usually cause by?
viral infection
what is the collapse of the alveoli
atelectasis
what causes atelectasis
occurs due to shallow breaths and trapped secretions
mucus exudate plugs areas of lungs that are not well aerated, alveoli cannot inflate thus they collapse
atelectasis is common in what kind of patients and why
post op they take shallow breathes because they are in pain and they are on bed rest and have decreased movement
what is key to avoid atelecatsis and pneumonia
prevention
how can transmission of infectious particles be spread and cause pneumonia
-cough of an infected individual
-contaminated respiratory therapy equipment
-infections in other parts of the body
-aspiration of bacteria from the mouth pharynx or stomach
what populations are at risk for pneumonia
-very young
-elderly
-chronic diseases such as copd
-smokers
-compromised immune systems
-post op patients
what is one of the high preventable things that happens in the hospital
pneumonia
various strains of bacteria cause what type of pneumonia
bacterial pneumonia
influenza is the most common cause of this type of pneumonia and increases the patients susceptibility to a secondary bacterial pneumonia
viral pneumonia
caused by foreign substances entering the lungs and commonly occurs if a patient has a decreased gag reflex
aspiration pneumonia
three types of pneumonia
bacterial viral aspiration
signs and symptoms of pneumonia
-fever
-chest pain
-dyspnea
-fatigue
-oxygenation problems
-productive cough
-lung sounds
-older adults may show new onset confusion or lethargy
what kind of sputum would be produced with pneumonia
hemoptysis
purulent
what kind of lung sounds would you expect to hear with pneumonia
coarse crackles
wheezes
what diagnostic tests would be done for penumonia
-chest xray
ct scan
sputum culture
wbc
est and crp
blood culture
therapeutic interventions for pneumonia
fluids
rest
deep breathing
incentive spirometry
supplemental oxygen
chest physiotherapy
medications for pneumonia
-antibiotics
-expectorants
-bronchodilators
bronchodilators used for pneumonia
albuterol
duoneb
how do you prevent pneumonia
-good hand and oral hygein
-coughing into elbow
-influenza vaccine because flu can cause viral pneumonia
-pneumococal vaccine
who can get the pneumococcal vaccine
anyone 65 or older
immunocompromised
chronic disease
how to prevent pneumonia in the hospital
*prevent atelectasis
encourage coughing and deep breathing
abulation
changing positions
incentive spirometer
chronic inflammation of airs and hyperresponsiveness of bronchioles
asthma
what are the classifications of asthma
mild, moderate, severe
how is asthma classified
by the type of medications required to control it
a substance pr reason that can cause an asthma flare or attack
triggers
asthma triggers
-smoking or second hand smoke
-allergens
-respiratory infection
-ecxercise
-stress
signs and symptoms of asthma
-chest tightness
-dyspnea
-tachypnea
-wheezing
-use of accessory muscles
-may be worse at night
if lung sounds move to no sounds at all or very diminished sounds it is what
a medical emergency
_________ is necessary to avoid acute asthma attacks
daily management
patients can self-monitor asthma with what daily?
peak flow meter
attack prevention for asthma
daily management
peak flow meter daily
avoid triggers
educate on taking prevention meds
educate on when to take rescue inhalers
develop asthma action pain
this device measures the patients peak expiratory flow
peak flow meter
the fastest speed at which air is forced out from the lungs
peak expiratory flow
use peak flow meter to check for ______
changes
using peak flow meter you breathe _____
out forcefully
log peak expiratory flow on what?
peak flow chart
what zone means the patient has current drug therapy and lifestyle choices that are working and no changes need to be made
green zone
what zone means asthma is beginning to worsen and pt needs to use rescue inhaler to improve s/s, if s/s dont improve pt may need to seek help
yellow
what zone means pt needs to use rescue inhaler asap and seek help
red zone
if yellow zone is a fequent reading patient should what
see dr for medication change
who fills out the asthma action plan
dr
what is the nurses role in the asthma action plan
educated patient on how to implement it
daily preventative medications for asthma
antihistamine
inhaled corticosteroids
inhaled corticosteroids+bronchodilator
bronchodilator
inhaled steroids
what are two inhaled cortocosteroid medications
fluticasone (flovent)
budesonide (pulmicort)
two inhaled corticosteroid+bronchodilator medications
fluticasone + salmeterol (advair)
budesonide + formoterol (symbicort)
what should a patient do after using an inhaler
rinse and spit to prevent thrush
rescue asthma medications
-bronchodilators
corticosteroids
rescue bronchodilators
albuterol (ventolin)
ipratropium (atrovent)
duoneb (combo of albuterol and ipratropium)
rescue corticosteroid for asthma
methylprednosolone (solu-medrol) IV
prednisone - oral
what is a metered dose inhaler
handheld device that delivers medication directly to the lungs
how do you use a metered dose inhaler
-shake it
exhale
-place lips to inhaler
-push canister down while breathing in slowly and deeply
-hold breath for 5-10 seconds
ensure patient knows how to use inhaler by having them do a ______ demonstration
return
this is used for a metered dose inhaler to increase the amount of medication that administered into the lungs and not stuck to oral mucosa
spacer
device used to administer misted medications directly to the lungs
nebulizer
where are nebulized mist treatments most often used
hospital settings during acute respiratory issues
nebulized mist treatments helps _______ everything and helps break up _______
moisten
secretions
nursing interventions for asthma
-educate on medications
-high fowlers
-spo2 monitoring
-respiratory assessment
-breathing interventions
-supplemental o2
-medication as prescribed
what is status asthmaticus
a medical emergency due to severe and sustained asthma attacked
when is status asthmaticus seen?
when patients do not get to the hospital in time for asthma attack treatment
status asthmaticus causes ______ respiratory rate to compensate lack of _______ causing ____ to be blown off too quickly which causes changes to the blood __
increased
oxygen
co2
ph
status asthmaticus can lead to what
respiratory failure
death
characterized by air trapping and difficulty getting air out of the lungs
obstructive disorders
types of obstructive disorders
-chronic obstructive pulmonary disease
-emphysema
-chronic bronchitis
-asthma
a group of pulmonary disorders characterized by difficulty exhaling (air trapping)
copd
copd is progressive and _______
irreversible
symptoms of copd can _______ with lifestyle changes, but disease never ______
improve
goes away
copd is classified as
-chronic bronchitis
-emphysema
-a combo of both
symptoms of this disorder occurs at least 3 months of the year for two consecutive years
chronic bronchitis
chronic bronchitis causes:
-chronic inflammation
-hypertrophied mucous glands in bronchi
-impaired ciliary function
chronic bronchitis narrows airways blocked by ________ and _______ and cause an ineffective airway clearance
inflammation and mucus
destruction and loss of elastic recoil of bronchioles and alveolar walls cause alveoli to enlarge and merge together causing damage to pulmonary capillaries surrounding damaged alveoli and reduced surface area for gas exchange
emphysema
air trapped causes
co2 retention and impaired gas exchange
copd etiology
-smoking
-passive smoke exposure
-air pollutants
-exposure to industrial chemicals
-familial predisposition
what is the number one risk factor for copd
smoking
copd signs and symptoms - emphysema
-chronic cough
-diminished breath sounds
-dyspnea
-activity intolerance
-barrel chest
-prolonged expiration
-use of accessory muscles
copd signs and symptoms: chronic bronchitis
-wheezing, crackles, rhonchi
-chronic cough, productive
-thick, tenacious sputum
-dyspnea
-activity intolerance
-prolonged expiration
-increased susceptibility to infection
-mucous plugs
-use of accessory muscles
what are the signs and symptoms of copd emphysema and chronic bronchitis that are the same
-chronic cough
-dyspnea
-activity intolerance
-prolonged expiration
-use of accessory muscles
what are the signs and symptoms of copd emphysema and chronic bronchitis that are the different
-chronic cough characteristics
-lung sounds
-barrel chest
-sputum
-susceptibility to infection
-mucous plugs
what is different about the cough with emphysema and chronic bronchitis
chronic bronchitis cough is productive
which disorder causes diminished breath sounds
emphysema
which disorder causes wheezing, crackles, rhonchi
chronic bronchitis
which condition causes barrel chest
emphysema
which condition causes thick tenacious sputum
chronic bronchitis
which condition causes increases susceptibility to infection
chronic bronchitis
which condition causes mucous plugs that a person has a hard time coughing up and can stoop airation
chronic bronchitis
diagnostic tests for copd
-chest xray or ct scan
-cbc
-wbc - can cause infection
-rbc - body compensating by making more rbc to help with oxygenation
-sputum culture
-arterial blood gasess
during acute exacerbation of copd expect ____ levels to decrease and ____ levels to increase
o2 to decrease and co2 to increase
which diagnostic test is typically used to diagnose copd
ventilation profusion scan
therapeutic interventions for copd
-smoking cessation
-encourage breathing exercises
-encourage fluids
-huff cough to expel air
-pneumococcal and yearly influenza vaccination
-increase activity as tolerated
what diet should a pt be on with copd
high protein and high fat
high calorie meals that are smaller and easier to eat so it is less work for the patient
medications for copd
bronchodilators
corticosteroids
expectorants
when will you apply oxygen on a patient with copd and about how many liters
when spo2 is <88% and 1-2 L/m
spo2 ranges between what at baseline for copd paatients
88-92%
copd patients depend on ______o2 levels to stimulate breathing and respirations
lower
high supplemental oxygen flow rates can _______ respirations
depress
if patient with copd get flooded with oxygen what can happen
patients body thinks it does not have to breath
a foreign object traveling through blood stream
embolism
embolism in a pulmonary artery
pulmonary embolism
Embolism in the pulmonary artery does not allow
blood to flow into the lungs for gas exchange to occur
where do most pulmonary emboli develop from
a deep vein thrombosis
how do you prevent a PE
prevent a DVT
signs and symptoms of PE
-sudden onset dyspnea and sob
-chest pain
-tachypnea
-gasping for breath
-anxious
-decreased spo2
-tachycardia
-cough
-crackles
-hemoptysis
tell-tale sign something bad is going to happen to a patient is when the patient has what type of feeling
impending doom feeling
diagnostic test for PE
-d-dimer
-ct angiogram chest
interventions for PE
- high fowlers
-oxygen
-thrombolytics
-anticoagulants
what kind of medication will treat current clots
tpa
what medication prevents new clots from forming
anticoagulants
names of anticoagulants
heparin
enoxaparin (lovenox)
warfarin (coumadin)
what do medications for PE put patients at risk for?
bleeding
prevention of PE
-prevent dvt
-abulation
-promote circulation
-prophylactic dvt treatment
-prompt treatment of dvgt if present
