NUR353 Exam Prep Flashcards
What makes us breathless? (List 5)
- Pain
- Exercise
- Obesity
- Genetics
- Smoking
- Allergy: Dust, Pollen, Fur, Grass, etc.
List some common respiratory conditions: (List 5)
Chest Infection Pneumonia Emphysema Dyspnoea Respiratory failure Asthma COPD PE TB Bronchiectasis Bhronchitis CF
What is pneumonia?
Infection that inflames air sacs in one or both lungs, which may fill with fluid.
What are some of the symptoms of pneumonia?
cough with phlegm or purulent,
fever,
chills,
difficulty breathing.
What is emphysema?
Emphysema is a long-term, progressive disease of the lungs that primarily causes shortness of breath due to over-inflation of the alveoli (air sacs in the lung). In people with emphysema, the lung tissue involved in exchange of gases (oxygen and carbon dioxide) is impaired or destroyed.
Define dyspnoea:
Difficult or laboured breathing.
What is COPD?
Chronic obstructive pulmonary disease (COPD) is an umbrella term for chronic lung conditions characterised by airflow obstruction that cannot be fully reversed, such as emphysema and chronic bronchitis.
What are some symptoms of COPD?
shortness of breath, wheezing chronic cough (can be dry or with phlegm) frequent respiratory infections fatigue or inability to exercise chest pressure
Indications for an adjunct airway:
- GCS < 8,
- Compromised airway,
- Patient unconscious, not breathing,
- Patient being anaesthetised.
- Decreased respiratory centre due to drug/opioid overdose
- Possible aspiration
What causes respiratory acidosis?
Alveolar hypoventilation
Inadequate perfusion
Mechanical ventilation
Diseases:
Asthma
COPD
Pneumonia
Describe the differences between Type I Respiratory Failure and Type II Respiratory Failure:
Type I respiratory failure involves low oxygen, and normal or low carbon dioxide levels.
Type I respiratory failure occurs because of damage to lung tissue. This lung damage prevents adequate oxygenation of the blood (hypoxaemia); however, the remaining normal lung is still sufficient to excrete the carbon dioxide being produced by tissue metabolism. This is possible because less functioning lung tissue is required for carbon dioxide excretion than is needed for oxygenation of the blood.
Type II respiratory failure involves low oxygen, with high carbon dioxide.
Type II respiratory failure is also known as ‘ventilatory failure’. It occurs when alveolar ventilation is insufficient to excrete the carbon dioxide being produced. Inadequate ventilation is due to reduced ventilatory effort, or inability to overcome increased resistance to ventilation – it affects the lung as a whole, and thus carbon dioxide accumulates. Complications include: damage to vital organs due to hypoxaemia, CNS depression due to increased carbon dioxide levels, respiratory acidosis (carbon dioxide retention). This is ultimately fatal unless treated. Complications due to treatment may also occur.
ABG normal results: PaO2 PaCO2 HCO3 pH BE
PaO2: 70-100 mmHg PaCO2: 35-45 mmol/l HCO3: 22-26 mmol/l pH: 7.35 – 7.45 BE: +/- 2mmol/l
Differentiate between objective and subjective data:
Subjective data: data collected from the patients information
Objective data: data collected using the 5 human senses.
Give examples of subjective date in regards to respiratory history:
- Important health information: Past health history, medications, surgery or other treatments
- Any risk factors for respiratory disease
- Smoking: Pack years (PPD x years), exposure to smoke, history of attempts to quit, methods, results
Give examples of objective date in regards to respiratory history:
Objective data: data collected using the 5 human senses.
- Respiratory rate, depth and rhythm, breath sounds, equal chest movement - use of accessory muscles.
- Mouth and pharynx: use light source/tongue blade
- Tracheal central. Neck symmetry, palpate glands
- O2 saturations.
- Auscultation
Define stridor:
High pitched noise on using on inspiration but can be on expiration, indicates a disturbance to the airflow in the upper respiratory tract.
Define stertor:
Snoring during sleep or altered consciousness
What is Non Invasive Positive Pressure Ventilation and how is it delivered?
Non Invasive Positive Pressure Ventilation:
- Delivers positive pressure breaths to a spontaneously breathing patient
- Reduces the occurrence of patients being intubated
- Delivered by a mask with an airtight seal
Discuss what CPAP is, how it works and who it is used for.
Continuous positive airway pressure:
- Provides support for spontaneously breathing patients and ventilated patients
- Is delivered non invasively via a mask
- Addition to mechanical ventilation
(The raised positive pressure assists in reducing the work of breathing on inspiration, increases gas exchange and reduces hypoxia)
What conditions is CPAP commonly used for? (List 3)
Pulmonary oedema
COPD
Asthma
What is BiPAP and what does it involve?
Bilevel Positive Airway Pressure
Involves
IPAP (Inspiratory positive airway pressure)
-Higher pressure delivered on inspiration
EPAP (Expiratory Positive Airway Pressure)
-Lower pressure (still +ve) on expiration
Define wheeze:
High pitched whistling sound heard on expiration, indicates resistance to airflow in lower respiratory tract.
Define rattle:
Heard on inspiration and expiration, associated with secretions in the lower respiratory tract (death rattle!)
What are some indications for invasive positive pressure ventilation? (Mechanical) (List 4)
◦ Inability to protect own airway (gag response diminshed, GCS reduced)
◦ inadequate breathing pattern rate and/or depth (vital capicity <15mL/kg; resp rate < 10 or > 30/min)
◦ inability to sustain O2 demands of the body PaO2 <55 mmHg, with supplemental O2,
◦ hypercapnia PCO2 > 50mmHg with acidosis pH< 7.30
Define asthma:
A chronic inflammatory disease of the airways that causes hyper-responsiveness, mucosal oedema and mucous production.
List the diagnostic testing you would do for a respiratory patient in the community. (List 3)
Chest x-ray
Pulse oximetry
Microscopy, culture and sensitivity (MC&S)
What are some treatments for a respiratory patient in the hospital? (List 6)
Oral/IV antibiotics Oxygen therapy Nebulisers Chest physio Non-invasive ventilation Surgery
List the assessments you would perform on a respiratory patient. (List 4)
- Inspection: respiratory rate, rhythm and depth. Symmetry of chest rise and fall. Use of accessory muscles, nasal flaring or head bobbing in children. Tracheal central or deviated. Breath sounds. Tidal volume, cyanosis or diaphoresis.
- Auscultation
- O2 sats
- GCS
What is the treatment aim for asthma and how is it treated?
Treatment aim is for symptom control/optimised lung function/lowest effective dose of medication/fewest possible side effects.
• Quick-relief medications (relievers)
• Long-acting medications (preventers)
What is BiPAP commonly used in? (List 6)
- High dependency patients
- Neurological disorders (Guillain Barre syndrome)
- Obstructive sleep apnoea
- COPD
- Asthma
- Post extubation weaning issues
What are some indications of invasive positive pressure ventilation? (Mechanical) (List 4)
◦ Inability to protect own airway (gag response diminshed, GCS reduced)
◦ inadequate breathing pattern rate and/or depth (vital capicity <15mL/kg; resp rate < 10 or > 30/min)
◦ inability to sustain O2 demands of the body PaO2 <55 mmHg, with supplemental O2,
◦ hypercapnia PCO2 > 50mmHg with acidosis pH< 7.30
What are some common conditions mechanical ventilation is used in? (List 6)
- Acute lung injury
- Asthma
- Pulmonary embolism
- Pneumonia (Community, hospital, ventilator associated)
- Aspiration
- Severe acute respiratory syndrome
What are the bodies compensatory mechanisms for respiratory acidosis? (List 4)
Compensations: • Initial response increased respiratory rate and depth of breathing • Increase in minute ventilation • Increased heart rate • Possible vasoconstriction
What effect does mechanical ventilation have on the full body in A-E format?
A – protection and patency
B – respiratory failure (hypercapnic or hypoxic), increase FRC, decrease WOB, secretion management/ pulmonary toilet, to facilitate bronchoscopy
C – minimise oxygen consumption and optimize oxygen delivery (e.g. sepsis)
D – unresponsive to pain, terminate seizure, prevent secondary brain injury
E — temperature control (e.g. serotonin syndrome)
Other — safety for transport (e.g. psychosis), humanitarian reasons
Define croup:
Croup is a condition caused by a viral infection. The virus leads to swelling of the voice box (larynx) and windpipe (trachea). This swelling makes the airway narrower, so it is harder to breathe. Children with croup develop a harsh, barking cough and may make a noisy, high-pitched sound when they breathe in (stridor).
Define PE:
Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism). Symptoms of a PE may include shortness of breath, chest pain particularly upon breathing in, and coughing up blood.
Define bronchitis:
Inflammation of the lining of bronchial tubes, which carry air to and from the lungs.
Define pneumothorax:
A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall.
Outline the indications for oxygen therapy: (List 3)
Indications:
• The treatment of documented hypoxia/hypoxaemia as determined by SpO2 or inadequate blood oxygen tensions (PaO2).
• Achieving targeted percentage of oxygen saturation (as per normal values unless a different target range is specified on the observation chart.)
• The treatment of an acute or emergency situation where hypoxaemia or hypoxia is suspected, and if the child is in respiratory distress manifested by:
o Dyspnoea, tachypnoea, bradypnoea, apnoea
o Pallor, cyanosis
o Lethargy or restlessness
o Use of accessory muscles: nasal flaring, intercostal or sternal recession, tracheal tug
Outline the complications of oxygen therapy: (List 5)
Complications:
• CO2 Narcosis - This occurs in patients who have chronic respiratory obstruction or respiratory insufficiency which results in hypercapnea (i.e. raised PaCO2). In these patients the respiratory centre relies on hypoxaemia to maintain adequate ventilation. If these patients are given oxygen this can reduce their respiratory drive, causing respiratory depression and a further rise in PaCO2.
• Pulmonary Atelectasis
• Pulmonary oxygen toxicity - High concentrations of oxygen (>60%) may damage the alveolar membrane when inhaled for more than 48 hours resulting in pathological lung changes.
• Retinopathy of Prematurity (ROP) - An alteration of the normal retinal vascular development, mainly affecting premature neonates (<32 weeks gestation or 1250g birthweight), which can lead to visual impairment and blindness.
• Substernal pain-due: characterised by difficulty in breathing and pain within the chest, occurring when breathing elevated pressures of oxygen for extended periods.
What PPE should be used for a patient with pneumonia (droplet precautions)?
- Mask
- Gloves
What is Kussmaul breathing?
Kussmaul’s breathing is a deep and laboured breathing pattern often associated with severe metabolic aci-dosis, particularly (DKA) but also kidney failure.
What is Cheyne–Stokes breathing?
Cheyne–Stokes is an abnormal pattern of breathing characterised by progressively deeper, and some-times faster, breathing followed by a gradual decrease that results in apnoea.
What is TB?
Tuberculosis (TB) is an infectious disease usually caused by the bacterium Mycobacterium tuberculosis (MTB). It usually affects the lungs, but can involve the kidneys, bones, spine, brain and other parts of the body.
What are some symptoms of TB? (List 5)
- Can be asymptomatic
- Cough (sometimes blood-tinged),
- Weight loss,
- Night sweats
- Fever.
People may experience:
Pain areas: in the chest
Pain circumstances: can occur while breathing
Cough: can be chronic or with blood
Whole body: chills, fatigue, fever, loss of appetite, malaise, night sweats, or sweating
Also common: loss of muscle, phlegm, severe unintentional weight loss, shortness of breath, or swollen lymph nodes
What is bronchiectasis?
Bronchiectasis is a common lung disease characterised by chronic infection in small airways that results in some parts of the lung becoming damaged, scarred and dilated, allowing infected mucus to build up in pockets.
What are some symptoms of bronchiectasis? (List 3)
- chronic cough,
- producing mucus (sputum)
- sinusitis/nasal inflammation and fatigue.
Less common symptoms include
- chest pain,
- shortness of breath and
- coughing up blood.
What is CF?
People with CF develop an abnormal amount of excessively thick and sticky mucus within the lungs, airways and the digestive system. This causes impairment of the digestive functions of the pancreas and traps bacteria in the lungs resulting in recurrent infections, leading to irreversible damage. Lung failure is the major cause of death for someone with CF.
What are some causes of respiratory alkalosis? (List 4)
Hyperventilation - anxiety induced
Asthma
Pneumonia
PE
What are the 2 common types of adverse blood transfusion reactions and 3 of their symptoms?
Febrile non-haemolytic reaction
- Tachycardia
- Febrile
- Hypotensive
Acute haemolytic reaction
- Febrile
- Flank pain
- Hemoglobinuria (excretion of free haemoglobin in the urine)
What are you observing when assessing a patients breathing pattern?
Respiratory rate, rhythm, and depth. Regularity of breathing, chest wall movement and difficulty in breathing. (Accessory muscle use - intercostal recession, nasal flaring, head bobbing in children.)
How can you determine a patients difficulty in breathing?
Orthopnoea – DIB Lying down
Use of accessory muscles
Nasal Flaring
Head bobbing (Children)
What does chest recession indicate and what is it caused by?
Chest recession / Intercostal retractions indicate that something is blocking or narrowing your airway.
Asthma, pneumonia, and other respiratory diseases can all cause a blockage.
List some symptoms of asthma? (List 4)
Cough
Chest tightness
Wheezing
Dyspnoea
Describe the pathophysiology of asthma?
- muscles of bronchial tubes tighten and thicken
- air passages become inflamed and mucous filled
Triggers of asthma: (List 6)
exercise allergies emotions irritants infections cold air
What patient teaching would you implement for a asthmatic patient? (Hint - there is 7 points.)
The nature of asthma as a chronic inflammatory disease
Identification of triggers and how to avoid them
Purpose and action for each medication
Proper inhalation techniques
How to perform peak flow monitoring
How to implement an action plan
When and how to seek assistance
What are you assessing when looking at the C aspect of the A-E assessment?
Blood pressure, pulse, cap refill, urine output, pallor
What are the different types of haemodynamic monitoring and why is each used?
Non-invasive - clinical assessments (HR, BP, Temp, urine output, SpO2)
Direct measurement of arterial pressure - frequent titration of vasoactive drips, unstable BP, frequent ABGs, if unable to obtain non-invasive NP
Invasive haemodynamic monitoring - invasive monitoring is more accurate, should be higher than BP cuff
What are the common medications used in the treatment of ACS:
Anticoagulants, beta-blockers, antiplatelets, nitroglycerin
What is the recommended position for a patient with breathing difficulties and why?
Nurse in Upright position in chair or bed
Increases lung expansion
Assists gaseous exchange in alveoli
May help relieve anxiety
AVOID laying flat
Allow patient to lean e.g. over bedside table
How do you perform peak flow monitoring? (If you were to explain to a patient.)
Move the marker to the bottom of the numbered scale.
Stand up straight.
Take a deep breath. Fill your lungs all the way.
Hold your breath while you place the mouthpiece in your mouth, between your teeth. Close your lips around it. DO NOT put your tongue against or inside the hole.
Blow out as hard and fast as you can in a single blow. Your first burst of air is the most important. So blowing for a longer time will not affect your result.
Write down the number you get. But, if you coughed or did not do the steps right, do not write down the number. Instead, do the steps over again.
Move the marker back to the bottom and repeat all these steps 2 more times. The highest of the 3 numbers is your peak flow number. Write it down in your log chart.
What does a peak flow monitor do?
A peak flow meter is a small device that helps check how well asthma is controlled. Measuring peak flow can tell how well air is being blown out of a patients lungs. If the airways are narrowed and blocked due to asthma, the peak flow values drop.
What are two assessments to assess a patients conscious state?
AVPU and GCS
How do you calculate the HR on an ECG?
Regular: Count the number of large boxes between 2 R waves
Divide the number of large squares by 300
-Eg. 300/4 = 75
HR=75
Irregular: On a 10 second rhythm strip - Count the number of QRS complexes and multiply by 6
-Eg. if there are 9 QRS complexes on the strip 9x6=54
HR=54
What is the normal width of a QRS interval on a ECG?
2.5 small squares
What is the normal length of the p-r interval on a ECG?
Less than 5 small squares
What is Intravascular disseminated coagulation disorder?
A condition affecting the blood’s ability to clot and stop bleeding. In disseminated intravascular coagulation, abnormal clumps of thickened blood (clots) form inside blood vessels. These abnormal clots use up the blood’s clotting factors, which can lead to massive bleeding in other places.
What are shockable and non-shockable rhythms?
Shockable:
Atrial fibrillation (AF) if newly diagnosed.
Ventricular tachycardia (VT)
Ventricular fibrillation (VF)
Pulseless ventricular tachycardia (PVT)
Non-shockable:
Asystole
Pulseless electrical activity (PEA)
When and what drugs should be given during an MI?
For non-shockable rhythms:
Adrenaline 1mg immediately (then every second loop)
For shockable rhythms:
Adrenaline 1mg after second shock (then every second loop)
Amiodarone 300mg after three shocks
What should be done to provide post resuscitation care?
Re-evaulate ABCDE 12 lead ECG Treat precipitating causes Aim for SpO2 94-98%, normocapnia and normoglycaemia Targeted temperature management
What is the equation for calculating IV fluid requirements for a burns patient?
(4 mL of intravenous solution [Ringer’s lactate solution] x patients weight prior to burns x percentage of total body surface area burned) and modified according to clinical variables such as urine output.
What are you assessing when looking at the C aspect of an A-E assessment?
Blood pressure, pulse, cap refill, urine output, pallor
What are you assessing when looking at the ‘D’ aspect of an A-E assessment?
Pt’s concious state - AVPU and GCS.
Pt’s pupil response.
Neurological observations.
Pain?
