Problems of Oxygenation - Part 3 Flashcards
Fluctuation of fluid that occurs during respiration
Tidaling
If tidaling is not occurring, what does this indicate?
That there is a block in the system (chest tube)
When checking bubbling in the water compartment of the chest tube, what is normal, what is not?
Occasional bubbling is normal, continuous indicates air leak
What is the purpose of milking the tubing?
Used to dislodge fragments of blood clots or lung tissue that are blocking the tubing
Why should milking the tubing not be done regularly?
Because it increases intrapleural and intrapulmonary pressures
Although clamping the drainage tube of a chest tube is often contraindicated, when is it appropriate?
Appropraite when assessing the readiness for the removal of the chest tube and when changing the drainage system
It is best to clamp the drainage tube during _______.
expiration
Clamping the drainage tube:
- if the tubing becomes unattached, it is best to try to _______ or immerse in bottle of sterile _______ to reestablish seal.
reattach
saline
Removing the chest tube:
- _______ decision
- Not to be removed if > ___-____ mL of drainage daily
- the sooner the tube is removed, the faster the improvement in post-operative _____
- removal can be moderately painful so, __-_______
- One should have equipment to apply ________ dressing over the site immediately to ensure ________ does not occur
physician decision (although a trained nurse can remove it) 50-70mL pain pre-medicate occlusive; pneumothorax
Collection of fluid in the pleural space
pleural effusion
Pleural effusion occuring in non-inflammatory connditions - CHF, chronic liver or renal disease
Transudative effusion (hydrothorax)
Pleural effusion that occurs in an area of inflammation with pulmonary malignancies, pulmonary infections, pulmonary embolization and GI disease (pancreatitis)
Exudative effusion
A pleural effusion containing pus
Empyema
Complication of empyema, where there is a fibrous fusion of the visceral and parietal pleura
Fibrothorax
Procedure done when there is too much fluid in the pleural space. This allows pleural fluid analysis to be performed in lab to figure out the cause of fluid accumulation around one or both of the lungs.
Thoracentesis
Describe thoracentesis.
Use a large needle (with a 60mL syringe) to pull out fluid
What is another name for thoracentesis.
Pleural tap
Abnormal accumulation of fluid in the alveoli and interstitial spaces of the lungs.
Pulmonary edema
What is the most common cause of pulmonary edema?
Left sided congestive heart failure
Pulmonary HTN: can be primary, or secondary.
Secondary results from a complication of a ______ or ________ disorder.
respirator, cardiac
Enlargement of the right side of the heart secondary to respiratory system disorders./
Cor pulmonale
The most common cause of Cor pulmonary is what?
May also result from this.
COPD
may also result from pulmonary HTN
IF pulmonary HTN goes unchecked, this cardiac disorder will occur.
CHF
If we cannot fix cor pulmonale, the patient will go into _______.
arrest
Chronic inflammatory disorder of the airway causing hyper-responsiveness and broncho-constriction.
Asthma
What are the obstructive pulmonary diseases we learn about in class?
Asthma, COPD, CF
Asthma is a result of environmental effects on the airway, ______, ______ and _______ agents trigger airway inflammation and airway narrowing.
allergens, chemicals, infectious agents
Bronchospasm that occurs after vigorous exercise, cold or dry climate may also trigger the response.
Exercise-induced asthma
What are symptoms of asthma?
Wheezing, breathlessness, chest tightness, cough (At night and early morning)
What is something we can teach parents to help with their child’s asthma during the winter months?
Cover the mouth of the child with a scarf
Describe how the bronchioles are narrowed in asthma.
Inflammatory response narrows the lumen, and mucus further occludes it.
Looks at the literature on a specific topic and an expert panel uses the information to inform practice
Cochrane review
What is the most common drug that may trigger asthma response in children?
Asparin (may cause Reye’s syndrome and asthma in kids)
What do we give instead of aspirin to a feverish child?
Tylenol
What dyes may cause allergic reaction in certain individuals?
Blue 1, Red 40, yellow 5 and yellow 6
Which dyes are the most notorious for triggering asthmatic responses?
Yellow 5 (and 6)
These internal triggers may trigger asthmatic response.
GERD and emotional stress
Asthma treatment:
- Limit exposure to ______
- Educate patients and family
- Drugs - which ones?
- continuous asssessment of asthma control and severity
- Have an action plan
- Regular follow up with HCPs
triggers
Drugs - short-acting B2-agonist inhaled bronchodilators (e.g. salbutamol, terbutaline)
- inhaled or oral corticosteroids
Why is the patient’s mouth rinsed after steroid inhalation?
To prevent oropharyngeal candidiasis
What would an action plan entail for an person with asthma?
Having an epipen ready
if the temperature drops, warm up the child
Want to stress having a plan to the patient
What is given first for asthma treatment, the bronchodilators or corticosteroids?
B before C
bronchodilators before corticosteroids
How does one know if the bronchodilator canister is full?
Sumerge it in water - if it sinks it is full, if it floats it is empty
What is the purpose of shaking the canister?
Evenly distributes the medication
What is the person’s mouth washed with after corticosteroid inhalation?
diluted mouthwash or water
When using an inhaler, where should it be positioned?
In what cases would this not be possible? What is done?
4cm or 2 inches away from mouth
For some patients with respiratory decline, will have to put mouth over inhaler or use a spacer
If a patient will have a second puff, how long should they wait before taking the other?
1-2 minutes
Describe the steps for teaching a client to use an inhaler.
Shake inhaler vigorously
Discharge a dose if inhaler has not been used in last 24 hr.
Breathe out to end of normal breath
Position inhaler 4 cm from mouth
Open mouth, tilt head slightly back, at the same time as you start to breathe in depress the inhaler
Continue breathing in for about 5 sec, hold for 8-10 sec, then breathe out.
Wait 1-2 min in between puffs
Oral rinse pc steroid inhaler to avoid oropharyngeal candida
Describe the tongue position when using an aero chamber spacer
keep tongue down and relaxed
What are the causes of COPD?
smoking (number one cause), reoccuring RTI, heredity and aging
What are the cardinal symptoms of COPD?
SOB and limitations in activity
Hyperinflation of alveoli, destruction of alveolar walls and capillary walls, narrowed, tortuous, small airways and loss of lung elasticity, Barrel-chest due to alveolar distension
Emphysema
Excessive production of mucus in the bronchi, recurrent persistent cough
Chronic bronchitis
A person with emphysema will have oxygen at what frequency?
24 hours a day
What is the mainstay of treatment for COPD?
Bronchodilators and steroids
Why are COPD patients given drugs before their meals?
Makes eating less labourous and makes eating more successful
What vaccines are given to COPD patients?
Describe hydration goals for these patients.
Describe O2 therapy for these individuals.
Flu and pneumovax vaccines
Try for 3L per day to thin secretions
Use lowest flow rate for oxygen therapy
Describe the physical exercise plan for COPD patients.
What do we implore patients stop doing?
provide exercises that are doable - e.g. walking
stop smoking
What are some patient and family teaching we provide centered around COPD?
Huff coughing, small frequent meals, rest periods, take meds before meals and exercise, energy conserving strategies (e.g. sitting while doing tasks)
What does CPAP stand for? IPAP?
Continuous positive airway pressure
inspiratory positive airway pressure
Respiratory ventilation used primarily in the treatment of sleep apnea and for those critically ill in hospital with respiratory failure, and with neonates
PAP - positive airway pressure
How does IPAP help?
Decreases work done by respiratory muscles
bronchioles and alveoli are prevented from collapsing at the end of expiration
Autosomal recessive, multi-system disease of endocrine glands involving primarily the lungs, pancreas and sweat glands.
It causes abnormally thick, abundant secretions from mucus glands which can lead to obstructive pulmonary disorder.
CF
CF genetics?
Carrier rate?
Found in what proportion of births?
Most children diagnosed by?
autosomal recessive
1:25 carrier rate
1:300 live births (1:2000 on slide)
Most diagnosed by age 2
What are parents of CF children taught to do as a treatment?
Postural drainage - feet higher than head, drain mucus out of lungs - also use clapping back and anterior chest to help move secretions
Also taught how to suction mucus out
What machines are used in CF treatment?
PEP - positive expiratory pressure breathing machines
What type of drugs are CF patients on?
Bronchodilators, steroids, antibiotics (prophylactically) and handfuls of pancreatic enzymes (digest mucus)
vitamins as well due to malabsorption
Why does a lung transplant not cure a patient?
There are still sweat gland and GI issues
worn over the chest, vest is attached to an air generator that inflates and deflates the vest very quickly. This motion vibrates the chest and loosens mucus.
Vibrating vest for CF treatment
