Pulmonary Flashcards
Chronic Obstructive Pulmonary Disease (COPD)
a disease characterized by a decreased ability of the lungs to perform the function of ventilation
cardiac and circulatory diseases may allow blood to pool in the large veins of the pelvis and lower extremities causing …
pulmonary emboli
Processes of Gas Exchange
Ventilation
Diffusion
Perfusion
Major function of the respiratory system is to
exchange gases with the environment. Oxygen is taken in and carbon dioxide eliminated, a process known as gas exchange.
Ventilation
is the mechanical process of moving air in and out of the lungs
Diffusion
the movement of molecules through a membrane from an area of greater concentration to an area of lesser concentration
In diffusion the gases move between
the alveoli and the pulmonary capillaries.
As the red blood cells moves through the pulmonary capillaries..
they become enriched with oxygen. less oxygen will pass into the bloodstream as the gradient between alveolar and capillary oxygen concentration decreases
Perfusion
the circulation of blood through the capillaries
lung perfusion is dependent on three conditions
Adequate blood volume
intact pulmonary capillaries
efficient pumping of blood by the heart
hemoglobin
the transport protein that carries oxygen in the blood
oxygen is transported in the bloodstream in one of two ways
bound to hemoglobin
dissolved in the plasma
carbon dioxide is transported from the cells to the lungs in one of three ways
as bicarbonate ions
bound to the globin portion of the hemoglobin molecule
dissolved in plasma (measured in PCO2)
respiration
the exchange of gases between a living organism and its environment
diseases that affect the upper respiratory tract will result in
obstruction of air flow to the lower structures.
upper airway trauma produces
both significant hemorrhage and swelling
infections of the upper airway structures can obstruct
airflow
lower air obstruction may be caused by
trauma, foreign body aspiration, mucus accumulation (asthmatics), smooth muscle constriction (in asthma and COPD) and airway edema produced by infections or burns
traumatic injuries to chest wall/diaphragm will disrupt the normal mechanics causing..
negative pressure within the pleural space.
pneumothorax
a collection of air in the pleural space, causing a loss of the negative pressure that binds the lung to the chest wall.
open pneumothorax
air enters the pleural space through an injury to the chest wall
closed pneumothorax
air enters the pleural space through an opening in the pleura that covers the lung
tension pneumothorax
develops when air in the pleural space cannot escape, causing buildup of pressure and collapse of the lung
hemothorax
a collection of blood in the pleural space
flail chest
one or more ribs fractures in two or more places, creating an unattached rib segment
cheyne-stokes respirations description
pattern with progressively increasing tidal volume, followed by a declining volume, separated by periods of apnea at the end of expiration
what patient is cheyne-stokes typically seen in
older patient with terminal illness
brain injury
Kussmails respirations decription
deep, rapid breaths that result as a corrective measure against such conditions as diabetic ketoacidosis that produce metabolic acidosis
apneustic respiration description
is characterized by long deep breaths that are stopped during the inspiratory phase and separated by periods of apnea.
when would you see apneustic respirations in a pateint
result of stroke or severe central nervous system disease
hypoxia
state in which insufficient oxygen is available to meet the oxygen requirements of the cells.
when an area of lung tissue is appropriately ventilated but no capillary perfusion occurs, available oxygen is not moved into the circulatory system … what is this called
pulmonary shunting
General Impression of Respiratory Status
position colour mental status ability to speak respiratory effect
pallor
paleness
diaphoresis
sweatiness
cyanosis
bluish discoloration of the skin. the condition is directly related to poor ventilation
tracheal tugging
retraction of the tissues of the neck due to airway obstruction or dyspnea
noisy breathing nearly always means …
partial airway obstruction
obstruction breathing is now always..
noisy
the brain can only survive only a few minutes in ..
asphyxia
asphyxia
a decrease in the amount of oxygen and an increase in the amount of carbon dioxide as a result of some interference with respiration
what breathing signs should suggest a possible life-threatening respiratory problem in adults
- alterations in mental status
- severe central cyanosis
- absent breath sounds
- audible stridor
- one-two work dyspnea
- tachycardia
- pallor or diaphoresis
- presence of intercostal and sternocleidomastoid retractions
- use of accessory muscles
orthopnea
dyspnea while lying surpine
paroxysmal nocturnal dyspnea
short attacks of dyspnea that occur at night and interrupt sleep
hemoptysis
expectoration of blood from the respiratory tree
if a patient complains of dyspnea what should you obtain
SAMPLE
if the chief complaint suggests respiratory disease what should you ask for
OPQRST questions about current symptoms
SOME GOOD QUESTIONS TO ASK FOR OPQRST
- how long has the dyspnea been present
- was the onset gradual or abrupt
- is the dyspnea better or worse by position
- is there associated orthopnea or PNS
- has the patient been coughing
- character and colour of the sputum
- is there any hemptysis
- is there any chest pain associated with the dyspnea (what is the location of the pain, was the onset of pain sudden or slow, what was the duration of the pain, does the pain radiate to any area, does the pain increase with respiration)
- are there associated symptoms of fever or chills
- what is the patients past medical history
- has the patient experienced wheezing
- is the patient or close family member or smoker
why should you inspect the finger for clubbing
any clubbing may indicate chronic respiratory or cardiac disease
principles of management for respiratory disorders include….
give first priority to the airway and always provide oxygen to patients with respiratory distress or the possibility of hypoxia, including patients with COPD
common causes of airway obstruction
tongue foreign matter trauma burns allergic reaction infection
Management of a conscious adult in an upper airway obstruction
1) ask the patient .. are you choking? can you speak? if the patient can speak they should be able to produce a forceful cough to expel the foreign body
2) if the patient has a complete obstruction or poor air exchange (can speak) … perform Heimlich manoeuvre,
management of unconscious adult or is loosing conscious in an upper airway obstruction
1) head-tilt, chin lift, the jaw thrust to try and open airway
2) insert an NPA and attempt to give 2 ventilation’s via BVM; if attempts fail, repositon head and repeat attempt
3) if step 1&2 fail start chest compressions. three sets of five
4) if step 3 fails, try the tongue-jaw lift and if the object is visual attempt to sweep it out of the way. If successful resume ventilation, if unsuccessful call an ACP
Adult respiratory distress syndrome (ARDS)
form of pulmonary edema that is caused by fluid accumulation in the interstitial space within the lungs
if airway obstruction is caused by laryngeal edema (anaphylactic reactions, angioedeme) .. what do you do?
1) head tilt chin lift/jaw thrust manoever
2) administer supplemental oxygen
3) attempt BVM
4) start an IV and administer EPI
patients with cardiogenic pulmonary edema have a poorly functioning…..
left ventricle
Positive end expiratory pressure (PEEP)
a method of holding the alveoli open by increasing expiratory pressure.
obstructive lung diseases
emphysema
chronic bronchitis
asthma
if the patient has asthma & chronic bronchitis what do we call that?
chronic obstructive pulmonary disease (COPD)
Obstructive lung diseases result in obstruction primarily in what?
bronchioles
cor pulmonale
hypertrophy of the right ventricle resulting from disorders of the lung
polycythemia
an excess of red blood cells
Emphysema is rarely associated with….
a cough except in the morning
how does emphysema result?
destruction of the alveolar walls distal to the terminal bronchioles.
continued exposure in emphysema can lead to…
hypertension which can lead to cor pulmonale, right heart failure or death
why does emphysema turn into hypertension
diffusion defects, the number of pulmonary capillaries in the lung is decreased, thus increasing resistance to pulmonary blood flow.
what are the signs and symptoms a patient may have with emphysema
report a history of recent weight loss, increased dyspnea with exertion, well developed accessory muscles and progressive limitation of physical activity. Rarely has a cough only in the morning, a barrel chest, clubbing of the fingers, hypertension and pink skin.
Chronic bronchitis
results from an increase in the number of the goblet cells in the respiratory tree.
how is chronic bronchitis characterized
characterized by the production of a large quantity of sputum.
unlike emphysema… in chronic bronchitis the aveoli are….
not severely affected, and diffusion remains normal
hypoxia may increase red blood cell production which in turn leads to
polycythemia
chronic bronchitis is usually associated with…
productive cough and copious sputum production
patients tend to be overweight and are often cyanotic
usually a smoker
what is the first step in treating a patient suffering an exacerbation of emphysema or chronic bronchitis
establish an airway
What are the steps to managing emphysema and chronic bronchitis
establish an airway
place patient in a seated or semi seated position
apply pulse oximeter
administer supplemental oxygen at low-flow rate
** may have to BVM
establish an IV and you may have to administer and bronchodilator medication.
emphysema and chronic bronchitis management goals
relieve hypoxia
reverse bronchoconstriction
Common signs of asthma
dyspnea
wheezing
cough
what happens in the body when someone takes an asthma attack
a two phase reaction occurs.
the first phase: characterized by a release of chemical mediators such as histamine. these mediators cause contraction of the bronchial smooth muscle and leakage of fluid from peribronchial capillaries. this results in both bronchoconstriction and bronchial edema. the two factors can decrease expiratory airflow.
the second phase: will typically not respond to inhaled beta-agonist drugs. will need anti-inflammatory agents, such as corticosteroid’s will be required.
asthma management goals
correct hypoxia - give oxygen
reverse bronchospam - give a beta-agonist
reduce inflammation
remember to always to monitor the patient and be prepared to provide airway and respiratory support.
status asthmaticus
is a severe, prolonged asthma attack that cannot be broken even by repeated doses of bronchodilator’s.
this patient will be exhausted, severely acidotic, and dehydrated.
TRANSPORT IMMEDIATELY
pleuritic
sharp or tearing, as a description of pain
pneumonia
is an infection of the lungs.
what happens in pneumonia within the body
the infection begins in one part of the lung and often spreads to nearby alveoli. as the diseases progresses fluid and inflammatory cells collect in the alveoli, and alveolar collapse may occur. if the infection gets into the blood stream to more distant sites in the body this may lead to SEPTIC SHOCK
assessing a patient with pneumonia
- may have had a recent history of chills and fever
- complain of deep, productive cough that may expel yellow to brown sputum often streaked with blood
- many cases involve pleuritic chest pain (may be upper abdominal pain since pneumonia affect lower lobes of the lung)
- secondary assessment will commonly reveal fever, trachypnea, tachycardia, and a cough. Auscultation of the check demonstrates crackles.
managing pneumonia
place patient in comfortable position and administer high flow oxygen.
if wheezing is present you can administer a beta-agonist for some symptomatic relief.
lung cancer management goals
administer oxygen
support ventilation
be aware of any DNR order
provide emotional support
toxic inhalation management sequence
ensure safety or rescue personnel
remove patient from toxic environment
maintain an open airway
provide humidified, high-concentration oxygen
pulmonary embolism
a blood clot or some other particle that lodges in a pulmonary artery, effectively blocking blood flow through that vessel.
what happens when a pulmonary embolism occurs
the blockage of blood flow through the affected artery causes the right heart to pump against increased resistance. this results in an increase in pulmonary capillary pressure. the area of the lung supplied by the occluded pulmonary vessel can no longer effectively function in gas exchange, since it receives no effective blood supply.
a patient with acute pulmonary embolism may have a sudden onset of …
severe unexplained dyspnea with or without pleuritic chest pain
a large pulmonary embolism may lead to …
cardiac arrest
spontaneous pneumothorax
a pneumothorax that occurs spontaneously, in the absence of blunt or penetrating trauma.
what is a spontaneous pneumothorax
the primary derangement is one of ventilation as the negative pressure that normally exists in the pleural space is lost. this prevents proper expansion of the lung in concert with the chest wall.
Assessing a patient with a spontaneous pneumothorax
presents with a sudden onset of sharp, pleuritic chest or shoulder pain.
management of a spontaneous pneumothorax
supplemental oxygen
what should you be careful of when managing a spontaneous pneumothorax
too much pressure may result in a tension pneumothorax
what should you consider hyperventilation
indicative or a serious medical problem until proven otherwise
central nervous system (CNS) dysfunction pathophysiology
can be a causative factor in respiratory depression and arrest. causes include head trauma, stroke, brain tumours and various drugs.
Managing CNS dysfunction
establish and maintain an open airway. if respiratory depression is noted or respiration’s are absent, initiate mechanical ventilation with supplemental oxygen and establish an IV or normal saline at a “to-keep-open” rate
extubation
removing a tube from a body opening
paradoxical breathing
assymetrical chest wall movement that lessens respiratory efficiency
anoxia
the absence or near absence of oxygen
pulses paradoxus
drop in blood pressure of greater than 10mmHg during inspiration
Kussmaul’s respirations
deep, slow or rapid, gasping breathing, commonly found in diabetic ketoacidosis
cheyne-stokes respiration’s
progressively deeper, faster breathing alternating gradually with shallow, slower breathing, indicating brain stem injury
Biot’s respiration’s
irregular pattern of rate and depth with sudden, periodic episodes of apnea, indicating increased intracranial pressure
central neurogenic hyperventilation respiration’s
deep, rapid respirations, indicating increased intracranial pressure
agonal respiration’s
shallow, slow, or infrequent breathing, indicating brain anoxia
snoring sound’s
results from partial obstruction of the upper airway by the tongue (airflow compromise)
gurgling sound’s
results from the accumulation of blood, vomitus, or other secretions in the upper airway (airflow compromise)
stridor sound’s
a harsh, high-pitched sound heard on inhalation, associated with laryngeal edema or constriction (airflow compromise)
wheezing sound’s
a musical, squeaking, or whistling sound heard on inspiration and/or expiration. Associated with bronchiolar constriction (airflow compromise)
Quiet sound’s
diminished or absent breath sounds are ominous finding and indicate a serious problem with the airway, breathing or both. (airflow compromise)
crackle sound’s
a fine bubbling sound heard on inspiration associated with fluid in the smaller bronchioles (compromise gas exchange)
rhonchi sound’s
a coarse, rattling noise heard on inspiration, associated with inflammation, mucus or fluid in the bronchioles (compromise gas exchange)
compliance
the stiffness or flexibility of the lung tissue
tachycardia usually accompanies…
hypoxia in an adult
bradycardia hints at…
anoxia with imminent cardiac arrest
tank life in minutes formula is…
gauge pressure - safe residual pressure/oxygen delivered in litres per minute x constant
