Pulmonary - Interactive Lecture Flashcards by Lucy Su

how does aging affect breathing

brain is less sensitive to changes in gases (hypoxia, hypocapnea)
higher residual volume which increases chances of pneumonia & bronchitis

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bulging of intercostal spaces could indicate what

tumor, aneurysm, cardiac enlargement

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define barrel chest

AP to transverse of 1:2 is normal
barrel chest is 1:1 ratio

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normal RR for different ages

infant: 30-60
toddler: 25-40
preschooler: 20-35
school-age: 20-30
adolescent: 12-16
adult: 16-20

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men vs. children vs. women breathes typically from where

men & kids: diaphragm breathing
women: thoracic breathing

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describe pleural friction rub

loud, dry, crackling sound in anterior and lateral areas

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5 main symptoms of respiration issues

Cardiac Beats With Strong Pulse

Cough
Breathlessness
Wheezes
Sputum
Pain

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what does WBC & pathogen filling the alveoli lead to

thick, blood-tinged yellow-green sputum with pus

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population that is at risk for pneumonia

weaker immune system
decreased cough & epiglottal reflexes
hospitalization or use of ventilators
weaker lungs (COPD, asthma, smokers)
work in an environment that has pollutants

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CAP
MCAP: HAP, VAP, HCAP

CAP: community acquired pneumonia
MCAP: medical care associated pneumonia
HAP: hospital associated
VAP: ventilator associated
HCAP: health care associated

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what part of the lungs does CAP affect

lower respiratory infection

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signs and symptoms of pneumonia

acute fever/chills
cough
pleuritic chest pain
crackles, SOB, dyspnea
pulmonary consolidation (alveoli filled with fluids instead of air)
confusion in older adults

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what does subcutaneous emphysema feel like

palpitation leads to crackling sound (crepitation)

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Where are bronchial sounds heard

manubrium & sternum

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what does bronchial sounds sound like

1:1.5 insp slightly shorter:exp
high pitched

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what does tracheal sounds sound like

loud, high pitched

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where are bronchiovascular sounds heard

1-2nd ICS anterior, scapula posterior

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what does bronchiovascular sounds sound like

1:1 insp:exp
mid intensity & pitch

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where are vesicular sounds heard

most lung fields

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what do vesicular sounds sound like

2:1 insp:exp
soft, low pitch

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how many times anterior and posterior we should auscultate to

12 anterior
14 posterior

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what do crackles sound like;
where & when is it heard

bubbling, popping, clicking in the lower lung bases
mostly during inspiration

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what are crackles associated with

fluid in alveoli
PE, early CHF, pneumonia

what do wheezes sound like

high-pitched whistle heard in most lung fields
heard mostly during expiration but can happen during inspiration depending on severity

what do wheezes indicate

constricted airways due to asthma, chronic bronchitis, COPD

what does rhonchi sound like

low-pitched snoring, gurgling over the larger airways

what does rhonchi indicate

blockage in larger airways acute bronchitis

what does stridor sound like

inspiratory musical wheeze during inspiration

what does stridor indicate

obstructed trachea or larynx - emergency turbulent flow through narrow upper airways

which population should get pneumococcal vaccine

- at risk: chronic heart/lung dx, diabetes - recovering from severe illness - older than 65yrs old - in a long-term care facility

which abx to give for pneumonia

fluoroquinolones ("floxacin"), beta-lactams, macrolides (Azithromycin)

what is commonly characterized by barrel chest, muscle wasting, weight loss, and air trapping

emphysema

what is emphysema

alveoli damaged over time

is acidosis or alkalosis easier for the body to balance

acid easier to deal with

what part of the brain control breathing

medulla

purpose of renal system in controlling acid/base balance

excretes free H+ with ammonia through urine conserves bicarbonate

where are ABG tests taken from and what does it tell you

ABG taken from arteries pH, O2, CO2 monitored

upper vs. lower airway issues

- upper is less severe - cough, rhinitis, mild fever, sore throat - lower is worse - increased RR/HR, high fever (>38.5), O2 sat below 95%, retractions, cyanosis

ROME mnemonic

Respiratory Opposite Metabolic Equal

normal pH range

7.35 - 7.45

normal PaCO2 range

35 - 45

normal HCO3 range

22 - 26

causes of metabolic acidosis

ACIDOTIC mnemonic Aspirin toxicity Carbohydrates unmetabolized (malnutrition) Insufficiency of kidneys Diarrhea Ostomy fisTula Intake of high fat Carbonic anhydrase inhibitors and DKA

S/S of metabolic acidosis

- Kussmauls breathing - weakness, confusion - hypotension - change in cardiac - N&V

nursing interventions for metabolic acidosis

- assess neuro/seizures - treat renal failure - monitor fluids/electrolytes - treat DKA, manage resp distress

causes of metabolic alkalosis

ALKALI mnemonic Aldosterone production excess (hyperaldosteronism) Loop diuretics alKali ingestion (antiacids) Anticoagulant - citrates Loss of fluids (vomiting, NG tube suctioning) Increased sodium bicarb administration

reasoning behind getting metabolic alkalosis

decrease in H+ which is required to transport HCO3 out of blood so HCO3 will accumulate in blood

S/S of metabolic alkalosis

- bradypnea - hypokalemia

nursing interventions for metabolic alkalosis

- antiemetics - stop NG suction, diuretics - monitor Na & Cl

causes of respiratory acidosis

DEPRESS mnemonic Depressed breathing & NMS (neuroleptic malignant syndrome - rxn to anti-psychotic meds) Edema Pneumonia Resp. center damage Emboli Spasms of bronchi (asthma) Sac elasticity changes (COPD/emphysema) chronic: severe obesity, neuromuscular d/o, scoliosis acute: obstructed airways, sedative overdose, cardiac arrest

S/S of resp acidosis

- neuro changes - headache - decrease in BP/RR

nursing interventions for resp acidosis

- supply O2 - DB&C - potassium monitoring, EKG - Abx - endotracheal intubation

causes of resp alkalosis

TACHYPNEA mnemonic Temp increase Aspirin toxicity Controlled mechanical ventilation Hyperventilation hYsteria Pain, pregnancy, pneumonia Neurological injuries Embolism/Edema Asthma

S/S for resp alkalosis

- tachypnea - change in LOC - tetany, chvostek sign from hypocalcemia - changes in EKG - muscle cramps

nursing interventions for resp alkalosis

- paper bag breathing - monitor K & Ca - monitor mechanically ventilated pts

what is thoracentesis

needle in pleural space or lungs to drain fluids

what is pneumothorax

air leakage from punctured pleural space leading to collapse of lungs