Pulmonary - Interactive Lecture Flashcards
how does aging affect breathing
- brain is less sensitive to changes in gases (hypoxia, hypocapnea)
- higher residual volume which increases chances of pneumonia & bronchitis
bulging of intercostal spaces could indicate what
tumor, aneurysm, cardiac enlargement
define barrel chest
AP to transverse of 1:2 is normal
barrel chest is 1:1 ratio
normal RR for different ages
- infant: 30-60
- toddler: 25-40
- preschooler: 20-35
- school-age: 20-30
- adolescent: 12-16
- adult: 16-20
men vs. children vs. women breathes typically from where
men & kids: diaphragm breathing
women: thoracic breathing
describe pleural friction rub
loud, dry, crackling sound in anterior and lateral areas
5 main symptoms of respiration issues
Cardiac Beats With Strong Pulse
Cough
Breathlessness
Wheezes
Sputum
Pain
what does WBC & pathogen filling the alveoli lead to
thick, blood-tinged yellow-green sputum with pus
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
CAP
MCAP: HAP, VAP, HCAP
CAP: community acquired pneumonia
MCAP: medical care associated pneumonia
HAP: hospital associated
VAP: ventilator associated
HCAP: health care associated
what part of the lungs does CAP affect
lower respiratory infection
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
what does subcutaneous emphysema feel like
palpitation leads to crackling sound (crepitation)
Where are bronchial sounds heard
manubrium & sternum
what does bronchial sounds sound like
1:1.5 insp slightly shorter:exp
high pitched
what does tracheal sounds sound like
loud, high pitched
where are bronchiovascular sounds heard
1-2nd ICS anterior, scapula posterior
what does bronchiovascular sounds sound like
1:1 insp:exp
mid intensity & pitch
where are vesicular sounds heard
most lung fields
what do vesicular sounds sound like
2:1 insp:exp
soft, low pitch
how many times anterior and posterior we should auscultate to
12 anterior
14 posterior
what do crackles sound like;
where & when is it heard
bubbling, popping, clicking in the lower lung bases
mostly during inspiration
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
