resp 2 Flashcards
COPD lab values-blood-3
elevated:
RBC 4.2-6.1
Hgb 12-18
Hct 37%-52%
COPD lab values- WBC differential-2
elevated:
neutrophils 2500-8000, 55-70%
eosinophils 50-500, 1-4%
COPD lab values- ABG-2
Decreased: PaO2 80-100
elevated PaCO2 35-45
sputum production
- assess color, consistency, odor, and amount
- normal 90mL a day
smokers sputum
mocoid
pulmonary edema sputum
excessive pink, frothy
bacterial pneumonia sputum
rust colored
lung abcess sputum
foul smelling
hemoptysis
blood in sputum most seen in lung cancer and chronic bronchitis
grossly bloody sputum
TB, pulmonary infarction, lung cancer, lung abcess
palpation resp assessment
- identify areas of tenderness and check vocal or tactile fremitus (vibration)
- place hands at 9th rib inhale moves thumbs up and out, uneven expansion could be from pain, trauma, or air in pleural cav
- palpate abnormalities, crepitus
crepitus
air trapped in and under skin, subcutaneous emphysema
- crackle beneath fingertips
- alert HCP if around wound, trach, or if pneumothorax suspected
tactile (vocal) fremitus
- vibration felt on chest wall when speaking
- decreased with air (pneumothorax) or fluid (plearal effusion), or if bronchus obstructed
- increased with pneumonia and lung abcess
percussion resp assessment- resonance
normal lung tissue
percussion resp assessment- hyperresonance
presence of trapped air
percussion resp assessment- flatness
may be pleaural effusion
percussion resp assessment- dullness
atelectasis or consolidated lung
percussion resp assessment- tympany
large pneumothorax
breath sounds- fine crackles/rales
popping, discontinuous sounds caused by air moving into previously deflated airways; hair rolled between fingers
-asbestosis, atelectasis, interstitial fibrosis
high-pitched rales
velcro sound, late in inspiration usually associated w restrictive disorders
-bronchitis, pneumonia, chronic pulm disease
coarse/low pitched crackles
rattle produced by fluid/secretions in large airways, likely to change w cough/suction
-bronchitis, pneumonia, tumors, pulm edema
wheeze
squeaky/musical/continuous ass. w air moving through narrowed small airways; heard w/o stethoscope, not cleared by coughing
-inflammation, bronchspasm, edema, secretions, pulm vessel engorgement
rhonchus
low pitched, coarse, cont snoring, come from large airways
-thick tenacious secretions, sputum prod, foreign body obstruction, tumors
pleural friction rub
loud/rough/grating/scratching due to inflamed surfaces of pleura rubbing together, pain on deep resp, heard in lateral lung fields
-pleurisy, TB, pulm infarction, pneumonia, lung cancer
CT IV contrast contraindications
allergy to iodine or shellfish, kidney function, type 2 DM (nephrotoxic)
-metformin stop 24 prior and not restarted until adequate kidney funct reestablished
benzocaine complications
may induce methemoglobinemia- altered iron state that does not carry oxygen results in tissue hypoxia
pneumothorax signs
- can occur 24 hrs after thoracentesis
- pain on affected side worse at end of inhalation and exhalation, rapid heart rate, rapid shallow resp, feeling of air hunger
- prominence of affected side that does not move in and out w resp, trachea slanted to unaffected side, new nagging cough, cyanosis
thoracentesis positioing
depends on vol and location of fluid, sitting leaning forward
chronic hypercarbia oxygen requirements
Fio2 should be titrated to achieve oxygen saturation between 88-92%
non-rebreather mask safety
ensure valve and flaps are intact and functional during ea breath, remove mucus and saliva, closely assess pt, intubation next step
