resp Flashcards
resp distress intervention
raise them up suction o2 adm assess lung sounds notfy hcp
what is cystic fibrosis
deficiency of protein that is responsible of transportion sodium and chloride causing the secretions to be thicke and stickier
CF complications
pnuemothorax
infection
pnuemothorax signs
dyspnea
tacypnea
tacycardia
DROP IN O2- EARLIEST CLUE
CF normal
chronic cough
inabiltity to clear secretions
blood streaked sputum
decreased pulse o2 but 90 or less is urgent untervention
-hard to gain weight bc of malasoprtion of carbs, fats , and portein
-fecal retention and impaction due to decreased water and sodium secretion into the intestines
-short lifepsna up to 30s
carbon manoxiete vs o2
Carbon manoxide has a stronger bond to hgb than O2 causing o2 to be dispalced from hgb causing hypoxia that is NOT REFLEXTED BY PULSE O2
carbon manoxide poisiong intervnetion
100% O2 using nonretbreather at 15/min
why is pulse o2 reading no accurate in CO posiioning
dont ever look at pulse ox to determine pt o2 because pulse ox cannot differentiate CO from o2
dignosis of CO poisioning
co-oximtry of a blood gas sample
COPD leads to
chronic air trapping
-reduced gas excange by decreased ventilation
Copd clients are at increasd risk for
resp infections which can trigger exacerbations
COPD education
get pnumonccal cavvine
-seek help for increased sputum, worsening sob, lack or relive from mesd
COPD expected
polycetmehmia so iron isnt needed and can cause harm
-ANEMIA IS NOTTTT a problem so dont give IRONNNN
normal o2 levels
95-99
what provides o2, ventilation in a client with resp failure
ABG
when do you clamp chest tube
few hours prior to remove it to check for air leak
how often do you check the chest tube chamber
every hour for the first 8 hours after surgery, then every 8 hours until removed
what is epected after surgery
low o2
pleural effusion
abnormal collection of fluid >15 ml in the pleural space that prevevnts lungs from expanding fully, decreasing lung volume, ineffective gas exchange, atelecatasis
plural effusion disgnosed by
chest xray or CT scan
plueral effusion pt report waht signs
dyspnea with NON productive cough
- chest pain with respiration
- diminished breath sounds
- dullness to percussion
- decreased tacile fremitus
- WHEEZING NOT A SIGNNNNN
- decreasd mov over the affected lung
wheezing is seen in
obstructive process such as COPD
AND ASTHMA not pleural effusion
perussion in pnuemothorax
hypoerresoonse
in pleural effusion it is DULL
earliest sign of hypoxemia
restleness
whatt should not be used in pt with COPD
benzodiapines and morphine bc they depress the resp system
rib fractures intevention
if there are no singigicat injuries then do PAIN MANGEMENT
AND PUL HYGEINE
expected finding of rib fractures
shallow breathing
pain on inspiration
dont need HCP if they are complianing of these things
bronchitis
inflammation of the upper airways by viral infection
rhonchi souund
continous, low pitched adventious sound
-sounds like moaning or snoring and hear mainly on expiration but inspiration as well sometims
rhonchi sounds occur when
thick secretions or forgin bodies like tumor obstruct the airflow in the upperairways
rhonchi sounds are manily heard in
bronchitis
Cystic F
pneumonia
asthma signs
high pitched, muscual wheezes
croup sound
manifests with strifor
plurisy
pleural friction rub, loud, rough rubbing
on inspiration and exp
-caused by pleural surfaces rubbing together
-similar to crackles
crackles are only heard on
inspiration
CF tratment
- chest physio
- aerobic acervise- promote removal of airway secretions, improve muscle strength
- finicial needs
diet of CF
high in fat and calories
fluids are recommneded
to open up an occuluded airway
head tilt and chin lift
airway obstruction signs
cynosis
snoring
acessory muscles
dec o2 sat
post op client after gernal anesgthia requires mointoring for
hypoxia
gardening doesnt cause
pnuemonia
oenmuonia risk factors
advanced age >65 young age <2 CNS depression decrease LOC chronic disease (cv) immunsupression inadq nutrition proglonged imm smoking, air pollution URTI tracheal intubation
claming the CT during transport
contrindicated bc air willa ccumate in the plural caivty causeing tension pnuemthroax
tension pnuemothriax results in
compression of the unaffected lung and pressure on the heart and great vesels
chest tube should be hung
below the chest to promote draniage and reentry of fluids
nasopharyngeal airway (NPA)
tube like device used to maintain upper airway patency
nasopharyngeal airway (NPA frequently used in
alert or semiconscious or oral trauma or maxillofacial surgery clients that are at less liekly to cause gagging
NEVER USED IN HEAD TRAUMA
nasopharyngeal airway (NPA should nevere be used in
head trauma clients (fical or basiallar)
-use ct scan to rule out fracture
verify placmeent nasopharyngeal airway (NPA
asuculating the lungs
inappropriate nasopharyngeal airway (NPA) sizr
risk of airway obstruction
sinus blockage
infection
nasopharyngeal airway (NPA) meaasuring size
tip of nose to earr lope and selectes diamter smaller than the naris
contrinidations to nasopharyngeal airway (NPA
head trumaa
bleeding disorders
use of anticog or anntiplaet
tach tube pirooty goal
checking to see if tube i s placed securely
by CHCKECING THE TIGHTNESS AND ALLOWING FOR ONEEE finger to fit under these ties
yes mouth care to prevent infection is priority but not as important as checing tightness
changing inner cannalu and trach ties
not done until 24 hours after insertion bc of the dislogement with immature tract
dressing of trach
can be change if it becomes wet or solied
cuff of trach
are not regulary delfated or re inflated and the RT therpost does this
common asthma triggers
cigar smoke and nsaids
clients with asthma and are atlhestes should take
inhaled bronchodilator 20 mins before before activity
abdominal breathing with huff
forced expiraory cough tech and good in mobilizing secretions
purses lips and secretions
not good to get secretions out and prolongs exhalation
pneumonia signs
crackles PLEURTIC CPP fever chills prpductive cough increasedd vocal .tactile fremitus -bronchial breath sounds in peripheral lung fields -unequal chest expanision -dullness
how to perform huff coughing
sit upright
- perform slow deep inhaltion
- hold breath for 2-3 seconds
- then perfrom q aquick forceful exhaltion creating an audible huff
- repear the hugg once or twice more
- rest for 5-10 regular breaths and repeat as necessary
huff coughing can be beneifical in
COPD
pnuemonia
PE signs
pleuuritc chest pain (sharp pain when inhaling)
-dyspnea
hypoxemia
-tacypnea
-cough (dry or productive with bloody sputum)
-tacycardia
-umilaterla swelling, erthyema and tenderness
pleurisy pain
stabbing chest pain that increases on inspiration or with cough
palpitation virbation
fremitus
expected finding in pnuemonia
complication of pbeumonia
pleurisy
acute respiraotry failure signs
PaO2 ≤60 mm Hg
PaCO2 ≥50 mm Hg
pH ≤7.30.
peak flow meter helpful in clients with
moderate to severe asthma
peak flow mete how to use
exhale as quicky and forcibly
- move the scale to 0 or the lowest number on scale
- personal best reading is the highest peak flow usually over 2 wk period
- peak flow is used after short acting bronchodilator not after coricosteoid such as fluticonsone MDI
atlextasis prevention in post op pt, penumonia, resp prob, trauma pt
incentive spiromter
complication of doing thoracentesis
pneumo hemothorax pulmoary edema infection diff breathingn taycpnea hypoxemia hypotension
throcentesis afvantages
diagnotistic- cause of pleural effusion (infection, malignacy, HF)
2) therputic - removal of excessive dluif (>1L)
hallmark sign of acute resp distress syndrome (ARDS)
refractory hypoxemia
refractory hypoxemia
inability to improve oxygenation with increases in o2 concerntration
when chest drainage stops abruptyly
asuculate the breath sounds to see if lungs have rexpanded
- cough and deep brathe
- reposition client
changing suction level
only performed after obtaning HCP prescirbtion
resp acidiosis
over seadtion aleep apnea anesthia drug overdose neurosmuclar disase copd
met aicdsosis
diahrea
keotafisosis
lactic acid
renal failure
met alka
gi suction
vomintig
resp alka
hypoxia
anxiety
pain
preoxygentte
pro2 100%o2 before suctioning for 30 seconds
if suctions are thick and diff to remove
dont suction
instead do hydration
how to thin secretions
sterile normal saline
muclystics such as acetylcysteine (Mucomyst) administered by nebulizer BUT NOTTTT WATERRRR
limit suctioning to
10-15 seconds
if chest tube discconects from drainage tubing without containation
wipe the end of the chest tube with antisepctic and reconenct it
to prevent discoonection of the chest tube from tubing
secure all conections with tape or bands
if chest tube disconnected with contamination or it breaks , cracks
submerge the distal end of the chest tube 1-2 in below the surace of 250 ml bottle of sterile water or saline
what should be kept bedsite for chest tube
2 chest tube clamps
250 ml bottle of sterile water or saline solution
antiseptic wipes
nasal cannula
short term
inexpensive
allows pt to eat and drink
o2 up to 44 percent
non rebreather
emergencies
high o2 conc (90-95 percent)
simple face mask
40-60 percent
venturi
for unstable chronic obstructive pul disease
pneumonia discharge teaching
aviod using OTC cough supressant med
- follow up with HCP for chest xray
- cool mist humdifier
- incecntive
HAP
bacterial infection in health care faciiality tht was not present on admission
treatment hap
antibiocis is first line and if abx is effective, improvement is seen in 3-4 days
best indiicator of abx treatment effectivness
WBC
dust mite allergy reduced
washing bed linens every 1-2 wk with hot water
High temperature (>140 F [60 C]) is needed to kill the dust mites; warm or cold water washing should not be recommended.
-allergy-proof mattress and pillow covers and vacuuming the mattress on a regular basis.
crackles are not
cleared by coughing
courase vs fifne crackles
loud, low pitched bubbling
fine- high pitched pooping (atlectaiss)
emphysema clients should be taught
pursed lip breathing to prevent alveloar collapse
tossillectomy bleeding signs
swallowing
cough
resltness
discharge teaching for tosillectomy
avoid coughing, clearing throat, or blowing of the nose
- limit physical act
- milk products are discoruaged due to their coating effect which makes you want to clear your throat
- oral mouth rinses, garling, and tooth brushing viprgiusly should be avoided
common and expected findings on tosillectomy
ear pain, low grade fever ad mouth odor for the first 5-10 days
pnemoccal vaccinate states that
all adults age ≥65 should receive 2 pneumococcal vaccinations
sucking chest wound
traumatic or “open” penumothroax and is med emergency bc resp distress appens
sucking wound treatment
sterile occlusive dressing (eg, petroleum gauze) taped on three sides.
trach tube dsilogment in a mature >7 days after insertion
attempt to open the airway by inserting a curved hemostat to maintain stoma patency and insert a new tracheostomy tube with an obturator
if the trach tube cannot be resinserted
stoma is covered with a sterile, occlusive dressing.
bronchscopy
precudre in which the bonrchi is cisualized with a flexible bronchscopoe that is passed down through the nose
sedation for bonchscopt
mild sedation (midazolam) -topical ansestic (lodoscaine) to supress gag and cough reflexes
bronscopy is done to
diagnose, obtain tissue sample -lavage -tissue sample -recome objects
what is noral in bronchscopy
blood tinged sputum
what is not normal in bronconscpy
hemptsysis or bight red- hemm esp if bippsy done
what is expected after a procedure
low o2 and low resp
complications of broncschopscy
hemoptysis, hypoxemia, hypercarbia, hypotension, laryngospasm, bradycardia, pneumothorax, and adverse effects from medications used before and during the procedure.
resp failure signs
paco2 >50 pao2 <60 paradoxial breathing mental status changes absence of wheezing or silent chest single word dyspnea
what is elevated in allergy
esopinopholl
normal neutrophils
55-70
reticulocytes
immature RBC
normal reticuloytes
0.5%-2.0%. Levels are elevated in hemolytic anemia or hemorrhage when the marrow is attempting to compensate for lost blood.
non rebreather mask consists of
o2 decie, face mask, and resvoir bag
resvoir bag
the liter flow must be high enough (15L/MIN) to keep the reservious bag at least 2/3 inflated
- INcrease the o2 amt if it is deflated
- the ports should be occuleded when filling with o2
green zone
PEF is 80-100
asthma under control
no worsening of cough, wheezing, or trouble breathing
yellow zne
caution
even if it goes to green after taking meds, you need further med or chnage in treatment
red zone
med alert, emergency
ermgency treatment if the level does not imm return to yellow after taking rescue meds
colors in chest tube
sanguieous (bright red) for severeal hours, then change to serosangious (pink) and then serous (yellow)
bright red chest drainage from CT
indicate active bleeding and imm concern
preventing post op penumonai
pain contol 0ambulate within 8 hours -coughing -deep breathing -incetive -flowers poistion (45-60) swab mouth with chloehexidine swabs q 12 hours
pneumatic compression
promotes venous return and helps prevnt venous thormbosis
DOES NOT PREENT PNEUMONIA
to help remove secretions
hydration
huff ocughing
chest physiotherpy
FOWELER POUSTION NOTTTT SIDE LYING
bipap for resp failure
will help expel co2 and provide postive pressure o2
lethagy and cofusion in resp failure
later sign
what is thre treatment to decrease co2 levels
bipap
peritonsillar results from
tonsilltis or phargyngitis
signs of peritonsillar
hot potato (muffled voice)
trimus (inability to open the mouth)
-pooling of the salivia (drooling)
-deviation of the uvula to onse side
-abscees
complication of peritonsillar
the abseccess can progress to airway obstruction (dysphagia, stridor, restleness)
nosebleeding that doesnt resolve with external pressure
hemostatic interventions such as caterization, nasal packing
acute pancreatitis can develop
resp complications (plerual effisions, atelectasis, ARDS)
dont give what for OSA
sedatives bc it can lead to airway obstruction by relaxing the muslces
-dont nap during the nap
what is not assoicated with the dev of COPD
etoh use
poor nurtrition
overweight
what can cause copf
tacbaoo smoke, occulpational exposre, air pollution, geqnetics
VAP
HAI that occurs within ≥2-3 days after the initiation of mechanical ventilation.
VAP signs
purulent secretions, positive sputum culture, leukocytosis, elevated temperature, and new or progressive pulmonary infiltrates on chest x-ray.
