Resp. Assess, Asthma Flashcards
What do pulmonary function tests measure?
Lung volumes and the flow rate.
What is ALTE?
Apparent life threatening Event -clinical presentation of apnea of infancy, including some combination of changes in color,muscle tone, and choking and gagging.
What are the purposes of pulmonary function tests?
Dx pulmonary dz and set a baseline
Monitor dz progression
Evaluate how much disability they have
How well are meds and tx working
FEV1
The amount of air that is expired in the first second of exhalation
Peak expirtatory flow rate
At what rate is air moving out. Rate will change with diameter of large air ways. How much air is being expired
What test provides gas exchange information?
ABG’s and SPO2 need numbers
What are the nursing considerations for thoracocentesis?
Pre- informed consent
Sit upright or bent over table
Get baselines RR, O2, HR, BP, effort
During- quiet, no movement
Watch patient carefully for distress, VS
Post- Verify breath sounds bilaterally,
Look at excursion-expansion is even
VS
Look for drainage at the site
What complications can happen from a thoracocentesis ?
Pneumo
Hypotension if take off too much fluid
What are retractions?
An inspiration due to upper airway obstruction or conditions causing decreased pulmonary compliance.
What are four clinical signs of respiratory assessment?
LOC
RR
Respiratory effort and mechanics
Skin and mucous membrane color
What are signs and symptoms of respiratory distress in regard to cardiac signs?
Tachycardia
Dysrhythmias-low O2in muscles
Cyanosis of fingers and toes, cold (sympathetic nervous system keeps the O2close to the heart and brain
What are signs of respiratory distress in the central nervous system?
Change in LOC
Anxiety
Lethargy, sommelance -increases CO2 in brain
What are the clinical symptoms of asthma?
Chest tightness- change in pressure, pulling air in is easier than blowing it out.
Dyspnea
Cough
Wheezing
What is the treatment for asthma?
O2 if needed HOB up PLB Medications with order Self monitoring of symptoms and daily use of PEFR measurements Avoidance of triggers Daily medication plan Treat underlying conditions
What is the difference between ventilation and oxygenation?
Ventilation is the movement of air into and out of the lungs.
Oxygenation is the ability to move O2 into blood.
What does SaO2 measure
The amount of oxygen bound to hemoglobin in comparison to the amount of O2 the hemoglobin can carry.= if SaO2 = 90% then 90% of the hemoglobin attachments for oxygen have oxygen bound to them.
What do normal lungs sounds on an infant or child sound like?
Soft, tubular breath sounds on inspiration and minimal to no lung sounds on expiration.
What does Stridor sound like?
High pitched sounds secondary to obstruction between the supraglottic space and the lower trachea.
What does wheezing sound like?
Prolonged expiration indicates obstruction of the intra thoracic airway, e.g
What are signs of mild respiratory distress in a child with chronic lung dz?
Increased respiratory rate
Retractions- intercostal and subcostal
Interactive with environment
Where do you auscultate lung sounds on a pediatric patient and why?
Over peripheral lung fields, chest is so small breath sounds are readily transmitted from one side to the other. Listen at midaxillary toward the back
What is grunting?
Premature closure of the glottis during active expiration in an attempt to increase end expiratory pressure.
What asthma meds are short acting beta adrenergic agonists?
Albuterol ( Proventil)
What asthma meds are fast acting bronchodilators?
Albuterol
Ipratropium (atrovent)
What medications will decrease swelling in mucous membranes with asthma?
Fluticasone (flo-vent)
Montelukast (singular)
Prednisone
Salmeterol/fluticasone (advair)
What meds can be combined in an MDI? In a nebulizer?For asthma
Albuterol and ipratropium (duoneb)= nebulizer
(Combivent)=MDI
What is involved with a focused respiratory assessment?
Inspects for nasal flaring
- asses for expiratory grunting,coughing, and drooling
- inspects, palpate and auscultates chest
- pal pages CRT, skin temp, diaphoresis, color, and peripheral pulses.
What are common indications for ET intubation?
Upper airway obstruction
- Apnea
- High risk aspiration
- Ineffective clearance of secretions
- Respiratory distress
How does the RN know that correct ET tube placement is being maintained?
Symmetric chest wall expansion
Auscultate to confirm bilateral breath sounds
What are indications for suctioning tracheostomy tube?
Clear secretions if pt is unable to
Noisy wet respirations-course crackles or rhonchi over large airways
Decreases SpO2 or PaO2, restless and agitated
Increased peak inspiratory pressure on mechanical vent
What should be done pre procedure when suctioning a trach tube?
Per oxygenation for 3-4 breaths with 100% O2
How much suction or negative pressure should be used when suctioning trach tubes for adults? Children?
120-150mmHg-adults
60-100mmHg -children
What is the length of time with each suction?
10-15 seconds
What is the length of time between sections?
1 min
What is the safe number of suctioning passes in one session?
3
What are indications for discontinuing suction?
HR-drops more than 20 beats/min
HR -increases more than 40 beats / min
Dysrhythmias
SpO2 drops to <90%
What is done post trach suction?
Rinse catheter and suction the oral pharynx or use mouth suction
Listen to breath sounds
Document-time, amount,character of secretions and response to suction
How do you perform tracheostomy care?
Sterile technique
Get a water proof container
Clean the inner cannula, stoma and faceplate:
-unlock and remove inner cannula
- put it in 3% hydrogen peroxide! clean inside and out with a tube brush or a pipe cleaner
-drain H2O2, rinse with sterile H2O
