Resp Disorder Flashcards
what is a normal pH level and what is acidosis and alkalosis
normal: 7.35-7.45
acidosis: <7.35
alkalosis: >7.45
what is normal partial pressure of Co2 in arterial blood
35-45 mmHg
what is normal partial pressure of O2 in arterial blood
80-100 mmHg
what is a normal bicarbonate concentration in plasma
22-26 mEglL
what is a normal base excess, measure of buffering capacity
-3 to +3
what is ABG interpretation
R-respiratory
O-opposite
M-metabolic
S-same
what are the s/s of metabolic acidosis
headache, decreased BP, hyperkalemia, muscle twitching, warm flushed skin, N/V, decreased muscle tone and reflexes, Kussmaul respiration
causes of metabolic acidosis
- increased H production
- decreased H elimination
- decreased HCO3 production
- increased HCO3 elimination
what common studies are done for resp. diseases diagnoses
sputum studies: culture and sensitivity
- acid fast smear thoracentesis: palliative
- position client like epidural
- pulls fluid off of lungs
broadly describe Laryngeal cancer/tumor
- can develop on any part of glottis
- cancer is differentiated, slow growing
- metastasis occurs late in illness
risk factors of laryngeal cancer/tumor
- tobacco and alcohol
- HPV
- race, poor nutrition, asbestos
manifestations/ s/s of laryngeal cancer
hoarseness (doesnt improve) difficulty eating (lost wt d/t difficulty eating) white growth inside mouth (friable) change in voice quality
diagnosis of laryngeal cancer/tumor
visual inspection and biopsy
treatment of laryngeal cancer
radiation therapy (chemo cures 80% of the time)
goal of laryngeal cancer
preserve airway
remove malignancy
achieve optimal cosmetic appearance (surgery will permanently disfigure)
what psychological effects does laryngeal cancer have
suicide rate is high with head and neck cancers d/t disfigurement from surgery
when does hoarseness improve after surgery
4-6 wks after surgery
will initially worsen
what is important after surgery for laryngeal cancer
need to rest voice after surgery
gargle with saline and use ice
what does friable mean
bleeds easily
trachea and esophagus function
trachea: air
esophagus: food
what is xerostomia
when salivary glands are in the path of treatment (radiation)
causes permanent dry mouth
what does xerostomia increase risk in pt for
- dental cavities (saliva is a natural protectant)
- oral infections
- halitosis (bad breath)
- change in taste buds-nutrition help
- difficulty swallowing
what helps with xerostomia
mouth swabs, sprays, artificial saliva
increase fluid intake
radiation and chemo cause what is laryngeal cancer pt
mouth sores
what is surgical management of laryngeal cancer determined by
size, location, and degree of cancer
what are the types of surgery for laryngeal cancer
laser laryngoscopy
laryngectomy
radical neck dissection
neck dissection (removal of neck muscles/lymph nodes)
what is the normal flow of air when we talk
trachea, larynx, mouth, formation of words
what is a laryngectomy
complete removal of larynx
how is the trachea adjusted in laryngectomy
- rerouted through neck
- no more connection to mouth, no words out of mouth
- can still eat, esophagus not altered
what is the biggest concern with laryngectomy
communication (need to re teach how to talk)
what is nursing priority with laryngectomy pt
airway management
why do laryngectomy pts have drain
to collect blood from site and ensure patent airway
why can aspiration not occur in laryngectomy pt
trachea completely separated from esophagus (trach rerouted to neck)
what type of management is necessary post laryngectomy
- pain management (PCA)- very uncomfortable
- before initiating eating, Barium swallow
- speech rehabilitation
describe the types of speech rehabilitation
- electrolarynges-easiest to use (robot voice)
- esophageal speech-burp air up to form words (air from esophagus)
- tracheoesophageal puncture- one way valve to make sound (most normal voice) * not everyone is a candidate for this
post op care of laryngectomy
- trach care, sterile technique with suctioning
- cough secretions up
- do not suction unless sats drop
- change inner cannula each shift
- maintain fluid intake
- may choke when swallow-relearn by head forward and food at back
broadly describe what asthma is
- immune response gone wrong (overboard reaction to normal response)
- reversible airflow obstruction and wheezing
- intermittent occcurence
describe bronchiole during asthma attack
Normal bonchiole: wide open lumen (easy for air to pass through)
asthmatic bronchiole: very small lumen (difficult for air to pass through)
patho of asthma attack
1) trigger (ie dust)
2) IgE pick up trigger and carry to mast cells
3) mast cell releases excessive histamine response
what are the arterial CO2 levels early and late in asthma attack
early: decreased CO2
late: increased CO2
how is asthma classified
based on response to asthma drugs
s/s of asthma attack
cough, increased mucus, SOB, chest tightness, wheezing and prolonged expiration, retractions
when is asthma attack an emergency
if symptoms do not respond to usual treatment in 30 min, seek medical attention
what are indicators of hypoxemia
tachycardia, increased restlessness, tachypena
potential triggers of asthma attack
hypersensitivity, URI, exercise, air pollutants
how is asthma diagnosed
pulmonary function test and peak expiratory flow rates
describe pulmonary function test (PFT)
looking for reversibility of airway obstruction
*hallmark of asthma
describe peak expiratory flow rates
most valuable in determining severity and effectiveness of treatment
how well are they moving air in and out?
what is a firm diagnosis of asthma
20% less than what is normal (PEFR)
OR
increased by greater than 12% after rescue drug
what is the management of asthma
A-adrenergics (beta 2 agonists and Albuterol)
S-steroids (inhaled)
T-theophylline (when not responsive to meds)
H-hydration (IV with severe distress)
M-maintain patent O2 sat (>90)
A-anticholinergics
what is important education for pt taking corticosteroids
rinse mouth out after inhaled corticosteroids to prevent thrush
