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EXAM 2B - RESP/IV/RESP PATHO > RESP LECTURE > Flashcards

RESP LECTURE Flashcards

1
Q

Aetiology

A

A study of the causes, origins and reasons for disease process

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2
Q

Pathophysiology

A

A study of the functional changes that occur within an individual due to a disease or pathologic state

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3
Q

Review of respiratory terminology

Hypoxia

A

Less than normal levels of O2 in the cell(tissue)

HYPOXADMIA IS Less than normal levels of O2 in blood
PaO2 < 80mmHg (< 60mmHg significant hypoxaemia)

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4
Q

Review of respiratory terminology

Hypoxaemia

A

Less than normal levels of O2 in the cell
Less than normal levels of O2 in the blood
PaO2 < 80mmHg (< 60mmHg (significant)

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5
Q

Review of respiratory terminology

Hypercapnia

A

Greater than normal levels of CO2

PaCO2 > 45mmHg

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6
Q

Review of respiratory terminology

Hypocapnia

A

Less than normal levels of CO2

PaCO2 < 35mmHg

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7
Q

Efficient gas exchange is dependent on adequate:

A

VQ ratio - ventilation and perfusion

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8
Q

Blood flow can be redirected from a poorly ventilated alveolus to a well-ventilated alveolus through

A

vasoconstriction = shunt

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9
Q

Mechanical and functional insufficiency (mechanical changes that can affect V/Q)- Medication

A

CNS depressants - morphine, massive CNS and RESPIRATORY depressant

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10
Q

Mechanical and functional insufficiency (mechanical changes that can affect V/Q) - Functional (Factors affecting gas exchange
)

A

Cardiac compromise
Pulmonary embolism - clots can block up huge sections of lungs
Hb - has four binding O2 cells
Tumour
Infection - necrotic tissue, or build up of mucus/pus
COPD
Compliance
Resistance
Surface area - if someone only has one lung, surface area is significantly reduced

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11
Q

Difference between a ventilation problem to a perfusion problem?

A 
Ventilation problem (air in/air out)
Perfusion problem (blood to lungs and body)
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12
Q

Ventilation problem (air in/air out) - name some main causes

A

Inflammation of bronchial walls, Exudate in lower airways, Exudate in alveoli, Inflammation in alveolar wall

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13
Q

Ventilation problem (air in/air out) - Describe the cause and process of this problem - Inflammation of bronchial walls

A

causing epithelial oedema = ↓ air entry, ↓ gas exchange

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14
Q

Ventilation problem (air in/air out) - Describe the outcome and process of this problem - Exudate in lower airways

A

causing obstruction to air flow = ↓ air entry, ↓ gas exchange

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15
Q

Ventilation problem (air in/air out) - Describe the outcome and process of this problem - Exudate in alveoli

A

causing increased diffusion distance = ↓ gas exchange

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16
Q

Perfusion problem (blood to lungs and body) - name some common perfusion problems

A

Partial or complete obstruction to pulmonary artery and Ineffective functioning alveoli (from exudate or oedema)

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17
Q

Perfusion problem (blood to lungs and body)) - Describe the outcome and process of this problem - Partial or complete obstruction to pulmonary artery

A

Partial or complete obstruction to pulmonary artery causing reduced blood flow = ↓ gas exchange

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18
Q

Perfusion problem (air in/air out) - Describe the outcome and process of this problem - Ineffective functioning alveoli (from exudate or oedema)

A

Ineffective functioning alveoli (from exudate or oedema) causing vasoconstriction of surrounding pulmonary capillaries = further ↓ gas exchange

19
Q

Work of breathing5 signs of respiratory distress - what acronym/framework/mnemonic can we use

A 
DiapHRaGM - Diaphoresis
Hypoxia
respiratoryRate
Gasping 
accessoryMuscle
20
Q

Clinical presentationWhat can we MEASURE?

A

*Respiratory rate, depth and pattern
Arterial blood gas (ABG) analysis
Peak flow measurement
Specialist tests

21
Q

How and what does this measure? Arterial blood gas (ABG) analysis

A

Measurement of partial pressure of O2, CO2, HCO3¯, pH (as well as other values)
Assessment of respiratory function
Information about the body’s response to changes in pH

22
Q

How and what does this measure? Peak flow measurement

A

Measurement of maximum forced exhaled air flow (L/min)
Baseline and to measure effectiveness of interventions
Useful for people with asthma

23
Q

Specialist tests - name some that can measure

A 
Spirometry
CT/MRI
CXR
Pulmonary angiogram
VQ scan
24
Q

Chronic Obstructive Pulmonary Disease - Explain what this is?

A

Progressive chronic disease characterised by irreversible airway obstruction, hindering expiratory flow

Umbrella term encompassing EMPHYSEMA, CHRONIC BRONCHITIS & other conditions

Each has their own pathophysiology but all contribute to airway inflammation initiated by a noxious irritant

25
Q

Emphysema is

A

the destruction of elastin in alveoli, inhibiting full relaxation of alveoli, resulting in gas trapping [hypercapnia]

26
Q

Emphysema

Air or gas trapping - explain what this is, what it results in and what it causes

A

Loss of elasticity allows the alveoli to expand with inspiration, but reduces its ability to recoil in expiration

Results in CO2 being ‘trapped’ increasing the alveolar PCO2

*Bronchiole constriction also contributes to air/gas‘trapping’

A rise in alveolar PCO2 means CO2 cannot diffuse readily from pulmonary capillaries, causing a build up in arterial blood = hypercapnia

27
Q

EmphysemaDamaged alveolar walls. this results in REDUCED surace area. what does this cause? result in?

A

Accumulation of damage causes large air spaces to develop

Surface area is reduced, reducing gas exchange between alveoli and pulmonary capillaries = hypoxaemia and hypercapnia

Direct contact of alveoli with capillary beds is reduced, reducing gas exchange

28
Q

John was admitted to your ward overnight following an acute exacerbation of his COPD. You have just received a shift report and proceed to John’s room to assess him.

Using the ABCDE rapid assessment framework, consider what your expected findings might be on assessing him?

AIRWAY & BREATHING ONLY

A

Airway
Patent but potentially under threat if ↓ LOC due to hypercapnia/hypoxaemia

Breathing
Increased WOB and accessory muscle use in response to hypercapnia
Pursed lip breathing to assist with expiration and overcome gas trapping
Tachypnoeic (RR> 20/min, TACHY means OVER - like tacycardic (HB over 100).
SpO2 <90% due to hypoxaemia – supplemental oxygen if hypoxaemia severe
Depth of breathing likely to be shallow due to gas trapping and hypercapnia

29
Q

John was admitted to your ward overnight following an acute exacerbation of his COPD. You have just received a shift report and proceed to John’s room to assess him.

Using the ABCDE rapid assessment framework, consider what your expected findings might be on assessing him?

CIRCULATION & DISABILITY ONLY

A

Circulation
Cool pale peripheries and/or cyanosis due to hypoxaemia
CRT > 3 seconds due to peripheral vasoconstriction
Possible elevated core temperature due to increased metabolic rate or infection
Diaphoresis due to ↑ WOB or hypercapnia

Disability
Anxiety or fear of dying due to dyspnoea
Possible disorientation or confusion due to hypoxaemia > hypoxia
Reduced LOC due to hypercapnia and/or hypoxaemia
Low mood or reduced cognition due to long-term effects of inflammatory mediators

30
Q

John was admitted to your ward overnight following an acute exacerbation of his COPD. You have just received a shift report and proceed to John’s room to assess him.

Using the ABCDE rapid assessment framework, consider what your expected findings might be on assessing him?

ENVIRONMENT ONLY

A

Environment
Elevated EWS due to > RR, HR and < SpO2 (remember to identify trends)
Increased falls risk due to dyspnoea, dizziness and/or confusion
Increased Braden score due to corticosteroids, reduced mobility and possible oedema
COLDSPA of irritants/triggers and previous exacerbations (plus treatment/length of hospital stay) to help inform nursing plan of care
Identify allergies or drug reactions to avoid further complications

31
Q

Nursing interventions for JOHNNursing care of the patient with acute exacerbation of COPD

AIRWAY & BREATHING ONLY

A

Airway
Suction.

Breathing
Ensure patient upright to optimise air entry and facilitate gas exchange
Encourage pursed lip breathing to facilitate exhalation of CO2 (reduce gas trapping) and reduce dyspnoea
Administer oxygen as prescribed to reverse hypoxaemia – caution especially with CO2 retainers
Administer bronchodilators/corticosteroids as prescribed for relaxation of smooth muscle in airways to facilitate gas exchange
Obtain a sputum sample for microbiology, culture and sensitivity for antibiotic selection

32
Q

Nursing interventionsNursing care of the patient with acute exacerbation of COPD

CIRCULATION & DISABILITY ONLY

A

Circulation
Administer IV fluids as prescribed to prevent dehydration and thin secretions
Administer DVT prophylaxis as prescribed to prevent clot formation from venous stasis/polycythaemia
Administer antibiotics as prescribed to treat infected exacerbation
Encourage patient to foot pedal to encourage venous return to prevent venous stasis
Consider elevation of lower limbs to reduce peripheral oedema

Disability
Maintain a low stimulus environment to reduce anxiety and further dyspnoea
Educate the patient on interventions and plan of care to reduce anxiety and encourage compliance with therapeutic interventions
Consider hospital aide special or a family member to sit with the patient if confused to maintain patient safety and/or to reduce anxiety and further dyspnoea

33
Q

2 patients are admitted lastnight due to resp distress. What basic interventions would you use?

A

Administer medications as prescribed (bronchodilators/corticosteroids) either through nebuliser or spacer
Administer oxygen as prescribed
Sit patient upright to maximise air entry for gas exchange
Reassure/educate patient and family members to lower anxiety and reduce SNS stimulation ↓RR, ↓WOB
Observe/educate patient re: use of spacer
Mobilise/rest as tolerated
Education re: use of asthma plan on discharge

34
Q

Asthma: how would we treat it?

A

Bronchodilators
Corticosteroids
Metered Dose Inhaler (puffer)/spacer/nebuliser use
Oxygen therapy
Positioning (sit upright)
Reassurance to decrease anxiety which reduces SNS response

35
Q

The two different types of bronchodilators are?

A

The two different types of bronchodilators are? Long acting (LABAs) = Controllers and Short acting (SABAs) = relievers

36
Q

Bronchodilators: β2-agonists - difference between Short acting (SABAs) = relievers and Long acting (LABAs) = Controllers
with examples of both

A 
Short acting (SABAs) = relievers
Provide relief for 4-6 hrs
Rapid onset of action – 5-10 mins
Can be used in an acute asthma attack (usually blue inhalers)
Examples: Salbutamol (Ventolin)  	
Terbutaline (Bricanyl))
Long acting (LABAs) = Controllers
Long duration of action (12hrs)
Slow onset of action
Not to be used to relieve acute symptoms
Examples: Salmeterol (Serevent)	
Eformoterol (Oxis)
37
Q

Inhaled corticosteroids - ICS (preventers) = what are these? and some nursing considerations?

A

Potent anti- inflammatory agents
Given via inhalation route greatly reduces systemic adverse effects
Must be taken continuously

38
Q

Effects of hypercapnia are

A

Tachypnoea (↑ RR) to “blow off” excess CO2

Use of accessory muscles to increase chest expansion and help with forced exhalation to expel CO2 and recruit O2

39
Q

Effects of hypoxaemia are

A

Tachypnoea once PO2 < 60mmHg to recruit more O2
Activation of SNS response (↑ HR, BP) to increase O2 circulation to tissues
Peripheral vasoconstriction (poor peripheral perfusion) to preserve O2 for vital organs

40
Q

EMPHYSEMA vs chronic bronchitis - difference?

A

Emphysema
Damage to alveoli sacs, inability to inflate and deflate properly. Alveoli loses elasticity and results in gas trapping.

Chronic bronchitis
Inflammation of bronchi walls due to increased production of goblet cells secreting mucous, damage due to noxious irritant

41
Q

Hypoxaemia: is and causes what to increase?

A

< 02 in arterial blood = < Pa02

(Normally causes HR and RR to increase)

42
Q

Normal values of PA02 and Sp02?

A

PaO2 > 80mmHg (amount 02 dissolved in plasma) found on an ABG
SpO2 > 95% (amount of 02 bound to haemoglobin compared to amount of 02 haemoglobin can carry) found on a sats probe

43
Q

How will you evaluate whether oxygen therapy has been effective? What are some measured signs e.g. < RR

A

↓ respiratory rate

> in depth of respirations

> tissue oxygenation (mucous membranes, not just SpO2)

↓ work of breathing/accessory muscle use

SpO2

EXAM 2B - RESP/IV/RESP PATHO (2 decks)

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