Respi Flashcards
The clinical history of the respiratory system is divided into six components:
(1) chief complaint,
(2) history of present illness,
(3) past health history,
(4) family history,
(5) personal and social history, and (6) review of systems.
The patient’s history starts with the
chief complaint and information about the present illness.
Data about the present illness and any symptoms are thoroughly investigated using the
NOPQRST
Principal symptoms that should be investigated in more detail commonly include
-Dyspnea
-Chest Pain
-Sputum production
-Cough
-Shortness of breath
-Wheezing
-Sleep disturbance
What is NOPQRST?
N: Normal - describe normal baseline. what was it like b4 the symptoms
O: Onset - kanus a nag sugod ang gibati
P: Precipitating and palliative factors - what brought the symptom? unsay naka trigger?
Q: Quality and quantity - how does it feel, i-describe unsa
R: Region and radiation - where does the symptom occur
S: Severity - pain scale
T: Time - how long does symptom last? how often do you get the symptom?
When should you begin physical examination?
After taking patient’s history
What should you do if patient is in respiratory distress?
establish the priorities of your nursing assessment, progressing from the most critical factors (airway, breathing, and circulation [the ABCs]) to less critical factors.
Respiratory Monitoring
- Pulse Oximetry
- Arterial Blood Gas Analysis
- Capnography/ETCO2 Monitoring
This provides continuous, noninvasive measurement of oxygen saturation in arterial blood (SpO2). Pulse oximetry is used to assess for hypoxemia, to detect variations from the patient’s oxygenation baseline
(e.g. due to procedures or activity level), and to support the use of oxygen therapy.
Pulse Oximetry
is frequently performed in critically ill patients to assess acid-base balance, ventilation, and oxygenation.
ABG Analysis
commonly assessed ABG values and what the findings indicate:
-pH measurement of the hydrogen ion (H+) concentration is an indication of the blood’s acidity or alkalinity.
-Partial pressure of arterial carbon dioxide (Paco2) reflects the adequacy of ventilation of the lungs.
-Pao2 reflects the body’s ability to pick up oxygen from the lungs.
-Bicarbonate (HCO3 – ) level reflects the activity of the kidneys in retaining or excreting bicarbonate.
measures the level of carbon
dioxide at the end of exhalation.
CAPNOGRAPHY / END TIDAL CARBON DIOXIDE (ETCO2) MONITORING
ETCO2 values are obtained by
monitoring samples of expired
gas from an
endotracheal tube,
an oral airway, or a
nasopharyngeal airway.
The exhaled carbon dioxide waveform is displayed on the monitor as a plot of ETCO2
versus time called a
CAPNOGRAM
On a capnogram, the waveform is composed of FOUR PHASES, each one representing a specific
part of the respiratory cycle:
1st phase - baseline phase
2nd phase - expiratory upstroke
3rd phase - plateau phase
4th phase - inspiratory downstroke
Capnography
which represents both the inspiratory phase and the
very beginning of the expiratory phase, when carbon dioxide–free air in the anatomical dead
space is exhaled.
1st - baseline phase
Capnography
which represents the exhalation of carbon dioxide from the lungs. Any process that delays
the delivery of carbon dioxide from the patient’s lungs to the detector prolongs the _______________.
2nd phase - expiratory upstroke
capnography
begins as carbon dioxide
elimination rapidly continues; a ____ on the capnogram indicates the exhalation of alveolar
gases
3rd - plateau phase
capnography
The downward deflection of the
waveform is caused by the washout of carbon dioxide that occurs in the presence of the
oxygen influx during inspiration.
4th - inspiratory downstroke
Respiratory Diagnostic Studies
- Chest Radiography
- Ventilation-Perfusion scanning or V/Q scan
- Pulmonary angiogram
- Sputum Culture
- Bronchoscopy
- Pulmonary Function Test
- Thoracentesis
This is an essential noninvasive diagnostic tool for evaluating respiratory disorders, infiltration, and abnormal lung shadows, as well as identifying
foreign bodies.
Chest radiography
in critical care settings are also used to check and monitor the effectiveness and placement of tubes and lines such as an endotracheal tube, chest tubes, and pulmonary artery lines.
Chest x-ray
Normal lung fields appear ______ because they are air-filled spaces.
Black
Thin, wispy ____ streaks are seen as vascular markings.
white
Blood vessels can also appear ____
gray
However, grayness in the lung fields usually suggests
Pleural effusion
______ areas indicate fluid, blood, or exudate.
Light white
is a nuclear imaging test used to evaluate a suspected alteration in the ventilation– perfusion relationship. A ventilation–
perfusion scan is helpful in detecting the percentage of each lung that is functioning normally, diagnosing and locating pulmonary emboli, and assessing the pulmonary vascular supply.
Ventilation–perfusion scanning
The ventilation–perfusion scan
consists of two parts:
Ventilation Scan
Perfusion Scan
is the preferred test for a
critically ill patient with a
suspected pulmonary
embolus.
Pulmonary angiography
First part of V/Q
Radioactive material is breathed in, and pictures or images are taken to look at the airflow of the lungs.
Second part of V/Q
(different radioactive material) is injected into a vein in the arm, and images are taken to see the blood flow going to the lungs. It is like COPD, and can impair airflow th a little effect of pulmonary blood flow resulting in low ventilation and nearly
normal perfusion. This is usually described through a VQ scan.
V scans aren’t commonly used for
patients on mechanical ventilators because the
ventilation portion of the
test is difficult to perform
Pulmonary angiography
-NPO 6-8 hours before test
-mag insert ug needle sa arm or groin (pero mag local anesthesia sa una)
-insert dayon ug catheter sa vein padung sa right-sided heart chambers padung sa pulmonary artery. then after ana kay mag inject dayon ug dye
-x ray images are then used para maklaro how the dye moves padung sa arteries aron ma detect if naa bay blockages or blood clots sa lungs or blood flow.
-after needle cath is removed, mag apply kag pressure sa puncture site for 20-45 minutes to stop bleeding
-tight bandage is applied
-keep legs straight for 6 hours
Abnormal results from pulmonary angiography
-Aneurysms of pulmonary vessels
-Blood clot in the lungs
-Narrowed blood vessel
-Primary pulmonary hypertension
-Tumor in the lung
RISKS of pulmonary angiography
-abnormal heart rhythm
-allergic reaction
-damage to blood vessel
-blood clot travelling to the lungs causing embolism
-excessive bleeding
-heart attack or stroke
and more *see photos
Is a test that checks for bacteria or another type of organism that may be causing an infection in your lungs or the airways leading to the lungs.
Sputum Culture
Different color of sputum and what it indicates
o Clear - no disease present but large amounts of clear sputum may be a sign of lung disease
o White or Gray - may be normal but increased amounts may mean lung disease
o Dark yellow or green - bacterial infection e.g pneumonia
*yellowish green sputum is common in cystic fibrosis
o Brown smokers, common sign of black lung disease
o Pink - pulmonary edema (common in people with CHF)
o Red - early sign of lung cancer. may also be a sign of pulmonary embolism
Sputum culture is often done with another test called ____.
it is a test that checks for bacteria at the site of a suspected infection or in body fluids such as blood or urine. it can help identify the specific type of infection you may have
Gram Stain
