Respiratory 1 Flashcards
Bronchodialators that relax the smooth muscles of the bronchial tree and decrease airway resistance
Short Acting Beta Agonists
Medication for short term relief for asthma attacks, or premedication when attacks are likely
Albuterol
What are the side effects of Albuterol?
Tachycardia
How should Albuterol be used?
Before other inhaled drugs to better enable penetration of other medications
Group of medications that relaxes bronchospasms and increases ciliary motility
Long Acting Beta Agonists
Medication for the maintenance of asthma or bronchospasms
Salmeterol
How long before exercise should Salmeterol be taken?
30-60 minutes
What is the therapeutic range of Theophylline?
10-20 mcg/mL
Name a Cholinergic antagonist
Ipratropium
If a patient has over 20 mcg/mL of Theophylline, what will happen?
Adverse reactions of the nervous system
Bronchodialators that are xanthine derivatives and are given via PO or IV drip
Theophylline and Aminophylline
What is Ipratropium used for?
Maintenance therapy for chronic bronchitis and emphysema
What is a side effect of Aminophylline?
Rash
What are the side effects of Theophylline?
Nausea, vomiting, diarrhea, tachycardia, dysrhythmias, restlessness
How should Ipratropium be taken?
Wait 30-60 seconds between puffs and 5 minutes between this and other inhaled meds and rinse mouth after taking to get rid of the bitter taste
What is the action of Theophylline?
Relieves broncho spasms of bronchitis, emphysema, and asthma
Medications that block the parasympathetic nervous system and are bronchodialators
Anticholinergic agents
If a patient has over 35 mcg/mL of Theophylline, what will happen?
Seizure and cardiac arrhythmias
Name the 5 types of Bronchodialators
Short acting Beta agonists, long acting Beta agonists, Methylxanthines, Cholinergic antagonists, and Leukotriene antagonists
Inhaler, nebulizer, or nasal spray that inhibits acetylcholine, blocking cholinergic bronchomotor tones and therefore stops vagally mediated bronchospasms
Ipratropium
What is the nasal spray form of Ipratropium used to treat?
Rhinitis and the common cold
Name examples of Methylxanthines
Theophylline and Aminophylline
Name Leukotriene antagonists
Accolate and Singulair
What are the types of Anti-Inflammatories?
Corticosteroids and Inhaled or Nasal Sprays
Bronchodialator that inhibits leukotriene and therefore inhibits inflammation and bronchoconstricition
Leukotriene Antagonists
What are side effects of Leukotriene antagonists?
Headache and increased incidence of URI if given with corticosteriods
What are the side effects of Ipratropium?
Blurred vision, eye pain, headache, palpitations, nervousness
Name a corticosteroid
Prednisone
What do Leukotriene antagonists do?
Prevents airway edema, smooth muscle constriction, altered cell activity due to inflammation
Which side effect of Ipratropium is an overdoes symptom?
Nervousness
At what point is the maximum effectiveness of an inhaled anti-inflammatory obtained?
2-3 days after initiation
Medications with anti-inflammatory properties used for severe respiratory symptoms
Corticosteroids
Which drug, when taken with Leukotriene antagonists, increases plasma concentration of Accolate?
Aspirin
Name types of inhaled anti-inflammatories
Budesonide, Veramyst, Flonase, and Beclomethasone
What are Singulair and Accolate used for?
Prophylaxis and chronic treatment of asthma associated with increased leukotriene production
What are the side effects of inhaled anti-inflammatories
Predisposition towards oral infection, dry mouth, hoarseness, sore throat, transient nasal irritation, epistaxis, nasalpharyngeal itching, dryness, crusting, headache, nausea, and vomiting
What are inhaled anti-inflammatories used for?
Steriod dependent asthma, and seasonal rhinitis
When giving Prednisone, what education should be completed?
Dose should be tapered off and never abruptly stopped, should be taken with food to decrease GI irritation
Which drug do mucolytics bind with?
Aspirin
Systemic mucolytic that reduces surface tension and adhesiveness of secretions for easier expectoration
Guaifenisin (Mucinex)
Reduces viscosity of mucus in patients with COPD, cystic fibrosis, and acetylcysteine
Mucolytics
In what forms does Guaifenisin come in?
Capsules and syrup
Name a mucolytic
Mucomyst
What effect does Prednisone have on electrolytes?
It causes sodium retention and potassium excretion
When taking Mucinex, what should the patient incease?
Fluids
What forms are mucolytics given in?
Nebulized, PO, IV
Combines Serevent, a long-lasting Beta agonist, and Flovent, a steroid
Advair
Which type of infection can occur while using inhaled anti-inflammatories if the patient does not rinse out their mouth?
Candidiasis
What are the side effects of Mucinex?
Stimulates sympathetic nervous system, elevates blood pressure, and causes tachycardia
Which type of medication smells like sulfur?
Mucolytics
How should inhalers be used?
Shake before use, inhale slowing while activating inhaler, hold breath for 5-10 seconds and exhale slowly
How long should a patient wait between puffs from an inhaler with the same medication?
1 minute
How often should inhalers be cleaned?
Daily
After taking an inhaled steroid, how can the patient prevent thrush?
Rinse mouth and gargle with warm water
What are the side effects of all inhaled steroids?
Irritation, dryness, and thrush
How should nasal inhalants be given?
Blow nose, shake medication well, instill medication, wash nose piece with warm water and dry
If two sprays of nasal inhalants are ordered, how should they be aimed?
One towards the upper part of the nostil and one towards the lower part
How often should the nasal inhalant nose peice be washed?
Daily
Oxygen exchange in tissues
Perfusion
What should you look for when examining the external nose?
Deformities or tumors
If a patient is using accessory muscles to breath, what lung sounds will generally be heard?
Stridor
Why do patients with sleep apnea have increased hemoglobin levels?
To have more places for oxygen to join up
What history should you aquire when are assessing the respiratory system?
Family and personal data, smoking (pack-years), drugs, allergies, travel, nutritional status, cough, sputum production, chest pain, dyspnea, PND, orthopnea, occupation and hobbies
Oxygen exchange in lungs
Oxygenation
Why do people have sinus issues in the winter?
Because heaters make sinuses very dry
Everything above the alveoli in the lungs
Dead space
What should you look for when examining the mucous membranes?
Abnormalities
What should you look for when examining the nares?
Symmetry of size and shape
What respiratory diseases should you assess a patient for when getting a health history?
Respiratory failure, asthma, COPD, abnormal blood tests, sleep apnea, and exercise endurance
In what position will the patient be if they are using accessory muscles to breath
Tripod
What is the purpose of turbinates?
To force inhaled air to flow in a steady, regular patter around the largest possible surface of cilia and climate controlling tissue
What population is likely to have mucous membrane abnormalities?
Drug abusers
Taking in lots of oxygen but not much goes to tissues
Shunting
What should you look for when examining the nasal cavity?
Color, swelling, drainage, and bleeding
What are considered accessory muscles for breathing?
Face muscles, sternoclidomastoid, intercostals, and stomach muscles
When assessing the neck, what are you looking for?
Symmetry, alignment, masses, swelling, bruises, and the use of accessory muscles for breathing
Which respiratory organ reflects the heart?
The mouth
Patients with sleep apnea will have high levels of what?
Hemoglobin
Long, narrow, and curled bone shelves that protrude into breathing passages of the nose
Turbinates
Which patients are generally barrel chested?
Patients with COPD and pregnant women
Where are bronchial lung sounds normal?
Over the trachea
When assessing the trachea, what are you looking for?
Palpate for position, mobility, tenderness, and masses
What population is most likely to have septal deviations?
Athletes
Cracking air in muscles
Crepitus
Where are bonchocesicular lung sounds normal?
Over the mid lungs
When assessing the mouth, what are you looking for?
Ulcerations and the presence of pink mucous membranes
What would cause a patient to have wheezing?
Inflammation, mucus, asthma, or excess secretions
Chest is wider than it is long
Barrel chest
How should the thorax be assessed?
With the patient sitting up, observe the chest and compare for symmetry; check the rate, rhythm, and depth of inspiration; examine the AP diameter and the distance between the ribs
When assessing respiratory function, what specifically are you looking for in the blood?
Abnormal hemoglobin levels
When is weight loss a bad sign?
When 10% of teh body fat is lost without trying
Where can crackles be heard?
Over the bases of the lungs or in the right upper lobes
When preparing to administer pulmonary function tests, what teaching should take place?
No smoking six hours before the test, no inhalers or medications during the test, and notify the testers if SOB or chest pain develops
Aspiration of pleural fluid or air from pleural space
Thoracentesis
When is wheezing very bad?
On expiration
What does the end tidal of CO2 value tell you?
Whether the patient has good oxygen exchange or not
Where are vesicular lung sounds normal?
Over the lower lobes
What laboratory tests should be performed on patients during a respiratory assessment?
Blood, sputum, CXR, CT, V/Q scan, and pulse ox
What are the strongest bones in the body?
The scapula and first rib
What is the normal pressure of PETCO2?
20-40 mmHg
Obtain tissue for histological analysis, culture, and cytologic examination
Lung biopsy
Which medications put a patient into twilight sedation?
Versed and fentanyl
Evaluates lung volume and capacities, flow rates, diffusion capacity, gas exchange, airway resistance, and distribution of ventilation
Pulmonary function tests
What psychosocial aspect worsens respiratory problems?
Stress
What are the signs and symptoms of pneumothorax?
Sudden and severe shortness of breath
Measures the amount of carbon dioxide present in exhaled air
Capnometry and Capnography
After a lung biopsy, how often do vital signs and breath sounds need to be assessed?
At least every 4 hours for 24 hours
Type of medical imaging using scintigrapy and meidcal isotopes to evaluate the circulation of air and blood within a patient’s lungs
V/Q Scan
What is the purpose of a biopsy?
Diagnosis
Which medications wake a patient from twilight sedation?
Narcan and benzodiazepam
What should be reported immediately if found on a patient after a lung biopsy?
Reduced or absent breath sounds
Coughing blood
Hemoptysis
Nose bleed
Epistaxis
What are the clinical manifestations of respiratory distress?
Dyspnea, nasal flaring, use of accessory muscles, pursed-lips or diaphragmatic breathing, decreased endurance, and skin and mucous membrane changes
Low levels of oxygen in the blood
Hypoxemia
What systems work together to provide sufficient tissue perfusion to the body?
Respiratory, cardiovascular, and hematologic systems
What are the hazards and complications of oxygen therapy?
Combustion, oxygen-induced hypoventilation, oxygen toxicity, absorption atelectasis, drying of the mucous membranes, and infection
What is the best way to determine the need for oxygen therapy?
Arterial Blood Gas analysis
What patient population is most susceptible to oxygen toxicity?
Premature babies
Loss of senstivity to high levels of CO2
CO2 Narcosis
What are the late signs of respiratory distress?
Pallor and cyanosis
Why are COPD patients most susceptable to CO2 Narcosis?
Because their drive to breath is based on low O2 levels and raising the level of O2 only decreases this drive
Why do we need oxygen?
It is essential for life and function of cells and tissues
Decreased tissue oxygenation
Hypoxia
Does not provide enough flow to meet total oxygen and air volume
Low flow oxygen delivery systems
What is the purpose of oxygen therapy?
To improve oxygenation and, hopefully, tissue perfusion; to treat hypoxemia
Retention of CO2
Hypercarbia
What is the most important value in arterial blood gases?
pH of the blood
What is the goal of oxygen therapy?
To use the lowest fraction of inspired oxygen to obtain acceptable blood oxygen levels without causing harmful side effects
What does the type of oxygen delivery system used depend on?
Oxygen concentration required, the importance of accuracy and control of oxygen concentration, patient comfort, the importance of humidity and patient mobility
What is the flow rate of a nasal cannula?
1-6 L/min
How can oxygen tubing be made safer for mobile patients?
Duct tape the oxygen extention to the floor
New onset of crackles and decreased breath sounds while on oxygen therapy
Absorption atelectasis
Why does a flow rate of greater than 6 L/min on a nasal cannula not increase oxygen saturation?
Because the anatomical dead space is full
Which patients are most susceptable to CO2 narcosis?
Patients with COPD
What should be assessed before placing a patient on a nasal cannula?
Patency of the nostrils and changes in respiratory rate and depth
What are the types of low flow oxygen delivery systems?
Nasal cannual, simple facemasks, partial rebreather facemasks, and non-rebreather facemasks
How much oxygen requires humidification?
If the patient is on any amount of oxygen for more than 15 minutes or if the patient is on 4 liters or more
What is the oxygen concentration of a nasal cannula?
24%-44%
What is the oxygen concentration of a partial rebreather?
60%-75%
How should the rate of a partial rebreather be adjusted?
To keep the reservoir bag inflated
Which patients are non-rebreathers used for?
Unstable patients requiring intubation
What is the oxygen concentration of a simple facemask?
40%-60%
What is the flow rate of a non-rebreather?
10-15 L/min
What is the flow rate of high flow oxygen delivery systems?
8-15 L/min
What are the types of high-flow oxygen delivery systems?
Venturi masks, face tent, aerosol masks, tracheostomy collar and T-piece
What should be added to simple facemasks?
Humidity
Where is a Venturi facemask titrated?
At the bottom of the mask
What is the oxygen concentration of high-flow delivery systems?
24%-100%
How much tidal volume is exhaled with each breath when using a partial rebreather?
1/3
What should be assessed before putting a patient on a non-rebreather mask?
Ensure that the valves are patent and functional
What is the minimum amount of oxygen a simple facemask delivers?
5 L/min
What is the oxygen concentration of a non-rebreather mask?
Greater than 90%
What is the flow rate of a partial rebreather?
6-11 L/min
When a patient has a simple facemask, what should they be closely monitored for?
Aspiration
When are CPAPs used?
For patients with sleep apnea, cardiac-induced pulmonary edema, and for atelectasis after surgery
What does the T-piece do?
Ensures humidifier creates enough mist
What are the types of Pressure Ventilation?
BiPAP and CPAP
How does a patient using a Venturi facemask eat?
By switching to a nasal cannula
How are TTO systems set up?
A small, flexible catheter is passed into the trachea through a small incision
Fits over the chin, with the top extending halfway across the face
Face tent
Why are TTO systems not used?
Probability of infection
What is the best oxygen delivery system for patients with chronic lung disease?
Venturi Masks
Uses positive pressure to keep alveoli open, improving gas exchange without airway intubation
Pressure Ventilation
Long term delivery of oxygen directly into lungs
Transtracheal oxygen delivery
What patients are face tents used for?
Patients with facial trauma or burns
Delivers desired FIO2 for tracheostomy, laryngectomy, and ET tube patients
T-Piece
Why are transtracheal oxygen delivery systems used?
To avoid the irritation that nasal prongs cause
Delivers set positive airway pressure throughout each cyle of inhalation and exhalation
CPAP
How do you know that a T-piece is working?
Mist should be seen during inspiration and expiration
How much oxygen do face tents deliver?
10 L/min
Used when high humidity is needed after extubation or upper airway surgery or for thick secretions
Aerosol Masks
What is the oxygen concentration of a Venturi facemask?
24%-50%
How much oxygen does a Trach collar deliver?
10 L/min
What patient education needs to take place before there can be home oxygen therapy?
Safety, tripping hazards, fire hazards, humidification, don’t self-diagnose and treat with increased oxygen
What is the oxygen concentration of an aerosol mask?
24%-100%
Surgical incision into the trachea for the purpose of establishing an airway
Tracheotomy
What is the oxygen concentration for face tents?
24%-100%
What are the priority problems for tracheostomy patients?
Reduced oxygenation, inadequate communication, inadequte nutrition, potential for infection, and damaged oral mucosa
What is the most important post-operative care to give to tracheostomy patients?
Ensure the airway is patent
What is the concentration of a Trach collar?
24%-100%
If a post-operative tracheostomy patient has a constant, non-productive cough, what does this indicate?
Tube dislodgement
How much oxygen does a Venturi mask deliver?
4-10 L/min
How much oxygen does a aerosol mask deliver?
10 L/min
Used to deliver high humidity and the desired oxygen to the patient with a tracheostomy
Trach collar
How should oxygen be weened?
0.5-1.0 liters at a time over 15-30 minutes with ambulation
Stoma that results from a tracheotomy
Tracheostomy
What is the oxygen concentration of a T-piece?
24%-100%
Why are tracheostomy patients at risk for damaged oral mucosa?
Because the mouth is bipassed and dried out, making it an infection breeding ground
How much oxygen does a T-piece deliver?
10 L/min
What assessments should be done on a post-operative tracheostomy patient?
Tube obstruction or dislodgement, assess for crepitus, excessive bleeding, and constant non-productive cough
What nursing interventions should be done with a patient who has a tracheostomy?
Check cuff pressure often, keep extras at the bedside, make sure suction equipment works, prevent tube friction and movement, and prevent malnurtition, hemodynamic instability and hypoxia
Why is suctioning so important for tracheostomy patients?
To maintain patent aitways and promote adequate gas exchange
What does over inflation of the tracheostomy cuff do?
Causes damage to the trachea and mucosal ischemia
How can hypoxia be prevented during the suctioning of a patient with a tracheostomy?
Apply suction on the way out and only suction 10-15 seconds at a time
What possible complications accompany a tracheotomy?
Pneumothorax, subcutaneous emphysema (crepitus), bleeding, and infection
How can a nurse prevent friction and movement of a tracheostomy?
Secure trach ties
Why would a patient have a fenestrated tracheostomy?
To talk
What does under inflation of the tracheostomy tube do?
Causes the patient to not be able to talk
How should tracheostomy patients be suctioned?
Through their nose and mouths
Why must air be humidified for tracheostomy patients?
Because the air they are breathing bypasses the nose and mouth, which normally warms, humidifies, and filters it
If a patient has vagal stimulation during suctioning, what will happen to their heartrate?
It will drop dramatically
What are some side effects of suctioning?
Hypoxia, tissue and mucosal trauma, infection, vagal stimulation and bronchospasms, and cardiac dysrhythmias
How should a tracheostomy tube be weaned?
Gradually decrease tube size until you ultimately remove the tube
How can you encourage good bronchial and oral hygeine of a tracheostomy patient?
Turn and repostion every 1-2 hours, support out of bed activities, encourage early ambulation, encourage coughing and deep breathing, chest percussion, postural drainage, and avoid glycerin swabs
How should a client who has a tracheostomy be positioned when they are eating?
Tuck chin down and forward when swallowing
What should you do if a patient’s tracheostomy accidentally dislodges?
Check for breathing, get a pulse ox, and call someone to recannulate as you are staying with them
When can a tracheostomy cuff be deflated?
When the patient can manage their secretions and they don’t need assissted ventilation
What should you do when feeding a patient with a tracheostomy?
Elevate head of bed for at least 30 minutes after eating to prevent aspiration, and use thickening
Breath sounds that E>I
Bronchial
Breath sounds that I>E
Vesicular
Breath sounds that I=E
Bronchial vesicular
High pitched breath sounds
Bronchial
Low pitched and breezy breath sounds
Vesicular
