Respiratory Flashcards
lwr respir system structures
left lung- 2 lobes right lung- 3 lobes (upper, middle, lower) pleura mediastinum bronchi and bronchioles alveoli
oxygen transport
diffuses across alveolar mem into arterial blood, oxygenated blood carried to tissues (o2 bind w/ hgb= oxyhemoglobin)
*diffuses frm areas of higher partial p to lower partial p
c02 transport
end product metabolic combustion
diffuses across alveolar cap mem into venous blood, deoxygenated blood perfuses back to lungs
co2 diffuses easier than o2
respiration def
process of gas exchange btw atm air and the blood and blood and cells of the body
removes co2 from airway and oxygenates the blood
oxygen concen in lungs v alveoli
lower conc in cap of lungs than alveoli
= o2 diffueses from alveoli into blood (remember o2 goes frm high to low pressure)
ventilation-perfusion inequality or mismatch
v/q
air in alveoli/ blood flow in cap
normal = 1-1
shunting
low v/q, dec vent to well perfused areas
blood passes alveoli w/out exchange
results- dec o2 sat, dyspnea
causes- pneumonia, atelectasis, respir depression
alveolar dead space
high v/q, poor perfusion
cause- inc residual co2, pulmonary emboli
inhaled air not participate in gas exchange= alv damage`
gerontologic considerations
dec surface are available for O2 dec elasticity dead space inc dec cough reflex, inc mucus peak lung function-middle age
s/s and cause (shortness of breath, cough, sputum production)
SOB- inc airway resistance, dec lung compliance, bronchospasms, anemia (dec 02 carrying capacity)
cough- irritation mucus mem (dry)- ACE inhib (lisinopril)
sputum- yellow-infection
white/pink and frothy- pulm edema
s/s in physical assessment- chronic respir dis (COPD)
clubbing fingers, cyanotiic skin color
retraction, use acces musces, tripod position
lung sounds
crackles (fluid) pneumonia, heart failure (if gone w/ cough= atelectasis (IS/ mobility important))
wheezing- asthma, COPD (inc airway resistance)
rhonchi- course crackle- bronchitis, pneumonia
diagnostic tests
abg
sputum (id malignant cells, rinse mouth and obtain before eat/antib)
chest x-ray
CT
MRI
Radioisotope (lung scan, inject tracer tags specific tissue)
Thoracentesis (remove fluid frm lungs w/ needle)
biopses
purpose of supplemental o2
dec work of breathing, reduce stress on the myocardium
risks assoc w/ supp o2
oxygen toxicity, dry muc mem, (trt w/ wtr based lubricant), pressure sores frm tubing
COPD supp O2 considertions
88-92%
hypoxemia
not enough o2 avaliable
cause- abnorm v/q, inc mem thickness, edema, dec surface area
dec in arterial o2 tension in blood
hypoxia
dec o2 supply to tissues/ cells
can be lifethreatening
supp o2 admin
low v high flow
low- nasal can (variable performance bc breath in RA too
simple mask and non-rebreather mask
high- venturi (COPD) specific inspired control 4-8L
chest tube drainage
suction or gravity-powered
collects pleural drainage (position changing can = dumping)
prevents air from re-entering chest w/ inhalation
removes fluid/air from pleural space
wet water seal or dry suction
pneumonia def
inflamm lung parenchyma caused by microo (bac, mycobac, fungi and virus)
alveoli fill w/ fluid
pneumonia- community-acquired
viral/bac
<48h after admission
incubating before
trt w/ antib
pneumonia- nosocomial (healthcare assoc)
non-hospitalzied ppl w/ extensive healthcare contact
pts been in hospital >2 days within last 3 mon, nursing home res, pt on chronic antib, chemo pt, wound care, hemodialysis, pt w/ family member of MDR (mult drug resistant)
hospital aquired pneumon/ ventilator-associated
greater than 48 h after admission (not icubating)
pneumonia risk factors
Occurs in patients with certain underlying disorders and diseases
Heart failure, diabetes, alcoholism, COPD, and AIDS
Influenza, COVID-19shallow breathing, smoking, immobilization, NG tube (aspiration (good oral care, head bed elevated >30°))
Cystic fibrosis (lrg amnt mucus, inc risk bacterial infection= pneumonia)
pneumonia clinical manifestations- general, strep, viral, other, orthopnea
Varies depending on type, causal organism, and presence of underlying disease
general- dyspneic, sputum production, chest painsystemic-cough, fever, chills
Streptococcal:-Sudden onset of chills, fever, pleuritic chest pain, tachypnea, and respiratory distress
Viral- mycoplasma, or Legionella: relative bradycardia
Other-Respiratory tract infection, headache, low-grade fever, pleuritic pain, myalgia, rash, and pharyngitis
Orthopnea- crackles, increased tactile fremitus, purulent sputum
pneumonia- hx questions
recent respir tract infection
pneumonia- what to look for in physical exam
signs respir distress, vitals, IV v Po antibiotics, immed need for help= determine if treated outpatientdec lung sounds, rhonchi, crackles
pneumonia- purpose blood culture
Blood culture (assess for risk bacteremia) blood 2 opposite sites (rule out contamination) 2-3 days for results
pneumonia diagnostic tests-
blood culture
chest x-ray
sputum exam
physical exam
pneumonia- care plan goals (incl complications)
Improved airway patency interv- bronchodil, steroids (dec inflamm), fluid bal, humidif O2 etc…
Increased activity
Maintenance of proper fluid volume 1000-1200mL
Maintenance of adequate nutrition
Understanding of the treatment protocol and preventive measures
Absence of complications pleural effusion shock, respir failure, bacteremia
pneumonia- care plan interventions
Oxygen with humidification to loosen secretions Face mask or nasal cannula Coughing techniques Chest physiotherapy postural drainage (vibration- cystic fibrosis) Position changes Incentive spirometry Nutrition Hydration Rest Activity as tolerated Patient teaching Self-care
pneumonia- drug therapy
Administration of the appropriate antibiotic as determined by the results of a culture and sensitivity
Supportive treatment includes fluids, oxygen for hypoxia, antipyretics, antitussives, decongestants, and antihistamines
Antibiotics not indicated for viral infections but are used for secondary bacterial infection
pneumonia- education
Educate about pneumococcal vaccine (23+ Prevnar 15) reduce incidence pneumon. Reccom. +65 yr even if infected- risk for severe complications much less
pnemonia- goals contin/ expected outcomes
Demonstrates improved airway patency (assessed w/ lung sounds, improved pulse ox)
Rests and conserves energy and then slowly increasing activities
Maintains adequate hydration; adequate dietary intake (assessed w/ I&O/ daily weight)
Verbalizes increased knowledge about management strategies
Complies with management strategies
Exhibits no complications
risk factors aspiration
Decreased LOC Seizure Stroke Swallowing disorder Flat positioning
aspiration in relation to pneumonia
complication that can cause pneumonia
*can be silent
aspiration def
inhalation foreign material into the lungs
s/s aspiration
tachycardia, dyspnea, central cyanosis, hypertension, hypotension, and potential death
aspiration- nursing interventions
Keep HOB elevated >30 degrees Avoid stimulation of gag reflex with suctioning or other procedures Check for placement before tube feedings Thickened fluids for swallowing problems Oral care
Pulmonary emboli
Obstruction of the pulmonary artery or one of its branches by a thrombus (or thrombi) that originates somewhere in the venous system or in the right side of the heart
surgeries assoc w/ PE
multi-trauma, shortness of breath, long bone surgeries, no mvmnt
PE patho
Inflammatory process obstructs area, results in diminished or absent blood flow
Bronchioles constrict, further increasing pulmonary vascular resistance, pulmonary arterial pressure, and right ventricular workload
PE diagnosed via
diagnosed w/ v/q scan and d-dimer lab (measure fibrin lvl from clot lysis) abg’s (show respir alkalosis early on and acidosis later due to low O2 anaerobic metab)
immediate bed side interventions for PE
ex. 84% on 28rr- respir physical assessment, start O2 suppl therapy, sit upright, anticipate EKG (test IV function)
risks for PE
Trauma Surgery Pregnancy (hormone- inc risk clotting) Heart failure Hypercoagulability- (birth control inc risk) Immobility, venous stasis (DVT)
prevention/treatment PE
Exercises to avoid venous stasis
Early ambulation
Anti-embolism stockings
Treatment
Measures to improve respiratory and vascular status
Anticoagulation and thrombolytic (prevent new clots forming) therapy
Surgical interventions embolectomy- remove clotreassurance- use inferior vena cava filter (stops clots frm lwr extremities) temporary, long term anti-coagulant
COPD def
COPD is a slowly progressive respiratory disease of airflow obstruction
Emphysema, & chronic bronchitis
Preventable and treatable but not fully reversible smoking #1 cause
Involving the airways, pulmonary parenchyma, or both
COPD patho
Airflow limitation is progressive, associated with abnormal inflammatory response to noxious particles or gases
Chronic inflammation damages tissue
Scar tissue in airways results in narrowing
Scar tissue in the parenchyma decreases elastic recoil (compliance)
Scar tissue in pulmonary vasculature causes thickened vessel lining and hypertrophy of smooth muscle (pulmonary hypertension)
chronic bronchitis def
Cough and sputum production for at least 3 months in each of 2 consecutive years
Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucous may plug airways
Alveoli become damaged, fibrosed, and alveolar macrophage function diminishes
The patient is more susceptible to respiratory infections
Poor lung function @ baseline w/ exacerbation (accompanied w/ components COPD)
emphysema def
Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli alveoli chronically expanded
Decreased alveolar surface area increases in “dead space,” impaired oxygen diffusion
Hypoxemia results
*Increased pulmonary artery pressure (frm resistance) may cause right-sided heart failure (cor pulmonale)
Elevated CO2 lvl
”pink puffers”
COPD manif
Four primary symptoms Chronic cough Sputum production Dyspnea Wheezing Weight loss due to dyspnea specifically in emphysema “Barrel chest” A/P diameter 1:1 v 1:2 retraction supraclavicular fossa and abdomen
how to diagnose COPD
Pulmonary function tests Spirometry Arterial blood gas Chest x-ray Note ability talk and complete sentences, use of accessory muscles, R sided-heart failure, enlarged neck veins, LOC (hypercapnia), tripod position
COPD complications
Respiratory insufficiency and failure acute nonchronic respir failure= O2 @ home Pneumonia Chronic atelectasis Pneumothorax Cor pulmonale
COPD nursing interventions
Promote smoking cessation
Reducing risk factors hygiene, avoid lrg crowds
Managing exacerbations SABA, ICS, LABA etc
Providing supplemental oxygen therapy
Pneumococcal vaccine
Influenza vaccine
Pulmonary rehabilitation
COPD drug therapy
Bronchodilators, MDIs
Beta-adrenergic agonists
Muscarinic antagonists (anticholinergics)
Combination agents
Shake, use spacer, inhale, wait 5 sec then use again
Prioritize bronchodil before corticosteroid
Corticosteroids- rinse after use, dec risk thrush
Antibiotics
Mucolytics
Antitussives
COPD patient education
COPD- diaphragmatic breathing (blow out w/ pursed lip breathing), 88-92% O2
metered dose inhaler- check physical/ cog ability to use
COPD goals
Achieving airway clearance
Improving breathing pattern
Improving activity tolerance
asthma def
Chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucus production- reversable
Inflammation leads to cough, chest tightness, wheezing, and dyspnea (Fig. 24-6)
Asthma is largely reversible; spontaneously or with treatment
Allergy is the strongest predisposing factor
asthma clinical manif
Cough, dyspnea, wheezing Exacerbations Cough, productive or not Generalized wheezing Chest tightness and dyspnea Diaphoresis Tachycardia Hypoxemia and central cyanosis
asthma- drug therapy
Quick-relief medications Beta2-adrenergic agonists Anticholinergics Long-acting medications Corticosteroids Long-acting beta2-adrenergic agonists Leukotriene modifiers
asthma- patient ed
How to identify and avoid triggers Proper inhalation techniques How to perform peak flow monitoring How to implement an action plan When and how to seek assistance
