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MedSurg 1 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

lwr respir system structures

A 
left lung- 2 lobes
right lung- 3 lobes (upper, middle, lower)
pleura
mediastinum
bronchi and bronchioles
alveoli
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2
Q

oxygen transport

A

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

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3
Q

c02 transport

A

end product metabolic combustion
diffuses across alveolar cap mem into venous blood, deoxygenated blood perfuses back to lungs
co2 diffuses easier than o2

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4
Q

respiration def

A

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

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5
Q

oxygen concen in lungs v alveoli

A

lower conc in cap of lungs than alveoli

= o2 diffueses from alveoli into blood (remember o2 goes frm high to low pressure)

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6
Q

ventilation-perfusion inequality or mismatch

A

v/q
air in alveoli/ blood flow in cap
normal = 1-1

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7
Q

shunting

A

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

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8
Q

alveolar dead space

A

high v/q, poor perfusion
cause- inc residual co2, pulmonary emboli
inhaled air not participate in gas exchange= alv damage`

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9
Q

gerontologic considerations

A 
dec surface are available for O2
dec elasticity
dead space inc
dec cough reflex, inc mucus
peak lung function-middle age
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10
Q

s/s and cause (shortness of breath, cough, sputum production)

A

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

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11
Q

s/s in physical assessment- chronic respir dis (COPD)

A

clubbing fingers, cyanotiic skin color

retraction, use acces musces, tripod position

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12
Q

lung sounds

A

crackles (fluid) pneumonia, heart failure (if gone w/ cough= atelectasis (IS/ mobility important))
wheezing- asthma, COPD (inc airway resistance)
rhonchi- course crackle- bronchitis, pneumonia

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13
Q

diagnostic tests

A

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

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14
Q

purpose of supplemental o2

A

dec work of breathing, reduce stress on the myocardium

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15
Q

risks assoc w/ supp o2

A

oxygen toxicity, dry muc mem, (trt w/ wtr based lubricant), pressure sores frm tubing

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16
Q

COPD supp O2 considertions

A

88-92%

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17
Q

hypoxemia

A

not enough o2 avaliable
cause- abnorm v/q, inc mem thickness, edema, dec surface area
dec in arterial o2 tension in blood

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18
Q

hypoxia

A

dec o2 supply to tissues/ cells

can be lifethreatening

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19
Q

supp o2 admin

A

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

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20
Q

chest tube drainage

A

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

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21
Q

pneumonia def

A

inflamm lung parenchyma caused by microo (bac, mycobac, fungi and virus)
alveoli fill w/ fluid

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22
Q

pneumonia- community-acquired

A

viral/bac
<48h after admission
incubating before
trt w/ antib

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23
Q

pneumonia- nosocomial (healthcare assoc)

A

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)

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24
Q

hospital aquired pneumon/ ventilator-associated

A

greater than 48 h after admission (not icubating)

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25
Q

pneumonia risk factors

A

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)

26
Q

pneumonia clinical manifestations- general, strep, viral, other, orthopnea

A

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

27
Q

pneumonia- hx questions

A

recent respir tract infection

28
Q

pneumonia- what to look for in physical exam

A

signs respir distress, vitals, IV v Po antibiotics, immed need for help= determine if treated outpatientdec lung sounds, rhonchi, crackles

29
Q

pneumonia- purpose blood culture

A

Blood culture (assess for risk bacteremia) blood 2 opposite sites (rule out contamination) 2-3 days for results

30
Q

pneumonia diagnostic tests-

A

blood culture
chest x-ray
sputum exam
physical exam

31
Q

pneumonia- care plan goals (incl complications)

A

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

32
Q

pneumonia- care plan interventions

A 
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
33
Q

pneumonia- drug therapy

A

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

34
Q

pneumonia- education

A

Educate about pneumococcal vaccine (23+ Prevnar 15) reduce incidence pneumon. Reccom. +65 yr even if infected- risk for severe complications much less

35
Q

pnemonia- goals contin/ expected outcomes

A

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

36
Q

risk factors aspiration

A 
Decreased LOC
Seizure
Stroke
Swallowing disorder
Flat positioning
37
Q

aspiration in relation to pneumonia

A

complication that can cause pneumonia

*can be silent

38
Q

aspiration def

A

inhalation foreign material into the lungs

39
Q

s/s aspiration

A

tachycardia, dyspnea, central cyanosis, hypertension, hypotension, and potential death

40
Q

aspiration- nursing interventions

A 
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
41
Q

Pulmonary emboli

A

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

42
Q

surgeries assoc w/ PE

A

multi-trauma, shortness of breath, long bone surgeries, no mvmnt

43
Q

PE patho

A

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

44
Q

PE diagnosed via

A

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)

45
Q

immediate bed side interventions for PE

A

ex. 84% on 28rr- respir physical assessment, start O2 suppl therapy, sit upright, anticipate EKG (test IV function)

46
Q

risks for PE

A 
Trauma
Surgery
Pregnancy (hormone- inc risk clotting) 
Heart failure
Hypercoagulability- (birth control inc risk)
Immobility, venous stasis (DVT)
47
Q

prevention/treatment PE

A

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

48
Q

COPD def

A

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

49
Q

COPD patho

A

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)

50
Q

chronic bronchitis def

A

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)

51
Q

emphysema def

A

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”

52
Q

COPD manif

A 
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
53
Q

how to diagnose COPD

A 
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
54
Q

COPD complications

A 
Respiratory insufficiency and failure	acute nonchronic respir failure= O2 @ home
Pneumonia
Chronic atelectasis
Pneumothorax
Cor pulmonale
55
Q

COPD nursing interventions

A

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

56
Q

COPD drug therapy

A

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

57
Q

COPD patient education

A

COPD- diaphragmatic breathing (blow out w/ pursed lip breathing), 88-92% O2

metered dose inhaler- check physical/ cog ability to use

58
Q

COPD goals

A

Achieving airway clearance
Improving breathing pattern
Improving activity tolerance

59
Q

asthma def

A

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

60
Q

asthma clinical manif

A 
Cough, dyspnea, wheezing
Exacerbations
Cough, productive or not
Generalized wheezing
Chest tightness and dyspnea
Diaphoresis
Tachycardia
Hypoxemia and central cyanosis
61
Q

asthma- drug therapy

A 
Quick-relief medications
Beta2-adrenergic agonists
Anticholinergics
Long-acting medications
Corticosteroids
Long-acting beta2-adrenergic agonists
Leukotriene modifiers
62
Q

asthma- patient ed

A 
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

MedSurg 1 (9 decks)

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