Respiratory Flashcards
The higher the altitude, the [higher/lower] the oxygen pressure
lower
At high altitudes, respirations will be [↑/↓], heart rate will [↑/↓], and red blood cell production will [↑/↓]
all ↑
Alcohol, barbituates, benzodiazepines [↑/↓] the central nervous system
↓ depress
alveoli collapse from lungs not being able to expand fully
atelectasis
t/f: a cough is always infectious
false. Determine how long it’s been present, how frequent, what helps, and what makes it worse.
a “productive” cough indicates the presence of:
sputum
dyspnea
shortness of breath
t/f: chest pain can be based on respiratory conditions
true. Chest pain in peds is typically respiratory and in adults is typically cardiac. But both can happen to either group.
What level of dyspnea do we worry about in the clinical setting?
III or higher: short of breath while talking or performing ADLs
What does the curve of normal respiratory rates look like as age increases?
A lopsided smile! Higher in infants, decreasing through adulthood, increases again in older adults
elevated CO2 in the blood
hypercapnia
low O2 in the blood
hypoxemia
Using abdomen, shoulder, and neck muscles when breathing
use of accessory muscles
clubbing related to respiratory is a sign of
long term hypoxia
normal ratio for antierior-posterior chest diameter
1:2
COPD patients have what ratio of anterior-posterior chest diameter (compared to lateral)
closer to 1:1
tactile fremitus means ____, increases with ____, and decreases with
feeling of vibration on someone’s back when they talk
increases with consolidation: fluid or other substance has taken the place of air in the lung
decreases with pleural effusion
fluid in the lung gives a [dull/sharp/resonant] sound on percussion
dull
fine crackles late in inspiration
pneumonia, congestive heart failure
O2 goal for COPD patients
88-92% (outside of crisis)
In COPD patients, the drive to breathe is [hypercapnia/hypoxia], whereas in others the drive to breathe is [hypercapnia/hypoxia]
COPD: hypoxia
Normal: hypercapnia
End-tidal carbon dioxide monitoring is attached to ___ and indicates ___
attached to nasal cannula and indicates immediate breathing status
sites for pulse oximetry
fingers, toes, earlobe, forehead
when to use end-tidal CO2 monitoring
any medications that cause respiratory depression or any condition that messes with breathing rate.
diagnostic test to
diagnose lung conditions and determine placement of medical devices
x ray
diagnostic test to
visualise trachea and bronchi, remove foreign objects or mucus, obtain sputum sample
bronchoscopy
diagnostic test to
check exposure to tuberculosis or assess allergies
skin test
pulmonary function test
volume of air inhaled and exhaled in a normal breath
tidal volume
volume of air exhaled after taking the deepest possible breath
vital capacity
pulmonary function test
volume of air forcibly exhaled in 1 second after taking the deepest possible breath
forced expiratory volume in 1 second
Pulmonary function test or diagnostic:
Diagnostic test: chronic situation to assess interventions
pulmonary function test
Pulmonary function test or diagnostic:
acute situation to understand pathology
diagnostic
t/f: pulse oximeter should be removed while ambulating
false, can be useful
hyperventilation: [↑/↓] CO2
decreased
hypoventilation: [↑/↓] CO2
increased
ABG measures
oxygen, carbon dioxide, bicarbonate, pH
mild hypoxemia
60-80 mmHg
normal: 80-100
mild: 60-80
moderate: 40-60
severe: <40
normal oxygen PaO2
80-100 mmHg
normal: 80-100
mild: 60-80
moderate: 40-60
severe: <40
% oxygen in environment
21%
moderate hypoxemia PaO2
40-60 mmHg
normal: 80-100
mild: 60-80
moderate: 40-60
severe: <40
severe hypoxemia PaO2
<40 mmHg
normal: 80-100
mild: 60-80
moderate: 40-60
severe: <40
Positioning: bad lung goes up or down
up, so it can expand more easily without weight
t/f: movement and repositioning is advised
true - breaks up mucus
ABG
normal pH
7.35-7.45
ABG
normal PaCO2
35-45 mmHg
ABG
normal bicarb
22-26 mEq/L
normal SpO2
95-100%
normal FiO2
21%
fraction of inspired oxygen – oxygen in room air
normal EtCO2
35-45 mmHg
with respiratory issues, raise or lower head of the bed
raise
ambulation helps reduce risk of these two respiratory conditions
pneumonia and atelectasis
inhale or exhale with incentive spirometer
inhale
incentive spirometer helps reduce risk of…
atelectasis and pneumonia
**Interventions that reduce risk of atelectasis and pneumonia
ambulation, incentive spirometer, deep breathing, coughing
What to do if a patient is immobilized and experiences pain when trying to cough
splinting incision (pillow over wound), stacked coughing (multiple coughs in short period), low flow cough (say “huff huff huff” on exhale), quad cough (push in and up on lower ribs on exhale)
coarse crackles
low pitched, from pneumonia, pulmonary fibrosis, pulmonary edema
fine crackles early in inspiration
COPD or asthma
sonorous wheeze indicates
single-brochus obstruction
sibilant wheeze indicates
acute asthma or chronic emphysema
pleural friction rub indicates
pleuritis (sounds like a superficial crackle, during inspiration and expiration)
four options for chest physical therapy
percussion (through bed control or vest)
vibration
oscillatory positive expiratory pressure therapy
postural drainage
immobilized pt with mucus should receive [mucolytic or percussive therapy] to mobilize secretions
percussive therapy
goals of oxygen therapy
- improve tissue oxygenation
- decreased respiratory work in pts with dyspnea
- decreased cardiac work in pts with cardiac disease
(it’s a medication and requires an order/prescription!)
Nasal cannula percentage o2
24-44%
Nasal cannula formula
1L=24%. Add 4% for every additional liter.
4L+24
venturi mask percent o2
24-50
simple mask percent o2
40-60%
reservoir mask percent o2
90% or more
oral airway device can also be used to
block bite
artificial airway devices
oral airway, nasal trumpet, endotracheal tube, tracheostomy
yankauer device is used for [oral/deeper] suctioning
oral
with nasopharyngeal suctioning, patients should be [hyperoxemic, hypercapnic]
hyperoxemic
inspiratory stridor
high pitched: near-total airway obstruction
most common cause of airway obstruction
tongue
how to manage tongue blocking airway
reposition – turn pt on side. (if unconscious, oral airway device)
education points for home oxygen
- infection risk: clean and know signs
- fire risk
- energy conservation
Can you give too much supplemental oxygen
Yes! oxygen toxicity, or COPD issues
CNS and vision problems related to oxygen toxicity are [acute/chronic]
acute
alveolar problems related to oxygen toxicity are [acute/chronic]
chronic
Oxygen should be titrated to the lowest level needed for adequate oxygenation. Which value is most accurate for assessing oxygen?
PaO2, but SpO2 is used because it’s not invasive.
O2 sats are low: top things to check
positioning, if they’re on ordered oxygen
elevating head of bed is quicker and better
position to use if pt needs to lay flat due to cardiac cath but has trouble breathing
reverse trendelenburg
go-to interventions for nursing students when pts are in respiratory distress
reposition, ambulation
