Respiratory Flashcards by Chris Letts

The higher the altitude, the [higher/lower] the oxygen pressure

lower

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At high altitudes, respirations will be [↑/↓], heart rate will [↑/↓], and red blood cell production will [↑/↓]

all ↑

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Alcohol, barbituates, benzodiazepines [↑/↓] the central nervous system

↓ depress

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alveoli collapse from lungs not being able to expand fully

atelectasis

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t/f: a cough is always infectious

false. Determine how long it’s been present, how frequent, what helps, and what makes it worse.

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a “productive” cough indicates the presence of:

sputum

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dyspnea

shortness of breath

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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.

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What level of dyspnea do we worry about in the clinical setting?

III or higher: short of breath while talking or performing ADLs

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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

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elevated CO2 in the blood

hypercapnia

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low O2 in the blood

hypoxemia

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Using abdomen, shoulder, and neck muscles when breathing

use of accessory muscles

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clubbing related to respiratory is a sign of

long term hypoxia

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normal ratio for antierior-posterior chest diameter

1:2

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COPD patients have what ratio of anterior-posterior chest diameter (compared to lateral)

closer to 1:1

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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

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fluid in the lung gives a [dull/sharp/resonant] sound on percussion

dull

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fine crackles late in inspiration

pneumonia, congestive heart failure

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O2 goal for COPD patients

88-92% (outside of crisis)

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In COPD patients, the drive to breathe is [hypercapnia/hypoxia], whereas in others the drive to breathe is [hypercapnia/hypoxia]

COPD: hypoxia
Normal: hypercapnia

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End-tidal carbon dioxide monitoring is attached to ___ and indicates ___

attached to nasal cannula and indicates immediate breathing status

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sites for pulse oximetry

fingers, toes, earlobe, forehead

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when to use end-tidal CO2 monitoring

any medications that cause respiratory depression or any condition that messes with breathing rate.

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# 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