Respiratory Flashcards
Acidosis Manifestations
Alterations in cardiac contractions, decreased vascular response to catecholamines, decreased response to certain medications, decreased LOC
Alkalosis Manifestations
Impaired neuro and muscular function, muscle twitches, tingling sensations, nervousness
PaO2 measures
the pressure of O2 dissolved in the blood and how O2 moves from airspace of lungs into the blood
PaCO2 measures
the pressure of CO2 dissolved in the blood and how it is able to move out of the body
pH measures
hydrogen ions in the blood
HCO3 (bicarb) measures
the bicarbonate buffer that keeps pH from becoming too acidic/basic
HCO3 (bicarb) measures
the bicarbonate buffer that keeps pH from becoming too acidic/basic
pH normal range
7.35-7.45
PaCO2 range
35-45
HCO3 normal range
22-26
Common ABG draw sites
Radial, brachial, femoral
pH abnormal values
<7.35 is acidosis, >7.45 is alkalosis
CO2 abnormal values
<35 is alkalosis, >45 is acidosis
HCO3 abnormal values
<22 is acidosis, 26 is alkalosis
PaCO2 indicates the _____ of the ____
efficiency; lungs
HCO3 is an indicator of the _____ component of the _____
metabolic; kidneys
ROME acronym
Respiratory opposite, metabolic equal
Metabolic acidosis s/s
confusion, drowsiness, N/V, low BP, clammy skin, headache, Kussmaul’s breathing, coma
Kussmaul’s respirations
result of metabolic acidosis; deep, rapid, labored breathing
metabolic acidosis values (pH and CO3)
pH <7.35, HCO3 <22
metabolic acidosis treatment
administer bicarb IV, dialysis if R/T kidney failure
Respiratory acidosis values
pH <7.35, PCO2 >45
Respiratory acidosis causes
Inadequate ventilation, airway obstruction, pulmonary edema, chest trauma, drug OD
Respiratory acidosis S/S
increased pulse and BP, mental cloudiness
Respiratory acidosis treatment
Improve ventilation; bronchodilators, suctioning, adequate hydration
Metabolic alkalosis values
pH >7.45, HCO3 >26
Metabolic alkalosis causes
Loss of gastric juices per vomiting or NG suction, overuse of antacids
metabolic alkalosis s/s
tingling in fingers and toes, dizziness, lethargy, weakness, muscle twitching, cramps, tetany, decreased BP and gastric motility
metabolic alkalosis treatment
restore fluid volume with NaCl containing fluids (kidneys absorb NaCl allowing excretion of bicarb)
respiratory alkalosis values
pH >7.45, PCO2 <35
Respiratory alkalosis causes
hyperventilation, anxiety, high altitudes
respiratory alkalosis s/s
light headedness, numbness and tingling, tinnitus, restlessness, n/v, dysrhythmias
respiratory alkalosis treatment
breathe into a paper bag; retention of CO2
acidosis pathophysiology
increase in plasma H+ concentration resulting in depression of the nervous system
alkalosis pathophysiology
decrease in plasma H+ concentration resulting in over excitability of the nervous system
Pneumonia definition
inflammation of the lung parenchyma
Types of pneumonia
CAP (community), HAP (hospital), VAP (ventilator), aspiration
CAP pneumonia
within the first 48 hours of hospitalization, most common in patients under 60
leading bacteria causing CAP
H. influenzae
Pneumonia HAP
onset of symptoms occurs more than 48 hours after admission
HAP pneumonia bacteria
E. coli, Klebsiella, MRSA
Aspiration pneumonia
pulmonary consequences of entry of substances into lower airway
Aspiration pneumonia causes
normal bacteria from upper airway, gastric contents, chemicals, gases, foods
Pneumonia clinical manifestations (age dependent consideration)
Fever, pain, cough with blood or thick sputum, tachypnea, orthopnea, cyanosis
Pneumonia breath sounds
diminished, absent, adventitious
Adventitious sounds
crackles (rales), wheezes, gurgles (rhonci), friction rub
Pneumonia geri considerations
May be primary problem or complication of chronic illness (ex: COPD), classic s/s may be mission, general deterioration, abdominal symptoms, confusion, weakness, much higher rate of mortality
Pneumonia medical management
Antibiotic (culture dependent), oxygen, antipyretics, antitussives, antihistamines, hydration, respiratory therapy, rest
COPD types
Chronic bronchitis and emphysema
Bronchitis (acute) definition
inflammation of the bronchial tree often following an URTI
Bronchitis (acute) S/S
mucous in sputum, noisy inspirations, sternal soreness from coughing, fever, general malaise
Bronchitis (acute) treatment
(symptomatic treatment) cool steam inhalation, increased fluid intake (2-3L/24 hours), bedrest, antibiotics after sputum culture
Bronchitis (chronic) s/s
productive cough lasting minimum of three months a year for two or more consecutive years, hx of frequent respiratory infections, common cigarette smoke or pollution exposure
Bronchitis (chronic) diagnosis mechanisms
ABGs, x-ray, pulmonary functions testing (shows a decrease in vital capacity and forced expiratory volume)
Bronchitis (chronic) treatment
bronchodilators, postural drainage, increase fluids 2-3L/24 hours, rest, corticosteroids if client fails to respond
Emphysema (definition/explanation)
Alveolar walls are destroyed, leading to permanent distention of airspaces, increased WOB because there is decreased functional tissue
Emphysema S/S
Progressive dyspnea on exertion, thin client, tachypnea with prolonged expiration, anterior/posterior chest diameter enlarged (Barrel chest), accessory muscle use
Emphysema Treatment
bronchodilators and steroids, oxygen (1-3L – be careful not to use too much because it can obliterate respiratory drive), moist mucous membranes, cluster NSG care, pursed lip breathing
Asthma pathophysiology
chronic inflammatory process and disorder of the bronchial airways characterized by episodes of bronchospasm and narrowing of airways
Asthma S/S
Dyspnea, cough, chest tightness, nasal flaring, pursed lip breathing, expiratory wheeze, anxiety
Status asthmatics duration
over 24 hours
status asthmatics definition
acute episode of asthma, life threatening complication with severe bronchospasms, paradoxical pulse, hypoxemia, acidosis, and can cause cardiac arrest
Asthma treatment: SABA (strong acting beta agonists)
Albuterol, Xopenex, Maxair
Asthma treatment: anticholinergics
Atrovent
Asthma treatment: Anti-inflammatory
Corticosteroid (ex: prednisone)
Asthma treatment: Bronchodilators
Long acting beta agonists (Advair), theophylline
Asthma treatment: Leukotriene modifiers
Singular
Asthma treatment (non pharm)
Low dose O2, hydration, energy conservation, maintain patent airway, maintain effective gas exchange
Asthma treatment for ineffective bronchodilators
Nebulizer of atropine sulfate or epinephrine, Theophylline IV or steroids IV
TB test results are read within ____ Hours
48-72
What can cause a false positive in a TB test?
BCG vaccination
Tuberculosis is cause by
mycobacterium tuberculosis
TB affects the
lung parenchyma
Risk factors for TB
poverty, malnutrition, living in close quarters, inadequate healthcare
Tuberculosis pathophysiology
First time infection is “primary” and then cells undergo the process of necrotic degeneration
What happens to the lung tissue when TB has invaded?
It grows tubercules that liquify masses of dead WBC and the invading bacteria. (those then heal over time after being coughed up but leave scar tissue)
Reasons for TB reinfection
Advanced age, HIV, malnutrition, alcoholism, institutionalized, severe disease states (immunosuppression)
Only definitive diagnostic TB test
sputum
Medications for TB
isoniazid, rifampin, streptomycin, pyrazinamide
TB treatment includes ___ antibiotics
multiple (R/T killing any resistant organism)
Patient is non-infectious after TB after ___ weeks of starting medication
2-3
Lung Abscess causes
aspiration, mechanical or functional obstruction, infections that result in necrosis
Lung abscess S/S
Fever, chills, pleuritic pain, cough, copious sputum (foul or bloody), decreased breath sounds, dullness to percussion, friction rub over affected area, crackles as abscess drains
Lung Abscess diagnosis
CXR, CT scan, sputum, bronc
Lung Abscess treatment
antibiotics, therapeutic bronc, postural drainage, frequent mouth care, high calorie and high protein diet, lobectomy
Pleural Effusion causes
CHF (usually w/o pleuritic pain), Liver/renal failure, infections, TB, lupus, arthritis, cancer, trauma, lymphatic obstruction
Pleurisy is inflammation of the
pleurae (parietal and visceral layers of the lungs)
____ pleura has nerve endings
parietal
_____ pleura does not have nerve endings
visceral
Pleurisy s/s
pleuritic pain, sharp, severe, knifelike on one side and felt suddenly with deep inspiration, sneezing, and coughing
Pleurisy medical management
Treat the pain and find underlying cause
Pleural effusion primary diagnostic test
Thoracentesis to remove excess fluid, obtain specimen and relieve dyspnea
Pleural effusion is a _____ of _____ in the _____ space
collection, fluid, pleural
Pleural effusion s/s
SOB, lies/sites in position of comfort, decreased chest wall excursion, dry and non-productive cough, pleurisy (pain), dull percussion
Respiratory medications (list of types)
Bronchodilators, antihistamines, expectorants, cough suppressants
List of bronchodilators
Albuterol, ipratropium, metaproteranol, aminophylline, theophylline
List of antihistamines
vistaril, atropine, Benadryl, phenergan, epinephrine
list of expectorants
Robitussin (guiafenesin), mucinex
List of cough suppressants
codeine, dextromethorphan
List of antifungals
Diflucan, amphotericin B
List of corticosteroids
Hydrocortisone (IV) prednisone (PO) dexamethasone (inhaler)
Nursing precautions for corticosteroids
take PO steroids with food, don’t skip or alter doses, don’t stop taking suddenly
Potential long term problems with corticosteroids
cataracts, osteoporosis, ulcers
Fremitus definition
vibrations felt with speech
bronchophony definition
voice sounds over a consolidated lung
ego phony definition
change in the sound of “e” as in bee to “a” as in say when auscultated
Resonance lung sound
heard over normal lungs, usually low pitched
hyper resonance lung sounds
low pitched but lower than normal, heard over hyper-inflated lungs
Flat Percussion sound
High pitched with soft quality, heard over dense tissue where there is no air
Dull percussion sound
medium pitch, heard where there is a combination of solid and fluid-filled area
tympany percussion sound
drum-like and heard from a gas filled area as well as a pneumothorax
Best time of the day to get a sputum sample is the
morning
optimal pH range for most life
6.2-8.5
