Respiratory Flashcards
reflex, irritation in URT - removing irritant
sneezing
severe SOB & coughing attacks at night
paroxysmal nocturnal dyspnea
PFT & spirometry
measures…
pulmonary function test
pulmonary volumes & airflow times
FEV
measures…
forced expiratory volume
how much air a person can forcibly exhale
FEV1
amt of air exhaled in first second
FVC
measures…
forced vital capacity
amt of air exhaled during FEV test
TLC
measures…
total lung capacity
amt of air in lungs at max inspiration
exercise tolerance test measures…
ability of lungs & heart to supply O2 & remove CO2 before, during, after exercise
peak flow meter measures…
how well air moves out of lung
smooth & even respirations
E > I
eupnea
rapid superficial breathing
regular or irregular
tachypnea
slow, deep RR
regular rhythm
bradypnea
cessation of breathing
apnea
increased depth of breathing
regular rate & rhythm
hyperpnea
periods of apnea alternating with climbing & falling respiratory cycles
Cheyne-Stokes respirations
periods of apnea alternating with shallow breaths of equal depth
ataxic breathing
deep, regular sighing respirations
high RR
Kussmaul respirations
long, gasping inspiration
short, inadequate expiration
apneusis
long, ineffective expiration
shallow
increased RR
obstructed breathing
brief & inadequate respiratons
labored gasping or snorting
during or following cardiac arrest, CVA
agonal
high pitched continuous musical sound
I and/or E
narrowed airway
wheezes
“sonorous wheeze”
deep, low rumbling
respiratory secretions
rhonchi
high pitched, discontinuous, intermittent popping sounds
heard during early inspiration
air forced through passage/alveoli narrowed by pus, mucus, fluid
crackles/rales
fine crackles heard during…
late inspiration
coarse crackles heard during…
early inspiration
high pitched monophonic inspiratory wheezing
loudest over anterior neck
partially obstructed URT
stridor
low pitched grating noise
I and E
rough, inflamed or scarred pleura rub against one another
pleural friction rub
Passage of foreign material into trachea & lungs
aspiration
aspiration of gastric acid
chemical pneumonitis
aspiration of oral/pharyngeal bacteria
aspiration pneumonia
exogenous lipid pneumonia
aspiration of oil
aspiration of an object
foreign body aspiration
3 populations most affected by aspiration
premature babies
college age people who binge drink
dysphagia pts
s/s of aspiration (11)
coughing; fever
wheezing
stridor
hoarseness
nasal flaring
chest retraction
chest discomfort
cyanosis
pulmonary edema
resp distress syndrome
excess fluid in pleura
increased pressure on lungs
pleural effusion
etiology of pleural effusion (2)
↑ fluid production
↓ fluid absorption
r/f for pleural effusion (5)
CHF
kidney failure
PE
trauma
infection
s/s of pleural effusion
dyspnea
chest pain
tachypnea
tachycardia
percussed dullness
absence of breath sounds over area
tracheal deviation
hypotension
collapsed lung
alveoli deflated
little/no gas exchange
atelectasis
atelectasis uni/bilateral
unilateral (usually)
etiology of atelectasis (3)
airway blockage
pressure on lung
↓ surfactant
r/f for atelectasis (5)
obesity
general anesthesia
OSA
lung disorders
resp distress syndrome
s/s of atelectasis (5)
dyspnea; cough
tachycardia
chest pain
cyanosis
collapsed lung
may be open, closed, tension
pneumothorax
etiology of closed pneumothorax (3)
spontaneous
idiopathic
ruptured emphysematous bleb
etiology of open, tension pneumothorax
puncture wound
s/s of pneumothorax
s/s of 3 types
increased, labored respirations; dyspnea; tachycardia; pleural pain; asymmetrical chest movement
- Closed - absent breath sounds; hypoxemia
- Open- “sucking” noise; tracheal swing; ↓ BP; moderate hypoxemia
- Tension - absent breath sounds; tracheal deviation to unaffected side
tx for open pneumothorax
protect wound
as wound starts to heal, cover with 3-sided bandage so air can move out, but not into lung
tx for tension pneumothorax
needle decompression
chest tube to keep pressure from returning
Portion of ribcage removed from part of chest wall
flail chest
complications of flail chest (6)
hypoxia
pneumothorax
hemothorax
pulmonary contusion
pneumonia
atelectasis
URI most likely type of pathogen
virus
r/f for URI (6)
smoking
young age
chronic disease
altered immune system
stress
crowding
s/s of URI (9)
cough
congestion
runny nose
sinus pressure
excessive mucus
sore throat
mild fever
body aches
itchy eyes
influenza season
Oct - March
inflammation/swelling of epiglottis
epiglottitis
epiglottitis mostly caused by…
Haemophilus influenzae bacteria
r/f for epiglottitis (3)
male
unvaccinated
immunocompromised
s/s of epiglottitis
fever
sore throat
stridor
painful swallowing
drooling
anxiety
leaning forward (instinctively protecting airway from saliva)
interventions for epiglottitis
do NOT look in pt’s mouth or ask pt to open their mouth
keep them leaning forward
complications of epiglottitis (4)
meningitis
abscess
pneumonia
death with airway obstruction
immunization for epiglottitis
Hib vaccine series for babies
Bronchioles infection only in children
bronchiolitis
most likely pathogen causing bronchiolitis
viral
Human metapneumovirus (HMPV)
r/f for bronchiolitis (7)
child
heart or lung condition
2nd hand smoke
never been breastfed
crowding
siblings
daycare
s/s of bronchiolitis (5)
cough; fever
rhinitis
stuffy nose/congestion
wheezing
complications of bronchiolitis (4)
dehydration
hypoxia
apnea
cyanosis
infection of alveoli
pneumonia
r/f for pneumonia (5)
older age; smoking
recent hospitalization
chronic illness
immunosuppressed
s/s of pneumonia (7)
fever; fatigue; cough; dyspnea
chest pain
nausea
confusion in older pts
immunizations for pneumonia
which populations are they for
- PCV13 - <2yo
- PCV23 - >65yo OR smokers >19yo
Infection by Histoplasma capsulatum fungus found in bird & bat feces in humid areas
histoplasmosis
histoplasmosis mode of transmission
inhaling fungal spores
3 forms of histoplasmosis
- Acute primary
- Chronic cavitary
- Progressive dissemination
r/f for histoplasmosis
age <2 or >55
weak immune system
being around caves, barns
s/s of histoplasmosis (10)
fever
myalgia
chest pain
malaise
pneumonia
pulmonary lesions
worsening cough and dyspnea
hepatomegaly
lymphadenopathy
wt loss
complications of histoplasmosis (2)
meningitis
Addison’s disease
encapsulated TB on chest x-ray
latent TB
latent TB may become active if…
immune system is weakened/compromised
r/f for TB (6)
close contact c infected
immunocompromised
homelessness
close quarters (prison, shelters etc)
drug/alcohol abuse
occupation
s/s of TB (7)
fever; fatigue; cough
wt loss
hemoptysis
night sweats
chills
immunization for TB
BCG vaccine
not used in USA
difficulty exhaling
obstructive disorders
difficulty inhaling
restrictive disorders
etiology of OSA in adults & children
- Adults - tongue and throat relax, soft tissue at back of throat blocks airway
- Children - large tonsils/adenoids in upper airway
r/f for OSA (7)
obesity; DM; smoking; family hx
male
asthma
narrow airway
s/s of OSA (7)
snoring
noisy breathing
tiredness after sleeping
morning h/a
dry mouth
waking gasping for air
observed apneic spell
A gene changes in a protein regulating salt movement
causes a thick, sticky mucus in resp, GI, reproductive systems
cystic fibrosis
best for these patients not to gather together
because…
CF
can pass resistant forms of bacteria to one another - less capable of getting rid of them
s/s of CF (9)
persistent cough
wheezing
chronic/resistant infection
exercise intolerance
steatorrhea (fat in stool)
poor wt gain
intenstinal blockage
constipation
salty sweat
steatorrhea indicates…
CF
genetic condition that increaes risk for contracting a resistant infection
CF
tx for CF
percussion to help clear airways
avg CF lifespan
37 years
Chronic, intermittent
overresponse of immune system to an allergen
inflames & narrows airways in lungs
excessive production of mucus
remodelling of airways
asthma
r/f of asthma (6)
family hx; obesity
male
African American
exposure to toxins
poverty (exposed to more triggers)
which populations is asthma more common in?
males
African Americans
in poverty
s/s of asthma (7)
cough; dyspnea
chest tightness
nighttime coughing
wheezing
use of accessory muscles
↓ O2 sat
common asthma triggers
danders; cockroach droppings; viral illness; smoking; pollutants; physical activity
2 diseases included in COPD
emphysema
chronic bronchitis
“pink puffer”
emphysema
“blue bloater”
chronic bronchitis
overinflation of alveoli
emphysema
chronically inflamed bronchi produce excessive mucus
chronic bronchitis
etiology of emphysema
irreversible breakdown of alveolar walls
permanent holes in lower lung tissue
etiology of chronic bronchitis
repeated irritation/damage to airways
major risk factor/cause of emphysema
smoking
other r/f for COPD besides smoking
exposure to toxins
EMPHYSEMA OR CHRONIC BRONCHITIS
rhonchi & wheezing
CB
EMPHYSEMA OR CHRONIC BRONCHITIS
diminished lung sounds
emphysema
EMPHYSEMA OR CHRONIC BRONCHITIS
excessive sputum
both
EMPHYSEMA OR CHRONIC BRONCHITIS
hypercapnia
both
EMPHYSEMA OR CHRONIC BRONCHITIS
pursed lip breathing
emphysema
EMPHYSEMA OR CHRONIC BRONCHITIS
cyanosis
CB
EMPHYSEMA OR CHRONIC BRONCHITIS
hyperresonance
emphysema
EMPHYSEMA OR CHRONIC BRONCHITIS
orthopnea
emphysema
EMPHYSEMA OR CHRONIC BRONCHITIS
thin with barrel chest
emphysema
EMPHYSEMA OR CHRONIC BRONCHITIS
overweight
CB
EMPHYSEMA OR CHRONIC BRONCHITIS
prolonged expiratory time
emphysema
EMPHYSEMA OR CHRONIC BRONCHITIS
tachypnea
both
EMPHYSEMA OR CHRONIC BRONCHITIS
anxiety, fatigue, short sentences
emphysema
EMPHYSEMA OR CHRONIC BRONCHITIS
use of accessory muscles to breath
both
EMPHYSEMA OR CHRONIC BRONCHITIS
hypoxia, cyanosis, clubbing
CB
EMPHYSEMA OR CHRONIC BRONCHITIS
recurrent productive cough (daily for more than 3 months)
CB
EMPHYSEMA OR CHRONIC BRONCHITIS
cardiac enlargement
CB
EMPHYSEMA OR CHRONIC BRONCHITIS
peripheral edema
CB
2 restrictive lung disorders
chest wall abnormality
pulmonary fibrosis
chest wall abnormality etiology examples
kyphosis; scoliosis; poliomyelitis; ALS; botulism; muscular dystrophy
Chronic, progressive
alveoli become scarred & stiff
makes gas exchange difficult/impossible
pulmonary fibrosis
s/s of pulmonary fibrosis (6)
dyspnea; cough
clubbing
wt loss
myalgia
rapid shallow breathing
Fluid accumulates in tissue & alveoli of lungs, making gas exchange difficult
pulmonary edema
etiology of pulmonary edema
left-sided HF
r/f for pulmonary edema (7)
DM; obesity; HTN; HLD
HF
medications
IV fluids
s/s of pulmonary edema (12)
dyspnea
coughing frothy pink sputum
feeling like suffocating (especially lying)
wheezing
orthopnea
cold clammy skin
tachycardia
irregular heartbeat
palpitations
anxiety
cyanosis
death
blood clot blocks artery in lungs
pulmonary embolism
r/f for PE (10)
smoking; HTN; obesity
clotting disorder
pregnancy/30-60 days postpartum
oral contraceptive
arrhythmia
surgery
injury
decreased mobility
s/s of PE (6)
dyspnea; weakness
sudden onset
severe chest pain
hemoptysis - usually frank blood
syncope
dizziness
vessels in lungs blocked or destroyed leading to increased BP
pulmonary HTN
pulmonary HTN affects…
lungs
right side of heart
etiology of pulmonary HTN (5)
vessel destruction
left side HF
lung disease
chronic PE
comorbidities
r/f for pulmonary HTN (5)
family hx; obesity
medications
high altitudes
congenital CV diseases
s/s of pulmonary HTN (10)
dyspnea; fatigue
dizziness
syncope
chest pain
edema
ascites
palpitations
tachycardia
cyanosis
surfactant deficiency in neonates
infant respiratory distress syndrome
first 30 days of life
neonate
r/f for IRDS
prematurity
s/s of IRDS
rapid labored breathing
grunting
visible ICS (suprasternal & substernal retractions)
flaring of nostrils
lethargy
cyanosis
irregular breathing
apnea
cardiac failure
fluid builds up in alveoli from response of immune system
acute respiratory distress syndrome
etiology of ARDS
damaged membrane between alveoli & blood vessels
r/f for ARDS (6)
hospitalization
sepsis
smoke inhalation
pneumonia
injury
underlying disease
tx for ARDS
ventilation
most cancer deaths/year in US caused by…
lung cancer
2 types of lung cancer
small cell
non small cell
small cell lung cancer occurs in…
heavy smokers
localized small cell prognosis
56%
localized non small cell prognosis
16%
metastasized lung cancer prognosis
16%
pack life =
packs/day x years person has smoked
screening for lung cancer
low-dose computed tomography (LDCT) for people 55-80yo with a 30-year hx and have smoked in the last 15 years
after ___ years of not smoking, the risk for lung cancer is the same as someone who never smoked
15
5 A’s of encountering a smoker patient
- Ask pt if they use tobacco products
- Advise pt that smoking is bad for them
- Assess willingness to quit smoking
- Assist pt in quitting
- Arrange a follow up evaluation for pt
abnormal heart sound associated with pulmonary HTN
split S2