Respiratory Flashcards
What parts of the body are involved in the upper respiratory system?
Nose
Paranasal sinuses
Pharynx
Larynx
Trachea
Bronchi
T/F
Most upper respiratory infections and disorders are serious
False. Most of them are actually minor. However some of them can progress to be serious.
Most common upper respiratory infection?
Common cold that requires no treatment
Upper respiratory infections are the most common reason for …. (2)
Seeking healthcare
Absences from school/work
What type of infection are 90% of upper respiratory infections caused by?
Virus
Obstructive sleep apnea
Recurrent apnea during sleep
Risk factors for obstructive sleep apnea
Obese males
Large necks
Common symptom of obstructive sleep apnea
Snoring
Hearing periods where they aren’t breathing
Nursing interventions you need to do for obstructive sleep apnea patients? (2)
Make sure the alarm is on
Reposition the patient to maintain the airway
Why is repositioning a priority for patient with obstructive sleep apnea?
By repositioning, we are trying to maintain their airway
Your patient is expressing symptoms of obstructive sleep apnea but they are undiagnosed. What do you do?
Make a referral to physician to get RT on board and get a CPAP
What is a deviated septum?
Sideways displacement of the walls between the nostrils of the nose
Will your patients know they have a deviated septum?
Usually not
What is the cause of a deviated septum?
Nasal injury of some sort
If a patient does have symptoms from their deviated nasal septum, what kind would you expect?
Nose bleed
Mild congestion
Loud noisie breathing during sleep
Treatment for deviated septum patients
Decongestants
Antihistamines
Nasal steroids if its bad
Refer to ENT specialist if bad
Why are nose fractures so common?
Due to the location making it more susceptible. It’s bony too.
What can a nose fracture result in?
Hematoma
Infection
Abscess
Avascular or septic necrosis
Why are we concerned about infection with a nose fracture?
Bacteria growth in mucus membranes of the nose
Why are worried about avascular necrosis from a nose fracture?
Blood flow to the area is reduced with a fracture and can cause the avascular necrosis.
- so don’t let a patient avoid the specialist
Epistaxis
Nose bleed due to rupture of tiny vessels in nose
What if epistaxis is frequent?
Go see ENT if it is frequent in order to figure out why
- high bp could be the reason
A big reason why patients have frequent epistaxis?
High BP
Laryngeal obstruction
When upper breathing passage is narrowed or blocked causing difficulty in breathing
Areas that can be affected by a laryngeal obstruction?
Trachea
Larynx
Pharynx
Exercised induced laryngeal obstruction
Transient reversible narrowing of larynx that occurs with high intensity exercise that impedes airway and causes stridor, discomfort, and shortness of air
When young athletes have exercise induced laryngeal obstruction, what are they often misdiagnosed as?
Exercise induced asthma or bronchoconstriction
Larynx is a ______ box with a ______ lining.
stiff box with mucosal lining
When exactly does the laryngeal obstruction dangerous?
When there is edema at the opening of the glottis - can obstruct breathing.
What is Sinusitis ?
Inflammation of the paranasal sinuses that is adjacanet/around the nasal cavity
What are the main causes of sinusitis?
Infection from virus, bacteria, or fungus
Autoimmune reaction to allergies
Explain the autoimmune response causing sinusitis rt allergies
Histamine is released which causes inflammation of mucosal lining
Why do doctors refer to sinusitis as rhinosinisutis?
Because both the sinuses and the nose are inflamed
With sinusitis, what are the possible sinuses that could be having inflammation?
Maxillary
Frontal
Ethmoid
Sphenoid
Maxillary sinusitis symptoms
Pain or pressure in the cheek
Toothache or headache
- they go to the dentist
Frontal sinusitis symptoms
Pain or pressure behind the eyes
Headache
Tight eyes
Cool, warm compress
Ethmoid sinitusus symptoms
Pain between eyes
Sphenoid sinusitis symptoms
Pressure or pain on the top of the head
What is sinusitis linked to?
What is an extra symptom?
Asthma - so the sinusitis may be apart of generalized airway inflammation
Cough may be associated with it ; wheezing and stridor
Why use salt saline/spray for sinusitis?
It is supposed to relieve congestion and mucus
Nonpharm treatment for sinusitis
Saline salt washes and sprays
Steam inhalation
Drink fluids
You offer a patient with sinusitis steam inhalation. What methods do you use?
Hot shower
Hot compress to face
Why do patients with sinustitis need to drink plenty of fluids?
Avoid dehydration and break up the dry mucous membranes to relieve congestion
Pharm treatment for sinustutis
Antibiotics to tx infection
Nasal Corticosteroids as nasal spray to decrease inflammation
- doesn’t always work
If patients getting frequent sinusitis, what do you anticipate?
Prophylactic antibiotics treatment
What if pharm treatment doesn’t work for sinusitis?
Surgery
What is Acute Tracheobronchitis?
Inflammation membranes of trachea and bronchial tree epithelium
What does acute tracheobronchitis usually follow?
Upper respiratory infection
Pathogens that cause acute tracheobronchitis
adenovirus
rhinovirus
influenza - parainfluenza, corona, RSV
Bacterial causes of Acute tracheobronchitis
Staph
Strep
Micoplasma
Pneumonia
Catarolis
Bordetella Pertusis
How do irritants cause acute tracheobronchitis?
When inhaled, irritants can get into the trachea lining causing a horrible cough
First signs of acute tracheobronchitis
Convulsive cough when patients is breathing in on inspiration
- usually occurs at night
Why are acute tracheobronchitis infections sometimes hard to treat?
Because it is often viral (80%) - and obviously you can’t treat them.
If it is bacterial, they’ll go ahead and do antibiotics and anti-inflammatories.
How do we identify the pathogen that can cause the acute tracheobronchitis?
Sputum culture
Bronch wash
Pneumonia
Inflammation of the lung parenchyma and air sacs of one or both lungs that fills with fluid and puss
What is included when we say lung parenchyma?
Any form of lung tissue which includes bronchioles, bronchi, vessels, interstitial, and alveoli
Pneumonia symptoms
Fever
Chills
Difficulty breathing
What organisms can cause pneumonia by getting in the lungs?
bacteria
viruses
fungi
What age groups is pneumonia serious?
Infants & kids
Elderly +65
Hx of pneumonia - increased predisposition for microbial invasion
Who does pneumonia typically kill?
Children under the age of 5
What type of pneumonia is typically the most common?
Who is it most common in?
viral pneumonia
- most common in kids and not adults
A kid with viral pneumonia has come in. What do you need to make sure gets done?
Make sure to watch their symptoms but also make sure they get that chest x ray
Where can patient acquire pneumonia?
Hospital
Out in the community
What is meant by hospital acquired pneumonia?
Ventilator patients often acquire it from the vent itself
What instances can have aspiration pneumonia in general?
OG tubes
Vent patients
Poor gag reflex
Stroke patients
How do you prevent pneumonia?
Immuminizations
What populations do we really try to push immunizations for?
Young
Elderly
What nutrition can help with pneumonia?
Need adequate nutrition for protein levels to fight infection
Why do we look at the environmental factors around the patient when they have pneumonia?
Environments like the dorms, long term care facilities, and day care can spread it
What does pneumonia affect pathology wise (2)
Ventilation
Diffusion
Explain how pneumonia can cause death
Blood will lack oxygen, rbc cannot deliver oxygen, infection risk increases and spreads >> death
What does exudate in alveoli due to pneumonia do?
Blocks diffusion of oxygen and co2 gas exchange
What components of pneumonia occlude ventilation?
The secretions + edema occlude breathing/ventilation
When pneumonia causes the vent-perfusion mismatch, what reading do you look for and why?
Look at the partial pressure of oxygen in arterial blood (paO2) for artieral hypoxia.
- less than 80 mmhg on room air is indicative of the hypoxia
Clinical manifestations of pneumonia
Headache
Low grade fever
Pleuritic pain (pleurisy on the side of lungs)
Myalgia
Pharyngitis
Cough +Purulent sputum
Orthopnea
Elderly - confusion + lethargy
What do you as the nurse need to do before the patient gives their sputum culture?
We need their sputum for cultures so we need them to brush their teeth first and then spit in the cup.
Why will not all pneumonia patients present the same way?
Underlying conditions could alter the symptoms
What criteria do we use for diagnosis of pneumonia?
Chest x ray
Full history of patient with immunizations list
Full physical exam
Sputum cultures
Antibiotics for pneumonia
Zithromax for 3 days
How can we help patients loosen up secretions and mucus?
Drink plenty of fluids! We want them to be able to get rid of the mucus
How can we control fever for pneumonia?
Tylenol
Why do we want patients to avoid cough suppressants if they have pneumonia?
It defeats the purpose of them coughing up their secretions. We want them to get that stuff out of there.
Patient with pneumonia says they have plans to go to the gym later. What do you need to educate them on?
The importance of rest
Your patient has viral pneumonia. They’ve been started on antibiotics and want to know how long it takes to work. What do you tell them?
Antibiotics don’t help viral pneumonias
What do we need to monitor for when it comes to the pneumonia patients?
Monitor for shock and respiratory failure
What labs/measurements can we use to monitor for shock and respiratory failure?
Lactate
CRP
WBC
RR
Sao2
HR/pulse
BP
UO
CVP
Why do we need to be on top of making sure elderly are eating?
They tend to lose appetite and so we don’t want to make anything worse.
What do we want to encourage when it comes to managing pneumonia?
Fluids
Coughing
Deep breathing
What is CPT?
Chest physiotherapy - to loosen up secretions
After doing all your interventions, what do you need to do as the nurse?
Evaluate your interventions always
