Respiratory Flashcards
most potential getting injured dfirst
alveoli
shunt
Results when something interferes with air movement to the gas exchanging areas
Blood bypasses alveoli without picking up oxygen
dont want shunting and its caused by blockage (pulmonary htn)
Examples of shunt
Foreign body(coins)
Bronchospasm-asthma, allergic reaction,inhalants
Mucous plugging in bronchioles-cystic fibrosis, alveoli not getting O2, chest percussion, nebulized saline and chest pt jacket
Pneumonia
Pulmonary edema- from sick heart pump and kidneys
Hypoventilation- with drug overdose, deprives O2 from tissues
Dead space
air passages without gas exchange
mouth, nose, trachea, bronchi
150 ml in adult dead space left after expiration (inhalation tidal volume is 400-500 ml)
pulmonary embolus, shock(prolonged vasoconstriction)
hypoxemia vs hypoxia
hypoxemia- blood oxygen is low (clubbing), hold on to CO2, longer to notice and body compensates,
hypoxia- deficiency of oxygen supply to body(cyanosis,decreased SpO2)
if you keep having to increase oxygen, call physician may need tests
Resp changes with age
Chest wall weakens, barrel chest
Pharynx & larynx stiffen, less compliant,walls collapse on eachother
Lungs-lose compliance
Alveoli-less compliant, capillaries shrink, vasoconstrict,
Pulmonary vasculature-shunting, decerase perm
Muscular Strength declines
Risk factors
Smoking- lungs sound coarse ronchi from increased mucus trapping and decreased cilia(have them cough first)
Allergies- can get bronchospasm
Drug use- depress cns and resp drive
Travel-high altitudes, exposure virus
Socio-economic status-med compliance, access to care,living conditions(mold)
Family History-second hand smoke
Occupation-factory,chemical,hair dressers
physical assessment
-inspection- rate depth rhythm accessory muscles
-palpation- precordium, hand on chest it RR smooth even shallow, tactile fremitus, vocal resonance (access to xrays so dont need to do this)
-percussion- for cystic fibrosis
-auscultation- woman 4 on anterior, 6 on back ,2 on sides, if abnormal repeat,absent diminished
-VS,appearance tripod pale flushed,signs impaired gas exchange
-cough- how long, productive, barking crouping sounds
-sputum- productive color consistency think
-chest pain aching dull sharp pressure tightness
-dyspnea shallow rapid deep
Diagnostics
CBC- wbc for infection and influence resp, pefusion rbc hgb and hct for oxygen carrying capacity how well circulating
-ABGs
-lactate- sepsis, lactic acid build up from lack of O2 in tissues
-sputum- for bacteria to treat
-radiography- chest x ray one of first thing to do to get genreal idea lungs and heart
- CT scan - for more details, IV dye to get closer look at arteries and structures lungs to rule out masses and pulmonary embolism
-V/Q scan- dif radioactive material if allergic to dye for CT, look at ventilation/perfusion ratio
-pulse ox(92 goal, 90 anticipate new lung disease)
-lung biopsy
-MRI gives better look than cat,VQ; cant have metal, not in emergency , tAKES LONGER20-40mon
pulmonary function test
looks at capacity of lungs inhalation and exhalation to treat with meds
bronchoscopy
camera on cord down into trachea
patient conscious sedated
-pull out tissue sample and see whats is impairing oxygen flow
-covid pt for large amount of mucus and dont know why unable to oxygenate them-
-when cant figure out whats going on or deteriorating or mass for biopsy
capnography
ER and ICU detects CO2 (30-40 or 35-45)for mechanic ventilation and BIPAP patients, drug overdoses for CNS depression decreases RR and build up CO2, alcohol overdoses
thoracentesis
-sit on edge of bed, lidocaine in back to pleural space of lungs to pull fluid
-paracentesis- liver fluid pt accumulate fluid
-collapsed lung risk?
before cat scan what lab do we do (before exposing to radiology)
D-dimer- SOB and chest pain for high risk for potential blood clot. Multiple PE will get this
number on reason for thoracentesis
pleural effusions related to cancer or significant heart failure
