Respiratory Flashcards
what is included in the upper airways
nose, sinuses, pharynx, larynx , lungs
what is included in the lower airways
trachea, bronchi, segmental bronchi, bronchioles, alveolar ducts, alveolar sacs
what happens in the alveoli
where gas exchange actually occurs also secrete surfactant to reduce surface tension and prevent alveolar collapse
what is the function of the respiratory tract
: Gas exchange (alveoli oxygen transport to the cells and Co2 away from the cells), Ventilation (atmospheric air – higher in O2 into lungs and removal of CO2), respiratory diffusion (movement of air across alveolar) , perfusion (blood flow – by the heart = central perfusion)
what changes happen to respiratory system with age
structure chest stiffness, decrease muscle mass (harder to expand lungs, less elasticity, alveolar are enlarged) a lifetime exposure to environmental pollutants could also harm the body over time
how can you prevent respiratory problems
Minimize exposure to inhalation irritants, stop smoking (including 2nd/3rd hand smoke),
what does the IPREPARE assessment stand for
Investigate, presenting work, resident, environment, past work, activity, resources/referral, educate
what should you ask when talking about family history
allergies, current health problems, current meds, genetic risk, smoking, drug use, travel, veterans (deployment location)
what is included on the physical assessment on the nose and sinuses
External nose – deformities or tumors, Septum – perforation or deviation, Nares – symmetry, size, shape, Nasal Cavity/Sinuses – color, swelling, drainage, bleeding, Mucous membranes- color, abnormalities
what is included on the assessment on pharync, trachea and larynx
– Mouth- can show early cyanosis (pale blue lips and mouth = central cyanosis = bad), Posterior pharynx, Neck – symmetry, alignment, masses, swelling, bruises, use of accessory muscles, lymph nodes, Trachea- palpate for position, mobility, tenderness, masses, Larynx – voice abnormality, hoarseness
what is included on the assessment of the lungs
Have them sit look at front and back, observe the chest and compare both sides while breathing and a rest, Assess breathing and respirations – rate rhythm, depth, effort, if retractions show remove shirt and get a better look, Percussion for pulmonary resonace, organ boundaries, diaphragmatic excursion, dull (pneumonia), Palpate – for movement, symmetry, tenderness, tactile fremitus and Auscultate
what does hemoglobin tell you and what doe low levels mean
low means less O2 to body = hypoxemia can also help identify deficiencies that may lead to hypoxemia
what do sputum specimens (culture and sensitivity) tell you
Identify the causative organism and the specific antibody to treat it
what does cytologic examination tell you
identifies cancer cells, allergic conditions
what do low/high levels of CBC tell you
could be increases in chronic disease r/t increased production of erythropoietin, decrease seen in anemia, hemorrhage, hemolysis
what does high/low levels in WBC tell you
elevation in acute infections or inflammation, Decrease in overwhelming infection, autoimmune disorder, immunosuppressant therapy
what does high levels of differential WBC tell you
can be decreased in sepsis, autoimmune and immunosuppressant therapy
what do low/high levels of neutrophils tell you
elevated in acute bacterial infection, COPD, or smoking, Decreased in viral infections
what do high levels of eosinophils tell you
elevated in COPD, asthma, allergies
what do high/low levels of basophils tell you
elevated could mean chronic infections, decreased in acute infection
what does high/low levels of lymphocytes tell you
elevated in viral infections, pertussis, and mononucleosis, decreased in corticosteroid therapy
what does a chest x-ray show you
Assess lung pathology (pneumonia, atelectasis, pneumothorax, tumor), Detects (pleural fluid, ETT placement, invasive line placement, chest tube placement
what position should the pt be in for chest x ray
position= posteroaneterior and left lateral (so air will rise),
what is the limitation for chest xray
may appear normal even with severe disease present
what does a CT show you
assess soft tissue, consecutive cross section of the chest, identifies lesions or clots, IV contrast to enhance,
what are the nursing considerations for CT
considerations allergies to IV contrast, iodine, shellfish, renal function, stop taking metformin 24 hours before, restart when renal function is good
what does a pulse ox do
infrared light is used to identify the percentage of hemoglobin saturated with oxygen, placement on finger, toe, earlobe, or forehead
what does a Capnometry/capnography do
measures carbon dioxide in exhaled air, provides info about: Co2 production, pulmonary perfusion, alveolar ventilation, respiratory patters, ventilator effectiveness, rebreathing of exhaled air, it is a more sensitive indicator of gas exchange then pulse ox
what does a pulmonary function test do
determines lung function/breathing diffuclties, compare data to expected findings, screen for lung disease or guide management, preoperative testing to identify patient’s at risk for lung complications
what does an exercise pulmonary function test do
identifies cause of dyspnea (cardiac, lung or muscle weakness)
what are the considerations for pulmonary function test
: explain the procedure of the test, no smoking 6-8 hours before, assess patient for dyspnea and bronchospasms after, doc meds administered during
what is exercise testing
– assesses the patient ability to work and perform ADLs, differentiates reasons for exercise limitations, evaluated influence of disease on exercise capacity, self paced 12 min walk/treadmill/bike, pulmonary patient’s limited by breathing capacity, gas exchange compromise or both
what should be considered for exercise testing
explain the test, assure the patient, monitor closely
what is a laryngoscopy
visualize the vocal cords, remove foreign objects, obtain tissue samples
what is a mediastiniscopy
insertion above the sternum to the area between the lungs, visualize tumors, obtain tissue samples
what is a bronchoscopy
diagnose and manage pulmonary disease, evaluate the airway, placement of ETT tube, collect specimen, remove secretions, stent to open airways, rigid scope – general anesthesia, flexiable scope – low dose sedations
what are the complications of bronchoscopy
bleeding, hypoxia, pneumothorax
what are the considerations for bronchoscopy
explain procedure, obtain pre procedure diagnostics like CBC, PT, platelet count, NPO for 4-8 hours,
what are the indications for a throcentesis
needle aspiration of pleural fluid or air , to diagnosis, manage, exam, relieve pressure on blood vessel or lung compression, relieve respiratory distress, instill meds
what are the considerations for thoracentesis
explain procedure, get consent, assess for allergies to anesthetic, do not cough/move/deep breath to avoid puncturing lung, provider should wear goggles, remove no more then 1000ml, apply pressure to site, follow up chest xray, assess for bleeding/drainage, doc everything
what are the complications of thoracentesis
fluid accumulation, subcutaneous emphysema, infection, tension, pneumothorax (crunchy
when would you see ss of pneumothorax after thoracentesis
may occur up to 24 hours after procedure
what are the indications for lung biopsy
obtain tissue for histological analysis, culture, or cytology, differential diagnosis of cancer, infection, inflammation, or lung disease
what are the different types of lung biopsies
transbrochial biopsy, transbrochial needle aspiration, thansthoracic needle aspiration
what are the considerations of lung biopsy
explain procedure, assess allergies, may need chest tube
what is the post op monitoring for lung biopsy
VS, respiratory assessment q4 for 24 hours, pneumothorax, respiratory distress, hemoptysis
why is ABG used
monitor blood Ph level, monitor the effectiveness of various treatments
how is an ABG taken
heparinized syringe, allens test to confirm radial/ulnar circulation, explain and reinforce procedure, use surgical asepsis, place specimen on ice (to keep Ph from changing), hold pressure on site for 5 mins (20 mins if patient on anticoagulants), monitor for swelling/bleeding/ change in color or temp, document, report results, administer O2 or change vent settings as prescribed
what are the complications of ABG
Arterial occlusion (on the artery you stuck) – monitor for changes in color temo, swelling, loss of pulse, or pain – tell doc of persistent findings, Hematoma – apply pressure to the site, call doc, Air embolism – place on left side trendleburg, monitor for sudden onset of SOB, decrease O2 sats, chest pain, anxiety, air hunger, call doc ASAP, get ABG from diff site, continue to assess respiratory status
what is normal Ph level of ABG and what do high/low levels mean
Ph= 7.35-7.45 ( increased= metabolic aklalosis, loss of gastric fluids, decreased K intake, diuretics, fever, sailcyte tocicity, repiratory alkalosis- hyperventilation Decreased = metabolic/respiratory acidosis, ketosis, renal failure, starvation, diarrhea, hyperthyroidism),
what is a normal Pao2 level for ABG and what do high/low levels mean
80-100 ( increased= increased ventilation, oxygen therapy, Decreased= respiratory depression, high altitude, carbon monoxide poisoning, decreased cardiac output decreased perfusion
what is a normal PaCO2 level in ABG and what do high/low levels mean
35-45 (Increased= respiratory acidosis, emphysema, pneumonia, cardiac failure, respiratory depression, Decreased = respiratory alkalosis, hyperventilation, diarrhea
what is a normal HcO3 level
21-28
what is a normal SaO2 level
95-100%
what is a normal bicarbonate level and what do high/low levels mean
Bicarbonate = 21-28 (increased = metabolic alkalosis, bicarb therapy, metabolic compensation for respiratory acidosis Decreased= metabolis acidosis, diarrhea, pancreatitis
what are the characteristics of metabolic acidosis
decrease Ph, Decrease HCo3, decrease PaCo2
what are the characteristics of metabolic alkalosis
increase Ph, Increase HCo3 and Increase PaCo2
what are the characteristics of respiratory acidosis
decrease Ph, Increase PaCo2, Increase HCo3,
what are the characteristics of respiratory alkalosis
= increase Ph, decrease PACo2, Decrease HCo3
what are some ss of acidosis
Cardiovascular: heart rhythm changes, Tall T waves, widened QRS complex, prolonged PR interval, hypotension, thready peripheral pulses, CNS (bc Ph is low): depressed activity (lethargy, confusion, stupor, coma), Neuromuscular: hyporeflexia, skeletal muscle weakness, flaccid paralysis, Respiratory: Kussumal respirations (metabolic), variable respirations (respiratory), Integumentary: warm, flushed, dry skin in metabolic, pale to cyanotic and dry skin in respiratory
what are some ss of alkalosis
Cardiovascular- increased HR, normal to low BP, increased digoxin toxicity, CNS (Ph is high): increased activity, positive Chvostek’s and trousseau, paresthesia, Neuromuscular: hyperlexia, skeletal muscle weakness, muscle cramping and twitching, Respiratory: hyperventilation in respiratory, and decreases respiratory effort with skeletal muscle weakness in metabolic
what is allergic rhinitis
inflammation r/t exposure to allergens (plant pollen, animal dander, molds, foods)
what are the ss of allergic rhinitis
sneezing, itchy nose, rhinorrhea, watery eyes, congestion
what is the treatment for allergic rhinitis
nasal corticosteroid spray (non-systemic – flonase), second generation antihistamines (non-sedating = loratadine, cetirizine, fexofendadine), allergy shots
what are the interventions for allergic rhinitis
avoid triggers, med as prescribed, supportive care
what is an upper respiratory infection
inflammation of the nasal mucosea and sinuses, common cold cause by a virus spread by droplets, allergic or non allergic, cute or chronic, coexists with other disorders (asthma, allergies)
what are the risks for upper respiratory infection
extremely young/advanced age, recent exposure, lack of current immunization, smoker, chronic lung disease immunocompromised
what are the ss of upper respiratory infection
rhinorrhea, purulent nasal drainage, sneezing, itchy nose, dry sore throat, redden, swollen nasal mucosa, low-grade fever, watery eyes, congestion
what are the interventions/education for upper respiratory infection
encourage 6-8 hours rest, humidified air, cough etiquate, hand hygiene, vaccination, limit exposure espically is immunocompromised
what is the treatment for upper respiratory infection
– decongestants (phenylephrine – constricts blood vessels and decrease edema), antipyretics for fever, antibiotics for bacterial infection
what are some complementary options for upper respiratory infection
echinacea, large dose of vitamin c, zinc preparations, improve immune response
what is sinusitis
inflammation of the mucous membrane of one or more of the sinuses, swelling and inflammation block drainage and lead to infection occurs after rhinitis
what are the risk factors for sinusitis
deviates septum, nasal polyps, inhaled air pollutants or cocaine, facial trauma, dental infection, immunocompromised
what are the ss of sinusitits
nasal congestion, headache, facial pressure/pain, cough, bloody or purulent nasal drainage, tenderness on palpation of sinuses, low-grade fever
what are the interventions/education for sinusitis
encourage rest, humidified air, increased fluid intake, cough etiquate, hand hygiene, decrease swimming, driving, air travel, smoking cessation, sinus irrigation
what is the treatment for sinusitits
decongestants (phenylephrine), antipyretics for fever, broad spectrum antibiotics for bacterial infection (amoxicillin, antibiotic stewardship) Pain relievers (NSAIDs, Acetaminophen, Asprin)
what are some complications of sinusitis
meningitis – report suspected findings to provider
what is seasonal and pandemic influenza
fall/winter, highly contagious acute viral infection, contagious from 24 hours before symptoms manifest to 5 days after onset, pandemic influenza – viral infection in birds or animals that has mutated and is highly infectious to humas (swine and avian flu)
what are the risk factors for seasonal and pandemic influenza
history of pneumonia, over 65, pregnant women, health care workers
what are the ss of seasonal and pandemic influenza
severe headache, muscle aches, chills, fatigue, weakness, severe diarrhea, fever, cough (avian flu) hypoxia (avian flu)
what are some antivirals used for seasonal and pandemic influenza
amantadine, rimatadine, ribavirin, zanamivir, oseltamivir, begin antiviral treatment within 24-48 hours of symptoms onset
what are some vaccines used for seasonal and pandemic influenza
trivalent vaccines prepared annually, IM injection, vaccines encouraged for everyone 6 mths and older
what are the interventions for seasonal and pandemic influenza
encourage rest, droplet precautions, saline gargles, monitor hydration status, administer fluids, monitor respiratory status, encourage vaccination, avoid personal contact, avoid identified areas of pandemic flu
how do you diagnosis seasonal and pandemic influenza
AV advantage A/H5N1 flu test
what are the complications of seasonal and pandemic influenza
pneumonia in older adults and immunocompromised
what is covid
caused by SARS-CoV-2 virus, spreads quickly through droplets
what are the risks for covid
older adults, immunocompromised, people with certain medical conditions – asthma, cancer, chronic lung/kidney/liver disease, diabetes, dementia, cystic fibrosis
what are the ss of covid
fever, chills, cough, SOB, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestions or runny nose, nausea, vomiting, diarrhea
how do you diagnosis covid
PCR (most reliable), rapid antigen test, home/self test (antigen)
what is the education for covid
follow CDC guidelines, testing, isolation, seek higher level of care
how are you considered up to date for covid vaccine
based on – age, first vaccine date, length of time since last dose
what are some approved vaccines for covid
Pfizer-BioNTech, Moderna, Novavax, J&J
what is bronchitis
inflammation of the bronchi
what are the risks for bronchitis
viral, air pollution, dust, chemical inhalation, smoking, sinuisitis, asthma
what are the ss of bronchitis
cough up to 3 weeks, clear sputum, headache, fever, hoarseness, myalgia, chest pain, dyspnea
how do you diagnose bronchitis
chest x-ray
what is the treatment for bronchitis
cough suppressants/expectorants, antipyretic, beta2 agonist for wheezing (albuterol), Antibiotics (if prolonged over 3 weeks with purulent sputum)
what should be considered for bronchitis
encourage increased fluid intake, cough etiquette, hand hygiene, stop smoking, encourage ambulation, prevent pneumonia
what is pneumonia result in
in reduced gas exchange (aspiration, inhalation, hematogenous), excess fluid in the lungs, acute infection of lung parenchyma
what are the risks for getting pneumonia
older adult, smoking, recent respiratory infection, immunocompromised, tracheal intubation, decreased LOC, immobility, lack of vaccines, smoking, chronic disease
what is community acquired pneumonia
contracted outside the healthcare system,
what is healthcare associated pneumonia
occurs less then 48 hours of hospital admission
what is hospital acquired pneumonia
onset/diagnosis over 48 hours of hospital admission
what is ventilator associated pneumonia
onset/diagnosis within 48-72 hours after ETT intubation
what is aspiration pneumonia
chemical pneumonitis of gastric contents
what is necrotizing pneumonia
rare, cavitation of lungs and abcess
what is opprotunistic pnumonia
immunocompromised leading to pneumocystis, jiroveci and cytomegalovirus
what are some ss of pneumonia
: anxiety, fear, weakness, chest discomfort r/t to coughing, confusion, fever, chills, flushing, diaphoresis, dyspnea, tachypnea, pleuritic chest pain, yellow tinged sputum, crackles, wheezes, dull chest percussion, decrease O2 sats, purelent, blood tinged sputum
how do you diagnosis pneumonia
- sputum culture/sensitivity, CBC, ABG, Blood culture, serum electrolytes, chest xray, pulse ox
what are some interventions for pneumonia
– high fowlers, encourage cough and deep breathing, incentive spirometer, give breathing treatments and meds, oxygen therapy, cluster care, promote adequate nutrition, increase fluid intake, provide rest periods, reassure client experiencing respiratory distress
what are some antibiotics prescribed for pneumonia
– pencillin and cephalosporins mostly used, sputum culture and sensitivity FIRST, start with IV then oral as condition improves, monitor renal function, observe for diarrhea with cephalosporins, encourage to take with food, some PNC must be taken 1 hour before or 2 hours after meals
what do bronchodilators do
reduce bronchospasm and irritation, short acting beta 2 agonist (albuterol – rapid relief), Anticholinergics (ipratropium – allow for increase bronchodilation – suck on hard candy, rinse mouth, increase fluid intake), Methylxanthines (theophylline – requires close monitoring for therapeutic range
what do glucocorticoids do for pneumonia
– fluticasone and prednisone – reduces airway inflammation
what are some complications of pneumonia
atelectasis, bacteremia (sepsis), acute respiratory distress syndrome
what is tuberculosis
caused by mycobacterium tb, airborne transmission, lodges in bronchioles and alveoli, primary infection, reactivated infection, latent (exposed not infected)
what are the risks for TB
low seriocomic status, homeless, foreign born, travel to endemic area, immigration from Mexico, Philippines, Vietnam, china, Japan, easter Mediterranean countries, employed of living in prisons, long-term facilities shelters or healthcare, IV drug users, immunocompromised
what are some ss of TB
persistent cough over 3 weeks, purulent blood tinged sputum, fatigue, lethargy, weight loss, anorexia, night sweats, low- grade fever in the afternoon
what test show an active phase of TB
QuantiFERON-TB, Chest Xray, Acid-fast bacilli smear and culture
what tests show a latent phase of TB
QuantiFERON, Mantoux
what are some considerations/education for TB
heated/humidified o2, prevent infecition, promote adequate nutrition, encourage adequate fluid intake, encourage foods rish in protein, iron, and vitamins B and C, provide emotional support, airborne precautions not required at home
why are some pts non compliant to TB treatment
duration of therapy being 6-12 months, follow up for 1 year
how can you prevent TB
- wear N95 mask, negative air flow room, barrier protection, have patient wear surgical mask when transported, cough etiquette
what is Histoplasmosis
fungal infection inhalation of spores, not trasnmitttable
what are the risks for getting Histoplasmosis
immunocompromised
what are some ss of Histoplasmosis
similar to pneumonia but very ill
what is the treatment of choice for Histoplasmosis
Amphotericin B-IV
what is epitaxis
nose bleed
what are the risks for epitaxis
hypertension, low humidity, allergies, sinusitis, upper respiratory infection
how do you diagnosis epitaxis
ENT-scope
what is the treatment for epitaxis
sit with head forward apply uninterrupted pressure for 5-15 minutes
what are some differnt types of epitaxis
anterior bleeds pledget placed for 48-72 hours, posterior- rapid rhino-balloon or packing (prophylactic antibiotic if left in place over 48-72 hours)
what is the teaching involved for epitaxis
sneeze with mouth open, saline nasal spray daily, avoid straining 4-6 weeks, afrin for no more then 3 days
what is obstructive sleep apnea
obstruction or narrowing of air passages r/t relaxation, tongue/soft palate fell back, results in hypoxemis and hypercapnia, central – cessation of breathing- neuro cause
what are the risks for obstructive sleep apnea
BMI over 30, over 65 years, neck circumference over 17cm, craniofacial abnormalities, acromegaly (over production of growth hormone), smoking, male
what are some ss of obstructive sleep apnea
insomnia, frequent arousal, daytime sleepiness, snoring, headaches, irritability, observation of apnea over 10 seconds
how do you diagnosis obstructive sleep apnea
questonaire and polysomnography = positive if over 5 apnea episodes per hour with a decrease of SPO2 3-4%
what is the treatment for obstructive sleep apnea
side sleeping, HOB elevated, avoid alcohol, weight loss, mouth guard, CPAP or BiPAP with severe apnea (over 15 episodes in an hour)
what are some complications of obstructive sleep apnea
untreated can lead to cardiac dysrhythmias, heart failure, and pulmonary hypertension
