Respiratory Flashcards
capillaries are where
exchange of nutrients/oxygen and waste products occur
gas exchange happens in the
alveoli
ventilation is the
air movement in and out of the lungs
oxygenation is the
oxygen in the blood stream
perfusion is the
oxygen in the tissues
Airway = _________
Breathing = _________
Circulation = ____________
Ventilation
Oxygenation
Perfusion
Flow in respiratory support is
how many L/min of gas is flowing into the client; low flow or high flow
Fraction of Inspired Oxygen (FiO2) is
percent of the gas that is oxygen
Types of pressure respiratory support are
CPAP and BiPAP
CPAP stands for
continuous positive airway pressure
BiPAP stans for
Bilevel positive airway pressure
what does CPAP do
delivers air pressure at single set level that stays consistent during sleep; inhalation and exhalation is a constant set pressure
CPAP is not as good for ____________ and is usually used for
accommodating breathing changes; obstructive sleep apnea
what does BiPAP do
uses two two different pressure settings for inhale vs exhale and allows for lower pressure during exhalation; inhale is at a constant set pressure and exhale is set at a lower constant set pressure
BiPAP is used for
complex breathing problems such as central sleep apnea, and heart/lung/neurological disorders that require additional airway support during sleep (CHF, COPD, Parkinson’s, ALS)
High ventilator alarm means
pressure in circuit is too high
Causes of high ventilator alarms
coughing, gagging, bronchospasm, fighting the ventilator, ETT occlusion, kink in tubing, increased secretions, thick secretions, water in ventilator circuit
Low ventilator alarm means
pressure in the circuit is too low
Causes of low ventilator alarms
tubing is disconnected, loose connections, leak, extubation, cuffed ETT or trach is deflated, poorly fitting CPAP/BiPAP mask
ETT placement should be verified by a
CXR and assessment of equal breath sounds
An ETT can become displaced into the ________ main stem bronchus
right
tracheostomy infection risk is high because
natural defenses of the nose and mouth are bypasse
prevent trach infections by
daily trach care and which is a sterile procedure
positioning for trach pts should be
fowlers or semi-fowlers
how to suction a trach
only to pre measured depth
don’t suction for longer than 10 seconds
insert suction catheter and apply suction catheter on the way out
some clients may need to be pre-oxygenate with 100% FiO2
____ fingers should fit underneath a trach tie
1
at the bedside of a trach pt you need to have
two back up trachs: 1 of the same size and 1 half a size smaller
Indications for chest tube
Pneumothorax
Effusions (pleural)
Abscess
Cancer (lung)
Hemothorax
________ chamber is connected to suction on chest tube system
suction control chamber
in the suction control chamber there should be ___________ bubbling
gentle bubbling
in the water seal chamber there should be __________ bubbling
intermittent bubbling
the ___________ chamber is connected to the pt in a chest tube system
drainage collection chamber
the drainage collection chamber should have _________ bubbling
no bubbling
the drainage system for a chest tube should always be kept
below the level of the client’s chest
drainage from a chest tube should be no more than ___________ and should be checked _________-
100ml/hr; hourly
drainage from a chest tube should be (characteristics)
color: serous - serosanguinous
Odor: none
Consistency: thin-thick
If the chest tube comes out of the pt
cover site with sterile dressing and tape on 3 sides
if the chest tube disconnects from the drainage system
place end of tube in bottle of sterile water
bronchodilators
bind to beta2 adrenergic receptors in the airway leading to relaxation of the smooth muscles in the airways
bronchodilators can cause
tachycardia
use caution when administering bronchodilators to pts with
heart disease, diabetes, glaucoma, or seizures
Bronchodilator examples
albuterol, terbutaline, ipratropium
side effects of terbutaline includes
shakiness, dizziness, drowsiness, sleep disturbances, weakness, headache, n/v, tachycardia, htn, hyperglycemia, CNS overstimulation
montelukast
leukotriene modifier: long term control medication, helps prevent/control flare ups of allergic rhinits, allergies, asthma
guaifenesin
expectorant; loosens up mucus and stimulates cough to get mucus out of respiratory tract
acetylcysteine
mucolytic; breaks up mucus to get rid of it
pseudophedrine, phenylephrine
decongestant; work on CVS system; capillaries in nasal passages and cause vasoconstriction which reduces edema leading to decongestion
antitussives
dextromethorphan, codeine; cough medications, suppress the cough reflex
methylprenisolone
steroid to reduce inflammations and suppress normal immune response
too much steroid can cause
cushing’s symptoms
Side effects of steroids
immunosuppression, hyperglycemia, osteoporosis, delayed wound healing
antihistamines 2 types
histamine 1 blocker and histamine 2 blocker
histamine 1 blockers and example
block H1 receptors in CNS -> stop allergies; used in resp system as blocking the CNS receptors cause depression of symptoms
example) diphenhydramine
histamine 2 blockers and example
blocks production of stomach acid
example) famotidine, ranitidine
diphenhydramine has anticholinergic effects which include
drying the body up, urinary retention, constipation
COPD
group of lung diseases that block airflow and make it difficult to breathe; includes emphysema, chronic bronchitis, asthma
emphysema
destruction of the alveoli due to chronic inflammation; decreased surface area of alveoli for gas exchange
chronic bronchitis
chronic inflammation with a productive cough and excessive sputuma
asthma
respiratory condition marked by spasms in the bronchi of the lungs causing difficulty in breathing - chronic inflammation of the bronchi and bronchioles and excess mucus
COPD assessment findings
barrel chest
accessory muscle use
congestion
lung sounds diminished, crackles, wheezes
acidotic, hypercarbic, hypoxic
explanation of ABGs in COPD pt
CO2 increases because air is being retained = hypercarbic, CO2 is an acid so they become acidotic; poor gas exchange due to surface area of alveoli decreasing leads to hypoxia
COPD treatment
oxygen (carefully), bronchodilator, chest physio, increase fluid intake, pursed lip breathing, small frequent meals
in a normal pt ___________ stimulates the body to breathe, but in COPD pts __________ is the driving factor to breathe because
hypercarbia; hypoxia; because they have been hypercarbic for an extended period of time
asthma has to have a
trigger
acute asthma exacerbation treatment
open up airway (albuterol? intubation?), O2 admin followed by bronchodilator, anticholinergic, steroid, IV fluids
status asthmaticus
asthma attack that is refractory to treatment and leads to severe respiratory failure; will intubate to keep airway open (may give magnesium sulfate to vasodilate and sedation to help relax muscles)
pneumonia
inflammation of the lung affecting alveoli, they become filled with pus and liquid
diagnosis of pneumonia
CXR (patchy infiltrates), sputum culture
pneumonia S&S
high fever, cough, tachypnea, crackles, chest pain, increased work of breathing
Acute respiratory distress syndrome
characterized by bilateral pulmonary infiltrates and severe hypoxemia in absence of any cardiac relation
ABGs in a pt with ARDS will show
respiratory acidosis; due to impaired gas exchange
damage to the lungs from ARDS is reversible or irreversible
irreversible
ARDS causes an increase in capillary membrane permeability which means
the cells spread out causing fluid to leak into alveoli leading to poor gas exchange
causes of ARDS
anything that causes an inflammatory reaction in the lungs (trauma, sepsis, burns, aspiration pneumonia, overdose, near drowning)
Diagnosis of ARDS
CXR showing diffuse bilateral infiltrates, hypoxemia; pale, cool, mottles, low SpO2
treatments for ARDS
treat underlying condition, intubation and mechanical ventilation, prone, prevent infection (VAP), prevent barotrauma (too much pressure to alveoli)
spontaneous pneumothorax occur due to a
disease process
Pneumothorax S&S
SOB, chest pain, desaturation, hypotension, tachycardia, tracheal deviation?
tension pneumothorax
air goes into lungs and leaks into pleural space where it then accumulates, it pushes on the lungs, trachea, and heart causing the trachea to shift
pulmonary embolism
blood clot in lungs, causing hypoxemia
pulmonary embolism can lead to _______ sided HF if untreated
right
Pulmonary embolism S&S
dyspnea, chest pain, anxiety, hypoxemia, rales, diaphoresis, hemoptysis
treatment and interventions for pulmonary embolism
O2 admin, high fowlers, anticoagulants, thrombolytics
positioning for air embolism
durants: maneuver, left lateral trendelenburg
positioning for pulmonary embolism
high fowlers
