1. Is the pt breathing? 2. How are they breathing? baseline and acute vs. chronic 3. Is the airway patent? 4. Positioning: high-fowlers/orthopneic 5. VS: pulse ox, possibly ABG's 6. Respiratory Interventions: meds, O2 therapy, and REQUEST HELP IF NEEDED!

Respiratory Flashcards by Saul Duarte

Some cells can survive for a short period of time without ________.

oxygen

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Brain cells will die after ___ to ___ minutes if they don’t get enough oxygen.

3 to 5

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Pulse ox should be what? For pts with COPD?

at least 95%
90-95%

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Emergency Assessment

Is the pt breathing?
How are they breathing? baseline and acute vs. chronic
Is the airway patent?
Positioning: high-fowlers/orthopneic
VS: pulse ox, possibly ABG’s
Respiratory Interventions: meds, O2 therapy, and REQUEST HELP IF NEEDED!

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Primary intervention for clients with chronic difficulties like asthma and COPD?

AVOID triggers and crowded places

Should see their doctor at the first sign of respiratory infection

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Three main categories of respiratory medications

Anti-inflammatory
Bronchodilators
Mucolytics

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Types of Anti-inflammatory Meds

Corticosteroids
Leukotriene Receptor Antagonists

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What are examples of corticosteroid anti-inflammatory?

fluticasone (Flovent) and
budesonide (Pulmicort)

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Nurse teaching for corticosteroid inh?

rinse mouth after use

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What is an example of leukotriene receptor antagonists anti-inflammatory?

montelukast (Singulair)

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Three classes of Bronchodilator Meds:

B2-Adrenergic Agonists
Methylxanthine Derivatives
Anticholinergics

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What are examples of B2-Adregenic Agonist bronchodilators?

albuterol (Proventil, Ventolin)
metaproterenol (Alupent)
terbutaline (Brethine)

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Which are the first-line drugs of choice for acute asthma attacks, and what are some examples?

B2-Adregenic Agonist

Proventil, Ventolin, ProAir, Alupent, Brethine

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Side effects of B2-Adregenic Agonist when used too frequently

Anxiety
Tachycardia
Tremors
Nausea
Palpitations

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Long-acting B2 Adrenergic Agonists should be combined with a corticosteroid and used in what occasion?

BID for longer-term relief; NOT for emergency bronchodilation

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Methylxanthines are not as effective as

B2-Adrenergic Agonists and often given to prevent acute bronchospasm

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What is an example of a Anticholinergic bronchodilator?

ipratropium bromide (Atrovent)

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What are examples of Mucolytics?

guaifenesin (Robitussin, Mucinex)
aetylcysteine (Mucomyst)

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Client takes asthma medication in what order?

Airway Is Beautifully Managed

albuterol (Proventil) - B2 Agonist (bronchodilator)

ipratropium bromide (Atrovent) - anticholinergic (bronchodilator)

budesonide (Pulmicort) - steroid (anti inflammatory)

montelukast (Singulair) - leukotrine antagonist (anti inflammatory)

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Best way to clear secretions from lower airways?

Turning and repositioning at least q2hr

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Best way to clear secretions from upper airways?

Effective coughing

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How much fluid should you push a day to help thin secretions?

3L/day

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What is the formula for tobacco history?

PPD (packs per day) x Years

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Best way to prevent the spread of the flu?

Handwashing

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Pleurisy is

a knife-like, stabbing chest pain caused by inflamed pleural membranes rubbing against each other

Pleural Effusion is

a collection of fluid, usually in the intrapleural spaces of the lung base(s)

What is the most common cause of pulmonary edema?

Left-sided Heart Failure

Nursing Assessment/Intervention for pulmonary edema?

VS High fowler's 2L of oxygen if under 90% Call MD to see STAT

Which lab test will show that there is likelihood the person has a PE?

D-dimer

How common is it for people with DVT to experience no signs or symptoms?

Up to 50% of patients

What is something to consider when patients are taken off of corticosteroids?

They should NEVER be discontinued abruptly; must always be tapered.

What is COPD, and what is it characterized by?

Chronic Pulmonary Obstructive Disease by airflow limitation that is not fully reversible

What is emphysema?

hyperinflation of alveoli with destruction of alveolar walls and capillaries

How is chronic bronchitis determined?

presence of chronic productive cough for 3 months in each of 2 successive years where other causes of chronic cough have been excluded

Cyanosis and where to assess

Bluish skin discoloration Central - Mucous membranes of eyes and mouth Peripheral - toes/fingers, extremities

Clubbing

Enlargement and rounding of the tips of fingers/toes

Chest deformity due to expansion of chest after long-term inability to exhale all air

**Barrel-shaped** in COPD patients

Ronchi

Low-pitched, snoring or moaning Fluid in larger airways

Wheeze

High-pitched, musical sounds Associated with narrowed airways

Crackles

High-pitched, popping sounds Alveoli

Stridor

High-pitched, most severe type of inspiratory wheeze

Venturi Mask

Most precise

Before you suction, you should always

Hyperoxygenate / Preoxygenate

Quad Cough

Helps quadriplegic pts generate an effective cough; nurse will help by pushing in and upward like the Heimlich maneuver

Low-Flow (Huff) Cough

Pt inhales deeply and says “huff” three or four times while exhaling

Suctioning max time

no more than 10 seconds at a time

Peak Flow Meter

Measures highest flow during maximal **expiration**

**In**centive Spirometer

Motivates the pt to breathe (**inhale**) deeply by offering the incentive of measuring progress

Fremitus is what and how do you assess?

Vibration of air movement through the chest wall palpating the back while the pt says "99"

Atmosphere contains how much oxygen?

21%

Sputum culture (does what)

to identify the specific agent causing the infection

Sputum sensitivity test (does what)

will determine which antibiotic to use

Hyperventilation

PaCO2 **lower than 35** mm Hg

Fermitus increase

consolidation in the lung

Fermitus decrease

pleural effusion or pneumothorax

Pts should use a spirometer how often?

8-10 times an hour

Peak flow meter used for (population)

**Asthmatics** Chronic Bronchitis Emphysema

What is the purpose of Pursed-lip breathing?

Causes back pressure in the airways Eases expiration Prevents air trapping

What is the purpose of Aerosol Therapy?

Add moisture to oxygen delivery systems **Hydrate thick sputum** and prevent mucous plugging **Administer drugs** to the airways (bronchodilators and corticosteroids)

What is the purpose of a closed-chest drainage system?

Removes air and fluid from the pleural cavity Restores negative pressure Promotes lung expansion and alveolar ventilation

Normal ABG: PaCO2

35-45mmHg

Normal ABG: HCO3

22-26mEq/L