Respiratory Flashcards
Some cells can survive for a short period of time without ________.
oxygen
Brain cells will die after ___ to ___ minutes if they don’t get enough oxygen.
3 to 5
Pulse ox should be what? For pts with COPD?
at least 95%
90-95%
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!
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
Three main categories of respiratory medications
Anti-inflammatory
Bronchodilators
Mucolytics
Types of Anti-inflammatory Meds
Corticosteroids
Leukotriene Receptor Antagonists
What are examples of corticosteroid anti-inflammatory?
fluticasone (Flovent) and
budesonide (Pulmicort)
Nurse teaching for corticosteroid inh?
rinse mouth after use
What is an example of leukotriene receptor antagonists anti-inflammatory?
montelukast (Singulair)
Three classes of Bronchodilator Meds:
B2-Adrenergic Agonists
Methylxanthine Derivatives
Anticholinergics
What are examples of B2-Adregenic Agonist bronchodilators?
albuterol (Proventil, Ventolin)
metaproterenol (Alupent)
terbutaline (Brethine)
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
Side effects of B2-Adregenic Agonist when used too frequently
Anxiety
Tachycardia
Tremors
Nausea
Palpitations
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
Methylxanthines are not as effective as
B2-Adrenergic Agonists and often given to prevent acute bronchospasm
What is an example of a Anticholinergic bronchodilator?
ipratropium bromide (Atrovent)
What are examples of Mucolytics?
guaifenesin (Robitussin, Mucinex)
aetylcysteine (Mucomyst)
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)
Best way to clear secretions from lower airways?
Turning and repositioning at least q2hr
Best way to clear secretions from upper airways?
Effective coughing
How much fluid should you push a day to help thin secretions?
3L/day
What is the formula for tobacco history?
PPD (packs per day) x Years
Best way to prevent the spread of the flu?
Handwashing
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
Incentive 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
