Respiratory Flashcards by enah tolo

paradoxical breathing

flail chest

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what test for finger clubing

schamroth’s window test
-Lovibond’s angle

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assessment for respiratory and position

inspection, palpation, percussion auscultation. upright, posterior first, apex to base, side to side assessment, “zigzag”

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if the elderly can tolerate sitting up, what is the position and where to start to auscultate

upright, posterior, base first

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if the elderly unable to tolerate upright, what is the position and where to start to auscultate?

semifowlers, anterior- posterior

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normal breathing

eupnea

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deep and slow breathing, after exercise with high altitude

Hypernea

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deep and fast breathing

Kussmaul’s - “air hunger”/ “sawtooth”

-metabolic acidosis, DKA

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absent breathing-

apnea

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“waiting warning” (+) apnea >20sec, nearly dying pts
characterized by progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in a temporary stop in breathing called an apnea.

cheyne strokes
-CHF, Acute Increased ICP, Brain stem damage

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chaotic respiratory pattern characterized by irregular periods of deep, shallow, fast, and slow breathing.

BIOTS/ ataxic Cluster breathing
d/t opoid overdose

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BQ: what is the respiratory pattern of px with morphine toxicity

BIOTS
-meningitis, chronic increased ICP, severe brain stem damage

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what is the ratio of shoulder to shoulder

N- 1:2

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what is the ratio of barrel chest

equal 2:2 or 1:1
-common in COPD and chronic asthma

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what is the ratio of pigeon chest

2:1
anterior is longer
-common in px with marfan’s syndrom & kyphoscoliosis

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pectus excavatus ratio

1:5
-Marfan’s syndrome

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where does the nurse stand when palpating the the lung chest pt

at the back posterior
-thumbs at the T9-T10
-normal should be equal moving of the thumb
-abnormal- unequal thumb moving

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what part of the hand are you going to use during assessing Tactile Fermitus

use both palms of the hands and let the pt say “ninety-nine”, “1-2-3” “eee-eee”

increased TF- consolidation (mucus, secretion, inflammation, tumors)
decreased TF- Air trapping such as
COPD- emphysema/ barrel chest.
Pneumothorax- pleural space

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normal lung sound

resonance- soft low sound

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what type of lung sound that is extreme dullness/ flat

Flat
-percussing the muscle and bones

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mudlike sound, condolidation (lot of fluids inside the lungs)

Dull
-percussing the liver, heart and urinary bladdder

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type of lung sound that is booming= air tapping

hyper resonance
-copd px/ pneumothorax

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drum like sound, loud high pitch, excessive passive force

tympany
-stomach, colon

sound in the anterior high pitch sound

Bronchial/ tracheal sound
-found in the trachea

anterior & posterior-medium speech

bronchovesicular- found in the bronchi anterior 1-2 ICS posterior- between scapular region

found in the anterior & posterior- low pitch "sighing"

vesicular- lung fields only normal lung sound

Sound does not match in the location

adventitious

BQ: pneumonia px has expected adventitious sound

Bronchovesicular-bronchial

popping, gurgling, crackling. heard with mucus, secretions, fluids (asthma), Both heard at inspi and expi

crackles or Rales -more prominent in inspi 1. coarse crackles- bronchial secretions early inspi (chronic bronchitis) 2. fine- alveolar (late inspi)

is it musical sound during expi. asthma, allegries, anaphylaxis. bronchoconstriction

wheezing 1. sonorous/ rhonchi- low pitch (snoring) 2. sibilant (high) more severe

rough, grating, leather rubbing. both inspi and expi

Friction rub - inflammation in pleuritis, pleurisy, pericarditis

harsh, violent, high pitch, hoarse, whistling sound, air obstruction such as choking, epiglottitis, laryngospasm

stridor

silent chest

status asmaticus

silent chest lung

tension pneumothorax and respi failure

silent lung

atelectasis

BQ:what is the most common affects pulse ox?

artifacts/ motion such as Parkinson dse

maximum of how many x-ray in a year?

2 or q6 months

what is the Gold standard of the CTPA

for pulmonary embolism -inject through femoral (contrast dye) Iodine= ask for allergies and ask about metformin (need to hold for 48hrs)

what is the Gold standard of sputum culture for TB

DSSM- direct sputum smear microscopy 3 consecutive days at least 2(+)= +TB take it AM before breakfast -no brushing and mouthwash - gargle with water only -deep breathing 3x and cough forcefully C/I superficial saliva >5ml sputum in a sterile container

in getting the stool sample and urine sample =, which container must the nurse use, the sterile container or clean container?

clean container only

what are the 3 non invasive Dx test for respiratory

x-ray, ct scan, MRI

tuberculin skin test AKA? what is the route and Gauge

Mantoux test Purified Protein Derivative (PPD)-inject in ID route (5-15) tuberculin syringe (0.1ml) 27 G - has a wheal/ bleb= check after 48- 72 use ruler to measure -healthy >15mm- filipino - at risk <10mm- foreign -immunocompromised >5mm

in antibiotic skin test after how many mins you recheck the bleb?

30mins

what are the s/sx of TB

fever, cough, night sweats -bloody mucopurulent sputum (green-yellowish sputum)

rusty sputum/ brownie sputum

pneumococcal pneumonia

what is the position during bronchoscopy

supine with neck extended* or upright with neck extended -NPO for 6-8hrs - if emergency bronchoscopy "lavage" and atropine sulfate S/e blurred vision, dry mouth, uo retention and constipation

what are the expected and unexpected of post bronchoscopy

Expected- absent gag reflex for 2 hrs, decreased RR & O2 sat, blood tingled saliva sputum Unexpected- gagreflex >2hrs RR<8 O2 <92% -coughing out of blood/ Hemoptysis & frequent swallowing

it is a rough, crunchy feling

crepitus/ subcutaneous emphysema

complications after surgery of bronchoscopy

1. perforation- risk for shock, can cause pneumothorax. WOF: subcutaneous emphysema= +crepitus 2. risk for infection- Normal to have fever after 24hrs of surgery but the succeeding hrs not 3. risk for bronchospasm and laryngo spasm

only confirmatory test of respiratory failure* only ventilation can support it

ABG ANALYSIS

in Respiratory acid base that is underventilation, hypo, absent, CO2 trapping

respiratory acidosis

in Respiratory acid based that is overventilation, hyper, CO2 elimination

respiratory alkalosis

in Metabolic acid base that is vomiting, gastric suctioning and antacid, HCL loss

metabolic alkalosis

in Metabolic acid base that is everything else=gavage

metabolic acidosis

cause by toxic gas, burns. that is colorless, odorless, tasteless, Hgb ha 200x affinity to CO than O2

carbon monoxide poisoning

confirmatory test for CO

carboxyhemoglobin test N=0-10% Px will turn "cherry red' appearance

mgt for carbon monoxide poisoning

pure 02 100%. highest is non rebreather mask (10-15 Lpm) Nc: reservoir bag must be inflated at all times, this is for severe hypoxia. the bag must be inflated for 2/3