Respiratory Flashcards
paradoxical breathing
flail chest
what test for finger clubing
schamroth’s window test
-Lovibond’s angle
assessment for respiratory and position
inspection, palpation, percussion auscultation. upright, posterior first, apex to base, side to side assessment, “zigzag”
if the elderly can tolerate sitting up, what is the position and where to start to auscultate
upright, posterior, base first
if the elderly unable to tolerate upright, what is the position and where to start to auscultate?
semifowlers, anterior- posterior
normal breathing
eupnea
deep and slow breathing, after exercise with high altitude
Hypernea
deep and fast breathing
Kussmaul’s - “air hunger”/ “sawtooth”
-metabolic acidosis, DKA
absent breathing-
apnea
“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
chaotic respiratory pattern characterized by irregular periods of deep, shallow, fast, and slow breathing.
BIOTS/ ataxic Cluster breathing
d/t opoid overdose
BQ: what is the respiratory pattern of px with morphine toxicity
BIOTS
-meningitis, chronic increased ICP, severe brain stem damage
what is the ratio of shoulder to shoulder
N- 1:2
what is the ratio of barrel chest
equal 2:2 or 1:1
-common in COPD and chronic asthma
what is the ratio of pigeon chest
2:1
anterior is longer
-common in px with marfan’s syndrom & kyphoscoliosis
pectus excavatus ratio
1:5
-Marfan’s syndrome
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
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
normal lung sound
resonance- soft low sound
what type of lung sound that is extreme dullness/ flat
Flat
-percussing the muscle and bones
mudlike sound, condolidation (lot of fluids inside the lungs)
Dull
-percussing the liver, heart and urinary bladdder
type of lung sound that is booming= air tapping
hyper resonance
-copd px/ pneumothorax
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
- coarse crackles- bronchial secretions early inspi (chronic bronchitis)
- 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
- perforation- risk for shock, can cause pneumothorax.
WOF: subcutaneous emphysema= +crepitus - risk for infection- Normal to have fever after 24hrs of surgery but the succeeding hrs not
- 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
