Respiratory Flashcards
What is our stimulus for breathing?
CO2
What is the stimulus for breathing of a pt with COPD?
O2 - pt retains so much CO2 that the sensors become “used” to it so when O2 is introduced, it stimulates
What is eupnea?
normal breathing
Should you be concerned that your pt’s inspiration rate to expiration rate is 1:2?
No, the expiration rate is longer than the inspiration
What is normal RR for an infant/baby?
30-60bpm
How does the body’s position affect respiration?
Sitting up: lungs can maximally expand
How does the environment affect respiration?
- Allergens
- Pollutants
- Humidity
How do lifestyle habits affect respiration?
- Smoking
- Drugs
- Alcohol
Your pt has increased WOB. What does WOB mean?
work of breathing
What are two conditions that increase WOB?
- restriction of lung movement
- obstructive of the lung (airway)
What characterizes restrictive lung movement/disease and how does it increase WOB?
while both restrictive and obstructive conditions cause SOB, restrictive lung disease (RLD) is defined by difficulty filling the lungs with air during inhalation
RLD is characterized by the following:
- Decreased elasticity of the lungs
- Decreased total volume of air and capacity
- Decreased expansion of the chest wall during inhalation
- Stiffening of the lungs (ex. idiopathic pulmonary fibrosis)
Your pt is diagnosed with pneumonia, what is happening in their lungs?
Accumulation of pus or fluid in the alveoli d/t inflammation, which causes consolidation
Your pt now has atelectasis, what does that mean?
Lung collapsed (alveoli collapse)
Pneumothorax vs Atelectasis
Pneumothorax: air trapped; tension causes a shift in your chest
Atelectasis: alveoli collapse and cause the lung to partially or completely collapse
What characterizes obstructive lung disease and how does it increase our WOB?
obstruction in the air passages causing more difficulty with exhaling air, which causes an increase in residual air volume
What is happening with airway obstruction and how does it increase WOB?
The diameter of the airway is decreased and the resistance is increased
What are some examples of Obstructive Lung Disease?
asthma and COPD
What are the 3 main components of Obstructive Lung Disease?
bronchoconstriction
What is COPD?
airways in the lungs become inflamed and thickened and the tissue where O2 is exchanged is destroyed - CO2 retention
Your pt has COPD, what symptoms would you expect to see?
- DOE
- SOB
- Cough with. mucous
- Fatigue
- Prone to lung infections
You have two additional pts, one has emphysema and one has bronchitis. Are these different than COPD?
COPD includes both conditions
Your pt is using accessory muscles to breathe, what does that mean?
- SOB
- Dyspnea
- Increased WOB
- Using your trapezius muscles, abdominal muscles, intercostal muscles; or any other muscle other than the diaphragm
The pt is having difficulty breathing, what position are they in to attempt to breathe easier?
- Tripod
Pt admitted into ED, what signs/symptoms would you see that indicate altered respiratory function?
- Cough
- Sputum
- Accessory muscle use
- Cyanosis (late symptom)
- SOB/Dyspnea
- Chest pain
- Tachypnea, Bradypnea, Cheyne Stokes
- Adventitious breathing sounds
What is Cheyne-Stokes breathing?
Breathing fast with deep breathes then you stop breathing for a period (apnea) - Cyclic, end-stage
What is Stirdor?
- High pitch sound (adventitious)
- Inhalation sound
- Commonly seen in kids
- Associated with upper airway obstruction and/or edema
What type of pts would you see with Clubbing?
pts with chronic cardiac/respiratory disease
What causes clubbing?
lack of O2 from chronic tissue hypoxia
What are some interventions to improve respiratory function?
- deep breathing
- repositioning
- tell them to cough
- hydration
- ambulation
Metered Dose Inhaler (MDI)
Device use for a measured delivery of respiratory medication to the lungs
Peak Flow Meter
Measures the peak expiratory volume with forced exhalation - record before and after treatment
Acapella
Uses positive expiratory pressure to force air behind the sputum and move it upward
Spacer
Ensures the pt receives all the medication and decreases the bad taste of the med
Nebulizer Treatment
Delivers aerosolized medicine directly to the lungs
What are the 3 principles of O2 therapy?
- lowest concentration for the shortest period of time
- Asses the pt’s respiratory status
- monitor ABG’s and O2 sat
If O2 is >3L, how should you deliver it?
humidified
What is the typical order for O2?
2L/min OR keep sats >95%
What does low flow mean?
mixed with room air
- does not meet all pt ventilatory demand
What are some examples of low-flow devices?
- nasal cannula (1-6L/min; 24-60% O2)
- partial rebreather (10-15L/min; 30-60% O2)
- simple face mask (5-10L/min; 40-60% O2)
- non-rebreather (10-15L/min; 55-90% O2)
What does high flow mean?
- meets all the ventilatory demands
- fixed concentration
What are some examples of high-flow devices?
- high-flow nasal cannula (60L/min; heated and humidified)
- tracheostomy collar (28-98%; high humidity)
- O2 hood ( >60%; high humidity)
- Venturi mask (COPD pts; colored valves ranging 24-60%)
When do you use a partial rebreather?
hyperventilation - losing too much CO2
When do you use a nonrebreather?
pt in need of a high concentration of O2
Your pt is admitted with pneumonia, RR 28, pulse Ox 94% - Which O2 delivery system would you use?
Low Flow - Nasal cannula or simple face mask
- no other signs of WOB or respiratory distress
Smith is admitted with an exacerbation of COPD. She is SOB. What O2 delivery system would you use?
Venturi mask
35 y/o admitted to ED, suspected to have a panic attack. She is lightheaded, SOB, and complaining of tingling and numbness around her mouth. RR is 40bpm, what O2 delivery system should you use?
Partial rebreather - she is losing too much CO2 so you want her to rebreath some of that CO2 back
Pt admitted to ED with pneumonia and ARD; symptoms include SOB and cough, RR 38, HR 106, and Chest Pain - What O2 delivery system should you use?
Non-rebreather
What to do when you’re weaning a pt off O2
Assessment: pulse ox, breath sounds, WOB, RR
- manage according to what the pt can tolerate
What is the purpose of tracheal suctioning?
remove secretions –> keeping the airway open
What is a stoma?
surgical opening to a pt’s airway
How do we assess the need for suctioning?
- Increase WOB
- Abnormal upper airway sounds: gurgling
- Sats drop
- Adventitious breath sounds
- Cyanosis (late indicator)
- Restlessness and agitation (early indicator)
- Tachypnea
What are the principles of suctioning?
- only suction on the way out; intermittently
- rotate the catheter as you apply suction
- no more than 3x (no more than 3 passes in one session)
- 10-15 seconds in the airway (adults); 5-10 seconds (children)
- hyper-oxygenate the pt between passes
- suction to the end of the tube
What are some complications of suctioning?
- Decannulation
- Edema, obstruction
- Hypoxia/Bronchospasm
- Infection
- Hemorrhage
- Skin Breakdown
