Respiratory Flashcards
What is our stimulus for breathing?
CO2
What is the stimulus for breathing for a patient with COPD?
O2
What is eupnea?
Normal breathing
What is bradypnea?
Slow breathing
What is tachypnea?
Fast breathing
Should you be concerned that your patient’s inspiratory rate to expiatory rate is 1:2
No, expiration is longer than inspiration
What is a normal respiratory rate for infants?
30-60 breaths/min
How does body positioning affect respiration?
Upright posture promotes ease of lung expansion
How does the environment affect respiration?
Pollution, allergens, and humidity negatively impact respiration?
How can lifestyle habits negatively affect respiration?
Smoking, drugs, and alcohol can cause respiratory damage
Your pt has increased WOB, what is WOB?
Work of breathing, describes the effort it takes to breathe.
What are the two conditions or circumstances that increase WOB?
think circulatory system (airways & organs involved)
1) restrictive lung movement
2) airway obstruction
What characterized restrictive lung movement/diseases?
Decreased expansion of the lung.
How does restrictive lung movement/diseases increase WOB?
They cause shortness of breathe due to difficulty filling the lungs with air during inspiration
How is restrictive lung disease (RLD) characterized?
Decreased total volume of air and capacity.
Decreased elasticity.
Decreased expansion of the chest wall during inhalation.
Stiffening of the lungs.
Your patient is diagnoses with pneumonia, what is happening to the alveoli of the lungs?
Accumulation of fluid in the alveoli d/t inflammation, which causes consolidation
Your patient has atelectasis, what does that mean?
The lung has collapsed, meaning the alveoli collapse inside of the lung. Therefore, gas exchange cannot occur
What characterizes obstructive lung diseases and how does it increase WOB?
difficulty to get air in or out?
Difficulty getting air out of the lung. There is an obstruction in the air passages, increases 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 is COPD? What is the pathophys behind COPD? How does it affect gas exchange?
Chronic Obstructive Pulmonary Diseases, the airways in the lungs become inflamed and thicken. The tissue where O2 is exchanged is destroyed.
The flow of air decreases. Airway obstruction and resistance occurs with decreased gas exchange; CO2 retention
Your patient has COPD. What symptoms would you expect to see?
Dyspnea with exertion, pain in chest, coughing with mucus, SOB, fatigue, prone to frequent lung infections, etc.
You have 3 patients, one patient with COPD, one with emphysema, one with bronchitis. Are these different than COPD?
COPD includes both conditions.
Your patient is using accessory muscles to breath, what does that mean?
Their body is compensating for a lack of oxygen in the blood.
What are accessory muscles?
Neck muscles, nasal flaring, trapezius, intercostal muscles, abdominal muscles, pectoris major.
The patient is having difficulty breathing. What position are they in?
Tripod
A patient is admitted into the ED. What S/S would you expect to see that indicate altered respiratory function?
Cough, sputum, accessory muscle use, SOB, change breathing rate, chest pain, adventitious breath sounds
What is Cheyne-stokes breathing?
Increase rate of respiration and depth followed by apnea.
What kind of patient would you observe Cheyne-stokes breathing?
End of life patients
What is stridor?
Upper airway obstruction, caused by viral or bacterial infection swelling the voice-box
Central cyanosis can be seen in the…
lips and mucous membranes
What causes clubbing?
Lack of oxygen from chronic tissue hypoxia.
What are some interventions to improve respiratory function?
Positioning, encourage deep breathing, incentive spirometer, hydration
How to use incentive spirometer
Suck in air to see how much air can be taken in
Metered Dose Inhaler (MDI)
Device used to a measured delivery of respiratory medication to the lungs
Nebulizer treatment
Delivers aerosolized medicine directly to the lungs
Peak flow meter
When do you measure and what does it measure?
Measures the peak expiratory volume with forced exhalation. Record before and after treatment
Spacer
Ensures patient receives all medication and decreases bad taste of medication
Acapella
How does it work?
A device used as part of a treatment to help people who have difficulty clearing sputum (phlegm) from their lungs. Uses positive expiratory pressure to force air behind the sputum and move it upward.
3 principles of O2 therapy
- Lowest concentration for the shortest period of time
- Assess the Pt’s respiratory status
- Monitor ABGs and O2 sat
If oxygen is greater than 3L, how should it be delivered?
With humidity, because air is dry
What is a typical order for O2?
O2 sat & L?
O2 to keep sats > 95%
or
O2 via NC at 2L/min
What does low flow mean?
The system is mixed with room air when delivered to the patient AND it doesn’t meet all the ventilatory demands.
Examples of low flow devices
Nasal cannula, NRB, Partial rebreather, 100% non rebreather, simple face mask
What does high flow mean?
Meets all the ventilatory demands of the patient and is pre-mixed ratio of O2 and air (fixed concentration)
Examples of high flow devices
High flow nasal cannula, venturi mask, tracheostomy collar, O2 hood
Nasal cannula delivers how many L of O2
1-6L of 24 to 60% O2
Simple face mask delivers how many L of O2
> 5-10L per minute 40-60%
Partial rebreather delivers how many L of O2
10-15L per minute 30-60% O2
Non rebreather delivers how many L of O2
10-15L per minute 55-90% O2
When do we use partial rebreathers?
For patients who are hyperventilating
When do we use non-rebreathers?
For patients in respiratory distress and need high concentrations of oxygen
What do the high flow nasal cannulas do?
Flow rate (L/min)? Other accommodations?
Increase fl O2
Generates up to 60L/min flow. Heated & humidified
When do we use venturi?
COPD patients
What does the venturi do?
Colored valves at 24-60%. Requires humidification. Is precise and accurate.
How much O2 does the tracheostomy collar deliver?
28-95% O2. High Humidity
How much O2 does the Oxygen hood/tent deliver?
O2 concentration >60%. High humidity
Your patient is admitted with pneumonia and his RR is 28 and pulse ox is 94% and he is not complaining of SOB. Which O2 delivery would you use?
Nasal cannula low flow or simple face mask. He can meet some of his demand. Elevated RR but not other signs of WOB or use of accessory muscles
Your patient is admitted with exacerbated COPD. She is SOB and tachypneic. What O2 delivery would you use?
Venturi nask.
a 35 y/o is admitted and suspected of having a panic attack. She is SOB, and complaining of tingling and numbness around her mouth. Her RR is 40. What is happening?
Pt is hyperventilating mostly from panic attack
A 35 y/o is admitted and suspected of having a panic attack. She is SOB, and complaining of tingling and numbness around her mouth. Her RR is 40. What will we use?
Partial rebreather to rebreathe her own CO2
Tell her to take slow deep breathes
Patient is admitted with pneumonia and acute respiratory distress. She is SOB, has a cough, RR 38, HR 106, chest pain, course and diminished breath sounds, paO2 is 89% sat. What do we do?
High flow method. Non re-breather mask with bag. Flow rate 10-15L (all the way up to fill the bag)
How would you wean a patient of O2?
What are you assessing as you wean them off?
You do it slowly in increments (3L to 2.5 or 2L).
Reduce as patient tolerates. As you wean them, you assess pulse ox, RR, WOB, breathe sounds, etc.
What is the purpose of tracheal suction?
To remove mucus secretions and keep the airway open.
Stoma
A surgical opening. Related to the lecture would be a trach tube in the neck
What signs in a patient indicate the need for suctioning?
stats? objective findings? relevant info?
Increased WOB, sats drop, audible upper airway noise/gurgling, adventitious breath sounds, cyanosis, decreased PaO2 or decreased pulse ox, restlessness, agitation, SOB.
What are the principles of suctioning?
You only suction on expiration.
You don’t do it more than 3 times in one session.
You only suction 10-15 seconds (5-10 for peds) at a time.
You hyper-oxygenated the patient before and between passes. Give supplemental oxygen via ambu-bag.
Rotate catheter as you apply suction
What are some complications of suctioning?
Decannulation (trach falls out), edema, obstruction, bronchospasm, infection, hemorrhage, skin breakdown
What is an oropharyngeal airway?
a curved device inserted through the patient’s mouth into the pharynx to help maintain an open airway
Laryngoscope
instrument used for visual examination of the larynx during intubation
When is rapid response called?
(HR, BP, RR, O2 sat, neuro)
Heart rate < 40 or > 130
Systolic blood pressure < 90
RR < 8 or > 28
Oxygen saturation <90
Significant mental status changes new seizure/prolonged seizure with apnea
