Respiratory Flashcards
1
Q
Upper Respiratory Tract
A
- Nasopharynx
- Pharynx
- Larynx
2
Q
Lower Respiratory Tract
A
Trachea and Below
3
Q
Aging adult respiratory status
A
Age related changes
- Ridgid chest wall
- Decreased lung capacity
- Normal O2 sats: 93-94%
4
Q
Risk Factors for COPD
A
- Exposure to cigarette smoke
- Occupational Exposures
- Genetic Factors
- Advanced age
5
Q
COPD Pathophysiology
A
- Chronic Bronchitis and Emphysema
6
Q
COPD physiological/psychosocial implications
A
- Increased risk for pneumonia and respiratory failure
- Poor health status/Decreased physical activity
7
Q
COPD: Chronic Bronchitis
A
“Blue Bloater”
- Mucus and edema inhibit ventilation
- Cannot get air IN
- Cyanosis
- Cough
- Chronic hypoxia
- Clubbing of fingers
- Right heart failure, JVD, Ascites, Hepatosplenomegaly, Ankle edema
8
Q
COPD: Emphysema
A
“Pink Puffer”
- Alveoli integrity destroyed, nonrecoiling alveoli -> Retention of air (CO2)
- Cant get air OUT
- Prolonged exhalation
- Barrel Shaped Chest
- Chronic hypercapnia
- Shallow Respirations
9
Q
COPD Manifestations
A
- Exertional Dyspnea
- Chronic cough
- Sputum production
- Wheezing and chest tightness
10
Q
Advanced COPD
A
- Barrel chest
- Weight Loss
- Right sided heart failure (Resulting in edema)
- Clubbing of fingers
- Decreased O2 sats
- Altered ABGs (Resp. Acidosis)
11
Q
COPD: Role of the Nurse
A
Safety
- Smoking cessation
- Oxygen management
Client education
- Self management
- Medication management
Individual factors
- Mangaing breathlessness, Stress, Energy conservation
Environmental
- Anxiety
- Occupational exposure to irritants
12
Q
Pneumonia Pathophysiology
A
Lung infection
- Viral
- Bacterial
- Aspiration
13
Q
Pneumonia Manifestations
A
- Cough
- Dyspnea
- Pleuritic chest pain
- Adventitious breath sounds
- Fever
- Malaise
- Myalgia
- Decreased appetite
14
Q
Pneumonia Lab testing/Diagnostics
A
Chest X-Ray
15
Q
Pneumonia: Role of the Nurse
A
Safety
- Smoking Cessation
Client education
- Management of illness
- Encourage adherence to treatment
Individual factors
- Severe vs Mild manifestations
Environmental
- Anxiety
- Take a calm focused approach
16
Q
Pneumonia Assessment (Recognize cues)
A
Assess
- VS
- Cough
- Lung sounds
- Myalgia and other pain
17
Q
Pneumonia Presentation
A
- Respiratory distress
- Hypoxemia
- Sepsis
- Altered LOC
18
Q
Pneumonia Plan (Prioritize hypothesis/ Generate Solutions)
A
- ABC - Respiratory is priority
- Patent Airway
- Adequate Oxygenation
19
Q
Pneumonia Intervention (Take Action)
A
- Encourage coughing to remove secretions
- Titrate O2 as needed
- Positional changes (Raise HOB)
- Increase fluid intake
- Antibiotics (Bacteria)
20
Q
Pneumonia Evaluation
A
- Did interventions work (Antibiotics or other therapy)
- Did conditions improve, Worsen, or stay the same
21
Q
Acute Pulmonary Edema
A
LIFE THREATENING EMERGENCY
22
Q
Acute pulmonary edema manifestations
A
- Anxiety
- Tachypnea
- Acute Respiratory Distress
- Dyspnea at rest
- Change in LOC
- Evidence of fluid in lungs (Crackles, Cough, Frothy sputum)
23
Q
Acute Pulmonary Edema Treatment
A
- Positioning
- High flow O2 (Simple face mask or NRB. Intubation and mechanical ventilation)
- IV morphine
- Rapid acting Loop diuretics (Furosemide)
- Frequent monitoring
- Labs (ABGs, Electrolytes- especially if on diuretics)
- Fluid restriction (Stop or slow IV fluids)
24
Q
Pneumothorax Pathophysiology
A
Lung Collapse
25
Types of Pneumothorax
- Traumatic Pneumothorax
- Open Pneumothorax
- Iatrogenic Pneumothorax
- Sponatneous Pneumothorax
26
Primary Spontaneous Pneumothorax
- No underlying conditions
- Commonly males between 20-30 years old
- Tall, White, Skinny, Males
27
Secondary Spontaneous Pneumothorax
- Have underlying lung disease (COPD)
- Usually older, between 60-65
28
Pneumothorax Risk Factors
- Smoking
- Genetic Predisposition
- Atmospheric pressure drops (Mountain climbing)
- Certain procedures (Thoracocentesis)
29
Pneumothorax Epidemiology
Primary Spontaneous Pneumothorax: Between 20-30 years old
Secondary Spontaneous Pneumothorax: Between 60-65
30
Pneumothorax Clinical Presentation
- Asymetrical Lung expansion
- Decreased breath sounds or absent breath sounds
- Resp. Discomfort (Pleuritic Chest Pain)
- Increased RR
- Decreased Tactile Fremitus
- Hyper sesonant percussion notes
31
Pneumothorax: Role of the Nurse
Environmental
- Fear due to breathing difficulty and pain
- Prepare client for chest tube insertion
Individual Factors
- Recognize severity
Safety
- Emergency situation
31
Tension Pneumothorax: Presentation
- Tracheal Deviation
- JVD
- Cyanosis
- Hypotension
- Tachycardia
32
Tension Pneumothorax Labs/Diagnostics
Chest X-Ray, CT, Ultrasonography
33
Hemothorax Pathophysiology
Blood in pleural space associated with trauma
- Life threatening hemodynamic and respiratory compromise
34
Hemothorax Etiology/Epidemiology
- Blunt chest trauma from MVA
- Other causes: Less common
35
Hemothorax Presentation
- Similar to pneumothorax
- Blood in clients lung instead of air
- No JVD
- Loss of blood in chest cavity
- Subcutaneous emphysema
36
Hemothorax Lab/Diagnostics
- Chest tube drainage
- Thoracocentesis
37
Chest tube indications
- Pleural effusion
- Pneumothorax
- Hemothorax
- Post op chest drainage
- Pulmonary empyema
Placed to remove air, blood, or fluid from pleural space to re-establish negative pressure
- Keep sterile water at bedside
38
Wet Seal Chamber
Suction control (-20cm)
- Wet system: should have gentle bubbling
Water seal chamber
- Allows air to leave pleural cavity but not re-enter
- Tidaling expected
- Monitor for continuous bubbling (Air leak)
Drainage chamber
- closed system: If filled, get new chest tube
39
Dry Seal Chamber
Suction Control
Dry system
- Bal or accordion mechanism
Water seal chamber
- Allows air to leave pleural cavity but not re-enter
- Tidaling expected
- Monitor for continuous bubbling (Air leak)
Drainage chamber
- closed system: If filled, get new chest tube
40
Removing chest tubes
- Pain medication
- Assist provider
- Instruct patient to bear down (Valsalva Maneuver)
- Cover site with petroleum gauze
- Obtain chest X-ray
- Continue to monitor
41
Pediatrics: Acute Respiratory Infections
- Most common respiratory disease seen in children
- Viral or bacterial
- May be upper or lower airway obstruction
42
Pediatrics: Acute Respiratory Infections Pathophysiology
- Infected particles (Virus, Bacteria, Fungi) spread via contact or droplet
- Cause inflammation of airway tissue, Nasal Drainage, Congestion
- Incubation period: 1-3 days then sudden onset of symptoms
Course: 4-10 days
43
Pediatrics: Acute Respiratory Infections: Clinical presentation
- May vary from minimal to severe (Resp. Distress)
- Physical assessment is best method to identify manifestations and treatment
Mild- sneezing, coughing, eye drainage, fatigue, headache, and/or low-grade temperature
More serious:
Tachypnea
Increased work of breathing
Wheezing or other unexpected lung sounds
Hypoxia with or without hypercapnia
Retractions
Nasal flaring
Changes in level of consciousness (LOC) that could progress to a minimally responsive state
44
Pediatric Acute Respiratory Infections: Labs/Diagnostics
Mild: will not need any kind of diagnostic testing
- Assessment, Evaluation, and history from parent use to develop diagnosis
- Diagnostic testing may be ordered depending on severity
- Rapid, simple testing - swabs for throat infections, influenza A and B, respiratory syncytial virus (RSV), or COVID-19, can be completed.
CXR and CBC with diff if needed
45
Pediatric Acute Respiratory Infections: Psychosocial/Developmental
Varying reactions due:
to child’s developmental level
age
support systems
and previous experiences with illnesses and medical care
Influenced by severity of disease and treatment
46
Pediatric Acute Respiratory Infections: Health promotion
Well-child visit
Vaccines
Parent/guardian education
Prevention measures
47
Croup: Pathophysiology
- Upper & middle airway swelling result in restricted airflow
- Cause maybe allergen (Spasmodic), virus (Viral), or bacteria
- Manifestation typically occur at night – barky cough
48
Viral Croup
Exposure to virus – typically para-influenza
- Respiratory illness with fever
- Inflammation
49
Spasmodic Croup
- Exposure to allergen
- No fever
- Edema
- Manifestations most often occur at night
50
Croup Risk factors
6 months to 3 years of age and more often in males.
Previous family history
Peak times of the year - autumn and early winter
Often follows a reported history of nasal drainage
51
Croup Clinical Presentation
1 to 2 days of nasal congestion and discharge (coryza)
Day 3 - fever, barky cough, and hoarseness develop
Swelling in the airway
52
Croup Lab Test
May involve x-ray to assess soft-tissue swelling
WBC may be completed to rule out other infectious causes
53
Croup Treatment and therapies
Based on the cause, manifestations, and severity of the illness
Racemic Epinepherine
Cool humidified air
Nebulized medications
Oral or injectable steroids
Mild cases-shower steam, cold outside air
Severe cases – mechanical ventilation
54
Epiglottitis
Epiglotis: part of the GI tract responsible for covering trachea to prevent aspiration
- Inflammation can completely cover the trachea and cause respiratory failure
MEDICAL EMERGENCY
55
Epiglottitis Cause
Infectious particle that enters through the nasopharyngeal passages
Most common - Haemophilus influenzae type B (Hib)
Other: Trauma, inhalation of smoke, chemicals, heat, Burns
56
Epiglottitis: Clinical Manifestations
Similar to Croup
More severe respiratory distress
Prefer orthopnea (tripod) position
Drooling
57
Bronchiolitis pathophysiology
Inflammation at the end of the bronchioles
Epithelial cells become damaged, causing edema and excessive mucus production
Epithelial cells slough, block air, cause alveoli to collapse
58
Bronchiolitis Etiology/Epidemiology
Caused by viral pathogen
- Influenza
- RSV (Typically)
- COVID-19
Seasonal
59
Bronchiolitis Risk Factors
Children younger than 2 years of age
Born prematurely
Low birth weight
Underlying heart condition
Underlying lung disease
Immunocompromised
60
Bronchiolitis Clinical Presentation
Cough
Fever
Tachypnea
Wheezing and/or crackles
History of recent URI
Difficulty breathing
Retractions
Hypoxia
61
Bronchiolitis Lab testing/Diagnostics
History & physical exam
Oxygen saturation
62
Bronchiolitis Treatment
Hydration
Fever management
Nasal drops
Nasal suctioning
63
Respiratory Syncytial Virus (RSV) Pathophysiology
Direct contact via nasal or eye mucous membranes
Droplet
Virus lives for hours on surfaces
Replicates in nasopharynx, spreads down respiratory tract, settles in bronchioles
64
Respiratory Syncytial Virus (RSV) Epidemiology
Seasonal – fall to early spring
Virus is seen in all age groups
Manifestations lessen with age
65
RSV Risk Factors
Similar to RSV
- Down syndrome
- Attend daycare or older siblings
- Exposure to secondhand smoke
- Low SES
66
RSV Clincial Presentation
Varying presentation
Lower respiratory tract manifestations
Restricted airflow, increased mucus production, and stasis
Wheezing and/or crackles
Alteration in respiratory rate and pattern
Bronchospasms resulting in severe coughing
Tachycardia
May result in hypoxia
67
RSV Testing/Diagnostics
Gold-standard testing - a nasal secretion sample test - nasal washing
Nasal swab. can also test for other viruses
The polymerase chain reaction (PCR) test is most preferred to confirm RSV
68
RSV Treatment
Hydration
Fever management
Nasal drops
Nasal suctioning
69
RSV Pharmacology
Palivizumab
Nirsemivab
Maternal vaccine during pregnancy
70
Asthma Pathophysiology
Inflammation of the airway.
Airway narrowed decreasing the amount of oxygen reaching the alveoli
Results in impaired gas exchange and difficulty breathing.
71
Asthma Etiology
Exact cause is not known
Environmental factors and family history
Triggers can include pet dander, dust mites, weeds, tobacco smoke, cold air, chemicals, scents (like perfumes or scented lotion), and medications
72
Asthma Risk Factors
- Puerto Rican or African American
Exposure to allergens, tobacco smoke, workplace chemicals, and dust are environmental risks that contribute to the development
- Male Children/ Female Adolescent
A family history of asthma, history of other inflammatory conditions, obesity can be a contributing factor
73
Asthma Clinical Presentation
Difficulty breathing,
Short but persistent cough with possible mucous production
Chest tightness
Irritability
Restlessness
Wheezing
Presence of retractions
Assuming a tripod position
Anxiety
Sweating
Drop in oxygen saturation
74
Status Asthmaticus
severe asthma attack that does not respond to at-home medications and requires immediate treatment
75
Asthma Lab testing/Diagnostics
Physical exam
History
Pulmonary function testing (PFT) is used for the initial diagnosis
Baseline chest x-ray
Allergy testing will identify allergens that could lead to asthma exacerbation
76
Asthma Treatment
- SABA during attack
- LABA prevent attack
- Minimize use of SABA by using LABA
- Corticosteroid
77
Asthma Action Plan
Green: Manifestations are well controlled
Yellow: Some manifestations of exacerbation
Red: Severe manifestations and emergency treatment is needed
78
Asthma Developmental effects
Children who are obese tend to have more severe asthma than children who are not obese
Asthma manifestations can lead to excessive absences that can impact academic performance
79
Asthma Health Promotion
Reduce asthma triggers
Asthma action plans
Daily monitoring by peak flow meter
Compliance with immunizations
Educate all children about the dangers of tobacco smoke and vaping
80
Asthma Client Education
- Correct treatment devices
- Compliance with immunization schedule
- Avoid triggers
- Know emergency action plan at school
81
Cystic Fibrosis Pathophysiology
- Develops due to anomoly in the protein responsible for making mucus in the organ
- Mucus is syrupy and thick
- Protein anomaly affects movement of sodium and water
- Sodium in blood is depleted
82
Cystic Fibrosis Etiology
Genetic condition caused by an absent or mutated protein needed to properly distribute sodium across various tissues in the body
83
Cystic Fibrosis Clinical Presentation
Sweat will have an elevated salt content
Newborn, not passing meconium stool
Chronic lack of oxygenation and respiratory involvement
Chronic cough and obstructive emphysema
Chronic constipation, steatorrhea, and abdominal discomfort
Low body mass index (BMI), growth restriction, and delayed puberty
84
Cystic Fibrosis Labs/Diagnostics
Assessment findings and physical manifestations
Genetic testing identifies the gene mutation responsible for CF
Sweat chloride test
Chest x-ray
Sputum cultures
Pulmonary Function Tests
Stool analysis
85
Cystic Fibrosis Treatment
No cure for CF
Sodium chloride supplements
Maintain health and prevent complications.
Humidified oxygen
Chest physiotherapy
Bronchodilators, mucolytics, and vests that induce chest vibrations
Antibiotics as needed
Cystic fibrosis transmembrane conductance regulators (CFTR) medications
86
Cystic Fibrosis Psychosocial
Chronicity of CF can have an immense psychosocial impact on children and their parents
Anxiety and depression rates are two or three times higher in adolescents who have CF
87
Cystic Fibrosis Developmental
Malnutrition and corticosteroid use may delay physical growth and development
Repeated respiratory infections and hospital admissions lead to missed school
88
Cystic Fibrosis Considerations and health promotion
Establishing routines for treatments beneficial
Importance of follow-up appts
Maintain immunization schedule
Same as for Acute Respiratory Infection
89
Cystic Fibrosis Client Education
Continuous education
Assess the child’s and parent’s best learning styles to adapt the teaching of various treatment interventions, medication administration, dietary modifications, and hydration
Parents should be aware of the impact dealing with CF can have on the siblings
Report worsening wheezing, coughing, fever, or yellow or green mucous color
90
Cause of Bronchiolitis
RSV
