Respiratory #2 Flashcards
Measures lung volume and airflow-
Pulmonary Function Test
Used to Diagnosis, monitors disease progression, evaluates response to bronchodilators
Pulmonary Function Test
Spirometry- given by a trained personal
Measures airflow.asked to take a deep breath and blow as hard as possible. Lung function test. Hand held
Peak Flow meter
Used at home. Hand help. Blows forefully and quickly. Can be done by the pt.
6-minute walk test
Measures functional capacity
Pulse ox monitored during walk
ABGs: Acid Base regulation
Buffer System, Respiratory System (happens in mins, maximum effectiveness in hours), Renal System
Fastest-Immediate Reaction
Buffer System
Primary Regulator
Buffer System
Neutralize Acids
Buffer System
Respiratory and Renal systems must have adequate function
Buffer System
Excrete CO2 and H20
Respiratory System
Respiratory Regulation in Medulla
Respiratory System
Normal Acid elimination
Renal System
Absorb HCO3 increasing blood PH and decreasing urine acidity
Renal System
Keep on eye of ABGs to see if
tx is working
Chemically change stronger acid to weaker ones or completely neutralize it-
buffer system
Both have to work together-
resp and renal
Lungs help maintain normal ph by excreting co2 and h2o=
cellular metabolism
Respiratory Center in the medulla controls the rate of
excretions of CO2
If co2 or hydrogen is high the respiratory system is stimulated it will
increase rate of breathing to get rid of CO2
If co2 is low the level of respirations are
inhibited
Renal system-
last resort, hours to days.
Kidney function is to balance through the
urine.
Normal ph is 6 for urine but can go to
4 or 8 depending what is needed.
Kidneys will reabsorb additional bicarb and eliminate excess of hydrogen for
Acidosis
___ normal pH
7.35-7.45
ABGs- goes on wrist.
Measures acidity and alkalinity in arteries.
Nurses need to note when the ABGs values are
abnormal.
pH “acidity” or “alkalinity”
7.35 – 7.45
PaCO2 (pulmonary) Carbon dioxide “Acid”
35 - 45
HCO3 (Kidney) Bicarbonate “Base”
22 - 26
PaO2 Oxygen Hypoxemia
80 - 100
Breath co2 and hydrogen-which is linked to acid.
The more co2 the higher the acid
Is it Acidosis or Alkalosis? pH
3 Step ABG Interpretation
Is it Respiratory or metabolic? Co2/HCo3
3 Step ABG Interpretation
Is it compensated or uncompensated?
3 Step ABG Interpretation
pH <7.35
Acidosis
pH >7.45
Alkalosis
PaCO2
Respiratory
Acid
HCO3
Metabolic
Base
PaC02- abnormal and HC03- is normal =
respiratory
HC03-abnormal and PaC02 is normal =
kidney
CO2 is high-
acid, lungs will breathe deep and fast to get risk of co2 loss
CO2 is low or alkaline=
respirations will be decreased
Kidneys will absorb the
bicarb
PaCO2 <35
Respiratory Alkalosis
PaCO2 >45
Respiratory Acidosis
HCO3 <22
Metabolic Acidosis
HCO3 >26
Metabolic Alkalosis
Respiratory acidosis is a sign of
respiratory failure
Lung working too hard- pulmonary edema, etc
Respiratory acidosis
Too slow lungs- sedated or problem with brainstem, problem with mobility, muscle paralysis of respiratory muscles
Respiratory acidosis
Respiratory acidosis Cardio symptoms
Low BP, v-fib, warm flushed skin
Respiratory acidosis Neuromuscular symptoms
Seizures, muscle weakness, hyperflexia
Respiratory acidosis S/sx
Hypoventilation= Hypoxia
Rapid, shallow respirations
Skin/Mucosa Pale to Cyanotic
HA
Hyperkalemia
Dysrhythmias
Drowsiness, Dizziness, Disorientation
Respiratory acidosis Causes
Respiratory depression (Anesthesia, Overdose, Increase intracranial pressure), Airway obstruction, decrease alveolar capillary diffusion (Pneumonia, COPD, ARDS, PE)
Respiratory acidosis
Fixing the problem
Respiratory Acidosis Tx: Fix respirations- exhale co2 to decrease carbonic acid in blood
Respiratory Acidosis Tx: Bronchodilators-
reverse airway obstruction (inflammation)
Beta agonist- albuterol
Anticholinergic- ipratropium
Methylxanthines- theophylline
Respiratory Acidosis Tx: Respiratory stimulants-
to increase respiratory drive and help breathe.
Respiratory Acidosis Tx: Increase respiratory drive and stimulate ventilation, pts w copd
can have respiratory acidosis.
Respiratory Acidosis Tx: Diuretic- acetazolamide-
causes metabolic acidosis by increasing bicarb excretion causing body to increase body ventilation.
Respiratory Acidosis Tx: Drug antagonists-Antidotes- reverse effects-
Narcan, flumazenil-reverse effects of benzodiazepines
Respiratory Acidosis Tx: O2 improves gas exchange.
Prevent hypoxemia and restore acid base balance.
CO2 is the main drive for
breathing.
Copd patients do not have the drive anymore.
O2 sat 88-92 percent is normal.
Respiratory Acidosis Tx: Vent
Support
Respiratory Alkalosis:
pH: >7.45 and PaCO2 <35
Hyperventilation with anxiety (Rapid rate)
Respiratory Alkalosis Causes
Hypoxemia (primary cause of alkalosis)
Respiratory Alkalosis Causes
Pneumonia
Respiratory Alkalosis Causes
Pulmonary Embolus
Respiratory Alkalosis Causes
Pregnancy (normal finding)
Respiratory Alkalosis Causes
Ventilatory settings too high or too fast
Respiratory Alkalosis Causes
High altitudes
Respiratory Alkalosis Causes
Liver failure
Respiratory Alkalosis Causes
Septicemia (fever)
Respiratory Alkalosis Causes
Stroke
Respiratory Alkalosis Causes
Overdose of salicylates or progesterone
Respiratory Alkalosis Causes
Seizures
Deep Rapid Breathing
Respiratory Alkalosis s/sx
Hyperventilation
Tachycardia
Respiratory Alkalosis s/sx
Low or normal BP
Respiratory Alkalosis s/sx
Hypokalemia
Numbness and tingling of extremities
Respiratory Alkalosis s/sx
Lethargy and confusion
Respiratory Alkalosis s/sx
Light headedness
N/V
Respiratory Alkalosis s/sx
Respiratory Alkalosis causes
Hyperventilation (Anxiety, PE, Fear)
Mechanical Ventilation
Treat underlying cause to resolve problem
Respiratory Alkalosis Tx
Decrease tidal volume or resp rate- slow down
Respiratory Alkalosis Tx
Pain control/sedation-help with anxiety
Respiratory Alkalosis Tx
Breathe into paper bag- Used during acute episodes
Respiratory Alkalosis Tx
Antidepressants- to depress CNS and help slow down breathing. Unresponsive to paper bag or decrease stress.
Respiratory Alkalosis Tx
Correct Co2 slowly to prevent metabolic acidosis. The kidney will try to compensate and decrease bicarb reabsorption.
Respiratory Alkalosis Tx
Metabolic Acidosis
pH < 7.35 HCo3 < 22
Diabetic ketoacidosis- accumulation of acid. Keto acid accumulation
Metabolic Acidosis
Lactic acidosis- accumulation of acid, pts that have shock
Metabolic Acidosis
Starvation
Metabolic Acidosis
Diarrhea- losing bicarb
Metabolic Acidosis
Renal tubular acidosis
Metabolic Acidosis
Renal failure
Metabolic Acidosis
GI fistulas
Metabolic Acidosis
Shock
Metabolic Acidosis
Ileostomy- risk for metabolic acidosis bc fluid is
higher than the plasma
Carbonic acid accumulates in the body and losing bicarb through body fluids
metabolic acidosis
Always accompined with hyperkalemia
metabolic acidosis
Metabolic acidosis S/Sx
HA, Decreased BP, Hyperkalemia, Muscle twitching, Warm flushed skin, N/V/D, LOC changes, Kussmaul respirations (compensatory hyperventilation).
Metabolic acidosis Causes
Diabetic Ketoacidosis, Severe diarrhea, Renal Failure, Shock
Raise plasma pH > 7.20
Metabolic Acidosis Tx
Treat underlying cause to get problem resolved faster
Metabolic Acidosis Tx
Sodium Bicarb
Metabolic Acidosis Tx
Follow ABGs- to track pt and to see if better
Metabolic Acidosis Tx
Continuously monitor patient.- vital signs
Metabolic Acidosis Tx
Kidney-
potassium bicarbonate
Diabetic Keto Acidosis-
Insulin and hydration
Lactic acid-
bicarbonate and reversal agent for ethanol and methanol poising
Sodium bicarbonate low- give
bicarbonate
If pt not responding to therapy give-
sodium bicarbonate meanwhile
Metabolic alkalosis
pH > 7.45 HCO3 > 26
Metabolic alkalosis Causes
Vomiting
NG suctioning
Diuretic therapy- loss acid, potassium, and gi/renal hydrogen. Decrease in chloride.
Hypokalemia
Excess bicarb intake
Loses potassium
Metabolic alkalosis
Seeing in pts overusing antacids- makes gut alkaline
Metabolic alkalosis
Lose much bicarbonate and little acid
Metabolic alkalosis
Metabolic Alkalosis s/sx
Restlessness followed by lethargy, dysrhythmias, Compensatory hypoventilation, confusion (Decreased LOC, Dizzy, Irritable), N/V/D, tremors, muscle cramps, tingling of fingers and toes
Metabolic Alkalosis Cause
Severe vomiting
Excessive GI suctioning
DIuretics
Excessive NaHCO3 (Sodium Bicarbonate)
Treat underlying cause
Metabolic alkalosis tx
Stop K+ wasting diuretics- change to loop or thiazide like diuretics
Metabolic alkalosis tx
Spironolactone- potassium sparing
Metabolic alkalosis tx
Acetazolamide- potassium sparing
Metabolic alkalosis tx
IV fluids- NS
Metabolic alkalosis tx
Sodium chloride
Metabolic alkalosis tx
Replace K+ by food or IV therapy
Metabolic alkalosis tx
Monitor Resp rate- respirations decreased which leads to hypoxia. if any decrease in oxygenation report to doctor
Metabolic alkalosis tx
Monitor HR- changes due to electrolyte disturbances
Metabolic alkalosis tx
Seizure precautions
Metabolic alkalosis tx
Change in o2 sats put them on high flow non rebreather mask, seizure precaution (electrolyte imbalance)
Metabolic alkalosis tx
Sodium choride- helps sodium, fluid, and water
Metabolic alkalosis tx
Be careful with HF and renal insufficiency
Metabolic alkalosis tx
Pt has large amout of mucosity (thick)- position to help move secretions in the lungs
Chest Physiotherapy (CPT)
Group with physical therapy technique to improve function and breath better
Chest Physiotherapy (CPT)
Expands lungs- strengthens muscles, loosens and drain thick lung secretion
Chest Physiotherapy (CPT)
Needed to unclog the airways, uses gravity, and percussion
Chest Physiotherapy (CPT)
Head should be lower than the chest
Chest Physiotherapy (CPT)
Same intention connected to machine.
High Frequency Chest Wall Oscillation Vest
Vibration at high vibration.
High Frequency Chest Wall Oscillation Vest
Every 5 minutes the pt is supposed to cough and bring out secretion
High Frequency Chest Wall Oscillation Vest
Incentive speedometer- common
Vibratory Positive Expiratory Pressure Device (PEP)
Causes vibration also to remove secretions
Hand held
Vibratory Positive Expiratory Pressure Device (PEP)
Establish a patent airway due to mass- temporary or permanent.
TRACHEOSTOMY needed
Object not allowing person to take breaths
TRACHEOSTOMY needed
Bypass an upper airway obstruction
TRACHEOSTOMY needed
Facilitate removal of secretions
TRACHEOSTOMY needed
Permit long term mechanical ventilation
TRACHEOSTOMY needed
Facilitate weaning from mechanical vent
TRACHEOSTOMY needed
Surgical creates stoma in interior portion of trachea
TRACHEOSTOMY
Post op- NPO
TRACHEOSTOMY
Monitoring for abnormal lung sounds, check o2 sats min q4h.
Post op more often- when they get there q 15 mins, q30 mins, q1h
TRACHEOSTOMY
Nothing restricting the stoma
TRACHEOSTOMY
Inflated cuff most common with mechanical ventilation or pts at risk for ventilation or no cuff
TRACHEOSTOMY
Cuffless- for pts with longer term trache for eating and talking. Inner part, may be fenestrate (hole) to allow pts to breathe and speak
TRACHEOSTOMY
Trachcolar to keep in place
TRACHEOSTOMY
Not much humidity there where the ostomy is. If have humidifier watch for condensation
TRACHEOSTOMY
Will require a sterile field
Tracheostomy Care
Will require use of solutions from non-sterile containers
Tracheostomy Care
Will require oxygen and suction
Tracheostomy Care
Delegation: established trachs may delegate to unlicensed personnel, but
new fresh trachs, RN’s must perform the care and assess
Use only sterile manufacture precut dressings or folded 4X4,
never use cotton-filled gauze sponge.
Already prepared for cleaning
EBP: patient may aspirate
cotton or gauze fibers
If there is powder, hair or chemicals present-
protect trachea ostomy
Assess patient’s respiratory status prior to care
Tracheostomy Care Assessment
Respiratory rate, depth, rhythm, breath sounds, color, pulse oximetry (determines whether patientcan tolerate trach care)
Tracheostomy Care Assessment
Assess trach site for drainage, redness or swelling (indications of infection)
Tracheostomy Care Assessment
Assess when patient last ate, schedule care at least 3 hours after meal to decrease risk of vomiting oraspirating stomach contents
Tracheostomy Care Assessment
Shouldn’t be taking a long time
Tracheostomy Care Assessment
If any think yellow tenuous secretion-
sign of infection
-Lower head of the bed to access trach
dressing and ties
-Loosen one side of trach ties, remove
old dressing and discard with gloves
-Prepare sterile field and
loosen caps to sterile saline
-Open sterile gloves and don
ENSURE contents of the tray remain dry*
-Using non-dominate hand open and pour sterile saline into each
compartment of the tray
-Remove inner cannula of trach and place in larger compartment
CLEAN PROCEDURE
-Use the brush to clean the inner cannula thoroughly with
saline
-Rinse inner cannula by immersing in one compartment of
sterile saline
-Use pipe cleaners to dry .
inner cannula thoroughly
-Replace inner
cannula
-Use sterile swabs and remaining UNUSED compartment of sterile saline to
cleanse stoma area.
-Pat stoma dry with sterile
4x4
-Replace sterile trach
dressing.
Re-secure
trach tie.
Date and time performed
Tracheostomy CareDocumentation
Note color, amount consistency and odor of secretions
Tracheostomy CareDocumentation
Note condition of stoma and skin around stoma site, any drainage, redness, or swelling
Tracheostomy CareDocumentation
Document respiratory status before and after
Tracheostomy CareDocumentation
Patient’s tolerance of procedure
Tracheostomy CareDocumentation
Note any problems that arose and interventions provided for those problems
Tracheostomy CareDocumentation
On documentation always-
how you found the patient, what you did in-between, and how you leaving patient
Suction only when necessary
Suctioning Tracheostomy
Use suction catheter no more than ½ size of internal diameter of airway tube
Suctioning Tracheostomy
Adjust suction regulator per policy, lowest possible setting to accomplish suction (just to remove secretion:
Adults 100-150 mm Hg
Children: 100-120 mm Hg
Infants: 50-95 mm Hg
Suctioning Tracheostomy
Too much secretion=
suction
Suction only when necessary.
The more suction the more mucus.
Dominant hand sterile, non-dominant hand unsterile
Suctioning Tracheostomy
Dominant hand sterile, non-dominant hand unsterile
Suctioning Tracheostomy
Place patient in semi-fowler position
Suctioning Tracheostomy
Hyperoxygenate patient prior to suction
Suctioning Tracheostomy
Insert catheter gently without applying suction (closing suction opening with thumb)
Suctioning Tracheostomy
Place pt in semifolwers position, hyper oxygenate(take deep breaths) insert gently then when coming out apply suction
Suctioning Tracheostomy
Do NOT force catheter
Suctioning Tracheostomy
Do NOT apply suction as you enter the airway
Suctioning Tracheostomy
Rotate the suction catheter when withdrawing it
Suctioning Tracheostomy
Apply suction as you remove the catheter but no longer than 15 seconds
Suctioning Tracheostomy
Avoid saline lavage during suctioning
Suctioning Tracheostomy
Repeat suction as needed allowing 30 second intervals hyper oxygenate between passing catheter
Suctioning Tracheostomy
When suctioning is completed, provide oxygen source
Suctioning Tracheostomy
Provide oral care
Suctioning Tracheostomy
Reposition patient
Suctioning Tracheostomy
Provide for safety
Suctioning Tracheostomy
Date and time suction was performed
Suctioning Tracheostomy: Documentation
Note suction techniques (sterile) and catheter size used
Suctioning Tracheostomy: Documentation
Note color, consistency, and odor of secretions
Suctioning Tracheostomy: Documentation
Document patient’s respiratory status before and after the procedure
Suctioning Tracheostomy: Documentation
Document patient’s tolerance of procedure and any complications encountered
Suctioning Tracheostomy: Documentation
Document any interventions performed to address complications.
Suctioning Tracheostomy: Documentation
Epistaxis- Nose bleed.
Mucosa erodes and vessels become exposed and break.
Epistaxis Patho/Etiology
Caused by trauma, mucosa irritation, inflammation, tumors, septal abnormalities, foreign bodies, prolonged inhalation of dry air, hypertension, migraines, heat.
Epistaxis Patho/Etiology
Nose bleeding
Epistaxis S/Sx
Monitor h&h
Epistaxis Diagnostic/Labs
Apply pressure.
Epistaxis Interventions
Forward and down.
Epistaxis Interventions
Breathe through mouth.
Epistaxis Interventions
If not stopping may need to cauterize to stop bleeding.
Epistaxis Interventions
Packing-folded gauze with petroleum or nasal tampon.
Epistaxis Interventions
If bleeding more towards back will do a balloon system through the mouths
Epistaxis Interventions
Topical vasoconstriction.
Epistaxis Medications
Large bleed- or tetracaine, or lidocaine solution, 4% cocaine solution.
Epistaxis Medications
Hemostatic packing with absorbable gelatin
Epistaxis Medications
Nose bleeding disorder
Epistaxis
Epistaxis Patho/Etiology
Dry cracked mucosa and Trauma
Dry cracked mucosa Meds
Nasal Saline
Trauma Interventions
Ice Packs
Pressure
Pressure interventions
Pack with petroleum or iodoform gauze
Rapid Rhino / small foley cath / nasal tampons
Pack with petroleum or iodoform gauze Medications
Antibiotics
Pack with petroleum or iodoform gauze
Rapid Rhino / small foley cath / nasal tampons
Conceptual concern
Gas exchange/Oxygenation
Epistaxis Interventions
Sit upright leaning forward
Educate not to blow nose x 48 hrs, avoid nose picking, avoid bending over
Epistaxis S/Sx
Nose Bleed
Epistaxis/Nose Bleed Conceptual Concern
Clotting
Clotting Interventions
Monitor Vitals and Bleeding
Clotting Medications
Phenylephrine-vasoconstriction
Silver nitrate- to clot
Clotting Labs/Diagnostics
Hgb
At Home tx for epistaxis
Pinch tip of nose with two fingers for 15-20 mins
Sit up
Slightly lean forward and tilt head forward
If bleeding continues use
topical nasal sprays- vasoconstricts and local anesthetics
If medication doesn’t work
posterior epistaxis
Hospital setting tx
In case of recurrent or non stopbleeding
Nasal packing- insert gauze like material or nasal tampon in nasal cavity
Nasopharyngeal cancer-
recurring nosebleeds
Inflammation of sinuses
Sinusitis Patho/Etiology
Due to bacterial infection, upper respiratory illness.
Sinusitis Patho/Etiology
Most commong organism is streptococcus pneumonia and hemophilius influenzas.
Sinusitis Patho/Etiology
Can be acute or chornic and unresponsive to tx.
Sinusitis Patho/Etiology
Maxillary and ethmoid sinus are most effected
Sinusitis Patho/Etiology
Nasal inflammation, thick discolored discharge,
Sinusitis S/Sx
runny noise, nasal drainage,
Sinusitis S/Sx
stuffy nose, difficulty through nose,
Sinusitis S/Sx
pain and swelling eyes, cheeks, nose, forehead.
Sinusitis S/Sx
Reduced sense of smell and taste.
Ear pain, headache, aching up upper jaw and teeth, sore throat, bad breath, fatigue
Sinusitis S/Sx
Insensitive nasal swab to determine antibiotics.
Sinusitis Diagnostics/Labs
Xray for sinus problems. Nasal endoscopy. Ct scan, MRI
Sinusitis Diagnostics/Labs
Nasal irrigation with NS solution to clear mucous
Sinusitis Interventions
Can give warm packs for 1 2 hours twice a day and to decrease inflammation.
Sinusitis Interventions
Oral fluids and humidifier helps loosen secretion.
Sinusitis Interventions
Antihistamines can help dry secretions.
Sinusitis Interventions
If tx doesn’t work they will drain sinus and irrigate with NS and antibiotic solution.
Sinusitis Interventions
Nasal spray, fluticasone or Flonase (corticosteroid).
Sinusitis Interventions
Constrict blood vessels- osetavesolamine be cautious with heart problems. Used up to three day bc will cause rebound congestion
Sinusitis Interventions
Acetaminophen or ibuprofen for fever.
Antibiotics for most sinus infections.
Sinusitis Meds
Benedryl makes mucus thick can cause
bronchitis.
Inflammation of sinuses disorder
Sinusitis
Sinusitis Patho/Etiology
Inflammation of sinus membranes, Allergies, NG tube irrigation and Bacteria/Virus/Fungus
Inflammation of sinus membranes conceptual concern
inflammation
Inflammation of sinus membranes s/sx
Swelling/Inflammation, Pain
Inflammation of sinus membranes interventions
Warm moist packs
Swelling/Inflammation meds
Adrenergic nasal sprays (Afrin), Corticosteriods (Flonase)
Adrenergic nasal sprays (Afrin) Interventions
Educate to only use for up to 3 days
Pain interventinos
Semi fowlers position
Pain meds
Analgesics (Acetaminophen, ibuprofen)
bacteria/Virus/Fungus medications
antibiotics
Antibiotics labs/diagnostics
culture
Bacteria/Virus/Fungus S/Sx
Purulent nasal discharge
Purulent nasal discharge labs/diagnostics
Culture
Purulent nasal discharge intervention
8-10 glasses of water and generalized fatigue to rest
Purulent nasal discharge Meds
Nasal irrigation
Purulent nasal discharge conceptual concern
Gas Exchange / Oxygen
Bacteria / Virus / Fungus conceptual concern
Infection
Bacteria / Virus / Fungus S/sx
Fever, generalized fatigue
Inflammation of nasal mucous membrane, release of histamine that causes vasodilation and edema.
Viral Rhinitis Patho/Etiology
Pollen, dust, foods cause.
Viral infection like common cold, rhinovirus or bacterial infection
Viral Rhinitis Patho/Etiology
Slow onset, nasal congestion, localized itching, cough, sneezing, sore throat, nasal discharge.
Viral Rhinitis S/Sx
Rare head ache. Malaise, fever, commonly muscle aches
Viral Rhinitis S/Sx
throat culture and rapid flu.
Viral Rhinitis Labs/Diagnostics
Control stress.
Stop slow down drinking.
Stay away allergens dander dust pollen and mold.
Viral Rhinitis Interventions
Does not cure but tx symptoms OTC Ibrophen, Tylenol, Vicks, nasal spray, cough drops, syrups and warm fluids to sooth the throat
Viral Rhinitis Meds
Inflammation of nasal mucous membrane disorder
Viral Rhinitis (Common Cold)
Viral Rhinitis (Common Cold) Patho/Etiology
Inflammation of nasal membranes, Virus, Rhinovirus
Inflammation of nasal membranes s/sx
Sore throat, nasal congestion
Inflammation of nasal membranes conceptual concern
Inflammation
Sore throat labs/diagnostics
Throat culture or rapid flu test
nasal congestion intervetions
Fluids
nasal congestion S/Sx
Nasal discharge, Localized itching, and sneezing
nasal congestion meds
decongestants
Virus conceptual concern
Infection
Virus S/Sx
Fever, Malaise
Virus interventions
Educate why antibiotics are not used
Malaise intervention
Rest
Viral Rhinitis (Common Cold) labs/diagnostics
s/sx to diagnose
Sore throat.
Inflammation of pharynx main cause if viral
Pharyngitis patho/etiology
Sore throat, dysphagia due to inflammation.
Red swollen with exudate(bacterial infection).
Can be accompanied by fever child and headache
Pharyngitis s/sx
Strep, throat culture, sensitivity test
Pharyngitis labs/diagnostics
Salt water gargles and honey (antibacterial), lemon mixed with warm water and push fluids
Pharyngitis Interventions
Antibiotics if bacterial-penicillin. Tylenol. Throat Lozenges
Pharyngitis Meds
Inflammation of pharynx disorder
Pharyngitis
Pharyngitis Patho/etiology
Inflammation of pharynx, Virus, Bacteria, Beta-hemolytic streptococci
Inflammation of pharynx CC
Inflammation
Beta-hemolytic streptococci causes
Strep throat
Strep throat not treated can cause -
Rheumatic fever-may go away or cause problems in long run
Glomerulonephritis-damage inside kidney
Strep Throat Labs/diagnostics
Rapid strep test
Rapid strep test meds
Antibiotics (Penicillin)
Bacteria labs/diagnostics
Throat culture and sensitivity
Throat culture and sensitivity meds
Antibiotics (Penicillin)
Bacteria s/sx
Fever/chills, exudate, generalized malaise
Fever/chills meds
Acetaminophen
Bacteria CC
Infection
Fever/chills interventions
fluids
generalized malaise interventions
Rest
Exudate s/sx
Sore throat that is red and swollen and dysphagia
Sore throat that is red and swollen meds
throat lozenges
Sore throat that is red and swollen interventions
saltwater
Pharyngitis pediatric considerations
Highest incidence in ages 4-7
Occurs when filtering function of the tonsils become overwhelmed with virus or bacteria and results in infection.
Tonsillitis Patho/Etiology
Masses of lymphoid tissue that lie on each side of pharynx. Filter micro organisms protects lungs.
Tonsils
Viral bc of bacterial-stepococcus aureus and influenza.
Tonsillitis Patho/Etiology
Pneumococcus species tonsillitis more prevalent in children but more serious in adults
Tonsillitis Patho/Etiology
Sore throat. Pain when swallowing, ear ache, temp 100.4
Tonsillitis S/Sx
Chills. Malaise. Headache. Muscle pain. Redness with selling.
Tonsillitis S/Sx
Culture and sensitivity of tonsils and throat. WBCs count.
Vitals for fever and visual inspection of tonsils
Tonsillitis L/D
Yellow or white exudate on tonsils. Symptoms sudden and will go away within 3-4 days
Tonsillitis S/Sx
Monitor airways.
push fluids.
encourage rest. Put high fowlers to breathe better. Worst case- tonsillectomy
Tonsillitis interventions
Acetaminophen
Tonsillitis Meds
Inflammation of the tonsils disorder
Tonsillitis
Tonsillitis s/sx
HA, pain on swallowing, sore throat Malaise, Fever/Chills, Myalgia
Headache and sore throat meds
acetaminophen
Pain on swallowing interventions
Saltwater gargles
Sore throat s/sx
red and swollen tonsils with exudate
red and swollen tonsils with exudate interventions
Monitor airway, tonsillectomy
tonsillectomy interventions
monitor for bleeding, semi fowlers, keep suction equipment readily available
red and swollen tonsils with exudate CC
Gas exchange, oxygen and inflamamtion
Myalgia meds
acetaminophen
Malaise interventions
rest
Fever/chills interventions
fluids
Tonsillitis Pediatric concerns
Highest incidence in ages 4-7
Tonsillitis etiology
virus/bacteria
Virus and bacteria L/D
Throat and culture sensitivity and WBC with differential
Virus and bacteria CC
Infection
Bacteria meds
antibiotics
If big tonsils-
monitor airway or tonsillectomy
If bleeding call doctor asap
Cold shakes/ice cream
Tonsillitis
Viral infection of respiratory tract.
Influenza patho/etiology
Young children and critical patients, and older at increased risk complications such as immunocompromised system= death.
Influenza patho/etiology
Transsmsion of cough- droplet and contact with object that has virus. 1-3 days incubation
Influenza patho/etiology
Fever, aching muscles, chills, sweat, tiredness weakness, stuffy nose, sore throat, eye pain, vomiting diarrhea common in children
Influenza s/sx
Throat culture and flu test
Influenza L/D
Rest fluids
Influenza interventions
Acetaminophen. Aspirin. Antiviral meds-tamaflu
Influenza meds
Viral infection of respiratory tract disorder
Influenza
Influenza S/Sx
Malaise, HA, Sore throat, myalgia, fever/chills
Malaise interventions
rest
Acetaminophen pediatric consideration
avoid aspirin
HA and Myalgia meds
acetaminophen
Myalgia CC
Comfort
Fever/Chills interventions
fluids and monitor for dehydration
Influenze Patho/etiology
Virus
Virus meds
Antivirals (Tamiflu)
Virus L/D
Viral throat culture rapid flu test
Viral throat culture rapid flu test CC
Infection
Virus patho/etiology
Transmitted via droplets and physical contact
Transmitted via droplets s/sx
cough
vitals and lung sounds q4h disorder
pneumonia
cough interventions
vitals and lung sounds q4h
Transmitted via physical contact interventions
hand hygiene
Virus interventions
preventative measures
preventative measures meds
antivirals(tamiflu) and flu vaccine
flu vaccine interventions
Assess Allergies/ Educate
Could develop pneumonia- common complication monitor ABGs
Influenza
Avoid crowds for flu season, sharing food and drinks/utensils
Influenza
Antibiotics not effective for viruses
Influenza
Cold Onset
Slow
Cold fever
none or low grade
cold HA
rar
cold myalgia
less common
cold cough
present
cold chest pain
absent
cold fatigue
slight
cold sore throat
common
cold runny nose
common
cold complications
rare
cold tx
rest/fluids
flu onset
sudden
flu fever
comon
flu HA
common
flu myalgia
common (severe)
flu chest pain
common
flu fatigue
common (prolonged)
flu cough
present (dry)
flu runny nose
less common
flu complications
pnemonia
flu sore throat
less common
Bacterial Infection onset
usually slow
flu tx
rest/fluids and antivirals (Tamiflu)
Bacterial Infection HA
less common
Bacterial Infection fever
common
Bacterial Infection Myalgia
less common
Bacterial Infection chest pain
common
Bacterial Infection fatigue
common
Bacterial Infection cough
present (dry/productive)
Bacterial Infection runny nose
less common
Bacterial Infection sore throat
less common
Bacterial Infection complications
pneumonia
Bacterial Infection tx
antibiotics
inflammation of the bronchial tree s/sx
excessive mucus and congested airways
Acute bronchitis patho/etiology
virus, inflammation of the bronchial tree
Inflammation of Bronchial Tree patho/etiology
Occurs >3 months of year x 2 years
Occurs >3 months of year x 2 years disorder
chronic bronchitis
Dilation of the bronchiole airways where area becomes scarred.
Bronchiectasis patho/etiology
Can be localized in the bronchus then goes to the lungs.
Bronchiectasis patho/etiology
Excessive sections = risk for infections.
Bronchiectasis patho/etiology
It’s a secondary disease from asthma.
Bronchiectasis patho/etiology
Inflammation of the airways (comes after dilation), dyspnea. cough, purulent sputum, bloody sputum (hemoptysis)
Bronchiectasis s/sx
sputum culture to know organism. Xray, CT and lung function tests.
Bronchiectasis D/L
Chest Physiotherapy
Flu and pneumonia shot encouragement
Bronchiectasis interventions
Azithromycin.
Bronchiectasis meds
If they develop distended neck veins- call provider bc life threatening condition
Bronchiectasis meds
Bronchiectasis patho/etiology
Secondary to chronic respiratory disorder
Secondary to chronic respiratory disorder
L/D
Chest x-ray / CT Scan
Bronchoscopy
inflamed airways meds
bronchodilators and corticosteroids/leukotriene inhibitors
inflamed airways s/sx
bloody sputum
Secondary to chronic respiratory disorder patho/etiology
Dilation of Bronchial Airways
Secondary to chronic respiratory disorder
s/sx
inflamed airways
Dilation of Bronchial Airways s/sx
cough, dyspnea
Dilation of Bronchial Airways patho/etiology
Secretions pool in dilated areas
copious purulent sputum L/D
sputum cultures
copious purulent sputum interventions
fluids and Chest physiotherapy
copious purulent sputum meds
mucolytic (bronchitol)/expectorant
Secretions pool in dilated areas s/sx
wheezes/crackles, copious purulent sputum, recurrent lower respiratory tract infection
recurrent lower respiratory tract infection meds
antibiotics
recurrent lower respiratory tract infection s/sx
fever during active infection
fever during active infection interventions
oxygen and prevent infection
prevent infection meds
Flu & Pneumonia vaccines
Azithromycin
Bronchiectasis CC
infection and gas exchange
Bronchoscopy-
goes through nose then bronchus.
After procedure make sure gag reflex.
Bronchoscopy
Bronchospasm can happen
bc a lot of secretion in airways-wheezing crackles
Bronchoscopy
Check for edema
Bronchoscopy
Could heart problems- distended neck veins
Bronchoscopy
Expectorants for mucus
Bronchiectasis
Mucus causes bacteria/inflammation
Bronchiectasis
Lungs become scarred and damage causing dyspnea.
Pulmonary Fibrosis patho/etiology
Could be due to autoimmune disease or environmental hazards such as asbestos, cigarettes’, radiation therapy
Pulmonary Fibrosis patho/etiology
clubbing, crackles in inspiration, SOB, cough,
Pulmonary Fibrosis s/sx
CT, chest xray, bronchoscopy-Gag reflex before fluids, rebound bronchospasm right away, spirometry
Pulmonary Fibrosis L/D
O2 therapy, pulmonary rehabilitation or lung transplant
Pulmonary Fibrosis interventions
Pulmonary Fibrosis (interstitial lung disease) interventions
smoking cessation
Pirfenidone-decreases progress of disease. Nintendanib- slows rate of lung function decline. Both does not cure it but slows down progress
Pulmonary Fibrosis meds
Pulmonary Fibrosis (interstitial lung disease)
meds
flu and penmonia vaccines, antifibrotics (pirfenidone, nintedanib)
Pulmonary Fibrosis (interstitial lung disease) s/sx
flu like symptoms
Pulmonary Fibrosis (interstitial lung disease) and Scarring and fibrosis of lung tissue. L/D
Chest x-ray, CT Scan, bronchoscopy, ABGs, Spirometry
Pulmonary Fibrosis (interstitial lung disease) patho/etiology
Injury to alveoli = chronic inflammation
Injury to alveoli = chronic inflammation
patho/etiology
Scarring and fibrosis of lung tissue.
Scarring and fibrosis of lung tissue. s/sx
Inspiratory Crackles
Cough
Scarring and fibrosis of lung tissue. CC
Gas exchange
Gas exchange s/sx
Clubbing, fatigue, SOB
Airways are narrow and blocked by inflammation, mucus, and loss of elasticity in the alveoli.
COPD patho/etiology
dyspnea, SOB, wheezing, Chronic cough with sputum production (clear, white , yellow, green.)
COPD s/sx
Need more effort to push air out.
more prone to respiratory infections.
Infection can cause exacerbation of copd.
COPD patho/etiology
Can hear coarse crackles. Decrease in O2 sat with exacerbation. Increase in CO2
COPD s/sx
Smoking cessation, breathing exercises, huff cough to expel air.
Dyspnea- help repositioning. CPT.
Educate to increase calories and protein.
COPD interventions
Sputum cultures. WBCs, chest xray, CT, ventilation perfusion scan.
COPD L/D
Bronchodilators-can cause rebound bronchospasm if not used right.
Albuterol-fast acting.
Corticosteroids- decrease inflammation.
Antibiotics spectrum.
COPD meds
COPD L/D
Spirometry
COPD patho/etiology
Smoking, air pollution, industrial chemicals
Smoking, air pollution, industrial chemicals interventions
smoking cessation
Smoking, air pollution, industrial chemicals patho/etiology
Chronic Bronchitis and emphysema
Chronic Bronchitis s/sx
cough, diminished breathe sounds/crackles/wheezes, increased mucus and inflammation
Emphysema s/sx
Increased mucus and inflammation, decreased alveolar elasticity, prolonged exhalation, air trapping, barrel chest
increased mucus and inflammation patho/etiology
blocked airways
blocked airways s/sx
dyspnea, accessory muscle use, activity intolerance, weight loss, chronic hypoxemia
blacked airways L/D
ABGs (Respiratory acidosis)
weight loss intervention
High protein, high calorie
increased mucus and inflammation meds
adrenergic and anticholinergic, corticosteroids
Dyspnea CC
Gas exchange
Dyspnea interventions
tripod position and breathing exercise
High protein, high calorie CC
nutrition
chronic hypoxemia disorder
polycythemia
chronic hypoxemia meds
oxygen
Chronic inflammation of the airways and hyperresponsiveness of the bronchiole smooth muscle (bronchospasm).
Asthma Patho/etiology
Genetic, exercise induced, certain drugs. Does not grow out of it.
Asthma Patho/etiology
Wheezing, SOB, chest tightness, coughing,
Asthma s/sx
Spirometry, peak flow meter, allergy skin test- asthma triggers,
Asthma L/D
Albuterol(bronchodilator)- gives fasted relief, Prednisone or methyl prednisone, solumedrol- corticosteroids (increase BGL) for attack, Montelukast-pill for inflammation
Asthma meds
4Educate about peak expiratory flow rate- which level green, yellow, or red(emergency).
Animal dander, food, dander.
O2, vital signs, wheezes.
Accessory muscles to breathe- High fowlers position
c interventions
Asthma patho/etiology
chronic inflammation of airways
chronic inflammation of airways L/D
Spirometry and peak expiratory flow rate
chronic inflammation of airways patho/etiology
asthma triggers
asthma triggers L/D
allergy skin test
Asthma triggers patho/etiology
bronchospasms
Bronchospasm S/sx
accessory muscle use, dyspnea, air trapping, prolonged expiration, increased RR, wheezing, chest tightness, cough
Bronchospasm CC
Gas exchange
Measures the maximum speed of expiration
Peak Expiratory Flow Rate
Results are higher when well lower when airflow is constricted
Peak Expiratory Flow Rate
Expected value depends on the patients sex, age, and height
Peak Expiratory Flow Rate
Higher result good
Low result- airway constricted
Helps to figure out Tx
Peak Expiratory Flow Rate
Peak flow results
Green Zone
Usually 80% to 100% of personal best
Remain on medications to prevent asthma attack
Peak flow results
Yellow Zone
Usually 50% to 80% of personal best
Indicates caution
Something is triggering asthma.
Peak flow results
Red Zone
50% or less of personal best
Indicates serious problem
Definitive action must be taken with health care provider
Short-Acting Beta-Agonists (SABAs)
Albuterol
Albuterol S/E
Tremors, anxiety, tachycardia, palpitations and nausea
Inhaled corticosteroids (ICS) – Flovent, Budesonide
Inhibit the inflammatory process
Long-acting Beta-Agonists (LABAs)
Salmeterol (Servent Diskus, Formoterol (Perforomist), Arformoterol (Brovana).
Teach to rinse mouth after using bc of thrush.
Used in combination with ICS
Leukotriene Receptor Antagonists (LTRAs)
Montelukast (Singulair).
Prophylacitc-blocks IgE to prevent bronchospasm.
Used when ICS cannot/will not be used or if ICS not controlling asthma
Theophylline
Bronchodilator
Theophylline Therapeutic range
> 20 = toxic
Theophylline Toxicity s/sx:
N/V, rapid HR, seizures, dysrhythmias
Xolair
Omalizumab
Reduces sensitivity to allergens
Omalizumab
Used when high doses of corticosteroids does not work
Omalizumab
Not a rescue med
Omalizumab
SubQ Q2-4 weeks
Omalizumab
Genetic. Exocrine gland.
Cystic Fibrosis Patho/Etiology
Abnormal sodium and chloride. Effects GI tract, respiratory system and lungs.
Cystic Fibrosis Patho/Etiology
inhale in producing mucus and sweat- sodium and chloride. If defected- thick mucous
Cystic Fibrosis Patho/Etiology
Salty tasting skin, persistent coughing with phlegm. prone to lung infections-Pneumonia and bronchitis.
Cystic Fibrosis S/sx
Poor gross weight with no anorexia.
Cystic Fibrosis S/sx
Frequent bulky stools. Fowl odor and greasy stools steatorrhea.
Cystic Fibrosis S/sx
Developed pancreatic insufficiency- takes pancreatic enzymes before meals.
Cystic Fibrosis S/sx
Sweat and chloride test to see sodium in sweat. Genetic testing. Spirometry.
Cystic Fibrosis L/D
Feeding tube sometimes. Lung transplant-urgent. Increase fluids.
Cystic Fibrosis interventions
4.Lifetime changes-support groups. teach airway clearance techniques.
Cystic Fibrosis interventions
Chest physiotherapy. Pulmonary rehab. O2 therapy.
Cystic Fibrosis interventions
Pancreatic Enzymes given before they eat even if snack- helps with digestive system.
Cystic Fibrosis Meds
If foul odor stool the med is not working.
Cystic Fibrosis Meds
Pancrelipase. Oral pancreatic enzymes to help absorb nutrients.
Cystic Fibrosis Meds
If chest therapy do it before eating and if doing after eat wait
2 hours to prevent emesis.
give bronchodilators to open airways.
Cystic Fibrosis Meds
Pay attention to stools to see if med is working.
Cystic Fibrosis Meds
Teach airway clearance- observe coughing techinique
Cystic Fibrosis Meds
Cystic fibrosis patho/etiology
genetic exocrine gland disorder
genetic exocrine gland disorder L/D
genetic testing
genetic exocrine gland disorder patho/etiology
Abnormal NA and Cl transport
Abnormal NA and Cl transport L/D
Sweat chloride test
Sweat chloride test intervention
hydration
Abnormal NA and Cl transport patho/etiology
lungs, reproductive tract, sweat glands/skin, gi tract
sweat glands/skin L/D
sweat chloride test
sweat glands/skin s/sx
salty sweat glands
GI tract s/sx
Steatorrhea, bowel obstruction, pancreatic blocked ducts
Bowel obstruction CC
Elimination
pancreatic blocked ducts s/sx
malabsorption of nutrients, retained enzymes
malabsorption of nutrients intervention
High-calorie nutrient dense diet
retained enzymes meds
pancreatic enzymes
Reproductive s/sx
delayed sexual maturity and infertility
infertility CC
reproduction
Lungs CC
Gas exchange
Lungs s/sx
thick tenacious respiratory secretions, air trapping, resp infections
thick tenacious respiratory secretions meds
Pulmozyme, bronchitol, bronchodilators, NMTs
Thick tenacious resp secretions interventions
High-frequency chest wall oscillation
CPT
respiratory infections intervention
Prevention of infection
respiratory infections meds
antibiotics
Both parents carry gene- genetic testing
cystic fibrosis
Abdominal pain, bloating, steatorrhea- pancreatic enzyme is not working
cystic fibrosis
Amylase-
carbs digestion
Protease-
protein digestion
Mucous- prevent respiratory infections.
cystic fibrosis
Put on antibiotics and bronchodilator.
cystic fibrosis
1-2 hrs after meals- CPT
cystic fibrosis
Keep effective airway clearance.
cystic fibrosis
15 seconds for
suction.
Lipase-
digest fat
metabolic acidosis-
aspiration
Tonsillectomy and vomiting for kids-
turn to side and suction
Listen to lungs after
surgery
Albuterol can stop
asthma attack
Teach vaccine, wash hands, no drinking-
flu teaching
Trach patient-
reposition q2h, do not restrict fluids,
Crackles and wheezes in
asthma
Sore throat-
salt and water gargle
Labs for infection-
WBCs
Icepack lean forward-
nose bleed
Hemoptysis-
bloody sputum
Emergency-
JVD
Education- cystic fibrosis-
fluids, postural drainage, monitor stools
Normal pH and abnormal pH
7.35-7.45= normal
