Respiratory Flashcards
1
Q
Physical Assessment
A
- Cyanosis (late finding..by this time the majority of hemoglobin don’t carry O2)
- Clubbing (chronic condition)
- Trachea deviated from midline
- Chest (look at movement and shape)
- Breathing pattern
- Breath sounds (stridor is airway closing down)
- Crepitus (means air is in tissue….note how big of an area it covers)
2
Q
Diagnostic Test
A
- Pulmonary Fx Tests (PFTs measure how much breath in take in and push out and measure every phase of respiratory cycle)
- Pulse Ox
- Sputum sample (can’t have spit in it)
- Imaging studies (see other flash)
- ABGs (can show artery blood gas because pulse ox has veinous blood)
- Bronchoscopy (direct visualization of lung tissue)
- Thoracentesis (normally between lungs and pleural wall are 20cc of fluid)
3
Q
Diagnostic Imaging
A
- Chest X-ray (one dimensional)
- CT Scan (identifies structures)
- MRI
- Fluroscopy (shows structures and movements, use contrast dye)
- Pulmonary angiography (dx of PE)
- Lung Scan (radioisotopic dye)
4
Q
Arterial Blood Gas - Step 1
A
pH:
Alkalosis (>7.45)
Acidosis (
5
Q
Arterial Blood Gas - Step 2
A
Responsible system:
Respiratory (PaCO2: 35-45mm Hg)
>45 acidosis
6
Q
Arterial Blood Gas - Step 3
A
Compensation? If so, which sx?
7
Q
Arterial Blood Gas - Step 4
A
Oxygenation:
PaO2 - 80-100 mm Hg
O2 Sat - >94%
8
Q
Endotracheal Tube
A
- balloon is inflated past vocal cords
- note which # is at lip so that you can know if it’s shifted
- since this bypasses the humidification process of the airway so you must humidify or secretions will get dry
- make sure HOB @ 30 degrees; oral care Q2H
9
Q
Bi-Level Positive Airway Pressure
A
- this gives extra breaths if they’re not breathing fast enough
- need to make sure mask has good seal
10
Q
Invasive Mechanical Ventilation
A
- Atmospheric pressure is 760
- we suck; vents blow
- make sure to know mode, rate, AC/SIMV, FiO2 and volume for pts on ventilators
- care of assess the patient, turn the patient, oral care and wean
11
Q
Continuous Positive Airway Pressure
A
*may be attached to mask or cannula
12
Q
Complications for Ventilated Pts
A
- Barotrauma occurs when openings occur in the lung tissue or in the pleura surrounding the lung tissue. This will cause pneumothorax, which alter pressures within the thoracic cavity and impede chest wall expansion. Airway trauma can occur with tube dislodgement. The way we prevent barotrauma is by turning the patient to promote gas exchange and secretion removal. Assessing the patient so that changes are detected as early as possible hopefully not requiring a more aggressive treatment plan.
- Ventilator associated pneumonias are best prevented through aggressive oral care turning and weaning from the ventilator.
- Decreased cardiac output is best avoided or lessened through assessment, turning, and weaning as soon as possible
13
Q
PEEP
A
- Positive End Expiratory Pressure
- it’s added to the end of the expiration so that the alveoli don’t collapse with every breath
- this is in addition to our own natural PEEP
- but it can cause barotrauma and decreased cardiac output because the lung tissue in these pts is often stiff and doesn’t want to stay open
14
Q
Chest Drainage sx
A
- Can be water seal and use suction
- the suction creates a negative pressure which helps promote both fluid removal and air removal
- helps to reestablish lung expansion proper pressures within the thoracic cavity
- for pts with pneumothorax among other things
- tidaling which is a movement of fluid back and forth and moves in with inspiration and returns to baseline with expiration.
- CARE OF PATIENT
- securing the tube to the patient making sure tight proper dressing… no air leaks!
- assure all the connections are tight on the system the drainage system.
- monitor the chest tube for drainage.
15
Q
Chronic Bronchitis Manifestations
A
- cough
- COPIOUS sputum
- cor pulmonale (peripheral edema, elevated JVD)
- lung capacity increased or decreased or slightly normal
- electric recoil normal
16
Q
Emphysema Manifestations
A
- Dyspnea
- LITTLE sputum
- rare cor pulmonale
- total lung capacity elevated
- elastic recoil decreased
17
Q
COPD Manifestations
A
- dyspnea
- chronic cough
- sputum production
18
Q
Diagnostic criteria for COPD
A
FEV1 of