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
19
Q
COPD Medical Management
A
-Smoking cessation
- Bronchodilators by MDI (correct use will give 15-20% of meds) and spacer
- Anticholinergics = ipratropium (short); tiotropium (long)
- Sympathomimetics (aka beta adrenergics) = are SABA (helps with dyspnea and secretion clearance) or LABA
- Corticosteroids
- Oxygen therapy
- Surgery (lung vol. reduction)
20
Q
MGMT of Acute SOA
A
- Position (lean forward)
- Breathing
- Relaxation
21
Q
COPD Nursing Management
A
Priority is to help with ADLs and respiratory fx
Goals and interventions should address: smoking cessation chronic dyspnea impaired gas exchange cough exercise tolerance, self care and coping nutrition complications
22
Q
Asthma Manifestations
A
- cough
- wheezing
- dyspnea
- chest tightness
- hyperresponsiveness (smooth muscle spasms)
- inflammation
- airway edema
- mucus
Status Asthmaticus s/s:
- diaphoresis
- widened pulse pressure
- wheezing on inspiration
23
Q
Medical and Nursing Management of Asthma
A
Goals are:
- symptom control
- maintenance of pul. fx and activity
- prevention of recurrent exacerbations
- provision of optimal pharmacotherapy (see table…leukotriene inhibitors might be used instead of corticosteroids)
- pt education
24
Q
Atelectasis
A
Risk Factors:
- morbid obesity
- post-op
S/S:
- dyspnea
- cough
- sputum production
- leukocytosis
Mgmt:
- position changes
- IS (if encouraging pt to cough, make sure to use IS after that to ensure that alveoli are expanding and to encourage surfactant replacement)
- chest physiotherapy (CPT) - this includes postural drainage, chest percussion and breathing retraining
- nebulizer therapy (use BEFORE CPT)
25
Pneumonia Manifestations
Pneumonia is infection of lower respiratory tract
S/S vary depending on causal organism; but classics are fever, cough, dyspnea, leukocytosis
* note that purulent sputum may be only distinguishing s/s in pts with COPD
* S/S of older adults are weakness, abdominal symptoms,, confusion, tachycardia and tachypnea
26
Medical and Nursing Mgmt of Pneumonia
- Antibiotic therapy
- Supportive care
- Prevention
- O2 therapy
NC:
- improve airway patency
- conserve energy
- maintain proper fluid volume
- maintain adequate nutrition
- understand tx and prevention
- prevent complications
27
Pulmonary TB Manifestations
S/S are insidious and include: low grade fever, night sweats, weight loss, fatigue, cough
*note that with progression of disease you might see bloody sputum and chest pain
test for TB with skin tests and QFT-G test (which is enzyme-linked immunosorbent assay)
28
Pulmonary TB Treatment
Medications:
| -INH, rifampin, pyrazinamide, ethambutol
29
Pulmonary Edema Manifestations
S/S:
| -increased respiratory distress (shown as dyspnea, air hunger and hypoxemia)
30
Pulmonary Edema Risk Factors
Patho is: abnormal accumulation of fluid in lungs; capillary fluid leaks or is forced into alveolar spaces
Causative origins:
- ARDS
- neurologic
- re-expansion
- negative pressure edema
- cardiogenic factors
31
Medical and Nursing Mgmt of Pulmonary Edema
- O2 therapy
- intubation
- mechanical vent
32
Pleural Conditions
Have to do with Lung MEMBRANES
Pleurisy: inflammation of both layers of pleurea (parietal and visceral); S/S are deep breathing, sneezing, worsening pain when coughing
Pleural effusion (fluid) and Empyema (pus): accumulations in pleural space)
33
Transudate and Exudate
Transudate: filtrate of plasma moved across intact capillary walls
Exudate: extravasation of fluid into tissue
34
Ventilation and Perfusion
Ventilation: brings O2 to the lungs and removes the alveolar CO2
Perfusion: blood brings CO2 to the alveoli and takes up the O2 from the alveoli
35
Acute Respiratory Failure Patho
- Alveolar hypoventilation
- Diffusion abnormalities
- Ventilation-perfusion mismatching
- Shunting (perfusion is adequate but ventilation is inadequate)
- Increased physiologic dead space
36
ARF Causes
- Decreased Respiratory Drive
- Dysfunction of the chest wall
- Dysfunction of the lung parenchyma
- Other causes
37
ARF Management
- restore adequate gas exchange
| - assist with intubation and mechanical vent.
38
ARDS Patho and S/S
Occurs as a result of an inflammatory trigger that initiates the release of cellular and chemical mediators, causing diffuse epithelial cell injury to the alveolar capillary membrane; this leads to leakage of protein-rich fluid and blood cells into the alveolar interstitial spaces and alterations in the capillary bed
Several VQ mismatching occurs; alveoli collapse because of the inflammatory infiltrate, blood, fluid, and surfactant dysfunction; small airways are narrowed because of interstitial fluid and bronchial obstruction; lung compliance is decreased (STIFF LUNGS) and result sis decreased FUNCTIONAL RESIDUAL CAPACITY and SEVERE HYPOXEMIA
39
ARDS Medical and Nursing Mgmt
Medical:
- Medications: often IV sedation and pain medication; the meds include
- human recombinant interleukin-1 receptor antagonists
- neutorphil inhibitors
- pulmonary-specific vasodilators
- surfactant replacement therapy
- antisepsis agents
- antioxidant therapy
- corticosteroids
- Nutritional Therapy: ARDS pts require 15 to 20 kcal/kg/day
Nursing:
- pt in prone position for better oxygenation
- frequent assessment
- anticipate pain needs
- oral care
- suctioning
- turning frequently
- nebulizer therapy
- CPT
40
Pulmonary Arterial HTN Manifestations
with PAH, pulmonary pressure could exceed 25 mmHg at rest and 30 mmHg with activities
S/S:
- dyspnea
- chest pain
- weakness
- fatigue
- syncope
- occasional hemoptysis
- s/s of right HF (peripheral edema, ascites, distended neck veins, crackles, heart murmer
41
Pul. Arterial HTN Medical and Nursing Mgmt
Medical:
- treat underlying cause
- supplemental O2
- vasodilating agents
Nursing:
- be able to ID pts at risk for this
- supply O2
- emotional support
42
Occupational Lung Diseases
Silicosis: chronic fibrotic pul. disease caused by inhalation of silica dust
Asbestosis: diffuse nodular interstitial fibrosis from inhalation of asbestos dust
Coal miner's pneumoconiosis (black lung disease): includes a variety of respiratory disorders found in coal miners
S/S: dyspnea, weight loss, fever, cough, rapid progression; early findings include bibasilar fine, end-inspiratory crackles; more advanced will see clubbing
Medical MGMT: O2 therapy, diuretics, inhaled beta-adrenergic agonists, anticholinergics and bronchodilators
43
Chest Trauma Types and Patho
Types:
- Tension
- Simple
- Traumatic
Pathological states resulting from chest traumas:
- Hypoxemia from disruption of airway, injury to lung tissue, rib cage, respiratory muscles; or massive hemorrhage, collapsed lung; or pneumothroax
- Hypovolemia from massive fluid loss from the great vessels, cardiac rupture or hemothorax
- Cardiac failure from cardiac tamponade, cardiac contusion or increased intrathoracic pressure
44
Chest Trauma Manifestations and Assessment
Rapid assessment involves the ABCDEs (Airway, Breathing, Circulation, Disability "neurologic", and Exposure)
Know:
- time elapsed since injury occurred
- mechanism of injury
- level of responsiveness
- specific injuries
- estimated blood loss
- recent drug or alcohol use
- prehospital tx
45
Chest Trauma Mgmt
Same for any trauma - restore and maintain cardiopulmonary function, do diagnostic tests, treat shock.
May need chest tubs, catheters
46
Chest Trauma Complications
Complications of chest trauma includes sternal and rib fractures. So think about what's under the sternum are the heart & great blood vessels, airway. Of course under the ribs are the lungs.
- Flail chest is a more severe form of rib fractures. Flail chest is where you have ribs that are normally attached in a firm structure have become free-floating. The danger from these types of injuries are that one of these bony structures that are broken can now puncture and organ near it.
- Pulmonary contusions can be thought of as really bad bruises on the loan. This bruised area frequently is irritated becomes inflamed and develops infiltrates.
- Cardiac tamponade is a medical emergency there is a sac that just like online surrounds the heart and it's designed to support and cushion the heart. Like the pleura has a small amount of fluid designed to lubricate and cushion things. If something happens and that sac is punctured bleeding can occur and if left unchecked, enough bleeding can occur to inhibit the heart from pumping.
47
Aspiration
Risk Factors:
- prone to GERD
- do not have an intact swallow or gag reflex
- have endotracheal tube in
Prevent and MGMT:
- patients who are immobile we went there headed their bed up
- we want them turning side to side
- we want good oral care
- make sure that the balloon on the endotracheal tube is appropriately inflated
- possibly that they may even need an NG tube to keep stomach contents sucked
