Respiratory Flashcards
Acinus
All structures distal to the terminal bronchiole.
Physiology of Type II Alveolar Cells
Located in the walls of the alveoli. Secrete surfactant that reduces surface tension. Without it the alveoli would collapse.
Nerves responsible for respiratory innervation
Phrenic, Vagus, & Thoracic
Parietal & Visceral Pleura: A&P
Parietal lines the inside of the thoracic cavity, including the upper surface of the diaphragm. Visceral covers the pulmonary surfaces. Cells lining the pleura secrete a fluid that acts as a lubricant so the lungs may glide smoothly during respiration.
Accessory muscles of respiration
Scalene muscles - elevate the first two ribs
Sternocleidomastoid muscles - raise the sternum
Trapezius & Pectoralis muscles - fix the shoulders
Risk factors for respiratory disorders
Allergies Chest Injury Crowded living conditions Chemical/pollutant exposure Family Hx of infectious disease Freq. respiratory illness Geographic residence/travel to foreign countries Smoking Surgery Use of chewing tobacco Viral syndromes
Specimen collection - Pre & Postprocedural Actions
Pre: Instruct to rinse mouth prior to collection, obtain 15 mL of sputum, instruct to take several deep breaths and then cough deeply to obtain, always collect before they have begun antibiotic Tx
Post: Bring to lab immediately if culture is prescribed. Assist w/ mouth care
Pre-procedural actions for Laryngoscopy and Bronchoscopy
- Get informed consent
- Maintain NPO status from midnight a/ procedure
- Obtain VS
- Assess results of coag. studies
- Remove dentures & eyeglasses
- Prepare suction equipment
- Establish an IV access as needed & admin meds for sedation per order
- Have emergency resuscitation equipment available
Post-procedural actions for Laryngoscopy and Bronchoscopy
- Monitor VS
- Maintain the client in semi-fowlers
- Assess for return of gag reflex (maintain NPO until then)
- Have emesis basin readily available for expectorating
- Monitor for bloody sputum
- Monitor respiratory status, esp. if sedation was used
- Monitor for complications: bronchospasm, bronchial perforation (look for facial/neck crepitus), dysrhythmias, hemorrhage, hypoxemia, and pneumothorax.
- Notify HCP if: fever, DIB, or other signs of complications
Nursing Actions for Respiratory Suctioning
- Explain procedure to client
- Assist to an upright position (ie semi-fowlers w/head hyperextended unless contraindicated)
- Hand hygiene & gloves
- Prep equipment and turn on suction
- HYPEROXYGENATE THE PT
- Insert the cath without suction applied
- Once inserted, apply intermittently and rotate as you withdraw
- HYPEROXYGENATE
- Listen to breath sounds
- Document procedure, response, & effectiveness
Asthma - Definition
An inflammatory disorder of the airways stimulated by triggers (infection, allergens, exercise, irritant)
Status Asthmaticus
A life-threatening condition unresponsive to treatment. Despite all medical efforts their body isn’t responding (airways aren’t opening up)
Asthma - Assessment Findings
Wheezing, crackles, restlessness, diminished breath sounds, tachypnea
Asthma - Therapeutic managment
Place in high fowler’s position, administer O2, administer bronchodilators BEFORE corticosteroids. Ultimate goal is to open the airways.
Asthma Prevention - Teaching
Avoid triggers, use daily inhaler regardless of whether symptoms are present.
Asthma Physiology
Bronchiole walls swell and produce mucous. Can’t get enough air into their lungs.
Rationale: why bronchodilators are given prior to corticosteroids
Bronchodilator will open up the airways which will allow the corticosteroid to be more effective because more will be able to enter the airway
Proper inhaler use with Spacer
- Shake 10-15 times
- Take lg. breath and exhale completely
- Place spacer in mouth and seal with lips
- Tilt head back slightly
- Press down - breath in slowly and deeply
- Hold 5-10 seconds
- Open mouth and breath out slowly
Peak Flow Meter
Monitors the peak expiratory flow rate of air from a persons bronchi
EpiPen
Adrenaline causes bronchodillation via beta2 (remember - 2 lungs) receptor activation
- used in emergent situations
Asthma Meds
Bronchodilators, corticosteroids, immunomodulators, short acting beta agonists (epi)
Nursing Roles with Asthma patients
Assess status of airways, check that they are aware of their triggers
COPD - Definition
Obstruction of airflow d/t emphysema and chronic bronchitis
Emphysema
- Destruction of alveoli d/t chronic inflammation
- Decreased surface area for gas exchange
- CO2 isn’t being removed from the blood effectively and O2 isn’t entering the blood efficiently
Chronic Bronchitis
- Chronic airway inflammation with productive cough
- Excessive sputum production
COPD - Assessment Findings
- Barrel chest
- use of accessory muscles
- congestion on ches xray
- ABG with elevated CO2 and decreased pH (respiratory acidosis)
COPD - Therapeutic Management
- DO NOT administer O2 at greater than 2 L/min (stimulus to breath is low PO2, not the the usual elevated PCO2)
- Assess SpO2 (~89-91 or something lower than normal for someone healthy is normal for these pts)
- Provide chest physiotherapy (CPT)
- Teach pursed lip breathing
- Avoid allergens and triggers (dust, infections, spicy foods, smoking)
- Increase fluid intake to 3000 mL/day to keep secretions thin (if not C.I.)
- small frequent meals to prevent hypoxia
