Respiratory Flashcards
Where does gas exchange take place?
The alveoli
What is the lining of the chest cavity called?
The parietal pleura
What is the lining of the lungs called?
The visceral pleura
What is the name of the fluid found between the parietal and visceral pleura?
Pleural fluid
What is the function of the pleural fluid?
Allows the lungs to expand and move against the thoracic cage smoothly, easily and without pain.
How is excess pleural fluid disposed of?
Drained by lymphatic circulation
What is a pleural effusion?
A buildup of excess pleural fluid
What is the name of the muscles found between the ribs?
Intercostal muscles
About how much air do you take in with a normal breath?
500 mL
What is hypoxia?
Oxygen deficiency in the body tissues
What is hypoxemia?
Oxygen deficiency in the blood
What is hypercapnia?
Increased arterial CO2
What nursing diagnoses would be associated with hypoxia, hypoxemia or hypercapnia?
Impaired gas exchange
What lab tests would be evidence for a diagnoses of impaired gas exchange?
Decreased O2 and Increased CO2
Describe normal findings of a respiratory assessment of the nose.
Symmetric with no deformities, mucosa pink with no edema, exudate, blood or polyps. Nasal septum straight, nares patent bilaterally.
Describe normal findings of a respiratory assessment of the oral mucosa.
Light pink, moist, no exudate or ulcerations.
Describe normal findings of a respiratory assessment of the tonsils.
Not inflamed or enlarged
Describe normal findings of a respiratory assessment of the pharynx.
Smooth, moist and pink.
Describe normal findings of a respiratory assessment of the neck.
Trachea midline, no cervical nodes palpable.
Describe normal findings of a respiratory assessment of the chest.
AP (Anterior-Posterior) diameter 1:2, respirations non-labored 12-20 bpm, equal chest expansion, breath sounds equal and vesicular.
What subjective data would you ask about during a respiratory assessment?
Dyspnea, orthopnea, cough, sputum, chest pain, wheezing, hemoptysis
What is pleurisy?
Inflammation of the pleural linings.
What is hemoptysis?
Coughing up blood.
What is a pack year?
The number of years a person has been smoking multiplied by how many packs smoked per day.
Describe what you would expect to find while using percussion during a respiratory assessment. What would be abnormal?
A resonant sound. A dull sound would be abnormal.
4 adventitious breath sounds
Crackles, rhonchi, wheezes, stridor
When are crackles heard?
On inspiration
When are rhonchi heard?
On inspiration and expiration
Where is stridor heard?
The upper airway
Where are wheezes heard?
The lower airway
What are 2 early signs of inadequate oxygenation?
Tachypnea and dyspnea on exertion
What are 4 late signs of inadequate oxygenation?
- Dyspnea at rest
- Use of accessory muscles
- Retraction of interspaces on inspiration
- Pause for breath between sentences or words
Name this disease
- Increased pCO2
- Headache
- Conjunctival hyperemia
- Flushed skin
- Mental status changes
- Tachycardia
- Diaphoresis
- Increased BP
Hypercapnia
What is conjunctival hyperemia?
Bloodshot eyes
Name 4 things that can trigger asthma
- Infection
- Allergens
- Exercise
- Irritants
3 nursing diagnoses used for asthma
- Impaired gas exchange r/t airway obstruction
- Ineffective airway clearance
- Anxiety
Name this disease
- Retractions
- Night-time cough
- ↑ mucus
- Shortness of breath
- Expiratory wheeze
- ↑ CO2 retention
- Prolonged expiration
Asthma
When should a person seek medical attention when experiencing signs and symptoms of asthma?
If symptoms do not respond to usual treatment within 30 minutes.
What is “status asthmaticus”?
Acute severe asthma which doesn’t respond to treatment. This is life threatening, a medical emergency.
8 things the nurse can do for a patient during an asthma attack.
- Stay calm.
- Position the patient in the high fowler’s position
- Teach them breathing techniques such as pursed lip breathing or diaphragmatic breathing.
- Do a respiratory assessment
- Administer prescribed medications
- IV fluids to keep them hydrated
- Small frequent meals
- Ask yes or no questions
5 types of medications are given for asthma?
- Beta 2 agonists
- Mast cell stabilizers
- Corticosteroids
- Leukotriene receptor antagonists
- Bronchodilator
Patient education. 3 things the nurse can teach the asthma patient.
- Avoiding triggers
- Proper medication administration
- How to use the peak flow meter
What does a peak flow meter measure?
How much air they can move out of their lungs in one breath
How does obstructive pulmonary disease affect breathing?
Air flow is limited in and out of the lungs.
Name this disease
- Easily fatigued
- Frequent respiratory infections
- Accessory muscle use
- Orthopneic
- Thin body
- Wheezing
- Pursed lip breathing
- Chronic cough
- Barrel chest
- Dyspnea
- Prolonged expiratory time
- Digital clubbing
- Hypoxemia
- Hypercapnia
- Edema in ankles
COPD
What causes COPD?
Noxious particles and gases such as tobacco smoke or air pollution.
What is the pathology involved with COPD?
- Mucus hypersecretion
- Cilia dysfunction
- Airflow limitation
- Hyperinflation of the lungs
- Gas exchange abnormalities
- Pulmonary hypertension
- Cor pulmonale
What is cor pulmonale?
An alteration in the structure and function of the right ventricle (RV) of the heart resulting in right sided heart failure due to lung disease.
How is chronic bronchitis defined?
The presence of cough and sputum production for 3 consecutive months, 2 years in a row.
How is chronic bronchitis different from asthma?
It is not reversible.
The following are clinical manifestations of what disease?
- Skin color is dusky to cyanotic
- Recurrent cough
- ↑ sputum
- Hypoxia
- Hypercapnia
- Acidosis
- Edematous
- ↑ Respiratory rate
- Exertional dyspnea
- ↑ incidence in heavy smokers
- Digital clubbing
- Cardiac enlargement
- Accessory muscle use
- Cor pulmonale
Chronic bronchitis
What are 3 causes of emphysema?
- Smoking
- Air pollution
- Family history of pulmonary disease
How does pursed lip breathing benefit the patient with emphysema?
It helps to get rid of CO2.
The following are clinical manifestations of what disease?
- ↑ CO2 retention resulting in a pink skin color
- No cyanosis
- Pursed lip breathing
- Dyspnea
- Ineffective cough
- Hyperresonance on chest percussion
- Orthopneic
- Barrel chest
- Exertional dyspnea
- Prolonged expiratory time
- Speaks in short jerky sentences
- Anxious
- Accessory muscle use
- Thin body appearance
- Leads to right sided heart failure
Emphysema
What is the difference between Chronic Bronchitis and Emphysema in regards to the obstruction?
Chronic bronchitis is due to mucus. Emphysema is due to lack of elastic recoil of the alveoli.
Name 5 nursing diagnoses for COPD
- Ineffective airway clearance
- Impaired gas exchange
- Imbalanced nutrition, less than body requirements
- Insomnia
- Risk for infection
What 9 things can the nurse do for the COPD patient?
- Stay calm
- Assess respiratory system
- Ask only yes or no questions
- Assist the patient into a high fowler’s or tripod position.
- Teach them breathing techniques such as pursed lip breathing and diaphragmatic breathing.
- Administer prescribed medications appropriately.
- Teach them to enhance their coughing with diaphragmatic breathing.
- IV fluids to keep them hydrated
- Small frequent meals.
For the patient with COPD where should PAO2 and SpO2 be?
PAO2 should be between 50 and 90.
SpO2 should be at 90%.
Why shouldn’t SpO2 be higher than 90%?
Any higher will decrease the respiratory drive.
Patient education. What 7 things should the nurse teach the COPD patient?
- Smoking cessation.
- Vaccines
- Oxygen
- Activity tolerance
- Self-care
- Avoid emotional triggers
- Correct medication administration
What is a pulmonary embolism?
A portion of the pulmonary blood vessels that get occluded by an embolus.
What are possible sources of a pulmonary embolism?
- A clot, such as a DVT
- Tumors
- Air
- Fat
- Bone marrow
- Septic thrombi
- Vegetation on heart valves (endocarditis)
- Major operations
- Atrial fibrillation in the right side of the heart
What is the classic triad of symptoms of a PE?
- Chest pain
- Dyspnea
- Hemoptysis
Other than the classic triad, what are 10 other symptoms of a PE?
- Tachypnea
- Anxiety
- Hypoxemia
- Apprehension
- Sense of impending doom
- Pallor
- Severe dyspnea
- Crushing chest pain
- Right sided heart failure
- Low grade fever
What lab test can detect a pulmonary embolism?
Increased D-Dimer, ABG, PTT, PTINR,
What diagnostic imaging tests helps to diagnose pulmonary embolism?
A ventilation–perfusion (VQ) scan, Spiral CT, pulmonary angiography
What 2 nursing diagnoses can be used with a pulmonary embolism?
- Impaired gas exchange
2. Anxiety
Nursing management of a patient with pulmonary embolism.
- Prevention
- Stay calm and stay with patient
- Assess vital signs and respiratory status
- Keep the head of the bed elevated (bedrest)
- Oxygen
- IV access
What medications are used to treat a PE?
Anticoagulants such as heparin or coumadin.
Thrombolytics
Analgesics such as morphine for pain and anxiety
Patient education: What can the nurse teach the patient to prevent a future PE?
- Turning, coughing, deep breathing.
- The use of an Incentive spirometer
- The signs and symptoms of right sided heart failure
- Correct medication administration
What do studies show is even more effective than anti-coagulants in preventing PE?
3x a day range of motion exercises.
