Respiratory Flashcards
Test #3
Structure of respiratory system
- Larynx
- Trachea
- Cartilage
- Bronchus
- Bronchioles
- Alveoli
- Diaphragm
- Intercostal muscles (between ribs)
Inspiration (1/3 of resp cycle)
contraction of diaphragm (floor moves down) and external intercostal muscles increases space in the chamber
-Lowered intrathoracic pressure causes air to enter through airways and inflate lungs
Expiration (2/3 of resp cycle)
relaxation of diaphragm (floor moves up) and intrathoracic pressure increases
- Increased pressure pushes air out of lungs
- Requires elastic recoil of lungs
Chronic Obstructive Pulmonary Disease (COPD)
Chronic inflammatory lung disease causing obstructed airflow-chronic bronchitis and emphysema
Not reversible-Treatable but not curable
What other disorder can coexist with COPD?
asthma
What is chronic bronchitis?
inflammation of lining of bronchial tubes, causing increased mucous and coughing
What is Emphysema?
Alveoli at the end of the bronchioles are destroyed.
Risk factors of COPD
environmental exposures and host factors
Primary symptoms of COPD
S/S don’t typically appear until a lot of damage has already occurred. Gets worse with time.
cough
wheezing
sputum production
dyspnea
Etiology of COPD
- *Smoking causes 80-90% of cases
- passive smoking
Occupational exposure
Ambient air pollution
Infection-Pneumonia
- *Genetic Abnormalities
- Alpha 1-antirypsin deficiency
Age
-35-40 before symptoms, but probably already have problem
Pathophysiology of COPD
Inflammatory response causes changes in pulmonary vasculature-definitely changes the walls.
COPD causes bronchial tubes and alveoli (used to force air out of lungs and body) to lose elasticity and over expand, leaves air trapped in lungs when exhalation, damaging alveoli.
Airflow limitation
during forced exhalation due to loss of elastic recoil
Airflow obstruction
due to mucous hyper-secretion, mucosal edema, and bronchospasms
Diagnostic tests of COPD
PFT
ABG-take from arteries! MUST put pressure for 5 min
Sputum tests-Pneumonia, TB
Chest X-ray, CT, MRI
Fluoroscopic studies and angiography
Radioisotope procedures (lung scans)
Arterial Blood Gases (ABG)
Measurement of arterial O2 and CO2 levels
Used to assess adequacy of alveolar ventilation and ability of lungs to provide O2 and remove CO2
Assess acid-base balance (7.35-7.45 pH)
**If on O2 all the time, look for resp acidosis (under 7.35)
Prevention of COPD
Stop smoking
Avoid irritants
Yearly flu shots
Pneumonia shots q5years
Therapies for COPD
O2-usually 2L
-If O2 given too much, they lose drive to breathe
Pulmonary rehab
Meds for COPD
Bronchodilators
Inhaled/oral steroids-CHECK CBG
Combo inhalers-rinse mouth
Phoshodiesterase 4 inhibitors-reduce inflammation
-causes diarrhea
Theophylline-tremors, tachycardia
Antibiotics
Bronchoscopy
Look in lungs with scope
Numb throat, NPO until gag reflex-could aspirate
When would you put a non-rebreather on?
When a patient is struggling for air and needs increased percentage of air
Ways to break up mucous
- Pulmonary toilet
- High frequency compression device
- Nebulizers
- Acapella airway-breathe in, ball vibrates
- Flutter device
Surgical management of COPD
Bullectomy-removal of expanded alveoli
Lung volume reduction surgery-gets rid of lung tissue that isn’t functioning
Lung Transplantation
Nitrate foods
Bologna
Bacon
Why can’t patients with COPD have gassy foods?
They could aspirate when they burp
Sulfites food
meats and salad bars
Chronic Bronchitis Symptoms
Blue Bloater
Usually heavy smoker
Will lead to Right Sided Heart Failure
- Hypoxic=Low O2 and High CO2
- Cyanotic-fingertips and nose
- Cough with thick sputum
- Hypercapnia (High pCO2)
- Resp acidosis
- High Hgb
- Club fingers
- Cardiac enlargement
- Hard time sucking in & out
- Skinny
- Increased respiration rate
- Dyspnea-exertion, then at rest
- coarse rhonci and wheezes-high-pitched snoring sound
Emphysema
Pink Puffer
Tripod breathing-leaning forward to open more room for lungs.
- Sucks in everywhere to breathe-pursed lips
- High CO2 (pink)
- CO2 poisoning-cherry red lips
- Dyspnea
- Barrel chest but thin appearance
- anorexia, weight loss-increase calories
- Leads to right sided HF (cor pulmonale)
- minimal cough and mucous
- long time to breathe out
- decreased breath sounds
Other lung diseases
Pneumonia
TB
Occupational Lung
Atelectasis
Going into pneumonia
Collapse/airless condition of the alveoli
Postop patients are high risk
Symptoms of Atelectasis
cough, sputum production, low-grade fever
If area is large-respiratory distress, anxiety, hypoxia
Prevention of Atelectasis
Frequent turning and immobilization
Deep breathing every 2 hours
coughing exercises, suctioning, aerosol therapy, chest physiotherapy
Treatment for Atelectasis
Strategies to improve ventilation
Remove secretions
Pneumonia types
- Aspiration-food
- Inhalation-chemicals, fumes
- Hematogenrous-carried by blood
- bacterial
- viral
- fungal-bird poop
- parasites
- Opportunistic-HIV
- Pneumocyctic carni pneumonia (PCP)
- Lesionares-cooling towers and fountains
- winter-inside, not outside
Pneumonia
- Obstruction of bronchioles
- Decreased gas exchange
- Increased Exudate
- Cough
- fever
- tachycardia/tachypynea
- dyspnea-resp distress
- pleural pain
- decreased breath sounds-crackles, snoring, wheezing
- dull percussion
Pus
WBC eating bacteria
Pneumonia etiology
Variety of aspirated organisms
-Organism dependent on whether community acquired in previously healthy pt (more likely streptococcus)
Community acquired pneumonia
in pt with depressed pulmonary defenses such as chronic bronchitis (more likely Klebsiella or Pseudomonas spps)
Hospital acquired pneumonia
Within 2 days of adult community acquired.
After 2 days=hospital acquired
