Respiratory Flashcards
What is ventilation?
The exchange of air between the lungs and the external atmosphere so oxygen can be exchanged for CO2 in the alveoli
What is diffusion?
The exchange of gases (O2 and CO2) between the lungs and the blood
What is perfusion?
The passage of fluid through the circulatory system to organs in the body
What is normal ventilation?
Normal transfer of oxygen into the lungs and transfer of carbon dioxide through the blood
What is respiratory failure?
A condition that occurs as a result of one or more diseases involving the lungs or other systems. Pathophysiological condition affecting lung function, O2 delivery, cardiac output or the baseline metabolic state
What is type 1 respiratory failure?
Failure of oxygenation resulting in hypoxia with normal PaCo2
What is type 2 respiratory failure?
Failure of ventilation resulting in both hypoxemia and hypercapnia
What is hypoxemia?
Normal PaCO2
Decreased Pao2
Decreased Sao2
Poor oxygenation of the blood
What is hypercapnia?
Increased PaCO2
pH over 7.35mmHg
Failure of ventilation and insufficient CO2 removal
What are examples of hypoxemia?
Pneumonia, Shock, Pulmonary edema, Asthma, PE, Pneumothorax
What are examples of hypercapnia?
Asthma, COPD, Sedative and or opioid overdose, Brain stem infarction,
What are some signs and symptoms of respiratory failure?
Sudden development or chronic
Gradual change in Pao2 and PaCo2 - compnensation
What would be the expected signs and symptoms patients would exhibit as their respiratory function decreased?
Restlessness
Paradoxical breathing
Change in manner of speech (sentences to jumbled up words)
Respiratory rate (Change from fast to slow)
Posture,
Air hungry
Accessory muscle use
What is ARDS?
High mortality rate
Sudden and progressive form of ARF where the alveolar capillary interface becomes damaged and more permeable. Fluid containing proteins fills alveoli resulting in severe dyspnoea and hypoxemia refractory to supplemental O2.
Causes an inflammatory chain reaction
What is the treatment for ARDS?
Intubation & mechanical support Oxygen Circulatory support Adequate fluid volume Nutritional support ABG monitoring Continuous vital sign monitoring –Art line, cardiac monitor, SV02 Positioning in bed
What is pneumonia?
An acute inflammation of the lung parenchyma with associated symptoms.
How do organisms reach the lung?
Aspiration of normal flora nasopharynx or oropharynx
Inhalation of microbes
Haematogenous spread from primary infection elsewhere.
What are the types of pneumonia?
Bacteria Virus Mycoplasma organism Fungi Parasite Chemical Community (CAP) Medical care acquired (MCAP)
What are the three forms of MCAP?
Hospital (HAP) - 48 hrs or greater after hospitilisation
Ventilator (VAP)
Healthcare (HCAP)
Main symptoms of pneumonia?
High fever Chills Cough with sputum or phlegm Shortness of breath Pleuritic chest pain Fatigue Muscle ache Headache Appetite loss Low BP High HR Nausea, vomiting Pain
What is CURB-65?
C- confusion
U- BUN (Greater than 19.6 mg/dL)
R- Respiratory rate (30 or greater breaths/min)
B- BP (SBP less than 90, DPB less than 60)
65- Patient age is 65 or older.
What are some subjective nursing assessment for patient with acute resp, infection
Past health history
Medications
Surgery or other treatment
Functional health patterns
What are some objective nursing assessments for patient with acute resp. infection?
General Respiratory Cardiovascular Neurological Possible diagnosis findings
What are some diagnositc studies for pneumonia?
History and physical examination CXR Gram stain sputum Sputum culture ABG's Blood cultures (if fever present) FBC and Lytes
Collaborative care for pneumonia?
Appropriate antibiotic therapy Increased fluid intake/IVF Limited activity and rest Antipyretics Analgesics O2 therapy - SPo2/ABG dependent Chest physiotherapy Nutritional therapy and hydration
What are interventions foe pneumonia?
O2 therapy Mobilisation of secretions Effective coughing and positioning Hydration and humidification Chest physiotherapy Airway suctioning Drug therapy Relief of bronchospasm Reduction of airway inflammation, pulmonary congestion Treatment of pulmonary infections Reduction of anxiety, pain and agitation Medical supportive therapy Treating the underlying cause Maintaining adequate cardiac output Maintaining adequate hemoglobin concentration Nutritional therapy
What is the early phase of asthma?
Peak is 30-60 min
What is the late phase of asthma?
Can recur 4-6 hours after the early phase
What happens during an asthma attack?
Bronchospasm Vascular congestion Oedema formation Mucus secretion Impaired mucocilliary function Thickening of airway walls Leads to Bronchial hyper-responsiveness and airway obstruction
When do severe and life-threatening asthma exacerbation occur?
Dysponeic Speaks in words not sentences Sitting forward to maximise diaphragmatic movement with prominent wheezing Respiratory rate greater than 30 Accessory muscles in neck are straining Patient is agitated
What is step 1 to treating asthma?
SABA as required
What is step 2 to treating asthma?
Low-dose ICS
LTRA
Theophyllin
What is step 3 to treating asthma?
Low dose ICS + LABA
Medium-dose ICS
Low dose ICS + LTRA/theophyllin
What is step 4 to treating asthma?
Medium dose ICS + LABA
Medium dose ICS + LTRA/theophyllin
What is step 5 to treating asthma?
High dose ICS + LABA
Consider omalizumab for patients who have allergies
What is step 6 to treating asthma?
High dose ICS + LABA + oral corticosteroid
Consider omalizumab for patients who have allergies.
What is pursed lipped breathing?
Helps prolong exhalation Prevents collapse of bronchioles Prevent air trapping Slows respiratory rate Inhale slowly through the nose and exhale slowly three times and more through pursed lips.
What is Arterial Blood Gas (ABG)?
Blood sample taken from an artery by a special syringe and needle
Measures acidity (pH)
Measures levels of oxygen (pO2) and carbon dioxide (pCO2)
Measures how well lungs are functioning
Performed by Dr’s or advanced practice nurses
What are the ABG components?
pH PaO2 PaCO2 HCO3 SaO2
What is normal pH?
Acid Alkaline
What is normal PaO2?
Hypoxemia Over-oxygenated.
What is normal PaCO2?
Alkaline, Hypocapnia Hypercapnia, Acid
What is normal HCO3?
Acid, Metabolic acidosis Metabolic alkalosis, Alkalosis
What is normal SaO2
Low saturations
What happens in acid conditions of the body?
Presence of ketoacids (ketones)
Lactic acids
Hydrochloric acids
What happens in alkaline conditions of the body?
A result of several metabolic processes
Ingestion of too much antacids
Prolonged D&V’s, gastric suctioning
Some diuretics, hypokalemia, hypomagnesemia, laxative abuse
What are the types of buffers?
Buffer System (chemical) - most rapid regulation
Respiratory Buffer - controls CO2, rapid regulation
Renal Buffer - controls bicarbonate, slowest regulation
What is the main extracellular buffer?
Bicarbonate - carbonic acid buffer
What is pH?
Measures acidity or alkalinity of a solution which depends on the number//concentration of H+ ions
Higher H+ = acidosis
Lower H+ = alkalosis
How to interpret an ABG result?
Focus on pH, PaCO2 and HCO3
1: check each component against it’s normal value
2: assess the PaCO2 to determine the primary problem - respiratory or metabolic
3: assess the HCO3 to determine the type of problem by matching pH with PaCO2 and HCO3
What are the ABG indications of respiratory acidosis?
pH less than 7.35
CO2 greater than 45
What causes respiratory acidosis?
Obstruction of gas exchange or hypoventilation
Severe pneumonia, pulmonary oedema, asthma
Impaired mechanics of breathing
What are the symptoms of respiratory acidosis?
H/A, blurred vision, restlessness, confusion, lethargy, dyspnea,
tachycardia, respiratory distress, shallow resps, convulsions, coma
What are the ABG indications for respiratory alkalosis?
pH greater than 7.45
CO2 less than 35
What causes respiratory alkalosis?
Hyperventilation, pain, fear, anxiety, leads to elimination of lots of Co2 (hypocapnia) being blown off by tachypnea
What are the ABG indications for metabolic acidosis?
pH less than 7.35
HCo3 less than 22
What are the causes of metabolic acidosis?
Not enough base or alkali in the blood and too much acid, shock, DKA, renal failure, diarrhoea, diuretics, certain drugs
What are the manifestations of respiratory alkalosis?
Dizziness, confusion, paraesthesia, convulsions, restlessness, spasms
in fingers/toes, tetany, coma
What are the manifestations of metabolic acidosis?
H/A, lethargy, Kussmaulresps, N&V, diarrhoea, arrhythmias, coma,
death
What are the ABG indications for metabolic alkalosis?
pH greater than 7.45
HCo3 greater than 26
What are the causes for metabolic alkalosis?
Excess base/bicarbonate or too little acid, excessive antacids, gastric suctioning, excessive vomiting
What are the manifestations of metabolic alkalosis?
Dizziness, lethargy, weakness, muscle cramps & twitching, cramps,
tetany, shallow & slow resps, tachycardia, coma
