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Exam 3, Mods 5,6 &7 > Respiratory Acidosis, COPD, Resp. failure And Infections > Flashcards

Respiratory Acidosis, COPD, Resp. failure And Infections Flashcards

0
Q

What assessment data is seen with respiratory acidosis?

A 
Change in LOC/HA
Progressive sleepiness as CO2 levels increase
Dyspnea
Rapid shallow breathing
Tachycardia
Dysrhythmias 
Hypertension
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1
Q

What are the diagnostic findings for respiratory acidosis?

A 
PH-below 7.35
PaCO2- above 45mmHg
HCO3- normal
PaO2-low
Hyperkalemia
Hypercalcemia
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2
Q 
What are the normal levels of:
PH
PaCO2
HCO3
PaO2?
A

pH- 7.35-7.45
PaCO2- 35-45
PaO2- 75-100
HCO3- 24-30

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3
Q

What does respiratory compensation with hypoxemia look like?

A

PaCO2 is high
pH-low
HCO3- normal
PaO2- is low

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4
Q

What is the relationship between acid-base compensation and correction?

A

Acidosis can be temporary corrected by the medical team by administering NaHCO3.
Compensation occurs with in the body through the effects of the respiratory and renal systems.

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5
Q

What is pulmonary toilet?

What is effective coughing?

A

Chest physiotherapy
Effective cough= augmented coughing
Huff coughing
Staged coughing

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6
Q

What are the nutritional needs of a patient with respiratory acidosis?

A

Parenteral nutritional support
Enteral nutritional support
Adequate calories and protein
May need to limit carbs= in patient who retains CO2

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7
Q

What are the therapeutic nursing interventions for a person with respiratory acidosis?

A

Assess LOC
Monitor adequacy of ventilation (ABG’s, WOB,SPaO2) admin,O2 prn
Monitor cardiovascular status
Adequate fluids to liquefy secretions and maintain cardia output
Position pt HOB up
Encourage to cough/augment cough/suction
Admin and monitor response to medical therapy

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8
Q

What are the signs/symptoms of emphysema?

A 
50-70% of lung function is lost before symptoms
Barrel chest d/t hyperinflation 
-prolonged expiration
- wheezing and decreased breath sounds
-distant heart sounds
Hyper-resonance
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9
Q

Later in the dz process of emphysema what do you see?

A

Increased resp rate
Use of accessory muscles
Cyanosis
Peripheral edema

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10
Q

What are the symptoms od chronic bronchitis?

A

Associated with frequent resp. Infections (such as acute bronchitis or (pneumonia)
-rhonchi or wheezing
Concurrent cor-pulnonale
Edema associated with right sided heart failure

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11
Q

How is COPD diagnosed?

A

Pulmonary function tests (PFT)
CXR
-small heart and flat diaphragm in emphysema
-increased bronchial markings in chronic bronchitis.
EKG to r/o right ventricular hypertrophy
ABG’s, Hgb/HCT to for polycythemia

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12
Q

What are the techniques of pursed lip breathing (PLB)?

A

Inhale deeply and slowly through nose- breathing out through pursed lips. Relax face muscles without puffing cheeks( like whistling) while you are exhaling making exhale 3x longer than inhale

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13
Q

Why do PLB?

A

Maintains positive pressure and abdominal breathing which slows the RR and encourages deeper breaths. Prolongs exhalation and thereby prevent bronchiolar collapse and air trapping.

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14
Q

How often should PLB be done?

A

8-10 repetitions of PLB 3-4x/day.

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15
Q

How is postural drainage and cupping preformed?

A

Whatever lung you want to clear has to be superior, then drain and sit up.
If bases need to be cleared use trendelenburg position, then sit up to cough.

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16
Q

What is the purpose of postural drainage?

A

Drain each segment toward larger airways. If everything is full start at the top of the lungs, cup than drain and work your way down,

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17
Q

When is cupping contraindicated?

A

Over breast tissue
Head/neck/back/chest instability and/or injuries
Percussion- anatomical deformities, severe spasticity, mental limitations
Postural drainage- chest trauma, hemoptysis, heart dz, PE, head injury

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18
Q

What is done before chest physiotherapy?

A

Aerosolized bronchodilators and hydration therapy are usually used before postural drainage

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19
Q

When is chest physiotherapy performed?

A

Q 4hr in acute situation
2-4x/day.
Planned either 1hr before meals or 3hrs after meals

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20
Q

What does a flutter valve do?

A

Provides pt with positive expiratory pressure for pts with mucous production. When exhales through flutter valve the metal ball causes oscillations in the airway to loosen mucous.

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21
Q

Describe augmented breathing.

A

Place palm of hand on pts abdomen below xiphoid.
As pt ends a deep inspiration and begins the expiration, move your hands for fully downward increasing abdominal pressure and facilitating cough.

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22
Q

What is huff coughing?

A

Inhale slowly through mouth, breath deep, hold breath for 2-3 sec.
Forcefully exhale quickly saying huff..refrain from coughing till mucous is in large airway.
Rest 5-10 breaths, repeat for 3-5 cycles.

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23
Q

What is staged coughing?

A

Sitting position, breath 3-4 times in and out of mouth and cough while bending forward and pressing a pillow inward against diaphragm.

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24
How can you tell that someone has had chronic bronchitis for a while?
``` Cough daily Dyspnea initially with exertion then while at rest Barrel chest-trapped CO2 Wheezing and chest tightness Weight loss and anorexia Fatigue Hypoxemia Hypercapnia then respiratory acidosis later in dz Polycythemia and cyanosis ```
25
What are the complications of COPD?
``` Cor Pulmonale Secondary polycythemia Acute exacerbations Acute resp failure Depression and anxiety ```
26
Why polycythemia in COPD?
Compensatory response Chronic hypoxia causes increased erythropoietin production from the kidneys More RBC's become available to transport the less available O2=high HCT and plethora (ruddy complexion)
27
What medications are used for COPD?
Bronchodilators and inhaled corticosteroids Long acting-advair(fluticasone/salmeterol),spiriva (tiotropium bromide, inhaled powder) symbicort. Short acting-combivent( ipratropium and albuterol) Rescue and maintenance- MDI, DPI, nebulization
28
What are nursing interventions for nutrition with someone dealing with COPD?
``` Rest before meals Small, frequent meals Eat high calorie foods first Liquid or blenderized foods High calorie,high protien diets with supplementation Bronchodilator before meals Sodium restriction if heart failure Weight checks ```
29
What are nursing interventions with COPD?
``` Breathing retraining, Effective coughing Chest physiotherapy Percussion/vibration Postural drainage Flutter mucus clearance device Small frequent high calorie meals Stay active but go at own pace-resp. Muscle strenght Use bronchodilators or nebulizer Encourage fluids to thin secretions ```
30
What are cardiac signs of COPD?
Enlarged heart JVD Edema Increased cap refill time
31
What is hypoxemic respiratory failure?
PaO2 is less than 60 on 60%or more O2
32
What is PaO2?
Arterial O2, the saturation of hemoglobin
33
What is hypercapnic respiratory failure?
When PaCO2 is greater than 45 and pH is less than 7.35mmHg
34
What is a shunt?
When blood exits the heart without having participated in gas exchange.
35
What is epiglottitis?
Inflammation of the epiglottis. Covers trachea when swallows
36
How is epiglottitis treated?
It is bacterial, antibiotics | Maybe corticosteroids
37
What are the nursing considerations with epiglottitis?
``` Protect the patients airway! Nothing by mouth! No exams, IV fluids Emergency cart outside door Droplet precautions ```
38
What is laryngealtrachealbronchitis (LTB)... Croup
Viral, inflammation of tracheal and laryngeal mucosa causes narrowed airway.
39
What are key signs of LTB?
Stridor | Retractions, dry seal barking cough, non productive
40
What is the treatment of LTB?
High humidity, cool mist Recimic epinephrine (nebulizer) Fluids O2mist tent if need O2
41
What are the nursing considerations for LTB?
Rest Fluids Humidity
42
What is bronchiloitis?
A viral infection caused by RSV | Swollen bronchioles filled with mucus
43
What is the treatment for bronchiloitis?
High humidity-thin out secretions Adequate fluids, check IV or oral if RR and WOB are ok O2
44
What are the key symptoms of bronchiloitis?
URI symptoms with copious amounts of secretions Mild fever Wheezing in lower lung fields
45
What are the treatments for bronchiloitis
``` High humidity, Sit them up O2if needed- mist tent if need(frequent changes of bedding and clothes to prevent hypothermia) Can nebulize with epi Chest physiotherapy Decrease activity Nebulize with saline ```
46
What are some nursing considerations with bronchioloitis?
Good hand washing Contact precautions if possible RSV Droplet precautions for possible influenza
47
What are the key symptoms of pneumonia?
High fever Productive cough or crackles or rhonchi Resp distress Retractions,grunting, nasal flaring,color and smelly secretions
48
What is the treatment for pneumonia?
``` Antibiotics O2 Cool mist Thin out secretions Tylenol Chest physiotherapy ```
49
What are the nursing considerations for pneumonia?
Watch closely-resp, and VS Try to suction it out after coughing it up Reduce anxiety
50
What does a PPD test show?
That a person has been exposed to TB
51
What if the test is negative but we still think the person is positive?
Do a booster= a second PPD on top of the first or if pts immune system is compromised then test with yeast or mumps because everyone reacts to that. If they test positive for that then they are ok.
52
What happens if someone is PPD test positive?
Get a CXR -will show tubercles in lungs if active disease
53
What are symptoms of TB?
``` Hemoptysis Febrile Malaise Wt loss No appetite Night sweats Chest pain ```
54
What is the treatment for TB
Isoniazid INH | 6months to a year
55
What are the nursing considerations for INH?
``` Check liver function test Check hearing, can get tinnitus Check vision-can get optic neuritis No alcohol for full treatment Binds to aluminum based antacid Can't have tyramine- red wine, chocolate, cheese, deli meat ```
56
When are TB people cleared?
AFB neg. Need three consecutive cough samples to test negative for acid fast bacillus and not have any symptoms
57
From what sites do pulmonary embolism arise?
``` Femoral or iliac veins Right side of the heart with a fib Pelvic veins esp. After sx or childbirth Central venous catheter and Cardiac pacing wires ```
58
What are the risk factors for developing a PE?
``` Immobility Obesity Sx with in the last 3 months Smoking Medications-estrogen, corticosteroids Pregnancy-increased blood volume ```
59
What is virchows triad?
Venous stasis Damage to endothelium Hyper coagulability
60
What are TNI's for PE?
``` O2 HOB up Continuous O2sat Neuro check TCDB to prevent atelectasis Pain meds Bed rest-O2 demand increases as you move..no sudden movements ```
61
What can a PE cause? What would you see?
Acute cor Pulmonale -rt sided heart failure JVD, dysrhythmias, edema, Chest pain SOB
62
What is non-invasive positive pressure ventilation?
BiPAP-bilevel positive airway pressure) | CPAP-continuous positive airway pressure
63
Describe CPAP
A ventilator mode in which a constant positive pressure is delivered to the airway during inspiration and expiration. Administered via a tight-fitting face or nasal mask or endotracheal/tracheal tube
64
Describe BiPAP
A ventilator mode that provides two level of positive pressure support, higher during inspiration and lower during expiration. Administer via a tight-fitting face mask
65
What are the indications to use noninvasive CPAP or BiPAP
``` More than 15 apnea events per hour-major 5-10 apnea events per hour-mild Morning HA Can be used to ween off ventilator OSA Chronic respiratory failure Severe COPD ```
66
When is noninvasive positive pressure ventilation not appropriate?
Absent respirations--Have to breath on own!! Excessive secretions Decreased LOC High O2 requirements Facial trauma They have to be able to operate equipment, recognize when there is a problem with it Understands how it fits
67
What are the problems/complications with BiPAP/CPAP?
``` Uncomfortable Impaired communication Skin problems Dry,crusty secretions Get gastric distention at night ```
68
What is a V/Q mismatch?
When there is either good ventilation but poor perfusion or vise versa.
69
What diagnostic tests are preformed to dx a PE?
Spiral CT V/Q scan D-Dimer Pulmonary angiography
70
What are physician ordered treatments for PE?
Heprin infusion Embolectomy Placement of green field filters
71
What management would be helpful in preventing the reoccurrence if another PE?
Coumadin-need INR levels Lovanox Heprin shots Teaching- risk for bleeding, safety, need to test INR, protect from sudden changes-standing, mechanical forces- increase in cardiac demand
72
What are the risk factors for OSA?
``` Overweight Smoking Hx of COPD Age Resp Hx ```
73
What are signs and symptoms of OSA?
Snoring, morning HA Daytime sleepiness Difficulty concentrating
74
What complications can arise from OSA?
Worsen HTN Dysrhythmias Social issues-:{ grumpy
75
How is OSA diagnosed?
Patient history | Polysomnography (PSG)- sleep study, measures chest and abdominal movements and airflow
76
What are important teaching instructions for a patient with CPAP or BiPAP?
Decrease weight Exercise more Stop smoking Control BP Don't wear Vaseline or petroleum jelly-break down plastic Sleep sidelying No alcohol-decreases respiration and decreased cardiac output
77
What is mechanical ventilation?
The process by which room air or oxygen enriched air is moved into and out of the lungs mechanically.
78
What are the complications of mechanical ventilation?
Uses positive pressure in the thorax during inhalation, lung tissue can suffer damage and venous return to the heart is reduced.
79
What is negative pressure ventilation?
Pressure that pulls the chest wall or body pulled outward for inspiration, reducing intra thoracic pressure. Expiration is passive.
80
What is peep?
Pressure applied to the patients airway at the end of expiration only. Helps keep alveoli from collapsing during exhalation.

Exam 3, Mods 5,6 &7 (2 decks)

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