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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
Q

How can you tell that someone has had chronic bronchitis for a while?

A 
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
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25
Q

What are the complications of COPD?

A 
Cor Pulmonale
Secondary polycythemia
Acute exacerbations
Acute resp failure
Depression and anxiety
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26
Q

Why polycythemia in COPD?

A

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)

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27
Q

What medications are used for COPD?

A

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

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28
Q

What are nursing interventions for nutrition with someone dealing with COPD?

A 
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
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29
Q

What are nursing interventions with COPD?

A 
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
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30
Q

What are cardiac signs of COPD?

A

Enlarged heart
JVD
Edema
Increased cap refill time

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31
Q

What is hypoxemic respiratory failure?

A

PaO2 is less than 60 on 60%or more O2

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32
Q

What is PaO2?

A

Arterial O2, the saturation of hemoglobin

33
Q

What is hypercapnic respiratory failure?

A

When PaCO2 is greater than 45 and pH is less than 7.35mmHg

34
Q

What is a shunt?

A

When blood exits the heart without having participated in gas exchange.

35
Q

What is epiglottitis?

A

Inflammation of the epiglottis. Covers trachea when swallows

36
Q

How is epiglottitis treated?

A

It is bacterial, antibiotics

Maybe corticosteroids

37
Q

What are the nursing considerations with epiglottitis?

A 
Protect the patients airway!
Nothing by mouth!
No exams,
IV fluids
Emergency cart outside door
Droplet precautions
38
Q

What is laryngealtrachealbronchitis (LTB)… Croup

A

Viral, inflammation of tracheal and laryngeal mucosa causes narrowed airway.

39
Q

What are key signs of LTB?

A

Stridor

Retractions, dry seal barking cough, non productive

40
Q

What is the treatment of LTB?

A

High humidity, cool mist
Recimic epinephrine (nebulizer)
Fluids
O2mist tent if need O2

41
Q

What are the nursing considerations for LTB?

A

Rest
Fluids
Humidity

42
Q

What is bronchiloitis?

A

A viral infection caused by RSV

Swollen bronchioles filled with mucus

43
Q

What is the treatment for bronchiloitis?

A

High humidity-thin out secretions
Adequate fluids, check IV or oral if RR and WOB are ok
O2

44
Q

What are the key symptoms of bronchiloitis?

A

URI symptoms with copious amounts of secretions
Mild fever
Wheezing in lower lung fields

45
Q

What are the treatments for bronchiloitis

A 
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
Q

What are some nursing considerations with bronchioloitis?

A

Good hand washing
Contact precautions if possible RSV
Droplet precautions for possible influenza

47
Q

What are the key symptoms of pneumonia?

A

High fever
Productive cough or crackles or rhonchi
Resp distress
Retractions,grunting, nasal flaring,color and smelly secretions

48
Q

What is the treatment for pneumonia?

A 
Antibiotics
O2
Cool mist
Thin out secretions
Tylenol
Chest physiotherapy
49
Q

What are the nursing considerations for pneumonia?

A

Watch closely-resp, and VS
Try to suction it out after coughing it up
Reduce anxiety

50
Q

What does a PPD test show?

A

That a person has been exposed to TB

51
Q

What if the test is negative but we still think the person is positive?

A

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
Q

What happens if someone is PPD test positive?

A

Get a CXR -will show tubercles in lungs if active disease

53
Q

What are symptoms of TB?

A 
Hemoptysis
Febrile
Malaise
Wt loss
No appetite
Night sweats
Chest pain
54
Q

What is the treatment for TB

A

Isoniazid INH

6months to a year

55
Q

What are the nursing considerations for INH?

A 
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
Q

When are TB people cleared?

A

AFB neg.

Need three consecutive cough samples to test negative for acid fast bacillus and not have any symptoms

57
Q

From what sites do pulmonary embolism arise?

A 
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
Q

What are the risk factors for developing a PE?

A 
Immobility
Obesity
Sx with in the last 3 months
Smoking
Medications-estrogen, corticosteroids
Pregnancy-increased blood volume
59
Q

What is virchows triad?

A

Venous stasis
Damage to endothelium
Hyper coagulability

60
Q

What are TNI’s for PE?

A 
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
Q

What can a PE cause? What would you see?

A

Acute cor Pulmonale -rt sided heart failure
JVD, dysrhythmias, edema,
Chest pain
SOB

62
Q

What is non-invasive positive pressure ventilation?

A

BiPAP-bilevel positive airway pressure)

CPAP-continuous positive airway pressure

63
Q

Describe CPAP

A

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
Q

Describe BiPAP

A

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
Q

What are the indications to use noninvasive CPAP or BiPAP

A 
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
Q

When is noninvasive positive pressure ventilation not appropriate?

A

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
Q

What are the problems/complications with BiPAP/CPAP?

A 
Uncomfortable
Impaired communication
Skin problems
Dry,crusty secretions
Get gastric distention at night
68
Q

What is a V/Q mismatch?

A

When there is either good ventilation but poor perfusion or vise versa.

69
Q

What diagnostic tests are preformed to dx a PE?

A

Spiral CT
V/Q scan
D-Dimer
Pulmonary angiography

70
Q

What are physician ordered treatments for PE?

A

Heprin infusion
Embolectomy
Placement of green field filters

71
Q

What management would be helpful in preventing the reoccurrence if another PE?

A

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
Q

What are the risk factors for OSA?

A 
Overweight
Smoking
Hx of COPD
Age
Resp Hx
73
Q

What are signs and symptoms of OSA?

A

Snoring, morning HA
Daytime sleepiness
Difficulty concentrating

74
Q

What complications can arise from OSA?

A

Worsen HTN
Dysrhythmias
Social issues-:{ grumpy

75
Q

How is OSA diagnosed?

A

Patient history

Polysomnography (PSG)- sleep study, measures chest and abdominal movements and airflow

76
Q

What are important teaching instructions for a patient with CPAP or BiPAP?

A

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
Q

What is mechanical ventilation?

A

The process by which room air or oxygen enriched air is moved into and out of the lungs mechanically.

78
Q

What are the complications of mechanical ventilation?

A

Uses positive pressure in the thorax during inhalation, lung tissue can suffer damage and venous return to the heart is reduced.

79
Q

What is negative pressure ventilation?

A

Pressure that pulls the chest wall or body pulled outward for inspiration, reducing intra thoracic pressure. Expiration is passive.

80
Q

What is peep?

A

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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