Respiratory Conditions Flashcards
Central Chemoreceptors
sense changes in pH (increased CO2) of CSF
Peripheral Chemoreceptors
Sense changes in paCO2 but primarily sensitive to PaO2
PaO2 and normal range
Partial pressure of oxygen. The diffused oxygen in the arteries and arterioles. Very sensitive indicator of gas exchange impairment. Indicator of oxygen availability in blood.
Want it between 60-100
Perfusion
Exchange of gasses in the lungs
Ventilation
Air entering the lungs and respiratory tract
Most important cause of pulmonary artery constriction is…
Low oxygen (pulmonary hypotension)
Respiratory Defense Mechanisms
- Filtration of air
- Mucociliary escalator
- IgA antibodies
- Cough reflex
- Reflex bronchoconstriction
- Alveolar macrophages
Diagnostic Studies for Respiratory Disorders (PVAX)
P - pulmonary function tests
V - ventilation/perfusion scan
A - arterial blood gas
X - chest X-ray
Arterial Blood Gas (ABG)
- Assess for hypoxemia, hypercapnia, respiratory acidosis
Ventilation/perfusion (V/Q) scan
- for diagnosis of PE (pulmonary embolism)
Chest X-ray
Enlarged airways & check for pneumonia
Pulmonary Function Tests
- Spirometry
- Forced spirometry
- Peak flow meter
- Lung volume test
FVC
Forced vital capacity. Measuring the vital capacity that an individual can expire in one breath
FEV1
Forced expiratory volume in 1 second
SaO2
Oxygen saturation. Percentage of available binding sites on hemoglobin that are bound with oxygen in arterial blood.
normal values 95-100%
Hypoxia
Reduced level of tissue oxygenation. Can be due to defective delivery of oxygen or defective utilization of oxygen by the tissue.
Hypoxemia
Decrease in the partial pressure of oxygen in the blood.
Hypercapnia
Elevated CO2 in the blood
Oxygen-hemoglobin dissociation curve
- relationship between SaO2 and PaO2
- tells us our oxygen saturation and how a condition impacts our bodies way of releasing oxygen
What is Atelectasis and when is it common
Collapse of alveoli or lung tissue common after surgery
Those at risk for atelectasis
- Older adults
- Obese
- Bedridden
- Smoking hx
How do nurses prevent atelectasis (main goal)
- Frequent position changes
- early ambulation
- DB&C
- Incentive spirometry
- Pain meds, with caution (can lead to respiratory depression)
Treatment of underlying causes of Atelectasis
- O2 administration
- Postural drainage
- physiotherapy
- Tracheal suctioning
What is pneumonia
- acute infection of lung “paranchyma” caused by a microbial agent
- associated with a marked increase in interstitial fluid & alveolar fluid
- leading cause of death and hospitalization in older people and people with chronic disease
Predisposing Factors for Pneumonia (6)
- Older adults
- Smoking
- Bedrest
- Intubation
- People with HIV (immunocompromised)
- Upper respiratory tract infection
Types of Pneumonia (7)
- Lobar
- Lobular of Bronchopneumonia
- Community acquired
- Hospital acquired
- Fungal
- Aspiration
- Opportunistic
Lobar Pneumonia
Consolidation of one lobe and of one lung
Lobular of Bronchopneumonia
Patchy consolidation throughout the lung
Community-Acquired Pneumonia
- Streptococcus pneumonia, mycoplasma, mycobacterium tuberculosis, legionella, chlamydia, viral
Hospital-Acquired Pneumonia
- Pseudomonas, Enterobacter, S. aureus, MRSA, S. pneumonia
Clinical Manifestations of Pneumonia
Green/yellow sputum, fever, shaking, chills, hemoptysis, pleuritic chest pain, headache
Older adults: confusion, lower body temp
Diagnostic tests
chest x-ray
Sputum C&S provides diagnosis of specific bacteria or virus causing pneumonia
Subjective Data Pneumonia
health history
Symptoms
Fever/weakness/fever/chills
Objective Data Pneumonia
General Respiratory status Cardiovascular and neurological Blood work VS
Nursing Diagnosis Pneumonia (5)
- Ineffective breathing pattern
- Ineffective airway clearance
- Acute pain
- Imbalance nutrition: less than body requirement
- Impaired gas exchange
Care for Pneumonia (FVANS)
F - fluid & electrolyte management V - vaccines A - antibiotic therapy N - Nutrition support S - Supportive measures (oxygen, analgesics, antipyretics, bronchodilators, postural drainage, chest physiotherapy, suctioning)
What is Tuberculosis
- bacterial infection that usually involves the lungs
- caused by mycobacterium tuberculosis
- kills more people worldwide than any other infectious disease
How is TB spread?
- Spread via airborne droplets
- Not highly infectious
- Spread via lymphatic system and grows in favourable environments: Kidneys, adrenals, bones, brain, lungs
TB in its latent phase
- Majority of people have mount effective immune response to encapsulate TB organisms, preventing primary infection from progressing disease
- reactivation of TB can occur if host’s defense mechanisms become impaired
Clinical Manifestations of TB (Systemic)
- fatigue, malaise, anorexia, weight loss, low-grade fevers, night sweats, chest pain (dull or tight), hemoptysis
Acute manifestations of TB
- high fever, chills, generalized flulike symptoms, pleuritic pain, productive cough
Diagnostic Studies for TB
TB skin test - positive reaction 2-12 weeks after initial infection
Chest X-ray
Bacteriological studies - sputum test for acid-fast bacilli (3 consecutive samples)
Collaborative Care for TB
- antimicrobial drugs are mainstay of treatment. aggressive. combination of 4 drugs.
- follow up bacteriological studies & chest x-ray. (sputum samples weekly then monthly)
- long-term follow up to ensure adherence to treatment regimen.
- follow up for 12 months after completion of therapy
Nursing management of TB
- place in respiratory isolation in negative-pressure room
- N-95 mask
- four drug therapy
- teach patient to cover mouth and nose when producing sputum
- careful hand washing
- identification of contacts to determine possibility of infection
Four Drugs for TB (PRISE)
- Pyrazinamide
- Rifampin
- Isoniazid
- Streptomycin & Ethambutol
