Respiratory Diagnostics and Treatments Flashcards
Normal lung sounds
Bronchial (tracheal)
blowing sounds (air blowing through hollow pipe)
Normal lung sounds
Bronchovesicular sounds
heard over the main stem bronchi on either side of the sternum and on posterior chest between the scapula
Normal lung sounds
vesicular sounds
gentle rustling sounds heard over lung areas except major bronchi (bronchioles, alveoli)
Abnormal lung sounds
Crackles (fine/coarse)
bubbling in water or sometimes sounds like velcro
Abnormal lung sounds
wheezes (rhonchi)
musical or whistling sound (high pitch)
Abnormal lung sounds
pleural friction rub
grating sound or sandpaper rubbing together
Abnormal lung sounds
stridor
foreign body airway obstruction
Abnormal lung sounds
egophony
sounds like a bleating goat. “eee” sounds like “ehh”
typically heard in pleural effusion or pneumonia
Bronchophony
used to test suspected consolidation by having pt say “ninety-nine”
postural drainage
uses gracity to drain mucus from lungs by positioning body specific ways (laying prone)
pursed-lip breathing
helps slow breathing and inhale/exhale more air
diaphragmatic breathing
promotes lung expansion by taking deep, full breaths. Decreases work of breathing, oxygen demanda, and uses less effort and energy to breathe.
Sputum
samples by expectoration, tracheal suctioning, bronchoscopy, or induction
Acid-Fast Stain
tests for TB
Mantoux test
Tests for TB by injecting PPD intradermally.
Indurations > 15mm are positive!
Indurations > 5mm in compromised or “at-risk” populations are positive
(if positive send sputum specimen to check for AFB for 2-3 consecutive days)
Bronchoscopy
NPO 6-12hrs before
Bronchoalveolar lavage (BAL): 30mL of saline injected via scope and aspirated to cells
Asses lesions and pneumothorax post op
Pulmonary function test
No bronchodilators 6 hours before for accurate results of patient’s baseline
Peak flow meter
used for asthma, COPD
V/Q Scan
- Used for patients allergic to contrast dyes
- patients breathe in air with radioactive isotopes to visualize alveoli and ventilation is assessed
- diminshed radiactivity = lack of perfusion or airflow
- ventilation without perfusion suggests PE
Spiral CT also diagnoses PE
Thoracentesis
- insertion of large-bore needle through chest into pleural space to obtain specimens, remove pleural fluid, or instill meds into pleural space
- patient should be position at bedside seated upright
- deep breaths AFTER procedure
- Observe for pneumothorax
Chest Tubes
- Management: Keep tubing below cherst, secure connections, don’t “strip”, “milk” per MD prder, notify MD if output > 100mL/hr, DON’T CLAMP, turn, cough, deep breathe and use IS to prevent pneumonia
- Monitor for leaks, continuous bubbline in water seal chamber = leak, intermittent bubbling during exhalation coughing or sneezing is normal,rising and falling of water (tidaling) signals intrapleural pressure changes during inspiration and expiration (disappears as lungs reexpand), if system breaks put distal end in 2cm sterile water
Tracheostomy
- indication: bypass upper airway obstruction (i.e. tumor, mainly neuro), long term ventillation, permit oral intake and speech for pt’s with long-term vent needs
- Care: OXYGENATE BEFORE SUCTION, clean stoma, change ties, inner canula care, have obturator ready at bedside
Invasive mechanical ventilation
life-saving used with artifical airways (ET or Trach)
Noninvasive ventilation
maintain positive airway pressure and improve alveolar veentilation (BiPAP, CPAP)
