Respiratory Exam Flashcards
1
Q
What organs make up the upper respiratory tract?
A
1) Nose
2) Mouth
3) Pharynx
4) Adenoids
5) Tonsils
6) Epiglottis
7) Larynx
8) Trachea
2
Q
What organs make up the lower respiratory tract?
A
1) Bronchi
2) Bronchioles
3) Alveolar ducts
4) Alveoli
3
Q
What part of the respiratory tract does gas exchange take place in?
A
Lower respiratory tract
4
Q
What part of the respiratory tract involves the introduction of oxygen?
A
Upper respiratory tract
5
Q
What is the purpose of cilia in the upper respiratory system?
A
Helps move mucus through contaminants & trap foreign substances to prevent them from moving into the lower respiratory tract
6
Q
What is the purpose of the nose?
A
1) Brings in air
2) Wams & moisturizes air
3) Filter particles with nose hairs
7
Q
Where is the pharynx located and what does it connect?
A
-Located behind the nose and mouth
-Connects them both to esophagus
8
Q
What causes the cough reflex?
A
The carina
9
Q
What is the organ located right under the pharynx that is a flap behind the tongue that closes over the larynx during swallowing to prevent aspiration
A
Epiglottis
10
Q
Where does the 5 in long trachea bifurcate?
A
At the carina – split located at 2nd rib
11
Q
True or false:
The left bronchus is shorter, wider, and straighter than the left
A
False- the right is shorter, wider, and straighter
**If you aspirate, more likely to occur in right lung because of this
12
Q
What organ in the lower respiratory tract participates in gas exchange?
A
Alveoli
13
Q
What happens if there is fluid in the alveoli (pulmonary edema)?
A
Decrease in gas exchange
14
Q
Name the chest wall lining:
Outer lining, lines chest wall, has a lot of nerves which increases risk for pain
A
Parietal pleura
15
Q
Name the chest wall lining:
Inner layer, on top of each lung
A
Visceral pleura
16
Q
Name the chest wall lining:
In between parietal and pleura, normally has some fluid to keep membranes from rubbing
-Aids in lung expansion
-Allows air into lungs and pressure within pleural spaces to help move air out of the lungs
A
Intrapleural space
17
Q
What is the normal volume of fluid for the intrapleural space?
A
25 mL
18
Q
What happens if there is more than 25 mLs of fluid in the intrapleural space?
A
Pleural effusion
19
Q
What is it called when a person has pain with breathing, usually as a result of inflammation of parietal pleura?
A
Pleuracy
20
Q
What are the 2 kinds of blood supply to the pulmonary system?
A
1) Pulmonary blood supply
2) Bronchial blood supply
21
Q
What does the pulmonary blood supply do?
A
1) Helps with gas exchange
2) Takes de-O2 blood from RV to lungs and O2 blood back to LA
22
Q
What does the bronchial blood supply do?
A
1) Provides circulation to pulmonary tissues and smooth muscle around the bronchioles
23
Q
What is the common med given when there is broncho-constriction & air cannot move down into the alveoli, impairing gas exchange?
A
Albuterol (bronchodilator0
24
Q
What regions of the respiratory tract are considered the “anatomical dead space”?
A
Nose/mouth to bronchioles (all the way up until air reaches the bronchioles)
25
For every 500 mL of inhaled gas, how much remains in the dead space?
150 mLs
26
Name the vocab:
Measurement of amount of air taken with each breath
Tidal volume
27
What happens when you sigh?
1) Alveoli stretch
2) Promotion of surfactant secretion
28
Name the vocab:
A lipoprotein that lowers the surface tension in the alveoli
Surfactant
29
What is the role of surfactant?
1) Decreases the tendency of the alveoli to collapse
2) Helps lubricate the alveoli to help them participate in gas exchange or inflation
30
What is atelectasis?
Collapsed, airless alveoli
- AKA "collapsed lung"
***Need to promote spread of surfactant
31
What organ controls the mechanics of breathing?
The diaphragm
32
What controls the motor movement of the diaphragm?
The phrenic nerve
33
What is ventilation?
The mechanical movement of air (diaphragm is a big aide in this)
**Alveolar sacs are filled with inspired air
34
What is respiration?
Gas exchange
35
How does the diaphragm move in gas exchange?
Contracts and moves down to make more room for O2 & lungs to expand
36
Where is the phrenic nerve located?
In the cervical spine (top part) --> C3-C5
37
What happens if someone has an injury at the levels above C3?
Diaphragm will be paralyzed so they will need lifelong ventilation assistance
38
True or False:
Expiration is normally passive
True
39
What happens to expiration in someone who has COPD or exacerbations of asthma?
Expiration becomes more active (muscles are working more than normal for expiration)
40
Why does air move in and out of the lungs?
D/t changes in intra-thoracic pressure
41
What does it mean when it is said that gas moves from atmospheric to intrathoracic?
Air moves from an area of higher pressure to an area of lower pressure
42
Name the vocab:
Transport of oxygen into the blood & CO2 out of the blood & across the capillary membranes until equilibrium is reached
Diffusion
43
What do you need for proper respiratory functioning?
1) Patent airway****
2) Lung tissue that will expand & contract (for ventilation)
3) Musculoskeletal function (for ventilation)
4) Alveoli that can receive O2 & CO2
5) Perfusion of tissues
44
What is the respiratory system controlled by?
Renal, cardiovascular, and neurologic systems
45
What does it mean if someone has ventilation without perfusion?
Have movement of air, but no perfusion (blood not perfusing alveoli)
46
What usually causes ventilation without perfusion?
Blockage of bloodflow (clot) or pulmonary HTN
47
What does it mean if someone has perfusion without ventilation?
Blood cannot participate in gas exchange
48
What causes perfusion without ventilation?
D/t fluid (pneumonia) b/c alveoli cannot be filled with air
49
What does it mean if someone has no ventilation and no perfusion?
The lungs cannot inflate
"Silent unit" -- like pneumothorax
50
Name the vocab:
A measure of the ease of expansion of the lungs (inversely r/t elasticity)
Compliance
51
What happens when you have thin lung tissue, and low amount of elastic tissue?
-Low recoil (seen in COPD)
-Increased compliance (lungs fill up easily)
52
What happens when you have thich/high amounts of elastic tissue?
-Decreased compliance (harder to stretch)
-Increased recoil
53
What can cause decreased lung compliance?
Pulmonary edema or pneumonia
54
True or False:
When compliance is increased, the lungs are more difficult to inflate
False -- when lung compliance is DECREASED the lungs are more difficult to inflate
55
What controls the physical respiration process?
Respiratory center in the brainstem medulla
56
What does the respiratory center in the brainstem medulla respond to?
Mechanical and chemical signals
57
Impulses are sent from the medulla to the respiratory muscles via....
The spinal cord and phrenic nerves
58
Where are central chemoreceptors located?
In the medulla
59
What do chemoreceptors respond to?
Changes in hydrogen ion concentration (when CO2 dissolves in the blood, it becomes a hydrogen ion)
60
What happens when there is high concentrations of hydrogen and CO2 in the blood?
Acidosis -- increases RR & Vt
61
What happens when there is low concentrations of hydrogen and CO2 in the blood?
Alkalosis -- decreased RR and Vt
62
In healthy people, increases in PaCO2 or decrease in pH cause ...
Increased RR -- body trying to flow out excess CO2
63
Where does the drive to breathe come from?
a buildup of CO2
64
Where are mechanical receptors located?
1) Lungs
2) Upper airways
3) Chest wall
4) Diaphragm
65
True or False:
Signals from stretch receptors aid in control of respiration, and prevent over-distention of lungs
True
66
What are the defense mechanisms of the respiratory system?
1) Filtration of air
2) Mucociliary clearance system
3) Cough reflex
4) Reflex bronchoconstriction
5) Alveolar macrophages
67
What does PaO2 (partial pressure of O2) measure?
Amount of pressure exerted on vessel walls from oxygen
68
What are the problems presented with the mucociliary clearance system?
1) Dehydration --> decreases effectiveness b/c it decreases mucus
2) Anesthesia
3) Alcohol --> r/t dehydration
4) Smoking --> can cause paralysis of cilia
69
True or False:
There is no cilia located in the lower respiratory system
True
70
What does the mucociliary clearance system do?
-Located below larynx
-Made up of mucus and cilia
**Can help propel particles out of the respiratory system
71
What do alveolar macrophages do?
Macrophages phagocytize foreign particles that get past the upper respiratory tract
72
What can impair alveolar macrophages?
Smoking
73
True or False:
Some irritants/bacteria that cannot be phagocytized result in inflammation
True
74
Why is it important to ask about weight changes during a subjective assessment?
-Fluid retention d/t HF --> crackles
-If you can't breathe, you may not want to it
-If you are ill, you may not want to eat
75
How does COPD affect protein metabolism?
Can cause muscle breakdown
76
Why is it important to ask during an objective assessment if a patient was taking an ACE inhibitor (--pril)?
Common SE of this med is dry, hacking cough
77
Name the indicator of respiratory disease:
1) D/t constriction in the airway
2) High-pitched noise
3) May have chest tightness d/t constriction
Wheezing
78
What are the indicators of respiratory disease?
1) Dyspnea
2) Wheezing
3) Chest pain
4) Cough
5) Sputum
6) Hemoptysis
7) Voice change
8) Fatigue
79
What causes fatigue in respiratory disease?
Lack of oxygen movement to the blood, leading to decreased perfusion (may be unrelieved with rest)
80
What is hemoptysis?
Coughing up blood
81
When do people with respiratory problems usually complain of pleurisy/chest pain?
Felt with deep breaths r/t inflammation of pleura
82
What is the difference between coughing up blood vs vomiting up blood?
Coughing up blood is more frothy
**Can check pH --> vomiting is more acidic
83
Why do you ask about elimination patterns in a respiratory assessment?
Does your breathing make it difficult for you to get to the toilet?
84
What objective respiratory findings can you inspect in children?
Retractions & use of accessory muscles r/t respiratory depression
85
What does COPD breathing look like upon inspection?
Breathing with pursed lips to prolong expiration
86
Where does cyanosis usually show in children?
Around the mouth
87
What is the definition of AP diameter?
Front to back should be < transverse
88
What is a normal AP diameter?
1:2
89
What does a 1:1 AP diameter indicate?
Barrel chest common in COPD
90
Name the type of breathing pattern:
1) Hard
2) Fast
3) Shallow breathing
Hyperventilation
91
Name the type of breathing pattern:
1) Hard, fast, deep
2) Usually seen to correct acid-base imbalance
3) Sx of DKA to blow off CO2 b/c they are acidic
Kussmaul
92
Name the type of breathing pattern:
1) Breaths are absent for a period of time & then rapid
2) Pts near death, TBI, stroke
Cheyne-Stokes
93
What is crepitus?
Air escaping into subcutaneous tissue
94
How do you feel for fremitus?
Put hands on back and have pt say "99" -- feel for vibrations
95
Would people with pneumothorax/collapsed lung have vibrations (fremitus)?
No
96
How do you test for thoracic expansion?
Hands on their back and have them take a deep breath?
97
What is a normal thoracic expansion?
1 in & symmetric
98
What are normal lung field sounds during percusssion?
Hollow or resonant
99
What does a dull percussion sound over the lungs indicate?
Fluid in lung tissue -- pneumonia
100
How do you listen to breath sounds?
From apex to base
Ladder pattern
101
What are the adventitious breath sounds?
1) Pleural friction rub
2) Crackles (coarse, medium, fine)
3) Rhonchi
4) Wheezing
5) Absent
102
Name the adventitious breath sound:
1) Long in duration
2) Low-pitched
3) Air passing through mucus
4) Heard on inspiration
5) Sounds like blowing a straw in water
Coarse crackles
103
Name the adventitious breath sound:
1) Shorter in duration
2) Sounds like if you take some hair and roll it
Fine crackles
104
What can cause fine crackles?
-Early pulmonary edema
-Pneumonia before a lot of mucus build up
105
Name the adventitious breath sound:
1) Rattle during expiration
2) Low-pitch, continuous
Rhonchi
106
Name the adventitious breath sound:
1) High-pitched, continuous
2) Starts on expiration & then moves to having it on inspiration & expiration
3) seen in COPD
Wheezing
107
What can cause absent lung sounds?
-Pneumothorax
-Pleural effusion
-Lobectomy
108
If you are testing for egophony, what happens if someone has fluid or blood in their lungs and they try to say "EEEEE"
It sounds like they are saying "AAAA"
109
What are early S&S of inadequate oxygenation?
1) Tachypnea
2) Dyspnea on exertion
3) Tachycardia
4) Mild HTN
5) Apprehension/anxiety
6) Restlessness
7) Unexplained confusion
8) Mild fatigue
110
What are late S&S of inadequate oxygenation?
1) Dyspnea at rest
2) Use of accessory muscles
3) Hypotension
4) Cyanosis
5) Cool, clammy skin
6) Lethargy
7) Confusion
8) Diaphoresis
9) Severe fatigue
111
What are the dx studies of respiratory disease?
1) Oximetry
2) Pulmonary function tests
3) Sputum culture
4) CXR or CT
5) Bronchoscopy
6) Thoracentesis
7) Lung biopsy
8) Skin test
9) ABGs
112
Name the dx study of respiratory disease:
1) Utilizes wavelengths of light to measure the saturation of Hgb with oxygen
2) Non-invasive
3) Not the most reliable method
Oximetry
113
What can interfere with oximetry results?
-Nail polish
-Being cold
-Low Hgb (can mask other sx because all hgb may have oxygen, but they could simultaneously have low Hgb)
114
What can you look at to determine if oximetry reading is accurate?
Waveform -- should be symmetrical all the way through
115
Name the dx study for respiratory disease:
1) Evaluates lung volume
2) Exhale into mouthpiece
3) Shows tidal volume and forced vital capacity
Pulmonary function test
116
What are the normal values of a pulmonary function test based on?
-Gender
-Weight
-Height
-Smoking
117
What is normal Vt in a man?
500 mL
118
What is normal Vt in a female?
400 mL
119
What is tidal volume?
Amount of air in and out with normal breathing
120
What is the normal value for FVC?
80% of 5,000 mL
121
What is FVC?
Amount of air forcefully exhaled after max expiration
122
What is FVC useful in determining?
How advanced COPD is
123
What are the 2 ways to obtain sputum culture?
1) Sterile container --> cough and depost expectorated sputum
2) ET/trach tube --> sterile suctioning
124
Name the dx study of respiratory disease:
1) Shows how big lungs are
2) Shows if heart is displaced or enlarged
3) Can show pneumonia
4) Typically 1st line dx study
CXR
125
Name the dx study of respiratory disease:
1) Shows more soft tissue
CT
126
Name the dx study of respiratory disease:
Go into vesel to tell bloodflow & if there is pulmonary embolism
Angiogram
127
Name the dx study of respiratory disease:
1) Can be used for biopsy/collect specimens
2) Can suction mucus plugs
3) Usually involes sedation
Bronchoscopy
128
What does a nurse need to make sure of with a post-op pt of a bronchoscopy?
Return of gag reflex
129
Name the dx study of respiratory disease:
1) Can take a specimen of pleural fluid
2) Use local anesthesia
3) Can be used for biopsy
Thoracentesis
130
What is acid-base balance controlled by?
Respiratory & renal system
131
How do the kidneys try to compensate in respiratory acidosis?
Hold onto more bicarb
132
How does the respiratory system try to compensate in respiratory alkalosis?
Kussmaul respirations to blow off more CO2
133
What are the compensatory mechanisms for acid-base imbalances?
-Chemical buffers
-Respiratory system
-Kidneys
134
What does ABGs tell?
Oxygen status
135
What is the absolute normal pH?
7.40
136
What is the normal range for pH?
7.35 - 7.45
137
What can cause acidic pH?
-Anaerobic metabolism (like DKA)
-CO2 retention
138
What can cause alkolitic pH?
-Loss of CO2 (hyperventilation)
-Hydrogen loss through vomiting
139
What is the normal range for PaCO2?
35-45
140
What regulates PaCO2?
Respiratory system
141
What does PaCO2 measure?
Amount of CO2 dissolved in the plasma
142
How is carbonic acid of PaCO2 formed?
CO2 combines with H2O
143
What causes PaCO2 acidosis (> 45)?
-Respiratory arrest
-Respiratory depression (like w/ narcotic use)
-Trapping of CO2 (like COPD or pneumonia)
144
What causes PaCO2 alkalosis (< 35)?
-Hyperventilation
-Fever
145
What is normal range of PaO2?
80-100
146
What measurement should not be used in the interpretation of ABG because it looks for hypoxemia, but is the most accurate status of oxygenation?
PaO2
147
What is the normal range for HCO3?
22-26
148
What does HCO3 measure?
Amount of bicarbonate in the blood
149
What is HCO3 regulated by?
Kidneys (metabolic)
150
What causes HCO3 acidosis?
-DKA
-Renal failure
-Aspirin use
151
What causes HCO3 alkalosis?
-Antacid use
-Vomiting
-NG suctioning
152
What test is used before getting an ABG?
Allen's test
153
What does a modified Allen's test test?
Only the ulnar artery -- checking for adequate perfusion
154
What does a positive Allen's test mean?
Hand flushes within 5-15 seconds
*** Indicates good artery
155
What does a negative Allen's test mean?
Hand does not flush within 5-15 seconds -- do not use that hand for ABG draw
156
What does partially compensated mean?
-pH abnormal
-ALL ABG values are abnormal
157
What does fully compensated mean?
pH is the ONLY normal value
158
What does no compensation mean?
pH & one other value are abnormal
159
True or false:
Body will NEVER overcompensate
True
160
What is the normal Hgb range for a male?
13.5-18
161
What is the normal Hgb range for a female?
12-16
162
What is the normal Hct range for a male?
40-50%
163
What is the normal Hct range for a female?
38-47%
164
What is the normal WBC range?
4,000-11,000
165
What is the normal SvO2 range?
60-80%
166
What is a normal d-dimer range?
< 250
167
What is normal aPTT range?
24-36 sec
168
What is the therapeutic aPTT range?
46-70
169
What is the normal INR range?
0.75-1.25
170
What is the therapeutic range for INR?
2-3
171
Is pneumonia an upper respiratory or lower respiratory problem?
Lower
172
What is pneumonia?
Acute infection of the lung parenchyma (functioning lung tissue- alveoli)
173
What can interfere with filtration, warming, and humidification?
-Someone with a trach
-If particles are too big and bypass the system
174
What could interfere with epiglottis function?
Pts with decreased LOC & strokeW
175
What could interfere with the cough reflex?
-Someone w/ a neuro injury
-Someone who is on sedatives
176
What could interfere with the mucociliary clearance system?
-Dehydration
-Smoking
-Alcohol
-Intubation
177
What could interfere with alveolar macrophages?
-Smoking
-Malnutrition
-Immunocompromised
178
What could alter oropharynheal flora and/or cause immunosuppression?
-Antibiotics
-Anesthesia
-Corticosteroids
-DM
-Thyroid disorders
-Leukemia
-HIV
-Tube feedings
-Immobility
179
Who is most at risk for developing pneumonia besides the elderly & immunocompromised?
-Neuro disorders
-Trach
180
What are the RFs of pneumonia?
1) Aging
2) Air Pollution
3) ALOC
4) Altered oropharyngeal flora
5) Immobility
6) Chronic diseases
7) Acute illness
8) HIV or immunosuppression drugs
9) Inhalation or exhalation of noxious substances
10) Aspiration
11) Malnutrition
12) Long-term care
13) Smoking
14) Intubation
15) URI
16) Animal exposure (birds and feces)
17) IV drug use
18) Recent antbx use
181
What are the causative agents/organisms of pneumonia?
-Bacteria
-Viruses
-Fungi
-Parasites
-Chemicals
182
What is the most common causative agent of pneumonia?
Bacterial pneumococcal pneumonia (can occur on its own or after a bacterial infection like a cold)
183
Name the type of pneumonia:
-Onset in community of within 48 hrs of admission
-Have not been hospitalized or in long-term care within the last 14 days
-May or may not be treated at home
Community-acquired pneumonia
184
What does the CURB scale look at?
-Confusion
-BUN ( > 20 mg/dL)
-RR (>/= 30)
-BP (systolic < 90)
**If they score 4 or 5 = ICU admin
185
What is.a PSI scale?
Pneumonia Severity Index
186
What does a PSI look at?
-Labs (pH, BUN, glucose)
-Measures comorbidities
-In conjunction with H&P
***Better predictor of long-term mortality
187
What is the tx for community-acquired pneumonia?
Impuric antbx tx (broad spectrum until results of C/S are back)
188
Name type of pneumonia:
-Onset after 48+ hrs of admission
-Someone who has not been intubated
-Harder to tx d/t association w/ multiple drug resistant organisms
-HAPS, VAPs, and HCAPs
Hospital-acquired pneumonia
189
Name the type of pneumonia:
- > 48 hrs after endotracheal intubation
-Type of HAP
Ventilator Associated Pneumonia
190
Name the type of pneumonia:
-Acquired in a healthcare setting away from hospital
-Someone in long-term care facility or nursing home
Health-care Associated Pneumonia
191
Name the type of pneumonia:
-Abnormal entry of material from mouth into lungs
-Tube feedings or NG tubes (materials can cause inflammatory response)
Aspiration pneumonia
192
Name the type of pneumonia:
-Complication of bacterial lung infection (usually CAP)
-Rare
-S&S of respiratory failure
-Can change antbxs to tx better or surgery to debried tissues
Necrotizing pneumonia
193
Name the type of pneumonia:
-Inflammation & infection of lower respiratory tract in immunocompromised patients
-Can be life-threatening
Opportunistic pneumonia
194
What are S&S of pneumonia?
-Respiratory acidosis
-Hypoxemia leading to hypoxia
-VQ mismatch
-Fine or coarse crackles
-Egophony and fremitus
-Dullness
195
What are the most common S&S of pneumonia?
-Fever
-Productive cough
-Chills
-Dyspnea
-Tachypnea/tachycardia (weak/thready pulse)
-Chest pain
196
What is the body''s first defense mechanism to compensate for decreased oxygen in the blood?
Tachypnea
197
What S&S of pneumonia would you see in an older patient?
-Confusion or stupor
-Hypothermia
-Anorexia
-Fatigue
-HA
198
True or False:
Fluid and rest may sometimes be the only treatment for pneumonia
True
199
Is it bacterial or viral pneumonia:
-Gradual onset w/ or w/o fever
-Diffuse involvement of the lungs (both lungs)
-Less severe & may heal on its own
-Typically had some type of infection prior
Viral
200
Viral or bacterial pneumonia:
-Sudden onset
-One lobe/lung
-Requires agressive tx --> empiric & other antbx
Bacterial
201
What are the dx assessments for pneumonia?
-H&P
-CXR -- 1st line
-CBC -- WBCs
-C/S -- sputum & blood
-ABGs
-C-reactive protein (sometimes -- sensitive to inflammation)
202
How soon after starting tx for a pneumonia should the pt start feeling better?
24-72 hrs
203
What antibiotics are typically given for pneumonia?
-Macrolides
-Fluoroquinolones
-Beta Lactam
204
What are comps of macrolides (--mycins)?
-GI discomfort
-Prolonged QT
-Ototoxicity
205
What are comps of fluoroquinolones (--floxacin)?
-GI discomfort
-Achilles tendon rupture
-Thrush
-Vaginal yeast infection
-Phototoxicity
206
What are the super infections to look out for during antibiotic therapy?
-Thrush
-Yeast
-C.diff
207
What are examples of beta lactams?
-Penicillins
-Cephalosporings
-Carbapenems
-Monobactams
***Watch for cross-sensitivity
208
What are comps of pneumonia?
1) Atelectasis
2) Pleurisy
3) Pleural effusion
4) Bacteremia
5) Pneumothorax
6) Acute resp failure
7) Septix shock
209
Name the problem:
Disease state characterized by the persistent airflow limitation that is slowly progressive
S&S = cough that produces large amounts of mucus
COPD
210
What causes are commonly associated with COPD?
-Chronic inflammatory response of the airways
-Lungs to noxious particles or gases
211
What is COPD accompanied by?
Airway hyper-reactivity
212
According to the NIH, what does COPD include?
-Emphysema
-Chronic bronchitis
213
Name the problem:
-Walls between air sacs are damaged
-Leads to fewer and larger air sacs vs many tiny ones
-Results in impaired gas exchange
Emphysema
214
Name the problem:
-Lining of the airways are constantly irritated and inflamed
-Mucus formation
-Difficult breathing
Chronic bronchitis
215
What are RFs of COPD?
1) Smoking
2) Recurrent URI
3) Hereditary
4) Aging
5) Occupation
6) Air pollution
7) Asthma
8) Gender (male > females)
216
What kind of effects are these on the respiratory system d/t smoking:
-Decreased sense of smell/taste
-Hoarseness
-Bronchospasm
-Cilia paralysis
-Increased Secretion/cough
-Decreased Alveolar Macrophage function
Acute
217
What kind of effects are these on the respiratory system d/t smoking:
-Cancer
-Chronic cough, bronchitis
-Asthma
-Increased incidence of infection
-Emphysema
Long Term
218
What is the defining feature of COPD?
Not fully reversible airflow limitation during expiration
219
What does alveolar destruction lead to?
Decreased PaO2 & Increased PaCO2 = VQ mismatch, decreased ventilation & CO2 retention
220
What can cause decreased airflow in COPD?
1) Airway and air sacs lose elasticity
2) Walls between air sacs are destroyed
3) Walls of airway are thick & inflamed
4) Airway makes more mucus and becomes clogged
221
What are the S&S of COPD?
1) Frequent productive cough
2) Air hunger
3) Bronchospams (wheezing & chest tightness/heaviness)
4) Frequent infections
5) Gradual DOE that can progress to SOB at rest
6) Hypoxemia & hypercapnia
7) Barrel chest -- chest breather
8) Edema
9) Increased compliance & decreased recoil
222
What are the dx studies for COPD?
1) H&P
2) CXR
3) Spirometry
4) ABGs
5) EKG & cardiac tests
6) Questionnaires -- CAT & MRC
7) 6 min walk test
223
What are comps of COPD?
-Cor pulmonale
-Acute exacerbations
-Acute respiratory failure
-Depression/anxiety
224
What are the NIs for COPD?
-Admin meds
-Small, frequent meals
-Semi-Fowlers
-O2 therapy
-Breathing retraining/airway clearance techniques
-Nutritional support
-Pulmonary rehab
225
What is the difference between and embolus and a thrombus?
Embolus is a mobile clot, thrombus is just a clot
226
Where in the lungs do you usually see a pulmonary embolus?
Lower lobes
227
What are predisposing factors of PE?
1) VTE/DVT
2) A-fib
3) Pelvic surgery/LE surgery or childbirth
4) SCI
5) Fracture of long bones
6) Improperly administered IV therapy
7) Cancer/malignancy
8) Altered capillary permeability
9) OCs, smoking, prolonged air travel, HF, clotting disorders
228
True or False:
Men who are obese that smoke and have HTN are most at risk of developing PE
False -- women who are obese that smoke and have HTN
229
Up to how long can it take to recover from a PE?
2 weeks
230
What are S&S of PE?
1) Anxiety
2) Sudden onset of dyspnea
3) Tachycardia, tachypnea
4) Cough, pleuritic chest pain
5) Hemoptysis
6) Crackles
7) Fever
8) Change in mental status
9) ECG changes
10) Shock
231
What is the cardinal sx of shock?
Hypotension
232
What is the most common presenting sx of PE?
Dyspnea
233
What 2 scoring tests are given to those with a potential PE?
-Wells score
-Revised Geneva score
234
What is usually the first dx study done for PE?
EKG
235
What tests besides an EKG are done for PE?
1) Spiral CT
2) VQ Scan
3) D-dimer
4) ABGs
5) CXR
6) Pulmonary angiography
236
Name the PE dx study:
1) Allows visualization of entire anatomic regions as the lungs
2) Ability to create a 3D image
3) Contrast to help visualize what's happening in the vasculature
4) Assess for pts kidney function and allergies
Spiral CT
237
Name the PE dx study:
1) Requires compliance -- not for critically ill pts
2) Two components
3) Perfusion scan (IV injection of a radioisotope)
4) Ventilation scan (inhalation of a radioactive gas)
VQ Scan
238
Name the PE dx study:
1) Degredation product -- rarely found in healthy people
2) Measures amount of fibren fragments
3) Not specific, and not very sensitive
4) Can use when Geneva is low or intermediate to rule out a PE
D-dimer
239
What is a normal D-dimer result?
< 250 mcg/L
240
True or False:
ABGs in PEs are not diagnostic, but monitor
True
241
True or False:
CXR will show abnormal findings, but not specific in dx PE
True
242
Name the PE dx test:
1) Access via a large vein to pulmonary artery
2) Injection of dye with visualization of blood flow in the pulmonary vasculature
3) Most sensitive & Specific, but most expensive & invasive***
4) Done in cath lab
5) Usually done when they are going in to physically remove clot
Pulmonary Angiography
243
What needs to be assessed post-op of a pulmonary angiography?
1) Site for bleeding/hematomas
2) Pain
3) Coolness or numbness to extremity
244
How long do you need to lay flat for post op of a pulmonary angiography?
1-2 hrs
245
What are complications of PE?
1) Pulmonary infarction
2) Pulmonary HTN
246
What causes a pulmonary infarction?
Death of lung tissue d/t:
-Alveolar necrosis
-Hemorrhage
247
How big does the occlusion have to be to cause a pulmonary infarction?
> 2 mm
248
When does pulmonary HTN occur?
-When > 50% of normal pulmonary bed is compromised
-Can result from hypoxemia
-Recurrent PEs
249
What can pulmonary HTN result in?
Dilation & hypertrophy of the RV
250
What med classes are given for PE?
1) Narcotics
2) Anticoagulants
3) Thrombolytics
251
What lab value needs to be monitored for heparin?
aPTT
252
What is the antidote for heparin?
Protamine sulfate
253
What is the antidote for warfarin?
Vitamin K
254
What lab value needs to be monitored with warfarin?
INR
255
What is a normal/therapeutic INR?
1.5-2.5 (60-70 secs)
256
What is a therapeutic INR?
2.0-3.0
257
True or False:
The higher the INR, the longer it is taking the blood to clot
True
258
How frequently does aPTT need to be drawn for heparin therapy?
Before admin & q4-6h during
259
How long does warfarin take to start working?
3-5 days but start right away with combo of heparin
260
What is the recommended anticoagulation tx for PE?
Low-Molecular Weight Heparin -- Lovenox
**Safest and most effective
261
True or false:
Pts on LMWH need to have aPTT monitored weekly
False -- LMWH has more predictable factors, therefore does not need to monitor aPTT
262
What surgeries can be done for a PE?
1) IVC filter
2) Embolectomy
263
What is an IVC filter?
1) Helps prevent further emboli from reaching lungs
2) Placed by angio through femoral vein and placed in diaphragm
264
What teachings need to be provided for those with PE?
-Bleeding precautions (electric razors, bleeding gums, bloody stools, hematuria, oozing wounds)
-Increase exercise & smoking cessation
-S&S of DVT
265
What are the S&S of DVT?
1) Pain
2) Redness
3) Swelling
4) Warmth
266
Name the problem:
Elevated pulmonary pressures resulting from an increase in pulmonary vascular resistance to blood flow
Pulmonary HTN
267
What measures pulmonary HTN?
Mean pulmonary arterial pressure
268
What is a normal mean pulmonary arterial pressure?
12-16
269
What value of mean pulmonary arterial pressure can indicate pulmonary HTN?
> 25 mm Hg
270
Name the type of pulmonary HTN:
Severe & progressive & idiopathic
Primary
271
Name the type of pulmonary HTN:
Comes from comps of respiratory & CV diseases
Secondary
272
What can primary pulmonary HTN be associated with?
-HIV
-Cirrhosis of liver
-CT disorders
273
_____ increases vascular resistance leading to sustained pulmonary HTN leading to hypertrophy/cor pulmonae/right sided HF
Scarring
274
What are S&S of Primary pulmonary HTN?
1) DOE
2) Fatigue
3) Exertional syncope, dizziness, chest pain
4) Eventually dyspnea at rest
275
True or False:
Primary pulmonary HTN is usually not recognized until it is very advanced (between onset and 2 yrs)
True
276
What are the dx studies for primary pulmonary HTN?
1) EKG
2) CXR
3) PFT
4) ECG
5) CT
6) Cardiac cath
277
What is the purpose of collaborative care in primary pulmonary HTN?
Promote vasodilation and reduce RV overload
278
What systolic BP would you hold giving vasodilators for?
< 85
279
What kind of diet should someone with PPH have?
Low Na+ (decrease amt of fluid holding onto & decrease BP to decrease vascular resistance)
280
What do diuretics do in PPH?
Reduce right ventricular overload
281
What Ca+ Channel Blockers are used in PPH?
-Nifedipine
-Dilitiazem
282
What are CCBs used for in pts with PPH?
-Relaxes smooth muscle
-Good for pts with HF
283
What parenteral vasodilators are used in PPH?
-Epoprostenol
-Treprostinil
-Adenosine
284
What inhaled vasodilators are used in PPH?
-Iloprost
-Treprostinil
285
What is the purpose of endothelin receptor blockers in PPH?
Promote realization of pulmonary artery to decrease pressures
286
What endothelin receptor blockers are used in PPH?
-Bosentan
-Ambrisentan
287
What is the purpose of phosphodiasterase enzyme inhibitors in PPH?
PO smooth muscle relaxer
288
What is the contraindication of using phosphodiasterase enzyme inhibitors in PPH?
those taking nitroglycerin (causes life threatening hypotension)
289
What phosphodiasterase enzyme inhibitors are used in PPH?
-Sildenafil (Viagra)
-Tadalafil
290
Name the surgical intervention for PPH:
-Considered palliative
-Done while awaiting transplant
-Creates shunt from RV to LV to help decompress some of that pressure
Atrial Septostomy
291
Name the problem:
-Primary disease increases pulmonary arterial pressures
-Need to tx the underlying disorder
-Need to tx the sx
Secondary Pulmonary Arterial Hypertension (SPAH)
292
What are some causes of SPAH?
-COPD
-Chronic Emboli
293
Name the problem:
Enlargement of RV secondary to diseases of the lung, thorax, or pulmonary circulation
Cor pulmonale
294
What is the most common cause of cor pulmonale?
COPD
295
What are S&S of cor pulmonale?
1) Dyspnea
2) Cough
3) Wheezing
4) Fatigue
5) Polycythemia
6) HF
296
What are diagnostics of cor pulmonale?
1) ABGS, SPO2
2) Serum/urine electrolytes
3) BNP
4) EKG
5) CXR
6) Echo
7) CT/MRI
8) Cardiac Cath
297
What meds are given to tx cor pulmonale?
1) Bronchodilators
2) Diuretics
3) Vasodilators
4) CCBs
5) Inotropic agents
298
What do inotropic agents do?
-Increase SV
-Decrease pulmonary vascular resistance
299
What inotropic agent is used in cor pulmonale?
Dobutamine
300
What are absolute contraindications for a lung transplant?
-Malignancy
-Hep B or C
-HIV
-Advanced organ dysfunction
-Smoker
