Respiratory Nursing

Question 1

Identify the potential causes of hypoxaemia or hypoxia:

Answer 1

Insufficient oxygen present
Breathing depression (brain injury, opiods, drugs)
Ventilation insufficiency (pneumothorax)
Diffusion disorder (lung removal, fractured ribs)
Lung circulation disorder
Anaemia
Oedema or arterial thrombus
Muscular-thoracic disorders

Question 2

What is the difference between hypoxaemia and hypoxia:

Answer 2

Hypoxaemia= low cocentration levels of oxygen in the arterial red blood cells- PaO2

Question 3

What are the signs and symptoms of hypercapnia?

Answer 3

Symptoms and signs of early hypercapnia include flushed skin, full pulse, tachypnea, dyspnea, extrasystoles, muscle twitches, hand flaps, reduced neural activity, and possibly a raised blood pressure. According to other sources, symptoms of mild hypercapnia might include headache, confusion and lethargy.

Question 4

Identify the signs and symptoms of respiratory

distress:

Answer 4

Tachypnoea
 Tachycardia
 Nasal flaring
 Use of accessory muscles
 Intercostal retractions
 Cyanosis
 Increasing restlessness
 Anxiety or decreased LOC

Question 5

What are the signs and symptoms of hypoxaemia?

Answer 5

• Dyspnoea
• Tachypnoea
• Prolonged expiration
• Decrease SpO2 under 80%
• Cyanosis (late)
• Agitation
• Disorientation
• Delerium
• Confusion
• Use of accessory muscles
• Intercostal muscle retraction
• Tachycardia
• HTN
• Fatigue
• Skin clammy, cool

Question 6

Definition of hypercapnia?

Answer 6

Co2 retention (>45mmHg) - normal is 35-45mmHg
To assess paCO2, arterial blood gases test must be performed

Question 7

What is type 1 respiratory failure?

Answer 7

Characterised by hypoxia with normal CO2

Question 8

What is type 2 respiratory failure?

Answer 8

 Characterised by hypoxia with hypercapnia

Question 9

Describe how one would assess respiratory status?

Answer 9

Past health history
- Medications, Surgery +/- other treatment
 Health assessment
-Subjective
-Objective (physical)
-Nose, Mouth/Pharynx, Neck, Thorax/lungs
 INSPECTION
-Note the shape of the chest, Inspect for deformities and asymmetry, Observe trachea position
PALPATION
 For tenderness, For any abnormalities, Tracheal alignment, Palpate spinous processes, costovertebral angles, Check tactile fremitus, Assess chest wall symmetry and expansion
PERCUSSION
 Top to bottom & side to side (two fingers), Compare (right to left), Note sounds location & quality (chest consolidation will not resonate, just like percussing bone- it’s ‘solid’), Resonance, Abnormal, hyperesonance/dullness)
AUSCULTATION
 For breath sounds top to bottom & side to side (right to left), Compare breath sounds and air entry, Note sound location & quality, Normal V abnormal

Question 10

Definition of atelectasis?

Answer 10

Collapsed lung

Question 11

What are some of the causes of hypoxaemia?

Answer 11

Respiratory Disorders: COPD, pneumonia, atelectasis, lung cancer, PE
Cardiovascular Disorders: MI, arrhythmias, angina, cardiogenic shock
CNS Disorders: Overdose, head injury, sleep apnoea

Question 12

Describe the bronchial breath sounds:

very upper bronchi/chest area, loud sounds expected, expiration should be louder than inspiration

Answer 12

Loud, high pitched sounds
 Expiration > Inspiration
 Heard over manubrium

Question 13

Describe the broncho vesicular breath sounds:

Answer 13

Medium pitch & intensity of sounds
 Inspiration = Expiration
 Heard anteriorly over bronchus &
posteriorly between scapula

Question 14

Describe the vesicular breath sounds:

have to lift a womens breasts up for this one

Answer 14

Soft, low pitched, gently sounds
 Inspiration > Expiration
 Heard over all lung except major
bronchi

Question 15

Describe the abnormal crackle breath sounds:

Answer 15

Short, discrete, crackling or bubbling sounds

 e.g. pneumonia, bronchitis, CHF

Question 16

Describe the abnormal wheeze breath sounds:

Answer 16

 Continuous musical sound

 e.g. bronchitis, emphysema, asthma

Question 17

Describe the abnormal friction rub breath sounds

Answer 17

This to do with the pleural space rubbing against the chest wall
Loud, dry, crackling sound
 e.g. pleural inflammation

Question 18

List some of the abnormal respiratory assessment findings:

Answer 18

Pursed lip breathing
 Tripod position (sitting up straight, leaning forward with hands on knees)- Unable to lie flat
 Accessory muscle use
 Intercostal retractions (are due to reduced air pressure inside your chest)
 Splinting (holding the pillow)
 Related to pain
 Tachypnoea
 Kussmaul respirations (Regular, rapid & deep respirations) (usually someone is dying)
 Cyanosis
 Clubbing of fingers
 Abdominal paradox

Question 19

What are some of the diagnostics performed to assess for respiratory distress?

Answer 19

 Pulse Oximetry
 Sputum Specimen (mucus color, consistency etc)
 Laboratory Tests
 Chest X-Rays
 Capnogram or ETCO2 (end tidal Co2 monitoring)
 Arterial Blood Gases (ABGs)
 Respiratory Function Tests
 Bronchoscopy
 CT Scan
 Ventilation/Perfusion Scan

Question 20

List nursing interventions for respiratory distress:

Answer 20

Vital signs
 Ongoing monitoring
 Physical assessment
 Positioning
 Splinting
 Deep breathing & coughing
 Analgesics
Group cares
 Oxygen therapy
 Humidification
 Physiotherapy
 Suctioning
 Hydration
 Administer medications
 Nebulisers/inhalers
 Steroids
 Antibiotics
 Reassurance
 Assistance with ADLs
 Documentation
 Patient education

Question 21

What is tactile fremitus?

Answer 21

In common medical usage, it usually refers to assessment of the lungs by either the vibration intensity felt on the chest wall (tactile fremitus) and/or heard by a stethoscope on the chest wall with certain spoken words (vocal fremitus), although there are several other types.

Question 22

LLL=

Answer 22

Left lower lobe