Respiratory System

Question 1

ABG arterial blood Gas

Answer 1

ABG is a blood test that measures the acidity,pH ,the levels of oxygen ,and carbon dioxide in the blood.

Question 2

What does the main elements which help in interpreting a ABG

Answer 2

PH,Hco3 (bicarbonate), and PCO2 (partial pressure of carbon dioxide ),
CO2 is considered as the “acid” part as it is the gas from the carbonic acid (Respiratory)
Bicarb is considered as the “base”/ alkaline metabolic

Question 3

What is the normal values of ABG

Answer 3

PH normal value= 7.35to7.45, less than PH7.35Acidosis orPH more than 7.45 Alkalosis.
Hco3 normal value =22 to 28, less than 22 Acidosis or 28 more than Alkalosis
Pco2 normal value 35to45,less than 35Alkalosis or 45more than that Acidosis.

Question 4

How to find out acidosis or alkalosis

Answer 4

Client who has late -stage salicylate poisoning-metabolic Acidosis (acetylsalicylic acid).
DKA(diabetic keto acidosis)-Metabolic acidosis.
peptic ulcer disease (PUD): with excessive amounts of oral antacids-metabolic alkalosis (antacid-reduce acid – alkalosis)
diarrhea or ileostomy-metabolic acidosis,(intestinal secretions, pancreatic secretions are high in bicarbonate-alkali. So loss of alkali leading to acidosis.
panic attack -respiratory alkalosis (blow out co2)
Drugs addicts/sedated /pneumothorax/hemothorax- respiratory acidosis (shallow breathing, holding on to CO2)

Question 5

compensation

Answer 5

Compensation is the renal and respiratory adjustments to changes in PH.If Ph is normal, the body is compensated.
Respiratory system compensate by adjusting CO2 level by changing ventilation(RR)
the renal system compensate by adjusting bicarbonate, producing more acidic or alkaline urine

Question 6

Different types of compensation

Answer 6

If PH is normal and be a PaCO2 and HCO3 are both abnormal, then the patient is compensated
If all three values PH,PaCO2, Hco3 are abnormal, then the patient is partially compensated.
If pH is abnormal is a PaCO2 or Hco3 are normal , the patient is uncompensated.

Question 7

Hypoxia – less oxygen in the body

Answer 7

Early findings: tachypnea,
tachycardia,
restlessness, pale skin and mucous membranes,
elevated blood pressure,
symptoms of respiratory distress, (use of accessory muscles, nasal flaring, tracheal tugging,and adventitious lung sounds).

Question 8

Hypoxia oxygen less in the body late findings

Answer 8

 late findings:confusion and stupor
cyanotic skin and mucous membranes,
bradypnea, bradycardia,
hypotension, cardiac dysrhythmias.

Question 9

Sinusitis

Answer 9

Sinusitis is an inflammation of the mucus membrane of one or more of the sinuses, usually the maxillary or frontal sinus.
S/symptoms facial pressure and pain (worse when the head is tilted forward)
Nasal congestion, headache,cough, bloody or purulent nasal drainage,
tenderness to palpation, of forehead, orbital and facial areas, low-grade fever.

Question 10

They sinusitis diagnostic procedures

Answer 10

CT scan or sinus x-rays
nursing care: increase the use of steam humidification,
sinus irrigation, Saline nasal sprays, hot and wet backs to relieve sinus congestion and pain,
teach the client to increase fluid intake and rest. discourage-air travel , swimming and diving. Encourage cessation of tobacco use in any form.
instruct the client and correct technique for sinus irrigation and self administration of nasal sprays.

Question 11

influenza

Answer 11

Highly contagious acute viral infection. Example H1 N1 (swine flu), and H5N1 (avian flu),
preventable by vaccine
S/symptom:severe headache and muscle aches , fatigue, weakness, hypoxia, severe diarrhea and cough (avian flu)

Question 12

influenza: nursing care 

Answer 12

maintain airborne and contact precautions for hospitalized clients with the pandemic influenza. Provide saline gargles. Monitor hydration status, intake and output,
administer fluid therapy as prescribed by the provider .
Monitor respiratory status and complications

Question 13

Pneumonia

Answer 13

Pneumonia: inflammatory process: produce excessive fluids. Infection or inflammation the air sac is filled with fluids or pus.
triggered by infectious organisms or by the aspiration of an irritant, such as fluid or a foreign object.
Immobility is a contributing factor in the development of pneumonia.

Question 14

Two types of pneumonia

Answer 14

Community acquired pneumoniaCAP): is the most common type and often occurs as a complication of influenza
Health care-associated pneumonia(HAP) has a higher mortality rate and is more likely to be resistant to antibiotics.
(VAP) ventilator associated pneumonia VAPclinicalmanifestations:purulent- sputum,positive sputum culture.
Leukocytes (12,000 MM3), fever (>100.4 f), chest x-ray changes infiltrates

Question 15

 pneumonia laboratory tests 

Answer 15

Sputum culture and sensitivity
obtain specimen before starting antibiotic therapy.
Obtain specimen by suctioning if the client is unable to cough.
The responsible organism is the identified about 50% of the time.
CBC - elevated WBC count (may not be present in older adult clients)
ABGs-hypoxemia (decrease the Pa02 less than 80 MM of Hg)
blood culture-to rule out organism in the blood
serum electrolytes to identify causes of dehydration.

Question 16

Pneumonia assessment

Answer 16

Assessment: crackles, fever chills, productive cough, Dyspnea,and pleuritic chest pain.
Increased vocal/tectile fremitus - transmission of palpable vibrations (fremitus)is increased when transmitted through consolidated versus normal lung tissue
bronchial breath sounds in Peripheral lung fields-high pitched,harsh sounds conducted through consolidated long tissue.
Bacterial or viral (x-ray -infiltrates/)consolidation.
Fever, chills, chest pain, SOB, cough crackles,wheezes.

Question 17

pneumonia medication

Answer 17

Meds– antibiotics, analgesic, steroids, bronchodilators..
Oxygen, nutrition, fluids.
Prevention in hospitalized patients –measures
infection control, avoid crowded areas, aspiration precautions.
early ambulation after procedures, turn, cough and deep breath-incentive spirometer exercise immunization.

Question 18

Complications of pneumonia

Answer 18

Atelectasis (alveoli lung collapse),risk for hypoxemia (SOB).
The client has diminished or absent breath sounds over the affected area
A chest x-rays shows an area of density.bacteremia (sepsis).
This occurs if pathogens enter the bloodstream from the infection in the lungs
Acute respiratory distress syndrome ARDS: hypoxemia persists despite oxygen therapy.
the client dyspnea worsen as bilateral pulmonary edema develops that is non-cardiac related.
A chest X-ray shows an area of density with a “groundglass appearance
ABG findings: high CO2 levels.
Assessment terms; crackles rates-find/course. Pleuritic chest pain.

Question 19

Epiglottitis and (croup laryngo-trachea– bronchitis)

Answer 19

Inflammation and swelling of epiglottis.
Flu,fever, sore throat, dysphasia,dysphonia(difficulty labored at sound changes
Tripod position(sit upright leaning on arms, chin thrust out and mouth open).
Droplet precautions (mask).don’t examine the throat-spasm!!!
ET and trucheostomy set at bedside.
NPO,IVF, Antipyretics, antibodies.
Hib vaccine to reduce incidence. Tripod position-drooling priority in this case.

Question 20

Chronic obstructive pulmonary disease(COPD)

Answer 20

Health promotions and disease prevention.
Promote smoking cessation . Avoid exposure to secondhand smoke.
Use protective equipment , mask and ensure proper ventilation while working in environment that contains carcinogens in our particles in the air.
Influenza and pneumonia vaccination are important for all clients who have COPD, but especially for the older and adult client

Question 21

COPD-Asthma

Answer 21

Chronic inflammation of airway leading to intermittent of obstruction.
spasm of bronchial smooth muscle with airway edema(spasm is a sudden involuntary muscular contractions or convulsive moments)
mucosal edema, bronchoconstriction, excessive mucus production.
Pulmonary function test (PFT)are the most accurate tests for diagnosing asthma and it’s Severity 
Watch for triggers.

Question 22

COPD triggers

Answer 22

Environmental factors, such as changes in temperature (especially warm to cold) and humidity. Air pollution pollutants, strong odor perfume. Seasonal allergens (grass,tree and weed pollens). Perennial allergens (mold,feathers,dust ,roaches ,and animal dander)
Foods treated with sulfites: example: baked goods, jams,canned vegetables, pickle foods,potato chips. (Patient might have wheezing, chest tightness and cough)stress and emotional distress.

Question 23

COPD nursing care

Answer 23

Highfowelers,, oxygen, I/v, rest, medicine, vaccine, teaching.
ABG ,Tele,(dysrhythmias), PFT monitoring
medications :steroids, bronchodilators, anticholinergics, aphtous lesions (cancer sores in the mouth white patchelike ulcers)
Asthma patient -metered dose inhaler explanation