Respiratory System Flashcards
Oxygen - Hemoglobin Dissociation Curve
PaO2 100-60 - Pulse ox 97-90% - plateau ( reserve of O2)
describes the affinity (relationship) of hemoglobin for oxygen ; oxygen delivery to the cell depends upon the amount of oxygen in the blood and the release of the oxygen once it reaches the cell
Shift to Right
Decreased pH - acidosis
Increased CO2, T, 2,3 - DPG ( made by RBC)
!!! Hgb releases O2, decreased affinity ( bond )
Shift to Left
Increased pH
Decreased CO2, T
!!! Hgb latches onto O2 ( picks up )
ABGs - determines oxygenation and acid-base balance ; evaluates respiratory, renal and cardiovascular function
- pH 7.35-7.45
- PaO2 80-100
- PaCO2 35-45
- HCO3 21-28
Oxygenation
- Changes with age - lower in infants & after 30 with aging
PaO2 = 104- (age x 0.27 )
Pulse oximetry
Amount of O2 contained in Hgb ; > 95 %
Positive pressure mechanical ventilation (MV)
pushes air into lungs
MV can be programmed to
- Assist - pt breathes - set Vt delivered
- Control - set Vt + RR
- Assist-control - most common
Vt - Tidal volume
air inhales and exhaled with each breath 0.5 L
MV - Assist-control
can initiate breathes - Vt delivered ; if pt does not initiate a breath - machine will ( set rate ) Risk !!! - hyperventilation
SIMV - synchronized intermittent mandatory ventilation ( + CPAP )
Commonly used for weaning ; when breathing above ventilator - get their own Vt
MV pressure support modes
- PSV - pressure support ventilation-decrease WOB
- PC-IVR - pressure controlled inverse ration ventilation - inspiratory > expiratory time - to expend airways and alveloli ( no normal pattern - sedation )
PEEP and CPAP - maybe used with MV - can cause cardiac output impairment - breathing against the pressure
- PEEP - positive end expiratory pressure - allows reduction of FlO2 while improving oxygenation - maintains positive pressure in lungs at the end of expiration to keep alveoli open
- CPAP - continuous positive airway pressure - breathes on their own ; weaning, sleep apnea
Adverse effects of MV - Barotrauma
rupture of blebs or alveoli - pneumothorax
Monitor - subcut emphysema ; lung sounds - displacement of tube into right bronchus ; TX anxiety hyperventilation
Adverse effects of MV - Compromised CO
positive pressure increases intrathoracic pressure - decreases venous return to the heart and CO - hypotension
Adverse effects of MV - Fluid and electrolyte imbalances
- decreased CO - decreased blood flow to kidneys - activate renin-angiotensin-aldosteron systme - Fluid retained
- Fluid loss - increased RR
Monitor: I&O, weight, hydration, electrolytes
Adverse effects of MV - GI complications
- Stress ulcers - antacids, PPI, histamine blockers
2. Malnutrition - parenteral or enteral nutrition
Adverse effects of MV- Infection
- hand washing
- Sterile
- secretion mobilization
- nutrition, aspiration precautions
- frequent oral care
Ventilator settings
- Vt
- Rate
- FlO2
- Sighs - an intermittent inflation of the lungs with a large volume from a mechanical ventilator ( !!! Barotrauma )
- PIP
PIP
peak airway inspiratory pressure - amount of pressure needed to deliver the Vt
Increased PIP
- pinched tubing
- secretions - suction
- PE
- decreased pulmonary compliance
- bronchospasms
Chest tube ( or thoracostomy tube ) placement
tube inserted into the space to drain air or fluid
- anterior 2nd intercostal - remove air
- lateral 5th - fluids
Chest tube - indications
- Pneumothorax
- Hemothorax
- Pleural Effusion
- Empyema - pus
Chest tube - collection system - 3 - below level of the chest - sterility
- Fluid collection
- Water seal - permits air out but no air in ; tidaling - function well
- Suction control - setting on the chamber determines suction - not the suction device !!! wet suction - bubbling - works well
Chest tube - complications
- Bleeding
- Infection
- Subcut emphysema
- Pneumothorax , cardiac tamponade
Chest tube - key points
- Tiding ( bubbling) rising with insp, falling with exp - NOT - blocked or lungs are reexpanded ( clear LS)
- CDB - Q1 hr
- ROM of the affected side
- Pain ; turn and position
- Cont. bubbling - air leak
- Do not strip, milk, clamp
Traumatic chest injuries - Emergency care
- Airway
- O2
- IV - large bore
- cover sucking wound on 3 sides
- stabilize impaled objects - do not remove
- Flail chest - place on injured side - prevent movement
- Semi-fowlers or uninjured side
Pneumothorax - open or closed - S/s - chest tube
- Chest pain - SHARP , increased with respirations
- Absent / decreased breath sounds
- Hyperresonace over the area
- tachycardia , tachypnea
Heimlich valve
one way valve to remove air from the pleural space
Hemothorax - causes - chest tube or thoracocentesis
Trauma, surgery, malignancy, PE, anticoagulation therapy
Tension Pneumothorax - Medical emergency - deviation of trachea
Mediastinal shift ; impairs CO and venous return
Cuses - pneumothorax; blocked or clamped CT
Flail chest - multiple fractured ribs - S/s and TX
Paradoxical chest movement - prevent adequate ventilation ; shallow respirations
TX: MV with PEEP is used to stabilize
ARDS - acute respiratory distress syndrome S/s
- Hypoxemia - unresponsive to O2 therapy
- PE - Increased RR - respiratory alkalosis ( decreased O2; increased WOB)
- Initial CXR - normal or patchy infiltrates
- Later CXR - diffuse consolidation - “white-out” or “ground glass”
- Pulmonary hypertension may occur
ARDS - causes - main trigger - systemic inflammatory response
- Sepsis
- Massive trauma
- Pneumonia
- O2 toxicity
- Multiple organ dysfunction syndrome
- Pancreatitis
ARDS - pathophisiology
Systemic inflammatory response - injury to alveolar-capillary membrane & release of chemical and cellular mediators - leaking fluid in alveolar interstinal spaces - surfactant and alveolar dysfunction - decrease lung compliance - refractory hypoxemia - VQ mismatch - alveoli receive blood but cannot oxygenate it - increasing shunt
ARDS - TX
- Corticosteroids - anti inflammatory; can decrease immune system
- Antibiotics - prevent infection
- Colloids - to restore osmotic pressure in vasculature - to suck fluid out of lungs back to vasculature
- Proning - face down ( on stomach ) - Increase oxygenation; decrease atelectasis
Oxygen toxicity - high flow rates for extended periods - > 60 % for more than 24-48 hrs
- Cough
- Hypoxia
- Pulmonary edema
Shunting - extreme VQ mismatch
- Anatomic ( septal defect)
2. Intrapulmonary -blood flows through pulmonary capillaries without participating in gas exchange
Trach cuffs used for patients
- Risk of aspiration
- Mechanical ventilation
Complications : overinflated - occlude airway; pressure on inominate artery - rupture
Fenestrated Trach
one or more holes in the outer cannula. The holes allow air to pass from your lungs up through your vocal cords and out through your mouth and nose - can talk
Cancer of the Larynx - Risk factors
- Smoking - chewing
- Alcohol
- Over 50
- Male
Cancer of the Larynx - S/s
- Hoarseness/ voice change
- Lump in throat or neck
- Oral lesions - leukoplakia or erythroplakia
- Dysphagia - swallowing
- Persistent or recurring sore throat
- Late - anorexia, weight loss, SOB
Cancer of the Larynx DX
- Swallow test - barium
- Laryngoscopy & bronchoscopy - biopsy
- ST, MRI, CAT scan
- PET scan - metabolic activity
- Blood tests - anemia ( alcoholic - poor nutrition - folic acid or iron deficiency
Cancer of the Larynx - SX
- Laser sx - laryngoscopy, small tumors
- Cordectomy
- Hemilaryngectomy
- Supraglottic Laryngectomy
- Total Laryngectomy
- Radical neck dissection
Cordectomy
partial removal of vocal cords ; in-situ lesions ; retain voice - hoarseness
Hemilaryngectomy
removal of one true and one false vocal cord ; temporary trach ; changed but understandable voice
Supraglottic Laryngectomy
removes the false vocal cords and epiglottis ( aspiration !!! ) ; temp. trach; changed but understandable voice
Total Laryngectomy - Aspiration is not a concern !!! - uncuffed trach
removes the vocal cords ; changed airflow pattern ; permanent trach (or laryngectomy tube ) ; no voice - no air is going via mouth and nose
Radical neck dissection
wide excision of lymph nodes and associated neck structures - muscles, mandible, glands, …
Cancer of the Larynx - Voice Rehabilitation
- Esophageal Speech - burping of air
- Electronic larynx
- Tracheoesophageal voice prosthesis
Tracheoesophageal voice prosthesis
- Electronic larynx - placed against the neck or a tube into the mouth - mechanical sound is produced
- Blom-Singer voice prosthesis or Panje voice button - inserted into a created fistula between esophagus and the trachea - stoma must be blocked with the finger to speak
Cancer of the Larynx - prevent aspiration ( supraglottic laryngectomy )
*Thicken liquids ( avoid thin liquids and water )
Chin tuck when swallowing
Avoid straws
Trach cuff inflating - check
Supraglottic swallow - Take a breath and hold it - take a small bite - swallow - cough - swallow - do not breath in until completed
Pulmonary hypertension
- Primary ( women ; Fen-Phen - diet drug ) > 25 mmHg ( absence of cause ) - no cure -lung transplant - Prostacyclin (IV)
- Secondary - due to respiratory or cardiac condition - TX underlying disorder
Lung cancer
- NSCLC - Squamous, Adenocarcinoma ( not associated with smoking ) , Large cell
- SCLC - poor prognosis !! Smoking !!!
Lung cancer S/s - late and nonspecific
- Cough
- Hemoptysis
- Chest pain
- Dyspnea
- Weight loss
Lung cancer - SX
- Wedge - chest tube
- Segmental
- Lobectomy - common
- Pneumonectomy - no chest tube
- small area of lung
- partial lobe
- one lobe of lung
- entire lung - space fills with fluid which later semisoldifies - Do not lay on unaffected side - pressure on the heart
Lung abscess
- pus in the lung - cavity forms
- caused by aspiration, infectious organism - bacterial, TB
- S/s - cough with purulent, malodorous sputum
- TX: antibiotics for a prolonged period
Empyema
- pleural effusion containing pus ;
2. associated with TB, pneumonia, lung abscess infection of wounds ;
Pleural Effusion - symptom not a disease
- collection of fluid in the pleural space
- related to malignant process, CHF, infection
- TX: thoracentesis - treat underlying condition
ERV and IRV
expiratory reserve volume - air exhaled after normal exhalation 1.0 L
inspiratory - inhaled 3.0 L
RV
residual volume - air remaining in lungs after maximal expiration - 1.5 L
VQ scan ( radioactive ) - Dx of PE ( embolus ) - no injected material reaches …mismatch of inhaled and injected compounds on the lung scan images
Lung perfusion scan + inhalation (ventilation) scan
PET scan - nursing care
Positron Emission Tomography
- Avoid caffeine, alcohol, and tobacco for 24 hrs pretest
- Drugs that alter glucose metabolism - may alter test
- Eat 4 hrs before test
- Fluids 24-48 hrs post test
