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NURS 2501 > Respiratory System > Flashcards

Respiratory System Flashcards

1
Q

Oxygen - Hemoglobin Dissociation Curve

PaO2 100-60 - Pulse ox 97-90% - plateau ( reserve of O2)

A

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

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2
Q

Shift to Right

A

Decreased pH - acidosis
Increased CO2, T, 2,3 - DPG ( made by RBC)
!!! Hgb releases O2, decreased affinity ( bond )

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3
Q

Shift to Left

A

Increased pH
Decreased CO2, T
!!! Hgb latches onto O2 ( picks up )

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4
Q

ABGs - determines oxygenation and acid-base balance ; evaluates respiratory, renal and cardiovascular function

A
  1. pH 7.35-7.45
  2. PaO2 80-100
  3. PaCO2 35-45
  4. HCO3 21-28
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5
Q

Oxygenation

A
  1. Changes with age - lower in infants & after 30 with aging
    PaO2 = 104- (age x 0.27 )
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6
Q

Pulse oximetry

A

Amount of O2 contained in Hgb ; > 95 %

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7
Q

Positive pressure mechanical ventilation (MV)

A

pushes air into lungs

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8
Q

MV can be programmed to

A
  1. Assist - pt breathes - set Vt delivered
  2. Control - set Vt + RR
  3. Assist-control - most common
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9
Q

Vt - Tidal volume

A

air inhales and exhaled with each breath 0.5 L

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10
Q

MV - Assist-control

A

can initiate breathes - Vt delivered ; if pt does not initiate a breath - machine will ( set rate ) Risk !!! - hyperventilation

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11
Q

SIMV - synchronized intermittent mandatory ventilation ( + CPAP )

A

Commonly used for weaning ; when breathing above ventilator - get their own Vt

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12
Q

MV pressure support modes

A
  1. PSV - pressure support ventilation-decrease WOB
  2. PC-IVR - pressure controlled inverse ration ventilation - inspiratory > expiratory time - to expend airways and alveloli ( no normal pattern - sedation )
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13
Q

PEEP and CPAP - maybe used with MV - can cause cardiac output impairment - breathing against the pressure

A
  1. 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
  2. CPAP - continuous positive airway pressure - breathes on their own ; weaning, sleep apnea
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14
Q

Adverse effects of MV - Barotrauma

A

rupture of blebs or alveoli - pneumothorax

Monitor - subcut emphysema ; lung sounds - displacement of tube into right bronchus ; TX anxiety hyperventilation

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15
Q

Adverse effects of MV - Compromised CO

A

positive pressure increases intrathoracic pressure - decreases venous return to the heart and CO - hypotension

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16
Q

Adverse effects of MV - Fluid and electrolyte imbalances

A
  1. decreased CO - decreased blood flow to kidneys - activate renin-angiotensin-aldosteron systme - Fluid retained
  2. Fluid loss - increased RR
    Monitor: I&O, weight, hydration, electrolytes
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17
Q

Adverse effects of MV - GI complications

A
  1. Stress ulcers - antacids, PPI, histamine blockers

2. Malnutrition - parenteral or enteral nutrition

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18
Q

Adverse effects of MV- Infection

A
  1. hand washing
  2. Sterile
  3. secretion mobilization
  4. nutrition, aspiration precautions
  5. frequent oral care
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19
Q

Ventilator settings

A
  1. Vt
  2. Rate
  3. FlO2
  4. Sighs - an intermittent inflation of the lungs with a large volume from a mechanical ventilator ( !!! Barotrauma )
  5. PIP
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20
Q

PIP

A

peak airway inspiratory pressure - amount of pressure needed to deliver the Vt

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21
Q

Increased PIP

A
  1. pinched tubing
  2. secretions - suction
  3. PE
  4. decreased pulmonary compliance
  5. bronchospasms
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22
Q

Chest tube ( or thoracostomy tube ) placement

A

tube inserted into the space to drain air or fluid

  1. anterior 2nd intercostal - remove air
  2. lateral 5th - fluids
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23
Q

Chest tube - indications

A
  1. Pneumothorax
  2. Hemothorax
  3. Pleural Effusion
  4. Empyema - pus
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24
Q

Chest tube - collection system - 3 - below level of the chest - sterility

A
  1. Fluid collection
  2. Water seal - permits air out but no air in ; tidaling - function well
  3. Suction control - setting on the chamber determines suction - not the suction device !!! wet suction - bubbling - works well
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25
Q

Chest tube - complications

A
  1. Bleeding
  2. Infection
  3. Subcut emphysema
  4. Pneumothorax , cardiac tamponade
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26
Q

Chest tube - key points

A
  1. Tiding ( bubbling) rising with insp, falling with exp - NOT - blocked or lungs are reexpanded ( clear LS)
  2. CDB - Q1 hr
  3. ROM of the affected side
  4. Pain ; turn and position
  5. Cont. bubbling - air leak
  6. Do not strip, milk, clamp
27
Q

Traumatic chest injuries - Emergency care

A
  1. Airway
  2. O2
  3. IV - large bore
  4. cover sucking wound on 3 sides
  5. stabilize impaled objects - do not remove
  6. Flail chest - place on injured side - prevent movement
  7. Semi-fowlers or uninjured side
28
Q

Pneumothorax - open or closed - S/s - chest tube

A
  1. Chest pain - SHARP , increased with respirations
  2. Absent / decreased breath sounds
  3. Hyperresonace over the area
  4. tachycardia , tachypnea
29
Q

Heimlich valve

A

one way valve to remove air from the pleural space

30
Q

Hemothorax - causes - chest tube or thoracocentesis

A

Trauma, surgery, malignancy, PE, anticoagulation therapy

31
Q

Tension Pneumothorax - Medical emergency - deviation of trachea

A

Mediastinal shift ; impairs CO and venous return

Cuses - pneumothorax; blocked or clamped CT

32
Q

Flail chest - multiple fractured ribs - S/s and TX

A

Paradoxical chest movement - prevent adequate ventilation ; shallow respirations
TX: MV with PEEP is used to stabilize

33
Q

ARDS - acute respiratory distress syndrome S/s

A
  1. Hypoxemia - unresponsive to O2 therapy
  2. PE - Increased RR - respiratory alkalosis ( decreased O2; increased WOB)
  3. Initial CXR - normal or patchy infiltrates
  4. Later CXR - diffuse consolidation - “white-out” or “ground glass”
  5. Pulmonary hypertension may occur
34
Q

ARDS - causes - main trigger - systemic inflammatory response

A
  1. Sepsis
  2. Massive trauma
  3. Pneumonia
  4. O2 toxicity
  5. Multiple organ dysfunction syndrome
  6. Pancreatitis
35
Q

ARDS - pathophisiology

A

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

36
Q

ARDS - TX

A
  1. Corticosteroids - anti inflammatory; can decrease immune system
  2. Antibiotics - prevent infection
  3. Colloids - to restore osmotic pressure in vasculature - to suck fluid out of lungs back to vasculature
  4. Proning - face down ( on stomach ) - Increase oxygenation; decrease atelectasis
37
Q

Oxygen toxicity - high flow rates for extended periods - > 60 % for more than 24-48 hrs

A
  1. Cough
  2. Hypoxia
  3. Pulmonary edema
38
Q

Shunting - extreme VQ mismatch

A
  1. Anatomic ( septal defect)

2. Intrapulmonary -blood flows through pulmonary capillaries without participating in gas exchange

39
Q

Trach cuffs used for patients

A
  1. Risk of aspiration
  2. Mechanical ventilation
    Complications : overinflated - occlude airway; pressure on inominate artery - rupture
40
Q

Fenestrated Trach

A

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

41
Q

Cancer of the Larynx - Risk factors

A
  1. Smoking - chewing
  2. Alcohol
  3. Over 50
  4. Male
42
Q

Cancer of the Larynx - S/s

A
  1. Hoarseness/ voice change
  2. Lump in throat or neck
  3. Oral lesions - leukoplakia or erythroplakia
  4. Dysphagia - swallowing
  5. Persistent or recurring sore throat
  6. Late - anorexia, weight loss, SOB
43
Q

Cancer of the Larynx DX

A
  1. Swallow test - barium
  2. Laryngoscopy & bronchoscopy - biopsy
  3. ST, MRI, CAT scan
  4. PET scan - metabolic activity
  5. Blood tests - anemia ( alcoholic - poor nutrition - folic acid or iron deficiency
44
Q

Cancer of the Larynx - SX

A
  1. Laser sx - laryngoscopy, small tumors
  2. Cordectomy
  3. Hemilaryngectomy
  4. Supraglottic Laryngectomy
  5. Total Laryngectomy
  6. Radical neck dissection
45
Q

Cordectomy

A

partial removal of vocal cords ; in-situ lesions ; retain voice - hoarseness

46
Q

Hemilaryngectomy

A

removal of one true and one false vocal cord ; temporary trach ; changed but understandable voice

47
Q

Supraglottic Laryngectomy

A

removes the false vocal cords and epiglottis ( aspiration !!! ) ; temp. trach; changed but understandable voice

48
Q

Total Laryngectomy - Aspiration is not a concern !!! - uncuffed trach

A

removes the vocal cords ; changed airflow pattern ; permanent trach (or laryngectomy tube ) ; no voice - no air is going via mouth and nose

49
Q

Radical neck dissection

A

wide excision of lymph nodes and associated neck structures - muscles, mandible, glands, …

50
Q

Cancer of the Larynx - Voice Rehabilitation

A
  1. Esophageal Speech - burping of air
  2. Electronic larynx
  3. Tracheoesophageal voice prosthesis
51
Q

Tracheoesophageal voice prosthesis

A
  1. Electronic larynx - placed against the neck or a tube into the mouth - mechanical sound is produced
  2. 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
52
Q

Cancer of the Larynx - prevent aspiration ( supraglottic laryngectomy )

A

*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

53
Q

Pulmonary hypertension

A
  1. Primary ( women ; Fen-Phen - diet drug ) > 25 mmHg ( absence of cause ) - no cure -lung transplant - Prostacyclin (IV)
  2. Secondary - due to respiratory or cardiac condition - TX underlying disorder
54
Q

Lung cancer

A
  1. NSCLC - Squamous, Adenocarcinoma ( not associated with smoking ) , Large cell
  2. SCLC - poor prognosis !! Smoking !!!
55
Q

Lung cancer S/s - late and nonspecific

A
  1. Cough
  2. Hemoptysis
  3. Chest pain
  4. Dyspnea
  5. Weight loss
56
Q

Lung cancer - SX

  1. Wedge - chest tube
  2. Segmental
  3. Lobectomy - common
  4. Pneumonectomy - no chest tube
A
  1. small area of lung
  2. partial lobe
  3. one lobe of lung
  4. entire lung - space fills with fluid which later semisoldifies - Do not lay on unaffected side - pressure on the heart
57
Q

Lung abscess

A
  1. pus in the lung - cavity forms
  2. caused by aspiration, infectious organism - bacterial, TB
  3. S/s - cough with purulent, malodorous sputum
  4. TX: antibiotics for a prolonged period
58
Q

Empyema

A
  1. pleural effusion containing pus ;

2. associated with TB, pneumonia, lung abscess infection of wounds ;

59
Q

Pleural Effusion - symptom not a disease

A
  1. collection of fluid in the pleural space
  2. related to malignant process, CHF, infection
  3. TX: thoracentesis - treat underlying condition
60
Q

ERV and IRV

A

expiratory reserve volume - air exhaled after normal exhalation 1.0 L
inspiratory - inhaled 3.0 L

61
Q

RV

A

residual volume - air remaining in lungs after maximal expiration - 1.5 L

62
Q

VQ scan ( radioactive ) - Dx of PE ( embolus ) - no injected material reaches …mismatch of inhaled and injected compounds on the lung scan images

A

Lung perfusion scan + inhalation (ventilation) scan

63
Q

PET scan - nursing care

A

Positron Emission Tomography

  1. Avoid caffeine, alcohol, and tobacco for 24 hrs pretest
  2. Drugs that alter glucose metabolism - may alter test
  3. Eat 4 hrs before test
  4. Fluids 24-48 hrs post test

NURS 2501 (11 decks)

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