Respiratory System Flashcards
Pathophysiology of COPD
COPD is a pulmonary disease that causes obstruction of airflow in the lungs.
inflammation of bronchioles become deformed, narrow
Excessive mucus production
Inability to fully exhale
COPD is irreversible
can be mild or severe
managed with lifestyle changes + medications
Causes of COPD
Environmental irritants, ie. smoking, poor air pollution.
Usually happens gradually, most notice signs and symptoms middle age
May have constant or chronic COPD
productive or non-productive cough
dyspnea
recurrent lung infections
Gas Exchange Related to COPD
Not enough oxygen getting in, retaining carbon dioxide
Experiencing respiratory acidosis
Red blood cells waiting to be deoxygenated but cannot due to low amounts of oxygen
The body compensates by producing more red blood cells but this causes the blood to become too thick
increases the pressure in the pulmonary artery = pulmonary hypertension
blood backs cup in right side of heart
Right side heart: pulmonary artery brings un-oxygenated blood to the lungs to become oxygenated
Blue Bloaters COPD
Chronic bronchitis = Blue bloaters
Cyanosis and edema due to hypoxia (blue Around the mouth), swelling
can lead to right sided HF
Bronchioles inflamed, damaged + produce mucous = Retain CO2 which leads to hyper inflammation of the lung and a flattened diaphragm
Pink Puffers COPD
Hyperventilation = Pink complexion = empyema
Alveoli sac loses elasticity due to inflammation
poor gas exchange
increased CO2 = low oxygen
Hyperinflation of the lungs
enlarged lungs
flattened diaphragm
use of accessory muscles
Barrel chest
Symptoms of COPD
Remember LUNG DAMAGE
Lack of energy
Unable to tolerate activity (SOB)
Nutrition poor (weight loos, emphysema)
Gas abnormal (PCO2 >45 + PO2 <90 - respiratory acidosis )
Dry productive cough
Accessory muscles for breathing/abnormal lung sounds
Anteroposterior diameter (barrel chest)
Gets in tripod position to breath
Extrememe dyspnea
Nursing Interventions COPD
High Fowlers
Assess lung sounds and sputum production
Teach pursed lip breathing + diaphoretic breathing
Adminster breathing tx such as inhalers
Oxygen as needed
Keep O2 88-92% due to low oxygen levels (too much oxygen could cause them to stop breathing or increase CO2 production)
How to diagnose COPD
Spirometer: how much volume the lungs can hold during inhalation, how fast air volume is exhaled
Low reading = restrict breathing and Increased Severity
Other tests: Chest Xray and ABGs
Complications COPD
(Rylee loves licking pachos penis)
Right sided HF
Lung infections
Lung Cancer
Pneumonia
Pneumothorax
Education COPD
Nutrition: High cal + protein
Small frequent meals
2-3L of Water
Avoid sick people + irritants
Stop smoking
Vaccinations up to date
Pathophysiology Asthma
Chronic lung disease that causes
narrowing and inflammation of the airways
no cure
Asthma is caused by triggers
The smooth muscle constricts
less airflow
Chest tightness
Dyspnea
Mucosa lining and goblet cells produce excess mucus leading to
coughing
decreased airflow
wheezing (heard on expiration)
Respiratory acid
Cause of Asthma
unknown
there are many triggers
environmental factors
respiratory infections
GERD
hormonal shifts
exercise induced
Substance indued
Early Signs and Symptoms of Asthma
Early: should have asthma action plan in place
Shortness of breath
Easily fatigued with physical activity
Frequent cough (night) + issues sleeping
Signs and symptoms similar to cold: sneezing, scratchy throat, tired, irritable, wheezing with activity
Active Signs and Symptoms of Asthma
Active: During asthma attack
Chest tightness
Wheezing
Coughing
Dyspnea
Increased respiratory rate
If not treated can progress to…
Cannot speak
Chest retractions
Cyanosis lips + Skin
Sweaty
Rescue inhalers do not work - medical treatment asap
Nursing Interventions Asthma
Presents with an attack…
Be sure to gather a baseline assessment
High fowlers
O2 95-99%
Keep pt clam
Bronchodilators
Assess lungs, Vital signs cyanosis, retractions, ease of speaking and peak flow meter reading
Peak Flow Meter
Shows how controlled asthma is/is it getting worse
Use with action plan + lets to know when they need their short acting bronchodilator + when its time too get medical help
Personal best = highest number over a period of time, number will be used to compare against other readings, should do this when asthma is under control
Less than 80% = follow action plan
Patient Education Asthma
Asthma Action plan
Know the Triggers + warning signs
Don’t quit exercising: Warm up 10-15 min before exercising, take short acting beta agonist before
Breath through nose, wear scarf on cold windy days
Don’t exercise when sick
Pathophysiology Pneumonia
Lower respiratory infection
inflammation of the alveoli sacs (alveoli sacs are responsible for gas exchange)
Alveoli sacs become inflamed, full of fluid, WBCs, RBCs and bacteria which makes them unable to open and close properly
Build up of CO2 = low oxygen = Hypoxemia = Respiratory acidosis
Risk Factors Pneumonia (could lead tot death if you have…)
Prior infection (influenza, cold)
Weak immune system (young/old or HIV)
Immobile: Stroke, decreased neurological status, aspiration risks
Lung problems: COPD, smoker
Post op: abdominal + chest surgery (hospital acquired pneumonia)
Types of Pneumonia
Community acquired: Most occurring, pt got germs outside healthcare setting
Hospital acquired: Pt on technical ventilation is at major risk
hard to treat, most serious, bacteria tends to be very strong and resistant to antibiotics, pt developed 48-72 hours after admission
Diagnosis Pneumonia
Auscultation of lungs
Coarse crackles, bronchi or brachial breath sounds
Chest X-ray + sputum culture (to identify germ)
Education Pneumonia
Incentive spirometer usage every 1-2 hours
Stay hydrated 2-3L per day = thin secretions
If they have a fever/dehydration they will loose 300-400ml/day watch for HF
Immobile = turn pt + keep HOB 30%
Stop smoking
Keep vaccinations up to date
Signs and Symptoms Pneumonia
P N E U M O N I A
Productive cough
Pleuritic pain (chest pain when coughing or breathing)
Neurological changes (elderly/fatigue, increased respiratory rate)
Elevated labs: PCO2 > 45 + Increased WBCs
Unusual breath sounds
Mild to high fever
Nausea + vomiting
Need for oxygen
Increased HR + RR
Aching all over + activity intolerance with SOB
Nursing Interventions Pneumonia
Assess Lung sounds, Vitals, Color of skin
Collect sputum
Monitor ABG results
Chest xray
Breathing treatments
Chest percussion
Suction as needed
Pulmonary Edema Pathophysiology
Fluid in the lungs
risk factors: anything that can cause fluid overload eg. kidney failure, HF
Medical Emergency:
results in SOB
prevents the body from being able to get adequate amounts of oxygen
Signs and Symptoms Pulmonary Edema
(happy people don’t try pot just cocaine careful of over dose)
Hypoxemia
Dyspnea
Tachypnea
Pink frothy secretions
Orthopnea
Diaphoresis
Cyanosis
Peripheral edema
JVD
Crackles on auscultation
Diagnosis (Tests) Pulmonary Edema
Chest X-ray
ABGs
Treatment Pulmonary Edema
Oxygen
Diuretics
Medication to strengthen heart muscles/relieve pressure on the heart
Cause of Pulmonary Edema
CHF
the left ventricle struggles to pump blood which causes fluid to leak from the vessels and begin to accumulate in the lungs
Refractory Hypoxemia
The patient will maintain a low blood oxygen level even though they are receiving high amounts of oxygen
Acute Respiratory Distress Syndrome
Type of respiratory failure
occurs when the capillary membrane that surrounds the alveoli sac becomes damaged which causes fluid to leak into the sac
Results in impaired gas exchange
Not enough oxygen to the body and organs
fast onset
occurs in people who are already sick
high mortality rate
Indirectly: Sepsis, burns, blood transfusion, drug overdose, inflammation off pancreas
Direct: Pneumonia, aspiration, inhaling toxic substance, drowning, embolism
Pleural Effusion Pathophysiology
Collection of fluid in the pleural space (outside the lungs)
restriction of lung expansion
The pleural are thin membranes that line the lungs and the inside of the chest cavity
Causes of Pleural Effusion
Very common
Excess fluid may either be protein poor (transudative) or protein rich (educative) these categories help determine the cause of the pleural effusion
Common causes of Transudative plural effusion
Protein poor
Heart Failure
Pulmonary Embolism
Cirrhosis
Post open heart surgery
Common causes off exudative plural effusion
Protein Rich
Pneumonia
Cancer
Pulmonary embolism
Kidney Disease
Inflammatory disease
Signs and Symptoms Pleural Effusion
(Al, Cries, over, Dead, Dogs)
Some patients are asymptomatic
Chest pain
Dry, non productive cough
Dyspnea
Orhopnea: inability to breath easily, unless the person iim sitting up straight out standing
Diagnosis of Plural effusion
Chest Xray
CT scan of chest.
Ultrasound of chest
Thoracentasis - sample of fluid
Pleural fluid analysis
Treatment of Pleural Effusion
Based on underlying condition
Diuretics + other heart failure meds are used
If causing respiratory symptoms - thoracentesis or chest tubes may be used for drainage
Pulmonary Fibrosis Pathophysioloogy
Lung disease, tissues become damaged and scarred
Scared tissue more difficult for your lungs to work properly
Causes of Pulmonary Fibrosis
Long term exposure to certain toxins
Radiation therapy
Medications
Smoking
Signs and Symptoms of Pulmonary Fibrosis
(don’t worry, falling apples, dont worry)
dry cough
Widening and rounding of the tips of fingers for toes
Fatigue
Aching muscle and joints
Weight loss
Dyspnea
Complications of Pulmonary Fibrosis
High blood pressure (pulmonary hypertension)
Right sided HF
Resp failure
Lung Cancer
Lung complications
Lung transplant may be a treatment option to improve quality of life
Diagnosis of pulmonary Fibrosis
Auscultation of the lungs
Chest Xray
CT scan
Echo cardiogram
Pulmonary function test
Pathophysiology Influenza
Influenza “the flu’
Highly contagious respiratory disease caused by the influenza virus
There are 3 types of the virus that can affect humans
Influenza A.B,C
A+B are responsible for the annual flu (flu season)
C = Mild illness but not epidemics
Causes + Risk Factors Influenza
Most likely to spread virus 1 day before symptom onset
Onset = 5-7 days after becoming sick
Risk = Close contact with infected individual or in small spaces with large groups of people during flu season
Schools, work, nursing homes + public transit are common places the virus spreads
Complications Influenza
Sinus or ear infection
Secondary bacterial infection
Clients most at risk for developing complications include children <5, pregnant women, or people with a chronic heart or lung disease
Signs + Symptoms Influenza
Symptoms present 4 days after exposure
Usually last 1 week
Headache
Fever
Chills
Fatigue + weakness
Body aches
Nasal discharge (runny nose)
Sore throat
Cough - persists 2 weeks
Influenza B may lead to nausea, vomiting and diarrhea
Influenza Diagnosis
Test to detect influenza in resp secretions
PCR
Rapid-molecular tests
Influenza Treatment
No cure for influenza
Always stay up to date soon vaccinations
Treatment involves supportive care to reduce symptoms:
Rest and Rehydration
Analgesics
Antipyretics
Antihistamins
Antiviral medications
Start medications asap
Influenza Education
Cover Mouth and Nose
Wash hands
Rest
Avoid People
Sinusitis Pathophysiology
Inflammation of the paranasal sinuses
Acute sinusitis can last up to 4 weeks
Subacute sinusitis can last up to 1-3 months
Chronic sinusitis lasts more than 3 months
Acute Sinusitis
Most Common
Viral
Rhinovirus + Influenza Virus (common cold)
Streptococcus pneumonia
goblet cells to over secret mucus = congestion
If it does not resolve quickly it will be considered subacute/chronic
Subacute and Chronic Sinusitis
Caused by infection
Eg. Environmental allergies
dust, pollution, fungii
Chronic Hyperplastic Sinusitis
Connective tissue
Hyperplasia = proliferates faster than usual, could cause nasal polyp = noncancerous outgrowths off inflamed tissue
Signs and Symptoms Sinusitis
Mainly associated with mucus build up
Can cause facial pain
pressure in the face and headache
Infection (bacterial) can cause fevers, changes in voice, sense of smell
Cough worse when lying down
Diagnosis Sinusitis
Based on symptoms
Subacute or chronic
CT scan
Rhinoscopy: Tube with camera in nose
Treatment Sinusitis
Bacterial: Antibiotics
Decongestants = reduce swelling, promote drainage
Allergy or polyps = steroids or allergy medication
Chronic or recurrent sinusitis, may require sinus surgery too open wall of sinuses
Tuberculous Pathophysiology
Contagious bacterial infection caused by Mycobacterium tuberculosis which mainly affects the lungs (upper respiratory tract)
Once in the body it may spread to the brain, joints, liver, spine and kidneys
Acid-fast bacteria - sputum test will stain red
Aerobic (loves O2) needs lots of oxygen to thrive and grow, stays in upper respiratory tract since this is where you have higher amounts of oxygen
Spread through the air (airborne precautions)
Latent TB
being controlled by the immune system
Not contagious, no signs + symptoms
Will have normal X-ray and negative sputum test but a positive TB skin test = immune system responded to bacteria
Treatment is still needed to prevent active TB
Active TB
Immune system unable to contain bacteria
Contagious, signs and symptoms, positive blood test, positive sputum test, abnormal chest x-ray
Bacteria can spread to lymphatic system and through the body
Signs and Symptoms of TB
Linda, cooks, carrots, celery, corn, for, wight loss, and, nutrition
Most patients are asymptomatic until they reach the active phase
Cough lasts three weeks or more
Coughing up blood
Fever
Night sweats
Fatigue
Unintentional weight loss
Chills
Loss of appetite
Chest pain with breathing or coughing
Risk Factors TB
Remember ‘TB RISK’
Tight living quarters (shelters, long-term care)
Below or at poverty line
Refugee (TB in home country)
Immune system issues
Substance abusers
Kids less than age 4-5
As nurses it is important to assess pt for risk especially who are presenting with respiratory symptoms
Testing for TB
Mantoux test: purified protein in derivative is injected with a tuberculin needle on the inner part of the forearm
Must be read 48-72 hours
Assess for induration of injection site, hard or swollen area raised on the skin, measure in mm (redness is not measured)
15mm = positive for everyone
10mm = positive if immigrant, IV drug user, tight living quarters or child less than 4
5mm = Positive if HIV in contact with TB, organ transplant or immunosuppressed
Will need a sputum culture and chest X-ray to confirm
Collect 3 different sputum specimen on 3 different days, morning is best
Nursing Interventions TB
Initiate airborne precautions
N95 mask + hand hygiene
Isolation until 3 negative sputum. cultures
Take medications as prescribed
Pneumothorax Pathophysiology
The collapsing of a lung due to air accumulating in the pleural space
Tension Pneumothorax
Medical emergency
Opening of intrapleural space
Creates one way valve where air collects but never leaves = compression on lungs and heart
hypoxia
decreased cardiac output
heart, trachea, esophagus shift to unaffected side
Pt on ventilation w/peep
Key Points Pneumothorax
Can be partial or total collapse of the lung (mainly affects one lung)
Causes include:
Trauma to the chest, lung disease, medical procedure
Diagnosed with chest X-ray, ultrasound, CT scan
Small = Self resolves
Large = requires treatment, chest tube to remove air from intrapleural space or needle aspiration (tension pneumothorax
Signs and Symptoms Pneumothorax
Remember “COLLAPSED”
Chest pain
Over tachycardia and tachypnea
Low blood pressure
Low SPO2
Absent lung sound on affected side
Pushing of trachea to unaffected side
Subcutaneous emphysema
Expansion of chest rise + fall unequal
Dyspnea
*Keep head of bed elevated
Nursing Interventions Pneumothorax
Monitor breath sounds
Rise + fall of chest
Vital signs
Subcutaneous emphysema (air becoming trapped in tissues beneath the skin)
Administer oxygen as needed
Chest tubes if placed by physician
Types of Pneumothorax
Open Pneumothorax : Opening in chest wall from a gunshot etc that causes a passage between outside air and the intraplural space. Allows air to pass back and forth during inspiration and expiration. Body will shunt air though chest wall instead of trachea
Nursing intervention: Sterile occlusive dressing over opening and tape on 3 sided allowing exhaled air to leave - creating a valve
Closed Pneumothorax: Air leaves into the intrapleural space without any outside wound (chest wall and pleural space stay intact.
Cased by something puncturing the lung, causing air to be released to intrapleural space. Common cause spontaneous pneumothorax
Spontaneous pneumothorax
Primary = occurs in people without lung disease
Secondary = people with lung disease
Pulmonary Hypertension Pathophysiology
Rare disease characterized by high blood pressure in the blood vessels off the lungs, specifically the pulmonary arteries which carry blood from the right side of the heart through the lungs,
when pulmonary arterial pressure rises, blood backs up into the right side off the heart eventually leading to right-sided heart failure - common in middle aged females
Signs and Symptoms Pulmonary Hypertension
Difficulty breathing
Fatigue
Weakness
Chest pain
Dizziness
Syncope
Later more Severe symptoms
Hemoptysis: Coughing up blood
Hoarseness: Compressed nerve by an enlarged pulmonary artery
Cystic Fibrosis Pathophysiology
A genetic disorder that causes exocrine glands to produce mucus that is thick and sticky rather than thin and slippery
Can affect the respiratory tract both upper and lower, digestive tract (pancreases, liver, intestine) integumentary and reproductive systems
Infertility: Unable to have children because of thickened mucus blocking sperm or ducts not formed correctly
Key Facts Cystic Fibrosis
Most common in white males
Life expectancy is age 37
Most commonly detected during the 1st years of life - child will have GI and respiratory issues
Severity differs for each person
It is an autosomal recessive disorder which means the child had to receive one mutated gene from both parents
Diagnosis Cystic Fibrosis
Sweat tests measures amount of salt in the sweat
39mmol or less = negative
40 - 59mmol = further testing
60mmol = positive for CF
Nursing Interventions Cystic Fibrosis
Focus: nutrition, treatment for infection, preventing GI blockages
Stool softeners, pancreatic enzymes, nasal sprays, vitamins, antibiotics, anti-inflammatories, mucolytics, bronchodilators
Mucus: Chest physio, postural drainage, PEP devices and nebulizers, huff coughing
Chest physio: 1-2hr after meals (in between meals)
Prevent infection
Promote exercise
How CF affects the body
Lungs (upper and lower):
snoring, nasal stiffness, blockage of airways, overtime leads to obstructive pulmonary disease like emphysema
could lead to pneumothorax
right sided HF
clubbing of nails = lack of oxygen
hemoptysis
very susceptible too lung infections
Gastrointestinal
mucus blocking the pancreatic duct impacts digestion
May develop diabetes and can contribute to malnutrition, greasy stools, abdominal pain
need feeding tube and pancreatic enzymes
Liver:
Blocks binary ducts
bile becomes thicker
gallstone can develop + gallbladder inflammation
Blockage of intestine - thick mucus and stool blockage on the gut
Integumentary: Sweat glands produce too much sweat = dehydration + electrolyte complications
Pulmonary Embolus Pathophysiology
a pulmonary embolism is a blood clot that blocks and stops blood flow to the lung.
In most cases the blood clot starts in a deep vein in the leg and travels to the lung.
pulmonary embolism can be life threatening.
Signs and Symptoms Pulmonary Embolus
Pulmonary embolism symptoms vary
Shortness of breath
Chest pain
Fainting
A cough - hemoptysis
Rapid of irregular HR
light headed or dizzy
Excessive sweating
Fever
Leg pain or swelling usually in back of lower leg
Clammy or discoloured skin
When to see a doctor Pulmonary Embolus
PE can be life - threatening seek medical attention iim you experience SOB, chest pain or fainting
Causes Pulmonary Embolism
Occurs when blood clot gets stuck in artery in the lungs, blocking the flow of blood.
Prevention Pulmonary Embolism
More likely to form during long period of inactivity such as bed rest and long trips
Anticoagulants
Compression stockings
Leg elevation
Physical activity
Purpose of Chest Tubes
Reestablish negative pressure allowing the lungs to recoil and expand
pleural space is where negative pressure is good
Normal lungs, negative pressure in the pleural space to ensure lungs expand in accordance with the chest walls rise and fall
Abnormal lungs when blood/air is in the pleural space (positive pressure pushes chest wall from lungs)
negative pressure needs to be restored by placing chest tubes and removing air and blood
Intermittent bubbling: in the water seal chamber is a good thing
Continuous bubbling: in the suction chamber is good thing, fluid drainage should not be more than 100ml/hr
Pneumothorax
air in the pleural space causes lung to collapses
no breath sounds on affected side
Location - APICAL (upper)
Hemothorax
Blood in the the pleural space
Puts pressure on lung preventing it from fully inflating and causing it to eventually collapse
Pneumohemothorax
Air and blood in the pleural space
Chest tube Malfunctions
Water seal breaks and falls on the floor:
clamp, cut, submerge in water, unclamp - must be done in 15sec
If chest tube gets pulled out: glove hand and cover opening, sterile vaseline gauze and tape 3 sides
Advantageous Lung Sounds
Crackles: Fluid in the lungs, pneumonia, heart failure, pulmonary edema
Wheezing: Relieve with brochoconstriction - asthma
Ronchi: Snoring during expiration
Stridor: Airway obstruction, anaphylaxis, high pitched breathing
Acid Base
Normal PH: 7.35 - 7.45
Normal CO2 = 35 - 45
Normal HCO3 22 - 26
Look at ph is it too low or too high
too low = acidosis
too high = alkalosis
Rule of Bs Bicarb Both
ph + bicarb = same = metabolic
opposite = respiratory
Respiratory Acidosis
Low ph + High CO2 = respiratory acidosis
any condition causing airway obstruction, COPD, asthma
Metabolic Acidosis
Low ph + low bicarb = metabolic acidosis
insufficient insulin, DKA, drug poisoning, diarrhea, shock
Respiratory Alkalosis
High ph + low bicarb = respiratory alkalosis
Hyperventilation, anxiety, panic attack - asks pt to breath slower
Metabolic Alkalosis
High ph + high bicarb = Metabolic alkalosis
GI suctioning, vomiting, hypovolemia, hypokalemia
High Ph indicates
As my ph goes, so does my pt except for potassium
High PH = tachycardia, tachypnea, hypertension, seizures, irritability, diarrhea, hyperreflexia
K+ = hypokalemia
Main intervention = suction for seizures
Low ph indicates
As my ph goes so does my pt expect for potassium
Low ph = bradycardia, constipation, lethargy, bradypnea, hypotension
K+ = hyperkalemia
Main intervention = intubation and ventilation for respiratory arrest
Acid Base Facts
Lungs = respiratory either over ventilating or underventilating
Under-ventilating = acidosis
Over-ventilating = alkalosis
Not lung = metabolic
Vomiting or suction pick metabolic alkalosis
everything else that’s not lung pick metabolic acidosis
