Respiratory System Flashcards

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1
Q

Pathophysiology of COPD

A

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

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2
Q

Causes of COPD

A

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

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3
Q

Gas Exchange Related to COPD

A

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

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4
Q

Blue Bloaters COPD

A

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

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5
Q

Pink Puffers COPD

A

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

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6
Q

Symptoms of COPD

A

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

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7
Q

Nursing Interventions COPD

A

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)

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8
Q

How to diagnose COPD

A

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

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9
Q

Complications COPD
(Rylee loves licking pachos penis)

A

Right sided HF
Lung infections
Lung Cancer
Pneumonia
Pneumothorax

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10
Q

Education COPD

A

Nutrition: High cal + protein
Small frequent meals
2-3L of Water
Avoid sick people + irritants
Stop smoking
Vaccinations up to date

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11
Q

Pathophysiology Asthma

A

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

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12
Q

Cause of Asthma

A

unknown

there are many triggers
environmental factors
respiratory infections
GERD
hormonal shifts
exercise induced
Substance indued

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13
Q

Early Signs and Symptoms of Asthma

A

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

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14
Q

Active Signs and Symptoms of Asthma

A

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

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15
Q

Nursing Interventions Asthma

A

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

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16
Q

Peak Flow Meter

A

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

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17
Q

Patient Education Asthma

A

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

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18
Q

Pathophysiology Pneumonia

A

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

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19
Q

Risk Factors Pneumonia (could lead tot death if you have…)

A

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)

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20
Q

Types of Pneumonia

A

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

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21
Q

Diagnosis Pneumonia

A

Auscultation of lungs
Coarse crackles, bronchi or brachial breath sounds

Chest X-ray + sputum culture (to identify germ)

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22
Q

Education Pneumonia

A

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

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23
Q

Signs and Symptoms Pneumonia
P N E U M O N I A

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

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24
Q

Nursing Interventions Pneumonia

A

Assess Lung sounds, Vitals, Color of skin
Collect sputum
Monitor ABG results
Chest xray
Breathing treatments
Chest percussion
Suction as needed

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25
Q

Pulmonary Edema Pathophysiology

A

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

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26
Q

Signs and Symptoms Pulmonary Edema
(happy people don’t try pot just cocaine careful of over dose)

A

Hypoxemia
Dyspnea
Tachypnea
Pink frothy secretions
Orthopnea
Diaphoresis
Cyanosis
Peripheral edema
JVD
Crackles on auscultation

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27
Q

Diagnosis (Tests) Pulmonary Edema

A

Chest X-ray
ABGs

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28
Q

Treatment Pulmonary Edema

A

Oxygen
Diuretics
Medication to strengthen heart muscles/relieve pressure on the heart

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29
Q

Cause of Pulmonary Edema

A

CHF
the left ventricle struggles to pump blood which causes fluid to leak from the vessels and begin to accumulate in the lungs

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30
Q

Refractory Hypoxemia

A

The patient will maintain a low blood oxygen level even though they are receiving high amounts of oxygen

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31
Q

Acute Respiratory Distress Syndrome

A

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

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32
Q

Pleural Effusion Pathophysiology

A

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

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33
Q

Causes of Pleural Effusion

A

Very common
Excess fluid may either be protein poor (transudative) or protein rich (educative) these categories help determine the cause of the pleural effusion

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34
Q

Common causes of Transudative plural effusion

A

Protein poor

Heart Failure
Pulmonary Embolism
Cirrhosis
Post open heart surgery

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35
Q

Common causes off exudative plural effusion

A

Protein Rich

Pneumonia
Cancer
Pulmonary embolism
Kidney Disease
Inflammatory disease

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36
Q

Signs and Symptoms Pleural Effusion

(Al, Cries, over, Dead, Dogs)

A

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

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37
Q

Diagnosis of Plural effusion

A

Chest Xray
CT scan of chest.
Ultrasound of chest
Thoracentasis - sample of fluid
Pleural fluid analysis

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38
Q

Treatment of Pleural Effusion

A

Based on underlying condition
Diuretics + other heart failure meds are used
If causing respiratory symptoms - thoracentesis or chest tubes may be used for drainage

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39
Q

Pulmonary Fibrosis Pathophysioloogy

A

Lung disease, tissues become damaged and scarred
Scared tissue more difficult for your lungs to work properly

40
Q

Causes of Pulmonary Fibrosis

A

Long term exposure to certain toxins
Radiation therapy
Medications
Smoking

41
Q

Signs and Symptoms of Pulmonary Fibrosis
(don’t worry, falling apples, dont worry)

A

dry cough
Widening and rounding of the tips of fingers for toes
Fatigue
Aching muscle and joints
Weight loss
Dyspnea

42
Q

Complications of Pulmonary Fibrosis

A

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

43
Q

Diagnosis of pulmonary Fibrosis

A

Auscultation of the lungs
Chest Xray
CT scan
Echo cardiogram
Pulmonary function test

44
Q

Pathophysiology Influenza

A

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

45
Q

Causes + Risk Factors Influenza

A

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

46
Q

Complications Influenza

A

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

47
Q

Signs + Symptoms Influenza

A

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

48
Q

Influenza Diagnosis

A

Test to detect influenza in resp secretions
PCR
Rapid-molecular tests

49
Q

Influenza Treatment

A

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

50
Q

Influenza Education

A

Cover Mouth and Nose
Wash hands
Rest
Avoid People

51
Q

Sinusitis Pathophysiology

A

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

52
Q

Acute Sinusitis

A

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

53
Q

Subacute and Chronic Sinusitis

A

Caused by infection
Eg. Environmental allergies
dust, pollution, fungii

54
Q

Chronic Hyperplastic Sinusitis

A

Connective tissue
Hyperplasia = proliferates faster than usual, could cause nasal polyp = noncancerous outgrowths off inflamed tissue

55
Q

Signs and Symptoms Sinusitis

A

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

56
Q

Diagnosis Sinusitis

A

Based on symptoms
Subacute or chronic
CT scan
Rhinoscopy: Tube with camera in nose

57
Q

Treatment Sinusitis

A

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

58
Q

Tuberculous Pathophysiology

A

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)

59
Q

Latent TB

A

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

60
Q

Active TB

A

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

61
Q

Signs and Symptoms of TB
Linda, cooks, carrots, celery, corn, for, wight loss, and, nutrition

A

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

62
Q

Risk Factors TB

A

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

63
Q

Testing for TB

A

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

64
Q

Nursing Interventions TB

A

Initiate airborne precautions
N95 mask + hand hygiene
Isolation until 3 negative sputum. cultures
Take medications as prescribed

65
Q

Pneumothorax Pathophysiology

A

The collapsing of a lung due to air accumulating in the pleural space

66
Q

Tension Pneumothorax

A

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

67
Q

Key Points Pneumothorax

A

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

68
Q

Signs and Symptoms Pneumothorax

A

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

69
Q

Nursing Interventions Pneumothorax

A

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

70
Q

Types of Pneumothorax

A

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

71
Q

Pulmonary Hypertension Pathophysiology

A

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

72
Q

Signs and Symptoms Pulmonary Hypertension

A

Difficulty breathing
Fatigue
Weakness
Chest pain
Dizziness
Syncope

Later more Severe symptoms
Hemoptysis: Coughing up blood
Hoarseness: Compressed nerve by an enlarged pulmonary artery

73
Q

Cystic Fibrosis Pathophysiology

A

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

74
Q

Key Facts Cystic Fibrosis

A

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

75
Q

Diagnosis Cystic Fibrosis

A

Sweat tests measures amount of salt in the sweat
39mmol or less = negative
40 - 59mmol = further testing
60mmol = positive for CF

76
Q

Nursing Interventions Cystic Fibrosis

A

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

77
Q

How CF affects the body

A

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

78
Q

Pulmonary Embolus Pathophysiology

A

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.

79
Q

Signs and Symptoms Pulmonary Embolus

A

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

80
Q

When to see a doctor Pulmonary Embolus

A

PE can be life - threatening seek medical attention iim you experience SOB, chest pain or fainting

81
Q

Causes Pulmonary Embolism

A

Occurs when blood clot gets stuck in artery in the lungs, blocking the flow of blood.

82
Q

Prevention Pulmonary Embolism

A

More likely to form during long period of inactivity such as bed rest and long trips
Anticoagulants
Compression stockings
Leg elevation
Physical activity

83
Q

Purpose of Chest Tubes

A

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

84
Q

Pneumothorax

A

air in the pleural space causes lung to collapses

no breath sounds on affected side
Location - APICAL (upper)

85
Q

Hemothorax

A

Blood in the the pleural space

Puts pressure on lung preventing it from fully inflating and causing it to eventually collapse

86
Q

Pneumohemothorax

A

Air and blood in the pleural space

87
Q

Chest tube Malfunctions

A

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

88
Q

Advantageous Lung Sounds

A

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

89
Q

Acid Base

A

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

90
Q

Respiratory Acidosis

A

Low ph + High CO2 = respiratory acidosis
any condition causing airway obstruction, COPD, asthma

91
Q

Metabolic Acidosis

A

Low ph + low bicarb = metabolic acidosis
insufficient insulin, DKA, drug poisoning, diarrhea, shock

92
Q

Respiratory Alkalosis

A

High ph + low bicarb = respiratory alkalosis
Hyperventilation, anxiety, panic attack - asks pt to breath slower

93
Q

Metabolic Alkalosis

A

High ph + high bicarb = Metabolic alkalosis
GI suctioning, vomiting, hypovolemia, hypokalemia

94
Q

High Ph indicates

A

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

95
Q

Low ph indicates

A

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

96
Q

Acid Base Facts

A

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