Respiratory System Flashcards
Ventilation
Air movement in and out of the lungs
Oxygenation
Oxygen in the bloodstream
Perfusion
Oxygen in the tissues
Crackles
Description: Wood burning in a fire place, popping
Cause: Air moving through mucous, fluid, pus
Rhonchi
Description: Low-pitch, snoring
Cause: Secretions in large airways
Wheezes
Description: High-pitched musical sound
Cause: Airway constriction
Diminished
Description: Quiet
Cause: Shallow or restricted breathing
Stridor
Description: High-pitched inspiratory sound
Cause: upper airway obstruction
Low Flow Oxygen masks
- Nasal Cannula
- Simple face mask
- Non-rebreather
High flow Oxygen Mask
- Venturi mask
- High flow nasal Cannula
CPAP
Continuous Positive Airway Pressure
- Delivers air pressure at single set level that stays consistent during sleep
- Not as good for accommodating breathing problems
- Generally recommended for obstructive sleep apnea (OSA)
- Typically less expensive
Inhale & Exhale: constant set pressure
BiPAP
BiLevel Positive Airway Pressure
- 2 different pressure settings for inhale VS exhale allowing for lower pressure during exhalation
- Used for more complex breathing problems such as central sleep apnea, heart/lung/neurological disorders that require additional airway support during sleep (CHF, COPD, Parkinson’s, ADS)
- Inhale: constant set pressure
Exhale: Lower constant set pressure
Endotracheal Tube
What is it
* Invasive, artificial airway used when the client is unable to protect their own airway
* Plastic tube inserted into the trachea through the mouth or nose
* Maintains an airway to deliver oxygen and positive pressure to the lungs
* “Breathing tube”
Nursing Must Know
* After placement of an ETT, placement should be verified by a chest x-ray
* Assess for equal breath sounds bilaterally
○ The ETT can become displaced into the R main stem bronchus
Ensure that breath sounds are heard equally bilaterally or the tube may need to be repositioned
Tracheostomy
What is it
· An artificial airway used for long-term needs
· Stoma is made in the neck and the tube inserted into the trachea
· Breathing is through the tracheostomy tube, not the nose and mouth.
Used for
· Tracheal obstruction
· Slow vent weaning
· Tracheal damage
· Neuromuscular damage
Trach Care
* Infection prevention is key!
○ The natural defenses of the nose and mouth are bypassed - higher risk for infection
○ Daily trach care - inpatient, this is a sterile procedure
* Position: Fowler’s or semi-Fowler’s
* Perform hand hygiene, don clean gloves
* Remove soiled dressing, don sterile gloves
* Clean the tracheostomy site
○ Use sterile applicators or gauze dressings moistened with normal saline
§ 1:1 NS and Hydrogen peroxide is used with some clients
○ Use each applicator/gauze once, then discard
○ Dry client’s skin
* Apply new sterile dressing
* Change tracheostomy ties
* Check tightness - ensure 1 finger can fit underneath
Suctioning
* Only suction to the pre measured depth
○ Suctioning too deep can cause damage or cause laryngospasm
○ Don’t suction longer than 10 seconds
* Some clients may need pre-oxygenated with 100% FiO2
Safety
* You must keep two back up trachs at the bedside incase of emergency
○ 1 of same size
○ 1 a half size smaller
* If the trach comes out, first try to insert the back up of the same size
If unsuccessful, try to insert the half size smaller
Chest Tubes
What is it?
* Tube inserted into the pleural space of the lungs
* Helps to remove air or fluid that has caused the lung to collapse
* Also placed after cardiac surgery to help drain blood and fluid from around the heart
Indication for chest Tube
* Pneumothorax
* Effusion
* Abscess
* Cancer
* Hemothorax
Nursing Considerations
* Always keep the drainage system below the level of the client’s chest
* Ensure the tubing is free of kinks and draining freely
* There should be no dependent loops in the tubing
○ Monitor the drainage
§ Color - serous - serosanguinous. Know WHY the client has a CT!
§ Odor - none
§ Consistency - thin-thick
§ Amount - no more than 100ml/hr. More? Call the doc!! Mark hourly
