Respiratory System Flashcards
The nose, mouth, pharynx, larynx and trachea are part of the _____ respiratory system
Upper
Function of the upper respiratory system
Warm, humidify, and filter air we breathe
The bronchi, bronchioles, alveolar ducts, and alveoli are part of the _____ respiratory system
Lower
Function of the lower respiratory system
Gas exchange
The functional units for gas exchange
Alveoli
The flow of air in and out of the alveoli
Ventilation
The exchange of oxygen and carbon dioxide between the alveoli and red blood cells in the bloodstream
Diffusion
The exchange of oxygen and carbon dioxide between the red blood cells and the body’s tissues
Perfusion
Structure that surrounds and cushions the lungs
Pleura
Normal pH
7.35-7.45
Normal PaCO2
35-45
Normal HCO3
22-26
Normal PaO2
80-100
Normal SaO2
95-100%
Insertion of a tube into a patient’s airway that allows for visualization of the airway and collection of specimen
Bronchoscopy
Pre-procedure nursing care for bronchoscopy
NPO (ranges between 4-8 hours)
Post-procedure nursing care for bronchoscopy
Assess for return of gag reflex before providing anything to eat or drink
T or F: the nurse should educate the patient that a sore, dry throat and blood tinged mucus is expected following a bronchoscopy
True
The nurse should monitor the patient for complications such as _________ following a bronchoscopy
Pneumothorax
The insertion of a needle into the patient’s posterior chest to remove fluid or air from the pleural space
Thoracentesis
Pre-procedure nursing care for thoracentesis
Have patient sit upright with arms supported on bedside table or pillows
Nursing care during thoracentesis
Advise patient to remain perfectly still (do NOT talk, move, or cough)
Post-thoracentesis, the nurse should monitor the patient for complications such as
Pneumothorax, bleeding, hypotension
T or F: an SpO2 of 90% is an expected finding in a patient with COPD
True
Nasal cannula O2 delivery
1-6 L/min
A patient receiving O2 over 4 L/min via nasal cannula may experience drying of the nares. What can the nurse provide to prevent this?
Water-based lubricant; humidified oxygen
Simple face mask O2 delivery
6-10 L/min
The nurse should inflate the bag attached to a partial rebreather and a non-rebreather mask to about ___ full. Flow rate should be adjusted to keep the bag inflated to this fullness to prevent the patient from suffocating.
2/3
Non-rebreather flow rate
10-15 L/min
Partial rebreather flow rate
10-12 L/min
Which oxygen delivery device provides high humidifcation and the most precise oxygen delivery without intubation?
Venturi mask
Venturi device flow rate
Depends on mask attached to it; varies between 4-12 L/min
Face tents are ideal for patients with facial trauma. This device provides high humidification and delivers over ___ L/min
15
Insufficient O2 in the arterial blood (<80 mmHg)
Hypoxemia
Insufficient tissue oxygenation
Hypoxia
Restlessness, irritability, abnormal breathing (use of accessory muscles, nasal flaring, adventitious lung sounds), tachycardia, hypertension and pallor are _____ signs of hypoxia
Early
Decreased LOC, increases lactic acid levels (lactic acidosis), dysrhythmias, bradypnea, bradycardia, hypotension, and cyanosis are _____ signs of hypoxia
Late
S/S of oxygen toxicity
Non-productive cough, nasal congestions, substernal pain, headache, N/V, fatigue, sore throat
Sleep apnea is defined as breathing disruption that occurs during sleep lasting at least ___ seconds and occurs ___ or more times per hour
10; 5
Sleep apnea risk factors
Obesity, large tonsils, neuromuscular/endocrine disorders
S/S of sleep apnea
Persistent daytime sleepiness or irritability
Chronic inflammatory disorder of the airway that is intermittent and reversible
Asthma
S/S of asthma
Dyspnea, wheezing, chest tightness, coughing, tachypnea, use of accessory muscle, prolonged expiration, barrel chest (w/ severe and prolonged asthma)
The nurse should educate the patient to keep tabs on their asthma using a _________ which alerts the patient to airway narrowing before they even experience symptoms
Peak flow meter
How should the nurse instruct the patient to use their peak flow meter for asthma?
Use three times and record the highest number of the three attempts
For exercise-induced asthma, the patient should take their bronchodilator ___ min before exercise
30
A life threatening complication of asthma is _____ _____ which is airway obstruction that is unresponsive to usual therapy. This can lead to pneumothorax and respiratory arrest
Status asthmaticus
S/S of status asthmaticus
Extremely labored breathing, gasping/inability to speak, decreased LOC, cyanosis, neck vein distention, pulsus paradoxus (decrease in systolic BP during inspiration)
Chronic Obstructive Pulmonary Disease (COPD) is a combination of two conditions including
Emphysema; chronic bronchitis
T or F: COPD is reversible
False
_________ is characterized by destruction of the alveoli leading to decreased lung elasticity, hyperinflation, and air-trapping in the lungs
Emphysema
_________ is characterized by inflammation of the airway and hypersecretion of mucus leading to hypoventilation, hypoxemia, and hypercapnea (retention of CO2 in lungs)
Bronchitis
What is the number 1 risk factor for COPD?
Smoking
S/S of COPD
Cough, excess sputum, crackles/wheezes in lungs, hyperresonance during percussion (d/t trapped air), barrel chest, use of accessory muscle when breathing, clubbing of fingers, cyanosis, rapid shallow respirations, tripod position (helps breathe more effectively)
A patient with COPD will have _________ PaCO2 and _________ PaO2
Elevated; decreased
COPD nursing care
- place patient in upright position (for breathing)
- administer O2 as ordered by provider
- monitor for complications such as R-sided HF
COPD patient education
- smoking cessation
- abdominal and pursed-lip breathing
- effective coughing and use of incentive spirometer (breathe IN! 10x/hr while awake)
COPD diet
Small, frequent meals; increase fluids, calories, and protein
Cystic fibrosis is a genetic __________ _________ disorder that severely impairs lung function
Autosomal recessive
S/S of cystic fibrosis
Respiratory symptoms (d/t thick mucus), steatorrhea, elevated sweat chloride
Pancreatic enzymes are given to patients with cystic fibrosis…
With meals and snacks
Percussion, vibration, postural drainage, to help loosen respiratory secretions in patients with CF
Chest physiotherapy
When should chest physiotherapy sessions be scheduled?
Before meals or several hours after meals to prevent vomiting
Bronchodilators should be administered ___ to ___ before chest physiotherapy
30 min to 1 hr
CF diet
Increase fluid, protein, calorie intake; fat soluble vitamin supplements
What is a key complication of pulmonary hypertension?
Cor pulmonale (increased resistance in lungs that causes back flow of blood and enlargement of right ventricle of heart)
Influenza is a viral infection spread primarily through
Droplets
Tamiflu (antiviral) can be given within the first ___ hrs of the onset of influenza symptoms
48
Excess fluid in the lungs due to inflammation
Pneumonia
Pneumonia labs: CBC, PaO2, PaCO2
CBC - WBC elevated
PaO2 - decreased
PaCO2 - increased
Pneumonia treatment nursing consideration
Collect sputum culture PRIOR to antibiotic therapy (early morning sample is preferred!)
Tuberculosis mode of transmission
Airborne
S/S of tuberculosis
Cough lasting >3 wks, purulent or bloody sputum, night sweats, unexplained weight loss, lethargy
A mantoux skin test for tuberculosis requires the client to return 48-72- hours after initial injection. A positive result is indication if
Client has induration of 10 mm or more (this means the client has an active TB infection or has had a previous TB infection)
A ___ mm induration indicates a positive TB result in immunocompromoised patients
5
T or F: people who have lived internationally and have received a BCG vaccine may end up with a false positive TB result
True
An acid-fast bacilli sample can be used for diagnosis of TB infection using ___ early morning sputum samples
3
Medications often used to treat TB
Rifampin, isoniazid, pyrazinamide, ethambutol (RIPE)
Treatment for TB includes combination antibiotic therapy for up to _________
1 year
TB nursing care
Negative airflow room, airborne precautions, wear N95 mask, if patient leaves room they must wear surgical mask, screen family for TB, sputum sample required every few weeks during therapy
After how many negative sputum samples is a patient no longer infectious with TB?
3
Hallmark sign of fat emboli
Petechiae (along with s/s of PE)
What lab will be elevated in the presence of blot clots?
D-Dimer
What is the most common cause of a pulmonary embolism (PE)?
Deep Vein Thrombosis (DVT)
Accumulation of air in the pleural cavity
Pneumothorax
Accumulation of blood in the pleural cavity
Hemothorax
Accumulation of fluid in the pleural cavity
Pleural effusion
S/S of pleural disorder
Respiratory distress, decreased or absent breath sounds on affected side
Percussion assessment of pneumothorax
Hyperresonance
Percussion assessment of hemothoracx or pleural effusion
Dull percussion
Pleural disorder treatment
Chest tube (removes accumulation air, blood, fluid), Benzos (anxiety), opioids (pain)
What are the three chambers of chest tubes?
Drainage collection, water seal chamber, suction control chamber
Chest tube drainage greater than ___ mL/hr should be reported to the provider
100
T or F: tidaling and continuous bubbling is normal in the water seal chamber of chest tube
FALSE; tidaling is normal, however, continuous bubbling indicates an air leak
Continuous bubbling is expected for which chamber of chest tubes?
Suction control chamber
Chest tube nursing care/best-practices
- chest x-ray to confirm placement
- occlusive dressing over insertion site
- check insertion site regularly for subcutaneous emphysema (trapping of air under skin - feels like rice crispies)
- monitor site for signs of infection
- only clamp if ordered by provider
What should the nurse do if the chest tube becomes disconnected from the drainage system?
Place end of tube in sterile water
What should the nurse do if the chest tube is accidentally removed from the patient’s chest?
Place dry, sterile gauze over insertion site and notify provider
Occlusion of a chest tube is a key risk factor for
Tension pneumothorax
The trapping of air in the pleural cavity under positive pressure (air enters pleural space upon inspiration, but cannot escape upon expiration)
Tension pneumothorax
Tension pneumothorax can lead to
Lung collapse
S/S of tension pneumothorax
Tracheal deviation towards unaffected side, absent breath sounds on affected side, asymmetry of thorax, respiratory distress, neck vein distention
Tension pneumothorax treatment
Immediate insertion of large bore needle into pleural space to remove air and allow for lung re-expansion; placement of chest tube
Respiratory failure that occurs due to non-cardiac pulmonary edema
Acute Respiratory Distress Syndrome (ARDS)
The inability of the lungs to maintain arterial oxygenation or to eliminate CO2 from the body leading to tissue hypoxia
Acute Respiratory Failure (ARF)
Optimal position for patient with ARF
Good lung down
Low pressure alarms of mechanical ventilation are due to
Leaks (disconnection, cuff leak, tube displacement)
High pressure alarms of mechanical ventilation are due to
Increase in pressure r/t pulmonary edema, pneumothorax, bronchospasm, biting, secretions, cough, kink (remember: 2 PB sandwiches can make you SiCK)
Mechanical ventilation setting that describes the volume of gas delivered with each breath
Tidal volume (VT)
Mechanical ventilation setting that describes the O2 concentration of the air being delivered to patient
Fraction of inspired oxygen (FiO2)
FiO2 can vary between ___-___%
21-100
Normal I:E (duration of inspiration to expiration) ratio of mechanical ventilation
1:2 or 1:1.5
Mechanical ventilation setting that describes the pressure applied at the end of expiration to distend the alveoli and prevent collapse
Positive end expiratory pressure (PEEP)
What supplies should be kept at the bedside of a client who is mechanically ventilated?
Manual resuscitation bag, reintegration equipment including two different tube sizes
ET tubes should be repositioned every ___ hours or more frequently to prevent skin breakdown
24
What complication should the nurse monitor for in a mechanically ventilated patient?
Ventilator-associated pneumonia
