Respiratory system Flashcards
what should you observe?
position breathing
LOC
fingers and toes (clubbing/cyanosis)
respiratory rate
pulse oximetry (95< normal)
History?
respiratory history
smoking/other tobacco use
drug use
complementary/ integrative therapies
allergies
travel
area of residence
family history
genetic risk
current health problems
changes with aging?
decr. in lung elasticity
decr. in cilia function
muscle atrophy
additional cue for respiratory issues?
chest pain
cough
productive
color/amount
SOB with simple ADLs
apnic
orthopnea
I PREPARE
Investigate (possible exposure)
Present work
Residence
Environment (exposure)
Past work
Activities
Resources
Educate
the A’s of quitting smoking?
Ask about tobacco usage
Advise to quit
Assess willingness to quit
Assist in quitting
Arrange for a follow up
Inspection?
Chest shape/configuration (type of breathing)
Respiratory assessment
Chest expansion/ respiration quality
Palpate
Breathing posture/type of breathing
Breath sounds
Expected findings?
equal rise and fall
narrow from front to back
side to side wider
RR 12-22
no difficulty breathing
symmetry
unexpected findings
flail (chest trauma)
pneumothorax (collapsed lung due to air)
hemothorax (collapsed lung due to blood)
crackles/wheeze/rhonchi/plural friction tub/chyene stoke
hyperinflation of lungs
barrel chest
tripod position to breath
use of accessory organs to breathe
Psychosocial assessment?
anxiety
changes in roles/relationships
social isolation
financial problems
unemployment
disability
coping mechanisms
Labs to assess?
H&H (incr)
RBC (incr hypoxic) (decr. anemia, hemolized, speptic)
ABG (assess gas exchange/perfusion)
Sputum specimen (bacteria)
Imaging to assess?
chest X-ray
CT scan
Noninvasive Diagnostic testing?
pulse oximetry
capnometry/capnography (CO2 levels)
pulmonary function test (PFTs) (lung function/breathing)(no dilators, smoking, heavy meals, 4hr prior)
Exercise testing(90min)
Invasive diagnostics testing?
Endoscopic examination(NPO 4hr prior)
1)Bronchoscopy (tube into airway to assess and take specimen)
2)Thoracentesis (needle aspiration of fluid/air from plural space) (sterile dressing)
3)Lung biopsy (samples/needle aspiration for definitive diagnosis)
complications for endoscopic examinations?
worsening pain
incr HR
incr RR
air hunger
asymmetric chest movement
trachea movement
new nagging cough
what is hypoxia?
low oxygen to the tissue
what is hypoxemia?
low oxygen to blood
Normal VQ balance
ventilation/perfusion at right ratio
4L per min/ 5L per min= 0.8
(ventilation and perfusion both occurring)
VQ imbalances?
shunt
dead space
silent unit
what is a VQ shunt?
no ventilation/perfusion
(a blockage, prevents O2 entering)
supplemental O2
(shunting is 20%, normal is 2%)
(hypoxia)
What is a VQ dead space?
ventilation/no perfusion
(blockage of blood flow through lungs)
getting O2, no gas exchange due to no perfusion
What is a VQ silent unit?
no ventilation/no perfusion
cardiac arrest
what is hemothorax?
lung collapse due to blood fluid up in plural space
what is pneumothorax?
lung collapse due to air build up in plural space
what is Oxygen therapy?
least amount of O2 given that is effective
(relieves hypoxemia &hypoxia)
Nasal cannula
1-6L/min
long term
25-40%
simple face mask
5-10L/min
short term
40-60%
venturi mask
2-15L/min
last step before intubation
24-60%
non-rebreather mask
10-15L/min
1 way valve, ER use
80-95%
High flow nasal cannula
up to 60L/min
heat humidity
21-100%
non-invasive positive-pressure ventilation
CPAP
one pressure (continuous)
BiPAP
bilevel pressure (inspiration or expiration)
T piece
test for extabation
Lung Sounds?
Wheezes
Crackers
Stridor
Rhonchi
Plural friction rub
Wheeze
whistle
narrow airway
chest/back during exhalation
asthma/COPD
AIM
what is AIM
Albuterol (rescue drug)
Ipratropium (anticholinergic)
Methyprednisolone (steroid for swelling)
Crackles
Crazy fluid
high pitched crackles/ bubbling
lower lobes
pulmonary edema(fluid in lungs/alveoli)
Diuretics
Stridor
Squeak
harsh whistle
throat region during inspiration
blockage in larynx (choking)
Diuretics
Rhonchi
Rumble
low pitched rumble/rattle
bronchi in airway
obstruction/mucus
Bronchitis/COPD
percussion
Plural friction rub
pebbles rubbing
dry rubbing
from side of lung
plural inflammation
worsening pneumonia
incentive spirometer
What is the most common lower respiratory disorder, reducing gas exchange, and causes an airway obstruction?
Asthma
causes of asthma?
airway obstruction
bronchial obstruction
eosinophilia asthma
asthma airway obstruction causes
inflammation
airway tissue sensitivity
bronchoconstriction
asthma bronchial obstruction causes
muscle spasms
mucosa eduma
thick secretions
eosinophilia asthma causes
different types of WBC
causes of asthma
allergens
irritants
microorganisms
aspirin
NSAIDs
narcotics
urban>rural areas
Triggers for asthma ASSSSS
Allergens (elevated eosinophils)
Smoking
Stress
Sickness
Severe weather (cold)
Strenuous activity (take inhaler 30 min before to prevent)
Asthma control stages
0 controlled
1-2 partly controlled
3-4 uncontrolled
Labs for asthma and COPD
ABG
PFT
FVC
FEV
peak flow
what is a peak flow meter used for?
to anticipate a severe asthma attack before it occurs
Green on peak flow meter
Green, Good to Go
Asthma is 80-100% controlled
Yellow on peak flow meter
Yellow mellow
NOT under control, additional meds
(rescue drug Q4 for 1-2 days)
red on peak flow meter
Red is Really Bad
emergency treatment
ASTHMA s/s
Accessory organs (for breathing)
SOB (dyspnea)
Tight chest (tachypenia)
High pitched wheezing
Minimal breath sounds
Absent breath sounds( leads to Air trapping causing acidosis)
Asthma assessment
symptoms?
prominent at night or day?
what provides relief?
how many flare ups?
activity restrictions?
episode pattern
Interventions for asthma
control/prevent episodes
improve airflow/gas exchange
self management
(personal asthma action plan)
drug therapy
exercise/activity
oxygen therapy
what and when to take meds
Drugs for asthma BAMS
Beta agonist –> albuterol (rescue drug)
Anticholinergics–> Ipratropium (decr. secretions, dries out airway)
Methylxanthines–> theophylline (therapeutic window 10-20mg/dL) (suppress CNS to open airway)
Steroids–> reduce inflammation
Status Asthmaticus
severe life-threatening asthma attack
doesn’t respond to normal meds
lead to pneumothorax or cardiac/respiratory arrest
treatment for status asthmaticus
2.5mg albuterol every 20min for 1hr the per hr after
nebulize ipratropium
IV methoprednisolone every hr for 24hr
oral steroids 10-14 days after
HyperCapnic means
High Carbon dioxide
AIM for acute asthma attacks
Albuterol
Iprotropium
Methylprednisolone
Inhaler teaching
1) shake inhaler
2) remove cap
3) place spacer if needed
4) exhale all the way
5) close mouth around inhaler (seal)
6) inhale slowly while administering inhaler
7) remove inhaler and hold breath 10 sec
8) rinse mouth to prevent thrush
(if giving steroids rinse after every use, if given bronchodilators rise twice a week)
A collection of lower airway disorders that interfere with airflow and gas exchange
COPD
(normal O2 95-100%)
(COPD O2 88-93%)
type of COPD
chronic bronchitis
emphysema
Chronic bronchitis
Airway problems
bronchioles narrow/blocked w/ mucus
(swelling from inflammation)
hyper inflated lungs
(mucus build up can lead to infection like pneumonia)
emphysema
alveolar problems
alveoli loose elasticity
(airsacks break down from toxins/irritants)
can also have chronic bronchitis
Air trapping
air hunger
faster CO2 ventilation (inhaling before exhale is complete)
acidosis
what is air trapping?
collection of CO2 in the lungs
What causes the use of accessory organs when breathing?
enlarged alveoli–> bronchial collapse–> hyperinflated lungs–> diaphragm flattens weakening its muscles–> use of accessory organs to breathe
COPD assessment
risk factors (genetics, exposure, job, gender)
smoking history
breathing problems
Activity level
weight (typically wt. loss due to SOB when eating)
general appearance (pale, stooped over, tachypenia, look older poor grooming, blue)
respiratory/cardiac changes (rate, depth, rhythm)
psychosocial (isolated, anxious, change of roles)
Asthmas link to COPD
adults with asthma are 12 times more likely to develop COPD
COPD complications
Hypoxemia(decr. O2 to heart)
Acidosis(PaCO2 levels incr)
Dyspnea(inflammation/mucus buildup)
Incr. risk respiratory infection(long term steroid risk, mucus infection)
respiratory failure(disrupted gas exchange)
Cardiac failure(hypoxemia)
Dysrhythmias(hypoxemia, acidosis)
Pink Puffers
hyperventilate
(short fast breath=redness in chest/face)
weight loss
(appear thin)
barrel chest
(hyperinflation from air trapping)
SOB/dyspnea
Blue bloaters
mucus obstruction=decr. oxygen
(cyanosis, blue skin hypoemia)
overweight/obese
(HF)
Chronic cough, rhonchi, wheezing
HyperCapnic COPD
BiPAP
what meds should COPD patients not have
Opiods
Benzos
Emphysema diet
incr calories
small frequent meals
chronic bronchitis diet
incr. fluids
drink in-between meals nor during
COPD medication
Bronchodilators (albuterol)
wait 5 min
Steroid (budesonide)
vaccination
be up to date with respiratory infections
Pursed lip breathing
inhaling through nose(mouth closed)
Exhaling through pursed lips
Diaphragmatic breathing
lay on back with a book or hands resting on abdomen, and breathe by moving the hands/books
how to calculate pack years
of packs smoked per day
times
#of years smoked
Silent lung s/s
difficulty speaking
chest tightness
anxiety
inability to take in air
pass out
cyanosis
rapid breathing
no lung sounds
pneumothorax s/s
chest pain
hypoxia
tachycardia
air in plural space
(from trauma)
paracentesis
needle inserted into plural cavity to remove air or fluid
must stay still during procedure
(sterile dressing assess for s/s of worsening, infection, changes)
SABA
short acting beta agonist
dilates bronchi(bronchodilator)
Albuterol=Acute Attacks
rescue drug=immediate relief
LABA
long acting beta agonist
dilate bronchi(bronchodilator)
arformoterol= slow and steady
(works for a long time)
long term management
COPD
Theophylline
Methylxanthines
dilates bronchi by CNS(bronchodilator)
therapeutic 10-20mcg/dL
Vomiting
Restlessness
Tachycardia
Sweating
Anxiety
Corticosteroids
budesonide
anti-inflammatory
asthma/COPD
long term(report signs of infection, incr. calcium intake, yearly optometrist appointment, decr. when stressed, never stop suddenly)
rinse mouth after taking to prevent thrush
