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)