Respiratory System Flashcards
Bronchiectasis
abnormal permanent dilation of the large bronchi; associated with infection and destruction of the bronchial walls
Infection damages the cilia and inflammation occurs along with pooling of secretions = more infections
What causes bronchiectasis
s/t some type of other condition
ex. TB, fungal infections, tumor, lung abscess or
Cystic Fibrosis
Congenital abnormalities
How does bronchiectasis progress/develop
Obstruction of the bronchial airways
Atelectasis (alveoli close off = no gas exchange)
Smooth muscle relaxes and dilation of the airways
Airway remains patent resulting in
Infection, Inflammation and Impaired mucociliary function = Pooling of secretions, chronic inflammation, and the development of new infections
Manifestations of Bronchiectasis
Fever and recurrent bronchopulmonary infection
Production of copious amounts of foul smelling purulent sputum
Hemoptysis (blood in airways/lungs)
Weight Loss and anemia
Dyspnea and Cyanosis (typically in the chronic end condition)
Cystic Fibrosis (mucoviscidosis)
autosomal recessive genetic defect on chromosome #7 that affects the EXOCRINE glands and cells.
It produces large amounts of thick mucous and increased concentration of Na and Cl in sweat
Lots of thick secretions collect and inspissate (dry thick and harden) in ducts
Typically survive for 40 years
What are some effects of CF
Blocks alveolar ventilation
absorption atelectasis (no gas exchange)
edema of the capillary alveolar interfaces
Bronchial scarring and fibrosis destroys bronchial airways
Overinflated barrel chest
Increased risk of pneumonia and chronic bronchitis = and can result in bronchiectasis over time
Clubbing of fingers
What is the main way CF works
fluid builds up in the interstitial space causing edema and and increased distance which O2 and CO2 have to diffuse across
How does CF effect the pancreas?
mucus clogs the pancreatic ducts and the digestive enzymes don’t reach the small intestines and as a result they auto digest the pancreas itself
over time the decreased insulin secretion can result in Type I diabetes
How does CF effect the liver
over years it obstructs the small bile ducts - biliary cirrhosis, portal HTN and Liver failure
How does CF effect the intestines?
Blocks digestion and absorption = malabsorption of fats, CHO, and proteins (can’t take nutrients because no digestive enzymes to help them do this
typically have a poor nutritional status and could result in failure to thrive in infants
Manifestations of CF
Resp - Wheezing Chronic Cough, Barrel Chest
Developmental - Delayed weight gain and bone grown
GI - Inspissated (dry and thick and harden in ducts) meconium in fetal gut (baby can’t shit), Meconium ileum - blocked GI tract) and Frequent bulky foul smelling pale stool with high fat contents (steatorrhea), Vit K deficiencies, Voracious appetite (eat and eat, but don’t take in nutrients)
How do you diagnoses CF?
Sweat test (1mo-20yr) since you have increased Cl in sweat Genetic screening- Amniocentesis and Recombinant DNA (since it tends to be genetic in caucasions) Chest Xray - hyperinflation, fibrotic changes, and consolidation Stool - measure smelly stools - trypsin (fecal fat is 15-30grams when normal is 4g)
CF nursing care
24 hr a day job - you want to prevent and t respiratory failure and pulmonary complications early!!!
Inhale Aerosol with normal saline to prevent bronchodilation (Dnase)
Need to get an annual flu vaccine
Chest physiotherapy/drainage
O2 therapy
Pancreatic enzymes (capsule) to be taken with food so they can digest and get nutritional needs
The major cause of death and disability from cystic fibrosis is
recurrent pulmonary infections
What is unique about the pulmonary arteries
they carry deoxygenated blood from the heart to the lungs
What is unique about the pulmonary veins
they carry oxygenated blood from the lungs to the heart
Pulmonary HTN
increased pressure in the pulmonary circulation (**the pulmonary system is naturally a low pressure system in order for in to easily receive blood)
> 30 mmHg SYS and >12mmHg DIAS
(normal is 28 mmHg sys and 8 mmHg Dias)
What are the 2 types of pulmonary HTN
Primary and Secondary
Primary pulmonary HTN
unknown cause 7% familial, autosomal DOMINANT with variable expression
Secondary Pulmonary HTN
d/t alveolar HYPOventilation, COPD, CF, chronic bronchitis, emphysemsa etc.
S/Sx of pulmonary HTN
LOOKS LIKE HEART FAILURE
murmurs (s3 and s4)
dyspnea, JVD, chest pain, palpitations, dizziness, syncope, cough
Dx of pulmonary HTN
there are lots of tests, but not 1 magically diagnoses it. Need to do a few
Ex. EKG, V/Q scan (perfusion no good), Cardiac cath
Cor Pulmonale
Right sided heart failure d/t pulmonary problems in the lungs
Acute and Chronic types
Acute Cor Pulmonale
acute dilation of the R ventricle s/t pulmonary HTN (usually d/t pulmonary embolism)
** someone who gets a blood clot in the lung and everything backs up to the Right ventricle = stretches and dilates = acute cor pulmonale
Chronic Cor Pulmonale
hypertrophy and dilation of the R ventricle d/t disease of the pulmonary parenchyma and/or vascular system (emphysema, and chronic bronchitis)
Manifestations of Cor Pulmonale
Both peripheral and pulmonary symptoms cough with or w/o sputum JVD Rhonchi and Wheezing Hepatomegaly and a cities Cyanosis
Cause of Cor Pulmonale
Bronchiectasis Cystic Fibrosis Tumors COPD, pulmonary fibrosis, or Granulomatous diseases (Rheumatoid arthritis) Primary pulmonary HTN IV drug abuse Chronic hypoxia at high altitudes
***KNOW that kyphoscoliosis affects the thoracic cage and cause also cause this
Tx of Pulmonary HTN and Cor Pulmonale
Since they have low flow O2 you want to give O2 >60mmHg on arterial end
Bronchodilators
Diuretics - to remove fluid, but need to monitor electrolytes
What do you AVOID when tx pulmonary htn and cor pulmonale
sedatives and respiratory depressants
For a person with a pulmonary embolism what would the V/Q scan indicate
the number would go up because ventilation is okay but perfusion is not good
Pleural effusion
fluid in the pleural space >15mL
Trasudate
clear watery fluid with LOW proteins
usually cased by increased pulmonary venous pressure from HF with buildup of back pressure
**alveoli and pleura become filled with fluid “squished” out of capillaries from increased pressure
Low albumin d/t loss of osmotic pressure (hypo albumin)
Exudate
fluid HIGH in protein and cellular content d/t inflammatory response (ex pneumonia, Tb, gunshot wound)
LOCAL INFECTION OR A TUMOR
Cell content = WBCs or cancer cells or dead cells or both
Air at the apex
Fluid at the base
empyema (pus) in lungs
Thorocentesis
drawing of fluid out of the lungs - want to draw lower since air is at the base and fluid is at the apex
Manifestations of pleural effusion
ALWAYS caused by an underlying disease
PAIN - most common s/sx - sharp stabbing intensified by respiration; pleura friction rub (esp exudative)
DYSPNEA - Effusion compresses normal lung
Hemoptysis - coughing up blood d/t underlying cause
Decreased Breath sounds (reduced/absent bronchial)
Mediastinal shift - trachea and mediastinum shifted away from side of effusion (seen on chest X-ray)
Dx of Pleural Effusion
Throacentesis - fluid w/drawn and examined for protein, blood, and malignant cells
Cone Biopsy - extract small portion of pleural tissue if Tb or tumor suspected
Tx of Pleural Effusion
TREAT THE UNDERLYING PROBLEM
Chest tube - continuous drainage esp with empyema (pus in lungs)
Decortication/peeling of pleural layers/irritate them to make them fuse when healed so no fluid can get in (does decrease lung function though)
Pleurodesis - pulmonary vessel sclerosis
Transudative pleural effusions may be caused by
Hypoalbuminemia
Pneumothorax
rapid accumulation of intrapleural air in chest = collapse of lung
The pressure in the pleural space is always
Negative (exp -4mmHg; insp -10mmHg)
What is pneumothorax caused by
any opening into the pleural space through the visceral pleura, chest wall or mediastinum
What are some types of pneumothorax?
spontaneous pneumothorax closed pneumothorax tension pneumothorax open pneumothorax hydropneumothorax (accompanied by transudate) hemopneumothorax (accompanied by blood)
Spontaneous pneumothorax
air gains access to pleural cavity through defect in bronchus/alveloi (such as a rupture or blebs) s/t emphysema
Primary and Congenital may occur in otherwise healthy young adults 20-40yrs old
S/Sx of Pneumothorax
Primary symptom = CHEST PAIN OR SHOULDER PAIN thats worse with inspiration or cough
DYSPNEA from pain and lung collapse
Decreased respiratory excursions/asymmetry
Decreased breath and voice sounds
**won’t hear air moving in that spot)
Closed Pneumothorax
caused by air leaking into the pleural space from an opening within the lung (ex. perforation of the peripheral pleura while the visceral remains intact)
Interferes the least with reparations because the opposite lung is unaffected
**Body will eventually reabsorb extra air problem if there is NOT TOO MUCH!
Tension Pneumothorax
valve like opening in versceral pleura permits the entry of air during inspiration but closes during exportation
air accumulates under excessive positive pressure and completely collapses the lung = compresses mediastium = the lung, aorta, vena caves, heart and trachea deviate away from the side with the pneumothorax (away from the pressure)
MUST BE DEALT WITH IMMEDIATELY OR CAN RESULT IN DEATH WITHIN MINUTES
Cardiac tamponade
parietal pleura is continuous with pericardium and increased pressure occurs around the heart to the point where it can’t pump
**tension pneumothorax
Open pneumothorax
open penetrating chest injuries or when the opening in visceral pleura is very large and remains open despite complete collapse of the lung
How does an open pneumothorax with with an open chest wound
affected lung DOES NOT EXPAND on inspiration bc no neg pressure an be created around it
Positive pressure develops in trachea on EXPIRATION an affected lung Expands to some degree
Air in trachea is rebreathed by unaffected lung on next inspiration
PARADOXICAL BREATHING - rising of chest wall on expiration and fall on inspiration on affected side
PARADOXICAL BREATHING is related to what type of pneumothorax and can also be called what
open pneumothorax
FLAIL chest
Hydropneumothorax
TRANSUDATE FLUID at bottom
air moves to the top of the lung intrapleurally and fluid steals at the base
can be caused by a misplaced IV catheter in subclavian vein = ALWAYS check placement before infusing fluid
Hemopneumothorax
Blood and air enter into the pleural space
Most commonly seen with chest trauma or surged where blood vessels are cut
Thoracotomy tubes
removes air, fluid, or blood from intrapleural space and reexpands the lung
Typically used after chest surgery; it is inserted between the ribs through ICS (6-7th for fluid)
Holes in the ruble allow air/fluid to get out
**when air and fluid must be removed may use 2 chest tubes - 1 @ top for air and 2 @ bottom for fluid
What are the 3 chambers of the collection system for a chest tube
suction control chamber
water seal chamber
collection chamber
What does the collection chamber do
collects any fluid coming back from the patient and prevents air/fluid from returning to the lungs
Water Seal
allows air into the chamber, but not back to the lungs
Obvious BUBBLING IN THE WATER SEAL occurs when the pt is known to have an air leak from bronchopleural fistula or if tube is disconnected btwn pt and water seal allows for entrance of atmospheric air
**if air is bubbling through, the brochopleural fistula has no closed
Tidaling
up and down movement on inspiration and expiration should occur until lung fully expanded = eventually results in no movement
Suction control
determines amount of suction given to pt (the more H2O it receives = the more suction it will give)
Care of patient with a chest tube
Pleurevac/Thoraklex ***MUST BE BELOW THE LEVEL OF THE CHEST TUBE AT ALL TIMES
Pt in semi fowlers or turned toward side of the tube
DO NOT MILK TUBING
DRESSING DOES NOT GET CHANGED - if soiled/saturated put more gauze on and notify the MD
**we don’t change it because we don’t want it to open - if it opens air can get in and it defeats the whole purpose
What are things you want to encourage for patients with chest tubes
MOBILITY
Encourage ROM on affected side (so pneumonia doesn’t occur)
Deep breath and coughing ESSENTIAL for re-expansion of the lungs and preventing atelectasis
Deep inspiration - expands lung and pushes air and fluid into the tube
**Deep breathing hurts = split it put pillow over area and allow them to cough
When caring for a patient with a chest tube should you clamp the tube at any time?
NEVER clamp unless changing a full collection device or system has been opened by damage
If patient has an air leak - clamping will result in tension pneumothorax
When caring for a patient with a chest tube what are some things you need to remember about suctioning
Gentle continuous bubbling in suction chamber is all that is necessary
Use the device to regulate pressure (wall unit can be set to anything)
Check fluid levels in suction chamber (if decreased add more ASEPTICALLY)
Check and record the amount of drainage frequently - look blood
VS
Fluid drainage should stop in 3-4 days
The amount will be ordered by a physician (usu. 20 cm H2O)
Removal of a Chest tube
CXR FIRST
always done by a MD PA or NP
ALWAYS give pain medication prior to removal
Suture clipped - pt takes deep breath and bears down
REGULAR gauze and tape to prevent reentry of air
