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Nursing Acutely Ill > Respiratory System > Flashcards

Respiratory System Flashcards

1
Q

Function of pulmonary ventilation

A

Breathing. Promotes air movement in and out of the lungs.

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2
Q

Function of external respiration

A

Gas exchange at the alveoli and pulmonary capillary interface. Loading of O2, unloading of CO2.

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3
Q

Process of respiratory gas transport

A

O2 and CO2 transportation from and to the lungs and body cells via blood in the circulatory system.

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4
Q

Process of internal respiration

A

Gas exchange at the interface between systemic capillaries and tissue cells.

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5
Q

Definition of Type I respiratory failure. SpO2 and SpCO2 values

A

Hypoxaemia with normocapnia
(PaO2 low, PaCO2 normal/low)
Causing an increased alveolar gradient

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6
Q

Definition of Type II respiratory failure, SpO2 and SpCO2 values. Target SpO2.

A 
Hypoxaemia with hypercapnia 
(Low PaO2 with
high PaCO2) 
Normal alveolar gradient 
Decreased pH. 
SpO2 88-92%.
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7
Q

Tachypnoea definition

A

RR >20rpm.

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8
Q

Bradypnoea definition

A

RR <12rpm.

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9
Q

Apnoea definition

A

Absence of respiration

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10
Q

Cyanosis definition

A

Lack of oxygen in the blood that causes bluish discolouration of skin and mucous membranes

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11
Q

Hypoxia definition

A

Inadequate oxygen supply to the tissues

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12
Q

Dyspnoea definition

A

Difficult, laboured breathing

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13
Q

Hypoxaemia definition and value

A

Reduced arterial blood PaO2 <8kPa, with or without increased arterial PaO2.

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14
Q

Hypercapnia definition and value

A

Increased arterial PaCO2 >6kPa.

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15
Q

Definition of SaO2

A

Percentage of haemoglobin saturated with oxygen. Arterial SaO2 very similar to capillary SpO2 measures

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16
Q

SpO2 definition and target value.

A

Peripheral capillary blood haemoglobin oxygen saturation (not a measure of effective ventilation). SpO2 94-98%

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17
Q

PaO2 definition and normal values

A

Partial pressure of oxygen in the arterial system. Normal values 11-13kPa

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18
Q

Normal haemoglobin value

A

11.5-18.0g/dL

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19
Q 
Arterial blood gas (ABG) analysis normal values with unit of measure: 
pH 
PaO2 
PaCO2 
HCO3- 
BE 
SaO2
Lactate
A 
pH: 7.35-7.45 
PaO2: 11-13.3kPa
PaCO2: 4.8-6.0kPa 
HCO3-: 21-28mmol/L
BE: -2 to +2 
SaO2: 95-100% 
Lactate: 0.5-1mmol/L
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20
Q

PaCO2 normal values

A

4.6-6.0kPa

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21
Q

What occurs in respiratory acidosis

A

Increasing PaCO2 with decrease PaO2 causing decrease in pH

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22
Q

Compensatory mechanisms for respiratory acidosis

A

Increased respiratory rate. Depletion of HCO3- store/increase in circulating HCO3-

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23
Q

What is pink throthy sputum a sign of

A

Cardiac failure

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24
Q

Definition of chenye-stokes respiration

A

Irregular breathing pattern with periods of apnoea associated with brain stem death.

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25
Q

What is Kussmal breathing and what is it associated with? What may cause it?

A

Deep and rapid breathing associated with metabolic acidosis. Caused by sepsis, uraemia or diabetic ketoacidosis

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26
Q

Flail chest

A

Breaking of ribs away from chest wall, preventing normal mechanics of breathing from occurring efficiently.

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27
Q

Surgical emphysema

A

Air under the surface of the skin on the chest from the lungs, feels like bubble wrap.

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28
Q

What can an X-ray of the chest help to diagnose in relation to the respiratory system

A

Pneumothorax, pleural fluid, pulmonary oedema, infection, lung fibrosis.

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29
Q

What occurs in respiratory alkalosis?

A

Decrease CO2

Increase in pH

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30
Q

What is base excess?

A

Provides a numerical value for the the degree of acid base imbalance.

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31
Q

What does a BE of +2 mean?

A

Increase in bicarbonate due to metabolic alkalosis causing compensatory respiratory acidosis to try and bring pH back within range

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32
Q

What does a BE of -2 mean?

A

Reduced bicarbonate due to metabolic acidosis causing compensatory respiratory alkalosis to bring pH back within range.

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33
Q

What type of process is inspiration/expiration

A 
Inspiration= active process 
Expiration= passive
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34
Q

What determines airway resistance?

A

Diameter of airway

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35
Q

What is lung compliance?

A

Ability of lungs to stretch and expand easily.

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36
Q

What is the name of the membrane that covers the lung and chest wall?

A

Pleura (visceral and parietal)

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37
Q

What keeps the visceral and parietal pleura together?

A

Negative pressure within the inter plueural space that constantly pulls the two membranes together.

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38
Q

What is the costal angle?

A

Space/angle between the two sides of the rib cage by the diaphragm.

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39
Q

What is the function of bronchial circulation?

A

Supply oxygen and nutrients to the lung parenchyma, airways, pulmonary arteries/veins and pleura

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40
Q

What is the lung parenchyma and its function?

A

Portion of the lung involved in gas transfer.

The alveoli, alveolar ducts and respiratory bronchioles

41
Q

What is the normal volume for expectoration?

A

100mls

42
Q

What is haemoptysis?

A

Coughing up of blood

43
Q

Where are the cough receptors located?

A

Receptors in the pharynx, larynx and bronchi

44
Q

What is a lower airway cough associated with?

A

Sputum production

45
Q

What is phlegm rather than sputum an indication of?

A

Inflammation and infection

46
Q

What does white grey sputum indicate?

A

Chronic irritation

47
Q

What colour may the sputum of someone with pneumonia be?

A

Rusty

48
Q

What does pink throthy sputum indicate?

A

Pulmonary oedema

49
Q

What is haemoptysis a sign of?

A

Serious lung disease

50
Q

How to tell if blood is from the stomach or lungs in haemoptysis?

A

Dark red= lung

Bright red= stomach

51
Q

Which structures of the lung have no pain receptors?

A

Lungs and visceral pleura

52
Q

Which structures of the lung have pain receptors?

A

Parietal pleura, chest wall and medistinal structures

53
Q

What are the symptoms of pleurtric pain? Such as in the case of pleural effusion

A

Sharp, stabbing, worse on deep inspiration and coughing

54
Q

What type of pain indicates muscle strain or rib fracture?

A

Chest wall pain.

Pain worse on turning or twisting n bed.

55
Q

What is stridor?

A

Harsh inspiratory and expiratory noise

56
Q

Where is the respiratory centre located in the brain?

A

The medulla oblongata of the brain stem.

57
Q

What are the names of the nerves that coordinate the respiratory movement?

A

Phrenic and intercostal nerves

58
Q

Which nervous system controls airway tone?

A

Autonomic nervous system

59
Q

Is it noradrenaline or adrenaline that stimulates bronchodilation?

A

Noradrenaline

60
Q

What is the name of the group of drugs that cause bronchodilation?

A

Beta androgenreceptor agonists

61
Q

What can inhaling smoke, dust or cold air stimulate and result in?

A

Stimulate cough receptors triggering brochoconstriction via vagus parasympathetic activity.

62
Q

What are the 4 factors that cause change in respiration?

A

Conscious change in rate/depth
Limb receptors in response to exercise
Pulmonary receptors in response to stretch/irritation
Chest wall muscle receptors

63
Q

What are the 3 chemical stimulants for breathing?

A

Rise in PaCO2
Metabolic acidosis- remove CO2
Fall in PaO2/increase in H+ conc detected by receptors in carotid and aortic bodies

64
Q

What 2 factors influence efficient gaseous exchange?

A

Adequate ventilation and capillary perfusion.

65
Q

Which 2 factors lead to ineffective gaseous exchange?

A

Inadequate perfusion or ventilation at the alveoli

66
Q

Which 3 factors determine effective gaseous exchange?

A

Airway resistance - diameter
Lung compliance - ease of expansion
Elasticity - stretch and recoil

67
Q

What is the definition of type 1 respiratory failure?

A

Insufficient O2 availability at alveoli-capillary interface decreasing arterial oxygen level

68
Q

What is the definition of type 2 respiratory failure?

A

Insufficient arterial O2 with increased CO2 (hypercapnia)

69
Q

What are the 3 main diseases included in COPD?

A

chronic bronchitis
emphysema
chronic asthma

70
Q

What is chronic bronchitis?

A

Inflammation and swelling of airways, narrowing of airways, reduced airflow, reduced alveolar ventilation.
Hypertrophy and increase in goblet cells.

71
Q

What is emphysema?

A

Dilation, permanent enlargement and destruction of alveoli. Meaning less surface area for gaseous exchange

72
Q

What is chronic asthma?

A

Inflammation of the airways, constriction of airway smooth muscle

73
Q

What drug via what route reverses bronchospasm?

A

Inhaled bronchodilators such as salbutamol.

74
Q

What are the 2 initial clinical symptoms of COPD?

A

Increased sputum production and increasing dyspnoea

75
Q

What does spirometry investigation measure?

A

Volume of air expelled from lungs after maximal inspiration of breath.

76
Q

What are the 3 tests for airway function?

A

Peak flow
Spirometry
Flow loop volumes

77
Q

In terms of respiration what is the classification of obstructive lung disease?

A

Increased resistance to airflow

78
Q

In terms of respiration what is the classification of restrictive lung disease?

A

Expansion of the lung is restricted

79
Q

What is the classification of vasular lung disease?

A

Disease of the lung vasculature

80
Q

What is the classification of environmental lung disease?

A

Inhaled particles

81
Q

What are the 5 stages that occur in the exacerbation of asthma?

A 
Inhalation of irritants 
Epithelial shedding 
Inflamatory oedema 
Smooth muscle contraction 
Increased secretions
82
Q

What is the acronym used to assess the severity of pneumonia?

A

CURB score

83
Q

What does CURB stand for? And whats it used in the assessment of?

A

Confusion
Urea
Respiration rate
Blood pressure

84
Q

What are the clinical signs of pneumonia?

A 
Coughing up pussy sputum 
Pleuritic pain 
Fever 
Breathlessness 
May have cyanosis and tachypnoea
85
Q

What is the normal volume of pleural fluid?

A

5mls

86
Q

What causes a pleural effusion to occur?

A

Disruption in hydrostatic pressure causing fluid to accumulate

87
Q

What can be observed in a pt with a pleural effusion?

A

SOB

Tachypnoea

88
Q

What occurs in a pneumothrax?

A

Air in pleural space, leaked from alveoli due to a gap in the visceral pleura

89
Q

What are 2 diagnostic of pneumothorax?

A

Sudden onset of pleuritic pain

Breathlessness

90
Q

What determines the extent of the breathlessness experienced in pneumothorax?

A

Health of the lung

Size of pneumothorax

91
Q

What is a tension pneumothorax?

A

A flap valve forms allowing air to only enter the pleural space on inspiration

92
Q

What are the general management interventions for respiratory conditions?

A 
Oxygen therapy
ABG- identify T1RF/T2RF 
Bronchodilators 
Steroids 
Antibiotics 
Analgesia 
Physiotherapy
93
Q

What is the management for asthma?

A

Inhalers, dry powders, nebulisers
Anti-inflamatory agent i.e. steroids
Bronchodilators: short and longterm beta agonists
Magnesium sulphate
Oxygen
Sit up
Mechanical ventilation if trouble to breath and silent chest

94
Q

What is the management for COPD?

A

Oxygen therapy and long term oxygen therapy
Abx
Physio therapy
Bronchodilators
Non invasive positive pressure ventilation

95
Q

What is the management for chest infection?

A 
O2 therapy 
Analgesia 
Optimum fluid balance 
Abx- depending on presentation 
Physiotherapy 
Sputum samples
96
Q

What is the management for pleural effusion?

A

Transudate effusions= control underlying problem, usually self-reabsorbing. Large effusions drained 1.5L max
Exudate effusions- treat underlying cause, repeated aspirations, irritate introduced to adhere the pleura together

97
Q

What is pleurodesis?

A

Adhesion of pleural surfaces

98
Q

What is the management for pneumothorax?

A

Passive absorption- repeat xrays to see progress
Aspiration of air from pleural space
Intercostal tube drain- cannulae into chest wall; wide bore tube to drain air; under water seal drain
Surgery

99
Q

What is involved in the assessment of a chest drain?

A 
Fluid level 
Fluid swing 
Bubbling 
Pain 
Respiratory rate, rhythm, depth 
Positioning

Nursing Acutely Ill (11 decks)

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