Respiratory System Flashcards
37 - Bronchoscopy:
+ What is it for?
+ Pre and post procedure nursing care
BRONCHOSCOPY: Allows for visualization of airway (larynx, trachea, bronchi), biopsies, aspiration of deep sputum, or excision of lesions.
PRE-PROCEDURE: Patient NPO 4-8 hours, administer prescribed meds (atropine, anti-anxiety meds, viscous lidocaine).
POST-PROCEDURE: ENSURE PATIENT’S LOC AND PRESENCE OF GAG REFLEX BEFORE ALLOWING PATIENT TO EAT/DRINK. Sore throat, dry throat, and small amount of blood-tinged sputum is expected.
38 - Thoracentesis: \+ What is it? \+ Symptoms of pleural effusion \+ Nursing are during procedure \+ Complications
THORACENTESIS: Surgical perforation of chest wall and pleural space with a large-bore needle to obtain specimens, inject medication, or remove fluid/air.
SYMPTOMS OF PLEURAL EFFUSION: Chest pain, shortness of breath, cough.
NURSING CARE: Have patient sit upright, with arms support on pillows or overbid table. Patient should remain totally still. Amount of fluid removed should not exceed 1L (to prevent cardiovascular collapse). After procedure, closely monitor respiratory status.
COMPLICATIONS: Mediastinal shift, bleeding, infection, pneumothorax (symptoms: deviated trachea, pain on affected side, unequal movement of chest during inhalation/exhalation, air hunger, tachycardia, shallow respirations).
39 - Chest Tubes:
+ What are they for?
+ Three chambers
CHEST TUBES: Drains fluid, air, or blood from pleural space. Chest tube tip positioned UP for pneumothorax, and DOWN for hemothorax or pleural effusion.
DRAINAGE COLLECTION CHAMBER: Chart amount and color of drainage. REPORT DRAINAGE >70ML/HR TO PROVIDER.
WATER SEAL CHAMBER: Add sterile fluid up to 2 cm line, check every 2 hours. Chamber must be kept upright and below chest tube insertion site. TIDALING EXPECTED. Lack of tidaling = lung re-expansion or obstruction. CONTINUOUS BUBBLING INDICATES AIR LEAK.
SUCTION CONTROL CHAMBER: -20cm H20 common. CONTINUOUS BUBBLING EXPECTED.
40 - Chest Tubes
+ Nursing Care
+ Chest tube removal procedure
NURSING CARE FOR CHEST TUBES:
+ Assess chest tube insertion site for erythema, pain, crepitus.
+ Position patient in semi-high Fowler’s position.
+ OBTAIN CHEST X-RAY TO VERIFY TUBE PLACEMENT!
+ Keep 2 hemostats, sterile water, occlusive dressing at bedside.
+ Only clamp when ordered; do not strip/milk tubing.
CHEST TUBE REMOVAL: Tell patient to take a deep breath, exhale, and bear down (or take a deep breath and hold it) during removal. Apply sterile petroleum jelly gauze dressing over chest tube site.
41 - Chest Tubes:
+ Complications
+ If drainage system becomes compromised, place end of tube into sterile water (to maintain water seal).
+ If chest tube is accidentally removed, place occlusive dressing over insertion site - taped only on THREE sides.
+ TENSION PNEUMOTHORAX: can result from kink in tubing or obstruction. Symptoms: TRACHEAL DEVIATION, absent breath sounds on affected side, respiratory distress, asymmetry of chest.
42 - Oxygen Delivery:
+ Nasal cannula, Simple face mask, Partial rebreather Nonrebreather, Venturi mask, Aerosol mask/face tent
NASAL CANNULA: 1-6 L/min. Use humidification for flow rate >=4L/min
SIMPLE FACE MASK: 5-8 L/min
PARTIAL REBREATHER MASK: 6-11 L/min. Adjust oxygen flow to keep reservoir bag from deflating.
NONREBREATHER MASK: 10-15 L/min. Keep reservoir bag 2/3 full. Assess valve, flap hourly.
VENTURI MASK: 4-10 L/min. MOST PRECISE OXYGEN DELIVERY.
AEROSOL MASK/FACE TENT: Good for patients with facial trauma or burns; provides high humidification.
36 - Arterial Blood Gas (ABG)
+ Normal ranges of: pH, PaO2, PaCO2, HCO3, SaO2
+ Procedure: Key points
ABG NORMAL RANGES: \+ pH 7.35-7.45 \+ PaO2: 80-100 mmHg \+ PaCO2: 35-45 mmHg \+ HCO3: 21-28 mEq/L \+ SaO2 95-100%
ABG PROCEDURE KEY POINTS
+ Usually performed by respiratory therapist
+ Perform Allen’s test prior to puncture (compress ulnar and radial arteries simultaneously)
+ Hold direct pressure over site for at least 5 min (20 min if patient on anticoagulants) afterwards.
+ If air embolism suspected, place patient on left side in Trendelenburg position.
43 - Oxygen Delivery:
+ S/S (Early and Late) of hypoxemia
+ S/S of oxygen toxicity
+ Avoiding combustion
S/S OF HYPOXEMIA:
+ EARLY: RESTLESSNESS/IRRITABILITY, tachypnea, tachycardia, pale skin, hypertension, nasal flaring, use of accessory muscles, adventitious lung sounds.
+ LATE: Confusion, cyanosis, bradypnea, bradycardia, hypotension, dysrhythmias.
S/S OF OXYTEN TOXICITY:
+ Non-productive cough, substernal pain, nasal congestion, n/v, fatigue, headache, sore throat.
AVOIDING COMBUSTION: Post “no smoking” signs. AVOID SYNTHETIC OR WOOL FABRICS, do not use flammable materials (alcohol, acetone).
45 - Pneumonia:
+ S/S, Lab tests, Diagnosis, Nursing care, Medications
S/S: fever, shortness of breath, chest pain, cough, dyspnea, CONFUSION (VERY COMMON IN OLDER PATIENTS), crackles/wheezes.
LAB TESTS: OBTAIN SPUTUM SAMPLE BEFORE STARTING ANTIBIOTIC THERAPY. Elevated WBC, decreased PaO2 levels.
DIAGNOSIS: Chest x-ray (shows consolidation).
NURSING CARE: Position patient in high-Fowler’s, administer O2 as prescribed. Encourage coughing, deep breathing, use of an incentive spirometer, increased fluid intake.
MEDS: antibiotics, bronchodilators (albuterol), anti-inflammatories (glucocorticosterioids).
46 - Asthma:
+ S/S, Diagnosis, Medications, Status asthmaticus
ASTHMA: Chronic inflammatory disorder of the airway; intermittent and reversible.
S/S: Wheezing, coughing, prolonged exhalation, low SaO2, barrel chest, use of accessory muscles.
DIAGNOSIS: Pulmonary function tests (FVC, FEV1).
MEDS: Bronchodilators (short-acting: albuterol, long-acting: salmeterol), anticholinergic meds (ipratropium), anti-inflammatory meds I(corticosteroids).
STATUS ASTHMATICUS: Airway obstruction unresponsive to typical treatment. Administer O2, bronchodilators, ephinephrine. Prepare for emergency intubation.
47 - Chronic Obstructive Pulmonary Disease (COPD)
+ What is it?
+ S/S
+ Lab results
COPD: Emphysema (loss of lung elasticity and hyperinflation of lung tissue) and chronic bronchitis (inflammation of bronchi). Irreversible. Smoking is primary risk factor.
S/S: Dyspnea upon exertion, crackles/wheezes, barrel chest, use of accessory muscles, clubbing, hyperresonance (due to trapped air), decreased SaO2 levels, rapid and shallow respirations.
LABS: Increased Hct (due to low O2 levels); PaO2 <80mmHg, PaCO2 >45mmHg, respiratory acidosis.
48 - COPD
+ Nursing Care
+ Meds
+ Complications
NURSING CARE FOR COPD: Position patient in high-Fowlers. Encourage coughing, deep breathing, use of incentive spirometer. Ensure proper nutrition (increased calories and protein). Teach breathing techniques:
+ ABDOMINAL BREATHING: take breaths from diaphragm, lie on back w/knees bent.
+ PURSED LIP BREATHING: breath in throw nose and out through mouth.
MEDS: Bronchodilators, Anita-inflammatories, mucolytic agents (acetylcysteine, guaifenesin).
COMPLICATIONS: Right-sided heart failure. Symptoms: dependent edema, distended neck veins, enlarged liver.
53 - Respiratory Emergencies:
+ Pneumothorax, Tension pneumothorax, Hemothorax, Flail Chest
+ Treatment of above conditions
PNEUMOTHORAX: Lung collapse due to air in the pleural space. KEY SYMPTOM: HYPERRESONNANCE W/PERCUSSION.
TENSION PNEUMOTHORAX: Air enters pleural space during inspiration, but cannot exit during expiration. KEY SYMPTOM: TRACHEAL DEVIATION.
HEMOTHORAX: Blood accumulates in pleural space. KEY SYMPTOM: DULL PERCUSSION.
FLAIL CHEST: Chest wall expansion limited due to multiple fractured ribs. KEY SYMPTOMS: PARADOXICAL CHEST WALL MOVEMENT.
COMMON S/S OF ALL: Respiratory distress, reduced/absent breath sounds on affected side.
TREATMENT: O2, meds (benzodiazepines for anxiety, opioids for pain), chest tube (for pneumothorax and hemothorax).
49 - Tuberculosis (TB)
+ What is it?
+ S/S
+ Diagnosis
TB: Infectious disease in lungs caused by Mycobacterium tuberculosis.
S/S: Cough lasting > 3 weeks, night sweats, purulent/bloody sputum, lethargy, weight loss.
DIAGNOSIS:
+ Quantiferon Gold (blood test)
+ Mantoux test (skin test): Read within 48-72 hours. INDURATION 10MM = POSITIVE RESULT (5mm for immunocompromised patients). Those who had the BCG vaccine may get a false positive result.
+ Chest x-ray: to visualize active less in lungs.
+ Acid-fast bacilli culture: use 3 early morning sputum samples.
50 - Tuberculosis (TB)
+ Nursing care
+ Meds
NURSING CARE:
+ PLACE PATIENT IN NEGATIVE AIR FLOW ROOM, WEAR N95 MASK IN ROOM; have patient wear N95 mask if they need to lead the room.
+ Screen family members for TB.
+ Teach patient that sputum samples will be needed every 2-4 weeks. Patients are not infectious after 3 negative sputum cultures.
MEDS:
+ Up to 4 antibiotics are required for 6-12 months of treatments, including isoniazid, rifampin, pyrazinamide, ethambutol.
