Respiratory - Unit 3 - Assessment, Tests and Interventions Flashcards
What are parts of the conducting airways of the upper respiratory tract?
Nose, paranasal sinus, pharynx, larynx, trachea
What are parts of the conducting airways for the lower respiratory tract?
Bronchi, alveoli, lungs, pleura, pleural cavity
Pulmonary ventilation - def
the process of air entering or leaving.
Alveolar Ventilation - def
the amount of air leaving the alveoli
inspiration - def
breathing in.
expiration - def
breathing out.
compliance - def
ability of the lung to expand/contract/etc.
Elastic Recoil - def
the rebound of the lungs after being stretched.
Intra-pulmonary (intra-alveolar) Pressure =
atmospheric pressure when glottis is open and there is no movement of air.
Intra-pleura pressure =
negative pressure produced by opposite forces of elastic recoil between lungs and chest wall (prevents lung from collapsing).
Intra-thoracic pressure =
generally a negative pressure that equals intrapleural pressure. With forced expiration against a closed glottis (valsalva maneuver), it becomes positive!
Vital Capacity =
the maximum amount of air a person can expel from the lungs after a maximum inhalation.
Inspiratory reserve volume =
the max amount of air that can be inhaled after a normal inspiration.
residual volume =
the volume of air remaining in the lungs after a maximum expiratory effort.
Total Lung Capacity =
the volume at the end of a maximal inspiration.
What do the pulmonary arteries do?
They carry deoxygenated blood from the heart to the lungs.
What do the pulmonary veins do?
They carry oxygenated blood back to the heart!
How does diffusion work in respiratory system?
Movement of air and O2 from atmosphere into alveoli —-> O2 crosses into pulmonary capillaries —> CO2 diffuses out of pulmonary capillaries into alveoli
CO2 diffuses better than O2. T/F?
true!
What are some respiratory changes associated with aging?
Fewer cilia, less effective cough reflex, increased risk of : chocking and aspiration, pneumonia, effects of smoking.
What are some parts of the respiratory assessment?
Determine frequency of respiratory problems (astha?), immunization, medications, family history, smoking, etc.
What are some common respiratory health problems?
Cough (w/sputum, pain, or without), bloody sputum (hemoptysis), chest pain w/ inspiration, dyspnea, etc.
Pulmonary edema - biggest symptom is…
pink, frothy sputum!
What are parts of the physical assessment for respiratory?
nose & sinuses, pharynx, trachea, larynx, lungs, and thorax.
What do we inspect for with respiratory?
Breathing pattern, rate/depth, symmetry, movement, accessory muscles?, skin color, membranes, clubbing of fingers, etc.
What are some palpation things we do for respiratory?
99 - Fremitus (increased = liquid/pneumonia, fibrosis, etc.), decreased = obstructed or collapsed.
Tender areas.
What does hyperresonance mean?
Emphysema, pneumothorax
What does decreased resonance mean?
tumor, plueural thickening, pneumonia, etc.
What are crackles and rales?
Crackling/poping with inspiration - rales are harsher - begin in bases and may clear with cough….. Pulmonary edema? Fluid overload?
Wheeze - when?
W/inspirations and/or expiration —- Asthma?
Rhonchus/Course crackles - ?
low pitched, snoring, gurgling —- smokers? Aspiration of foreign body?
Pleural friction rub - ?
Grating, creaking, rubbing === pleural inflammation?
Strider - ?
rough w/ inspiration. Obstruction of the larynx!
Does having trouble breathing make you anxious?
YES
What is the best position for a respiratory assessment?
Sitting upright!
What are some radiographic tests for respiratory?
Chest XRay, in bed = anterior to posterior, in machine = posterior to anterior,
MRI, Pulmonary Angiogram, ventilation perfusion scan, etc.
What’s the preferred method for diagnosing PE?
MRI
What does pulse oximetry measure?
Arterial oxygen saturation
What is the pulmonary function test?
uses a spirometer to measure lung volumes and capacities during forced breathing.
What is a bronchoscopy? When is it contraindicated?
trachea/bronchial treat. Contraindicated in asthmatics - try not to take an unstable patient back as well unless absolutely necessary!
CHECK FOR GAG REFLEX AFTER to tell them when they can eat!
What is a laryngoscopy?
Larynx. Pre-op = meds, vitals, consent, allergies to drugs, npo, remove dentures, O2 given, etc.
What are some post op things to do for an endoscopy?
Keep patient on side when unconscious and semi-fowler’s when conscious. Check vitals, gag reflex, assess breath sounds, o2, ABG’s, etc.
What is a thoracentesis?
Aspiration of pleural fluid or air from the pleural space through a needle.
How should a patient lie when having a thoracentesis done?
Either hunched forward or on unaffected side!
What are some complications for a thoracentesis?
Pneumothorax (watch for diminished/no breath sounds), hemothorax, infection, injury to diaphram, liver, or spleen.
What is a lung biopsy?
They sick a needle in and biopsy a part. That’s about it! The usual stuff after - like assessing, breath sounds, etc.
What are some lab tests for respiratory?
Maxtoux test, ABG’s, CBC, WBC, cultures, sputum analysis, skin testing, etc.
If you need to collect sputum, when should it be done?
First thing in the morning, if possible!
What’s the preferred way to open an airway?
Head tilt & chin lift.
If the patient has a suspected neck injury, use the __ ___ maneuver to open the airway
Jaw-thrust (you thrust the jaw up!)
What are some general nursing interventions for respiratory?
Elevated HOB (#1!!!!), stop smoking, oral hygiene (to prevent pneumonia), increase hydration, balance nutrition, early and frequent assessments, infection control, mental health support, etc.
What are some respiratory therapies?
O2 therapy, IPPB (intermittent pressure positive breathing), Incentive Spirometry, Chest Physiotherapy (diaphragmatic breathing, pursed-lip breathing (slows down expiration), coughing, postural drainage
What are some things that a respiratory therapist does?
CPAP, BiPAP, O2, IS, trach care, pulmonary functioning tests, CODES, etc.
What are some antitussives (used to stop non-productive coughs) ?
Opioids (codeine, hydrocodone), nonopioids (benzonatate - tessalon perles), Robittusin - dextromethorphan)
What are some decongestants/vasoconstrictors? Used for????
Used for nasal allergies, opening nasal passages - Naphazoline, Phenylephrine, Pseudophedrine (Sudefed)
What are expectorants?
liquifies sputum and increased mucous flow, stimulates a productive cough. Guaifenesin!
Mucolytic - def? example?
Administered by inhalation to liquify secretions, facilitates sputum removal. Used for the common cold and sinusitis - acetylcysteine.
What are a few examples of bronchodilators?
Beta 2 Agonists & Methyl Xanthenes
What do beta 2 agonists do?
Relax bronchial smooth muscle to relieve bronchospasms and produce bronchodilations. Used for acute asthma attack. Watch with patients who have tachycardia. Albuterol, Salmeterol, etc = examples.
What are (Methyl) Xanthenes?
Bronchial dilation - due to smooth muscle relaxation. Used to treat bronchial constriction with COPD, status asthmaticus. Has stimulating effects on CNS - aminophyline, theophyline are examples.
With theophyline, can it be given IV?
Yes - monitor VS, EKG, give with histamine blockers (pepcid), draw blood levels ever 6-12 months for toxicity!
What do corticosteroids?
Inhibit inflammatory response in airways. Reduce edema and may aid in increasing responsiveness in bronchial smooth muscle to beta-agonists.
What are some examples of an intranasal steroid?
Dexamethasone, Fluticasone, Flunisolide, Budesonide
What are antihistamines used for in respiratory problems?
treat allergies, hayfever, urticaria, dries mucosal membranes and reduces edema.
What are some nonsedating antihistamines?
Fexofenadine, Loratadine
What are some sedating antihistamines?
Chlorpheniramine (Chlortrimetron), Promethazine (Phenergan)
What do mast-cell stabilizers do and what are some examples?
They are for allergies, exercise asthma - examples = cromolyn sodium, intal, crohom
What do leukotriene receptor antagonist’s do - examples?
protects against allergy triggers, reduces asthmatic symptoms. Examples = montelukast and zafirlukast.
What do anticholinergics/vagal blockers do? Examples?
Prevent bronchospasm and reduces mucous production. Example = ipratropium (Atrovent)
