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Respiratory Unit Flashcards

1
Q

Respiratory Excursion

A

Estimation of thoracic range and expansion, May disclose information about movement during breathing. Should be symmetrical.

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2
Q

Tactile Fremitus

A

Detection of palpable sound vibrations transmitted to the chest wall as the patient speaks. Air does not conduct sound well; but solid substances (tumors, fluids) enhances fremitus.

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3
Q

Crepitus

A

Subcutaneous emphysema is air bubble present in the subcutaneous tissue or underlying muscle. Upon palpation crackles can be heard.

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4
Q

Thoracic percussion

A

Normal lung sound - resonant dullness - over a bone (tumor)

Hyperresonant - louder and lower pitched are associated with COPD/pneumothorax

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5
Q

Thoracic auscultation - what is it used to assess?

A

Useful in assessing the flow of air through the bronchial tree and in evaluating the presence of fluid or solid obstruction in the lung.

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6
Q

Tidal volume

A

volume of each breath, around 500 mL

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7
Q

Minute ventilation

A

amount of expiration in one minute (RR x Tidal Volume)

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8
Q

Forced vital capacity

A

Maximum inhale and exhale

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9
Q

Atelectasis

A

Not using all of the lungs, causing a collapse in alveoli. Decrease gas exchange.

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10
Q

Who’s at risk for atelectasis

A

thoracic and abdominal surgeries

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11
Q

Age related changes >40/>50

A

>40 - decreased surface area of alveoli

>50 - alveoli lose elasticity

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12
Q

What is ARDS

A

Acute respiratory distress syndrome - fluids leak into lungs from capillaries

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13
Q

What’s PND

A

Paroxysmal nocturnal dyspnea - awaken client from sleep with inability to breathe (CNS problem)

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14
Q

Dead space

A

No gas exchange in the lungs

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15
Q

Dry and irritating cough

A

upper respiratory viral infection

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16
Q

High pitched irritating cough

A

Laryngotracheitis

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17
Q

Brassy cough

A

Tracheal lesion

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18
Q

Long, stridor inspiratory noise (whoop before cough)

A

Pertussis

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19
Q

Hacking

A

Pneumonia

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20
Q

Changing cough

A

cancer

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21
Q

Cough in AM

A

Bronchitis

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22
Q

Worse when supine

A

post-nasal drip

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23
Q

Coughing after food

A

aspiration

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24
Q

purulent sputum

A

bacterial lung abscess, bronchiectasis

yellow-green in color

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25
small amount of purulent
bronchitis, pneumonia
26
Currant jelly sputum
Klebsiella
27
Rust colored sputum
Pneumococcal
28
Musty smelling sputum
Pseudomonas
29
pink tinged mucoid
lung cancer
30
frothy white
pulmonary edema
31
3 Effects of smoking
1. Decreased ciliary action 2. Increases bronchial secretions 3. Causes inflammation and reduces surfactant (increases lubrication of the lungs)
32
Joint commission required documentation of what?
Screening for and a tobacco treatment was offered
33
Crackles
May be cleared with coughing Inflammation Heard on inspiration Pneumonia, bronchitis, HF, bronchiectasis, pulmonary fibrosis "popping" Non-continuous
34
Wheezes
Change in diameter in the lumen that air flowing through expiration Asthma continuous musical sounds
35
Stridor
Demands immediate attention High pitch
36
ABGs
Measures blood pH and arterial oxygen and CO2 tensions
37
Restrictive Disorder
Makes lung stiff Upper respiratory Decreases the amount of air that the lungs can hold Decrease in elasticity ex. Fulmonary fibrosis, asbestosis, sarcoidosis
38
Obstructive Disorder
Causes a narrowing or blockage in exhaled airflow and are commonly associated with COPD
39
Chronic bronchitis primary teaching
smoking cessation
40
Report what after bronchoscopy (not gag)
Bronchospasms
41
V/Q imbalance is from
inadequate perfusion or ventilation
42
What does a V/Q scan do
trace and measure perfusion through the lungs and evaluation of blood flow abnormalities
43
Atmosphere FiO2 + add \_\_% per L of O2
21% (add 4% per L of O2)
44
Ventilation but no perfusion
Deadspace
45
Perfusion but no ventilation
shunt
46
No ventilation or perfusion
Silent unit (cardiac arrest)
47
Most people can do \_\_\_\_% of vital capacity in 1 second
80%
48
Examples of shunting
Mucous plug Atelectasis Infection Tumor
49
Deadspace example
PE
50
Emphysema is...
Exertional dyspnea Prolonged expiratory time Short, jerky sentences Use of accessory muscles Thin Pink puffer Increased CO2 Hyperresonance during chest percussion Affects alveoli shape - large and flabby with decreased air for gas exchange
51
Chronic bronchitis is...
Blue Bloater Increased Hgb Increased RR Clubbing Recurrent cough and sputum Hypoxia Hypercapnea Cough and sputum for at least 3 months in each of the two years Affects airway, not alveoli
52
COPD is severe if FEV1 is
\< 50%
53
SABAs are quick relief in
Asthma and COPD
54
Tiotropium is recommended for COPD or asthma
COPD patients (and people who have asthma AND COPD)
55
Ipatropium is a ...
SAAC - short acting anticholinergic
56
Tiotropium is a ...
LAAC - long-acting anticholinergic
57
Tiotropium should not be ... Do not take with...
SWALLOWED Ipatropium
58
Creatinine clearance greater than 50 mL/min allows for use of Tiotripium (Spiriva) for bronchospams (T/F)
T
59
LABA example
Salmeterol (Serevent)
60
SABA example
Levalbuterol (XOPENEX) albuterol (ProAir, Proventil, Ventolin)
61
Risk factors for COPD
Smoking environment asthma infection alpha1-antitrypsin deficiency
62
Why is cardiac failure a complication of COPD
Heavy workload on the right side of the heart (pushing out oxygenated blood)
63
Bronchodilator reversibility tests help distinguish between
asthma and COPD
64
Mast cell stabilizer examples
Cromolyn Sodium (oral solution) Nedocromil
65
Mast cell stabilizers are used when (what does it do too)
Patients not tolerating corticosteroids Exercise-induced asthma Mast cell stabilizers -\> stabilize mast cells. Mast cells are cells that create a histamine release in the body that creates an allergic/inflammatory process. Mast cell stabilizers therefore reduce inflammatory process.
66
Corticosteroids end in (or have) these letters. Preventer/Reliever?
-son(e) Preventer
67
Monoclonial antibodies are given how? What are they for?
additional therapy for patients with severe persistent asthma who are sensitive to specific allergies. IV (anti-IgE)
68
Monoclonial antibody example. Class?
Omalizumab (Xolair) Anti-asthmatics
69
Leukotrienes examples. Class?
SIngulair (montelukast) Zilueton (Zyflo) Bronchodilator (leukotriene antagonist)
70
Leukotrienes do what?
Inhibit effects of leukotrines (decrease inflammation). Prevention/chronic treatment of asthma and allergic rhinitis
71
Methylxanthines/Xanthines examples Class?
Aminophylline Theophylline Bronchodilator
72
Corticosteroids do what to the immune system? What's the white throat called?
Suppress it Thrush
73
Emphasize these three things with asthma education
Identify triggers s/s of an acute episode take meds AS DIRECTED
74
Obstructive sleep apnea is an upper or lower airway obstruction?
Upper
75
How many obstructive events per hour classifies OSA
five
76
Which mechanical issue can cause OSA
large tonsils (recommend a tonsillectomy)
77
Pathophysiology of OSA
Airway obstrution -\> apneic events caused by reduction in VENTILATION
78
What lab values will you see in OSA?
Decreased oxyhemoglobin, increased RR
79
Complication of OSA
Hypercapnia
80
What populations should be screened for OSA
Hypertension CAD HF Metabolic syndrome Diabetes
81
Risk factors for OSA
Obesity male older age large tonsils smoking short neck
82
S/s of apneic event
Loud snoring with breathing cessation for 10+ seconds
83
1 Medication for OSA to remember
Modafinil (Provigil)
84
Diagnosing OSA
sleep study Epworth sleepiness scale (likelihood of falling asleep during scenarios)
85
CPAP vs BiPAP
CPAP is one setting of pressure for inhalation and exhalation BiPAP is two levels for inspiration and exhalation
86
Biggest problem with CPAP
compliance (due to skin irritation/dryness/eye irritation)
87
SABA/LABA interactions
beta blockers diuretics (non-K sparing - furosemide) because it lowers potassium levels MAOIs (lead to HTN crisis) Stimulants Digoxin (decrease serum digoxin levels)
88
Status asthmaticus
when the inhaler doesn't work

Nursing Med-Surg (3 decks)

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