RESPIRTATORY SYSTEM

Question 1

NORMAL BREATH SOUNDS:

Answer 1

Bronchial: I<E
High-pitched (heard on large airways; trachea)

Vesicular: I>E
Low pitched (heard on narrow airway; Lung field)

Bronchovesicular: I=E
Blowing sounds (heard on bronchus)

Question 2

ABNORMAL BREATH SOUNDS:

Bronchial breath sounds Over lung field

Answer 2

Pneumonia

Question 3

ABNORMAL BREATH SOUNDS:

Wheezing- [ineffective airway clearance)

Answer 3

-asthma
-bronchitis
-smoke inhalation
-allergic reaction
-transfusion reaction
-choking

Question 4

ABNORMAL BREATH SOUNDS:

Rales/Crackles [Impaired gas exchange] ; lung field

Answer 4

-left sided CHF
-Pulmonary Edema
-Fluid Overload
-Renal Failure
-Pneuomonia

Question 5

Absence breath sounds
[altered breathing pattern];
pleural space

Answer 5

-Pneumothorax
-Pleural effusion (air)
-Hydrothorax (fluid)
-hemothorax (blood)
-flail chest (unequal paradoxical chest expansion)
-atelectasis
-Visceral Pleural space

Question 6

RONCHI=SNORING
Obese; close pharynx; short neck

Answer 6

Nrsg Responsibility:
-High back rest 1st
-Sidelying 2nd

Question 7

ABG( ARTERIAL BLOOD GAS)

Answer 7

Ph= 7.35-7.45
PCO2= 35-45
HCO3= 22-26

Question 8

Terminilogy

Answer 8

Hypoxia= Decrease o2 in tissue (Pulse Oximeter/ o2 sat)

Hypoxemia= decrease o2 in blood = ABG

SO2= 95-100% (SO2= 92% COPD & Asthma)
PaO2= 80-100%

Question 9

Buffer System (Compensate)

Answer 9

Lungs–> PcO2 (ACID) = Compensate Faster

Kidneys –> HCO3 (BASE) = Compensation is delayed up to 72 hours or 3 days

Question 10

RESPIRATORY ACIDOSIS
PH- LOW; PCO2-HIGH; CO2 EXCESS (RETENTION)

Answer 10

Cause: HYPOVENTILATION (low RR)

1st sign is Decrease LOC (Confusion/Disorientation)

PLAN OF CARE:
1.Encourage Hyperventilation
2.Pursed-lip Breathing
3.Avoid Carbonated drink (SODA)
4.Mechanical Ventilator- eliminate excess CO2
5.DOC: NARCAN (NALOXONE) increase RR

Question 11

RESPIRATORY ACIDOSIS
Co2 retention

Answer 11

HYPOVENTILATION (LOW RR)
1.Pneumothorax
2.Hemothorax
3.Hydrothorax
4.Pleural effusion
5.Atelectasis
6.Fractured ribs
7.Flail chest
8.COPD
9.Colappsed alveoli =Co2 is not released
10.Brainstem Damage= CVA
11.Near Drowning

Question 12

RESPIRATORY ALKALOSIS
PH- HIGH; PCO2-LOW;CO2- DEFICIT

Answer 12

Cause: Hyperventilation (high RR)
1ST sign: Numbness of lips & extremities
PARESTHESIA

PLAN OF CARE:
1.Encourage hypoventilation
2.Paper bag/ Cup hands
3.Offer carbonated drinks
4.Rebreather mask
5.DOC: DIAZEPAM (VALIUM)
-decreases rr
-Anxiolytic; Muscle relaxant
CALCIUM GLUCONATE
MORPHINE SULFATE- cns depress.

Question 13

RESPIRATORY ALKALOSIS
CO2 DEFICIT

Answer 13

HYPERVENTILATION (high RR)
1.Pregnancy- shallow breaths
2.Ascites
3.Obesity
4.Anxiety
5.Angry
6.Shock -hypo,tachy,tachy

Question 14

BRONCHIAL ASTHMA

Answer 14

Narrowing of tracheobronchial tree due to presence of allergens

FACTORS: Intrisic= Flu, common cold, URTI Extrinsic= Dust, fur, pollens, perfume, fumes, spray, smoke inhalation, changes in climate, foods & drug allergy

MANIFESTATION: SOB Expiratory wheezing Nasal flaring  Use of accessory muscle Stridor Reslessness- earliest s/sx of hypoxia Somnolence (decrease LOC) Cold, clammy perspiration

Question 15

ACID-BASE IMBALANCE

Answer 15

1.ACUTE ATTACK- Respiratory alkalosis; due to hyperventilation
2.UNTREATED- Respiratory Acidosis; due to CO2 retention

Question 16

ACID-BASE IMBALANCE
PLAN OF CARE:

Answer 16

Priority: Establish & maintain patent airway
1.ACUTE ATTACK
DOC: Epinephrine
-rapid acting bronchodilator
-SE: Short-acting

2.LATENT PHASE
DOC: Theophylline
-long acting bronchodilator

3.Nebulize with Salbutamol (Ventolin) ; Albuterol (bronchodilator)
*SE: Tachycardia; Palpitation

4.Steroids (Prednisone) ; Anti-inflammatory
SE= Inahalation
(Fungal infection; candidiasis/ oral thrust)
Insruction: ORAL CARE (GARGLE)
Nrsg alert: Give Bronchodilators before steroids!
**If bronchodilators & steroid inhalation is given at the same time, then administer bronchodilators before steroids- to promote absorption of steroids.

5.Problem: Airway obstruction
-Bedside= ET (Endotracheal) set

Question 17

PROMOTE BREATHING (Lung Expansion)

Answer 17

A.Position :1st Orthopneic/ Tripod- sitting leaning forward
2nd : Sitting, upright, high-backrest
*ADMINISTER EPINEPHRINE AND HIGH-BACKREST- ASTHMA

B.Cough & Deep-breathing

C.Chest physiotherapy
-Mobilize secretion
-After nebulization
Contraindicated: Collapsed Alveoli; Emphysema; ARDS; Fractured ribs; PTB w/ Hemoptysis; Lung tumor

D.Increase Fluid Intake
-to liquify secretions

E.DOC: CROMOLYN
-To decrease secretions

F.Cough Medication

Question 18

DECREASE O2 ADMINISTRATION

Answer 18

High CO2; low O2= HYPOXIC DRIVE (Inversely proportional)
**Safest: 2LPM via Nasal Cannula
Respi Acidosis: high CO2 retention
-if CO2 is high, the pt will breath only at low level of o2 and lungs will not expand: HYPOXIC DRIVE.
*If co2 is high & o2 is high it suppress the breathing and leads to APNEA

PROMOTE REST
-To retain energy
(+) ALLERGENS
DOC: ANTIHISTAMINE
**BENADRYL (DIPHENHYDRAMINE)
SE: Drowsiness