Test 2 Respiratory Flashcards
Primary function of respiratory system
Provide O2 for metabolism in tissues
Remove CO2 that waste product of metabolism
Secondary function of respiratory function
Facilitate sense of smell
Produces speech
Maintains acid base balance
Maintains body water levels
Maintains heat balance
components of upper respiratory tract
Nasal cavity
Sinuses
Pharyngeal tonsils
Nasopharynx
Pharynx
Larynx
Epiglottis
Esophagus
Nose
Humidifies, warms and filters inspired air
Sinuses
Air filled cavities within hollow bone that surround nasal passages
Provide resonance during speech *
Pharynx
Located behind the oral and nasal cavities
Passage for both respiratory and digestive tracts
Divisions of pharynx
Nasopharynx
Oropharynx
Laryngopharynx
Larynx
Located above trachea and just below pharynx
“The voice box”
Two pairs of vocal cords
Glottis
Opening between the true vocal cords
Important role in coughing
Most fundamental defense mechanism of the lungs
Coughing
Epiglottis
Leaf shaped elastic structure attached to top of larynx
Prevents food from entering tracheobronchial tree by closing over glottis during swallowing
Components of the lower respiratory tract
Trachea
Bronchus
Bronchi
Bronchioles
Trachea
Located in front of esophagus
Branches into right and left main stem bronchi
Carina
Point where left and right main stem bronchi branch off
Main stem bronchi
Divide into 5 secondary or lobar bronchi that enter each of 5 lobes of lung
Bronchi are lined itch cilia, which propel mucus up and away from the lower airway to trachea where it can be expectorated or swallowed
Difference between right and left main stem bronchi
Right is slightly wider, shorter and more vertical than left
Bronchioles
Branch from the secondary bronchi and subdivide into the small terminal and respiratory bronchioles
Contain no cartilage and depend on elastic recoil of lung for patency
Terminal bronchioles
Contain no cilia and do not participate in gas exchange
Alveoli
*basic unit of gas exchange
On terminal bronchioles
Alveolus
Alveolar capillary network
Acinus (acini)
All structures distal to terminal bronchioles
Alveolar ducts
Branch from respiratory clusters
Surfactant
Secreted in the walls of alveoli
Phospholipid protein that reduces surface tension in alveoli
Without alveoli would collapse
lobes of lungs
3 in right 2 in left
Visceral pleura
Covers pulmonary surfaces (lungs)
Parietal pleura
Lines the inside of thoracic cavity including upper surface of diaphragm
Pleural fluid
Produced by cells lining the pleura and lubricates visceral and parietal pleurae
Allows them to guide smoothly and painlessly during respiration
Accessory muscles
Scalene muscles
Sternocleidomastoid muscles
Trapezius and pectoralis muscles
Risk factors for respiratory disease
Smoking
Chewing tobacco
Allergies
Frequent resp. Illness
Chest injury
Surgery
Chemicals/pollutants
Crowded living
Fam history of infection disease
Geographic residence and travel
Chest X-ray
Provides info regarding anatomic loco and appearance of lungs
Cheap easy and quick
Sputum specimen
A specimen obtained by expectoration or tracheal suctioning to assist in identification of organisms or abnormal cells
Sputum specimen pre procedure
Determine purpose
Early morning is best
15 mL
Rinse prior, several deep breaths, cough deeply
Bronchoscopy
Direct visual exam of larynx, trachea and bronchi with fiberoptic bronchoscope
Bronchoscopy pre procedure
Informed consent
NPO midnight prior
Vitals
Monitor coagulation studied
Remove dentures and glasses
Meds for sedation
Need crash cart available
Bronchoscopy post procedure
Vitals
Semi- Fowler
Assess gag reflux
NPO until gag reflex returns
Emesis basin
Check for bloody sputum
Monitor resp status, especially if had sedative
Complications
Notify if fever or difficulty breathing
Complications of Bronchoscopy
Bronchospasm, bacteremia, bronchial perforation indicated by facial or neck crepitus, dysrhythmias, fever, hemorrhage, hypoxemia, and pneumothorax
Pulmonary angiography
Invasive fluoroscopic procedure following injection of iodine or radio plaque or contrast material through a catheter inserted through the antecubital or femoral vein into the pulmonary artery or one of its branches
Lights up vasculator of lungs
Helps see if they have blood clots
Pre procedure pulmonary angiography
Informed consent and allergies
NPO 8 hours prior
Monitor vitals
Monitor coagulation studies
Establish IV access
Sedate
Crash cart near
Instruct that they must lie still and may feel urge to cough or experience flushing, nausea or salty taste
Post procedure pulmonary angiography
Monitor vitals
Don’t take blood pressure in extremity used for IV for 24 hrs
Monitor peripheral neurovascular status
Assess insertion site for bleeding
Monitor for delayed reaction to dye
Thoracentesis
Removal of fluid or air from pleural space via transthoracic aspiration
Pleural effusion
Gathering of fluid in the pleural space, can’t respirate well with it
Is not pleural fluid, has unwanted matter
Thoracentesis pre procedure
Informed consent
Baseline vitals
Ultrasound or CXR prior if perscribed
Assess coagulation studies
Sitting upright with arms and hear supported by table at bedside
If can’t sit up lay on unaffected side
Informed to NOT cough, breathe deeply or move
Thoracentesis post procedure
Monitor vitals and resp status
Pressure dressing and assess puncture site for bleeding and crepitus
Complications of Thoracentesis
Pneumothorax, air embolism and pulmonary edema
Pulmonary function tests (PFTs)
Include a number of different tests used to evaluate lung mechanics, gas exchange and acid base disturbance through spirometric measurements, lung volumes and arterial blood gases
Pulmonary function tests pre procedure
Determine if any analgesics is being admin
Consult physician regarding holding bronchodilators prior to testing
Instruct:
Void before
Wear loose clothing
Remove dentures
No smoking or eating heavy meals for 4-6 hrs before
Pulmonary function tests post procedures
Resume to normal diet and bronchodilators that were held prior
Inspiration reserve volume IRV
Breath in in in as much as possible and then hold
How much extra can you take in?
Tidal volume TV
Normal volume of air breathed in and out when not exerting self
Expiratory reserve volume ERV
The maximum amount of air you can forcible breathe out after a breath
Residual volume RV
What’s left when a person breaths out as much as possible
Vital capacity VC
Everything you can take in minus the residual volume
Total lung capacity TLC
Everything you can take in including residual volume
Percutaneous Lung biopsy
Performed to obtain tissue for analysis by culture or cytologic examinations
Needle lung biopsy
Done to identify pulmonary lesions, changes in tissue and the cause of pleural effusion
Lung biopsy pre procedure
Informed consent
NPO prior
Information of local anesthetic but may feel pressure during needle insertion and aspiration
Admin analgesics and sedatives as prescribed
Lung biopsy post procedure
Monitor vitals
Apply dressing to site and monitor for drainage and bleeding
Monitor for resp distress
Monitor for signs of pneumothorax and emboli
Ventilation perfusion lung scan
Perfusion scan: blood flow to lungs is evaluated
Ventilation scan: determines patency of the pulmonary airways and detects abnormalities
Radionuclide may be injected
Sees if arteries match veins
Ventilation perfusion lung scan pre procedure
Informed consent
Allergies for dye
Remove jewelry
Review breathing methods
Establish IV access
Admin sedation if perscribed
Crash cart near
Skin tests
An intradermal injection used to assist and diagnosing various infectious diseases
Skin test procedure
Use test site free of excessive body hair dermatitis and blemishes
Apply at upper 1/3 of inner surface of left arm
Circle and mark injection test site
Document date, time and test site
skin test pre procedure
Determine hypersensitivity or previous reactions to skin tests
Skin tests post procedure
Instruct not to scratch to prevent infection and abscess formation and to avoid scrubbing
Interpret reaction at injection site 24-72 hours after
Assess site for amount of induration (hard swelling) and presence of erythema and blister like elevations
Arterial Blood Gases (ABGs)
Measures the dissolved O2 and CO2 in the arterial blood and reveals the acid base state and how well the O2 is being carried in the body
Allen test
Normal pH
7.35-7.45
Normal PCO2 ABG
35-45 mmHg
Normal HCO3 ABG
22-27 mmHg
PO2 ABG
80-100 mmHg
ABG pre procedure
Perform Allen test on both writsts
Have rest for 30 minutes prior to
Avoid suctioning prior to drawing blood
Do not turn off O2 unless blood gases are ordered on room air
ABG post procedure
Place specimen on ice
Not temp on lab form
Note O2 and type of ventilation
Apply pressure to site for 5-10 minutes (longer if on anticoagulants or have bleeding disorder)
Transport the specimens to lab w/in 15 minutes
Pulse Oximetry
Noninvasive test that registers O2 saturation of hemoglobin
After a hypoxia client uses up the readily available O2 reserve O2 attached to the hemoglobin is drawn on the provided O2 to tissues
Alerts hypoxemia before clinical signs occur
Pneumonias
Acute inflammation of parenchymal tissues functional parts = alveoli and bronchioles
Affects 1% of pop each year
4 mil cases a year
6th leading cause of death
Most common cause of death from infectious disease
Nasopharyngeal defenses
Resistance factor of pneumonia
Remove particles from air and destroy invading organisms
Risks: hay fever, common cold, nasal trauma
Glottic and cough reflexes
Host resistance for pneumonias
Prevents aspiration into tracheobroncial tree
Risk factors: stroke, abdominal or chest surgery, sedation, NG tube
Mucociliary blanket
Host resistance for pnnemonias
Remove secretions microorganisms and particles
Risk factors: smoking, inhalation if irritating gases
Pulmonary macrophages
Host resistance of pneumonias
Removes microorganisms
Risk factors: alcohol intoxication and smoking
Complications of pneumonias
Bacteremia/septicemia
Empyema
Lung abscess
Pneumonias etiology
Droplet inhalation
Bacterial: streptococcus pneumonia, diplococcus pneumonia
Viral: influenza, parainfluenza, RSV, CMV
Other: mycoplasma pneumoniae
Smoke inhalation
Aspiration
Subjective pneumonia manifestations
Lassitude and severe malaise
Chest pain that increases with inspiration, dyspnea
Objective manifestations of pneumonias
^ temp
^ RR, HR, use of accessory muscles, orthopedia
Cough and sputum
Gray complexion
Raleigh (fine crackles)
Rhonchi
Decreased breath sounds over consolidation
Friction rub
Dull to percussion
E > A changes
Sputum for diff types of pneumonias
Pneumococcal: purulent, rusty
Staphylococcal: yellow, blood streaked
Klebsiella: red gelatinous
Mycoplasma: non productive that advances to muciod
Diagnostics of pneumonias
^ WBC and ESR
CXR is patchy or lobar pulmonary infiltrates
Sputum/blood cultures
ABGs for pneumonias
Hypoxemia
Respiratory alkalosis
Pathologic changes in pneumonia
Congestion 4-24 hrs
Red hepatization 48 hrs
Gray hepatization 1 week
Resolution 7-12 days
Congestion
Serous exudate from initial inflammatory response pours into alveoli
Red hepatization
Extravasation of RBCs, fibrin, PMNs into alveoli
Tissue is firm and red
Gray hepatization
Fibrin accumulates and granulates, RBCS and PMNs start disintegrating
Pneumonias treatment
Pneumococcal: penicillins and cephalosporins
Gram negative: gentamycin or tobramycin
Obstructive airway disorders
Asthma
Chronic bronchitis
Emphysema
Chronic obstructive pulmonary disease
Cystic fibrosis
Restrictive airway disorders
Pleural effusion
Hemothorax
Pneumothorax
Pneumoconioses
Thoracic cage disorders
Adult respiratory distress syndrome
Asthma
Hyper-responsive, reversible form of airway disease caused by restriction in airway size from bronchospasm, chronic inflammation and increased airway secretion
- bronchial and bronchiolar narrowing from ^ smooth muscle tone
- mucosal edema
- hypersecretion of mucus
Asthma epidemiology
9-12 mil in US
^ incidence prevalence and mortality
Most common cause of chronic illness in <17
Extrinsic atopic asthma (type 1)
Immediate hypersensitivity response mediated by IgE
Mast cells release histamine and prostaglandins on exposure to allergens
Usually have fam history of allergies, urticaria or hay fever
Usually affects children
Good prognosis - complete remission in adolescence
Intrinsic (non-atopic) idiopathic asthma (type 2)
Adult onset (> 30)
Chronic mucopurulent bronchitis
More serious, more difficult to control
Poorer prognosis
Exercise induced asthma
40-90%
Triggers: hypocapnia, cool air with less water vapor
Bronchospastic asthma triggers
Cold air - loss of heat and water
Exercise
Emotional upset - vagal pathways
Exposure to bronchial irritants - receptors and vagal reflex
Inflammatory asthma triggers
Exert effects through inflammatory response
IgE mediated response to allergens
- dust mite and cockroach excrement
- molds and mildew
- animal dander
Asthma early response
Immediate bronchoconstriction on exposure to inhaled irritant or antigen
Sx’s w/in 10-20 min
Recovery 60-90 min
Caused by re;ease of chem mediators from IgE coated mast cells on mucosa
Asthma late response
Develops 3-5 hours after exposure to trigger may last for days or weeks
Involves inflammation and increased airway responsiveness
Caused by release of chemical mediators from mast cells, macrophages and epithelial cells (induce migration and activation of other inflammatory cell)
Produces epithelial edema and injury changes in mucociliary function, reduced clearance or secretions
^ airway responsiveness
Asthma manifestations 1
Bronchi widen and lengthen on inspiration BUT collapse on expiration
Expiration becomes difficult d/t edema, narrowing and mucus obstruction
Primary problem is getting air out of lungs
Expiration requires use of accessory muscles
Asthma manifestations 2
Decreased FEV and PEFR
Dyspnea - orthopnea
Wheezing esp. on expiration
PaO2 60-72 mmHg
PaCO2 low initially
D/t ^ RR but ^ D/t decrease in alveolar ventilation
V/Q mismatch
Cyanosis
Intercostal retraction
Fatigue
Bronchial Asthma in children
Most frequent admitting dx in children’s hospitals
Sex: 10-15% of boys 7-10% of girls
Onset: 30% by age 1, 80-90% by age 4-5
Fam links: 1 parent = 25% risk, both = 50%
Polygenic / multifactorial determinants
Asthma pharmacologic treatment
Beta 2 adrenergic bronchodilator
- albuterol
- epinephrine
- xanthines
Anticholinergic bronchodilator: Ipratropium (atovent)
Corticosteroids
- beclomethasone
- hydrocortisone, methylprednisolone, IV if severe
Heukotriene receptor antagonists
Mast cell stabilizers FOR PREVENTION ONLY
- cromolyn sodium
Chronic Obstructive Pulmonary Disease (COPD)
Aka chronic obstructive lung disease (COLD) or chronic airway obstruction (CAO)
Group of diseases that result in obstruction of airflow
COPD includes
Chronic bronchitis
Emphysema
Chronic bronchitis
Inflammation on bronchial walls with hypertrophy of the mucous goblet cells
Characterized by a chronic productive cough (copious mucus)
Present for at least 3 months out of year OR 2 months/yr for 2 successive years
Often have frequent and recurrent respiratory infections
“blue bloater”
Bronchitis etiology
Cigarette smoking
Inhalation of industrial gases and other toxic substances
COPD etiologies
Air pollution, smoking, chronic respiratory infections, exposure to molds and fungi, allergic reactions
Effects of bronchitis
Inhibits cilia and macrophages
Inflammation of major and small airways
Hypertrophy of mucosal glands
Excessive secretion
Narrowing and smooth muscle constriction
Manifestations of bronchitis
DOE
Decreased PaO2 ^ PaCO2
D/t decreased alveolar ventilation
V/Q mismatch
Hypoventilation of of alveoli d/t air trapping, hypoxemia, hypercapnia, cyanosis
Scattered rhonchi and rales on forced expiration
Abnormal ABGs
Chronic cough
Copious yellow green sputum
Exercise intolerance
Plycythemia
Clubbing of fingers
Emphysema
Destruction of walls of alveoli
Dilatation and less of elasticity of airspaces distal to terminal bronchioles and loss of normal elastic recoil
Results in air trapping with ^ AP diameter “barrel chest”
Larger airways become thinned and atrophied > become more collapsible
Less prone to acute bronchitis or pneumonia but is very serious or fatal when they do get it
“Pink Puffer”
Etiology emphysema
Cigarette smoking
Often genetically determined
- autosomal recessive
- esp. early onset and severe progression
- deficiency of alpha antitrysin which inhibits proteolytic enzymes of leukocytes
- loss of inhibition -> digestion of lung tissue with bacteria
Centrilobular emphysema
Assoc. with smoking
Affects respiratory bronchioles and alveolar ducts
Unevenly distributed BUT affects upper and posterior portions of lungs more severely
Panacinar emphysema
Destruction and enlargement of alveoli distal to terminal bronchioles
Results of genetic abnormality or progression of chronic bronchitis
* lower portions of lung more affected
Emphysema manifestations
Dyspnea even at rest
Tachypnea
V/Q mismatch NOT prominent d/t loss of capillaries with alveoli
- cyanosis and heart failure less prominent
- pink puffers
Usually little cough or sputum
ABGs usually normal or respiratory alkalosis d/t hyperventilation
May be unable to eat
Hyperinflation of lungs “barrel chest”
Slowly debilitating
Treatment of bronchitis and emphysema
Control of environment irritants and infection
Nutritional support
Exercise training
Breathing exercises and retraining
Managing secretions
Pharmacologic treatment
Oxygen therapy
Psycho-emotional support
