Week 1: Respiratory Health Challenges Flashcards
Thr right lung is divided into
3 lobes
the left lung is divided into
two lobes
the upper respiratory tract includes
nasal cavity, pharynx, adenoids, tonsils, epiglottis, larynx, and trachea.
the lower respiratory tract includes
bronchi, bronchioles, alveolar ducts, and alveoli.
normal adult tidal volume
500mL
surfactant is a
lipoprotein that helps keep the alveoli open, thus preventing alveolar collapse
contraction of the ______, results in ____________, allowing air to enter the lungs
diaphragm, decreased intrathroacic pressure
ventilation involves
inspiration and expiration
chemoreceptor
receptor that responds to a change in the chemical composition (PaCO2 and pH) of the fluid around it
mechanical receptors
(juxtacapillary and irritant) are stimulated by a variety of physiological factors, such as irritants, muscle stretching, and alveolar wall distortion.
respiratory defense mechanisms
filtration of air, the mucociliary clearance system, the cough reflex, reflex bronchoconstriction, and alveolar macrophages.
three normal breath sounds
vesicular, bronchovesicular, and bronchial
adventitious breath sounds
crackles, wheezes, pleural friction rub
bronchoscopy
procedure in which the bronchi are visualized through a fibre-optic tube and may be used for diagnostic purposes to obtain biopsy specimens, assess changes resulting from treatment, and remove mucous plugs or foreign bodies.
thoracentesis
the insertion of a needle through the chest wall into the pleural space to obtain specimens for diagnostic evaluation, remove pleural fluid, or instill medication into the pleural space.
pulmonary function tests
use a spirometer to measure lung volumes and airflow.
deviated septum
deflection of the normally straight nasal septum that is most commonly caused by trauma to the nose or congenital disproportion
rhinoplasty
the surgical reconstruction of the nose, is performed for cosmetic reasons or to improve airway function when trauma or congenital deformities result in nasal obstruction.
epistaxis (nose bleed)
It may be caused by trauma, foreign bodies, nasal spray abuse, street drug use, anatomical malformation, allergic rhinitis, or tumours.
allergic rhinitis
rxn of nasal mucosa to a specific antigen
sinusitis
develops when the ostia (exit) from the sinuses is narrowed or blocked by inflammation or hypertrophy (swelling) of the mucosa.
nasal polyps
benign mucous membrane masses that form slowly in response to repeated inflammation of the sinus or the nasal mucosa
acute pharyngitis
Is an acute inflammation of the pharyngeal walls that may include the tonsils, palate, and uvula.
acute pharyngitis causes
viral, bacterial, or fungal infection
tracheotomy
surgical incision into the trachea for the purpose of establishing an airway
tracheostomy
the stoma that results from the tracheotomy
laryngeal polyps
polyps on the vocal cords develop as a result of vocal abuse or irritation
early s&s of head and neck cancer
difficulties in chewing, swallowing, moving the tongue or jaw, & difficulty breathing.
acute bronchitis
an inflammation of the bronchi usually caused by infection
pneumonia
acute inflammation of the lung parenchyma caused by a microbial agent
community aquired pneumonia
lower respiratory tract infection of the lung parenchyma with onset in the community or during the first two days of hospitalization.
hospital aquired pneumonia
pneumonia occurring 48 hours or longer after hospital admission and not incubating at the time of hospitalization.
aspiration pneumonia
sequelae occurring from abnormal entry of secretions or substances into the lower airway.
4 stages of pneumonia
congestion, red hepatization, grey hepatization, and resolution.
nursing management of pneumonia
In the hospital, the nursing role involves identifying the patient at risk and taking measures to prevent the development of pneumonia.
o The essential components of nursing care for patients with pneumonia include monitoring physical assessment parameters, facilitating laboratory and diagnostic tests, providing treatment, and monitoring the patient’s response to treatment.
o Treatment with antibiotics is necessary for bacterial pneumonia; all patients require supportive measures
TB
infectious disease caused by M. tuberculosis, a gram-positive, acid-fast bacillus that is usually spread from person to person via airborne droplets.
way to diagnose laten tb
the tuberculin skin test using purified protein derivitive
main tx of TB
drug therapy
MDR TB occurs
when resistance develops to two or more anti TB drugs.
pts strongly suspected of having tb should
(1) be placed on respiratory isolation, (2) receive four-drug therapy, and (3) receive an immediate medical workup, including chest x-ray examination, sputum smear, and culture.
pulmonary fungal infections are found frequently in
seriously ill patients being treated with corticosteroids, antineoplastic and immuno-suppressive drugs, or multiple antibiotics.
drug most widely used in treating serious systemic fungal infections
amphoceterin b
bronchiectasis
permanent, abnormal dilation of one or more large bronchi. The pathophysiological change that results in dilation is destruction of the elastic and muscular structures supporting the bronchial wall.
hallmark of bronchiesctasis
persistent or recurrent cough with production of greater than 20 mL of purulent sputum per day.
lung abcess
pus-containing lesion of the lung parenchyma that gives rise to a cavity.
pneumoconiosis
general term for a group of lung diseases caused by inhalation and retention of dust particles.
most important risk factor in the dev. of lung cancer
cig smoking
tx for lung cancer
- surgery
- radiation
- SRT
- chemo
- biological targeted therapy
overall nursing mgt of pt with lung cancer
(1) effective breathing patterns, (2) adequate airway clearance, (3) adequate oxygenation of tissues, (4) minimal to no pain, and (5) a realistic attitude toward treatment and prognosis.
pneumothorax
presence of air in the pleural space. As a result of the accumulation of air, there is partial or complete collapse of the lung.
closed pneumothroax
no associated external wound. The most common form is a spontaneous pneumothorax, which is accumulation of air in the pleural space without an apparent antecedent event. It is caused by the rupture of small blebs (air-filled alveolar dilations <1 cm in diameter on the edge of the lung at the apex of the upper lobe or superior segment of the lower lobe) on the visceral pleural space.
open pneumothorax
air enters the pleural space through an opening in the chest wall
tension pneumothorax
a pneumothorax with rapid accumulation of air in the pleural space causing severely high intrapleural pressures with resultant tension on the heart and great vessels. It may result from either an open or a closed pneumothorax.
hemothorax
accumulation of blood in the intrapleural space. It is frequently found in association with open pneumothorax and is then called a
hemopneumothorax.
chylothorax
lymphatic fluid in the pleural space due to a leak in the thoracic duct. Causes include trauma, surgical procedures, and malignancy.
flail chest
results from multiple rib fractures, causing an unstable chest wall. The affected (flail) area will move paradoxically to the intact portion of the chest during respiration. During inspiration, the affected portion is sucked in, and during expiration, it bulges out. This paradoxical chest movement prevents adequate ventilation of the lung in the injured area.
flail chest therapy
adequate ventilation, administration of humidified O2, careful administration of crystalloid IV solutions, and pain control.
monitering chest tubes
evaluate if the chest drainage is successful by observing for tidalling in the water-seal chamber, listening for breath sounds over the lung fields, and measuring the amount of fluid drainage.
thorocotomy
considered major surgery because the incision is large, cutting into bone, muscle, and cartilage. The two types of thoracic incisions are median sternotomy, performed by splitting the sternum, and lateral thoracotomy.
pleural effusion
collection of fluid in the pleural space. It is not a disease but rather a sign of a serious disease.
empyema
pleural effusion that contains pus
pleurisy
inflammation of the pleura. The most common causes are pneumonia, TB, chest trauma, pulmonary infarctions, and neoplasms.
atelectasis
complete or partial collapse of a lung or segment of a lung that occurs when the alveoli become deflated.
idiopathic pulmonary fibrosis
characterized by scar tissue in the connective tissue of the lungs as a sequel to inflammation or irritation.
sarcoidosis
chronic, multisystem granulomatous disease of unknown cause that primarily affects the lungs. The disease may also involve the skin, eyes, liver, kidney, heart, and lymph nodes.
pulmonary embolism
blockage of pulmonary arteries by a thrombus, fat, or air emboli, or tumour tissue.
common risk factors for pulmonary embolism
immobility, surgery within the last 3 months (especially pelvic and lower extremity surgery), stroke, paresis, paralysis, history of DVT, malignancy, obesity in women, heavy cigarette smoking, and hypertension.
objectives of tx of pulmonary embolism
(1) prevent further growth or multiplication of thrombi in the lower extremities, (2) prevent embolization from the upper or lower extremities to the pulmonary vascular system, and (3) provide cardiopulmonary support if indicated.
pulmonary hypertension
severe and progressive disease. It is characterized by mean pulmonary arterial pressure greater than 25 mm Hg at rest (normal 12 to 16 mm Hg) or greater than 30 mm Hg with exercise in the absence of a demonstrable cause.
cor pulmonale
enlargement of the right ventricle secondary to diseases of the lung, thorax, or pulmonary circulation.
most common cause of cor pulmonale
COPD
4 types of lung transplant
single lung transplant, bilateral lung transplant, heart-lung transplant, and transplant of lobes from living related donor.
asthma
chronic inflammatory lung disorder of the airways that results in recurrent episodes of airflow obstruction, but is usually reversible. Inflammation causes varying degrees of obstruction in the airways, which leads to recurrent episodes of wheezing, breathlessness, sensation of chest tightness, and cough, particularly at night and in the early morning.
hallmarks of asthma
airway inflammation, airway hyper responsiveness
severe acute asthma complications
pneumothorax, pneumomediastinum, acute cor pulmonale with right ventricular failure, and severe respiratory muscle fatigue that leads to respiratory arrest (which can be fatal).
two main features in diagnosis of asthma
symptoms and variable airflow obstruction.
COPD
preventable and treatable disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking.
COPD s&s
dyspnea, difficulty breathing, or shortness of breath and limitations in activity. Symptoms are usually insidious in onset and progressive. Dyspnea is the subjective experience of shortness of breath and is the most disabling symptom in COPD.
emphysema
describes only one pathological change present in COPD: destruction of the alveoli.
chronic bronchitis
the presence of chronic productive cough for 3 months in 2 successive years, is a useful epidemiological term but does not convey how airway limitation severely affects morbidity and mortality in patients with COPD.
α1-Antitrypsin (AAT) deficiency
autosomal recessive disorder, is currently the only known genetic abnormality that leads to COPD.
complications of COPD
- cor pulmonale
- acute exacerbation
- anxiety & depression
primary goals of care for pt with COPD
(1) prevent disease progression (smoking cessation), (2) reduce the frequency and severity of exacerbations, (3) alleviate breathlessness and other respiratory symptoms, (4) improve exercise tolerance and daily activity, (5) treat exacerbations and complications of the disease, (6) improve health status and quality of life, and (7) reduce the risk of mortality
lung volume reduction surgery
reduce the size of the lungs by removing about 20% to 35% of the most diseased lung tissue so the remaining healthy lung tissue can perform better.
lung transplantation
pts with very advanced copd
pursed lip breathing
technique that is used to prolong exhalation, prevent bronchiolar collapse and air trapping, and assist with dyspnea. Exhalation should be at least three times longer than inhalation.
cystic fibrosis
autosomal recessive, multisystem disease characterized by altered function of the exocrine glands primarily involving the lungs, pancreas, and sweat glands.
main objectives of therapy in CF are
(1) promote clearance of secretions, (2) control infection in the lungs, and (3) provide adequate nutrition.
nursing care for pt with CF
revolves around the diagnoses of ineffective airway clearance, impaired gas exchange, ineffective breathing patterns, imbalanced nutrition: less than body requirements, and ineffective coping.
