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NUR205 > Week 3 > Flashcards

Week 3 Flashcards

1
Q

Purpose of respiration

A

The lungs, in conjunction with the circulatory system, deliver oxygen to and expel carbon dioxide from the cells of the body

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2
Q

Upper respiratory tract includes

A

Nose
Trachea
Warms & filters

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3
Q

Lower respiratory tract includes

A

Bronchi
Lungs (alveoli)
Gas exchange

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4
Q

Three processes of respiration

A

Ventilation (inspiration & expiration)

Diffusion (exchange of O2 & CO2 at the alveolar-capillary membrane)

Perfusion (blood flow through the pulmonary circulature)

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5
Q

Arterial blood gases

A

Measurement of arterial oxygen and carbon dioxide levels in the arterial circulation
Used to assess the adequacy of respiration
Also assesses acid-base balance

The lungs & kidneys attempt to compensate to maintain acid-base balance

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6
Q

COPD

A

Common, preventable & treatable
Characterised by a progressive, persistent airflow limitation
Enhanced chronic inflammatory response to noxious particles/gases
Made more severe by exacerbations/co-morbidities

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7
Q

Characteristics of COPD

A 
Often from long term exposure to cigarette smoke
Chronic asthma
Chronic bronchitis
Emphysema
Some cases of Bronchiectasis
Alpha 1 anti-trypsin deficiency (rare)
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8
Q

Diagnosis and presentation of COPD

A

Evidence of airway obstruction by spirometric testing, that does not return to normal with treatment
History of progressive symptoms of cough and/or dyspnoea and/or chronic sputum production
Recurrent respiratory infections
Weight loss
Cigarette smoking history (80-90%)
Occupational/air pollution exposure
Genetic disposition
Frequent exacerbations leads to progressive destructive changes leading to a worsening condition (becomes cyclic)

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9
Q

Signs and symptoms of COPD

A 
Over inflated lungs
Pursed lip breathing and use of accessory muscles
Possible weight loss
SOBOE
Decreased exercise tolerance 
Cough:
Non-productive
Productive
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10
Q

Dry cough

A

Develops without the presence of secretions caused by irritant in upper airway eg smoke

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11
Q

Productive cough

A

Excess mucus or sputum (phlegm) is present in the respiratory tract. When airways are inflamed (infection) excess secretion of mucus accumulates in the airways. Expectorated by coughing.

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12
Q

Sputum observations

A

The nurse should observe the colour, consistency, quantity and odour of any sputum produced
record in nursing notes
Sputum specimen must be sent for MC&S

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13
Q

Characteristics of sputum

A

White Mucoid - Severe ‘Cold’
Yellow/green Containing pus (Purulent) – bacterial infection, Common in COPD/CF
Red – Containing Blood (Haemoptysis). Caused by Cancer, pneumonia, TB, trauma, PE

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14
Q

Sputum consistency

A

Viscous/sticky – difficult to exporate ?dehydration

Copious watery, frothy secretions – Pulmonary oedema – usually white can have pink tinge

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15
Q

Sputum quantity

A

Increasing or decreasing amounts should be documented

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16
Q

Sputum odour

A

Foul smelling sputum may be indicative of bronchiectasis or lung abscess or Empyema.

17
Q

Differences between COPD and asthma

A

Symptoms consistent and rarely variable
Asthma is reversible/ COPD is usually not
Asthma is not generally associated with sputum production
Smoking history
COPD destruction of alveoli (bullae)

18
Q

Mild COPD

A

FEV1 60 – 80% predicted
No abnormal signs
Smoker’s cough
Little or no breathlessness

19
Q

Moderate COPD

A

FEV1 40 – 50% predicted
Breathlessness (+/- wheeze on moderate exertion
Cough (+/- sputum)
Variable abnormal signs (reduction in breath sounds, wheezes

20
Q

Severe COPD

A 
FEV1 < 40% predicted
Breathlessness on any exertion/at rest
Wheeze and cough often prominent
Ung over inflation
Cyanosis
Peripheral  oedema
Polycythemia
Hypoxemia
21
Q

Collaborative management for COPD

A

General Nursing Care as per “breathless pt”
Medication therapy:
Various inhaled gluco-corticoids & broncho-dilators
Oxygen therapy:
Long-term
During exercise
For acute exacerbation
The goal is to increase PaO² over 60mmHg/SaO² over 90%
Pulmonary rehabilitation
Multi disciplinary (chest physiotherapy)
Breathing exercises (pursed lip, diaphragmatic breathing)
Lifestyle changes
Activity rehabilitation
Discharge patient teaching

This is to prevent/improve pulmonary hypertension/right ventricular hypertrophy/cor pulmonale – pt education is extremely important in this area

22
Q

COPD complications

A 
Acute exacerbations frequent/year
Asthma 
Influenza or pneumonia 
Pulmonary hypertension
Heart failure (cor pulmonale)
Polycythaemia
Cachexia
Depression
Osteoperosis
Cardiovascular diseases
23
Q

Pneumonia

A

Community-acquired or hospital-acquired
Immuno-compromised or aspiration type

Acute inflammation of the lung
By an infection (bacterial/viral/fungal/mycobacterial)

Resulting in:
Alveoli & surrounding tissues become oedematous
Alveoli fill with exudate & then consolidate
Affects ventilation & diffusion
Shunting occurs
hypoxia/arterial hypoxaemia
High mortality rate

24
Q

Nursing assessment for pneumonia

A

Varies with type/organism/co-morbidities
Vital signs: Changes in temperature/pulse/respirations
Dyspnoea/use of accessory muscles
Cough
Productive (rusty/blood-tinged/purulent)/dry/expectorating(?)
Changes in physical assessment (IPPA)

Changes in CXR (? areas of consolidation)
Concomitant heart failure (especially in elderly patients)
Changes in mental status
Fatigue/dehydration

25
Q

Nursing diagnosis for pneumonia

A

Ineffective airway clearance

Impaired gas exchange

26
Q

Nursing expected outcomes for pneumonia

A

Improved gaseous exchange

Improved airway clearance

27
Q

Nursing implementation for pneumonia

A

Oxygen therapy
Humidification may be used to loosen secretions
With air (face mask)

Deep breathing & coughing exercises (physio)

Antibiotics (as ordered)
For bacterial types
For viral types to prevent secondary bacterial infections

Promoting rest
Regular position changes

Promoting fluid intake:
To at least 2 L a day
Maintaining nutrition

General nursing care
Patient teaching

28
Q

Low flow oxygen systems

A 
Nasal Cannula
All age groups
1-5L/Min
Comfortable
Can dry mucous membranes
Hudson Mask

6-8L/Min
Inexpensive
Comfortable

Non-Rebreather
12-15L/Min
HighO2 Concentration

29
Q

High flow oxygen systems

A

Venturi Mask
4-8L/Min
Provides Low levels of supplemental O2
Precise FiO2

Other devices used in VERY specialist areas

NUR205 (11 decks)

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