Week 4 Flashcards
What are the main functions of the respiratory system?
Gas exchange, ventilation, and perfusion.
Gas exchange involves the transfer of oxygen and carbon dioxide between the lungs and the bloodstream.
What is the difference between ventilation and oxygenation?
Ventilation refers to the movement of air in and out of the lungs, while oxygenation is the process of adding oxygen to the blood.
Both processes are essential for effective respiration.
What physiological process involves inhalation and exhalation?
Ventilation.
Inhalation is the intake of air, while exhalation is the expulsion of air from the lungs.
What do chemoreceptors respond to in the respiratory system?
Changes in the chemical composition of the fluid around them.
Chemoreceptors play a critical role in regulating respiration based on the levels of carbon dioxide and oxygen.
What are the primary defence mechanisms of the respiratory system?
- Filtration of air by nasal hairs
- Mucociliary clearance system
- Cough reflex
- Bronchoconstriction
- Alveolar macrophages
These mechanisms protect the lungs from microorganisms, inhaled particles, allergens, and pollutants.
What changes occur in the respiratory system related to age?
Changes include decreased chest recoil, altered chest wall compliance, and reduced ciliary function.
Age-related changes can impact overall respiratory efficiency and immune response.
What are the components of a physical assessment of the respiratory system?
- Inspection
- Palpation
- Percussion
- Auscultation
These techniques help identify respiratory issues and abnormalities.
What are common abnormal lung sounds assessed during auscultation?
- Crackles
- Expiratory wheezing
- Stridor
These sounds can indicate various respiratory conditions.
What diagnostic imaging studies are used for the respiratory system?
- Chest radiograph (chest x-ray)
- CT scan
- MRI
- VQ scan
- Pulmonary angiography
- PET scan
These imaging techniques help visualize abnormalities in the respiratory system.
What blood studies are commonly conducted for respiratory assessment?
- Hemoglobin (Hb)
- Hematocrit (Hct)
- Arterial blood gas (ABG)
These tests provide information about oxygenation and overall lung function.
What is the purpose of pulmonary function tests (PFTs)?
To measure inspiratory/expiratory function and efficiency, diagnose diseases, and track disease progression.
PFTs are particularly useful in conditions such as asthma and COPD.
What is nicotine replacement therapy?
A treatment method that includes various replacement methods to aid in smoking cessation.
It helps to mitigate withdrawal symptoms and reduce cravings for nicotine.
True or False: The cough reflex is considered the first line of defence in the respiratory system.
True.
The cough reflex helps to clear the airways of irritants and pathogens.
Fill in the blank: The _______ is the most important respiratory defence mechanism distal to the respiratory bronchioles.
Alveolar macrophage.
Alveolar macrophages play a crucial role in immune response within the alveoli.
What procedure is performed to remove pleural fluid for analysis?
Thoracentesis.
This procedure involves inserting a needle into the pleural space to collect fluid.
What is the role of surfactant in the pulmonary system?
It reduces the surface tension of the alveoli.
Surfactant is crucial for maintaining alveolar stability and preventing collapse.
Coughing can only remove particles up to which level
Bronchi, segmental bronchi
What is the expected volume of fluid in the pleural space
25 mL
Visceral pleural
Coating the lungs, closest layer to the lung
Parietal pleura
Against the chest cavity, outer most layer of lungs
Inspiration
ACTIVE air flow into the lungs
- the chest is expanded laterally, the rib cage is elevated
- the diaphragm CONTRACTS depressed and flattened
Pressure changes r/t inspiration
Higher pressure (atmospheric) to lower pressure region (intrathoracic)
Expiration
PASSIVE air is leaving the lungs
- chest is depressed and the lateral dimension is reduced
- rib cage is descended
- the diaphragm RELAXES is elevated and dome shaped
Alveoli
The grapes of the lungs
Alveoli have a natural tendency to…
Collapse
Atelectasis
Comes from greek word Ateles meaning incomplete and ektasis meaning expansion
Surfactant
Lipoprotein that lines the alveoli, lowers the surface tension, and keeps the alveoli open during end expiration (PEEP example), reduces the amount of pressure to inflate the alveoli
Chemoreceptors
-In the medulla oblongata, carotid and aortic arch
- respond to changes in the chemical composition of the fluid around it
Mechanoreceptors
Located in the lungs, upper airway, chest wall and diaphragm, and signal from stretch or irritant receptors
- mechanoreceptors inhibit further long expansion (Hering-Breuer reflex) or triggers the cough reflex
Role of nasal hairs
- filter the inspired air
Mucocillary clearance system
AKA: mucociliary escalator
- mucus is secreted at a rate of about 100mL/day by goblety cells and submucosal glands. It forms a mucous blanket that contains the impacted particles, ciliated cells do not exist past the respiratory bronchioles
Bronchospasm/ Bronchoconstriction
- The clamping down of the bronchi
- Response to irritating substances
- Some patients are more prone to, or have hyper-excitable bronchioles that react to anything (ie hyperactive airways of asthma)
Macrophages
(Phage = to eat)
- engulf bacteria in alveoli, is moved to the level of the ciliated bronchioles in mucous, then either coughed out or removed by the lymphatic system
Crackles
Can be from air passing through fluid (mucous, serous fluid, etc). It is commonly heard in the base of the lung lobes during inspiration. Crackles can be further categorized as coarse or fine. Coarse crackles sound quality is low pitched and moist; it may be years in pulmonary Edelman and bronchitis
Wheezes
Heard more commonly during expiration because the airways normally narrow during this phase of respiration. Wheezing during expiration alone is general indicative of milder obstruction than if present during both inspiration and expiration, which suggests more severe airway narrowing.
Stridor
Higher pitched sound originating from the upper airway and occurs on inspiration. It is distinguished from other sounds by its intensity in the neck more so than the chest, timing (inspiratory), and pitch (high). Life wheezes, stridor is produced by airway narrowing, but only in the upper airways
Rhonchi
Large airway sounds
- continuous gurgling or bubbling sounds typically heard during both inhalation and exhalation. There sounds are caused by movement of fluid and secretions in larger airways (in asthma, viral upper respiratory infection)
What is chronic obstructive pulmonary disease (COPD)?
COPD is a preventable and treatable (but not reversible) disease state characterized by airflow limitation.
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.
What are the two main characteristics of COPD?
- Chronic bronchitis
- Emphysema
What is a key symptom of chronic bronchitis?
Chronic, productive cough (for 3+ months per year for 2+ years)
What are common symptoms of COPD?
- Dyspnea
- Shortness of breath (SOB)
- Activity limitations
What are the primary causes of COPD?
- Cigarette smoking (80-90% of Canadian cases)
- Chemicals, dust, vapours
- Recurring respiratory infections
- α1-Antitrypsin deficiency
- Aging (risk factor)
What are some clinical features of COPD?
- Chronic, productive cough
- History of smoking or exposure to risk factors
- Progressively worsening dyspnea
- Anorexia and weight loss in late stages
- Auscultation findings: prolonged expiratory phase, wheezes, or diminished sounds
What is cor pulmonale in the context of COPD?
Cor pulmonale is a late manifestation of COPD characterized by hypertrophy of the right side of the heart due to pulmonary hypertension.
What are some complications associated with COPD?
- Cor pulmonale
- Acute exacerbations of COPD (AECOPD)
- Acute respiratory failure
- Depression and anxiety
What diagnostic tests are used for COPD?
- History of smoking
- Physical examination with dyspnea scale
- Pulmonary function testing (PFTs)
- Serum α1-Antitrypsin level (AAT)
- Chest x-ray or CT scan
- ABG
- Exercise testing with oximetry
- ECG
- Echocardiogram
- Blood work
- Sputum culture
What are the primary goals of care for patients with COPD?
- Prevent disease progression
- Reduce the frequency and severity of exacerbations
- Alleviate breathlessness and other respiratory symptoms
- Improve exercise tolerance and daily activities
- Treat exacerbations and complications of the disease
- Improve health status and quality of life
- Reduce the risk of mortality
What are possible priority nursing diagnoses for COPD?
- Ineffective breathing pattern
- Ineffective airway clearance
- Impaired gas exchange
- Imbalanced nutrition: less than body requirements
- Disturbed sleep pattern
- Risk for infection
What pharmacological treatments are commonly used for COPD?
- Inhaled Corticosteroids (ICS)
- Short-acting bronchodilators (SABAs, SAMAs)
- Long-acting bronchodilators (LAMAs, LABAs)
Fill in the blank: The primary medication goal in COPD management is to reduce _______ and control AECOPD.
inflammation
True or False: Smoking is the single most effective intervention to increase quality of life and decrease morbidity and mortality directly caused by smoking.
True
What are some physiologic effects of nicotine?
- Rapid onset
- Increased BP, HR, cardiac output (CO)
- CNS stimulation
- Dependence due to withdrawal symptoms
What is the typical SpO2 goal for oxygen therapy in COPD patients?
88-92%
What is the role of pulmonary rehabilitation in COPD management?
To improve exercise tolerance, quality of life, and reduce symptoms through a structured program.
What are some nursing interventions for COPD patients?
- Airway clearance techniques
- Adequate hydration
- Relaxation techniques
- Long-term oxygen therapy
- Nutritional supplementation
Influenza
- influenza season (-November to april)
- viral illnes
- typically within the upper respiratory tract (URTI)
- common complications are secondary infections (such as pneumonia)
- commonly confused with the community version of the flu
-abrupt onset, last 7-10 days - fever, cough, myalgias
- vaccines are typically 70-90% effective for preventing influenza in adults
Measure s to reduce the spread of influenza include:
- good hand hygiene practices, such as handwashing or use of an alcohol based hand rub after contact with the eyes, mouth, nose or secretions
- avoid handling soiled tissues or objects used by an ill person
- ill person should stay at home
In healthcare settings, routing practices should be used consistently with all patients including
- hand hygiene before and after all patient contact
- appropriate use of personal protective equipment (gloves, mask, eye protection) for contact with all patients secretions/excretions
- cleaning/disinfecting of all patient contact surfaces after patient leaves an examining room or area
Target groups of influenza immunizations
Groups at high risk
- indigenous people
- healthy children between 6- 59 months
- pregnant females in the third trimester, if their delivery date is in influenza season
- residents of nursing homes or long term care facilities
- people with chronic conditions such as diabetes, anemia, cancer, immunodeficiency, immunosuppression, neurological conditions, renal disease or conditions that compromise management of respiratory secretions
- health care workers
Supportive management of influenza: alternative and complementary therapies
- goldenseal
- zinc
- echinacea
Supportive care of influenza
- hydration
- symptoms relief (pain, fever)
- ensuring adequate ventilation and oxygenation
What is emphysema
Destruction of alveoli
What are the common types of pneumonia?
- Community-acquired pneumonia (CAP)
- Hospital-acquired pneumonia (HAP)
- Ventilator-acquired pneumonia (VAP)
- Fungal pneumonia
- Aspiration pneumonia
- Opportunistic pneumonia
These categories help in understanding the source and treatment options for pneumonia.
What are some risk factors for pneumonia?
- Age
- Air pollution
- Altered LOC (e.g., ETOH, head injury, seizure, drug OD, stroke)
- Bedrest, immobility
- COPD, DM, CHF, CKD, cancers
- HIV
- Immunosuppressant medications
- Tube feeds
- Malnutrition
- Smoking
- Inhalation or aspiration of noxious substances
- Viral URTIs
- Intubation
Understanding these risk factors can help in identifying at-risk populations.
What are the stages of pneumonia?
- Congestion: first 24 hours of infection
- Red hepatization: initial days of infection
- Grey hepatization: turning point
- Resolution: with proper treatment or worsening complications
Each stage has distinct symptoms and clinical implications.
What does empirical therapy mean?
Empirical therapy refers to treatment initiated before a definitive diagnosis is made, often based on the most likely pathogens.
What are the classes of antibiotics used for bacterial pneumonia?
- Cephalosporins
- Beta-lactam antibiotics
These antibiotics are chosen based on their spectrum of activity and the patient’s history.
List the generations of cephalosporins and their characteristics.
- 1st Generation: cefazolin (Ancef) - Gram +, limited Gram -
- 2nd Generation: cefuroxime (Ceftin) - More Gram +, better Gram -
- 3rd Generation: ceftriaxone (Rocephin) - Most potent for Gram -, some Gram +
Each generation has increasing activity against Gram-negative bacteria.
What are common adverse effects of cephalosporins?
- Diarrhea
- Abdominal cramps
- Rash
- Pruritus
- Redness
- Edema
Awareness of these side effects is essential for patient safety.
What are the clinical manifestations of pneumonia?
- Cough
- Shortness of breath (SOB)
- Hypoxemia
- Fever
- Chest pain
- Fatigue
These symptoms can vary based on the type and severity of pneumonia.
What diagnostic imaging is typically used for pneumonia?
Chest X-ray
X-rays can reveal consolidation and other changes in lung architecture.
What is the recommended fluid intake for pneumonia patients?
Increase fluid intake to 3L/day.
What is the role of the pneumococcal vaccine?
Recommended for all children < 2 years and adults > 65 years.
True or False: The influenza vaccine is the same as the pneumococcal vaccine.
False.
Fill in the blank: The priority nursing diagnosis for pneumonia may include _______.
[Impaired gas exchange].
What are some nursing interventions for pneumonia?
- Administer IV meds as ordered
- Maintain a patent airway and adequate oxygenation
- Encourage oral intake and high-calorie soft foods
- Provide symptom management
- Monitor vital signs
These interventions prioritize patient safety and recovery.
What is a possible complication of pneumonia?
Superinfections, such as Clostridium difficile.
