Week 4 Respiration Flashcards
What flow range can you administer with a Nasal Cannula?
- 1L-2L (24-30%)
- 3-4L (30-38%)
- 5-6L (38-44%)
When do you attach a humidifier for NC?
>4L flow rate
What is the flow range for a Simple Face Mask?
8-12L (35-60%)
6-10L?
What is the flow range for a partial non-rebreather?
6-10L (40-60%)
What is the flow range for a 100% non-rebreather?
8-15L (60-100%)
Venturi Mask flow range?
- Varies w/ adapter valve (24%-65%)
- 2-15L
- Usually percentages are used not LPM
What are some risks that result from various O2 therapies?
- NC can cause skin break down behind ear
- Dry air can irritate nose
- All mask type O2 devices can have a risk of aspiration if pt is nauseous and throws up with mask on
What is Asthma?
- Disorder of bronchial airways
- Periods of reversible bronchospasm
What is the etiology and risk factors of Asthma?
- May be inherited
- Environmental factors: allergens, smoke, foods, dust, etc
- excitatory states
- exercise
- changes in temp
- strong odors
What does a patient w/ asthma undergo (clinical manifestations)?
- Shortness of breath (dyspnea)
- chest tightness
- wheezing on expiration
- WOB
- nasal flaring
- accessory muscles
What is the pathophysiology of Asthma?
- Chronic inflammation
- mucosal edema/secretion
- airway inflammation
How and why does airway constriction and capillary dilation occur?
- mast cells release chemical mediators of inflammation (histamine and prostaglandins for ex) inducing capillary dilation to attempt to wash away allergen
- Same chemicals also promot bronchoconstriction to close airway in attempt to prevent inhalation of more allergen
What is the difference between the late and early phase of Asthma?
- In general both have chemical mediators that induce an airway response
- In late phase, however, other inflammatory cells are attracted that create a self-sustaining cycle of obstruction and inflammation
- causes hyper responsiveness of airways to triggers such as cold weather
- delayed rxn
Why does the O2 sat of an asthma patient still remain normal?
- issue w/ air trapping
- can inhale not exhale for the most part
What are the classifications of Asthma?
- mild intermittent (< 2x per week)
- mild persistant (>2x per week, <1 per day)
- moderate persistent (daily, affects activity)
- severe persistent (contiual symptoms, frequent exacerbations)
- status asthmaticus (severe, life threatening, unresponsive to meds, paradoxal pulse, pneumothorax, acidosis can begin, cardiac arrest)
What things do we need to address in order to medically manage asthma patient?
- airway spasm
- mucous production
- inflammation
How can you reverse airway spasm in asthma pts?
- administer Beta-agonsists
- dilate airways
- nebulized atropine
- anticholinergic blocks parasympathetic system
- IV steroids
- decrease inflammation
How can you control inflammation in Asthma pts?
- inhaled corticosteroids
- prevents mast cell from emptying/ attracting inflammatory mediators
- reduces edema/spasms
- mast cell stabilizers
- surpresses bronchoconstrictive substance release
- leukotriene modifiers
- block action of leukotrienes (cause of smooth muscle constriction, vascular permeability, edema or airway mucosa, and attract eosinophils which promote inflammation
What are three possible nursing diagnoses for Asthma?
- ineffective breathing pattern
- ineffective airway clearance
- impaired gas exchange
What outcomes would result from the RN Dx of ineffective breathing pattern?
- improved breathing patterns
- RR w/n normal limits
- decreased dyspnea
- ” nasal flaring
- ” accessory muscles
- “anxiety
- return of ABG levels
What are outcomes for the RN Dx ineffective airway clearance?
- client will have effective airway clearance AEB decreased inspiratory/expiratory wheezing/ other breath sounds, and decrease coughin
- regular RR
What are the outcomes for the RN Dx impaired gas exchange?
- adequate gas exchange w/ O2 sat >94%/ PaO2 >80%
- normal skin color
- same as ineffective airway clearance
What are possible interventions for RN Dx of ineffective breathing pattern?
- assessment
- position of comfort: semi-fowlers position
- O2 therapy
- nebulizer treatment
What are the possible interventions of RN Dx of ineffective airway clearance?
- suctioning
- sputum eval/culture
- encourage fluids
- position changes
- oral care
What are the possible interventions of RN Dx impaired gas exchange?
- monitor pulse ox
- assess lung sounds
- O2 therapy
- admin meds
- reassess
What are some medications for asthmatics?
-
Albuterol
- rescue Inhaler
-
Salmeterol
- long acting inhaler
-
Fluticasone
- inhaled corticosteroid
-
Cromolyn
- mast cell stabilizer
-
Singular
- leukotriene modifier
What is the etiology and risk factors for chronic bronchitis?
- irritants in cigarrette smoke
- chronic respiratory infections
- sinusitis
- bronchitis
What is the pathophysiology of chronic obstructive bronchitis?
- Inflammation of bronchi
- Mucus
- chronic cough
- 3months of year for 2 years
- Decreased FEV1/FVC ratio
- Increase in size and number of submucous glands
- Increased number of goblet cells
- Impaired ciliary fxn
What causes the SOB in chronic bronchitis?
- airways collapse because of thick mucous and inflamed brochi
- reduced alveolar ventilation
- increase PaCO2 retention
- decrease PaO2
Why would a patient with bronchitis be more susceptible to infection
- impaired mucociliary fxn
- causes even more mucous production and thick inflamed bronchial walls
What are the clinical manifestations of chronic bronchitis?
- productive cough
- decreased exercise tolerance
- wheezing, rhonchi, moist breath sounds
- Barrel chest
- SOB
- prolonged expiration
- copous sputum
- frequent pulmonary infections
- chronic hypoxemia/hypercapnia
Why would someone appear puffy with chronic bronchitis?
Use of steroids to treat inflammation
Which nursing diagnosis from those presented w/ Asthma would be the priority diagnosis for Chronic Bronchitis?
- ineffective airway clearance based on the fact that mucous is overproduced with these type of pts
What is the pathophysiology of emphysema?
- alveolar walls destroyed
- permanent over-distention of air spaces
- air passages obstructed
- destruction of walls between alveoli
- partial airway collapse (crackles)
- loss of elastic recoil
- bleb formation
- increased ventilatory dead space
Why does WOB increase w/ emphysema pts?
- less fxnl lung tissue to exchange O2&CO2
- decreased O2 perfusion due to destruction of pulm capillaries
What are the clinical manifestations of emphysema?
- progressive DOE
- thin appearance
- use of accessory muscles
- chest is hyperresonant to percussion
- CXR shows over inflation and flattened diaphragms
- normal ABG’s until latter stages
- enlarged heart/RV
- cyanosis
- clubbed fingers
- pitting peripheral edema
- tachypenea (fast RR)
- WOB
Which nursing diagnosis for asthma would be the priority diagnosis for emphysema?
Impaired gas exchange RT destroyed alveolar fxn
What are the complications of COPD?
- CB
- infections more common
- Emphysema
- spontaneous pneumothorax more common
- Both
- infections
- acute respiratory failure
- worsens at night
- spontaneous pneumothorax
What things should one address when attempting to manage COPD?
- improve ventilation
- facilitate removal of bronchial secretion
- prevent complications
- remove bronchial secretions
*
How can we improve ventilation in COPD pt?
- bronchodilators
- anticholinergic agents
- theophylline
- corticosteriods
- O2
How can we remove bronchial secretions in COPD patients?
- pulm hygiene
- bronchodilators
- postural drainage
- chest physiotherapy
- positive pressure air flow (Bipap or CPAP)
How can we prevent complications in COPD pts?
- treat edema
- steroids; bronchial meds
- promote exercise
- home O2
- breathing exercises
- diaphragmatic breathing
- pursed lip breathing
How can you assess the management of the COPD pt?
- review hx for COPD dx source
- assess resp muscles/degree of respiratory distress
- assess ability to speak in full sentences
- baseline O2 sat/RR/ABGs
- LOC
- lung sounds
What are the possible RN Dx for COPD?
- impaired gas exchange RT decreased ventilation/mucus plugs
- ineffective airway clearance RT excessive secretions and ineffective coughing
- anxiety RT acute breathing difficulties/fear of suffocation
- activity intolerance
- imbalanced nutrition
- distrubed sleep pattern
What are the desired outcomes for COPD pts?
-
adequate gas exchange AEB:
- ABG values PaO2>60%
- ph w/n normal limits 7.35-7.45
- PaCO2<50%
- O2 Sat >90%
- minimal anxiety
- LOC at baseline
- improved airway clearance AEB effective cough/patent airway
- increase in psychological comfort/ demonstrate effective coping mechanisms
- improved activity tolerance AEB maintaining realistic activity level and demonstrating energy conservation techniques
- eat 75% of meals and maintain normal body weight
- adequately rested
What are some RN Interventions for COPD pts?
- monitor RR, pattern, O2 sat
- admin. O2
- adjust positioning of pt
- meds
- recognition of decreasing resp fxn
- lung sounds every 2-8 hrs
- hydration
- supervise cough techniques
- IS
- oral care
- paced activity w/ rests
*
What is pneumonia?
- inflammatory process in the parenchyma
- increase in interstitial/alveolar fluid
- 2nd most common HAI
What is the etiology and risk factors for pneumonia?
- bacterial
- virus
- mycoplasms
- fungus
- age, hx of smoking, URI, intubation, prolonged immobility
- aspiration of food, fluids, vomit
- inhalation of toxic air
- immunosupressive therapies
- malnutrition
- dehydration
- chronic disease states
What is the pathophysiology of pneumonia?
- inflammatory pulm response to offending agent
- distruption of mechanical defenses of cough/ ciliary motility
- inflamed/fluid filled alveolar sacs cannont exchange O2
What are the clinical manifestations of pneumonia?
- fever(elderly might not), chills, sweats
- pleuritic chest pain
- cough
- sputum (green/yellow)
- hemoptysis
- dyspnea
- headache
- fatigue
- crackles/breathsounds over consolidations
- dulled percussion sounds
Why is the RLL more commonly infected w/ infiltrates during pneumonia caused by aspiration?
During aspiration, the sloping angle of the right bronchus makes it easier for substances to travel in the right lung
What are the types of pneumonia?
- segmental (one segment)
- lobar (usually RLL)
- bilateral (both R&L)
How can you manage a pt w/ pneumonia?
- O2
- antibiotics
- fluid/electrolyte management
- respiratory support if needed
- bronchodilator meds
- chest physiotherapy
- tracheal suctioning
- nutritional support
What are the RN Dx for pneumonia?
- ineffective airway clearance
- impaired gas exchange
- ineffective breathing pattern
- activity intolerance
What are some interventions for a pneumonia pt?
- meds
- IS, effective coughing
- repositioning every 2 hours, encourage mobility
- SIMS, Good lung down
- monitor O2; keep 92%
- splint chest wall for coughing
- teach to avoid risky conditions
- smoking, temp extremes, weight gain, stress
How can you prevent pneumonia?
- Wash hands; gloves!
- HOB 30 degrees
- oral care am/pm/between meals
- hourly IS use
- proper nutrion/fluids
- prevent aspiration risks
- control pt pain so they can breath deeply and cough adequately
- pneumococcal vaccine (65y or older)
What are the respiratory changes that occur due to age?
- calcification of costal cartilage interfering w/ chest expansion
- decreased elastic recoil
- ” respiratory muscle strength
- ” fxnl alveoli
- ” cough effectiveness/secretion clearance
- ” ciliary fxn
- ” ability to mainatin acid-base balance
What is the physiological phenomena that causes a BP drop on inspiration?
Negative pressure in the chest: Inhale = neg pressure; Exhale = positive pressure
What is the class, fxn, and treatment method albuterol (proventil)
- SABA; Bronchodilator
- asthma through rescue inhaler
- monitor for increased HR/BP
- CNS stimulation/excitation
- risk of dysrythmias
What is the class, fxn, and treatment method of ipratropium (atrovent)?
- anti-cholinergic
- block bronchoconstricting effect of parasymp nervous system (relaxer)
- COPD & Asthma
- quick relief
- used only when one can’t tolerate SABA
- can be nebulized w/ SABA
What is the class, fxn, and treatment method of levelbuterol (xopenex)?
- SABA
- Asthma, rescue enhaler
- Recommended for ppl having issues w/ albuterol
- reduced HR increases
What is the class, fxn, and treatment method of mutelukast (Singulair)?
- leukotriene modifier (receptor blockers)
- leukotrines/inflammatory mediators
- tablets
- long-term asthma therapy
What is the class, fxn, and treatment method of fluticasone/ salmeterol (Advair)?
- fluticasone: corticosteroid
- salmeterol: LABA
- ASTHMA, combined inhaler
- rinse mouth AFTER use
What is the class, fxn, and treatment method of Combivent (ipratropium/albuterol)?
- Ipratropium: anti-cholinergic
- albuterol: SABA
- Asthma, quick relief
- combined inhaler
What is the class, fxn, and treatment method of methylprednisolone (solumedrol, medrol)?
- corticosteroid - decrease inflammation
- COPD/long term Asthma therapy
- MONITOR
- increase BP/HR
- Glucose
What is the class, fxn, and treatment method of dexamethasone (Decadron)?
- corticosteroid
- COPD exacerbation
- similar to Solumedrol
What is the class, fxn, and treatment method of magnesium?
- IV: bronchodilation in acute severe asthma/COPD exacerbations
What is the class, fxn, and treatment method of theophylline?
- methylxantheine
- bronchodilator/anti-inflammatory
- alternate therapy for mild persistant asthma
- MONITOR
- serum blood levels
- high incidence of interaction w/ other drugs
What is the class, fxn, and treatment method of cefazolin (Ketzol)?
- antibiotic
- can be given pre-op to prevent infection
What is the class, fxn, and treatment method of ceftriaxone (Rocephin) and Azithromycin (Zithormax, Zmax)?
- antibiotic
What is the class, fxn, and treatment method of heparin?
- anti-coagulant
- prevent DVT
- increase oxidation in COPD exacerbations
- affects PTT
- risk of bleeding
What is the class, fxn, and treatment method of enoxaparin sodium (Lovenox)?
- anti-coagulant
- prevent DVT
- affects PTT
- risk of bleeding
What is the class, fxn, and treatment method of pantoprazole (Protonix) and esomeprazole (Nexium)?
- PPI (proton pump inhibitor)
- acid reflux
- PPI’s okay for elderly, but AVOID
- H2 blockers: Zantac, Pepcid, Cimetidine
- side effects: diarrhea, nausea, vomiting, headaches, rash/dizziness
What is the class, fxn, and treatment method of morphine?
- opiod analgesic/narcotic
- pain
- ASSESS RR
- side effects
- constipation
- itching
- nausea
- vomiting
- sedation
- urinary retention
What are the class, fxn, and intended treatment for hydrocodone/acetaminophen (Norco, Lortab)?
- Hydrocodone: Opioid analgesic
- Acetaminophen: Non-Opioid
- Pain
- ASSESS RR
- side effects
constipation
itching
nausea
vomiting
sedation
urinary retention
