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Foundations: Exam 2 > Week 4: Respiratory System > Flashcards

Week 4: Respiratory System Flashcards

1
Q

Control of ventilation

A

Occurs in the respiratory center of the brain; peripheral and central chemoreceptors are sensitive to circulating blood levels of CO2 and H+

Pathway:

  1. Increased CO2 (stimulus for breathing)
  2. Chemoreceptors are stimulated
  3. Increase depth and rate of respirations
  4. Decrease CO2
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2
Q

Breathing patterns

A

Increased breathing: Activity, awake status, exercise

Decreased breathing: Sleep, rest, athletically-fit individuals

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3
Q

Lifespan considerations

A

Normal adult: RR = 12-20 bpm.; resp. is automatic, smooth, regular

Infants, RR = 30-60 bpm d/t:

  1. Increased BMR (increased CO2 byproduct)
  2. Immature lung development (increased RR to meet O2 intake/CO2 release demand)

Older adults may have DECREASED (1) lung elasticity, (2) ciliary action and (3) muscle strength

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4
Q

Factors that affect respiratory function

A
  1. Body position (upright postures promote ease of lung expansion)
  2. Environment (Air pollution, allergens, heat/humidity)
  3. Lifestyle/habits (Smoking, drugs, alcohol)
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5
Q

Work of Breathing (WOB)

A

Describes the EFFORT used to breathe

Increased WOB is caused by:

  1. Airway obstruction
  2. Restricted lung movement
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6
Q

Obstructive and restrictive lung disease

A

Causes:

  1. Decreased lung expansion, volume, and capacity
  2. Lungs to stiffen and tissue to swell
  3. Reduced airway diameter

Ex.: Pneumonia, atelectasis, FB aspiration, exposure to toxins (radiation, asbestos), neuromuscular disease (Myasthenia Gravis), skeletal conditions (severe scoliosis, kyphosis)

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7
Q

Airway obstruction

A

Any process that decreases airway diameter causing increased airway resistance, and air-trapping

Ex. Asthma, the main components are:

  1. Bronchonstriction
  2. Mucus production
  3. Inflammation of airway
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8
Q

Pneumonia

A

Infection that inflames the air sacs in lungs causing accumulation of fluid and mucus in the airway

Can cause atelectasis (lung collapse) d/t lung consolidation (secretions that obstruct the airways)

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9
Q

COPD

A

Poorly reversed/worsened over time; causes:

  1. Airway obstruction
  2. Increased airway resistance
  3. Decreased gas exchange
  4. CO2 retention (hypercapnia)

Stimulus for breathing is reversed (hypercapnia and shift of normal respiratory to HYPOXIC DRIVE to maintain respiratory hemostasis); the best O2 delivery system is the Venturi mask

Risk factors: Smoking/e-cigs (greatest impairment) and exposure to environmental chemicals/toxins

S/S: SOB, cough with mucus production, fatigue, frequent lung infections, barrel chest/tripod position

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10
Q

Emphysema

A

Destruction of alveolar cell walls (septae); reduces lung surface area (and lungs’ ability to recoil and stretch)

Causes: bronchioles to collapse causing air-trapping (CO2 retention), increased mucus production, and accumulation in the airway

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11
Q

Chronic bronchitis

A

Chronic inflammation and mucus production that causes epithelial changes and damage to the bronchial tubes, scaring, and fibrosis (NOT effective for gas exchange)

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12
Q

Altered respiratory function: S/S

A
  1. Acute/chronic cough: response to irritation in the airways
  2. Sputum production (in the nose, throat, or lungs); and/or hemoptysis (blood-filled sputum)
  3. SOB (or dyspnea)
  4. Bradypnea/tachypnea
  5. Cheyne-Stokes: an increased rate and depth of respirations followed by a period of apnea (true apnea is 15-20 sec.); often seen at the end stages of illness
  6. Chest pain: pain caused by inflammatory mediators that stimulate nerve endings
  7. Adventitious/abnormal breath sounds: wheezes, stridor, crackles
  8. Accessory muscle use: evident by (1) leaning forward to breath, (2) spaces between ribs or sternum (retractions), and (3) straining neck and shoulder muscles; as well as: Nasal flaring, agitation, change in LOC
  9. Cyanosis: bluish/grey skin discoloration, poor O2 sat.; can be (1) central (lips, tongue, mucous membranes) OR (2) peripheral (nails, fingers, toes)
  10. Clubbing: seen in respiratory or cardiac disease r/t chronic/severe tissue hypoxia (bulging d/t increased blood flow and surface area to compensate for lack of O2)
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13
Q

Physical assessment

A
  1. Inspection
  2. Palpation
  3. Percussion
  4. Auscultation
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14
Q

Diagnostic tests

A

CXR (fluid/air, tumors)

Pulmonary function tests (lung volume and capacity)

Bronchoscopy (visualize the airways directly via scope in trachea and bronchi)

Sputum culture (gram stain to C&S)

ABG (arterial pH, PaO2, PaCO2, HCO3-)

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15
Q

Pulse oximetry

A

Diagnostic procedure that measures arterial % of Hgb saturated with O2

Normal: 95-100%; Abnormal: <93%

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16
Q

Oxyhemoglobin curve

A

Equates the % O2 saturation (x-axis) of Hgb to the arterial PaO2 (y-axis); it is non-linear

17
Q

Nursing interventions to improve respiratory function

A
  1. Hydration (encourage fluids especially water, avoid milk and thick fluids, and caffeine and alcohol)
  2. Positioning (upright, raise HOB, frequent position changes, “good-side-down” helps drain secretions)
  3. Ambulation: prevents pneumonia and lung complications (upright, OOB, walking, not supine)
  4. Deep breathing: expands alveoli and promotes cough (inhale slowly through nose); analgesics promote ease of techniques
  5. Coughing (deep cough/splinting post-surgery; stacked cough or low flow/”huff” cough for COPD)
  6. Incentive spirometry: motivation to breathe deeply by visually measuring progress
  7. Pursed lip breathing: keeps airways open longer to remove air that is trapped in lungs by slowing RR and relieving SOB; prevents atelectasis
  8. Aerosol/nebulizer medication: suspension and delivery of liquid droplets in air or O2 directly to lungs
  9. Metered dose inhalers (MDI): measured dose of medication (powder or gas); MDI with spacer increases medication delivered to lungs, and decreases unappealing taste
  10. Peak flow meter: measures peak expiratory flow rate and reflects changes in airway diameter; green, yellow, red zones based upon pt’s best (record am/pm, before/after treatment)
18
Q

Nursing intervention: chest PT

A
  1. Percussion: mechanical waves to remove secretions
  2. Postural drainage: positioning to drain secretions from particular lobes or segment of lungs for easier removal (“good-side-down”)
  3. Vibration: loosens secretions; devices: flutter valve or acapella, high frequency pulsator test
19
Q

Oxygen therapy

A

Purpose: Meet demands of body for O2 by improving tissue oxygenation

Maintain arterial PaO2 >60 mmHg and pulse ox. >93%

Results in:

  1. Decreased WOB (pts with dyspnea)
  2. Decrease cardiac workload (pts with cardiac disease)
20
Q

Principles of oxygen therapy

A
  1. Use lowest concentration possible for the shortest amount of time
  2. Assess pt for: responsiveness and effectiveness, color, alertness, HR, RR, WOB, ABGs, pulse ox. >93%, PaO2 >60 mmHg
21
Q

Oxygen delivery

A

Oxygen is prescribed in terms of either:

  1. Flow (L/min)
  2. Concentration (% of inspired air)

Oxygen should be humidified if >3 L/min (it has drying effects on mucous membranes)

Ex.: RA provides 21% FiO2 (fraction of inspired air that is O2 is 21%)

22
Q

LOW flow O2 delivery systems

A

Systems that mix with RA (do NOT provide enough gas flow to meet inspiratory demand)

Types of low flow systems:
1. NC: 20-60% FiO2, 1-6 L/min; most common, comfortable, convenient

  1. Simple face mask: 40-60% FiO2, 6-10L/min
  2. Partial-rebreather mask: 30-60% FiO2, 10-15 L/min; re-breathing some CO2 (anxious, hyperventilating, stab wound)
  3. Non-rebreather mask (NRB): 55-90% FiO2, 10-15 L/min; pure O2 (ARD, hypoxic)
23
Q

HIGH flow O2 delivery systems

A

Systems that PRE-mix, humidify, and heat O2/RA to deliver a fixed, precise oxygen concentration (EXCEEDS inspiratory/ventilatory demand)

Ideal for pts: (1) low O2 sat., (2) require humidification, (3) COPD and CO2 retention

Types of high flow systems:
1. High flow NC: 20-100% FiO2, up to 60 L/min; pre-mixes, humidifies, and heats to increase oxygen delivery and reduce dead space; ideal for premature infants (ventilator may damage lungs)

  1. Venturi mask: 20-60% FiO2; colored valves deliver precise oxygen concentration; ideal for pts with COPD (too much O2 decreases their stimulus for breathing)
  2. Tracheostomy collar: 28-98% FiO2; provides high humidity
  3. Face tent/oxygen hood: >60% FiO2; provides high humidity; ideal for P/NICU
24
Q

Clinical scenario 1:

Pt admitted with pneumonia; S/S: Not complaining of SOB; VS: RR 28 bpm, pulse ox. 94%

What O2 delivery system would you use?

A

Assess: Elevated RR, but no other signs of increased WOB, resp. distress, or O2 sat. <93%

Treatment: Low-flow delivery system; NC or simple face mask (begin with 2L O2)

Monitor: Pulse ox., RR, and WOB

25
Q

Clinical scenario 2:

Pt admitted with exacerbation of COPD and is currently on 2L NC; S/S: SOB, tachypneic, fatigued; VS: Pulse ox. 92%

What is the best O2 delivery system while they are hospitalized?

A

Assess: Stimulus to breathe is O2

Treatment: Venturi mask (provides most accurate % of FiO2 to prevent excessive oxygenation)

26
Q

Clinical scenario 3:

35 y/o pt admitted to ED with suspected panic attack; S/S: Lightheadedness, SOB, tingling and numbness around mouth; VS: RR 40 bpm

What is happening to this pt? Treatment plan?

A

Assess: Pt is hyperventilating (excess loss of CO2) likely d/t panic attack

Treatment: Partial-rebreather mask (to re-breathe own CO2 and provide additional O2); slow, deep breaths

27
Q

Clinical scenario 4:

Pt admitted to ED with pneumonia and ARD; S/S: SOB, cough, chest pain, course and diminished breath sounds; VS: RR 38, HR 106, pulse ox. 89-90% RA

A

Assess: S/S of ARD: Hypoxic, tachypneic, tachycardic, low oxygen sat.

Treatment: NRB (provides pure O2 at 55-90% FiO2, 10-15 L/min)

28
Q

Artificial airways

A

Oral (while sedated) or nasal pharyngeal airways (in nares to back of throat)

Endotracheal tubes (while sedated)

Tracheostomy tubes: plastic or metal; outer/inner cannula (outer remains until replacement, inner cleaned); cuffed/uncuffed (cuff prevents air from leaking with pts that are ventilated); size

29
Q

Artificial airway management: tracheal suctioning

A

Removal of secretions through a tube in a surgical opening (stoma) to maintain a patent airway

Reason to suction:

  1. Audible upper airway noise/gurgling
  2. Adventitious/abnormal breath sounds
  3. S/S of cyanosis
  4. Decreased arterial PaO2 or pulse ox.
  5. Restlessness or agitation
  6. Increased WOB; retractions, nasal flaring, tachypnea, SOB

Equipment (at bedside): Extra trach. (same and smaller size); obturator/Kelly clamp; trach. insertion kit; suctioning/O2 equipment

30
Q

Suctioning

A

Principles:

  1. Suction ONLY on way out, intermittently or continuously, from end of trach. tube or max 1 cm. beyond
  2. Rotate catheter while suctioning
  3. Do NOT suction >10-15 sec. (>5-10 sec. for infant/young child)
  4. Hyper-oxygenate before and in-between passes
  5. No more than 3 passes/session

Complications: Edema or obstruction (secretions, FB), hypoxia, bronchospasm, decannulation, infection, hemorrhage, skin breakdown

*Can also suction nasopharyngeal or nasotracheal route

Foundations: Exam 2 (3 decks)

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