X Respiratory (Grant) Flashcards
External Respiration
exchange of O2 and CO2 btwn lung and envt
Internal Respiration
exchange of O2 and CO2 at cellular level
Ventilation
movement of air in and out of alveoli
Diffusion
molecular mvmt from UP concentration to LO concentration
Factors affecting diffusion
- surface are of lung
- thickness of alveoli lining
- concen of gases
Upper Resp Tract
- Nose (entry way, air filtered, warmed)
- Pharynx (5” length, 3 subdivisions)
- Larynx (voice box)
- Trachea (wind pipe)
Pharynx: 3 subdivision
- Nasopharynx, addenoids
- Oropharynx, tonsils
- Laryngopharynx
- inner lining is continuous-
- infection in pharynx w lead to inner ear d/t connection to eustachian tubes
Larynx
Voice box
- connects to pharynx w trachea
- made of 9 areas of cartilage
- largest area (Thyroid, adams apple)
- same side in men/women until puberty when boys grow and become larger.
Trachea
Wind Pipe
- into mid chest , L/R bronchi
- contains C shaped cartilage rings. allows expansion when swallow
Lower Resp Tract
-Brochial tree
(Brochioles, alveolar ducs, alveoli)
-L (has horizontal slant) R (larger, enters into lunch. More vulnerable because of vertical tube.
-Risk for aspiration
Mechanics of Breathing
Lungs: occupy most of the thoracic space (visceral and parental pleura)
Respiratory Mvmt and Ranges: rhythmic mvmts of chest walls, ribs and muscles allow air to be inhaled and exhaled.
Parietal Pleura
touches outside thoracic cavity.
Visceral Pleura
touches the lung. Membrane is air tight, keeping lungs inflated.
Mediastinum
- Heart, Great Vessels
- are protected by sternum, ribs, thoracic vertebrae
Regulation of Respiration
Nervous Control: medulla oblongata, pons, chemoreceptors (in carotid and aorta)
The Medulla Oblongata and Pons control what?
rate and depth of respiration
Chemoreceptors in Medulla respond to changes in what?
- CO2 levs and CSF pH.
- w send message to lungs to change depth and rate
- CO2 in blood (Carbonic Acid) is a chem stimulant for respiratory regulation.
- UP CO2 = UP ACIDIC
- more alkaline after exhale
Normal Respiration Rate
14-20
affected by Age, Sex, Activity, Disease, Temp
Normal blood pH
7.35 - 7.45
Assess of Resp System: Subjective Data
- SOB (cause, duration, cough during, sudden, gradual, upon waking, running, walking)
- Dyspnea
- Cough (mucous color, amount, harsh, dry, hacking?)
- what causes your SO
Assess of Resp System: Objective Data
- Expression, chest mvmt, respirations
- respiratory distress, wheezes, orthopnea (have to sit/stand to breath)
- adventitious breath sounds (abnormal)
Adventitious Breath Sounds
- Sibilant Wheezes
- Sonorous wheezes
- Crackles
- Pleural friction rubs
Adventitious Breath Sounds: Sibilant wheezes
abnormal breath sounds
- hissing/whistling heard on inspiration or expiration
- air passing through obstructed airway
Adventitious Breath Sounds: Sonorous wheezes
snoring (aka Ronchi)
-low pitch, loud, course, snoring sound. Heard on expiration in trachea and bronchi
Adventitious Breath Sounds: Crackles
- bubbling, cracking, short, interrupted on inspiration.
- sounds like rubbing hair, rice crispies
- air forced thru fluid/mucous/pus filled passage way r/t inflammation d/t infection in bronchi/alveoli
Adventitious Breath Sounds: Pleural Friction Rubs
low pitched grating, creaking sound. Inflamed pleural rubbing together
Assessment of Respiratory System
- while breathing, does chest expand evenly on both sides?
- note: rate, rhythm, depth, effort of breathing
- Hyperpnea (exaggerated, deep, rapid, labored resp)
- Tachypnia (fast breathing)
- Cheyne Stokes breathing
- listen for wheezes
- observe pt chest (normal, barrel?)
- look at posterior chest. deformities? Scoliosis?
- palpate chest for areas of tenderness?
- visible abnormal tumor/mass?
- respiratory expansion while breathing
- Tactile Fremitus (vibratory tremors that can be felt thru chest while speaking, UP vibrations w PNA or completely absent. Problem indicative of obstuction)
Hyperpnea / Hyperpnoea
increased depth of breathing when required to meet metabolic demand of body tissues, such as during or following exercise, or when the body lacks oxygen (hypoxia), for instance in high altitude or as a result of anemia.
What can you determine from Precussing lungs?
- Resonant Sounds: normal, lo pitched, hollow, heard over normal lung tissue
- Fluid buildup?
- Hyper resonance: louder, lower pitched than resonant. More likely to hear over thin adult or children. Hear in hyperinflated lungs w air (i.e. COPD, Ashtma)
- Typanic Sound: hollow drum like sound, hi pitch, heard over stomach area, indicatove of pheumothorax (collapsed lung). w be normal in abd area, not chest area
Hypoxia - SS
Lo O2
- anxiety, restlessness
- LO concentration
- vertigo
- behavioral changes
- UP pulse
- Bradycardia, as hypoxia INC
- UP respiration/depth
LATE SS:
- shallow, slow resp
- changes in color (palor)
Lab & DX Tests
- Chest Roentgenogram (xrays)
- Computed tomoraphy (CT)
- Mediastinoscopy
- Laryngoscopy
- Bronchoscopy **
- Sputum Specimen
- Cytological Studies
- Thoracentesis
- Arterial Blood Gasses (ABG)
- Pulse Oximetry
Dx Tests: Chest Roentgenogram
Visualization of chest/lungs, size/shape, position of lungs to detect tumors, foreign bodies etc.
Dx Tests: Computed Tomography
CT, slices of pulmonary tissue. look for pulmonary lesions
- painless, non invasive
- anxiety, enclosed space
Dx Tests: Helical/Spiral CT Scan
- more accurate than regular CT scans.
- If contrast used, can pick up pics in seconds.
- improved imaging
Dx Tests: Pulmonary Angiography
- Contrast looking at pulmonary arteries to detect embolism or lesions.
- Congenital or acquired lesions.
- For an emboli, w do lung scan first then this
Dx Tests: PFTs, Pulmonary Function Test
- Umbrella term, several tests
- measuring functionality of lungs
- measurement obtained w spirometer
Types of Pulmonary Function Tests
- TIDAL VOLUME: vol air inhaled/exhaled in normal breath
- INSPIRATORY RESERVE: max vol air normally inspired
- EXPIRATORY RESERVE: max vol air normally exhaled, by forced expiration
- RESIDUAL VOLUME: vol air left in lungs after max expiration
Mediastinoscopy
- visualization of mediastinum under General Anes.
- incision made into upper mediastinum
- gather sample of lymph nodes and/or biopsy if needed
Laryngoscopy
- Direct visualization of Larynx to detect lesions and evaluate laryngal functioning and any inflammation
- can use for biopsy or to remove polyps.
Bronchoscopy ***
- direct vis larynx, trachea, bronchi
- introduced thru nose or mouth using flexible fiberoptic scope.
- sometimes direct into trachea
- used to treat lung disease, obtain biopsy, remove foreign objects
- collect sputum
Bronchoscopy: NI
- NPO until gag reflex returns
- semi fowler
- lie on side to help w secretions
- monitor for laryngal edema or spasms
- stridor d/t obstruction
- scope could cause inflammation
- UP Dyspnea
- monitor SS of Hemorrhage
Sputum Specimen
for microscope eval
Cytological Studies
test on body secretions, sputum, pleural fluid to detect abnormal or malignant cells
Thoracentesis ***
- insert needle thru chest wall, pleural space for aspiration of fluid
- for Dx or therapeutic purposes
- Removed fluid w be examined (WBC, RBC, Glucose, Protein Culture for abnormal cells.
- can detect malignant cells.
- color of fluid ,amount
- insertion site
***Thoracentesis: NI
- explain to pt (really Dr’s job but nurse should know)
- need written consent
- pt anxious, provide support
- asst pt w position
- 30* HOB raised
- check VS, Resp (through out procedure)
- no more than 1300ml removed w/in 30 min to prevent intra vascular shift
- could lead to pulmonary edema
- after procedure, place pt on unaffected side
- specimen sent to lab ASAP
Arterial Blood Gasses (ABG)
- hurts
- measures ability of lungs to oxygenate arterial blood adequately
Pulse Oximetry
provide continual monitoring of SAO2 (sat of Oxy)
-not in strong sunlight**, can affect reading. pull curtains
Epistaxis
Nose bleed
Epistaxis: Cause
- congestion of nasal membrane leading to capillary rupture
- primary or secondary
- pick nose
- menstruation
- severe dryness (use humidifier)
- foreign body in nose
- excessive nose blowing
- deviated septum
Epistaxis: Subjective Data
-Deviation, severity
Epistaxis: Objective Data
1 nostril or both
anterior or posterior
Epistaxis Types
Anterior: 90%, constant ooze
Posterior: farther back in nasal cavity. Profuse, arterial origin
RSK: airway compromise, aspiration of blood, difficulty controlling bleeding
Epistaxis can contribute to HTN
anxiety of bleed causes HTN
Epistaxis: Assess
- bright red bleeding from one or both nostrils
- can lose as much as 1L/hr
- women, menstruation d/t hormones fluctuating Estrogen
- BP, TP, Resp
- evidence of hypovolemic shock (LO BP, if low enough, can stop bleeding
Epistaxis: NI
- sitting position,leaning forward
- direct pressure by pinching nose
- ice compress to nose
- nasal packing (saturated)
- cautery using silver nitrate
- balloon tamponada (foley like catheter inserted in nose, inflate balloon to put presssure against vessel to stop bleeding
- Rhinoscopy w lighted speculum to look into nasal passageway
- ABX profilactically to LO risk for infect
- saline spray
- humidifier
- vaseline on nostrils to prevent dryness
Deviated Septum/Nasal Polyps
- congenital abnormality
- injury
- nasal septum deviates from midline and can cause a partial obstruction
- nasal polyps are tissue growths usually d/t prolonged inflammation
- pt w seasonal allergies
Deviated Septum/Nasal Polyps: SS
- stertorous respirations (snoring)
- dyspnea
- postnasal drip
Deviated Septum/Nasal Polyps: NI
- MEDS (corticosteroids(prednisone), antihistamines, abx)
- Analgesics
- Nasaseptoplasty
- Nasal polypectomy
- sinus X-rays (polyps, dev septum)
- nasal packing after Sx to stop bleeding for 24hrs
- check for hemorrhage (excessive swallowing)
- sucking sound normal d/t packing
- maintain nasal mucosea hydration, nasal irrrigarion w saline
- vaseline to nares for dryness
- Semi Fowlers, UP breathing, drainage, LO edema
- NO nose blowing
- NO bend over
- encourage mouth breathing
- no heavy lifting/straining
- NO ASA (hemrrorhage
- NO ETOH, TOBACCO
- patent airway
- some meds cause Rebound Effect and stop working and start to cause the original symptoms (i.e. Affrin)
MED: Prednisone
- Corticosteroid
- LO polyps, reduce size
MED: Antihistamine
- LO congestion
- SS of allergies
MED: Abx
profilactically
MED: Analgesics
pain, HA