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Respiratory
| Question | Answer |
|---|---|
| Ventilation | Utilizes 5% of total BMR at rest; Depends on: 1. thorax movement-space, rib cage intact, muscle 2. patent airway-tongue obstruction 3. Closed cavity-so visceral and parietal pleura adhere c surface tension/moisture 4. surfactant-decreases work of bre |
| Diffusion | result of pressure gradients between gases in alveolar air and blood; alveoli has to be open |
| Perfusion | -in non lung tissue cells: >co2 or <o2 leads to vasodilation, increases blood flow ,and fixes the problem -in pumonary circulation: ,02 causes vasoconstriction and pnuemoconstriction resulting in blood shunting to better parts of lung; -lungs think if > |
| Gas exchange | single cell thickness; need alveoli & good perfusion |
| Good gas exchange depends on: | -large # of capillaries in contact c air -unimpaired diffusion of gases-clear alveoli -normal pulmonary blood flow -normal alveoli |
| Shunting | High vent & poor perfusion = pulmonary embolus; Low vent & good perfusion = asthma |
| Kyphosis | thorax deformity; increased risk for pneumonia b/c compromised chest cavity size/shape |
| Barrel Chest | normal for infants to have; look for hyper accessory muscles; may play into increased risk for complications |
| Pectus Excavatum | funnel chest, congenital, may need surgery |
| Pectus Carnatum | pigeon chest; changes orientation of ribs, so harder to exhale; rounded ibe cage; more extensive surgery needed or may just live c it |
| Normal Defense Mechanisms | *gag-if missing, easier to aspirate *cough-not always bad *bronchoconstriction-normal if irritated-exercise induced asmthma *cilia/mucus blanket-contains macrophages (WBCs) to eat bact., impaired if smoker *alveolar macrophages *IgA-lives in resp. sy |
| Pulmonary Diagnostics | *CXR, if dye used, beware of allergies, anaphylactic reactions *CT *Angiography-inject dye, look @ perfusion *MRI-remove metal, beware pacemakers, claustrophobia *oximetry *capnography-measures expired co2 *pulmonary functions tests-forced expiratio |
| Nursing implications of dx tests | *allergy hx-especially if using dye*ABG-wrist area, hurts:**allen test**heparinized syringe**apply hard pressure**put sample on ice to "freeze" gases, loses O2 and CO2 @ room temp**client temp-document, important variable in interpreting blood gases |
| Dx tests: direct laryngeoscopy | *NPO*remove dentures*observe for distress*rest voice to allow healing |
| Dx tests: bronchoscopy | *hemoptysis- sx of ca*lesions*removal of foreign body*burn debridement*clip away dead tissue |
| Post bronchoscopy care | *monitor VS, especially pulse*assess for cubcutaneous emphysema; crepitus*dyspnea b/c of hole in lung |
| Dx tests: any "scope" procedure | *assess for complications**perforation**aspiration-dyspnea**bleeding-hemoptysis**laryngeospasm-wheezing, may need to trach ptYour anxiety level makes big difference in pt's response. |
| Nursing care for pt c thoracentesis | drawing fluid off outside of lungs c needle; pt sit on bed, rest on high table*ned consent*local anesthetic-lidocaine*feeling of pressure*stay still*don't remove >1500 mL to avoid shock*OR may use continuous chest tube to drain |
| Ineffective airway clearance: suction | Two types:1. Oral-yankauer tip-tonsil tickler, pressure 80-100 mmHg on suction, change q 24 h2. tracheal |
| Tracheal suction | sterile technique:*size of catheter-adult 12-14 french**if too small, ineffective, if too large, may collapse lung/hypoxia**use 1/2 diameter of ET or trach |
| Tracheal suction complications | *hypoxia: limit time to 15 seconds from start to finish, pre & post oxygenate*infection*irritation-hydrate (1.5-2L/day) IV; humidify air |
| Epistaxis: tx | *lean forward to prevent aspiration *pressure a/g stiff cartilage *ice compress *vasoconstricting agent *cautery *packing *balloon tx-Foley; Preventative: *humidify air c cold H2O *saline spray *if Hgb below 8 or 9, transfuse |
| Epistaxis cont... | *biggest risk? aspiration *avoid blowing nose, straining to have BM, NSAIDS and ASA *Add humidity |
| Sinusitis | *usually follows URI *predisposed for any drainage impairment: -swimming, allergies, dental manipulation (swelling), polyps (#1 issue, small growth that obstructs drainage, will need surgery, 7-10 day risk of bleeding) |
| Sinusitis sx | *pain *drainage *nasal congestion *malaise *edematous mucosa *Headache! *difficult to tx b/c blood flow is obstructed |
| Sinusitis tx | *Abx *Decongestants *Nasal steroids to reduce swelling *Mucolytics-breaks apart mucus, decreased appetite b/c eating mucus proteins *Hydration-2L/day *Nasal irrigation *No smoking *Allergy control |
| Pharyngitis/Laryngitis | *70% viral etiology *be aware of laryngeal polyps(precancerous), will always remove *Sx: -hoarseness, dyspnea c significant swelling, irritation |
| Pharyngitis tx | *cool fluids *analgesic *warm saline gargles *prevent complications -acute follicular pharyngitis (Strep): **endocarditis, rheumatic fever, glomerulonephritis--causes toxins from infection that can land in other organs if untreated |
| Epiglottitis | *usually bact. *Sx: -severe sore throat, high temp, drooling b/c of obstruction, MUFFLED cry *most often in children c smaller airway *can quickly & completely obstruct airway *do NOT manipulate glottis! can trigger swelling & obstruct airway-will n |
| Lower Respiratory Disorders: Pneumonia, common causative agents | *bacteria *viruses *mycoplasma *fungi *parasites *chemical agents |
| Viral Pneumonia | *50% of all pneumonia, esp. in children *RSV (Respiratory syncitial virus) most common cause in kids, very contagious *Influenza-high mortality in elderly and premies |
| Aspiration Pneumonia | *toxic chemicals *dusts *gases *inhaled foods |
| Fungal pneumonia | In immunosuppressed only *HIV *Malnutrition *extended Abx use |
| Bacterial pneumonia: Pneumococcal | *untreated mortality 20-40% *may show up as vomiting or seizure in infants *may cause meningitis--Brudzinski's sign-severe pain c bending neck *friction rub, have pt hold breath to decipher if pleural or pericardial in origin * stiff neck |
| Bacterial pneumonia: Mycoplasma | *atypical *stomach pain c high temp *10-20% of childhood *no dyspnea |
| Bacterial pneumonia: Staph | *20-40% of adults have staph in nares *usually under age of 1 or: *adults who are drug abusers, diabetic, or hemodialyzed |
| Bacterial pneumonia: Strep | *at risk for chronic disease, DM, cirrhosis *similar risk group as staph |
| Bacterial pneumonia: Klebsiella | *necrosis *abscesses *hemoptysis *untreated mortality-40-60% *may collapse lung |
| Typical sx of pneumonia | *dyspnea *temp (viral lower grade than bact.) *infants-retractions, grunting, flaring-obligate nose breathers (nature's way of keeping from aspirating when feeding) *letharhy *irritability |
| Assessment findings: pneumonia | *Auscultation-bronchial breath sounds over areas of consolidations (I>E, high, loud) *Inspection-unequal chest wall expansion *Palpation-increased tactile fremitus-louder over fluid *Percussion-dull over areas of consolidation |
| Pneumonia Tx | *TCDB *position on side if cognitive impairment-if worried about aspiration *bronchodilators-wheezing, stridor *analgesics-watch for resp. depression (mycoplasma, Klebsiella) *ABGs *Breath sounds *raise HOB *O2 *maintain airway *keep epiglottitis |
| Epistaxis: tx | *lean forward to prevent aspiration *pressure a/g stiff cartilage *ice compress *vasoconstricting agent *cautery *packing *balloon tx-Foley *humidify air c cold H2O *if Hgb below 8 or 9, transfuse *avoid nose blowing, straining, NSAIDS, or ASA-pl |
| Sinusitis | *usually follows URI *predisposed by any drainage impairment-swimming, allergies, dental manipulation, polyps (#1 issue, small growth that obstructs drainage, risk of bleeding 7-10 days) |
| Sinusitis sx | pain, drainage, nasal congestion, malaise, edematous mucosa, HEADACHE, difficult to tx b/c blood flow is onstructed |
| Sinusitis Tx | *Abx *decongestants *nasal steroids to decrease swelling *mucolytics-decreased appetite b/c eating mucus proteins *hydration-2L/day *nasal irrigation *no smokin *allergy control |
| Pharyngitis/Laryngitis | *70% viral etiology *laryngeal polyps, pre-cancerous and will always be removed *sx: hoarseness, dyspnea c swelling, irritation |
| Pharyngitis tx | *cool fluids, analgesics, warm saline gargles, prevention of complications--acute follicular pharyngitis (strep) **endocarditis, rheumatic fever, glomerulonephritis (canuses toxin from infection that can land in other organs if untreated) |
| Epiglottitis | *usually bacterial infection *sx: -severe sore throat, high temp, drooling b/c of obstruction, muffled cry *most often in children, can quickly & completely obstruct airway *"thumb print" sign on x-ray *do NOT manipulate the glottis!-will need trache |
| Pneumonia: common causative agents | *bacteria *viruses *mycoplasma *fungi *parasites *chemical agents |
| Viral pneumonia | *50 % of all pneumonia, esp in kids, usually starts are phar/laryngitis *RSV-Respiratory syncitial virus, very contagious *Influenza-high mortality in elderly and premies |
| Aspiration pneumonia | *toxic chemicals *dusts *gases *inhaled food |
| Fungal pneumonia | in immunosuppression only *HIV, malnutrition, extended Abx use |
| Bacterial: pneumococcal | *untreated mortality 20-40% *may show up as vomit or seizure in infants *Brudzinski's sign-pain in neck *friction rub-have pt hold breath to distinguisg b/c pleural and pericardial |
| Bacterial: mycoplasma | *atypical *stomach pain c high temp *no dyspnea *10-20% of childhood |
| Bacterial: staph | 20-40% of adults have staph in nares *usually under age of 1 or *adults who are drug abusers, diabetic, hemodialyzed |
| Bacterial: strep | *similar risk groups as staph *at risk: chronic disease, DM, cirrhosis |
| Bacterial: Klebsiella | *necrosis *abscesses *hemoptysis *untreated mortality-40-60%, may collapse lung |
| Typical sx of pneumonia | *dyspea *temp *infants-retractions, grunting, flaring-obligate nose breathers, nature's way of keeping from aspirating when feeding *lethargy *irritability |
| Assessment findings: Pneumonia | *auscultation-bronchial sounds over areas of consolidation (I>E, high, loud) *inspection-unequal chest wall expansion *palpation-increased tactile fremitus-louder over fluids *percussion-dull over areas of consolidation |
| Pneumonia tx | *TCDB *position on side if cognitive impairment-if worried about aspiration *bronchodilators-wheezing, stridor *analgesics-watch for resp depression-mycoplasma, klebsiella *ABGs *breath sounds *raise HOB * O2 *maintain airway |
| Lung cancer: predisposing factors | *tobacco use-25X risk, also 2nd hand smoke; *asbestos-inhalation irritant; *pollution (urban 2-3X risk of rural, although agricult. chems. increases risk for migrant workers) *radioactive ore *industrial products-14,000 new chemicals each year manufac |
| Lung cancer: warning signs | *NONE-part of reason why it's so lethal, isn't found until late in the disease *change in resp pattern *COUGH-classic sx; however smokers usually have cough anyways, so may miss this sx *hemoptysis-LATE, often rust colored *chest pain-if ca eats into |
| Lung cancer: dx | *requires biopsy *uses T,N,M staging *not solid tumor, harder to detect c x-ray |
| Lung cancer: management, surgery | *many are too high risk *requires "passing" PFT *pneumonectomy-whole lung *lobectomy-lobe *wedge resection-small tumor in one lobe *segmentectomy-larger part of a lobe *increased risk of bleeding, lung collapse, many chest tubes, possible broken rib |
| Lung cancer: surgery complications | *atelectasis *empyema-resistant organisms, pus in lungs *bleeding b/c highly vasuclarized, sx are inside, watch for dyspena, low pulse *Atrial fibrillation (tx c Digoxin, to slow & strengthen heart beat), can throw clots, sx-irregular pulse, P wave wil |
| Lung cancer: surgery, post-op care | *Always airway 1st!-swelling, response to stimulation, allergies *chest tubes-expect decreasing drainage <200cc/hr, need to stay lower than the pt; if drainage amount or character increases, notify Dr, if tubes pulled out, cover hole c air occlusive ster |
| Lung cancer tx: Radiation | *Most effective as adjunct to surgery or palliation *offered when cancer hasn't spread beyond thorax *used to prevent brain mets *causes thick, tenacious secretions-issues c airway clearance & may need suctioning *watch for other localized sx that are |
| Laryngeal cancer | *Primary sx: hoarseness *Tx: laryngectomy, will have trach. and no voice *Esophageal speech one option, swallow air, use artificial voice box, & plug trach to talk |
| Laryngeal post op cares | *JP drain-drainage should decrease and become clearer over time *potential for decreased blood flow to brain (sacrifice of carotid a.) *Watch for pulsation of trach, lying next to carotid, beward of BLEEDING-High Risk! *Observe for CVA b/c circulation |
| Emphysema risk factors | *Typical age onset: 50-60 *Smoking *Polution *Connective tissue disorders |
| Emphysema Sx | *dyspnea *"Pink Puffer"-reduced airway patency on expriation, plenty of O2, but can't exhale *Decreased breath sounds, b/c thicker chest wall and shallow breathing *Hematocrit <60% *Hyperinflation of lungs-Barrel Chest! *Blebs (small air pockets) & B |
| Chronic Bronchitis: risk factors | *Smoking (20 daily cigs X 20 years) *Age: onset 40-60 years *not CT disease |
| Chronic Bronchitis: sx | *productive cough all the time *recurrent infection *copious (a lot) sputum *expiratory wheeze (airway expands a little on inspiration but not on expiration) *hematocrit >60%-hypoxic, erythropoietin from kidneys make more RBCs, sludgy blood *increase |
| Cyanosis | *5 grams of unsaturated Hgb to become cyanotic *Central cyanosis-tip of nose, circum oral area *peripheral cyanosis-extremities *polycythemic, Hgb could be 20 (normally in men 14-16, women 12-14), if 25% short of O2 = 5 grams Hgb, and would be blue. |
| Right Heart Failure | *Mucus-->decreased O2-->1. RBC (polycythemia)increased heart work load-->cyanosis AND 2. shunting in lungs (vasoconstriction)-->Cor Pulmonale (Rt HR c resp origin) *Rt heart hypertrophy b/c trying to pump sludgy blood |
| COPD | Chronic Obstructive Pulmonary Disease *at end stage of disease, chronic bronchitis and emphysema blur together and COPD exists *also untreated asthma contributes |
| Right Heart Failure sx | *distended neck veins b/c dilation of systemic circulation *bounding pulse *peripheral edema-dependent *enlarged liver b/c blood is backed up |
| COPD tx | *bronchodilators/steroids *CPT *No smoking *LIMIT O2-already high COx levels, body becomes immune to it and switches to O2 levels as respiratory stimulus; if they get all the O2 they need, they'll stop breathing; by staying slightly hypoxic, they keep |
| Assess for complication c COPD | *Cor Pulmonale *Steroid use -DM -Osteoporosis -Weight gain -Fluid retention |
Created by:
rlvander
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