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RESPIRATORY
Med Surg II
| Question | Answer |
|---|---|
| Pulmonary Function Tests | Most accurate test for asthma; evaluates lung mechanisms, gas exchange, acid-base, lung volumes, ABGs |
| pH | 7.35-7.45 |
| CO2 | 35-45 |
| CO3 | 22-27 |
| O2 | 80-100mm Hg |
| <85% | Comprised oxygen to tissues |
| <70% | Life threatening |
| Incentive Spirometer | Sit upright, mouth on device, inhale & keep between 600-900, hold breath 5s, exhale through pursed lips; repeat 10x/day |
| Women | Greater responsiveness to environmental irritants; risk for a more rapid decline in lung function |
| Dark skinned individuals | 3-5% lower saturation |
| Pulmonary Pain | Feels like something is rubbing inside on deep inhalation or at end of inhalation/exhalation; not made worse by touching |
| Bronchoscopy | Conscious sedation; CBC/platelet before, NPO 4-8h prior; benzocaine numb pharynx; lidocaine preferred |
| Benzocaine | Can induce methemoglobinemia (altered iron state so less O carrying capacity) |
| Non-Rebreather Mask | 60-100%; most oxygen. Valves open expiration and close on inspiration |
| Oxygen Delivery | Nasal V Simple Non-Rebreather |
| Droplet Precautions | Mask w/n 3 ft, disinfect equipment, mask with transportation, cohort w/ same organism, door can be open and special air handling not necessary |
| Hypoxia | lack of oxygen to tissues |
| Hypoxemia | decreased arterial oxygen (O2 <50) |
| Hypoxia Causes | Decreased cardiac output, arterial supply, anemia, carbon monoxide poisoning |
| Kidney, Brain, Heart | Organs sensitive to hypoxia |
| Hypoxia symptoms | Early RAT (Restless anxiety tachyHR/R) is Late to BED (BradyHR Extreme restlessness Dyspnea) |
| Pediatric Hypoxia Symptoms | FINES (Feeding difficulty Inspiratory stridor Nasal flare Expiratory grunting Sternal retractions) |
| Chronic Hypoxia | Clubbing, polycythemia (increased Hgb), hypercarbia/capnia (increased CO2) |
| Obstructive Sleep Apnea | Characterized by recurrent episodes of upper airway obstruction and a reduction in ventilation |
| OSA Risk Factors | Obesity, male, postmenopausal, larger neck circumference, increased amounts of fat, structural issues, advanced age |
| OSA S | Hypercapnia, hypoxia, >5/hour, abrupt awakening, 3 S's (snoring, sleepiness, significant other) |
| OSA Complications | personality changes, HTN, dysrhythmias, polycythemia, enuresis |
| Epistaxis Tx | Nasal decongestants (vasoconstriction), caudery, cotton tampon, petroleum jelly/gauze If bleeding unidentified |
| Epistaxis Education | no exercise several days, hot/spicy foods, tobacco, nose blowing, picking, high altitudes |
| Pneumonia | Excess fluid in lungs from inflammation (community or nosocomial) |
| Sepsis | if organisms of pneumonia move into blood stream |
| Empyema | If pneumonia infection extends into pleural cavity; stiffens lung and decreased vital capacity |
| Atelectasis | Early (dyspnea, cough, sputum) Late (TachyHR/R, decreased O sat, pleural pain, central cyanosis) |
| Atelectasis Care | Reposition, encourage deep breathing, coughing, incentive spirometer, monitor for resp. acidosis, and chest physiotherapy |
| Chest Physiotherapy (CPT) | In morning (1h AC 2-3 PC) Stop if in pain, bronchodilators q15min before, percuss 1-2 minute and vibrate |
| Pneumonia S | Increased Na/BUN/Creatinine (r/t dehydration), Crackles, wheezing (narrowed airways), rhonchi (secretions in large airways), fremitis increased, percussion dull, chest expansion diminished, o.hypo, dysrhythmias (r/t hypoxia) |
| Pneumonia Tx | Timely antibiotics w/n 4h ABGs w/n 24h-blood cultures prior to antibiotic; smoking risk factor, flu vaccine (oct-jan) |
| Pleural Effusion | R/t hydrostatic pressure; pleural fluid has large protein amounts and results in fluid shift out of capillaries |
| Asthma | Recurrent attacks of dyspnea, with wheezing due to spasmodic constriction of bronchi; inflammation and hyperresponsiveness leads to bronchoconstriction |
| Asthma Irritants | cold air, dry air, fine airborne particles, microorganisms, ASA, NSAIDS |
| Asthma Risk Factors | Males, family hx, onset before 12 |
| Asthma S | Hypoxemia (tachyHR/R), cough, SOB, mucus, wheeze, CO2 retention decrease early increase late, prolong expiration, retractions, barrel chest (air trapping) O2 decrease |
| Incentive Spirometry | FVC, FEV1 (1st second), PEFR (peak expiratory flow rate) |
| Asthma Bronchodilators | beta agonists, cholinergic antagonists, methylxanthines |
| Status Asthmaticus | Life threatening; intensifies and doesn't respond to common therapy, may develop pneumothorax/cardiac arrest/resp arrest |
| Pack Years | years x #/day |
| COPD | Emphysema & Chronic bronchitis; c/b bronchospasm and dyspnea; not reversible |
| Emphysema | Loss of lung elasticity and hyperinflation of lung; increased R, air trapping and collapse of small airways; alveolar problem; air hunger CO2 retained and O2 drops |
| Chronic Bronchitis | Airway problem; exposure to irritants (especially smoking); produces thick mucus |
| COPD Risk Factors | cigarette smoking, alpha1-antitrypsin (AAT) deficiency, air pollution |
| AAT | Helps regulate proteases; recessive; proteins degrade proteases to destroy/eliminate particulates and organisms inhaled during breathing; when present in large amounts damage small airways by breaking down elastin |
| COPD Drug Therapy | Beta agents, cholinergic antagonists, methylxanthines, steroids, NSAIDS, mucolytics |
| Pleural Effusion | dull percussion and absent/decreased sounds |
| Pneumonia | dull percussion and crackles |
| Bronchiesctasis | Abnormal dilation a/w necrotic infection and occurs usually as complication of recurrent resp infections, cystic fibrosis, etc |
| Bronchiesctasis S | Cough with foul sputum, coughs with change in position, affects ability to hold job, fetid breath, clubbing, weight loss |
| Bronchiectais Tx | Drain cavities (can't heal them), elevated food, 3-4L/day, avoid URI, high calorie/protein, antibiotics |
| Lung Biopsy | sterile dressing after procedure |
| Pneumonectomy | operative side |
| Lobectomy | either side |
| Segmental Resection | unoperative side |
| Pneumonectomy | increased pressure in RV and PA, no chest tube |
| Air | Drained by tube near apex |
| Liquid | Drained by tube near base |
| Call HCP CT | 70-100 mL/h < or bright red drainage, tracheal deviation, dyspnea suddenly, o sat <90%, drainage stops |
| Suction Chamber | 20cm H20, barely bubble |
| Post-OP CT | NSAIDS, Opiods, PVCs, Afib/flutter (regular pattern) |
| Water Seal Chamber | 2cm, one-way valve, moves with breathing (up-inhalation), bubbles indicate leak |
| Tension Pneumothorax | if tubing enters fluid drainage stops and can lead to this |
| CT disconnects from drainage system | reconnect quickly and reinforce with tape (tip in sterile water) |
| CT pulls out of chest | Cover with Vaseline or dry gauze - watch for pneumothorax |
| Pt transfer | Disconnect suction and send drainage system with pt below chest level - don't clamp |
| No tidaling in water seal chamber | Lung has expanded or kinks/clots |
| Drainage stopped collecting | lung has expanded or clots |
| Bubbling in water seal chamber | clamp near insertion site and move down tube until leak found |
| Clamp CT | Changing to new system, looking for leaks, orders |
| Pneumothorax | Open (atm air enters into pleural cavity) closed (air enters pleural space from w/n lung), tension (pulseless electrical activity) |
| Pneumothorax S | Sudden sharp pain, SOB, decreased breath sounds one side, decreased chest movement, subcutaneous emphysema, cyanosis, trachea deviated to unaffected side |
| Isotonic Dehydration | isonatremic; ringers and NS |
| Hypotonic dehydration | hypoNa dehydration; shift from EC to IC; burns, prolonged dehydration, renal dx; D5W, 1/2NS, 0.33 NS |
| Hypertonic dehydration | HyperNA, ICF to ECF; DI, IVF, overload tube feedings; 3% NS, protein solutions, colloids |
| Solvent | liquid that can hold another substance |
| Solute | Substance dissolved in a solution |
| Hourly UO | |
| Na | 135-145 |
| K | 3.5-5 |
| Ca | 8.6-10 |
| Appropriate Rehydration | Pedialyte, rehydralyte, ceral-based, infalyte, home made |
| Inappropriate Rehydration | water, soft drinks, fruit juice, broth, sports drinks |
| Gastroenteritis | <5 years 2 episodes/year; caused by rotavirus, salmonella, diarrhea, gluten sensitivity, lactose, antibiotics, iron; rotavirus most common |
| Rotavirus | Causes watery diarrhea (18-36h after eating), prevent dehydration, spread by contaminated hnds |
| Diarrhea Priority Goal | Correct f&e imbalances - avoid antidiarrheals |
| HyperNa | Children with dev. delay don't perceive thirst, [high sugar], inadequate breast milk, DI; decreased LOC |
| HypoNa | H20 intoxication, swallowing pool water, kidney probs |
| HyperK | Kidney probs, K in IV, blood transfusion, false + heel stick; muscle weakness |
| HypoK | Anorexia, bulemia |
| Pediatric Respiratory | Long floppy epiglottis, larynx&glottis higer (risk for aspiration) fewer muscles |
| Pediatric URI | Common due to immature resp tract; mucous membranes can't produce enough mucous to warm/humidify inhaled air |
| Funnel chest | rickets or marfans |
| Wide nipple space | Turner's syndrome |
| Newbrn resp rate | 30-60 |
| 1-3 year resp rate | 20-40 |
| 6-10 year resp rate | 16-22 |
| apnea | cessation of resp for longer than 20s |
| Oxygen Tent | 30-50% O, loss greater at bottom |
| Oxygen Hood | 40% O, used with smaller infants, must be able to breath on own |
| Cystic Fibrosis | Mutation on chromosome 7; reduced ability to regular Cl channels to transport NaCl; increased viscosity of mucous and abnormal mucociliary action |
| Cystic Fibrosis Digestion Issues | Excrete undigested food; bulky stool (foul,frothy fatty - steatorhea), pancreatitis, diabetes, vitamin def A D E K, anemia, rectal prolapse |
| Earliest Sign CF | Meconium ileus |
| CF Diagnosis | FTT, recurrent infections, mec. ileus, pilocarpine (sweat test) of 60 |
| CF Tx | CPT, flutter device, chest wall oscillation, + expiratory P, ibuprofen qd, higher dose antibiotics, high cal high protein diet |
| Lactulose | Helps with intestinal obstruction a/w CF |
| Asthma S | Tripod position, short speech, restless, orthopnea, prolonged expiration |
| Peak Flow Meter | Stand, deep breath, meter in mouth close lips, hard expiration, highest of 3; tongue not in way don't puff cheeks, redo if cough |
| Acute Asthma Attack | Assess, O, Quick relief meds, IV, radiograph prep, abg blood sample |
| Rescue Medications | Beta agonist, corticosteroids, anticholinergics (bronchospasm) |
| Asthma Controller Medications | Beta agonist, methylxanthines, mast cell inhibitors, corticosteroids, leukotriene modifers, NSAIDS |
| Exercise induced Asthma | Peaks 5-10 mins after exercise, more easy on cold dry day, give Albuterol 10-15 min before exercise to prevent |
| Croup | Worse at night, viral, winter months; mucosa swelling, secretions, and muscle spasms |
| Croup Tx | Nebulized epi (vcxr - decrease swelling), heliox (decrease work of breathing) NPO to prevent aspiration |
| Acute Epiglottitis | Medical emergency r/t H.influenzae, ages 2-8; abrupt onset |
| Acute Epiglottitis S | Drooling, dysphonia, dysphagia, difficulty breathing; restless and frog like croak on inspiration |
| Croup S | Bark cough, stridor, crackles/wheezes, increased R |
| Bacterial Tracheitis | R/t staph or group A strep; common in children immunized against H. influenza, drooling rare; child on back, not improved with nebulized epi, antibiotics |
| Respiratory Syncytial Virus | Most common cause of bronchiolitis; r/t parainfluenza; classic sign of wheezing and secretions; transmission hands and droplets |
| RSV under 2 S | Fever, cough, wheezing, abnormal breathing |
| RSV older children | Common cold, runny nose, sore through, headache, mild fever |
| RSV tx | Riboflavin (antiviral aerosol - no pregnant ppl near and dangerous to HCP) Synagis (IM give winter and spring) elevate 30-40 |
| AOM | Invasion through Eustachian tube, sudden and short duration; ear pain |
| OME (Effusion) | Middle ear inflammation with fluid behind TM and no signs of infection |
| Chronic OM | Inflammation of middle ear longer than 3mo; found via exam on asymptomatic child |
| Pediatric Eustachian Tubes | Shorter, wider, straighter, positioned horizontally |
| Nonverbal expressions OM | Pulling on ear, covering with hair, laying on ear and refusing to move, not responding |
| OM Tx | 1st - Amoxil 2nd - Augmentin |
| OM Prevention | avoid second hand smoke, immunizations, no horizontal feeding, breastfeeding |
| Tonsillitis | Children more prone r/t more lymphoid tissue, frequent URI, infected children; sore throat, dysphagia, fever |
| Tonsillitis Tx | Viral - warm saline gargle, non-ASA analgesics; bacterial - same with antibiotic |
| Post-op tonsillectomy | Don't blow nose or cough, no straws, cool non-carb non-acid beverages, soft food 3 weeks, lots of fluid, limited activity |
| Tonsillectomy Recovery | Membrane forms first few post-op hours, 4-10 days begins to pull apart (risk for hemorrhage), heals 3 weeks |
| Simple Pneumothorax | Trachea midline, decreased expansion and breath sounds, normal or hyperresonant percussion |
| Tension Pneumothorax | Trachea on unaffected side, decreased chest expansion or fixed hyperexpansive, air hunger, agitated, hypotension, tachyHR |
Created by:
TedMed
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