12 resp system, 13 disorders w/ upper resp system, 14 disorders w/ lower resp system Flashcards by Em Fulton

pt is scheduled to have direct laryngoscopy for removal of polyps, advise the pt
room _
ice_
mild _
hoarseness _

-room will be darkened
-an ice collar may be applied after the procedure to decrease swelling
-mild sore throat
-hoarseness may occur

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Order in which air flows 1-6

external nares
larynx
trachea
right upper lobe bronchus & left main bronchus
bronchiole
alveoli

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Mucous membrane lining the many small branches of the bronchial tree contains these tiny hairlike projections: c_, trap and propel small inhaled foreign particles towards entrance of respiratory tract; this reflex works to expel secretions and particles

cilia; cough

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signals of changing levels of hydrogen ions, CO2, and O2 trigger the r_ c_ to send signals through the s_ c_ and s_ n_ to the peripheral nervous system and to the phrenic and intercostal nerves that control the diaphragm and respiratory muscles

respiratory center
spinal cord
spinal nerves

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Breaths are initiated based on p_

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-about how many mL of air move in and out of lungs with each breath
-primary respiratory muscle

500 mL
diaphragm

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-diaphragm contracts, moving d_
-other chest muscles contract, pulling rib cage u_ and o_, expanding the lungs and creating an area of negative pressure
-air from the atmosphere, has p_ p_, flows into the lungs

downward
up and out
posititve pressure

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-Surfactant secreted by cells in the a_;
-d_ surface tension on alveolar wall, allowing for diffusion to take place
-when surfactant levels are l_, alveoli cannot properly e_, O2 and CO2 cannot cross the membrane adequately

alveoli
decreases
low, expand

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when interstitial edema occurs in the l_ t_, alveolar membrane is thickened and gases cannot diffuses across membrane as easily

lung tissue

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major portion of O2 attaches to the h_ portion of the h_ molecule carried by the e_ and forms o_

heme
hemoglobin
erythrocytes
oxyhemoglobin

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-aging results in decreased c_ reflex, and increased potential for a_
-O_ may cause kyphosis, which impinges on lung e_
-muscle atrophy may affect r_ m_, diminishing their strength

cough
aspiration
osteoporosis
expansion
respiratory muscles

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the extent to which the lungs are able to return to their original position after being stretched or distended: e_

elastance

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broad term referring to diminished availability of oxygen to the body tissues

hypoxia

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ability of the lungs to distend in response to changes in volume and pressure of inhaled air. L_ c_ first increases and then decreases with age as the lungs become stiffer and the chest wall more rigid: l_ c_

lung compliance

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delivery of fluid through the blood vessels to body tissues: p_

perfusion

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methods used to clear secretions from the airways: p_ h_

pulmonary hygiene

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the force working against the passage of air, major determinant is the radius of the airway: r_

resistance

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an abnormality of gas exchange with either an excess of CO2 or a deficit of O2 or both: r_ f_

respiratory failure

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intrapulmonary s_ is the diverting of blood so that it does not take part in the gas exchange at the alveolar sites. When this occurs, blood enters the left side of the heart without being oxygenated, a possible cause of hypoxemia

shunting

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produced by lipoprotein produced by cells lining the alveoli, lowers surface tension within alveoli preventing the collapse of the lung by stabilizing the alveoli and decreasing capillary pressures: s_

surfactant

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clinically measured by CO2, movement of air from external environment to the gas exchange units of the lung and back to the environment: v_

ventilation

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-O_ p_ diseases are characterized by problems moving air into and out of the lungs
-narrowing of the openings in the tracheobronchial tree i_ resistance to the flow of air, making it difficult for O2 to enter and contributing to air trapping, making exhalation difficult; examples of obstructive lung diseases- a_, e_, c_ b_, t_

obstructive pulmonary
increases
asthma
emphysema
chronic bronchitis
tumors

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Pulmonary disease classifications, obstructive or restrictive:
airway diseases-
a_
c_
b_
o_ s_ a_
c_ b_
e_

asthma - o
COPD - o
bronchiectasis - o
obstructive sleep apnea -o
chronic bronchitis - o and r
emphysema - o

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Pulmonary disease classifications, obstructive or restrictive:
Lung tissue disease-
p_ f_
sarcoidosis - r and o
p_
c_ f_
ARDS - o

pulmonary fibrosis - r
pneumonitis - r
cystic fibrosis - r

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Pulmonary disease classifications, obstructive or restrictive: extrapulmonary causes: neurologic disorders (ALS, MD, MD) - r body habitus conditions (scoliosis, obesity, arthritis)-r p_ e_ a_

pulmonary effusion - r ascites - r

Pulmonary disease classifications, obstructive or restrictive: Lung diseases- p_ hypertension p_ e_

pulmonary hypertension - constriction or obstruction of blood flow in the lungs pulmonary embolism - obstruction of blood flow in the lungs

certain groups: o_ a_, c_ i_, immunization against influenza and pneumonia is effective against reducing incidence of r_ d_. h_ w_, n_, should also be immunized

older adults chronically ill respiratory disease healthcare workers nurses

influenza vaccine prepared from c_ e_, screening pt's for allergy to e_ is important

chicken embryos eggs

assessing an older adult: important to obtain smoking and alcohol Hx. Approx _% of throat cancer occurs in people who both smoke and immoderately drink alcohol, _ times more common in men

90% 4 times

-bronchovesicular breath sounds: found over the m_ b_ below the level of the clavicles, besides the sternum; posteriorly between the s_ -sounds: moderate to high p_ with a h_, muffled quality; equal time of inspiration and expiration

mainstem bronchi scapulae pitched hollow

-c_ produced by air passing through moisture in the smaller airways -f_ c_ are high pitched, can be heard in pt's who have atelectasis, fibrosis, pneumonia, or early congestive heart failure -c_ c_ are louder, low in pitch and are heard in pt's with bronchitis, pulmonary edema, and resolving pneumonia -if c_ are heard, have pt take a deep breath, c_, then listen again. If c_ are no longer present, atelectasis has been cleared

crackles fine crackles coarse crackles crackles cough crackles

In pt's with altered breathing patterns, coach the pt to perform this type of breathing p_-l_ and d_. -the h_ f_ position is best for pt's with dyspnea, this position supports and allows the respiratory muscles to function at maximum efficiency

pursed-lip diaphragmatic high fowlers

the measurement and display of CO2 levels: c_

capnography

retention of excessive amounts of CO2, result of hypoventilation, where the usual amount of CO2 is not eliminated by exhalation

hypercapnia (capina= CO2 in blood)

a deficit of CO2, occurs as a result off hyperventilation, can result in respiratory alkalosis. Conditions include: those with increased metabolic rate like thyrotoxicosis, persistent fever, acute anxiety; salicylate overdose, and improper use of mechanical ventilation

hypocapnia

clinical signs of r_ a_: hyperactive neuromuscular reflexes, tetany, carpopedal spasms, vertigo, blurred vision, and diaphoresis

respiratory alkalosis

r_ f_ defined by arterial blood gases: arterial oxygen below 50mm Hg, partial pressure of carbon dioxide equal or greater than 50mm Hg

respiratory failure

alterations in nutrition and hydration: a_ and i_ n_ common in pt's with respiratory disorders (particularly when the disorders are chronic. Pt may have an impaired sense of taste or smell, or sputum can leave a bad taste in the mouth or cause nausea. Pt may fear chewing or swallowing may bring on an attack of coughing or may be so tired that eating or preparing food is too exhausting

anorexia and inadequate nutrition

d_-b_ exercises and c_ t_ should be planned whenever the pt is able to do them w/ or w/out assistance. Should be followed by good mouth care and a short period of uninterrupted rest

deep-breathing coughing techniques

-pt's with a cold are contagious for about _ days after symptoms first appear -colds are spread by d_ infection

3 droplet

b_ i_ is likely to present with a 'cold' persists for more than 7-10 days w/out improvement or if the pt begins to feel worse, has temp of 101 and develops chest pain or coughs up purulent sputum. This is a s_ i_

bacterial infection secondary infection

What helps with epistaxis

sit forward apply direct pressure just under the bone for 10-15 min cold compress

-p_ (inflammation of the pharynx) also called a sore throat, may be caused by a v_, b_, or f_. -acute pharyngitis (s_ t_) caused by beta-hemolytic streptococcal infection -

pharyngitis virus bacteria fungus strep throat

post-op instructions for tonsillectomy

cold or warm liquids, progressing to semisolid foods for the first 24 hrs. Avoid red foods, citrus fruits, hot fluids, and rough foods until throat has completely healed. Do not use a straw, it may cause bleeding

sleep condition where person is making breathing effort, but there is no or extremely limited airflow

Obstructive sleep apnea

Obstructive sleep apnea: what is the most common cause- m_ r_ at the back of the t_, which make the t_ fall back and block the airway

muscle relaxation at the back of the throat, tongue

Obstructive sleep apnea: daytime symptoms include f_, m_ h_, and difficulty c_. nighttime they w_ frequently

fatigue morning headache concentrating wake

Obstructive sleep apnea: physical examination revels o_, enlarged n_ c_, and hypert_

obesity neck circumference hypertension

Obstructive sleep apnea: how to determine if one has condition, s_ s_

sleep study

Obstructive sleep apnea: those with mild apnea may be treated with conservative measures- w_ l_, avoiding a_ 4-6 hrs before bed, and sleep p_ m_

weight loss alcohol position modification

Nasal fracture: -pt is observed for frequent s_ postop, which could indicate posterior n_ b_ -vital signs monitored closely, amount of d_ on dressing observed -pt should rest in s_-f_ position and cool compress used to decrease swelling

swallowing nasal bleeding drainage semi-fowlers

Cancer of the Larynx: -pt's who use excessive amounts of a_ are at highest risk -lack of f_ and v_, gastroesophageal reflux disease, i_, and infection with h_ p_ or h. pylori, have all been linked to increase in cancer of larynx -exposure over long periods of time to environmental pollutants, a_, p_ or w_ or c_ dust has increased risk -most common malignant tumor of the larynx is s_ c_ c_, growing from the mucous membrane lining the respiratory tract. Metastasis may occur in the l_

alcohol fruits and vegetables immunosuppression human papillomavirus asbestos paint fumes wood or coal squamous cell carcinoma lung

Tracheostomy tubes: o_ is used during insertion as a guide to protect against scraping the sides of the trachea with the sharp edge of the tube

obturator

one-way tracheostomy valve box can be fitted into the tube opening, allowing air to be inhaled thorough the tracheostomy opening. Valve closes when pt exhales, diverting the air through the larynx enabling the pt to s_

speak

p_ support of the tracheostomy pt and family is essential. Pt must learn to breathe differently and cannot speak, or call out. Passy-Muir speaking tracheostomy valve may be used by some. Providing verbal r_ shows awareness of apprehension and readiness to help. E_ what is being done and why each time trach care is provided. T_ begins as soon as pt is alert after trach tube is placed. Pt may experience g_ over losing their natural voice and the change in eating

psychological reassurance explain teaching grief

Proper r_ is important in the acceptance of surgery and its consequences. A s_ t_ helps pt with e_ speech. First pt's learn s_ air and then moving it forcibly back up through the esophagus

rehabilitation speech therapist, esophageal swallowing

Acute bronchitis: treating the symptoms includes h_ using either warm or cool moist air. Cough suppressants or broncod_ are used to reduce coughing and soothe the irritated tracheal and bronchial mucosa. Maintain n_ and f_ balances. Rest is recommended to prevent progression from acute to c_. Antibiotics are used if s_ culture identifies s_ b_ o_

humidifier bronchodilators nutrition and fluid chronic sputum, specific bacterial organism

Influenza: a prophylaxis with an antiviral agent (amatadine: Symmetrel, rimantadine: Flumadine, sanamivir: Relenza, oseltamivir: Tamiflu) may be given to a h_ r_ pt who is has been known to have come in contact with type A influenza. Drugs must be started within __ hours of the start of symptoms

high risk 48

Influenza: -children 6 - 59 months -pregnant women -people >50 yrs -people of any age with certain chronic medical conditions (diabetes) -nursing home residents -people who live or care for persons of high risk

who is recommended for flu vaccine

Pneumonia: -S. pneumoniae (pneumococcus) is the most c_ cause of bacterial pneumonia -pathogenic m_ are always present in the upper respiratory tract; pneuonia can occur when resistance is lowered by some other factor such as c_ d_, a_, d_, p_ i_ or extremes in age -pneumonia occurs after an i_ infection in many instances

common microorganisms chronic diseases alcoholism debilitation physical inactivity influenza

Pneumonia: Pneumocystis jirovecii (PCP) infection associated with A_ and is treated with trimethoprim-sulfamethoxazole (Bactrim) give I_ or orally depending on the s_ of the infection

AIDS IV severity

-first signs of decreasing oxygenation: r_ or c_. -pt may want to s_ u_ to allow for better chest excursion -respiratory rate will i_ and later the nares will f_, then r_ of the intercostal muscles if the condition worsens

restlessness or confusion sit up increase flare retraction

Fungal infections: h_ occurs in central and eastern portions of North America. The fungus lives in moist soil such as that in which mushrooms grow, on the floor of chicken houses and bat caves, and in bird droppings. Clinical signs are f_, f_, c_, dyspnea, and w_ l_ over 1 to _ months

histoplasmosis fever fatigue cough weight loss 2

TB: -test is positive when the site of injection is >_ mm in diameter 48 to _ hours after injection for people who have had a history of contact with infectious TB or in immunocompromised pts -i_ of >_mm in diameter is positive in recent immigrants from countries where TB is prevalent, in medically underserved groups, and in the homeless -those are low risk, and induration of >_mm is considered positive -Skin testing is contraindicated for those who have had a s_ reaction -vaccination with bacillus Calmette-Guérin (BCG) is not a c_ but must be considered when i_ results

5 72 induration 10 15 severe contraindication interpreting

TB: -pt's and families should be e_ about the importance of medication compliance and the basic principles of i_ c_: covering mouth when c_ or s_, disposing of t_ in plastic bags, good h_ h_, wearing a m_ in c_ until medication effectively suppresses the infection -s_ examinations are required monthly during treatment -pt needs _ negative cultures to e_ e_ of medications and to be considered no longer infectious, may resume work etc.

educated infection control coughing or sneezing tissues, hand hygiene mask, crowds sputum 3 evaluate effectiveness

Occupational lung disorders: -occupational Hx is part of the r_ a_ -coal dust; dust from hemp, flax, and cotton processing; exposure to silica in the air can cause work-related l_ d_ -a_ exposure may cause mesothelioma, a rare cancer of the chest lining. a_ exposure also causes s_ of the lung tissues -the other exposures cause o_ of small airways or s_ and l_ of e_ and c_

respiratory assessment lung disorders asbestos, asbestos, scarring obstruction, scarring, loss of elasticity and compliance

Nutrition consideration for pts with COPD: -drink _ to _ glasses of noncaffeinated fluids per day to keep m_ thin and easier to cough up (if pt is on f_ r_ they need to check with their hcp) -rest before e_ -a d_ stomach will make it h_ to breathe, pts should avoid o_ and avoid foods that cause gas or bloating because -to decrease stomach fullness and reduce f_, eat _ to _ small meals a day rather than 3 regular meals -eat a well-balanced diet with adequate p_ -avoid l_ d_ an hour after eating -if pt becomes short of breath while eating or right after meals: ~take s_ bites and chew s_ ~choose food that are easy to s_ ~use oxygen while eating -steroid medications put pts at risk for o_, take in sufficient c_ via dairy, vegetables, and supplements -cook when feeling most e_; make e_ portions and freeze them for easy, quick, reheatable dinners

6 to 8, mucous, fluid restrictions eating distended, harder, overeating fatigue, 4 to 6, protein laying down smaller, slowly swallow osteoporosis, calcium energetic, easy

Emphysema: -d_ is an early sign of emphysema -c_ with small amounts of mucoid sputum is present and more common in the m_ -as disease progresses, d_ worsens and eventually interferes with ADLs -the d_ becomes permanently f_ by o_ of the lungs, the muscles of the rib cage become r_, and the ribs f_ o_. pt can have a c_ skin tone -pt develops a "b_ c_"

dyspnea coughing, morning, dyspnea diaphragm, flattened, overdistention, rigid, flare outward, cyanotic barrel chest

Montelukast (Singular): -classified as a c_ a_ -action is providing both b_ and a_ effects

combination agent bronchodilation, anti-inflammatory

Using peak flow meter: -peak flow should be monitored d_ -if reading is _% below pts best, treatment should be a_ -"green zone" means airflow is n_ -"yellow zone" airflow has d_ and routine medications should be i_ -"red zone" rescue medications are needed and hcp should be notified

daily 60%, adjusted normal decreased, increased

Properly peak flow meter: -set point to zero -while s_, take a deep breath -put mouthpiece in mouth and clamp the lips firmly around it for tight seal -blow into meter as h_ and f_ as possible -record the value and reset pointer -rest for a couple breaths -repeat procedure for a total of _ readings -record the h_ reading on the peak flow sheet

standing hard and fast 3 highest

Cor pulmonale: -e_ of the r_ side of the heart as a complication of p_ h_ caused by constriction of the pulmonary vessels in response to hypoxia -to overcome the increased p_ in the lungs, the r_ side of the heart must pump more f_, causing e_

enlargement pulmonary hypertension pressure right forcefully enlargement

Cor pulmonale: -c_ hypoxia stimulates e_, with resulting polycythemia (blood cancer) and increased v_ of blood

constant erythropoiesis viscosity

Cor pulmonale: -eventually, right-sided heart failure causes s_ v_ congestion, which manifests as distended neck veins, r_ u_q_ tenderness from an e_ l_, peripheral edema, weight gain, gastrointestinal distress, and ascites -treatment includes c_ l_ f_ o_, and medications to treat both the heart failure and f_ v_ o_

systemic venous congestion right upper quadrant engorged liver continuous low flow oxygen fluid volume overload

intrathoracic surgery (resection of lung tissue and other pulmonary structures requiring opening the chest wall and entering the pleural cavity) : -positioning for comfort, optimal ventilation, and adequate drainage of the operative site is important during p_-t_ care. -many surgeons do not permit lying on the u_ s_ because this position diminishes the e_ of the good lung -if pt has a tube for draining, lying on o_ s_ will facilitate the flow of drainage -taking care when positioning pt to prevent k_ of the chest tubes

post-thoracotomy unaffected side, expansion operative side kinking

care of pts with chest tubes and closed drainage: -persistent b_ in the water-seal chamber indicates an a_ l_ -fluid in the chamber s_ fluctuate with i_ and e_ -occasional b_ may appear with breathing, sneezing, or coughing -if a p_ is present, b_ will occur with i_, as air is forced out of the area of the p_

bubbling, air leak should, inhalation and exhalation bubbling pneumothorax, bubbles, inspiration, pneumothorax

pulmonary hygiene: -because there is likely some g_ during coughing episodes that take place during p_ d_, it's best to carry out procedure before meals, when stomach is relatively empty and v_ is less likely -after p_ d_ is completed, g_ m_ c_ (including brushing the teeth, and using mouthwash) should be performed

gagging, postural drainage, vomiting postural drainage good mouth care

oxygen therapy: -amount of O2 the pt receives depends on r_ and d_ of breathing -n_ c_ provides low flow rates, should not exceed _L/min flow -higher flow rates cause d_ and c_ of n_ m_ -if a mask system is used, it's important that the flow rate is at a minimum of _L/min; lesser flow rates are not adequate to wash out exhaled CO2 and will cause the pt to rebreathe the exhaled CO2

rate and depth nasal cannula, 5 drying and cracking, nasal mucosa 6

mechanical ventilation, modes of ventilation: -assist-mode ventilation d_ the work of breathing for the pt -pt takes a breath, the machine delivers a set t_ v_ -assist-mode ventilation is combined with the control function to provide an assist-control mode. if pt's respiratory rate f_, the machine will d_ a set number of breaths per min. if the pt i_ a breath, the machine f_ it at the s_ t_ v_

decreases tidal volume falls, deliver, initiates, finish, set tidal volume

mechanical ventilation, noninvasive positive-pressure ventilation: -delivery device uses r_ a_ and not O2 for gas delivery -primary function is to keep p_ p_ in the airway to prevent it from c_ during sleep -delivery of supplemental O2 is n_ the goal of the therapy

room air positive pressure, closing not

throat cultures can test for: p_ t_ m_ w_ c_ s_

pneumonia tonsillitis meningitis whooping cough strep

why would a lung ventilation and perfusion scan(VQ scan) be ordered

to assess lung ventilation and lung perfusion; to locate pulmonary embolism and diagnose tumor, emphysema, bronchiectasis, or fibrosis

why is a bronchoscopy/ laryngoscopy used

to inspect bronchi; and to remove foreign objects or mucous plugs, or to biopsy lesions

why would a thoracentesis be ordered

to remove pleural fluid, instill medication, or obtain fluid for diagnostic studies

-who would use a peak flow meter -normal range, compared against what -what does this assess

asthma or COPD pts 300-700 L/min; compares against pt's baseline peak expiratory flow

characteristics of sputum: pneumococcal pneumonia

scant, sticky, rust colored

characteristics of sputum: frothy, pinkish or blood-tinged

pulmonary edema

characteristics of sputum: blood-tinged, bloody, or blood-streaked

TB, ulcerated pulmonary vessel, or bronchogenic carcinoma

characteristics of sputum: large amounts

pneumonia or bronchitis

characteristics of sputum: scanty

asthma

characteristics of sputum: very thick and viscous

inadequate hydration

adventitious lung sounds: wheeze; whistling, musical, high-pitched sound

occurs when air is forced through a narrowed airway asthma

adventitious lung sounds: rhonchi; coarse, low-pitched rattling

occurs with secretions in larger air passages

adventitious lung sounds: crackles; fine: high-pitched or coarse: louder and low-pitched

occurs when air passes through moisture in smaller airways fine- pneumonia, CHF coarse- bronchitis, pulmonary edema

adventitious lung sounds: pleural friction rub; grating/scratching sound- creaking shoe leather, opening squeaky door

occurs when visceral and parietal pleura rub against each other

adventitious lung sounds: stridor; "croaking sound" heard without a stethoscope

occurs when there is partial obstruction of upper air passages croup in children upper airway obstruction

Nursing goals: (SMART) promote o_ prevent i_ prevent f_ l_ d_ promote r_

(specific, measurable, achievable, realistic, timely) oxygenation infection further lung damage rehabilitation

s/s of resp. acidosis: -first see n_ changes: d_, d_, c_, won't answer questions appropriately (maybe nod off while you're talking and fall asleep) -complain of h_ -respiratory d_, have l_ bp -watch p_ levels, this will i_ levels, see EKG changes of tall T waves, flat P waves or prolonged QRS and PR interval

neuro, decline, drowsy, confused headache distress, low potassium, increase

12 resp system, 13 disorders w/ upper resp system, 14 disorders w/ lower resp system Flashcards

(98 cards)