Unit 3 Flashcards
What are the 3 types of alveolar cells?
Type 1-majority-serve as barrier between air and alveolar surface area
Type 2-very little but important-produce type 1 and surfactant (reduces surface tension)
Alveolar macrophages-phagocytic, ingest foreign matter (defense mech)
Diff resp vs ventilation.
Gas exchange
Vs
Movement to breathe (req. air pressure variance, airway resistance, and lung compliance)
Explain air pressure variances.
On inspiration, diaphragm opens thoracic cavity lowering pressure inside thorax below atmospheric press. Air in.
Expiration, relaxation, passive, recoil, decrease thoracic cavity size, exceeds atmospheric pressure, air out.
What is airway resistance and some causes?
Any process changing the radius or size of bronchioles alters rate of airflow. Inc resis more effort is needed to maintain normal vent levels.
Asthma(bronchioles smooth muscle contraction)
Chronic bronchitis (thick mucosa)
Obstruction (tumor, foreign body)
Emphysema (loss of lung elasticity)
What is compliance?
What are factors that determine compliance?
Elasticity and expand ability of the lungs. Which is needed to create pressure gradient as in air pressure variances.
Alveolar surface tension, connective tissue and water content of lungs, and compliance of thoracic cavity.
What are the neurological controls of respiration?
Medulla controls rate/depth. Also has chemoreceptors that respond to changes in PH in CSF, and make changes to compensate.
Pons-pneumotaxic center-controls pattern
Peripheral chemoreceptors-aortic arch/carotid-respond to pao2, paco2, then ph.
Baroreceptors in aorta/carotid- detect changes in BP and compensate with either hyper/hypoventilation.
What is the desired outcome with partial pressures of o2 and co2, ph and note their normal ranges.
O2 pressure in blood equal to o2 pressure in alveoli.
Co2 is the major determinate of PH balance.
PH-7.35-7.45
Paco2-35-45
O2 sat-95-100
Pao2 80-100
What is V/Q ratio? Goal? And the 4 types of v/q states? What alterations can cause imbalances?
Ventilation perfusion ratio. Equal to one another (1:1)
Normal
Low:shunting, perf exceeds vent, blood bypass alveoli w/o exchange. (Lung tissue issue)causes:pneumonia, atelectasis, mucous plug.
High:dead space, good vent, no blood flow to alveoli. Causes:pulm emboli, cardiogenic shock.
Absent: absence of both. Causes:pneumothorax, ARDS
Explain the oxyhemoglobin dissociation curve. What occurs with left and right shifts?
Shows the relationship of partial pressure of o2 and percentage of o2 saturation.
Increases in co2, H, and temp (inc HR, metab) will shift curve to R, decreasing hemoglobin and oxygen affinity.(unloading, using more o2)
Decreases shift to L, inc Hemo/Oxy affinity (couch potato)
What are the general risks for respiratory d/o?
Malnourished Smoking Obesity Occupational hazard Family hx
What are common complaints for those with resp d/o?
Dyspnea Cough Sputum production Chest pain Wheezing/crackles Hemoptysis
What are the general physical assessments to perform on the respiratory d/o pt?
Gen appear:skin cond, color, clubbed fingernails, altered Mental status
Upper resp:nose, sinuses, mouth, pharynx, trachea
Lower resp:thorax (inspection, auscultation, palpation, percussion), positioning
What are the adventitious breath sounds? What is the reasoning behind these?
Crackles:discontinuous, indicates fluid, can be fine or coarse (louder). Pneumonia, pulm edema
Wheezes:continuous, indicates constriction. Bronchitis, emphysema.
Rhonchi-fluid/constriction mix (inc. secretions) coarse
Pleural rub-only during breath
When palpating and per cussing thorax in resp d/o, what are you looking for?
Masses Excursion (expansion)-dec indicates fibrotic dz, rib fx, pelurisy/uniobstruction
Dull-fluid
Fremitus- (vibration during speech is normal) dec-emphysema inc-pneumonia, lung constriction
What are the severe abnormal resp patterns?
Kussmaul-fruity acetone breath, shallow, then deep
Cheyne-stokes-near death breathing pattern. Rate and depth inc then dec w/ apnea reaching 20 secs
Biots-ataxic, CNS d/o, irregular
Define the TV, VC, Ins. Force, Minute vent.
tv-amount of air normally inspired and expired
Vital capacity-amount fully expired
MV-TVxRR. Amount air exchanged per minute
Ins. Force-insp efforts
What are the culture studies done in the respiratory pt?
Sputum: CandS-dx for drug sensativety Cytology-malignant cell AFB-causes TB (check 3 days in row) Throat: Rapid strep(15 min) Pathogen ID Nasal swab/wash
What is the purpose of using the following diagnostic assessment exams? PFT ABG SpO2 CBC
PFT:Evals gas exchange, lung volume, diffusion (chronic resp d/o-see if tx working.)*no smoke, inhaler, eat 6hrs pre-test
ABG-status of oxygenation, acid/base balance (blood gases, ph, co2)
SpO2-o2 binding to hemoglobin
CBC:WBC-infection RBC-O2 transport
What are some useful imaging studies for the resp pt?
CXR:pneumonia, pneumothorax
CT:PE, aortic dissection
Fluoro:aspiration, MOVEMENT:lung, chest wall, heart diaphragm. lung masses, chest needle bx
Angiography:thromboembolic d/o’s (lung vessels and patency)
MRI:abnormal lesion/tumor
What are the 3 useful lung scans and how do these help?
V/Q-PE probability, measures lung blood perfusion
Gallium-inflam d/o’s abscesses, source of infection. Measures gallium uptake over lapsed time w/ mult images.
PET-Malignancy takes up dye, regional blood flow, necrotic tissues
Discuss the following procedures: Bronchoscopy Thoracoscopy Thoracentesis Biopsy
Bronch-inspect upper airway, examine tissue, obtain tissue/secretions. Risks:infection, aspiration, bronchospams, hypoxia, pneumothorax.
Thorac-chronic pleural effusions
Thoracen-needle aspirate blood/air.s/p proc. X-ray, equal breath sounds, bleeding/dressing
Bx-excision of tissue
Describe the diff methods of o2 delivery and their suggested flow rate and percentage setting.
Cannula 1-6L 23-42FiO2 Simple mask 6-8L 40-60Fio2 Partial rebreather 8-11L 50-75FiO2 Non rebreather 12-15L 80-100FiO2 Venturi:4-6L 24-28FiO2 Trach collar, Tpiece, Face Tent:8-10L 30-100FiO2
What is the peak flow meter for?
Used after nebulizer tax. Highest air flow for exp.
Mod. Asthma
How many ml of chest tube drainage should you report to the provider?
What occurs in the water seal chamber?
Suction control chamber?
70mls or greater per hour
Tidaling (inspiration) w/ intermittent bubbling (expiration)
Cont bubbling
What are some nursing care measures for the pt w/ a chest tube?
Mon. Rest rate/rhythm BP Apical Pulse Temp Hypoxia CO2 retention HOB up 30 deg. EKG mon. Turn q2hr, C and DB q 1-2 HR Excessive drainage/ system monitoring Tube connections/clearance
What are the common d/o of the upper airway?
D/O of Nose and Sinuses -Rhinosinusitis -epistaxis D/O of the larynx -laryngitis -laryngeal obstruction -ca of the larynx
What is Rhinosinustis? And the different types?
Symptoms?
Tx?
Complications?
Inflammation of sinuses/nasal cavity.
Acute:starts rapidly, resolves w/tx (hard to differ from cold, usually follows URI or cold) bacterial infection.
Chronic:pt has 12 weeks of 2 or more episodes.
Symps:facial pain/pressure/tenderness, fever, HA, ear pain, fullness in ear/nose. Worse when laying down at night.
Comps:cavernous sinus thrombosis, meningitis, brain abscess, ischemic brain infarction, orbital cellulitis. Avoid travel, swimming, smoking.
Tx:antibiotics (Amox/doxy)
What is an epistaxis? Where does it occur?
Nurse tx?
Nose bleed in anterior septum due to rupture of vessel (there major ones).
Tilt head.pinch outer mid septum 5-10 min. Vasoconstrictor nasal decongestant may be used (phenylephrine), keep emesis near.
More serious: rhino rocket w/ antibiotic for days. Cauterize do w/silver nitrate.
What is laryngitis?
S/S?
Nurse management?
Inflamed larynx s/p voice abuse, inhaled irritants, or w/ URI.
Hoarseness or aphonia, sudden onset made worse by cold air, worse in am, better indoors, dry cough/sore throat. Common in immunosuppresed.
Resting the voice, avoid irritants, expectorants, inc. fluid intake.
Pt to call dr when:difficult to swallow, Hemoptysis, strider.
What can occur in laryngeal edema?
Tx?
Fatal. Laryngeal obstruction, anaphalaxis due to angioedema.
Croupy cough due to aspirated contents falling down the bronchi.diff swallowing.
Patent airway-emergent maneuver (no blind sweep). If from allergy:corticosteroid, epinephrine. Tracheotomy.
Ice pack to neck.pulse ox.
What is the most common laryngeal cancer? Risk factors? S/S? What surgical management is available.
Squamous cell (epithelium).
Carcinogens:smoking, asbestos, fumes, dusts, chemicals, tar, Vit. Def., age, race, gender, immunosuppresed. Need riboflavin in diet.
2 weeks hoarseness/cough/sore throat.lump. Later:dysphasia, dyspnea, nasal obstruction.
Stage 1 and 2:surg/rad
Stage 3 and 4:add chemo
No voice box
What are 12 general types of lower airway conditions?
Atelectasis Resp. Infect:acute bronchitis, pneumonia, TB, lung abscess Pleural condition:pleurisy, pleural effusion, empyema COPD:chronic bronchitis, emphysema Asthma Pulm Embo Pulm Edema Sarcoidosis Anthrax Lung Ca Chest trauma:rib fx, flail chest, pneumo/hemothorax, tension pneumo Aspiration
Describe the patho of atelectasis-non obstruct/obstruc
Non-reduced ventilation (common w/post op-shallow breathing)
Obstructive-blockage. Trapped alveolar air is absorbed into blood stream.lung becomes airless and alveoli collapse:excess secretions/mucous plugs, foreign body, tumor/growth compressing airway, chronic airway obstruction.
What are some causes (etiology) of atelectasis?
Altered breathing Pain Supine positioning (dec v/q) Increased abd pressure (lack of expansion) Reduced lung volumes Retained secretions (blockage) Post op (dec breaths v/q, immobile)
What factors elicit compressive atelectasis?
Pleural effusion Pneumo/Hemo thorax Pericardial effusion Tumor growth Elevated diaphragm
