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Flashcards in Cardiac & Resp. - Notes Deck (268):
1

Thoracic cavity

contains the lungs and the mediastinum

2

mediastinum

contains the heart and the major blood vessels

3

true ribs

- 1st seven pairs
- Attached to vertebral and sternum

4

false ribs

- 8-10 ribs
- Attach to rib above
- No sternum attachment

5

floating ribs

- 11-12 ribs
- No anterior attachment

6

Intercostal spaces

spaces b/t ribs

7

1st intercostal space

Count from collar bone and first rib is space 1

8

where do you hood up leads EKG?

intercostal spaces

9

Diaphragm

major muscle of respiration

10

External intercostal muscles

Allow inspiration and lift ribs

11

Internal intercostal muscles

Accessory muscles for exhalation

12

Primary functions of the nasal cavity

warm, filter debris, and (moisture) the incoming air

13

what transports air?

nasal cavity

14

Sinuses

- Air filled cavities with in the bones surrounding the nose
- Provide resonance during speech and decrease the weight of the skull

15

Pharynx

nasopharynx, oropharynx, and laryngopharynx

16

Nasopharynx

contains the adenoids and the openings of the Eustachian tubes which connect the pharynx to the middle ear

17

Oropharynx

contains the tongue and palatine tonsils.

18

tonsils

- filter debris
- important part of immunity

19

Laryngopharynx and larynx

- connect the pharynx to the trachea
- houses the epiglottis and the vocal cord
- Strong cough and spasm reflex to prevent aspiration

20

Upper Respiratory Tract

Nasal cavity, sinuses, mouth, pharynx, and larynx

21

Lower Respiratory Tract

Trachea, bronchi, and bronchioles.

22

Carina

division where bronchi break off into rt and lt

23

bronchi

Main stem

24

Right main stem

shorter and wider, more likely to aspirate onto this side because of the angle, listen for crackles in rt lung

25

left main stem

can aspirate here but more likely to go to the rt side

26

Terminal bronchiole

last of pure conducting

27

Cilia in the Lungs

- Move debris out
- Make you cough
- Bring up sputum

28

Lower airways

- anatomical dead space
- Lined with cilia and mucus - protectant

29

How much air is trapped here?

150 mL of air, never really goes anywhere, keeps lung in place

30

what paralyzes cilia?

Smoking, asthma, inhaled chem. exposure, pneumonia, anesthesia

31

bronchioles

Transition from conducting airways to respiratory zone

32

where does gas exchange begin?

with bronchioles which lead into the alveolar ducts, alveolar sacs and ultimately the alveoli

33

how many alveoli does an adult have?

300 million

34

what do type II cells produce?

surfactant

35

surfactant function

- Keep alveoli open
- Lubricates
- Reduces surface tension
- Prevent alveolar collapse
- Keep lungs inflated
- Limits expansion - prevents over inhalation

36

Lung compliance

lost ability to recoil, decreased surfactant

37

who has a barrel chest?

Emphazema and COPD

38

what is the chief organ of respiration?

lungs

39

which lung is thicker, wider, and shorter?

right

40

which lung has 3 lobes?

right

41

why does left lung have only 2 lobes?

placement of heart

42

3 parts to lungs

Apex, mid-lung (right side only), and base (lower)

43

how many layers are the lungs covered with?

2

44

names of the layers that surround the lungs

visceral pleura & parietal pleura

45

what is the inner layer to the lungs called?

visceral pleura

46

what is the outer layer to the lungs called?

parietal pleura

47

what is between the two layers around the lungs?

Small amount of lubricating fluid

48

what is the space between the two layers named?

pleural space

49

why is their lubricant between the two layers?

glide over each other without friction

50

should you be able to see the pleural space on x-ray?

no

51

when can you see the pleural space?

when their is pleural effusion

52

pleural effusion

the pleural space fills with fluid, blood, pus

53

what causes pleural effusion?

- Gun shot wound, car accident, trauma
- Inflammation and infection

54

why would you insert a chest tube?

drain the fluid, blood or pus that has collected in the pleural space

55

what is an early sign of lung cancer?

Frequent pneumonia/fluid in pleural effusion

56

Functions of the Respiratory System

- Gas exchange
- Synthesis of surfactant and other chemicals
- Metabolism and detoxification of drugs and toxins
- Defense against infection

57

why do you want babies to be born at full term?

- Babies make surfactant closer to term
- May give mom supplemental surfactant so that it goes to baby to develop lungs

58

what respiratory function is important to pharmacology?

Metabolism and detoxification of drugs and toxins

59

how does the respiratory system defend against infection?

- Nose tries to get rid of things
- Cilia work against infections

60

External respiration

- Bringing in atmospheric air
- Most important, cant bring it in then you can't exchange it
- Much of interventions happen here
- Help people breathe better
- Mechanical ventilation

61

mechanical ventilation

Intubate and ventilator

62

Internal respiration

Cellular level

63

Ventilation

movement of gases into and out of the lungs. Ventilation is affected by lung compliance, elastic recoil, and airway resistance

64

what limits ventilation?

disease, infection, and inflammation

65

how is ventilation studied?

utilizing spirometry, peak flow meters, pulmonary function testing

66

Perfusion

refers to the blood flow thru the vessels of a specific organ or body part

67

Diffusion

movement of gases across the capillary membrane from areas of higher concentration to areas of lower concentration

68

Involuntary ventilation

- During sleep, coughing
- Back up system

69

Factors that Influence Oxygenation

Triggers you to breathe
Hematology system
Lifespan and Development
Environment
Lifestyle
Medications
Pathophysiological Conditions

70

Factors that Influence Oxygenation - Triggers you to breathe

- CO2 levels builds up
- Triggers you to take a breath (bring in oxygen)

71

Factors that Influence Oxygenation - Hematology system

- Enough hemoglobin to allow oxygen to bind
- Anemic patients will sometime have respiratory issues

72

Factors that Influence Oxygenation - Lifespan and Development

- RDS (respiratory distress syndrome) - infant or adult
- ARDS - adult
- URI - upper respiratory infection
- Adolescent smoking
- How well you can oxygenate

73

Factors that Influence Oxygenation - Environment

Stress and allergies

74

Factors that Influence Oxygenation - Lifestyle

- Nutrition, exercise, substance abuse, etc.
- Nutrition - adequate diet of iron to make RBC
- Exercise - improves oxygen

75

Factors that Influence Oxygenation - Medications

- Can alter oxygen levels
- Help them breathe or make it worse

76

Factors that Influence Oxygenation - Pathophysiological Conditions

- Alterations in oxygen and carbon dioxide levels
- Alterations in pulmonary system
- Pulmonary circulation
- Neuromuscular abnormalities
- Cardiovascular abnormalities
- Oxygen transport problems
- Metabolic problems

77

Pathophysiological Conditions - Alterations in oxygen and carbon dioxide levels

- Asthma
- Chronic bronchitis
- COPD
- Emphysema

78

asthma

harder time getting appropriate oxygen in

79

Emphysema

no problem with bringing oxygen in but struggle with getting CO2 out

80

Pathophysiological Conditions - Alterations in pulmonary system

structure, airways, and tissue

81

Pathophysiological Conditions - Pulmonary circulation

hypertension

82

Pathophysiological Conditions - Neuromuscular abnormalities

MS, Lou Gehrig's

83

Pathophysiological Conditions - Cardiovascular abnormalities

- heart disease/vessel disease
- Cardiac and respiratory go hand in hand
- If you have cardiac disease you are at risk for respiratory disease and vice versa

84

Pathophysiological Conditions - Metabolic problems

Endocrine disorder

85

how big is the heart?

Generally about the size of a fist and weighs less than one pound

86

how much blood does the heart pump in a lifetime?

80 million gallons

87

function of the circulatory system

1. Provide oxygen, nutrients, and hormones to the cells.
2. Remove CO2 and waste products from the cells.
3. Distribute heat throughout the body to maintain body temperature

88

If temp is too high

vasodilation occurs

89

If temp is too low

vasoconstriction, conserve heat, protect inner core

90

Layers of the Heart

- Endocardium
- Myocardium
- Epicardium

91

Endocardium

- inner lining of the heart
- made of endothelial cells
- line the heart chambers and valves

92

Myocardium

- thickest part of the heart that consists of cardiac muscle
- does the work
- muscle layer

93

Epicardium

consists of a visceral layer and parietal layer

94

Cardiac tamponade

heart stops because it can't pump, cardiac standstill, too much fluid between the two spaces, too much pressure

95

visceral epicardium

attaches to the myocardium and is the outer layer of the heart

96

parietal epicardium

forms the sac called the pericardium that surrounds the heart

97

how many chambers does the heart have?

4

98

what do the chambers do?

fill and empty of blood with each contraction and relaxation

99

Contraction

depolarization (no charge) of the cardiac muscle

100

relaxation

repolarization (get ready to take on new electrical charge) of the cardiac muscle

101

what are the upper chambers of the heart called?

atria

102

what are the lower chambers of the heart called?

ventricles

103

is the myocardium thicker on the left or right?

left

104

why does the left ventricle work the hardest?

needs to contract efficiently enough to get all of the blood into aorta which is a high pressure system

105

where does congestive heart failure occur?

left ventricle

106

where is the worst place to have a heart attack?

Posterior side of heart, don't have a lot of vessels but 2nd worst is lt ventricle

107

how many valves does the heart have?

4

108

name the heart valves

- tricuspid, pulmonic, mitral, and aortic
- tissue paper my assets

109

chordae tendineae

- Valves have fibrous cords
- Attached to the cusps of the mitral and tricuspid valves that attach to the papillary muscles

110

Valve dysfunction

- what does it affect: valve, chordae tendonae, papillary muscles

111

Mitral valve prolapse

- Graded or staged according to how much destruction into chordae tendonae or papillary muscle
- Grade 4 - entire anatomical structure is destroyed

112

how many arteries serve the heart?

2

113

Rt coronary artery

feeds rt side of heart has a little bit that goes back to the posterior side

114

Lt coronary artery

- Circumflex - left coronary artery that goes around to the posterior
- Patient presented in ER - doa, turn them over and have big bruise on their back (blood that is pooling), posterior side of heart blows out, no ability to revive them

115

how much blood is on the posterior side of the heart?

not a lot

116

Rt ventricle just contracted where must blood go next?

Pulmonic valve must open

117

Stroke volume

volume of blood pumped by the ventricles with each contraction

118

Cardiac output

volume of blood pumped by the left ventricle per minute

119

How does cardiac output impact pharmacology principles?

Medicine affects stroke volume and cardiac output

120

what happens to meds if cardiac output is too high?

- med goes out into circulation to quickly, go through liver for first past quickly, come back to liver
- meds do not get the half life that they expect
- benefit of med for shorter amount of time

121

what happens to meds if cardiac output is too low?

- half life too long, do not clear through liver in a timely manner, become toxic from meds

122

early sign of lenoxin toxicity

- Patient will ask if it looks hazy, blurry, smoky, halos
- Meals - play with food
- Next day don't want to eat, smell makes them nauseous
- Call physician

123

CHF

- extra fluid in heart
- lt ventricle is working harder already
- increased cardiac output to a point and then it starts to fall behind

124

where is the electrical impulse sent from?

SA node

125

what is the pacemaker of the heart?

SA node

126

where does the SA node send the impulse?

AV node

127

what happens when the impulse reaches the AV node?

the atria contracts creating a P wave on the EKG

128

where does the impulse go after the AV node?

Bundle of HIS

129

where does the impulse go after the bundle of HIS?

the message splits into the left and right bundle branches until it reaches the Purkinje Fibers

130

what happens when the impulse reaches the purkinje fibers?

the ventricles contract creating the QRS complex on the EKG

131

QRS complex

- ventricles have contracted
- got rid of electrical charge
- depolarized

132

Q

goes down

133

R

is the spike

134

S

is at the base line

135

T wave

ventricular repolarization, ventricles are ready to take another charge

136

Atrial repolarization

overcome by QRS complex so you don't see it, might see a U wave, most people don't have these

137

U wave

- may be normal for some but others might be an electrolyte imbalance most likely Potassium imbalance
- if all of a sudden present with P wave, notify dr

138

Nursing assessment

- Patient history
- Health history
- Last CXR, mantoux, and PFT
- Family history
- Smoking
- Occupation
- Military history

139

Nursing assessment - smoking

- How much, how long
- Packs per day over the number of years

140

Nursing assessment - occupation

- Now and in past
- May have worked in factory prior

141

Nursing assessment - military history

- Where did they serve
- Exposed to? Ex. Agent orange

142

Nursing assessment - Health history

- Respiratory/cardiac illnesses
- TB, asthma

143

Nursing assessment - family history

- TB, asthma

144

Cough, nasal secretions, pain, dyspnea, and fatigue

- Cough like
- Kind of secretions

145

Physical exam

Chest - changes in diameter/structure

146

Auscultation of lung sounds

what is the rate, depth, effort

147

What is the expansion

- use of accessory muscles
- flare nostrils

148

Crackles

- Discontinuous sounds
- High pitched popping sounds
- Low pitched bubbling sounds
- Caused by - fluid in alveoli

149

Wheezes

- High pitched, continuous musical sounds
- Caused by - Narrowing of the airways

150

Rhonchi

- Low pitched continuous gurgling sounds
- Caused by - Secretions in the large airways

151

Pleural rub

- Squeaking or grating sounds of the pleural linings rubbing together
- Caused by - layers are inflamed and have lost their lubrication

152

Stridor

- Piercing, high-pitched sound
- Primarily during inspiration
- Caused by - Experiencing respiratory distress or obstructed airway

153

Cough

protective mechanism for clearing the lower airways

154

Cough - Chronic

- Associate with some type of irritation
- Experience for months or longer

155

Cough - Chronic - Common causes

- Smoking
- Allergies
- Chronic sinus infection
- Living in inner cities - pollution

156

Cough - Paroxysmal

- Spasmodic
- Cough and cough and cough, feel terrible, hard to get it to stop, feel like you will pee your pants

157

Cough - Paroxysmal - Common Causes

- Asthma
- Chronic bronchitis

158

Cough - Dry or nonproductive

- Not able to bring anything up
- Hydrate to loosen up secretions

159

Cough - Productive

- Able to cough and bring up sputum
- Color of sputum, describe sputum

160

Mucoid

white to clear

161

Purulent

- dark yellow green
- might be from smoker and not an infection
- sudden onset, feel pressure across face, chest tight, fever - can assume that their might be an infection

162

Mucopurulent

combination of more mucus than pus

163

Rusty

- traces of blood but not frank bright red
- indication of TB

164

Bloody

hemoptysis - really bloody, frank blood

165

Frothy

- white might be pink/blood tinged
- congestive heart failure or pulmonary edema

166

Nasal secretions/Expectoration of Sputum

- 95% water
- the more you drink the better
- harder to bring up when secretions get below 95% water

167

Pain

- Tissue in lungs doesn't have ability to feel pain
- Likely from the muscles work (Coughing/Work hard at breathing)

168

Pleuritic pain

- Pleural space should only have enough fluid to allow the layers to glide over them
- Gets dry or fluid builds up

169

Pleurisis

point to side, hurts worse when they take in a deep breath

170

Intercostal pain

Cartilage between ribs, comes from coughing a lot

171

Generalized pain

Over all pain from coughing and fever or infection

172

Dyspnea

have two of these descriptors, rapid audible labored breathing, use of accessory muscles, dilated or flared nostrils, tachycardia, anxious, gasping, orthopnea, paroxysmal nocturnal dyspnea, conversational dyspnea, or cyanosis

173

Hypoxemia

low oxygen in blood, reflective in arterial blood gasses

174

Hypoxia

low oxygen in tissue

175

How do you know patient has hypoxia?

changes in color, cyanosis, modeling

176

ABG

arterial blood O2 stats

177

O2 stats

have margin of error of couple of percent

178

Hypnoxia

no oxygen; absence of oxygen

179

Hypercapnia

- too much co2, not ventilating proper
- pneumonia
- COPD live in hypercapnia all of the time, CO2 levels are always higher than they should be

180

Hypocapnia

- not enough co2, breathe too quickly, blow off to much CO2
- anxiety or panic attack
- numbness/tingling around mouth and extremities; look like they maybe having a stroke; get them to slow down breathing usually makes the symptoms subside

181

Respiratory Failure

not specific diagnosis, system as whole is not able to do job adequately, body not getting enough oxygen and not getting rid of co2

182

Respiratory Failure causes

Caused by COPD, asthma, airway obstruction, broken ribs, drug overdose, anesthesia, pneumonia, head trauma, pulmonary embolus

183

Carbon dioxide narcosis

people become comatose; CO2 goes so high that it starts to suppress respiratory center in brain; may turn around by putting them on a ventilator of some sort (bipap, mechanical vent)

184

Is it typical chest pain-patient needs to describe and when does the pain occur?

- Subjective Complaints
- Crushing, elephant standing on chest
- Feels like indigestion
- Atypical symptoms are harder to diagnosis

185

Does the patient have any complaints of dyspnea?

- Subjective Complaints
- Has it changed, if so how?
- Present over the course of time - 6 months ago, 3 months ago, recently
- Gradually onset vs sudden onset
- Different tests for gradual and sudden onset

186

Does the patient voice any concerns about edema?

- Subjective Complaints
- Patient points out obvious signs
- Does it resolve itself during the night or unrelently edema
- Can easily gain 10 pounds before you see edema
- 4+ pitting, 20 to 25 extra pounds of water

187

Do they ever experience any vertigo?

- Subjective Complaints
- Microvalve prolapse
- Connection between heart and vertigo

188

Do they ever have cardiac palpitations?

- Subjective Complaints
- Stress induced is pretty common
- Caused by caffeine

189

Do they ever become diaphoretic?

- Subjective Complaints
- Sweat really bad
- Indication of heart disease
- Come in to wipe themselves off when shoveling snow, heart attack waiting to happen

190

Do they fatigue easily?

- Subjective Complaints
- Develop over time, valve issues
- Develop over a course of time tend to be valve problems

191

Monitor skin

- Objective Complaints
- Paleness, cyanosis

192

Assess the neck veins for distention

- Objective Complaints
- Jugular vein distention

193

What are the vital signs?

- Objective Complaints

194

Examine the abdomen and check for ascites

- Objective Complaints
- Ascites is the build up of fluid in the space between the lining of the abdomen and abdominal organs (the peritoneal cavity)

195

What is their current weight and is this their usual weight?

- Objective Complaints
- Is this typical weight? Down or up
- Not everyone tells the truth

196

Do they have any edema?

- Objective Complaints
- Remember a patient can gain ten pounds before edema can be detected by sight
- 1+ Barely visible
- 2+ Obviously present
- 3+ Able to indent but rebounds
- 4+ Indentation remains

197

Pulmonary Function Studies

- Inhalation, exhalation
- Done by respiratory therapy or nurse
- Dr order to get an overall picture of respiratory condition
- Measure volume & capacity of lungs
- Use to make diagnosis and how effective is treatment

198

ABG’s

- pH, CO2, O2, bicarb level
- Go on O2 at home, need to meet criteria to have insurance cover the cost
- Nurses don’t generally do arterial blood draws

199

Pulse Oximetry

normal is 95-100%

200

Cultures and smears

- Nasal
- Sputum

201

When is the best time to get a sputum sample?

First thing in morning, brush teeth, and then get sample

202

Smears

- cytology
- cancer

203

X-ray

- Chest
- Common starting point for all people who have respiratory and cardiac disease
- What is size and shape of heart and lungs
- What position are they in
- Do the lungs look symmetrical
- Look at pleural spaces
- Pericardial sac
- Helps to decide on other tests they want to do

204

What should you ask a female before doing x-ray?

- ask if they are pregnant
- if pregnant need to shield abdomen and pelvis

205

Fluoroscopy

- Chest xray
- Projected on a screen
- Dr is going to go into a mass in the lung with a needle and try to get biopsy
- Allows them to see where they are at
- Go directly into lesions that they are looking at
- Use fluoroscopy to place some needles or markers

206

Lung Scan

- Ventilation - air flow
- Perfusion - what is blood flow like in lungs
- Pulmonary embolism, pulmonary edema, lung cancer

207

Peak Flow Monitor

- Patients who have asthma
- Measures max expiratory flow rate
- Use everyday and record where they are at
- Dr uses this to treat patients more effectively

208

EKG

starting point, is it normal or abnormal

209

Stress

EKG is marginal, walk on tread mill, hooked up to monitors, increase speed and incline, stay on as long as possible, make sure to cool down on treadmill slowly, have them sit and watch them when they are done, make sure you have a dr there before you start

210

Thallium

- injection of dye, does the same thing to heart that exercise dose, increases heart rate and then brings it down, helpful if they can go on treadmill for a short time, see x-ray of rate
- Positive - heart disease, need some type of treatment

211

Holter or event monitor

leads on chest, 24 to 72 hours, takes the monitor home, diary of what you do, is there something in the day that triggers events, button to press when you feel symptoms, person reading the report can identify when the person felt the symptoms

212

Bronchoscopy

- Surgical procedure so you need consent
- Direct visualization of trachea, branches, lung tissue
- Complete for diagnosis
- Treat and evaluate disease
- Take biopsies
- Remove item from lungs (penny, peanuts, sunflower seeds)

213

Laryngoscopy

- Need consent
- Diagnostic or therapeutic
- Surgical - looks at larynx
- Done in DR office or ER bay
- Quick procedure
- Use local anesthesia
- Look at why patient is hoarse, polyps, lesions
- Tells dr if they should refer to ENT

214

Atropine

- Used prior to bronchoscopy/laryngoscopy
- Medicine that dries up secretions, given before

215

Thoracentesis

- Consent form
- Aspirate fluid, air or pus
- Take out fluid from pleural space
- May need a chest tube
- Possibility of collapsing a lung during procedure
- Watch for hemorrhage, collapse, increased shortness of breath

216

Lung Biopsy

- Brush on lesion, needle, cut
- Trying to know if lesion is cancerous or not

217

Promote Venous Return

- Feet up
- TEDS
- compression
- Leg exercises, movement, ambulation

218

Immunizations

- Prevent upper respiratory infection
- Flu shot - once per year
- Pneumonia vac - once per 10 years or as prescribed by DR

219

Positioning

Elevate head of bed

220

Pneumonia

- side to side, move around and don’t stay on back
- more they reposition gives the fluid and infection less time to settle

221

Aspiration Precautions

- Any patient that you think will aspirate is RN level assessment, do not delegate
- Able to swallow/risk for aspiration - done by RN or speech therapy

222

Mobilizing secretions

- Deep breathing and cough
- Keep well hydrated
- Chest Physiotherapy
- Oxygen Therapy

223

Arterial blood gas measurement

- Measures the amount of CO2, O2, & pH
- CO2 is an acid
- pH falls if CO2 rises
- pO2 reflects O2 level in blood
- SaO2 (or SpO2) reflects % saturation

224

Nursing Interventions

- Cough and deep breath
- Incentive Spirometer
- Diaphragmatic breathing

225

Nursing Assessment

- Arterial blood gas measurement
- Pulmonary function studies
- Peak flow meter

226

Diaphragmatic Breathing

- Use diaphragm rather than accessory muscles.
- Lie down, left hand on ribcage, right hand just above navel, little finger on navel and thumb on sternum.
- Take a deep breath thru the nose and use pursed lip breathing on expiration. If done correctly left hand should not move.
- Use for CPOD, chronic bronchitis, issues post-op
- Enhance ability to bring O2 in and CO2 out
- Conserve energy and breathe better
- Improve CO2 and O2 in blood

227

Pursed-Lip Breathing

- Prolongs expiration and increases pressure in the lower airways preventing collapse of bronchioles.
- Moves CO2 out so more room for fresh O2.
- Inhale thru nose with relaxed abdominal muscles and exhale slowly with pursed lips and abdominal muscles contracted.
- Exhalation needs to be twice as long as inhalation.
- Patient can practice by using a straw to make small bubbles in a glass of water.

228

CPAP

provides pressure to the airways at the end of expiration to prevent airways from collapsing

229

BIPAP

provides end expiration pressure like CPAP plus pressure at the end of inhalation to assist greatest inhalation

230

Manual respiration

- Uses resuscitator bag (ambu); O2 source, tubing; face mask or airway adaptor (if intubated), 2 people if not intubated
- O2 to 15 L, position mask for a tight seal, compress bag until chest rises, allow exhalation, every 5 seconds (adult)
- Watch for gastric distension

231

Chest physiotherapy

- To assist in removal of secretions when large amounts are present
- Postural drainage, percussion, vibration
- Trendelenburg is the best position or modified - Trendelenburg
- Make sure that they haven't just eaten
- Listen to lungs before and after

232

Postural drainage

- Position downward angle, < = 25 degrees
- Remains in position 3-15 minutes • Side to side, then supine, repeat
- Cough in dependent position, deep breath between position changes
- Slowly return to sitting position, address sputum produced, hygiene, evaluate

233

Chest percussion

- Hands cupped, flex elbows and wrists
- Gently, rhythmically, clap over area to be drained
- Alternate hands, hollow sound, no pain
- Each area 3-5 minutes, not breasts or bones
- Cough after percussion
- Handle secretions, hygiene, evaluate

234

Chest vibration

- Follows percussion, postural drainage in each position
- Client to exhale slowly through pursed lips
- Hands flat, moderate pressure, contract and relax your arms and shoulders, 3-4 exhalations over each area, cough before position change
- Handle secretions, hygiene, evaluate

235

How much oxygen do you breathe in?

21%

236

How much oxygen do you breathe out?

15-16%

237

Nasal Cannula

- Delivers 24-44% oxygen at flow rates from 1-6 liters … dependent on rate and depth of respiration
- 24% oxygen at 1 L
- 44% oxygen closer to 6 L

238

Simple mask

- Provides 35-65% FIO2 at 8-12 Liter/min flow rate
- Can run at 5 to 6L

239

Masks with reservoir bag

- Allow for higher FIO2 levels
- Acute situation or near end of life

240

Masks with reservoir bag - Partial rebreathing

- Beginning of expiration mixes in the bag with inspired air, most escapes
- FIO2 40-60%, 6-10 L/min
- Exhales the O2 gets trapped in bag and rebreathe it

241

Masks with reservoir bag - Non-rebreathing

- Valve closes during expiration so is not “rebreathed”, no inhalation of room air
- FIO2 60-100%, 6-15 L/min

242

Venturi mask

- Uses adaptors, more precise FIO2 delivery with minimal CO2 buildup
- FIO2 24-50% depending on liter flow and adapter used
- Most precise
- Intensive care

243

Bubblers

- Connected to concentrator/tank
- Get more humidify air
- Look at when it gets to 5L
- Use distilled water

244

Oxygen hood

- Fits over a baby’s head
- Warms and humidifies the O2
- 28-85 % at 5-12 L
- OB, NICU

245

Why do you have to be careful when using an oxygen hood?

- Can cause child to go blind - oxygen toxicity
- Deteriorates retina

246

Oxygen tent

- Encloses the child, canopy, provides O2, humidity, and cool environment
- FIO2 up to 50%, 10-15L/min.
- Also called “croup tent”
- Acute bronchitis, bronchio spasm

247

What precautions do you need to take with the oxygen tent?

Make sure tent is well supported by crib, suffocation hazard

248

Oropharyngeal

- Use in OR, keep tongue in place, airway open
- Easier to use with ambu bag
- Side of mouth to ear to measure
- Insert upside down and rotate; patient can take out

249

Nasopharyngeal

- Go in nose, lubricate with water soluble
- Variety of sizes
- Oral surgery, car accident

250

Endotracheal

- Use metal blade to guide - laryngoscope
- Hold tongue down
- Secure with strap or tape
- Balloon inflated to keep in place
- May come out of surgery with one
- Contemplating to hooking up to ventilator, short term
- Can use ambubag with this
- Short term use, 7-10 days
- Not usually put in by a nurse

251

Tracheostomy

- May have an inner and outer cannula
- May have a cuff
- Change every 30 to 90 days
- Weaning process if it is going to be taken off, heal from inside out
- Need two people to change trach
- Sometimes when you try to put it back in the person will have a broncho spasm
- Sterile procedure
- Want the tube that goes into the patient to remain sterile

252

How often do you change an inner cannula?

every day

253

When would you deflate the cuff?

- Deflate at particular times of the day
- Can leave balloon deflated
- Vent full time, don't usually deflate balloon

254

Mechanical Ventilation

- Used to overcome the patient’s inability to ventilate or oxygenate adequately
- Can be intermittent or continuous.
- Can be short-term or long-term

255

Mechanical Ventilation - Negative pressure or positive pressure

- Most often see positive pressure
- Exerts full pressure on alveoli

256

Mechanical Ventilation - Assist

- Respiratory efforts trigger vent
- Will come on when there is not enough thoracic pressure

257

Mechanical Ventilation - Control

- Machine does all the work
- No breaths on own
- Head injury

258

Mechanical Ventilation - assist-control

- Back up to make sure that there is control
- Triggered by each breath that is inadequate
- Based on tidal volume

259

how often should you check a mechanical ventilator?

every 2 hours

260

Mechanical Ventilation - high alarm

resistance to machine, something is wrong, something is occluding their airway

261

Mechanical Ventilation - low alarm

pressure has significantly dropped, something has come apart, often happens in suctioning

262

Chest Tubes

- Lungs are surrounded by the pleura which should have negative pressure within the pleural space which creates a vacuum that keeps the lungs expanded.
- Breaking this vacuum causes the lungs or lung to collapse.
- To recreate this a chest tube must be placed.

263

How do you know if a chest tube is operating properly?

seeing normal tidaling

264

How do you know if a chest tube is NOT operating properly?

- rapid bubbles
- start at entry point, check for leaks and kinks all the way

265

Nasopharyngitis (Common cold)

common in children can have 6 to 9 colds per year

266

Pharyngitis

common in the 4-7 year old

267

influenza

common in school-age children

268

Why would you deflate a balloon in an endotracheal patient?

- it damages trach and vocal cords
- do not leave patient while it is deflated