Exam 3 Flashcards
(194 cards)
1
Q
How many R and L lobes of the lungs?
A
R - 3 - upper, middle, lower
L - 2 - upper, lower
2
Q
What are the braches of the bronchi starting with lobar branch down?
A
Lobar branch (3-R, 2-L)
Segmental bronchi (10-R, 8-L)
Subsegmental bronchi
Bronchioles
Terminal bronchioles
Respiratory bronchioles
alveolar ducts and sacs
Alveolo
3
Q
What do the segmental bronchi do
A
facilitate effective postural drainage
4
Q
The conducting airways contain about —–of air in the tracheobronchial tree that does not participate in gas exchange….AKA?
A
150ML
Physiologic dead space
5
Q
THe lungs are made up of how many alveoli?
A
300million
6
Q
What are the mechanics of ventilation
A
air pressure variances
resistance to airflow
lung compliance
7
Q
What are air pressure variances?
During inspiration?
During expiration?
A
air flows from a region of higher pressure to a region of lower pressure
-Inspiration - thoracic cavity enlarges & lowers pressure inside below atmospheric level & air is drawn in
-Expiration- lungs recoil/thoracic decreases creating higher pressure to push air out
8
Q
What is airway resistance determined by
A
radius or size of airway through which air is flowing
9
Q
What are factors that determine lung compliance?
A
surface tension fo alveoli, connective tissue adn water content of lungs and thorax
10
Q
Increased compliance occurs if the lungs are
Decreased compliance occurs if the lungs are
A
lost their elastic recoil (emphysema)
Stiff
11
Q
Conditions associated with decreased compliance are
A
severe obesity
pneumothorax
hemothorax
pleural effusion
pulmonary edema
atelectasis
pulmonary fibrosis
Acute respiratory distress syndrome
12
Q
What is pulmonary diffusion
A
the process by which oxygen and carbon dioxide are exchanged from areas of high concentration to areas of low concentration at the air-blood interface
13
Q
WHat is pulmonary perfusion
A
the actual blood flow through the pulmonary vasculature
14
Q
The blood is pumped into the lungs by the _____
A
right ventricle through the pulmonary artery which divides to R and L branches to supply both lungs
*2% of blood pumped does not perfuse teh alveolar capillaries - drains into the L side of heart w/o gas exchange
15
Q
Is pulmonary circulation low-pressure or high pressure
A
low pressure bc the pressure in pulmonary artery is 20-30mmHg and diastolic is 5-15 mmHG
16
Q
What 3 things determine the patterns of perfusion
A
Artery pressure, gravity, alveolar pressure
17
Q
What is TIDAL VOLUME
TV or VT
Normal value
Extra
A
The volume of air inhaled and exhaled with each breath
500ML or 5-10mL/kg
**Tidal volume may not vary even with severe disease
18
Q
What is inspiratory reserve volume
IRV
Normal value
A
The max volume of air that can be inhaled after a normal inhalation
3000mL
19
Q
What is EXPIRATORY RESERVE VOLUME?
ERV
Normal value
Extra info
A
The max volume of air that can be exhaled forcibly after a normal exhalation
1100mL
*Decreased with restrictive conditions, such as obesity, ascites, pregnancy
20
Q
What is RESIDUAL VOLUME
RV
Normal value
Extra info
A
The volume of air remaining in the lungs after max exhalation
1200mL
*Residual volume may be increased with obstructive disease
21
Q
What is VITAL CAPACITY
VC (Formula)?
Normal value
Extra info
A
the max volume of air exhaled from the point of max inspiration VC=TV+IRV+ERV
4600mL
- may be found in neuromuscular disease, generalized fatique, atelectasis, Pulmonary edema, COPD and obseity
22
Q
What is INSPIRATORY CAPACITY
IC (formula)?
Normal value
Extra info
A
The max volume of air inhaled after normal expiration IC = TV+IRV
3500ML
*may indicate restrictive disease/obseity
23
Q
WHat is FUNCTIONAL RESIDUAL CAPACITY?
FRC (formula)?
Normal value
Extra info
A
Volume of air remaining in lungs after normal expiration FRC=ERV+RV
2300mL
*May be increased with COPD and decreased in aRDS and obesity
24
Q
What is TOTAL LUNG CAPACITY
TLC (formula)?
Normal value
Extra info
A
Volume of air in lungs after max inspiration TLC=TV+IRV+ERV+RV
5800mL
*decrease with the restrictive disease, increased with COPD
25
What are the 4 possible ventilation/perfusion states V/Q in lungs?
1. Normal ratio
2. Low ratio (shunt)
3. High ratio (dead space)
4. absence of ventilation & perfusion (silent unit)
26
What is the gaseous mixture of air we breathe?
78% nitrogen
21% oxygen
1% argon
trace amounts of other gases
27
What is the atmospheric pressure at sea level
760 mmHg
28
What is partial pressure?
Pressure exerted by each type of gas in a mixture of gases
29
What would cause a shunt producing disorder?
when perfusion exceeds ventilation
a certain % of blood does NOT get reoxygenated and goes back to body to give O2 but is short
*identified by not improving to normal after giving 100% oxygen
30
What would cause a high perfusion ratio: dead space
when ventilation exceeds perfusion
Alveoli do not have adequate blood supply for gas exchange
31
Why is carbon dioxide higher partial pressure in blood than alveolar gas?
due to carbon dioxide being a by-product of oxidation in the cells (there is more of it in the blood)
32
The partial pressure of alveolar oxygen (PAO2) is
approx 100 mmHG
33
The volume of oxygen physically dissolved in plasma is measured by--
the partial pressure of oxygen in arteries (Pa02)
-the higher amount of Pa02 the greater amount of oxygen dissolved
34
What does oxygen saturation measure
the % of 02 that could be carried if all the hemoglobin held the max possible amount of 02
*When Pa02 is 150mmHg, hemoglobin is 100% saturated
35
What are the partial pressures of 02 and c02 as they travel into the lungs?
Atmosphere - P02 - 160mmHg & Pc02 .25%
Alveoli - P02 -100mmHg & Pc02 - 40mmHg
pulmonary veins - P02 - 40mmHg & Pc02 46%
AFTER EXTERNAL RESPIRATION
pulmonary arteries - P02 40mmHg & Pc02 100mmHG
Tissue cells - P02 40 mmHg & PC02 46%
36
What controls the rate and depth of ventilation to meet the bodys demands?
Medulla oblongata and pons
37
What in the brain promotes deep and prolonged inspirations?
Apneustic center in lower pons
38
What controls the pattern of respirations
(in brain)
Pneumotaxic center in upper pons
39
What do the chemoreceptors located in medulla do to respond to chemical changes in the blood?
Respond to an increase or decrease in pH and convey message to the lungs to change depth and rate of ventilation to correct balance
40
What does the Hering-Breuer reflex do
activated by stretch receptors in alveoli
* when lungs are distended inspiration is inhibited
41
What do proprioceptors do
in muscles and chest/ respond to body movements causing increased ventilation
*ROM exercises
42
What do baroreceptors do?
located in aortic and carotid and respond to increase or decrease in arterial bp and cause reflex hypoventilation or hyperventilation
43
at approx what age to alveoli begin to lose elasticity?
50
44
What are the majors signs of respiratory disease?
Dyspnea
cough
sputum production
chest pain
wheezing
hemoptysis
45
What is dyspnea
subjective feeling of discomfort while breathing
46
What would sudden dyspnea in a healthy person indicate?
pneumothorax, acute respiratory obstruction, allergic reaction, MI
47
In patients who are immobilized what would sudden dyspnea indicate?
may denote pulmonary embolism
48
Dyspena, tachpnea, hypoxemia in a person who recently experienced lung trauma, shock or cardiopulmonary bypass by signal?
ARDS
49
Orthopnea (shortness of breath when laying flat, relived by sitting or standing) can be found in patients with
heart disease
Occasionally COPD
50
Dyspnea with an expiratory wheeze occurs in patients with
COPD
51
Dyspnea with nosiy breathing may indicate
narrowing of airway/obstruction by tumor or foregin body
52
What questions should the nurse ask to determine the cause of dyspnea
1. Is the SOB related to other symptoms? Cough?
2. Was the onset of SOB sudden or gradual?
3. What time does SOB occur? Day or night?
4. Is SOB worse when laying flat?
5. How much exertion triggers SOB? Excercise? at rest?
6. How severe is SOB? Scale of 1-10
53
A client presents to the emergency department with fluid overload. The nurse is concerned about fluid accumulation in the lungs. On which of the following areas would the nurse focus the lung assessment?
Bilateral lower lobes
54
The nurse is caring for a client who is in respiratory distress. The physician orders arterial blood gases (ABGs) to determine various factors related to blood oxygenation. What site can ABGs be obtained from?
a puncture at the radial artery
55
Coughing at night may indicate
onset of left-sided heart failure or bronchial asthma
56
A cough in the morning with sputum may indicate
bronchitis
57
A cough that worsens when the patient is supine suggests
postnasal drip (rhinosinusitis)
58
Coughing after food intake may indicate
aspiration of material into the tracheobronchial tree or reflux
59
A cough of recent onset is usually from
acute infection
60
A dry irritative cough is charateristic of
upper respiratory tract infection or a side effect of ACE inhibitor therapy
61
an irritative high pitched cough can be caused by
laryngotracheitis
62
A brassy cough is the result of
tracheal lesion
63
Pleuritic chest pain that accompanies coughing may indicate
pleural or chest wall involvement
64
A patient who has a dry irritating, non-productive cough, nurse should ask?
are they taking ACE inhibitors
65
A lot of purulent (thick yellow/green/rust) sputum is a common sign of
bacterial infection
66
A thin mucoid sputum usually indicated
Viral bronchitis
67
a gradual increase of sputum overtime may indicate
chronic bronchitis or bronchiectasis
68
Pink tinged mucoid sputum suggests
lung tumor
69
Profuse, frothy, pink sputum often welling up into the throat suggest
pulmonary edema
70
Foul smelling sputum indicates
lung abscess, bronchiectasis or infection caused by fusospirochetal or other anaerobic organisms
71
Chest pain associated with pulmonary conditions may feel like?
Sharp, stabbing and intermittent or dull, aching and persistent
72
Why does lung disease not always cause thoracic pain?
lungs and visceral pleura lack sensory nerves and are insensitive to pain
73
How would a patient describe pleuritic pain?
Sharp and seems to "catch" on inspiration.
like "being stabbed with a knife"
**more comfortable when laying on affected side
74
What does Wheezing sound like
What does it mean when a pt wheezes on expiration?
Inspiration?
A high-pitched musical sound that is continuous
Expiration- asthma
Inspiration - Bronchitis
75
What is hemoptysis?
Common causes?
Blood from the respiratory tract
*onset is usually sudden and may be intermittent or continuous
Pulmonary infection, Carcinoma, Abnormalities of heart or vessels, PE or infarction
76
What does clubbing of the fingers indicate?
What conditions is it seen in?
lung disease, chronic hypoxic conditions, chronic lung infections, malignancies of the lung, congenital heart disease, endocarditis or inflammatory bowel disease
77
What is cyanosis
A bluish coloring of skin
late indicator of hypoxia / not reliable sign of hypoxia
**Appears at 5g/dL of unoxygenated hemoglobin
**Presence or absence is determined by the amount of unoxygenated hemoglobin in blood
78
In chronic rhinitis what may develop?
and are distinguished by what color?
Nasal polyps
Gray
79
What conditions may indicate a displaced trachea?
pneumothorax or pleural effusion
80
What is barrel chest?
1:1 ratio of chest
occurs as result of overinflation of lungs
EMPHYSEMA and COPD
81
What is a funnel chest?
(Pectus excavatum)
depression in lower portion of sternum
may compress heart and vessels resulting in murmurs
*may occur with rickets or Marfan syndomre
82
What is pigeon chest
(pectus carinatum)
result of anterior displacment of sternum and increases diameter
*may occur in rickets, Marfan syndrome or sever kyphoscoliosis
83
What is kyphocoliosis?
elevation of scapula and S shaped spine
Limits lung expansion
*occurs on osteoporosis and other skeletal disorders
84
How to define bradypnea
Assoc with
Slower than 10bpm, normal depth/rhythm
*Intracranial pressure, brain injury, drug OD
85
How to define tachypnea
Assoc with
Greater than 24 bpm, rapid/shallow
*pneumonia, pulmonary edema, metabolic acidosis, septicemia, severe pain, rib fracture
86
How to define hypoventilation
shallow, irregular breathing
87
How to define hyperventilation
AKA in what disorders
Increased rate/depth that results in decreased PaCO2 levels
*called Kussmals respiration if assoc with DKA or untreated kidney failure
88
how to define Cheyne-stokes?
Regular cycle then decrease until apnea (20 sec) occurs
89
How to define Biots respirations
AKA
resulting from
Periods of normal breathing (3-4 breathes) followed by apnea (10-60 sec)
AKA ataxic breathing
resulting from respiratory depression from drug OD or brain injury
90
How to define obstructive respirations
prolonged expiratory phase
Associ with asthma, COPD, bronchitis
91
Do patients with emphysema exhibit tactile fremitus>
Almost no tactile fremitus
92
Percussion over the lungs helps the nurse to determine what
if underlying tissues are filled with air, fluid or solid material
93
What is bronchophony?
describes vocal resonance that is more intense and clear than normal
94
Egophony
Describes voice sounds that are distorted
Patient repeat letter "E" / nurse will hear letter A
95
Whispered pectoriloquy
ability to hear clearly and distinctly whispered sounds that should not be heard
96
Formula for minute volume?
tidal volume X respiratory rate = Minute volume
97
What do Venous blood gas studies reflect?
balance between the amount of oxygen used by tissues and amount of oxygen returning to right side of heart
98
What are normal Sp02 levels?
95% or higher
Values lower than 90% indicate tissues are not receiving enough oxygen
99
What is therapeutic bronchoscopy used for
1. remove foreign bodies or secretions from tracheobronchial tree
2. control bleeding
3. treat postop atelectasis
4. destroy and excise lesions
5. Provide brachytherapy
6. insert stents and relive airway obstruction
100
What is thoracoscopy?
a diagnostic procedure in which the pleural cavity is examined with an endoscope and fluid and tissues can be obtained
101
how is sleep apnea characterized?
freq loud snoring with breathing cessation for 10 sec or longer, for at least 5 episodes per hour, followed by awakening abruptly with a loud snort as blood oxygen levels drop
102
What is the surgical management for sleep apnea?
Simple tonsillectomy
Uvulopalatopharyngoplast
Nasal sectoplasty
Macillomandibular
Tracheostomy
103
What are the meds for sleep apnea
Modafinil
Armodafinil
Protroptyline
AMedroxygrogestrone acetate
Acetazolamide
104
What is Atelectasis?
Closure or collapse of alveoli
* most commonly encountered abnormalities seen on chest Xray
105
Atelectasis commonly occurs in pt who?
in postop setting following thoracic/upper abdominal procedures
-immobilized & have shallow monotonous breathing
-Excess secretions/mucus plugs
-Pt with chronic airway obstruction
106
Nonobstructive atelectasis occurs as a result of
Obstructive atelectasis occurs
Nonobstructive - reduced ventilation
Obstructive - blockage that impedes passage of air
107
Causes of atelectasis include
foreign body
tumor or growth
altered breathing patterns
retained secretions
pain
alteration in small airway function
prolonged supine position
increased abdominal pressure
surgical procedures
108
Atelectasis resulting from bronchial obstruction by secretions may also occur in patients with impaired?
cough mechanisms, debilitated and confined to a bed, excessive pressure on lung tissue from fluid air or blood
109
What is pleural effusion
fluid accumulating within pleural space
110
What is pneumothorax
air in pleural space
111
What is hemothorax
Blood in pleural space
112
Where is the pleural space
area between parietal and visceral pleurae
113
What is pericardial effusion
pericardium distended with fluid
114
What are signs of atelectasis
increasing dyspnea
cough
sputum production
tachycardia, tachypnea, pleural pain, central cyanosis, difficulty breathing in a supine position
115
What symptoms will diagnosis atelectasis
Increased work with breathing
Hypoxemia
Decreased breath sounds and crackles heard of affected area
Xray may reveal patchy infiltrates or consolidated areas
Sp02 lower than 90%
116
What are things a nurse would do to prevent atlectasis?
Freq turning
early mobilization & strategies to expand lungs
Voluntary deep breathing every 2 hours
incentive spirometry
117
What is incentive spirometery
a method of deep breahting that provides visual feedback to encourgae pt to inhale slowly and deeply to maximize lung inflation
118
What are the 2 types of incentive spirometers
Volume - the tidal volume is set using manufacture instructions. Pt deep breath, pause, exhales
Flow - volume is not preset. balls pushed by force of breath
119
What is used in patients who 1st line measures for atelectasis don't work?
PEEP mask, continuous postive airway breahting, or bronchoscopy
120
What is thoracentesis?
Removal of the fluid by needle aspiration
121
What is actue tracheobronchitis?
an acute inflammation of the mucous membranes of trachea and bronchial tree, often follows infection of upper respiratory tract
122
What are the clinical manifestations of acute tracheobronchitis
dry irritating cough and small amount of mucoid sputum
Sternal soreness
fever, chills, night sweats, headache
SOB, noisy inspiration/expiration
Purulent sputum
*servere cases - blood streaked sputum
123
How do we treat acute traceobronchitis
ANtibiotics
Fluid intake increased
Suctioning
increase vapor pressure in air
mild analgesics
124
What is pneumonia
an inflammation of lung parenchyma caused by various organisms, including bacteria, mycobacteria, fungi and viruses.
125
What are the 4 classifications of pneumonia?
CAP - community-acquired pneumonia
HCAP - health-care associated
HAP - hospital-acquired
VAP = Ventilator-associated
126
CAP is defined as
Occurs either in a community setting or within 1st 48 hours after hospitalization or institutionalization
127
How is mycoplasma pneumonia spread
infected respiratory droplets through person to person contact
128
What is HCAP
Health-care associated pneumonia
causative patho is often MDROs
129
What is HAP
develops 48 hours or more after hospitalization and does not appear to be incubating at the time of admission
130
What are the contact precautions in patients with MRSA
Isolated in private room
Contact precautions (gown, gloves, antibacterial soap)
# of people in contact minimized
131
What is the usual presentation of HAP
a new pulmonary infiltrate on Xray
combined with fever, respiratory infection, purulent sputum, or leukocytosis
132
What is VAP
Ventilator-assoc pneumonia
w/in 96hr usually antibotic sensitive bacteria
after 96hrs MDROs
133
What is aspiration pneumonia
refers to pulmonart consequences resulting from entry of endogenous or exogenous substances into lower airway
*common form is bacterial infection from aspiration of bacteria that normally reside in upper airways
134
How does pneumonia happen?
arises from normal flora present in pt whose resistance has been altered or from aspiration of flora present in oropharynx
*Pneumonia affects both ventilation and diffusion
135
What are risk factors for pneumonia
Conditions which produce mucus/interfere with normal lung drainage
Immunosuppressed
Smoking
Prolonged immobility
Depressed cough reflex
NPO status/placement of tubes
Antibiotic therapy
Alcohol
General anesthetic, sedative, or opioid preparations
Advanced ages
136
What are the signs of streptococcal pneumonia
sudden onset of chills, rapidly rising fever, pleuritic chest pain aggravated by deep breathing and coughing
Tachypnea, sob, use of accessory muscles
137
What are the two pneumonia vaccines?
| PCV13 & PPSV23
PCV13 - 65 year and older & 19 years with conditions that weaken the immune system
PPSV23 - 65 year and older & 19 who smoke, chronic heart, lungs or liver diesease. Alcoholism
138
WHat is SARS-CoV-2
community acquired coronavirus occurs in respiratory tract
Transmitted person to person contact via respiratory droplets
139
What are severe complications of pneumonia?
hypotension, septic shock, respiratory failure
140
# ](http://)
What is a parapneumonic effusion
any plueral effusion assoc with bacterial pneumonia, lung abscess, or bronchiectasis
141
What are the 3 stages of parapneumonic pleural effusions?
uncomplicated
complicated
thoracic empyema
142
what is an empyema
occurs when think, purulent fluid accumulates within the plueral space often with fibrin development in a walled off area where infection is located
143
When nonfunctioning nasogastric tube allows teh gastric contents to accumulate in the stomach, what conditon may result?
silent aspiration
144
What is TB
an infectious disease that primarly affects the lung parenchyma
*may also be transmitted to meninges, kidneys, bones & lymph nodes
Airbone transmission
145
What are the clinical manifestation of tB
low-grade fever
cough
night sweats
fatique
weightloss
146
What is pulmonary edema
| noncardiogenic
abnormal accumulation of fluid in lung tissue, the alveolar space, or both
*severe life threatening condition
**noncardiogenic occurs due to damage of pulmonary capillary lining
147
What is pulmonary Hypertension?
elvated pulmonary arterial pressure greater than 25mmHg at rest and greater than 30mmHg with exercise and secondary right heart ventricular failure
148
What are the clinical manifestations of Pulmonary hypertension
dyspnea
substernal chest pain
weakness, fatigue, syncope, hemoptysis, signs of right sided heart failure, anorexia and ab pain
149
What is t he medical management of PH?
Diuretics, oxygen, anticoagulation, digoxin, exercise
150
Cor pulmonale
a condition that results from pulmonary hypertension which causes the right side of the heart to enlarge bc of increased work required to pump blood against resistance
*this causes R sided heart failure
151
WHat is pulmonary embolism?
Obstruction of pulmonary artery or one of its branches by a thrombus that originates somewhere in the venous system or the right side of the heart
*DVT is a related condition, refers to thrombus formation in deep veins
*VTE is a term that includes both DVT and PE
152
What is parenchyma?
Includes any form of lung tissue, including bronchioles, blood vessles, interstitium and alveoli
153
What is COPD
Preventable, treatable slowly progressive respiratory disease of airflow obstruction invovling airways, pulmonary parenchyma or both
154
What is the pathophysiology of COPD
1. Lungs abnormal inflam response to noxious particles or gases
2. In the proximal airways (treachea & bronchi <2mm) increases globlet cells & enlarged submucosal glands = hypersecretion of mucous
3. In perihperal airways (>2mm) inflam causes thickening of airway wall overtime this causes scar formation and narrowing of airway lumen
4. Alveolar wall destruction leads to decrease in elastic recoil
5. Lastly, thickingen of lining of vessel and hypertrophy of smooth muscle
155
Define Chronic Bronchitis
disease of airways
presence of cough and sputum production for at least 3 months in each of 2 consecutive years
*more susceptible to respiratory infection due to increased mucus which reduces ciliary function
156
Define emphysema
Impaired oxygen and CO exchange from the destruction of the walls of overdistended avlveoli.
*increase in dead space
**Alveoli surface area in direct contact with capillary is decreased
## Footnote
Can lead to hypoxemia, hypercapnia, respiratory acidosis
157
What is Cor pulmonale
complication of emphysema
-right sided heart failure brought on by long term high blood pressure in pulmonary arteries
*edema, distended neck veins, pain in region of liver
158
What is panlobular emphysema?
destruction of respiratory bronchiole, alveolar duct, and alveolus.
*all air spaces are essentially enlarged but there is little inflammatory disease
**hyperinflated chest, dyspnea on exertion, weight loss typically occur / expiration becomes an active process requiring muscular effort
159
What is centrilobular emphysema
takes place in center of secondary lobule, preserving peripheral portions.
*leads to central cyanosis and respiratory failure, also develops peripheral edema
160
What is Alpha1-antitrypsin deficiency
enzyme inhibitor that protects lung parenchyma from injury
*May lead to lung and liver disease
161
What are the clinical manifestations of COPD
Chronic cough, sputum production, dyspnea
*Symptoms worsen over time
**weight loss, barrel chest, musculoskeletal wasting, metabolic disturbances, depression
162
Spirometry is used to evaluate airflow obstruction, which is determined by
ratio of FEV to forced vital capacity
*results are expressed in absolute volume and as a % of the predicted value
163
What diagnostic tests are performed for COPD
Spirometry
arterial blood gas
Chest Xray
High resolution CT scan
Screening for alpha1-antitrypsin deficiency
164
What are the 4 grades for COPD?
I - Mild - FEV > 80%
II - Moderate - FEV 50-79%
III - Severe - FEV 30-49%
IV - Very Severe - FEV - <30%
165
# [](http://)
What are the complications of COPD
Respiratory insufficiency & Failure
pneumonia
chronic atelectasis
pneumothorax
pulmonary arterial HTN
166
Oxygen transport to tissues depends on what factors?
cardiac output
arterial oxygen content
concentration of hemoglobin
metabolic requirments
167
Hypoxemia
decrease in arterial oxygen tension in the blood
*results in changes in mental status, dyspnea, increase in BP, changes in HR, arrhythmias, central cyanosis, diaphoresis and cool extremities.
168
Difference between low flow systems and high flow systems
Low flow - Patient breathes some room air. Do not provide constant or precise concentration of inspired oxygen
High flow - provide the total inspired air. specific % is delivered
169
# ```
NASAL CANNULA
Flow rate
02%
Advantages
Disadvantages
Low flow
1-6L/min
24-44%
Pro- lightweight, move
Con - drying, easily removed
170
SIMPLE MASK
Flow rate
02%
Advantages
Disadvantages
LOW FLOW
5-8L/min
40-60%
Pro-simple to use
Con - poor fit, must remove to eat
171
Partial rebreathing
Flow rate
02%
Advantages
Disadvantages
LOW FLOW
8-11L/min
50-75%
Pro- moderate 02 concentration
Con - poor fit, remove to eat
172
NONREBREATHER
Flow rate
02%
Advantages
Disadvantages
LOW FLOW
10-15L/MIN
80-95%
Pro- High 02 concentratin
Con - poor fit, remove to eat
173
VENTURI MASK
Flow rate
02%
Advantages
Disadvantages
HIGH FLOW
4-8L/min
24-40%
Pro- low levels of sup 02 precise, humidity
Con - Must remove to eat
174
TRANSTRACHEAL OXYGEN CATHETER
Flow rate
02%
Advantages
Disadvantages
HIGH FLOW
1/4-4L/min
60-100%
Pro - comfortable, concealed by clothing
Con- freq cleaning, surgical intervention, complications
175
AEROSOL MASK
Flow rate
02%
Advantages
Disadvantages
HIGH FLOW
8-10L/.MIN
28-100%
Pro - humidity, accurate
Con - Uncomfortable
176
Desaturate
precipitous drop in hemoglobin molecule saturation with oxygen
177
What are treatments for
Grade I COPD-
Grade II or III
Grade III or IV
Grade I - Short acting bronchodialtor
Grade II or III - Short acting bronchodilator & reg treatment with 1 or more long actiong bronchodialtor
Grade III or IV - reg treatment with long action bronchodialtor and inhaled corticosteroids
178
What are pMDI's
| Pressured metered-dose inhalers
Pressurized devices that contain aerosolized powder of medications
*a precise amount of medication is released
## Footnote
deep inhalation followed by 10s hold
179
What are DPI's
| Dry-powdered inhalers
rely soley on patients inspiration for medication delivery
*user press lever
## Footnote
Rapid deep inhalation
180
WHat is SVN?
| Small volume nebulizer
handheld device - requires a power source
181
What are the classes of bronchodialtors used to treat COPD
Beta-2-adrenergic Agonist - **Terol**
Anticholinergic agents - **IUM**
Combo - Salbutamol/ipratropium
Inhaled corticosterioids -
Combo corticosteroids/beta 2
182
What are some surgical options for COPD?
**Bullectomy** - removal of bullous that do not contribute to ventilation but occupy space
**Lung volume reduction** - removal of portion of diseased lung
**Lung transplant**
183
What is chest physiotherapy?
postural drainage
chest percussion & vibration
breathing retraining
184
Bronchiesctasis
Chronic irreversible dilation of bronchi and bronchioles that results in destruction of muscles and elastic connective tissue
185
What contributes to bronchiecstasis?
Recurrent respiratory infections, CF, rheumatic and other systemic diseases, primary ciliary dysfunction, TB, immune deficiency disorders
186
What are the clinical manifestations of bronchiestasis
Chronic cough
production of purulent sputum
Hemoptysis
Clubbing fingers
episodes of pulmonary infection
187
What are the treatements for bronchiectasis>
Chest physiotherapy
bronchoscopy
Antibiotics
Secretion management
Nebulzized mucolytics & bronchodilators
188
What is asthma
heterogeneous disease characterized by chronic airway inflammation
*causes hyperresponsiveness, mucosal edema, mucus production
189
Patho of asthma
Cells (lymphocytes, neutrophils, eosinophils, mast cells, macrophages) play role in inflammation.
Cells release inflam mediators causing increased blood flow, vasoconstriction, WBC, mucus, and bronchoconstriction.
**IgE-dependent** release of mediators from mast cells
190
# W
Clincial manifestations of asthma
Cough, dyspnea, wheezing
191
Quick relief meds for Asthma
Inhaled short acting Beta 2 adrenergic agonist - **TEROL**
Anticholinergics - **ipratropium**
Corticosteriods - **prednisone**
192
Long term meds for Astham
Inhaled corticosteriods - **"nide", fluticasone, "sone"**
Systemic corticosteroids - **prednisone**
Long acting beta 2 adrenergic agonists - **"terol"**
Phosphodiesterase inhibitors - **theophylline**
Combo -
Leukotriene modifiers - "**lukast**"
5-Lipoxygenase inhibitor - **Zileuton**
Immunomodulators - **omalizumab**
IL-5R - "**zumab**"
IL-4ra - **dupilumab**
193
Status asthmaticus
rapid onset, severe, and persistent asthma that does not respond to conventional therapy
194
Status asthmaticus
rapid onset, severe, and persistent asthma that does not respond to conventional therapy
