Lecture 4 Flashcards by Sydney Coopland

Upper respiratory tract
Lower respiratory tract
Chest wall

Structures of the Respiratory System

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________ reduces fluid accumulation and keeps the airways dry by reducing surface tension

Surfactant

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Elastic recoil and compliance

Ventilation

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Oxygen–hemoglobin dissociation curve

Diffusion

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test measures the oxygen and carbon dioxide levels in your blood as well your blood’s pH balance

Arterial blood gases

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Ability to carry oxygen in our body

Oxygen delivery

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Captures blood from the superior and inferior vena cavae and the coronary sinus to reflect a true mixture of all of the venous blood coming back to the right side of the heart

Mixed venous blood gases

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(PaCO2)

Partial Pressure of Carbon Dioxide

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Oxygen saturation is a crucial measure of how well the lungs are working

Oximetry

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Control of respiration

Chemoreceptors
Mechanical receptors

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Filtration of air
Mucociliary clearance system
Cough reflex
Reflex bronchoconstriction
Alveolar macrophages

Respiratory defence mechanisms

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↓ Response to hypoxemia
↓ Response to hypercapnia

Age Related Changes: Respiratory control

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↓ Elastic recoil
↓ Chest wall compliance
↑ Anteroposterior diameter
↓ Functioning alveoli

Age Related Changes: Structure

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↓ Cell-mediated immunity
↓ Specific antibodies
↓ Cilia function
↓ Cough force
↓ Alveolar macrophage function

Age Related Changes: Defense mechanisms

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Blood studies
Oximetry
Sputum studies
Skin tests

Diagnostic studies of Respiratory System

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Radiological studies:
Chest x-ray
Computed tomography (CT)
Magnetic resonance imaging (MRI)
Ventilation–perfusion scan
Pulmonary angiography
Positron emission tomography (PET)

Diagnostic studies of Respiratory System

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Endoscopic examinations
Bronchoscopy
Mediastinoscopy
Lung biopsy
Thoracentesis
Pulmonary function tests
Exercise testing

Diagnostic studies of Respiratory System

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__________ from birth or trauma can result in altered air flow through the nasal passage. Individuals can have troubles breathing through their nose which can result in mouth breathing and problems snoring at night. Individuals who have are prone to epistaxis and sinusitis ( caused form decreased or blocked mucus drainage from the sinus cavities).

Deviated septum

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trauma
can result in complications such as a meningeal tear (causing a csf leak), airway obstruction, epistaxis and deformity.

Nasal Fracture

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Nosebleed
Occurs in all age groups, especially in children (anterior bleeding) and older adults (most commonly posterior bleeding)
Causes: Trauma, foreign bodies, nasal spray abuse, street drug use, anatomical malformation, allergic rhinitis, dry air, tumours, alcohol use
Aspirin, NSAIDs, and conditions prolonging bleeding time or altering platelet counts predispose clients

Epistaxis

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Keep the client quiet
Place in a sitting position, leaning forward - head and shoulders elevated
Apply direct pressure to entire lower portion of the nose (10-15 min)
Apply ice to forehead - have client suck on ice
Apply digital pressure if bleeding continues
Obtain medical assistance if bleeding doesn’t stop

Management of Epistaxis

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Allergic rhinitis
Acute viral rhinitis
Influenza
Sinusitis

Inflammation and Infection of the Nose and Paranasal Sinuses

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Reaction of the nasal mucosa to a specific allergen
Clinical manifestations
Nasal congestion; sneezing; watery, itchy eyes and nose; altered sense of smell; thin, watery nasal discharge
Nasal turbinates appear pale, boggy, and swollen
Chronic exposure to allergens: Headache, congestion, pressure, postnasal drip, nasal polyps
Patient may complain of cough, hoarseness, snoring, or recurrent need to clear the throat.

Allergic rhinitis

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Identify and avoid triggers of allergic reactions.
Drug therapy: Nasal sprays, leukotriene receptor antagonists (LTRAs), antihistamines, and decongestants to manage symptoms
Intranasal corticosteroid and cromolyn sprays (decrease inflammation locally)
Provide instructions on proper use of nasal inhalers (they can cause rebound effect from prolonged use).
Immunotherapy (allergy injections) may be used if drugs are not tolerated or are ineffective.
Involves controlled exposure to small amounts of a known allergen through frequent (at least weekly) injections with the goal to decrease sensitivity

Management of allergic rhinitis

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Common cold or acute coryza Caused by viruses that invade the upper respiratory tract; spread by airborne droplet sprays emitted while breathing, talking, sneezing, or coughing or by direct hand contact Nursing and collaborative management Supportive therapy such as rest, fluids, proper diet, antipyretics, and analgesics

Acute Viral Rhinitis

Clinical manifestations Onset abrupt; systemic symptoms of cough, fever, myalgia, headache, sore throat In uncomplicated cases, symptoms subside within 7 days; older adults may experience persistent weakness or lassitude that persists for weeks Most common complication: Pneumonia Nursing and collaborative management Hand hygiene Influenza vaccination Supportive measures

Influenza

Clinical manifestations Acute: Significant pain, purulent nasal drainage, nasal obstruction, congestion, fever, malaise Chronic: Facial pain, nasal congestion, increased drainage; severe pain and purulent drainage are often absent Symptoms may mimic those seen with allergies. Difficult to diagnose because symptoms may be nonspecific; client is rarely febrile Nursing and collaborative management Environmental control Appropriate drug therapy Client interventions Increase fluid intake Nasal cleaning techniques and irrigation Persistent complaints may require endoscopic surgery.

Sinusitis

Polyps Foreign bodies

Obstruction of the nose and paranasal sinuses

Benign mucous membrane masses Clinical manifestations: Nasal obstruction, nasal discharge (usually clear mucus), speech distortion

Polyps

Inorganic may go undetected. Organic produce local inflammation, nasal discharge, may be foul smelling. Should be removed through route of entry.

Foreign bodies

Acute pharyngitis Peritonsillar Abcess

Conditions related to the pharynx

Airway obstruction Tracheostomy Laryngeal Polyps

Conditions Related to the Trachea and Larynx

May include tonsils, palate, and uvula Can be caused by a viral (most common), bacterial (strep throat), or fungal infection (candidiasis)

Acute Pharyngitis

A complication of acute pharyngitis or acute tonsillitis when bacterial infection invades one or both tonsils Tonsils may enlarge sufficiently to threaten airway patency. Patient experiences a high fever, leukocytosis, and chills.

Peritonsillar Abcess

May be complete or partial Complete obstruction is a medical emergency. Partial obstruction may occur as a result of aspiration of food or a foreign body; laryngeal edema following extubation; laryngeal or tracheal stenosis; CNS depression; or allergic reactions. Symptoms: Stridor; use of accessory muscles; suprasternal and intercostal retractions; wheezing; restlessness; tachycardia; cyanosis

Airway obstruction

Surgical incision into the trachea for the purpose of establishing an airway ________ the stoma (opening) that results

Tracheotomy

Indications To bypass an upper airway obstruction To facilitate removal of secretions To permit long-term mechanical ventilation To permit oral intake and speech in the client requiring long-term mechanical ventilation

Tracheostomy

May develop on the vocal cords from vocal abuse or irritation Most common symptom is hoarseness Surgical removal may be indicated for large polyps. Usually benign, but may become malignant

Laryngeal polyps

Brings oxygen into the body and removes carbon dioxide – __________ (process by which gas is exchanged)

respiration

________ the process of moving air into and out of the lungs. The rate is modified by a number of factors, including emotions, fever, stress, the PH of the blood, and certain medications.

Ventilation

Blood flow through the lungs is called

perfusion

Involves two main processes. Ventilation moves air into and out of the lungs and perfusion allows for gas exchange across the capillaries.

Physiology of respiratory system

are lined with smooth muscle that controls the amount of air entering the lungs.

Bronchioles

Dilation and constriction of the airways are controlled by the ________ nervous system

autonomic

During fight or flight response, ___________ receptors of the sympathetic nervous sytem are stimulated, and the bronchiolar smooth muscle relaxes, and bronchodilations occurs

beta2-adrenergic

________ nervous system also increases the rate and depth of breathing.

Sympathetic

Pulmonary drugs are delivered to the respiratory system by _________ treatments.

aerosol

Can give immediate treatment for ___________ (bronchiolar smooth muscles contracts)

bronchospasms

For loosening viscous mucus in the bronchial tree

Pulmonary Drugs via inhalation

produce a fine mist to be inhaled by mask or a handheld device.

Nebulizers

delivers a fine powder

Dry powder inhaler (DPI)

use of a propellant to deliver a measured dose of drugs to the lungs during a breath.

Metered dose inhalers (MDI)

A chronic disease with inflammatory and bronchospasm components. Typical causes of _______ attacks: allergens, air pollutants, chemicals and foods, respiratory infections, stress

Asthma

________ focuses either on the bronchial constriction and or the inflammation component of asthma.

Pharmacotherapy

1. Achieve acceptable control of the disease. 2. Treatment of asthma should focus on managing inflammation; inhaled glucocorticoids are the first- line - anti inflammatory therapy. 3. Control the environment. 4. A written action plan for guided self-management should be provided for all clients. 5. If acceptable control is not obtained, other drugs can be used in addition to moderate doses of corticosteroids.

5 fundamentals aspects of asthma care accord to the canadian asthma consensus guidelines endorsed in 2003

Beta-adrenergic agonists and anticholinergics Mucolytics Expectorants Glucocorticoids Mast cell stabilizers Antitussives

Drugs used to treat respiratory disorders

Dilate bronchi

Beta-adrenergic agonists and anticholinergics

Loosen mucus

Mucolytics

Produce thinner mucus

Expectorants

Suppress inflammation

Glucocorticoids

Inhibit histamine release

Mast cell stabilizers

Suppress cough

Antitussives

- drugs of choice in the treatment of acute bronchoconstriction - relax bronchial smooth muscles resulting in lower airway resistance - easier breathing for patients. -inhaled produce little systemic toxicity because only small amounts of the drugs are absorbed.

Beta-adrenergic agonists

Used to prevent and treat wheezing, difficulty breathing, chest tightness caused by lung diseases such as asthma, and COPD; Side effects – irritability, nervousness, tachycardia, insomnia and anxiety are common side effects of beta adrenergic agonist bronchodilators that result from sympathetic nervous system stimulation.

Beta-adrenergic agonists

Ultra short acting Immediate effect but lasts only 2-3 hours

Isoproterenol (Isuprel)

Short acting Act quickly but last 5-6 hours

Metaproterenol (Alupent, Orciprenaline)

Short acting Act quickly but last 5-6 hours

Terbutaline (Bricanyl)

Short acting Act quickly but last 5-6 hours Salbutamol (Ventolin) Intermediate acting 8 hours

Pir(Maxair)

Up to 12 hours

Salmeterol

- patient should use an aero chamber and hold their breath for 10 seconds after inhaling the medication and wait for 2 full minutes before the second inhalation. Limit the use of caffeine. Report any difficulty breathing, change in eyesight, heart palpitations, tremor, nervousness, and vomiting. Bronchodilator should be taken before other inhalers.

Educating patient

a rapidly acting bronchodilator and is the first line medication in rescue inhalers that reverses airway narrowing in acute asthma attacks Beta2-adrenergic agonist that causes dilation of the bronchioles. MDI, 1-2 inhalations tid-qid/day (max 8 inhalations/day) Can be given every 30 – 60 minutes until relief is obtained. Nebulizer solution, 2.5mg tid-qid PRN

Salbutamol (Ventolin)

Acts by selectively binding to beta2 - adrenergic receptors in bronchial muscle to cause bronchodilations. When taken 30 to 60 minutes prior to physical activity – helps to prevent exercise induced bronchospasm. Asthma maintenace therapy drug because of long effect Takes 15 to 25 minute to act so not good for acute symptoms. Half life of 3 – 4 hours

Salmeterol (Serevent)

An older alternative to beta agonist for the treatment of asthma The methylxanthines are older established drugs (Aminophylline, theophyline).Side effects include nausea and vomiting, and CNS stimulation and dysrythmias. One anticholinergic (Atrovent) has widespread use.

Methylxanthines and anticholinergics

can dry mucous membranes.

Methylxanthines

should be used cautiously in elderly men with BPH and cllients with glaucoma.

Anticholinergics

can aggravate urine retention.

Anticolinergics

Anticholinergic (muscarinic antagonist), causes bronchodilation by blocking cholinergic receptors in bronchial smooth muscle. Given via inhalation with effects peaking in 1 – 2 hours and continue up to 6 hours. Half life of 2 hours. Less effective then the beta2 agonist –or glucocorticoids for an additive effect. Sometimes used for nasal congenstion and chronic bronchitis.

Atrovent (ipotropium)

Inhaled glucocorticoids used for the long term prevention of long term management. Oral glucocorticoids may be used to the short term management of acute asthma. Inhaled glucocorticoids are first line therapy for asthma – they suppress airway inflammation without major side effects and help to prevent acute asthma attacks. (Evidence-based therapy for asthma)

Glucocorticoids

Beclomethasone Pulmicorte Flovent

Inhaled glucorticoids

Methylprednisolone Prednisone

Oral glucorticoids