Respi Flashcards by Kris Angela Pascual

What are the early signs of hypoxia in bronchial asthma and what are the late signs as well

Altered level of consciousness

cyanotic clubbing of fingers

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What will be the position if a patient with asthma has wheezing

Orthopneic position

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What will be the sign that a patient with asthma is worsening

diminished breath sounds

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ASTHMA Air trapping
prolonged inhalation or exhalation?

Exhalation

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First sign of hypoxia what will be the ABG

respiratory alkalosis

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What will be the ABG if w status asthmaticus or in ET intubation

Respiratory acidosis

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Peak expiratory flow rate
green means
yellow means
red means

Green means go under control,

yellow means mellow rescue drug every four hours for one to two days.

Red means alert.

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Is there a need to avoid strenuous exercise or activity in asthma?

No need you just have to take the meds before the exercise.

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drugs to avoid in asthma

NSAIDs beta blockers

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Example of NSAIDs

naproxen, aspirin, ibuprofen, indomethacin ketorolac

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Pharmacology for asthma

bam and slam
Beta2 agonist (terol),
anti-cholinergics (tropium), methylxantines (phylline),

steroids,
leukotriene inhibitors (lukast),
mast cell stabilizers (cromolyn)

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Cholinergic

constriction or dilation
parasympathetic or sympathetic nerve system

Constriction parasympathetic

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2 orders of medicine bronchodilator and anti-inflammatory how will you give it?

Wait for five minutes interval give the bronchodilator first but if same med you just have to wait for 1 to 2 minutes

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Medicine for brutal asthma attacks

albuterol

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Anticholinergics makes your body?

Dry

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Theophylline symptom of toxicity and therapeutic range

Very fast heart rate , 10 to 20

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Three S side effects of steroids

Sores or oral thrush, sepsis and sickness, sugar increased

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Metered dose inhaler instruction

hold your breath for 10 seconds after inhaling. You can use spacer to increase the delivery of meds.

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Metered dose inhaler instruction

hold your breath for 10 seconds after inhaling. You can use spacer to increase the delivery of meds.

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Two memory trick of COPD

chronic air trapping
carbon dioxide HIGH

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Signs and symptoms of emphysema

PINKO

Pink skin, pursed lip reading

Inc prolonged expiratory/barrel chest/ accessory muscles

no chronic cough

keep tripoding

overdistended alveoli

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Bronchitis signs and symptoms

BLUE

Blue skim/Cyanosis

long-term cough and sputum

unusual lung sounds (crackles and wheezes)

edema/ ascites

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How many months or years bronchitis will be considered as chronic

last three months in each two consecutive years

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COPD can be caused by genetics what deficiency

alpha one antitrypsin deficiency

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BLOOD COUNT IN emphysema

POLYCYTHEMIA kaya pink

WHAT IS THE ABG IN COPD

RESPIRATORY ACIDOSIS

NUMBER ONE COMPLICATION OF COPD?

RESPIRATORY -BIPAP

Second complication of COPD?

Cor pulmonale

Explain hypoxic drive

Decreased oxygen brain will detect positive breathing, if increase oxygen no breathing, then apnea

Type of mask for COPD

Venturi mask

Position for COPD

orthopneic position

drugs should be restricted in COPD

opioids and benzos

Diet of COPD,

soft diet high calories, high protein, low carbohydrates, low fiber

Vaccine prevention in COPD?

Flu vaccine every year and pneumococcal vaccine every five years

Mobilize secretions you may give?

Guaifenesin or cool mist humidifier

How to do a pursed lipreading?

Inhale 2 seconds in nose and exhale 4 seconds with pursed lips

COPD HUFF coughing technique

hold his breath and forcefully exhale.

type of COPD when there is damaged Goblet cells or increased mucus production?

Chronic bronchitis.

type of cough chronic bronchitis have?

Productive cough

type of COPD that have pulmonary hypertension and bloatedness or ascites?

Chronic bronchitis.

How many 02 percent Venturi mask give? How about nasal cannula?

Lowest possible 33% lowest possible 45%

pulmonary toileting

Deep breathing exercises, coughing, pursed lip breathing .

How many times will you perform chest physiotherapy COPD?

3 to 4 times a day

Antitussives is given for what type of COPD? How about expectorants?

Emphysema chronic bronchitis

best activity for Olds?

Gardening

other complication of COPD?

heart failure and sepsis

Type of COPD when there is a alveoli problem or over distended alveoli?

Emphysema

RIB FRACTURE AND FLAIL CHEST Which is which isang rib lang affected

RIB FRACTURE

FLAIL CHEST tawag if both sides or ribs affected, if unilateral lang affected?

COMPLETE, INCOMPLETE

RIB FRACTURE classic sx

CHEST PAIN/ REFERRED PAIN + shallow breathing

FLAIL CHEST classic six

CHEST PAIN/ REFERRED PAIN + paradoxical breathing (inhale=inward chest) normal is inhale=outward chest

PNEUMOTHORAX ano loob

AIR

PNEUMOTHORAX Ano type if pumutok ung bleb if inc pressure if may opening sa pleural wall

SPONTANEOUS TENSION OPEN

PNEUMOTHORAX Tension pneumothorax sx that may lead to HF

TRACHEAL DEVIATION

PLEURAL EFFUSION ano sa loob

WATER

PLEURAL EFFUSION secondary cause

PTB, PNEUMONIA, CA

PLEURAL EFFUSION 3 types

HEMOTHORAX PYOTHORAX/EMPYEMA HYDROTHORAX/ PLEURAL EFFUSION

PLEURAL EFFUSION Sa lungs, san makikita ang air at fluid? Ano meron sa breath sounds

Air- apex Fluid- base Dec or absent breath sounds

PLEURAL EFFUSION Confirmatory test

CT SCAN

PLEURAL EFFUSION Aside CT scan ano pa dx

CXR + clinical sx UTZ

PLEURAL EFFUSION Mngt

Thoracentesis CTT: pneumothorax Diuretics Emergency H dialysis Pigtail insertion

UTZ 3 fxns

LOC VOL SEPTATION

SEPTATION

windowing/ kalat- kalat ung butas sa lungs not conducive for thoracentesis

CHEST TUBE 1st bottle: 2nd: 3rd:

DWS (Drainage bottle, Water Seal, Suction control)

CTT DRAINAGE BOTTLE Abn collection

>100 cc/hr + bright red

CTT DRAINAGE BOTTLE <50cc/3h gagawin

assess breath sounds and notify

CTT DRAINAGE BOTTLE Nagpositive nung ni auscultate ni doc ano expect mo

CXR (reexpansion)

CTT DRAINAGE BOTTLE Expansion what to expect? If di nag expand?

Pain med 30 mins prior removal Notify and assess

CTT DRAINAGE BOTTLE (-) breath sounds gagawin

Notify

CTT WATER SEALED normal?

Intermittent, no oscillation, no tidaling and no bubbling

CTT WATER SEALED continues?

Air leak

CTT WATER SEALED No DOB? with DOB?

Assess breath sounds Notify

CTT SUCTION CONTROL normal and abn

Continuous gentle bubbling Continuous vigorous

CTT Tatransfer pt sino hahawak

Nurse below the chest

CTT Natanggal/ dislodged gagawin

3 way method sterile dressing

CTT Disconnect ung tubes gagawin

Submerged tube 2-3 cm

CTT Bakit 3 way method pag magcover

if not kasi, tension pneumothorax

CTT Tube disconnection materials

gauze, clamp, 2 bottles isa pang replace & isa pang submerge

RESPI ANATOMY Lining of ciliated mucosa divided by septum and contains olfactory receptors

NOSE

RESPI ANATOMY contains FEMS (frontal, ethmoid, maxillary, sphenoid)

Sinuses

Biggest sinus

Frontal

Widest sinus

Maxillary

Sinusitis mngt

OFI

RESPI ANATOMY contains muscles w mucous lining & lympathic system

Pharynx

Pharynx 3 fxns

Passageway, Immunity, Protection

3 parts of Pharynx (NaOL)

NASOPHARYNX OROPHARYNX LARYNGOPHARYNX

oropharynx passageway of?

Air and food

Nasopharynx & larynopharynx passageway of?

Air

Laryngopharynx prob mngt

INTUBATION, BRONCHOSCOPY

Laryngopharynx prob mngt

INTUBATION, BRONCHOSCOPY

LARYNX

Adam’s apple’s cartilage

THYROID CARTILAGE

Signet Ring Cartilage?

CRICOID CARTILAGE

Lid/flap that opens (air to lungs), closes (food to stomach)

EPIGLOTTIS

EPIGLOTITTIS consideration

NO INSERT, NO EXAMINATION

Produces voice through Vibrations + expiration

VOCAL CORDS

aka WINDPIPE, c-shapes pero flat sa likod, 10-12 cm long, passageway of air to lungs

TRACHEA

Branch the trachea to bronchioles

MAINSTEM BRONCHI

Smaller branches of bronchi

BRONCHIOLES

smaller branches of bronchioles? smallest?

primary secondary

Gate going to alveoli

ALVEOLAR DUCTS

unit of gas exchange

ALVEOLI

ACCESSORY MUSCLE elevates first 2 ribs

SCALENE

ACCESSORY MUSCLE Raises sternum

STERNOCLEIDOMUSCLE

ACCESSORY MUSCLES shoulder movt

TRAPEZIUS & PECTORALS MAJOR

ACCESSORY MUSCLE entire muscles

External intercoastal

resp center

MEDULLA “MIDDLE/CENTER”

Resp regulator

BRAINSTEM

Controls rate & rhythm

PONS

BREATHSOUNDS large airways (larynx, bronchi, trachea/LBT)

BRONCHIAL

BREATHSOUNDS loud harsh, high pitch

BRONCHIAL

BREATHSOUNDS Smaller airways (bronchioles, distal part ng bronchi)

BRONCHOVESICULAR

BREATHSOUNDS moderate breezy sound

BRONCHOVESICULAR

BREATHSOUNDS alveoli

VESICULAR

BREATHSOUNDS low pitch (bell)

VESICULAR

BREATHSOUNDS Fluid accumulation, hair strand like sound

FINE CRACKLES

BREATHSOUNDS short high pitch bubbling sound

FINE CRACKLES

BREATHSOUNDS short low pitch Mucus accumulation

COURSE CRACKLES

BREATHSOUNDS High pitch musical hissing/whistle

WHEEZING

BREATHSOUNDS grating, squeky, scratchy/ sand paper, crackling

PLEURAL FRICTION RUB

3 I’s maririnig si pleural friction rub

INFECTION (PTB, Pneumonia) INFLAMMATION (pleuritic) INFILTRATION (tumor, air/fluid)

DX Looks for anatomical, appearance of lungs that uses low beam radiation

XRAY

Kidney fxn test Fastest: Reliable:

CREATININE CREATININE CLEARANCE & GFT

Kidney fxn test orient pt na?

METALLIC TASTE, WARM FLUTTERY FEELING

Kidney fxn test Withhold_ bc __

OHA, nephrotoxic for 3 days

Kidney fxn test 3 Complications

HEMATOMA, HEMORRHAGE, CIRCULATORY IMPAIRMENT

hematoma abn centimeters

>4 cm (microvascular bleeding)

Mngt for hemorrhage

Pressure dressing, sand bag

To do if may circulatory impairment

check distal pulse (no contralateral) Pulse grading and sx of hypoxia

removal of pleural fluid THORACENTESIS

THORACENTESIS 3 POSITIONS

1. chair straddling tas arms and shoulder rested (posterior back)- upong tambay 2. Sit w arms and shoulders rested sa table/bedside 3. Unaffected side 30-45 HOB

THORACENTESIS why position Unaffected side 30-45 HOB before and after

reexpansion

THORACENTESIS why maintain in 1 position

baka mag compli to tension pneumothorax

Epistaxis types

Anterior - mc trauma Posterior- ⬆️pressure, most serious

Epistaxis mngt

Sit lean forward Pressure >5 mind sa soft area (below bones) Cold compress

Epistaxis interventions 1. Closure of wound 2. 2 topical vasoconstrictions 3. Mouth breather 4. 2 things to avoid

1. cautery (electric and silver nitrate/chemical cautery) 2. Epi and phenylephrine 3. Nasal packing/ balloon inflated catheter 4. Oral temp & blowing

Nasal packing/ balloon inflated catheter Duration— Diet—

3-5 days Liquid to soft

Sinusitis cause

OBSTRUCTION (nasal congestion, polyps, deviated septum)

Sinusitis pain is worsen by?

Bending or lying down

Sinusitis mngt

WARM compress Fluids “NET POT” (warm saline irrigation) Heat mist (sauna, suob, hot shower)

Sinusitis dt polyps bawal bigay na gamot

ASPIRIN (bleeding)

Tonsillitis and adenoiditis common causes

Cold weather, sweets. Post nasal drainage

Causative agent of TONSILLITIS AND ADENOIDITIS

GABHS

TONSILLITIS AND ADENOIDITIS mngt

Warm saline gargle Fluids Tonsillectomy and adenoidectomy

TONSILLECTOMY and ADENOIDECTOMY position— sx of bleeding— Avoid— Put—

position—SEMI F or S LYING sx of bleeding—FREQ SWALLOWING Avoid—CLEARING of throat, BLOWING, dark colored beverages Put—cold/ice COLLAR

Tonsillectomy and adenoidectomy bawal na nagpapathick ng secretion + irritants

Bawal mga ICE CREAM, PUDDING, CITRUS, JUICES