What part of the body regulates temperature?
T or F: Temperature is part of the immune and inflammatory response and serves to protect us.
True. If you have a mild fever, it should not be treated. This is the body's way of creating a harsh environment for invaders (viruses ad bacteria).
A normal range of HR is?
T or F: Pulses can be bounding weak thready noraml
The PMI is located in the fifth intercostal space. What is another name for this location?
Capillary refill should be less than ....
What factors affect pulse?
exercise, temp, emotions, pain, medication, health disruptions
_____ is the exchang of gases between the atmosphere and the blood and cells. What is the normal range?
What factors affect respiration?
exercise, pain, anxiety, smoking, anemia, meds, body position
The force of blood against the wall of an artery is called...
blood pressure 120/80mmHg is max normal
What is a normal range for pulse ox?
should be greater than 92% ABG should have SAO2 of 95%+
What factors affect BP?
age (peripheral resistance increases as we age - caused by atherosclerosis), stress, ethnicity, gender, diurnal variation (higher in morning than at night), meds
How do you measure PP (part. press)
systolic - diastolic = PP
____ is a sensory and emotional experience in discomfort
pain single most common medical complaint. It is what the patient says it is
What parts of the body make up the upper airway? What does it do?
Nose and nasal cavity sinuses pharynx larynx trachea bronchi It does the following: *brings oxygen into the body, allows for has exchange then expels carbon dioxide *filters and humidifies incoming air
What are the protective feature of the upper airways?
nose hair filters nose warms/humidifies air goblet cells produce mucus to trap material cough and sneeze reflexes clear the airways
-sneeze reflex initiated by ....
receptors in nasal cavity
cough reflex stimulate by
receptors in walls of trachea and bronchi are stimulated, CNS reflex initiated cough causes air o be pushed up through bronchial tree under tremendous pressure
Little hairs in nose, trachea and bronchi are called...
cilia can be damaged by smokin This is why people who smoke get more colds... less clearing of yucky stuff
Lungs: We have two lobes on which side? Three on which?
tri right three two left
Lower respiratory tract is composed of ...
smallest bronchioles and alveoli considered functional unit of the lungs (the part that makes the whole thing work)
gas exchange occurs in ....
What is ventillation? Diffusion? Perfusion?
Ventilation- exchange of air between alveolar spaced and atmosphere; surfactant keeps them open Diffusion - gas exchange of CO2 and O2 across capillary; travels on HGB Perfusion – when hgb travels throughout the body. Carrying oxygen around…more a function of the heart…
Differene between Inspiration and exhalation
Inspiration- Active = inhaling Expiration = passive = exhaling We use accessory muscles to breathe (abdomen, neck, back)
What controls inspiration?
Stretchability/inflation of lungs is called _____. Impediment or obstruction that air meets as it moves through airway
What is central cyanosis?
oral mucosal is blue; not getting oxygen
The common cold, seasonal rhinitis, sinusitis, pharyngitis and laryngitis are all diseases of the _____ respiratory tract
upper Use two week rule, not usually treated. Colored sputum means infection
Antitussives do what? Dextromorphan (Benylin) is our prototype
block cough reflex. Dextromorphan (Benylin) is our prototype
Decongestant do what? Topical: Ephedrine (Pretz-D) - (I remember sudafed) Nasal: Flunisolide (flu inside my nose)
Pretz D as in Decongestant
decrease blood flow to the upper respiratory tract
shrink swollen membranes and decrease the overproduction of secretions
Topical: Ephedrine (Pretz-D) - (I remember sudafed)
Nasal: Flunisolide (flu inside my nose)
How do we remember that decongestants are sympathomimetic?
Lets remember that ALpha 1 constricted blood vessels in ANS drugs....so do decongestants
What do antihistamines do? Diphenhydramine (Benadryl)
block the release or action of histamine which increases secretions and narrows airways Benadryl is also used as an antivert...against vertigo. HOw can you be dizzy if you are asleep when benadryl knocks you out?
What does an expectorant do? (Remember the mucinex commercials?) Guaifenesin (mucinex)
increases productive cough to clear airways. loosens bronchial secretions For one big cough, take guaif!
What does a mucolytic do? Acetylcysteine (Mucomyst)
mucus lysis...increases or liquifies resp secretion to aid in clearing of airways Acetylcysteine (Mucomyst) Acetyl makes me think of acid which would liquify the lungs Muco - mucus
Why would we take antitussive such as dextromorphan (benylin)?
To stop an irritating dry hacking cough. If the cough is productive, we wouldn't use this. sympathetic system - dries you out - SNS away from rest and digest which is when you need saliva for digesting makes you sleep, don't drive!
Why is topical nasal decongestant better than oral? Ephedrine (Pretz-D)
*Works faster *Does not effect the whole body like a pill would because you put it right where it is needed. LESS side effects. *works on the site. less absorption. Can cause rebound congestion!
What is rebound congestion?
When you overuse decongestant and it does the reverse of what it is supposed to do. Body gets used to it, reliant on it. Don't use more than 3-5 days.
MAO inhibitor is an old time antidepressant that causes HTN when taken with...
almost all of our meds. Never take with nasal decongestants. with pseudoephedrine because it decreases urinary output. SNS - can cause fast HR, HTN, dizziness, nervousness, rash
When administering nasal decongestants, monitor for vitals, insomnia, dizziness, weakness, tremors and
irregular heartbeat SNS! Fight or Flight....same as alpha/beta stimulators
Topical nasal steroid FLUNISOLIDE (FLU N SIDE my nose) is used for seasonal allergic rhinitis. It decreases inflammation. The downside to this medication is that it......
1. suppresses the immune system 2. it must be tapered when stopping use 3. Might sting, burn your nose and give you a headache 4. takes awhile to be effective (has to build up in the system and wake up the adrenal glands to get to work)
Antihistamines such as diphenhydramine (Benadryl), selectively block the effects of histamine. It is an anticholinergic drug. It can relieve itchy skin which means it has an ........ effect.
antipruritic effect Benedryl makes you really REST....PSNS.... can be used as an antivert...you can be dizzy if you are asleep.
Antihistamines are anticholinergic which means we are moving away from the PSNS to the SNS, so what might it do to our heart? Kidneys?
(SNS = Fight or Flight - dry mouth, increase HR, no toileting) 1. cause arrhythmias (inappropriate heart rhythm) 2. kidney impairment = urinary retention 3. dry mouth
______ is rapid swelling (edema) of the dermis, subcutaneous tissue, mucosa and submucosal tissues that could be caused by allergies (imagine someone ate shellfish)
What is the benefit of taking second generation antihistamines like claritin or allegra?
Mucinex is used to make a cough productive. How does it work?
Enhances output of respiratory tract fluids by reducing adhesiveness (stickiness) and surface tension; allowing easier movement of the less viscous secretions. Can cause a rash. May mask seriosu underlying disorder
How long should you wait to go see a Dr about a cough?
no more than one week
If a person is taking an expectorant, should they decrease or increase fluid intake?
increase fluid intake to 2-3L/day
Mucolytics such as acetylcysteine (mucomyst) is used for high-risk respiratory patients. What does it do? (aside from reversing the effects of tylenol)
breaks down mucus in order to aid the high risk resp pt in coughin up thick, tenacious secretions.
Used for pts who have diffifculty coughing, postoperatie patients, patiens who develop atelectasis (partial or complete collapse of the lung), pt undergoing diagnostic bronchoscopy, pt with trachemostomies AKA this is some serious stuff used to break up some serious lung butter for patients who are seriously struggling.
Mucolytics can cause stomatitis. What is stomatitis?
inflammation of the mucous membrane of the mouth The smell is horrific! Watch for aspiration (people are gonna gag trying to swallow this nasty stuff)
What is atelectasis?
collapse or incomplete expansion of alveoli; state of airlessness in lungs caused by bronchial obstruction from secretions on the lung (post op pt)...air sacs squish down. Also caused by excessive pressure on the lung tissue (pleural effusion)
What is splinting an incision?
putting a pillow across the incision and creating pressure then coughing to decrease the pain.
What are some atelectasis interventions?
- TCDB (Turn cough and deep breathe )
- Incentive Spirometer - 10 times per hour. Pt inhales and attempts to raise the ball a certain amount.
- Humidification Hydration
- Chest Percussion
What is bronchitis?
- Inflammation of the bronchi affects the airway but not alveoli
- get copious mucous caused by phsyical/chemical irritants, viruses/bacteria
- get copious mucous caused by phsyical/chemical irritants, viruses/bacteria
Pneumonia can be caused by viruses, bacteria, fungi, parasites, aspiration. What does it mean when it is HAP or hypostatic?
HAP = nosocomial hospital acquired pneumonia. WASH YOUR HANDS!!!!! hypostatic means hen you breathe you have fluid in the bottom of your lungs just sitting there.
What are nursing interventions for pneumonia?
- Encourage coughing and deep breathing (shallow breathing can lead to pneumonia, so we def don' want to make t worse)
- increase fluid intake (3L a day) maintain semi fowlers position (easier to breathe)
- monitor for resp distress instruct pt to cover nose and mouth(Don't spread it!)
What is the best way to prevent pneumonia?
Annual pneumonia vaccine and flu vaccine. Asthma, children and elderly.
How do you treat bronchiitis and pneumonia?
1. Anitbiotics 2. mucolytics (serious infection needs serious mucus med) 3. antitussives - for naggin cough 4. bronchodilators (finally we can breathe) 5. Corticosteroids - reduces inflammation
How can you tell the difference between heart related chest pain and pneumonia related chest pain?
chest pain increases with inspiration if it is lung related.
T or F: You can tell where the infection is located (upper or lower respiratory system) by auscultating for diminished breath sounds.
True. In the case of pneumonia the diminished sounds will be in the lower lobes of the lungs.
COPD is a group of diseases related to obstructed airflow and includes...
emphysema (end stage of COPD) chronic bronchitis This is chronic, progressive, irreversible, you will eventually suffcate to death PRIMARY CAUSE IS SMOKING!
What are physical signs of COPD?
*hyperinflation *large barrel shaped chest *prominent accessory resp muscles in neck *low flat diaphragm *diminished breath sounds
How do we treat COPD?
- Oxygen (low flow 2L/min max; pt will not be encouraged to breathe if they receive any more oxygen than 2 L)
- antibiotics if infection
For stable COPD, use a bronchodilator and an anticholinergic. Why? How does it work?
1. Bronchodilators can be short or long acting. They stimulate beta 2, to dilate lungs. (short acting is a rescue inhaler/long acting is a maintenance inhaler) 2. Anticholinergic is given to stay out of the psns (remember PSNS is cholinergic, it constricts, we don't want that). This is given to keep the lungs open! (Methylxnthine [aminophylline/Theophylline) is an oral med for bronchodilation) You can use oral steroid to reduce inflammation
How do bronchodilators work?
reverse bronchomotor tone relaxes smooth muscle, reduces hyperinflation, improves breathlessness
Why don't we use the sympathetic bronchodilater called methylxanthines very often? (aminopylline/Theophylline all end in ine...)
The therapeutic range is very narrow (10-20 mcg/ml) They are very sensitive to stimulants like nicotine and caffeine. Toxic, hyperactive and tachycardia (Stimulate SNS means fight or flight) EXTREME JITTERS! (Sympathetic system so ....when I used nebullizer I feel like Tyrone Biggums from Chappelle Show - gives you wangs!)
Emphysema is the end stage of COPD. What physical signs will we see?
bronchioles lose elasticity which means the patient will have an increased resp rate (around 32+) will shallow breath (no more real expansion); dyspnea Patient stays hyperinflated
Reminder: Sympathetic-->agonist-->Beta 2-->bronchodilation Anticholinergic -->against the PSNS So, if you use an anticholinergic after a bronchodilator....
THe anticholinergic drug blocks the PSNS from taking over...prevents from constricting the lungs. If you use an anticholinergic after a beta 2 stimulator, it will keep the lungs open.
How do we treat COPD, Bronchitis, emphysema and pneumonia?
Antibiotics if infected Mucolytics Antitussives Bronchodilators corticosteroids
Astham can be triggered by extrinsic or intrinsic factors. What is an example of each?
Extrinsic: Mast cell activation allergens (fluffy the cat, pollen, dust, etc.) Intrinisc: stress drugs exercise pollution cold
Mast cells can trigger asthma. What is a mast cell?
a cell filled with basophil granules, releases histamine and other substances during inflammatory and allergic reactions.
What is bronchiospasm?
spasm of bronchial smooth muscle producing narrowing of the bronchi.
What happens when asthma is triggered?
*increased airway constriction (caused by bronchialspasm/hypersecretion of mucous) *thick mucus *wheezing *hyperinflation *Chest discomfort
What are medical interventions for asthma?
Prevention - rest, get rid of the cat, Treat with oxygen bronchodilators corticosteroids antihistamine
Anticholinergics, Short acting Beta2 adrenergic agonists (bronchodilators), and methylxanthines (aminophylline) are all?
quick relief medications
Corticosteroids, long acting beta 2 agonists, and leukotreine (a pill like singulair) modifiers are all?
long acting medications (usually taken 1-2 times per day)
Cystic Fibrosis is a autosomal (chromosomal) recessive multisystem disease due to altered function of the ....
exocrine gland first sign/symp in children mom kisses kid...is it salty? yes? Sweat a lot of salt. Short life expectancy or requires double lung transplant; Usually die of lung infection Affects lungs and pancreas Lung congestion/difficult digestion usually in fair skinned people....
What is the goal in treating cystic fibrosis? what treatments can we do?
*We want to promote clearance *Control infection in the lungs *Provide adequate nutrition *Break up the mucus by: Chest percussion therapy or vibrating chest vest Meds: Antibiotics, mucolytics, bronchodilators
A baby born before ___ weeks will not have developed enough _____ and may be born with RDS (resp distress syndrome)
32 weeks; surfactant unable to keep the alveoli open Mom may get an injection to speed up production of surfactant
What are some causes of ARDS?
cardiovascular collapse, major burns, severe trauma and rapid depressurization
What is the treatment for RDS/ARDS?
reversal of the underlying cause combined with ventilatory support.
__________ are bronchodilators such as theophylline (theo-dur). The names of this group of bronchodilators end in -ine. They are easily effected by caffeine and nicotine and have a tiny therapeutic range of 10-20 mcg/ml. It is easy to become toxic. It can cause seizure, brain damage and even death.
Theo, dur! everything you take has a dur-ect effect...caffeine nicotine on xanthines
cipro and tagament interact
Sympathomimetics -->sympathetic system-->fight or flight-->adrenaline rush-->bronchodilation...what is our prototype?
epinephrine (sus phrine)
What is our prototype anticholinergic to prevent constriction of the muscle bronchi?
Ipratroprium (atrovent) - keeps you open... anticholinergic...AnTi constriction....pRO VENTillation...atrovent
We can inhale a steroid to reduce swelling and bronchospasm. What is the prototype?
Budesonide (Pulmocort) Pulmocort...cort....corticosteroid
Leukotriene are one of a group of chemicals produced by the body that accompanies inflammation. Leukotrienes are believed to play a major role in causing the symptoms of hay fever and asthma.
Leukotreine receptor antagonist blocks receptors for production of leukotreines. What is our prototype for this group?
zat first I had a problem with hay fever and astham but at last I acclimated.
reduces edema and bronchospasm (inflammatory)
A ____ _____ ______ prevents the release of histamine at the cellular level. The prototype is cromolyn (Intal)
Mast Cell Stabilizer
I was sniffling and sneezing (until) Intal I took cromolyn
Breathe it INtal (inhaler)
OTC now and i used for allergies
Lung surfactant is a naturall occurring compound that reduces surface tension in alveoli. The prototype is...
________ is used to treat anapylactic shock. It works on the SNS and causes bronchidilation and increased respiration. Albuterol is an inhaler version of this (used for acute asthma attack).
Remember: SNS means fight or flight means symptoms of fight or flight... cardiac arrhythmias, HTN, etc.
Inhale this anticholinergic bronchodilator is used as part of a maintenance treatment plan for COPD. It takes only 15 minutes to work and last for 3-4 hours. If you are allergic to peanuts, you cannot take this med! What is the name of this med and what are it's side effects?
since it is ANTIcholinergic...against cholinergic...against psns...we are in SNS....same adverse affects as the others... dry mouth, palpitations, urinary retention.
What are the steps in using multiple types of inhalers?
- use the inhaled bronchodilator
- 2-3 minutes later use the corticosteroid
- 2-3 minutes take atrovent to keep the lungs open
- RINSE MOUTH!!
T or F: Steroids supress the immune system and the inflammatory response of the body so we must taper off of steroids.
Although inhaled is less than systemic
What happens if a person does not rinse their mouth after inhaling steroids?
Oral thrush known as Candida Albicans
beractamt (Survanta) is used to replace the _____ that is missing in the lungs of neonates with RDS. What is the most dangerous side effect of this medication?
risk pneumothorax and pulmonary air leak
How do you fix a pneumothorax?
chesttube to drain