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NSG 121 > Respiratory system > Flashcards

Respiratory system Flashcards

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1
Q

what should you observe?

A

position breathing
LOC
fingers and toes (clubbing/cyanosis)
respiratory rate
pulse oximetry (95< normal)

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2
Q

History?

A

respiratory history
smoking/other tobacco use
drug use
complementary/ integrative therapies
allergies
travel
area of residence
family history
genetic risk
current health problems

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3
Q

changes with aging?

A

decr. in lung elasticity
decr. in cilia function
muscle atrophy

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4
Q

additional cue for respiratory issues?

A

chest pain
cough
productive
color/amount
SOB with simple ADLs
apnic
orthopnea

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5
Q

I PREPARE

A

Investigate (possible exposure)

Present work
Residence
Environment (exposure)
Past work
Activities
Resources
Educate

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6
Q

the A’s of quitting smoking?

A

Ask about tobacco usage
Advise to quit
Assess willingness to quit
Assist in quitting
Arrange for a follow up

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7
Q

Inspection?

A

Chest shape/configuration (type of breathing)
Respiratory assessment
Chest expansion/ respiration quality
Palpate
Breathing posture/type of breathing
Breath sounds

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8
Q

Expected findings?

A

equal rise and fall
narrow from front to back
side to side wider
RR 12-22
no difficulty breathing
symmetry

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9
Q

unexpected findings

A

flail (chest trauma)
pneumothorax (collapsed lung due to air)
hemothorax (collapsed lung due to blood)
crackles/wheeze/rhonchi/plural friction tub/chyene stoke
hyperinflation of lungs
barrel chest
tripod position to breath
use of accessory organs to breathe

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10
Q

Psychosocial assessment?

A

anxiety
changes in roles/relationships
social isolation
financial problems
unemployment
disability
coping mechanisms

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11
Q

Labs to assess?

A

H&H (incr)
RBC (incr hypoxic) (decr. anemia, hemolized, speptic)
ABG (assess gas exchange/perfusion)
Sputum specimen (bacteria)

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12
Q

Imaging to assess?

A

chest X-ray
CT scan

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13
Q

Noninvasive Diagnostic testing?

A

pulse oximetry
capnometry/capnography (CO2 levels)
pulmonary function test (PFTs) (lung function/breathing)(no dilators, smoking, heavy meals, 4hr prior)
Exercise testing(90min)

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14
Q

Invasive diagnostics testing?

A

Endoscopic examination(NPO 4hr prior)
1)Bronchoscopy (tube into airway to assess and take specimen)
2)Thoracentesis (needle aspiration of fluid/air from plural space) (sterile dressing)
3)Lung biopsy (samples/needle aspiration for definitive diagnosis)

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15
Q

complications for endoscopic examinations?

A

worsening pain
incr HR
incr RR
air hunger
asymmetric chest movement
trachea movement
new nagging cough

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16
Q

what is hypoxia?

A

low oxygen to the tissue

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17
Q

what is hypoxemia?

A

low oxygen to blood

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18
Q

Normal VQ balance

A

ventilation/perfusion at right ratio
4L per min/ 5L per min= 0.8
(ventilation and perfusion both occurring)

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19
Q

VQ imbalances?

A

shunt
dead space
silent unit

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20
Q

what is a VQ shunt?

A

no ventilation/perfusion
(a blockage, prevents O2 entering)
supplemental O2
(shunting is 20%, normal is 2%)
(hypoxia)

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21
Q

What is a VQ dead space?

A

ventilation/no perfusion
(blockage of blood flow through lungs)
getting O2, no gas exchange due to no perfusion

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22
Q

What is a VQ silent unit?

A

no ventilation/no perfusion
cardiac arrest

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23
Q

what is hemothorax?

A

lung collapse due to blood fluid up in plural space

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24
Q

what is pneumothorax?

A

lung collapse due to air build up in plural space

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25
what is Oxygen therapy?
least amount of O2 given that is effective (relieves hypoxemia &hypoxia)
26
Nasal cannula
1-6L/min long term 25-40%
27
simple face mask
5-10L/min short term 40-60%
28
venturi mask
2-15L/min last step before intubation 24-60%
29
non-rebreather mask
10-15L/min 1 way valve, ER use 80-95%
30
High flow nasal cannula
up to 60L/min heat humidity 21-100%
31
non-invasive positive-pressure ventilation
CPAP one pressure (continuous) BiPAP bilevel pressure (inspiration or expiration)
32
T piece
test for extabation
33
Lung Sounds?
Wheezes Crackers Stridor Rhonchi Plural friction rub
34
Wheeze
whistle narrow airway chest/back during exhalation asthma/COPD AIM
35
what is AIM
Albuterol (rescue drug) Ipratropium (anticholinergic) Methyprednisolone (steroid for swelling)
36
Crackles
Crazy fluid high pitched crackles/ bubbling lower lobes pulmonary edema(fluid in lungs/alveoli) Diuretics
37
Stridor
Squeak harsh whistle throat region during inspiration blockage in larynx (choking) Diuretics
38
Rhonchi
Rumble low pitched rumble/rattle bronchi in airway obstruction/mucus Bronchitis/COPD percussion
39
Plural friction rub
pebbles rubbing dry rubbing from side of lung plural inflammation worsening pneumonia incentive spirometer
40
What is the most common lower respiratory disorder, reducing gas exchange, and causes an airway obstruction?
Asthma
41
causes of asthma?
airway obstruction bronchial obstruction eosinophilia asthma
42
asthma airway obstruction causes
inflammation airway tissue sensitivity bronchoconstriction
43
asthma bronchial obstruction causes
muscle spasms mucosa eduma thick secretions
44
eosinophilia asthma causes
different types of WBC
45
causes of asthma
allergens irritants microorganisms aspirin NSAIDs narcotics urban>rural areas
46
Triggers for asthma ASSSSS
Allergens (elevated eosinophils) Smoking Stress Sickness Severe weather (cold) Strenuous activity (take inhaler 30 min before to prevent)
47
Asthma control stages
0 controlled 1-2 partly controlled 3-4 uncontrolled
48
Labs for asthma and COPD
ABG PFT FVC FEV peak flow
49
what is a peak flow meter used for?
to anticipate a severe asthma attack before it occurs
50
Green on peak flow meter
Green, Good to Go Asthma is 80-100% controlled
51
Yellow on peak flow meter
Yellow mellow NOT under control, additional meds (rescue drug Q4 for 1-2 days)
52
red on peak flow meter
Red is Really Bad emergency treatment
53
ASTHMA s/s
Accessory organs (for breathing) SOB (dyspnea) Tight chest (tachypenia) High pitched wheezing Minimal breath sounds Absent breath sounds( leads to Air trapping causing acidosis)
54
Asthma assessment
symptoms? prominent at night or day? what provides relief? how many flare ups? activity restrictions? episode pattern
55
Interventions for asthma
control/prevent episodes improve airflow/gas exchange self management (personal asthma action plan) drug therapy exercise/activity oxygen therapy what and when to take meds
56
Drugs for asthma BAMS
Beta agonist --> albuterol (rescue drug) Anticholinergics--> Ipratropium (decr. secretions, dries out airway) Methylxanthines--> theophylline (therapeutic window 10-20mg/dL) (suppress CNS to open airway) Steroids--> reduce inflammation
57
Status Asthmaticus
severe life-threatening asthma attack doesn't respond to normal meds lead to pneumothorax or cardiac/respiratory arrest
58
treatment for status asthmaticus
2.5mg albuterol every 20min for 1hr the per hr after nebulize ipratropium IV methoprednisolone every hr for 24hr oral steroids 10-14 days after
59
HyperCapnic means
High Carbon dioxide
60
AIM for acute asthma attacks
Albuterol Iprotropium Methylprednisolone
61
Inhaler teaching
1) shake inhaler 2) remove cap 3) place spacer if needed 4) exhale all the way 5) close mouth around inhaler (seal) 6) inhale slowly while administering inhaler 7) remove inhaler and hold breath 10 sec 8) rinse mouth to prevent thrush (if giving steroids rinse after every use, if given bronchodilators rise twice a week)
62
A collection of lower airway disorders that interfere with airflow and gas exchange
COPD (normal O2 95-100%) (COPD O2 88-93%)
63
type of COPD
chronic bronchitis emphysema
64
Chronic bronchitis
Airway problems bronchioles narrow/blocked w/ mucus (swelling from inflammation) hyper inflated lungs (mucus build up can lead to infection like pneumonia)
65
emphysema
alveolar problems alveoli loose elasticity (airsacks break down from toxins/irritants) can also have chronic bronchitis Air trapping air hunger faster CO2 ventilation (inhaling before exhale is complete) acidosis
66
what is air trapping?
collection of CO2 in the lungs
67
What causes the use of accessory organs when breathing?
enlarged alveoli--> bronchial collapse--> hyperinflated lungs--> diaphragm flattens weakening its muscles--> use of accessory organs to breathe
68
COPD assessment
risk factors (genetics, exposure, job, gender) smoking history breathing problems Activity level weight (typically wt. loss due to SOB when eating) general appearance (pale, stooped over, tachypenia, look older poor grooming, blue) respiratory/cardiac changes (rate, depth, rhythm) psychosocial (isolated, anxious, change of roles)
69
Asthmas link to COPD
adults with asthma are 12 times more likely to develop COPD
70
COPD complications
Hypoxemia(decr. O2 to heart) Acidosis(PaCO2 levels incr) Dyspnea(inflammation/mucus buildup) Incr. risk respiratory infection(long term steroid risk, mucus infection) respiratory failure(disrupted gas exchange) Cardiac failure(hypoxemia) Dysrhythmias(hypoxemia, acidosis)
71
Pink Puffers
hyperventilate (short fast breath=redness in chest/face) weight loss (appear thin) barrel chest (hyperinflation from air trapping) SOB/dyspnea
72
Blue bloaters
mucus obstruction=decr. oxygen (cyanosis, blue skin hypoemia) overweight/obese (HF) Chronic cough, rhonchi, wheezing
73
HyperCapnic COPD
BiPAP
74
what meds should COPD patients not have
Opiods Benzos
75
Emphysema diet
incr calories small frequent meals
76
chronic bronchitis diet
incr. fluids drink in-between meals nor during
77
COPD medication
Bronchodilators (albuterol) wait 5 min Steroid (budesonide)
78
vaccination
be up to date with respiratory infections
79
Pursed lip breathing
inhaling through nose(mouth closed) Exhaling through pursed lips
80
Diaphragmatic breathing
lay on back with a book or hands resting on abdomen, and breathe by moving the hands/books
81
how to calculate pack years
of packs smoked per day times #of years smoked
82
Silent lung s/s
difficulty speaking chest tightness anxiety inability to take in air pass out cyanosis rapid breathing no lung sounds
83
pneumothorax s/s
chest pain hypoxia tachycardia air in plural space (from trauma)
84
paracentesis
needle inserted into plural cavity to remove air or fluid must stay still during procedure (sterile dressing assess for s/s of worsening, infection, changes)
85
SABA
short acting beta agonist dilates bronchi(bronchodilator) Albuterol=Acute Attacks rescue drug=immediate relief
86
LABA
long acting beta agonist dilate bronchi(bronchodilator) arformoterol= slow and steady (works for a long time) long term management COPD
87
Theophylline
Methylxanthines dilates bronchi by CNS(bronchodilator) therapeutic 10-20mcg/dL Vomiting Restlessness Tachycardia Sweating Anxiety
88
Corticosteroids
budesonide anti-inflammatory asthma/COPD long term(report signs of infection, incr. calcium intake, yearly optometrist appointment, decr. when stressed, never stop suddenly) rinse mouth after taking to prevent thrush

NSG 121 (6 decks)

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