Unit 1 Respiratory Flashcards by Daphmy Francois

The maximum volume of air that can be inhaled aged a normal inhalation
3000mL

Inspiratory reserve volume

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The maximum volume of a that can be exhaled forcibly after a normal exhalation
1100mL

Expiratory reserve volume

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The volume of air remaining in the lungs after a maximum exhalation
1200mL

Residual volume

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Respiratory alkalosis
Hypocapnia
Hypoexmia
Hyperventilation

Asthma

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Status asthmaticus
Respiratory failure
Pneumonia
Atelectasis

Complications of Asthma

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Albuterol
Ventolin
Medications of choice for relief is acute symptoms and prevention of asthma exercise induced asthma and relax smooth muscle

Short acting beta adrenergic agonist

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Symptoms occur usually less than 2 times a week or at night less than 2 times per month. These patients will not be on daily medications. If anything, they will be on very low dose systemic corticosteroids in order to decrease inflammation to the bronchiole tree area.

Mild Intermittent Asthma

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Symptoms occur weekly, however not every day. Those episodes now start to affect their ability to go to school, work, and exercise. It is not unusual for these patients to wake up in middle of the night with coughing, wheezing and chest tightness. Night symptoms occur more than 2 times per month. These patients will be on low dose inhaled corticosteroids via an MDI (metered dose inhaler).

Mild Persistent Asthma

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Ipratropium

Inhibit muscarinic cholingeric receptors and reduce intrinsic catalog tone of the airway.

Anticholinergics

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Symptoms occur daily, requiring bronchodilator inhaler use. These episodes affect activity and sleep. They will begin to have symptoms at night more than 1 time per week. These patients will be treated with:

low dose inhaled corticosteroids
LABAs (Long Acting Beta Agonist drugs). Ex: salmeterol/Serevent. These drugs open up airways and relax bronchiole airways. They are LONG ACTING- work for about 12 hrs! LABAs are used for prophylaxis, for the control of asthma (whereas SABAs (short acting) are used for acute flare-ups).

Moderate Persistent Asthma

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This is the worst case scenario! Symptoms will be continuous and ongoing; they are there all the time. These patients will have frequent episodes during the day and at night. Additionally, activities are limited because of their symptoms. They will be treated with multiple medications at a time:

High dose inhaled corticosteroids
LABAs
PO corticosteroids- Prednisone. Key thing to remember in terms of patient teaching for anyone taking a corticosteroid by mouth is that it causes GI distress so take with food or milk.

Severe Persistent Asthma

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Used to control asthma symptoms particularly those that occur at night. Effective J prevention of exercise induced asthma

Long acting beta adrenergic

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Meters measure the highest airflow during a forced expiration
• helps measure asthma severity and when added to symptom monitoring indicates the current degree of asthma control
• for moderate to severe asthma

Peak flow

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Monitoring severity of symptoms
Breath sounds
Peak flow oximetry
Vital signs

Respiratory status

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Bronchus narrowed. 
Impaired air flow due to multiple mechanisms 
Inflammation 
Excess mucous production 
Smooth muscle construction 
Broncospams

Chronic bronchitis

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End result= Hypoxia (low O2 levels) and Hypercapnea (high CO2 levels)

Chronic bronchitis

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Cough- because of the hypersecretion of goblet cells
Cyanosis- many times use accessory muscles to breathe
Compensation- HR and RR goes up

3 Cs of Chronic Bronchitis:

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is a condition in which the walls between the alveoli/air sacs within the lung lose their ability to stretch and recoil (in English: these patients lose the elasticity of their lungs). The patient will have alveoli destruction as the air sacs weaken overtime. When elasticity of the lung tissue is lost, air can get trapped (barrel chest) in the air sacs impairing the exchange of O2 and CO2.

Emphysema

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o Extreme SOB
o Cough with or without sputum production
o Limited exercise tolerance
o Weight loss (dyspnea interferes with eating)- patients are very skinny with a barrel chest
o Generalized fatigue
o Anxiety
o Use of accessory muscles to breathe
o Pursed lip breathing
o Hypoxia and hypercapnea overtime

Clinical Manifestations of Emphysema

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o extreme difficulty breathing
o nasal flaring
o cyanosis
o absent or severely diminished breath sounds
o wheezing or crackles heard on auscultation
This patient may end up in cardiac arrest because overtime there will be less oxygen feeding the heart thus causing a decrease in CO, BP, and HR and the patient will develop arrhythmias.

Acute Respiratory Distress (ARD) symptoms

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o Impaired oxygenation
o Hypoxemia
o Hypercapnea
o Agitation / Restlessness
o Headaches
o Compensatory Tachycardia (heart compensates)
o Tachypnea
o Diaphoresis

Clinical Manifestations of Acute Respiratory Failure

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soft, low pitched, and mostly heard on inspiration. Entire lung field except over the upper sternum and between the scapulae. I > E

Vesicular

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medium pitched, mostly heard over the sternum and between the scapulae. I = E

Broncho-Vesicular

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loud, high pitched, heard next to the trachea on either side, heard loudest on exhalation. I

Bronchial

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- very harsh sound, heard directly over the trachea on both inspiration and expiration. I = E

Tracheal

- mostly heard on inspiration and can be heard throughout the lungs. It sounds like a bubbling, gurgling sound as the air moves through secretions. Heard in patients with COPD and pulmonary edema (a lot of fluid accumulating in their lung bases). Collapse lung - alveoli is popping open, chronic bronchitis, asthma.

Coarse crackles

- A high pitched musical sound, mostly heard on expiration

Wheezing

side-lying position with HOB elevated about 30 degrees until the patient’s gag reflex returns. Prior to the procedure, teach the patient that post-procedure a temporary sore throat or hoarseness is ok. However, bloody mucous, wheezing or chest pains are abnormal afterward and must be reported.

Bronchoscopy NI

amount of air remaining in the lungs after a maximum exhalation (1200 ml). In patients with emphysema or asthma, their RV is usually increased because they have air trapping- trouble getting air out.

Residual Volume

Restrictive lung disease: emphysema, impaired gaseous exchange, bronchitis… o Drug overdosing- Narcotics (dilaudid, morphine) o Respiratory arrest o Airway obstruction CNS depression

Respiratory acidosis

Hyperventilation – anxiety, pain, fever, fearfulness o Acute anemia- difficulty breathing, SOB, tachypnea (blowing off too much CO2) o Salicylate poisening- lungs are being overworked Clinical Manifestations o Rapid respirations (tachypnea) o Headache o Dizziness

Respiratory alkalosis

pH abnormal | One value abnormal

Uncompensated

Abnormal pH | Two value abnormal

Partial compensation

Normal pH | 2 values abnormal

Full compensation

Process of gas exchange between the atmospheric air and the blood and Brewer the blood and cells of the body

Respiration

Actual blood flow through the pulmonary circulation

Perfusion

``` Shunting producing disorders Perfusion exceeds ventilation Blood bypasses the alveoli without gas exchange Pneumonia Atelectasis Tumor mucous plug ```

Low ventilation-perfusion

When ventilation exceeds perfusion resulting in dead space Alveoli do not have enough blood supply for gas exchange to occur Pulmonary embolism Pulmonary infarction Cardio genie shock

High ventilation-perfusion

In the absence of both ventilation and perfusion or with limited ventilation and perfusion Pneumothorax Severe ARDS

Silent unit

Deceased lung compliance | Increased airway resistance

Dyspnea

High pitched usually heard on inspiration when someone is breathing through a partially blocked upper airway

Stridor

``` Continuing symptoms after initiation of therapy Shock Respiratory failure Atelectasis Pleural effusion Confusion ```

Complications of pneumonia

The volume of air inhaled and exhaled with each breath | 500mL

Tidal volume

80-100 mm/Hg | Measures how much O2 is in arterial blood- Partial pressure of oxyge

PaO2

Measures percentage of Hgb that is saturated with O2 ( | 95-100%

SaO2

Mucosal edema- swelling of the bronchiole tubes which reduces airway diameter o Bronchospasm of the smooth muscles of the respiratory tract causing further narrowing of the airways o Mucous production- these patients make LOTS of mucous, however they have difficulty bringing it up. during an acute episode of asthma, they start hyperventilating, they become air hungry and start using accessory muscles to breathe. These patients truly experience insensible fluid loss

Asthma

Classic Symptoms: o Coughing- with or without mucous production o Chest tightness o Wheezing- an expiratory wheeze, however you may also hear it on inspiration. Depending on how loud the wheeze is, you may be able to hear it without a stethoscope. o Dyspnea is a chronic condition, overtime you will see that they do pursed lip breathing- it takes them a much longer time to breathe out because they have air trapping

Clinical Manifestations of Asthma

• Anxious o Diaphoretic o Tachycardic o Hypoxemic • overtime, their expiration becomes longer than inspiration • often occur at night or in early AM and they may begin abruptly.

Asthma exacerbations

Sputum Analysis and blood tests- Eosinophil Count. Many times it will be elevated, especially if the patient also has allergies. ABG- In an acute flairup, the patient will be hyperventilating (getting rid of CO2-acid), therefore their pH will go up, placing them in a state of Respiratory Alkalosis. Pulse Oximetry PFT (Pulmonary Function Test)- assesses Tidal Volume (how much air they’re taking in and how much air they’re breathing out) CXR- may pick up hyperinflation of the lungs, aka “air trapping”

Asthma Diagnosis

``` o Move the pointer to a zero setting o Take a deep breath o Place mouthpiece in the mouth, create a seal around it o Blow out as hard and fast as possible o Record the setting where the pointer stopped o Repeat 2 more times o Record the highest number o Personal best is the highest of the 3 ```

peak flow meter

is when a person has a cough with sputum production for at least 3 months each year for two consecutive years.

Chronic Bronchitis

o chronic inflammation and swelling of the peripheral airways (bronchi) o excessive mucus production and accumulation o bronchial airway obstruction (result of inflammation and hypersecretion of mucous) o hyperinflated alveoli in the lungs

Chronic Bronchitis

1. Inflammation of the bronchial tree 2. Hypersecretion of mucous from goblet cells in respiratory tract 3. Loss of ciliary hairs in the respiratory tract (function is to keep out foreign material) so as they’re making all this mucous they can’t get it up so it goes deeper into the lungs and settles there, thus making them prone to many respiratory tract infections 4. Continuous bronchospasm 5. Hyperinflated lung 6. Airway obstruction

Chronic Bronchitis

periorbital edema o JVD o sacral edema o dependent edema (hands and feet)

Right sided heart failure related to chronic bronchitis

Emphysema

o Extreme SOB o Cough with or without sputum production o Limited exercise tolerance o Weight loss (dyspnea interferes with eating)- patients are very skinny with a barrel chest o Generalized fatigue o Anxiety o Use of accessory muscles to breathe o Pursed lip breathing o Hypoxia and hypercapnea overtime • pursed lip breathing, expiration will take longer than inspiration • Overinflated lung on a CXR and flattening of the diaphragm

Clinical Manifestations of Emphysema

air builds up in the pleural cavity and compresses the lung. As the air pressure continues to compress the lung, that lung will collapse (atelectasis). Therefore, a tube is placed in the 2nd intercostal space in order to remove the excess air.

Pneumothorax

blood or fluid builds up in the pleural cavity. Because the blood/fluid is heavy, it settles at the bottom of the lung. Therefore, a tube is inserted somewhere between the 4th and 5th intercostal spaces in order to drain the excess fluid settling at the bottom of the lung.

hemothorax

regulates the amount of negative pressure applied to the chest- suction promotes drainage of fluid and removal of air. The physician determines how much suction should be applied to the patient (how much water). The chamber is filled with 10-20 cm of sterile water and you will see there is continuous bubbling as air and fluid is being pulled out of the chest.

Suction Control chamber

prevents air from moving back into the chest on inspiration. This chamber has the smallest amount of water in it. When the patient breathes in and out you will see a gentle rise and fall of the water

Water Seal chamber

air and fluid become trapped in the lung and tension will develop in the chest as pressure starts to build in the lung.

tension pneumothorax

* SOB * Anxiousness * Wheezing stops with SOB * Symptoms increase * Cyanosis * asthma that does not respond * Can occur w/little or no warning * Severe bronchospasm * Mucus plugging leading to asphyxia * Hypoxemia * Respiratory alkalosis

Status Asthmatics

o Cardiovascular compromise- they now develop a decrease in venous blood return because too much pressure is being applied to their lungs. The nurse may need to decrease the pressure setting on the machine. In order to assess for cardiovascular compromise, check the patient’s central venous pressure and pulmonary capillary wedge pressure. o Pneumothorax- the reason could be that too much pressure is being applied to the lungs. Chest tubes will need to be inserted and the machine settings lowered. o Pulmonary infection- these patients have an impaired cough reflex to begin with and have decreased mobility (bedrest).

Patient problems with Vents

o Bronchopneumonia- involves distal airways / alveoli (deep in respiratory tract) o Lobular pneumonia- involves a part of the lobe of the lung o Lobar pneumonia- involves an entire lobe

Types of Pneumonia

Occurs suddenly, without warning, when air enters the pleural space through a breach of either the parietal or visceral pleura. These patients will end up with extreme hypoxia and their lung will collapse. Etiology: o Rupture of an air-filled bleb or blister on the surface of a lung, allowing air from the airways to enter the pleural cavity. o Diffuse interstitial lung disease o Severe emphysema

Spontaneous Pneumothorax

Occurs when air is drawn into the pleural space from a lacerated lung or through a small opening or wound in the chest wall. With a tension pneumothorax, there is increasing positive pressure in the pleural space with each breath (air gets trapped and can not escape on expiration through the air passages or chest wall as in an open pneumothorax). On inspiration, the mediastinum will shift toward the unaffected lung impairing ventilation. On expiration, the mediastinal shift will compress the heart and its blood vessels (vena cava) leading to a reduction in venous return.

Tension Pneumothorax

``` o Profuse diaphoresis o Agitation o Respiratory distress- air hunger o Cyanosis o Tachycardia- heart compensates o Tachypnea- really struggling to breathe o May go into cardiac arrest ```

S/S of a Tension Pneumothorax

when 3 or more ribs are fractured at 2 or more sites. They will have free floating rib segments because they have multiple broken ribs

Flail chest

is normally found over the mainstem bronchi near the clavicles in the front or between the scapulae in the back. As you move your hands downward and outward, should decrease.

Tactile fremitus

in areas where fremitus is normally expected indicates obstruction, pnemothorax, or emphysema • where alveoli collapse

Decreased fremitus

may indicate compression or consolidation of lung tissue, as occurs in pneumonia.

Increased fremitus

Coarse rales

APE

Fine rales

Atelectasis

99 | Pneumonia water transmit sound

Bronchophy

E, E | Sound like A, A, A

Egophony

Area where Pt has water you can hear ABC, 123, quite clear

Voice sounds | Whispered pectoriloquy