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Flashcards in Week 3 Deck (29):
1

Purpose of respiration

The lungs, in conjunction with the circulatory system, deliver oxygen to and expel carbon dioxide from the cells of the body

2

Upper respiratory tract includes

Nose
Trachea
Warms & filters

3

Lower respiratory tract includes

Bronchi
Lungs (alveoli)
Gas exchange

4

Three processes of respiration

Ventilation (inspiration & expiration)

Diffusion (exchange of O2 & CO2 at the alveolar-capillary membrane)

Perfusion (blood flow through the pulmonary circulature)

5

Arterial blood gases

Measurement of arterial oxygen and carbon dioxide levels in the arterial circulation
Used to assess the adequacy of respiration
Also assesses acid-base balance

The lungs & kidneys attempt to compensate to maintain acid-base balance

6

COPD

Common, preventable & treatable
Characterised by a progressive, persistent airflow limitation
Enhanced chronic inflammatory response to noxious particles/gases
Made more severe by exacerbations/co-morbidities

7

Characteristics of COPD

Often from long term exposure to cigarette smoke
Chronic asthma
Chronic bronchitis
Emphysema
Some cases of Bronchiectasis
Alpha 1 anti-trypsin deficiency (rare)

8

Diagnosis and presentation of COPD

Evidence of airway obstruction by spirometric testing, that does not return to normal with treatment
History of progressive symptoms of cough and/or dyspnoea and/or chronic sputum production
Recurrent respiratory infections
Weight loss
Cigarette smoking history (80-90%)
Occupational/air pollution exposure
Genetic disposition
Frequent exacerbations leads to progressive destructive changes leading to a worsening condition (becomes cyclic)

9

Signs and symptoms of COPD

Over inflated lungs
Pursed lip breathing and use of accessory muscles
Possible weight loss
SOBOE
Decreased exercise tolerance
Cough:
Non-productive
Productive

10

Dry cough

Develops without the presence of secretions caused by irritant in upper airway eg smoke

11

Productive cough

Excess mucus or sputum (phlegm) is present in the respiratory tract. When airways are inflamed (infection) excess secretion of mucus accumulates in the airways. Expectorated by coughing.

12

Sputum observations

The nurse should observe the colour, consistency, quantity and odour of any sputum produced
record in nursing notes
Sputum specimen must be sent for MC&S

13

Characteristics of sputum

White Mucoid - Severe ‘Cold’
Yellow/green Containing pus (Purulent) – bacterial infection, Common in COPD/CF
Red – Containing Blood (Haemoptysis). Caused by Cancer, pneumonia, TB, trauma, PE

14

Sputum consistency

Viscous/sticky – difficult to exporate ?dehydration
Copious watery, frothy secretions – Pulmonary oedema – usually white can have pink tinge

15

Sputum quantity

Increasing or decreasing amounts should be documented

16

Sputum odour

Foul smelling sputum may be indicative of bronchiectasis or lung abscess or Empyema.

17

Differences between COPD and asthma

Symptoms consistent and rarely variable
Asthma is reversible/ COPD is usually not
Asthma is not generally associated with sputum production
Smoking history
COPD destruction of alveoli (bullae)

18

Mild COPD

FEV1 60 – 80% predicted
No abnormal signs
Smoker’s cough
Little or no breathlessness

19

Moderate COPD

FEV1 40 – 50% predicted
Breathlessness (+/- wheeze on moderate exertion
Cough (+/- sputum)
Variable abnormal signs (reduction in breath sounds, wheezes

20

Severe COPD

FEV1 < 40% predicted
Breathlessness on any exertion/at rest
Wheeze and cough often prominent
Ung over inflation
Cyanosis
Peripheral oedema
Polycythemia
Hypoxemia

21

Collaborative management for COPD

General Nursing Care as per “breathless pt”
Medication therapy:
Various inhaled gluco-corticoids & broncho-dilators
Oxygen therapy:
Long-term
During exercise
For acute exacerbation
The goal is to increase PaO² over 60mmHg/SaO² over 90%
Pulmonary rehabilitation
Multi disciplinary (chest physiotherapy)
Breathing exercises (pursed lip, diaphragmatic breathing)
Lifestyle changes
Activity rehabilitation
Discharge patient teaching

This is to prevent/improve pulmonary hypertension/right ventricular hypertrophy/cor pulmonale – pt education is extremely important in this area

22

COPD complications

Acute exacerbations frequent/year
Asthma
Influenza or pneumonia
Pulmonary hypertension
Heart failure (cor pulmonale)
Polycythaemia
Cachexia
Depression
Osteoperosis
Cardiovascular diseases

23

Pneumonia

Community-acquired or hospital-acquired
Immuno-compromised or aspiration type

Acute inflammation of the lung
By an infection (bacterial/viral/fungal/mycobacterial)

Resulting in:
Alveoli & surrounding tissues become oedematous
Alveoli fill with exudate & then consolidate
Affects ventilation & diffusion
Shunting occurs
hypoxia/arterial hypoxaemia
High mortality rate

24

Nursing assessment for pneumonia

Varies with type/organism/co-morbidities
Vital signs: Changes in temperature/pulse/respirations
Dyspnoea/use of accessory muscles
Cough
Productive (rusty/blood-tinged/purulent)/dry/expectorating(?)
Changes in physical assessment (IPPA)

Changes in CXR (? areas of consolidation)
Concomitant heart failure (especially in elderly patients)
Changes in mental status
Fatigue/dehydration

25

Nursing diagnosis for pneumonia

Ineffective airway clearance
Impaired gas exchange

26

Nursing expected outcomes for pneumonia

Improved gaseous exchange
Improved airway clearance

27

Nursing implementation for pneumonia

Oxygen therapy
Humidification may be used to loosen secretions
With air (face mask)

Deep breathing & coughing exercises (physio)

Antibiotics (as ordered)
For bacterial types
For viral types to prevent secondary bacterial infections

Promoting rest
Regular position changes

Promoting fluid intake:
To at least 2 L a day
Maintaining nutrition

General nursing care
Patient teaching

28

Low flow oxygen systems

Nasal Cannula
All age groups
1-5L/Min
Comfortable
Can dry mucous membranes
Hudson Mask

6-8L/Min
Inexpensive
Comfortable

Non-Rebreather
12-15L/Min
HighO2 Concentration

29

High flow oxygen systems

Venturi Mask
4-8L/Min
Provides Low levels of supplemental O2
Precise FiO2

Other devices used in VERY specialist areas