Week 3 Flashcards
(28 cards)
Describe the nervous control of breathing
- Respiration is an automatic function needing no conscious awareness
- The respiratory centres in the medulla oblongata and pons in the brainstem (respiratory centre - control depth and rate of breathing)
- Excitatory impulses are transmitted to the diaphragm and external intercostal muscles to contract and commence inspiration
Describe central chemoreceptors
- Located near respiratory centre in the medulla
- Sensitive to carbon dioxide levels
- Most important
Describe peripheral chemoreceptors
- Located in the carotid and aortic bodies
- Sensitive to arterial carbon dioxide and oxygen levels
What is the function of the respiratory system?
Function of respiratory system is to transfer O2 from atmosphere to blood and remove CO2 from blood
Define respiratory failure
Inability of the lung to meet the metabolic demands of the body. This can be failure of tissue oxygenation and/or failure of CO2 homeostasis
Describe Type 1 and Type 2 Respiratory Failure
Type 1 = Low O2 levels
Type 2 = High CO2 levels and low O2 levels
What is the treatment for respiratory system infections?
Focus to ensure effective gas exchange between lungs, blood and tissues
Describe Pneumonia
- Inflammation (and often infection) of the alveoli and bronchioles
- Alveoli and terminal bronchioles fill with infectious debris (WBC) and exudate, reducing gas exchange
- Some microorganisms also release toxins which damage lung tissue
What is Hospital Acquired Pneumonia?
- Occurs 48-72 hours or more post admission
- Highest mortality rate of all the nosocomial infections
- Organisms responsible for hospital-acquired pneumonia are different from those responsible for community-acquired pneumonia
- Many are antibiotic resistant and difficult to treat
List the other pneumonias
- Aspiration Pneumonia
- Parasitic Pneumonia
- Opportunistic Pneumonia
Describe Aspiration Pneumonia
- Abnormal entry of bacterial-filled secretions from the pharynx or gastrointestinal tract into lower airway
- Suppressed or incomplete gag and cough reflexes (e.g. due to loss of consciousness, stroke, drug overdose)
What are the pre-disposing factors of pneumonia?
- Age -> elderly and very young
- Decreased conscious state - decreased cough and reflexes allow in inspiration
- Chronic illnesses, coexisting respiratory disease
- Mechanical ventilation and airway instrumentation
- Immunosuppression - impaired defence mechanisms
- Smoking
- Upper respiratory tract infection (URTI)
List the signs and symptoms of pneumonia
- Fever
- Tachypnoea
- Tachycardia
- Dyspnoea
- Cough
- Hypoxaemia
What is the nursing management associated with pneumonia?
- Auscultation
- Vital signs
- O2 therapy
- Positioning
- Hydration - assists with cleaning mucus
- Pain relief
- Oral and general hygiene
- Chest physio - deep breathing and coughing
- Antibiotics as prescribed
- Nutrition
Describe Myobacterium Tuberculosis
- Fundamentally a respiratory disease
- Into lungs by inhalation
- The bacteria has ability to persist in the form of a long term asymptomatic infection
Describe Whooping Cough
- Infection by the bacteria (Bordetella Pertussis) - toxins with the bacteria are released when it bursts
- Bacteria attaches to ciliated cells of trachea
- First impede ciliary action and then progressively destroy cells
- Production of several toxins which can enter bloodstream
Describe Influenza
- Influenza epidemics regularly occur worldwide and cause significant morbidity and mortality
- Influenza viruses can affect all levels of the respiratory tract and cause a range of clinical conditions
List the signs and symptoms of influenza
- Body aches, especially joints and throats
- Coughing and sneezing
- Irritated watery eyes
- Nasal congestion
- Redenned eyes, skin, mouth, throat and nose
What is the pathophysiology of Bronchial Asthma?
- Triggering stimuli bring about an exaggerated hypersensitivity
- Causes inflammation of the airway epithelium
- This leads to bronchospasm and increased secretion of mucus
- Onset within 10-20 minutes
- Release chemical mediators by pre-sensitised mast cells
- Inflammatory response
- Bronchoconstriction
- Mucosal oedema
- Increased mucus secretions
- Wheezing, chest tightness, dyspnoea and cough
How is asthma diagnosed?
- Detail history and physical exam
- Chest x-ray
- Arterial blood gas (ABGs)
- Peak flow monitoring
- Peak Expiratory Flow Rate (PERF) = highest flow rate of air in forced expiration (L/sec)
List the signs and symptoms of a Mild Episode of Asthma
- Feeling of chest tightness
- Increased respiratory rate with prolonged expiration
- Mild wheezing
- Productive or non-productive cough
- PEFR 60-80% of expected
List the signs and symptoms of a Moderate Episode of Asthma
- Use of accessory muscles
- Distant breath sounds (air trapping)
- Loud wheezing
- Fatigue, anxiety, apprehension
- PEFR >80% of normal/expected
List the signs and symptoms of Severe and Life Threatening Asthma
- Severe dyspnoea
- Inaudible breath sounds (lungs hyperinflated)
- Diminished or no wheeze
- Ineffective cough
- Cyanosis
- PEFR <60% of expected (if can do at all)
These are signs of impending respiratory arrest
What nursing management is associated with Asthma?
- O2 therapy
- Bronchodilators - Beta 2 agonists (salbutamol) and anticholinergic drugs
- Anti inflammatories
- SpO2 monitoring, ABGs, lung function
- Intubation and mechanical ventilation
- High fowler’s position and IV fluids
