Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
255 test 2
| Question | Answer |
|---|---|
| Bronchi | The large air passages that lead from the trachea (windpipe) to the lungs. main path into the lungs |
| Bronchioles | lung structures surrounded by smooth muscle that can constrict & dilate |
| Alveolar Ducts | where the alveoli are located |
| Alveoli | where gas exchange takes place (o2 & co2) Oxygen moves from the lungs to the bloodstream to travel through the body Carbon dioxide moves from the bloodstream to the lungs to be exhaled |
| If smooth muscle contracts around the bronchioles, what happens? | bronchoconstriction |
| If smooth muscle relaxes around the bronchioles, what happens? | bronchodilation |
| What happens to the alveoli with pulmonary edema? | fills with fluid |
| What is pulmonary edema? | a critical condition defined by excess fluid buildup in the lung's air sacs (alveoli), which impairs gas exchange and makes breathing difficult |
| How does pulmonary edema affect gas exchange? | decreased |
| Right lung lobes | upper, middle, lower |
| left lung lobes | upper and lower |
| Parietal pleura | membrane that lines the chest cavity |
| Visceral pleura | membrane that lines the lungs |
| Intrapleural space | space between both Contains 20-25ml of fluid for lubrication so the parietal and visceral pleura can slide over each other when breathing |
| Pleural effusion | excess fluid in the intrapleural space (more than 25ml) |
| Empyema | purulent fluid in the pleural space (indicates infection) |
| Diaphragm | major muscle of respiration What does the diaphragm do during inspiration?- moves down to make room for air. This process is controlled by a nerve that lives between c3 & c5 |
| As the thoracic cavity gets bigger, the pressure inside that area | decreases. gas flows from high to low pressure. Constantly trying to equalize pressure in the environment & lungs When thoracic cavity pressure decreases, air is going from outside into lungs |
| VENTILATION | Air moving in & out AKA inspiration & expiration Or inhalation & exhalation |
| OXYGENATION | Breathing in O2 & getting it to body organs & tissues |
| What are some assessment findings of a patient who isn’t oxygenating well? | confused, diaphoresis, clubbing, high RR and HR, low O2, cyanosis |
| ELASTIC RECOIL | When the lungs return to their original size after expanding This is a passive process, so it happens on its own |
| Increased compliance = | easier for lungs to inflate |
| RESISTANCE | Anything that blocks airflow in or out Air meeting resistance won’t be able to move with ease Ex: A narrow airway during asthma exacerbation Ex: Secretions partially occluding airway and creating a more narrow airway |
| CHEMORECEPTORS | Receptors that respond to chemical changes Hydrogen plays a role in breathing and is acidic |
| ACID-BASE BALANCE | lungs can help fix acid base imbalance. correct it by breathing out co2. When H+ concentration (acid) increases, the medulla sends a signal to incr the respiratory rate |
| In a healthy person, a decrease in | pH (lower number) causes an immediate increase in the respiratory rate to fix the acid-base imbalance |
| MECHANICAL RECEPTORS | Stimulated by physiological factors Ex: Receptors trigger a cough reflex with things like aerosols or particles Ex: Receptors prevent overstretching when you take a deep breath in |
| RESPIRATORY DEFENSE MECHANISMS | protect lungs inhaled particles, Air filtration, Mucociliary Clearance System: Mucus traps particles; cilia moves particles up, Hindered by dehydration, smoke, alcohol, and anesthesia, Cough Remove secretions, Macrophages:destroy particles |
| cheyne stokes | a dangerous, abnormal breathing pattern characterized by a "waxing and waning" cycle |
| kussmal | a deep, rapid, and labored breathing pattern (often called "air hunger") that acts as a compensatory mechanism for severe metabolic acidosis, most commonly diabetic ketoacidosis (DKA) |
| Bronchial: | Loud & high pitched Heard high near the patients neck |
| Bronchovesicular | medium pitched Heard around 1st & 2nd intercostal space |
| Vesicular: | Soft & low pitched Heard everywhere else |
| ADVENTITIOUS BREATH SOUNDS | Crackles (fine or coarse) 2. Wheeze 3. Stridor 4. Pleural friction rub |
| DIAGNOSTICS: ARTERIAL BLOOD GASES (ABGS) | looks at ph, co2, and HCO3 |
| THORACENTESIS | removes pleural fluid. Ultrasound guides placement of a catheter through the chest wall into the pleural space to remove fluid |
| PULMONARY FUNCTION TESTS | Use of a spirometer to assess lung volumes & air flow to evaluate lung function “Normal” depends on age, gender, race, & height |
| BRONCHOSCOPY | A flexible fiberoptic tube is inserted into the bronchi for diagnosis, biopsy, or intervention Can remove mucus plugs, foreign objects, or place stents to open obstructed airways (usually tumor) |
| Tidal Volume | Volume of air inhaled & exhaled with each breath Normal: about 0.5 L |
| inspiratory Reserve Volume (IRV): | Additional air that can be forcefully inhaled after normal inhale Normal: about 3 L |
| Expiratory Reserve Volume (ERV): | additional air that can be forcefully exhaled after normal exhale Normal: about 1 L |
| Residual Volume (RV): | mount of air left in the lungs after forced exhalation. This is the air left in the lungs for gas exchange between breaths Normal: about 1.5 L |
| Total Lung Capacity: | Max amount of air lungs can hold Normal: about 6 L |
| Functional Residual Capacity | Amount of air in lungs at the end of normal exhale Normal: about 2.5 L |
| Vital Capacity: | Max amount of air that can be exhaled after maximum inspiration Normal: 4.5 L |
| Inspiratory Capacity | Max amount of air that can be inhaled after normal expiration Normal: 3.5 L |
| DIAGNOSTICS: RADIOLOGY | Chest X-ray (CXR) CT: Diagnose things not easily seen on CXR MRI: In depth diagnosis of lesions VQ Scan: Patient inhales radioactive gas then is scanned to assess ventilation/perfusion AKA: Ventilation/Perfusion Scan |
| DIAGNOSTICS: RADIOLOGY pt 2 | Pulmonary Angiogram: Uses a catheter to put IV dye into the pulmonary artery to visualize pulm. vasculature PET Scan: Scan used with a glucose substance to identify cancer cells. Cancer cells consume glucose faster than normal cells |
| DEVIATED SEPTUM | Shifted nasal septum, Minor deviations can be asymptomatic Severe deviations may need surgery to realign and reconstruct Congestion & sinus infections are common because they can’t clear mucus well so bacteria stays trapped |
| NASAL FRACTURE | Worry about: Persistent clear or pink-tinged drainage can be cerebral fluid, Bruising around the eyes can indicate a basilar skull fracture, Bleeding loss or bleeding not stopping on its own after 15 min |
| NASAL FRACTURE treat | Use Tylenol instead of NSAIDS for pain because NSAIDS increase risk of bleeding, Decongestants can treat congestion from swelling, Ice: 10-20 minutes, Hot showers (48 hrs) to prevent vasodilation that would increase blood flow |
| RHINOPLASTY | Surgical reconstruction of the nose Nasal packing: Inserted after surgery to provide pressure & prevent bleeding/hematoma (1-2 days) External plastic splint: Protects & supports shape of nose during healing (1-2 weeks), Cold compress & elevation |
| EPISTAXIS (NOSE BLEED) | Anterior bleed: can be self treated because it usually stops spontaneously 2. Posterior bleed: require medical attention Common in older adults with other problems like HTN because more pressure in vessels equals an increased risk fo bleed |
| EPISTAXIS (NOSE BLEED) treat | Sit up & lean slightly forward Squeeze nostrils to apply pressure (anterior) Seek medical attention if bleeding longer than 15 mins Nasal saline & humidifiers can help keep the mucus membranes moist, Watch for excessive swallowing |
| ALLERGIC RHINITIS | Inflammation of nasal mucosa in response to allergen Exposure to allergen produces immunoglobulin E (IgE) when exposed to an allergen IgE releases histamine and leukotrienes, histamine cause inflammation, leukotrienes tight airway |
| ALLERGIC RHINITIS symptoms | Sneezing Watery, itchy eyes & nose Congestion Sinus pressure Runny nose (rhinorrhea) |
| ALLERGIC RHINITIS treat | Identify & avoid triggers Antihistamines to treat inflammation, Anticholinergic nasal spray blocks cholinergic receptors to reduce secretions, Corticosteroid nasal spray can stop the inflammatory response |
| ALLERGIC RHINITIS CLASSIFICATION | Episodic: Allergen not in their everyday environment, Ex: pet dander at a friend’s house, Intermittent: symptoms present for: Less than 4 days/week or Less than 4 weeks/year Persistent: symptoms present for: More than 4 days/week |
| ALLERGIC RHINITIS CLASSIFICATION causative agent | Seasonal: Pollen allergy Usually fall or spring Perennial: Year round like pet dander |
| ACUTE VIRAL RHINOPHARYNGITIS (COMMON COLD) | Upper respiratory tract infection Contagious: Droplet spread Survives on objects up to 3 days Symptoms start 2-3 days after infection Contagious for 1-2 days before symptoms start |
| ACUTE VIRAL RHINOPHARYNGITIS (COMMON COLD) treat | res, hydrate to thin secretions, acetaminophen for fever, cough suppressants |
| INFLUENZA (FLU) | Droplet spread Highly contagious Yearly flu vaccine (Contraindicated egg allergy) Transmissible 1 day before symptoms & 7 days after symptoms start |
| Flu vs. cold? | Onset is more abrupt Fever (especially high fever) & body aches are more common Diagnosed with viral culture |
| INFLUENZA (FLU) treat | Rest & hydrate Antipyretics Analgesics Antivirals (1st 48 hours of onset) Oseltamivir (Tamiflu) Zanamivir Newest antiviral: baloxavir marboxil Inhibits viral replication with only one dose |
| A nurse is caring for an elderly patient diagnosed with the flu. What common secondary infection is the patient at risk for | pneumonia |
| SINUSITIS | Sinus inflammation that causes mucus to accumulate From polyp, deviated septum, allergies, foreign body, etc. An inflamed sinus cavity is an ideal environment for viruses, bacteria, and fungus because it is warm dark and moist |
| SINUSITIS symptoms | nasal pain, obstruction, congestion, fever, and purulent nasal drainage |
| SINUSITIS treat | Decongestants Nasal corticosteroids Analgesics Saline nasal spray ABX or antifungals if needed |
| NASAL POLYPS | Soft, painless, and benign growth From repeated nasal inflammation Symptoms: Nasal obstruction Nasal discharge Treatment: Corticosteroids Surgery |
| FOREIGN BODIES | Symptoms: Pain Difficulty breathing Nasal bleeding Treatment Sneezing Blowing nose with opposite nostril closed |
| ACUTE PHARYNGITIS | Inflammation of the pharyngeal wall Can also include tonsils, palate, and uvula Cause can be: viral, bacterial, fungal (Throat culture can help determine cause) S/S: Range from scratchy throat to trouble swallowing |
| ACUTE PHARYNGITIS causes | dry air, smoking, GERD, nasal drip, intubation, chemical fumes, cancer |
| ACUTE PHARYNGITIS viral | ABX will not help Most common type Pharynx red & edematous |
| ACUTE PHARYNGITIS bacteria | Need ABX (azithromycin & cephalosporins) Ex: strep throat Pharynx red & edematous Fever over 100.4 Lymph node enlargement Tonsil or pharyngeal exudate Treat with ABX |
| ACUTE PHARYNGITIS fungal | More common in immunocompromised patients or with inhaled corticosteroid use White patches over oropharyngeal area Treat with nystatin: an antifungal antibiotic (swish and swallow) |
| AIRWAY OBSTRUCTION | Causes: Aspiration of food or foreign body Allergic reactions Edema or inflammation: trauma, burns, abscess, etc. Goal: Establish patent airway |
| AIRWAY OBSTRUCTION: INTERVENTIONS | Interventions to establish patent airway: 1. Heimlich maneuver 2. Intubation 3. Cricothyroidotomy: tube placed through cricothyroid membrane Used in emergency & temporary 4. Tracheostomy |
| HEAD & NECK CANCER risks | Tobacco use Marijuana use Excess alcohol use Exposure to sun, asbestos, and industrial carcinogens Radiation therapy Poor oral hygiene |
| RESTORING ORAL COMMUNICATION | Electrolarynx: hand-held device that uses sound waves to create speech “replaces” vocal cords 2. Tracheoesophageal puncture (TEP) voice restoration: valve used with trach 3. Esophageal speech: patient alters how they push air out to speak |
| ANALGESICS | Decreases pain, inflammation, and fever by blocking prostaglandins (Aspirin) &(Tylenol) Aspirin side effects: increased bleeding time (don’t give with GI bleed or bleeding disorders) Acetaminophen contraindicated with liver disease so check LFTs |
| analgesics use | flu, nose bleeds, sinusitis, acute pharyngitis |
| ANTIBIOTICS (ABX) | Kills bacteria Risk for developing c diff, Probiotic will often be given 2 hours after ABX Give 1 hour before or 2 hours after antacids & supplements Used in the treatment of bacterial sinusitis & bacterial pharyngitis |
| ANTIFUNGALS | Used in the treatment of fungal sinusitis & fungal pharyngitis Give 1 hour before or 2 hours after antacids Examples: “-azoles” for sinusitis Fluconazole ketoconazole Nystatin for pharyngitis swish and swallow |
| ANTIHISTAMINES effects | Blurred vision Urinary hesitancy Dry mouth Constipation Paradoxic side effects: restless, nervous, insomnia |
| ANTIPYRETICS | Prevents or reduces fever Side effects: rare; usually allergic reactions Example: acetaminophen (Tylenol) Used in the treatment of fever with colds and flu |
| Antitussives | Treats dry cough by suppressing cough reflex Contraindicated with other respiratory illness especially if you want the patient to cough, Example: benzonatate & dextromethorphan Used in the treatment of cold symptoms |
| Opioids | Treats dry cough by suppressing cough reflex Contraindicated with respiratory depression and CNS depressants. Don’t mix with medications that will decrease the resp drive |
| DECONGESTANTS | Shrinks swollen mucus membranes Side effects: CNS Stimulation Insomnia Increased BP Increased HR Palpitations Rebound nasal congestion can occur with overuse Contraindicated with HTN, tachycardia, and arrythmias |
| IMMUNOTHERAPY (ALLERGY SHOTS) | Treats a specific unavoidable allergen Used when patient isn’t responding to drug therapy Small amount of allergen in injected weekly Decreases sensitivity to allergen |
| Acids (H+) are produced | continually during normal metabolism |
| buffer system | If inc H+ then HCO3 will react to form H2CO3 (carbonic acid) which will then by converted to H20 and CO2 Cells can shift H+ into cell for exchange for potassium and vice versa Hemoglobin shifts chloride in and out in exchange for bicarbonate |
| CO2= | acid |
| more CO2= | less ph |
| acid base resp system | Amount of CO2 in blood is directly related to carbonic acid and H+ concentration Medulla can inc. RR & depth or dec. RR & depth |
| Renal System | Kidneys can reabsorb HCO3 and excrete H+ in urine or can extcrete HCO3 and retain H+ |
| Respiratory Acidosis | Causes: Hypoventilation = CO2 retained S/S: hypoventilation, hypoxia, lethargy, confusion, headache, Dec BP, v. fib, warm, flushed skin, seizures |
| Respiratory Alkalosis | Causes: Hyperventilation = CO2 blown off S/S: hyperventilation, Dizziness, confusion, headache, Tachycardia, Dysrhythmias, N/v/d, Tetany, numbness, tingling, hyperreflexia, seizures |
| Metabolic Acidosis | Causes: Acid accumulates (Diabetic ketoacidosis or lactic acidosis/shock) or Bicarb loss (Severe diarrhea, renal disease) S/S: Lethargy, confusion, headache, coma, Dec BP, Dysrhythmias, cold, clammy skin, N/v/d, Deep rapid resp., muscle weakness |
| Metabolic Alkalosis | Causes: Loss of acid (Prolonged vomiting, gastric suction) S/S: Irritability, lethargy, Confusion, headache, Tachycardia, Dysrhythmias, N/V, Tetany, tremors, seizures, tingling, muscle cramps, hypoventilation |
| normal ph | 7.35-7.45 |
| normal PaCO2 | 35-45 |
| normal HCO3 | 22-26 |
| normal PaO2 | 80-100 |
| normal Sa)2 | > or = 95 |
| Respiratory Acidosis | Kidneys will try to compensate by retaining HCO3 |
| Respiratory Alkalosis | Kidneys will try to compensate by excreting HCO3 |
| Metabolic Acidosis | Lungs will try to compensate by inc. RR & depth, kidneys will try retain HCO3 unless kidney disease |
| Metabolic Alkalosis | Kidneys will try to excrete HCO3 and lungs will try to compensate by dec. RR & depth however chemoreceptors will eventually inc RR |
| Determine if compensating | either CO2 or HCO3 going in opposite direction of the pH |
| acute bronchitis | Most are Viral Other triggers: air pollution, dust, inhalation of chemicals, smoking, chronic sinusitis, asthma Manifestations Cough (last up to 3 weeks), HA, fever, malaise, myalgias Hoarseness, dyspnea, CP, sputum clear-green |
| acute bronchitis pt 2 | Normal, rhonchi, wheezes on expiration or exertion Can develop into pneumonia Treatment: Relieve symptoms and prevent pneumonia Cough suppressants, bronchodilators, fluids, humidification Avoid respiratory irritants |
| pneumonia | Acute infection of lung parenchyma Gas exchange parts of the lung Alveoli, Respiratory bronchioles Pneumonia and lower resp infections – 4th leading cause of death in US Etiology |
| pneumonia pt 2 | More likely to occur when defense mechanisms are incompetent or overwhelmed by virulence of infectious agent Pathogens reach lungs by: Aspiration Inhalation hematogenous spread from a primary infection elsewhere in the body |
| pneumonia risk factors | Abdominal or chest surgery Air pollution Altered consciousness Prolonged immobility Debilitating illness Exposure to animal droppings Immunosuppressive disease or therapy NG tube feedings IV drug use Malnutrition Smoking |
| Community-acquired pneumonia | Acute infection of lung in patients who have not been hospitalized or living in long-term care facility within 14 days of dx Use Pneumonia Severity Index (PSI) to evaluate |
| Hospital-acquired pneumonia | Pneumonia in a non-ventilated patient that begins 48 hrs after admission to hospital and was not present on admit |
| Ventilator-associated pneumonia | Pneumonia that occurs > 48 hours after endotracheal intubation Both associated with longer hospital stays and incr mortality |
| Empiric antibiotic tx started | as soon as pneumonia is suspected Adjust abx after pathogen is identified |
| Viral Pneumonia | Most common, seen in influenza |
| Bacterial Pneumonia | May need hospital admit, IV abx |
| Aspiration Pneumonia | Abnormal entry of stomach contents into the lung NG tubes and tube feedings, swallowing difficulty, loss of consciousness |
| Opportunistic Pneumonia | Seen in immunocompromised pts (chemo, immunosuppressive tx, radiation, corticosteroid use) Pneumocystis jiroveci (carinii) Most common with HIV Cytomegalovirus (CMV) Most common after stem cell transplant |
| Need sputum cultures to | determine organism in all types penuomia |
| Pneumonia patho | According to the pathogen; inflammatory response in lungs leading to atelectasis and consolidation S/S Cough, fever, chills, dyspnea, tachypnea, pleuritic chest pain Cough may be productive (green, yellow, rust colored) Rhonchi, crackles |
| older adult pneuomia signs | Confusion s/t hypoxia Hypothermia Diaphoresis Anorexia Abdominal pain |
| Pneumonia complications | Multidrug resistant pneumonia Pleurisy Pleural effusion Atelectasis Bacteremia Lung abscess Empyema, sepsis, pneumothorax |
| Pneumonia diagnostics | Chest Xray Sputum Culture & Gram stain (BEFORE beginning abx ideally, however do not delay abx if sputum not avail) Blood Cultures ABGs, CBC, CMP |
| TB | Infectious disease caused by mycobacterium tuberculosis. 25% of world’s population is infected with TB Occurs more in poor, underserved, and minorities Asians highest rate, then Hispanics and blacks |
| tb risk | Homeless and Inner-city neighborhoods Foreign-born Living or working in institutions IV drug users Poverty Overcrowded living situations Poor access to healthcare Immunosuppression |
| tb pt 2 | Mycobacterium tuberculosis infection, gram pos. acid-fast bacillus (AFB) Affects lungs and other organs Transmission: airborne droplets Usually prolonged close contact Breathing, sneezing, coughing, talking causes granuloma |
| Primary TB infection | Bacteria are inhaled and start an inflammatory reaction, symptomatic Active disease develops within 2 years of infection Person is infectious and contagious Airborne spread (isolation needed) +skin test or +blood test |
| Latent TB infection | Does not have active TB disease; no symptoms Needs treatment for latent disease to not progress to active disease Not contagious +skin test or +blood test Normal CXR, -sputum smear AFB |
| tb manifestations | Dry cough that becomes productive Fatigue Weight loss Anorexia and malaise Low grade fever Night sweats |
| tb complications | Miliary TB Widespread TB, affecting many organs Pleural TB Extrapulmonary TB |
| tb skin test | Induration means antibodies present Patient exposed to TB ≥5mm for immunocompromised or chest lesions ≥10 for recent immigrants, drug users, residents & employees in high risk areas ≥15mm for all other low risk people |
| Additional dx tests tb | interferon gamma release assay QuantiFERON Gold Chest X Ray Sputum Culture Gold standard for TB dx |
| drug therapy latent tb | Isoniazid (INH) for 6-9mths |
| drug active tb | Initial Phase 4 drug therapy for 8 weeks Isoniazid (INH), rifampin, pyrazinamide, ethambutol Continuous Phase INH & rifampin for 18 wks |
| tb meds | Antituberculins Rifampin Isoniazid (INH) Nursing Considerations Monitor liver function Hepato, nephro, ototoxicity NO alcohol: inc risk for hepatitis Encourage B vitamins |
| Rifampin | discolor urine, tears, saliva, stains clothing |
| tb meds care | Have normal lung function Adhere to therapeutic regimen Prevent spread of disease No recurrence of disease |
| tb acute care | Airborne precautions Obtain CXR, sputum smear, culture Give appropriate drug therapy Identify close contacts Teach infection control and hand washing Wear mask when out of room |
| tb ambulatory care | Monthly sputum smears until 2 are negative Minimize exposure Adhere to drug regimen |
| atelctasis | Collapsed, airless alveoli Diminished or absent BS & dullness to percussion Most common cause is small airway obstruction from secretions Bedridden Postop Deep breathing & cough |
| pleural effusion | Abnormal collection of fluid in pleural space Not a disease, but an Indication of disease Types: Transudative: clear, pale yellow Causes: noninflammatory (CHF, decreased albumin levels) Exudative: inflammatory reaction |
| pleural effusion s/s | Dyspnea, cough, sharp CP worse with inhalation, dec movement on affected side, dim BS Treat the underlying cause Thoracentesis 1000-1200ml at one time CXR post procedure Monitor VS & resp distress |
| rib fractures | Most common chest injury Usually ribs 5-9 Painful, shallow respirations Tx: pain management w/ NSAIDS, opioids Teach deep breathing & coughing, IS, pain med use |
| flail chest | Fracture of several consecutive ribs S/S: Paradoxical chest movement, Rapid, painful shallow resp., tachycardia Tx: provide O2 as needed, monitor for atelectasis, pain management |
| pneumothorax | Air in pleural cavity Small pneumothorax: mild tachycardia, dyspnea Large pneumothorax: resp distress, dim. or absent BS, shallow, rapid resp., dec O2sat |
| Spontaneous pneumothorax | Small blebs rupture Healthy young, chronic lung dz Risk factors: smoking, tall, thin, male, family history, previous pneumothorax |
| Iatrogenic pneumothorax | Laceration or puncture during a medical procedure Needle insertions, barotrauma from ventilation |
| Tension pneumothorax | Air enters the pleural space but cannot escape= lung compression Mediastinal shift toward unaffected side Can result from open or closed pneumothorax, Mechanical ventilation, Chest tube obstruction MEDICAL EMERGENCY!! Immediate needle placed |
| Tension pneumothorax s/s | Dyspnea, marked tachycardia, tracheal deviation, neck vein distention, cyanosis, diaphoresis, absent breath sounds |
| hemothorax | Blood in the pleural space Immediate chest tube insertion Autotransfusion possible |
| chest tube insertion | Connected to pleural drainage system Wound is covered with occlusive dressing (petroleum gauze) Placement confirmed by xray Collection chamber Receives fluid and air from the pleural space |
| chest tube water seal chamber | Acts as a one-way valve, prevents backflow of air into the patient May see intermittent bubbling during exhalation, coughing or sneezing Fluctuation of water in chamber reflects pressure changes during inspiration and expiration |
| chest tube Suction control chamber | Applies suction to the chest drainage unit, from a mobile or wall suction unit Water or dry |
| chest tube gen care | Do not clamp for transport Monitor and record drainage amount Meticulous sterile technique during dressing changes Assess water seal chamber for continuous bubbling Encourage cough/deep breathing/IS Report drainage >200ml in first hour, |
| Chest Tube Removal | Pre medicate for pain Cover site immediately with Petroleum jelly (airtight) dressing Chest xray post Observe wound, monitor VS, breath sounds, resp distress |
| chest surgery | Lobectomy, Pneumonectomy, Thoracotomy, Video-Assisted Thoracoscopic Surgery (VATS) Preop: Postop expectations: O2, intubation, blood & fluids, Chest tubes, pain relief, PCA Teaching: Deep breathing, IS, splinting, ROM exercises |
| chest surgery post op | Adequate pain management Assess resp function, temp., pain, surgical site, chest tube site and drainage, daily CXR |
| lung cancer | Leading cause of cancer-related deaths in U.S. High mortality and low cure rate 80-90% r/t smoking 10-15 years of quitting = nonsmokers risk |
| lung cancer risk | S moking 1st & 2nd hand M en more O ccupational exposure K in (family; genetics) E thnicity: African Americans highest, whites second |
| lung cancer patho | Mutated epithelial cells by carcinogens Prefers upper lobes |
| Non-small cell lung cancer | Squamous cell carcinoma Slow growing; low risk of mets Adenocarcinoma Moderate growing; most common Large cell carcinoma Rapid growing: Metastatic |
| Small cell lung cancer | Small cell carcinoma (10-15% of lung ca) Very rapid growing; Most aggressive & early metastasis; freq mets to brain |
| lung cancer care | Adequate airway clearance Effective breathing patterns Adequate oxygenation of tissues Minimal to no discomfort Realistic outlook on treatment and prognosis |
| PE | Blockage of pulmonary artery by a thrombus, fat, or air Massive PE: 10% die within 1st hour Most are S/T DVT Risk factors: immobility, surgery 3mths, DVT history, malignancy, obesity, oral contraceptives, hormone therapy, pregant |
| pe manifestations | Varied and nonspecific May begin slowly or appear suddenly Dyspnea Tachypnea, hypoxemia, cough, chest pain, crackles, hemoptysis Massive PE: sudden change in LOC, hypotension, impending doom, cardiopulmonary arrest |
| pe diagnositics | Spiral CT angiography with IV contrast (gold standard) Ventilation-perfusion scan (V/Q scan) |
| pe collab care | Bedrest, HOB semi Fowlers O2 as ordered Assess VS, cardiac rhythm Teach long-term anticoagulant therapy Monitor CBC, coag studies |
| pe treat | Immediate anticoagulation with enoxaparin (Lovenox) (SQ) or Heparin (SQ or IV) Warfarin or apixaban (Eliquis)(oral) Fibrinolytics (tPA) (used in select pts) Embolectomy, ivc filter |
| most aspirated contents go to | left lower lobe |
| never give carbapenems in | deltoid |
| Surfactant | lubricant made in lungs to keep alveoli from collapse |
| Atelectasis cause | anesthesia, opioids = slow, unproductive breathing decreasing gas exchange •Encourage coughing, deep breathing, incentive spirometry |
| Lung Compliance | he point to which a lung can expand • Diseases such as emphysema, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, and atelectasis can either increase or decrease lung compliance. |
| Airway Resistance: | the pressure or opposition of the tissues in the airway to the flow of air |
| Forced Vital Capacity | amount of air that can be expelled from the lungs in 1 second during forced expiration |
| Vital Capacity | maximum amount of air that is expelled after maximal inspiration |
| Inhalation: • Restrictive Lung Disease | Chest or lung trauma (COLLAPSED LUNG) • compromised lung expansion • Interstitial lung disease (e.g., pulmonary fibrosis), scoliosis, neuromuscular diseases (e.g., muscular dystrophy), and severe obesity |
| Exhalation: • Obstructive Lung Disease | COPD (including chronic bronchitis and emphysema) • Asthma • cystic fibrosis • bronchiectasis |
| Nursing Interventions for Hypoxia | Position: Sit the patient in High Fowlers •Turning: Elevate the lung that is compromised •Hydration: Loosen Mucus •Coughing: Huff cough, Incentive Spirometry |
| Oxygen Toxicity | FiO2 Levels above 50% for longer than 24 hrs. is considered potentially toxic • Results: • Alveolar Injury • Decreased production of Surfactant which is needed to keep the alveoli open |
| If Surfactant is inactivated it can lead | to atelectasis & ARDS (Adult Respiratory Distress Syndrome) |
| Nasal Cannula (NC) | Advantages: Safe, simple, inexpensive, easily tolerated, and does not impede eating or talking. Disadvantages: Drying to mucus membranes, can dislodge easily, and may cause skin breakdown around ears or nares. |
| NC limitaions | Cannot be used with nasal obstruction; exact FiO2 varies based on breathing pattern. COPD Protocol: Slow increases to achieve 88-92% saturation |
| High Flow Nasal Cannula | Wide range Fio2 (21-100%) • PEEP Effect • Dead Space Washout of CO2 • Heated Air and Humidified • Indicated Use for: • Acute Hypoxemic Respiratory Failure • Post-Extubation/Weaning • Do Not Intubate |
| High Flow Nasal Cannula considerations | Monitor for failure: High Respirations, anxiety, low saturation • Skin Care: Monitor Nares and Ears for Injuries • Water Level: Ensure Water bag does not go dry |
| Simple Face Mask | Useful for short periods of time (ex transport) • Contraindicated for clients who retain CO2 • Claustrophobia feelings • Interrupts eating and drinking • Risk for aspiration |
| Venturi Mask | Delivers specific amount of O2 with humidity added • Low constant O2 • Hot and confining, mask may irritate skin • Interferes with eating and talking • Goal Standard for hypoxic COPD patients |
| Partial Nonrebreather | Delivers increased FiO2 • Easily humidified • Does not dry mucus membranes • Useful for short periods • Hot and confining • May irritate skin • Bag should always remain partially inflated; O2 flow must be high enough to keep bag inflated |
| Endotracheal Tube | Placed orally or nasally •Tapped securely with risk of skin breakdown •Confirmation of bilateral breath sounds and Chest X-Ray •Routine oral care •Inter-link suction •Risk for VAP |
| Improving Ventilation/Oxygenation | Medications VIA NEBULIZERS/INHALIANTS •Peak Flow Meters •Huff Coughing •Incentive Spirometry •CPT: Vibration & Percussion |
| Peak Flow Meter | Forced Vital Capacity: • Measures the volumes of air that is forcefully expired into A mouth piece Over 1 second. •Normal Lung Functioning: expel 80% of the air in the lungs • Rapidly Exhale into Meter |
| Incentive Spirometry | Patient inhales slowly and deeply oReduce post-op atelectasis oReduce risk for pneumonia oVisual feedback of depth of breath oAble to set goals with patient oDizziness, Lightheaded |
| Indications for CPT | Chest Physiotherapy • Mobilizing secretions by percussion, vibration, & postural drainage • Guidelines: BOX 41.7 •Used for: • Bronchitis • Asthma • Cystic Fibrosis • Pneumonia |
| Postural Drainage | Using positioning techniques to drain secretions from certain segments of the lungs/bronchi into the trachea •Contraindications: • Increased intracranial pressure, head/neck injury, active hemorrhage or hemoptysis, pulmonary edema, pleural effusion |
| Oral Airway | Unconscious patients only •Ensure there is no gag reflex! •Measure from corner of mouth to angle of jaw •Insert sideways then turn, may use tongue depressor |
| Nasopharyngeal Airway/Nasal Trumpet | Semi-conscious patients •Measure from tip of nose to tragus or earlobe |
| Reasons for a Tracheostomy | Establish patent airway 2. Bypass upper airway obstruction 3. Facilitate removal of secretions 4. Long-term mechanical ventilation 5. Assist with weaning from vent |
| CUFFED trach | inflated: • air is blocked from moving up pass the vocal cords to the nose and mouth. Instead, air flow moves in and out of the trach & lungs |
| UNCUFFED trach | (or deflated cuffed trach): • allows some air to be pushed up pass the vocal cords to the nose and mouth. Because of this, speech is possible |
| FENESTRATED tube: | has more openings so more air can be pushed up. This makes speaking easier |
| NONFENESTRATED tube | doesn’t have those extra openings, so air is not pushed up. |
| Passy Muir Valve | Valve opens when they breathe in Valve closes when they breathe out to force air up Passy-Muir valve with an inflated cuff is a life-threatening error (the patient can inhale but cannot exhale, causing air trap. CUFF MUST DEFLATED BEFORE PLACING VALVE |
| Adaptations with a Stoma | No swimming Wear special plastic covering in shower Cover stoma when shaving or applying makeup |
| Providing Oxygen to a Trach T-tube & Trach Collar | Should always be humidified •T-Piece (Briggs Adapter) •Tracheostomy Collar (Mask) •Flow Meter at 10L/min= 100% FiO2 •Adjust FiO2 |
| Tube dislodgement | Call for help, notify MD, attempt to reposition trach if not completely out if completely out instill the obturator and bag- mask ventilation • Prepare to replace with new trach |
| Tidaling | Fluctuation of water in chamber reflects pressure changes during inspiration and expiration |
| Chest Tube Placement | Baseline: Establish baseline Vital Signs (V/S) and Oxygen Saturation (SaO2). Connection: Assist in connecting the patient to the pleural drainage system. Dressing: Cover the wound with an occlusive dressing (petroleum gauze). confirm placement x ray |
| Initial Monitoring of a Chest Tube | Respiratory: Monitor breath sounds, respiratory patterns, and skin color. Complications: Check for crepitus (subcutaneous emphysema). Drainage Monitoring: Observations: Monitor amount, color, and consistency. Check eve 15 minutes for the first 2 hours |
| Heimlich (Flutter) Valve | For small uncomplicated pneumothorax with little or no drainage and no need for suction. The valve allows for escape of air but prevents reentry of air into the pleural space. |
| Coarse crackles are a series of | long-duration, discontinuous, low-pitched sounds caused by air passing through an airway intermittently occluded by mucus |
| leukotrienes cause | tightening of air muscles and more secretions |
| dont give cough suppressant for a patient | coughing up mucus |
| The cap off the central line could allow | entry of air into the circulation, causing an air embolus. Catheter occlusion, precipitate build up in lumen manifest with sluggish infusions |
| After a paracentesis of 5 L or greater of ascites fluid | 25% albumin solution may be used as a volume expander. |
| Restlessness is an early cerebral sign that | dehydration has progressed to the point where an intracellular fluid shift is occurring |
| The nurse should withdraw the catheter while the patient performs | Valsalva maneuver to prevent an air embolism. |
| IV administration of 0.45% saline is hypotonic and is used for maintenance | fluid replacement and dilutes the extracellular fluid. |
| In dehydration, fluid is lost first from the | blood vessels. To compensate, fluid moves out of the interstitial spaces into the blood vessels to restore circulating volume in that compartment |
| risk for metabolic alkalosis | ng tube |
| the right ventricle sends | oxygenated blood to the lungs through the pulmonary artery |
| oxygenated blood flow thru | pulmonary vein to left atrium |
| what sends oxygenated blood to the entire body | left ventricle |
| common causes of pleural effusion | HF and kidney disease. excess fluid volume |
| total diaphragm paralysis | injury above c3 nerve |
| mri | lesions/tumors |
| pet scan | identify cancer cells |
| vq scan | inhales gas to see how it moves |
| who gets asthma | Boys more before puberty Girls & women more after puberty African Americans more than whites, Puerto Ricans most |
| asthma risk factors | Genetic Immune Response Obesity Allergens & Triggers |
| asthma symptoms | wheezing, labored breathing, sleep problems, chest pain, cough, allergies, cold, tired, Tachypnea – Tachycardia - Hypertension, Nonproductive or thick, tenacious, secretions |
| asthma cause and triggers | smoke, pollution, chemicals, genetic, dust, fatty foods, pets, bacteria |
| Pulmonary function tests (PFTs) | Increased Total Lung Capacity Increased Residual Volume Expiratory volume is decreased or normal Peak flow Used at home, can help predict asthma attack |
| Status asthmaticus | LIFE-THREATENING MEDICAL EMERGENCY! hypoxia, hypercapnia, acute resp failure, chest tightness, severe increase in SOB, unable to speak, cyanosis hypotension, bradycardia, resp/cardiac arrest immediate intubation/ mechanical ventilation |
| Short-acting Beta2 adrenergic agonist (inhaled) (SABA) | Albuterol(Ventolin, Proventil), levalbuterol(Xopenex) (“rescue inhaler”) Relieves bronchospasm Effective within minutes and last hours Side effects: tachycardia, tremors, anxiety, palpitations, nausea |
| Anti-inflammatory meds | Inhaled: beclomethasone (Qvar), budesonide (Pulmicort), fluticasone (Flovent) Max effects: 1-2 weeks Nursing considerations: Monitor for oral candidiasis, rinse mouth after use |
| Anti-inflammatory meds oral | Prednisone Used for 3-10 days at the start of therapy or for gradual deterioration. Not used for immediate relief of acute attack Take with food or milk, observe for GI distress |
| Anti-IgE | omalizumab (Xolair) Monoclonal antibody Moderate to severe asthma Risk for anaphylaxis |
| ACUTE ASTHMA ATTACK TREATMENT | O2 sat, monitoring, resp assessment, ABGs, inhaled B2 adrenergic agonists and anticholinergics, IV magnesium, oxygen |
| copd | Chronic bronchitis • Cough and sputum for 3 months annually for 2 years • Emphysema • destruction of the alveoli without fibrosis |
| RISK FACTORS FOR COPD | Cigarette smoking (#1) 20% of smokers develop COPD Occupational chemicals & dust Air pollution Infection Asthma Genetics Aging |
| very severe copd | <30% FEV1 |
| severe copd | >30% FEV1 |
| DIAGNOSTICS Spirometry | FEV1/FVC ratio less than 70% Confirms the presence of airflow obstruction and determines the severity of COPD |
| copd manifestations | Slow development Chronic intermittent cough Dyspnea with exertion daily Unable to take deep breath Chest heaviness Hyperinflation – flattened diaphragm – accessory muscle use, Barrel chest, tripod position |
| copd complications | Acute COPD Exacerbations Worsening of resp symptoms ventilation Cor Pulmonale & pulm HTN Right sided heart enlargement and chronic lung disease, leads to right sided heart failure |
| Beta2 adrenergic agonist | Albuterol (short acting) Salmeterol (long acting) |
| Combination Therapy | Albuterol/ipatropium (DuoNeb) fluticasone/salmeterol (Advair), budesonide/formoterol (Symbicort) |
| Roflumilast (Daliresp): | oral med, phosphodiesterase inhibitor, decrease inflammation = decrease frequency of exacerbations |
| Low-Flow (use a portion of room air, not precise) | Nasal cannula (1-6L/min): most commonly used; can add humidification Simple face mask (6-12L/min): use for short periods Partial and non-rebreather mask (60-90% at 10-15L/min): short term, higher O2 concentration |
| High-Flow (fixed concentrations of O2) | Trach collar (1-15L/min): used in trach patients Venturi mask (up to 50%): precise delivery High flow nasal cannula (up to 60L/min): must be humidified, more comfortable than mask CPAP, Bipap, mechanical ventilation |
| COMPLICATIONS OF OXYGEN THERAPY | Combustion Prohibit smoking, post signs for home O2 Carbon dioxide (CO2) narcosis COPD > tolerance to high CO2 levels > resp center loses “sensitivity” to high CO2 levels Drive to breathe is now hypoxemia instead of high CO2 |
| COMPLICATIONS OF OXYGEN THERAPY pt 2 | Oxygen toxicity Results from prolonged exposure to high level of O2 Rare, causes severe pulm edema, shunting of blood and hypoxemia Prevent by using only the amount of O2 needed to maintain O2 levels |
| Goal for COPD patient: | O2 sat of at least 90% PaO2 of at least 60mmHg Safely administer O2 by gradually increasing Assess mental status and vital signs frequently while using O2 Closely monitor PaO2 and PaCO2 (ABG) |
| Chest Physiotherapy (CPT) | For pts with excess secretions who have difficulty clearing them Postural drainage: Position for drainage determined by area of lung involved Percussion: cup hands and percuss area Vibration: flutter device, Acapella device |
| CYSTIC FIBROSIS (CF) | Autosomal recessive disorder Multisystem Altered Na & Cl transport Secretions low in water content |
| who gets CF | 30,000 Americans CF gene (10 million are carriers!) Whites highest (1 in 3,000 white births) Uncommon among other ethnic groups 1 in 25 whites are carriers of the gene |
| CF manifestations | Frequent cough, recurrent resp infections Purulent sputum, bronchitis, pneumonia Over time = pulmonary remodeling = pulmonary hypertension = cor pulmonale Insufficient pancreatic enzymes Protein and fat malabsorption, liver damage |
| DIAGNOSTICS CF | Sweat chloride test = gold standard High concentration of chloride in sweat = CF Genetic testing All newborns in the United States are screened for CF at birth |
| CF complications | CF related diabetes Bone, sinus and liver disease Cor Pulmonale/Pulm HTN Delayed puberty and reproductive/fertility issues DIOS (distal intestinal obstruction syndrome) |
| CF assesment | recurrent resp infections, use and compliance with meds cyanosis, clubbing, salty skin Resp: congestion, runny nose, adventitious breath sounds (wheezing, crackles, rhonchi), thick sputum, incr breathing,accessory muscles, barrel chest, tachycardia |
| CF medications | Pancrealipase (Pancrease) Pancreatic enzyme replacement Taken before each meal/snack Fat soluble vitamins (Vit A, D, E, K) Dornase alfa (Pulmozyme) Degrades DNA in sputum and helps to increase airflow and reduce exacerbations |
| hypoxemic | paO2 less than or equal to 60, |
| hypercapnic | ventilatory failure, PaCO2 greater than 50 and ph lower than 7.35 |
| Hypoxemic causes | ARDS Pneumonia Toxic inhalation PE Hemorrhage Shock |
| hypercapnia causes | Asthma COPD Cystic fibrosis CNS injury (brainstem or spinal cord) Chest wall trauma Neuromuscular d/o Myasthenia gravis, guillian- barre, MD, MS |
| Hypoxemia s/s | Dyspnea Tachypnea (early) O2 sat < 80% Accessory muscle use Neuro Agitation, restless (early) Confusion, dec LOC (late) Cardiac Tachycardia, HTN (early) Diaphoretic (early) Cyanosis |
| hypercapnia s/s | Dyspnea Dec RR or Rapid shallow Pursed lip breathing Neuro Morning HA Disoriented Somnolence Cardiac Tachycardia (early) Hypertension (early) Cyanosis |
| DIAGNOSTICS resp problems | CXR Helps to identify possible causes of respiratory failure ABG Used to evaluate oxygenation, ventilation and acid-base balance Hemodynamic Monitoring Arterial, central venous, and/or pulmonary artery (PA) pressure monitoring |
| Respiratory Therapy | Oxygen Mobilize secretions Positive pressure ventilation (CPAP > Bipap > intubation) |
| resp meds | Relief of bronchospasm (albuterol) Reduce airway inflammation (Corticisteroids) Reduce pulm congestion (furosemide, morphine) Tx infection (antibiotics) Reduce anxiety (lorazepam) |
| ACUTE RESPIRATORY DISTRESS SYNDROME | Sudden and progressive form of acute respiratory failure Alveolar-capillary membrane becomes damaged and more permeable to intravascular fluid |
| PREDISPOSING CONDITIONS TO ARDS | Aspiration of gastric contents Viral or bacterial pneumonia **Sepsis (most common cause) Severe massive trauma Less common: Embolism, toxic inhalation, near-drowning, O2 toxicity, drug overdose, acute pancreatitis |
| ARDS PATHO | injury or Exudative phase (day 1-7, usu 24-48 hr) Alveoli fluid, no oxygenate blood, hypoxemia proliferative phase (1-2 wks after injury) Increased inflammatory response and fibrosis Fibrotic phase (2-3 weeks after injury)-Lung is scarred |
| ARDS CLINICAL MANIFESTATIONS | Presentation subtle initially Dyspnea, tachypnea, cough, restlessness Symptoms worsen due to increased fluid and decreased lung compliance Tachycardia, mental status changes, diaphoresis, pallor, cyanosis |
| ARDS diagnosis | ABG: Refractory hypoxemia is hallmark sign (nonresponsive to O2) Chest xray: whiteout, diffuse bilateral infiltrates |
| COMPLICATIONS OF ARDS | Ventilator-associated pneumonia Impaired host defenses,, aspiration of GI contents, Barotrauma VTE Overdistending fragile alveoli from mechanical ventilation Stress GI Ulcers Blood from GI tract to resp system Renal failure |
| MANAGEMENT OF ARDS | Managed in critical care setting Identification and tx of cause Hemodynamic monitoring , critical care setting Nutritional therapy |
| ards meds | Inotropic and vasopressors (Dobutamine, Dopamine, norepinephrine [Levophed]) Diuretics IV fluids, PRBCs Sedation |
| MANAGEMENT: RESPIRATORY THERAPY | Oxygen Maximize O2 delivery with high-flow Mechanical Ventilation Used in mod-severe ARDS Prevents alveolar overdistention and rupture by keeping airway pressures from becoming too high |
| Prone positioning | Used in refractory hypoxemia in pts who do not respond to other strategies Up to 16 hours a day |
| VENTILATOR MANAGEMENT | Critical care setting Ensure good handwashing and infection control measures Elevate HOB 30-45˚ (if tolerated) Daily assessment for readiness for extubation VTE & GI ulcer prophylaxis Frequent oral care Analgesia and sedation |
| asthma frequent sign | night time awakeness |
| SABA stimulates | beta 2 |
| what o2 sat qualifies for home O2 | below 88% 6 min walk test |
| LABA are effective for | 12 hrs |
| IS is not for | COPD bc lungs are alr expanded |
| give copd | flue, pneumonia, covid vaccine |
| CF related | diabetes can happen bc pancreas is not effective |
| CF sweat | 4x more than normal |
| PANCRELIPASE TAKEN | BEFORE MEAL OR SNACK |
| bipap | last resort before ventilator, inspiratory/expiratory pressure |
| what important to monitor in ards | renal failure |
| pneumonia breath sounds | bronchial, incr fremitus |
| sputum cultures obtained | 2-3 consecutive days |
| effects of tb meds | hepatitis, look for jaundice |
| continuous bubbling is expected in | suction control chamber, air leak is detected in water seal chamber |
| teach lung transplant patient | call doctor if there is a fever |
| what should improve after thoracentesis | O2 sat |
| drug interactions can occur between | antiretrovirals used to treat HIV and TB meds |
| patients who received | BCG vaccine will have positive mantoux test (TB) |
| open wounds get | non porous dressing so air can escape but air wont get in. |
| lung abscess need | long term antibiotic therapy |
| nasal decongestants should be used no more than | 5 days to prevent rebound vasodilation |
| hypokalemia | muscle weakness |
Created by:
cwehner125