1409 Respiratory Exam 1 Blueprint
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| Sputum studies | Collect early in the AM. Examines sputum for pathogenic microorganisms and cancer cells. Get this before starting antibiotics.
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| C&S | Sometimes done over successive days. Can be done during a bronchoscopy.
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| Thoracentesis is a procedure done to | aspirate accumulated fluid in between the visceral and parietal pleural layers of the lungs. Meds may be added directly into this layer to fight infection.
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| Thoracentesis complications | pneumothorax, csubcutaneous empysema, infection, pulmonary edema, cardiac distress
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| Post Care for a thoracentesis | Monitor chest sounds for crackles often
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| Bronchoscopy allows for direct visualization of | the larynx, trachea, and bronchi.
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| Bronchoscopy is used to | diagnose, treat, or evaluate lung disease. Biopsies and sputum may be obtained. Retrieval of foreign bodies.
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| Precare of bronchoscopy | NPO, consent, local anesthetic to stop gag, atropine to dry secretions. Sedative to depress vagus nerve.
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| Postcare of bronchoscopy | NPO until gag reflex returns. VS, neuro checks
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| Complications of bronchoscopy | hypotension, bradycardia, dysrhythmias, bronchospasm, laryngospasm, hypoxemia, perforation/bleeding, aspiration, infection
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| pH Normals | 7.35 - 7.45
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| PaO2 Normals | 80-100
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| PaCO2 Normals | 35-45
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| HCO3 Normals | 22-26
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| SaO2 Normals | 95-100%
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| Acidosis | Increased levels of acids or decrease of HC03
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| Alkalosis | Decreased levels of acids or increase of HCO3 Can be caused by respiratory or metabolic dysfunction.
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| High pH is alkaline | Low pH is acidic
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| High CO2 is Acidic | Low CO2 is alkaline
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| Respiratory Acidoses | PaCO2>45mmHg. Body holding onto CO2. Low pH. Can be caused by pneumothorax, pulmedema/asthma/atelectasis. drug overdose. cystic fibrosis.
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| S/S Respiratory Acidosis | slow or irregular breaths, absence of breathing, tachycardia, cyanosis, mental status changes, confsuion, disorientation, flushed skin, ha, stupor that advances to coma.
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| Treatment for respiratory acidosis | support of respiratory function. oxygen/ippb/cpap, bronchodilators, suction to clear airways, ventilator, chesttubes, sodium bicarb, antibiotics.
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| Respiratory alkalosis | PaCO2 <35mmHg. Can be caused by: Rapid breathing. Release of too much CO2. Thyrotoxicosis. ASA poisoning. Hypoxemia. Mechanical Ventilation.
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| SS of Respiratory Alkalosis | rapid respiratory and heart rate. dizziness. numbness and tingling of fingers and toes. circumoral paresthesia. tingling around mouth. sweating. convulsions.
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| treatment of respiratory alkalosis | measures to slow respiratory rates. breathing into paper bag. Sedation.
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| Metabolic Acidosis | Decrease in pH from increase in acids or decrease in HCO3 levels. Can occur during: shock and cardiac arrest. DKA. starvation. May also follow renal failure. ASA OD. Diarrhea.
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| SS of Metabolic Acidosis | Deep and rapid breathing. Kussmauls breathing. Anorexia. NVD. Confusion. Lethargy. Cardia Dysrhythmias RT Decrease in Contractility. Stupor-coma-death.
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| Treatment of Metabolic Acidosis | Fluid and electrolytes replaced. IV HCO3
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| Metabolic Alkalosis | Increase in pH from elevated HCO3 or decrease in hydrogen ions Caused by: oral consumption of HCO3. Tums/baking soda. Loss of H and Cl from: NV, suctioning, elevated aldosterone.
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| SS Metabolic Alkalosis | Anorexia, NV, confusion, Carpopedal spasms, Hypertonic reflexes, tetany, decrease in respiratory rate and death, headache.
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| Treatment of Metabolic Alcalosis | K+ replacement, NaCl IV to replace volume,
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| Hypoxia is less than 95% on the pulse oximeter and low oxygen of the hemoglobin and results in | Restless, tachycardia, Anxiety, Tachycardia.
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| Hypercapnia | Excess carbon dioxide in the blood
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| Route of inspired air through respiratory structures | nose - sinuses - turbinate bones - pharynx - larynx - trachea - bronchi - alveoli - lungs.
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| Fluoroscopy | views thoracic cavity in motion
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| O2 Humidification | The upper respiratory system is designed to moisturize and warm the air that is inspired through the nose. Humidity is necessary in the respiratory tract to prevent secretions from becoming ispissated (thickened and dried) which irritates the mucosa.
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| Humidifiers | creat water vapor to raise the relative humidity of inspired gas to 100%
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| Aerosol therapy (breathing treatments | used to liquefy and mobilize respiratory secretions and to deliver medications. Delivered by nebulizer. May require deep breathing and coughing. posturual drainage. percussion/vibration/suctioning.
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| Intermittent positive pressure breathing treatments. | used to achieve max lung expansion. Delivers humidified gas with positive pressure which forces air into lungs with inhalation. Used for specific conditions: atelectasis. Decreased lung compliance. and cardiogenic pulmonary edema.
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| Part of brain that controls ventilation | Controlled by the respiratory center in the medulla oblongota and pons.
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| Adventious Breath Sounds | Crackles, wheezing, sneorous, friction rub
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| VQ Scan | Ventilation and Perfusion Scan. Detect patterns of blood flow through the lungs and patterns of air movement and distro int he lungs. Looks at ration of Vent and Perf. Any area receiving Vent should also receive perf. and vice versa.
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| Chief purpose of VQ Scan is to diagnose | Pulmonary Emobolism. Also done to diagnose cancer, copd, and pulmonary edema
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| Postural Drainage | The technique of positioning the pt to facilitate gravitational movement respiratory tract secretions toward the bronchi and trachea for expectoration.
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| Contraindication of POstural drainage | experience of heart rate > 120bpm / dysrhythmias / HTN, hypotension / dizziness / signs of hypoxemia
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| Hypoxemi | Low oxygen in blood
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| O2 administration for pt with COPD | 1-3 liters only monitor for complications
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| Pulmonary angiography Pt Teaching | May feel pressure at site - May have bleeding at site - You will feel warm flushed feeling and the urge to cough is expected.
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| Pulmonary Angiography | Radioisotope study that allows the MD to assess the arterial circulation of the lungs. Radiography catheter is advanced into the pulmonary artery through an arm vein while dye is injected into the femoral artery
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| Lung Scans | VQ scan
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| Vesicular Breath Sounds | produced by air movement in bronchioles and alveoli; have long inspiration and short expiration
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| Pharyngitis | Inflammation of the throat, highly contagious, spread by inhalation or direct droplet contamination
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| Pharyngitis treatments | antibiotic therapy after c&s for 7-10 days. PCN drug of choice. Erythromycin if allergy to PCN.
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| Respiratory assessment | mental status WITH SOB. Using accessory muscles to breathe? Shape of chest (barrel chest). Skin Color.
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| Bronchial Breath sounds | Produced by air movement thouigh the trachea, heard over the trachea and are loud with long expiration.
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| Trach Suctioning | May be required if excessive secretions accumulate in tracheal airway.
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| The goal of trach suctioning is to improve | oxygen and carbon dioxide exchange in the lungs by removing excessive mucus secretions with a suction catheter.
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| Key points of trach suctioning | sterile. admin oxygen nbefore inserting the suction catheter because it temporarily obstructs the patients airflow.
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| Trach suctioning. Only SUCK when | withdrawing the catheter. Limit to 10 seconds. Rest. Repeat.
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| Assess tracheotomy every | 2 hours for mucous and listen to the airway.
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| Nursing Intervention for client on ventilator | Goals: improve respirations. Maintain patent airway. Communicate needs to others.
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| Nursing assessment for client on vent | vital signs. abgs. pulseox. response to respiratory support amd complications. mental status. breathing patterns. humidifier. maintain patent airway. bite blocks. turn q2hours. ROM. TED. oral care. emo support. alt method of communcation
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| Norsing care of extubated client | emergency equipment at bedside. High-fowlers or semi-fowlers position to keep from aspirating easiest to breath. assess for: laryngeal edema. increased respiratory distress. and LOC changes.
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| Respiratory meds to avoid if pt has hypertension | Decongestants
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| Meds to avoid after nasal surgeriess | ASA, ibuprofen, alcohol, tobacco
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| POsition to have maximum lung capacities | sitting or standing upright
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| Aspiration | shrimps go into the right lung
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| The amount of CO2 the lungs need to expel is determined by what in the blood | amount of hydrogen ions
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| Antihistamines do what to treat respiratory infections | dry out secretions - temporarily relieving symptoms
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| Purposes of endotracheal tube | maintain an open airway
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| trach care | supine or low fowlers position - maintain aspetic technique
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| Laryngeal cancer Risk factors | curable if detected early. most common in 50-70 years of age. cause is unknown. can be caused by tobacco, alcohol, industreial pollutants. chronic laryngitis, habitual overuse of voice, heredity,
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| Tracheostomy complications | infection, bleeding, airway obstruction, aspiration,. injury to laryngeal nerve, erosion of trachea, fistula formation between esophagus and trach, penetration of posterior trach wall
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| What to assess for after pt extubated | laryngeal edema, increased respiratory distress, LOC changes
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| SS Laryngeal obstruction | trauma causes neck swelling, bruising, and tenderness, stridor, high pitched sound heard during respiration, dysphagia, hoarseness, hemoptysis, if not corrected swelling can lead to total obstruction.
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| Acute sinus infection nursing interventions | increase fluids, rest, nutrition, antipyretics, analgesics, antihistamines, humidifier, NO antibiotics or antivirals.
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| Post care Sinus surgery | No blowing nose, no lifting > 10lbs, avoid valsalva 10-14days, avoid smokey places,
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| SS of sleep apnea | snoring, absence of breathing ~ 10 seconds, waking self with loud and hard snorts, daytime fatigue, HA upon rising in AM, sore throat, enuresis, erectile dysfunction, restless sleep, trouble concentrating, irritability, forgetfulness
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| Post care of tonsil and adenoidectomy | semi-fowlers position, ice collar to prevent swelling, monitor for frequent swallowing, fluids, assess respiratory distress, dyspnea, restlessness, cyanosis
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| epistaxis | aka nosebleed. ruprture of tiny capillaries in the nasal mucous membrane. most commonly in the kiesselbachs area.
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| epistaxis can be caused by | trauma, infection, htn, nasal tumors, blood dyscrasias, oxygen therapy
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| SS of epistaxis | inspection of the nares reveals the area of bleeding, deviation, and foreign bodies if present.
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| treatment for epistaxis | dependent and the location and severity of bleeding. direct pressure to the nares 5-10mins. with head slightly forward. ice packs to the nose. nasal packing with cotton tampon. cauterization with silver nitrate
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| nursing management of epistaxis | monitor VS, assess for continued bleeding, itiiation of above measures to control bleeding, emotional support
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| SS of allergic rhinitis | nasal stuffiness and dryness, sneezing, runny nose, clear nasal discharge, ha, sore throat, lethargy, fatigue, severe cases: chills and fever
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