-
what does cilicated epithelium do?
warms and moistens air, sweeps mucous and pathogens away
-
where does gas exchange take place?
alveoli
-
What is ventilation?
movment of air in and out of the alveoli. air moves from high pressure to low pressure
-
What is inhalation?
occurs when motor impulses from the medulla cause contration of the resp muscle
-
what is exhalation
passive process when the diaphragm and intercostal muscles relax.
-
where is the respiratory center in the brain
medulla
-
what is the regulator of respirations?
Carbon Dioxide -hypoxic drive
-
how is oxygen carried in the blood?
attached to iron on hemaglobin in rbc
-
how is CO2 carried in the blood?
its carried as bicarbonate ions in the plasma
-
How much o2 is exhaled with each breath?
16%
-
What is respiratory acidosis?
- Accumulation of CO2 causing the blood pH to decrease caused by decrease in the rate or efficiency of respirations (hypoventilation).
- causes: chronic lung disease or shallow respirations
-
What is respiratory alkalosis?
increases rate of respiration causing an increased elimination of C02 increasing the blood pH. occurs with anxiety or hypervenilation
-
How do you measure SOB?
Scale of 1-10
-
what does it use of accessory muscles look like when breathing?
shoulders will rise with each breath
-
Barrel shaped chest is associated with?
trapped oxygen in lungs.
-
what is crepitus?
air under skin; feels like rice crispies popping.
-
How do you do a throat culture?
Use a tongue blade and only touch the back of the throat.
-
how do you do a sputum culture?
have pt take several deep breaths and cough sputum in to sterile container. not spit. sputum. deep breath to loosen the junk up
-
When a pt's O2 sat is low, what is the first thing you do?
Elevate head of bed
-
Special considerations for CT scan
- Have pt void before
- npo 4 hrs
- check allergies to dye
-
What is a PFTs ?
Determines lung volume, capacity, and flow rate.
-
Special considerations for pulmonary angiogram?
- Check peripheral pulses
- lie flat for 8 hours to prevent bleeding.
-
Describe a bronchoscopy.
- Use of endoscope to examine larynx, trachea, and bronchial tree.
- NPO 6-8 hrs
- Pt is NPO until gag reflex returns.
Atropine is used to dry up secretions
-
What drug is used with bronchoscopy to dry secretions?
Atropine
-
Interventions to help with smoking cessation?
- behavior modification
- counseling
- setting a quit date
- nicotine replacement
- drug therapy
- hypnosis
- e-cigs
-
Therapeutic measures to improve resp function
- Deep breathing and coughing
- huff cough to clear the airways
- Autogenic drainage*taught by rt
-
what is Diaphragmatic breathing?
Where pt places one hand on the chest and the other on the abd and tries to push out the abd during inspiration and relax it during expiration.
-
describe Pursed lip breathing
using abd muscles, blow out slowly through pursed lips to a count of 4
-
Benefits of fowlers postioning for resp pt?
keeps abd contents from crowding lungs and allows for maxium expansion
-
what is good lung down positioning?
placing pt on side of unaffected lung to allow for greater blood flow increasing o2 sat and gas exchange.
-
Nasal cannula is considered?
a low flow device
-
Describe oxygen masks
- may make pt feel claustrophobic
- used when higher o2 concentration is needed.
- either partial rebreather or non rebreather.
- still considered low flow
-
describe partial rebreather o2 mask
used to capture some exhaled co2 for rebreathing
-
describe non rebreather o2 mask
- has closed vents to limit the mixing of room air with oxygen.
- **has reservoir bag that will be inflatted*
-
describe a venuturi mask
- high flow
- has combination of valves to set specific flow rates
-
Pts with COPD usually have?
Chronically high CO2
-
COPD pts depend on____ to stimulate breathing
low co2- hypoxic drive
-
_____ can cause depressed respirations in COPD pts
flow rates greater than 1-2 L/minute of O2
-
What do nebulizer treatments do?
Deliver meds directly to the lungs
-
What medication is most commonly used with nebulizer treatments?
Albuterol
-
What do metered dose inhalers do?
administer topical meds directly into the lungs
-
_____increases the amount of medications that gets to lungs when using an inhaler
spacer
-
Using a MDI more than prescribe causes?
rebound bronchoconstriction
-
Why is an incentive spirometer used?
to encourage deep breathing
-
When is an incentive spirometer most commonly used?
after surgery
-
What is chest physiotherapy
- involves postural drainage, percussion, and vibration to help move secretions
- indicated for pts who have weak or ineffective cough
-
What is a high frequency chest wall oscillation?
- vest therapy
- alternative to cpt bc it doesnt require a therapist
-
What is positive expiratory pressure device
- small hand held device
- when you blow into it, steel ball vibrates and sends the vibrations into the airways to loosen mucus
-
What is a thoracentesis
- involves the insertions of a needles into the pleural space to aspirate fluid.
- provides immediate relief
-
Indication for chest drains
when fluid or air has collected in the pleural space
-
Describe the drainage system for chest tube
has water seal chamber, a suction chamber, and a drainage chamber
-
_____ occurs once pneunothorax is resolved
tidaling
-
_____ occurs when there is an air leak in an chest drainage system?
vigorous bubbling
-
Describe a tracheostomy
a tube inserted into the opening of the trachea to maintain patency
-
nursing care for traches
- suctioning no longer 10-15 sec
- cleaning
- ask pt to cough and deep breath before suctioning
-
What is intubation
placing an ET though the nose or outh into the trachae to maintain adequate oxygenation because of airway obstruction or respiratory failure
-
what should you check before intubating a pt ?
if they have an advanced directive
-
oral tubes should be repositioned every ______
24 hrs
-
Indications for mechanical ventilation?
provides ventilation for pts who are unable breath effectively on their own by utilizing positive pressure.
-
Low pressure alarm for ventilation means?
disconnected tubing, leaks in tubing or around et tube, or an underinflated cuff
-
High pressure alarm for ventilation means?
- if pts needs to be suctioned
- biting on tubing
- coughing
- trying to talk
- kinked or obstructed tubing
-
Nursing care for ventilation?
- Check directives
- hob 30-45
- oral care with chlorhexidine
-
Indications for NIPPV
alternative to intubation and mech ventilation for pts who are able to breath on their own but unable to maintain normal abgs
-
what is CPAP NIPPV
continous positive airway pressure- same amount of o2 pressure is maintained throughout inspiration and expiration
-
what is BIPAP NIPPV
bilevel positive airway pressure- a lower positive pressure is used on expiration
-
place pts using vent in semifowlers to _____
prevent gastric distention
-
what is epitaxis
nose bleeds
-
what causes epitaxis
- dry cracked MM
- trauma
- hypertension
- hemphillia
- medications-aspirin
-
positioning for pt with epitaxis
lean forward and apply direct pressure
-
you can apply ice to stimulate ____
vasoconstriction to stop bleeding
-
_____ is a vasoconstrictive agent used to stop bleeding with epitaxis
epinephrine
-
nasal polyps are usually___
benign/non-cancerous
-
nasal polyps occur more often with___
Allergies
-
Symptoms of deviated septum?
- stuffy nose
- blocked sinus drainage
- headaches
-
What is nasoseptoplasty?
- revising or removing the deviated portion of the septum
- out pt procedure
-
special considerations for nasoseptoplasty
- monitor for bleeding (excessive swallowing)
- teach pt to avoid activities that increase pressure and aspirin (increases bleeding)
- avoid nsaids and ibruprofen- increase bleeding
-
what is sinusitis?
inflammation of sinus mucosa caused by bacteria or allergies
-
s/s of sinusitis?
pain over sinuses:
- ethmoid sinus= pain behind eyes
- maxillary sinus = face and teeth pain
- fever
- nasal discharge
-
interventions for sinusitis
- saline irrigation
- corticosteroids-inflammation
- decongestants
- hot packs
- acetaminophen/ibuprofen
- oral fluids
- positioing
- surgical drainage
- adrenergic nasal spray (ex. affrin)
-
special consideration for adreneric nasal sprays used to treat sinusitis?
do not use for more than three days or it will cause rebound congestion
-
risk factors for obstructive sleep apnea
- obesity
- high palate
- receded mandible
- smoking
-
complications of sleep apnea
- heart disease
- hypertension
- stroke
- diabetes
-
s/s of sleep apnea
- dnoring
- daytime sleepiness
- headache
- memory and attention problems
-
Dx test for sleep apnea
Nonturnal polysomnography
-
Tx for sleep apnea
- Nasal patches
- weight loss
- NIPPV
- Surgery
- Avoiding Sedatives
-
another name for rhinitis is ?
common cold
-
what is pharyngitis
- inflammation of the pharynx caused by strep
- aka strep throat.
- left untreated it causes Rheumatic fever
-
what is laryngitis
inflammation of mucous membrane of the larynx
-
special consideration for tonsillitis?
After tonsillectomy have suction at bed side
-
How is the flu transmitted?
coughing and sneezing-droplet
-
what is the most common complication of the flu?
Pneumonia
-
how to prevent the flu?
- vaccination
- handwashing
- avoid infected people and crowds
- dont share utensils with people
-
s/s of flu
- fever
- chills
- myalgia/malaise
- sore throat/cough
- HA
-
Interventions for flu
- acetaminophen
- antivirals
- rest
- fluids
- **AVOID ASPIRN**
-
taking aspirin when you have the flu can cause___
Reyes Syndrome-affects the liver.
-
How is the west nile virus transmitted?
mosquitoes
-
do antibiotics work for viruses?
no
-
Describe cancer of the larynx
- primarily a tumor of the mucosal epithelium
- can metastasize to lungs, liver, and lymph nodes
-
Larynx cancer is caused by
smoking and alcohol use
-
Laynx cancer occurs mainly in ___
men
-
s/s of larynx cancer
- hoarseness *** first symptom
- change in voice
- pain
- sob
- cough
- dysphagia
- airway obstruction
-
Dx test for larynx cancer
-
Pt teaching for larynx cancer
- how to care and protect new trache
- avoiding pollutants
- may be taught to communicate by burping
-
interventions for larynx
- radiation
- chemo
- laryngectomy
-
Highest priority after laryngectomy?
maintain patent airway
-
______Cannot be given after a laryngectomy bc it can depress resp and prevent coughing (needed to move secretions post op)
high dose narcotics
-
what is bronchiectasis
chronic infection causing the dilation of one or more large bronchi resulting in airway obstruction
-
What causes bronchiectasis
-
-
s/s of bronchiectasis
- sob
- cough
- large amounts of sputum
- anorexia (cant eat and breathe at the same time)
- recurring infection
- clubbing of nails
- crackles/wheezing
-
interventions for bronchiectasis
- antibiotics
- mucolytics
- bronchodilators
- CPT
- o2
- surgical resection
-
describe pneumonia
- acute lung infection caused by inflammation and alveolar damage.
- alveoli fill with exudate reducing the surface area fro gas exchange
-
pneumonia is caused by?
- screp pneumoniae
- viruses
- fugus
- aspiration
- Ventilator-associated pneumonia
- chemicals
-
Groups at risk for contracting Pneomonia
- *Immunocompromised*
- very young
- elderly
- hospitalized
- intubated
-
How to prevent Pneumonia?
- vaccinations
- coughing and deep breathing
- handwashing
- oral care and suctioning for VAP
-
s/s of pneumonia
- chest pain
- fever chills
- cough, sob
- yellow,rusty, bloody sputum
- crackles/wheezing
- malaise
-
what is hemoptysis
bloody sputum
-
S/s of pneumonia in the elderly
- confusion
- lethargy
- fever
- dyspnae
-
complications of pneumonia
- pleurisy
- pleural effusion
- atelectasis
- spread of infection
-
dx test for pneumonia
- CXR
- sputum cultures
- blood culures (tests for symstemic infection)
-
interventions for pneumonia
- po or iv antibiotics
- antivirals
- bronchodilators
- expectorants
- O2
- fluids
- wbc and abg levels
-
What is TB
- acid-fast bacillus implant on (infect) bronchioles or alveoli.
- immune system can typically keep it in check but it can form tubercles (pouch of inactive bacteria).
- 10-15% of infected persons become ill
**is the number one WORLD WIDE killer of adults and children
-
people are risk for tb
- elderly
- alcoholics
- high density populations
- new immigants
- those with HIV are at greatest risk (immunocompromised)
-
s/s of TB
- cough
- hypotysis
- night sweats
- anorexia and weight loss
- low-grade fever
- sob and chest pain (late symptom)
-
interventions for tb
- combo drugs for 6-24 months
- occasional surgical removal
- isolation
-
how long do tb pts have to take medications for
6-24 months
-
what medications are commonly given to treat TB
isoniazid and Rifampin
-
Intervention for Impaired Gas exchange
- lung sounds
- sob
- mental status
- PO2 and ABGs
- Fowlers positioning or good lung down
- give O2
- teach diaphoretic breathing or pursed lip breathing
- discourage smoking
- **Difficulty breathing and new onset of confusion should be corrected immediately**= hypoixa= potentially life threatening
-
if a tb pt has to leave their isolated room you should?
put a mask on THEM
-
pt teaching for TB pt
- take drugs as scheduled to prevent resistant bacteria
- avoid spreading disease to others
- *maintain isolation precaution*
-
How to prevent tb
- clean well ventilated living areas
- isolation for infected individuals
- high efficiency filtration masks
- gowns, gloves, goggles
-
Describe restrictive disorders
- reduce compliance
- limit chest wall expansion
-
describe pleurisy
inflammation of visceral and parietal pleurae causing friction on inspiration caused by pneumonia, tb, or cancer.
-
dx test for pleurisy
- CXR
- CBC
- Forced Vital capacity/ forced expiratory volume in one second.
-
s/s of pleurisy
- sharp pain on inspiration
- shallow breathing
- fever increase wbc
- friction rub
-
complications of pleurisy
pleural effusion caused by serous fluid production from inflamed plueral membranes.
-
interventions for pleurisy
- pain meds (nsaids or opioids)
- treat cause
-
What is pleural effusion
excess fluid between visceral and parietal pleurae that cannot be reabsorbed causing a collapsed lung.
-
what caused pleural effusion?
- transudative fluid from heart failure or liver/kidney disease
- exucative fluid from pneumonia, tb, or cancer
-
what is transudative fluid?
leakage from the capillaries
-
what is exudative fluid?
leakage from the cells around the capillaries
-
dx test for pleural effusion
-
s/s of pleural effusion
- sob
- pain
- cough
- tachypnea
- diminished lung sounds (listening to sounds through all the liquid; underwater sounding)
-
interventions for pleural effusion
- treat underlying cause
- pain meds
- thoracentesis/ chest tube
-
what pulmonary fibrosis
alveoli become thick and scarred making gas exchange difficult
-
what causes pulmonary fibrosis
- heredity
- virus
- environmental/occupational exposure
- immune dysfunction
- idiopathic
-
dx test for pulmonary fibrosis
- CXR
- CT
- ABG
- Bronchoscopy
- lung biopsy
- antinuclear antibodies tier
-
s/s of pulmonary fibrosis
- progressive SOB
- crackles
- chronic cough
- fatigue
- clubbing
-
interventions for pulmonary fibrosis
- smoking cessation
- oxygen
- flu/pneumonia vaccination
- pulmonary rehab
- lung transplant
- *pirfenidone and nintendanib ** -reduce disease progression
-
what antifobrotic drugs are used to treat pulmonary fibrosis?
Pirfenidone and Nentendanib
-
what caused atelectasis
collapse of alveoli caused by hypoventilation
-
s/s of atelectasis
- fine crackles
- diminished breath sounds
- sob
-
interventions for atelectasis
-prevention by: cough and deep breath, incentive spirometer, turn, ambulate
-
Describe obstructive disorders
airway obstruction and difficult exhalation
-
what is COPD
- combo of chronic bronchitis and emphysema
- chronic airflow limitation
-
describe chronic bronchitis
chronic inflammation,with low-grade infection,causing hypertrophies mucous glands in the bronchi resulting in impaired ciliary function and airway clearance.
-
how is chronic bronchitis diagnosed?
pt is ill 3 months a year for two years
-
what is emphysema?
- destruction of alveolar walls caused by the loss of elastic recoil resulting in air trapping and impaired gas exchange.
- Causes damage to pulmonary capillaries
-
What causes emphysema
- smoking
- passive smoke exposure
- pollutants
- familial predisposition
- alpha1 AT deficiency
-
COPD prevention
No Smoking
-
s/s of COPD
- cough
- sputum
- cob
- prolonged expiration
- barrel chest= air trapping
- activity intolerance
-
s/s of bronchitis
- wheezing/crackles
- chronic crackles
- sob
- thick/tenacious sputum
- increase risk for infection
- mucous plus
-
s/s emphysema
- diminished breath sounds
- sob
- progressive activity intolerance
-
complications for COPD
- Cor Pulmonale-abnormal enlargement of the right side of the heart
- Pneumothorax
- weight loss
- resp failure
-
dx test for COPD
- CXR
- CT
- ABG
- CBC
- Alpha1 AT level
- spirometry
- sputum analysis
-
interventions for COPD
- Stop smoking!!
- o2
- rehab
- surgery-lung reduction
- endobronchial valve to block off part of lung
- mechanical ventilation
- end of life planning
- chroninc o2 level of less than or equal to 88% should have o2 at home
- meds and nebulizer
-
Special considerations for COPD
- o2 is usually 1-2 L/minute; anything higher is suspicious and can reduce hypoxic drive
- iv morphine can help reduce dyspnea and encourage more efficient respirations
-
S/s of impaired tissue perfusion?
- rapid Pulse
- rapid RR
- decreased Bp
-
What is asthma
- inflammation of bronchial mucosa causing the smooth muscle to spasm.
- results in air trapping
- usually is reversible by airway remodeling
-
causes of asthma
- heredity
- allergies
- pollution
- smoke
-
triggers for asthma
- smoking
- allergies
- infection
- sinusitis
- exercise
- stress
- some meds
-
s/s of asthma
- dyspnea
- whezing
- cough
- sputum
- use of accessory muscles
-
dx tests for asthma
- hx, physical exam
- spirometry
- ABGs
- allergy and blood tests
-
interventions for asthma
- monitor peak flow meter by keeping daily record. important for treatment plans
- avoid triggers and smoking
-
what bronchodilators are used to treat asthma
- albuterol (saba)
- Leuko triene inhibitors: ZafirLUKAST and MonteLUKAST (laba)
-
What corticosteroids are used to treat asthma
solu-medrol
-
complications of asthma
status asthmaticus: sever, sustained asthma, worsening hypoxia,resp alkalosis turns to acidosis, may be life threatening
-
what is cystic fibrosis
exocrine gland disorder(blocked pancreatic enzymes) that causes thick tenacious secretions.is genetic
-
s/s of cystic fibrosis
- thick sputum
- frequent resp infections
- finger clubbing
- malabsorption
- fatty stinky poops
- death from resistant infections
-
dx testing for cystic fibrosis
- genetic testing (both parents have to be carriers)
- blood immunoreactive trypsinogen
- sweet chloride test
- CXR
- spirometry
- GI testing
-
interventions for cystic fibrosis
- antibiotics
- bronchodilators;steroids
- CPT
- expectorants
- mucolytics
- inhaled HYPERTONIC saline (cf causes nacl imbalance)
-
medications used to treat cystic fibrosis
- Doenase Alfa (pulmozyme)
- ivacaftor
- pancrease;viokase
- ibuprofen to slow lung deterioration
-
what causes a pulmonary embolism
- **dvt=most common
- fat emboli or amniotic fluid emboli
-
how to prevent pulmonary embolism
- regular ambulation
- prompt treatment for DVT
- anticoagulant meds for high risk pts (warfarin/enoxaparin/heparin)
-
s/s of PE
- sudden dyspnea
- tachycardia
- tachynpea
- cough
- crackles
- hemoptysis
-
what do you do if pt has PE?
Stay wthi pt, yell for help and start O2 therapy. have somone call the doc
-
dx test for PE
- D-dimer
- Spiral ct
- Lung scan
- Angiogram
-
Interventions for PE
- thrombolytics
- anticoagulants
- o2
- embolectomy
- jugular or femoral filter
-
what is pneumothorax
air in the intrapleural space causing collapse of the lungs
-
s/s of pneumothorax
- shallow rapid resp
- asymmetrical chest expansion
- dyspnea
- absent breath sounds
-
s/s of TENSION pneumothorax
- tracheal deviation
- bradycardia
- cyanosis
- shock and death
-
dx test for Pneumothorax
- hx and exam
- ultrasound
- CXR
- ABG,S PO2
-
interventions for pneumothorax
- monitor abgs and resp status
- chest tube
- pleurodesis (scarring of pleura)
-
What causes rib fractures
-
how do you care for rib fractures
- control pain
- encourage coughing and deep breathing
- promote adequate vent
-
what cause flail chest
- multiple rib fx
- the ribcage is not able maintain bellows action (chest sinks in on exhalation)
-
what is acute resp failure
hypoventilation and the inability to maintain ABGs caused by COPD, aspiration, neuro disease, opioid overdose
-
s/s of acute resp failure
- worsening ABG
- increasing dyspnea
- restlessness/ confusion
- lethargy
- coma and death
-
dx test for Acute resp failure
ABGs (PAO2 less than 60; PACO2 moore than 50)
-
Normal bleb size for tb test on someone who ISNT immunocompromised or a carrier for tb
up to 10mm
-
normal bleb size on a tb skin test for the immunocompromised
between 5-9mm
-
interventions for acute resp failure
- o2 to maintain sat of 88-92%
- bronchodilators
- correct cause
- intubation and vent (check advanced directive)
-
what is acute resp distress syndrome (ards)
- alveolocapillary membrane damage
- pulmonary edema
- alveolar collapse
- lungs stiff and noncompliant
- lungs may hemorrhage
-
what causes ARDS
acute lung injury
-
s/s of ARDS
- Dyspnea
- increased RR
- fine crackles
- resp acidosis
- death rate= 40%***
-
-
Interventions for ARDS
- o2
- intubation
- mechanical vent
- supportive care
-
what causes lung cancer?
(80-90% of lung cancer is from smoking; smokers 13xs more likely to develop cancer than non-smokers)
- smoking
- environmental tobacco smoke
- asbestos
- arsenic
- pollution
-
s/s lung cancer
- none until late
- productive cough
- infections
- dyspnea
- hemoptysis
- anorexia
- pain
- wheezing/stridor
-
-
complications of lung cancer
- pleural effcusion
- superior vena cava syndrome
- ectopic hormone secretions
- metastasis
-
interventions for lung cancer
- staging the cancer
- chemo (pallative)
- radiation (pallative)
-
what is pneumonectomy
removing whole lung
-
what is lobectomy?
removing whole lobe of lung
-
what is resection of the lung
removing a small wedge of lung or segmental=removing segments of the lung.
-
post op care for thoracic surgery?
- icu
- monitor vs, o2, hemodynamic parameters and lung sounds
- ventilator
- chest tubes
-
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