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| Reason for seeking healthcare History of health care concern Medical history, including allergies Medications both prescribed and over the counter medications and herbal/dietary supplements Family history of respiratory diseases such as asthma, cystic fibrosis, emphysema Lifestyle and health habits: A current or past smoker or exposed to second-hand smoke; eating habits that reflect any recent weight gain or loss; home conditions that include pets or presence of allergens; and occupational history that may reflect exposure to toxins or pollutants. Calculate pack-year history which is the number of packs of cigarettes smoked per day by the number of years smoked. |
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| Signs and Symptoms for Resp |
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Definition
Dyspnea - Causes of dyspnea can be related to diseases of cardiac, neurological, muscular, respiratory, and hematological origin.
- Ask the patient what are the circumstances triggering dyspnea and if the symptom has recently increased or decreased.
Cough -The characteristics of cough can help point to the cause of cough.
- Ask the patient about the frequency and characteristics of the cough.
Sputum - Ask the patient the color, quality, and quantity of sputum.
- Ask if there has been a recent change in the sputum characteristics.
Chest Pain - The lungs and visceral pleura lack sensory nerves. Pain arises from inflammation of the parietal pleura, intercostal muscles, ribs, or the skin.
- Ask the patient if the pain is made worse with inspiration.
Hemoptysis - Hemoptysis is the expectoration of blood from the respiratory tract and usually is frothy and accompanied by sputum. - The causes can be pulmonary, cardiac, or hematological in origin.
- Assess the color and amount of blood produced. |
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| During the physical assessment of the patient with a respiratory issue, the nurse must include the following: |
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Definition
- Inspection of upper airway structures such as nose, mouth, and pharynx.
- Thoracic structure and respiratory excursion: Observe the chest for symmetry with an easy breathing pattern without use of accessory muscles or pursed-lip breathing. - Auscultate the breath sounds: This method should be a systematic comparison of one lung to the other. Findings are recorded as clear, crackles, rhonchi, and wheezes |
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| Breathing Patterns and Rates |
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Definition
- Eupnea: Normal and quiet respirations
- Bradypnea: Abnormally slow respiratory rate
- Tachypnea: Rapid respiratory rate
- Hyperpnea: Increased respiratory depth and rate
- Apnea: Period of cessation of breathing
- Cheyne-Stokes: Regular cycle where rate and depth of breathing increases followed by decreasing rate and depth until brief episode of apnea.
- Biot’s or cluster breathing: Periods of normal breathing followed by varying periods of apnea |
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| Breath sounds can be classified as: |
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Definition
- Crackles: Crackles are soft, high-pitched popping sounds heard on inspiration and/or expiration and are produced by fluid in the alveoli.
- Wheezes: Wheezes are high-pitched whistle-like sounds heard on inspiration and expiration and are caused by air passing through narrowed or partially occluded passages.
- Sonorous wheezes: Sonorous wheezes (rhonchi) are deep, low-pitched sounds heard during expiration and are caused by air moving through narrowed passages.
- Pleural friction rub: Pleural friction rub is a harsh grating sound like two pieces of leather being rubbed together and may be heard on inspiration and expiration.
- Friction rubs are related to loss of lubricating pleural fluid and secondary to inflammation |
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| respiratory issues. Some of the common diagnostic studies are: |
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Definition
- pulmonary function tests,
- arterial blood gas studies,
- pulse oximetry, and
- radiological studies (such as, chest x-ray, lung scans, and computerized tomography). |
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- a measure of hydrogen ions in the blood.
- The normal human blood value is slightly basic with a pH between 7.35 and 7.45.
- The cellular enzymatic activities depend on a pH within a 7.35 to 7.45 level.
- Acidemia is when the blood pH is below 7.35.
- Alkalemia is when the blood pH is above 7.45. |
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- This is a measure of the partial pressure of oxygen dissolved in the blood.
- It reflects how well oxygen can move from the airspace in the lungs into the blood |
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Definition
- This is a measure of the partial pressure of carbon dioxide dissolved in the blood.
- The value reflects the ability of the body to eliminate the byproducts of carbohydrate metabolism |
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Term: Respiratory acidosis
Cause: Hypoventilation
Examples: Chronic obstructive pulmonary disease (COPD), sleep apnea, over sedation, head trauma, neuromuscular disorders, pneumothorax |
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Definition
| Value: PaCO2 greater than 45 |
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Term: Respiratory alkalosis
Cause: Hyperventilation
Examples: Hypoxemia, sepsis, pregnancy, brainstem tumors, anxiety |
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Definition
| Value: PaCO2 less than 35 |
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Term: Metabolic alkalosis
Cause: Loss of acid; Increase of HCO3
Examples: Vomiting, diuretics, potassium deficiency, bicarbonate ingestion |
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Definition
| Value: HCO3 greater than 26 |
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Term: Metabolic acidosis
Cause: Gain of an acid that the kidney is unable to excrete or HCO3 lost and kidney is unable to regenerate
Examples: Diarrhea, drainage of pancreatic juices, lactic acidosis, uremia, ketoacidosis, drugs— methanol, paraldehyde, salicylates, ethylene glycol |
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Definition
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| the body’s response to maintain near normal pH. Compensation can be of two types: |
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Definition
- Respiratory disturbances (PaCO2) - leads to compensation by the kidneys. This may take days.
- Metabolic disturbances (HCO3) - leads to compensation by the respiratory system . This occurs within one hour. |
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| could indicate an underlying respiratory disorder |
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Definition
- Fatigue
- shortness of breath,
- dry cough,
- heart rate, and respiratory rate are abnormal |
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| Respiratory alkalosis with hypoxemia. |
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Definition
Interpret the results of an arterial blood gas test that was obtained:
- pH = 7.46;
- pCO2 = 32;
- HCO3 = 26;
- PaO2 = 55;
- oxygen saturation = 88% |
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| Respiratory alkalosis with hypoxemia |
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Definition
- pH is greater than 7.45 which makes this an alkalosis. (normal arterial pH is 7.35 to 7.45).
- pCO2, which is 32, is low (normal is 35 to 45). pCO2 reflects respiratory alkalosis.
-The HCO3, which reflects metabolic processes, is normal at 26.
- The next point to be noted is an oxygen saturation of 88% which is hypoxemia. |
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| ineffective breathing pattern |
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Definition
| is inspiration and/or expiration that do not provide adequate ventilation. A sign or symptom of this condition is the respiratory rate (tachypnea). |
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Definition
- oropharyngeal
- nasopharyngeal
- endotracheal tube
- tracheostomy |
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Definition
| is inserted through the mouth to keep the tongue from occluding the upper airway. It is used in the unconscious patient who breathes spontaneously. Potential complications include vomiting and aspiration with an intact gag reflex and worsening of airway obstruction when improperly placed |
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Definition
| is inserted through the nare and ends in the back of the pharynx. It is used in the conscious or unconscious patient who requires frequent nasotracheal suctioning or in facial and jaw fractures. Potential complications include nasal trauma and nosebleeds |
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| is inserted through the nose or mouth into the trachea. It is used to protect the airway. It requires expertise for insertion and maintenance. Some of the potential complications include aspiration, dysrhythmias, patient discomfort, and infection |
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Definition
| is a temporary or permanent surgically inserted tube in the trachea. It is used to maintain an airway by bypassing an upper airway obstruction, removing secretions, and permits long term use of mechanical ventilation |
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| Patient care considerations when a patient has an artificial airway include the following activities: |
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Definition
- Auscultate breath sounds.
- Monitor oxygen saturation.
- Ensure inspired oxygen is warmed and humidified.
- Maintain skin integrity.
- Promote nutrition and hydration.
- Assess for signs/symptoms of infection.
- Suction as needed per assessment findings.
- Provide frequent mouth care |
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| Non-invasive ventilation is |
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Definition
| a ventilation modality for preterm infants, children, and adults that supports breathing without using an invasive artificial airway |
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| Acute Use (Continuous, Short Term Use) of CPAP/BPAP |
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Definition
- Mask requires proper fit.
- Patient requires frequent monitoring of response to therapy.
- Mask needs to be removed if patient nauseated (risk for aspiration).
- Skin assessment around mask.
- Need to address nutritional needs |
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| Chronic Use (Night Time for Sleep Apnea) CPAP/BPAP |
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Definition
- Mask requires proper fit.
- Ongoing follow-up care for reassessment/readjustment of settings.
- Effective in relieving symptoms and reversing some complications of sleep apnea. - Patient/partner education.
- Can be expensive (insurance coverage). |
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Definition
- Insufficient physiological energy to endure daily activities - Activity intolerance
- Excess or deficit in oxygenation and/or carbon dioxide elimination - Impaired gas exchange
- Inspiration and/or expiration that does not provide adequate ventilation - Ineffective breathing pattern
- Inability to clear secretions from the respiratory tract to maintain a clear airway. - Ineffective airway clearance |
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Definition
is a chronic inflammatory disease of the airways that causes hyper responsiveness, mucosal edema, and mucous production.
- Signs and symptoms include cough, chest tightness, wheezing, and dyspnea.
- it is the most common chronic illness of childhood, but can occur at any age. |
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Definition
is classified by severity into four groups: intermittent, mild persistent, moderate persistent and severe persistent.
- The disease responds well to treatment when the individual adheres to the prescribed plan of care.
- Common triggers for the symptoms include airway irritants, exercise, stress, rhinosinusitis with post nasal drip, medications, viral respiratory tract infections, and gastroesophageal reflux |
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Definition
| includes the nose, sinuses, pharynx, larynx, trachea, and bronchi |
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Definition
- asthma
- rhinitis
- rhinosinusitis
- pharyngitis
- laryngitis
- sleep apnea
- upper airway obstruction |
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Definition
- Pathophysiology: Reversible and diffuse airway inflammation that leads to airway narrowing. The inflammation causes bronchoconstriction, airway edema, airway hyper responsiveness, and airway remodeling.
- Risk factors: Common triggers are pet dander, dust, changes in air quality, cold air, chemicals, strong odors, tobacco smoke, exercise, pollen, respiratory infections, nonsteroidal antiinflammatory medications.
- Causes: Acute bronchoconstriction, airway edema, and mucus hypersecretion occur in response to chemicals released in response to the allergen.
- Signs/symptoms: Cough, shortness of breath that worsens with activity, wheezing.
- Diagnostic tests: Allergy testing, peak flow measurements.
- Treatment: Prevention, Medications for acute episodes, Medications to prevent acute episodes
- Potential complications: Status asthmaticus, respiratory failure, pneumonia, death. |
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Definition
- Pathophysiology: Inflammation and irritation of the mucous membranes of the nose.
- Risk factors: Prolonged use of decongestant nasal drops or sprays, females (hormonal changes), exposure to fumes in the workplace, chronic illness.
- Causes: Allergies (more likely in patients under the age of 20), environmental irritants (smog, second hand smoke, strong perfumes), weather changes, infections (viral or common cold), foods, medications (nonsteroidal anti-inflammatory, beta blockers, antidepressants), pregnancy, stress.
- Signs/symptoms: Stuffy and runny nose, post-nasal drip.
- Diagnostic tests: Assess for underlying allergy or sinus condition.
- Treatment: Avoid triggers, symptom relief.
- Potential complications: Nasal polyps, chronic sinusitis, middle ear infections.
- Patient education: Reduce exposure to allergens and irritants, hand hygiene, cough etiquette, yearly influenza vaccination for persons six months and older |
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Definition
- inflammation of the paranasal sinuses and nasal cavity.
- Pathophysiology: Bacterial or viral infection that usually follows a viral upper respiratory infection or cold. When the nasal passages are congested or obstructed sinus cavity cannot drain.
- Risk factors: Allergies/hay fever, nasal polyps, deviated nasal septum, tooth infection, enlarged adenoids (children), cystic fibrosis, gastroestophageal reflux disease (GERD).
- Causes: Viral, bacterial, or fungal infection.
- Signs/symptoms: Difficulty breathing through nose, drainage of thick purulent mucus from nose or back of throat, pain/pressure around sinuses, cough that is worse at night.
- Diagnostic tests: Physical exam, possible allergy testing.
- Treatment: Symptom relief - saline nasal sprays, nasal corticosteroids, decongestions. Antibiotics are generally not needed to treat acute symptoms.
- Potential complications: Asthma attack, chronic sinusitis, meningitis, vision problems, ear infection |
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Definition
- is inflammation of the pharynx and/or tonsils.
- Pathophysiology: Usually infectious with most being viral in origin. The virus or bacteria invade the pharyngeal mucosa causing a local inflammatory response.
- Risk factors: Occurs with greater frequency in children aged four to seven years.
- Causes: 80% to 90% are viral.
- Signs/symptoms: Fever, sore throat, anorexia.
- Diagnostic test: Rule out streptococcal infections.
- Treatment: Usually self-limited and resolves in three to four days. Promote rest, comfort (warm saline gargles), reduce body temperature (acetaminophen or ibuprofen), promote hydration (do not force fluids), prevent spread of infection. Antibiotics for bacterial infection.
- Potential complications: Tonsillitis in children |
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Definition
is an inflammation of the larynx.
Pathophysiology: Vocal cords become inflamed and irritated. The swelling distorts sounds produced as air passes through the vocal cords.
Risk factors: Patients who are malnourished, immunosuppressed, or smokers. Occurs more frequently in winter months.
Causes: Usually triggered by viral infection or vocal strain. May also be caused by allergies, gastroesophageal reflux disease (GERD), and croup.
Signs/symptoms: Hoarseness or voice loss, sore throat, “tickle” in the throat, and dry cough.
Diagnostic tests: May need referral to a specialist if condition is ongoing.
Treatment: Rest, vocal rest, inhalation of cool steam.
Potential complications: May be more severe with very young or the elderly. Rarely severe respiratory distress may develop |
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Definition
Pathophysiology: Intermittent compressed upper airway during sleep that causes intermittent apnea.
Risk factors: Middle and older adults, obesity, male gender, smoking, use of alcohol, sedatives or tranquilizers, family history of sleep apnea, children with enlarged tonsils.
Causes: The muscle tone is reduced during sleep. The upper airway collapses when a small amount of negative pressure is generated during inspiration. With repetitive apnea episodes, hypoxia and hypercapnia then triggers the sympathetic nervous system.
Signs/symptoms: Loud snoring, excessive daytime sleepiness, morning headache, witnessed episode of apnea during sleep, memory or learning problems, personality changes.
Diagnostic tests: Polysomnographic (overnight sleep studies).
Treatment: Weight loss, avoidance of alcohol and hypnotics, sleep on side, smoking cessation, continuous positive airway pressure (CPAP), or bilevel positive airway pressure (BiPAP).
Potential complications: Diabetes mellitus type 2, hypertension, increased risk of heart failure, stroke and cardiac dysrhythmias, sleeping partner problems |
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Definition
Pathophysiology: A foreign body can settle in the larynx, trachea or bronchus. The larger objects tend to be lodged in the larynx. In adults bronchial foreign bodies tend to lodge in the right main stem bronchus; and in children can be either right or left bronchus. A severe allergic reaction or croup can also cause edema obstructing the upper airway.
Risk factors: Not completely chewing food; running when eating; alcohol. Causes: Most foreign body aspirations occur in children younger than 15 years. Signs/symptoms: Initially will see choking, coughing, or airway obstruction. Use of accessory muscles to maximize airflow signals high risk of respiratory collapse. The patient may become asymptomatic as the reflexes relax. Foreign bodies in the lower airways can produce erosions or obstructions leading to pneumonia or abscess. Diagnostic tests: X-ray for lower airway obstruction.
Treatment: Acute airway obstruction—if the person is unable to speak and has a complete obstruction, Heimlich maneuver can be life saving. An immediate tracheotomy would be required for complete airway obstruction. For severe allergic reactions, the treatment includes administration of epinephrine, a corticosteroid, and a histamine (H2) antagonist such as famotidine (Pepcid). For partial obstruction, removal by bronchoscope or surgery.
Potential complications: Brain damage, death |
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Definition
| Pets, wood smoke, perfumes, smoking, and cold air are triggers for |
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