Term
| upper and lower respiratory tract |
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Definition
-nasal cavity to lungs
-chest shape: 1:2
-loud over trachea, soft over lobes
-lungs: alveoli, bronchi, mucus, cilia
-palpate sinuses: trachea should be midline (if not, collapsed lung)
-percuss with COPD: hyperresonance |
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Term
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Definition
| best auscultated anteriorly |
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Term
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Definition
| decrease in diameter of airways due to contraction of smooth muscle |
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Term
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Definition
| increase in diameter of airways due to relaxation of smooth muscle |
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Term
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Definition
| small sacs; primary site of gas exchange |
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Term
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Definition
-excreted with inhalation and exhalation
-helps prevent alveolar collapse; |
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Term
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Definition
-at risk for alveolar collapse due to anesthesia
-pts taught to deep breathe even though it hurts (pain and cough);
-incentive spirometer (breathe in, 10x an hour)
-inhale: diaphragm down
-exhale: diaphragm up |
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Term
| what can change movement of diaphragm? |
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Definition
-phrenic nerve controls
-ALS
-COPD
-obese
-ascites on the liver can compress |
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Term
| blood supply to lungs (pulmonary circulation) |
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Definition
| r ventricle, pulmonary artery, pulmonary capillaries, alveoli, oxygen/ co2 occurs, pulmonary veins, l atrium, l ventricle, aorta, systemic arteries, capillary networks, r atrium via vena cavae.... |
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Term
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Definition
-smoking cessation
-can also affect lungs: flu, allergies, bronchitis, pneumonia
-wash hands
-if you're immunocompromised... stay home! (HIV, cancer, children, chronic steroid usage, new organ patients)
-deep breathe post op |
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Term
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Definition
-ventilation
-compliance
-diffusion
-oxy-hgb dissociation curve
-ABGs
-mixed venous blood gases
-oximetry |
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Term
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Definition
-chemoreceptors: PaCo2 & pH
-mechanical receptors: stimulated by irritants, stimuli or muscle distortion |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| respiratory defense mechanisms |
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Definition
--natural defense mechanisms against virus and bacteria but if you are immunocompromised you're more @ risk for infection
-filtration of air
-mucociliary clearance system
-cough relfex
-reflex bronchostriction (wotks to prevent irritants from entering lungs)
-alveolar macrophages (primary defense mechanism @ alveolar level) |
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Term
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Definition
-chest wall stiffness
-decreased elastic recoll
-decreased AP:T diameter
....leads to:
-kyphosis (hunchback)
-barrel chest
-decreased deep breathing
-diminished breath sounds (esp @ bases) |
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Term
| s/s of inadequate oxygenation |
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Definition
-CNS: apprehension, restlessness, confusion
-respiratory: tachypnea, dyspnea on exertion/rest, use of accessory muscles, retraction of intercostal muscles
-cardiovascular: tachycardia, mild HTN, PVCs, cyanosis
-other: diaphoresis, decreased urinary output, fatigue |
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Term
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Definition
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Term
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Definition
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Term
| critical values for O2 sat |
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Definition
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Term
| ausculatory sounds and locations |
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Definition
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Term
| plueritic vs. cardiac pain |
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Definition
| ask pt to hold their breath... if it goes away it is most likely pleuritic |
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Term
| cues to respiratory probs |
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Definition
| SOB, wheezing, pleuritic chest pain, cough, sputum production, hemoptysis, voice change, fatigue |
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Term
| venous vs. arterial blood |
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Definition
| venous is dark; arterial is bright; |
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Term
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Definition
-inspection
-palpation
-fremitus
-percussion
-auscultation
-egophany (ee)
-bronchophany (ninety nine)
-whispered pectoriloquy (one, two, three) |
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Term
| normal and abn lung assessment |
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Definition
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Term
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Definition
| must be NPO, very high risk of aspiration since the gag reflex is numbed during the procedure |
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Term
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Definition
-often sports-related trauma
-unilateral, bilateral, complex
-check for CSF drainage, septal deviation, hemorrhage internally (clear drainage should be checked for glucose)
-maintain airway, reduce edema, prevent complications, emotional support |
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Term
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Definition
causes...
-prolonged bleeding time
-HTN (difficulty controlling)
-keep quiet, lean forward in high fowlers, pressure 10-15 mins, ice, guaze, med assistance
-anterior or posterior packing
-watch for frequent swallowing (may vomit blood)
-ALWAYS ASSESS AIRWAY 1ST before blood
-nasal packing may put pt @ risk for aspiration
-sneeze with mouth open |
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Term
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Definition
-acute/seasonal - hay fever (pollen from grass, weeds)
-chronic - repeated episodes. perennial, associated with PND; house dust, foods, animal dander, numerous allergens (increased risk of nasal polyps- non malignant growth)
-s/s: pale (gray to dull red), boggy, swollen, mucous membranes with copious watery nasal discharge |
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Term
| nursing care for allergic rhinitis |
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Definition
-antihistamines, intranasal corticosteroids, and leukotriene receptor antagonists
-second-generation antihistamines over first (2nd- non-drowsy effects)
-start therapy 2-3 wks prior to pollen seasons
-flonase, singulair, claritin, benadryl (know what they are/ what they treat) |
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Term
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Definition
-common cold
-s/s: low grade fever, headache, malaise, and muscle aches; red, swollen nasal membranes with rhonorrhea -> micopurulent drainage (superimposed bacterial infection) |
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Term
| nursing care for viral rhitis |
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Definition
-rest, fluids, proper diet, antipyretics, analgesics
-superimposed bacterial infection: temp greater than 100.4, purulent drainage, tender/swollen glands, sore/ red throat -> antibiotics (even though antibiotics do not work for viruses) |
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Term
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Definition
-assess/teach flu patients for signs of pnuemonia
-highly communicable (2-3 days after onset of s/s)
-cough will linger (esp in elderly) |
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Term
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Definition
-vaccination: live/attenuated and inactivated
-live: nasally to healthy, non-pregnant people
-avoid crowded places late fall/ early spring
-avoid contact with children (in daycare) |
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Term
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Definition
-can follow an URI
-sinus passages narrowed/blocked by inflammation or hypertrophy
-fluids harbor bacteria
-pain over sinus areas, PND, nasal obstruction, congestion, fever, and malaise
-looks sick
-occurs when mucosa becomes hypertrophied allowing a place for bacteria to grow
-will often follow a head cold |
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Term
| nursing care for sinusitis |
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Definition
-amoxicillin 10-14 days
-oral/topical decongestants
-fluids, hot shower (humidification effects)
-blow nose
-nasal irrigations
-saline nasal sprays
-want to start a few weeks prior to "allergy season" |
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Term
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Definition
-episodes greater than 10 seconds
-obese men, but may be slender
-incidence increases with age
-during REM, pharynx collapses, tongue falls into pharynx -> snoring
-snorting, then breathing
-fat neck
-daytime sleepiness, difficulty concentrating
-stop breathing, snore, start breathing |
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Term
| nursing care for sleep apnea |
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Definition
-avoid sedatives/ alcohol 3-4 hrs before sleep
-lose weight
-oral appliance
-CPAP (high pressure/ hard to exhale against) DOES NOT PROVIDE O2
-BiPAP (adjusts - high pressure inhale, low pressure exhale) DOES NOT PROVIDE 02
-surgery for severe cases
-encourage head elevation so that pharynx is not occluded |
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Term
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Definition
-inflammation of bronchi
-infection after URI
-COPD may have chronic
-viral and bacterial
-persistent cough, clear production (most common problem)
-fever, headache, malaise, SOB with exertion
-elevated temp, pulse, and RR, normal of wheezing breath sounds
-CXR
-ATBX not necessary unless prolonged
-COPD gets empiric ATBX (more likely viral) |
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Term
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Definition
-one of the greatest leading causes of death in older adults
-non-infection causes: inhalation, radiation, aspiration
-infectious causes
-bacteria: streptococcus, staphylococcus, mycoplasma, chlamydia, |
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Term
| factors predisposing to pneumonia |
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Definition
-defense mechanisms incompetent or overwhelmed
-decreased consciousness
-tracheal intubation
-air pollution, cig smoke, URIs, aging
-almost all factors are a result of decreased LOC or immunocompromised |
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Term
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Definition
-CAP
-HAP
-fungal
-aspiration
-opportunistic (pneumocystis jiroveci [carinii] or PCP) |
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Term
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Definition
-sudden onset (greatest complication of the flu)
-fever/chills
-headache
-SOB
-cough (productive)
-pleuritic chest pain
-elderly may be confused (hypoxic)
-may be more gradual |
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Term
| physical examination of pneumonia |
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Definition
-dullness to percussion
-increased fremitus
-bronchial breath sounds
-crackles |
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Term
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Definition
-aggressive antibiotics
-o2 therapy
-chest physiotherapy
-patient education
-increased fluids
-rest
-antipyretics
-analgesics |
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Term
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Definition
-collection of fluid in pleural space
-sign of serious disease
-clinical manifestation: dyspnea, decreased movement of chest wall, pleuritic pain, dullness to percussion, absent or decreased breath sounds
-thoracentesis
-treat underlying cause
-chest tube, antibiotics |
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Term
| to be concerned about with chest tubes... |
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Definition
1) pre medicate for pain before chest tube
2) monitor resp status
3) evaluate sub q edema on chest tube site (swelling/ crackling) - could indicate collapsed lung
4) keep drainage below chest
5) do not change dressing unless ordered
**keep vaseline gauze by bedside incase dressing comes off |
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Term
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Definition
-inflammation of pleura
-common causes: PNX, TB, chest trauma, pulm infarctions, and neoplasms
-abrupt, sharp pain
-hurts with inspiration (hold breath)
-treat underlying cause and give pain meds
-splint when coughing |
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Term
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Definition
-scar tissue attached to lungs r/t trauma or inflammation/irritation
-risks: environmental or occupational inhalation, smoking, chronic aspiration
-clinical manifestations: DOE, non productive cough, inspirational crackles with or without clubbing
-CXR, CT, PFTs
-5 year survival rate 30-50%
-steroids, imuran, cytoxan, colchicine |
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Term
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Definition
-chronic, multisystem granulomatous disease primarily affects lungs, but can manifest in other organs
-familial, african-americans more at risk
-pulmonary fibrosis
-steroids for treatment
-ibuprofen
-PFTs, CXR, CT
-Reggie White & Bernie Mac |
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Term
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Definition
-blockage of pulmonary arteries by thrombus
-clot travels through venous system into pulmonary circulation
-may rise from DVT
-may be caused from Afib (right side of the heart) or the pelvic veins during childbirth
-also from sudden changes in rate of blood flow (standing after riding in plane) or from fractured long bones
-very risky; can cause sudden death |
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Term
| pulmonary embolism (cont'd) |
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Definition
| common risk factors: immobility, surgery within three months, stroke, paresis, paralysis, Hx of DVT, malignancy, obesity in women, heavy smoking, HTN |
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Term
| pulmonary embolism (cont'd) |
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Definition
-classic triad (occurs in only 20% of people): dyspnea, chest pain, hemoptysis
-prevention is key
-SCDs, early ambulation, prophylactic use of anticoagulant meds
-warfarin (coumadin), heparin, lovenox
-monitor PT/INR for WARFARIN
-monitor PTT for HEPARIN
-vit K antidote for WARFARIN (green leafy veggies)
-protamine sulfate antidote for HEPARIN |
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Term
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Definition
-chronic inflammatory lung disease
-airflow obstruction
-usually reversible
-wheezing, breathlessness, chest tightness, and cough
-risk factors: genetic and environmental
-at night/ early morning
-bronchospasms, edema, and mucous |
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Term
| asthma clinical manifestations |
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Definition
-unpredictable and variable
-minor breathing difficulty due to life-threatening episode
-wheezing, brethlessness, chest tightness, and cough esp at night or morning
-occurs after exposure to allergen
-expirations prolonged
-bronchospasm, edema and mucus in bronchioles produce wheezing, air trapping, and hyperinflation |
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Term
| asthma clinical manifestations (contd) |
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Definition
-feels like suffocating
-signs of hypoxemia: restlessness, anxiety, inappropriate behavior, increase pulse and BP, speak in short 2-3 word sentences, use of accessory muscles, pallor, confusion
-diminished or absent lung sounds |
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Term
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Definition
-peak flow 40% of personal best
-neck vein distension
-diaphoresis
-GERD can trigger an attack
-respirations greater than 30 |
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Term
| diagnostic studies for asthma |
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Definition
-detailed history and phys exam
-PFTs
-PEFR (used more for monitoring than diagnosis)
-CXR
-o2 sat
-allergy skin testing
-eosinophil count and IgE (e: higher with allergies) |
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Term
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Definition
| wheezing, cough, SOB, accessory muscle use, sweating, incr respiratory rate, intercostal muscle use, anxiety, vein distension, limited ability to speak |
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Term
asthma drug therapy
(short-acting beta agonists) |
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Definition
inhaled rescue drugs
-albuterol, proventil, maxair
(most effective for relieving ACUTE bronchospasm) |
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Term
asthma drug therapy
(long-acting beta agonists) |
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Definition
| serevent, foradil (not to be used for first-line treatment) |
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Term
asthma drug therapy
(methylxanthines) |
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Definition
| theophylline, aminophylline (less effective long-term control. theophylline has a narrow margin of safety. monitor blood levels) |
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Term
asthma drug therapy
(cholinergic antagonists) |
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Definition
| atrovent (used in combo with beta- adrenergics. monitor for dry mouth) |
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Term
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Definition
| most potent and effective anti-inflammatory med for asthma |
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Term
asthma drug therapy
(oral corticosteroid) |
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Definition
prednisone (use short course for acute exacerbations. causes side effects) GIVE WITH FOOD OR MILK DIE TO RISK OF ULCERS
-such an effective anti-inflamm (can suppress immune response) |
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Term
asthma drug therapy
(corticosteroid inhaler) |
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Definition
pulmicor, flovent, vanderil, azmacort, aerobid (first-line therapy for prophylaxis of chronic asthma)
-taken daily, NOT quick relief drug |
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Term
asthma drug therapy
(leukotriene antagonists) |
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Definition
| accolate, singulair (bronchodilator and anti-inflamm response; not for quick relief, used for prophylaxis) |
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Term
asthma drug therapy
(mast cell stabilizers) |
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Definition
croomolyn sodium (for seasonal asthma and exercise-induced asthma used 10-20 min before exercise)
-rinse mouth after inhaler to reduce candidas |
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Term
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Definition
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Term
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Definition
-preventable and treatable
-chronic airflow limitation-- not completely reversible
-progressive (but will slow down if trigger is eliminated)
-primarily caused by smoking
-2 types
-chronic bronchitis: presence of chronic productive cough for 3 months in each of 2 consecutive years
-BLUE BUFFER: RHF symptoms, barrel chest, edema, cyanotic
-cough, timespan
-emphysema: abnormal permanent enlargement of air spaces distal to terminal bronchioles
-PINK PUFFER: skinny, "puff" breathing constantly
-air trapping |
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Term
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Definition
| cigarette smoking (destroys cilia, alveoli, etc; irreversible depending on extent of usage), occupational chemicals and dust, air pollution, infection, heredity (genetics), antitrypsin deficiency, aging |
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Term
| clinical manifestations of COPD |
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Definition
| develop slowly, chronic intermittent cough, dyspnea (progressive), gradually change behaviors to avoid SOB |
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Term
| clinical manifestations of COPD (late signs) |
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Definition
| dyspnea at rest, chest breathing, weight loss and anorexia (encourage pt to eat smaller portions 6x/day of high calorie meals), fatigue, hemoptysis (may indicate cancer or infection), prolonged expirations, wheezes, decreased lung sounds |
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Term
| clinical manifestations of COPD (late signs) (contd) |
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Definition
-barrel chest most common
-tripod position when seated helps open chest and fctn diaphragm
-pursed lip breathing
-edema if right-sided heart failure occurring |
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Term
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Definition
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Term
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Definition
-preventable and treatable
-chronic airflow limitation-- not completely reversible
-progressive (but will slow down if trigger is eliminated)
-primarily caused by smoking
-2 types
-chronic bronchitis: presence of chronic productive cough for 3 months in each of 2 consecutive years
-BLUE BUFFER: RHF symptoms, barrel chest, edema, cyanotic
-cough, timespan
-emphysema: abnormal permanent enlargement of air spaces distal to terminal bronchioles
-PINK PUFFER: skinny, "puff" breathing constantly
-air trapping |
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Term
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Definition
| cigarette smoking (destroys cilia, alveoli, etc; irreversible depending on extent of usage), occupational chemicals and dust, air pollution, infection, heredity (genetics), antitrypsin deficiency, aging |
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Term
| clinical manifestations of COPD |
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Definition
| develop slowly, chronic intermittent cough, dyspnea (progressive), gradually change behaviors to avoid SOB |
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Term
| clinical manifestations of COPD (late signs) |
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Definition
| dyspnea at rest, chest breathing, weight loss and anorexia (encourage pt to eat smaller portions 6x/day of high calorie meals), fatigue, hemoptysis (may indicate cancer or infection), prolonged expirations, wheezes, decreased lung sounds |
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Term
| clinical manifestations of COPD (contd) (late) |
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Definition
-barrel chest most common
-tripod position when seated helps open chest and fctn diaphragm
-pursed lip breathing
-edema if right-sided heart failure occurring |
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Term
| complications of COPD (late) |
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Definition
-cor pulmonae (due to pulmonary hypertension- right sided heart failure occurs)
-dyspnea most common, JVD, hepatomegaly, peripheral edema, weight gain, give continuous o2
-right heart must pump harder in order to pump blood due to pulm constriction bc of probs with lungs... blood starts backing up in system
-worsening of COPD is recognized by: increased swelling in feet & legs |
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Term
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Definition
-exacerbations of COPD will increase in the frequency over time
-acute respiratory failure
-depression/anxiety |
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Term
| testing and interventions of COPD |
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Definition
diagnostic studies
-confirmed by PFTs (FEV1/FVC < 70%)
-BMI (less than 21kg/ m2 = increased mortality)
-6min walk to measure o2 during exercise
-ABGs
-echocardiogram/ecg may show right sided heart failure |
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Term
| testing and interventions of COPD |
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Definition
collaborative care
-smoking cessation
-drug therapy |
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Term
| testing and interventions of COPD |
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Definition
02 therapy
-used often with COPD to keep O2 sats greater than 90%
-to reduce the work of breathing
-methods of administration
-humidification and nebulizers |
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Term
| testing and interventions of COPD |
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Definition
complications of O2 use
-combustion
-CO2 narcosis - CO2 levels high - the pts drive to breathe is hypoxemia
-O2 toxicity: result of long term exposure to high levels of O2 |
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Term
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Definition
respiratory and physical therapy
-breathing retraining
-effective coughing
-chest physiotherapy: percussion, vibration, postural drainage |
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