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101 Cards in this Set

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Trap dust and microorganisms
nasal hairs and turbinates
warm and moisten inhaled air; trap inhaled particles
mucous membranes
move particles toward pharynx to be swallowed or coughed out
cilia
trigger sneeze and cough to remove foreign debris
irritant receptors in nose and airways
phagocytize foreign particles and bacteria
alveolar macrophages
Reduced number of alveoli
decreased gas exchange
reduced effectiveness of alveolar macrophages
increased risk of respiratory infections
decreased cough reflex
increased risk of respiratory infections
deteriorating cilia
increased risk of respiratory infections
reduced elastic recoil of lung tissue
decreased force of cough (causing increased risk of respiratory infections) PLUS air trapping (causing decreased gas exchange)
weakened and atrophied respiratory muscles
decreased force of cough (causing increased risk of respiratory infections)
Do you often have headaches or sinus tenderness?
may indicate sinusitis
Do you often experience nosebleeds?
a history of nosebleeds may indicate an abnormality that can predispose to future nosebleeds
has your voice changed?
voice change may indicate a variety of disorders of the nose or throat, including cancer. Further investigation is necessary
Do you ever feel SOB, like you cant get enough air?
many respiratory and cardiac problems result in SOB
Do you have a cough? Is it productive?
a cough indicates respiratory irritation or excessive secretions
what does the sputum look like?
yellow or green sputum may accompany an infection. Blood in the sputum may occur with tuberculosis, pulmonary embolism, or cancer
Have you recently experienced night sweats, chills, fever?
These are symptoms of tuberculosis
Do you ever feel confused, light headed, or restless?
These symptoms might indicates a low PO2, reducing oxygen to the brain
Have you had any chest surgeries?
this may reveal problem areas the patient has not yet mentioned
Do you have any allergies that cause respiratory symptoms? How do you treat them?
The patient may take over the counter medications for allergies that affect respiratory function or interact with prescribed medications
Do you smoke? How many packs per day? For how many years? Are you exposed to second hand smoke?
many respiratory disorders are caused or aggravated by exposure to tobacco smoke
are you or have you ever been exposed to airborne pollutants at work?
pollutants such as asbestos, coal dust, or chemicals can cause lung disease
Do you take any medications or use inhalers (prescribed or OTC) for your respiratory problems?
Information about medications gives further information about disorders, severity, and treatment. You should also consider drug interactions and side effects
Do you use home oxygen or other home respiratory treatments?
This helps determine the severity of disease and the severity of disease and the treatment
Do any of your blood relatives have emphysema, asthma, or tuberculosis
some respiratory disorders have a hereditary tendency. Tuberculosis is contagious
Pulmonary diseases associated with Japanese people include asthma related to dust mites in the straw mats that cover floors in Japanese homes and air pollution from living in urban areas. The nurse should encourage patients who have straw mats and who wish to keep them to have them sterilized.
Patients from Poland, Ireland, or other countries where mining is a primary occupation may have an increased incidence of respiratory disease. It is essential that health care providers carefully screen Polish and Irish immigrants for respiratory conditions.
Healthcare practitioners should be aware of the variations among ethnic peoples of color when assessing for cyanosis. Cyanosis and decreased blood hemoglobin levels in darker skinned individuals gives the skin an ashen color instead of a bluish color. Thus, the nurse must examine the sclerae, conjunctivae, buccal mucosa, tongue, lips, nailbeds, and palms and soles of the feet to assess for lowered oxygen levels.
Smoking is deeply ingrained in the Arab American culture. Offering cigarettes is a rits of Arab hospitality. Arabs may have difficulty stopping smoking because of these cultural rituals.
Populations living in inner cities are at increased risk for respiratory diseases related to pollution. Strategies to increase the effectiveness of smoking cessation in African Americans include working with community and church groups in African American communities.
Respiratory patterns
when assessing a patient's respirations, the nurse should determine their rate, thythm, and depth. These schematic diagrams show different respiratory patterns.
Normal respiratory rate and rhythm
Eupnea
Deeper respirations; normal rate
Hyperventilation
Increased respiratory rate
Tachypnea
Slow but regular respirations
Bradypnea
Absence of breathing (may be periodic)
Apnea
Respirations that gradually become faster and deeper than normal, then slower; alternates with periods of apnea
Cheyne-Stokes
Faster and deeper respirations without pauses
Kussmaul's
Name the paranasal sinuses
Frontal, Ethmoid, Sphenoid, Maxillary
Possible cause of Respiratory rate < 12
respiratory depression, possibly from opioid or sedative use
Possible cause of Respiratory rate > 24
Respiratory distress from underlying disorder
Possible cause for use of accessory muscles
restrictive or obstructive disorder (COPD)
Possible cause for Barrel chest
air trapping from COPD
Possible cause for cough
airway irritation or secretions
Possible causes for green, yellow, tan or bloody sputum
green, yellow, or tan sputum may indicate infection. Blood in sputum can indicate tuberculosis, cancer, or pulmonary embolism
Possible cause for Cyanosis
tissue hypoxia
possible cause for nail clubbing
chronic tissue hypoxia
possible respiratory cause for confusion
lack of oxygen to the brain
possible cause for weight loss
dypsnea interfering with eating; use of calories for breathing
Fluid in airways, sounds like moist bubbling, heard on inspiration or expiration associated w/ pulmonary edema, bronchitis, and pneumonia
course crackles (sometimes called rales)
Alveoli popping open on inspiration, sounds like velcro being torn apart, heard at the end of inspiration, associated w/ heart failure and atelectasis
fine crackles (rales)
narrowed airways, sounds like fine high pitched violins, mostly on expiration, associated w/ asthma
wheezes
airway obstruction sounds like a loud crowing noise heard without stethescope, associated with obstruction from tumor or foreign body
pleura rubbing together, sounds like leather rubbing together, grating, associated with pleurisy, lung cancer, pneumonia or pleural irritation
pleural friction rub
decreased air movement with faint lung sounds, associated with emphysema, hypoventilation, obesity, muscular chest wall
diminished
no air movement, no sound heard, associated with pneumothorax or pneumectomy
absent
If you remember that a normal blood pH is 7.35 to 7.45 then its easy to remember that:
a normal PaCO2 is 35 to 45 mm Hg
Normal value for RBCs
4.5 - 6.2 (male) and 4.2 - 5.4 (female)
Conditions associated with an increase/decrease in RBCs
increased in chronic lung disease or dehydration, decreased in anemia, hemorrhage, overhydration with intravenous fluids
Normal value for Hemoglobin
13.5-18 (male) 12-16 (female)
Conditions associated with hemoglobin increase/decrease
same as RBCs - increased in chronic lung disease or dehydration, decreased in anemia, hemorrhage, overhydration with intravenous fluids
Normal WBC count
5000-10,000
Conditions associated with abnormal WBC count
increased in infection
What condition is suspected if the doctor orders a "sputum for AFB"?
tuberculosis: ask if the patient should be isolated while waiting for test results
Test defined as air inspired and expired in one breath
Tidal volume
Defined as air remaining in lungs after maximum exhalation
Residual Volume
defined as air remaining in lungs after normal expiration
Functional residual capacity (FRC)
Defined as amount of air beyond tidal volume that can be taken in with the deepest possible inhalation
Inspiratory reserve
Defined as amount of air beyond tidal volume in the most forceful exhalation
expiratory reserve
Defined as maximum amount of air expired forcefully after maximum inspiration
Forced vital capacity (FVC)
Defined as amount of air expired in first second of forced exhalation, expressed as percent of FVC
Forced expiratory volume in one second (FEV1)
Defined as maximum flow of air expired during FVC (this is a rate rather than a volume)
Peak expiratory flow rate (PEFR)
Normal TV value
400-600 mL at rest
Normal RV value
1000-1500 mL
Normal FRC value
2300 mL
Normal Inspiratory reserve
2000-3000 mL
Normal expiratory reserve
1000-1500 mL
Normal FVC
3000-5000 mL
normal FEV1
65%-85% of the FVC
Normal PEFR
450 L/min
Drugs that assist with smoking cessation
bupropion (Zyban), buspirone (BuSpar)
Types of oxygen masks
simple, partial rebreather, nonrebreathing, venturi
Steps to use a metered dose inhaler
1) gently twist the canister into the inhaler unit, shake the inhaler, and remove the cap NEWLINE 2) exhale NEWLINE 3) place the inhaler mouthpiece in your mouth NEWLINE 4) Press the canister down to actuate a dose of mediation, simultaneously breathe in slowly and deeply, timing the dose and breath so the meds go into the lungs and not onto the tongue NEWLINE 5) hold breath for 5-10 seconds, repeat as ordered
Safety tip!
Label all medicaitons, medication containers (syringes, med cups, basins, ect) or other solutions on and off the sterile field in perioperative and other procedural settings
The diagrammed chest drainage system has this part of the system on the left:
suction chamber
Thediagrammed chest drainage system has this part on the right
drainage collection chamber
the diagrammed chest drainage system has this part in the middle
water seal chamber
When caring for the patient w/ a chest drainage system where do you begin?
start at the patient and move toward the drainage system
Caring for a patient w/ a chest drainage system: patient assessment
observe respiratory rate, effort, and symmetry, assess for SOB, pain, other discomforts, ascultate lung sounds, confirm dressing is intact, observe for drainage, if necessary reinforce the dressing and notify the physician, palpate around insertion sites for crepitus
Caring for a patient w/ a chest drainage system: system assessment
check tubing, ensure no excess loops, verify no cracks or leaks in bottles, verify water level for tidaling (unless lung reinflated), check suction control chamber for gentle bubbling and confirm correct amt of water, check and mark amount of drainage in collection chamber every 8 hrs and prn as needed
When using a chest drainage system, notify the RN or physician if:
patient suddenly complains of increasing dyspnea or chamber is full and needs to be changed
How often should you check and mark the drainage collection chamber?
every 8 hours and PRN or as ordered (report marked increase in bloody drainage)
In what situation would you not have tidaling in the water seal chamber?
if the lung reinflated
If continuous bubbling is present in the water seal chamber:
check for leaks and notify physician
Where should the drainage system be located?
below patient chest at all times
Where does excess tubing go?
should be coiled on the bed
What are you looking for when you palpate around chest drainage system insertion sites?
crepitus
What do you do if the chest drainage system dressing is soaked with drainage?
reinforce and notify physician…do NOT change dressing
How would you expect lung sounds to sound in a patient w/ a chest drainage system?
may initially be muffled or absent on the side of a collapsed lung but should gradually return to normal as the lung reinflates
Trach cleaning proceedure:
1) assemble equipment, trach care kit, sterile water or saline, suction equipment, hydrogen peroxide NEWLINE 2) explain the procedure to the patient NEWLINE 3) suction inner cannula if necessary NEWLINE 4) open and prepare the kit keeping all equipment sterile. Fill one side of basin w/ half peroxide and half saline and the other with saline
Trach cleaning proceedure:
5) Don clean gloves NEWLINE 6) remove old tracheostomy dressing NEWLINE 7) remove inner cannula from tracheostomy tube and place it in peroxide solution NEWLINE 8) while inner cannula is removed, patient may be suctioned if necessary NEWLINE 9) don sterile gloves
Trach cleaning proceedure:
10) use brush and pipe cleaners to clean inner cannula Place in water or saline to rinse. Dry inside of cannula with pipe cleaner. Reinsert into trach tube NEWLINE 11) use cotton swab and sterile gause w/ sterile peroxide and saline to clean around trach site. Rinse w/ saline to prevent skin irritation NEWLINE 12) replace ties, remove old ties after new ties are securely in place NEWLINE 13) apply sterile trach dressing (drain spong or "trach pants"). Use precut or folded dressing. Cutting gause creates fibers that can enter trach