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41 Cards in this Set

  • Front
  • Back
function of respiratory system
o2 and carbon exchange
acid bace balance
protection: 3 protective meausyres- gagging, coughing, & sneezing.
speech production
nasopharynx
nares to uvula
oropharynx
"throat"
inspiration
o2 attaches to hemoglobon portion of cell to transport o2. active process.
alveoli
Alveolar membrane is only 1 cell thick, anything that increases thickness will alter diffusion.
where gas exchange takes place
why we breathe
A LOW BLOOD LEVEL OF CO2 IS THE MAJOR STIMULUS FOR BREATHING, NOT OXYGEN LEVELS!
blood flow from r side of the heart to the lungs and to l side of heart.
The major regulator of respiration is
carbon dioxide
Expiration
passive process. a relax ation.
PULMONARY PERFUSION
Blood returns to ♥ (Ø O2, high CO2) →
Right atrium_ → right ventricle___ → L & R pulmonary arteries_(the only arteries that carry deoxox blood)_ →
arterioles__ → ____capillaries____________
where __diffusion___ of O2 & CO2 occurs → venules______ → pulmonary veins L & R__ → left atrium___ → left venticles___ →
_aorta____
Respirations are easily influenced by
. activity level
2. age
3. disease condition, smoking
4. environment, humidity
5. emotions, stress
6. pain
7. medication
8. fever
Which area of the respiratory system is more susceptible to
aspiration?
right bronchus b/c it is shorter that the left
Normal Breath Sounds
 Bronchial – heard over trachea, loud w/long expiration
 Bronchovesicular – heard between trachea & upper lungs, medium pitch, equal inspiration & expiration
 Vesicular – heard over lung fields, quiet
& low-pitched, long inspiration & short
expiration
Abnormal (Adventitious)
Breath Sounds
 Crackles- occurs at base of lungs
• Fine – asthma, empha, in alveoli
• Coarse- low pitch moist bubbling sound. bronchi
 Wheeze
• Sibilant- real high pitch musical sound, constricted airways. Asthma, emph
• Sonorous (Rhonchi)- snoring sound, low pitched wheezes, bronchitis,
 Friction Rub-pleaura rub together.
 Stridor- can hear w/o stethoscope. Harsh honking noise. Obstruction or bronchospasm. Most serious.
Diminished: slightly heard, not good gas exchange.
Absent: none, possible collapsed lung.
 Tuberculin
(Mantoux/PPD) – Skin test, intradermal injection, LPN may administer & determine results, a positive ppd doesn’t differentiate between active & dormant disease
A positive says that a person was exposed to tb and the body developed anibodies. It takes 10 weeks for antibodies to develop.
 Pulmonary Angiography
– Assesses arterial circulation of lungs, Diagnose Pulmonary Emboli
– Procedure knowledge, provide explanations, reinforce understanding
– Determine allergies: Iodine, shellfish, contrast dye,
post-procedure care = go in the groin w/ a needle and thread a long catheter to the heart into the pulmonary artery. Then insert the contrast dye. Risk of bleeding at catheter site; apply pressure. Check pedal pulse. Keep legs very still and straight. No movement.
Lung Scan
– V-Q scan includes measuring perfusion & ventilation
– Requires radioisotopes, scanning machine
– Radioactive contrast medium, change positions, hold breath
– Diagnose: Pulmonary emboli, Lung cancer, COPD, pulmonary edema
– Assess client: Allergies
– Adequate explanations to decrease anxiety
 Bronchoscopy
Direct visualization: Larynx, trachea, bronchi, insertion of bronchoscope, used for take tissue sample, bronchial flushing w/ saline, visualize, remove a foreign body, NPO,
– Fasting period, local anesthesia
– Medications before procedure: narcotic to depress vagus nerve, anticholinergic to dry secretions; potential complications
– Post-procedure care = NPO until gag reflex returns to normal. Monitor resp status, vitals, sore throat, pink sputum, HOB 30◦, perhaps bronchospasms, edema, cardiac arryth, encourage them to expectorate their secretions.
Mediastinoscopy
– Visualization of Mediastinum, location of incision
– Uses: Visualize lymph nodes, biopsy, possible Complications = close to the heart, can irritate the heart or cause arrythmia’s, damage to lungs. All very rare.
Thorascopy
– Examination of Pleural cavity
– Procedure: Incisions; endoscopy
– Fluid: Culture, cellular studies, biopsies, chest tube
Thoracentesis
Normal amount is less than 20ml
– Procedure = position of the client, remain still
– Obtain sample or drain pleural fluid (record amount, color, label & send specimen prn)
MD may instill medication
– Postprocedure care = lie on opposite side of wound site
– Complications = infection, sub cut emph
RESPIRATORY
ACIDOSIS & ALKALOSIS
norms: ph= 7.35-7.45
co2= 35-45
hco3= 22-26
Signs/Symptoms
 Resp. Acidosis
– Hypertension
– Headache, weakness
– Shallow, slow breaths
– Tachycardia
– Cyanosis
– Decreased LOC → coma
– Breath has fruity smell
 Resp. Alkalosis
Rapid, deep respirations
(hyperventilation)
– Dizziness
– Numbness/tingling hands & feet
– Weakness, sweating
– Seizures
– Feeling of panic
– Cardiac arrythmia
Treatment of Respiratory
Acid-Base Imbalances
 Acidosis:
 Respiratory treatment with bronchodilator
 Reverse narcotic or sedative drug effects (Narcan)
 Chest tube insertion
 Mechanical ventilation
 Alkalosis:
 Treat cause of CO2 loss – antianxiety drug
 Administer narcotic or sedative to decrease respirations
EFFECTS OF AGING ON THE
RESPIRATORY SYSTEM
 Decreased elasticity of respiratory structures
 Decreased # alveoli
 Decreased size of chest wall
 Decreased ability to breath & cough strongly
 Decreased client mobility
RESULTS OF AGING ON
RESPIRATORY SYSTEM
 More energy is needed to breathe
 Less ability to breathe deeply
 May develop DOE
 Decreased ability to expectorate secretions
 Less ability to compensate for respiratory needs during illness
 S/S of Inadequate Oxygen
 Circumoral cyanosis
 Sob
 Irregular breathing
 Tachypnea
 Shallow breaths
 Altered loc
 Lethargic
 Drowsy
 Anxiety
 Restlessness
 Use of accessory muscles
 Sitting up hunched over
 Tachycardia
 Flared nostrils
 Sweating
 Hypertension
 Pulse ox below normal 93 is around normal
MPROVING OXYGENATION
& VENTILATION
 Orthopneic
 Deep breathing (preventative)
 Incentive spirometry (preventative)
 Pursed-lip breathing (for COPD)
 Diaphragmatic breathing (for COPD)
 Nasal strips where appropriate
PULSE OXIMETRY
 Non-invasive, trans- cutaneous technique for monitoring of oxygen saturation
 Red light detects amount
Of light absorbed by hemoglobin
 Normal SpO2 is 95-100%
 Sustained level of <90%
Is cause for concern
CHEYNE-STOKES
COMBO OF DEEP & SHALLOW BREATHS, “STAIRCASE BREATHING” EACH BREATHE BECOMES DEEPER& MORE RAPID UNTIL PERIOD OF APNEA OCCURS (POSSIBLY UP TO 3 MIN),
FREMITUS
VIBRATIONS WHEN CLIENT SPEAKS
ABNORMALITIES
BARREL, FUNNEL, PIGEON CHEST, PULSE OX= NON-INVASIVE METHOD TO MEASURE O2 SAT OF HGB USING A LIGHT BEAM. ATTACH TO FINGERTIPS, EARLOBE OR TOES IF GOOD CIRCULATION, SKIN COLOR=PALE, CYANOTIC, CLUBBED NAILS =COPD, ANXIETY, CONFUSED, COMBATIVE
FIBEROPTIC SCOPE TO DIAGNOSE & EVALUATE LUNG DISEASE
TAKE LUNG BX, OBTAIN SPUTUM SPECIMEN, AGGRESSIVE CLEANSING OR REMOVE FOREIGN BODY, NURSING CARE= MAKE SURE CONSENT SIGNED, PRE-OP CHECKLIST DONE, PT UNDERSTANDS PROCEDURE, MEDS, WILL SUPPRESS GAG REFLEX, NPO 4-6 HRS BEFORE, COMPLICATIONS=BRONCHOSPASM, HYPOXIA, EDEMA, BLEEDING, PERFORATION, ASPIRATION, CARDIAC ARRYTHMIA, INFECTION, PT MAY HAVE SORE THROAT AFTER, DO NOT GIVE FOOD/LIQUIDS UNTIL GAG REFLEX RETURNS, KEEP HOB @ 30 DEGREES MONITOR RESP STATUS CLOSELY & REPORT HEMOPTYSIS, STRIDOR, DYSPNEA TO MD
DIAGNOSE IF VAGUS NERVE STIMULATED = HT, BRADYCARDIA, DYSRYTHMIAS MAY OCCUR, ATROPINE, PP CARE = ASSESS GAG REFLEX(USUALLY 2-8 HRS),INITIALLY OFFER ICE CHIPS/LIQUIDS, KEEP SUCTION EQIUPMENT @ BEDSIDE, PLACE IN SEMI-FOWLERS W/HEAD TO 1 SIDE, ENCOURAGE EXPECTORATION OF SECRETIONS
Thoracentesis
NORMAL AMT PLEURAL FLUID < 20 ML,
PP CARE = CXR R/O PNEUMOTHORAX, LIE ON UNAFFECTED SIDE, OBSERVE DSG FOR BLEEDING, VS, MONITOR RESPIRATORY STATUS
COMPLICATIONS = PNEUMOTHORAX, SQ EMPHYSEMA, INFECTION,
Normal ABG Values
pH 7.35-7.45
PaO2 80-100 mmHg
PCO2 35-45 mmHg
HCO3 22-26 mEq/L
SaO2 96-100 %
Mild O2 deficiency = 60 – 80 mmHg
Moderate O2 deficiency = 40 – 60 mmHg
Severe O2 deficiency < 40 mmHg
RESPIRATORY ACIDOSIS & ALKALOSIS
Acidosis Normal Alkalosis

pH < 7.35 pH = 7.35 – 7.45 pH > 7.45
CO2 > 45 CO2 = 35 – 45 CO2 < 35
HCO3 > 26 HCO3 = 22 – 26 HCO3 < 22
O2 sat <95% O2 sat >95%
RESPIRATORY ACIDOSIS
Increased CO2 concentration in lungs & blood
Increased hydrogen ions in blood lowers pH levels & increases bicarbonate
Acid-base imbalance caused by hypoventilation
due to :Chest injury
Pneumonia/Pneumothorax
Pulmonary edema/Pulmonary Embolus
Emphysema/Asthma
Neurological injury
Narcotic sedatives
Anesthetics
RESPIRATORY ALKALOSIS
Decreased CO2 concentration in lungs & blood
Decreased hydrogen ions in blood increases pH levels & decreases bicarbonate
Acid-base imbalance caused by hyperventilation
due to :Acute Asthma
Pulmonary vascular disease
Pneumonia
ASA toxicity
Anxiety
Fever, Sepsis
Hepatic failure (↑ abdominal fluid)
Pregnancy (elevated diaphragm)
Treatment of Respiratory Acid-Base Imbalances
Acidosis:
Respiratory treatment with bronchodilator
Reverse narcotic or sedative drug effects (Narcan)
Chest tube insertion
Mechanical ventilation
Alkalosis:
Treat cause of CO2 loss – antianxiety drug
Administer narcotic or sedative to decrease respirations
FLOWMETER
Gauge used to regulate amount of O2 delivered to the client (measured in liters per minute)
Attached to O2 source
The center of the floating ball should match to flow rate !
HUMIDIFIER
Produces small H2O droplets during O2 administration
WHY use? O2 IS DRYING TO MUCOUS MEMBRANES


Usually O2 humidified when >4L/min
Bottle contains distilled H2O, attaches to flowmeter
(bottle changed as needed
EPISTAXIS
Rupture of tiny capillaries in nasal mucosa
Causes =
Management =
1. apply pressure to bridge & nares
2. bend head forward slightly
3. apply ice to nose
4. don’t swallow blood
5. apply pressure to upper lip to decrease
blood flow to nose
6. if bleeding continues, electrocautery may
be necessary
Nasal Fracture
edema of soft tissue, external/internal bleeding, nasal deformity &/or obstruction, clear drainage (+ glucose = CSF)Nasal fracture: if there is clear drainage then check for glucose to determine if it is cerebral spinal fluid, black eyes and swelling common. Nasal trauma can lead to nasal obstruction. Laryngeal obstruction s/s would be strider (honking).

Strider=obstruction