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190 Cards in this Set
- Front
- Back
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The lungs work as an ___/____ Balance
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acid/Base
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Is CO2 acidic or basic?
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acidic
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When the body pH increases, the lungs do what?
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They try to breathe more
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When the body pH decreases what do the lungs do?
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They breathe less
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Inspiration
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breathing in
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expiration
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Breathing out
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The upper respiratory tract consists of...
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Everything from the chest up-
Nose sinuses Pharynx (Nasopharynx, Oropharynx, Laryngopharynx) Larynx |
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Lower respiratory tract consists of...
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Trachea
lungs (bronchi, bronchioles, alveoli, pleura) |
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In the nose, the ___ cleans/filters the air that we breathe
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cilia
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The nose has 3 functions...
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Filters the air we breathe
humidifies the air Smelling |
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Why is it important for the nose to humidify the air we breathe?
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For body temperature control, vascular
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What is the pharynx?
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URT, aka the "throat"
Back of nasal cavity to where esophagus begins Divided into 3 parts- oro, naso, laryngo |
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What is the pharynx's purpose?
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passageway for respiration and digestion
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At the nasopharynx, what do the adenoids do?
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Trap organisms that enter the mouth
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The oropharynx are used for ___ and ____. They are located...
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breathing and swallowing
near the tonsils |
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What are the tonsils' job?
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guard the body against invading organisms
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Process steps of inspiration to getting rid of wastes
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inspiration
O2 diffusion O2 to goes to heart to take O2 to body cells blood caries to body cells and carries back wastes and CO2 goes to lungs and expiration |
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Purpose of inspiration and expiration?
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gas exchange and getting rid of wastes
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What is the laryngopharynx?
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point where solid foods and fluids are separated from air
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Problems with age for the pharynx?
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muscles atrophy
vocal chords become slack soft, quiet, raspy voices |
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What problems can go wrong with the pharynx?
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tonsilitis and throat cancer
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Purpose of the nose?
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filter
heat humidify smell |
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4 types of sinuses?
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frontals
ethmoids maxillary sphenoids |
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The sinuses provide _____ and decrease the ___ of the _____
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resonance
decrease the weight of the skull |
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2 symptoms of sinus infections?
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pain and pressure
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What types of things will irritate sinuses?
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smoke
bacteria pollutants pollins etc. |
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what do we find at the naso/oropharynx?
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naso- eustachian tube
and tonsils |
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The tonsils are part of what system?
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immune system
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larynx AKA
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voice box
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Where is the larynx?
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Above the trachea and below the throat
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What is the larynx made of?
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cartilage
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where is the tracheostomy site?
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The larynx
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What is the job of the epiglottis?
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Prevent aspiration
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What is laryngitis?
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inflammation/irritation of the larynx
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The trachea is in front of what structure?
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Esophagus
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What part of the LRS has smooth muscle and cartilage and performs peristalsis?
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Trachea
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Can the trachea bleed?
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Yes- it has smooth muscle
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Lungs- Right side has how many lobes?
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3
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Lungs- Left side has how many lobes?
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2
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Why does the Left lung only have 2 lobes?
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To make room for the heart
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Where is the apex of the lungs?
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Top of the lungs- right above the clavicle
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Where is the base of the lungs?
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At the diaphragm
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What is the hilum of the lungs?
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Where the bronchi enter- the root of the lung
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What are normal CO2 levels?
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35-45
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What are normal ABG O2 levels?
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80-100%
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Too much CO2 makes a person....
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SLEEPY
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Lack of O2 at a cellular level
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hypoxia
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What is the pleura?
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2 membranes that enclose the lungs-
outer parietal and inner visceral |
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What is pleural effusion?
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Too much fluid in the pleural cavity
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What is a pneumothorax?
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Too much air in the pleural cavity or
a collapsed lung |
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What is the treatment for pneumothorax?
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Thoracentesis
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hemothorax
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blood in the pleural cavity
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empyema
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pus in the pleural cavity
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what are the alveoli?
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little sacs located in the lungs at the end of the bronchioles
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Are the alveoli very vascular?
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Yes, surrounded by lung capillaries- they share common walls- making gas exchange possible
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If there is blood in sputum, where is it coming from?
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the alveoli, since they are so close to the capillaries
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What is surfactant?
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a secretion that reduces the surface tension in the alveoli
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What cells secrete surfactant?
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Type II pneumocytes in the alveoli cell walls
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What would happen if the alveoli did not have surfactant?
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atelectasis would occur
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What is atelectasis?
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collapse of the alveoli
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What is the result of atelectasis?
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reduced gas exchange
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What do the lungs sound like when atelectasis occurs?
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crackles and rails
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What are some changes in the respiratory system that happen with age?
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cilia decreases
decreased elasticity muscles lose strength vascular resistance |
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What are some physical signs of chronic respiratory problems?
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barrel chest
ribs change and move in chest |
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What is a normal chest size?
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1 (depth) to 3 (width)
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During hypoventilation, will CO2 levels be high or low?
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High
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Interventions for elderly respiratory complications
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I.S.
deep breathing/coughing keep active |
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What is the difference between hypoxia and hypoxemia?
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Hypoxemia is low levels of O2 in the blood
Hypoxia is decreased tissue oxygenation |
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People with dark skin people may have artificially lower ____ levels
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SpO2
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What to assess for environmental history and respiration?
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home and workplace- love or work around mold or asbestos?
Coalminer? Baker (flour)? smog? allergies? Nurse in Or recovery room? |
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What to assess for illness history and respiration?
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childhood? allergies? bronchitis? pneumonia? meds?
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What meds can affect respiratory system?
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beta blockers
ACE inhibitors |
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What is included in the respiratory physical assessment?
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lung sounds, ribs, movement, cyanotic?
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What labs to assess for respiratory status?
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CBC (RBCs to transport O2)
ABG sputum |
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What do the ABGs assess?
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amount of O2, CO2, and pH
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The kidneys and lungs balance _____
The kidneys decide when to make _______, depending on the O2 level |
pH
erythropoietin |
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Diagnostic assessment of respiration include
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labs
X-ray CT VQ SpO2 Capnometry Pulmonary function tests |
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Computed tomography (CT) will find what in lungs?
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tumors, nodules
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Ventilation and perfusion scan (VQ scan)
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Will find Pulmonary Embolism (PE)
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Pulse Oximetry (SpO2) is finding....
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Is finding how much O2 is in the capillary beds
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Pulmonary Function Tests
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lung volumes and capacities, flow rates, diffusion capacity, gas exchange, airway resistance, and distribution of ventilation
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What does a bronchoscopy consist of?
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Conscious sedation, informed consent
A latex free fibra-optic camera views the airways and tissues of the lungs for diagnosis or to clear out the lungs Goes through the nose or mouth |
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How to prepare a pt for bronchoscopy
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NPO, Labs, preop check list,
Breathing treatment before, to open the airways On O2 during the procedure d/t O2 restriction from the scope |
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Why is it important to check the INR prior to a bronchoscopy?
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We do not want the patient bleeding
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Thoracentesis
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Removal of pleural fluid, x ray post procedure
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Goal of oxygen therapy
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to use the lowest fraction of inspired oxygen for an acceptable blood oxygen level without causing harmful side effects
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What is O2 % in room air?
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21%
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We want people with COPD to have what SpO2 levels?
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90 or below
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Why do we want people with COPD to have SpO2 @ 90% or below?
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Because they retain CO2 and this level has become their natural drive to breathe
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COPD pts normally have _____ H&H and RBC levels due to their disease process
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High
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Older people have lower SpO2 levels due to...
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poor perfusion and decreased capillary elasticity
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Oxygen toxicity
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Too much O2
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Absorption atelectasis
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Alveoli do not open very well
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How to avoid Drying of mucous membranes
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Humidify O2
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Biggest hazard of O2 therapy?
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Combustion
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What 3 things are needed to start a fire?
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heat O2 fuel
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How to prevent Infection when giving supplemental O2
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Change humidification container Q 24-48 hr
Change nasal cannula Q 7 days |
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Low-Flow Oxygen Delivery Systems include...
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Nasal Cannula
Simple Facemask Partial rebreather mask Non-rebreather mask |
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At what rate do we need to start humidifying O2?
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> 4L
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Nasal cannula
__-__ L __-__ % O2 |
1-6 L
24-44% O2 |
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Simple facemask
Minnimum- __ L __-__ % O2 |
Min 5 L
40-60& O2 |
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When is a simple facemask used?
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Short term use
ie: recovery room or for mouth breathers |
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What is the problem with using longer tubing for O2 therapy?
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the longer the tubing the less effective the therapy is
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What is a Partial rebreather mask?
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Mask attached to a reservoir bag
There are no flaps so pt rebreathes some of their exhaled volume |
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What is a Non-rebreather mask?
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A mask with a reservoir bag that must be inflated all the way with O2
There are one way valves to pt will not rebreathe CO2 This delivers up to 90% O2 |
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What is the benefit of Low-Flow O2?
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It is easy to tolerate
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When do we use High-Flow O2 delivery?
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for more critical patients
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High-Flow O2 delivers anywhere from __-___% O2
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24-100%
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What are some High-Flow Oxygen Delivery Systems?
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Venturi mask
Face tent Aerosol mask Tracheostomy collar T-Piece |
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What is the most accurate device/mask for O2 delivery?
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Venturi Mask
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Noninvasive Positive-Pressure Ventilation
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Technique uses positive pressure to keep alveoli open and improve gas exchange without airway intubation
(BiPAP and CPAP) |
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BiPAP
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mechanical delivery of set positive inspiratory pressure each time the patient begins to inspire; as the patient begins to exhale, the machine delivers a lower set end-expiratory pressure, together improving tidal volume.
HELPS CLEAR O2 |
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CPAP
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continuous positive airway pressure (decreases the workload-preload- of the heart)
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What are the 3 types of O2 for home delivery?
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Compressed gas in a tank or cylinder (green tanks)
Liquid oxygen in a reservoir (smaller bottle) Oxygen concentrator (concentrates room air) |
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How are O2 tanks stored?
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In racks and in an upright position
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Care of Patient with Noninfectious Upper Respiratory Problems Priorities
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Promote oxygenation
Patent airway |
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S/S of nasal fractures
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Misalignment, pain, change in breathing
Observe for CSF leak (glucose in fluid) |
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No NG tube for pts with ....
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nasal fractures
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Rhinoplasty
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repair of nasal fracture
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Fractures always get
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ice
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A CSF leak will have ____ in the fluid
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glucose
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Epitaxis
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nosebleed
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Causes of Epitaxis?
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Trauma, HTN, blood dyscrasia, decreased humidity, nose blowing or picking, cocaine
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Anterior epitaxis
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Most common
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Posterior epitaxis
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medical emergency- will be swallowing blood- use penlight to check back of throat
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How to treat epitaxis?
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semifowlers position, cold compresses
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Rhinitis is an ______ respiratory problem
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infectious
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rhinitis
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inflammation of the nasal membrane
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Causes of rhinitis?
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Viral (coryza, common cold), bacterial, allergies, overuse of nasal sprays
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Rhinitis is Most contagious first ___-___ ____ (droplet)
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2-3 days
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S/S of rhinitis?
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H/A, nasal congestion, rhinorrhea
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rhinorrhea
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watery drainage from nose
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How to manage rhinitis?
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Antihistamines, Decongestants, Antipyretics, Antibiotics, Rest, 2000+ ml/day intake
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histamines and WBCs cause local blood vessel....
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dilation
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Common cold management
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just manage the symptoms
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Sinusitis
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Inflammation of mucous membranes of sinuses, may obstruct flow of fluid from sinuses
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How to treat of Sinusitis
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Saline nasal sprays, warm packs over sinuses
decongestant Broad spectrum Antibiotic therapy for purulent drainage (Amoxicillin-penecillin) Surgical opening and drainage of sinus |
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Pharyngitis
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Inflammation of pharynx (throat)
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What causes Pharyngitis
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Bacterial (group A beta hemolytic streptococcus), viral, trauma, dehydration, irritant
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What is the danger of strep throat?
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Endocarditis, these little guys can travel through bloodstream to eventually end up living on heart valves... BAD NEWS causes damage and cal lead to L sided HF
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s/s of pharyngitis
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Sore throat, odynophagia, dysphagia, fever
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odynophagia
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painful swallowing
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*What meds for pts with strep throat
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Penicillin or cephalosproin,
*Macrolide (azithromycin or erythromycin if allergic to penicillins)* |
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Is pharyngitis viral or bacterial?
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Can be from both
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azithromycin AKA
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Z Pak
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T or F?
The Combat Methamphetamine Abuse Act states that all drugs containing pseudoephedrine now require a prescription to purchase and the amount of purchase is limited to a 10-day supply. |
False
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T or F?
Pseudoephedrine relieves nasal congestion by causing vasoconstriction in the nasal mucous membranes, which promotes sinus drainage and improves airflow. |
True
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T or F?
One advantage of using cetirizine (Zyrtec) in the pediatric population is that it is approved for use in children as young as 6 months of age. |
True
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T or F?
The majority of drugs used to treat symptoms of upper respiratory illness are safe for use by breastfeeding mothers because they do not cross into the breast milk. |
False
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T or F?
Pharyngitis and laryngitis are both bacterial infections that require treatment with antibiotics as well as decongestants. |
False
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Patients should be cautioned against long-term or excessive use of decongestants, which can induce _____________ .
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Rebound
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Phenylephrine (Neo-Synephrine) is a topical nasal decongestant and should not be used for longer than ________ continuous days.
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5
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Fexofenadine (Allegra) relieves symptoms of seasonal and perennial allergies by selectively blocking the effects of ______________ at the H¹-receptor sites.
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histamines
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Diphenhydramine (Benadryl) is an antihistamine that is also effective in treating the symptoms of ________________ in travelers.
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motion sickness
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The common cold can cause many symptoms, including __________, which is defined as inflammation of the nose and usually results in nasal discharge.
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rhinitis
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Decongestants Decrease nasal congestion by...
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constricting nasal arterioles
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2 ways to apply/use decongestants
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Oral or topical
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Psuedoephedrine (Sudafed)
What type of medication? O, D? |
decongestant
Onset 30 minutes, duration 4-6 hours |
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Does Psuedoephedrine cross placenta and enter breast milk?
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Yes
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Psuedoephedrine- Adverse side effects
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Htn, anxiety, tachycardia
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Decongestants are contraindicated in pts with...
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HTN
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Antihistamines work by...
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Stops histamine release during an allergic inflammatory response
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Which antihistamines are sedating, first generation or second generation?
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First generation
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Examples of 2nd generation antihistamines?
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Zertec, Claritin, Allegra
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Fexofenadrine (Allegra)
What is it? O,P? |
Second generation antihistamine
Oral onset rapid, peaks 2-6 hours |
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What ages are ok to use Fexofenadrine (Allegra)?
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Anyone over 6 mos old
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Diphenhydramine (Benadryl)
What is it? |
1st generation antihistamine (causes sleepiness)
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Diphenhydramine (Benadryl) is used for...
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Used for allergic symptoms,
Motion sickness (Nausea and vomiting), induce sleep, extrpyraminal sysmptoms |
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When is the only time Diphenhydramine (Benadryl) is ok to give during pregnancy?
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severe allergic reaction
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2 ways Diphenhydramine (Benadryl) can be admin?
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Po or IM
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What route is benadryl NOT GIVEN?
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IV
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How do expectorants work?
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Liquefy respiratory secretions
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Guaifenesin (Robutussin)
What type of med? O,D? |
Expectorant
Onset 30 minutes, duration 4-6 hours |
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When is Guaifenesin (Robutussin) used?
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When secretions need to be thinned and there is a nonproductive cough
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Guaifenesin (Robutussin) May cause...
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nausea, vomiting, anorexia
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What ages can take Guaifenesin (Robutussin)?
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children 2 years and older
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What other things can a pt do to help increase the therapeutic effect of expectorants?
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lots of fluids- keep hydrated and the use of humidifiers is very helpful
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First antibiotic was developed in
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1929
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How can Abx be admin?
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po, im or IV
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What organisms are penicillins used on and how do they work?
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Used in gram positive organisms, disrupts bacterial cell wall synthesis (prevents them from replicating)
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When do penicillins peak and how fast to excrete?
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Peaks in four hours, rapidly excreted- this is why we need a constant dose for therapeutic level
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Penicillins contraindicated in...
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Contradicted in people with allergies to Penicillins, cephlosporins, and imipenim
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Penicillins Adverse reactions...
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rash,n/v, diarrhea, wheezing, anaphlactic shock, death
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What do people with penicillin allergies need to have on hand?
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epinephrine, benadryl, or steroids handy, in case of anaphalactic shock
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What is important pt teaching for use of Abx?
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take until prescription is empty!
If PO, do not take on an empty stomach |
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Cephlosporins, what bacteria is it used on and what is special about it?
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Abx- Now 4 generations, now can be used for gram positive and negative can cross brain-blood barrier
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Cephlosporins are good to treat ___ infections
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neuro
Because it can cross brain-blood barrier |
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What is the first generation Cephlosporin?
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Cephazolin (Ancef)
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What are Cephlosporins used to treat?
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Used for many infections, Beta strep, skin, bone, heart, respiratory, GI, sinus, ear
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How do Cephlosporins work?
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Disrupts bacterial cell wall synthesis
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