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56 Cards in this Set

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Bradypnea
slow respiratory rate-less than 10 per minute

Chart resting respirations (RR)

could be cause by PCA or other Medications(Narcotics)
Cheyne-stokes
"death rattle"

4-5 cycles per min.

irritation to medulla

R/O nuerologic problem
Dyspnea
Difficulty (labored breating)

Dyspnea when ....

Some conditioning
Some disease pattern
Eupnea
Normal Respirations
Gasping
Inspiratory Effort ( asthma, hurts to breathe, etc.)
Hyperpnea
Increased RR (what they are doing- running up stairs, resting etc.)
Hypoventalation
BR, sedatives, meds,
sleeping(slow and shallow)
Kussmaul's
DM- keto acisosis(metabolic)
Fruity smelling breath (keytones). Attempt to rid CO2
Orthopnea
Difficulty breating while lying flat - raise HOB

sleep in recliner

could be respiratory or cardiac problem
Rales?crackles
Heard at end of respiration

Fluid around alveoli

can't cough out crackles

Dieretics and RT makes it better

Fluid rises (from bottom to top) Pulmonary Edema
Rhonchi coarse
Chest cold - mucus in bronchioles
Tachypnea
rapid respiratory rate
Wheeze
Squeaks

Air meets resistance going in and/or out

Note where you hear it - What side - inspiratory - Expiratory - with or w/o stethoscpoe

More swelling = more distress
Stridor
Inspiratory - difficulty getting air in (upper Respiratory- larger air passages)

Obstruction, croup
Respiratory Distress
Dyspnea- what activity with dyspnea (can't talk, eat, or think)

Abnormal secretions/ Nursing Care (Respiratory tree inflammed and/or infected [swollen, red, hot, fluid] hear secretions - describe productive cough- How much / what color

TCDB
Raise HOB
Suction (prn- no DO needed)
Humidified Air (need DO)
Hydration (Check I&O)
Postural Drainage (RT)
Postural drainage
RT

Head Down, on side (Left side if rt sided secretions, vis versa)

Morning, Before meals,and before sleep (not after meals)
Nebulizer treatments
(treatment modalities)
Meds through inhalation

Reduces side affects on other parts of the body
Incentive Spirometer
(treatment modalities)
Dr order required

Can measure progress

Involve Pt. & family
Tracheostomy
(treatment modalities)
Problem with upper airway occlusion

Can be done preop

Provides a patent airway & area to suction
Tracheostomy
Opening into trachea
Cuff
Neck ties
Suctioning
Trach care
Tracheostomy - Cuff
Normal influted

Seals airway around tube

Helps prevent aspiration
Tracheostomy - Neck ties
Neckties (old method) use knots

Velcro straps (more secure)

holds trachea in place in the neck

Rarly- a trache is sutured if permanent
Suctioning
Suction trachea to lungs than suction mouth/nose

Sterile technique

Through nose into Rt or Lft lung

one hand with sterile glove

Insert with no suction applied

Hit carnis, pull back a little than advance as far as it will go

Intermittant suction
(hold breath) hold suction (1,2,3)

Whole procedure should only take 10-15 sec.

Suction cath should be 1/2 the size of the trach

No more than 3X's per procedure(takes air, causes irritation and errosion)
Trache Care
Sterile technique

Remove intercannula

clean (trache cleaning kit)

Replace
Replacing trache
If trache is accidently coughed out replace it with a new one

Tell patient to imitate whistling
Hemoptysis

(Respiratory distress)
Coughing up blood (little & big clots)

how big & how often
cough

(respiratory distress)
excessive- seen in asthma pts
Hypoxia

(respiratory distress)
Pulse Ox, syonotic, blood gases
Increased pulse

(respiratory distress)
1st thing seen
Increased pulse

(repiratory distress)
2nd thing seen
Increased BP

(respiratory distress)
may see a slight change but not a reliable indicator
Restlessness
Due to brain sensitivity to low O2

Irritated

Lethargy

Non-responsive
Respiratory distress
Heart working properly?

Hemoglobin?

Air to lungs?
Hypercapnea
CO2 elevated in arterial blood (blood gases)
Cyanosis
Low O2 (SEVERE)

Lips

Mucous Membranes

Fingertips (could be caused by poor circulation)
Polycythemia
Increase in H/H

Chronic hypoxia

Blood doping

COPD

Thick blood (heart problems/clotting)
Cor Pulmonale
Enlargement of the rt ventricle(rt ventricle to lungs)

overworking

Chronic respiratory disease
Pneumothorax
Air in Pluera space

Always preceded by % (100% Rt pneumothorax)
Digital clubbing
Chronic hypoxia

COPD

Heart defects

Fat or squaring off at the ends of fingertips or toes
Chest X-Ray
diagnostic of pneumothorax & pneumonia

Screener for pneumonia, fluid in lungs, size of heart, if lung is expanded
CT or MRI
Fluid in chest, thoratic cavity, and pleura space

tumor mass- defines fluid & mass
Bronchoscope
Can be done @ beside
Takes 5-10 minutes
Rt, Lft or both bronchi

OP permit(puncture lung-cause pneumothorax), NPO(for 4-6 hrs-Aspirate), Gage reflex, Bleeding, Subcutaneous Emphysema/crepitus

Remove foreign objects, Biopsy, deliver Meds.

Could cause subcutaneous edema or rupture bronchi

Comfort pt, Check RR, VS, monitor for bleeding
Thoracentesis
Can be done @ BS, Needle into pleura space(lower aspect of lobe),Saginous fluid goes into sealed pleura vac

Op permit, position and support pt, specimens(label), Auscultate(could puncture lungs, chest X_Ray (to follow), fluid taken off goes on output record
Sputum Exam
Primarly lookin @ organisims(C&S) 1st thing in AM
#1 problem-no sputum-spit
Needs to be a coughed speci.
Speci goes to lab IMMEDIATELY
Culture- what bacteria
Sensitivity- what antibiotic will attack bacteria
Final report in 48hrs, Intermediate report in 24hrs
AFB-acid fast bacilli (TB)
3 tests confirm active TB
Skin Tests
Allergy testing- Immune response(reation to candida)

TB (PPD)- prensence of antigen for TB(+ does not mean you have TB. It means you have been exposed to TB.

Reactor- (- to +)

Not a valid test after having a + test result
V/Q Scan
Ventilation Quotrait(venalation/perfusion ratio)

looking for presence of PE (pulmonary Embolism)
high or low probibility
Pulmonary Function test
Look @ dynamics of the lungs

Adequate volume or retaining volume
Tidal Volume

(decreases with chronic illness)
amount of air with each breath 500ml

RT- attachment to mouth piece

Narcotics- don't hear much air exchange(shallow breating)
Minute Volume
TV X's RR 6000ml

Amount of air inhaled in one minute
Inspiratory Reserve

(increases in chronic illness)
Amount of air inspired from end of normal inspiration 3100ml

Deep breath - larger volume
Epiratory Reserve

(decreases with chronic illness)
amount of air forcibly expired after normal expiration 1200ml

chronic respiratory disease - retains air (can't get it out)
Residual Volume

(increased with chronic illness and increases in disease process)
Amount of air left in lungs after forced expiration 1200ml

always have air left in lungs to prevent collapse
Vital Capacity

(decreased with chronic illness)
Maximum amount of air that can be completely expired follwing maximum deep inspiration 4000-5000ml

breath in as much as possible than breath out as much as possible

Respiratory disease and chronic resp. conditions(decrease volume-gets worse)

Acute condition (will return to normal)
White Blood Cell Count
5000-10000
Elevates with infection/inflammation

Decreases rapidly with antibiotic therapy
Red Blood Cell Count
4.8 - 5.5 million

O2 carring capacity

ability to carry O2

RR & HR will increase due to problems with oxygenation due to blood loss
Pulse Oximetry
Greater than 95%

O2 saturation

Differs from ABG

Some causes of decrease: Resp. problems, pain meds., PCA, BR,etc.