Nursing Respiratory System

Front 1

Upper respiratory structures

Back 1

Nose, epiglottis, oropharnyx, layngopharynx, larynx (vocal cords),trachea, carina at the manubriosternal junction (angle of Loius)

Front 2

Lower Respiratory structures

Back 2

Once air is past the carina it is in the lower respiratory tract.
The mainstem bronchus, pulmonary vessels and nerves enter the lungs through a slit called the Hilus. The right mainstem bronchus is shorter, wider and straighter than the left. Aspiration is more likely to occur in the right . The mainstem bronchus is divided into bronchi-

Front 3

Primary role of the upper respiratory structures

Back 3

Warm, humidify, and filter the air

Front 4

Primary role of the lower respiratory structures

Back 4

Gas exchange

Front 5

Roles of the respiratory system

Back 5

Bring oxygen in and transport it to the blood, gas exchange of CO2 and O2, Acid, base, and pH balance

Front 6

Anatomical dead space

Back 6

the parts of the respiratory system that do not partake in gas exchange

Front 7

Parts that do the gas exchange

Back 7

Respiratory bronchioles and alveoli

Front 8

Ventilation

Back 8

A cycle of inhalation and exhalation

Front 9

Inhalation

Back 9

An Active process-The Diaphragm and intercostal muscles contract causing an increase in lung capacity and a decrease in pressure
(air moves in lungs)
-Signal comes from the medulla and monitors the CO2 levels

Front 10

Exhalation

Back 10

A Passive process- The Diaphragm and intercostal muscles relax causing a decrease in lung capacity and an increase in pressure
(air moves out of lungs)

Front 11

Oxygenation

Back 11

-O2 entering the lungs on inhalation crosses the alveolar membrane into the capillaries lining the alveoli and enters the vascular flow
(Diffusion – greater to lesser concentration)
-CO2 from the capillaries crosses the alveolar membrane into the lungs where it is exhaled

Front 12

Oxygen Transport

Back 12

-O2 is primarily transported through the body to the tissues by attaching itself to the hemoglobin molecules of the red blood cells
-Each hemoglobin molecule has the capacity to carry 4 molecules of oxygen

Front 13

Oxygen-hemoglobin dissociation curve

Back 13

-Oxygen detaching fro the hemoglobin when: pH, temp, CO2 are in hemostats
-Describes the affinity of hemoglobin for oxygen
-Oxygen delivery to the tissues depends on the amount of oxygen that can be picked up in the lungs and the ease with which hemoglobin gives up oxygen once it reaches the tissues

Front 14

When the curve shifts left

Back 14

blood picks up O2 more readily in the lungs but delivers O2 less readily to the tissues This is seen in alkalosis, hypothermia and with a decrease PaCO2

Front 15

When the curve shifts to the right

Back 15

blood picks up O2 less rapidly in the lungs but delivers O2 more readily to the tissues. This is seen in acidosis, hyperthermia and when the PaCO2 is increased

Front 16

Chemoreceptors & Mechanical receptors

Back 16

Located in the medulla of the brain, aortic arch and carotid arteries - measure O2, CO2, H+, and pH levels

Front 17

Control of Respirations

Back 17

An increase in CO2 and H+ levels and a decrease in O2 levels stimulates the body to respond by increasing rate and depth of inhalations
*normal stimulus to breathe is a rise in CO2 levels and decrease in pH

Front 18

Assessment of the Respiratory System

Back 18

-Subjective data: Important health information, Past, health history, Medications, Surgery or other treatments
-Objective data: Physical examination: Nose, Mouth and pharynx, Neck, thorax and lungs

Front 19

Normal Physical Assessment of the Respiratory System

Back 19

-Nose: symmetric with no deformities. Nasal mucosa pink, moist with no edema, exudate, blood or polyps. Nasal septum straight; nares patent bilaterally.
-Oral Mucosa: light pink, moist, with no exudate or ulcerations.
-Pharynx: smooth, moist, and pink.
-Neck: Trachea midline
-Chest: anterior-posterior to lateral diameter 1:2. Respirations non-labored at 14/min. Breath sounds vesicular without crackels, rhonchi, or wheezes. Excursion equal bilaterally with no increase in tactile fremitus.

Front 20

Hemoglobin Hgb- amt Hgb available for combination with oxygen

Back 20

normal range 12-18 g/dl

Front 21

Hematocrit-ratio of RBC’s to Plasma

Back 21

38-54%

Front 22

ABG’s

Back 22

assess acid-base balance

Front 23

Chest x-ray

Back 23

Most commonly used test for assessment of the respiratory system

Front 24

CT scan

Back 24

diagnose lesions

Front 25

MRI

Back 25

diagnose lesions when CT is inconclusive

Front 26

Ventilation/perfusion (V/Q) scan

Back 26

Identify areas of the lung not “ventilated or perfused” (ventilation without perfusion equates to a pulmonary emboli)

Front 27

Positron Emission Tomography (PET)

Back 27

Used to distinguish benign from malignant lung nodules

Front 28

Thoracentesis

Back 28

Pleural fluid specimen, removal, or medication administration

Front 29

Bronchoscopy

Back 29

fiber optic scope used to diagnose, gather specimens, remove plugs, lavage for CA cells, cauterize (gag reflex)

Front 30

Mediastinoscopy

Back 30

incision through suprasternal notch to biopsy lymph nodes

Front 31

Tidal Volume (TV) (Anatomical Dead Space)

Back 31

volume of air in one cycle 500ml

Front 32

Functional Residual Capacity (FRC)

Back 32

Volume of air left after normal exhalation

Front 33

Vital Capacity (VC)

Back 33

Volume of air exhaled after maximum inspiration 4800ml

Front 34

Total Lung capacity

Back 34

normal is 6000mL

Front 35

Inspiratory Reserve Volume (IRV)

Back 35

volume of air above tidal volume taken in with deep inhalation 2500ml

Front 36

Compliance

Back 36

is a measure of the ease of expansion of the lings—This is a product of the elasticity of the lung tissue and the elastic recoil of the chest wall–

Front 37

Forced Vital Capacity (FVC)

Back 37

Amount of air that can be quickly and forcefully exhaled after maximum inspiration

Front 38

Peak Expiratory Flow Rate (PEFR)

Back 38

Maximum air-flow rate during forced exhalation

Front 39

Acid/Base balance

Back 39

The body tries to maintain a pH balance within a narrow range. This balance shifts constantly as we expend energy and as we take in air, food, liquids which are converted into metabolites and energy

Front 40

acid-base status of the blood

Back 40

Normal pH range 7.35- 7.45

Front 41

The normal ratio of H2CO3 to HCO3

Back 41

1 part H2CO3 to 20 parts HCO3- indicates that the body is in acid-base balance

Front 42

H2CO3 carbonic acid ( acid) regulated by the lungs

Back 42

Lungs selectively retain or excrete CO3

Front 43

HCO3 bicarbonate (base) regulated by the kidneys

Back 43

Kidneys selectively retain (or conserve) or excrete H+ and bicarbonate ions (HCO3)

Front 44

The lungs and the kidneys are the principle acid/base regulators on the body

Back 44

They are able to do this with the help of two buffers HCO3- bicarbonate (base) and H2CO3 carbonic acid (acid)
They minimize a pH shift by neutralizing surplus H+ and bicarbonate ions (HCO3)

Front 45

ABG Normal Range pH

Back 45

7.35- 7.45

Front 46

ABG Normal Range pO2

Back 46

80-100 mmHg

Front 47

ABG Normal Range pCO2

Back 47

35-45

Front 48

ABG Normal Range HCO3

Back 48

22-26mEq/L

Front 49

ABG Normal Range O2 saturation

Back 49

>95%

Front 50

pH < (Less than) 7.35

Back 50

Acidosis

Front 51

pH is > (greater than) 7.45

Back 51

Alkalosis

Front 52

pH normal 7.35-7.45

Back 52

Compensated

Front 53

pH is < (less than) 7.35 or > (greater than) 7.45

Back 53

Uncompensated

Front 54

CO2 is < (less than) 35 or > (greater than) 45

Back 54

Respiratory

Front 55

HCO3 is < (less than) 22 or > (greater than) 26

Back 55

Metabolic

Front 56

Corticosteroids

Back 56

anti-inflammatory
Nasal Sprays : Flonase, Nasonex

Front 57

Mast cell Stabilizer

Back 57

inhibits degranulation of mast cells after exposure to antigens
Nasal Spray: Cromyln Spray (NasalCrom)

Front 58

Leukotriene Receptor Antagonists LTRA

Back 58

Inhibits leukotriene and so decreases edema and bronchoconstriction
Singulair

Front 59

Anticholinergic Nasal Spray

Back 59

blocks hypersecretion effects by binding to sites on cell
Atrovent

Front 60

Antihistamines, 1st generation

Back 60

relieve acute symptoms of allergic response
Benadryl

Front 61

Antihistamines, 2nd generation

Back 61

non-drowsy
claritin, zyrtec, allegra

Front 62

Decongestants oral

Back 62

vaoconstriction and decrease in nasal edema
*causes drowsiness
Sudafed

Front 63

Antibiotics

Back 63

treatment of bacterial infections
Amoxicillin, Bactrim, Erythromycin

Front 64

Antifungal

Back 64

treat candida
Nystatin, Mycostatin

Front 65

Antivirals

Back 65

decrease the symptoms and severity of viral illness
Symmetrel, Tamiflu

Front 66

Vaccinations influenza type A & B

Back 66

Inactivated > 50yrs
Live attenuated influenza vaccine (LAIV )5-49yrs, spray

Front 67

TB meds

Back 67

treatment of Mycobacterium tuberculosis
INH isoniazid, Rifampin, PZA, Ethambutol

Front 68

Pneumonia meds

Back 68

CAP and VAP
Erythromycin, Zithromax,Vibromycin, Augmentin

Front 69

Asthma and COPD meds

Back 69

Corticosteroids (Prednisone, Solumedrol, Flovent inhaled)
Methylxanthines (theophylline and Slo-bid (SR)

Front 70

Mast Cell Stabilizers

Back 70

prevent degranulation of mast cells
Cromylyn: Intal
For asthma or COPD

Front 71

Anticholinergics

Back 71

Atrovent, Spiriva
For asthma or COPD

Front 72

IgE Antagonists

Back 72

Xolair SQ injections
For asthma or COPD

Front 73

Leukotriene Receptor Blocker

Back 73

Singulair, Accolate, Zyflo, Serevent/Foradil (long acting)
For asthma or COPD

Front 74

Bronchodilators

Back 74

B2- Adrenergic Agonist
Albuterol, Proventil, Alupent
For asthma or COPD

Front 75

Allergic rhinitis

Back 75

-the reaction of the nasal mucosa to a specific allergen and is classified as either intermittent or persistent.
-Symptoms occurs whenever a client is exposed to a specific allergen
-Intermittent < 4days/wk or 4wks/yr
-Persistent > 4days/wk or 4wks/yr
-Most important step is identifying and avoiding triggers of allergic reactions

Front 76

Acute Viral Rhinitis- Common cold or acute coryza

Back 76

Caused by an adenovirus that invades the upper respiratory tract and often accompanies an acute respiratory infection. Sneezing, runny nose, watery, itchy eyes and nose, Boggy, pale and swollen nasal turbinates, Post nasal drip, cough, hoarseness, mild fever, headache.
-Antihistamines, 2nd generation antihistamines, Leukotriene receptor antogonists (LTRAs)
-Rest, Fluids, Analgesics, Antipyretics

Front 77

Influenza

Back 77

-Cough, Fever, Headache, Myalgia
-Uncomplicated cases Resolve within 7 days
-Pulmonary complication: Dyspnea, crackles
-Prevent with Vaccinations

Front 78

H1N1 Flu

Back 78

-Contagious virus spread from human to human (coughing, sneezing, touching an object with the flu virus and then touching nose or mouth)
-Fever, Cough, Headache, Sore Throat, Runny Nose, Body Aches, Chills, Fatigue. May have Respiratory symptoms w/o fever. Infectious from 1 day before getting sick to 7 days after.
-Pregnancy , Immunosuppression, CV Disease, Kidney Disease, Asthma, DM, Neurological Disorders, pre-existing medical condition

Front 79

H1N1 Flu Treatment and Prevention

Back 79

-Antivirals (Tamiflu) improve the recovery time and decrease the risk for developing complications
-Vaccinations are available in two forms:
Nasal Spray (Live Attenuated Nasal Vaccine)
IM Injection (Inactivated Flu Shot)

Front 80

Community acquired-Pneumonia

Back 80

-onset in the community or within 48 hours of admission to the hospital, lower respiratory infection of the lung parenchyma
Common organisms- S. pneumoniae (35%), H. Influenza

Front 81

Hospital-acquired (ventilator-associated, and health care associated)- Pneumonia

Back 81

Pneumonia occurring 48 hours or longer after hospital admission
Usually a bacterial infection
Pneumococcal pneumonia most common, caused by the streptococcus pneumoniae organism

Front 82

Predisposing factors and risk factors for Pneumonia

Back 82

Smoking, Aging, Altered consciousness, Prolonged immobility, Malnutrition, Upper respiratory infection, Tracheal intubation

Front 83

Acquisition of the Pneumonia organism

Back 83

-Aspiration
-Inhalation
-Hematogenous spread

Front 84

Pneumonia Signs and symptoms

Back 84

Fever, Shaking chills, SOB, Cough, productive, Pleuritic chest pain- headache, nausea and vomiting, Sore throat myalgias

Front 85

Complications of Pneumonia

Back 85

Much more likely to happen in elderly population and those with comorbidities
Pleural effusion, Bacteremia, Atelectasis

Front 86

Diagnostic studies for Pneumonia

Back 86

Chest x-ray
Sputum culture

Front 87

Nursing Management of Pneumonia

Back 87

Health promotion, Monitoring Vital signs, Assessing risk for complications, Assessing O2 needs, Hydration, nutritional support, Therapeutic positioning, Medication administration, Bronchodilators, antibiotics
-Incentive spirometry, TC& DB percussion, prolonged recovery rest- a prolonged period of rehab may be needed for the very frail or weak