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57 Cards in this Set

  • Front
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Revew the A+P
of lungs
Trachea, R and L main stem
bronchus, bronchi, alveolar
duct, alveoli. The continuous
exchange of O2 & CO2 is
required. Alveoli transfer O2
to blood and CO2 from blood
which is released back into
the air via lungs
Ventilation
includes both inspiration
(active movement of air in) and expiration (passive
movement of air out). Factor
in control is level of
arterial CO2 causes brain to
increase RR to rid excess CO2
Perfusion
Distribution of red blood
cells to and from the
pulmonary capillaries
Diffusion
movement of gases O2 and CO2
from high to low concentration
across alveolar cap membrane.
O2 atomosphere into arterial
blood. CO2 arterial blood
back to atmosphere.
Compliance
measure of lung and thoracic
elasticity or ability to
contract/expand. If decreased
lungs difficult to inflate
(pulm edema/effusion) If
increased loss of elasticity
and destruction of alveolar
walls (emphysema)
Hypoventilation
alveolar ventilation fails to
meet body's O2 demand or
eliminate CO2. Caused by
atelectasis and COPD. S+S change
in LOC, decrease RR
Hyperventilation
ventilation in excess, blowing
off CO2 too much. Anxiety, fear.
S+S dizzy, HA
Hypoxia
inadequate tissue oxygenation
or low levels of arterial O2.
Caused by: decreased Hgb
level, high altitued
(diminished O2 inspired) Poor
tissue perfusion w/ oxygenated
blood, impaired ventilation
S+S of
hypoxia
apprehension, restlessness,
inability to concentrate,
decreased LOC, dizzy, rapid
pulse, rapid RR
Cyanosis
blue discoloration of skin &
mucous membranes caused by
presene of desaturated Hgb in
cap. late stage of hypoxia.
CENTRAL-tongue, soft palate,
conjunctivia. PERIPERHAL
-extremities, nail beds
Discuss the role of
chemoreceptors in
the control or
respiration
chemoreceptor responds to change
in chem composition of fluid
surrounding it. located near the
respiratory center. are
sensitive to changes in the pH
Humidification
process of adding water to
gas. temp influences amt of
h2o a gas can hold. air/02
with a high relative humidity
keeps airways moist, help
reduce fever, loosens
secretions. necessary for pts
receiving 4L/min
Nebulization
adding moisture or meds to
inspired air by misting
particles w/ air. improves
clearance of secretions by
allowing our body's natural
mechanism for resp debris
removal
Chest
Physiotherapy
(CPT)
group of therapies used in
combination to mobilize
pulmonary secretions. should
be f/u by coughing or
suctioning. postural
drainage, chest percussion,
vibration
Normal changes
with aging
Decreased resp. muscle
mass/strenght, # of cilia,
airway clearance, cardiac
output, PaO2. Increase resp.
rate, risk of aspiration,
infection
Dyspnea
sign of hypoxia,
manifests as breathlessness.
difficult or uncomfortable
breathing.
Orthopnea
abnormal ocndition in which
patient must use multiple
pillows when lying down or must
sit with arms elevated in
order to breath
Clubbing
increased depth, bulk,
sponginess of distal digit
(finger/foot) due to hypoxemia
(chronic), lung ca,
bronchiectasis
Tachypnea
Increased rate of respirations
> 20/min. Possibly due to
fever, anxiety, hypoxemia
Hypoxic drive
when a patient depends on a
deficiency of O2 to stimulate
respiration (COPD)
Pursed lip
breathing
exhalation thru the mouth with
lips pursed together in order to
slow exhalation. Possibly
caused by COPD, asthma
Physiological
factors affecting
oxygenation
Decreased O2 carrying capacity
(anemia)Decreased inspired O2
concentration (airway
obstruction)Hypovolemia (fluid
loss)Increased metabolic rate
(increased tissue O2)
Conditions that
affect chest wall
movement:
Pregnancy
Fetus and large uterus force abd
contents to push up and against
diaphragm
Obesity
decreased compliance,
increased work of breathing,
decreased lung volume,
fatigue, CO2 retention. lungs
cannot fully expand and
pulmonary excretions are not
mobilized
Musculoskeletal
abnormalities
Pectus excavatum, kyphosis,
lordosis, scoliosis
Trauma
Multiple rib fx can cause a
flail chest can lead to
hypoxemia. Shallow breaths to
reduce pain.
Neuromuscular
disease
Can cause paralysis of the
respiratory muscles. Impaired
ventilation may cause hypoxemia,
atelectasis
CNS
alterations
Injury to medulla oblongata and
spinal cord may disrupt normal
breathing regulation, leading to
abnrml breathing patterns,
reduced lung volumes, hypoxemia
Influences of
chronic disease
decreased oxygenation as a
secondary effect (chronic
hypoxemia leading to secondary
polycythemia)
Kussmaul's respirations
abnormally deep, regular and
increased in rate. causes of
respiratory compensation for a
metabolic acidosis
Cheyne-Stokes
respiration
respiratory rate and depth are
irregular alternating periods of
apnea and hyperventilation.
Caused by instability in the
feedback control
Atelectasis
collapsed airless alveoli.
Cuased by inadequate lung
expansion due to anesthesia,
analgesia. Treatment -
increasing tissue oxygenation.
happens at bases. Use an
i.s.
Tracheal
sounds
Tracheal breath sounds are
heard over the trachea. These
sounds are high pitched,
harsh and sound like air is
being blown through a pipe
(hollow quality). air flow in
upper airways
Bronchial
sounds
Bronchial sounds are present
over the large airways. loud
and high in pitch with a short
pause between inspiration and
expiration; expiratory sounds
last longer than inspiratory
sounds. air moving thru
trachea close to chest wall
Vesicular sounds
soft, blowing, or rustling
sounds heard throughout most
of the lung fields. normally
heard throughout inspiration,
continue without pause through
expiration, and then fade
away about one third of the
way through expiration. Air
moving thru smaller airways
Bronchovesicular
sounds
heard in the posterior chest
between the scapula and in
the center part of the
anterior chest. sounds are
softer than bronchial sounds,
but have a tubular quality.
equal during inspiration and
expiration; air moving thru
large airways
Early and late
S+S of inadequate
oxygenation
Early: apprehension,
irritability, tachypnea,
tachycardia, HTN. Late:
combativeness, coma, cyanosis,
hypotension
Sputum characteristics
Color - clear, white, yellow, green, brown, red.
Color changes - same all day, clear with cough.
Quantity - decreased, increased. Consistency - frothy, watery.
Blood? Odor?
Pulse
oximetry
noninvasive technique that
determines O2 saturation.
SpO2 >95 %. Probe placed
on finger
WBC's
total count can indicate
infection if > 11,000
(4,000-11,000)Leukopenia <
4,000. WBC diff % of each type
of leukocyte.
Hemoblogin
measurement of gas-carrying
capacity of RBC's. can dx
anemia, determine fluid deficit.
norm 12-17.
Pulmonary Function
Tests (PFT's)
evaluate lung function by
measuring lung volumes and
airflow, dx pulmonary dz. Use
of a spirometer to diagram air.
Arterial blood
gases
determines acid-base
balance.
Crackles
caused by fluid in the small
airways or atelectasis.
referred to as discontinuous
sounds; heard on inspiration
or expiration.popping sounds
produced are created when air
is forced through respiratory
passages that are narrowed by
fluid, mucus, or pus.
Rhonchi
heard continuously during
inspiration or expiration,
wheezing. caused by air moving
through airways narrowed by
constriction or swelling of
airway or partial airway
obstruction.
Wheezes
an adventitious or abnormal
breath sound heard when
listening to the chest as a
person breathes. Wheezes are
continuous and musical
sounding, and usually caused
by airway obstruction from
swelling or secretions.
Wheezes can be high or low pitched, and are
also known as rhonchi.
Bronchophony
The spoken or whispered
syllable is more distinct
than normal upon auscultation.
PNA
Egophony
Spoken "e" similar to
"a" on auscultation.
PNA
Classic cues
to respiratory
problems
SOB (dyspnea), wheezing,
pleuritic cp, cough, sputum
production, hemoptysis, voice
change, fatigue
How can healthy
lifestyle decrease
risk of respiratory
problems?
Regular exercise,
diet/nutrition, tobacco,
alcohol, caffeine
Nursing interventions
to promote lung expansion,
mobilization of pulmonary
secretions and maintenance of a
patient airway
Humidification, nebulization,
CPT, suctioning techniques
Standard procedure for
collecting a sputum
specimen
Can be obtained by
expectoration, tracheal
suction, or bronchoscopy.
Specs are sent to lab for
organism i.d. Must be
collected with sterile
technique
Pulse ox -
proper use, purpose,
monitoring
Continual monitoring of SpO2.
Assess pt for factors that
could affect sat. Determine
baseline. Set alarms
accordingly.
Differentiate between
the following O2
systems:
Nasal cannula
Simple face mask
Nasal cannula - pt can
eat/talk, slow flow rate,
easily dislodge (up to 6L)
Simple face mask - mod O2 amt,
short-term, loose-fitting,
sensation of smothering (min
5L)
Venturi
Non-rebreather
Venturi - plastic face mask,
precise, high flow rates, pt
cannot speak easily/eat/talk
Non-rebreather - prevents
expired air from entering bag,
precise, high O2, pt can't
talk/eat
MDI
Metered dose inhaler; device
used to produce local effects
such as bronchodilation by
delivering meds directly to
resp tract. makes high pitch
sound if incorrectly used.
Yankhauer
used for oropharyngeal
suctioning, just mouth and
buccal cavity as fluid and
mucous accumulate in mouth.