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65 Cards in this Set

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Normal respiratory rates

Adult- 12-20


Toddler- 20-30


Infants-30-60g

Used to detect andidentify bacteria possibly infecting the lungs. Best to get in the morning. Request patient take a deepbreath and cough ensuring that the sputum is from deep within the chest. Spit into a cup, If patient is unableto cough or does not understand , you may need to _________.

Sputum Specimen;




Suction

measure lung volume and capacity. The client breathes into a machine attached to a computer to measure their pulmonary function in comparison to someone identical to them.

Pulmonary Function Test (PFT)

measured with a hand held flow meter. It tests current respiratory status is and compared to their previous best.

Peak Expiratory Flow Rate (PEFR)

Lifestyle assessment questions

What is their occupation? What do they like to do in their spare time? What is their exposure to pets? What are their current living conditions? Have they traveled to different climates recently? What sort of environment do they live in?

number one cause of any respiratory disorder

Are they currently a smoker?

________ and _________ are the firstsigns of an oxygenation complication.

Restlessness




confusion

Currentmedications being taken




(benzodiazepinesedative-hypnotics and antianxiety drugs [diazepam, lorazepam, midazolam],barbiturates [penobarbital], and narcotics [morphine and meperidinehydrochloride]

can greatly decrease the respiratory drive

Continuous,low-pitched, coarse gurgling, harsh, louder sound with a moaning or snoringquality.

Rhonchi

Chest X-Ray may done to establish a baseline for the patient. Other indications for a chest x-ray may include possible infection (pneumonia), a collapsed lung (pneumothorax), or any abnormalities (atelectasis, tumor, etc.). May show __________ and _________ diaphragm for emphysema patients.
hyperinflation



flattened

If the chest x-ray cannot provide enough information, _______ may get a better picture on what is happening to the patient’s lungs.
CT/MRI
Invasive procedure that views the airways and lungs. May diagnose lung disease. Since this is an invasive procedure, it will require a consent.
Bronchoscopy

____________ are used before corticosteroids because they open the airways to better receivethe corticosteroid medication.

Bronchodilators

Cause smooth muscle relaxation and bronchodilation. Act by selectively activating the beta2-receptorsin the bronchial smooth muscle resulting in bronchodilation. This helps relieve bronchospasm, inhibit histamine release, and increase ciliary motility.

Beta 2-Adrenergic Agonists/Stimulants

Rescue drug, if someone is having respiratory distress/exacerbation (asthma attack),this will help immediately.

Short-Acting Beta Agonist (Short Acting Inhaler)

Medication used for the prevention of asthma episode,inhaled, short-acting, used for prevention of asthma.

Albuterol (Proventil, Ventolin)

S/E: headache, dizziness, sleep problems(nervousness, restlessness, insomnia), cough, hoarseness, sore throat, runny orstuffy nose, mild nausea, vomiting, dry mouth and throat, muscle pain ordiarrhea.

Slower onsetand longer duration. Primarily used to prevent attack. Taken daily and stays inthe system most of the day.

Long-Acting Beta Agonist

Inhaled, long-acting medicationsused for long-term control of asthma.

Salmeterol (Serevent)



S/E: cough producing mucus,difficulty breathing, headache, irritation of the throat, runny nose, dyspnea/ShOB,sneezing, stuffy nose, chest tightness, wheezing.

beta-adrenergic blockers (__________) a decrease the effects of the medication. Do not take concurrently.
propranolol

Anticholinergics blocks muscarinic receptors of the bronchi, resulting in bronchodilation.Relieves bronchospasm associated with COPD, allergen-induced andexercise-induced asthma. Taken daily, long-acting medications.

Ipratropium (Atrovent, Apolpravent)




Tiotropium Bromide (Spiriva)

given as a last resort due to dangers of taking the medication. Is a bronchodilator. Medication is hard to regulate, unstable, acts similar to caffeine. Relaxes smooth muscles causing bronchodilation. May be administered PO or IV, be careful as there is a narrow margin of safety. Most effective dose is commonly very close to level of safety and toxicity. Long-acting, used in most chronic cases (COPD or chronic asthma).
Methylxanthines



Warning: Do not take caffeine and do not abruptly discontinue smoking as it may affect the effectiveness of the drug.

Methylxanthines
Theophylline (Theo-Dur, Elixophillin, Theolair, Slo-Bid)



Aminophylline (Somaphyllin)

prevent inflammation, suppress airway mucus production, and promote responsiveness of beta2 receptors in the bronchial tree. Increases airflow by decreasing inflammatory responses. Does not provide immediate effects, but promotes decreased frequency and severity of exacerbations and acute attacks.
Corticosteroids
Corticosteroids: anti-inflammatory, antipruritic.
Fluticasone (Flovent)



Prednisone (Deltasone, Predone)





administered by inhaler, taken daily to prevent attack, does not treat symptoms. Worksto inhibit the inflammation response.

Mast Cell Stabilizers/NSAIDs

preventthe effects of leukotrienes, thereby suppressing inflammation,bronchoconstriction, airway edema, and mucus production. Long-term treatment ofasthma and to prevent exercise-induced bronchospasm.

Leukotriene Modifiers

suppresses cough through its action in the CNS. Used for chronic nonproductive cough.

Antitussives

works on the H1 receptors which results in the blocking of histamine release in the small blood vessels, capillaries, and nerves during allergic reactions.

Antihistamines

Nasal Cannula: 1 to 6 L/minute of oxygen at a 24-45% concentration.



Face Mask: 5-10 L/minute at a 40 to 60% concentration




Nonrebreather: delivers 10-15 L/minute at a 95-100% concentration.

NC > Face Mask > Partial Nonrebreather > Nonrebreather > Intubation.
want to maintain anywhere between _______ a day. This helps thin secretions out and maintains the moisture of the respiratory mucous membranes

2-3 L

smell the roses, blow out the candle. This helps get out the excess CO2 that may have built up with COPD patients. Keeps the airway open longer.

Pursed Lip Breathing

helps move secretions from the airways.

Deep Breathing and Coughing

improves lung expansion by having the diaphragm full push the excess air out of the base of the lungs.

Diaphragmatic Breathing

improve pulmonary ventilation, counteract the effects of anesthesia or hypoventilation, loosen respiratory secretions, facilitate respiratory gaseous exchange, and expand collapsed alveoli.

Incentive Spirometry

Percussion: striking of the back with a cupped hand, loosens the secretions.



Vibration: flat hand on back, and shaking to loosen drainage.




Postural Drainage: putting in different positions to loosen and move secretions.

Encourage vaccinations. Especially influenza and pneumococcal vaccination
narrowing of the bronchial tubes by constriction of the smooth muscle around and within the bronchial wall. This occurs when small amounts of pollutants or respiratory viruses stimulate nerve fibers causing constriction of bronchial smooth muscle.
Bronchospasm
triggers asthma for some people when allergens bind to specific antibodies. These antibodies that start the local inflammatory responses. Chemicals can attract more WBCs to the area which will continue the responses of blood vessel dilation and capillary leak leading to mucous membrane swelling and increased mucus production.

Asthma inflammation response

is a chronic disease often identified in childhood. The airways of the asthmatic child react to stimuli such as allergens, exercise, or cold air by constricting, becoming edematous and producing excessive mucus. Airflow is impaired and the child may wheeze as air moves through narrowed passages.
asthma



Clinical: i. Coughing.ii. Wheezing.iii. ShOB.iv. Difficulty speaking more than 2-3 words- more acute problem.v. Retractions- the use of accessory muscles.vi. Chest tightness.vii. Tachypnea.viii. Tachycardia.ix. Fatigue.x. Anxiety.xi. Rapid, labored respirations.xii. Nasal flaring and intercostal retractions may be common.

have smaller airway diameter therefore attacks can progress quickly. respiratory system is not developed causing a quicker onset of symptoms.
Pediatrics



Coughing at night may be an early sign of asthma

use of accessory muscles
retractions
daytime manifestations may occur twice a week or less; no activity limitations or nighttime manifestations; reliever drug use used twice per week or less; PEF or FEV are within normal limits; treatment is maintained by lowest step that controls manifestations. Generally temporary and reversible.
Well Controlled
daytime manifestations occur more than twice per week; may have activity limitations and nighttime manifestations; PEF and FEV are less than 80% of predicted or established personal best; treatment requires continuous progression on a regular basis. May lead to chronic inflammation that causes damage and hyperplasia of the cells and smooth muscle. Can lead to COPD.
Partially Controlled/Uncontrolled
severe, life-threatening acute episode of airway obstruction that intensifies once it begins it does not respond to usual therapy. Patient will arrive with labored breathing and wheezing, use of accessory muscles for breathing and distention of neck veins are observed. If not reversed, patient may develop pneumothorax and cardiac or respiratory arrest. Patient may start off wheezing, coughing with diminished breath sounds that eventually leads to an ineffective cough, wheezing has decreased, no active breath sounds means there is no more air movement and intubation may be neces
Status Asthmaticus
includes both emphysema and chronic bronchitis. many patients with emphysema also have chronic bronchitis. is a chronic, progressive disease/disorder. Once the lung tissue is damaged, it is not reversible. Modifying risk factors will help to not worsen your condition, but does not repair damaged tissue. May affect older adults more acutely, particularly after years of exposure to cigarette smoke or industrial pollutants.
Chronic Obstructive Pulmonary Disease (COPD)
inflammation of the bronchi and bronchioles caused by exposure to irritants (chemicals, factory work, hair salons, smoke, etc.), especially cigarette smoke.
Chronic Bronchitis
loss of lung elasticity and hyperinflation of the lung. result in dyspnea and increased respiratory rate. damaging the alveoli and the small airways.
Emphysema
air-filled sacs within the lungs that form due to the excess tissue damage
bullae
less common, but important risk factor. AAT is present in the lungs, this inhibits excessive protease activity so that the proteases only break down inhaled pollutants and organisms and do not damage lung structures.
Alpha1-Antitrypsin Deficiency
air trapping, airway collapse, and stiff alveolar walls increase the lung tissue pressure and narrow lung blood vessels, complicating blood flow. This increased pressure creates a heavy workload on the right side of the heart, which causes the right side to generate high pressure. This increase in the workload causes the right chambers to enlarge and thicken, causing right-sided heart failure.
Cardiac Failure
chronic hypoxia (decreased oxygen to the heart muscle), other cardiac diseases, drug effects, or acidosis are all causes of
dysrhythmias.
Interdisciplinary Care: Immunizations (Pneumonia and Influenza), Antibiotics (for recurrent infections), __________ (to open airways), and Corticosteroids (decreases inflammation)
Bronchodilators

unplanned _______ loss is common in patients because the increased work needed to breathe increases metabolic needs

weight

Commonly in a forward bent position with arms forward



Changes in chest size and fatigue are common signs of respiratory changes

orthopenic position



Breath sounds completely gone may be a sign of airflow obstruction or a pneumothorax.

What would sign would the nurse find if the she suspected a patient to have COPD?
Coughing in the morning producing a clear sputum.

Late Signs of COPD: clubbing, cyanosis.

clubbing, cyanosis.

What questions would a nurse include todetermine activity intolerance?

Do you have difficulty sleeping(restlessness is a common complication from lack of oxygen)? How long does it take to perform your morning ADLs? Have you lost any weight lately?

this is where mucous builds up and patients begin coughing and having difficulty breathing. Patients will also have periods of relatively normal function.

Patients will have exacerbations

The nurse caring for a client with COPD recognizes which of the following as an early sign of possible respiratory failure-

restlessness and tachypnea
While collecting a history from a patient with chronic bronchitis the nurse would expect to find that the patient:
smoked cigarettes for 40 years
Occurs in October to March, transmitted through direct contact with respiratory secretions or indirectly through contaminated surfaces. Infected children sheds the virus for 3 to 8 days, with an incubation period of 2 to 8 days. Viruses are able to invade the mucosal cells that line the small bronchi and bronchioles, these invaded cells die when the virus bursts inside the cell when trying to invade adjacent cells. This causes adjacent cells to infuse with the membranes of infected cells creating large masses of cells or syncytia and irritates the airway. This causes the airway lining to swell and an increase in mucus production. Despite the attempt to fix the issue, this results in partial airway obstruction and bronchospasm. Air can get in, but cannot get out. This creates wheezing and crackles in the airways.
Respiratory Syncytial Virus (RSV)



cannot treat disease, must treat symptoms. Peak is around day five.

No smoking ___ hours prior to pulmonary function test

6

If Peak expiratory flow rate meter is yellow they need to take fast acting medication and retest. If it is red they need to...

seek medical attention

Barrel chest is a common sign of

COPD

Venturi mask will deliver the _____ _______ volume of oxygen.




Non rebreather mask delivers the most oxygen and the bag must remain inflated at least....

most accurate




2/3rds full

Aspirin and beta blocks may trigger

asthma attack