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184 Cards in this Set
- Front
- Back
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Right Bronchus |
Larger in diameter More vertical Probe to aspiration, infection, and misplacement of tubes |
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What lines bronchioles? |
Ciliated mucous membranes |
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Where does diffusion take place? |
Aveoli |
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Surfactant |
Secreted by alveoli Reduces surface tension Prevents collapse after each breath |
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Phases of respiratory system |
Ventilation Perfusion Diffusion |
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Thoracic Cavity |
Enclosed space under negative pressure to keep lungs expanded |
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What occupies most of the thoracic cavity? |
Lungs |
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Mediastinum |
Centermost area of thoracic cavity, containing heart and major vessels |
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Sternum |
ribs and thoracic vertabrae enclose intrapleural space |
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Differences between lungs? |
Right: contains 3 lobes, 60-65% of lung function occurs Left: Smaller, contains 2 lobes |
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Apex of lungs |
Narrowest part 1 inch above first rib |
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Base of lungs |
Lies in diaphragm |
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Pleura |
Thin, moist, serious membrane covering each lung |
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Parietal Pleura |
Covers walls of thoracic cavity |
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Pleurisy |
Caused by friction between the pleura and parietal pleura |
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RR of an adult |
12-20 |
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RR of a teen |
20-22 |
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RR of a school aged child |
22-44 |
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RR of a preschool child |
22-44 |
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Average RR of a preschool child |
25 |
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RR of an infant |
30-60 |
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Average RR of an infant |
30 |
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RR of a newborn |
40-60 |
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What regulates respiration? |
Medulla oblongata and pons |
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How does presence of CO2 affect respirations? |
Serves as a chemical stimulant in the form of carbonic acid. Decrease in blood pH stimulates increased RR |
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Cheyne Stokes Respirations |
Irregular |
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Kussmal respirations |
Slow |
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Normal AP diameter? |
1:2 |
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Barrel chest |
AP diameter 1:1 |
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DOE |
Dyspnea on exertion |
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DAR |
Dyspnea at rest |
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How do infants primarily breath? |
through the nose |
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How are infants' tongue and soft palates different than adults? How does that affect them? |
They are larger |
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How do infants' airways differ from adults'? |
They are smaller |
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How do infants' lungs differ from adults'? |
Less surface area, more compliant, less alveoli |
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How do infants' mucous membranes differ from adults'? |
They dehydrate more easily, leading to an increase in risk of infection |
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What is often the first sign of respiratory distress in young children? |
Tachypnea |
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What is a common late sign of respiratory distress in children? |
Nasal Flaring |
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What respiratory risk affects premature infants? |
They do not have enough surfactant |
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Nasal Cannula |
Low flow 24%-40% FiO2 |
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Simple Facemask |
Low Flow 40%-60% 5-8L/min |
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Partial Rebreather |
Low Flow 60%-75% 6-11L/min Reservoir bag should be 2/3 full during inspiration and expiration |
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Nonrebreather |
Low Flow 80%-95% Liter flow high enough to maintain reservoir bag 2/3 full |
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Venturi Mask |
High Flow 24%-50% FiO2 4-10L/min |
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Aerosol Mask Tracheostomy collar |
High Flow 24%-100% at least 10L/min |
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T-piece |
High Flow 24%-100% at least 10L/min |
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Tracheostomy collar |
High Flow 24%-100% at least 10L/min |
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Face Tent |
High Flow 24%-100% at least 10L/min |
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Low Flow systems |
Do not meet total O2 need or tidal volume |
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High Flow Systems |
Deliver 24-100% O2 |
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Cachexia |
When the body becomes emaciated due to the energy burned while attempting to breathe. |
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Pack Year |
Packs per day x # of years smoked |
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Decongestants |
Sympathomimetic Amines
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Antihistamines |
H1 Blockers Compete with histamine for receptor sites to prevent histamine response and decrease secretions |
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Expectorants |
Liquefies secretions so they can be eliminated with coughing |
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Antitussives |
Act on cough control center in medulla to suppress the cough reflex |
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Short Acting Bronchodilators |
Albuterol |
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Long Acting Bronchodilators |
Salmeterol Formoterol |
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Side Effects of Bronchodilators |
Palpitations Tachycardia Anxiety Flushing |
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Side Effects of Glucocorticooids |
Thrush |
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Antiallergenics |
Anti-inflammatory Can take 4-6 weeks to work |
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Side Effects of antiallergenics |
Cough, Wheeze, Dizziness, throat irritation, bitter taste |
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Mucolytics |
Act like detergents- decrease tension |
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Acetylcysteine |
Mucomyst |
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If patient is asthmatic and on a bronchodilator and acetylcysteine is ordered, how should they be administered? |
Bronchodilator should be given 5 minutes before acetylcysteine |
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Anticholinergics side effects and action |
Dilates bronchioles |
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Cautions for anticholinergics |
Smoking decreases the half life |
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Methylxanthine derrivatives |
Stimulate CNS and resp system |
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Order of inhalers |
Bronchodilator |
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What are cautions for a CT of the chest? |
Encourage fluids |
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When is a CT useful? |
When an x-ray reveals a suspicious lesion or when a clot is suspected |
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Pulmonary Function Test |
Evaluates lung function and breathing problems |
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Laryngoscopy |
Indirect: Laryngeal mirror |
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Caution for laryngoscopy patients |
Sterile procedure |
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Broncoscopy |
Insertion of a tube into airways as far as secondary bronchi |
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Thoracentesis |
Aspiration of pleural fluid or air from the pleural space. Can be used for diagnosis or treatment |
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Cautions for thoracentesis |
1300ml/30min maximum |
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Symptoms of hypovolemic shock |
High HR, High RR, Low BP |
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SpO2 range and critical value |
95%-100% |
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Capnometry/Capnography |
Measures amount of CO2 present in exhaled air 20-40mmHg |
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PaCO2 |
35-45 mm Hg |
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pH of blood |
7.35-7.45 |
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HCO3 |
22-26 mEq/L |
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Epistaxis |
Nosebleed Treated by lateral pressure to nose for 10 minutes and ice |
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S/S of a deviated septum |
Tilting to one side |
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S/S of nasal polyps |
Stuffy |
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Incubation period of virus |
about 5 days |
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Rhinitis |
Inflammation of the nasal mucosa that often involves the sinuses |
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S/S of rhinitis |
runny nose |
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Medications for rhinitis |
ASA or tylenol |
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Sinusitis |
An inflammation of the mucous membranes that often follows rhinitis |
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Common causes of sinusitis |
Deviated septum, common cold, nasal polyps, tumors, cocaine, allergies, facial trauma, dental infection |
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S/S of sinusitis |
Purulent drainage, fever, cellulitis, abscess, meningitis, pn over the cheek radiating to the teeth, tenderness over sinuses, referred pain to the temple or back of head, facial pain that is worse when bending over, sore throat, errythema |
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Treatments for sinusitis |
Fluids, analgesics, decongestants, antihistamines, saline nose drips, humidifier, warm compresses, at least 2,000ml/day of fluid |
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Tonsillitis |
Inflammation and infection of the tonsils and lymphatic tissues |
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S/S of tonsillitis |
Fever, sore throat, inflamed tonsils, airway obstruction, anorexia, pulmonary exodate, malaise, chills |
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Treatments for tonsillitis |
Hydration, humidified O2, analgesics, antibiotics, warm saline gargle, tonsillectomy (last resort) |
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How should a conscious patient with tonsillitis be positioned? |
On the side |
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Pharyngitis |
Sore throat |
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Treatments for pharyngitis |
Positioning in semi-fowlers, increased fluid intake, increased humidity, throat cultures, gargles, ice collar, ABT for 10 days |
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Viral pharyngitis vs bacterial pharyngitis |
Viral: Low grade or no fever, scant tonsillar exudate, no rash, rhinitis, mild hoarseness, CBC normal, WBC less than 10,000mm, negative throat culture, gradual onset |
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Laryngitis |
Inflammation of the mucous membranes lining the larynx that may include edema of the vocal chords |
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S/S of laryngitis |
hoarseness, cough, pain, scratchy, stridor in children |
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Treatment of laryngitis |
rest voice, antitussives, cough drops, antibiotics, increase fluid |
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Croup |
Acute epiglottis acute laryngotracheobronchitis acute spasmodic laryngitis |
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Acute epiglottis |
Emergency situation! Rapid progression! Inflammation of the epiglottis that occurs in children 2-8 y/o |
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Treatment of acute epiglottis |
Cool, moist air, IVs, O2, antibiotics, nebulized epinephrine, suctioning, tent, possible intubation, trach, NPO |
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Acute laryngotracheobronchitis |
The most common type of croup. Inflammation/infection that causes a barking cough, stridor, fever. Gets worse at night. |
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Acute Spasmodic Laryngitis |
Spasm due to irritation or infection |
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Treatment of acute spasmodic laryngitis |
emergency equipment, O2, NPO, IVs, epinepherine |
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S/S of atelectasis |
Hypoxemia, crackles |
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S/S Pleurisy |
Severe, sharp knife-like pain |
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Treatment for pleurisy |
anesthetic block, antibiotics, analgesics, O2, heat, cough and splint |
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Pleural Effusion |
A sign of excess collection of fluid within the pleural space |
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S/S of pleural effusion |
Coughing, chest pain, difficulty breathing when lying down, SOB, dyspnea, hiccups |
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Treatment of pleural effusion |
Thoracentesis, chest tube, O2 |
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Pleurodesis |
A treatment for recurrent pleural effusions |
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Agents used in pleurodesis |
Nitrogen mustard, sterile talc, bleomycin sulfate, doxycycline |
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Pulmonary empyema |
A collection of pus in the pleural space most commonly caused by an infection |
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Hemothorax |
When blood collects in the thoracic cavity |
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Causes of hemothorax |
Trauma, gunshot, stab wound, etc |
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Pneumothorax |
Collapse of larger airways caused by air in pleural space |
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Pulmonary Embolism |
A collection of particulate matter that enters venous circulation and lodges in the pulmonary vessels. Most commonly caused by DVT |
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High risk patients for PE |
Abd surgery |
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S/S of PE |
SOB, anxiety, impending doom, bloody sputum (hemoptysis), pettichaie, dyspnea, hypoxiaa, decreased PO2, tachypnea, decreased PCO2 |
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Treatment for PE |
Anticoagulant therapy |
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Heparin |
Will not dissolve clots, but will prevent from getting worse by inactivating prothrombin |
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Lab testing for Heparin |
PTT (Partial thromboplastin time) |
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Antidote for Heparin |
Protamine sulfate |
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Coumadin |
Interferes with the production of Vit K, resulting in a prolongation of clotting time |
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Lab for Coumadin |
PT (prothrombin time) Normal: 2-3.5 |
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Antidote for coumadin |
Vit K |
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Factors that interfere with PT/INR results |
Alcohol |
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Lovonox |
Low molecular weight heparin |
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Cautions specific for lovonox |
do not aspirate |
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Pulmonary Edema |
Accumulation of serious fluid in the lung tissues Medical emergency |
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Causes of Pulmonary edema |
Heart failure, blocked lymph, IV infusions 150ml/hr or more |
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S/S of pulmonary edema |
pink frothy sputum, confusion, impending doom, confusion, cyanosis, ctackles, DOE, tachypnea |
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Acute Bronchitis |
Inflammation or infection of bronchi |
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S/S of acute cronchitis |
productive cough, dyspnea, fever, malaise, chest tightness, increased HR, increased RR, accessory muscle use, wheezing and rhonchi |
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Cystic Fibrosis |
Genetic disease that affects many organs and lethally impairs pulmonary function |
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Dx for CF |
Positive sweat test (>60 sodium) |
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Manifestations of CF |
COPD |
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Treatment for CF |
Pulmonary therapy |
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Pulmonzyme |
Enzyme that digests DNA in thick sputum secretions in CF patients |
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Priorities for CF |
Nutrition |
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Respiratory Syncytial Virus (RSV) |
Most common cause of respiratory infections in children. Extremely contagious, contact/droplet precautions. |
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High risk for RSV |
Premature infants, winter or spring, homes of parents who smoke, low birth weight |
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S/S of RSV |
High WBC, copious nasal drainage, low grade temp, nasal flaring, tachypnea, cough, SOB |
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Diagnosis of RSV |
Elisa test (enzyme linked immunosorbent assay of nasal secretions- nasal swab WBC, CXR) |
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Treatment of RSV |
O2 Support, rest, humidity, hydration |
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Pneumonia |
An excess of fluid in the lings resulting from an inflammatory process |
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Causes of pneumonia |
Over sedation, aspiration, inadequate ventilation, bacterial, viral, fungal, protozoan |
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Risk factors for pneumonia |
Old or young, COPD, smoking |
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S/S of pneumonia |
productive cough, fever, chills, high pulse, high RR, cyanosis, dyspnea, crackles, rhonchi, rusty/purulent sputum, confusion in elderly |
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Vaccine recommendations for Pneumonia |
Q 5 years |
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High risk TB groups |
Immunocompromised |
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S/S of TB |
night sweats, recurrent fever, crackles, wheezes, spitting up blood, loss of muscle strength |
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Diagnosis of TB |
Mantoux test |
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Meds for TB |
Rifampin |
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Patient priority for TB patients |
Labs required |
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Rifampin |
Stains body fluids/contact lenses red/orange |
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Rifamate |
Combo of RIF and INH |
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Isoniazide |
Take on empty stomach Jaundice |
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Pyrazinamide |
Can cause hyperuricemia and gout, arthralgia, GI irritation |
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Ethambutal |
Can decrease visual acuity (get baseline eye exam) |
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Streptomycin |
Can cause oto and nephrotoxicity |
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When is someone cleared of active TB? |
3 negative sputum specimens |
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Asthma |
Chronic condition in which reversible airflow obstruction in the airways |
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Risk factors for asthma |
>25 y/o |
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Triggers in asthma |
allergens |
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Status asthmaticus |
severe asthma attack that fails to respond to therapy |
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Peak Flow Meters |
Indicates lung function |
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Early S/S of COPD |
Persistent, productive cough, mucous, hypoxia |
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Later S/S of COPD |
Severe coughing, chest congestion, SOB, use of accessory muscles |
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Advanced COPD S/S |
chronic, severe hypoxia, resp acidosis, hypercapnia, polycythemia (increased RBC production), cyanosis, edema |
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Meds for COPD |
Bronchodilators |
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Acute Resp Failure |
PaO2 <60mmHg |
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Hypovolemic Shock |
Low BP |
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SubQ Emphysema |
An emergency! |
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WBC |
5,000-10,000 |
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Before INH, what test needs to be ran? |
Liver function |
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What is the priority treatment for pain in bacterial pneumonia? |
Splinting |
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what medication should asthma patients avoid? |
Beta blockers due to risk of bronchospasms |
