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175 Cards in this Set
- Front
- Back
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They are the functional unit or place of exchange in the lungs.
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Alveoli
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What part of the CNS controls the respiratory system.
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Medulla Oblongata
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The Medulla Oblongata is responsible for what function regarding the respiratory system?
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Increasing levels of CO2.
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What part of the body, with what receptor, is responsible for decreasing oxygen levels.
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Peripheral receptors located in the carotids.
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What muscles are used for respiration?
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Intercostals, Diaphragm, and Accessory Muscles
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The apex of the lungs are located where?
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Above the clavical.
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This lubricant contributes to the elastic properties of pulmonary tissue.
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Surfactant
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This sac like structure for support and protection covers/lines the surface of the lungs.
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Visceral Pleura
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This area is located between the parietal and visceral pleura.
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The Pleural Space
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This protectant lines the thoracic cavity.
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Parietal Pleura
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In describing the function of the lungs, these terms are used to describe 'external respiration or ventilation'
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Inhalation/Exhalation
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In describing the function of the lungs, Internal respiration refers to...
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Exchange of O2 and CO2 at cellular level.
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This term describes the movement of air into and out of lungs.
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Ventilation
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This term refers to gass movement among the membranes in the lungs...
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Diffusion
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This term refers to blood flow passing the alveolar membrane.
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Perfusion
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This term describes the condition a client is in when they have an asbence of respirations.
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Apnea
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This term describes a condition resulting from a decrease in O2 and increase in CO2
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Asphyxia
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In describing a client with respiratory problems, which term would be appropriate for a client displaying bluish color of the skin and mucus membranes?
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Cyanosis
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This term is used to describe a client's breathing when it becomes difficult/labored and is also referred to as SOB.
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Dyspnea
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This term is used for a client who has decreased O2 to tissues.
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Hypoxic (Hypoxia)
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A client with low O2 begins to show symptoms of restlessness and confusion (early) leading to irritability, dyspnea, unexplained apprehension...The term associated with what the client has is?
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Hypoxemia
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A client with elevated CO2 shows s/s of sleepiness and confusion due to increased CO2 what is the term used to describe this?
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Hypercapnea
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In a client displaying s/s of Hypercapnea, what lab order could the nurse expect?
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Hypercapnea
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What are 4 respiratory changes occur in the elderly due to age.
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Total body H20 decreases
Some ciliary action impairment Drop in p02 to 75-80 vs 80-100. Decreased elasticity |
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What change in the respiratory occurs to due to a decrease in body H20?
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Mucus becomes thicker
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As a client ages and the ciliary action becomes more impaired what outcome results?
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Increased risk for infection
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In the aging client whos lungs have become less elastic what outcome persues...
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Affects the function of the lungs and ventilation.
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Upon physically assessing the lungs the nurse uses these 4 assessment techniques...
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Inspection
Palpation Percussion Aucultation |
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Upon inspecting the lungs the normal breathing pattern should include how many breaths per minute?
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12-20
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How would you describe the lungs of a client who has normal breathing?
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Quite and Non labored.
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A client having changes in respiratory pattern shows increased rate a decrease intital volume and shallow respirations...how are these symptoms described?
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Tachypnea
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A client with respiratory trouble has an increased rate with increase in tidal volume, also deep respirations and an increase in O2 and pH with decreasing CO2. What is this client experiencing?
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Hyperventilation
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A client who's breats per minute have decreased below 12 breaths per min is said to have ______.
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bradypnea
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A client in resp distress has bradypnea with shallow breaths, an increased co2 and decreased 02 and pH levels, what is this client said to have _______.
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Hypoventilation
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A dying client experiences Chyene strokes. Describe what they are
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Regular, irregular pattern begining with slow shallow respiration with increased depth and rate to a max point. Then gradual decrease to a point of apnea for 10-16 seconds. Then repeats.
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What is the term for a client who needs to be in a sitting posistion in order to breath?
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Orthopnea
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This term is also refered to as 'air hunger'. It is an increased depth and rate associated with DKA.
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Kussmaul's respirations
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Upon inspection of the chest, what are 4 abnormal structures of the chest the nurse could document.
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Funnel chest
Kyphoscoliosis Barrell chest Pigeon |
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Coughing is a result of ...
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Irritation of the Mucus Membrane
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When describing a cough there are two basic types what are they?
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Productive vs Nonproductive
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What is the term for coughing up blood?
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Hemoptysis
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Sputum is produced by what cells and glands?
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Goblet Cells and Mucus Glands
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Which direction do the Cilia move?
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They propel upward toward pharynx
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What are the 4 possible colors of sputum/mucus?
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Yellow-green
Rusty or blood tinged Muciod Frothy Pink |
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What is an enlargment of the distal phalanges called?
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Clubbing
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What is clubbing secondary to?
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Diminished O2 tension in the blood.
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What are 4 ways pain can be described when describing chest pain.
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Dull
Aching Stabbing Sharp |
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What are three (respiratory related) causes of chest pain?
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Pulmonary embolus, pleurisy, and Lung Cancer (late)
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Upon palpatitation of the Respiratory System the nurse is assessing for what?
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Ceptitus, Posistion of Trachea
Respiratory expansion Tactile Fremitus (vibrations) Tenderness Masses Lesions |
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When percussing resonance is described as the sound meaning hollow, and low pitched...this means?
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Normal sound
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When percussing the chest wall dullness is heard what does this mean?
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Consolidation
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Upon palpating a tympanic sound is heard this means...
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pneumothorax
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Hyperresonance is heard upon percussing what could this mean?
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COPD
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What are the three normal breath sound terms described based on their location?
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Bronchovesicular
Bronchial Vesicular |
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What are the 5 adventitious breath sounds (or abnormal).
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Wheezes
Pleural friction rubs Stridor Crackles (rales) Rhonchi |
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A client's CBC shows increased WBCs. How could this possibly be related to the respiratory system?
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Could indicate body defenses against respiratory infection.
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When RBCs and HgB levels are decreased what is happening to the delivery of 02 to the body.
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A decreased 02 Carrying capacity of the blood is failing to meet the requirements
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Pulmonary Function Tests measures these 5 things...
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Lung Volume
ventilatory Function Gas Exchange Lung compliance Airway Resistance |
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Pulmonary Function Tests determine ability of lungs to exchange gasses and for what else?
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Diagnose COPD
Determine risk for smokers who need surgery. |
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In a CXR (radiographic examp) the white on the x-ray indicates what?
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Fluid
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CT Scan works by...
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Successive cross sections by narrow x-ray beam and analyzed by computer.
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Pulmonary angiogram is described as...
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Radiopaque dye injected into pulmonary circulation, followed by series of x-rays to detect emboli.
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Ventilation/Perfusion lung scan is done to detect a what?
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Pulmonary Embolism
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A client must wear this in a ventilation/perfusion lung scan?
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Tight fitting mask
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Laryngoscopy is used to view the...
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Voice Box
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Laryngoscopy is used to check for
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Cancer of the Larynx
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A symptom related to Larynyx Cancer is..
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Hoarseness
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Name of the scope used in a Laryngoscopy
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Laryngoscope
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Is the client awake or asleep for the Laryngoscope?
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Awake
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Is the client sedated or given pain med prior to a bronchoscopy?
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May be lightly sedated and may use topical anesthetic.
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What is the purpose of a Bronchoscopy?
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To remove foreign bodies
Suction Secretions Observe respiratory disease Biopsy |
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Prior to a bronchoscopy the client should be taugh?
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How to breath properly during the surgery.
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Does a client need to fast prior to a bronchoscopy and for how long?
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NPO after midnight
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After a bronchoscopy can the client eat immediately or do they need to wait and how long?
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NPO until reflexes return
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After a bronchoscopy how should the client be positioned?
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HOB elevated
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What does the nurse monitor the client for post-op bronchoscopy?
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Respiratory Distress
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Post-op bronchoscopy a client has blood tinged sputum...is this normal or abnormal?
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Normal - client may have blood tinged sputum
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What is the name for the procedure that removes fluid from the pleural cavity?
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Thoracentesis
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What type of setting can a Thoracentesis be done?
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In the client's room
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What posistion is the client placed in during a Thoracentesis
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Sits up in bed with head and arms on pillow on overbed table
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In a client with a Thoracentesis what is used to reduce pain?
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Local anesthetic
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What is the nurse's role during a Thoracentesis...
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Keep client still, observe
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What is a benefit of ABGs and a reason why they are not taken unless required
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Exact Measurement
Invasive, Painful, Risk of Bleeding |
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What does a pulse ox Measure?
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Hgb saturation
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Who obtains a sputum collection?
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Nurse, RT, or Client
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When is the best time to collect sputum?
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Early AM
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What is the process of collecting sputum.
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Rinse mouth with clean water, cough, expectorate into sterile container.
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If a client is unable to obtain a sputum culture, then what other means could it be collected?
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Suctioning
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A client makes a gurgling sound, has an increased pulse and respirations with hasrh respiratory sound. The client is also restless and anxious showing pallor with oral cyanosis (generalized) what is probably wrong with the client?
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Respiratory obstruction
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Postural drainage drains from where?
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Bronchi and lungs
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Facilitating Postural Drainage by placing the client how?
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Where gravity is allowed to aid.
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Perform post. drainage before, during or after meals?
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Midway between meals
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What is the purpose for percussion?
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Loosens mucus plugs and moves them into the bronchi
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When percussing a client what is important to remember regarding the increase in secretions?
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Increased secretions may obstruct airway or prevent exchange of gasses.
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What are 5 classes of medications used in respiratory problems?
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Nebulizers
Antitussives Demulcents Expectorants Nasal Sprays |
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Nebulizers or aerosols are a way to admin med via..
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Mist, by adding water vapor
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Should Nebulizers be administered before, during, or after meals?
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Before
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Nebulizers promotes
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Coughing and expectoring
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Antitussives stop coughing and are narcotic and nonnarcotic what are examples of each:
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Narcotic - Codeine
Nonnarcotic - Dextromethorphan |
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What do Demulcents do?
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Relieve irritation, sooth, protects mucus membranes
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Expectorants are used to...
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Thin secretions, to facilitate expectoration
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Sedatives are used to
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Depress cough reflex
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What are three ways of relieving Irritation
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Gargling warm salt water
Nebulizers Humidifiers |
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Humidifiers work by
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adding water vapor to inhaled air, moisten dry mucous membranes
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When using a humidifier, cool or warm air should be used if the client as a tracheostomy?
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Warm air
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When using a humidifier via the upper air way cool or warm air should b eused?
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Cool
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For nasal congestion nose drops or sprays can be used...what are two examples of nose spray..
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Neosynephrine
Ephedrine sulfate |
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Overuse of nose drops/sprays can cause...
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Rebound Nasal Congestion
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In oxygen therapy a low flow provides what in each breath?
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Room air
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In oxygen therapy high flow is given through these two support devices...
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Venturi Mask
Trach Collar |
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5 Nursing intervetions for clients on O2
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Wash Face often
Use Nasal canula to eat Dry mask often Realized mask something causes feelings of suffocation Adjust straps often |
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8 Signs of oxygen deficiency
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Anorexia
N/V Sighing and yawning Headache Increased R and PR Confusion Excitement Restlessness |
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3 late signs of O2 deficit
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Decreased bP
Cyanosis Twitching of muscles |
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Shock vs Oxygen Deficiency
Pulse |
Increaed P - Weak vs Increased P
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Shock vs Oxygen Deficiency
Respirations |
Increased/Shallow vs Increased
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Shock vs Oxygen
BP |
Decreased vs Normal or up
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Shock vs Oxygen Def
Urinary |
Nothing vs Oliguria
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Shock vs Oxygen Def
Mental Status |
Restless vs Confusion + Restlessness
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Shock vs Oxygen Def
Facial Expressions |
Nothing vs Sighing and Yawning
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Shock vs Oxygen Def
Strength |
Weakness vs Nothing
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Chronic Hypoxia results in what 4 symptoms
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Fatigue
Drowsiness Inattentiveness Delayed Reaction Time |
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Endotracheal Intubation allows for _______ and increases ________.
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suction
oxygen |
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Endotracheal intubation is inserted through either the _____ or ______
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mouth or nose
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Endotracheal tube is what?
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Ventilate by Mechanical Means. Used in surgery but also in emergency situations to facilitate breathing.
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What is a Thoractomy?
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A surgical opening into the thoracic cavity to remove blood, pus, air or to expedite the re-expansion of the lung or to explore the thoracic cavity.
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If atmospheric pressure enters pleural space and the lung collapses what will you need and why?
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Chest tubes to provide negative pressure to reexpand it.
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What is a Segmental Resection?
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small portion or segment of lung tissue removed.
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What is a lobectomy?
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Removal of an entire lobe
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What is a pneumonectomy?
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Removal of an entire lung
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Chest tubes are inserted into this cavity...
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Pleural Space
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Chest tubes are connected to a ____ Drainage system which have 3 different types what are they?
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Closed
Water Seal, Gravity or Suction |
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What is a tracheotomy?
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Any endotracheal intubation in which an incision is made into the trachea through the skin and tissues of the neck to create an artificial airway.
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What is a tracheostomy?
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The operation of incising the skin over the trachea and making a surgical wound (stoma) to permit an airway during tracheal obstruction or to replace the airway provided by a endotracheal tube that has been in place for several weeks; a tracheostomy tube is inserted into trachea after a tracheostomy is made.
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Reasons for treachotomy?
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Prolonged intubation/ mechanical ventilation
Airway obstruction Preliminary - head or neck surgery. Laryngeal dysfunction Trauma with facial fractures Clearance of respiratory secretions. |
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The two peices or three that make up a endotrach tube..
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Inner/Outter Canula
Obturator |
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Trachtube pressure must be maintained at _____ mm/hg and be checked every 8 hours.
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18-24
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Can a person talk post tracheostomy?
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No
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8 Nursing Interventions for a patient post Tracheostomy..
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Maintain patient airway
Suction frequently Keep secretions moist Mid Fowler's posistion Measures to assist with communication Provide emotional support Observe for signs of respiratory distress Keep emergency equipment at bedside |
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Post tracheostomy the emergency equipment should include what 4 things?
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Extra sterile tracheostomy set
Scissors Tracheotomy dilator or clamp Suction equipment If tube dislodges, clamp or dilator used to keep incision open Notify MD Never leave a new trach patient alone for 24 hours post procedure. |
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Upon discharge a patient with a trach should be taugh what 5 things...
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Teach client and family care
Arrange for home suction No swimming Use caution with bathing Use porous lint free material if covering trach |
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Three diseases that make up Chronic Obstructive Pulmonary Disease:
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Asthma
Emphysema Chronic Bronchitis |
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Explain the patho of emphysema:
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Alveolar walls and capillaries are destroyed which decreases the area available for exchange of gases between bloodstream and air.
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The largest contributing factor to COPD is....
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Smoking
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8 symptoms of Emphysema
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Insidious Onset
Dyspnea (predominant symptom) Hypoxia Coughing copious amounts of mucopurulent sputum. Barrell Shaped chest use of accessory muscles Wheezing Pneumothorax |
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Pulmonary Emphysema Interventions
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Prevention
Antibiotics Cough and deep breath Incentive Spirometry Aerosolized Bronchodilators LOW levels of oxygen Nutrition |
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What is the action of Bronchodilators used for pulmonary emphysema?
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Open up bronchioles by relaxing muscles and decreasing spasms
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What 3 classees of drugs are Bronchodilators?
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Beta 2 adrenergic agonist / Sympathomimetic
Anticholinergics Methylxanthines |
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3 examples of Beta 2 adrenergic agonist / Sympathomimetic
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Albuterol, Salmetrol, Levalbuterol
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What are three side effects of Beta 2 Adrenergic Agonist?
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Change in cardiac Function
CNS stimulation GI disturbance |
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An example of Anticholinergics and side effects
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Atrovent - Urinary retention, blurred vision, and dry mouth
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2 examples of Methylxanthines and side effects. Also what to monitor
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Aminophylline
Theophyilline Change in HR, N/V, convulsions Monitor serum drug levels (10-20mcg/L) |
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What is the major action of a steroid?
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Decrease inflammation
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When are steroids added to a client's medicine regimen?
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When bronchodilators dont work
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2 examples of inhaled steroids
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Beclomethasone(1-2 puffs tid)
Fluticasone (2-3 puffs bid) |
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Example of an oral steroid and normal dose range.
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Prednisone - 5-10 mg/day
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Side effects of steroids (4)
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GI upset
Increased appetite hypokalemia (may need K sup) hyperglycemia |
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Conditions associated with Pulmonary Emphysema (3)
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Right sided heart failure- heart has to work harder to perfuse the lungs.
Chronic Bronchitis Gastric Ulcers |
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What is Chronic Bronchitis?
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Increase in mucous secreting cells
Bronchi become thickened and bronchioles become fibrosed. Normal function of cilia is impaired. |
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Chronic Bronchitis Signs and Symptoms (5)
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Persistant cough with large amounts of thin sticky liquid mucous
SOB Dyspnea Cyanosis Wheezing |
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Interventions for Chronic Bronchitis
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Healthy Life style
Stop Smoking Avoid exposures to infections Antibiotic therapy Medications have limited effects (except antibiotics) |
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What is Asthma?
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Bronchi become narrowed and edematous along with spasms of bronchial muscles
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What is Extrinsic Asthma?
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An immune response
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What is Intrinsic Asthma
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Non-immunological
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3 Signs and symptoms of Asthma
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SOB
Wheezing Coughing |
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What drugs are given to patients with asthma who are having an attack?
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Epinephrine and Bronchodilators
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What medications are given to clients with Asthma to prevent exacerbations?
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Corticosteroids
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What is a Pulmonary Embolism?
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Occurs when a blood clot or other foreign material become lodged in a branch of the pulmonary artery or arteriole.
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Pulmonary Infarction
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The death of a portion of lung tissue resulting from an insufficient blood supply. Often a result of pulmonary embolus.
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6 signs and symptoms of Pulmonary Embolism
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Sudden Stabbing chest pain
Dyspnea and Fear Rapid shallow respirations Productive cough and blood tinged sputum Fever Increased Heart Rate |
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Interventions for Pulmonary Embolism - 5
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Prevention
Anticoagulant Therapy Bed Rest (no gatching of bed) Fibrinolytic Drugs Surgery |
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Pulmonary Embolus Risk factors include (4)
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Immobility
Surgery Cancer Pregnancy |
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Most common infectious cause of death in US
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Pneumonia
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What is a lobar?
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substantial portion of one or more lobes
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Bronchopneumonia -
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Patchy fashion pneumonia greater in bronchi than lobes
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Atelectasis -
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decreased breath sounds in bases, crackles that clear with coughing, can lead to pneumonia
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