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59 Cards in this Set
- Front
- Back
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Cough
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Reflex response to stimuli that irritate receptors in the larynx, trachea, or large bronchi
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Cough defends against what...
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physiological mechanism that defends against respiratory pathogens and helps to clear tracheo-bronchial tree of mucus, foreign particles, and noxious aerosols
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Acute Cough
follows what illness |
commonly follows viral or bacterial URI
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Chronic Cough
Cause |
low-grade chronic bronchitis secondary to exposure to tobacco smoke
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Chronic Cough
Other causes |
Angiotension-converting enzyme (ACE) inhibitors
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Hemoptysis
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expectoration of blood that originates below the vocal cords
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Evaluation of Hemoptysis should include...
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-CXR
-CBC (including platelets) |
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Best way to test Acid-Base status
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Arterial blood gas (ABG) analysis
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Hypercapnia
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elevated CO2 levels
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Hypercapnia Symptoms
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-asterixis (flapping tremor of outstretched hand)
-headache -productive cough -wheezing -increased somnolence -stupor |
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Normal ABG Values
pH, PaO2 |
pH 7.35 to 7.45
PaO2 80 to 100 mmHg |
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Normal ABG Values
PaCO2, HCO3, O2 Saturation |
PaCO2 35 to 45 mmHg
HCO3 22 to 26 mEq/L O2 Saturation 97 to 100% |
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ABG samples kept at room temp....what happens
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decrease in PaO2 & pH
increase in PaCO2 |
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Hypoxia
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lower than normal level of oxygen in inspired gases, aterial blood, or tissue
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Levels of hypoxia
PaO2 = |
60-79 mmHg = mild hypoxia
40-59 mmHg = moderate hypoxia <40 mmHg = severe hypoxia |
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Pulse ox saturation = ____ PaO2
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pulse ox 90% = PaO2 59
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Hypoxia
Cardinal symptoms |
disorientation, restlessness, agitation, dyspnea
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Respiratory system's response to hypoxia
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increase in the rate and depth of breathing
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Cardiovascular system's response to hypoxia
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increase in cardiac output that causes a paradoxical increase in myocardial hypoxia due to increased workload
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Acidosis
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pathological process leading to positive balance of fixed acid or CO2
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Mechanisms to maintain pH
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Respiratory Regulation
Buffer Regulation Urinary Regulation |
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Compensation
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occurs when a specific component of acid-base system has shifted outside the normal range as a means of compensating for an abnormality in some other compenent's level
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Compensation by respiratory system....
Fast or slow?? |
Fast -- within minutes
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Compensation by renal system...
Fast or slow?? |
Slow -- hours to days
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Respiratory acidosis
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characterized by elevation of CO2 > 45 with a decrease in pH
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Respiratory alkalosis
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occurs when CO2 levels are < 35 and pH is greater than 7.45
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Metabolic acidosis
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HCO3 <22
pH <7.35 |
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Metabolic acidosis
Compensation how? |
increase respiratory rate
increase renal runction to excrete H+ |
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Metabolic alkalosis
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HCO3 >26
pH >7.45 |
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Metabolic alkalosis
compensation how? |
decrease renal function to decrease secretion and excretion of H+
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Pleuritis (Pleurisy)
Caused by |
chest pain caused by stimulation of pain fibers in the parietal pleura as a result of acute pleural inflammation
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Pleuritis
Signs & Symptoms |
Pain = localized, sharp or stabbing, & fleeting
Worse with coughing, sneezing, deep breathing, or movement |
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Pleuritis
Treatment |
**treat underlying disease**
Analgesics & anti-inflammatory drugs |
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Pleural Effusion
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abnormal accumulation of significant volume of fluid in the pleural space
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Pleural Effusion
Results from... |
inflammation of the structures adjacent to the pleural space or from lesions within the chest
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Diagnostic thoracentesis
When to do?? |
whenever there is new pleural effusion and no clinically apparent cause
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Pleural Effusion
Signs & Symptoms |
dyspnea, cough, or chest pain worse with inspiration or expiration
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Pleural Effusions
Physical findings |
Small effusions -- no physicial findings
Large effusions -- dullness to percussion and diminished or absent breath sounds over the effusion |
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Pleural friction rub indicates what....
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myocardial infarction or pleuritis
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Pleural fluid samples should be measured for what labs??
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protein
glucose LDH total & differential WBC counts |
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Pleural effusion
Imaging...chest X-ray shows... |
blunting of costophrenic angle, loss of sharp demarcation of diaphragm and heart, & mediastinal shift to uninvolved side
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Pleurodesis
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procedure where an irritant is placed into the pleural space following a chest tube drainage and lung re-expansion
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Goal of Pleurodesis
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form fibrous adhesions between visceral and parietal pleura, resulting in obliteration of pleural space to prevent or reduce reaccumulation of pleural fluid
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Management of a small-volume hemothorax that is stable or improving
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Close observation
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Treatment of unstable hemothorax
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immediate insertion of large-bore thoracostomy tube
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Pneumothorax
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accumulation of air in the pleural space
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Spontaneous Pneumothorax
When it occurs... |
occurs in the absence of an underlying lung disease
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Spontaneous Pneumothorax
Who it usually affects |
tall, thin boys and men btwn 10-30 years old
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Spontaneous Pneumothorax
Other important factors |
family history and cigarette smoking
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Secondary Spontaneous Pneumothorax
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complication of preexisting pulmonary disease such as COPD, asthma, CF, TB
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Traumatic Pneumothorax
results from... |
results from penetrating or blunt trauma
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Tension Pneumothorax
results from... |
secondary to a sucking chest wound or pulmonary laceration that acts as a check-valve mechanism, allowing air to enter the chest with inspiration but not allowing it to leave on expiration
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Pneumothorax
Signs & Symptoms |
acute onset of chest pain, ranging from minimal to sever on affected side and dyspnea
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Small pneumothorax
S & S |
physical findings are unimpressive excpet for tachycardia
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Large pneumothorax
S & S |
diminished or absent breath sounds, decreased tactile fremitus, hyper-resonant percussion, decreased movement of chest
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When to consider Tension Pneumothorax as dx....
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presence of marked tachycardia, hypotension, and mediastinal and tracheal shift to the unaffected side
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Pneumothorax
X-Ray findings |
-absence of pulmonary vessels extending to chest wall
-collection of air btwn parietal and visceral pleura -visible pleural line -inc. lucency of one hemithorax -mediastinal shift toward unaffected side |
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Placement of chest tube
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over the top of the rib (avoid neurovascular bundle)
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Treatment of Tension Pneumothorax
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placing large-bore needle in 2nd intercostal space along the mid-clavicular line
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