Med Surg - Respiratory
Name the structures of the upper resp tract
nose, sinuses and nasal passages, pharynx, tonsils and adenoids, larnyx, and trachea
The purpose of the cilia is to move the mucus back to the larynx
Name the structures of the lower resp tract
lungs, pleura, mediastinum, lobes of the lungs (right has 3), bronchi, bronchioles, and alveoli
Place where gas exchange takes place
Gas exchange takes place by ____________
The movement of air in and out of the airways
The floor of the thoracic cavity is the ___________
Contraction of the diaphragm and contraction of the external intercostal mm increases the space in this chamber. Lowered intrathroacic pressure causes air to enter through the airways and inflate the lungs. This process is known as ___________
The process that requires increased pressure that pushes air out of the lungs and involves elastic recoil is _________________
Inspiration is normally ______ of the resp cycle and expiration is _______.
1/3rd ; 2/3rds -- you expire 2x as long as you inspire
The process of gas exchange between atm air and the blood at the alveoli, and between the blood cells and the cells of the body is ___________
The filling of the pulmonary capillaries with blood is known as ____________
Shunting occurs when there is an imbalance of ventilation and perfusion. This results in _____________.
Symptoms of hypoxia are:
Confused, dizzy, lack of o2
#1 risk factor for lung cancer
Exposure to/ smoking
Inspection should include:
1) Symmetry 2) Dyspnea 3) Use of accessory mm 4) Color - cyanosis? 5) Clubbed finger 6) Resp Rate and Rhythm 7) Chest shape - barrel shape?
Near death respiratory pattern is _____________
Characterized as 3-4 irregular breaths then a period of apnea is what breathing pattern?
Fruity acetone breath and an increase in rate and depth is known as what breathing pattern?
Grating, crackling or popping sounds and sensations experienced under the skin and joints or a crackling sensation due to the presence of air in the subcutaneous tissue.
Crepitus "snap, crackle, pop - can happen with chest tubes"
When doing a resp assessment, palpate:
1) Sinuses 2) Diaphragmatic Excursion 3) Crepitus
When doing a resp assessment, auscultate for:
normal or adventitious breath sounds
Normal breath sounds:
Vesicular (inspiration > exp)
Bronchial (ins < exp)
Abnormal (adventitious) sounds:
Crackles - rales, discont. high pitch
Wheezes - heard with asthma - narrowing of airway
Friction Rubs - pleurisy
Wheezes are considered a normal breath sound.
False - they are considered an adventitious breath sound
air volume of each breath
max vol that can be inhaled after a normal inhalation
Insp reserve volume
max vol that is exhaled after a normal exhalation
Exp reserve volume
the max vol of air exhaled from a maximal inspiration
Vital Capacity VC = TV + IRV + ERV
This instrument measures vol of air exhaled and i used to assess lung capacities.
This rate reflects maximal expiratory flow and is frequently done by pt using a home spirometer
Peak Flow Rate
This force evaluates the effort of the pt in making an inspiration
Normal inspiratory pressure is __________
Force less than ______ usually requires mechanical ventilation
100 cm H20 ; 25 cm
What does arterial blood gases measure?
Measurement of arterial oxygenation and co2 levels
What is an ABG used to assess?
The adequacy of alveolar ventilation and the ability of the lungs to provide oxygen and remove co2 --- it also assesses ACID BASE BALANCE
A noninvasive method to monitor the oxygen saturation of blood
Pulse oximetry can be used to replaced an ABG.
A mask is a form of oxygen therapy used for pt who need _____ concentrations of o2
A nasal cannula is a form of oxygen therapy that can deliver _______ L 02/minute.
When you are not sure, you should give no more than ____ L of o2.
When a pt is required to use an incentive spirometer, how often should he use it?
10 reps every hr while awake
Which diagnostic test should be done first thing in the morning after oral care?
Sputum tests/ throat culture
A consent must be signed before any invasive procedures.
What pt education should be given before undergoing a bronchoscopy?
NPO 6-8 hrs - no gastric contents
When caring for a pt who has a drainage system, where should it be kept?
Always keep on the floor below lvl of chest tube site w/no kinks in tubing
If you see air bubbles in the chest drainage system, what should you do?
Call the Dr.
A surgically created breathing hole in the neck
How often should a nurse do trach care?
Every 8 hrs
When would a pt receive a tracheostomy?
When the pt is not getting air flow from the UR to the LR
What are the three parts to a tracheostomy?
Outer cannula with flange (neck plate), inner cannula, and an obturator
Inflammation of the sinus mucosa
_____ and ______ are used to dx Sinusitis (Rhinosinusitis)
ct scan and xray
Signs and symptoms of Sinusitis
pain over affected sinus, fever/chills, nasal discharge
Inflammation of the nasal mucous membranes. The release of histamines cause vasodilation and edema which is what causes the symptoms of __________
S/s of bacterial rhinitis
nasal congestion, itching, sneezing, and nasal discharge (typically cold)
S/s of viral rhinitis (common cold)
fever and malaise
Inflammation of the pharynx
S/s of Pharyngitis
red, swollen, sore throat; pus may be present, dysphagia, fever, chills, and malaise
Pharyngitis is commonly known as :
Ppl who smoke and use ETOH habitually, use their voice a lot, and are around much dust are at risk for _________ pharyngitis
Inflammation of the larynx caused by inflammation, vocal abuse, occasionally GERD
S/s of laryngitis are
hoarseness and sore throat
Acute pharyngitis of a bacterial nature is most commonly caused by group A, beta hemolytic streptococci
Bacteria in the blood
When doing an assessment on someone with an upper resp infection, inspect the nose, neck, and throat and palpate what?
Potential complications of someone with an upper respiratory infection are: (5)
Sepsis, meningitis, peritonsillar abscess, otitis media, and siusitis
What are 5 nursing dx that were mentioned in class for upper resp infections?
Ineffective airway clearance, acute pain, impaired verbal communication, deficient fluid volume, and deficit of knowledge related to prevention, treatment, surgical procedure, and post op care
How many L a day should be encouraged as an intervention for an upper resp infection?
2-3 L a day
The #1 prevention of upper airway infections is:
An early sign of cancer of the larynx in the glottic are enlarged lymph nodes.
False - hoarseness
Cancer of the larynx is most common in _______ of ages 60-70 yrs old.
Collapse or airless condition of alveoli caused by hypoventilation, obstruction to airways, or compression
Who is at high risk for atelectasis?
post op pt
What type of breath sounds are common in pt who have atelectasis?
diminished or crackles over the area
Turning a pt once per shift will prevent atelectasis.
False - frequent turning and early mobilization
What strategies improve ventilation?
deep breathing exercises every 2 hrs and using an incentive spirometer
What strategies can be used to remove secretions?
coughing, suctioning, aerosol therapy, chest physiotherapy
A bronchoscopy may be used to remove obstruction of the airway
When diagnosing pneumonia, a sputum culture must be taken when?
prior to starting ATB and after oral care
If an etologic agent of pneumonia is not identified, utilize ___________ antibiotic therapy.
What lung sound would a nurse expect to hear when listening to a pt who has pneumonia?
What coughing technique is encouraged to improve airway clearance of someone who has pneumonia?
What medical position promotes breathing?
Seizure activity, brain injury, decreased lvl of consciousness, endotracheal intubation, flat body positioning, stroke, swallowing disorder, cardiac arres are ALL RISK FACTORS FOR _______________
Aspiration of stomach contents into the lungs is a serious complication that can cause _________
When a nonfunctioning nasogastric tube allows gastric contents to accumulate in the stomach, a condition known as _________ aspiration may result
What are some ways to prevent aspiration?
1) elevate HOB, turn pt to side when vomit 3) prevent stim of gag reflex with suctioning
S/s of TB
cough, **blood tinged sputum, night sweats, anorexia and weight loss, low grade fever, dyspnea and chest pain (late)
What is the difference between a purified protein derivitive (ppd) and quantiferon tb gold test are test?
PPD is intradermal and a positive test would indicate an induration at the site; whereas, a quantiferon tb gold test is a blood test.
If the PPD is positive, a person must do what type of test thereafter?
a chest xray
What type of room is a pt placed in and what type of mask must a nurse where when she enters the room for protection?
a Neg press rm; a N95 mask
Inflammation of both layers of pleurae caused by URI, TB, PE, Pneumonia, and Trauma to chest
What happens during pleurisy?
inflamed surfaces rub together with respirations causing sharp pain that is intensified with each inspiration
Collection of fluid in pleural space - and is usually secondary to another disease. Caused by heart failure, TB, pneumonia, bronchogenic carncinoma
Pt who are diagnosed with pleural effusion may have __________ deviation
Accumulation of THICK, PURULENT fluid in pleural space
Emphysema usually occurs as a complication of ________ pneumonia or lung abcess
Characterized by sudden, progressive pulmonary edema, increasing bilateral lung infiltrates on CXR, hypoxemia refractory to ox2 therapy, decreased lung compliance
Acute Respiratory Distress Syndrome (ARDS)
ARDS is severe form of acute lung injury and most pts are sent to __________
ICU and on a vent
What are the symptoms of ARDS
Rapid onset of SEVERE dyspnea, hypoemia that does not respond to supp oxygen
ARDS pts require ____________
obstruction of pulmonary artery or branch by blood clot, air, fat, amniotic fluid, or septic thrombus
Pulmonary Embolism - most blood clots from leg veins
The first s/s of a pulmonary embolism is _________
sudden onset dyspnea
When diagnosing a pulmonary embolism, it should be confirmed with a ___________
Bradypnea is the most common sign for a possible pulmonary embolism
False - sudden onset of dyspnea
Occupational lung disease that causes death to 124,846 ppl in the US
Pneumoconiosis - Prevention is key!
Small cell and large cell grow ________; whereas, adenocarcinoma does not.
What is the most common surgery for a small apparently curable tumor of the lung?
Spontaneous pneumothroax is most commonly seen in __________ pts
The trachea is not midline is this type of pneumothorax
In this type of pneumothorax,air enters and can't leave so pressure is built up
Commons s/s of pneumothorax are:
sudden onset of chestpain (simple) asymmetrical chest expansion and tracheal deviation
Best treatment for pneumothorax is __________ and ___
chest tube and o2
Tension pneumothorax s/s are:
tracheal deviation to the unaffected side, cyanosis, shock, hypotension
An initial characteristic symptom of a simple pneumothorax is a sudden onset of chest pain
Characterized by airflow limitation that is not full reversible (GOLD)
COPD is currently the 4th leading cause of death and the 12th leading cause of disability
COPD includes what two diseases or a combo of ?
Emphysema and Chronic Bronchitis
Characterized by the presence of a cough and sputum production for at least 3 months in each of 2 consecutive years
What types of respiratory sounds would a nurse expect to hear in a pt who has chronic bronchitis?
Crackles and Wheezing
For pt with chronic bronchitis, the nurse expects to see the major clinical symptoms of tachypnea and tachycardia
False - wheezes, sputum, cough, shortness of breath
Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli
Decreased alveolar surface area causes an increase in ______ and impaired oxygen diffusion
Increased pulmonary artery pressure may cause ____________ heart failure
A pt with emphysema will present what type of chest due to air trapping?
What is the primary clinical symptom of emphysema?
Typical posture of someone who has COPD is
shoulders rising using sternocleidomastoid mm and leaning forward
Leading cause of COPD
A commonly prescribed methyxanthinine is theophylline.
A chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucous production.
The most chronic disease of childhood
The strongest prediposing factor to asthma is ________
Severe, sustained asthma is called _________
Status Asthmaticus - may be life threatening
You must rinse your mouth after using this long acting medication for asthma to avoid getting thrush
Singulair is this type of medication
What type of breathing technique should a person with asthma use?
Purse lip breathing
The most common fatal autosomal recessive disease AMONG CAUCASIAN population
Characterized by thick, viscous secretions of sputum making it hard to breathe, __________ is key!