Respiratory System - Chapters 26/27/28
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bethanistan on March 27, 2011
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85 terms
Terms | Definitions |
|---|---|
 Function of the Respiratory System | Gas Exchange |
| Structures of the Upper Respiratory System | - Nose - Pharynx - Adenoids - Tonsils - Epiglottis - Larynx - Trachea |
| Structures of the Lower Respiratory System | - Bronchi - Bronchioles - Alveolar ducts - Alveoli - Right lung (divided into 3 lobes) - Left lung (divided into 2 lobes) - Chest wall |
| Subjective data in Respiratory assessment | - Past health history - Medications - Surgery or other treatments |
| Objective data in Respiratory Assessment | - Physical examination of nose, mouth, pharynx, neck - Inspection, palpation, percussion and auscultation of thorax and lungs |
| Resonance | Percussion sound low-pitched sound heard over normal lungs |
| Hyperresonance | Percussion sound Loud, lower pitched sound than normal resonance heard over hyperinflated lungs, such as in chronic obstructive lung disease and acute asthma. |
| Tympany | Percussion sound Sound with drum-like, loud, empty quality heard over gas-filled stomach or intestine or pneumothorax. |
| Dull | Percussion sound Sound with medium-intensity pitch and duration heard over areas of "mixed" solid and lung tissue, such as over top area of liver, partially consolidated lung tissue (pneumonia), or fluid-filled pleural space |
| Flat | Percussion sound Soft, high-pitched sound of short duration heard over very dense tissue where air is not present, such as posterior chest below level of diaphragm. |
| Adventitious lung sounds | - Crackles - Rhonchi - Wheezes - Pleural friction rub |
| Deviated septum | - Deflection of the normally straight nasal septum - Normally caused by trauma or congenital disproportion - The septum is bent to one side, altering the air passage |
| Symptoms of Deviated septum | - obstruction to nasal breathing - Nasal edema - Dryness of the nasal mucosa with crusting and epistaxis - May result in Sinusitis |
| Nasal fracture | - 40% of all bone injuries in cases of facial trauma - Often caused by blow to the middle of the face |
| Complications of Nasal fractures | - Airway obstruction - Epistaxis - Meningeal tears - Septal hematoma - Cosmetic damage |
| Unilateral Nasal Fracture | little or no displacement |
| Bilateral Nasal Fracture | - most common - Give nose a flat look |
| Complex nasal fracture | - Powerful frontal blows - damage to adjacent facial structures (eyes, teeth etc) |
| Signs of Nasal fractures | - Deformities - Epistaxis |
| Diagnosis of Nasal fractures | - Physical assessment * Able to breath * Edema * Blood inside and out - Heath history |
| Goals in Nasal fractures | - Maintain airway - Reduce edema - Prevent complication - Provide emotional support |
| Epistaxis | - Nosebleed - Children <10yrs = anterior nasal bleeding - Adults >50yrs = posterior nasal bleeding |
| Anterior nasal bleeding | Usually stops spontaneously or can be self-treated |
| Posterior nasal bleeding | May require medical treatment |
| Causes of Epistaxis | - trauma - foreign bodies - topical corticosteroid use - nasal spray abuse - street drug use - anatomic malformation - allergic rhinitis - tumors |
| Nursing and collaborative management for Epistaxis | - Control bleeding - Keep client quiet - Place client sitting forward - Apply direct pressure - Apply ice - Insert a small gauze pad into nostril * If not working = CALL DOC |
| Teaching in Epistaxis | - Avoid vigorous nose blowing - Avoid strenuous activity, lifting, straining for 4-6 weeks. |
| Allergic Rhinitis clinical manifestations | - The reaction of the nasal mucosa to a specific allergen - Sneezing - Watery/itchy eyes and nose - altered sense of smell - Thin, watery nasal discharge that can lead to congestion - Nasal turbinates appear pale, boggy and swollen |
| Intermittent Allergic Rhinitis | -symptoms present less than 4 days a week or less than 4 weeks a year - Usually in spring/fall - Caused by allergies to pollens from trees, flowers, or grasses - Develops and disappears around same times annually |
| Persistent Allergic Rhinitis | - Symptoms are present more than 4 days a week and for more than 4 weeks per year - Not attached to a season - Described as constant |
| Nursing and Collaborative management for Allergic Rhinitis | - Identifying triggers - Keep a diary of allergy occurrence and activities - Medication therapy (Antihistamine, intranasal corticosteroids) |
| Influenza clinical manifestations | - 36,000 related deaths affecting ppl mostly over age 60 - Can be prevented with vaccine - Onset is abrupt with systemic symptoms * Cough * Fever * Myalgia * Headache * Sore throat - Symptoms subside within 7 days |
| Nursing Management and Collaborative care for Influenza | - Vaccines (inactivated and live) - High priority to high risk individuals |
| Clinical manifestations of Sinusitis | - Significant pain over affected sinus - purulent nasal drainage - Nasal obstruction - congestion - Fever - malaise - Patient looks and feels sick |
| Nursing management and collaborative care for Sinusitis | - Assessment - Environmental control of allergies - Medication therapy |
| Acute Pharyngitis (Strep Throat) Clinical Manifestions | - Range in severity - scratchy throat to severe pain in swallowing - Can be viral or bacterial - red and edematous pharynx - Some times patchy yellow exudates |
| Predisposition factors of Acute Pharyngitis | - Aspiration - Inhalation - Hematogenous spread * Infection from another part of body and spreads |
| Types of Pneumonia | - Bacteria, virus, fungi, parasites, chemicals - Community acquired - Hospital acquired |
| Hospital acquired Pneumonia | - 2nd most common nosocomial infection (#1 UTI) - Ventilator associated (shows up 48-72 hours after endotracheal intubation) - Health care associated (shows up after 48 hours in acute care, long term facility, recent IV antibiotic/chemo/wound care, or hemodialysis clinic) |
| Pathophysiology of Pneumonia | - Streptococcus pneumonie organism - found in nose and throat - Invasion of the lung - Upper respiratory track, blood and nervous system - 40,000 deaths/ 500,000 cases - African american at higher risk |
| Stages of Pneumonia disease process | 1. Congestion 2. Red Hepatization 3. Gray Hepatization 4. Resolution |
| Stage one of Pneumonia | - Congestion - after the pnuemococcus organisms reach the alveoli, there is an outpouring of fluid into the alveoli. The organisms multiply in the serous fluid, and the infection in spread. The pneumococci damage the host by their overwhelming growth and by interfering with lung function. |
| Stage two of Pneumonia | - Red Hepatization - There is massive dilation of the capillaries, and alveoli are filled with organisms, neutrophils, RBCs and fibrin. The lung appears red and granular, similar to the liver, which is why the proess is called hepatization. |
| Stage three of Pneumonia | - Gray hepatization - Blood flow decreases, and leukocytes and fibrin consolidate in the affected part of the lung. |
| Stage four of Pneumonia | - Resolution - Complete resolution and healing occur if there are no complications. The exudate becomes lysed and is processed by the macrophages. The normal lung tissue is restored, and the person's gas-exchange ability returns to normal. |
| Clinical manifestations of Pneumonia | - Sudden onset of symptoms - Fever - shaking chills - shortness of breath -cough productive of purulent sputum (rust colored in pneumococcal pneumonia) - pleuritic chest pain - May see confusion due to hypoxia in some cases |
| Assessment of Pneumonia | - Signs of pulmonary consolidation (dullness to percussion, increased fremitus, bronchial breath sounds, and crackles) |
| Complications of Pneumonia | - Pleurisy - Pleural effusion - Atelectasis - Bacteremia - Pericarditis - Meningitis - Endocarditis |
| Diagnostic studies of Pneumonia | - Chest X-ray - Sputum Gram stain and cultures - Pulse Ox - ABGs (Arterial Blood Gases) - WBCs |
| Collaborative care of Pneumonia | - Antibiotics - Oxygen - Analgesics, antipyretics - Pneumococcal vaccine - Nutrition |
| Lung Cancer | - Leading cause of all cancer related deaths - 28% of all cancer deaths - 172,580 new cases - 58% deaths are men - Highest: African american - Lowest: Hispanics - Leading cause of death in women, surpassing breast cancer (attributed to smoking) - 36.5% of teenagers smoke - >50years of age - Found in people 40-75 years of age with a long history of smoking - Peak incidence between 55-65 |
| Etiology of Lung Cancer | - Most important risk factor: Cigarette smoking - Responsible for 80-90% of all lung cancer - Interfere with normal cell development - Causes changes in bronchial epithelium - Risk lowers with cessation of smoking - Mortality reduced by 30-50% after 10 years - 2nd hand smoke= 35% of lung cancer in nonsmokers - another risk = industrial employees exposures (mining, chemical or petroleum manufacturing) |
| Pathophysiology of Lung Cancer | - Not well understood - Arise from bronchial epithelial cells - Grow slowly; it takes 8-10 years for a tumor to reach 1cm - Occur primarily in the segmental bronchi - Have preference to upper lobes |
| Clinical Manifestations of Lung Cancer | - Clinically silent - Found by X-ray - Nonspecific and appear late in disease process - Depend on the type. location and metastatic spread - Persistent cough, may be productive - Blood-tinged sputum = malignancy - Chest pain: localized or unilateral (mild to severe) - Dyspnea; wheeze - Later manifestations: Anorexia; fatigue; weight loss; n/v - Horseness - Palpable nodes on axilla or neck |
| Diagnostic Studies for Lung Cancer | - Chest x-ray (masses) - CT scan (metastasis) - MRI (metastasis) - PET scan (Staging) - Sputum cytology (Malignant cells) - Biopsy (Definitive diagnosis) - Mediastinoscopy (metastasis) - VAT - Thoracentesis |
| Thoracentesis | puncture of the chest wall to obtain fluid for diagnostic purposes |
| Staging system of cancer | - TNM |
| T of staging system | - Primary Tumor T 0 = no evidence of primary tumor T is = carcinoma in situ T 1-4 = Ascemdomg degrees of increase in tumor size and involvment T x =Tumor can not be measured or found |
| N of staging system | - Regional Lymph Nodes N 0 = No evidence of disease in lymph nodes N 1-4 = Ascending degrees of nodal involvement Nx = Regional lymph nodes unable to be assessed clinically |
| M of staging system | - Distant Metastases M 0 = No evidence of distant metastases M 1-4 = Ascending degrees of metastatic involvement of the host, including distant nodes M x = Cannot be determined |
| Stage One of Non-Small cell Lung Cancer | - Tumor is small and localized to lung. No lymph node involvement A = Tumor <3cm B = Tumor >3cm and invading surrounding local areas *Surgical candidate for both A and B |
| Stage Two of Non- Small cell Lung Cancer | A = Tumor <3cm with invasion of lymph nodes on same side of chest *surgical candidate B = Tumor >3cm involving the bronchus and lymph nodes on same side of chest and tissue of other local organs *surgical candidate |
| Stage Three of Non-Small cell Lung Cancer | A = Tumor spread to the nearby structures (chest wall, pleura, pericardium) and regional lymph nodes *surgical candidate B = Extensive tumor involving heart, trachea, esophagus, general lymph nodes, scalene or supraclavicular lymph nodes *inoperable/poor prognosis |
| Stage Four of Non-Small cell Lung Cancer | Distant metastasis *inoperable/poor prognosis |
| Collaborative care for Lung Cancer | - Surgical therapy - Radiation therapy - Chemotherapy |
| Complications of Radiation Therapy | - esophagitis - skin irritation - radiation pneumonitits |
| Pneumothorax | - Air In the plural space - Partial or complete collapsed lung - Blunt trauma to the chest wall |
| Closed pneumothorax | - No associated external wound - Most common is spontaneous pneumothorax (caused by rupture of small blebs on the visceral pleural space. Happens to male underweight young smokers) - Other causes: Injury to lungs from mechanical ventilation injury to the lungs from insertion of subclavian catheter perforation of the esophagus injury to the lungs from broken ribs ruptured blebs or bullae in patient with COPD |
| Open Pneumothorax | Direct communication between external environment and pleural space such as with gun shot or knife and surgical thoracotomy, occurs when a penetrating chest wound allows outside air to penetrate the plural space causing the lung to collapse AKA sucking chest wound Do NOT remove object without doctor present |
| Clinical manifestations of Pneumothorax | small= mild tachycardia and dyspnea Large= respiratory distress, shallow/rapid respirations; dyspnea; air hunger and O2 desaturation - Chest pain and cough may be present - On auscultation, no breath sounds on affected area. |
| Collaborative Care for Pneumothorax | - If minimal no treatment may be necessary. Could also be aspirated with large-bore needle - Heimlich valve may also be used - Chest tube insertion with chest drainage system - If keeps happening = treated surgically by a partial pleurectomy, stapling, or pleurodesis to promote adherence of the pleurae to one another |
| Heimlich valve | portable, lightweight, one-way flutter valve device similar to a water-seal drain. |
| Pulmonary Edema | - Abnormal accumulation of fluid in the alveoli and interstitial spaces of the lungs - Complication of heart and lung diseases - Interferes with gas exchange between alveoli and capillaries - Most common cause L side HF - Medical emergency as it may be life threatening |
| Pulmonary Embolism | - Blockage of pulmonary arteries by a thrombus, fat or air embolus or tumor tissue - Material gains access to the venous system and then to the pulmonary circulation - Most arise from thrombi in the deep veins of legs - Other sites of origin include the right side of heart, the upper extremities, and pelvic veins. - It lodges in an arterial vessel; causing perfusion obstruction - More than 500,000 clients/year - 200,000 deaths - 13,000 die because of lack of treatment |
| Pulmonary Embolism Etiology and Pathophysiology | - Lungs extensive arterial and capillary network - Sudden standing and changes in blood flow rate may cause PE - Other causes include: fat emboli (fractured long bones) air emboli (improperly administered IV), bacterial vegetations, amniotic fluid, and tumors. |
| Risk Factors for Pulmonary Embolism | Immobilization Surgery within the last 3 months Stroke History of DVT Malignancy |
| Who are at increased risk of pulmonary emboli? | - Women Associated with obesity, heavy cigarette smoking and hypertension |
| Clinical Manifestations of Pulmonary Embolism | - Generally subtle and nonspecific, making diagnosis difficult - Mild to moderate hypoxia - most common: anxiety and unexplained dyspnea, tachypnea, or tachycardia - Other: cough; pleuritic chest pain; hemoptysis; crackles; fever; sudden change in Mental Status; accentuation of pulmonic heart sounds - Massive: Sudden collage with shock; pallor; sever dyspnea; hypoxemia; crushing chest pain |
| Classic Triad of Pulmonary Emboli | 1. Dyspnea 2. Chest pain 3. Hemoptysis * Only occurs in about 20% of patients |
| Hemoptysis | coughing up blood from the respiratory tract |
| Complications of Pulmonary Emboli | - Pulmonary infarction: occlusion/ low blood flow - Pulmonary Hypertension: more than 50% of the area of the pulmonary bed is compromised |
| Diagnostic Studies of Pulmonary Embolism | - Ventilation perfusion scan; IV or gas - D-dimer - CT scan or spiral CT - ABGs; X-rays and EKGs |
| Collaborative Care of Pulmonary Embolism | - Immediate treatment - Therapy varies - Supplemental O2 - Turning, coughing and deep breathing - Anticoagulant therapy - Heparin and Coumadin - Tissue plaminogen activators (tPA) - Surgery: Pulmonary embolectomy (rare with at %50 mortality rate) |
| Tissue plasminogen activators (tPA) | - Alteplase (Activase)- dissolve the pulmonary embolus and the source of the thrombus in the pelvis or deep leg veins, thereby decreasing the likelihood of recurrent emboli. |
| Heparin | Works to to prevent future clots but does not dissolve existing clots. |
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