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LPN ~ Introductory Medical-Surgical Nursing I-Respiratory
Terms in this set (158)
Factors Influencing Respiratory Function:
Cardiac output, Number of erythrocytes (red blood cells), Exercise
amount of blood pumped by the heart
Number of erythrocytes (red blood cells)
Hematocrit is a measurement of the percentage of RBCs in the blood
increases the need for oxygen
The rate, volume rhythm and relative ease or effort of respiration.
absence of respirations
characterized by and increase and decrease in rate and depth followed by periods of apnea.
deep and rapid breathing caused by metabolic acidosis (diabetic ketoacidosis)
characterized by groups of quick, shallow inspirations followed by regular or irregular periods of apnea. Indicate increased intracranial pressure.
Common diagnostic tests to diagnose respiratory disorders
Sputum specimens. Throat cultures. Skin testing for allergies. Pulmonary function tests. Pulse Oximetry
Amount of oxygenated hemoglobin in arterial blood
Intervention needed <91%
Life Threatening <80%
Pulmonary Function Tests- (PFTs)
Measures lung volume and capacity
FVC: Forced Vital Capacity:
measures the amount of air you can exhale with force after you inhale as deeply as possible
FEV: Forced expiratory Volume:
measures the amount of air you can exhale with force in one breath. Can be measures at 1 second (FEV1), 2 seconds (FEV2), or 3 seconds (FEV3)
PEF: Peak Expiratory Flow:
measures how quickly you can exhale. Usually measured at the same time as your FVC
MVV: Maximum Voluntary Ventilation:
measures the greatest amount of air you can breathe in and out in one minute.
SVC: Slow Vital Capacity:
measures the amount of air that you can slowly exhale after you inhale as deeply as possible
TLC: Total Lung Capacity:
measures the amount of air in your lungs after you inhale as deeply as possible
FRC: Functional Residual Capacity:
the amount of air in your lungs after a normal exhalation.
RV: Residual Volume:
measures the amount of air in your lungs after you have exhaled completely (it can be done by breathing in helium or nitrogen gases and measuring how much is exhaled.
ERV: Expiratory Reserve Volume:
Measures the difference between the amount of air in your lungs after a normal exhale (FRC) and the amount after you exhale with force (RV)
Normal Values of PFTs
Absolute FEV1/FVC ratio: Within 5% of predicted ratio
Normal total lung capacity
Acute Respiratory Distress Syndrome:
A disorder in which fluid builds up in the lungs causing them to stiffen. A ground glass appearance in the lungs. There is bilateral consolidation.
Acute Respiratory Failure:
Occurs when the PaO2 is >50 mm Hg, PaCO2 is 50 mm Hg or more, and pH is 7.25 or less.
When the Resp. System can't supply the body w/the O2 it needs or it can't remove CO2.
the amount of free hydrogen ions in the arterial blood
Partial pressure of oxygen
Partial pressure of carbon dioxide
Concentration of Bicarbonate in arterial blood
percentage of oxygen bound to Hgb, as compared to the total amount that can possibly be carried
Classified as a medication and is prescribed by the physician
Does not burn or explode
It facilitates combustion and burning
The greater the concentration of the oxygen, the more rapidly fires start and burn, and the harder they are to extinguish
Normal Vital capacity
The major indication for mechanical ventilation is acute respiratory failure, of which there are two basic causes.
deliver air at a preset pressure through an endotracheal tube
deliver a preset volume of air through an endotracheal tube
Ventilator Lingo MODE:
AC (assisted control) or SIMV (synchronized intermittent mandatory ventilation)
Ventilator Lingo FiO2:
Fraction of inspired oxygen
Ventilator Lingo VT:
tidal volume; mL/kg, (Tidal volume during normal spontaneous breathing equals 5 ml/kg)
Ventilator Lingo RR:
Ventilator Lingo Vi:
Inspiratory flow rate in liter (L)
Ventilator Lingo PEEP :
Positive end-expiratory pressure, measured in cm of water (cm H2O)
common cold-nasal congestion and drainage. Treatment: comfort measures, decongestants, etc.
headache, sinus tenderness, and nasal drainage or congestion. Treatment: irrigation, antibiotics, decongestants, surgery, external sphenoethmoidectomy, etc.
Easily spread by airborne, droplet and direct contact
profuse nasal drainage, cough, sore throat, fever, chills, gastrointestinal disturbances, and neuralgia. Treatment: rimantadine (Flumadine) or amantadine (Symmetrel), zanamivir (Relenza) or oseltamivir, (Tamiflu), analgesics, antitussives
Influenza Risk Factors:
very young, very old, immunocompromised, poor hand hygiene
annual vaccine, wash hands, avoid exposure to known carriers
sore throat, low-grade fever, fatigue, swollen lymph nodes, pus. Treatment: penicillin, analgesics, antipyretics
extremely sore throat, difficulty swallowing, high fever, tachycardia, otalgia, and malaise. Treatment: penicillin, analgesics, antipyretics, needle aspiration, tonsillectomy
mild hoarseness; aphonia, or inability to speak; sore or scratchy throat; decreased appetite; and a dry cough. Treatment: vocal rest, analgesics
elevation in pulmonary arterial pressure
vessels that carry blood from your heart to lungs become hard and narrow causing increased workload on the heart. Can lead to heart failure. Treatment: diuretics, anticoagulants, vasodilators, prostacyclin agents, oxygen therapy
includes blunt and penetrating traumas
Treatment: nerve blocks, immobilization, intubation, ventilation
Pulmonary function can be severely compromised following inhalation of smoke, gases, fumes, toxins, and even hot air. Treatment: endotracheal intubation, mechanical ventilation, oxygen therapy, bronchodilator therapy, chest physiotherapy
Asphyxia and aspiration
Asphyxia and aspiration are the physical conditions most often associated with drowning or near-drowning. Treatment: induced coma, corticosteroid therapy, osmotic diuretic therapy
Acute Respiratory Failure Type 1)
Ventilatory Failure: due to alveolar hypoventilation.
Acute Respiratory Failure Type 2)
Oxygenation Failure: occurs when blood flows to lung tissue that's experiencing reduced ventilation, or ventilation to lung tissue that's experiencing reduced blood flow, or shunting from the R side of the heart to the L side of the heart.
Interference w/respiration leading to cardiopulmonary arrest & death.
One of three types of COPD. Bronchial lining overreact, causing episodic spasms and inflammation and severe restriction of the airways.
Drink 3L of fluid/day. Perform pursed lipped breathing.
"Incomplete expansion of the lung/alveoli clusters ("lobules") or lung segments. Lack of deep breathing leads to this. May cause a partial or a complete collapse of the lung."
Post-op cough encouragement, and pain management, deep breathing, holding a pillow over chest while cough/deep breathe, walking, incentive spirometer.
Bronchioectasis 3 types:
Condition is D/T: Gas inhalation, gastric juices in lungs, obstruction, or recurrent lung infections that are poorly treated.
Chronic abnormal dilation of the bronchi, Destruction of the walls of the bronchi. Usually found in the lower lobes. Treated with early morning & bedtime chest percussion.
One of three types of COPD. It develops from irritants & infections.
bluish discoloration of the skin, nail beds, and/or mucous membranes due to reduced hemoglobin/oxygen concentrations. May be present with hypoxia
Chronic Bronchitis Interventions:
Encourage >3L of fluid intake/day, pursed lip breathing, incentive spirometer. Low flow O2 as Pts are hypercapnic & have a hypoxic resp. drive. Intubation may become necessary.
Chronic Bronchitis Manifestations:
Increased mucous production, impairs airway clearance, causes irreversible narrowing of the small airways. CO2 is retained.
Chronic Bronchitis S/S:
Finger clubbing, hyperinflation, tachycardia, R sided heart failure w/JVD.
Cor Pulmonale: Interventions:
Limit fluid intake to to 1-2L/day. Low Na diet to trt this disease/condition. Requires oxygen therapy of 24%-40%.
Copious sputum production: High amount of sputum by goblet cells.
Blue Bloater Cough:
Irritation of the cough receptors, by the mucous, in the smaller and the large airways.
Blue Bloater Cyanotic:
inadequate oxygenation of the blood; most prominent in the lips and the nail beds.
Blue Bloater Volume overload
Most likely from the right ventricular (RV) failure, known as cor pulmonale.
Blue Bloater Wheezy
Due to airway obstruction. Compared to asthma, there is less bronchospasm and more mucus/hypertrophy in COPD
Blue Bloater Rhonchi
due to mucus hypersecretion in the airways
This disease is d/t an increased PVR which leads to an increase in R ventricular pressure. Causes the enlargement of the R ventricle of the heart. 25% of COPD Pts get condition.
This is one of 3 types of COPD. "Pink Puffer". Recurrent pulmonary inflammation damages then destroys alveolar walls L/T large spaces when they collapse. Pus, blood, chyle, and necrotic tissue in the pleural space.
Fluid: 3L/day, steroids, Vit C, diet: High protein/calories, Vit C., low flow O2, intubation. alpha-1 antitrypsin therapy.
Deficiency in alpha 1-antitrypsin, smoking.
This disease paralyzes the resp. muscles.
Severe constant dyspnea/tachypnia ("puffing"): (decreased recoil). Patients use accessory muscles (tripod position) and breath faster (hyperventilation) feeling of inadequate ventilation.
Pink Puffer Mild cough
Irritation of the smaller airway can lead to the production of cough.
Pink Puffer Thin/cachexic:
Loss of skeletal muscle and subcutaneous fat due to inadequate oral intake as well as high levels of inflammatory cytokines (TNF-α) that cause such wasting.
Pink Puffer Diminished breath sounds on auscultation:
Hyperinflation of alveoli and destruction of alveolar architecture causes decreased airway resistance
Pink Puffer Non cyanotic ("pink"):
Gram negative bacteria causes bronchopneumonia & inflammation. Occurs in late Summer & early Fall. Mild to 15% mortality Fluorescent.
Unregulated cell growth & division L/T a tumor. Second most common cancer. Leading cause of cancer deaths in both sexes.
Lung cancer: primary Nursing Consideration:
emotional support for both client and support people.
Lung Cancer meds:
Excess of fluid in the pleural space.
Pleural Effusion: Complication:
Empyema:pus, blood, chyle, and necrotic tissue in the pleural space
Pleural Effusion: Intervention:
Pleural Effusion: Test/lab:
Lactate dehydrogenase levels.
Inflammation of the membranes which envelop the lungs/line the inside of the thoracic cage (the visceral and parietal pleurae).
Pleural friction rub, sharp stabbing pain, bed rest. Thoracentesis.
Is now called 'Pneumocystis jirovecii".
Pneumocystis carinii Pneumonia:
90% of HIV Pts get it. Normal flora found in ppl. In immunosuppressed is fatal.
Pneumocystis carinii Pneumonia. S/S, manifestations:
Fluffy infiltrates, nodular lesions, spontaneous pneumothorax.
Pneumocystis carinii Pneumonia. Tests:
Fiber optic bronch. Xray.
Inflammation of the alveolar spaces. Increases in alveolar fluid.
to make a more effective cough
provide cool mist to room air
deliver humidity and medications
Blood accumulates in the pleural space
Collapse of the lung from a loss of negative intrapleural pressure. There are 4 types.
Unilateral diminshed breath sounds, sharp pain
Xray of the chest shows a mediastinal shift.
Chest tube to a water seal drainage. Or, a needle thoracotomy.
There is a hole which goes from the lung to the intrapleural space.
There is hole from the outside of the body which goes to the inside of the body, into the intrapleural space.
This is due to a bleb rupture.
A buildup of air in the pleural space.
A result of blunt chest trauma.
Inserted into the pleural cavity to correct a collapsed lung by restoring negative pressure. Allows the lung to reinflate, drains collected fluid or blood
Because air rises and fluids fall
Pneumothorax- upper anterior
Hemothorax- lower lateral
An undissolved substance obstructs the flow of blood: Fat, air, thrombus, clot.
Pulmonary Embolism Causes:
A fracture, Coagulation issues, Contraceptives.
Pulmonary Embolism Etiology:
Clot starts in the venous system, travels to R side of heart, into pulmonary artery, and obstructs small vessels.
Pulmonary Embolism S/S:
Sudden onset of dyspnea, tachypnea, crackles. Elevated temp.
Pulmonary Embolism. Tests:
Xrays show dilated pulmonary arteries & the diaphragm elevated on the effected side.
Pulmonary Embolism Interventions:
IVC filter, anti-coagulants, morphine, diuretics, fibrinolytics. Stockings.
Too much CO2 in the blood. Reduced alveolar ventilation. an occur from an airway disease, suppressed breathing, obstruction (ie: Obesity, COPD, etc.), illegal drugs.
Respiratory Acidosis: pH:
below normal. CO2 is higher than 45 mm Hg.
Respiratory Acidosis: Interventions:
CPAP, bronchodilators, intubation, dialysis (to remove the illegal drugs that are causing the reduced ventilation), coughing, deep breathing, intubation.
Continuous positive airway pressure, is a treatment that uses mild air pressure to keep the airways open.
Bi-level positive airway pressure,
allows the air that is delivered through the mask to be set at one pressure for inhaling and another for exhaling.
Anxiety, asthma. Lots of resps blow off CO2 faster than the body can make CO2. A decrease in CO2 causes the blood to be less acidic and more alkalinic, thus the 'alkalosis' is caused by respirations. Not enough CO2 in the blood. Elimination of CO2 by the lungs exceeds production of CO2 at the cellular level.
Respiratory Alkalosis Acute S/S:
Prickling sensations around the mouth or extremeties ("circumoral"/"peripheral" paresthesia). Twitching leading to tetany. Deep, rapid breathing is the cardinal sign (+40 resp./min.) w/dizziness. PACO2 is less than 35 mm Hg. Increased pH. Bicarb is normal.
Respiratory Alkalosis: S/S:
Spasms of the wrists & feet ("carpopedal spasms"). Chronic. S/S:: pH is normal. Bicarb is below normal.
Respiratory Alkalosis Interventions:
Breathe into a paper bag. This causes CO2 to increase.
Respiratory Alkalosis two types:
1) Acute. 2) Chronic.
Nodules of inflamed tissue. Multisystemic. Effects 20-40 y.o.
Sarcoidosis: S/S manifestations:
Substernal pain, arthralgia of wrists, ankles, elbows, erythema nodosum (sub q skin nodules w/eruptions), uveitis/glaucoma, large spleen, hepatitis, nerve palsies, meningitis. Blindness.
Exposure to zirconium, beryllium. Genetics, senstivity to bacteria, fungi, pine pollen.
High CA in urine. Positive Kveim-Silzbach Test.
Low CA diet, corticosteroids, cytotoxics, high calorie nutritious diet, no exposure to sunlight for Pts w/hyper CA.
Types of COPD:
Emphysema, Chronic Bronchitis, and Asthma.
Disease is due to acid fast bacilli. Bacteria invade the alveoli then spread via the lymph system & into the circulatory system.
3-6 wks after invasion, cell mediated immunity contains then arrests the disease., when the infection reactivates, necrotic tissue turns cheesy, undergoes fibrosis, or form cavities lined w/multiplying tubercule which spreads thru the lungs & into the tracheobronchial tree.
Night sweats & fever
x-ray of the chest shows active or calcified lesions
Must wear a N95 respirator w/high efficiency particulate air filter.
Negative pressure room.
Finish the entire course of meds (6-18 months!).
x-ray of the chest shows active or calcified lesions.
Cystic Fibrosis Treatment:
bronchodilator inhalers, annual immunization against pneumonia and influenza, prompt treatment of infections, anti-inflammatory agents, oxygen therapy, lung or heart transplantation,
pancreatic enzyme replacement, high-calorie and high-protein diet
Inherited recessive disorder of the exocrine glands. Chronic long term illness, ultimately fatal, life expectancy 18 years
Cystic Fibrosis S/S:
Thick tenacious mucous, can obstruct the bronchi, resulting in hypoxia and infection.
Respiratory Syncytial Virus (RSV):
occurs in epidemics from October to March. Easily transmitted by direct or close contact with the respiratory secretions of infected individuals.
Pertussis (Whooping cough):
severe respiratory infection caused by Bordetella Pertussis
a term used to represent a group of respiratory illnesses that result from inflammation and swelling of the epiglottis, larynx, trachea and bronchi.
Cyanosis is a late sign of hypoxia in children. By the time cyanosis is seen, the child's oxygen saturation may be very low, and immediate intervention is required.
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