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Respiratory Overview

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mattisensept's version from 2017-06-04 00:32

Over view

Question Answer
What sounds should you hear when auscultating?Air movement is what creates the sound you hear
What is wheezing caused by?Bronchoconstriction or secretions in the airway
What part of the cycle do you hear wheezing occur?On experation first, later on inspiration
What tx should the nurse initiate?Open the patient up, coughing, administer broncho dilator
Explain the difference between asthma and COPD?Asthma big airways, COPD small airways
What is the difference between Rales and crackles?Same thing!
What are crackles/rales caused by?Having secretions in the terminal bronchi or aveoli, sode sound, end of espiration
Where do crackles/rales come from?the lower lobes of the lung
When do you hear the crackles during the respiratory cycle?A "Bubbly" sound at the end of expiration
What is rhonchi caused by?Having secretions in the larger airways
Where do rhonchi occur?Upper airway, upper parts of longs, louder over the trachea
How does a nurse hydrate secretions?Hydrate patient and then the air. Give luthilitic to dry out secretions.
How do you distinguish between a pleural friction run and rhonchi?Sticky substance, dryer sound, "crackling old leather", symmetrical sound over the chest
What type of monitoring should the nurse provide with rhonichi?Monitoring respiratory rate and rhythm, pulse oxymetry, get ABG lab
What is the concern when giving O2 to a COPD patient?Can cause worsening acidosis
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Terms

Question Answer
CPAP Positive airway pressure during spontaneous breaths
Bi-PAP Positive pressure during spontaneous breaths and preset pressure to be maintained during expiration
SIM V Preset Vt and f. circut remains open between mandatory breathes so pt. can take addition breathes. Ventilator doesn't cycle during spontaneous breaths so vt varies Mandatory breaths synchronized so they do not occur during spontaneous breaths
Assist Control Preset Vt and f and inspiratory effort required to assist spontaneous breaths. Delivers control breaths. Cycles additionally if pf. inspiratory effort is adequate. Same Vt delivered for spontaneous breaths.
Pressure support Preset inspiratory support level. When the pt. initiates a breath, the positive pressure flows to assist the pts. spontaneous breaths
PEEP (positive end-espiatory pressure) Maintenance of pressure above atmospheric at end expiration
Auto PEEP Trapping of gas in the lung caused by insufficient expiatory time (breath stacking). Increases risk of bactrouma.
PIP (peak inspiratory pressure) Airway pressure at peak of inspiration.
Minute ventilation Vt X f; volume of air expired per minute
PA Co2 35-45 mm Hg Amount of C02 dissolved in arterial blood, Partial pressure of arterial C02
SA 02 (95-100%) Percentage of oxygenated hemoglobin in arterial blood, Indirectly measured via Sp02(pulse ox)
PA 02 80-100mm Hg Amount of oxygen dissolved in blood plasma
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DYSPNEA

Question Answer
DDo you see troubled breathing? or orthopnea (positional)? airway breathing narrow because of inflammation, secretions, choking?
YYes! Take VS early, early signs= increased everything. Late signs=decreased everything.
SSecretions altered. Yellow/clear=allergy. Green=infection. Pink/frothy= heart failure.
PPrecipitating factors must be treated. Treat underlying factors.
NNote the characteristics of their cough. Strong? Weak? Productive?
EEvaluate Sa02 or ABG if possible
AAdventitious breath sounds, what are you hearing? wheezing, crackles, both sides?
Wheezing Constriction, means they are moving some air
Crackles Fluid in the lungs
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BREATHE

Question Answer
Striter Neck area, preme babies
Wheezes Upper chest, large bronchi get really small, inspiratory, expiratory
Rails/crackles Lower chest, air through fluid. Moving air through thick fluid. Pulmonary edema.
Ronchi Snoring sound from lungs. Lower back.
BBreath sounds. Listen to sounds. What do you hear? Look at VS, assessment. Find out why they are not breathing.
RReposition, Sit them up, open them up, semi fowlers to high fowlers. Tip pod (winded, COPD)
EEvaluate airway status, prepare for supplemental oxygen, initiate emergency management
AAssess and document ABG, sputum, give good oral care
TThe airway needs to be suctioned
HHandwashing, wear your PPE
EEncourage them to cough and deep breath. Get stuff out of lungs. Keep airway open. Incentive spirometer.
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Thoracentesis

Question Answer
Before the procedure Informed consent (ect), only take a few minutes, do not cough when needle inserted, Diagnostic to find the fluid might be preformed prior, may receive sedative before, site shaved, remove jewelry, VS before
During the procedure Verbal support, VS, supplement O2, Observe for distress,
Position Sitting position arms raised resting on an over bed table, this aids in spreading out the spaces between the ribs for needle insertion.
How much fluid is to be removed?No more than 1000ml in 30 mins
After the procedure Observe, clie on unaffected side for at least 30 minutes to facilitate expansion of the affected lune and eases respirations. Send specimen to lab, watch dressing.
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Bronchoscopy

Question Answer
Before procedure Describe numbing sensation to patient, explain cough reflux, NPO 4-6 hrs prior, VS, Start IV if necessary, explain incentive spirometer, no food red in color
During procedure Monitor VS, Changes in breathing pattern, Note any bleeding in the airway
After the procedure Monitor VS, note breathing changes, signs of bleeding, NOP until gag reflux is back
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Bronchitis

Question Answer
What is bronchitis Inflammation of the bronchial tubes caused by irritation or some type of infection. The bronchial tubes carry air to and from the lungs.
Nursing interventions Fluids, steroid, controlled coughing, pursed lip breathing, monitor 02 sat, wheezing sounds, reposition them to sit in high fowlers.
Present with Possible fever, dyspnea, chest pain
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Cor pulmonale

Question Answer
What is Cor pulmonale?Weakening of the heart. THey are not pulling in enough O2 as they should. Heart with mimic symptoms of CHF. Trouble breathing, fluid overload.
Interventions Get oxygen back up. COPD --> chart and educate them on their medicine correctly.
Education Yes this is a heart problem, but this is happening because of a breathing problem. All you can do is try to keep them from getting worse.
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Inhilation injury

Question Answer
Symtoms?Burned and swollen, causes you to stop breathing.
AssessSmall airways, wheezing, listen to lung sounds to hear what is going on.
Emergency Having suction, ambu bag, crash cart ready
MedicationsBronchodilator and steroid. Swelling go down.
Priority Make sure they can breath. Airway is open.
Nursing considerations Make sure you have trach tray, check 02, might have to intubate.
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Thoracotomy

Question Answer
What is a thoracotomy?Taken away part of the lung
Priority interventions?Pain management, breathing, gag refulux, protected airway
How can the nurse help the patient to achieve this priority intervention?Incentive spirometer, deep breaths, pain management under control, get them out of bed
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Pleural effusion

Question Answer
What is plural effusion?Buildup of fluid between the tissues that line the lung. Lung not expanding
What assessment data would you expect?Fast breathing, SOB, sharp chest pain, cough, low 02 asymmetric chest extension, silence on side of effusion.
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