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172 Cards in this Set
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positive end-expiratory pressure (ventilatory support) |
in ventilatory support, applies positive pressure to keep the alveoli from collapsing between breaths |
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assist/control mode (ventilatory support) |
responds to each breathing attempt by administering a breath, or delivers preset breath |
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synchronized intermittent mandatory ventilation [SIMV] (ventilatory support) |
delivers preset breaths but also allows pt to take unassisted breaths |
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controlled mandatory ventilation (ventilatory support) |
delivers preset breaths without regards to pts attempt to breathe rarely used except in paralyzed or anesthetized pts b/c of problems w/ synchrony |
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continuous positive airway pressure [cpap] |
+ pressure applied throughout respiratory cycle to a spontaneously breathing pt to promote alveolar & airway stability. helps prevent alveolar collapse infants: may be applied nasal prongs, nasopharyngeal tubes, or endotracheal tube criterion: must be able to breathe spontaneously w/ assistance to relieve respiratory distress in infants |
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chronic obstructive pulmonary disease [copd] |
when on 02 therapy, closely monitor for bradypnea b/c it could indicate impending problem. breath sounds are often diminished, but if still diminished following cpt it should be noted monitor pulse oximetry & ABGs to ensure proper oxygenationadequate hydration is one of the simple, effective ways to achieve clear breath sounds. hypoxemia helps stimulate pts respiratory effortsprovide incentive spirometry & encourage deep breathingprovide high calorie, protein rich foods to promote healingpt should receive o2 at 1-2Lmin to prevent respiratory depressionwhen prolonged disease or injury has made lungs less capable of meeting body's o2 needs "good lung down" & tripod positionex: chronic bronchitis, emphysema & asthmarisk factors: tobacco smoke, passive smoking, occupational exposure to dust & chemicals, ambient air pollution, genetic abnormalitiesactivity intolerance: estab. regular exercise routine |
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pursed-lip breathing (purpose) |
good to teach w/ emphysema pt. *prolongs exhalation & builds pts ability to control rate & depth of respirations (increase airway pressure) & ease sob. allows airways to not collapse between breaths. strengthens respiratory muscles |
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pneumonia |
key indicators of development: fever, tachypnea, cough, & crackles productive cough, rhonchi, wheezing & pleural friction rub lobar pneumonia: exudate infiltrates & fills alveoli which leads to ventilation-perfusion mismatch & altered ABGs |
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bronchiectasis |
chronic dilation of bronchus or bronchis/s: chronic cough, purulent secretions, hemoptysis, & clubbing |
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lung abcess (s/s) |
dyspnea, fatigue, anorexia & wt loss |
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orthopnea (positioning) |
high-fowler's w/ something like a pillow or table for the pt to rest on to help reduce fatigue & dyspnea |
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tracheostomy suctioning |
suctioning should be applied no longer than 10-15 seconds as cath is being w/drawn. longer suctioning can cause hypoxia, dysrhythmias, & even cardiac arrest |
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cromolyn sodium [intal] |
inhibits the release of histamine. keeps airway from narrowing in response to exercise or cold |
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tonsillectomy (nursing care) |
mntr for patent airway |
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hypoxia |
neurological effects are often first distinctive sign ex. mental confusion chronic renal failure is likely to predispose pt to hypoxia due to associated decrease in production of erythropoietin which is required for RBC production |
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asthma |
**airway obstruction caused by swelling of the bronchial lining & filling of the bronchi w/ mucus **pt should use inhaler in anticipation rather than waiting for troubling symptoms **restricted air movement through narrowed airway causes wheezing **no stuffed animals (collect dust) |
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mantoux TB skin test |
raised area of 10mm or more is a positive skin reaction in a child under 4 yrs old or having medical risk factors like hodgkin's disease. a positive skin reactions indicates sensitivity to the tuberculosis bacillus. this test uses purified protein derivative (pdd) & is unlikely to cause an allergic reactionnegative reaction: raised area less than 5mm |
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pneumococcal vaccine |
priority in those w/ cystic fibrosis b/c consequences of pneumococcal disease are very serious in cystic fibrosis |
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atelectasis |
"incomplete expansion". lung collapse (can be due to obstructed airway)causes labored breathing b/c of decreased surface area & obstructed airway. obstructive atelectasis is most common s/s: marked respiratory depression, dyspnea (orthopnea), tachycardia, tachypnea, pleural pain, central cyanosis, crackles, chest xray (patchy infiltrates & consolidated area) prevention: fx turning, early mobilization, deep breathing, incentive spirometrysecretion mngmnt: directed cough, suctioning, aerosol nebulizer tx followed by cpt & bronchoscopy |
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bronchitis |
causes mucus build-up & obstructed airflow |
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pleurisy |
teach comfort measures, turn frequently to affected side to splint chest wall & reduce stretching of pleurae. use hands or pillow to splint when coughing s/s: knifelike chest pain is classic |
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pneumothorax
|
positive pressure (air) w/in chest cavity from accumulated air that can't hape during expiration. leads to atelectasis, mediastinal shift & compression of heart & great vessels **may have no symptoms. sharp pain on inspiration does occur but is diagnostic s/s: may have sharp pain inc chest or referred to shoulder/arm on affected side, restlessness, anxiety, dyspnea, cough, cessation of normal mvmnts on affected side, absent BS on affected side, pallor, cyanosis, shock, tracheal deviation to unaffected side |
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flail segment |
detached rib segmentcauses paradoxical chest movement w/ difficulty breathing |
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pleural effusion |
abnormal accumulation of fluid in pleural space, usually secondary to other disease **s/s: dyspnea & tracheal deviation** pleuritic pain that is sharp & increases w/ inspiration, dry nonproductive cough, dyspnea on exertion, tachycardia, decrease breath sounds & elevated temp can result in cardiac tamponade |
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tension pneumothorax |
**classic signs: air hunger & agitation mediastinal shift to the opposite side of the chest 1-way leak.may occurs during mechanical vent or cps or complication of spontaneous or traumatic pneumothorax |
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laryngectomy |
removal of vocal chords. pt must learn alternative communication methods. stoma should be protected from water. stoma should never be tightly covered b/c it would obstruct pts airway. eventually pt may learn to speak using the esophagus or electric larynx. total laryngectomy: permanent tracheostomy. pt may lose sense of smell & taste |
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acid-base |
metabolic acidosis: low or normal PaCO2 & pH< 7.4 metabolic alkalosis: high or normal PaCO2 & pH>7.4 respiratory acidosis: combo of PaCO2 > 40 & acidosis respiratory alkalosis: low PaCO2 & alkalosis |
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respiratory acidosis |
excess CO2 retention. pH<7.35 | HCO3 >26 mEq/L (if compensating) | PaCO2 >45 mmHg respiratory acidosis is an an attempt of the body to compensate for excessive PaCO2. can be caused by any situation that would cause respiratory depression cns depression, asphyxia, hypoventilation due to pulmonary, cardiac, musculoskeletal or neuromuscular disease, obesity, postop pain, ab distentions/s: diaphoresis, h/a, tachycardia, confusion, restlessness, apprehension, drowsiness, tremor, myoclonic jerks, asterixis, stupor (co2 narcosis) & hypoxia |
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respiratory alkalosis |
excess co2 excretion. pH>7.45 | HCO3<22 mEq/L (if compensating) | PaCO2<35 mmHg (if compensating) compensatory mechanism aimed to increase excretion of HCO3 & retention of the hydrogen ions. from any condition that causes the respiratory system to be overstimulated hyperventilation > decreased PaCO2 > ^ ratio of bicarb concentration to PaCO2 > ^ pH = respiratory alkalosis alveolar hyperventilation (leads to decreased partial pressure of arterial PaCO2) due to anxiety, pain or improper ventilator settings. respiratory stimulation, gram-neg bacteremia, compensation for metabolic acidosis (chronic renal failure) chronic respiratory alkalosis: pH is almost norm to norm s/s: rapid, deep breathing, paresthesia, light-headedness, twitching, anxiety, fera, confusion, cramps, syncope, hyperpnea, tachypnea, carpopedal spasm, peripheral & cirumoral paresthesia |
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metabolic acidosis |
HCO3 loss, acid retention. pH<7.35 | HCO3<22mEq/L | PaCO2<35 mmHg (if compensating) body is pulling HCO3 into the cells as a buffer which depletes plasma level. HCO3 depletion due to renal disease, diarrhea, or small-bowel fistulas. excessive production of organic acids due to hepatic disease, & endocrine disorders s/s: rapid deep breathing, fruity breath, fatigue, h/a, lethargy, drowsiness, n&v, & coma (if severe) |
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metabolic alkalosis |
HCO3 retention, acid loss. pH>7.45 | HCO3>26 mEq/L | PaCO2>45 mmHg loss of hydrochloric acid from prolonged vomiting or gastric suctioning. loss of K due to increased renal excretion (as in diuretic therapy) or steroid overdose excessive alkali ingestion. compensation for chronic respiratory acidosis s/s: slow shallow breathing, hypertonic muscles, restlessness, twitching, confusion, irritability, apathy, tetany, seizures, coma (if severe), h/a, & lethargy |
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thoracentesis (position) |
involves insertion of a needle on affected side. pt should be positioned sitting on edge of bed w/ arms & head resting on over-the-bed table |
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peak expiratory flow meter |
pt must be standing. lips should be closed tightly around mouth piece, blow out as hard & quickly as possible. each use should include 3 separate readings w/ a 30 second wait between each attempt |
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activity intolerance in pts w/ chronic respiratory disease |
regular structured exercise (aerobic, strength, & inspiratory muscle training) is recommended to prevent deconditioning that comes from activity intolerance |
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ABG values (normal) |
pH: 7.35-7.45 PaCO2: 35-45 HCO3: 22-26 mEq/L PaO2: 80-95 mmHg SaO2: 95%-99% |
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ABGs (PaCO2) |
decreased ventilation has a higher value & increased ventilation has a lower value hyperventilation causes alkalosis because the patient is blowing off CO2 and hypoventilation causes acidosis because the patient is retaining CO2. |
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ABGs (HCO3) |
regulated by the kidneys & evaluates the metabolic component. below 22 is considered acidosis & above 26 is alkalosis. several days could be required to normal compared to PaCO2 abnormal levels which can be adjusted more quickly |
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ABGs |
|
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ABGs (compensation) |
acid is regulated by the respiratory system, alkaline is regulated by metabolic and if compensated everything shifts in the opposite direction |
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pulmonary arterial htn [PH] |
progressive & ultimately fatal disease that presents as elevated bp in the pulmonary arteries. evolves as comorbidity of other disease or conditions (connective tissue disease, lung diseases, liver disease, pregnancy, hiv, L heart failure, & others) affect both pulmonary & cardio systems w/ potential neg impact on life |
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pulmonary arterial htn [PH] (dx) |
on average PH is not dx until pulmonary vascular bed is significantly damaged resulting in sob. ECG may reveal R ventricular hypertrophy & strain & R atrial enlargement. ECG can't dx PH alone s/s similar to other pulmonary diseases: sob, exertional fatigue, nonspecific subjective & objective findings of PH resemble those of heart failure, possible differential dx include sleep apnea, cor pulmonale, PE, hypothyroidism, mixed connective tissue disease & portal htn |
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PH associated w/ L heart disease |
systolic dysfunction, diastolic dysfunction, & valvular disease |
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PH as a result of lung disease &/or hypoxemia |
copd, interstitial lung disease, other pulmonary disease w/ mixed restrictive & obstructive pattern, sleep-disordered breathing, alveolar hypoventilation disorders, chronic exposure to high altitudes, & developmental abnormalities |
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classification of PH |
pulmonary arterial htn, pulmonary ht associated w/ L heart disease, pulmonary htn as a result of lung disease &/or hypoxemia, chronic thromboembolic pulmonary htn, pulmonary htn w/ unclear &/or multifactorial mechanisms |
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pulmonary htn w/ unclear &/or multifactorial mechanisms |
hematological disorders: myeloproliferative disorders, splenectomy; systemic disorders: sarcoidosis, pulmonary langerhans cell histiocytosis; metabolic disorders: glycogen storage disease, gaucher's disease, thyroid disorders (may exacurbate PH); others: tumoral obstruction, fibrosing mediastinitis, chronic renal failure on dialysis |
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world health organization functional classes |
class I: no symptoms-induced limits on physical activity class II: slight symptoms-induced limits on physical activity class III: marked symptoms-induced limits on physical activity class IV: R-sided heart failure w/ dyspnea & fatigue at rest & inability to perform any physical activity w/o symptoms |
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pulmonary arterial htn [PH] (s/s) |
pt may reveal non-specific symptoms like dyspnea, fatigue, angina, syncope, weakness & ab distention & symptoms at rest occur in very advanced stages of PH L parasternal lift, abnormal heart sounds, jvd, hepatomegaly, peripheral edema, ascites, cool extremities may be present |
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PH (dx testing)
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supraventricular arrhythmias may be present in advanced stages of PH. chest radiograph may reveal R atrium & ventricular enlargement & pulmonary artery dilatation. pulmonary function tests identify underlying lung disease & assess severity of PH (lungs of PH are more stiff & smaller). decreased lung diffusion capacity for carbon monoxide. CT can detect interstitial lung disease along w/ possible emboli & give info on the heart doppler echocardiography more specific for DXing PH, measures pulmonary artery pressures noninvasively, pumping ability of R & L ventricles & valve function & can detect congenital heart defectsexercise tolerance test, 6-minute walk test (6MWT). healthy individual: minimum of 500 meters in 6 mins, pt w mod PH may be able to walk only 300 meters R heart cath is most accurate test for PH, normal MPAP at rest is between 12-16mmHG. pt w/ resting MPAP > or equal 25 is dx w/ PH. MPAP>30 while exercising is definitive for PH |
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PH (meds) |
meds that restore vasodilator effects & prevent overgrowth of cells in n attempt to decrease PA pressures & increase CO Calcium channel blockers: nifedipine, amlodipine besylate, & diltiazem hydrocholride used initially if pt has + response to vasodilator challenge prostanoids: epoprostenol (mimics prostoglandins, dilates blood vessels, prevents platelets from clumping, increases CO & slows growth of smooth muscle cells), iloprost & treprostil may be used in PH pt who has a + response to vasodilator challenge. endothelin receptor antagonists phosphodiesterase inhibitors lung transplantation: option when meds don't help pt improve |
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empysema |
permanent enlargement & loss of surface area for gas exchangeolder, thin, severe dyspnea, quiet chest, x-ray: hyperinflation w/ flattened diaphragmdistinguishing character: airflow limitation caused by thick elastic recoil in the lungsexertional dyspnea w/o cyanosispt teaching: drink 2L/day to help liquefy sections |
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pulmonary embolism |
causes ventilation-perfusion mismatch resulting in hypoxemia & intrapulmonary shunting massive consequence is pulmonary htn which ultimately leads to R-sided heart failure assist w/ admin o2 & intubation & mechanical ventilation if respiratory failure occur.admin meds |
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thoracotomy |
incision into pleural space in chest **airway clearance is one of the critical concerns following a thoracotomy b/c retained secretions can cause various complications |
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respiratory distress in infants (clinical manifestation) |
**rapid breathing, retractions, grunting, nasal flaring & pallor |
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laryngeotracheobronchitis (clinical manifestation) |
**stridor on inspiration is one of the defining manifestations typically low-grade fever |
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bronchospasms (complications) |
uncontrolled can lead to status asthmaticus, an emergency that can develop into respiratory arrest |
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ineffective airway clearance (nursing instructions) |
6-8 glasses of water a day (helps liquify & loosen secretions), use pursed-lip breathing prior to coughing & avoid cigarette smoke |
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way to optimize gas exchange in a pt on a vent |
frequent repositioning is a key intervention |
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cfc-based metered dose inhaler (mdi)
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canister floats=MDI is empty cfc-based MDI stands up straight on bottom of container=3/4 full MDI should be held upright & tilt head slightly back. inhalers w/o spacer are positioned 1-2 inches away from mouth. spacer is usually placed in mouth |
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epiglotitis |
combo of croupy cough, drooling & agitation suggests epiglotitis which is rapidly progressive & serious s/s: fever, severe sore throat, drooling & muffled voice |
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cigarette smoking |
increases ciliary (part of body's defense against RI) paralysis |
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asthma (long-acting meds) |
alleviate symptoms & improve airway function. needs to be taken regularly, not prn |
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incentive spirometer |
enhances lung expansion allowing max intake per inhalation while maintaining relatively low airway pressure (ideal for pt w/ atelectasis) helps maximize diffusion & alveolar surface area & can help prevent atelectasis |
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cyanosis (nursing intervention) |
indicates obstruction of airway child in recovery rm, initial response should be suction |
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upper respiratory infection (uri) |
increasing humidity helps liquify secretions. warm or hot showers & hot packs can help w/ relief of congestion. maintenance of patent airway, relief of pain |
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tracheostomy (prevent obstruction from secretions)
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humidify air being inspired
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orthopnea |
anxious, restless & breathless while lying down. upright position will usually provide relief after 10-30 mins |
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pulmonary edema |
collection of fluid in interstitium & alveoli as pressure rises in pulmonary vessels L ventricle can't effectively pump from heart, w/ increased resistence to L ventricullar filling fluid backs up into lungs. surface tension increases, alveoli shrink & lungs b/c stiff s/s: tachycardia, tachypnea, dyspnea, increased respirations, orthopnea, pulmonary htn, jvd, elevated pawp, pink frothy sputum, crackles tx: PA catheter, diuretics, intubation, mechanical vent, morphine to decrease preload respiratory rate & anxiety, for those who don't respond to med tx intra-aortic balloon pump to temporarily assist failed L ventricle or surgery |
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pulmonary edema (nursing consideration) |
admin o2 (aids ventilation, improve Pao2 & reverse hypoxemia), place pt in semi-fowler's, mntr i&o, meds for pain, frequently change positions to prevent ulcers & encourage lung expansion |
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respiratory depression
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morphine sulfate
respiratory rate may decrease, causing hypoventilation allowing build up of CO2 which causes cerebral |
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wheezing
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usually heard on expiration and commonly found w/ asthma, chronic bronchitis or bronchiectasis
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empyema
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pus in pleural space
objective: drain pleural cavity (needle aspiration, tube thoracostomy or open chest drainage via thoracotomy) & achieve complete expansion of lungs. admin appropriate antibiotics in large doses |
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pulmonary function tests
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measure long volume and airflow
dx pulmonary disease, mntr disease progression, evaluate disability and evaluate response to bronchodilators |
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xerostomia
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dryness of mouth from variety of causes
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pressure release ventilation (aprv)
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mechanical ventilation that allows unrestricted, spontaneous breaths throughout ventilatory cycle
on inspiration pt receives preset lvl of continuous + airway pressure & pressure is periodically released to aid expiration |
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chest physiotherapy (cpt)
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used to remove bronchial secretions, improve ventilation & increase efficiency of respiratory muscles
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fraction of inspired o2 (FiO2)
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concentration of o2 delivered. 1.0–100% o2
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hypoxemia
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decrease in arterial o2 tension in blood hypoxia, decrease in o2 supply to tissues & cells
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pressure support ventilation (psv)
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mechanical ventilation in which preset + pressure is delivered w/ spontaneous breaths to decrease work of breathing
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dullness over lungs
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when air–filled lung tissue is replaced by fluid or solid tissue
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asymmetric excursion
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may signal pleurisy, fractured ribs, trauma or unilateral bronchial obstruction
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bradypnea
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associated w/ intracranial pressure, brain injury & overdose
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acute tracheobronchitis
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clinical manifestations: dry, irritating cough & expectorates, scanty amount of mucous sputum. fever, chills, night sweats, h/a & general malaise.
as disease progresses SOB, noisy inspiration & expiration & produce purulent sputum |
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coughing at night
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L–sided heart failure or bronchial asthma
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dry cough
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URTI of viral origin or side effect of ACE inhibitor
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funnel chest
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depression in lower portion of sternum, may compress heart & great vessel
occurs w/ rickets or marfan's syndrome. |
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morning cough w/ sputum
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bronchitis
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irritative, high pitched cough
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laryngotracheitis
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pigeon chest
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occurs as result of displacement of sternum
may occur w/ rickets, marfan's syndrome or severe kyphoscoliosis |
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foul smelling sputum & bad breath
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lung abscesses, bronchiectasis or anaerobic infection
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assessing tactile fremitus
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air does not conduct sound. consolidation such as in pneumonia has increased fremitus
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purulent sputum (thick & yellow, green or rust colored) or change in color
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bacterial infection
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profuse, pink, frothy sputum
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pulmonary edema
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pharyngitis
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fiery–red pharyngeal membrane & tonsils, lymphoid follicles are swollen & flecked w/ white–purple exudates, enlarged & tender cervical lymph nodes & no cough. fever, malaise & sore throat may be present. can be virlal
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clubbing of fingers
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chronic hypoxic conditions, chronic lung conditions or malignancies of the lungs
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sinusitis (complications)
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acute may lead to meningitis, brain abscess, ischemic brain infarction or osteomyelitis
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biot's breathing
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cycles of breathing that vary in depth & have varying periods of apnea seen w/ some CNS disorders
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cheyne–stokes breathing
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alternating episodes of apnea & deep breathing. deep respirations b/c increasing shallow. duration of apnea b/c progressively longer
associated w/ heart failure & damage to respiratory center |
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high risk recommended for pneumonia vaccine
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65 yrs or older, immunocompetent w/ chronic illness, immnocompromised
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sputum sample
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1. rinse mouth w water to reduce contamination by normal flora
2. breathe deeply several times 3. cough deeply 4. expectorate raised sputum suction or bronchoscopy |
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tuberculosis
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place pt on isolation precaution including high–efficiency particulate mask (N95 mask) by those coming in contact w/ pt to prevent inhalation of potentially infectious respiratory sections. pt should be placed in neg–airflow rm
s/s of active TB: cough w/ frothy pink sputum, night sweats, anorexia & wt loss |
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cuffed endotracheal tube
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inflated cuff prevents aspiration of gastric contents
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excess tidal volume
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causes too much CO2 to be blown off causing respiratory alkalosis
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color of mucous membranes
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great indicator of pt's oxygenation status
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laryngotracheobronchitis
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nasal flaring, severe retractions, croupy or barking cough, & tachypneic
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montelukast sodium (singulair)
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leukotriene receptor antagonist that is used for prophylaxis & chronic tx of asthma.
1 tab qd |
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process for antibiotic therapy for serious infection
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culture infected site
while waiting, admin antibiotic known to tx common organisms susceptibility testing done when causative organism is IDed admin narrow spectrum antibiotic |
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sigh mechanism
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delivers a RXed # of sighs per hour to mimic normal respirations to prevent atelectasis
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TB meds
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rifampin
pt should notify if skin b/c jaundiced b/c it's indicative of onset of hepatotoxicity |
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imbalanced or mismatched VQ scan
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indicates some type of prob w/ ventilation or perfusion
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pneumocystis carinii infection
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pts are often acutely ill & fatigued b/c of hypermetabolism from AIDS
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unilateral lung disease
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"good lung down"
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high o2 concentration
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may depress breathing
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hypercapnia
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caused by poor ventilatory effort (ex. chest trauma which decreases lung ventilation)
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pulmonary fibrosis
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causes alveolar–capillary interface to b/c thicker increasing amount of time it takes for gas to diffuse across membrane
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barbituate
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CNS depression
opioid overdose develops hypercapnic respiratory failure which results from decrease in respiratory rate & depth. overdose can cause ARDS (adult respiratory distress syndrome) |
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bipap
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bilevel positive pressure ventilation requires pt initiate adequate respiratory rate to allow adequate gas exchange
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positive pressure ventilation (ppv) & PEEP
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complication: subcutaneous emphysema
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positive end–expiratory pressure (peep)
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+ pressure maintained by ventilator at end of exhalation to increase functional residual capacity & open collapsed alveoli
improves gas exchange & oxygenation by preventing alveolar collapse during expiration |
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ARDS, fibrotic phase
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chance for survival is poor b/c permanent damage to alveoli has occurred
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gram–neg sepsis & increased respirations
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ARDS may be developing
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FEV1/FVC
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indicates disease progression. ratio will be smaller when COPD worsens
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aminophylline
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changes in smoking patterns will have impact on amount of aminophylline needed
therapeutic range is 10–20 mcg/mL |
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inhaler
|
lips tightly sealed encourages nasal breathing which interferes w/ effectiveness
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acute lung injury
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umbrella term for hypoxemic, respiratory failure
ARDS is severe form |
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alpha 1 antitrypsin deficiency
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deficiency puts pt at increased risk for developing panacinar emphysema even in absence of smoking
alpha 1 antitrypsin is protective agent for lung |
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thoracic aortic aneurysm
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s/s: substernal chest pain, back & neck pain, dyspnea, cough & stridor. respiratory symptoms are due to pressure on trachea
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bronchoscopy
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informed consent required, explain what to expect during procedure, pt should be NPO for min of 6 hrs prior to procedure
post–procedure check for gag reflex, VS, mntr for laryngeal edema, dyspnea, stridor & hoarseness |
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pneumonectomy
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post–op: positioned either supine or on operative side to facilitate ventilation & perfusion. this allows fluid drainage to consolidate in pleural space on operative side rather than in pt's remaining lung
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alpha1–antitrypsin deficiency
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tachycardic, diminished BS w/ wheezing & exertion dyspnea
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chronic hypoxia
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elevation of H/H is a compensatory response
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acute respiratory failure
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Partial pressure of arterial O2 is below 60 mmHg or arterial O2 sat is below 91%PaCO2 above 50 mmHg & pH below 7.35
chPaO2 decrease or PaCO2 increase of 10 mmHg from baseline in pts w/ chronic lung disease s/s: tachycardia, tachypnea, periorbital or circumoral cyanosis, diaphoresis, accessory muscle use, diminished lung sounds, inability to speak in full sentences, impending sense of doom & altered mental status |
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chronic respiratory failure
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long–term condition that develops over time like w/ COPD. less apparent than acute
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respiratory failure (3 types)
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1) hypoxemic RF (failure to exchange o2)
2) hypercapnic RF (failure to exchange or remove CO2) 3) perioperative RF (subtype of (1) & results from lung or alveolar atelectasis |
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respiratory failure (s/s)
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SOB, mental–status changes & decreased SpO2
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respiratory failure (nursing care)
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asses tissue oxygenation status regularly. brain is extremely sensitive to o2 supply, decreased o2 can lead to altered mental status, angina signals inadequate coronary artery perfusion
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carbon monoxide poisoning
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CO is a colorless, odorless, tasteless gas. binds to hemoglobin molecule 200–250 times more tightly than O2. PaO2 is still norm, vasodilation caused by CO causes "cherry–red" skin
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croup syndrome
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airway obstruction
LTB (acute usually occurs in fall or winter in N Am. mild), laryngitis or acute spasmodic laryngitis (obstructive narrowing of larynx b/c of viral infection, genetic or emotional distress. common in kids w/ allergies) |
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epiglottitis
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serious inflammation of epiglottis resulting in obstruction, bacterial in origin (usually Haemophilus influenzae). usually abrupt & preceded by sore throat, emergency situation.
s/s: hgih fever, irritability, restlessness, red/inflamed throat w/ cherry edematous epiglottis, difficulty swallowing & drooling, muffled voice, inspiratory & sometimes expiratory stridor, suprasternal & substernal retractions, tripod positioning (child thrusts chin forward & opens mouth in attempt to widen airway), color of mmild hypoxia (possibly progressing to cyanosis) thumb sign is classic finding in lateral neck radiograph |
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epiglottitis (nursing interventions)
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assess for respiratory distress, axillary temp not oral, don't attempt to visualize posterior pharynx using tongue depressor (could result in spasm), maintain NPO, & mntr hydration status & i&o
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laryngotracheobronchitis (infectious croup)
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caused by inflammation of mucosa lining the larynx & trachea cause narrow airway. stridor. primarily affects children less than 5 yrs, gradual onset often preceded by URI
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laryngotracheobronchitis (stages)
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stage 1: anxiousness or fear, *hoarseness, croupy cough (barking seal) & inspiratory stridor
stage 2: respiratory stridor b/c continuous, soft tissue of neck may retract, intercostal retractions of lower ribs, accessory muscles of respiration are used, labored respiration, mild wheezing stage 3: signs of anoxia & Co2 retention develop (tachypnea, restlessness & anxiety), sweating & pallor stage 4: intermittent cyanosis to permanent cyanosis & respiratory failure |
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laryngotracheobronchitis (nursing interventions)
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mild croup (no stridor at rest) can be managed at home. educate on respiratory distress, progress to stage 2 need med attention, cool temp therapy (cool mist humidifier or night air), elevate head at rest, provide humidified o2, fluids & antipyretics, avoid cough syrups & cold meds, admin nebulized epinephrine in those w/ severe, resuscitation equip available
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acute spasmodic laryngitis
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brief attacks of laryngeal obstruction chiefly at night. child suddenly awakens w/ characteristic barking, metallic cough, noisy inspirations, hoarseness & restlessness. none – mild inflammation, on fever, duration is few hrs & child feels well the next morning.
nursing intervention: steam from hot bath or shower or cold steam from humidifier. attempt exposure to night air admin cough/cold meds if needed, admin bronchodilator if bronchospasm suspected, mod severe may need hospitalization |
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bacterial tracheitis
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involves mucosa upper trachea, exhibits features of croup & epiglottitis, preceded by URI w/ croupy cough, may be complication fo laryngotracheobronchitis
s/s: rever, brassy cough, inspiratory stridor, *HALLMARK production of thick purulent tracheal secretions which can result in obstruction & even respiratory arrest |
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sinusitis
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predisposing factors: allergic rhinitis, vasomotor rhinitis, rhinitis medicamentosa, URI, nasal polyps, immunodeficiency factors & environmental factors. most begin as unresolved URI of 7–10 days
s/s: purulent nasal secretion, increased posterior pharyngeal secretions, mucosal erythematic, periorbital edema, tenderness overlying sinuses tx: focuses on eradicating bacterial infection. 1st line med: amoxicillin, bactrim, erythromycin |
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sleep apnea
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3 types: obstructive, central & mixed
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sinusitis (nursing management)
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aside from completing course of antibiotics, non pharmacological therapies like warm compresses to the sinuses, humidifying air w/ steam or vaporizer, maintaining adequate hydration & smoking cessation
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sinusitis (tx)
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focuses on eradicating infection, shrinking nasal mucosa & reducing pain
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sinusitis vs allergy vs cold
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nasal obstruction
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non anatomic causes: chronic sinusitis, allergies, overuse of nasal sprays, birth control pills, htn & thyroid abnormality
anatomic causes: deviated septum, nasal polyps, enlarged adenoids, nasal foreign body & hypertrophic nasal turbinates |
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surfactant
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enables alveoli to remain open
bed rest decreases amount of surfactant produced. along w/ blockage of bronchiole w/ mucus can cause atelectasis (pooled secretions may accumulate in dependent area of bronchiole & effectively block it) |
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pulmonary fibrosis
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highly lethal interstitial lung disease, damage to lung tissue from excessive wound healing
lung injury>inflammation>neutrophilic response>lymphocyte & macrophage response>exudation of serum proteins into alveolar space>collapse of alveolar unites>healing by fibrosis |
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sarcoidosis (fibrotic lung disease)
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hallmark: noncaseating granulomas (can occur in almost any organ or tissue)
most commonly affect lungs (also liver, spleen, lymph nodes, eyes, small bones of hands & feet & skin) for most spontaneously resolve, others may develop pulmonary fibrosis & severe systemic disease |
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sarcoidosis (s/s)
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nonproductive cough, dyspnea, chest discomfort, severe results in loss of lung compliance & functional ability to exchange gases, cor pulmonale (R–sided cardiac failure)
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cystic fibrosis
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generalized dysfunction of exocrine glands which affects multiple organ systems. autosomal recessive trait, both parents are carriers, 1 in 4 incidence. lack phenylalanine (lack of essential amino acids leads to dehydration & mucosal thickening in respiratory & intestinal tracts). males w/ CF are sterile
pancreatic enzymes improve absorption & digestion of fat & protein. taken before or w/ meals or snacks. never mix w/ other meds in any fluid. DO NOT use cough suppressants, important to expectorate s/s: excessive salty taste to skin, barrel chest, clubbing of fingers & toes, crackers & wheezing, cyanosis, dyspnea, failure to thrive, poor wt gain, distended and, fx bouts of pneumonia, steatorrhea, fx URI, meconium ileus (intestinal obstruction in infants), persistent cough & thick secretions |
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cystic fibrosis (tx)
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diest w/ increased fat & NA, salt supplements, pancreatic enzyme replacement, breathing exercises, chest percussion & postural drainage, inhaled beta–adrenergic, broad–spectrum antimicrobials, NA channel blockers, heart or lung transplant, drones alfa (pulmozyme), high fx chest compression vest, o2 therapy prn, bronchodilators, mucolytic aerosols & corticosteroids
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cystic fibrosis (nursing considerations)
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amin pancreatic enzymes w/ meals & snacks, perform CPT, o2 therapy, high–calorie/high–protein diet w/ plenty of fats, admin vat A, D, E & K if deficient, plenty of liquids to prevent dehydration, provide exercise & activity periods, encourage deep–breathing
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asthma
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s/s: chest tightness, coughing w/ thick clear or yellow mucous, cyanosis (late sign), diaphoresis, nasal flaring, pursed–lip breathing, sudden dyspnea, tachycardia, tachypnea, use of accessory muscle for breathing & wheezing accompanied by coarse rhonchi
tx: low–flow humidified o2, steroids, singular, bronchodilators nursing considerations: high fowler's, anticipate intubation & mechanical vent, mntr serum theophylline lvls, perform postural drainage & chest percussion |
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status asthmaticus
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severe stoma attack w/ bonchospasm that doesn't respond to conventional therapy. severe mucous impactions & marked inflammatory infiltration has caused death
goal of therapy is to reduce obstruction by relaxing bronchial smooth muscles & reducing inflammation |
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albuterol
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bronchodilator of choice to tx asthma due to quick onset. commonly nebulizer & inhaler for emergencies
ae: tachycardia, tremors, chest pain & dysrhythmia |
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flail chest
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when 2 or more ribs are fractured leading to rib cage instability & possible organ injury resulting in pulmonary emergency
on inspiration flail segment is pulled inward by negative intrathoracic pressure. on expiration the positive pressure forces segment to protrude outward s/s: chest pain, dyspnea, tachypnea & tachycardia nursing dx: impaired gas exchange r/t dysfunctional rib cage, acute pain r/t flail chest, anxiety r/t dx of flail chest |
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exudative effusion
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chylous effusion: milky white effusion high in triglycerides
chyliform effusion: resemble chylous effusion but low in triglycerides & high in cholesterol hemothorax: bloody fluid in pleural space empyema: pus in pleural space trapped lung: lung encased by fibrous peel caused by empyema or tumor latrogenic effusion: can be caused by migration or misplacement of feeding tube into trachea or perforation of superior vena cava by cvc |
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chronic bronchitis
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daily productive cough for 3 months or more in at least 2 consecutive years
over–wt cyanotic, elevated hemoglobin, peripheral edema, rhonchi & wheezing barrel chest b/c of lung hyperinflation |
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high o2 concentration
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suppress drive to breathe
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CO2 narcosis (o2 toxcity)
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chronic o2 retention secondary to excessive o2 delivery
s/s: signs of hypoxia, drowsy, irritable, hallucinations, convulsions, tachycardia, arrhythmias & poor ventilation nursing considerations: keep o2 below 3L/min & no more than 70% o2 delivered |
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closed (spontaneous) pneumothorax
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rupture of sub pleural bulla, tuberculous focus, carcinoma, lung abscess, pulmonary infarction, severe coughing attack or blunt trauma
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open (traumatic) pneumothorax
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communication between atmosphere & pleural space because of opening in chest wall
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pneumothorax (nursing dx & considerations)
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ineffective breathing pattern r/t atelectasis
impaired gas exchange r/t abnormal thoracic mvmnt pain r/t trauma to chest area fear r/t emergency situation place sterile occlusive gauze over wound, tape dressing to three sides to allow air to escape during expiration, place pt on affected side to diminish possibility of tension pneumothorax, encourage slow breathing to improve gas exchange |
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adults respiratory distress syndrome (ards)
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aka: shock lung
fluid accumulates in lung interstitium, alveolar spaces & small airways causing lungs to stiffen severe ads can cause intractable & fatal hypoxemia hallmark: hypoxemia despite admin of o2 s/s: apprehension, crackles, dyspnea, hypoxemia, intercostal & suprasternal retractions, cough confusion, hypotension, mental sluggishness, motor dysfunction, rapid shallow breathing, restlessness, rhonchi & tachycardia tx: humidified o2 w/ continuous positive airway pressure, peep, fluid restriction, diuretics, correction of electrolyte & acid/base abnormalities, reverse severe metabolic acidosis w/ sodium bicarb |
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acidosis (ABGs)
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whether respiratory or metabolic in origin, is a CNS depressant
s/s: lethargic, confused or comatose |
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respiratory acidosis (causes)
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COPD, chest wall disorders, obesity, obstructive sleep apnea, CNS depression, lung & airway diseases & lung–protective mechanical ventilation w/ permissive hypercapnia in tx of acute respiratory distress syndrome
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pulmonary embolism (dx tests) |
positive d-dimer & ventilation/perfusion (v/q) scan indicates pulmonary embolus
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