Respiratory

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Author:
tiffanydawnn
ID:
133160
Filename:
Respiratory
Updated:
2012-02-06 00:35:00
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Respiratory
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Respiratory
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  1. upper airway
    • cleans, filters, humidifies, and warms air
    • nose, pharynx, larynx, epiglottis
  2. lower airway
    • conducts air, mucociliary clearance, production of pulmonary surfactant
    • trachea, lungs, pleura, bronchi, alveoli, rib cage/intercostals
  3. ventilation
    • the act of breathing
    • inspiration (1-1.5 sec)
    • and expiration (2-3 sec)
    • increased CO2 levels stimulate breathing
  4. respiration
    O2/CO2 exchange
  5. O2 transport
    O2 carried in blood (dissolved 1% or attached to hemoglobin 99%)
  6. diffusion
    • how O2/CO2 exhange
    • affected by alveoli surface area, thickening of alveoli membrane, partial pressures, solubility of gases
  7. central sleep apnea
    • impairment of neurologic drive to respiratory muscles
    • brain fails to communicate with respiratory muscles
  8. obstructive sleep apnea
    • intermittent absence of airflow through nose and mouth during sleep
    • excessive tissue causes airway to collapse
    • risk factors: obesity, male, age, large neck, alcohol and CNS depressant use
  9. OSA manifestations
    • loud snoring
    • daytime sleepiness
    • HA
    • irritability
    • restless sleep
    • HTN r/t vasoconstriction
    • impotence
  10. OSA complications
    • increased workload of heart -> pulm HTN -> R sided CHF
    • hypoxia -> acidosis -> ischemic heart disease -> CHF
  11. OSA dx
    • polysomnography - sleep studies - EEG, RR, airflow, HR, pulseox
    • PFTs
  12. OSA tx
    • lifestyle changes
    • --weight loss
    • --sleep on side
    • --avoid alcohol before bed
    • CPAP - continuous positive airway pressure - holds airway open
    • BiPAP - biphasic PAP - positive pressure on inhalation, lower pressure on exhalation
    • UPPP - uvulopalatopharyngoplasty - removal of excess tissues from uvula, soft palate
    • trach
  13. OSA nursing dx
    • disturbed sleep pattern
    • ineffective breathing pattern
    • fatigue
    • impaired gas exchange
    • risk for injury
    • risk for sexual dysfunction
  14. tuberculosis
    • chronic, recurrent disease caused by mycobacterium tuberculosis
    • slow growing, resistant, persistant
    • airborne
    • bacilli enters lungs, implant in upper lobe
    • causes local inflammatory response
    • WBCs isolate bac - forms tubercle (lesion)
    • caseation necrosis - center of tubercle - dead tissue
    • primary TB - disease spreads throughout the lung or other organs
    • reactivation TB - immunocompromised patients
  15. TB manifestations
    • fatigue
    • weight loss
    • night sweats
    • anorexia
    • low grade afternoon fever
    • cough - dry then blood tinged sputum
  16. TB dx
    • PPD > 15mm positive
    • PPD > 10mm positive for increased risk factors (prison, nurisng home, IV drug user)
    • PPD > 5mm positive for immune compromised (HIV, organ trans, close contact)
    • Positive ID - sputum culture x3 (first morning)
    • CXR
    • baseline tests before meds: LFTs, vision, hearing
  17. TB tx - prophylactic
    • +PPD -sputum -CXR
    • isoniazid (INH) 6-12 months
    • vitamin B6 for peripheral neuropathy
  18. TB tx - active
    • 4 ABTs
    • First 2-4 months
    • --INH (peripheral neuropathy - B6)
    • --rifampin (orange body fluids - contact lenses)
    • --pyrazinamide (hyperuricemia)
    • --ethambutol (optic neuritis)
    • Next 4 months (9 months if HIV+)
    • --INH
    • --rifampin
    • monitor LFTs, CBC, BUN/creat, uric acid
    • avoid alcohol, tylenol
    • take c meals
    • monitor compliance (mandatory CDC)
  19. TB nursing dx
    • deficient knowledge
    • ineffective therapeutic regimen management
    • risk for infection
  20. asthma
    • chronic airway inflammation
    • bronchial edema, mucus, inflammation (histamines, leukotrienes)
    • risk factors - allergies, genetics, environment, viruses, exercise, stress, meds (aspirin)
    • beta 2 receptors - stimulate = dilate, block = constrict
    • acute response - inflammation -> bronchoconstriction, edema, mucus
    • late response - increased airway resistance, WOB
  21. asthma manifestations
    • chest tightness
    • cough
    • dyspnea
    • wheezing (expiratory)
    • diminished breath sounds
    • cyanosis
    • pallor
    • tachycardia
    • tachypnea
  22. asthma dx
    • peak flows to measure exhalation
    • PFTs to eval airway obstruction
    • ABGs
  23. asthma meds
    • bronchodilators
    • --adreneric stimulants
    • --anticholinergics
    • --methyxanthines
    • anti-inflammatory agents
    • leukotriene modifiers
  24. adrenergic stimulants
    • beta 2 agonists
    • affect receptors on smooth muscle cells of resp tract
    • cause muscle relaxation and bronchodilation
    • albuterol, Maxair - short acting rescue
    • salmeterol (Serevent) - long acting maintenance
    • s/e: tachycardia, muscle tremors
  25. anticholinergics
    • prevent bronchoconstriction by blocking PNS input
    • slower acting (60-90 minutes)
    • ipratropium (Atrovent) - rescue
    • tiotropium (Spiriva) - maintenance
  26. methylxanthine
    • relaxes bronchial smooth muscle
    • narrow therapeutic index - monitor serum levels (10-20)
    • theophylline
  27. corticosteroids
    • suppress airway inflammation
    • inhalation to avoid systemic effects of steroids
    • rinse mouth after use to prevent thrush
    • fluticasone (Flovent), Advair (combo w/Serevent)
  28. leukotriene modifiers
    • reduce inflammatory response
    • 1 hour before or 2 hours after meals
    • montelukast (Singular)
  29. asthma nursing dx
    • ineffective airway clearance r/t bronchospasm and bronchoconstriction
    • ineffective breathing pattern
    • anxiet
    • ineffective therapeutic regimen management
  30. COPD
    • chronic airflow obstruction
    • chronic bronchitis and/or emphysema
  31. bronchitis - blue bloater
    • excess bronchial mucus secretion r/t chronic inflammation
    • productive cough 3+ months for 2 consecutive years
    • causes hypoxemia, hypercapnia, pulm HTN -> R side HF
    • cyanotic
    • obese
    • wet cough
    • bronchioles full of mucus - wheezing/rhonchi
  32. emphysema - pink puffer
    • destruction of walls of alveoli
    • decreased surface area for gas exchange
    • thin
    • cachectic
    • dry, hacky cough
    • stiff alveoli
    • barrel chest
    • diminished breath sounds
  33. COPD dx
    • PFTs to measure lung volumes
    • ventilation-perfusion scanning to measure air in/out and blood flow
    • serum alpha1-antitrypsin levels - genetic, destruction of alveoli, can affect liver
    • ABGs
    • pulse ox
    • CBC
    • CXR

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