-
upper airway
- cleans, filters, humidifies, and warms air
- nose, pharynx, larynx, epiglottis
-
lower airway
- conducts air, mucociliary clearance, production of pulmonary surfactant
- trachea, lungs, pleura, bronchi, alveoli, rib cage/intercostals
-
ventilation
- the act of breathing
- inspiration (1-1.5 sec)
- and expiration (2-3 sec)
- increased CO2 levels stimulate breathing
-
respiration
O2/CO2 exchange
-
O2 transport
O2 carried in blood (dissolved 1% or attached to hemoglobin 99%)
-
diffusion
- how O2/CO2 exhange
- affected by alveoli surface area, thickening of alveoli membrane, partial pressures, solubility of gases
-
central sleep apnea
- impairment of neurologic drive to respiratory muscles
- brain fails to communicate with respiratory muscles
-
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
-
OSA manifestations
- loud snoring
- daytime sleepiness
- HA
- irritability
- restless sleep
- HTN r/t vasoconstriction
- impotence
-
OSA complications
- increased workload of heart -> pulm HTN -> R sided CHF
- hypoxia -> acidosis -> ischemic heart disease -> CHF
-
OSA dx
- polysomnography - sleep studies - EEG, RR, airflow, HR, pulseox
- PFTs
-
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
-
OSA nursing dx
- disturbed sleep pattern
- ineffective breathing pattern
- fatigue
- impaired gas exchange
- risk for injury
- risk for sexual dysfunction
-
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
-
TB manifestations
- fatigue
- weight loss
- night sweats
- anorexia
- low grade afternoon fever
- cough - dry then blood tinged sputum
-
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
-
TB tx - prophylactic
- +PPD -sputum -CXR
- isoniazid (INH) 6-12 months
- vitamin B6 for peripheral neuropathy
-
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)
-
TB nursing dx
- deficient knowledge
- ineffective therapeutic regimen management
- risk for infection
-
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
-
asthma manifestations
- chest tightness
- cough
- dyspnea
- wheezing (expiratory)
- diminished breath sounds
- cyanosis
- pallor
- tachycardia
- tachypnea
-
asthma dx
- peak flows to measure exhalation
- PFTs to eval airway obstruction
- ABGs
-
asthma meds
- bronchodilators
- --adreneric stimulants
- --anticholinergics
- --methyxanthines
- anti-inflammatory agents
- leukotriene modifiers
-
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
-
anticholinergics
- prevent bronchoconstriction by blocking PNS input
- slower acting (60-90 minutes)
- ipratropium (Atrovent) - rescue
- tiotropium (Spiriva) - maintenance
-
methylxanthine
- relaxes bronchial smooth muscle
- narrow therapeutic index - monitor serum levels (10-20)
- theophylline
-
corticosteroids
- suppress airway inflammation
- inhalation to avoid systemic effects of steroids
- rinse mouth after use to prevent thrush
- fluticasone (Flovent), Advair (combo w/Serevent)
-
leukotriene modifiers
- reduce inflammatory response
- 1 hour before or 2 hours after meals
- montelukast (Singular)
-
asthma nursing dx
- ineffective airway clearance r/t bronchospasm and bronchoconstriction
- ineffective breathing pattern
- anxiet
- ineffective therapeutic regimen management
-
COPD
- chronic airflow obstruction
- chronic bronchitis and/or emphysema
-
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
-
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
-
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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