Level I W2013

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Level I W2013
2013-01-28 19:31:58

Respiratory, Lab Values, Men's Health
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  1. Compliance
    Measure of the ease of expansion of the lungs
  2. Resp issues with Hyperthermia and Acidosis
    Difficult for blood to pick up oxygen but diffuses into tissues more easily
  3. Resp issues with Hypothermia and Alkalosis
    Ease for blood to pick up oxygen but diffuses into tissues poorly
  4. Dyspnea
    Sensation of Shortness of Breath
  5. Hemoptysis
    Coughing of Blood
  6. Hematemesis
    Vomiting blood
  7. Fremitus
    vibration of the chest wall produced by vocalization
  8. Respiration
    • 1. ventilation/breathing, mvmt of air in/out of lungs as we inhale/exhale
    • 2. alveolar-capillary gas exchange, which involves the diffusion of oxygen and carbon dioxide between the alveoli and the pulmonary capillaries
    • 3. Transport of oxygen and carbon dioxide between the tissues and the lungs
    • 4. mvmt of oxygen and carbon dioxide between the systemic capillaries and the tissues
  9. Upper respiratory system
    mouth, nose, pharynx, and larynx
  10. Lower respiratory system
    trachea, lungs, bronchi, bronchioles, pulmonary capillary network, pleural membranes
  11. Stridor
    harsh, high-pitched sound, may be heard during inspiration
  12. Eupnea
    normal respiration
  13. Tachypnea
    rapid respirations
  14. Bradypnea
    abnormally slow respiratory rate
  15. Apnea
    absence of any breathing
  16. hypercarbia/hypercapnia
    high levels of Carbon dioxide
  17. Orthopnea
    inability to breathe easily unless sitting upright or standing
  18. Hypoxemia
    • insufficient oxygenation of blood: decreased PaO2 on ABG, decreased sat below norm on pulse ox
    • Cyanosis - late, Perifpheral vasoconstriction
  19. Hypoxia
    • insufficient oxygen in tissues
    • tachycardia, tachypnea, reslessness, irritability, apprehension, dyspnea (SOB), acute - brain is affected= confusion/decreased LOC, Metabolic acidosis due to anaerobic respiration
  20. Tidal Volume
    volume inhaled and exhaled during normal quiet breathing
  21. Inspiratory reserve volume
    maximum amount of air that can be inhaled over and above a normal breath
  22. Expiratory reserve volume
    Max amt of air that can be exhaled following a normal exhalation
  23. Residual volume
    amt of air remaining in lungs after maximal exhalation
  24. Total lung capacity
    total volume of the lungs at max inflation calculated by adding the tidal volume to IRV, ERV, and RV
  25. Vital Capacity
    Total amount of air that can be exhaled after a maximal inspiration calculated by adding tidal volume to IRV and ERV
  26. Inspiratory capacity
    total amt of air that can be inhaled following normal quiet exhalation; calculated by adding tidal volume and IRV
  27. Functional residual capacity
    volume left in the lungs after normal exhalation; calculated by adding the ERV and RV
  28. Minute volume
    total volume or amt of air breathed in 1 minute
  29. Anion Gap
    • Cations: Na + K = _mEq
    • Anions: Cl + HCO3 = _mEq
    • Cations - Anions = Gap
    • Range 10-20mEq
    • increase = metabolic acidosis
  30. Basophils
    decrease response to allergic or anaphylactic reactions; releases histamine, heparin, serotonin; increased post-acute inflammation &/or chronic infection, Leukemia, post-radiation; decreased allergic reactions, acute infections, hyperthyroidism & stress
  31. Eosinophils
    increase in allergic (ag-ab) responses: asthma, hay fever, drug allergies, used in parasitic infections & neoplasms; decreased in adreno-corticoseroids/glucocoticoids (decrease the immune response) in Purulent infections
  32. Monocytes
    phagocytosis of injured or dead cells, foreign substances & debris; increased in chronic inflammatory diseases (ulcerative colitis), some collagen diseases, TB, protozoan infections; decreased in bone marrow failure, some leukemias
  33. Lymphocytes
    B & T cells recognize ag. some attach & destroy the ag. ag carried to lymph nodes to be destroyed; increased in viral infections, TB, mono, pertussis, some tumors; decreased in AIDS, immunosuppressant drugs, Lupus
  34. Neutrophils
    first responders; phagocytosis of foreign objects until to big & die, eats acute necrotic tissue, segs made in bone marrow over 8-10 days, lives in bloodstream 5-6hrs, eats for 36-72hrs, PUS develops
  35. WBC differential
    • Neutrophils: Segs-45-75%, Bands-0-5%; phagocytosis
    • Eosinophils: 0-8%; allergic reactions & parasitic infections
    • Basophils: 0-3%; allergic/anaphylactic reactions
    • Agranulocytes-
    • Monocytes: 4-11%; phagocytosis
    • Lymphocytes: 16-46%; production of antibodies in response to specific antigens
  36. Hemoglobin
    • O2 & CO2 carrying capacity
    • Anemia
    • 3x's higher than RBC's
    • Female: 12-15g/dL
    • Male: 14-16.5g/dL
  37. Hematocrit
    • % RBC's per fluid volume of whole
    • Evaluates % of solids vs. plasma
    • Important in determination of anemia and fluid balance
    • 3x's higher than HCT
    • Female 35-47%
    • Pregnant >33%
    • Male 42-52%
  38. Platelets
    • Thrombocytes formed in red bone marrow
    • Act as hemostatic plug when in formation
    • 150,000-400,000
    • <150,000 = Thrombocytopenia
    • >400,000 = Thrombocytosis
  39. Platelet: Increase/decrease
    • decreased in 1. decreased production-bone marrow suppression, aplastic anemai, leukemia, lymphoma, medications (chemo) congenital or immune disorders; 2 increase destruction - autoimmune disorders, hyperspenism, or medications (heparin)
    • Increased in Leukemia or other malignancies, iron-deficiency anemia, hemorrhage, splenectomy
  40. RBC
    • anemia
    • produced by red bone marrow erythropoeisis
    • removed by liver, spleen, bone marrow
    • lifespan 120 days
    • Female: 4-5.5million
    • Male 4.5-6.2million
    • Pediatric: 3.5-6million depending on Age
  41. WBC
    • 4500-11000/uL
    • <4000 = leukopenia - immunocompromised
    • >11000 = leukocytes
  42. Muscles of expiration
    • Internal intercostals
    • abdominal muscles
  43. Muscles of inspiration
    • sternocleidomastoid muscles - lifts sternum
    • external intercostals
    • diaphragm
    • scalenes
  44. Central Chemoreceptors
    • Medulla: sensitive to increased PaCO2, hyperbaric drive sensitive to CO2 in cerebrospinal fluid
    • Pons: contain both expiratory/inspiratory neurons, upper pons fine tune our breathing
  45. O2 Transport
    • 1. ventilation of the lungs
    • 2. diffusion of oxygen
    • 3. perfusion of capillaries w/ oxygenated blood
    • 4. oxygen from capillaries to enter cells [tissues]
  46. CO2 transport
    • 1. Diffusion of CO2 from cells into systemic capillaries
    • 2. Perfusion of pulmonary capillary bed by venous blood
    • 3. Diffusion of CO2 into alveoli
    • 4. Removal of CO2 from lungs by ventilation
  47. Central Chemoreceptors
    • Found in Aortic arch & Carotid arteries
    • sensitive to decrease in blood PaO2
    • Can drown in O2 by causing overload of O2, which causes them to stop breathing (CO2 has increased shutting down primary receptors)
  48. Effects of Aging on Respiratory System
    • Decrease number of functional alveoli & lose elasticity
    • Compliance of chest wall decreases
    • Respiratory muscles strength decreases
    • Decreased pulmonary perfusion
    • decreased response to hypoxemia & hypercapnia
  49. Risk for pulmonary infection
    decreased: chest expansion, effective cough, cilia function, phagocytosis of alveolar macrophages, specific antibodies - IgA neutralizes viruses
  50. Subjective Focused Assessment of Respiratory
    • SOB
    • Chest tightness
    • Pain w/ breathing
    • Cough
    • Sputum
  51. Objective Focused Assessment of Respiratory
    • VS
    • Observe: RR, use of accessory muscles
    • Inspect: skin, nails, shape, symmetry, mvmt of chest wall
    • Auscultate: lung sounds
    • Diagnostic: ABG, CXR, Hct, Hgb, Pulmonary Function Test, Sputum culture
  52. Hemoptysis
    • blood in sputum
    • Gross blood (a lot of blood with sputum)
    • Frankly bloody (just blood)
    • Blood tinged (streaks in sputum)
  53. Pleural Friction Rub
    continuous scratching/grating sound during inspiration & expiration, often associate w/ pleurisy
  54. Crackles
    popping sounds as air passes through moist & or previously closed small airways, primarily on inspiration
  55. Rhonchi
    low-pitched continuous sounds, from narrowed or obstructed large airways, often from secretions, primarily on expiration. may disappear after coughing
  56. Wheezing
    • sound produced when air passes through partially obstructed or narrowed airways on inspiration or expiration
    • mucosal edema, airway secretions, collapsed airways, foreign objects, tumors
  57. Stridor
    • high pitched suonds produced when air passes through a partially obstructed or narrowed upper airway on inspiration
    • changes in voice characteristics, hoarseness, difficulty swallowing/drooling, sleep related disorders
  58. PaCO2
    • 35-45mmHg
    • hypocapnia - caused by hyperventilation; respiratory alkalosis; <35
    • hypercapnia - caused by hypoventilation; respiratory acidosis; >45
  59. HCO3-
    • reflects bopy's metabolic status
    • 22-26mEq/L
    • <22 = metabolic acidosis
    • >26 = metabolic alkalosis
  60. PaO2
    • dependant on ventilation & gas exchange
    • 80-100mmHg
    • <80 = hypoxemia
    • >100 = hyperoxemia
  61. Cause Respiratory Acidosis
    • decreased ventilation
    • respiratory depression - oversedation
    • altered diffuison: pulmonary edema, pneumonia, atelectasis, severe bronchospasm
  62. S/S & Interventions of Respiratory Acidosis
    • S/S: increased HR & BP, CNS depression/decreased LOC, lethargy/weakness, drowsiness, behavioral changes, h/a, coma
    • Interventions: Improve ventilation- airway: patent, suctioning of secretions, avoid over-sedation, raise HOB, Encourage client to breathe deeply to blow off CO2
  63. Cause Respiratory Alkalosis
    • Hyperventialtion
    • anxiety
    • pain
    • fever
    • head injury
    • hypoxemia/hypoxia
    • mechanical ventilation
  64. S/S & Interventions Respiratory Alkalosis
    • S/S: lightheaded/dizzy, sweaty, numbness/tingling of fingers, muscle weakness, hyper-reflexia/twitching/tetany, arrhythmias, convulsions
    • Interventions: treat underlying cause
  65. Sputum Culture
    • Assess for Bacteria,
    • Fungi,
    • cellular elements
  66. Nose/Throat cultures
    • assess for pathogens such as:
    • pertussis
    • influenza
    • RSV
  67. Laryngoscopy
    visualize larynx to dx: papillomas, nodules, polyps or CA
  68. Bronchoscopy
    detect tumors, inflammation, strictures, obtain biopsies
  69. Thoracentesis & Pleural fluid analysis
    • relieve pain
    • decrease SOB d/t excess pleural pressure from fluid
    • assess fluid for infection or cancer
  70. Biopsy
    assess for cancer or infection
  71. Respiratory ND
    • Ineffective Gas Exchange
    • Ineffective Airway Clearance
    • Ineffective Breathing Pattern
    • Acute Pain
  72. Ineffective Gas Exchange Interventions
    • Monitor for any change in mental status
    • monitor o2 sats
    • admin supplemental oxygen
    • Elevate HOB
    • Deep-slow or pursed-lip breathing
    • expectoration of sputum; suction as needed
    • assist w/ positive-pressure ventilation or intubation or emergency airway management
  73. Ineffective Airway Clearance Interventions
    • semi/high-fowlers position
    • frequent position changes
    • chest physiotherapy
    • hydration & humidification
    • Suction secretions
    • encourage ambulation
    • IS & Deep Breathing/coughing
    • -10q 1-2hr
    • Nebulizer treatments
  74. Ineffective Breathing Pattern Interventions
    • Monitor respiratory & o2 status
    • monitor for respiratory fatigue
    • Elevate HOB
    • Splint when coughing or deep breathing
    • IS
    • Medications that promote airway patency
  75. Asthma: Chronic Inflammatory disease
    • Mucosal edema
    • Hypersecretion of mucus
    • Bronchoconstriction
    • Results in airway narrowing (obstruction)
  76. Asthma: Epidemiology
    Results from hyper-responsiveness of the trachea and bronchi irritants
  77. Asthma: Etiology Unknown
    • Immunologic, infectious, endocrine & psychological factors
    • Genetic
    • Triggers
  78. Extrinsic Asthma
    foreign particle enters the body and our immune system over-reacts forming antibodies which are normally used to attack viruses or bacteria. Mast cells release these antibodies as well as other chemicals to defend the body.
  79. Extrinsic Asthma Irritants
    • Cockroach particles
    • Cat dander - hair & saliva
    • Dog dander
    • House dust mites
    • Mold/yeast spores
    • Pollen
  80. Intrinsic Asthma
    not allergy related. caused by anything except allergy. May be caused by inhalation of chemicals such as smoke, cleaning agents, taking aspirin, stress, laughter, cold air, etc.
  81. Intrinsic Asthma Irritants
    • smoke
    • exercise
    • gas, wood, coal, natural gas, propane, kerosene
    • fumes
    • smog
    • viral respiratory infections
  82. Asthma Pathophysiology
    • trigger - acute/early response
    • Inflammatory mediators ie histamine/prostaglandins constrict airways and increase capillary permeability. Causes edema & increased mucus production
    • 4-10hrs later airflow is reduced, work of breathing increases, inflammatory cells damage airway epithelium, produce mucosal edema, impair airway clearance, prolong bronchoconstriction. Trapped air mixes w/ inspired air, reducing O2 for gas exchange. Blood flow reduced to distended alveoli, hypoxemia develops
  83. Acute Asthma Clinical Manifestations
    • Tightness in chest
    • Cough
    • Thick spututm
    • Bronchospasm - wheezing w/ prolonged expiration
    • Rhonchi
    • Decreased breath sounds
  84. Clinical manifestations of Asthma
    • Dyspnea: anxiety; apprehension
    • Labored Respirations: accessory muscle use; tripod or upright position; tachypnea; speaks in short broken phrases or not at all
    • Hypoxia: tachycardia; change in LOC; Cyanosis-late
  85. Mild Intermittent Asthma
    symptoms occur less than twice a week
  86. Mild Persistent Asthma
    symptoms occur more than twice a week but less than once a day
  87. Moderate Persistent Asthma
    daily symptoms occur in conjunction with exacerbations twice a week
  88. Severe Persistent
    daily symptoms occur in conjunction with exacerbations that limit the client's physical activity and quality of life
  89. Asthma Interventions
    • O2 therapy
    • high fowlers position
    • monitor HR & rhythm for changes during acute exacerbation
    • IV access
    • Admin meds as ordered: short acting beta2 agonist, cholinergic antagonists, methylxanthines, anti-inflammatories, combination agents
    • Maintain calm atmosphere
  90. Respiratory Failure
    • Persistent hypoxemia
    • Monitor Oxygenation levels and acid/base balance
    • Prepare for intubation & mechanical ventilation if indicated: worse case scenario
  91. Status Asthmaticus
    • life-threatening: airway obstruction may be unresponsive to common treatment
    • extreme wheezing, labored breathing, use of accessory¬† muscles, distended neck veins, risk for resp/cardiac failure
    • prepare for emergent intubation
    • Medications: epinephrine, bronchodilators, steroids
  92. Family Teaching Asthma
    • eliminate allergens
    • avoid temperature extremes
    • avoid exposure to respiratory illnesses
    • teach early symptoms of asthma
    • proper use of meds, inhalers, nebulizers, peak flow meter
    • need for adequate rest, fluids, and nutrition
    • up to date immunizations including flu vaccine
  93. Inhaled Asthma Meds
    • Use spacer
    • Inhale puff hold 5-10seconds
    • Exhale through pursed lips
    • 1min between inhale
    • 5min between meds or puffs of Atrovent
    • Rinse mouth - Yeast growth
  94. Bronchodilaters
    • Beta2-adrenergic agonists
    • Anticholinergics
    • Methylxanthine
  95. Beta 2-adrenergic agonists
    • Rescue Inhaler: relieves bronchospasming, quick
    • SE: tremors, tachycardia, potassium imbalance, hyperglycemia, tachycardia, throat irritation
    • Albuterol (Proventil, Ventolin)
  96. Anticholinergics
    • Weaker, Supplement to Beta 2, not for acute attack
    • NOT rescue breather
    • SE: H/A, dizzy
    • Ipratropium bromide (Atrovent)
    • Tiotropium (Spiriva)
  97. Methylxanthine
    • Not used much, Last resort
    • SE: Tremors, serum lab values important, hypotension, nervousness, tremors, dizziness, H/A, anorexia, tachycardia, respiratory arrest, circulatory failure
    • Theophylline (PO)
    • Aminophylline (IV)
  98. Side Effects of Bronchodilators
    • palpitations & tachycardia
    • dyrhythmias
    • restlessness, nervousness, tremors
    • anorexia, N/V
    • H/A, dizziness
    • hyperglycemia - steroids
    • decreased clotting time
    • mouth dryness & throat irritation w/inhalers
    • Paradoxical bronchoconstriction w/inhalers
    • Diabetes & COPD complications w/ medications
  99. Theophylline
    • increases risk of digoxin toxicity
    • decreases effects of lithium & phenytoin (dilantin)
    • dysrhythmia when given with Beta 2
  100. Anti-Inflammatory Agents
    • Systemic Corticosteroids/Glucocorticoids
    • Inhaled Corticosteroids
    • Mast Cell Stabilizer
    • Leukotriene Modifiers
  101. Systemic Corticosteroids/Glucocorticoids
    • Acute/Short term
    • Prednisone PO
    • Methylprednisolone IV
  102. Inhaled Corticosteroids
    • Acute/Short term
    • Beclomethasone
    • Budesonide
    • Triamcinolone
  103. Mast Cell Stabilizer
    • Cromolyn
    • nedocromil
  104. Leukotriene Modifiers
    • smooth muscle constriction, edema of airway
    • zafirlukast
    • montelukast
    • zileuton
  105. COPD
    Chronic, progressive, usually irreversible group of diseases of the lungs that lead to airflow obstruction
  106. COPD Emphysema Patho
    • characterized by loss of elasticity of lung tissue caused by deficiency of alpha 1 antitrypsin
    • When alveolar walls are destroyed, air spaces enlarge and the surface area for gas exchange decreases
    • Alveoli become less elastic and airways tend to collapse during exhalation
    • Causes air trapping in distal airways
  107. Emphysema S/S
    • exercise intolerance
    • pursed-lip breathing
    • orthopnea
    • increased HR, RR
    • accessory muscle use
    • Marked dyspnea
    • normal ABG
    • Barrel Shaped Chest
    • Weight loss
    • Respiratory infections
  108. COPD Chronic Bronchitis Patho
    • Increased number/size of goblet cells and mucus glands of the airways
    • more mucus than usual in airways which contributes to narrow airways & causes productive cough
    • Infiltration of airway walls w/ inflammatory cells
    • Progressively worsens as the disease progresses
  109. Chronic Bronchitis S/S
    • Productive cough-yellow sputum
    • Recurrent pulmonary infections
    • Gradually worsening dyspnea
    • Accessory muscle use
    • Coarseness & wheezing on auscultation
    • Hypoxemia-polycthemia, clubbing of fingers, pulmonary hypertension, heart failure, peripheral edema, weight gain
    • Hypercarbia
  110. COPD overview
    • emphysema
    • progressive loss of lung tissue: wgt loss, mild hypoxemia, no hypercarbia, few secretions
    • Chronic Bronchitis
    • chronic airway inflammation: obese, hypoxemia, hypercarbia, increased HCT/secretions, cor-pulmonale
  111. COPD Interventions
    • Cessation of smoking
    • Alpha-1 antitrypsin
    • Flu/pneumonia vaccine
    • Antibiotics
    • Admin meds correctly
    • Mobilize secretions
    • Purse lip breathing
    • Prevent hyoxemia/hypoxia
    • Good Nutrition
    • Improve physical fitness
  112. COPD Cystic Fibrosis
    • autosomal recessive disorder - requires both recessive genes
    • Diagnosed in childhood, within 1st yr
    • abnormal secretion in exocrine glands: abnormality in chloride & sodium transport
    • formation of thick & sticky mucus, affects lungs, skin, pancreas & GI, & reproductive systems
    • Chronic & progressive
  113. Cystic Fibrosis Patho
    • thick mucus plugs small airways and impairs normal airway clearing mechanisms
    • leads to atelectasis, infection, bronchiectasis, airway dilation
    • lungs become scarred & stiff
    • lack appropriate pancreatic enzyme
  114. CF: Skin
    • taste salty
    • risk for dehydration & electrolyte imbalances esp. during fever
  115. CF: Lungs
    • repeated respiratory infections
    • wheezing, dry nonproductive cough
    • dyspnea, activity intolerance
    • clubbing fingers & toes
    • atelectasis
    • lung collapse (pneumothorax)
    • Respiratory failure
  116. CF: Pancreas & GI
    • meconium ileus in neonate
    • intestinal obstruction
    • steatorrhea - fatty stool
    • deficiency of fat-soluble vitamins ADEK
    • Hypoalbuminemia - edema
    • stool, fat, enzyme analysis
    • failure to thrive
  117. CF: Reproductive System
    • delayed puberty
    • infertility
    • -thick vaginal secretions
    • -block of vas deferens
  118. CF Interventions
    • antibiotics'bronchodilators
    • CPT
    • hydration
    • pace exercise
    • vaccines
    • O2
    • lung transplant
    • pancreatic enzymes
    • high protein
    • monitor weight, constipation, intestinal obstruction
  119. Tuberculosis
    • droplet nuclei containing bacillus implant in alveolus or bronchiole.
    • malaise, fever, cough, weight loss, anorexia, lymphadenopathy
    • mantoux test, sputum culture, CRX
  120. Tuberculosis Interventions
    • Meds: long term: isoniazid, rifampin, pyrazinamide
    • airborne precautions
    • adequate rest & diet
    • strict adherence to therapy