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2013-04-28 07:14:38

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  1. Rispiration is made up of
    Ventilation, Perfusion and diffusion
  2. what is ventilation
    the movement of air in and out of the lungs
  3. what is perfusion
    the flow of blood through the capillary system surrounding the lungs
  4. what is diffusion
    the process of gas exchange between the blood and the alveoli of the lungs
  5. what is tidal volume
    the amount of air taken in and out on  normal respiration (500)
  6. what is inspiratory reserve volume
    max amount of air that can be inhaled (3100)
  7. what is expiratory volume
    max amount of air that can be exhaled (1200)
  8. what is residual volume
    left over air after max has been exhaled (1200)
  9. what is vital capicity
    total amount of air that can be exhaled after max inhalation (4800)
  10. what is inspiratory capacity
    total amt of air that can be inhaled after normal exhalation (3600)
  11. What is functional residual capacity
    amount of air left in lungs after normal exhalation (2400) expiratory reserve + residual volume
  12. which is longer inspiration or expiration
  13. what does the upper respiratory system consist of
    nose, mouth, pharynx, larynx and trachea
  14. what does lower resp system consist of
    lungs, bronchi, bronchieoles
  15. where are  sinuses located
    nasal cavity
  16. which passage way is for food and air
    pharynx = food
  17. 3 sections of pharynx are
    naso, oro and laryngopharynx (naso is for air only)
  18. nasopharynx open to what tubes
     eustachian tubes connecting it to middle ear
  19. how does the body prevent food from entering the larynx
    the inlet of the larynx closes during swallowing and the epiglottis closes to prevent food from entering the larynx during swallowing
  20. describe the lungs and lobes
    right lung is larger and has 3 lobes, left lung is smaller and has 2 lobes...(remember only 2 left)
  21. what is lung compliance
    the ability of the lung to be able to stretch (elasticity)
  22. what part of the brain controlls respiration
    the medulla and the pons
  23. describe airway resistance
    if something is obstructing the lungs (such as mucous or other blockage) it can cause airway resistance
  24. alveolar surface tension
    is related to the amount of surfactant in alveolar walls. produced by epithelial cells.  tension (resistance) is the greatest in alveoli
  25. oxygen transport and unloading
    you need to drop off oxygen to be able to pick up carbon dioxide
  26. what happens to hemoglobin when as body temp increases (as in fever)
    the affinity of O2 and hemoglobin decreases as the temp of the body increases as a result less o2 binds with hemoglobin and o2 unloading increases. conversely as body is chilled o2 unloading decreases
  27. what happens to O2 unloading as body becomes more acidotic
    o2 unloading in the tissues increases
  28. factors that can affect O2 transport
    a clot, if pt is anemic (from lack of hemoglobin molecules to attact to)
  29. dx test ABG's
    arterial sample is collected in a heperinized needle and sample must be kept on ice. note if pt is on aspirin, anti coagulants or has a clotting problem.  need to know if pt is on O2, if they are being ventilated. do not collect from same arm as IV. apply pressure for 5 mins
  30. Broncoscopy details
    • need informed conscent
    • go down trachea and esophogus, pt must be sedated and pt will be NPO
    • for specemins, examine fluid, tissues look at tumors, collect sample (biopsy)
    • complications, pneumothorax, infection, bleeding. pt could have sore throat afterward. don't let pt drink or eat until gag reflex comes back
  31. chest xray details
    check for structure deformaties, check for pneumonia
  32. cat scan details
    better than xray, more detailed, pt may be NPO especially if contrast used (IV)check for allergies to shell fish (iodine). if pt is diabetic (type 2) metforman (glucaphage) needs to be held. (hold a few days before and after)
  33. MRI details
    more specific than CT, make sure pt has no metal. (tattoos too)
  34. Pulmonary angiogram test
    iodine precautions, using pulmonary artery (bigger artery)  and requires informed conscent, apply pressure for longer maybe using a sandbag. pt is at risk for bleeding or hemotoma.
  35. VQ scan (pulmonary scan)
    pt breathes in radioactive gas and lungs are scanned. radioactive blood should flow freely. (used for pulmonary embolism or other obstruction such as pneumonia)
  36. PET scan positive emission tomagraphy
    • similiar to CAT scan
    • looks specifically for cancers like lung CA
    • no alcohol, tobacco or caffiene
    • cuz it has a radioactive substance
  37. (sputum studies) AFB is test for
    • TB (acid fast bacillis)
    • best early in the AM
    • get sample before starting antibiotic (if possible) if you have to get culture after starting antibiotics make sure you note that pt is on certain antibiotic
  38. thoracentesis details
    • draining fluid from chest cavity (pleural fluid from pleural space)  done fo dx or tx. fluid is drained by long needle.  may be done also to relieve pressure. Can sometimes get liters out.  Comes from between the ribs. Use local anesthetic Sterile procedure
    • requires consent
    • patient must lie on unaffected side for an hour after the test.  will do chest xray afterwards to make sure lung hasn't collasped.  can go home afterward.
  39. Assesment for respiratory
    • History (personal, family)
    • when did it start (description in own words)
    • Occupation
    • smoker
    • allergies
    • nutritional issues
    • (protein deficiencys)
    • ask about cystic fibrosous
    • use PQRST

  40. what are vesicular sounds
    • soft low pitched
    • Heard all over except major bronchi
  41. what are broncho vesicular sounds
    • medium pitch and intensity of sound
    • equal on inspiration and expiration
  42. AP diameter is
    distance between front and back should be smaller than distance from side to side.  Barrell chest means entire chest is equal all the way around
  43. what are bronchial sounds
    • loud high pitched sounds
    • gap between inspiration and expiration
    • heard over manubrium
  44. Clubbing finger details
    • seen in advanced resp diseases
    • fingers are more rounded
    • can be found in COPD
  45. acute rhinitis is
    • the common cold (can last a few days to a few weeks and can lead to bacterial infection, sinusitis, ear infections etc)
    • is viral
    • highly contagious
    • peaks in late september and late jan due to school schedule then again in end of April
    • Rhinovirus is most common cause
    • and RSV (resp virus that is more severe in infant) causes lower resp infections in kids. May need antiviral drugs in conjunction with regular therapy. spread by droplet or direct contact, human and vector
    • can have fever, runny nose, malaise
    • drink a lot of fluids and wash hands and rest
    • can use analgesics
    • decongestants
    • antihistamines
    • antipyretics
  46. CORYZA is
    runny nose, clear watery drainage
  47. Influenza details
    • viral resp disease
    • coryza, fever, sore throat, dry cough, chills
    • muscle aches
    • (not vomiting and diarhhea)
    • spread by droplet and direct contact
    • viral so no antibacterial drugs
    • sinusitis can follow and otitis
    • reyes syndrome can follow the flu also
    • 3 major strains A,B and C
    • A is most severe and responsibile for most infections, C is the most mild
    • takes 18-72 hours to incubate and has abrupt onset, last 2-3 days, fever can last up to week and cough can last several weeks
  48. who needs flu shot the most
    ppl over 50, children (6month to 18), nursing home residents, health care workers, ppl w lung disorders, diabetics etc
  49. who should not get a flu shot
    ppl allergic to eggs
  50. nursing dx for flu
    • ineffective breathing pattern
    • ineffective airway clearance
    • disturbed sleep pattern
    • risk for (transmission of) infection
  51. sinusitis details
    • clear nasal drainage progressing to yellow or green
    • abscess tooth can cause it
    • accomp by conjunctivitis, toothache, headache, pain and swelling over the sinuses
    • aggravated by arising and bending forward
    • Pain may be worse in the morinig usually gets worse during the day
    • can be described as dull or intermittent
    • flu or cold can cause acute sinusitis
    • if untreated or undertreated can become chronic
    • things that comtribute, frequent use of nasal sprays, allergies, and smoking
    • usuall dx by hx and physical
    • may do xrays and CAT scans
    • treat with decongestants and nasal sprays, antibiotics and possible antihistimines, maybe cipro cephlosporins, saline, aerobic excersie you want it to drain 
  52. should you give antibiotics for the flu
  53. sleep apenea details
    • abscence of airflow thru the mouth during the sleep (obstructive and CNS sleep apnea)
    • chartarized by snoring
    • pt restless sleeper
    • mouth breather during sleep
    • Tounge falls back and blocks pharynx
    • skeletal musicle tone decreases when pt sleeps and pharynx collaspes during inspiration
    • happens mostly during REM sleep
    • shirt size greater than 17 (obese ppl)have nocturnal asphyxia from change in gas level (po2 and o2)
    • can last up to 2 mins
    • gasping an choking in sleep
    • tx lose weigh, don't drink, may have to reomve tonsils and Uvula
    • pt shouldn't sleep on back
  54. CPAP and BiPAP details
    • cpap (pressure on inspiration only)
    • BiPAP (presure on inspiration and expiration)
  55. nursing dx for sleep apnea
    • fatigue
    • ineffective breathing pattern
    • risk for impaired sexual dysfunction
    • impaired gas exchange
  56. antihistimine details
    • PREVENT the release of histimine from mast cells.  (H-1 blocker)
    • BETTER FOR PREVENTION than the action of reversing the effect of histimine release
    • ex: diphendramine <sedative effect, 1st generation, traditional> (benadryl) and loratadine (claritin), fexofenadine (allegra), cetirizine (Zyrtec) nonsedating.
    • 1st generation is sedating
    •  2nd generation is non sedating
  57. Antihistime is contrindicated in
    acute asthma attack and lower resp diseases, also glacouma (increased occular pressure) cardiac or renal disease, hypertension, COPD, peptic ulcer disease or pregnancy
  58. Clorpheneramine, and clortrimatom are both benadryl
    • 1st generation sedating antihistimines
    • has anticholinergic properties
  59. claritin, zertyc and allegra are catagorized as
    • 2nd generation won't put u to sleep
    • last longer than benadryl
    • usually once a day dosing
  60. antihistimines can have bad interaction with
    erythromycin, MAOI and CNS depressants
  61. Intranasal glucocorticoid details
    • steroids (starting to replace antihistimines for seasonal allergies but the take 1-3 weeks to kick in, also have decongestant effects
    • better preventive than after symptoms start

    • budesonide (rhinocort)
    • fluticasone (flonase)
    • mometasone (nasonex)
  62. 3 gropus of Decongestant (can be topical or oral)
    adrenergic, anticholinergic and topical steroids
  63. what do adrenergis do
    decongestions that cause vasoconstriction to open up nasal passages, they shrink engorged mucous membranes

    • (nasal) phenylephrine and others
    • problem is rebound congestion (blood vessels constrict then dialate) 
    • use only 3-5 days
    • nasal spray works faster
    • pills last longer
    • sudafed and other orals don't have rebound effect, but can cause hypertension and keep you awake at night, they raise pulse too so watch caffinee intake
    • (sudafed is used to make meth)
  64. tonsilitis is usually caused by
    streph  usually viral in orgin
  65. antitussive details
    • common side effects are dizziness and GI upset, no analgesic properties
    • repress the cough reflex, should be used for non productive dry cough (don't use for wet, productive cough) would want to used if coughing is contraindicated like after abdominal surgery or angiogram etc
    • can come in narcotic or non narotic...common narcotic used for cough is codiene. don't use opiod antitussive in COPD
  66. pharyngitis is caused by
    a bacterial infection (group A streph)
  67. expectorant details
    • help you cough it up and spit it out
    • mucalyntics etc
    • help you break down secretions
    • avail over counter
    • musinex is thought to be no better than plain water
  68. acute bronchitis details
    • moderate fever
    • cough that starts dry then progresses to cough spasms that are productive
    • stimualted by cold air and inhaled substances that irratate the lining
    • malaise
    • burning sensation when coughing
    • may do chest xray
    • if not infectious no antibiotic
  69. nursing dx for bronchitis
    • fatigue
    • ineffective breathing pattern
    • fluid volume deficit
    • nutrition less than body req especially in children
    • hyperthermia
  70. tx for bronchitis
    • if indectious give antibiotics
    • increase fluids
    • rest
    • humidifier
    • OTC analgesics/antipyretics
    • expectorants during the day (don't suppress productive cough)
  71. pnuemonia is
    • inflammation of the lung bronchioles and alveoli
    • caused by bacterias, virsuses, fungus, parasites, mycoplasma, or chemical irritants
    • most comon cause for community aquired is streph