Term
|
Definition
| refers to how well the cells, tissues, and organs of the body are supplied with oxygen. |
|
|
Term
| Which system regulates the movement of air into and out of the lungs? |
|
Definition
| musculoskeletal and neurological systems |
|
|
Term
| What system oxygenates blood? |
|
Definition
|
|
Term
| Which system circulates the blood throughout the body and back to the lungs? |
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Definition
|
|
Term
| What are the two major components of the pulmonary system? |
|
Definition
|
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Term
|
Definition
| The nasal passages, mouth, pharynx, larynx, trachea, bronchi, and bronchioles. |
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Term
| What is the function of the airway structures? |
|
Definition
Moisten the air
Warm the air
Filter the air |
|
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Term
| What does the upper airway consist of? |
|
Definition
Located above the larynx
Includes the nasal passages, mouth, and pharynx. |
|
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Term
| What does the lower airway consist of? |
|
Definition
The trachea, bronchi, and bronchioles.
The lower airway is considered sterile. |
|
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Term
|
Definition
Spasm of the smooth muscles in the walls of the bronchi and the bronchioles.
Narrows the airway and obstructs airflow. |
|
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Term
|
Definition
Lungs are separated by the mediastinum
the mediastinum contains the heart and great vessels |
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Term
|
Definition
Tiny air sacs with thin walls surrounded by a fine network of capillaries.
Composed of two types of cells:
Type I - gas exchange cells
Type II - produce surfactant, a lipoprotein that lowers the surface tension within alveoli to allow them to inflate during breathing. |
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Term
|
Definition
| The movement of air into and out of the lungs through the act of breathing. |
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Term
|
Definition
the exchange of the gases O2 and CO2 in the lungs.
The oxygenation of blood and elimination of CO2 in the lungs. |
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Term
|
Definition
Expansion of the chest cavity and the lungs, which creates negative pressure inside the lungs; this causes air to be drawn in through the nose or mouth and airways.
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|
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Term
|
Definition
| The major muscle of breathing. |
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Term
|
Definition
Occurs when the diaphragm and intercostal muscles relax, allowing the chest and lungs to return to their normal resting size.
Exhalation requires no energy or effort. |
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Term
|
Definition
| When a person breathes fast and deeply to move a large amount of air through the lungs, causing too much CO2 to be removed by the alveoli. |
|
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Term
|
Definition
Low level of O2 in the blood - low arterial blood O2 levels
can lead to hypoxia |
|
|
Term
| Apex of the lungs extends ________ |
|
Definition
| upward above the clavicle |
|
|
Term
| Base of the lungs rests _____________ |
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Definition
|
|
Term
| When blood oxygen is low ________ |
|
Definition
| Ventilation increases, carbon dioxide levels fall. |
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Term
|
Definition
An oxygen deficiency in the body tissues.
Inadequate oxygenation of organs and tissues. |
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Term
|
Definition
| refers to the ease of lung inflation. |
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|
Term
| Lung elasticity (or elastic recoil) |
|
Definition
refers to the tendency of the elastin fibers to return to their original position away from the chest wall after being stretched.
Alveoli that have been overstretched (emphysema) lose their elastic recoil over time. This inhibits deflation, leaving stale air trapped in the alveoli. |
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Term
|
Definition
| is the resistance to airflow within the airways. |
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|
Term
| Gas exchange occurs _____________? (2 places) |
|
Definition
1. At the alveolar-capillary membrane in the lungs (external).
2. At the capillary-cellular membrane in body tissues (internal). |
|
|
Term
| External respiration (alveolar-capillary gas exchange) occurs _________? |
|
Definition
| in the alveoli of the lungs. |
|
|
Term
| Conditions that slow diffusion in the lungs? |
|
Definition
pleural effusion (fluid in the lungs)
pneumothorax (lung collapse)
asthma (bronchospasms) |
|
|
Term
| Internal respiration (capillary-tissue gas exchange) occurs ________? |
|
Definition
| in body organs and tissues |
|
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Term
|
Definition
| is a waste product of cellular metabolism |
|
|
Term
| Respiratory centers in the brain stem |
|
Definition
control breathing using feedback from chemoreceptors and lung receptors
Chemoreceptors are located in the medulla of the brainstem
carotid arteries and the aorta detect changes in blood pH, O2, and CO2 levels |
|
|
Term
| what normally provides the primary stimulus to breathe? |
|
Definition
blood CO2 levels
secondary, hypoxemia, low blood o2 levels stimulate breathing to get more O2 into the lungs. |
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|
Term
| Factors that influence pulmonary function |
|
Definition
developmental stage
the environment
individual and lifestyle factors
medications
pathophysiological states |
|
|
Term
| Premature infants (less than 35 weeks) do not have ______? |
|
Definition
a fully developed alveolar surfactant system.
Surfactant is the substance that keeps air sacs inflated for effective respiration.
leads to hypercarbia and hypoxemia
They are at risk for RDS |
|
|
Term
|
Definition
|
|
Term
|
Definition
high CO2 blood levels from hypoventilation
high levels of CO2 can have an anesthetic effect on the nervous system and can lead to coma and death, a syndrome known as CO2 narcosis.
Pco2 levels will rise. |
|
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Term
|
Definition
| the first fecal excretion of a newborn child, composed of bile, mucus, and epithelial cells |
|
|
Term
| Why does the incidence of upper respiratory infections (URIs) remain high in toddlers? |
|
Definition
1. The tonsils and adenoids are relatively large, predisposing the to tonsillitis
2. Many children are exposed to new infectious agents in preschool and day care. |
|
|
Term
| Do preschool and school-age children have developed mature lungs, heart, and circulatory systems |
|
Definition
|
|
Term
| As a person ages, what happens to their lungs? |
|
Definition
The number of cells and the efficiency of the organs decline in a subtle and progressive way.
Reduced lung expansion and less alveolar inflation
difficulty expelling mucus or foreign material due to a less effective cough reflex, drier mucus, and fewer cilia in the airways.
Diminished ability to increase ventilation
declining immune response
gastroesophageal reflux disease |
|
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Term
|
Definition
| a hypersensitivity, or over-response, to an antigen. |
|
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Term
|
Definition
is an allergic reaction affecting the eyes, nose, and / or sinuses.
Causes the release of histamine which results in nasal fluid, swollen nasal membranes....
Antihistamines are effective in combating hay fever. |
|
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Term
|
Definition
an allergic reaction occurring in the bronchioles of the lungs.
Slow reacting anaphylaxis is released, which causes bronchoconstriction and lower airway edema and spasms. |
|
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Term
|
Definition
| constricts bronchioles, increases fluid secretion into the airways, causes inflammation and swelling of the bronchial lining, and paralyzes cilia. |
|
|
Term
| What do large amounts of alcohol do? |
|
Definition
| depress respiratory and vasomotor centers of the brain |
|
|
Term
| health effect of smoking cessation |
|
Definition
life expectancy increases
blood pressure and HR decrease
circulation to the extremities improves within 2 hours
O2 levels in the blood begin to improve within 8 hours
digestion improves
coughing, congestion, and shortness of breath decrease
overall energy increases
lungs increase ability to clean themselves, thereby reducing the risk of infection
risk of heart attack decreases and returns to that of a nonsmoker in one year
risk of lung and other cancers, stroke, and COPD decreases |
|
|
Term
| to determine adequacy of tissue oxygenation, you must...? |
|
Definition
| assess both circulation and tissue / organ function |
|
|
Term
| poor peripheral circulation is characterized by ______? |
|
Definition
| Weak or absent pulses; mottling (skin marbling); pale, ashen, or cyanotic skin and mucous membranes; and cool skin temperature. |
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Term
|
Definition
A low level of dissolved CO2 in the blood
Severe hypocarbia stimulates the nervous system, leading to muscle twitching or spasm (especially in the hands and feet) and numbness and tingling in the face and lips.
When a person hyperventilates, he exhales large amounts of CO2, causing arterial Pco2 values to fall. |
|
|
Term
| Upper respiratory infections and influenza are both caused by _____? |
|
Definition
| A virus. Both begin with similar symptoms. |
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|
Term
| Lower respiratory tract infections |
|
Definition
Acute bronchitis, respiratory syncytial virus (RSV), pneumonia, and TC.
Occur more often in people with impaired immunity or lung function. |
|
|
Term
| Pulmonary system abnormalities |
|
Definition
Structural abnormalities - restricts or limits free movement of the chest wall.
Airway inflammation and obstruction - allergic reactions or irritation from smoke or other irritants may cause inflammation (laryngospasm is an emergent situation)
Alveolar-capillary membrane disorders - change in the consistency of the lung tissue, especially at the alveolar level. The alveoli become still and difficult to ventilate, and gas exchange is impaired. (Pulmonary edema, acute respiratory distress syndrome (ARDS), and pulmonary fibrosis.
Atelectasis - anything that reduces ventilation (tumor, obstructed airway) can cause atelectasis, or alveolar collapse. |
|
|
Term
| Pulmonary circulation abnormalities |
|
Definition
| Most common causes are pulmonary embolus and pulmonary hypertension |
|
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Term
|
Definition
| an obstruction of the pulmonary arterial circulation by a foreign substance (blood clot, air, or fat) |
|
|
Term
|
Definition
an elevated pressure within the pulmonary arterial system.
Normally this is a low pressure system. High pressure in the pulmonary circulation increases the workload of the heart. Over time, this causes right-sided heart failure, with a reduced amount of blood pumped into the pulmonary circulation. |
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|
Term
| Neuromuscular abnormalities can affect gas exchange by____? |
|
Definition
| interfering with the regulation of breathing or by limiting movement of the muscles involved with breathing. |
|
|
Term
| Assessment of overall oxygenation includes _____? |
|
Definition
| A history and physical examination to assess lung, heart, and circulatory function. |
|
|
Term
| Four examination techniques to assess respiratory function are? |
|
Definition
Inspect - to observe respiratory patterns, signs of respiratory distress, chest structures and movement, skin and mucous membrane color, presence or absence of edema, sputum characteristics, and overall general appearance.
Palpate pulses, skin temp, heart pulsations through the chest wall, and areas of tenderness.
Percuss over the lung fields to screen for areas of consolidation or excess air pockets in the lungs.
Auscultate breath sounds, heart sounds, and vascular sounds. |
|
|
Term
|
Definition
The monitoring of the concentration or partial pressure of CO2 in the respiratory gases.
A monitoring tool in anesthesia and intensive care.
Measures the CO2 in inhaled and exhaled air.
Often used with pulse oximetry.
Provides information about ventilation.
More reliable indicator of respiratory depression than oximetry. |
|
|
Term
| Assess for normal and altered breathing patterns which are _____? |
|
Definition
| Eupnea, tachypnea, bradypnea, apnea, or periodic breathing, Kussmaul's breathing, Biot's breathing, and Cheyne-Stokes respirations. |
|
|
Term
|
Definition
| Respirations that are regular but abnormally deep and increased in rate. |
|
|
Term
|
Definition
| Irregular respirations of variable depth (usually shallow), alternating with periods of apnea (absence of breathing). |
|
|
Term
| Chenye-Stokes Respirations |
|
Definition
| Gradual increase in depth of respirations, followed by gradual decrease and then a period of apnea. |
|
|
Term
| Patients in pain ____________? |
|
Definition
Breathe shallowly and are at risk for atelectasis.
After medicating the patient, reassess breath sounds, and encourage the patient to breathe deeply and cough. |
|
|
Term
| Nasal flaring (increased respiratory effort) |
|
Definition
| The visible enlargement of the nostrils with inhalation. It helps reduce resistance to airflow in the nose and keep the nasal passages open to take in more air. |
|
|
Term
| Retractions (increased respiratory effort) |
|
Definition
| The visible "sinking in' of intercostal, supraclavicular, and subcostal tissue, caused by excessive negative pressures generated in the chest to try to increase the depth of inhalation. |
|
|
Term
| Use of accessory muscles during inspiration (increased respiratory effort) |
|
Definition
| The patient may use the intercostals, abdominal muscles, and muscles of the neck and shoulders when there is an increased demand for oxygen or problems with ventilation. |
|
|
Term
| Grunting (increased respiratory effort) |
|
Definition
| Caused by involuntary muscle contraction during expiration to help keep alveoli open and enhance gas exchange. |
|
|
Term
| Body positioning to facilitate respirations (increased respiratory effort) |
|
Definition
| The patient usually finds an upright posture the most comfortable. Most patients with dyspnea cannot tolerate lying down. |
|
|
Term
|
Definition
| difficulty breathing when lying down |
|
|
Term
| Paroxysmal nocturnal dyspnea (PMD) (increased respiratory effort) |
|
Definition
| Sudden awakening due to shortness of breat that begins during sleep. |
|
|
Term
| Conversational dyspnea (increased respiratory effort) |
|
Definition
| The inability to speak complete sentences without stopping to breathe. |
|
|
Term
| Stridor (increased respiratory effort) |
|
Definition
high-pitched, harsh, crowing, inspiratory sound caused by partial obstruction of the larynx or trachea.
You can hear without a stethoscope.
Patient needs immediate care! |
|
|
Term
| Wheezing (increased respiratory effort) |
|
Definition
A musical sound produced by air passing through partially obstructed small airways.
Often heard in patients with asthma and lung congestion.
Can be heard without a stethoscope. |
|
|
Term
|
Definition
Caused by fluid in the alveoli.
Discontinuous sounds usually heard on inspiration.
High-pitched, popping sounds, or low-pitched bubbling sounds.
Similar to the sound made by rubbing strands of hair together with the fingertips.
Need stethoscope to hear. |
|
|
Term
| When should a patient get a cough checked out? |
|
Definition
| One that lasts more than three weeks and cannot be explained. |
|
|
Term
|
Definition
| nasal congestion, sneezing, or watery eyes |
|
|
Term
| A cough due to upper respiratory tract infection |
|
Definition
cough occurring with fever, chest congestion, noisy breath sounds, and sputum production
Normal to produce sputum throughout the day |
|
|
Term
| A cough due to asthma or airway obstruction |
|
Definition
| Associated with dyspnea, chest tightness, and wheezing |
|
|
Term
|
Definition
Usually present in viral infections (cold, viral bronchitis)
Often requires only supportive care |
|
|
Term
|
Definition
|
|
Term
|
Definition
| caused by coal dust, smoke, or soot inhalation |
|
|
Term
|
Definition
| associated with pneumococcal pneumonia, TB, and possibly the presence of blood. |
|
|
Term
|
Definition
| The coughing up of blood or bloody sputum. It may range from small streaks of blood to large amounts of frank blood. |
|
|
Term
|
Definition
| associated with pulmonary edema |
|
|
Term
|
Definition
| usually indicates bacterial infection (pneumonia, lung abscess) |
|
|
Term
| How is a TB test administered? |
|
Definition
Must be done intradermally, not subcutaneously.
Sputum will show up on further testing if TB is active. |
|
|
Term
|
Definition
| Testing is performed by scratching antigen samples onto the skin. |
|
|
Term
|
Definition
a noninvasive estimate of arterial blood oxygen saturation (SaO2).
Only tests O2
SaO2 reflects the percentage of hemoglobin molecules carrying oxygen.
Normal value is 95% - 100%.
Works by measuring light absorption by hemoglobin in the circulating red blood cells.
Placed on a part of the body where capillary blood flow is near the surface. |
|
|
Term
|
Definition
| A measure of air that moves into and out of the lungs. |
|
|
Term
| Arterial blood gas (ABG) analysis |
|
Definition
measures the levels of oxygen and carbon dioxide in arterial blood.
usually the brachial, radial, or femoral
Measures pH, partial pressure of oxygen (Po2), partial pressure of carbon dioxide (Pco2), saturation of oxygen (Sao2), and bicarbonate (HCO3) levels. |
|
|
Term
| Which three values are important when assessing the degree to which the tissues are receiving oxygen? |
|
Definition
Hemoglobin - the iron-containing pigment of red blood cells that, as oxyhemoglobin, carries oxygen in the blood.
Po2 (Partial pressure of oxygen) - the amount of oxygen available to combine with hemoglobin to make oxyhemoglobin.
Sao2 (saturation of oxygen) - reflects oxygen that is actually bound to hemoglobin. |
|
|
Term
| Normal Po2 values at sea level |
|
Definition
|
|
Term
| Fraction of inspired oxygen (FIO2) |
|
Definition
the percentage of oxygen in the air the patient is inhaling
room air is 21% oxygen |
|
|
Term
| Partial pressure of carbon dioxide (Pco2( |
|
Definition
the measure of the CO2 dissolved in teh blood.
Normal arterial Pco2 is 35-45 mm Hg |
|
|
Term
| What does expiratory flow rate (PEFR) measure? |
|
Definition
The amount of air that can be exhaled with forcible effort.
Used by patients with asthma.
Expressed in liters per minute.
Patients should take a series of three readings and record the highest.
Should adjust their medication according to their highest reading.
Green - all clear
Yellow - caution (Peak flow is 50%-80% of normal rate)
Red - medical alert (Peak flow is less than 50% of personal best baseline). |
|
|
Term
| Ineffective airway clearance |
|
Definition
| the inability to maintain a clear airway |
|
|
Term
| ineffective breathing pattern |
|
Definition
| used to describe inadequate ventilation, such as hypoventilation, hyperventilation, tachypnea, or bradypnea |
|
|
Term
|
Definition
| the appropriate diagnosis if the patient is ventilating adequately but diffusion of gases across the alveolar-capillary membrane is impaired. |
|
|
Term
| Impaired spontaneous ventilation |
|
Definition
| describes a condition in which a patient, as a result of decreased energy reserves, is unable to maintain breathing adequate to support life. |
|
|
Term
| Dysfunctional ventilatory weaning |
|
Definition
| response represents a specific situation in which a patient who is being mechanically ventilated cannot adjust to lower levels of ventilator support, prolonging the ventilatory weaning process. |
|
|
Term
|
Definition
| Should be used when there is a risk for secretions, solids, or fluids entering into tracheobronchial passages (for patients who have had head or neck surgery or who have a reduced level of consciousness). |
|
|
Term
|
Definition
Relax the smooth muscles lining the airways.
Can be administered as oral or inhaled medicines.
(Beta-2 adrenergic agonists, anticholinergics, Methlyxanthine) |
|
|
Term
| Respiratory Anti-inflammatory Agents do what? |
|
Definition
Combat inflammation in the airways
Importnat in treating and controlling respiratory conditions characterized by hypersensitive airways and airway inflammation (asthma).
(Corticosteroids, cromolyn, leukotriene modifiers) |
|
|
Term
| Nasal decongestants do what? |
|
Definition
Relieve stuffy, blocked nasal passages by constricting local blood vessels through stimulation of alpha-I adrenergic nerve receptors in the vessels.
Can have systemic adrenergic effects causing elevated blood pressure, tachycardia, and palpitations, especially in those with a history of cardiovascular conditions. (ephedrine, pseudoephedrine, phenylephrine). |
|
|
Term
|
Definition
Prevent the effects of histamine release.
Used to treat upper respiratory and nasal allergy symptoms.
(Benadryl, Chlor-Trimeton, Dimetane, Claritin, Allegra, Zyrtec). |
|
|
Term
| What do cough preparations do? |
|
Definition
Antitussives (cough suppressants) reduce the frequency of an involuntary, hacking, nonproductive cough.
Expectorants help make coughing more productive.
The goal is to reduce the frequency of dry, unproductive coughing while making voluntary coughing more productive.
(Agents found mixed together in one preparation to achieve both desirable effects with one medication). |
|
|
Term
| Why do we use respiratory management interventions? |
|
Definition
Focus on maintaining a patent airway and promoting gas exchange.
They include Airway Management, Airway Suction, Cough Enhancement, Oxygen Therapy, and Respiratory Monitoring. |
|
|
Term
| What do specific nursing interventions for patients with oxygenation problems address? |
|
Definition
| ventilation, gas exchange, and circulation |
|
|
Term
| What are the major types of respiratory medicines? |
|
Definition
| Bronchodilators, corticosteroids, cough preparations, decongestants, antihistamines, and mucolytics. |
|
|
Term
| What does deep, regular breathing do? |
|
Definition
| Promotes ventilation and optimizes gas exchange |
|
|
Term
| How long do viral infections last? |
|
Definition
| 10-21 days, and are self-limiting |
|
|
Term
| Upper respiratory infections (URIs) are caused by what? |
|
Definition
|
|
Term
| Pneumonia is the leading cause of what? |
|
Definition
Infectious death in the US, with a mortality rate of 50% in people older than age 65.
Healthcare-associated pneumonia tends to be more complicated and to have a higher mortality rate than community-acquired pneumonia. |
|
|
Term
| What are the 5A's for treating tobacco dependence? |
|
Definition
Ask about tobacco use and document
advise to quit
assess willingness to quit
assist in quit attempt
arrange follow-up |
|
|
Term
| What is the best position for maximum ventilation? |
|
Definition
| An upright or elevated position pulls abdominal organs down, allowing maximum diaphragm excursion and lung expansion. |
|
|
Term
| What are incentive spirometers designed to do? |
|
Definition
Encourage patients to take deep breaths by reaching a goal-directed volume of air.
Usually reserved for patients at risk for developing atelectasis or pneumonia.
Visual cue = ball or piston elevation |
|
|
Term
| Who is at risk for aspiration? |
|
Definition
| Patients with a decreased level of consciousness, diminished gag or cough reflex, or difficulty with swallowing. |
|
|
Term
|
Definition
Deep inhalation and forceful expulsion of secretions.
Interventions that help enhance coughing and mobilize secretions include deep breathing, coughing exercises, and hydration. |
|
|
Term
| What activities are important to keep pulmonary secretions thin and mobile? |
|
Definition
| Hydration, humidify inhaled air. |
|
|
Term
|
Definition
| A device that turns liquids into an aerosol mist that can be inhaled directly into the lungs. Nebulizers can deliver medications and moisture to the lungs. |
|
|
Term
| What does a humidifier do? |
|
Definition
| Keeps secretions thin and mobile. Makes air moist. A device that delivers small water droplets from a reservoir. |
|
|
Term
| What does chest physiotherapy do? |
|
Definition
Moves secretions to the large, central airways for expectoration or suctioning.
It involves postural drainage, chest percussion, and chest vibration.
Usually a respiratory therapist performs this. |
|
|
Term
| What is postural drainage? |
|
Definition
Use of positioning to promote drainage from the lungs.
Must look at chest x-ray first.
Uses gravity to drain the lungs. Right lower lobe pneumonia, place on left side and elevate the foot of the bed. |
|
|
Term
| What does chest percussion and chest vibration do? |
|
Definition
| Used in conjunction with postural drainage to drain the lungs. |
|
|
Term
| What is chest percussion? |
|
Definition
| The rhythmic clapping of the chest wall using cupped hands. |
|
|
Term
|
Definition
The vibration of the chest wall with the palms of the hands.
Vibration is a gentle procedure, so you can use it in frail patients who cannot tolerate percussion. |
|
|
Term
|
Definition
Oxygen is a medication and requires a prescription for dosage and route.
2L can be given without orders, then get orders.
An oxygen flow meter must be connected to the O2 source to control the flow rate. |
|
|
Term
|
Definition
Wall outlets - connects to a large central tank of O2.
Compressed O2 in portable tanks.
Liquid oxygen tanks - often used for home therapy.
Oxygen concentrator - removes nitrogen from room air and concentrates O2. Requires a battery pack or electrical outlet. Can deliver up to 4L per minute to create an FIO2 of approximately 36%. |
|
|
Term
| What are the low-flow devices? |
|
Definition
| Nasal cannula, simple face masks, and rebreather masks. |
|
|
Term
| What are the high-flow devices? |
|
Definition
| Venturi masks, aerosol face masks, face tents, and tracheostomy collars - all capable of reaching up to 100% O2 concentration. |
|
|
Term
|
Definition
A surgical opening into the trachea through the neck.
O2 may be delivered through the tracheostomy via a collar or an adapter. |
|
|
Term
| What is a transtracheal catheter? |
|
Definition
A catheter placed into the tracheostomy to deliver O2 directly into the trachea.
O2 cannot be humidified through this device. |
|
|
Term
| What are the risks of O2 therapy? |
|
Definition
Oxygen toxicity can develop when O2 concentrations of more than 50% are administered for longer than 48 to 72 hours.
Prolonged use of high O2 concentrations reduces surfactant production, which leads to alveolar collapse and reduced lung elasticity. |
|
|
Term
| What do artificial airways do? |
|
Definition
| Provide an open airway for patients who have or who are at risk for airway obstruction. |
|
|
Term
| Most common artificial airways are? |
|
Definition
Pharyngeal airways provide an open air passage by holding the tongue away from the back of the pharynx.
Oropharyngeal and Nasopharyngeal airways are pharyngeal airways.
Endotracheal Airways |
|
|
Term
| Oropharyngeal airways (Pharyngeal airways) |
|
Definition
| Should be used only in unconscious patients because they are likely to trigger gagging, vomiting, or laryngospasm in responsive patients. |
|
|
Term
| Nasopharyngeal airways (Pharyngeal airways) |
|
Definition
| Are flexible rubber tubes that are inserted through a nostril into the pharynx. Patients who are semiconscious can tolerate nasal airways because they do not stimulate the gag reflex. |
|
|
Term
|
Definition
|
|
Term
| Who do you use an Endotracheal airway on? |
|
Definition
Patients who cannot breathe effectively on their own because of airway obstruction or respiratory or cardiac failure.
Endotracheal airways are pliable tubes inserted into the trachea through the following routes:
Orotracheal tube - the mouth
Nasotracheal tube - the nose
Tracheostomy tube - an opening directly into the trachea. |
|
|
Term
| What are the nursing responsibilities related to endotracheal airways? |
|
Definition
| Assist in their insertion, maintain stabilization, and provide routine suctioning and management. |
|
|
Term
| What technique is used for healed tracheostomies? |
|
Definition
Modified sterile technique.
Clean technique is the usual method in the home setting. |
|
|
Term
| What is sterile technique? |
|
Definition
| The use of a sterile suction catheter and other supplies with sterile gloves. |
|
|
Term
| What is modified sterile technique? |
|
Definition
| The use of sterile suction catheter and supplies, but with non-sterile procedure gloves. |
|
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Term
| What is the clean technique? |
|
Definition
The use of a clean catheter and clean hands or non-sterile gloves.
The portion of the catheter that will be inserted in to the tracheostomy tube is protected to avoid contact with unclean surfaces. |
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Term
| Why are airways suctioned? |
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Definition
To remove secretions and maintain patency.
Signs that indicate a need to suction include, agitation, gurgling sounds during respiration, restlessness, labored respirations, decreased oxygen saturation (SaO2), increased heart and respiratory rates, and adventitious breath sounds on auscultation.
Suctioning also removes air from the airways and causes the patients O2 levels to fall.
Must be done quickly and is often accompanied with supplemental O2. |
|
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Term
| What is the name of the tube used to suction the oral cavity? |
|
Definition
Yankauer tube
It is a rigid device
NAP may suction oral cavity. |
|
|
Term
| Who is responsible for suctioning care? |
|
Definition
Respiratory therapists, and nurses, and LPN's.
No NAP. |
|
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Term
| Why is pharyngeal suctioning performed? |
|
Definition
To prevent oral and nasal secretions from entering the lower airway when the patient is too weak to cough up secretions.
Suctioning the pharynx triggers a cough, which helps loosen and mobilize secretions.
The patients condition determines whether you suction the pharynx through the mouth or the nose.
Mouth is normally the best approach. |
|
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Term
| What do you do when suctioning through the nose or mouth? |
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Definition
| Insert the catheter into the pharynx, and advance it into the trachea during inspiration. This prevents the catheter from entering the esophagus and causing the patient to gag or vomit. |
|
|
Term
| What is a mechanical ventilator? |
|
Definition
A machine that assists a patient to breathe.
Before initiating ventilation, make sure there are no advance directives and consult with family members. |
|
|
Term
| What is a negative pressure ventilator? |
|
Definition
Consists of shells that fit externally around the chest.
Negative pressure generated inside the shell pulls the chest outward and forces the patient to inhale air.
Generally used for chronic conditions, and not acutely ill patients. |
|
|
Term
| What is a positive pressure ventilator? |
|
Definition
Most widely used type.
Positive pressure ventilation carries risks, including barotrauma (injury to the airways due to pressure changes) and drop in cardiac output as the positive pressure in the chest decreases venous return to the heart.
Also called mechanical ventilation.
RN's care for these patients, sometimes LPN may provide care. |
|
|
Term
| What are patients being mechanically ventilated at high risk for? |
|
Definition
| Developing ventilator-associated pneumonia (VAP) |
|
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Term
|
Definition
Accumulation of fluid and blood in the pleural space
Interferes with lung expansion, ventilation, and gas exchange. |
|
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Term
|
Definition
Air in the pleural space
Creates positive pressure (normally there is negative pressure in the pleural space and only a thin layer of fluid between the membranes), causing lung tissue to collapse. |
|
|
Term
| What is the purpose of a chest-drainage system? |
|
Definition
To remove air or fluid from the pleural space without allowing it to re-enter.
Types - Water-Seal Systems, One-Chamber Device, Two-Chamber System, Three-Chamber System, Dry-Seal System, Portable Systems. |
|
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Term
|
Definition
| A collection of pus in the pleural space. |
|
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Term
|
Definition
| Consist of one, two, or three chambers. |
|
|
Term
|
Definition
The simplest chest drainage system.
Chest tube connects to one drainage chamber, which serves as both a collector and a water seal.
Can only handle small volumes of fluid or air. |
|
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Term
|
Definition
Has one chamber that connects directly with the chest tube and serves as a collection bottle. The second chamber serves as the water seal; it maintains negative pressure as air flows through it.
Because the chest drainage never enters the water-seal chamber, you can measure drainage more accurately.
Can handle large amounts of fluid drainage, but its design can still contribute to labored breathing. |
|
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Term
|
Definition
Adds a third chamber; which connects to the water-seal chamber and placed to suction.
This creates controlled negative pressure within the system. |
|
|
Term
| What is the Dry-seal system? |
|
Definition
One-piece device with three chambers: Fluid collection, dry seal, and dry suction control.
Do not use water.
Automatic control valve (ACV) keeps the pressure constant by adjusting to changes in air leads and fluctuations in the suction source. |
|
|
Term
| What is a portable system? |
|
Definition
Consists of a single, dry-seal chamber attached to the patient's chest tube.
It drains by gravity.
The collection chamber holds a max of 500 mL, so they are not practical for those whose drainage is more than 500 mL. |
|
|
Term
| When is chest drainage greatest? |
|
Definition
| When the chest tube is initially inserted and decreases as the lung reexpands. |
|
|
Term
| What care is provided to a patient with a chest drainage system? |
|
Definition
1. Monitor breathing, gas exchange, and chest drainage.
2. Maintain an intact, properly functioning drainage system.
3. Promote lung reexpansion.
4. Monitor for complications and intervene promptly.
(Also note looks, color and amount) |
|
|
Term
| What can happen if you clamp chest tubes? |
|
Definition
Rapidly lead to a tension pneumothorax.
Clamp only for changing the drainage system, for a very short time.
Monitor patient's respiratory status constantly while clamping. |
|
|
Term
| Should you milk the tubing of a chest tube. |
|
Definition
No.
This will create a more negative pressure in the pleural space. |
|
|
Term
|
Definition
| The circulation of blood to all body regions. |
|
|
Term
| What are the two steps in oxygenation? |
|
Definition
1. Getting oxygen into the blood as it flows through the lungs.
2. The cardiovascular system transports oxygenated blood to the tissues. |
|
|
Term
| What are the structures of the cardiovascular system? |
|
Definition
| The heart, the systemic and pulmonary blood vessels, and the coronary arteries. |
|
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Term
|
Definition
| A sac of connective tissue located inside the chest cavity. |
|
|
Term
| What are the two thin-walled chambers called? |
|
Definition
atria
The receive blood into the heart. |
|
|
Term
| What are the two thick-walled chambers called? |
|
Definition
Ventricles
They pump blood out of the heart. |
|
|
Term
| What doe the heart valves do? |
|
Definition
| Allow blood to flow in one direction from one chamber to another without backflow. |
|
|
Term
| Where does deoxygenated blood go? |
|
Definition
| From organs and tissues, then flows through the venous system into the right side of the heart and then into the pulmonary circulation. |
|
|
Term
| Where does oxygenated blood go? |
|
Definition
| Flows from the lungs into the left side of the heart and out into the arterial circulation. |
|
|
Term
| What regulates the cardiac cycle? |
|
Definition
| The electrical activity of the myocardium. |
|
|
Term
|
Definition
acts as the pacemaker
located in the right atrium
initiates an impulse that triggers each heartbeat |
|
|
Term
| Order of impulse in the heart |
|
Definition
sinoatrial node
atrioventricular (AV) node
bundles of His
Purkinje fibers
ventricles |
|
|
Term
|
Definition
|
|
Term
|
Definition
smaller branches of arteries
smooth muscle and thinner than arteries
under the control of the sympathetic nervous system
constrict or dilate to vary the amount of blood flowing into capillaries and help maintain blood pressure |
|
|
Term
|
Definition
microscopic vessels
facilitate the exchange of gases, nutrients, and wastes between the tissue cells and the blood |
|
|
Term
| What is the holding tank for fluctuations in blood volume? |
|
Definition
|
|
Term
| What are the only arteries that fill with blood during diastole? |
|
Definition
|
|
Term
| What percentage of blood oxygen is bound to hemoglobin? |
|
Definition
|
|
Term
|
Definition
| The iron-containing protein in RBC's |
|
|
Term
| What is the purpose of hemoglobin? |
|
Definition
| Serves as a reservoir for oxygen until it is needed in the dissolved state. |
|
|
Term
| Which system regulates cardiovascular function? |
|
Definition
|
|
Term
| What does vascular tone do? |
|
Definition
| Maintains BP and blood flow even when a person is resting or asleep. |
|
|
Term
| what does the vasomotor center in the brain stem do |
|
Definition
| vasomotor center controls sympathetic stimulation of the heart and vascular system |
|
|
Term
| What does the cardioinhibitory center in the brain stem do? |
|
Definition
| Controls parasympathetic slowing of the heart rate. |
|
|
Term
|
Definition
Located in the walls of the heart and blood vessels and are sensitive to pressure changes.
When changes are sensed, they send messages to the brain stem centers |
|
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Term
|
Definition
Located in the aortic arch adn the carotid arteries, are sensitive to changes in blood pH, oxygen levels, and CO2 levels.
Regulates ventilation |
|
|
Term
|
Definition
| A hypersensitivity, or over-response to an antigen. |
|
|
Term
| The stress response stimulates _________? (3 things) |
|
Definition
1. Release of catecholamines - results in increased HR and contractility, vasoconstriction, and increased tendency of blood to clot.
2. Suppression of the immune and inflammatory responses - decreases resistance to infection.
3. Release of cortisol from the adrenal cortex - results in altered glucose, fat, and protein metabolism. |
|
|
Term
| What happens in an allergic response? |
|
Definition
Blood vessels dilate in areas affected
Eosinophils and neutrophils are attracted to the reaction site
Local tissues are damaged by protease
Capillaries become more permeable, resulting in fluid lead into tissues
Local smooth muscle cells contract (vascular) |
|
|
Term
| What happens to people who live at high altitudes? |
|
Definition
Increased production of RBC's
Increased vascularity of body tissues
Increased ability of tissue cells to use oxygen even when atmospheric oxygen pressure is low |
|
|
Term
| How does heat affect the body |
|
Definition
Heat generally causes vasodilation, which increases cardiac output and oxygenation.
Also increases metabolism. |
|
|
Term
| How does cold affect the body? |
|
Definition
Cold slows cell metabolism, reducing O2 demand.
Causes vasoconstriction, and slows the HR. |
|
|
Term
| What do large amounts of alcohol do? |
|
Definition
| Depress respiratory, cardiac, and vasomotor centers of the brain. |
|
|
Term
|
Definition
| Reduces blood-oxygen-carrying capacity. |
|
|
Term
| What do drugs that block beta-1 receptors do? |
|
Definition
| Slow the HR and decrease the strength of myocardial contraction. |
|
|
Term
|
Definition
| Occurs when the heart fails to pump |
|
|
Term
|
Definition
| heart muscle disorder that results in heart enlargement and impaired cardiac contractility |
|
|
Term
|
Definition
occurs when oxygen requirements of the heart are unmet
prolonged ischemia leads to MI as parts of the heart necrose from inadequate oxygen |
|
|
Term
|
Definition
is transient chest pain due to myocardial ischemia
tissue becomes injured but does not necrose |
|
|
Term
|
Definition
leading cause of cardiac ischemia
plaque builds up inside the coronary arteries and narrows the arteries |
|
|
Term
|
Definition
| alterations in heart rate or rhythm |
|
|
Term
| Heart valve abnormalities |
|
Definition
|
|
Term
| What are the S/S when arterial blood flow is compromised? |
|
Definition
| Pallor, pain, weak or absent pulses, poor capillary refill, cool skin, and tissue dysfunction. |
|
|
Term
| What are the S/S when venous blood is compromised? |
|
Definition
| Edema, brown skin discoloration, and tissue dysfunction (statis ulcers). |
|
|
Term
|
Definition
| An abnormally low level of RBC, hemoglobin, or both. |
|
|
Term
|
Definition
| A colorless, odorless gas produced by the combustion of flammable materials and fuels. |
|
|
Term
| What are the ways to assess the heart and peripheral vessels? |
|
Definition
| Inspection, palpation, and auscultation (sometimes percussion). |
|
|
Term
|
Definition
| inflammation in the pleural space. |
|
|
Term
|
Definition
Fatigue is a subjective experience.
It is a common symptom of various oxygenation problems. |
|
|
Term
|
Definition
Shortness of breath
Is a sign of hypoxia |
|
|
Term
| What are the complexes of an ECG? |
|
Definition
|
|
Term
|
Definition
| represents the firing of the SA node and conduction of the impulse through the atria |
|
|
Term
|
Definition
| represents ventricular depolarization (charging) and leads to ventricular contraction |
|
|
Term
|
Definition
| represents the return of the ventricles to an electrical resting state so they can be stimulated again (ventricular repolarization) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| ND - Decreased cardiac output |
|
Definition
| The appropriate diagnosis when the heart is unable to pump adequate amounts of blood to meet the metabolic demands of the body. |
|
|
Term
| ND - Ineffective tissue perfusion |
|
Definition
| appropriate for a patient experiencing poor perfusion to an organ tissue |
|
|
Term
|
Definition
| used for patients who have inadequate blood flow to body tissues (sepsis and hypovolemia) |
|
|
Term
| What are the measures to promote venous return increase the flow or blood back to the vena cava and the right side of the heart? |
|
Definition
Elevate the patient's legs above the level of the heart. Gravity promotes venous return from the feet and legs.
Flexion of the hips, legs, and knees constricts the veins and slows venous blood flow.
No legs crossed
Encourage and support early and frequent ambulation
ROM exercises
Compression devises (TED hose and SCD's) |
|
|
Term
|
Definition
| a stationary clot adhering to the wall of a vessel |
|
|
Term
|
Definition
| a clot that travels in the bloodstream |
|
|
Term
| To prevent clot formation ______ |
|
Definition
Turn patients frequently
Use sterile technique when inserting or handling IV lines
IV medication should be adequately diluted
Promote hydration
Promote smoking cessation |
|
|
Term
|
Definition
Cause vessel dilation
decrease venous return to the heart (preload)
can cause hypotension
(ACE) |
|
|
Term
|
Definition
increase removal of sodium and water from the body by increasing urine output
In patients with CHF, diuretics are used to reduce the volume of circulating blood and prevent accumulation of fluid in the pulmonary circulation. |
|
|
Term
|
Definition
increase cardiac contractility
make the heart a more effective pump |
|
|
Term
|
Definition
the cessation of heart function
signs include pale, cool, grayish skin |
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