Term
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Definition
targets people without disease: focus on education to prevent problem:ex
Immunizations (flu, pneumovac)
Healthy life style (don't smoke) |
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Term
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Definition
early detection & prompt treatment : such as
Screening (TB,CXR for high risk)
Tertiary Prevention
rehab service for optimal ADL: such as
Respiratory rehab ~
Support groups ~learning to live with chronic respiratory disorders |
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Term
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Definition
rehab service for optimal ADL: such as
Respiratory rehab ~
Support groups ~learning to live with chronic respiratory disorders |
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Term
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Definition
thickening of the flesh under the toenails and fingernails. The nail curves downward similar to the shape of the round part of an upside-down spoon
Indicates chronic decreased arterial O2 levels |
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Term
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Definition
| AP(anteroposterior)diameter |
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Term
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Definition
Bronchial heard over trachea (tubular, hollow sound)
Bronchovesicular heard between scapula and upper sternum (mix)
Vesicular heard over periphery of lungs (wind blowing) |
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Term
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Definition
There are some common errors to avoid:
1. Listening to breath sounds through a patients gown or clothes. 2. Allowing tubing to rub against bed rails or patient’s clothes. 3. Interpreting chest hair sounds as adventitious* sounds. 4. Auscultating on the convenient places only |
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Term
| Arterial Blood Gases (ABG’s) |
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Definition
Identifies abnormal oxygenation, ventilation and acid base balance
Respiratory regulation of acid-base balance is controlled by the CNS.
Special receptors in the brain are sensitive to changes in the level of CO2 |
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Term
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Definition
| An increase in CO2 triggers an increase in respirations (hyperventilation) utilized to blow off CO2 |
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Term
| normal parameters for ABG |
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Definition
pH = 7.35 – 7.45
PaCO2 = 35-45 mm Hg
PaO2 = 80-100 mm Hg
HCO3 = 22-26 mEq/L
BE = -3 to +3 |
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Term
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Definition
Acute Bronchitis
Pneumonia
Pleurisy |
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Term
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Definition
Acute inflammation of the bronchi in the lungs
Pathophysiology:
Usually follows a viral URI
The inflammatory response causes vasodilatation and edema of the lining of the bronchi
Mucosal irritation increases mucus production and initiates a cough
Etiology-
Virus or bacteria
Inhalation of toxic gas or chemicals
Impaired immune disease and smoking are common risk factors |
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Term
| Manifestations of Acute Bronchitis |
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Definition
Paroxysmal Cough- severe coughing attack
initially non-productive then productive
Chest wall pain
Fever & General malaise
Bronchovesicular breath sounds on auscultation |
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Term
Acute Bronchitis
Collaborative Care |
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Definition
Diagnostic tests:
Clinical S&S although CXR can differentiate between bronchitis & pneumonia
MD:
ASA & APAP for fever & malaise
Antimicrobial as needed since 50% of acute bronchitis are due to bacteria
Bronchodilators as needed
Cough expectorant during the day
Cough suppressant hs to facilitate rest |
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Term
Acute Bronchitis
Collaborative Care |
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Definition
Nursing Care:
Push fluids 3l/day if tolerated & rest
Teach importance of smoking cessation & recommend smoking cessation program
Explain use and effects of all OTC (over the counter) medication as well as prescribed medication ( therefore the nurse should be well educated in the delivery of these medications) |
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Term
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Definition
Inflammation of the bronchioles & alveoli (lung parenchyma)
May be lobar (a segment of a lobe) or
bronchopneumonia ( diffuse scattered patches within the lungs)
Pathophysiology:
Inflammation & the immune response causes edema, inflammation, exudates & debris which can fill the bronchioles & alveoli interfering with ventilation and gas exchange |
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Term
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Definition
3 ways organisms reach lungs
Aspiration from nasopharynx or oropharynx
Inhalation of microbes
Hematogenous spread from primary infection elsewhere in body
May be Viral, Bacterial or Fungal
Community acquired
Hospital acquired
Opportunistic |
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Term
| Community-acquired Pneumonia |
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Definition
Lower respiratory infection of lung
Onset in community or during first 2 days of hospitalization |
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Term
| Hospital-Acquired Pneumonia |
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Definition
Occurring 48 hours or longer after admission and not incubating at time of hospitalization
Second most common nosocomial infection |
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Term
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Definition
Patients at risk
Severe protein-calorie malnutrition
Immune deficiencies
Chemotherapy/radiation recipients
Transplant recipients |
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Term
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Definition
Chills & Fever & Malaise
Body aches especially in chest area
Cough with green to rust colored sputum
Decreased breath sounds
Crackles over affected areas
Dullness to percussion over affected areas
Dyspnea
Decreased O2 sats |
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Term
| Diagnostic tests Pneumonia |
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Definition
Sputum c/s with gram stain
CBC (increases WBC & neutrophil count with bacterial infection)
ABG (decreased Pa O2 & increased PaCO2)
O2 sats (decreased from baseline<95%)
CXR
Bronchoscopy ( suction,specimen |
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Term
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Definition
Immunizations: Prevention- influenza & pneumococcal vaccine
Medications:
Antibiotic as needed per C&S
Bronchodilators ( proventil, atrovent),
Mucolytics (mucomyst)
ASA, APAP, cough expectorant & suppressant as needed. |
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Term
| Antibiotic Treatment Pneumonia |
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Definition
Fluoroquinolone -Levaquin,Cipro,Avelox
Cephalosporin - cefuroxime or cefpodoxime) plus a macrolide azithromycin, clarithromycin, or erythromycin
High-dose amoxicillin or amoxicillin-clavulanate,
plus, macrolide antibiotic azithromycin, clarithromycin, or erythromycin)
High-dose amoxicillin or amoxicillin-clavulanate,
plus, macrolide antibiotic azithromycin, clarithromycin, or erythromycin) |
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Term
| Collaborative care Pneumonia |
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Definition
Respiratory Treatments:
02 Therapy:
Chest PT:
Nursing Care:
TCBB
I/S
Ambulation
Enc fluids
Immunizations: Prevention- influenza & pneumococcal vaccine
Medications:
Antibiotic as needed per C&S
Bronchodilators ( proventil, atrovent),
Mucolytics (mucomyst)
ASA, APAP, cough expectorant & suppressant as needed. |
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Term
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Definition
Pleuritis
Pleural Effusion
Meningitis
Septicemia
Respiratory failure
Death |
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Term
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Definition
Definition:
Inflammation within the pleural space of the lung
Pathophysiology:
Depends on the etiology
Basically there is an increased in the amount of fluid in the pleural spaces causing an inflammatory process |
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Term
| Clinical manifestations Pleuritis aka Pleurisy |
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Definition
Abrupt, *unilateral, *localized, *sharp & *stabbing chest wall pain
especially increased with deep breathing, moving or coughing
Increased & shallow respirations
Friction rub on auscultation |
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Term
| Collaborative care for pleurisy |
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Definition
MD:
Rx the cause (pneumonia ect)
Rx the symptoms with: analgesic
NSAIDS
Nursing:
Activities to promote comfort & rest
Positioning & splinting for comfort
TCDB
Teach to report increased pain, fever, SOB, productive cough with change in sputum consistency |
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Term
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Definition
Pleural effusion-is an accumulation of fluid between the layers of the membrane that lines the lungs and chest cavity
Atelectasis-(is the collapse of part or all of a lung caused by a blockage of the air passages (bronchus or bronchioles) or by pressure on the lung
Usually clears with cough and deep breathing
Bacteremia
Bacterial infection in the blood |
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Term
| Obstructive Pulmonary Diseases |
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Definition
Asthma
COPD
Chronic Bronchitis
Emphysema |
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Term
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Definition
Chronic, intermittent, reversible inflammatory disorder that affects the airways (not the alveoli)
Occurs in 2 ways
Inflammation
Airway hyperesponsivenss, leading to wheezing, breathlessness, chest tightness, and cough |
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Term
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Definition
Inflammation of the mucous membranes lining the airways triggered in response to
allergens or general irritants (cold ot dry air
fine airborne particles
Microorganisms
Airway hyperresponsivenss
Exercise, URI, unknown cause
Inflammatory mediators cause
(early-phase response)
Vascular congestion
Edema formation
Production of thick, tenacious mucous
Bronchial muscle spasm
Thickening of airway walls
Late-phase response
If airway inflammation is not treated or does not resolve, it may lead to irreversible lung damage |
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Term
| Collaborative care Asthma |
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Definition
MD
CXR
Labs
ABG
CBC
Theophylline level
PFT
Medications
Assessment
History & Physical
Sign and Symptoms
L/S- Audible wheeze, crackles
Increased respiratory rate
Unable to complete a sentence
Wheeze is louder on exhalation
Increase in coughing
Sputum white, thick tenacious
Use of accessory muscles
Muscle retraction at sternum
S&S of hypoxia
Labs
ABG’s- Pao2 decreased, Paco2 increases
Esonophil count may be elevated |
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Term
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Definition
Rate, rhythm, ease, labored, accessory muscles-
Resp >30, labored
O2sat<90%
Paco2 increased
L/S- wheezing, crackles, rhonchi, absent breath sounds
Wheeze then absent breaths sounds (red flag!)
Cough- productive(thick, white tenacious sputum
V/S –Tachycardia, HR>120, restless |
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Term
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Definition
Elevate HOB
Apply O2
Administer short acting bronchodilator
Resp tx
Assess response to tx
No response alert emergency team |
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Term
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Definition
Includes
Chronic bronchitis
Emphysema
A preventable and treatable disease state characterized by progressive airway limitation that is not reversible
Generally progressive
Abnormal inflammatory response of lungs to noxious particles or gases |
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Term
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Definition
Risk factors
Cigarette smoking
Occupational chemicals and dust
Air pollution
Infection
Heredity
Aging
Etiology-
Smoking biggest risk factor( second hand as well)
Triggers a release of excessive amounts of the protease enzyme
which in turn breaks down elastin: a major component in the alveoli
Environmental-protease proteins are altered
Genetic- deficiency of AAT(x1-antitripsin) |
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Term
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Definition
Clinically significant airway obstruction develops in 15% of smokers.
80% to 90% of COPD deaths are related to tobacco smoking.Effects of nicotine
↓ Amount of functional hemoglobin
↑ Platelet aggregation
Compounds problems in CAD
Effects on respiratory tract
Increased production of mucus
Hyperplasia of mucous glands
Lost or decreased ciliary activity |
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Term
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Definition
Defining features
Irreversible airflow limitations during forced exhalation due to loss of elastic recoil
Airflow obstruction due to mucous hypersecretion, mucosal edema, and bronchospasmPrimary process is inflammation.
Inhalation of noxious particles
Mediators released cause damage to lung tissue.
Airways inflamed
Parenchyma destroyed
Supporting structures of lungs are destroyed.
Air goes in easily, but remains in the lungs.
Bronchioles tend to collapse.
Causes barrel-chest look
Pulmonary vascular changes
Blood vessels thicken.
Surface area for diffusion of O2 decreases
Common characteristics
Mucous hypersecretion
Dysfunction of cilia
Hyperinflation of lungs
Gas exchange abnormalities
Commonly, emphysema and chronic bronchitis coexist |
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Term
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Definition
an inflammation of the bronchi and bronchioles caused by
Chronic exposure to irritants
Affects only the airways not the alveoli |
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Term
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Definition
abnormal permanent damage to the alveoli and elastic recoil in the alveolar walls causing
Air trapping
Hyperinflation of the lungs |
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Term
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Definition
affects oxygenation and tissue perfusion
Hypoxemia
Acidosis
Respiratory infection
Cardiac failure
Dysrhythmias
Cor pulmonale
Exacerbations of COPD
Acute respiratory failure
Peptic ulcer disease
Depression/anxiety
Hypoxemia and acidosis occur r/t decrease ability to exchange gas
O2 decreases
Co2 increases
Reducing cellular function |
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Term
| Respiratory infection- mucus production and poor oxygenation |
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Definition
Common organisms
Streptococcus and Haemophilus |
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Term
| Acute infection exacerbates disease |
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Definition
Increase inflammation
Increase mucus production
Dyspnea
Increases bronchospasms |
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Term
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Definition
Hypertrophy of right side of heart
Result of pulmonary hypertension
Late manifestation of chronic pulmonary heart disease
Eventually causes right-sided heart failure |
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Term
| Complications Cor Pulmonale |
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Definition
CARDIAC failure(cor pulmonale)
Right sided heart failure
Increased pressure from disease process increases the workload of the on the right side of the heart |
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Term
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Definition
Dyspnea
Distended neck veins
Hepatomegaly with upper quadrant tenderness
Peripheral edema
Weight gain
Approximately 50% of COPD patients experience depression.
If patient become anxious because of dyspnea, teach pursed lip breathing |
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Term
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Definition
Signaled by change in usual
Dyspnea
Cough
Sputum
Associated with poorer outcomes
Primary causes
Infection
Air pollution |
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Term
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Definition
Diagnosis confirmed by pulmonary function tests
Chest x-rays, spirometry, history, and physical examination are also important in the diagnostic workup |
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Term
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Definition
Spirometry typical findings
Reduced FEV/FVC ratio
Increased residual volume
ABG typical findings
Low PaO2
↑ PaCO2
↓ pH
↑ Bicarbonate level found in late stages of COPD
6-Minute walk test to determine O2 desaturation in the blood with exercise
ECG can show signs of right ventricular failure |
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