Respiratory:
Age related changes:
Loss of elasticity
Enlarged/relaxed bronchioles
Decreased vital capacity
Dry/bleeding of nose
Decrease sense of smelled
Curved spine
Abdomen extension
*know the anatomy of respiratory *
Diagnostic and Therapeutic Procedures:
Chest x-ray and Fluoroscopy- (and the difference) x ray is a static picture. Fluoroscopy is like an
x-ray but live.
ABG’s
What are they? (Arterial blood gas) measure and maintains your PH. involves respiratory and
urinary system
Allen Test- to ensure adequate circulation.
Normals: PH- 7.35-7.45
CO2- 35-45
CO3-22-26
Pneumonia puts you in respiratory acidosis
Hyperventilating puts you in alkalosis
When ABG’s drawn, how long to hold pressure (normally and if on coags) apply pressure
dressing and hold pressure for 5 minutes . if they are on Heparin or Coumadin 20 minutes
Practice:
PH- 7.32
CO2- 48
CO3-21
*Respiratory acidosis (ex: COPD- OVER ABUNDANCE OF CO2)
PH-7.46
CO2-45
CO3-30
* Metabolic Alkalosis
PH-7.35
CO2-47
CO3-24
*Respiratory Acidosis
PH-7.50
CO2-50
*Respiratory Alkalosis
CO3-24
PH-7.30
CO2- 47
CO3-28
*BOTH acidosis
O2 administration:
What is the difference between:
NC-(nasal cannula, most common) used for mild 2-4 liters of O2. Connedected to
a humidifier for people with long term O2
Face mask- gives more O2
Non-rebreather mask- if NC and mask doesn’t work . get 40-50% O2
Venturi mask- seals your mouth and nose and get 70-90% O2
Why must you use caution using O2 on a patient with COPD?
You will kill them because it is registering too much O2 and the body will read little CO2,
stopping your breathing to regain O2
What is normal flow rate for a NC?
2-4
Suctioning:
Explain oropharyngeal Suctioning- (what do you use?)
Use yonkers for their mouth to clear pharynx .NOT sterile.
Explain endotracheal suctioning- (the differences and time)
It is sterile. Deep suction. You oxygenate the patient ,put saline down their trachea down
into their lungs ( to liquefy the stuff) put the tube down in and suck. Never suction longer than
10 seconds . no suction going in . suction on when pulling out. Concern of hypoxia and
Breath sounds: (types and where to listen)
Crackles- deep in alveoli. Fluid in the sacks, wheezes-where the bronchus shrinks, rochiThroat culture: (How to obtain and why)
Get a cotton swab and swipe the pharynx looking for bacteria
Bronchoscopy:
Explain the procedure: scope to examine the respiratory system. Can also be for biopsy
Describe any nursing implications before, during, and after the procedure- pre; sign consent
.explain procedure. NPO. Vitals. During- assess airways. After- Vitals. Gag reflex.
Sputum sample: (how to collect and when)
Get spit from deep within. Get it right in the morning before mouth care since things settle
.Take a deep breath and cough. Don’t touch it
Chest Tubes:
What are they used for?
Why is the water seal so important?
Should the water seal fluctuate and/or bubble?
Thoracentesis:
What is this procedure? Pre-vitals,lung sounds Post-vitals and lung sounds to make sure you
didn’t hit or damaged anything. Document how much is in there or “Small,Moderate,Large” Exp
“pt had thoracentesis with large amount of serosanguiness fluid “ Why would it be used?
Removes excess fluid that are in the lungs to help with breathing
Serous is clear
Serosanquiness is pink
Anguiness is red
Tracheostomy:
Why is this done to patients? Cancer, trauma
Explain the difference between cuffed and uncuffed- Cuff is on the inside with balloon to
blow up, meaning that there is no breathing on their own and no talking because it is sealed no
air movement except through the pipe. Uncuffed is where the pipe just sits there since there is
no balloon, they can talk and breathe on their own.
Why do you keep an extra handy? What do you do if it accidentally is removed? 1. Try to
put it right back in and call it as an emergency
Mechanical ventilation:
What is this? Breathing on a machine
Explain some of the different type settings patients can be on- only inspiration: lets the
patient exhale. Only expiration: where patient does inhale. On demand(like a pacemaker): turns
on when your breathing gets unbalanced
Explain CPaP and BiPaP- Continuous Positive Pressure – mask that goes over your nose
ONLY where you wear at night that blows continuous pressure in usually for people with sleep
apnea (no breathing). BiPap- covers the mouth AND the nose worn all the time to give good
pressure of air in.
Diseases:
AsthmaWhat is it- inflammation of the bronchi (when bronchi gets inflamed, it shrinks which results
into expatory wheezes) caused it by allergy auto immune
S&S- wheezing
Treatment- bronchodilator, steroids prednisone
*if you do not treat it, it will get worse causing respiratory distress/failure
COPDWhat is it- there are 2 diseases that make COPD. (Emphysema and chronic bronchitis)
Bronchitis is obstruction of your bronchi with stuff inside .sounds are rhonchi
(mucous).Emphysema have floppy sacks? Smoker’s disease. Crackle sounds hear on in and
expiration. COPD will usually knock you into CHF which means more fluids in the lungs and
edema.
S&S-(bronchitis- Rhonchi, SOB, hypoxemia)
Treatment- (Bronchitis-Antibiotics, steroids, fluids) (Emphysema- oxygen, diuretic at times)
PFT’s – Pulmonary Function Tests: vital capacity (how much you can breathe out and in) ,
tidal capacity (how much you normally breathe) . Reserve (the difference in between your vital
and your tidal). In COPD the reserve shrink on both sides (in and out)
PneumoniaWhat is it- fluids in the lungs caused by bacteria and viral
S&S- Shortness of breath. Hypoxemia. Crackles . sometimes cough up blood
Treatment- antibiotic for bacterial. Antivirals for viral. Oxygen . fluids .
TuberculosisWhat is it- respiratory infection .
S&S- Night sweats, coughing, low grade fever
Treatment- isolation, antivirals for about two years antiturburculants
Laryngeal cancerWhat is it- cancer of the larynx
S&S- loss of voice, hoarseness
Treatment- chemo, radiation, surgery
LARYNGECTOMY: keep them on semi fowlers. Sense for bleeding . keep hydrated.
Lung cancerWhat is it- cancer of the lung
Staging- 1-4 . 1: just the tumor in the lung ; easy removal by taking it out then radiation to
make sure you got everything out. 2: is a tumor but is by the lymph nodes, starts to spread. 3:
goes from your lymph to the body 4: everywhere
S&S- Coughing, hemoptysis, chest pain
Treatment- chemo, radiation , surgery if possible
Pulmonary embolismWhat is it- embolism: something foreign in your body. Pulmonary Embolism : clotting that
travels through your heart and into your lung and blocks
S&S- pain, SOB
Treatment- Removal surgery, anticoagulants , thrombolytic, oxygen, sit up ,
Treatment to Prevent: ASA, platelets arrogates , ambulate, ROM , TED hoes ,
ARF/ARDS- Acute Respiratory Distress/Failure
What is it- someone goes into complete distress and can’t breathe
S&S- SOB, chest tightness, lung sounds,
Treatment- Oxygen , treat the cause, (fluid: diuretics, bacterial: antibiotic , viral: antivirals)
Hemothorax/pneumothoraxWhat is it- Air/blood in the plural space
S&S- SOB
Treatment- oxygen, Thoracentesis, chest tube
SinusitisWhat is it- sinus infection/inflammation
S&S- Toothache, stuffy/fullness (can lead to severe fever, which leads to seizures)
Treatment- Antibiotic, anti-inflammatory (prednisone), fluids
TonsillitisWhat is it- inflammation of the tonsils
S&S- sore throat, redness, swelling
Treatment- antibiotic, anti-inflammatory surgery- asses for bleeding
 If you get a sore throat more than three times in less than 6 months then it results into a
tonsillectomy
 If you have an apses on your tonsils they have to come out
 There is bacterial and viral.
Viral: when it progresses (slow/long)
Bacterial: when you wake up and it hurts right away (fast)
Influenza/common cold- both are viruses
What is itS&S- flu: fatigue, ache and pains, high fevers cold: no high fevers, no cramps , cough ,
shorter
Treatment- flu: anti-viral, fluids, rest, Tylenol (anti-pyretic) cold: antibiotic (amoxicillin)
 If you start on anti-viral within the first two days you can cut it down to half , problem:
no one does it
How is the flu and common cold spread: droplet
Rib fracture- why is Resp.? Can puncture lung and restrict how much you inhale and exhale
which can lead to pneumonia
What is it- fracture of a rib
S&S- SOB, pain
Treatment- oxygen , analgesics , deep breathing
Nasal Surgery
Post op- semi fowlers, always asses for bleeding (by frequent swallowing) , main nursing DX –
social isolation
*do not mess with the tampons in the nose (used to measure drainage)
Respiratory Vocabulary:
Pulmonary toileting- used for COPD pts when they have an acute attack where they get
drained of fluids (diuretics, antibiotics)
Stupor- drowsiness due to lack of oxygen
Tachypnea-fast breathing, over 20.
TCDB- Turn Cough Deep Breathe. How you prevent pneumonia by turning the patient every 2
hours. Encourage to cough and deep breathe
Hypoxia- low oxygen
Hypoxemia- low oxygen in the blood
Ventilation- breathing. One in and one out is 1
Perfusion- how good your circulation is of the blood
Aspiration- choking. When it goes in the trachea instead of the esophagus
Valsalva maneuver- forcing (ie: pushing when giving birth, or when using the restroom)
 when getting a chest tube out you ask pt to valsalva
Empyema- accumulation of pus in the body
Crackles- nonmusical sound of fluids in the alveoli
Barrel chest- when chest extends and turns round, almost like a barrel
Chest physiotherapy- 1. Percussion – take the hands or cups and tap the chest to break up stuff
in lungs (mostly for kids) 2. Postural drainage- just turning them to keep the fluids to clear
Pursed-lip breathing- where they breathe in through their nose and out through their mouth .
it slows your breathing and CO2
Clubbing- (fingers)- people with long term respiratory issues have it
Dyspnea- difficulty breathing
Cyanosis- turning blue
Pleural effusion- when you get liquid in your pleural area and it starts to crush
Spirometer- plastic thing that they suck on to exercise the lungs spirometry : ventilation
Cheyne-Stokes Respirations- breathing pattern . nice deep breathe and then short and then
stop, then after 30 seconds they do it again . when they are dying
Alveoli- sacks in your lungs
Laryngitis- inflammation of the larynx
Flail chest- where one side of your chest will rise and the other one stay when you
inhale/exhale
Echinacea- herbal remedies to help prevent from getting a cold or getting sick
Blue Bloater- patient with COPD who has chronic bronchitis. they have obstruction in their
bronchus so they don’t get good air in their air exchange so they start to turn blue and they get
barrel chest
Pink Puffer- patient with COPD who have emphysema .they have good perfusion they look fine
but they are still dying.
Atelectasis- when your alveoli shut down . when you stop producing surfactant (helps open
your alveoli)
Babies who are born early die usually because they haven’t produced any surfactant
MedicationsBronchodilators- albuterol (they dilate your bronchi)
Antibiotics- anything with “cillin” in it ie: amoxicillin . kill bacteria
Steroids- prednisone; help inflammation
Decongestants- stop mucous production but have bad SE such as raised BP . most
decongestants are like “Speed”
AntiTussive- robatusin . for cough .
AntiVirals- fights viruses. Need to be taken in the first two days
Top 5 nursing diagnosis for Respiratory and 1 intervention for each1. impaired gas exchange
2. activity intolerance
3. anxiety/fear
4. ineffective air clearance
5. impaired nutrition less than body requirements