BNKN602 > Respiratory > Flashcards

Respiratory Flashcards

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1
Q

Define Hypoxia

A
  • Less than normal levels of 02 in the body tissues
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2
Q

Define Hypoxemia

A

less than normal levels of 02 in the blood
Pa02 <80mmHg (<60mmHg significant hypoxaemia)

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3
Q

Define Hypercapnia

A
  • Greater than normal levels of C02
  • PaC02 > 45mmHg
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4
Q

Define Hypocapnia

A
  • Less than normal levels of C02
  • PaC02 < 35mmHg
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5
Q

What is the normal range of PaC02?

A

35-45mmHg

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6
Q

What is the normal range of Pa02 levels?

A

75-100mmHg

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7
Q

What is the normal range of Arterial Oxygen?

A

75-100mmHg

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8
Q

What are 12 signs and symptoms of hypoxaemia?

A
  1. Changes in the colour of your skin
  2. Confusion
  3. Restlessness
  4. Anxiety
  5. Increased heart rate
  6. Increased respiration rate
  7. Shortness of breath
  8. Sweating
  9. Wheezing
  10. Use of Accessory muscles
  11. Flaring of nostrils or pursed lips
  12. Decreased oxygen saturation levels
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9
Q

What are 8 clinical manifestations that a person would experience with COPD?

A
  1. Frequent chest infections
  2. Persistent wheezing
  3. Persistent chesty cough which can be dry or with sputum
  4. Difficulty breathing
  5. Dyspnea
  6. Decreased energy levels
  7. Tightness of the chest
  8. Swelling in the lower extermities
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10
Q

What is efficient gas exchange dependent on?

A

Adequate Ventilation and Perfusion

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11
Q

What is shunting?

A

When blood flow can be redirected from poorly ventilate alveolus (one air sac) to a well-ventilated alveolus through vasoconstriction

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12
Q

What is a dead space?

A

Poor perfusion and a well ventilated alveolus

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13
Q

What is a silent unit?

A

Poor ventilation AND Poor perfusion (no air moving through the lungs)

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14
Q

What are the two areas of Gas Exchange Insufficiency?

A

Mechanical
Functional

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15
Q

What are the three areas of Mechanical Insufficiency of gas exchange?

A
  • Structural damage
  • Airway obstruction
  • Medication
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16
Q

Describe how structural damage impacts on gas exchange

A
  • Nervous system (spinal injury high up, anything that impacts the nerve pathways)
  • Intercostal Muscles
  • Diaphragm (injury which impacts taking a deep breath to expel CO2 effectively, or on
    inspiration with the intake of O2)
  • Abdominal muscles (Pushing diaphragm out to push the air out)
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17
Q

Describe airway obstruction for gas exchange

A
  • Physiological and foreign objects (asthma, mucous)
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18
Q

Describe how medication can impact on gas exchange

A

CNS Depressants (Alcohol, benzodiazepines, sedatives. Anything which effects the
respiration rate)

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19
Q

What functional factors can impact on gas exchange?

A
  • Cardiac Compromise (Poor venous return)
  • Pulmonary Embolism (Block off blood vessels and lungs - ventilated but not perfused)
  • Tumour (blockage which effects perfusion)
  • Hb (Haemoglobin) (Not enough Haemogolbin = not enough red blood cells to carry
    enough oxygen as Haemogolbin has 4 oxygen particles)
  • Infection (pus, anything in the lungs which block the perfusion in the lungs)
  • COPD
  • Compliance (the ability for the lungs to inflate and recoil)
  • Resistance
  • Surface area (hold the alveolus open, if you lose this, the alveoli might collapse more
    easily as the surface area will be reduced - smoking)
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20
Q

What are 4 problems with ventilation (air in/out)?

A
  • Inflammation of Bronchial walls causing epithelial oedema = decrease air entry, decrease gas exchange
  • Exudate in lower airways causing obstruction to air flow = decrease air entry, decrease gas exchange
  • Exudate in alveoli causing increased diffusion distance = decrease gas exchange
  • Inflammation in alveolar wall causing increased diffusion distance = decreased gas exchange
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21
Q

What are 2 problems with perfusion (blood to lungs and body)?

A
  • Partial or complete obstruction to pulmonary artery (could be a clot and partially close off the artery) causing reduced blood flow = decreased gas exchange
  • Ineffective functioning alveoli (from exudate or oedema) causing vasoconstriction of surrounding pulmonary capillaries = further decrease gas exchange
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22
Q

What clinical presentations are we observing with the respiratory rate?

A
  • Tachypnoea/bradypnoea (fast and slow breathing)
  • Orthopnoea (have trouble breathing lying down, but can breathe normally when sitting up
    heart not pumping efficiently)
  • Dyspnoea (subjective feeling of breathing, reporting they are struggling to breath)
  • Rhythm and depth (are they breathing in a normal rhythm? Gasping? Breathing shallow?)
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23
Q

What clinical presentations are we observing with breath sounds?

A
  • Wheeze
  • Crackles
  • Stridor (usually on inspiration, sounds like a barking type sound. Inflammation or
    obstruction of the airway)
  • Reduced Air entry
  • Cough
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24
Q

What accessory muscles are we observing for within the clinical presentation?

A
  • Sternocleidomastoid
  • Scalenes
  • Trapezius
  • Pectoralis minor/major
  • Abdominals (on expiration)
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25
What clinical presentation are we observing for the patient's positioning?
- Upright - Tripod (leaning forward, supporting upper body with hands on knees/similar) - Chest symmetry
26
What are body tissues?
a group of cells that have similar structure and that function together as a unit.
27
Which usually comes first? Hypoxia or Hypoxaemia?
Hypoxaemia. We can assess and use interventions to prevent this from going to hypoxia hence preventing cell death
28
What is a common cause of Hypocapnia?
Hyperventillation. Taking in too much O2, and not being able to balance this with CO2
29
What is the cause of Hypoxia?
Often caused secondary to Hypoxaemia. Which is caused by any condition that reduces the amount of oxygen in your blood or restricts blood flow can cause hypoxia. People living with heart or lung diseases such as COPD, emphysema or asthma, are at an increased risk for hypoxia
30
What are the medical causes of Hypoxaemia?
ventilation-perfusion (V/Q) mismatch, diffusion impairment, hypoventilation, low environmental oxygen and right-to-left shunting.
31
What is Ventilation/perfusion mismatch?
Ventilation-perfusion mismatch is mismatched distribution of ventilation (airflow) and perfusion (blood flow)
32
When does ventilation/perfusion mis match occur?
Ventilation-perfusion (V/Q) mismatch occurs when either the ventilation (airflow) or perfusion (blood flow) in the lungs is impaired, preventing the lungs from optimally delivering oxygen to the blood
33
What does VQ ratio stand for?
ventilation/perfusion ratio
34
What is vasoconstriction?
Vasoconstriction is the narrowing (constriction) of blood vessels by small muscles in their walls. When blood vessels constrict, blood flow is slowed or blocked
35
What is an alveolus?
a small air-containing compartment of the lungs in which the bronchioles terminate and from which respiratory gases are exchanged with the pulmonary capillaries.
36
What are bronchioles?
A tiny branch of air tubes in the lungs
37
WOB: 5 signs of respiratory distress DiapHRaGM
- Diaphoresis (excessive sweating) different to normal sweating, clammy al over dripping in sweat and they feel cold. increased metabolic effort. hypocapnia - Hypoxia (less than normal level of 02 in the cells - Respiratory rate - Gasping associated with running out of breath, RR starts to drop and they start gasping, rhythm changes too) - Accessory muscle Need to intervene quickly or they can go into respiratory arrest
38
what we can measure: RR, depth and pattern
can be measured but a degree of subjectivity depending on how it is calculated
39
what we can measure: Work of breathing
- accessory muscle use nasal flaring/ pursed lip breathing - speaking long/short sentences, single words only, not speaking - intercostal indrawing
40
what we can measure: peak flow measurement
- measurement of maximal forced exhaled air flow (L/min) - baseline and to measure effectiveness of interventions - useful for people with asthma - used to keep an eye on maximal force
41
what we can measure: specialist tests
- CXR (chest X-ray) - spirometry - CT/MRI - ABG (arterial blood gas)
42
Airway assessments
patency is it open and is it fully open, partial obstruction? - is the airway patent - partial obstruction- snoring, stridor, you can hear something - complete obstruction- silence, no extra sounds - under threat? - what your assessing for, patency, expecting to find the airway patent, or patent and concern that it is under threat. possible cause of obstruction - tongue - vomit - epiglottis - uvulitis - secretions - inflammation - neurological impairment - foreign body
43
What is the rationale for "Sitting' the patient up to increase lung expansion"
In doing this we are increasing ventilation hence increasing gas exchange in the lungs.
44
What are the 7 things that we can clinically observe when thinking about a patient with a respiratory issue?
Respiratory rate Breath sounds Accessory muscles Positioning Neurological changes Skin Sputum
45
What are we observing in terms of the Respiratory rate when we are assessing a patient?
Tachypnoea/bradypnoea Orthopnoea Dyspnoea and Rhythm & Depth
46
What is Tachypnoea?
abnormally rapid breathing.
47
What is bradypnoea?
abnormally slow breathing.
48
What is orthopnoea?
Orthopnea is the sensation of breathlessness that affects a person when they are lying down and subsides in other positions, such as standing or sitting up.
49
What is Dyspnoea?
difficult or laboured breathing that is self reported by the patient
50
If we notice cyanosis what is an important factor to assess?
Cyanosis is the blue tinging of the skin so assess capillary refill of peripherals.
51
What is a peak flow measurement test?
Peak flow is a simple measurement of how quickly you can blow air out of your lungs. Normal adult peak flow scores range between around 400 and 700 litres per minute
52
What can we use a peak flow measurement for?
as a baseline and to measure the effectiveness of interventions (useful for diagnosing asthma)
53
What are clinical presentations of neurological changes?
Anxiety Agitation Confusion Drowsiness Pain
54
What are clinical presentations of Skin?
Diaphoresis Pallor Cyanosis Flushing
55
What are clinical presentations of Sputum?
Colour Odour Haemoptysis
56
Airway interventions:
Positioning: - maintaining head and neck alignment (chin tilt/jaw thrust) - Consider elevating head of bed/side positioning in OSA - Recovery position Clear secretions: - Encourage airway clearance with coughing - Consider suctioning (Yankeur/suction catheter) - Promote hydration to thin secretions for expectoration
57
Breathing assessments:
General appearance: Work of breathing Rate, depth and pattern Accessory muscle use Nasal flaring/pursed lips Cough Colour Skin moisture Positioning: Supine/erect Tripod Pillows to support Level of activity: What is your patient doing? Chest: AP measurement Symmetry Paradox Drains? Supplemental oxygen use: Nasal cannula Airvo (humidified O2) CPAP/BiPAP machine Posterior chest auscultation: Air entry Quality of breath sounds Wheeze Crackles Adventitious sounds Percussion: Resonance Hyper resonance Dullness
58
Breathing interventions:
Positioning: Sit the patient upright Support with pillows if required Mobilise as able Regular turns/repositioning Cough techniques: Huff coughing Incentive spirometry Deep breathing Administer prescribed medications: Bronchodilators (inhalers with spacer Oxygen Physiotherapy referral: Education Loosen secretions Secretions: Promote hydration to thin secretions Consider humidification of O2 Anxiety reduction: Education and reassurance to reduce respiratory effort and SNS response
59
Circulation assessments:
General appearance: Skin colour -Flushed -Cyanotic Temperature -Raised (core) -Peripherally cool Capillary refill time Diaphoresis Heart rate: Tachycardia/bradycardia Rhythm (regular/irregular) Quality (weak/bounding) Blood pressure: Hypertension Normotension Hypotension Renal function: Urine output eGFR Fluid balance
60
Circulation interventions:
Hydration: Oral Intravenous fluid as prescribed Administer prescribed medication: Consider DVT prophylaxis Mobilising: Foot pedalling Frequent mobilisation as able Regular repositioning
61
Disability assessments:
Level of consciousness: AVPU Orientated to time, person & place? Restlessness/agitation (hypoxaemia) Anxiety: Breathlessness Fear of dying Dyspnoea Increased work of breathing Mood SNS response Pain: COLDSPA Pleuritic pain will contribute to alveolar hypoventilation (decreasing gas exchange) Opioid analgesia causing ↓ RR and LOC
62
Disability interventions:
Pain management: Select appropriate analgesia Administer analgesia as prescribed Anxiety reduction to reduce SNS response: Patient education Communication of plan Involve family/whānau Not “reassure patient” – what does this mean?!
63
Environment assessment:
Patient risk assessment: Falls Braden Smoking Past medical/surgical history: Previous respiratory issues (COLDSPA) Medications Drug reactions Allergies Early Warning Score: Trends Action required?
64
Other assessments:
Occupation (hazards) Living situation Family/whānau supports Self-management of health issues Alcohol and drug use Cultural needs Spiritual needs
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