Respiratory

Question 1

Acinus

Answer 1

All structures distal to the terminal bronchiole.

Question 2

Physiology of Type II Alveolar Cells

Answer 2

Located in the walls of the alveoli. Secrete surfactant that reduces surface tension. Without it the alveoli would collapse.

Question 3

Nerves responsible for respiratory innervation

Answer 3

Phrenic, Vagus, & Thoracic

Question 4

Parietal & Visceral Pleura: A&P

Answer 4

Parietal lines the inside of the thoracic cavity, including the upper surface of the diaphragm. Visceral covers the pulmonary surfaces. Cells lining the pleura secrete a fluid that acts as a lubricant so the lungs may glide smoothly during respiration.

Question 5

Accessory muscles of respiration

Answer 5

Scalene muscles - elevate the first two ribs
Sternocleidomastoid muscles - raise the sternum
Trapezius & Pectoralis muscles - fix the shoulders

Question 6

Risk factors for respiratory disorders

Answer 6

Allergies
Chest Injury
Crowded living conditions
Chemical/pollutant exposure
Family Hx of infectious disease
Freq. respiratory illness
Geographic residence/travel to foreign countries
Smoking
Surgery
Use of chewing tobacco
Viral syndromes

Question 7

Specimen collection - Pre & Postprocedural Actions

Answer 7

Pre: Instruct to rinse mouth prior to collection, obtain 15 mL of sputum, instruct to take several deep breaths and then cough deeply to obtain, always collect before they have begun antibiotic Tx
Post: Bring to lab immediately if culture is prescribed. Assist w/ mouth care

Question 8

Pre-procedural actions for Laryngoscopy and Bronchoscopy

Answer 8

• Get informed consent
• Maintain NPO status from midnight a/ procedure
• Obtain VS
• Assess results of coag. studies
• Remove dentures & eyeglasses
• Prepare suction equipment
• Establish an IV access as needed & admin meds for sedation per order
• Have emergency resuscitation equipment available

Question 9

Post-procedural actions for Laryngoscopy and Bronchoscopy

Answer 9

• Monitor VS
• Maintain the client in semi-fowlers
• Assess for return of gag reflex (maintain NPO until then)
• Have emesis basin readily available for expectorating
• Monitor for bloody sputum
• Monitor respiratory status, esp. if sedation was used
• Monitor for complications: bronchospasm, bronchial perforation (look for facial/neck crepitus), dysrhythmias, hemorrhage, hypoxemia, and pneumothorax.
• Notify HCP if: fever, DIB, or other signs of complications

Question 10

Nursing Actions for Respiratory Suctioning

Answer 10

1. Explain procedure to client
2. Assist to an upright position (ie semi-fowlers w/head hyperextended unless contraindicated)
3. Hand hygiene & gloves
4. Prep equipment and turn on suction
5. HYPEROXYGENATE THE PT
6. Insert the cath without suction applied
7. Once inserted, apply intermittently and rotate as you withdraw
8. HYPEROXYGENATE
9. Listen to breath sounds
10. Document procedure, response, & effectiveness

Question 11

Asthma - Definition

Answer 11

An inflammatory disorder of the airways stimulated by triggers (infection, allergens, exercise, irritant)

Question 12

Status Asthmaticus

Answer 12

A life-threatening condition unresponsive to treatment. Despite all medical efforts their body isn’t responding (airways aren’t opening up)

Question 13

Asthma - Assessment Findings

Answer 13

Wheezing, crackles, restlessness, diminished breath sounds, tachypnea

Question 14

Asthma - Therapeutic managment

Answer 14

Place in high fowler’s position, administer O2, administer bronchodilators BEFORE corticosteroids. Ultimate goal is to open the airways.

Question 15

Asthma Prevention - Teaching

Answer 15

Avoid triggers, use daily inhaler regardless of whether symptoms are present.

Question 16

Asthma Physiology

Answer 16

Bronchiole walls swell and produce mucous. Can’t get enough air into their lungs.

Question 17

Rationale: why bronchodilators are given prior to corticosteroids

Answer 17

Bronchodilator will open up the airways which will allow the corticosteroid to be more effective because more will be able to enter the airway

Question 18

Proper inhaler use with Spacer

Answer 18

• Shake 10-15 times
• Take lg. breath and exhale completely
• Place spacer in mouth and seal with lips
• Tilt head back slightly
• Press down - breath in slowly and deeply
• Hold 5-10 seconds
• Open mouth and breath out slowly

Question 19

Peak Flow Meter

Answer 19

Monitors the peak expiratory flow rate of air from a persons bronchi

Question 20

EpiPen

Answer 20

Adrenaline causes bronchodillation via beta2 (remember - 2 lungs) receptor activation
- used in emergent situations

Question 21

Asthma Meds

Answer 21

Bronchodilators, corticosteroids, immunomodulators, short acting beta agonists (epi)

Question 22

Nursing Roles with Asthma patients

Answer 22

Assess status of airways, check that they are aware of their triggers

Question 23

COPD - Definition

Answer 23

Obstruction of airflow d/t emphysema and chronic bronchitis

Question 24

Emphysema

Answer 24

• Destruction of alveoli d/t chronic inflammation
• Decreased surface area for gas exchange
• CO2 isn’t being removed from the blood effectively and O2 isn’t entering the blood efficiently

Question 25

Chronic Bronchitis

Answer 25

- Chronic airway inflammation with productive cough | - Excessive sputum production

Question 26

COPD - Assessment Findings

Answer 26

- Barrel chest - use of accessory muscles - congestion on ches xray - ABG with elevated CO2 and decreased pH (respiratory acidosis)

Question 27

COPD - Therapeutic Management

Answer 27

* DO NOT administer O2 at greater than 2 L/min (stimulus to breath is low PO2, not the the usual elevated PCO2) - Assess SpO2 (~89-91 or something lower than normal for someone healthy is normal for these pts) - Provide chest physiotherapy (CPT) - Teach pursed lip breathing - Avoid allergens and triggers (dust, infections, spicy foods, smoking) - Increase fluid intake to 3000 mL/day to keep secretions thin (if not C.I.) - small frequent meals to prevent hypoxia