1
Q
What are the early symptoms that a client may not be getting enough oxygen?
A
Tachypnea and restlessness.
2
Q
What are 2 very common interventions with any respiratory problem?
A
- give oxygen
- sit up in a high Fowler’s position
3
Q
Teaching:
Prevent pneumonia
A
Teach clients to:
- turn, cough, and deep breath
- use an incentive spirometer
4
Q
Why would a client get a chest x-ray?
A
To look for abnormalities in the heart or lungs.
5
Q
What are the steps to get a sputum sample?
A
- get in AM before brushing
- rinse mouth with water
- take a few deep breaths
- then cough
- get 15 mL of sputum (not just saliva)
- send to lab
Start antibiotics after sputum sample is collected.
6
Q
What is a laryngoscopy or bronchoscopy?
A
Inserted down the throat and into the lungs to look for abnormalities.
7
Q
What is the priority concern after a bronchoscopy or lung biopsy?
A
Assess for pneumothorax and bleeding due to possible puncture.
8
Q
What is a pulmonary function test (PFT)?
A
A noninvasive test that shows how well the lungs are working.
The test measures lung volume, capacity, rates of flow, and gas exchange.
9
Q
What is the teaching before the client undergoes a pulmonary function test?
A
- hold bronchodilators
- no large meals
- no smoking beforehand
10
Q
What is a thoracentesis?
A
Removal of fluid or air from the pleural space using a needle.
11
Q
What is the best position during a thoracentesis?
A
- leaning over the bedside table or
- in bed with the affected side up
These positions promote separation of the ribs in order to reach the pleural space better and get the excess fluid out.
12
Q
What is chest physiotherapy?
A
Using percussion, vibration and postural drainage to get rid of respiratory secretions.
13
Q
Which medical conditions would chest physiotherapy be used for?
A
When thick secretions get stuck in the lungs such as:
- cystic fibrosis
- lower lung pneumonia
- COPD (chronic bronchitis)
14
Q
When would chest physiotherapy be contraindicated?
A
- head injury
- increased ICP
- chest trauma
15
Q
When is low flow nasal cannula used?
A
- chronic conditions such as COPD (2 liters/minute)
- post-operatively after receiving anesthesia
- may add humidification
Low flow nasal cannula is low dose oxygen administration (1-6 Liters/minute).
16
Q
When is high flow nasal cannula used?
A
- mild to moderate respiratory distress
- up to 10 Liters/minute
High flow nasal cannula is high dose oxygen administration.
17
Q
What is an oxygen face mask for?
A
To give oxygen for short term emergencies.
18
Q
When can a face tent be used to apply oxygen?
A
For those with facial trauma or burns and it needs to be loosely fitted.
19
Q
What is a CPAP and BiPAP machine?
A
An electronic breathing device used in the treatment of sleep apnea, lung disease, and to treat respiratory weakness.
It helps to improve oxygenation and is typically worn at night.
20
Q
What are the causes of a high-pressure ventilator alarm?
A
Due to obstructions such as:
- increased secretions
- water or kink in tube
- client coughs, gags, bites tube
- client is anxious and fights ventilator
21
Q
What are the causes of a low-pressure ventilator alarm?
A
- air leak
- disconnection of a tube
- client stops breathing
22
Q
Describe:
Flail chest
(Immediate complication)
A
When a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall.
There can also be rib fractures.
23
Q
What is the characteristic sign of flail chest?
A
Paradoxical respirations.
The injured area moves in during inspiration and moves out during expiration.
24
Q
Interventions:
Flail chest
A
- give pain meds
- encourage turn, cough and deep breath to prevent pneumonia
- possible intubation and ventilator
25
# Describe:
Pneumothorax
| (Immediate complication)
A **collapsed lung with air** in the pleural space.
## Footnote
It is caused by trauma. The client will get chest tubes.
26
# Describe:
Spontaneous pneumothorax
| (Immediate complication)
When there is a **sudden onset of a collapsed lung with no obvious cause.**
27
# Describe:
Hemothorax
| (Immediate complication)
A collapsed lung with blood in the pleural space.
28
What are the **characteristic signs and symptoms** of a pneumothorax and hemothorax?
* absent breath sounds on affected side
* tracheal deviation
* difficulty swallowing and breathing
* throat edema
* sucking sound with an open chest wound
* chest pain
* hypotension (heart is being squeezed)
* crepitus: cracking sound when tissue is pressed
29
# Treatment:
Pneumothorax and hemothorax
**Chest tubes**.
30
# Describe:
Acute respiratory failure **(ARF)**
| (Immediate complication)
When there is **not enough oxygen to get to the lungs or alveoli** (air sacs) and **CO2 builds up in the blood**.
## Footnote
The client becomes hypoxic and hypercapnic.
31
What **respiratory diseases** can cause acute respiratory failure?
* cystic fibrosis
* COPD
* pneumonia
* COVID-19
32
Which types of **trauma** can cause acute respiratory failure?
* fire/smoke inhalation
* spinal cord injuries
* chest trauma
* opioid overdose
33
Which types of **neuro** diseases can cause acute respiratory failure?
* stroke
* myasthenia gravis
* Guillain-Barré
34
# Interventions:
Acute respiratory failure
* give oxygen
* bronchodilators
* intubation with ventilator
35
# Describe:
Acute respiratory distress syndrome **(ARDS)**
| (Immediate complication)
A form of ARF that causes **inflammation and fluid to build up in the alveoli.** The client is unable to get enough oxygen.
## Footnote
The client will be intubated and placed on a ventilator.
36
# Cause:
Acute respiratory distress syndrome
| (Immediate complication)
ARDS is caused by many life-threatening conditions that cause **systemic inflammation or prevent the client from breathing**:
* shock
* sepsis
* burns
* fluid volume overload
* aspiration and inhalation of toxic substances
* trauma
* neuro injuries
37
# Describe:
Asthma
A **chronic inflammation in the lungs** caused by allergies, irritants or exercise.
## Footnote
The bronchioles become constricted preventing oxygen exchange.
38
What are the **characteristic signs and symptoms** of asthma?
* wheezing
* chest tightness
* coughing
39
# Interventions:
Asthma
* oxygen
* Inhalers
* bronchodilators
* steroids
40
# Describe:
Chronic obstructive pulmonary disease **(COPD)**
A group of inflammatory lung diseases that **block airflow** and make it difficult to breathe.
41
# Pathophysiology:
Chronic obstructive pulmonary disease
1. alveoli gets damaged by inflammation and lose elasticity
2. air gets trapped and respiratory rate increases
3. CO2 is produced faster than it can be eliminated
## Footnote
This causes respiratory acidosis and low oxygen levels of about 88%-93%.
42
What is the number 1 **cause** of COPD?
**Smoking**
43
What **2 diseases** fall under the category of COPD?
1. emphysema
2. chronic bronchitis
44
# Describe:
Emphysema
When the **alveoli (air sacs) in the lungs are damaged and enlarged**, resulting in hyperinflation and breathlessness.
45
# Describe:
Chronic bronchitis
When the **bronchial tubes become inflamed and excessive mucus production occurs** as a result from irritants or injury.
46
What are the **characteristic signs and symptoms** of COPD?
* barrel chest with emphysema
* accessory muscles for breathing
* orthopnea
* hyperinflation of lungs
* clubbed fingers
47
What **acid-base imbalance** does a client with COPD usually have?
**Respiratory acidosis**.
## Footnote
It's normal with COPD for the client to hold on to acid.
48
How much **oxygen** should a client with COPD be allowed to have?
Keep oxygen levels between 88%-93%, which is an average of **2-3 liters/minute** of oxygen. The client may need more oxygen if O2 level goes below 88%.
## Footnote
The drive to breathe for COPD is a low oxygen level.
49
# Interventions:
Chronic obstructive pulmonary disease **(COPD)**
* nebulizers: bronchodilators and steroids
* chest physiotherapy
* mucolytics
* oxygen nasal cannula 2-3 liters/minute
50
What is **pursed lip breathing**?
A technique used for COPD to **move more oxygen into the lungs and carbon dioxide out of the lungs**.
## Footnote
When you exhale with your lips pursed, there is increased pressure. This helps to keep airways open longer to remove the air that is trapped in the lungs. This slows down the breathing rate and relieves shortness of breath.
51
What **diet** is recommended with COPD?
**COPD diet** is based on issues with chronic fatigue and breaking up secretions:
* small frequent meals
* high calorie, high protein diet with supplements
* fluid intake up to 3000 mL/day to keep secretions thin
52
What **position** is best for clients with COPD to breathe easier?
**Fowler's position and leaning forward** to aid in breathing.
53
# Describe:
Pleural effusion
When **fluid goes into the pleural space or layers of the lungs.**
## Footnote
It can be caused from CHF, kidney failure or infection.
54
# Treatment:
Pleural effusion
**Thoracentesis**
55
# Describe:
Pulmonary edema
| (Immediate complication)
When **fluid gets backed up into the lungs**.
## Footnote
It can be caused by left-sided heart failure, kidney failure or liver failure.
56
What is the **characteristic** **sign** of pulmonary edema?
**Pink, frothy sputum**.
## Footnote
It is foamy and contains bubbles.
57
# Interventions:
Pulmonary edema
Focus on **getting rid of extra fluids and maximizing oxygen:**
* high-Fowler's position
* give oxygen
* diuretics and morphine (morphine eases breathing)
* foley for strict intake and output
* last resort is intubation and ventilator
58
# Describe:
Pulmonary embolism
| (Immediate complication)
When a **blood clot goes to the lungs.**
## Footnote
It is usually caused by a DVT.
59
What is the **characteristic sign** of a pulmonary embolism?
Blood-tinged sputum.
60
# Interventions:
Pulmonary embolism
* oxygen by face mask
* heparin IV to prevent more clots from forming
61
# Describe:
Pneumonia
An **infection in the lungs**.
62
# Causes:
Pneumonia
63
# Interventions:
Pneumonia
* encourage fluids
* antibiotics
64
# Describe:
Influenza
An acute **viral respiratory infection**.
65
How is influenza **prevented**?
Get the **yearly vaccination**.
66
# Interventions:
Influenza
**There is no cure**, just treat the symptoms:
* encourage rest and fluids
* antipyretics to reduce fever
* antitussives to prevent cough
67
# Describe:
Empyema
**Pus in the lungs** caused by infection or a lung abscess.
68
# Treatment:
Empyema
* antibiotics
* thoracentesis or chest tubes
69
# Describe:
Tuberculosis
A **highly infectious bacterial respiratory disease** that is spread from person-to-person by breathing in infectious airborne droplet nuclei.
70
What are the **precautions** with tuberculosis?
1. wear an N95 particulate respirator mask - possible gown, gloves, and googles
2. private room
3. negative air pressure with at least 6 air exchanges per hour
71
What populations are most at **risk** of getting tuberculosis?
* homeless
* living in large groups
* immunosuppressed
* IV drug users
72
What are the **characteristic** **signs and symptoms** of tuberculosis?
* low-grade fever
* chills
* night sweats
* persistent cough
73
# Diagnostic tests:
Tuberculosis
* TB skin/Mantoux test
* blood test
* sputum cultures
## Footnote
Chest x-ray is not a definitive test for TB.
74
How **often** is a sputum culture obtained for TB?
**Once every 2 - 4 weeks.**
## Footnote
After 3 negative sputum cultures, the client is no longer considered infectious.
75
How **long** are tuberculosis medications taken for?
**6 - 12 months**.
76
How **long** after tuberculosis meds are started are clients not likely to infect others?
After **2 - 3 weeks** of taking TB meds.
77
Is **respiratory isolation necessary** at the home of a tuberculosis client when around other family members?
**No.** Family members have already been exposed.
## Footnote
Family members will take prophylactic medications for at least 6 months to prevent infection.
78
# Teaching:
Home oxygen use
* don't use around combustible materials
* no smoking
* no open flames
79
What is the difference between CPAP and BiPAP?
* CPAP has 1 pressure setting that's the same for both inhalation and exhalation
* BiPAP has 2 pressure settings that are separate for inhalation and exhalation
80
With a ventilator, when should a client be suctioned?
* when the high pressure alarm goes off
* when client needs more oxygen
* bronchi breath sounds
* with increased coughing
81
What are the interventions when weaning a client off a ventilator?
* get ABGs
* oxygen requirements
* give high flow oxygen by non-rebreather mask
* apply continuous pulse oximetry
* high fowler's position
82
What are the interventions to prevent a ventilator associated pneumonia (VAP)?
* turn every 2 hours
* oral care every 4 hours + as needed
* increased HOB to 30 degrees
83
# Teaching:
Asthma
* prevent dust mites by washing bedding in hot water weekly
* exercise as tolerated
* avoid triggers
84
Besides pink, frothy sputum, what are some additional signs and symptoms of pulmonary edema?
* shortness of breath
* dyspnea
* crackles in lungs
85
What is a way to prevent pulmonary embolism?
Prevent blood clots by having the client wear compression socks or sequential compression devices (SCDs).
## Footnote
Compression socks and SCDs increase blood flow in legs.
86
# Describe:
COVID-19
An infectious respiratory disease caused by SARS-CoV-2. It can be prevented by getting vaccinated.
87
# Risk factors:
COVID-19
* immunocompromised
* previous heart or lung disorders
* diabetes mellitus
88
# Signs and symptoms:
COVID-19
Flu-like symptoms:
* fever
* chills
* cough
* shortness of breath
* fatigue
* muscle aches
* headache
* loss of taste or smell
* sore throat
* congestion
* nausea/vomiting/diarrhea
89
# Interventions:
COVID-19
* contact/droplet/airborne precautions
* treat symptoms
* possible intubation if severe
NCLEX-PN (5) Adult Health
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