Critical Care Respiratory Exam

cause of Rhinitus:

edamtous and inflamed nose caused by irritants, allergies, dust, odors, infection

S/s of Rhinitus:

excessive nasal drainage, congestions, sneezing, roof of mouth priuritus

treatment of rhinitis:

FLUIDS, antihistamines, analgesics, atrovent, humidifers

Cause of rhinosinusitis:

post viral URI

s/s of rhinosinusitis:

excessive nasal drainage, facial pain, facial pressure

Bacterial vs Viral rhinosinusitis:

Bacterial: fever, lasts longer than 10 days

Viral: no fever, less than 10 days

Complications of rhinosinusitis:

osteomyelitis, meningitis, cysts, brain abcess

cause of chronic rhinosinitus:

mechanical obstructions, fungus balls, CF, GERD, Tobacco

S/S of chronic rhinosinusitis:

mouth breathing, can't clear nose, filters and humidifies air->if breathing through the mouth than things are not getting filtered

complications of chronic rhinosinusitis:

pneumonia, osteomyelitis, meningitis, cysts, orbital cellulitis, pressure on cranial nerves

treatment for chronic rhinosinusitis:

surgery to correct deformities, avoid irritants, avoid sick people, do NOT blow nose all the time( increases IOP and ICP)

cause of laryngeal cancer:

smoking, irritants, overuse

s/s of laryngeal cancer:

Early: change in hoarseness, change in cough that lasts longer than 2 weeks

Late: dyspnea unilateral nasal obstruction due to swelling, foul breath,, dysphagia, increased RR

Treatment for laryngeal cancer:

vocal cord stripping, partial laryngectomy, total larygectomy, chemo, radiation

cause of influenza:

virus

patho of influenza:

aerosolized particles from coughing, sneezing, and kissing

S/S of Influenza:

fever, HA, chills, dry cough, malaise, weakness, SOB, diffuse crackles means flu is getting worse

treatments of flu:

antivirals, rest, fluids

prevention of flu:

flu vaccine and hand hygiene

cause of atelactasis:

alveoli do not expand which decreases surface area for gas exchange and prevents ventilation

Risk factors for Atelactasis:

COPD, BMI, procedures, pain, LOC changes, immobility

prevention for atelactasis:

deep breathing, incentive spirometer, cough, turn q2, mobility

patho for atelactasis:

decreased ventilation which leads to poor perfusion (V/Q mismatch)

S/S of Atelactasis:

pleural pain(early), cyanosis (late), restless

treatments for atelactasis:

mobility, IS 10x/hour, nebulizer, bronchodilators, physiotherapy

cause of acute tracheobronchitis:

bacteria, fungal, chemical

patho of acute tracheobronchitis:

typically follows a URI

prevention of acute tracheobronchitis:

adequate treatment of a URI

S/S of acute tracheobronchitis:

dry cough-> mucus w/ productive cough -> obstructions

infection symptoms with acute tracheobronchitis:

headache, fever, night sweats, soreness, bloody sputum

treatment for acute tracheobronchitis:

bronchodilators, antibiotics, suctioning & bronchoscopy to remove secretions, increase fluids

cause of TB:

bacterial transferred to alveoli

risk factors for TB:

immunocompromised, elderly, close quarters, 3rd world compromised

patho of TB:

affects the lung parenchyma

S/S of TB:

cough, tachypnea, hemoptysis, weakness, low grade fever

diagnostics for TB:

tuberculin skin test and quantiferon gold

gerontologic considerations with TB:

TB skin test often shows no result, care homes are common breeding grounds, show less s/s

medication for TB:

Rifampin

patient teaching for Rifampin:

red/orange tears are urine are normal side effects

cause of pleurisy:

cancer, irritants, pneumonia, TB, PE

Patho of Pleurisy:

when you breath in the 2 layers rub due to swelling which decreases deep breathing and cause atelactasis

s/s of pleurisy:

knife-like pain

assessment findings with pleurisy:

early=pleural rub

late= too swollen to make any noise

treatments for pleurisy:

turn on affected side, px management, splitting, turning, deep breathing

monitoring for pleurisy:

pleural effusion

cause of ARF:

sudden respiratory attack that can cause you to not ventilate or oxygenate

patho of ARF:

drug OD, head trauma, malnutrition, COPD, CF, asthma

s/s of ARF:

restless, anxiety, HA, increased HR, HTN->HoTN

late s/s of ARF:

cyanosis, lethargic, diaphoretic, increased HR, HoTn

treatments for ARF:

ventilation and intubation, ABGs, sedation, educate

Cause of ARDS:

aspiration, drug OD, infection, shock, trauma, direct/indirect injury to the lungs

patho of ARDS:

inflammation->chemical mediators->alveolar collapse->pulmonary edema->decreased lung compliance

s/s of ARDS:

restless, intercostal retractions, bilateral infiltrates on x-ray, presistent arterial hypoxemia, unresponsive to oxygenation, frothing

treatments of ARDS:

intubate, enteral access, px management, sedate/paralyze, DVT prophylaxis, PPI, turns, ROM

cause of pulmonary embolism:

r/t trauma, surgery, pregnancy, birth control, immobility

patho for pulmonary embolism:

obstruction of pulmonary artery by thrombus-> V/Q mismatch perfusion issue

s/s of pulmonary embolism:

dyspnea, sudden pleuritic pain, anxiety/restless/apprehension, rapid but weak pulse, shock, death q1hr

treatments for pulmonary embolism:

stabilize HR, o2 for anxiety, IV access (heparin, TPA), Labs (INR, PTT), I/O (kidney perfusion), EKG, V/Q scan

prevention for pulmonary embolism:

SCDs, movement

cause of lung cancer

smoking, occupational exposure, pollution

patho of lung cancer:

bronchogenic carcinoma, epithelial cell transfer

s/s of lung cancer:

insidious, completely unaware until late signs are present (change in chronic cough)

treatments for lung cancer:

surgery, chemo, radiation

cause of pneumonia:

bacteria, viruses, prior respiratory disorder like flu, aspiration

s/s of pneumonia:

chest pain, confusion, productive cough, fatigue, fever/chills, SOB

treatment for pneumonia:

always give antibiotics first!

cause of flail chest:

trauma

patho of flail chest:

multiple rib fractures, part of chest wall is completely moving freely, fails to fill

s/s of flail chest:

paradoxical chest movement, broken ribs expand the V/Q ventilatory issue

treatments for flail chest:

splinting, pain management, chest x-ray, ABGs, O2

complications of flail chest:

fix it in its place may cause popped lung, can cause atelactasis due to desire to not breath deeply due to pain

indications for chest tubes:

drain fluid and air from the thorax, restore negative pressure within the pleural space to re-expand the lung

purpose of collection chamber:

collects drainage

purpose of water seal chamber:

prevents air from reentering with inhalation

purpose of suction control chamber:

provides negative pressure to chest/promote drainage

troubleshooting collection chamber:

monitor characteristics (amount/color)-> 200mL/ hr for 1st hour

troubleshooting water seal chamber:

continuous bubbles= air leak

troubleshooting chest tube disconnecting:

immerse chest tube open end into 2cm of sterile water

troubleshooting chest tubes becoming dislodged:

apply tented dressing over insertion site

simple pneumothorax:

typically absense of trauma but a bleb on the lung pops allowing air in

traumatic pneumothorax:

air escapes from laceration of the lung itself

patho of pneumothorax:

air in the pleural cavity due to a breach in the parietal layer than leaves pleural space open to atmospheric pressure

s/s of pneumothorax:

absent breath sounds, dyspnea, tachycardia, tachypnea, air hunger, use of accessory muscles, tracheal deviation

treatment for pneumothorax:

chest tube set to suction

cause of COPD:

chronic bronchitis and chronic emphysema-> floppy alveoli with mucus

risk factors for COPD:

smoking, occupational exposure, environment

patho for COPD:

chronic bronchitis: cough-> sputum production-> constant irritation of glands

chronic emphysema: inability to breathe off CO2 due to overly distended alveoli

s/s of COPD:

chronic cough, sputum productive, dyspnea, weight loss, barrel chest, accessory muscle use, worsens with activity

treatments for COPD:

stop smoking, progressive exercise, bronchodilators, corticosteroids, vaccinations, risk reduction

pursed lip breathing purpose:

slows respiration, prevents collapse of small airways, and helps control rate and depth of respiration

pursed lip breathing used in:

most people with COPD breathe shallow, rapid, and ineffeciently

Pursed lip breathing:

diaphragmatic breathing/accessory muscle use which reduces RR, increases alveolar ventilation, and helps expel as much air as possible during expiration

how to do pursed lip breathing:

relax muscles, breathe in for 2 seconds keeping mouth closed, breathe out for 4 seconds through pursed lips

cause of asthma:

allergies are strongest pre-disposition for asthma

patho of asthma:

chronic airway inflammation that causes a narrowed airway

s/s of asthma:

wheezing, SOB, cough, chest tightness, worse in early morning and at bedtime

treatments:

bronchodilators, anticholinergics, corticosteroids, avoid triggers

complications of asthma:

status asthmaticus -> bronchospasm with mucus plug that creates V/Q mismatch -> labored breath, increased exertion

initial complications with asthma:

decreased O2, decreased CO2, alkalosis

worsening complications with asthma:

decreased O2, increased CO2, acidosis