respiratory 2

fvc and fev

• fvc = after taking in a big deep breath

  • the volume of the expiration

• fev = volume of air forcibly exhaled after 1 second

thoracentesis

• needle or thin tube to remove excess fluid from the pleural space

• pt sits upright + leaning on table

• fluid pushes on left lung → goes into bag

tracheostomy

• long-term airway support

• inner cannula - can be removed for cleaning (most disposable)

  • with saline + soft brush

tracheostomy - early complications

• pneumothorax

• embolism

• aspiration

• nerve damage

• emphysema

• bleeding

tracheostomy - long term complications

• dysphasia

• airway obstruction + artery rupture

• infection

• necrosis

vapotherm

• all ages

• high flow therapy = comfortable nasal cannula with medical grade vapor

complications of oxygen

• combustion

• hypoventilation

• infection

• atelectasis

acid-base normal values

• pH = 7.35-7.45

• paco2 = 35-45

• hco3 = 22-26

respiratory alkalosis

• low co2 in lungs

• cause - hyperventilation from anxiety or pain

• treatment - brown paper bag

respiratory alkalosis - symptoms

• dizzy + confused

• tingling + seizures

• nausea + numbness

respiratory acidosis

• high co2 in lungs

• cause = respiratory failure + over-sedation + neuromuscular disease

• treatment = hob elevated

respiratory acidosis symptoms

• low loc

• headache

• hypoxia

metabolic alkalosis - causes + treatment

• high bicarbonate in kidneys

• cause = vomiting, ng tube, diuretics

• treatment = replace potassium fluids

metabolic alkalosis - assessment

• dizziness

• tingling + twitching

• arrhythmias, hypokalemia + hypocalcemia

metabolic acidosis - causes and treatment

• low bicarbonate in kidneys

• causes = dka, renal failure, sepsis, diarrhea

• treatment = sodium bicarbonate IV

metabolic acidosis - assessment

• low loc

• tachypnea

• arrhythmias + hyperkalemia

compensation

• compensated = pH normal, rest abnormal

• partial = everything not normal

• non-compensated = one normal, rest abnormal

acid base mnemonic

• respiratory opposing

• metabolic equal

tuberculosis

• airborne infection - only transmitted when person coughs or speaks

• it is resistant to staining

• you have to do 3 sputum checks - 1 day apart each

• risk factors = homeless druggie, old, hiv

tuberculosis - patho

tb bacilli inhaled → land in bronchioles/alveoli → macrophages + lymphocytes surround bacteria → make granuloma (immune wall around tb) → calcified + becomes scar (shown on x-ray)

tuberculosis - what happens when immune system becomes weak?

• granuloma opens into bronchi

• tb bacteria multiply and spread

latent tb

• small number of inactive organisms

• not infectious

• asymptomatic

• can reactivate if immune system goes bad

latent tb screening

• positive ppd test

• normal cxr

• negative sputum

active tb + diagnostics

• large number of active organisms

• infectious + requires immediate drugs

• positive ppd, abnormal chest x-ray (lesion), positive sputum

active tb - symptoms

• cough + sputum

• low-grade fever + chest pain

• night sweats

• weight loss - anorexia

active tb - further stuff

• monthly sputum - until negative 3 times

• sleep alone + mask pt on exit

tb - positive test

if you get positive tst → if you ever do it again it will always show positive, therefore, lots of false positives/negatives + you need to do sputum and cxr instead

tb - hiv pt

• hiv-pos pt commonly show false negative

• can affect their = bone, renal, and loc

• higher risk of latent to active

• extended duration of antibiotics for 6 months beyond

pneumothorax - what is it and what are the symptoms?

• air enters pleural space which increases pressure

• you cannot expand lung = collapse

• symptoms = tachypnea, dyspnea, hypoxemia

primary spontaneous pneumothorax

• healthy lung → rupture of blebs on surface of the lung in apical region (upper)

• pao2 levels can be normal in 24 hours

• tall + thin men who spoke

secondary spontaneous pneumothorax

• pt with underlying lung disease

• ex. asthma, copd, tb, cystic fibrosis

• gas trapped and alveolar destruction from primary

traumatic pneumothorax

• from rib fractures + cpr

• hemothorax = blood in pleural cavity

tension pneumothorax

• air enters pleural space during inhaling but cannot escape during exhaling

• associated with traumatic chest trauma + positive-pressure mechanical ventilation

tension pneumothorax - symptoms and diagnostic

• tracheal deviation/shift toward good side = absent breath sounds

• hypotension + shock

• bruising on skin

• diagnostic - 2 large-bore needle decompression or chest tube

pleural effusion

• abnormal collection of fluid in pleural cavity

• clear serous (transudate or hydrothorax) = chf

• exudative (protein) = bacterial, viral, or cancer

pleural effusion management

• dullness to percussion

• thoracentesis - drain 1 L fluid

• chest tube drainage

• pleurodesis = install chemical into scar

chest tubes

• used for pneumothorax, hemothorax, pleural effusion

• inserted through chest wall → pleural space

• add water to seal chamber → dial suction 20 cm → attach to wall suction (maintain system below chest)

chest tube - complication

• subcutaneous emphysema

• some bubbling is fine but continuous is bad

flutter (heimlich) valve

• used for emergency transport and for smaller pneumothorax

• one-way valve opening when intrathoracic pressure > atmosopheric

• increased pt mobility + vent the drainage bag

pulmonary embolism

• blood-borne pathogen in pulmonary artery

• emboli originating from dvt consists of = air, fat, tumor

• causes = immobility + post-op

pulmonary embolism - complications

• v/q mismatch

• hypertension

• loss of surfactant

pulmonary embolism - small

• anticoagulant

• iv heparin with bolus

• enoxaparin and warfarin

pulmonary embolism - massive + what to do to alleviate symptoms?

• sudden collapse and low loc due to shock

• crushing substernal chest pain

• thrombolytic agent, catheter thrombectomy, inferior vena cava filter

pulmonary embolism - diagnostics

• dimer = measure fibrin

• ct angiography = inject

• v/q scan

• check troponin and cxr

pulmonary embolism - auscultation + pt teaching

• auscultation = crackles and wheezing

• pt teaching = long-term anticoagulant therapy for 3 months or indefinitely and they need to have follow-ups at anticoagulation clinics

interstitial lung disease

• initial injury to alveolar epithelium + forms cystic space

• inflammatory response = damages collagen and elastic tissue

• can happen from chemo or radiation

• low lung compliance

interstitial lung disease - symptoms

• dry cough - absence of wheezing sounds

• rheumatoid arthritis, lupus

• cyanosis and nail clubbing

• mine worker - idiopathic pulmonary fibrosis

sarcoidosis

• type of interstitial lung disease type

• creates granulomas

• need to confirm thru biopsy

• will have skin lesions

• affects mainly lungs and lymph