respi-hema system

lecture

what are the primary functions of respiratory

provide O2 important for cellular metabolism

remove waste products (carbon dioxide)

what are the secondary functions of respiratory

facilitates sense of smell

produces speech

maintains acid-base balance

maintain heat balance

maintains body water levels

what is the function of upper respiratory tract

protection

• filters

• humidifies

• warmth

this part of the URT that contains olfactory receptors & has a lining of ciliated mucosa, divides by septum (right & left nostril)

nose

what are the sinuses

FEMS

• frontal

• ethmoid

• maxillary

• sphenoid

which sinus the largest

frontal

which sinus is the smallest

ethmoid

pag wala ethmoid sa choices sphenoid

which sinus is the widest

maxillary

which part of the URT is composed of muscle with mucous lining

pharynx

pharynx composed of what 3 parts

NAOL

nasopharynx - air

oropharynx - air & food

laryngopharynx - intubation & bronchoscopy

voice box of URT

larynx

normal range of pH

7.35 - 7.45

normal range of PaO2

80 - 100

normal range of PaCO2

35 - 45

normal range of HCO3

22 - 26

the opening between the true vocal cords is the _

glottis

_ plays an important role in coughing

glottis

what is the most fundamental defense mechanism of the lungs

coughing

it is the leaf-shaped elastic flap structure at the top of the larynx

epiglottis

this opens when the air enters the tract

(closes when food enters)

epiglottis

what should you take note when there is alterations in epiglottis

no examination, no insertion, tracheostomy set @ bedside

function of lower respiratory tract

enables gas exchange

which part of the LRT has a smooth muscle that contains C shaped rings

trachea

part of LRT that functions as passageway of air into and from the lungs

trachea

this is the division between the left & right lung

bronchi

it is lined with cilia, which propel mucus up and away from the lower airway to the trachea where it can be expectorated or swallowed

bronchi

this is a small branches of the bronchi

bronchioles

pulmonary circulation happens in the

lungs

gas exchange happens in the

alveoli

which accessory muscle elevates the first 2 ribs

scalene

which accessory muscle raises the sternum

sternocleidomastoid

which accessory muscle fix the shoulders or shoulder movement

pectoralis major & trapezius

part of the brain that is a respiratory center of the brain

medulla oblongata

part of the brain that controls the rate & rhythm

pons

it is the location of respirator regulations

brain stem

fine crackles produce what kind of sound

short high pitch bubbling sound which is similar to hair strand rubbing together

fine crackles has a presence of

fluid

coarse crackles produce what kind of sounds

short low pitch bubbling sound

coarse crackles has a presence of

mucous

wheeze produce what kind of sound

high pitch, musical, or hissing sound

pleural friction rub has a presence of

roughed pleural spaces = accumulation of cushion

sounds produced of pleural friction rub is

grating, crackling which is similar to scratch papers

what are the 3 Iof PFR

infection

inflammation

infiltration

diagnostic procedure that reveals anatomical & appearance of the lungs, ribs, & heart

x-ray

is x-ray contraindicated to woman?

no

what kind of apron do you use when you undergo xray

lead apron

what is the purpose of matoux test/purified protein denvative (PPD)

tb exposure

can the nurse interpret the result of mantoux test

nurse can interpret serve with proper documentation with another nurse or capture with image

after PPD diagnostic when should the patient come back?

48 - 72 hours

results of PPD for individual with comorbidities

<10mm = negative

>10 mm = positive

results of PPD for immunocompromised patients

<5mm = negative

5-9mm = inconclusive (parang positive)

>10mm = positive

what happens when patient is positive in PPD

undergo confirmatory test which is sputum examination

purpose of sputum examination/collection

identification of TB & infection process

when is the best time to collect sputum

early in the morning, 5 - 6 am, before breakfast

amount of specimen needed for sputum collection

10 - 15ml (spoonful)

viability of sputum collected

last 30 minutes or less

what are the 3 mechanisms in good sputum collection

properly collected

properly labeled

properly transported

what health education should you do prior to collection

show the container

10 - 15 ml

give the sputum container before breakfast (tell px)

toothbrush not allowed

if px is ready to cough, call the nurse then nurse will label the container

if px can’t expectorate or px is intubated

sputum/mucous trap (sterile)

bronchscopy

direct visualization of larynx, bronchi, trachea

purpose of bronchoscopy

visualization, bronchial washing, bronchial suctioning, collection of tissue sample (check malignancy)

before procedure of bronchoscopy

Invasive

Consent

NPO (6 – 8 hours)

Vital signs monitoring (baseline)

Remove dentures

Emergency equipment: oxygen & tracheostomy set

after procedure of bronchoscopy

Monitor vital signs and circulatory status

Position: semi fowler’s

Presence of nausea & vomiting: side lying position

Assess the return of gag reflex (2 hours after the procedure)

·  Ask the patient to swallow while putting your arms on your anterior neck. If there’s a presence of wave motion = (+) swallowing reflex

Bawal ice chips or any solid food that turns to liquid at room temperature = risk of aspiration

it is chronic + inflammatory disorder

bronchial asthma

what are the 3 changes of airway

bronchoconstriction: narrowing of the airway

airway inflammation

increased mucus productions

how does asthma happens

Presence of allergens ➡ stimulate goblet cells to produce more secretions & inflamed smooth muscles  ➡ narrowing of airways ➡wheezes

triggering factors of asthma

Environment (pollens, dust, fomites)

Patient adaptation (Drugs, food, temperature, stress)

mixed type: Extrinsic + intrinsic

every when do you wash linen?

once a week

what kind of water do you use to wash linen?

warm water

how many minutes do you babad the linen?

at least 2 hours

signs of bronchial asthma

Abnormal lung sound: wheezing on expiration

Shortness of breath or difficulty of breathing

Tachycardia & hyperventilation

Acid base: respiratory alkalosis (lumalabas ang CO2; no retention)

Hypoxia

what is the compensatory mechanism of SOB/DOB to meet O2 requirement?

tachycardia & hyperventilation

what is the early sign of hypoxia

ALOC (irritable, confused, restless)

late sign of hypoxia

cyanosis, cyanotic nail bed, brittle hair

what happens when there is DOB but no wheezing

obstruction

when there is obstruction what is the DOC

epinephrine (next is steroids, O2, bronchodilator)

what is the management for bronchial asthma

Position: high fowler’s/upright

Administer O2 (1-2 lpm) ➡ notify physician pagka administer

Call for assistance (never leave patient unattended)

medications for bronchial asthma

Bronchodilators - Beta 2 agonist (-terol) Salmeterol, albutarol

Anti-cholinergic - (-tropium) Ipratropium, Tiotropium

Methyl xanthine - (-phulline) Aminophylline, therophylline

what do you need to WOF when administering bronchodilators

palpitations & tachycardia ➡ cardiac dysrhythmia ➡ cardiac arrest

what are the nursing considerations when administering methyl xanthine

monitor for therapeutic level (10 - 20)

avoid caffeinated, chocolates, tea (tannate) ➡ impairs absorption

meds to give for preventive measures in bronchial asthma

steroids & montelukast (leukotrienes)

nursing considerations in steroids

Parenteral (anytime)

Tablet (given after meals because it can cause GI discomfort)

Inhalation (gargle after because it can cause oral thrush)

Side effects: weight gain, moon face edema, stress ulcers

Never stop the medication abruptly; should be tapered

when is the best time to give montelukast

before bedtime (HS)

what are the side effects of montelukast

drowsiness, blurring of vision

it is a chronic + inflammatory disorder = airway obstruction

COPD

cause of COPD

smoking

what are the s/sx of emphysema

chronic cough, hypercapnea, barrel chest, polycythemia vera, pink puffers, pursed lip breathing, thin, hyperresonance, decreased fremitus

there is air trapping of CO2 in alveoli & overdistention of alveoli

emphysema

acid base of emphysema

respiratory acidosis

what causes continuous production of mucus

age + inflammation + damage to the goblet cells

s/sx of chronic bronchitis

chronic + productive cough, ⬆CO2, ⬇O2, blue bloaters (cyanosis), pulmonary hypertension, overweight, ronchi wheezing, peripheral edema

management for COPD

cessation of smoking

pulmonary toileting (secretions)

deep breathing exercises

pursed lip breathing

chest physiotherapy (done 3 - 4 times before meal)

⬆oral intake (3000ml/day)

small frequent feedings

what kind of mask is used in COPD

venturi mask (alternative is nasal cannula)

what is the diet for COPD

high caloric

high protein

low carbohydrate

moderate fat

medications for COPD

bronchodilators & mucolytics (acetylcysteine)

preventive measures for COPD

avoid places to extreme temperatures

up to date vaccination of influenzae & pneumonia

cause of rib fracture & flail chest

trauma

how many ribs affected in rib fracture

1

how many ribs affected in flail chest

2 or more

signs of rib fracture

chest pain

chest tenderness

shallow breathing