Respiratory A2

what helps keep in normal range of blood pH

O2 and CO2 help along with lungs

what happens when blood pH is not in range

organs start to fail

what system is respiratory system responsible for

ventilation and diffusion

ventilation

process of moving air in and out of respiratory tract

diffusion

process of moving and exchanging O2 and CO2 across alveolar capillary membranes

perfusion

process of moving and exchanging O2 and CO2 across alveolar capillary membranes

respiration

process in which cells in the body use oxygen for energy

inspiration

breathe in to get O2

unidirectional movement

inc chest cavity size and diaphragm goes down

expiration

remove CO2 from lungs

unidirectional movement

reduction in chest cavity and diaphragm relaxes to upward shape

hypoxia

oxygen depravation of cells

hypoxemia

decreased oxygen in arterial blood

where to O2 and CO2 exchange

capillary junction

surfactant

vital lubricant made of proteins that coat inner portion of alveolus

CO2 is an

acid

what does diffusion depend on\*\*\*\*

pressure (partial pressures of O2 and CO2)

solubility (CO2 is more soluble than O2)

membrane thickness

surface area

hypercapnia

increased CO2 in blood

respirations increase

releasing too much CO2

hyperventilating

carpal fetal spasms

cramped can’t really move

can but non rebreather with no O2

may pass out and reset respiratory drive

SOB

dyspnea

subjective sensation of uncomfortable breathing

orthopnea

dyspnea while lying down

paroxysmal nocturnal dyspnea (PND)

waking up gasping for air

coughs

can be acute or chronic

can be productive or non productive

abnormal sputum

amount, consistency, color

hemoptysis (blood)

abnormal breathing patterns

tachypnea

bradypnea

apnea

cheyne-stokes respirations

kussmaul respirations (hyperapnea)

tachypnea

rapid breathing

bradypnea

slow breathing

apnea

no breathing

cheyne-stokes respirations

respirations increase in rate and depth and then become shallow and slow

apnea may occur

kussmaul respiration

deep and rapid respirations

use of accessory muscles breathing

using stomach muscles

physical exam findings of respiratory disorders

adventitious lung sounds

use of accessory muscles

chest pain

barrel chest

clubbing (fingers)

cyanosis

systemic manifestations (fever, inc wbc)

mental status changes

edema (unilateral vs bilateral)(can be where area is dependent)

history of respiratory disorders

s/s

length of time of s/s

activities leading up to s/s

constant or intermittent

occupational or environmental exposures

past med/surg history

meds

allergies

smoking, substance, and family history

flail chest patho

blunt force trauma

fracture in 3 or more consecutive ribs in 2 or more separate places

cause an unstable segment of ribs

flail chest clinical manifestations

paradoxical movement during breathing

rapid shallow breathing

tachycardia

underlying lung could be contuses causing worsening hypoxemia

flail chest treatment

oxygen ventilation

O2 therapy

promote lung expansion

adequate oxygenation

Algeria can help promote adequate respiration

surgery

heals with time

pain for several weeks after resolved

may give analgesia

what to worry about with flail chest treatment

respiratory depression from meds

pneumothorax

air in plural space

pneumothorax facts

negative pressure become positive and lung collapses

primary or secondary

open or closed

primary pneumothorax

just pneumothorax occuring

secondary pneumothorax

in addition to an injury

what will you see on a pneumothorax x ray

black space indicating air

spontaneous (closed) pneumothorax

damage to pleura

air fills pleural space

drops negative pressure in thoracic cavity

affects lung recoil

lung collapses towards hilum

open pneumothorax

when penetrating object from outside punctures lung

closed pneumothorax

when inside body something penetrates the lung

iatrogenic pneumothorax

can be from a:

lung biopsy

barotrauma from ventilator

iatrogenic

from unknown cause or medical treatment

nosocomial infection

hospital acquired

tension pneumothorax

damage to pleural space via chest injury

air is allowed in with inspiration but not expired out

air pushes against the lung and mediastinum causing damage to alveoli and displacement of heart, great vessels, and trachea (mediastinal shift)

a tension pneumothorax is

VERY LIFE THREATENING

pneumothorax clinical manifestations

tachypnea

DOE

sudden onset pleuritic chest pain (classic sign)

decreased breath sounds on affected side (classic sign)

tracheal shift (tension pneumothorax)

mediastinal shift (tension pneumothorax)

classic signs of pneumothorax

sudden onset pleuritic chest pain

dec breath sounds on affected side

what can occur in a tension pneumothorax

tracheal shift

mediastinal shift

diagnosis of pneumothorax

h&p

chest x ray

ct chest

treatment of pneumothorax

chest tube (open)

needle decompression/chest tube+chest (tension)

pleurodesis (recurrent PTX)

where to decompress for tension pneumothorax

immediately through second anterior intercostal space

where is chest tube located

midaxillary line at the level of the nipple and directed posteriorly and superiorly toward apex of thorax

pleuritic chest pain

pain worse with breathing

nursing care of pneumothorax

assessment and monitoring of chest tube site/chest tube/pleurovac box

monitoring respiratory status

pain management

pleurodesis

shaking patient with talcum powder to help it adhere better

hemothorax patho

accumulation of blood in pleural space from injury to chest wall, diaphragm, lungs, blood vessels, or mediastinum

due to injury of chest wall, lungs, mediastinum, or blood vessels

a lot in GSW

hemothorax clinical manifestations

respiratory distress

tachycardia

dec or absent breath sounds

dullness to percussion

hypoxia

hypotension

hemothorax diagnostics

h&p

chest x ray

ct chest

chest ultrasound

hemothorax treatment

chest tube

autotransfusion

chlothorax patho

presence of lymphatic fluid in pleural space r/t damage to the lymphatic system

usually trauma or malignancy

chlothorax clinical manifestations

severe cough

chest pain

difficulty breathing

chlothorax diagnostics

h&p

chest x ray

chlothorax treatment

drainage

octreotide

pleurodesis

chest drainage system

to treat spontaneous and traumatic pneumothorax

postoperatively to re-expand lung and remove excess air, fluid, and blood

prevention of cardiopulmonary complication

assess clients vitals, reps and cardiovascular status regularly

type of drainage systems

traditional water seal

dry suction water seal

dry suction

do’s of chest tube

maintain water seal and patency of drainage system (tape connector site has straight line from bed to system, no KINKS in tubing, no pins/restraining tubing)

mark drainage on receptacle every shift (read at eye level, report if over 100ml/hr)

document color and drainage on I/o record and progress notes)

maintain integrity of system

dont’s of chest tubes

do not strip chest tubing unless orders

what to keep in room with chest tube

sterile water

rubber tipped clamps

sterile dressing materials (dry gauze, petroleum gauze and tape nearby)

what to do if chest tube disconnects

reattach after wiping ends quickly with alcohol

place distal end of tube un sterile water to restore underwater seal

what to do if chest tube comes out

apply petroleum gauze to opening immediately

always be certain to carry gloves and petroleum gauze when transporting or ambulating a patient with a chest tube

do NOT use hand to cover opening

what to see in chest tube water chamber

bubbling

where to place chest tube system or suction bottle

below level of the bed

why maintain suction control

to create bubbling because excess negative pressure can damage lung tissue

when is stripping done to chest tube

ONLY when ordered and within policy

when to clamp chest tube clamp

ONLY if agency policy dictates

pulmonary embolism

blockage of one or more pulmonary arteries by a thrombus

pe start

most commonly as a DVT in leg and migrates upward through right side of heart into pulmonary vascularture

why use petroleum gauze vs normal gauze to cover chest tube when disconnected

it creates a seal

what other components can cause pe

blood clot

tissue fragments

fat plaque

foreign body

air bubble

amniotic fluid

risk factors of pe

limited mobility

diseases that cause hypercoaguability (malignancy, inherited coagulation disorder)

oral contraceptive and hormone replacement use

injuries to vascular endothelial cells (trauma, infection)

genetic risk factors

smoking

smoke + birth control

blood clots

slow or stagnant blood

tissue fragments

related to IV drug use injections with dirty needles

fat plaque

rupture off epithelial wall of a vessel

foreign body

can be a bullet or pill

air embolism

iv injections

central line improperly removed

amniotic fluid

enters via the placental bed into maternal circulation often after a c-section, abortion, amniocentesis, or trauma

pe clinical manifestations

depends on size, type, and extent of emboli

acute onset SOB (classic sign)

pleuritic chest pain (classic sign)

cough

hemoptysis

crackles

wheezing

tachypnea/tachycardia +/- blood pressure changes

anxiety

syncope

pe classic signs

acute onset SOB

pleuritic chest pain

pe diagnostics labs

d dimer

pt/inr

ptt

pe diagnostics

ct w/ iv contrast

vq scan (nuclear medicine) (perfusion scan involves iv injection of radiosotope which shows pulmonary circulation)(ventilation scanning involves inhaling radioactive gas which shows gas distribution through the lung)

ultrasound (right heart strain on ultrasound with mastic pe is classic sign)

pe treatment

anticoagulants (heparin, lovenox, Coumadin)

tpa in extreme cases

surgery (pulmonary embolectomy, IVC filter)

pe nursing care

vitals

monitor anticoagulants labs (PTT vs unfractionated heparin level vs factor Xa)

monitor signs of bleeding and decline respiratory status

acute respiratory distress syndrome (ARDS) patho

severe acute inflammation and pulmonary edema without evidence of fluid overload or impaired cardiac function

causes of ARDS

severe lung infection, aspiration, SEPSIS

ARDS progression

lung injury to respiratory distress within 24-48 hours

ARDS can be

revered if caught early

mortality rate ARDS

30-40% from multi system organ failure in those untreated