1st Week Medsurge Prelims PDF

FUNCTIONS OF THE RESPIRATORY SYSTEM 1. Breathing - movement of air in and out of the lungs....

FUNCTIONS OF THE RESPIRATORY SYSTEM 1. Breathing - movement of air in and out of the lungs. a) Inhalation (inspiration) draws gases into the lungs RESPIRATORY SYSTEM b) Exhalation (expiration) forces gases out of the lungs 2. Gas Exchange Is made up of the organs in your body that help you 3. Body Temperature Regulation breathe. Remember, that RESPIRATION = BREATHING 4. Voice Production (Vocalization) - Subjective sensation of Uncomfortable Breathing, 5. Site for Olfactory Sensation feeling “short of breath” The goal of breathing is to deliver Oxygen to the Body 6. Regulation of the pH of the Blood - Ranges from Mild Discomfort after exertion to extreme difficulty and to take away Carbon Dioxide 7. Defensive Functions: This occurs through: breathing at rest a) Hairs - Usually caused by diffuse and extensive rather than focal b) Sneezing Reflex pulmonary disease ! Daily 10,000 Liters of Air - Filtered c) Cough Reflex  Due to: d) Secretion of Immunoglobulins i. Greater force needed to provide adequate ventilation F RESPIRATION ii. Wheezing sound due to air being forced through airways narrowed due to constriction or fluid 1. External Respiration: which consists of: accumulation a) Pulmonary VENTILATION: means the Exchange of Air between the Lungs and Atmosphere.  Signs of Dyspnea b) Pulmonary PERFUSION: means the Flow of Blood  Flaring Nostrils through the Pulmonary Capillaries.  Use of Accessory Muscles in Breathing c) The Pulmonary RESPIRATION: means the Exchange of  Retraction (Pulling Back) of Intercostal Spaces Gases between Alveolar Air and Blood 2. Transport of Oxygen and Carbon Dioxide by the Blood. 3. The Internal Respiration: means the Exchange of Gases between Tissues and Systemic Blood Vessels - Normal breathing (EUPNEA) is Rhythmic and Effortless. - Ventilatory Rate is 8 to 16 Breaths per Minute, and ! Respiratory Diseases are often classified as: - Tidal Volume ranges from 400-800 mL 1. Acute or Chronic - The rate, depth, regulatory and effort of breathing undergo 1. Upper Respiratory Passages 2. Obstructive or Restrictive characteristic alterations in response to physiologic and - Include: Nose, Nasal Cavity, Sinuses, and Pharynx. 3. Infectious or Non-infectious pathophysiologic conditions… - They warm and humidify air. Abdominal contents to exert pressure on the diaphragm, and 2. Lower Respiratory Passages decreases the efficiency of the respiratory muscles. 1. Inadequate to the Lungs - - Some individuals with left ventricular failure wake up at night i. Include: , , ,. 2. Inadequte to the Alveoli - gasping for air and must sit up or stand to relieve the dyspnea. This - Conduct air to respiratory surfaces, also warm type of positional dyspnea is termed: and humidify air  ; PND Results from fluid in the Lungs caused by the redistribution of i. Include: , , and body water while the individual is recumbent - Undergo gas exchange between Air and Blood  ACUTE COUGH  It is a cough that resolves within 2 to 3 weeks of the onset  is inadequate alveolar ventilation in relation to metabolic of illness or resolves with treatment of the underlying  ; is characterized by: demands. It is caused by allterations in pulmonary mechanics condition.  A slightly increased ventilatory rate, or in the neurologic control of breathing.  It is commonly the result of:  Very large tidal volume,  With hypoventilation, CO2 removal does not keep up with CO2  Upper Respiratory Infections,  No expiration pause. production and (PaCO2>44 mmHg).  Allergic Rhinitis,  Strenuous exercise or metabolic acidosis induces Kussmaul  This results in , which can affect the  Acute Bronchities, Respiration function of many tissues throughout the body. (Somnolence  Pneumonia, or Disorientation).  Congestive Heart Failure,  ; consists of:  Pulmonary Embolus,  slow ventilatory rate,  Is alveolar ventilation that exceeds metabolic demands. The  Aspiration  large tidal volume, lungs remove CO2 at a faster rate than it is produced by  increased effort, and cellular metabolism, resulting in decreased PaCO2 or CHRONIC COUGH  prolonged inspiration or expiration, depending on the site hypocapnia (PaCO2 Blood + Pus= Pneumococcal Pneumonia flow 3) If  Airway obstruction - reduced ventilation  In persons with dark skin can be seen in the whites of 4) (airways of the lungs the eyes and mucous membranes become widened, leading to build up of excess mucus that can make the lungs more vulnerable to infection) 5) (inherited disease caused by defective gene. It affects that cell that produces mucus, sweat, and digestive juices.)  Pain caused by pulmonary disorders originates in the pleurae, airways or chest wall.  Pleural pain is the most common pain caused by pulmonary disease and is usually sharp or stabbing in character, (infection and inflammation)  Pleural pain is also common with pulmonary infarction caused by pulmonary embolism.   Assess for allergies to iodine, seafood, or other radiopaque dyes  Maintain NPO status of the client for 8 hours before the procedure.  Remove all jewelry and other metal objects from the chest area.  Monitor vital signs  Assess the client’s ability to inhale and hold his or her breath.  Assess results of coagulation studies  Question women regarding pregnancy  Instruct the client to lie still during the procedure.  Help the client get dressed after the procedure  Instruct the client that he or she may feel an urge to cough, flushing, nausea, or a salty taste following injection of the dye.  Have emergency resuscitation equipment available  Avoid taking BP for 24 hours in the extremity used for the injection  Assess insertion site for bleeding  Monitor for delayed reaction to the dye  Direct visual examination of the larynx, trachea, and bronchi with a fiberoptic bronchoscope  Obtain informed consent  Maintain NPO status for the client from midnight before the procedure.  An invasive fluoroscopic procedure in which a catheter is  Obtain vital signs inserted through the antecubital or femoral vein into the  Remove dentures or eyeglasses pulmonary artery or one of its branches.  Prepare suction equipment  Specimen obtained by expectoration or tracheal suctioning to  Involves an injection of iodine or radiopaque contrast material.  Establish an IV access as necessary and administer medication for assist in the identification of organisms or abnormal cells.  Obtain informed consent sedation as prescribed.  Obtain an early morning sterile specimen from suctioning or  Have emergency resuscitation equipment available expectoration  Maintain the client in semi-fowler’s position after the procedure.  Instruct the client to rinse the mouth with water before  Assess for the return of gag reflex collection.  Have an emesis basin readily available for the client to  Obtain at least 15 mL of sputum expectroate sputum.  Instruct client to take several deep breaths and then cough  Monitor for bloody sputum deeply to obtain sputum  Notify the physician if Fever, Difficulty in breathing, or other signs  Always collect the specimen before the client begins antibiotic of complications occur following the procedure. therapy  If a culture of sputum is prescribed, transpoty the specimen to the laboratory immediately  Assist the client with mouth care.   After the procedure, client may resume normal diet and any bronchodilators and respiratory treatments that were held  Measurement of the dissolved oxygen and carbon dioxide in the  Removal of fluid or air from the pleural space via transthoracic before the procedures. arterial blood that helps indicate the acid-base state and how aspiration well oxygen is being carried to the body.  Obtain informed consent  Perform Allen’s Test before drawing radial artery specimens.  Obtain vital signs  Have the client rest for 30 minutes before specimen collection to  Prepare the client for ultrasound or chest radiograph if ensure accurate measurement of body oxygenation. prescribed before the procedure  Avoid suctioning before drawing the ABG sample  Note that the client is positioned sitting upright with the arms  Do not turn off oxygen unless the ABG sample is ordered to be and shoulders supported by a table at the bedside during the drawn with the client breathing room air. procedure.  Place specimen on ice  If client cannot sit up, the client is placed, lying in bed towards  Note the client temperature on the lab form the unaffected side, with the head of the bed elevated.  Note the oxygen and type of ventilation the client is receiving on  Instruct the client not to cough, breathe deeply, or move during the lab form the procedure  Apply pressure to the puncture site for 5 to 10 minutes or longer  Apply a pressure dressing, and assess the puncture site for if the client is taking anticoagulant therapy or has a bleeding bleeding disorder.  Transport the specimen to the laboratory within 15 minutes.  Obtain informed consent  Assess the client for allergies to dye, iodine, or seafood  Remove jewelry around the chest area  Review breathing methods that may be required during testing  Monitor client for reaction to the radionuclide  Instruct client that the radionuclide clears from the body in about 8 hours  Tests used to evaluate lung mechanics, gas exchange, and acid- base disturbance through spirometric measurements, Lung volumes, and arterial blood gas levels.  Consult with the physician regarding holding bronchodilators NOTE! before testing. In an arterial blood gas (ABG) analysis, pH, PaCO2, and HCO3-  Instruct the client to void before the procedure and to wear (bicarbonate) are key measurements used to assess the body’s acid- loose clothing. base balance and oxygenation. These are what they represent:  Remove dentures.  Instruct the client to refrain from smoking or eating a heavy meal for 4 to 6 hours before the test. A. pH: measures the acidity or alkalinity of the blood. i. Normal Range: 7.35 to 7.45  Apply direct pressure over the client’s ulnar and radial arteries  A percutaneous lung biopsy is performed to obtain tissue for Interpretation: simultaneously. analysis by culture or cytological examination  A pH below 7.35 ACIDOSIS (Excess acid in the blood).  While applying pressure, ask the client to open and close the  A needle biopsy is done to identify pulmonary lesions changes in  A pH above 7.45 indicates ALKALOSIS (Excess base in had repeatedly; the hand should blanch lung tissue,a nd the cause of pleural effusion the blood)  Release pressure from the ulnar artery while compressing the  Obtain informed consent radial artery and assess the color of the extremity distal to the  Maintain NPO Status of the client before the procedure. B. PaCO2 (Partial Pressure of Carbon Dioxide): reflects the amount pressure point.  Inform client that a local anesthetic will be used but a sensation of Carbon Dioxide (CO2) In the arterial blood and is a measure  If pinkness fails to return within 6 seconds, the ulnar artery is of pressure doing needle insertion and aspiration may be felt. of how well the lungs are removing CO2. insufficient, indicating that the radial artery should not be  Apply a dressing to the biopsy site and monitor drainage over i. Normal Range: 35 to 45 mmH. used for obtaining a blood specimen bleeding. Interpretation:  Monitor for Signs of Respiratory distress, and notify the physician  A high PaCO2 (>45 mmHg) suggests RESPIRATORY if they occur. ACIDOSIS, where CO2 retained, often due to  Is a non-invasive test that registers the oxygen saturation of  Prepare client for chest radiography if prescribed. HYPOVENTILATION the client’s hemoglobin  A low PaCO2 (26 mEq/L) indicates METABOLIC  Do not select an extremity with an impediment to blood flow ALKALOSIS (Excess bicarbonate or loss of acid)  Results lower than 91% necessitate immediate treatment  A decreased HCO3- (22 mEq/L) suggests METABOLIC  If the oxygen saturation is lower than 85% oxygenation to body ACIDOSIS (Bicarbonate deficit or excess acid). tissues is compromized; If less than 70% it is life threatening