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- 1. Respiratory System NURS156 Kapi’olani Community College
- 2. CH 26 – Respiratory System Review terms, Physiology, assessment – objective and subjective Discussion Diagnostic studies: Radiologic studies biopsy, bronchoscopy thorencentesis, Cultures ABG pulmonary function tests Common assessment abnormalities
- 3. Respiratory Function UPPER LOWER Warm Conduction of air, filter, mucocilliary & humidify clearance, production of inspired air pulmonary surfactant
- 4. Principles of gas exchange
- 5. Major functions: z Delivery of oxygen to the blood z removal of carbon dioxide z Control of acid-base balance
- 7. Ventilation The Process of Breathing z Inspiration: the active phase of ventilation z Negative pressure
- 8. Ventilation The Process of Breathing z Expiration: the passive phase of ventilation Increase in intrapulmonic pressure
- 9. total volume= amount of air inhaled and exhaled with each breath=1/2L total lung capacity=6L
- 10. Diagnostic Test: Pulmonary Function Tests (PFTs) total volume= amount of air inhaled and exhaled with each breath=1/2L total lung capacity=6L
- 11. Diagnostic Test: Pulmonary Function Tests (PFTs) total volume= amount of air inhaled and exhaled with each breath=1/2L total lung capacity=6L z Pulmonary Function Tests (PFTs)
- 12. Diagnostic Test: Pulmonary Function Tests (PFTs) total volume= amount of air inhaled and exhaled with each breath=1/2L total lung capacity=6L z Pulmonary Function z Measures the client’s volume of air in the lung with Tests (PFTs) inhalation & exhalation
- 13. Diagnostic Test: Pulmonary Function Tests (PFTs) total volume= amount of air inhaled and exhaled with each breath=1/2L total lung capacity=6L z Pulmonary Function z Measures the client’s volume of air in the lung with Tests (PFTs) inhalation & exhalation z Nursing Responsibilities y No bronchodilators or smoking 6 hours before the test y Instruction on how to inhale & exhale, reason for the test y Inform client that may feel short of breath (SOB) y Provide comfort as needed
- 16. Diagnostic Test: Thoracentesis z Purpose is to ___remove fluid or air from plural space________
- 17. Diagnostic Test: Thoracentesis z Purpose is to ___remove fluid or air from plural space________ z Nursing Responsibilities y Client must be _NPO__________________ y Client must not move and be able to _hold_ their breath y Monitor VS, for dyspnea, pain and difficulty breathing
- 20. Diagnostic Tests: Thoracentesis Cont’d z Tachypnea, dyspnea, cyanosis, retractions or ↓ breath sounds may indicate a _calapsed lung/ pneumothorax______ ______
- 21. Diagnostic Tests: Thoracentesis Cont’d z Tachypnea, dyspnea, cyanosis, retractions or ↓ breath sounds may indicate a _calapsed lung/ pneumothorax______ ______
- 22. Diagnostic Tests: Thoracentesis Cont’d z Tachypnea, dyspnea, cyanosis, retractions or ↓ breath sounds may indicate a _calapsed lung/ pneumothorax______ ______ z Define what this is.
- 23. Diagnostic Tests: Thoracentesis Cont’d z What should you record z Tachypnea, dyspnea, and where? cyanosis, retractions or ↓ breath sounds may indicate a _calapsed lung/ pneumothorax______ ______ z Define what this is.
- 24. Diagnostic Tests: Thoracentesis Cont’d z What should you record z Tachypnea, dyspnea, and where? cyanosis, retractions how the pt tolerated it, or ↓ breath sounds sent to lab, VS for before and after, O2 sats, may indicate a premeditate, education, _calapsed lung/ amount of fluid taken out pneumothorax______ and from where. ______ z Define what this is.
- 25. Diagnostic Tests: Thoracentesis Cont’d z What should you record z Tachypnea, dyspnea, and where? cyanosis, retractions how the pt tolerated it, or ↓ breath sounds sent to lab, VS for before and after, O2 sats, may indicate a premeditate, education, _calapsed lung/ amount of fluid taken out pneumothorax______ and from where. ______ z You must obtain _concent_ before procedure z Define what this is.
- 26. Diagnostic Tests: Thoracentesis Cont’d z What should you record z Tachypnea, dyspnea, and where? cyanosis, retractions how the pt tolerated it, or ↓ breath sounds sent to lab, VS for before and after, O2 sats, may indicate a premeditate, education, _calapsed lung/ amount of fluid taken out pneumothorax______ and from where. ______ z You must obtain _concent_ before procedure z Define what this is. z Why?
- 28. Diagnostic Test: Arterial Blood Gas (ABG)
- 29. Diagnostic Test: Arterial Blood Gas (ABG) z Uses arterial blood to measure PaO2, PaCO2, pH & HCO3-
- 30. Diagnostic Test: Arterial Blood Gas (ABG) z Uses arterial blood to measure PaO2, PaCO2, pH & HCO3- z Done by doctors &/or specialized nurses/or RT
- 31. Diagnostic Test: Arterial Blood Gas (ABG) z Uses arterial blood to measure PaO2, PaCO2, pH & HCO3- z Done by doctors &/or specialized nurses/or RT z Must know amount of oxygen receiving
- 32. Diagnostic Test: Arterial Blood Gas (ABG) z Uses arterial blood to measure PaO2, PaCO2, pH & HCO3- z Done by doctors &/or specialized nurses/or RT z Must know amount of oxygen receiving z Allen test must be completed before the procedure (what pulses need to be assessed?)
- 33. Diagnostic Test: Arterial Blood Gas (ABG) z Uses arterial blood to measure PaO2, PaCO2, pH & HCO3- z Done by doctors &/or specialized nurses/or RT z Must know amount of oxygen receiving z Allen test must be completed before the procedure (what pulses need to be assessed?) z After the procedure, continuous pressure must be applied to the site, i.e., 5” for ___________________ arteries and 10 minutes for ____________
- 34. Diagnostic Test: Arterial Blood Gas (ABG) z Uses arterial blood to measure PaO2, PaCO2, pH & HCO3- z Done by doctors &/or specialized nurses/or RT z Must know amount of oxygen receiving z Allen test must be completed before the procedure (what pulses need to be assessed?) z After the procedure, continuous pressure must be applied to the site, i.e., 5” for ___________________ arteries and 10 minutes for ____________ z Know normal values of the above
- 36. ABGs: Definitions & Normals Review p. 336-7
- 37. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood
- 38. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood
- 39. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z PaO2 - partial pressure of O2 in arterial blood
- 40. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z PaO2 - partial pressure of O2 in arterial blood
- 41. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z PaO2 - partial pressure of O2 in arterial blood z PaCO2 - partial pressure of CO2 in arterial blood
- 42. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z PaO2 - partial pressure of O2 in arterial blood z PaCO2 - partial pressure of CO2 in arterial blood
- 43. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z PaO2 - partial pressure of O2 in arterial blood z PaCO2 - partial pressure of CO2 in arterial blood z HCO3- - Amount of bicarbonate in arterial blood
- 44. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z PaO2 - partial pressure of O2 in arterial blood z PaCO2 - partial pressure of CO2 in arterial blood z HCO3- - Amount of bicarbonate in arterial blood
- 45. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z PaO2 - partial pressure of O2 in arterial blood z PaCO2 - partial pressure of CO2 in arterial blood z HCO3- - Amount of bicarbonate in arterial blood z BE - Base excess
- 46. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z 7.35 - 7.45 z PaO2 - partial pressure of O2 in arterial blood z PaCO2 - partial pressure of CO2 in arterial blood z HCO3- - Amount of bicarbonate in arterial blood z BE - Base excess
- 47. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z 7.35 - 7.45 z PaO2 - partial pressure of O2 in arterial blood z 80 - 100mm Hg z PaCO2 - partial pressure of CO2 in arterial blood z HCO3- - Amount of bicarbonate in arterial blood z BE - Base excess
- 48. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z 7.35 - 7.45 z PaO2 - partial pressure of O2 in arterial blood z 80 - 100mm Hg z PaCO2 - partial pressure of CO2 in z 35 - 45 mm Hg arterial blood z HCO3- - Amount of bicarbonate in arterial blood z BE - Base excess
- 49. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z 7.35 - 7.45 z PaO2 - partial pressure of O2 in arterial blood z 80 - 100mm Hg z PaCO2 - partial pressure of CO2 in z 35 - 45 mm Hg arterial blood z HCO3- - Amount of bicarbonate in z 21 - 29 mEq/L arterial blood z BE - Base excess
- 50. ABGs: Definitions & Normals Review p. 336-7 z pH - acidity or alkalinity of blood z 7.35 - 7.45 z PaO2 - partial pressure of O2 in arterial blood z 80 - 100mm Hg z PaCO2 - partial pressure of CO2 in z 35 - 45 mm Hg arterial blood z HCO3- - Amount of bicarbonate in z 21 - 29 mEq/L arterial blood z BE - Base excess z +2
- 52. Diagnostic Test: Oximetry z Assesses oxygenation non-invasively & continuously
- 53. Diagnostic Test: Oximetry z Assesses oxygenation non-invasively & continuously
- 54. Diagnostic Test: Oximetry z Assesses oxygenation non-invasively & continuously z Sometimes called the “5th” vital sign
- 55. Diagnostic Test: Oximetry z Assesses oxygenation non-invasively & continuously z Sometimes called the “5th” vital sign
- 56. Diagnostic Test: Oximetry z Assesses oxygenation non-invasively & continuously z Sometimes called the “5th” vital sign z Most commonly seen on the finger, ear lobe or toe
- 57. Diagnostic Test: Oximetry z Assesses oxygenation non-invasively & continuously z Sometimes called the “5th” vital sign z Most commonly seen on the finger, ear lobe or toe
- 58. Diagnostic Test: Oximetry z Assesses oxygenation non-invasively & continuously z Sometimes called the “5th” vital sign z Most commonly seen on the finger, ear lobe or toe z SaO2 closely correlates to the pulse oximetry > 70%
- 59. Diagnostic Test: Oximetry z Assesses oxygenation non-invasively & continuously z Sometimes called the “5th” vital sign z Most commonly seen on the finger, ear lobe or toe z SaO2 closely correlates to the pulse oximetry > 70%
- 60. Diagnostic Test: Oximetry z Assesses oxygenation non-invasively & continuously z Sometimes called the “5th” vital sign z Most commonly seen on the finger, ear lobe or toe z SaO2 closely correlates to the pulse oximetry > 70% z Movement, hypotension, hypothermia and vasocon- striction reduce arterial blood flow to the sensor
- 61. Diagnostic Test: Bronchoscopy z Reasons for this test: Post-procedure Dx & therapeutic x Monitor VS z Responsibilities x Assess for respiratory distress: Pre-procedure dyspnea, Δs in RR & x obtain informed consent breath sounds, use x NPO ≥ 6 hours of accessory x remove prostheses: muscles, hemoptysis dentures, contacts, etc. x topical anesthetic to x Withhold fluids till throat and IV started _gag reflex_ returns
- 62. Diagnostic Test: Sputum & Nose/Throat Cultures
- 63. Diagnostic Test: Sputum & Nose/Throat Cultures z Sputum Culture SPUTUM NOT SPIT y Client brushes teeth first & coughs into the container y Best to obtain in early AM y Assess for amount, consistency, color, odor & contents
- 64. Diagnostic Test: Sputum & Nose/Throat Cultures z Sputum Culture Nose/Throat Culture SPUTUM NOT SPIT y Client brushes teeth first & coughs into the container y Best to obtain in early AM y Assess for amount, consistency, color, odor & contents
- 65. Diagnostic Test: Sputum & Nose/Throat Cultures z Sputum Culture Nose/Throat Culture SPUTUM NOT SPIT z Nose or throat is swabbed y Client brushes teeth with a sterile cotton swab first & coughs into and placed in a tube & the container sent to lab ASAP y Best to obtain in early AM y Assess for amount, consistency, color, odor & contents
- 66. Diagnostic Test: Sputum & Nose/Throat Cultures z Sputum Culture Nose/Throat Culture SPUTUM NOT SPIT z Nose or throat is swabbed y Client brushes teeth with a sterile cotton swab first & coughs into and placed in a tube & the container sent to lab ASAP y Best to obtain in early AM z For tubes that have fluid, y Assess for amount, the swab should not touch consistency, color, it unless it is a medium odor & contents
- 67. Radiological Diagnostic Tests checking for pulmonary embolism z Scans: Ventilation/ Normal X-ray Perfusion (V/Q) z V → Ventilation z Q → Perfusion z What are the implications of a V/Q scan?
- 68. Diagnostic Tests: Skin z PPD - What is this test used for? y Properly administered y Read when? y Implications of the test z Allergy Testing y Administered properly y Emergency equipment readily available Why?
- 70. Common Causes of Lung Problems
- 71. Common Causes of Lung Problems z Inhaled pollutants such as cigarette smoke
- 72. Common Causes of Lung Problems z Inhaled pollutants such as cigarette smoke z Irritation of the airways
- 73. Common Causes of Lung Problems z Inhaled pollutants such as cigarette smoke z Irritation of the airways z Infections
- 74. Common Causes of Lung Problems z Inhaled pollutants such as cigarette smoke z Irritation of the airways z Infections z Chronic Diseases
- 75. Common Causes of Lung Problems z Inhaled pollutants such as cigarette smoke z Irritation of the airways z Infections z Chronic Diseases z Secondary to Other Diseases/Problems
- 76. Common Causes of Lung Problems z Inhaled pollutants such as cigarette smoke z Irritation of the airways z Infections z Chronic Diseases z Secondary to Other Diseases/Problems z Cancer
- 77. Assessment 517-525 z Subjective Data z Objective Data z Chief complaint z Physical Assessment z Pain z Color z Pharmacology z Clubbing, Cap refill z Hx of Resp Problems z Chest symmetry z Breath sounds z Family Hx z Diagnostic Tests z Environment/ Occupation z Labs z Risk Factors z Other
- 78. Assessment z Normal Lung z Abnormal Lung Sounds Sounds z Bronchial z Crackles z Bronchovesicular z Wheezes z Vesicular z Rhonchi
- 79. absent can mean, bronchospasm, sever pneumonia, collapsed lung
- 80. Abnormal findings absent can mean, bronchospasm, sever pneumonia, collapsed lung
- 81. Abnormal findings • Bradypnea absent can mean, bronchospasm, sever pneumonia, collapsed lung
- 82. Abnormal findings • Bradypnea • Eupnea=normal absent can mean, bronchospasm, sever pneumonia, collapsed lung
- 83. Abnormal findings • Bradypnea • Eupnea=normal • Propnes absent can mean, bronchospasm, sever pneumonia, collapsed lung
- 84. Abnormal findings • Bradypnea • Eupnea=normal • Propnes • Tachypnea absent can mean, bronchospasm, sever pneumonia, collapsed lung
- 85. Abnormal findings • Bradypnea • Eupnea=normal • Propnes • Tachypnea • Fremitis=can feel secreations absent can mean, bronchospasm, sever pneumonia, collapsed lung
- 86. Abnormal findings • Bradypnea • Eupnea=normal • Propnes • Tachypnea • Fremitis=can feel secreations • Bronchophony absent can mean, bronchospasm, sever pneumonia, collapsed lung
- 87. Abnormal findings • Bradypnea • Eupnea=normal • Propnes • Tachypnea • Fremitis=can feel secreations • Bronchophony • Egophony absent can mean, bronchospasm, sever pneumonia, collapsed lung
- 88. Abnormal findings • Bradypnea • Eupnea=normal • Propnes • Tachypnea • Fremitis=can feel secreations • Bronchophony • Egophony • Whispered pectoriloquy absent can mean, bronchospasm, sever pneumonia, collapsed lung
- 89. Abnormal findings • Bradypnea • Eupnea=normal • Propnes • Tachypnea • Fremitis=can feel secreations • Bronchophony • Egophony • Whispered pectoriloquy absent can mean, • Pleural friction rub bronchospasm, sever pneumonia, collapsed lung
- 90. Abnormal findings • Bradypnea • Orthopnea • Eupnea=normal • Propnes • Tachypnea • Fremitis=can feel secreations • Bronchophony • Egophony • Whispered pectoriloquy absent can mean, • Pleural friction rub bronchospasm, sever pneumonia, collapsed lung
- 91. Abnormal findings • Bradypnea • Orthopnea • Eupnea=normal • Dyspnea • Propnes • Tachypnea • Fremitis=can feel secreations • Bronchophony • Egophony • Whispered pectoriloquy absent can mean, • Pleural friction rub bronchospasm, sever pneumonia, collapsed lung
- 92. Abnormal findings • Bradypnea • Orthopnea • Eupnea=normal • Dyspnea • Propnes • Hemoptysis • Tachypnea • Fremitis=can feel secreations • Bronchophony • Egophony • Whispered pectoriloquy absent can mean, • Pleural friction rub bronchospasm, sever pneumonia, collapsed lung
- 93. Abnormal findings • Bradypnea • Orthopnea • Eupnea=normal • Dyspnea • Propnes • Hemoptysis • Tachypnea • Cyanosis • Fremitis=can feel secreations • Bronchophony • Egophony • Whispered pectoriloquy absent can mean, • Pleural friction rub bronchospasm, sever pneumonia, collapsed lung
- 94. Abnormal findings • Bradypnea • Orthopnea • Eupnea=normal • Dyspnea • Propnes • Hemoptysis • Tachypnea • Cyanosis • Fremitis=can feel • Pursed lips secreations • Bronchophony • Egophony • Whispered pectoriloquy absent can mean, • Pleural friction rub bronchospasm, sever pneumonia, collapsed lung
- 95. Abnormal findings • Bradypnea • Orthopnea • Eupnea=normal • Dyspnea • Propnes • Hemoptysis • Tachypnea • Cyanosis • Fremitis=can feel • Pursed lips secreations • Accessory muscles • Bronchophony • Egophony • Whispered pectoriloquy absent can mean, • Pleural friction rub bronchospasm, sever pneumonia, collapsed lung
- 96. Abnormal findings • Bradypnea • Orthopnea • Eupnea=normal • Dyspnea • Propnes • Hemoptysis • Tachypnea • Cyanosis • Fremitis=can feel • Pursed lips secreations • Accessory muscles • Bronchophony • Kussmaul • Egophony • Whispered pectoriloquy absent can mean, • Pleural friction rub bronchospasm, sever pneumonia, collapsed lung
- 97. Abnormal findings • Bradypnea • Orthopnea • Eupnea=normal • Dyspnea • Propnes • Hemoptysis • Tachypnea • Cyanosis • Fremitis=can feel • Pursed lips secreations • Accessory muscles • Bronchophony • Kussmaul • Egophony • Absent sounds • Whispered pectoriloquy absent can mean, • Pleural friction rub bronchospasm, sever pneumonia, collapsed lung
- 99. TERMINOLOGY
- 104. TERMINOLOGY z Hypoxemia z Hypoxia z Hyperventilation
- 105. TERMINOLOGY z Hypoxemia z Hypoxia z Hyperventilation
- 106. TERMINOLOGY z Hypoxemia z Hypoxia z Hyperventilation z Hypoventilation
- 107. TERMINOLOGY z Hypoxemia z ↓ in O2 in the lungs z Hypoxia z Hyperventilation z Hypoventilation
- 108. TERMINOLOGY z Hypoxemia z ↓ in O2 in the lungs z Hypoxia z ↓ in O2 in the tissue z Hyperventilation z Hypoventilation
- 109. TERMINOLOGY z Hypoxemia z ↓ in O2 in the lungs z Hypoxia z ↓ in O2 in the tissue z Hyperventilation z decrease in CO2 z Hypoventilation
- 110. TERMINOLOGY z Hypoxemia z ↓ in O2 in the lungs z Hypoxia z ↓ in O2 in the tissue z Hyperventilation z decrease in CO2 z Hypoventilation z increase in CO2
- 111. Chapter 27 – Upper Respiratory Problems Deviated septum Nasal fracture Polyps Pharyngitis/ laryngitis Laryngeal Cancer epitaxis means nose
- 112. Laryngeal Cancer z Malignant tumor of larynx z Spread by local extension z Presents as malignant ulceration z Diagnosis made by laryngoscope and biopsy showing positive cytological study for cancer cells horseness over 2 weeks should be checked out
- 113. Laryngeal Cancer S/S z Early signs: hoarseness, voice changes, hemoptysis, z Late signs: dyspnea, obstruction, dysphagia, weight loss, pain, decreased tongue mobility
- 114. Laryngeal Cancer s/s Laryngeal Polyps z there are usually no early signs but later the patient may have dyspnea, airway obstruction, dysphagia, weight loss & hemoptysis Supraglottic – false vocal cord z early signs include aspiration on swallowing liquids, persistent unilateral sore throat, feeling of something “stuck” in the throat, dysphagia, weight loss, neck mass, hemoptysis and late signs include dyspnea, pain in the throat or referred to the ear
- 115. Diagnostic tests z Visual inspection w/laryngeal mirror or flexible nasopharyngoscope z CT, MRI, PET- shows local and regional spread z Multiple biopsy specimens to determine extent z Disease is staged based on tumor size, number and location of involved nodes, and extent of metastasis
- 116. Laryngeal Cancer treatment Radiation z Partial laryngectomy z Supraglottic tumors with metastasis Laser Surgery z Partial, total, and modified
- 117. Surgery z Total Laryngectomy y Used for large glottic tumors where there is suturing of the trachea to the neck y no risk of aspiration because the trachea and esophagus is separated permanently by the surgery
- 118. Postop Concerns z Postop Concerns concentration on the airway/ respiratory status, e.g., trach suctioning/care, lung sounds, complications y HIGH Risk for aspiration, infection, gas exchange y Ineffective airway clearance, y nutrition y Swallowing Techniques y Communication concerns
- 119. Surgery Radical Neck Dissection (en bloc) z Indicated when there is metastasis to the cervical nodes z lymphatic channels and nodes, sternocleido-mastoid muscle, spinal accessory nerve, jugular vein and submandibular tissue are removed z Complications: hemorrhage, fistulas, airway obstruction
- 120. Radical dissection Radical Neck Dissection y Preop- The usual with concentration on body image/self esteem concerns y Postop-↑ edema can interfere with airway usually due to inflammation or bleeding y Positioning in Semi-Fowler’s to ↓ edema y Frozen shoulder
Notas do Editor
- These components are broken up into sections – Many texts discuss these sections separately because their function and diseases are specific and different
- Ventilation – movement of air in and out (breathing) Respiration – gas exchange btw the atmosphere air in the alveoli and blood in capillaries Perfusion – process by which oxygenated blood passes through to body tissues.
- Delivery – we need : blood, hemoglobin, a good heart, and arteries. Used for removal of wastes – blood, hemoglobin, heart and veins Control of acid base through ventilation – assessory muscles, diaphragm which increases depth of inspiration Chemo receptors in medulla and carotid bodies. Lungs major purpose is to breathe in O2 which combines with glucose to make energy, water and CO2 The lungs also exhale CO2 (a waste product)
- Diffusion or the transfer of a substance from an area of high_concentration to low concentration or pressure. This occurs at the alveolar-capillary level (external respiration) and the tissue level (internal respiration) Surfactant – detergent phospholipid reduces surface tension between moist membranes of alveoli. Preventing collapse. Pleural fluid acts as a lubricant and as an adhesive agent to hold lungs in expanded position (2-3 mL of fluid) Pressure in pleural space is negative pressure. Alveoli - What are their major purpose? Respiration – transfer of O2 to blood tissue and CO2 exhallation
- The lungs do the above using the diaphragm which is the main muscle for breathing. It contracts and descends in the thorax making negative pressure. The ribs expand with the diaphragm. Lungs fill with air because of pressure gradients. The pressure inside the chest is < the pressure outside making it possible for air to fill the lungs until the pressure equalizes
- Diaphragm relaxes, ribs relax, decrease in lung volume. This causes an increase in intra-pulmonic pressure which forces the air out.
- Measures volumes of inspired, expired, and retained volume of air Tidal volume &#x2013; Volume of air inhaled and exhaled with each breath normal 0.5 L Total lung capacity &#x2013; Max volume of air that lungs can obtain Normal 6.0 L
- Measures volumes of inspired, expired, and retained volume of air Tidal volume &#x2013; Volume of air inhaled and exhaled with each breath normal 0.5 L Total lung capacity &#x2013; Max volume of air that lungs can obtain Normal 6.0 L
- Measures volumes of inspired, expired, and retained volume of air Tidal volume &#x2013; Volume of air inhaled and exhaled with each breath normal 0.5 L Total lung capacity &#x2013; Max volume of air that lungs can obtain Normal 6.0 L
- Measures volumes of inspired, expired, and retained volume of air Tidal volume &#x2013; Volume of air inhaled and exhaled with each breath normal 0.5 L Total lung capacity &#x2013; Max volume of air that lungs can obtain Normal 6.0 L
- Measures volumes of inspired, expired, and retained volume of air Tidal volume &#x2013; Volume of air inhaled and exhaled with each breath normal 0.5 L Total lung capacity &#x2013; Max volume of air that lungs can obtain Normal 6.0 L
- Measures volumes of inspired, expired, and retained volume of air Tidal volume &#x2013; Volume of air inhaled and exhaled with each breath normal 0.5 L Total lung capacity &#x2013; Max volume of air that lungs can obtain Normal 6.0 L
- Measures volumes of inspired, expired, and retained volume of air Tidal volume &#x2013; Volume of air inhaled and exhaled with each breath normal 0.5 L Total lung capacity &#x2013; Max volume of air that lungs can obtain Normal 6.0 L
- Measures volumes of inspired, expired, and retained volume of air Tidal volume &#x2013; Volume of air inhaled and exhaled with each breath normal 0.5 L Total lung capacity &#x2013; Max volume of air that lungs can obtain Normal 6.0 L
- Drain fluid or air NPO Hold
- Drain fluid or air NPO Hold
- Drain fluid or air NPO Hold
- Pneumothorax Procedure, amount fluid, where it was sent, how the patient is, pain medication Need consent &#x2013; invasive and has risks
- Pneumothorax Procedure, amount fluid, where it was sent, how the patient is, pain medication Need consent &#x2013; invasive and has risks
- Pneumothorax Procedure, amount fluid, where it was sent, how the patient is, pain medication Need consent &#x2013; invasive and has risks
- Pneumothorax Procedure, amount fluid, where it was sent, how the patient is, pain medication Need consent &#x2013; invasive and has risks
- Pneumothorax Procedure, amount fluid, where it was sent, how the patient is, pain medication Need consent &#x2013; invasive and has risks
- Pneumothorax Procedure, amount fluid, where it was sent, how the patient is, pain medication Need consent &#x2013; invasive and has risks
- Pneumothorax Procedure, amount fluid, where it was sent, how the patient is, pain medication Need consent &#x2013; invasive and has risks
- Pneumothorax Procedure, amount fluid, where it was sent, how the patient is, pain medication Need consent &#x2013; invasive and has risks
- ABG&#x2019;s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot. ABG&#x2019;s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
- ABG&#x2019;s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot. ABG&#x2019;s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
- ABG&#x2019;s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot. ABG&#x2019;s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
- ABG&#x2019;s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot. ABG&#x2019;s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
- ABG&#x2019;s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot. ABG&#x2019;s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
- ABG&#x2019;s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot. ABG&#x2019;s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
- ABG&#x2019;s are obtained from an artery. Continuous ABG monitoring can be done through an arterial line. Specimen must be immediately placed on ice and sent to the lab for immediate processing. IF the patient is on O2 it must be noted (how much and how given). There should be no air bubbles in the blood specimen. The blood in the syringe has to be heparinized so it will not clot. ABG&#x2019;s show accurate level of O2 and CO2 to decide if the patient is breathing well enough on a vent or if the person needs a vent.
- Flexible scope used to view the bronchus, remove foreign debris, take tissue specimens, laser therapy on lesions
- Cultures are used to diagnosis the germ and to decide what medication would be best to give. Sensitivity refers to determining what drug is more lethal to the germs. Some throat swabs can be tested immediately for streptococcus.
- Cultures are used to diagnosis the germ and to decide what medication would be best to give. Sensitivity refers to determining what drug is more lethal to the germs. Some throat swabs can be tested immediately for streptococcus.
- Cultures are used to diagnosis the germ and to decide what medication would be best to give. Sensitivity refers to determining what drug is more lethal to the germs. Some throat swabs can be tested immediately for streptococcus.
- Cultures are used to diagnosis the germ and to decide what medication would be best to give. Sensitivity refers to determining what drug is more lethal to the germs. Some throat swabs can be tested immediately for streptococcus.
- 2 parts to the test Checking presence of a pulmonary embolism (perfusion needed to be tested for clot) Tested with a IV radioisotope Ventilation &#x2013; breathing in a radioactive gas and then a picture taken. Diminished or absent uptake of radioactive substances suggest lack of perfusion and aeration (bad)
- Exposure to tuberculosis bacilli. Intradermal injection, read 2 days later. Positive means &#x2013; exposure to antigen, but does not mean that TB is present. Negative &#x2013; no exposure, or have (HIV, depressed immunity) and cannot build a defence.
- P. 517-525
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- Blood Tissue Decrease Increase
- Blood Tissue Decrease Increase
- Blood Tissue Decrease Increase
- Blood Tissue Decrease Increase
- Blood Tissue Decrease Increase
- Blood Tissue Decrease Increase
- Blood Tissue Decrease Increase
- Blood Tissue Decrease Increase
- Blood Tissue Decrease Increase
- Blood Tissue Decrease Increase
- Blood Tissue Decrease Increase
- Blood Tissue Decrease Increase
- Nasal polyps Deviated septum
- Caused primarily by smoking, environmental pollutants, chemical exposure, with close association to ETOH use and smoking (promoters), radiation, beetlenut, chewing tobacco Metastasis to other structures due to lymphatic system except if tumor originates in the glottis Hoarseness > 2 weeks due to involvement of the muscles and cartilage surrounding the larynx causing fusion of the vocal cords
- Persistent hoarseness/sore throat Painless neck mass, lymph nodes enlarged Change in voice quality &#x2013; nasal, loss of voice Dyspnea Dysphagia Foul breath odor Mouth ulcer that does not heal Use penlight to examine oral cavity including under tongue and dentures
- If it involves the false cord, early signs include aspiration on swallowing liquids, persistent unilateral sore throat, feeling of something &#x201C;stuck&#x201D; in the throat, dysphagia, weight loss, neck mass, hemoptysis and late signs include dyspnea, pain in the throat or referred to the ear If it is a polyp, there are usually no early signs but later the patient may have dyspnea, airway obstruction, dysphagia, weight loss & hemoptysis
- The nasopharynx & posterior soft palate are viewed indirectly with a mirror to assess for drainage, bleeding or masses Assessment trhough direct visualization of the larynx looks at the base of the tongue, epiglottis and vocal cords. The patient is asked to vocalize so that the movement of the cords, color of the mucous membranes and the presence of lesions are noted CT and MRI scans, Bxs, PFTs, kidney & LFTs, CBC/Differential, electrolytes &#x2013; (surgery) The tumor is staged and then decisions on treatments are discussed and started
- Radiation for early stages: If the tumor is small and caught early and is on the true vocal cord, RT may be all that is needed. Voice is preserved. Problems with radiation &#x2013; Dry mouth, (increase fluids, chew gum) Fatigue, stomatitis, reddened skin Surgery to remove affected areas/tumors Supraglottic tumors may be treated with RT, a partial laryngectomy Supraglottic tumors with metastasis will entail getting a total laryngectomy with or without unilateral or bilateral radical neck dissection. Need a trach. Advanced lesions may require a total laryngectomy: entire larynx and preepiglottic region is removed and a permanent tracheostomy is performed A radial neck dissection usually accompanies total laryngectomy to decrease the risk of lymphatic spread. Multiple structures may be removed- review on p. 552 Modified could just involve one side of the neck Laser - can be used for small tumors to preserve as much of the glottis and voice
- A Total laryngectomy involves removing the entire larynx and preepiglottic region and a permanent trach is placed
- Edema and inflammation in the airway &#x2013; need for trach Drainage tubes (JP, hemovac) Frequent suctioning of airway 1. Parenteral fluids for first 24 to 48 hours 2. Tube feedings via NG or G tube 3. Assess for tolerance of feedings and regulate amount, time and formula if N/V/D or distention occurs. 4. Patient and family teaching regarding tube feeding. 5. When able to swallow give small amounts of water in high Fowler&#x2019;s position and assess closely for choking Have suction ready to prevent aspiration Removal of epiglottis &#x2013; need to learn how to protect their airway 7. Communication concerns &#x2013; written, communication board,
- arterial flow and venous outflow(may use Doppler), color, temperature, and blanching at least every hour for 24-36 hours ROM to shoulder because of forward rotation and dropping of the shoulder and interruption of nerve innervation to the upper trapezius muscle