Respiratory System
occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. More fluid in your lungs means less oxygen can reach your bloodstream
ARDS
Which of the following measures may increase complications for a patient with COPD?
Administering too much oxygen can result in the retention of carbon dioxide. Patients with alveolar hypoventilation cannot increase ventilation to adjust for this increased load, and increasing hypercapnia occurs. All the other measures are aimed at preventing complications.
After reviewing the pharmacological treatment for pulmonary diseases, the nursing student knows that bronchodilators relieve bronchospasm in three ways. Choose the correct three of the following options.
Alter smooth muscle tone Reduce airway obstruction Increase oxygen distribution
A nursing instructor is discussing asthma and its complications with medical-surgical nursing students. Which of the following would the group identify as complications of asthma? Choose all that apply.
Atelectasis Status asthmaticus Respiratory failure Complications of asthma may include status asthmaticus, respiratory failure, pneumonia, and atelectasis. Pertussis and pneumothorax are not complications.
Lower Respiratory Tract includes:
Bronchi Bronchioles Alveolar ducts Alveoli
Symptoms of impaired gas exchange
Cough Shortness of breath Chest pain with breathing
Symptoms of Asthma
Cough Wheezing Chest tightness Breathlessness
A client is being sent home with oxygen therapy. The nurse instructs that a) The client should raise the flow of oxygen if shortness of breath increases. b) The client will not be able to travel with oxygen. c) Oxygen is addictive and its use must be decreased. d) Smoking or a flame is dangerous near oxygen.
D
Which of the following exposures accounts for the majority of cases with regard to risk factors for COPD? Exposure to tobacco smoke Occupational exposure Passive smoking Ambient air pollution
Exposure to tobacco smoke Exposure to tobacco smoke accounts for an estimated 80% to 90% of COPD cases. Occupational exposure, passive smoking, and ambient air pollution are risk factors but do not account for the majority.
Respiratory Defense Mechanisms
Filtration of air Mucociliary clearance system Cough reflex Reflex bronchoconstriction Alveolar macrophages
process by which oxygen is transported to cells and carbon dioxide is transported from cells.
Gas exchange
process by which oxygen is transported to cells and carbon dioxide is transproted from cells
Gas exchange
is insufficient oxygen reaching the cells .
Hypoxia
In which stage of COPD is the forced expiratory volume (FEV) less than 30%?
III
A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 40% for a patient with COPD. What stage should the nurse document the patient is in?
III All grades of COPD are associated with an FEV1/FVC ratio of less than 70%. Grade I (mild) is associated with an FEV1 of greater than or equal to 80%. Grade II (moderate) is associated with an FEV1 of 50%-80%. Grade III is associated with an FEV1 of <30%-50%. Grade IV is associated with an FEV1 of <30%.
A patient with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this patient includes which of the following?
Implementing measures to clear pulmonary secretions
A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure?
In status asthmaticus, increasing PaCO2 (to normal levels or levels indicating respiratory acidosis) is a danger sign signifying impending respiratory failure. Understanding the sequence of the pathophysiologic processes in status asthmaticus is important for understanding assessment findings. Respiratory alkalosis occurs initially because the patient hyperventilates and PaCO2 decreases. As the condition continues, air becomes trapped in the narrowed airways and carbon dioxide is retained, leading to respiratory acidosis.
A nursing student understands that emphysema is directly related to which of the following?
In the later stages of emphysema, carbon dioxide elimination is impaired, resulting in increased carbon dioxide tension in arterial blood (hypercapnia) leading to respiratory acidosis.
Device encourages patient to inhale slowly and deeply to maximize lung inflation and alveoli expansion Used to prevent or treat atelectasis
Incentive Spirometry
device to measure inspiratory effort can be attached to a mask or endotracheal tube
Monometer
Upper Respiratory Tract includes:
Nose Mouth Pharynx Epiglottis Larynx Trachea
Administration of oxygen at greater than 21% (the concentration of oxygen in room air) to provide adequate transport of oxygen in the blood, to decrease the work of breathing, and to reduce stress on the myocardium.
Oxygen Therapy
O2 concentrations of greater than 50% for extended periods of time (longer than 48 hours) can cause an overproduction of free radicals, which can severely damage cells
Oxygen toxicity
Symptoms include substernal discomfort, paresthesias, dyspnea, restlessness, fatigue, malaise, progressive respiratory difficulty, refractory hypoxemia, alveolar atelectasis, and alveolar infiltrates on x-ray
Oxygen toxicity
A client has been classified as status asthmaticus. The nurse understands that this client will likely initially exhibit symptoms of:
Respiratory alkalosis There is a reduced PaCO2 and initial respiratory alkalosis, with a decreased PaCO2 and an increased pH. As status asthmaticus worsens, the PaCO2 increases and the pH decreases, reflecting respiratory acidosis.
The nurse is caring for a patient with status asthmaticus in the intensive care unit (ICU). What does the nurse anticipate observing for the blood gas results related to hyperventilation for this patient?
Respiratory alkalosis (low PaCO2) is the most common finding in patients with an ongoing asthma exacerbation and is due to hyperventilation.
For a client with chronic obstructive pulmonary disease, which nursing intervention helps maintain a patent airway?
Teaching the client how to perform controlled coughing Controlled coughing helps maintain a patent airway by helping to mobilize and remove secretions. A moderate fluid intake (usually 2 L or more daily) and moderate activity help liquefy and mobilize secretions. Bed rest and sedatives may limit the client's ability to maintain a patent airway, causing a high risk of infection from pooled secretions.
A client has chronic obstructive pulmonary disease (COPD) and is exhibiting shallow respirations of 32 breaths per minute, despite receiving nasal oxygen at 2 L/minute. To improve the client's shortness of breath, the nurse encourages the client to
When a client with COPD exhibits shallow, rapid, and inefficient respirations, the nurse encourages the client to perform pursed-lip breathing, which includes exhaling slowly. Deep breaths or upper chest breathing is an inefficient breathing technique and should be changed to diaphragmatic breathing for the client with COPD. Some clients with COPD cannot tolerate much oxygen without developing hypercapnia.
A patient with cystic fibrosis is admitted to the hospital with pneumonia. When should the nurse administer the pancreatic enzymes that the patient has been prescribed?
With meals Nearly 90% of patients with cystic fibrosis have pancreatic exocrine insufficiency and require oral pancreatic enzyme supplementation with meals (Warwick & Elston, 2011).
A client is diagnosed with a chronic respiratory disorder. After assessing the client's knowledge of the disorder, the nurse prepares a teaching plan. This teaching plan is most likely to include which nursing diagnosis? a) Anxiety b) Unilateral neglect c) Impaired swallowing d) Imbalanced nutrition: More than body requirements
a) Anxiety In a client with a respiratory disorder, anxiety worsens such problems as dyspnea and bronchospasm. Therefore, Anxiety is a likely nursing diagnosis.
At 11 p.m., a client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He's anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., the client's arterial blood oxygen saturation is 86%, and he's still wheezing. The nurse should plan to administer: a) albuterol (Proventil). b) propranolol (Inderal). c) morphine. d) alprazolam (Xanax).
a) albuterol (Proventil). The client is hypoxemic because of bronchoconstriction as evidenced by wheezes and a subnormal arterial oxygen saturation level. The client's greatest need is bronchodilation, which can be accomplished by administering bronchodilators. Albuterol is a beta2 adrenergic agonist, which causes dilation of the bronchioles. It's given by nebulization or metered-dose inhalation and may be given as often as every 30 to 60 minutes until relief is accomplished.
Impaired swallowing may occur in a client with an ________ respiratory disorder, such as upper airway obstruction, but not in one with a _______ respiratory disorder.
acute, chronic
HC03 >26
alkalosis
Pac02 <35
alkalosis
whats the strongest predisposing factor for asthma
allergies
Because _____________ are unstable, they have a natural tendency to collapse
alveoli
:decrease production increased loss of RBC or premature destruction of RBC
anemia
increases oxygen demand (psych)
anxiety
Pac02 >45
axcidosis
A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction? a) "Limit yourself to smoking only 2 cigarettes per day." b) "Weigh yourself daily and report a gain of 2 lb in 1 day." c) "Maintain bed rest." d) "Eat a high-sodium diet."
b) "Weigh yourself daily and report a gain of 2 lb in 1 day." The nurse should instruct the client to weigh himself daily and report a gain of 2 lb in 1 day. COPD causes pulmonary hypertension, leading to right-sided heart failure or cor pulmonale. The resultant venous congestion causes dependent edema. A weight gain may further stress the respiratory system and worsen the client's condition. The nurse should also instruct the client to eat a low-sodium diet to avoid fluid retention and engage in moderate exercise to avoid muscle atrophy. The client shouldn't smoke at all.
A client is admitted to a health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this client? a) Anxiety related to actual threat to health status b) Impaired gas exchange related to airflow obstruction c) Risk for infection related to retained secretions d) Activity intolerance related to fatigue
b) Impaired gas exchange related to airflow obstruction A patent airway and an adequate breathing pattern are the top priority for any client, making Impaired gas exchange related to airflow obstruction the most important nursing diagnosis. Although Activity intolerance, Anxiety, and Risk for infection may also apply to this client, they aren't as important as Impaired gas exchange.
anteroposterior to lateral diameter 1:1 ratio.
barrel chest
auscultation sound over trachea
bronchial
auscultation sound over main bronchi
bronchiovesicular
A nurse consulting with a nutrition specialist knows it's important to consider a special diet for a client with chronic obstructive pulmonary disease (COPD). Which diet is appropriate for this client? a) Low-fat b) Full-liquid c) High-protein d) 1,800-calorie ADA
c) High-protein Breathing is more difficult for clients with COPD, and increased metabolic demand puts them at risk for nutritional deficiencies. These clients must have a high intake of protein for increased calorie consumption. Full liquids, 1,800-calorie ADA, and low-fat diets aren't appropriate for a client with COPD
A nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect? a) Urine output of 40 ml/hour b) Heart rate of 100 beats/minute c) Respiratory rate of 22 breaths/minute d) Dilated and reactive pupils
c) Respiratory rate of 22 breaths/minute In a client with emphysema, albuterol is used as a bronchodilator. A respiratory rate of 22 breaths/minute indicates that the drug has achieved its therapeutic effect because fewer respirations are required to achieve oxygenation. Albuterol has no effect on pupil reaction or urine output. It may cause a change in the heart rate, but this is an adverse, not therapeutic, effect.
A nurse is assisting with a subclavian vein central line insertion when the client's oxygen saturation drops rapidly. He complains of shortness of breath and becomes tachypneic. The nurse suspects the client has developed a pneumothorax. Further assessment findings supporting the presence of a pneumothorax include: a) paradoxical chest wall movement with respirations. b) tracheal deviation to the unaffected side. c) diminished or absent breath sounds on the affected side. d) muffled or distant heart sounds.
c) diminished or absent breath sounds on the affected side. In the case of a pneumothorax, auscultating for breath sounds will reveal absent or diminished breath sounds on the affected side.
O2 diffuses from areas of __________ partial pressure to areas of _________ partial pressure
higher to lower
A physician orders metaproterenol (Alupent) by metered-dose inhalation four times daily for a client with acute bronchitis. Which statement by the client indicates effective teaching about this medication?
need to hold my breath as long as possible after i take a deep inhalation rationale: the client demonstrates effective teaching if he states that hell hold his breath for as long as possible after inhaling the drug. Holding the breath increases the absorption of the drug into the alveoli. Metaproterenol needs to be used over an extended period for maximum effect. The client shouldnt use the inhaler whenever he feels out of breath because dependency can develop if the drug is used excessively. The client should adhere to the prescribed dosage. Tachycardiais an expected adverse reaction to metaproterenol. The client should be taught how to monitor his heart rate and contact the physician only if the heart rate exceeds 130 beats/minute
A client is being seen in the emergency department for exacerbation of chronic obstructive pulmonary disease (COPD). The first action of the nurse is to administer which of the following prescribed treatments?
oxygen through nasal canula at 2 l/min
O2 is transported to the cells of the body by combining with Hemoglobin (plasma protein in RBC, Hgb), this combining is called
oxyhemoglobin, HgbO2
patients can develop a large bullae, which may rupture and cause a
pneumothorax
alveolar problem
pulmonary emphysema
may occur from thickening of the lining, smooth muscle hypertrophy of the pulmonary vasculature, and chronic hypoxemia, which causes the pulmonary arteries to constrict
pulmonary hypertension
normal percussion sound over lung tissue
resonant
asthma percussion sound
resonant to hyperresonant in patients experiencing asthma due to air trapping in the alveoli
the result of decreased pH with an increase in CO2
respiratory acidosis
Normally, each person takes a slightly larger breath, termed a _________, after every five to six breaths. This __________ stretches the alveoli and promotes surfactant secretion
sigh
A nurse is caring for a client experiencing an acute asthma attack. The client stops wheezing and breath sounds aren't audible. This change occurred because:
the airways are so swollen that no air can get through.
about 500 mL, is the amount of air inspired during normal, relaxed breathing.
tidal volume (TV
______________ position to ease work of breathing.
upright
The classification of Stage IV of COPD is defined as
very severe COPD.
auscultation sound over lesser bronchi, bronchioles, and lobes
vesicular
Many factors contribute to the severity of asthma:
viral respiratory infections, rhinitis, and sinusitis, GI reflux and stress Allergies play a significant role- important to reduce indoor and outdoor allergies
The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment?
Providing sufficient oxygen to improve oxygenation The main objective in treating patients with hypoxemia and hypercapnia is to give sufficient oxygen to improve oxygenation.
e goal for oxygen therapy in COPD is to support tissue oxygenation, decrease the work of the cardiopulmonary system, and maintain the resting partial arterial pressure of oxygen (PaO2) of at least ______ mm Hg and an arterial oxygen saturation (SaO2) of at least ___%.
60, 90%
PH
7.35-7.45
Pa02
80-100
Sa02
95-100
alcoholism, drug overdose, anesthesia or from neurologic disorder such as head injury, seizure, stroke. won't necessarily take deep breath, may have impaired gas exchange
Altered state of consciousness
is a chronic, irreversible dilation of the bronchi and bronchioles Caused by: Airway obstruction, pulmonary infections Diffuse airway injury Genetic disorders Abnormal host defenses Idiopathic causes
Bronchiectasis
procedure in which the bronchi are visualized through a fiber optic tube.
Bronchoscopy
Air pollution
Bush did 9/11
A nursing student is taking a pathophysiology examination. Which of the following factors would the student correctly identify as contributing to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Choose all that apply.
Inflamed airways that obstruct airflow Mucus secretions that block airways Overinflated alveoli that impair gas exchange
Which of the following is the key underlying feature of asthma?
Inflammation Inflammation is the key underlying feature and leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheeze, and dyspnea.
, about 1,200 mL, is the additional air that can be forcibly exhaled after the expiration of a normal tidal volume.
Expiratory reserve(ERV)
reduced oxygenation of the arterial blood
Hypoxemia
alters the bodys natural ability to fight infection making the individual prone to pulmonary infections
Immunosuppression
excess fluid fills the interstitial space and alveoli, markedly reducing gas exchange.
In conditions such as pulmonary edema
A home health nurse visits a client with chronic obstructive pulmonary disease who requires oxygen. Which statement by the client indicates the need for additional teaching about home oxygen use?
"I make sure my oxygen mask is on tightly so it won't fall off while I nap."l The client requires additional teaching if he states that he fits his mask tightly. Applying the oxygen mask too tightly can cause skin breakdown, so the client should be cautioned against wearing it too tightly
A male patient newly diagnosed with COPD tells the nurse, "I can't believe I have COPD, I only had a cough; are there other symptoms I should know about"? Which of the following is the nurse's best response?
"Other symptoms you may develop are shortness of breath on exertion, and sputum production."
client with chronic obstructive pulmonary disease (COPD) is admitted to the medical-surgical unit. To help this client maintain a patent airway and achieve maximal gas exchange, the nurse should: 1. Instruct the client to drink 2 L of fluid daily. 2. Maintain the client on bed rest. 3. Administer anxiolytics, as ordered, to control anxiety. 4. Administer pain medication as ordered.
1. Instruct the client to drink 2 L of fluid daily. nstruct the client to drink 2 l of fluid daily.-rationale: mobilizing secretions is crucial to maintaining a patent airway and maximizing gas exchange in the client with copd. Measures that help mobilize secretions include drinking 2 l of fluid daily, practicing controlled pursed-lip breathing, and engaging in moderate activity. Anxiolytics rarely are recommended for the client with copd because they may cause sedation and subsequent infection from inadequate mobilization of secretions.
Normal inspiratory pressure is approximately
100 cm H2O
Assess lung sounds at least every ___ to ___ hours.
2-4
HC03
22-26
Inspiratory Force of less than __________ cm usually requires mechanical ventilation
25
Pac02
35-45
used to measure functional capacity and response to treatment in patients with heart or lung disease. Pulse oximetry is usually monitored during the walk. The distance walked is measured and used to monitor progression of disease or improvement after rehabilitation.
6-minute Walk Test
Emphysema is described by which of the following statements?
A disease of the airways characterized by destruction of the walls of overdistended alveoli Emphysema is a category of COPD. Asthma has a clinical outcome of airflow obstruction. Bronchitis includes the presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years. Bronchiectasis is a condition of chronic dilatation of a bronchus or bronchi.
A nurse is caring for a client admitted with an exacerbation of asthma. The nurse knows the client's condition is worsening when he: 1. Sits in tripod position. 2. Has a pulse oximetry reading of 93%. 3. Uses the sternocleidomastoid muscles. 4. Wants the head of the bed raised to a 90-degree level.
A nurse is caring for a client admitted with an exacerbation of asthma. The nurse knows the client's condition is worsening when he: 1. Sits in tripod position. 2. Has a pulse oximetry reading of 93%. 3. Uses the sternocleidomastoid muscles. 4. Wants the head of the bed raised to a 90-degree level.
If there is doubt about the accuracy of the SpO2 reading, an __________ analysis should be obtained to verify accuracy.
ABG
lack of oxygen in the body tissues
Anoxia
relax the airways and prevent them from getting narrower. This makes it easier to breathe. They may protect the airways from spasms that can suddenly cause the airway to become narrower (bronchospasm). They also may reduce the amount of mucus produced by the airways.
Anticholinergics
Measurement of arterial oxygenation and carbon dioxide levels. Used to assess the adequacy of alveolar ventilation and the ability of the lungs to provide oxygen and remove carbon dioxide. Also assesses acid-base balance
Arterial Blood Gases
measured to determine oxygenation status and acid-base balance.
Arterial blood gases ABGs
Chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucus production Inflammation leads to cough, chest tightness, wheezing, and dyspnea
Asthma
has abnormal airways characterized primarily by reversible inflammation
Asthma
The wife of a patient who was admitted 3 days ago with an exacerbation of chronic obstructive pulmonary disease (COPD) states that she is worried about her husband because he appears to be breathing "really hard." The nurse performs a respiratory assessment. Which of the following findings would indicate a need for further interventions? (Select all that apply.) Patient states, "It always seems like I just can't catch my breath." Pale, paper-thin skin, O2 at 2L/min via nasal cannula BP 122/80, HR 116, R 24, pale and clammy skin, temp 101.3 degrees F BP 122/82, HR 102, R 24, noted barrel chest
BP 122/80, HR 116, R 24, pale and clammy skin, temp 101.3 degrees F Bronchopulmonary infections must be controlled to diminish inflammatory edema and to permit recovery of normal ciliary action. Minor respiratory infections of no consequence to people with normal lungs can be life-threatening to people with COPD. The breathing pattern of most people with COPD is shallow, rapid, and inefficient; the more severe the disease, the more inefficient the breathing pattern. Any factor that interferes with normal breathing quite naturally induces anxiety, depression, and changes in behavior.
Chronic air trapping flattens the diaphragm and increases the space between the ribs.
Barrel chest
Quick-relief medications asthma
Beta2-adrenergic agonists Anticholinergics
a cycling machine delivers a set inspiratory positive airway pressure each time the patient begins to inspire. As he or she begins to exhale, the machine delivers a lower set end-expiratory pressure. Together, these two pressures improve tidal volume, can reduce respiratory rate, and may relieve dyspnea.
Bi-level positive airway pressure (BiPAP)
Which of the following is true about both lung transplant and bullectomy?
Both are aimed at improving the overall quality of life of a patient with COPD.
For a patient with advance chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange? A Encouraging the patient to drink three glasses of fluid daily B Keeping the patient in semi-fowler's position C Using a high-flow venturi mask to deliver oxygen as prescribe D Administering a sedative, as prescribe
C. The patient with COPD retains carbon dioxide, which inhibits stimulation of breathing by the medullary center in the brain. As a result, low oxygen levels in the blood stimulate respiration, and administering unspecified, unmonitored amounts of oxygen may depress ventilation. To promote adequate gas exchange, the nurse should use a Venturi mask to deliver a specified, controlled amount of oxygen consistently and accurately. Drinking three glasses of fluid daily would not affect gas exchange or be sufficient to liquefy secretions, which are common in COPD. Patients with COPD and respiratory distress should be places in high-Fowler's position and should not receive sedatives or other drugs that may further depress the respiratory center.
chronic cough, sputum production, and dyspnea
COPD
chronic inflammation and narrowing of the airways
COPD
cough, sputum production, and dyspnea on exertion.
COPD
Includes postural drainage, chest percussion and vibration, breathing retraining, and effective coughing. Goals: remove secretions, improve ventilation, and increased efficiency of respiratory muscles
Chest Physiotherapy
Chronic cough Purulent sputum in copious amounts Clubbing of the fingers Postural drainage Chest physiotherapy Smoking cessation Antimicrobial therapy
Chronic Bronchitis
Cough and sputum production for at least 3 months in each of 2 consecutive years Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucous may plug airways Alveoli become damaged, fibrosed, and alveolar macrophage function diminishes The patient is more susceptible to respiratory infections
Chronic Bronchitis
Inflammation of bronchi and bronchioles caused by chronic exposure to irritants, especially cigarette smoke Inflammation, vasodilation, congestion, mucosal edema, bronchospasm Affects only airways, not alveoli Production of large amounts of thick mucus
Chronic Bronchitis
airway problem
Chronic Bronchitis
Characterized by airflow limitation that is not fully reversible (chronic bronchitis and emphysema) Causes airflow obstruction in the airways or obstruction in the parenchyma of the lung, or a combination of both
Chronic Obstructive Pulmonary Disease
Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern? (Select all that apply.)
Compromised gas exchange Decreased airflow Wheezes
the effect is to open collapsed alveoli. Patients who may benefit from this form of oxygen or air delivery include those with atelectasis after surgery or cardiac-induced pulmonary edema or those with COPD
Continuous positive airway pressure (CPAP)
Long-acting medications asthma
Corticosteroids Long-acting beta2-adrenergic agonists Leukotriene modifiers
promotes air movement through these pores and assists in moving mucus out of the respiratory bronchioles.
Deep breathing
Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli Decreased alveolar surface area increases in "dead space," impaired oxygen diffusion. Hypoxemia results Increased pulmonary artery pressure may cause right-sided heart failure (cor pulmonale)
Emphysema
Loss of lung elasticity and hyperinflation of lung Dyspnea; need for increased respiratory rate Air trapping caused by loss of elastic recoil in alveolar walls, overstretching and enlargement of alveoli into bullae, collapse of small airways (bronchioles)
Emphysema
Provides patent airway, access for mechanical ventilation, facilitates removal of secretions
Endotracheal Intubation
Which of the following is a common irritant that acts as a trigger of asthma?
Esophageal reflux
relaxation of the diaphragm (movement of chamber floor upward) relaxation of external intercostal muscles, increasing intrathoracic pressure (positive pressure), air exits the airways, deflation and elastic recoil of the lungs
Expiration
contraction of the diaphragm (movement of chamber floor downward) and contraction of external intercostal muscles increases space in thoracic chamber, lowering intrathoracic pressure (negative pressure); air enters the airways and inflates the lungs
Inspiration
bout 3,100 mL, is the additional air that can be forcibly inhaled after the inspiration of a normal tidal volume.
Inspiratory reserve(IRV)
lack of oxygenated blood to the tissue which results in cell injury and possibly cell death.
Ischemia
accomplishes gas exchange
Lower respiratory
to obtain tissue, cells, or secretions for evaluation.
Lung Biopsy
Handheld apparatus that disperses a moisturizing agent or medication into the lungs, make a visible mist Nursing care: Slow, deep breathes through mouth and hold a few seconds at the end of inspiration Coughing exercises to mobilize secretions Assess patent before treatment and evaluate patient response after treatment
Mini-Nebulizer Therapy
Airflow limitation is progressive, associated with abnormal inflammatory response to noxious particles or gases Chronic inflammation damages tissue Scar tissue in airways results in narrowing Scar tissue in the parenchyma decreases elastic recoil (compliance) Scar tissue in pulmonary vasculature causes thickened vessel lining and hypertrophy of smooth muscle (pulmonary hypertension)
Pathophysiology of COPD
works by measuring how fast air comes out of the lungs when you exhale forcefully after inhaling fully.
Peak flow monitoring
The nurse is assigned the care of a 30-year-old female patient diagnosed with cystic fibrosis (CF). Which of the following nursing interventions will be included in the patient's plan of care?
Performing chest physiotherapy as ordered
refers to the movement of blood; oxygen-rich blood moves to the cells, and carbon dioxide-saturated blood moves from the cells to the alveoli for elimination
Perfusion
The nurse is educating a patient with asthma about preventative measures to avoid having an asthma attack. What does the nurse inform the patient is a priority intervention to prevent an asthma attack?
Preparing a written action plan
reduces thoracic expansion which increases the risk for atelectasis, collapsed alveoli, and pneumonia.
Prolong bedrest/immobility
Which diagnostic is the most accurate in assessing acute airway obstruction?
Pulmonary function studies Explanation: Pulmonary function studies are the most accurate means of assessing acute airway obstruction. ABGs, pulse oximetry, and chest x-ray are not the most accurate diagnostics for an airway obstruction
A noninvasive method to monitor the oxygen saturation of the blood. Does not replace ABGs Normal level is 95% to 100%. May be unreliable
Pulse Oximetry
SpO2 is used to indicate the oxygen saturation of hemoglobin
Pulse Oximetry SpO2
during hypoventilation when carbon dioxide is retained. i.e. COPD
Respiratory acidosis
In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to which of the following acid-base imbalances? a) Respiratory acidosis b) Metabolic acidosis c) Metabolic alkalosis d) Respiratory alkalosis
Respiratory acidosis Increased carbon dioxide tension in arterial blood leads to respiratory acidosis and chronic respiratory failure. In acute illness, worsening hypercapnia can lead to acute respiratory failure. The other acid-base imbalances would not correlate with COPD.
during hyperventilation when excessive carbon dioxide is exhaled. i.e. panic attacks.
Respiratory alkalosis
To help prevent infections in clients with COPD, the nurse should recommend vaccinations against two bacterial organisms. Which of the following are the two vaccinations?
Streptococcus pneumonia and Haemophilus influenzae
Complications of Oxygen Therapy
Suppressed respiratory drive and low O2 tension Fire Oxygen toxicity: O2 concentrations of greater than 50% for extended periods of time (longer than 48 hours) can cause an overproduction of free radicals, which can severely damage cells
lipoprotein that lowers the surface tension in the alveoli. It reduces the amount of pressure needed to inflate the alveoli and decreases the tendency of the alveoli to collapse.
Surfactant
Vital capacity (VC) VC=
TV + IRV + ERV
the insertion of a large-bore needle through the chest wall into the pleural space to obtain specimens for diagnostic evaluation, remove pleural fluid, or instill medication into the pleural space
Thoracentesis t
is the single most preventable cause of death and disease in the united states and is the most significant risk factor for impaired gas exchange.
Tobacco use
refers to the availability of hemoglobin (in the red blood cells) to carry (transport) oxygen and carbon dioxide as blood moves through the body
Transport
warms and filters air
Upper respiratory
preventing Oxygen toxicity
Use lowest effective concentrations of oxygen PEEP or CPAP prevent or reverse atelectasis and allow lower oxygen percentages to be used
refers to inhalation of oxygen, exchange of oxygen and carbon dioxide, and exhalation of carbon dioxide in the lungs
Ventilation
Which of the following would not be considered a primary symptom of COPD? Cough Sputum production Dyspnea on exertion Weight gain
Weight gain COPD is characterized by three primary symptoms: cough, sputum production, and dyspnea on exertion. Weight loss is common with COPD.
A nurse has established a nursing diagnosis of ineffective airway clearance. The datum that best supports this diagnosis is that the client a) Has wheezes in the right lung lobes b) Reports shortness of breath c) Cannot perform activities of daily living d) Has a respiratory rate of 28 breaths/minute
a) Has wheezes in the right lung lobes
HC03 <22
acidosis
occurs from alveolar wall destruction and loss of elastic recoil
atelactasis
refers to collapsed, airless alveoli (The postoperative patient is at risk for ____________ because of the effects of anesthesia and restricted breathing with pain.)
atelectasis
the nurse assesses the severity of asthma by monitoring which measures
auscultation of lungs peak flow severity of the symptoms
result of long term lack of oxygenation
clubbing
Which of the following is a symptom diagnostic of emphysema?
dyspnea
in a patient with asthma, the nurse initially hears wheezing during which part of the respiration cycle
expiration
Preventing postoperative complications
incentive spirometer to deep breathe and cough at least every 2 hours. This will help prevent atelectasis, collapse alveoli. Mobilize patients to prevent dvt deep vein thrombosis.
Other factors that can alter the accuracy of pulse oximetry include
low perfusion, anemia, cold extremities, thick acrylic nails,
loss of protective mechanisms of the airways and increased mucous can lead to
pneumonia
Sudden chest pain Asymmetry of chest movement Unilateral retractions Oxygen desaturation
pneumothorax
risk factors for copd
secondhand smoke, smoking tobacco, exposure to dust, air pollution
The classification of Stage III of COPD is defined as
severe COPD.
tracheal deviation occurs in
tension pneumothorax
