Final Nursing 3, Things to remember

Smoking=cilia dnt work, cough out infection

Resp center = b/w pons upper medulla (co2 compensatory factor)
Neurological impulse= says breath
Breath in = decrease lung pressure/size (lower pressure outside air flow in
Aspirate= right side (most often)
Cilia= if not working can become breeding grounds for infection, cough up mucous to clear it,
hydration thins mucous
Rib cage = thoracic cage
h+h=how much o2 gets into body
Resp assessment = 1)assess chest, (resp and cardio assessment imp.),
Resp distress= retraction, grunting, nose flare, cranky (do spo2), decreased loc, diaphoresis, blue, sob
w/speaking, crowing, wheesing, stritorif under distress take spo2, ABC’S, did they aspirate? Swollow
anything? (can aspirate vomit in sleep) if severe distress only imp info is obtained
Cystic fibrosis = congenital chronic respiratory (genetic)
Know freq of uri, lower problems, allergies and reactions to them, O2 supplements?, surgeries, hx of
illness, asses cough, sputum, tobacco/alcohol use, fuctional health problems, immunizations, resp
equipment, last bm, elimination, hydration, nutritional, sleep (snore), cognitive/perceptual, self perception,
role, occupation (exposures), sex?, coping, values
#packs day x # of years smoking
Assess cough = character, timing, freq., paroxysmal (no relief) productive?
Assess sputum = color, amount, odor consistency, hemoptysis
Cough w/ sputum, blood, wheezing, chest pain or dyspnea = aspiration, airway disease, lung disease,
lft ventricular heart failure
Constipation = pressure on diaphragm cnt breath (vicodin causes constipation)
Tongue = lopsided; 7 nerve damage
Nose = flare, crust, cilia, patent, polyps
Pharynx - tonsils
Neck = trachea, offsided = collapsed lung
Chest examination = IPPA = Inspect PalpatePercussAusculation
Funnel Chest = pectus excavatum, lower sternum depressed and appears hollow
Pigeon chest = pectus carinatum; sternum protrudes out
Barrel Chest thorax is excessively large (birth/geriatric), sign of compensation of chronic lung
problems
Inspection = side of bed, rate, rhythm, depth, slope of ribs, use of accessory muscles, clubbing,
posterior chest
Normal RR = Adult 12-20, 6 yrs to 12yrs 15-25, 1yr to 5 yrs 20-40, baby 30-60
Kussmaul - deep breathing= metabolic acidosis, can be slow/fast but always deep
Chyne Stokes = end of life, slow, increase, apnea, (heart failure, bad stroke)
Kyphosis = spine bent outward (bone disease) geriatric
Scoliosis = S shaped spine
Kyphoscoliosis = hunchback deformity
Uncentered trachea = collapsed lung (deviation is away from affected side), pinpoint areas of pain
Fremitus = hands on back, thumbs together pt says 99, should vibrate same on each side = is the
vibration of mucous if heard unevenly
Percussion = not on bony mass, soft muffled sound heard over liver/spleen
Resonant = normal lung, low pitched
Tympanic = air, hyperinflation or hollow
Flat bone = dense tissue
Dull = mixed solid and lung tissue
hyper resonance = hyper inflated lungs COPD, lower pitched
Auscultation = breathing  normal, abnormal, adventitious (you tube to listen), note pitch duration
and type of sound heard, listen to child w/ bell
Bronchial - louder and higher pitched; harsh, heard over the trachea
Brochovesicular = medium pitch and intensity; heard anterior ally over main-stem bronchi on
either side of sternum and posterior between scapulas
Vesicular - soft, low pitched; heard over all lung areas except major bronchi
Hear breath sounds to 10th rib posterior, ausculate to 6th rib (nipple line) anterior, 8th rib mid
axillary, listen 4 - 5 times on each side, back and under axilla
Absent or diminished = r/t decreased air flow
Bronchial or bronchovesicular = sounds heard over lung fields, consolidation or increased
density of lung tissue
Bronchophony = “99” spoken words are not distinguishable but the vocal resonance is increased
in intensity and clarity
Egophony = “E” heard over an area of consolidation or compressed lung above an effusion
Whispered Petrology = “123 whispered” a sign of consolidation
Adventitous lung sounds are caused by mucous
Ronchi = continous rumbling, snoring or rattling sound
Coarse crackles (rales) = series of short low pitched sounds, gurgling on inspiration, like blowing
bubbles in milk
Stridor = continous musical sound of constant pitch “seal bark”
Pleural friction rub = creaking or grating sound from roughened inflamed surfaces of the pleura
rubbing together
Wheeze = inspiraton/expiration = lung field, high pitched musical tone
Lung sounds can only be heard posteriorly on interiorly
Chest x-ray = preceded all other studies!!!
CT =evaluates difficult to see areas (shellfish/iodine allergies?)
Mri - images of body structures, ( No metal, wires, clips, plates)
Ventilation perfusion scan = assesses pulmonary blood flow
Pulmonary Angiography = confirm diagtnosis of PE
PET = distinguishes benign and malignant lung nodules
FVC = amt of air quickly and forcefully exhaled after max inspiration
FEV = Amount of air exhaled in the 1st second of FVC
Peak expiratory flow rate = maximum airflow rate during forced expiration
Tidal Volume - volume of air inhaled and exhaled with each breath
ERV = Air that can be forcefully exhaled after normal exhalation
RV - amount of air in the lungs after forced expiration
IRV - max amt of air that can be forcefully exhaled after normal inhalation
Bronchoscopy - biopsy - insertion of scope to airway for direct viewing and specimen collection
Mediastinoscopy - in suprasternal notch, scope inserted for inspection and biopsy of lymph nodes
Lung Biopsy - Transbronci8al - pass forceps or needle through bronchoscope for specimen, open lung
Thoracentesis - needle through chest wall to pleural space, CHEST TRAY IN ROOM (LUNG CAN
COLLAPSE!!)
Removal of fluid from lungs = better LOC immediately
Geriatric patient assessment
Barrel chest, decreased compliance/elasticity 45-90
Osteoperosis = percussion can cause fractures
Pt may not tolerate deep breaths
Peds patient resp assessment
Louder breath sounds and in abdomenal breather till 6 or 7,
Assessment = palpate, percussion (echoes), use bell
Pharmacology
Bronchodilators
drugs expand the bronchial tube by relaxing bronchial muscles
 3 classes; inhalation, orally, subcutaneously, intravenously
Preterm labor  bronchial dialator terbuteline subq or oral
Adrenergic - short acting works w/I minutes, last 4-8hrs short term relief of bronchoconstriction 
tx of choice for acute exacerbation  prevents spasm precipated by exercise/stimuli  Albuterol,
Epinephrine, Alupent
Adrenergic = long acting - lasts 8-24 hrs, nocturnal control of asthma, not quick relief, exp Serevent
(seasonal allergies)
Common Bronchodilators s/e = tremors, tachycardia above 120, palpitations, (decreased in pt avoids
contact of the tongue w/ medication), hypocalcaemia
Xanthenes
Stimulates cns and respiration, dilates coronary and pulmonary vessels and causes diuresis
High incidence of side effects = nausea, headache, insomnia, gi distress, tachycardia, arrhythmias,
seizures,
Orally or IV
Caffeine (premature babes, apnea and tachycardia), aminophylline, theophylline,
Anticholinergics
Peaks 1 hr, lasts 4-6 hrs
Aerosol administration, used in combo w/ other bronchodilators
Poor absorption (few systemic effects)
Works in larger airways
Atrovent
Mucolytics
Loosen and liquefy thick mucous allowing expectoration
Dnt mix with other drugs
s/e nausea vomiting, stomatitis, runny nose is an antidote for Tylenol od
Smells and taste like rotten eggs
O2 administration
Only drug that may be administered in an emergency situation w/o order, 8-10 l,
5L copd, (retains CO2), chronic bronchitis, pts will not be able to breath if it is higher
O2 toxicity can inactivate surfactant  development of ARDS, pulmonary edema, copious sputum,
fibrosis, numb tingling, hyperventilation (fetal position will help),
O2 WITH CHILDREN HAS TO HAVE HUMIDITY
Humidity above 4l/m
Complications = collapsed alveoli ( a l e ctasis), retrolental fibroplasia (fibrotic changes behind the
lens), induced apnea from co2 retention
Incentive pyrometer
200 - 300 for weak pt
Bed rest - shallow breaths not expanding fully
Flow incentive = freely movable ping pong pall, inhale to elevate ball keep floating as long as possible
Volume incentive - better choice, permits slower inspiration with breath holds up to 10 seconds
Other info
Chest pt needs med order, DOCUMENT
Steriods decrease imflammation
Use suction with lots of mucous
Physiotherapy wait 1 hr before meals and 2 hrs after
Dnt give physiotherapy if abnormal vitals, anticoagulant therapy, osteoperousis, LOC altered, exercise
intolerance
Posteral drainage - rt lung straighter anlgle, can cause hypotension coughing afterwards or suctioned,
dnt do if blue, no suction equipment, pt cnt cough,
Percussion and vibration = clapping the chest wall w/ cupped hand, vibration over affected lung area,
cystic fibrosis pt does 3x a day, dnt do over cancer, bronchospasm is increase, pain is felt, hemorrhage or
seizure is possible, osteoperosis
Nutrition = respiration issues need high protein high calorie diet into 5 or 6 small meals, ice cream will
increase calories, control weight, meds can cause anorexia
NURSE EDUCATES!! Hyperinflative lungs push on belly making them,condense info, cold temps
decrease edema,
Teach = pursed lips, diaphragmatic, used the diaphragm instead the accessory muscles to increase lung
expansion
Walk 15-20 minutes, increase hr to max, 220 - age = max hr, sleep dim lights, prop up pt on wedge,
modify med schedule, train upper extremities
Nasal polyps = bluish glossy projections in the nare,
Diviated septum = chapped lips b/c they are lip breathers, caused by trauma
Nasal fracture = know limitations look for edema, excessive swallowing indicates bleding, miningeal
tears, dx wld be airway, hemorrhage, pain, reduce edema, open airway by doing this,