nursing: respiratory 2

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Bradypnea: slow respiratory rate-less than 10 per minute

Chart resting respirations (RR)

could be cause by PCA or other Medications(Narcotics)
Cheyne-stokes: "death rattle"

4-5 cycles per min.

irritation to medulla

R/O nuerologic problem
Dyspnea: Difficulty (labored breating)

Dyspnea when ....

Some conditioning
Some disease pattern
Eupnea: Normal Respirations
Gasping: Inspiratory Effort ( asthma, hurts to breathe, etc.)
Hyperpnea: Increased RR (what they are doing- running up stairs, resting etc.)
Hypoventalation: BR, sedatives, meds,
sleeping(slow and shallow)
Kussmaul's: DM- keto acisosis(metabolic)
Fruity smelling breath (keytones). Attempt to rid CO2
Orthopnea: Difficulty breating while lying flat - raise HOB

sleep in recliner

could be respiratory or cardiac problem
Rales?crackles: Heard at end of respiration

Fluid around alveoli

can't cough out crackles

Dieretics and RT makes it better

Fluid rises (from bottom to top) Pulmonary Edema
Rhonchi coarse: Chest cold - mucus in bronchioles
Tachypnea: rapid respiratory rate
Wheeze: Squeaks

Air meets resistance going in and/or out

Note where you hear it - What side - inspiratory - Expiratory - with or w/o stethoscpoe

More swelling = more distress
Stridor: Inspiratory - difficulty getting air in (upper Respiratory- larger air passages)

Obstruction, croup
Respiratory Distress: Dyspnea- what activity with dyspnea (can't talk, eat, or think)

Abnormal secretions/ Nursing Care (Respiratory tree inflammed and/or infected [swollen, red, hot, fluid] hear secretions - describe productive cough- How much / what color

TCDB
Raise HOB
Suction (prn- no DO needed)
Humidified Air (need DO)
Hydration (Check I&O)
Postural Drainage (RT)
Postural drainage: RT

Head Down, on side (Left side if rt sided secretions, vis versa)

Morning, Before meals,and before sleep (not after meals)
Nebulizer treatments (treatment modalities): Meds through inhalation

Reduces side affects on other parts of the body
Incentive Spirometer (treatment modalities): Dr order required

Can measure progress

Involve Pt. & family
Tracheostomy (treatment modalities): Problem with upper airway occlusion

Can be done preop

Provides a patent airway & area to suction
Tracheostomy: Opening into trachea
Cuff
Neck ties
Suctioning
Trach care
Tracheostomy - Cuff: Normal influted

Seals airway around tube

Helps prevent aspiration
Tracheostomy - Neck ties: Neckties (old method) use knots

Velcro straps (more secure)

holds trachea in place in the neck

Rarly- a trache is sutured if permanent
Suctioning: Suction trachea to lungs than suction mouth/nose

Sterile technique

Through nose into Rt or Lft lung

one hand with sterile glove

Insert with no suction applied

Hit carnis, pull back a little than advance as far as it will go

Intermittant suction
(hold breath) hold suction (1,2,3)

Whole procedure should only take 10-15 sec.

Suction cath should be 1/2 the size of the trach

No more than 3X's per procedure(takes air, causes irritation and errosion)
Trache Care: Sterile technique

Remove intercannula

clean (trache cleaning kit)

Replace
Replacing trache: If trache is accidently coughed out replace it with a new one

Tell patient to imitate whistling
Hemoptysis (Respiratory distress): Coughing up blood (little & big clots)

how big & how often
cough (respiratory distress): excessive- seen in asthma pts
Hypoxia (respiratory distress): Pulse Ox, syonotic, blood gases
Increased pulse (respiratory distress): 1st thing seen
Increased pulse (repiratory distress): 2nd thing seen
Increased BP (respiratory distress): may see a slight change but not a reliable indicator
Restlessness: Due to brain sensitivity to low O2

Irritated

Lethargy

Non-responsive
Hypercapnea: CO2 elevated in arterial blood (blood gases)
Cyanosis: Low O2 (SEVERE)

Lips

Mucous Membranes

Fingertips (could be caused by poor circulation)
Polycythemia: Increase in H/H

Chronic hypoxia

Blood doping

COPD

Thick blood (heart problems/clotting)
Cor Pulmonale: Enlargement of the rt ventricle(rt ventricle to lungs)

overworking

Chronic respiratory disease
Pneumothorax: Air in Pluera space

Always preceded by % (100% Rt pneumothorax)
Digital clubbing: Chronic hypoxia

COPD

Heart defects

Fat or squaring off at the ends of fingertips or toes
Chest X-Ray: diagnostic of pneumothorax & pneumonia

Screener for pneumonia, fluid in lungs, size of heart, if lung is expanded
CT or MRI: Fluid in chest, thoratic cavity, and pleura space

tumor mass- defines fluid & mass
Skin Tests: Allergy testing- Immune response(reation to candida)

TB (PPD)- prensence of antigen for TB(+ does not mean you have TB. It means you have been exposed to TB.

Reactor- (- to +)

Not a valid test after having a + test result
V/Q Scan: Ventilation Quotrait(venalation/perfusion ratio)

looking for presence of PE (pulmonary Embolism)
high or low probibility
Tidal Volume (decreases with chronic illness): amount of air with each breath 500ml

RT- attachment to mouth piece

Narcotics- don't hear much air exchange(shallow breating)
Minute Volume: TV X's RR 6000ml

Amount of air inhaled in one minute
Inspiratory Reserve (increases in chronic illness): Amount of air inspired from end of normal inspiration 3100ml

Deep breath - larger volume
Epiratory Reserve (decreases with chronic illness): amount of air forcibly expired after normal expiration 1200ml

chronic respiratory disease - retains air (can't get it out)
Residual Volume (increased with chronic illness and increases in disease process): Amount of air left in lungs after forced expiration 1200ml

always have air left in lungs to prevent collapse
Vital Capacity (decreased with chronic illness): Maximum amount of air that can be completely expired follwing maximum deep inspiration 4000-5000ml

breath in as much as possible than breath out as much as possible

Respiratory disease and chronic resp. conditions(decrease volume-gets worse)

Acute condition (will return to normal)
White Blood Cell Count: 5000-10000
Elevates with infection/inflammation

Decreases rapidly with antibiotic therapy
Red Blood Cell Count: 4.8 - 5.5 million

O2 carring capacity

ability to carry O2

RR & HR will increase due to problems with oxygenation due to blood loss
Pulse Oximetry: Greater than 95%

O2 saturation

Differs from ABG

Some causes of decrease: Resp. problems, pain meds., PCA, BR,etc.

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