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, stritorif 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 PalpatePercussAusculation 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,