Week 5 180

Nasal cavity, nose, throat, mouth, and larynx

Wheezing, breathlessness, chest tightness, and morning or nighttime coughing

The walls of the nasal cavity

-nasopharynx
-oropharynx
-laryngopharynx

-or voice box, is made up of cartilidge and connects the pharynx and trachea

Speech (contains the vocal cords)

Something has triggered it, such ad exercise, allergens, or viral respiratory infections

The airway becomes obstructed because of inflammation, which reduces the diameter of the airway

Bronchi narrowing in response to a stimulus, as seen in asthma or bronchitis

Allergy cells responsible for allergic reactions. They cause allergic manifestations by releasing mediators

White blood cells that play a role in the inflammatory response and host defense against parasites and allergic responses

Leukocytes, or white blood cells, which form the immune response immediate line of defense

White blood cell that stimulates G immune cells in addition to killing micro-organisms and removing dead cells

White blood cells found in the lymph tissue and made in the bone marrow. Also an immune cell

White blood cells that contain histamine and heparin and play a role in the inflammatory response

Mast cells secretory granules contain preformed mediators that are released into the extracellular environment upon cell stimulation, for example, histamine

Inflammation mediator released after skin damage, resulting in red welts on the skin; anaphylactic reactions occur when histamine is released

Lipid mediators that play a role in acute and chronic inflammation and allergic reactions and diseases

A group of lipids made at sites of tissue damage or infection that are involved in dealing with injury and illness

Inflammation, edema, and excess mucus production

Airway inflammation

Leads to permanent changes in the tissue and structure of the airway wall

Increase in airway wall thickness, including the smooth muscle, the mucus glands, and the connective tissue

Cell enlargement in a tissue or organ causing an increase in muscular size

Increased growth of normal cells in an organ

-Heterogenous disease (there are differences in the underlying disease process)
-There are differences in the types of inflammation observed and in what triggers hyperresponsiveness

Asthma that begins in childhood and is associated with family history and manifests as eczema, food or drug allergies, and allergic rhinitis

Asthma without hypersensitivity to allergens, onset in adulthood, and poor response to treatment other than corticosteroids

-Found in both adults and children
-Asthma flare-up following taking aspirin or NSAIDs
-Often also have chronic rhinitis or nasal inflammation

-Associated with asthma flare-ups that occur while the client is exercising
-Pre- and post-exercise medication can help reduce or minimize flare-ups

Allergic asthma

-Host factors: allergic conditions, genetics, and gender
-Environmental factors: exposure to allergens, respiratory infections, and pollution

A predisposition to generate IgE responses to molecules present in the environment

Wheezing, coughing, chest tightness, and dyspnea

Above the thoracic cavity

Within the thoracic cavity

At the alveoli in the lower tract; the rest of the system moves air in and out of the lungs

-Block entry of dust and other particles
-Warm and moisten inhaled air

The soft palate and uvula block it

Lymphatic tissue around the pharynx that destroys pathogens

Becomes progressively more muscular; bronchioles have no cartilage and are susceptible to bronchoconstriction

Hold a thin layer of fluid that acts as a lubricant against friction when the lungs expand

-Sacs at the end of bronchioles that act as the functional unit of the lungs where gas exchange occurs
-Lined with capillaries in the outside
-Open and close through surface tension of internal fluid, surfactant, and elasticity

-Caused by contraction of the respiratory muscles
-Pleural membranes expand, which causes lungs to expand
-Alveolar pressure falls below atmospheric pressure and air enters the nose and respiratory passages

-Passive process
-The recoil of elastic lung tissue compresses the alveoli
-Pressure within the alveoli rises above atmospheric pressure and air is forced out of the lungs
-Normal exhalation does not require energy, but forced exhalation is an active process

-Oxyhemoglobin is formed in the lungs, where partial pressure of oxygen (PaO2) is high
-Oxygen is bound to hemoglobin in red blood cells, where it is transported throughout the body to the capillaries, where the pressure is lower
-Where pressure is lower, hemoglobin releases oxygen
-Carbon dioxide enters red blood cells and converts to bicarbonate and hydrogen
-Bicarbonate leaves red blood cells for plasma, hydrogen is buffered by hemoglobin
-Blood enters the lungs, where pressure of CO2 is lower. Carbon dioxide reforms and is diffused into the alveoli to be exhaled

*chemical receptors
-Monitor levels of oxygen, carbon dioxide, and pH in the blood

-Caused by decrease in rate or efficiency of respiration
-More CO2 in the blood

-Caused by the exhalation of CO2 too quickly
-Less CO2 in the blood

Increased rate of depth and breathing to compensate for pH changes that have metabolic causes

Decreased rate of breathing to compensate for pH changes that have metabolic causes

-Weakened respiratory muscles
-Reduced elastic recoil of lung tissue
-Deteriorating cilia
-Decreased cough reflex
-Reduced effectiveness of alveolar macrophages
-Reduced number of alveoli
*Contributes to decreased force of cough, air trapping, increased risk of respiratory infections, and decreased gas exchange

-Frontal and maxillary sinuses
-Areas of heat
-Pain
-Crepitus (feels like rice crispies under the skin, caused when air leaks into subcutaneous tissues)

-Allergies
-Nosebleeds
-Smoking history
-Environmental exposures
-Medications
-Use of oxygen

500-600mL

2:1 (width:depth)

-Blood: CBC, ABG, D Dimer
-Swabs: Sputum, throat, nasal
-Gasses: Oxygen saturation, capnography
-X-ray, CT, Ventilation-perfusion scan, pulmonary function studies, pulmonary angiography, bronchoscopy

-Determine and eliminate triggers
-Manage weight
-Smoking cessation
-Pulmonary function tests
-Position in high-fowler’s
-Promote rest

-Promotes smooth muscle relaxation resulting in airway dilation
-Dilation of narrowed airways
-Improved airflow

-Quickly relieve or stop sudden symptoms
-Works within 15-20 minutes and effective for 3-6 hours
-End in “ol”

Work for 12 hours, should be used daily to prevent attacks

-Beta2 agonists
-Anticholinergics
-Methylxanthines (last-line treatment)

-Corticosteroids: fluticasone, prednisone
-Leukotriene antagonists: montelukast
-Mast cell stabilizers: Cromolyn
-Monoclonal antibodies: omalizumab

-Decreased healing and immunity
-Hyperglycemia
-Fluid retention and weight gain
-Lesions in the mouth or throat

-Monitor for black, tarry stool
-Drink plenty of fluids
-Do not stop medication abruptly
-Ensure good oral care and hand hygiene

-Leukotrienes are inflammatory molecules
-Singulair (montelukast) works by inhibiting leukotriene receptors
-Inhibition of leukotriene receptors leads to a reduction in airway edema, bronchoconstriction, and inflammation

-Inflammatory process in the lungs that produces excess fluid, edema, and exudate that fills the alveoli
-Can be a primary disease or a complication of another. Can be viral, bacterial, or fungal
-Impacts patients across the lifespan, but older adults and those who are immunocompromised are more susceptible
-Immobility is a contributing factor in the development of pneumonia

-Shortness of breath
-Weakness
-Anxiety
-Decreased LOC, changes in orientation
-Fever
-Tachypnea
-Coughing
-Wheezes, crackling

-Sputum culture and sensitivity before starting antibiotic therapy
-CBC (Elevated WBC count)
-ABGs: hypoxemia (decreased PaO2 less than 80mmHg)
-Blood culture
-Electrolytes
-Chest x-ray

-Position in high Fowler’s unless contraindicated
-Encourage coughing and suction to remove secretions
-Incentive spirometry
-Oxygen and medication administration
-Promote adequate nutrition, hydration, and rest

1. Instruct the client to exhale normally
2. Have the client put the mouthpiece up to their mouth
3. Instruct the client to take a long, slow, deep breath
4. Have the client hold their breath for 5 seconds
5. Have the client remove the mouthpiece and exhale
6. Set the gauge on the incentive spirometer to show the goal volume of inspired air
7. After the client is able to return demonstrate the procedure, provide instructions on performing it independently

10x an hour when awake!

-Bacterial pneumonia: antibiotics
-Bronchodilators, antipyretics, anti-inflammatories, and mucolytics may also be used

-Chronic bronchitis and emphysema
-Permanent enlargement of the alveoli due to emphysema, but significant loss of elasticity
-Usually caused by exposure to cigarette smoke and/or occupational air pollution

-Tachypnea
-Shallow respirations with accessory muscle use
-Irregular breathing pattern
-Exertional dyspnea
-Finger clubbing
-Hypoxia
-Dependent edema

-Blue bloaters: chronic bronchitis, younger, overweight with cyanosis
-Pink puffers: emphysema, older in age, thin with pink skin

-Oxygen therapy
-Bronchodilators
-Anti-inflammatories
-Mucolytics

Medications mixed with normal saline, which is aerosolized and inhaled; sometimes delivered with supplemental oxygen

1. Shake 10-15 times with cap secured
2. Remove cap
3. Take a deep breath in and breathe out completely
4. Place mouth around mouthpiece
5. Press inhaler down and take a slow deep breath in through your mouth
6. Hold breath for 10 seconds
7. Repeat for each prescribed puff
8. Replace the cap
*If using a corticosteroid inhaler, gargle water or mouthwash after to help reduce any side effects

Fraction of inhaled oxygen. Concentration of oxygen in the gas mixture

-Flow: 2-6 L/min
-FiO2: 25-40%

-Flow: 6-10 L/min
-FiO2: 35-50%

-Flow: 6-10 L/min
-FiO2: 24-60%

10-15 L/min

Variable, up to 15 L/minute

-Must breathe through their nose for the greatest therapeutic effect
-High pressure flow rates (5L/min or higher) can cause tissue damage; consider notifying the provider and changing to a mask at a lower flow rate

-Can experience lung damage
-Report dry cough, chest pain, numbness in hands/feet, lethargy, nausea, or PaCO2>100mmHg to the provider

Pressure ventilation that provides the same amount of pressure with inspiration and expiration

Pressure ventilation that provides higher-level pressure during inspiration and lower-level pressure during expiration

-Airborne respiratory infection
-Once infected, the body encapsulates the TB with collagen and other cells
-More easily spread in congregate, close-quarters settings

-Persistent cough>3 weeks
-Purulent, blood-streaked sputum
-Fatigue and lethargy
-Weight loss, loss of appetite
-Night sweats
-Low-grade fever

-Test for TB
-Respiratory secretions tested for presence of bacteria
-Can determine if strain is resistant to treatment
-Results in 24 hours (fastest and most accurate testing)

-TB test
-Intradermal injection of tubercle bacillus; two tests initially, then one test annually or as indicated

-Blood test for release of interferon-gamma, a cytokine released when a person is infected with TB
-Diagnoses latent and active TB
-Results within 24-36 hours

-Test for patients with active TB symptoms
-Sputum test for acid-fast bacteria
-Followed up with a culture

-Negative air pressure room
-Single occupancy
-Airborne precautions for all persons entering the room
-When transporting the patient outside the room, patient must be masked (surgical) and those transporting the patient should use a fit-tested N95

-2-4 medications used concurrently due to medication resistance of most TB bacteria
-Non-compliance is common due to length of treatment and side effects
-Teach about masking, cough etiquette, hand hygiene
-Follow up care for at least one year after treatment

-For TB treatment
-Bacteriocidal
-Take on an empty stomach
-Co-prescribed with B6 to prevent neurotoxicity: monitor for tingling in hands and feet
-Hepatotoxic; monitor for jaundice, anorexia, nausea
-DO NOT TAKE WITH ALCOHOL

TRUMP
-Thrombocytopenia/aplastic anemia
-Raised liver enzymes/hepatotoxicity
-Under normal vit. B6 levels
-Maculopapular rash/allergy
-Peripheral neuropathy

-Medication for TB
-Bacteriostatic AND bactericidal
-Hepatotoxicity can occur
-Liver function tests before starting treatment and monthly while on treatment
-Urine and body secretions will turn orange
-Discoloration of contact lenses
-Decreases effectiveness of oral contraceptives

-Medication for TB treatment
-Bacteriostatic AND bactericidal
-Hepatotoxicity can occur, monitor for jaundice, anorexia, and nausea
-Liver enzymes should be tested before treatment and every two weeks during treatment
-Assess for gout before starting treatment, this medication can cause joint pain
-Take with a full glass of water and increase fluid intake to avoid gout and kidney problems
-DO NOT TAKE WITH ALCOHOL

-Medication for TB
-Bacteriostatic
-Do not give to children under 8 years old
-Ocular toxicity can occur; assess eye function before starting treatment and intermittently during treatment

-Medication for TB
-Aminoglycoside antibiotic, increases efficacy of of macrophages
-Highly toxic, should only be used with multi-drug resistant strains of TB
-Ototoxicity can occur; assess hearing function before starting treatment and frequently during treatment
-Nephrotoxicity can occur, monitor for changes in urine output
-Teach patients to drink at least 2 liters of water per day while taking this medication

-Substance (fat, air, amniotic fluid, blood clot) enters venous circulation and travels to the lungs, blocking blood flow
-Most common cause: venous thromboembolism
-MEDICAL EMERGENCY

-Immobility
-Oral contraceptives, estrogen therapy
-Pregnancy
-Obesity
-Smoking
-Heart failure/atrial fibrillation, vascular disease

-Sweating
-Dizziness
-Leg pain
-Irregular heartbeat
-Shortness of breath

-ABG
-D Dimer (shows presence of significant clot formation and breakdown in the body)
-Computed tomography (CT)
-Ventilation-perfusion scan
-Chest x-ray

-High Fowler’s position
-Oxygen therapy
-Check respiratory status every 30 minutes
-Monitor cardiovascular status and level of consciousness and orientation

-Anticoagulants
-Heparin, enoxaprin, warfarin
-Direct factor Xa inhibitors: rivaroxiban, apixaban

-Check bleeding times
-Warfarin: Prothrombin time (PT) and international normalized ratio (INR)
-Heparin: Partial thromboplastin time (aPTT)
-Complete blood count (CBC)

Bleeding, peptic ulcer disease, hemorrhagic stroke, trauma

-Examples: Alteplase, reteplase, tenecteplase
-Used to dissolve blood clots and restore pulmonary flow

-Examples: Alteplase, reteplase, tenecteplase
-Similar to anticoagulants (Monitor for bleeding, anemia, hemorrhage)

-Blood pressure, heart rate, respirations, and oxygen saturation per facility protocol before, during, and after administration

Air or gas in the pleural space

Blood in the pleural space

-Pleuritic pain, anxiety
-Tachypnea, tachycardia, hypoxia, use of accessory muscles, cyanosis
-Reduced or absent breath sounds on the affected side
-Subcutaneous crepitus
-Asymmetrical chest wall movement

Insertion of a needle into the pleural space to withdraw fluid

Tubes inserted into the pleural space when fluid or air has collected there

-Speak to the patient each time you enter the room
-Explain care
-Protect sleep
-Administer medications as ordered
-Assist with communication
-Answer call lights and attend to alarms properly

-Systemic hypertension, cardiac dysrhythmias, heart failure, stroke
-Motor vehicle accidents due to daytime drowsiness
-Depression

Life threatening buildup of fluid in the lungs

-Systolic dysfunction
-Diastolic dysfunction
-Renovascular hypertension

-Excessive shortness of breath, gasping
-Anxiety, confusion, agitation
-Hypertension with jugular vein distension

-Lung collapse caused by blunt or penetrating trauma

-Tachycardia >134bpm
-Hypotension
-Tracheal deviation/Jugular veinous distention
-Cyanosis

Inhaled corticosteroids are preferred; ICS, theophylline, and montelukast

-Uncontrolled asthma during pregnancy has been linked to:
-Preeclampsia
-Pregnancy-induced hypertension
-Preterm labor and premature birth
-Low birth weight
-Neonatal hypoglycemia, seizures
-Congenital abnormalities

-Most children who wheeze before age 6 will likely have their symptoms resolved

-Preterm birth before 36 weeks is associated with increased asthma risk from childhood to adulthood due to impaired lung development

-Characterized by a genetic propensity to produce specific immunoglobulin E (IgE) antibodies in response to common environmental allergens
-Nearly one-third of children with atopy will develop asthma later in life