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Adam S Respiratory Study Guide
Adam S Respiratory Study Guide
Respiratory A and P
1. Upper respiratory tract
a. nose
b. paranasal sinuses
c. turbinate bones (Conchae): increased surface area filters and warms air
d. Pharynx, Tonsils, Adenoids
e. Larynx: vocalization, protects airway
f. Trachea
2. Lower respiratory tract:
a. Pleura: Visceral pleura (inner layer), Parietal pleura (outer layer)
b. Lobes: 3 on right, 2 on left
c. Mediastinum
d. Bronchi and Bronchioles
e. Alveoli
3. Function of respiratory system:
a. Respiration: diffusion of oxygen and CO2 across capillary and alveolar walls
b. Ventilation: movement of air in and out of lungs
c. Tidal volume: volume of air inhaled and exhaled with each breath
d. Vital Capacity: maximum volume of air exhaled after maximum inspiration
e. Diffusion: process by which O2 and CO2 are exchanged (Diffusion: Gases)
f. Perfusion: blood flow through pulmonary circulation (Perfusion: Blood)
4. When perfusion exceeds ventilation: oxygen not available in alveoli, blood passes by but is not
adequately oxygenated (low V/Q ratios/Shunts)
a. causes: obstruction of distal airways, pneumonia, tumor, mucus plug
5. When ventilation exceeds perfusion: oxygen available in alveoli, but blood flow is diminished or absent
(high V/Q ratio, Dead space)
a. causes: pulmonary emboli, pulmonary infarction, cardiogenic shock
Respiratory Pharmacology:
1. Bronchodilators, oral, nebulizer
a. xanthines: aminophylline, caffiene
b. symphathomimetics: albuterol, epinephrine, salmetrerol
2. Corticosteroids: are for maintenance, not used for emergency
3. Expectorants: thin out mucus to increase productivity of cough
4. Antibiotics: for pneumonia, bronchitis, COPD
5. Mucolytics: break up mucus
6. Decongestants: h2 blockers
7. Antitussives: anti cough
Blood gases
pH PaCO2 HCO3 Diagnosis
7.35 - 7.45 35 - 45 22 - 26 Homeostasis
Less than 7.35 Greater than 45 22 - 26 Respiratory Acidosis
Less than 7.35 35 - 45 Less than 22 Metabolic Acidosis
Greater than 7.45 Less than 35 22 - 36 Respiratory Alkalosis
Greater than 7.45 35 - 45 Greater than 26 Metabolic Alkalosis
Pulmonary embolism:
1. definition: obstruction of pulmonary artery or one of its branches (ventilation exceeds perfusion or high
V/Q ratio)
2. Patho
a. increased platelet clumping on valves in deep veins
b. clot forms
c. clot breaks off and moves to right side of heart, then to lungs
d. DVT is closely associated with PE
3. Clinical Manifestations: most common: dyspnea and tachypnea
a. chest pain
b. anxiety, cough, fever, diaphoresis, ptosis, syncopy
4. Diagnosis made upon chest xray, V/Q scan, ABGs: respiratory acidosis, pulmonary angiography,
elevated D-dimer
5. Medical management:
a. prevention is #1
b. anticoagulation, thrombolytics, surgery
c. Greenfield filter or IVC: lets blood flow through but catches clots
d. Load up RBC to increase oxygenation. Dont trust finger monitor! it will show a good
percentage of oxygenation, but with high V/Q ratios, not ENOUGH blood is getting to lungs, so the
percentage will be high, but the person will not be receiving enough O2, similar to anemia
e. INR range for PE patients is 2 to 3
1. Simple Pneumothorax:
a. spontaneous in nature, associated with disease states such as hernia of lung, emphysema.
b. treatment: Chest tube is necessary when greater than 25% of lung is compromised
2. Open Pneumothorax:
a. open chest wound
b. aire moves in and out of chest through hole
c. treatment: cover with 4x4 until surgery , tape only on 3 sides to prevent tension pneumothorax
3. tension pneumothorax;
a. open chest wound that closes, results in air that is unable to escape
b. one way valve effect
c. as pressure on one side increases, the other side of lung will become compromised, from
deviated trachea ect.
d. treatment: 14g need 2nd intercostal space, mid clavicle line to create air escape, chest tube,
surgery
3. Catagories:
a. Supraglottic: false vocal cords (33% make up this type)
b. Glottic: true vocal cords, this seldom metastasizes
c. Subgottic: not very common
4. Partial laryngectomy
a. cancer limited to 1 vocal cord
b. portion of larynx removed along with one vocal cord and tumor
c. all other structures remain, swallow preserved, rarely mets, voice quality hoarse
5. Supraglottic Laryngectomy (for stages 1 and 2)
a. hyoid bone, glottis, false cords removed along with tumor
b. true vocal cords, cricoid cartilage and trachea remain
c. airway preserved, swallow preserved
6. Hemilaryngectomy (for tumors less than 1cm in size)
a. portion of vocal cord removed with tumor, aryenoid cartilage and thyroid removed
b. airway preserved, swallow preserved
7. Total laryngectomy (indicated for advanced cancers)
a. all laryngeal structures (hyoid bone, epiglottis, cricoid cartilage, two or three rings of trachea
b. tongue, pharyngeal walls, trachea preserved
c. permanent tracheostomy: voice loss permanent, mucus production will decrease over time
d. swallow preserved
e. when suctioning trach, hyper oxygenate, then suction for brief time (only 15 sec)
Lung Cancer:
1. definition: transformed epithelial cells, fast growing
2. risk factors: 2nd hand smoke, chemical/occupational exposure, genetic/dietary
3. Clinical manifestations: cough, wheezes, weight loss, fluid built up in cavity
4. Diagnosis: chest xray: white cotton balls, CT, sputum samples
5. Medical Management: surgery/ removal of tumor cells, possible lobectomy ect, radiation, chemo,
palliative care
5. Treatment related complications
a. radiation; N/V, weight loss, pulmonary fibrosis, pericarditis, respiratory failure, scars
6. Nursing management: supportive care, increase calories, relieve breathing problems, O2, reduce faitgue,
psych support.
Thoracic Surgery
1. Pneumonectomy:
a. removal of entire lung
b. mediastinal shift
c. space fills with fluid
d. remaining lung over inflates
2. Lobectomy:
a. removal of lobe of lung
b. more common than pneumonectomy
3. Segmental Resection: portion of the lobe
4. Wedge resection: peripheral lung tissue
5. Assessments:
a. PFTs: to make sure patient can operate without the portion of lung being removed
b. ABGs, Bronchoscopy, PET scan ( to identify cancer)