Respiratory Shit

• Chronic bronchitis

  Inflammation of bronchi / bronchioles caused by irritants like cigarette smoke. Irritants trigger inflammation, vasodilation, edema, bronchospasm. Inflammation increases the amount of mucus secreted which impedes airflow
• Visceral pleura


  Exterior lining of the lungs
• Parietal pleura


  Lining on the inside of the chest
• Functions of the respiratory system

  • Supplying oxygen to the body for energy production
  • Removing carbon dioxide as a waste product of energy reactions
  • Maintaining homeostasis (acid- base balance)
• Ventilation


  The process of inhaling oxygen into lungs and exhaling carbon dioxide from lungs
• Causes of ventilation impairment

  • Rib fracture
  • Spinal injury
  • Narrowed airway
  • Poor gas diffusion
• Perfusion


  The ability for blood to transport oxygen to cells and return to alveoli
• Causes of perfusion impairment

  • Decreased cardiac output
  • Thrombus or embolus
• Oxygen transport

  The availability of hemoglobin and its ability to carry oxygen to cells and Co2 from cells
• Causes of oxygen transport impairment

  • Insufficient RBCs for oxygen transport
  • Low hemoglobin
• Hypercapnia

  Increased Co2 in the body
• Hypoxemia


  When partial pressure of arterial oxygen is below the range of 80-100 mmhg. Can lead to increased respirations
• Mild Impairment of gas exchange


  • Fatigue
  • Increase HR
  • Increase RR
• Moderate Impairment of gas exchange

  • Respiratory and metabolic acidosis
• Severe impairment of gas exchange

  • Cellular ischemia
  • Necrosis and death
• Impaired gas exchange risk factors

  • Population: infancy, young children, older adults
  • Individual: Tobacco use, altered LOC, bed rest, Chronic disease, Immunosuppression
• Collaborative interventions for impaired gas exchange

  • Lower airway Bronchodilators
  • Cough suppressants
  • Antimicrobials
  • Smoking cessation aids
  • Oxygen therapy
  • Chest tubes
  • Nutrition
• Emphysema


  Destruction of the lung tissue which reduces its ability to recoil. Leads to lung hyperinflation. Scars the lungs.
• COPD


  Collection of lower airway disorders that impair airflow and gas exchange
• Manifestation of COPD

  • Underweight
  • Slow and fatigued
  • Chronic cough
  • Rapid shallow respirations
  • Wheezing
  • Dyspnea
  • Barrel chest
  • Clubbing
  • Cyanotic appearance
• Lab tests for COPD

  • Sputum samples
  • CBC (hemoglobin, and hematocrit)
  • Electrolytes (hyperkalemia)
  • WBC (infections)
  • ABG's (hypercapnia, hypoxemia)
• Imaging for COPD


  • Chest x-rays to rule out lung diseases or check infections
• Pulmonary function test


  Used to classify COPD stages
• Improving Gas exchange

  1. Drug therapy

  2. Breathing techniques

  3. Effective coughing

  4. Oxygen therapy

  5. Help position patient

  6. Hydration

  7. Suctioning
• Improving gas exchange

  1. Administering 4 to 6 small meals a day

  2. Administering a high calorie and high protein diet
• Asthma


  • Involves airway bronchospasm, swelling of mucous membranes, and copious production of thick mucus
• Inflammation triggers an asthma attack


  Due to a variety of reasons (allergens, irritants, GERD)
• Asthma


  • Leads to wheezing, dyspnea, coughing which can exacerbate to respiratory failure
• Pharmacotherapy for COPD and asthma

  1. Glucocorticoids fixed schedule by inhalation

  2. Beta 2 antagonists administered on fixed schedule via inhalation
• Inhalers


  • Advantages: delivers directly to site of action, minimization of systematic effects, rapid relief
  • Types: Metered dose inhalers, Respimat's, Dry powdered inhalers, Nebulizers
• Pneumonia


  • Infection of the lungs causing excess fluid buildup from inflammatory response
• Risk factors of pneumonia


  • Older adult
  • Smoking
  • Chronic disease
  • Altered LOC
  • Dysphagia
• Manifestations of pneumonia

  • Discolored mucus
  • Chest pain
  • Dyspnea
  • Fever
  • Cough
  • Chest muscle weakness
  • Weak pulse
• Treatment of pneumonia

  1. Oxygen therapy: normally keep spo2 above 94 and for copd 88. Use minimal oxygen to achieve this result

  2. Preventing airway obstruction by deep breathing, hydration, and drug therapy

  3. Preventing sepsis with anti-infectives
• Common cause of fine or coarse crackles are pneumonia, asthma, COPD(Atelectatic - alveoli popping open- not pathological)
• Causes of wheezing

  • High: COPD, Asthma
  • Low: Bronchitis, single bronchial obstruction
• Stridor


  Stridor is an abnormal, high-pitched respiratory sound produced by irregular airflow in a narrowed airway. This condition indicates significant upper airway obstruction and is usually most prominent during the inspiration phase.
• Causes of stridor


  • Obstruction in the upper airway: croup, foreign body
• Trachea/Bronchi – dead space• Lined with goblet cells (mucus & cilia)• Defense mechanism
• Laboratory

  • ABGs: Hypoxia, hypercapnia, hypoxemia
  • Sputum samples: Culture & Sensitivity
  • WBC: Infection
  • CBC: Hemoglobin and hematocrit (polycythemia)
  • Electrolytes: Hyperkalemia