Respiration
What is pleura?
The thin, continuous layer of tissue surrounding the lungs.
Is RSV a virus or bacteria?
A virus.
Bonus Q: is there an antibiotic for RSV?
What are 4 signs of increased respiratory effort?
-accessory muscle use (retractions)
-grunting (mostly in infants)
-nasal flaring
-self positions (tripod positioning)
How is RSV transmitted?
It’s transmitted through direct contact with secretions.
Bonus Q: What steps can you as a nurse take to prevent it from spreading?
What is a pneumothorax?
When there is air in the pleural space.
What is the difference between and open and closed pneumothorax?
Open: there is an opening in the chest well, allowing atmospheric air to enter the pleural space.
Closed: The chest wall is intact. There is a rupture of the lung and visceral pleura, allowing air into the pleural space.
What is a thoracostomy?
Creating an opening in the chest wall in order to place a chest tube.
What are early symptoms of respiratory deterioration?
-restlessness/irritability
-tachycardia
-tachypnea (fast breathing)
-diaphoresis (sweating)
Bonus Q: reason through why each symptom would be happening.
A patient is diagnosed with croup. What is your first nursing priority?
Put them on droplet precautions.
What is a hemothorax?
When blood is in the pleural space.
Bonus Q: T/F- a hemothorax and a pneumothorax cannot exist at the same time.
Why can you not form a tension hemothorax?
You would bleed out before enough blood could gather in the pleural space.
T/F: chest tubes can drain either air or fluid, not both.
False!
Bonus Q: Where does a chest tube device have to be in relation to patient in order to be effective?
What is preferred for a responsive patient: a nasopharyngeal or an oropharyngeal tube?
A nasopharyngeal tube.
Bonus Q: Why?
What are late symptoms of respiratory deterioration?
-blood pressure changes
-dyspnea
-depressed respirations
-bradycardia
-cyanosis
What are the 2 different types of croup?
Acute layngotracheobronchitis (the classic croup) and acute epiglottitis
Bonus Q: Which is always considered an emergency?
Trachial deviation is a late sign of what?
A tension pneumothorax.
Bonus Q: Do tension pneumothoraxes occur from open or closed pnuemothoraxes, or both?
What is it called when there is transudate or exudate in the pleural space?
A pleural effusion.
Bonus Q: What is it called when this fluid is pus from an infection?
T/F: If an air leak is detected to be somewhere in the chest tube apparatus, this always means the chest tube must fully replaced.
False!
What is the difference between and endotracheal tube (ET tube) and a tracheostomy?
ET tube: inserted through the mouth, ending in the trachea
Tracheostomy: bypasses the upper airway altogether and enters directly into the trachea
Bonus Q: Why might a tracheostomy be called for?
List at least 2 differences in kids that make them more susceptible to respiratory infections. (+50 pts for each additional answer)
-smaller airway diameter (prone to clogs and obstructions)
-glottis & epiglottis are narrow and susceptible to swelling
-alveoli are less in number (less surface area for gas exchange)
-horitozant rib articulation- thorax decreases in diameter
Compare classic croup and acute epiglottitis in: emergency (or not), onset, fever, and unique symptoms
Croup: may or may not be an emergency, has a slower onset, low-grade fever, and a barking seal-like cough.
Acute epiglottitis: always an emergency, rapid onset, high-grade fever, muffled voide, dooling (especially in kids too old to drool)
What is a mediastinal shift?
When there is a tension pneumothorax and the pressure gets so high it pushed the heart and great vessels to the unaffected side of the chest.
Bonus Q: why would CPR not work on someone experiencing a mediastinal shift?
What is empyema?
Pus in the pleural space.
You start your shift and one of your patients has a chest tube. When the previous nurse gave report, she said there were bubbles in the air leak monitor hovering around a 2 and the provider was fine with that. You look at your patient’s chest tube and see the bubbles are now at of 4. Does this indicate that the air leak has gotten better or worse?
Worse. The higher the number, the worse the leak.
What are the 4 different settings/things we need to control when someone has mechanical ventilation?
Respiratory rate, tidal volume, PEEP, and FiO2
Bonus Q: What should each of these be set to?