Respiratory Basics
Medical term for "blue-tinged skin"
Cyanosis
Name 2 different respiratory sounds. What causes them?
Stridor: loud, high-pitched; severe obstruction in larynx or trachea. Wheezing: high-pitched; bronchoconstriction. Crackles/Rales: clicking or bubbling; fluid in lungs. Rhonchi: low-pitched, snoring, cleared with coughing; excessive mucus in large airways. Pleural friction rub: grating or creaking; inflammation in pleura
Basic imaging exam for patients with respiratory symptoms
Chest Xray
For a patient in respiratory distress, what 2 non-invasive interventions do we use FIRST?
Raise head of bed/assist pt to position of comfort; apply oxygen
In what situations does a patient require ventilatory assistance?
Apnea; respiratory rate <8 or >28
Equipment used for secretion management that should always be available at the bedside
Suction
What purpose do CO2 and HCO3 serve in acid-base balance?
CO2 is acidic/lowers pH; HCO3 is alkaline/raises pH
Nonspecific blood test used to help guide diagnostic exams for a suspected pulmonary embolism
D-dimer
Explain when to use NRB vs nasal cannula and what the max flow rate is for each
Nasal cannula: low-flow oxygen for uncomplicated hypoxia; max flow rate 6L/min
NRB: respiratory distress and/or hypoxia not resolved by NC; max flow rate 15L/min
What is the difference between CPAP and BiPAP?
CPAP (Continuous Positive Airway Pressure): constant air pressure to keep airways open
BiPAP (Biphasic Positive Airway Pressure): air pressure changes with respiratory phase: higher with inhalation, lower with exhalation
Name 3 signs/symptoms of respiratory distress
tachypnea; speaking in short/incomplete sentences; tripoding; audible lung sounds; accessory muscle use
What is a chest tube used for?
Allow trapped air/fluids to escape from pleural space and decompress the lungs
Name 2 lung conditions that can be seen on a chest xray
Pneumonia, pneumothorax, pleural effusion, tuberculosis, emphysema, lung abscesses, lung cancer
Name the 2 classes of medications most commonly used for asthma exacerbation
short-acting bronchodilators and steroids
What does FiO2 stand for and what does it mean?
Fraction of inspired oxygen; concentration of oxygen in a gas mixture a patient inhales, expressed as a percentage or decimal. Room air FiO2 is 21% or 0.21
Name 2 questions to ask a patient presenting with respiratory symptoms
When did it start? Has this ever happened before? Any history of CHF, COPD, asthma, etc.? Is it worse with exertion or lying down? Did you use an inhaler/nebulizer at home? Have you ever had to be intubated?
Name 2 non-respiratory diagnoses that can cause respiratory symptoms
myocardial infarction; anxiety; metabolic acidosis/DKA; anemia
What are the normal ranges for pH, HCO3, and PCO2 on an ABG?
pH 7.35-7.45
HCO3 22-26
PCO2 35-45
What class of medication is most commonly used to treat CHF?
Diuretics: furosemide (Lasix), torsemide, hydrochlorothiazide (HCTZ), spironolactone (Aldactone)
What does PEEP stand for and what does it do?
Positive End Expiratory Pressure; keeps alveoli open at the end of exhalation, preventing atelectasis and improving oxygenation
Name at least 4 differential diagnoses for a patient presenting with shortness of breath or respiratory distress
Asthma, COPD, CHF, pneumonia, pulmonary edema, pneumothorax/hemothorax, pulmonary embolism, anaphylaxis
Describe Kussmaul respirations. What condition causes them and why do they occur?
deep, rapid, labored breathing; seen in metabolic acidosis (DKA most common) and serve to expel CO2 to raise pH
In partially compensated metabolic acidosis, where would you expect the pH, HCO3, and CO2 levels to be on an ABG?
pH <7.35; HCO3 <22; PCO2 <35
Explain the mechanism of action and common side effects of albuterol
Reduces bronchoconstriction and bronchospasms; tachycardia, palpitations, jitteriness
Name 3 troubleshooting steps you can take when faced with a ventilator alarm
Check tubing for kinks; tighten BiPAP mask; check for pt biting ET tube; suction airway; check for disconnections in tubing/oxygen supply; ensure ventilator is plugged in; if all else fails, call RT!