on there Sh.
ange
get in in class review
X me
·
-
I
volume UNIT 3 ventilation issues
*~
m
manifest ass..
muscle use
accessory
BREATHING PATTERNS
-
tripod -
● Cheyenne stokes: ↳ intervention
○ Periods of inspiration & expiration w/ periods of apnea elevate HOB ·
02
low flow
○ Usually @ end of life
·
bronchodilator ·
G
● Biotes: mucolytics ·
○ Irregular periods of inspiration & expiration followed by apnea VS ·
○ Seein in- trauma or affected nervous system ↳ "ACUTE"
Sleep Apnea Pg 510-512 “Cessation of breathing = apnea”
● Cause: Repetitive upper airway obstruction
● RF:
○ Obesity
○ Male gender
○ HTN
○ Enlarged tonsils, adenoids & uvula
○ Smoking
● Manifestations:
○ Loud snoring w/ breathing cess 10 sec or > 5 episodes/hr
○ “3 S’s” (Snoring, sleepiness, spouse)
○ Morning HA > give
-
modanafil
○ Daytime sleepiness “hypersomnolence”
■ Daytime hypoventilation:
● Due to obesity SO O2 supplementation & HOB always up in
low fowlers
○ Frequent nocturnal awakening
○ Insomnia
○ Polycythemia
○ Arrhythmias
○ Enuresis “bed wetting”
○ HA when waking up, daytime sleepiness, dry throat in the morning
● Management:
○ Decrease weight
○ Avoid alcohol & sleep on back
○ Admin low O2 @ night to relieve hypoxemia
○ MAD (mandibular advancement device)
○ CPAP (prevents airway collapse) weight
loss
HOB
·
○ Surgical includes: elevate
-
■ Tonsillectomy position change
-
■ Uvulopalatopharyngoplasty
■ Maxillomandibular (enlarges posterior pharyngeal region)
■ Tracheostomy *last thing we do* major adverse effects:
● Speech difficulties
● Increase risk of infec.
○ MED
■ Modafinil (reduces daytime sleepiness) = 200-400 mg
■ Protriptyline (Triptil) *at bedtime, increase resp drive & improve upper
airway muscle tone*
■ Medroxyprogesterone acetate (Provera) & acetazolamide (Diamox)
prescribed for sleep apnea ass w/ chronic alveolar hypoventilation.
, BOX
-
No crowded areas
HA ,
healthy dief
>
- er use
rinsemouth
COPD Pg: 602 - 631
● Preventable resp disease of airflow obstruction involving the airways &
parenchyma
* *
● NANDA: ineffective airway clearance and impaired gas exchange
Chronic Bronchitis “BLUE BLOATER”
● Cough & sputum prod for 3m in 2 consecutive yrs
● Inflamm of bronchi & bronchioles caused by:
○ Environmental pollutants & cigarette smoke
■ Leads to thick mucus prod
■ Mucus plugging reduce ciliary function
■ Bronchial walls become damaged & fibrosed
■ Pt more susceptible to resp infec
■ Thick *yellow mucus* prod
■ R sided HF
2·
Emphysema “ PINK PUFFER”
● Loss of lung elasticity & hyperinflation
● Resulting in air trapping in alveoli walls
↑ PaCO2 ● RF:
1 PaO2
- PH ○ *Cigarette smoking 80-90% cases*
○ 2nd hand smoke
○ Increased age
○ Indoor & outdoor pollution
○ Dust & chemicals
● Manifestations:
○ Chronic cough, Sputum ↑
○ Dyspnea interferes w/ eating → leads to
■ Weight loss
○ Barrel chest d/t hyperinflation
○ Upward heave shoulders
○ Depression *
this would
*
- require a
○ PaO2 below 80 up
follow
● DX:
○ Spirometry
○ ABGs, Chest X-ray, CBC
● Management:
○ Reduce smoking
■ Set a quit date
■ Follow up within 3-5 days of quit date
■ Nicotine (gum, patch, nasal spray)
○ Bronchodilators (↑ HR, DO NOT USE B4 OR AFTER EATING)
○ Corticosteroids and mucolytics**
○ Pursed lip breathing (improves O2 & airway)
Pneumothorax Pg 593 - 598
● Parietal / visceral pleura is breached & pleural space exposed to (+) atmospheric
pressure
● Manifestations: “Depends on size & cause”
○ Will not hear anything on auscultation**
○ Small:
ange
get in in class review
X me
·
-
I
volume UNIT 3 ventilation issues
*~
m
manifest ass..
muscle use
accessory
BREATHING PATTERNS
-
tripod -
● Cheyenne stokes: ↳ intervention
○ Periods of inspiration & expiration w/ periods of apnea elevate HOB ·
02
low flow
○ Usually @ end of life
·
bronchodilator ·
G
● Biotes: mucolytics ·
○ Irregular periods of inspiration & expiration followed by apnea VS ·
○ Seein in- trauma or affected nervous system ↳ "ACUTE"
Sleep Apnea Pg 510-512 “Cessation of breathing = apnea”
● Cause: Repetitive upper airway obstruction
● RF:
○ Obesity
○ Male gender
○ HTN
○ Enlarged tonsils, adenoids & uvula
○ Smoking
● Manifestations:
○ Loud snoring w/ breathing cess 10 sec or > 5 episodes/hr
○ “3 S’s” (Snoring, sleepiness, spouse)
○ Morning HA > give
-
modanafil
○ Daytime sleepiness “hypersomnolence”
■ Daytime hypoventilation:
● Due to obesity SO O2 supplementation & HOB always up in
low fowlers
○ Frequent nocturnal awakening
○ Insomnia
○ Polycythemia
○ Arrhythmias
○ Enuresis “bed wetting”
○ HA when waking up, daytime sleepiness, dry throat in the morning
● Management:
○ Decrease weight
○ Avoid alcohol & sleep on back
○ Admin low O2 @ night to relieve hypoxemia
○ MAD (mandibular advancement device)
○ CPAP (prevents airway collapse) weight
loss
HOB
·
○ Surgical includes: elevate
-
■ Tonsillectomy position change
-
■ Uvulopalatopharyngoplasty
■ Maxillomandibular (enlarges posterior pharyngeal region)
■ Tracheostomy *last thing we do* major adverse effects:
● Speech difficulties
● Increase risk of infec.
○ MED
■ Modafinil (reduces daytime sleepiness) = 200-400 mg
■ Protriptyline (Triptil) *at bedtime, increase resp drive & improve upper
airway muscle tone*
■ Medroxyprogesterone acetate (Provera) & acetazolamide (Diamox)
prescribed for sleep apnea ass w/ chronic alveolar hypoventilation.
, BOX
-
No crowded areas
HA ,
healthy dief
>
- er use
rinsemouth
COPD Pg: 602 - 631
● Preventable resp disease of airflow obstruction involving the airways &
parenchyma
* *
● NANDA: ineffective airway clearance and impaired gas exchange
Chronic Bronchitis “BLUE BLOATER”
● Cough & sputum prod for 3m in 2 consecutive yrs
● Inflamm of bronchi & bronchioles caused by:
○ Environmental pollutants & cigarette smoke
■ Leads to thick mucus prod
■ Mucus plugging reduce ciliary function
■ Bronchial walls become damaged & fibrosed
■ Pt more susceptible to resp infec
■ Thick *yellow mucus* prod
■ R sided HF
2·
Emphysema “ PINK PUFFER”
● Loss of lung elasticity & hyperinflation
● Resulting in air trapping in alveoli walls
↑ PaCO2 ● RF:
1 PaO2
- PH ○ *Cigarette smoking 80-90% cases*
○ 2nd hand smoke
○ Increased age
○ Indoor & outdoor pollution
○ Dust & chemicals
● Manifestations:
○ Chronic cough, Sputum ↑
○ Dyspnea interferes w/ eating → leads to
■ Weight loss
○ Barrel chest d/t hyperinflation
○ Upward heave shoulders
○ Depression *
this would
*
- require a
○ PaO2 below 80 up
follow
● DX:
○ Spirometry
○ ABGs, Chest X-ray, CBC
● Management:
○ Reduce smoking
■ Set a quit date
■ Follow up within 3-5 days of quit date
■ Nicotine (gum, patch, nasal spray)
○ Bronchodilators (↑ HR, DO NOT USE B4 OR AFTER EATING)
○ Corticosteroids and mucolytics**
○ Pursed lip breathing (improves O2 & airway)
Pneumothorax Pg 593 - 598
● Parietal / visceral pleura is breached & pleural space exposed to (+) atmospheric
pressure
● Manifestations: “Depends on size & cause”
○ Will not hear anything on auscultation**
○ Small:
