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Chapter 25 & 26 Respiratory Assessment and Upper Respiratory Review Notes '17

Deep dive surge in medical termology about the respiratory and upper r...

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Medical Terminology (AHCC 003)

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Howard University

Academic year: 2020/2021

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Chapter 25 Respiratory Assessment

Surfactant and Atelectasis

Alveolar cells secrete surfactant - a lipoprotein that lowers the surface tension in the alveoli. Surfactant makes it easier to inflate the alveoli and decreases the alveoli’s tendency to collapse. Deep breathing stimulates production of surfactant.

Atelectasis refers to collapsed, airless alveoli. Patients with decreased mobility and postoperative patients are at risk for atelectasis because of lack of breathing stimulation, effects of anesthesia, and restricted breathing with pain. In acute respiratory distress syndrome (ARDS), lack of surfactant contributes to widespread atelectasis.

How do you prevent atelectasis?

Effects of Aging on Respiratory System (Table 25)

ABGs vs Pulse Oximetry: methods used to measure gas transfer in the lungs and tissue oxygenation. Arterial Blood Gases (ABGs) – obtained from arterial blood sample. Measures: Gas exchange  PaO2 (Partial pressure of oxygen) – amount of oxygen dissolved in plasma  PaCO2 (Partial pressure of carbon dioxide)  SaO2 – amount of oxygen bound to hemoglobin Acid-base balance  pH - acidity  HCO3 – bicarbonate

Normal ABG Values

Pulse Oximetry – obtained through a probe on finger, toe, ear lobe, forehead, bridge of nose Measures SpO2 – oxygen saturation of hemoglobin through pulse oximetry. Equivalent to SaO2, but less accurate when SpO2 at <70%.

Chapter 26

Upper Respiratory Problems

Understand deviated septum, nasal fracture, and the collaborative care/nursing management of rhinoplasty including nasal surgery.

Allergic Rhinitis Definition: Reaction of the nasal mucosa to a specific allergen. Can be classified according to causative allergen or the frequency of symptoms. Episodic refers to symptoms related to sporadic exposure to allergens that are not typically encountered in the client’s normal environment. Intermittent means symptoms are present less than 4 days a week or less than 4 weeks per year. Persistent means the symptoms are present more than 4 days a week and for more than 4 weeks a year.

Allergic Rhinitis

Clinical Manifestations

Sneezing, watery, itchy eyes and nose, altered sense of small, and thin, watery nasal discharge that can lead to more sustained mucus production and nasal congestion. Symptoms can lead to nasal chronic conditions 🠀 headache, congestion, pressure, nasal polyps, and postnasal drip.

Collaborative/Nursing Management

Identify and avoid triggers of allergic reactions. Instruct patient to keep a diary of time when allergic reaction occurs and activities surrounding reaction. Education regarding medications to reduce inflammation such as second-generation antihistamines. Refer to Table 26 Patient and Caregiver Teaching Guide.

Influenza Definition: highly contagious respiratory illness that causes significant morbidity and mortality. Vaccines available help to prevent many influenza related deaths per year. Influenza

Pathophysiology/Etiology Classified into A, B, and C serotypes.

Influenza A

- Causes seasonal epidemics - Two Subtypes

hemagglutinin (H)
neuraminidase (N)

Influenza B

- Causes seasonal epidemics

- No subtypes, but has different strains

Influenza C

- Causes mild respiratory illness

- Not thought to cause epidemics

Viruses have the ability to change over time, which accounts for widespread disease. Influenza is transmitted through direct contact and inhalation. Incubation period of 1-4 days with peak transmission risk starting at approx. 1 day before the onset of conditions.

Clinical Manifestations Onset is typically abrupt. Symptoms include  chills, fever, anorexia, malaise, and generalized myalgia often accompanied by headache, cough, rhinorrhea, and sore throat. Dyspnea and diffuse crackles are signs of pulmonary complications. Symptoms usually last about 7 days. Pneumonia  most common complication.

Diagnostic Studies Health history, clinical findings, and other cases of influenza within the community. Rapid flu test using nasal secretions. Viral cultures are the “gold standard”.

Collaborative/Nursing Management

Prevention! Education regarding flu vaccination. Relief of symptoms and prevention of secondary infection. Rest, hydration, analgesics, and antipyretics. May need antiviral medications such as Tamiflu and Relenza. Education regarding the risks and benefits of these drugs must be provided.

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