En dessous de la trachée est le système respiratoire inférieur.

Ventilation is the flow of air in and out of the alveoli (asthma)

Diffusion is the exchange of gas between alveoli and RBC (pulmonary fibrosis)
Perfusion is the exchange of gas with the body tissues (peripheral arterial disease)

Labos reliés :
Arterial blood gases asses acid base balance
- pH (7.35-7.45)
- PCO2 (35-45)
- HCO3 (22-26)
- PO2 (80-100)
- Sat

Pulmonary function tests are used for asthma and COPD diagnostics

Bronchoscopy:
- pre : NPO, sédation
- post : gag reflect return before drinking, expected sore throat, verify if pneumothorax

Thoracentesis: is a procedure used to obtain a sample of fluid from the space around the lungs, called
the pleural space

Nasal cannula : 1-6L/min. If more, it can dry the throat and needs a water lubricant
Simple face mask : 6-10L/min
Partial rebreather: one way valve
Non partial rebreather mask (masque à oxygène avec réservoir): it needs to be filled at ⅔ full, one
way valve, 10/15L/min
Masque à effet Venturi: précis, humidifié, 4/12 L/min

Hypoxémie: moins de sang artériel

Hypoxie: hypoperfusion des tissus
 - symptoms early: irritability, accessory muscles, bruits adventices, nasal flaring, tachytruc,
pâleur
- symptoms late: increased lactic acid levels, decreased consciousness, dysrhythmia,
hypotension, cyanosis

Symptoms of oxygen toxicity: non productive cough, nasal congestion, substernal pain, headache,
nausea and vomiting, fatigue, sore throat

Obstructive lung diseses (trouble getting air out):

ASTHMA
- trigger causes inflammation and airway responsiveness leading to airway constriction and
bronchoconstriction
- Symptoms : wheezing, dyspnea, chest tightness, cough, use of AM
- Treatment: bronchodilators, anticholinergics and anticholinergics
Patients should take their bronchodilators 30 minutes before exercise,

Albuterol: short acting (acute asthma attack)

Salmeterol : long acting, control therapy

COPD:
Is a combination of :
- emphysema
Destruction of alveoli in the lung leads to decreased lung elasticity, hyperinflation and air trapping.
- chronic bronchitis
Hypersecretion of mucus

Symptoms : cough, crackles/wheeze, barrel chest, AM, clubbing nails, cyanosis, shallow respiration
PaCO2 will be elevated, PaO2 will be decreased
Treatment : bronchodilators, anticholinergics, corticosteroids
NC: sit upright, provide oxygen, monitor complications (RHF), stop smoking, coarse lip breathing,
how to use spirometer

CYSTIC FIBROSIS
= abnormally thick sticky mucus impairing function of lungs, liver, pancreas, small intestine,
reproductive organs
Symptoms: wheezing, coughing, dyspnea, cyanosis, barrel shaped chest, chronic respiratory
infections, fatty stool, deficiency in fat soluble vitamins, delayed growth
Treatment: bronchodilators, anticholinergics, antibiotics, pancreatic enzymes, chest physio
NC: admin oxygen, increase fibre/protein intake, provide fat soluble vitamins

Interstitial lung diseases (trouble getting the air in because of non compliance)
- immune dysfunction
- sarcoidosis
Symptoms: dyspnea, fatigue, clubbing nails
Treatment : oxygen therapy, antiinflammatory and long term needs lung transplant
PULMONARY HYPERTENSION
= due to increased vascular resistance and bronchoconstriction
Main causes : cardiac diseases, lung diseases, pulmonary embolism
Symptoms : dyspnea, fatigue, palo, chest pain, right sided heart failure, oedema
Treatment: dixogine, diuretics, vasodilators
NC: oxygen, fluid restriction, monitor I/E, daily weight

UPPER RESPIRATORY TRACT DISORDERS

rhinitis : inflammation of nasal mucosa
sinusitis: inflammation of sinuses
pharyngitis : inflammation of pharynx
laryngitis : inflammation of larynx
tonsillitis : inflammation of tonsils

INFLUENZA (A,B,C)
Spreads by droplets

PNEUMONIA
= excess fluid in the lungs due to inflammation
= infectious organism causes fluid collection in alveoli and thickening in alveolar wall and decreased
gas exchange
Older patients can have confusion
PaO2 decreased, PaCO2 increased
Antibiotics, bronchodilators, oxygen therapy
NC: oxygen, encourage fluid intake, high fowler, encourage deep breathing, spirometer

TUBERCULOSIS
infection of lungs
airborn
granulomas/lésions
Symptoms (important) : bloody spit, cough +3 weeks, weight loss, night sweats, lethargy
People who got vaccinated can get a positive result for TB skin test
NC: airborn precautions, N95, surgical mask if patient leaves the room
Treatment : Rifampin, isoniazid, pyrazinamide, ethambutol

PULMONARY EMBOLISM
blockage in lungs caused by blood clot
Risk factors: combined contraception (both P and O), surgery, AF, pregnancy, femur fracture
Symptoms: shortness of breath, anxiety, chest pain with inspiration, tachytruc, hypotension, petechiae
(for fat emboli)
Labs: D-dimers, CT scan
Treatment: anticoagulants (warfarin, heparin), thrombolytics
NC: sit upright, admin oxygen, heparin and warfarin therapeutic levels,
make sure they eat a stable amount of vitamin K, since it is the antidote for warfarin, it could cause it
to stop working at therapeutic levels

PLEURAL DISORDERS
Pleural cavity is the space between the two pleura protecting the lungs
Pneumothorax: accumulation of air in the pleural cavity
Hemothorax : accumulation of blood in the pleural cavity
Pleural effusion: accumulation of fluid in the pleural cavity
Symptoms : reduced breath sounds, respiratory distress, hyperresonance during percussion is
hemothorax, dull resonance is Hemo/Pleur
Treatment: chest tube, benzodiazepines, opioids

chest tubes (right to left) :

- drainage collecting chamber : amount and color
- water seal chamber : add sterile water (up and down movement normally)
- suction control chamber : continuous bubble

NC: check insertion site (subcutaneous emphysema), signs of infection, not clamp, use inspirometer,
place end tube in sterile water if disconnects, check signs of tension pneumothorax

Tension pneumothorax: air enters upon inspiration,

caused by occlusion of chest tube, mechanical ventilation, fracture
Symptoms : tracheal deviation, absent breath sounds, asymmetry of thorax, resp distress, tachytruc,
palor, anxiety

ARDS(acute respiratory distress syndrome)

Caused by on cardiac pulmonary oedema, mostly caused by injury to the lung
Risk factors: sepsis, choc, trauma, pneumonia, pancreatitis, drowning
Symptoms: dyspnea, shallow breathing, cyanosis, crackles
NC: maintenant patent airway, monitor cardiac values, provide mechanical ventilation

AFR (acute respiratory failure)

= inability of lungs to maintain ventilation, tissue hypoxia
Risk atelectasis, cystic fibrosis, pneumothorax, heart failure
Symptoms: tachytruc, hypoxia signs
NC: maintenant patent airway, promote effective positioning, encourage coughing

MECHANICAL VENTILATION
Low pressure alarms (leaks)
High pressure alarms (two PB sandwiches can make you sick: Pulmonary oedema, pneumothorax,
Bronchospasm, Biting, secretions, cough, kink)

Resp rate : number of breaths per min

Tidal volume: volume of gas per min
FiO2: fraction inspired oxygen (concentration, 21% to 100%)
PEEP: positive end expiratory pressure

NC: reintubation equipment and resuscitation bag next to the bed, regularly level consciousness,
ABG, breath sounds, vital signs, suction tracheal secretions, reposition ET tube ev 24h,frequent oral
care, evaluation signs of pneumonie acquise par ventilation