2000- Test 3 Assessing Clients With Respiratory Disorders

Front 1

The function of the respiratory system is to

Back 1

provide cells of the body with oxygen and to eliminate carbon dioxide.

Front 2

The _____ is the passageway for air to move into the lungs and carbon dioxide to move out.

Back 2

upper respiratory system

Front 3

In the upper respiratory system air is ____, ____, and _____.

Back 3

cleaned, humidified, and warmed.

Front 4

5 structures of the Upper Respiratory System are

Back 4

nose, sinuses, pharynx, larynx, and trachea.

Front 5

The external opening of the upper respiratory system is the ____.

Back 5

nose

Front 6

The nose is lined with ____, ____, and _____. There are also turbinates that create turbulent air flow and increase surface area.

Back 6

hair follicles, sweat glands and sebaceous glands

Front 7

Turbinates are also called _____.

Back 7

nasal conchae

Front 8

The 5 functions of the nose are to

Back 8

-filter air
-trap dust and bacteria
-destroy bacteria
-move debris into pharynx
-warm air

Front 9

4 functions fo the skull are to

Back 9

-lighten the skull
-assist in speech
-produce mucus
-traps debris

Front 10

The ____ is the passageway for food and air.

Back 10

pharynx

Front 11

The ____ is the section of the pharynx that is a passageway for air only.

Back 11

nasopharynx

Front 12

The nasopharynx is lined with ____ that moves bacteria that is trapped in mucous to the back of the throat where it can be coughed up or swallowed.

Back 12

ciliated epithelium

Front 13

The ___ and ___ are located in the nasopharynx.

Back 13

tonsils and adenoids

Front 14

The tonsils and adenoids ___ and ____ infectious agents.

Back 14

tray and destroy

Front 15

Eustachian tubes open into the _____,

Back 15

nasopharynx

Front 16

The ____ and ____ are the sections of the pharynx that are passageways for food and air.

Back 16

oropharynx and laryngopharynx

Front 17

The oropharynx and laryngopharynx is lined with _____. This provides protection.

Back 17

stratified squamous epithelium

Front 18

During swallowing the ____ rises to prevent food from entering the nasopharynx.

Back 18

soft palate

Front 19

The ____ is the smallest opening of the upper respiratory system. It provides an airway and routes air and food to the proper passageway.

Back 19

larynx

Front 20

The larynx is where the division of the ___ and ____ occurs.

Back 20

trachea and esophagus

Front 21

The larynx is framed by ___, ___ and ____.

Back 21

thyroid, cricoid, epiglottis

Front 22

The ____ tips to cover the opening to the larynx during swallowing.

Back 22

epiglottis

Front 23

The cough reflex is initiated if anything other than air attempts to enter the _____.

Back 23

larynx.

Front 24

The ____ is the largest opening of the upper respiratory system. It divides to become the right and left primary bronchi.

Back 24

trachea

Front 25

The trachea is lined with ____.

Back 25

cilia

Front 26

The trachea divides to become the right and left primary bronchi. It can be palpated on the front as the ____ and on the back as the _____.

Back 26

Angle of Louis
T4

Front 27

The trachea produces ____ that will trap dust and debris in inspired air.

Back 27

thick mucous

Front 28

___ in the trachea moves the mucous up toward the throat where it can be swallowed or coughed out

Back 28

Cilia

Front 29

The ____ is the area between the right and left primary bronchus that is very sensitive and a nurse must careful with when providing deep endotracheal suctioning.

Back 29

Carina

Front 30

_____ kills and paralyzes cilia. However when you quit the cilia will begin to regenerated and this actually causes more _____.

Back 30

Smoking
coughing

Front 31

The structures of the lower respiratory system are the

Back 31

lungs
pleura
bronchi and alveoli
rib cage, diaphragm, and intercostal muscles.

Front 32

The top of the lung is the ____.

Back 32

apex

Front 33

Each lung is suspended in it's own _____.

Back 33

pleural cavity

Front 34

The ____ is where the blood vessels enter and exit the lungs.

Back 34

hilus

Front 35

The apex of the lungs is at the ____ and may extend slightly above it.

Back 35

clavicle

Front 36

The base of the lungs rest on the _____.

Back 36

diaphragm

Front 37

____ is elastic connective tissue that the lungs are made of.

Back 37

Stroma

Front 38

The left lung has ___ lobes and the right lung has ____.

Back 38

2
3

Front 39

___ is when the heart is on the right side instead of the left.

Back 39

Dextracardia

Front 40

Lung tissue receives its own blood supply from ____ and drains by bronchial and pulmonary veins.

Back 40

bronchial arteries

Front 41

____ deliver deoxygenated blood to the lungs for oxygenation.

Back 41

Pulmonary arteries

Front 42

____ deliver oxygenated blood to the heart.

Back 42

Pulmonary veins

Front 43

The ____ is a double-layered membrane that covers the outside of the lungs.

Back 43

pleura

Front 44

Pleura membranes produce ____ .

Back 44

pleural fluid

Front 45

The slightly ____ pressure in the pleural space acts like a vacuum in the pleural space to keep the lungs open.

Back 45

negative

Front 46

Positive pressure in the pleural space causes the lung to

Back 46

collapse.

Front 47

The right and left primary bronchi divide into ___ and ____.

Back 47

bronchi and alveoli

Front 48

The bronchi and alveoli divide into smaller and smaller branches ending in the _____.

Back 48

terminal bronchioles.

Front 49

___ is on the outside of the airway therefore constriction of smooth muscle makes the airway smaller.

Back 49

Bronchial smooth muscle

Front 50

Before age 4 a child may be diagnosed with _____. After age 4 the diagnosis may be ____.

Back 50

Restrictive airway disease
Asthma

Front 51

Gas exchange occurs in the ____.

Back 51

alveoli

Front 52

The alveoli is also called the _____.

Back 52

respiratory membrane

Front 53

The alveoli is where air meets ____.

Back 53

blood

Front 54

When there is a physiologic shunt there is ___ ventilation and ____ perfusion.

Back 54

no
normal

Front 55

When a person has a pulmonary embolism, an anatomic shunt occurs. This means there is ____ ventilation and ____ perfusion.

Back 55

normal
no

Front 56

When there is a physiologic shunt there is no air into the alveoli. This could be due to

Back 56

mucous plug or obstruction

Front 57

Around ____ is when the capillaries actually meet the alveoli.

Back 57

24 weeks gestation

Front 58

Progressing to smaller: terminal bronchioles->____-> alveolar ducts-> ____->_____.

Back 58

terminal bronchioles->respiratory bronchioles-> alveolar ducts-> alveolar sacs->alveoli.

Front 59

Gas exchange in the alveoli occurs by ____.

Back 59

simple diffusion

Front 60

Alveoli secrete ____ which reduces surface tension to keep the alveoli from collapsing.

Back 60

surfactant

Front 61

A normal adult has about ___ alveoli.

Back 61

300 million

Front 62

Surfactant starts being made in the alveoli at about ____.

Back 62

32 weeks gestation

Front 63

The ____, ____, and ____ protect the lungs.

Back 63

rib cage, diaphragm, and intercostal muscles

Front 64

There are ___ pairs of ribs.

Back 64

12

Front 65

The sternum is made of the ___, ___ and ____.

Back 65

manubrium, body and xiphoid process

Front 66

The ____ is the space between the ribs.

Back 66

intercostal space

Front 67

The ___ is the muscle between the ribs.

Back 67

intercostal muscle

Front 68

The intercostal space and muscles are numbered by the

Back 68

rib above it.

Front 69

Respiration has 4 parts:

Back 69

-Pulmonary ventilation
-External Respiration
-Gas transport
-Internal Respiration

Front 70

____ is air being moved in and out of the lungs.

Back 70

Pulmonary ventilation

Front 71

____ is the exchange of oxygen and carbon dioxide between alveoli and blood.

Back 71

External respiration

Front 72

____ is when O2 and CO2 are transported to and from lungs and the cells via blood.

Back 72

Gas transport

Front 73

____ is the exchange of O2 and CO2 between blood and cells.

Back 73

Internal respiration

Front 74

Breathing is dependent on ____ of air within the thoracic cavity.

Back 74

volume changes

Front 75

Gases flow from areas of ___ pressure to areas of ___ pressure.

Back 75

high to low

Front 76

Intrapleural pressure rises and falls with ____.

Back 76

ventilation.

Front 77

Intrapleural pressure is always ____ intrapulmonary pressure unless trauma occurs.

Back 77

less than

Front 78

Intrapulmonary pressure is the pressure within the _____. It rises and falls with ventilation.

Back 78

alveoli of the lungs

Front 79

____ lasts about 1-1.5 seconds. This is when the diaphragm and intercostal muscles contract, the diaphragm descends and the rib cage elevates.

Back 79

Inspiration

Front 80

During inspiration the lungs stretch and intrapulmonary volume ____ while intrapulmonary pressure ____.

Back 80

increases
decreases

Front 81

During inspiration air rushes in to equal ____.

Back 81

pressure

Front 82

On inspiration, the sternum moves ____ and the diaphragm moves _____.

Back 82

outward
down (contracts)

Front 83

___ lasts about 2-3 seconds and is primarily a passive process.

Back 83

Expiration

Front 84

During expiration the muscles ____; the diaphragm ___ and the ribs _____.

Back 84

relax
rises
descend

Front 85

During the expiration the lungs recoil and pressures ____ compressing alveoli.

Back 85

increase

Front 86

On expiration, intrapulmonary pressure ___ above atmospheric pressure and gases flow out.

Back 86

increases

Front 87

During expiration the sternum moves ____ and the diaphragm ____.

Back 87

inward
relaxes

Front 88

Respiration is controlled by the respiratory center in the ____ and ___ of the brain and chemoreceptors located in the medulla and carotid and aortic bodies.

Back 88

medulla oblongata and pons

Front 89

Chemoreceptors are associated with _____.

Back 89

acid base balance

Front 90

Respiratory passageway resistance can be caused by

Back 90

constriction, mucous, infectious material, tumors or inhaled objects.

Front 91

Lung ____ is how easily the lungs can expand and the flexibility of the rib cage.

Back 91

compliance

Front 92

Lung ____ is how well the lungs contract.

Back 92

elasticity

Front 93

If there is decreased surfactant the ___ will collapse between breaths.

Back 93

alveoli

Front 94

____ is the amount of air moved in and out of the lungs with each normal breath.

Back 94

Tidal Volume

Front 95

Normal TV is ___mL.

Back 95

500

Front 96

___ is the amount of air that can be inhaled forcibly over the tidal volume.

Back 96

Inspiratory Reserve Volume

Front 97

Normal IRV is ____mL.

Back 97

2100-3100mL

Front 98

___ is air that can be forced out over the tidal volume.

Back 98

Expiratory reserve volume

Front 99

Normal ERV is ____mL.

Back 99

1000mL

Front 100

____ is the amount of air that remains in lungs after a forced expiration.

Back 100

Residual volume

Front 101

Vital capacity is the sum of

Back 101

TV+IRV+ERV

Front 102

Normal vital capacity = ____mL

Back 102

4500mL

Front 103

The amount of air that never reaches the alveoli and remains in passageways is the ____.

Back 103

anatomical dead space volume

Front 104

The FEV1 is the _____.

Back 104

Forced expiratory volume in 1st second

Front 105

The ____ is used with patients with COPD and asthma.

Back 105

FEV1

Front 106

The majority of O2 is carried in the blood bound to ____.

Back 106

hemoglobin

Front 107

O2 binding is ___ and ____. It is affected by temperature, blood pH, pco2, po2 and 2, 3-DPG.

Back 107

rapid and reversible

Front 108

O2 saturation of hemoglobin in arterial blood is ____%.

Back 108

97.4%

Front 109

The O2 saturation of hemoglobin in venous blood is ____%.

Back 109

75

Front 110

When body temperature is increased, oxygen unloading is _____.

Back 110

enhanced.

Front 111

When oxygen unloading is enhanced it is less sticky and therefore hemoglobin lets oxygen off ____.

Back 111

faster

Front 112

When there is a decrease in body temperature oxygen unloading is _____.

Back 112

inhibited.

Front 113

As blood becomes more ____, oxygen unloading to the tissues is enhanced.

Back 113

acidotic

Front 114

Increased hydrogen ion concentrations and increased partial pressure of carbon dioxide ____ pH.

Back 114

decrease

Front 115

If a person is acidic it means they are retaining ____ and therefore...

Back 115

CO2
not breathing well.

Front 116

____ enhances the release of oxygen from hemoglobin by binding to the it during times of increased metabolism.

Back 116

2,3-DPG

Front 117

2,3-DPG helps hemoglobin to

Back 117

release O2.

Front 118

Conditions of low tissue oxygen concentration will tend to cause RBCs to generate more ___ in their effort to generate energy by allowing more oxygen to be released in tissues deprived of oxygen.

Back 118

2,3-DPG

Front 119

3 conditions of low tissue oxygen concentration are

Back 119

high altitude
airway obstruction
congestive heart failure

Front 120

Active cells produce about __mL of CO2 per minute.

Back 120

200mL

Front 121

Decreased po2 means there is ____ CO2 transport.

Back 121

increased

Front 122

CO2 is transported in 3 forms:

Back 122

-dissolved in plasma
-bound to hemoglobin
-bicarbonate ions in plasma

Front 123

4 major questions of a respiratory assessment are

Back 123

-Do you have any CP or pain with breathing?
-Do you have any cough?
-Are you coughing any sputum?
-Are you having any SOB or difficulty breathing?

Front 124

Patterns of normal breath sounds are created by the effect of ____ on ___ moving through airways.

Back 124

body structures
air

Front 125

Breath sounds are described by

Back 125

-duration
-intensity
-pitch
-timing

Front 126

Tracheal breath sounds are heard over the trachea. They are described as ___ and sound like air is

Back 126

harsh,
being blown through a pipe

Front 127

_____ sounds are present over the large airways in the anterior chest over the manubrium.

Back 127

Bronchial

Front 128

Bronchial sounds are described as more ___ and ____ sounding than vesicular sounds but not as ____ as tracheal breath sounds

Back 128

tubular and hollow
harsh

Front 129

Bronchial sounds are ____ and ____ in pitch with a short pause between inspiration and expiration.

Back 129

loud
high

Front 130

Bronchial: inspiration__ expiration

Back 130

inspiration < expiration

Front 131

_____ sounds are heard in the posterior chest between scapulae and on either side of the sternum anteriorly.

Back 131

Bronchovesicular

Front 132

Bronchovesicular breath sounds are ____ than bronchial sounds with a ____ quality.

Back 132

softer
tubular

Front 133

Bronchovesicular: inspiration ___ expiration

Back 133

inspiration = expiration

Front 134

With bronchovesicular breath sounds, differences in pitch and intensity are often more easily detected during _____.

Back 134

expiration

Front 135

_____ sounds are soft, blowing, rustling sounds.

Back 135

Vesicular

Front 136

Vesicular sounds are normally heard

Back 136

throughout most lung fields.

Front 137

Vesicular sounds are heard throughout ____ and fade during _____.

Back 137

inspiration
expiration

Front 138

_____ is when a pt says 99. Normal sound would be muffled. Abnormal is loud.

Back 138

Bronchophony

Front 139

____ is normally muffled when a pt says "E". Abnormal- it sounds like they say "A".

Back 139

Egophony

Front 140

1,2,3 loud and clear is abnormal result of ____.

Back 140

whispered pectoriloquy

Front 141

____ are abnormal breath sounds caused by opening of small airways or alveoli.

Back 141

Crackles

Front 142

Crackles are _____, ____ and ____.

Back 142

intermittent, non-musical, and brief

Front 143

_____ are coarse, high-pitched, whistling sound caused by narrowing or obstruction of some part of respiratory tree or heightened airflow velocity.

Back 143

Wheezes

Front 144

Wheezes are often louder during ____.

Back 144

exhalation

Front 145

____ are gurgling, rattling, snoring noises caused by secretion in the bronchial airways.

Back 145

Rhonchi

Front 146

____ is a high-pitched sound that results from turbulent gas flow in the upper airway.

Back 146

Stridor

Front 147

Stridor is louder and longer during ______.

Back 147

inspiration

Front 148

____ is continuous or intermittent low-pitched, scraping, raspy, grafting or creaking sounds.

Back 148

Pleural Friction Rub

Front 149

Pleural friction rub is most often heard on ____.

Back 149

inspiration

Front 150

If a pleural friction rub is suspected, ask patient to hold breath briefly. If rubbing sound continues, it is a ______.

Back 150

pericardial friction rub

Front 151

Normal changes in the older adult are

Back 151

-kyphosis
-barrel chest
-lung changes (loss or elastic recoil, stiffening, gas exchange changes)
-decreased smell
-decreased cough effectiveness
-higher r/f respiratory infections
-r/f exercise intolerance
-high r/f tissue hypoxia
-high r/f chronic pulmonary disease

Front 152

Normal respiratory differences in infants in children are:

Back 152

-lung more stiff: less compliant
-rib cage more compliant
-airways smaller
-poorly developed pathways of collateral ventilation
-relative mucous gland hypertrophy
-consequences of acute infection may be more severe but recovery and growth is tremendous

Front 153

____ are between the alveoli and allow oxygen to flow from a normal alveoli to an occluded alveoli.

Back 153

Pores of Kohn