Block #1 / Exam #4: Respiratory

Front 1

Where does gas exchange take place?

Back 1

capillaries

Front 2

What coordinate to accomplish gas exchange?

Back 2

respiratory system & circulatory system

Front 3

Respiratory System Functions?

Back 3

-transports O2 from air into body (binds with hemoglobin on the RBCs, needed for cell metabolism)
-removes CO2 (waste products of cell metabolism)

Front 4

Non-Respiratory Functions of Lungs:

Back 4

-protect against airborne irritants & infectious agents
-removes toxic byproducts of metabolism w/ CO2
-manufacture hormones & other chemicals which produce biochemical reactions

Front 5

What is the primary stimulus for breathing?

Back 5

CO2 retention in the blood

Front 6

What pts should be kept slightly hypoxic?

Back 6

COPD

Front 7

COPD pts adjust to what higher levels?

Back 7

CO2

Front 8

What needs to happen before chemoreceptors respond to hypoxia?

Back 8

decreased in O2

Front 9

Efficient gas exchange depends on a balance between?

Back 9

-ventilation or air flow & perfusion or blood flow

Front 10

V

Back 10

Ventilation

Front 11

Q

Back 11

air flow & perfusion

Front 12

What is a normal VQ ratio?

Back 12

0.8

Front 13

What causes a Pulmonary Embolus?

Back 13

blood flow to the alveoli is blocked

Front 14

Incresed VC ratio:

Back 14

-areas may be ventilated, but not perfused
-"dead space" due to gravity, anatomy, or pathology
-Pulmonary Embolus
-high pressure in alveoil may collapse capillaries

Front 15

Decreased VC ratio:

Back 15

-blood flow to lungs may be normal, but ventilation is reduced
-Fluid in alveoli
-mucus plugs
-bronchospasm & constriction

Front 16

Inspiration:

Back 16

-active process
-air flows from area of higher pressure to lower pressure when diaphragm moves down

Front 17

Expiration:

Back 17

-passive process
-elastic recoil of chest wall and lungs allows chest to passively return to normal position

Front 18

Diffusion:

Back 18

process of moving oxygen and carbon dioxide across the alveolar capillary membrane

Front 19

Hypoxemia:

Back 19

reduced oxygenation of arterial blood caused by respiratory alterations

Front 20

Hypoxia:

Back 20

reduced oxygenation of the cells or tissues; may be caused by hypoxemia, low cardiac output, anemia or cyanide poisoning

Front 21

Elastic Coil:

Back 21

tendency of lungs to recoil after being stretched or expanded

Front 22

Sx of Hypoxia?

Back 22

-restlessness
-apprehension
-anxiety
-dizziness
-inability to concentrate
-confusion
-progresses to drowsiness
-dyspnea w/ exertion
-orthopnea
-chest tightness
-pain or pressure
-palpitations
-fatigue

Front 23

Altered Alveolar Shape results in: (Aging)

Back 23

-increased alveolar diameter
-decreased alveolar surface area

Front 24

Decreased Elastic Recoil Leads to: (Aging)

Back 24

-increased residual volume, decreased vital capacity
-premature airway closure
-less efficient gas exchange

Front 25

What leads to chest wall stiffness?

Back 25

-stiffening of elastin and collagen connective tissue that supporting lungs

Front 26

Cardiovascular changes which affect pulmonary function include:

Back 26

-increased stiffness of heart & blood vessels make them less compliant to increased blood flow demands
-Cardiac output decrease with rest & exercise
-CHF can cause respiratory problems

Front 27

Decreased Immune function may lead to resp. problems

Back 27

-Less antibodies produced including after immunization
-Cilia less effective
-Meds can suppress immune function
-increased risk of pneumonia, flu, TB

Front 28

What is Cilia?

Back 28

-Sticky little hair on lungs

Front 29

Neuromuscular & Sensory Changes include:

Back 29

-Neuron loss in brain & CNS increase reaction time
-Loss of muscle tone
-Thoracic rigidity and osteoporotic changes to spine
-Meds cause fatigue, decrease cough reflex, insomnia, dehydration, bronchospasm
-Dementia, Parkinson’s, CVA affect respiratory status
-Increase AP diameter or “barrel” chest

Front 30

Pulmonary (pleuritic) chest pain may be:

Back 30

-Sharp, stabbing, and intermittent
-Dull, aching, and persistent
-Usually felt on affected side, may be referred

Front 31

What is a cough?

Back 31

sudden, audible explosion of air from lungs

Front 32

Purpose of cough?

Back 32

protective reflex to clear trachea, bronchi, & lungs of irritants & secretion

Front 33

What do you want to document about a cough?

Back 33

-sputum amount
-color
-odor
-consistency

Front 34

How can you tell if a patient is having trouble breathing?

Back 34

RR
HR
BP

Front 35

When does cyanosis occur?

Back 35

PO2 is below 40

Front 36

Eupnea

Back 36

normal quiet respiration

Front 37

Dyspnea

Back 37

difficulty breathing

Front 38

Bradypnea

Back 38

abnormally slow respiration

Front 39

Tachypnea

Back 39

rapis, shallow respiration

Front 40

Hyperventilation

Back 40

-Rapid, deep respiration
-Caused by exertion, fear, anxiety, compensation for acidosis

Front 41

Normal chest:

Back 41

-elliptical shape
-ribs slope down

Front 42

Barrrel Chest:

Back 42

-Width & depth equal
-ribs horizontal
-Emphysema
-Normal w/aging and in infants

Front 43

Emphysema:

Back 43

chronic lung hyperinflation

Front 44

Cheyne-Stokes

Back 44

Regular pattern of increased respirations followed by progressively more shallow respirations until apnea occurs

Front 45

Biot’s

Back 45

3-4 normal breaths with irregular periods of apnea

Front 46

If skin is dusky, cool, & clammy -why?

Back 46

-shunting O2 to vital organs

Front 47

clubbing:

Back 47

-base of nails >180 degrees
-SX of Chronic pulmonary disease

Front 48

What may increase RR?

Back 48

-pain
-fever
-anxiety

Front 49

Adventitious Sounds:

Back 49

Abnormal sounds that are superimposed on underlying breath sounds

Front 50

Crackles:

Back 50

-formerly rales
-like hair rubbing together
-fine or coarse, high-pitched crackling and popping noise

Front 51

Wheezes:

Back 51

-due to narrow airways
-high-pitched musical sound, similar to a squeak
-most common on expiration

Front 52

Rhonchi / Gurgles:

Back 52

-heard primarily during expiration
-coughing may clear
-low-pitched, course, loud

Front 53

Early inspiratory crackles in obstructive disease:

Back 53

COPD
Chronic bronchitis

Front 54

Late inspiratory crackles in restrictive disease

Back 54

Pneumonia
CHF

Front 55

Bronchoscopy

Back 55

– examine tissue, biopsy, remove mucous plugs, collect sputum

Front 56

Pulmonary Function Tests (PFTs)‏

Back 56

-Measures volumes, airspeed, & ease of airflow
-Strength of respiratory muscles

Front 57

What are s/sx of URI?

Back 57

-congestion
-excess sputum
-nasal discharge
-headache
-low-grade fever
-malaise

Front 58

What are possible complications on URI?

Back 58

-sinusitis
-otitis media
-pneumonia
-bronchitis

Front 59

Upper Respiratory Infection:

Back 59

Bacteria / virus invades upper airway

Front 60

What are interventions for all URIs?

Back 60

Rest
Fluid & nutrition
Meds

Front 61

Laryngitis:

Back 61

-inflammation of larynx (voicebox) usually cause by a virus

Front 62

S/SX of Laryngitis:

Back 62

-hoarseness
-Sore throat
-nasal congestion

Front 63

Pharyngitis

Back 63

-acute inflammation of the pharynx

Front 64

Strep throat

Back 64

-results from beta-hemolytic streptococcal invasion

Front 65

S/SX of Strep Throat:

Back 65

-sore throat with redness and inflammation
-white, irregular patches, red to purple
-hypertrophy of lymphoid tissue

Front 66

What are possible complications if Strep throat is untreated?

Back 66

-rheumatic fever
-rheumatic heart disease
-kidney disease

Front 67

Pharyngitis

Back 67

-acute inflammation of the pharynx

Front 68

Strep throat

Back 68

-results from beta-hemolytic streptococcal invasion

Front 69

S/SX of Strep Throat:

Back 69

-sore throat with redness and inflammation
-white, irregular patches, red to purple
-hypertrophy of lymphoid tissue

Front 70

What are possible complications if Strep throat is untreated?

Back 70

-rheumatic fever
-rheumatic heart disease
-kidney disease

Front 71

if sinusitis is not treated it can lead to?

Back 71

meningitis, brain abscess and/or osteomyelitis

Front 72

Frequently develops as a result of an URI?

Back 72

Sinusitis

Front 73

Pneumonia

Back 73

Acute infection of lungs caused by bacteria, virus, fungus, aspiration, Legionella, Pneumocystis carinii

Front 74

What can damage lung tissue due to inflammation, immune response?

Back 74

pneumonia

Front 75

S/SX of Pneumonia?

Back 75

fever
chills
increased RR
dyspnea
fatigue
crackles
wheezez
productive cough
Sputum-pink, yellow, green, rust
chest pain

Front 76

TB colonizes in?

Back 76

respiratory bronchioles or alveoli

Front 77

TB is caused by

Back 77

mycobacterium tuberculosis

Front 78

How does TB spread?

Back 78

by inhalation of droplets or ingested in unpasteurized milk

Front 79

S/Sx of TB?

Back 79

fatigue
malaise
weight loss
low-grade fever
night sweats
cough w/ mucopurulent sputum

Front 80

TB Class 0

Back 80

No TB exposure hx

Front 81

TB Class 1

Back 81

TB exposure, no evidence of infection

Front 82

TB Class 2

Back 82

Latent TB infection, no disease

Front 83

TB Class 3

Back 83

TB clinically active

Front 84

TB Class 4

Back 84

TB, not clinically active

Front 85

TB Class 5

Back 85

TB suspect, diagnosis pending

Front 86

COPD

Back 86

progressive airflow obstruction which decreases ability of lungs to perform ventilation

Front 87

COPD is caused by

Back 87

-chronic emphysema, chronic bronchitis, or both
-Chronic bronchiectasis & chronic asthma may also lead to COPD

Front 88

S/SX of COPD:

Back 88

-dyspnea on exertion
-<70% of normal breathing capacity on Pulmonary Function Tests
-may or may not have cough & mucous production

Front 89

Major contributing factors to COPD?

Back 89

-smoking
-recurring infection
-aging

Front 90

Chronic Bronchitis

Back 90

chronic productive cough for 3 months for 2 successive years

Front 91

Emphysema

Back 91

-permanent hyperinflation of alveoli
-Able to inhale, but air is trapped on exhalation

Front 92

Bronchiectasis

Back 92

permanent, abnormal distension of one or more large bronchi; associated w/recurrent bacterial infections

Front 93

Cor Pulmonale

Back 93

enlargement of right side of heart due to pulmonary hypertension leads to right-sided heart failure

Front 94

Treatment of COPD:

Back 94

-Promote improved ventilation
-Reduce secretions
-Slow disease progression
-Reduce risk of complications
-Promote pt. comfort & participation in care
-Improve quality of life

Front 95

Coccidioidomycosis

Back 95

Valley Fever

Front 96

Coccidioides immitis

Back 96

-fungus lives in soil, spores inhaled when dry soil is disturbed

Front 97

spherule

Back 97

Inhaled spores change into larger, multicellular structure

Front 98

What is the leading cause of death in geriatric clients with dysphagia?

Back 98

aspiration pneumonia

Front 99

What causes a barrel chest?

Back 99

Chronic hyperinflation of the lungs

Front 100

Clubbing?

Back 100

Chronic heart or resp disease, base of nail is greater than 180

Front 101

What is Cor Pumonale?

Back 101

Complication of COPD, right-sided heart failure

Front 102

Smoking increases risk of which respiratory diseases?

Back 102

COPD
emphazema

Front 103

What are s/sx early and later hypoxia?

Back 103

Early: change in LOC, restless, iratiable,
Later: less responsive

Front 104

Physiological effects of chronic hypoxia?

Back 104

Clubbing, High co2 levels, RBCs increased,

Front 105

Differentiate between central and peripheral cyanosis?

Back 105

Central: Buccal mucusa, conjuctiva
Peripheral: nail beds,

Front 106

In someone with darker skin?

Back 106

Bucol mucosa, conjunctiva

Front 107

How might you improve nutrition in a COPD pt?

Back 107

Lots of small meals, high protein, easy on fluids at meals

Front 108

Atelectasis?

Back 108

Alveoli don’t pop open, after surgery, prevent by using incentive spirameter,

Front 109

What should normal pulse ox levels be?
In a COPD pt?

Back 109

95-100% above 92
88-92