Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
105 Cards in this Set
- Front
- Back
What does the upper resp tract do?
|
warms and filters inspired air
|
|
What does the lower resp tract do?
|
(lungs) gas exchange- O2 to tissues via blood stream and expelling waste gases (CO2) during expiration
|
|
What is the resp system responsible for?
|
ventilation and diffusion
|
|
What makes up the upper resp tract?
|
nose, sinuses (frontal, ethmoidal, spenoidal, maxillary), nasal passages, pharynx (throat), tonsils, adenoids, larynx (voice organ), trachea (wind pipe)
|
|
What makes up the lower resp tract?
|
lungs, bronchial and alveolar
|
|
Does the inspiratory or expiratory phase require energy?
|
inspiratory requires energy, expiratory is normally passive except for COPD
|
|
Describe pleura- viseral and parietal.
|
visceral pleura lines the lungs, pariental pleura lines the thorax, pleural fluid is between to lubricate thorax and lungs
|
|
What is the mediastrinum?
|
middle of the thorax, all thoraic tissue between vertebral column and sternum expect for the lungs
|
|
describe the left and right lungs.
|
left: upper and lower lobe
right: upper, middle, and lower lobe |
|
Describe the bronchi, bronchioles, alveolar
|
bronchi--bronchioles (contain submucosal glands) both covered with cilia--respiratory bronchioles--alveolar ducts--alveolar sacs (gas exchange)
|
|
what is physioloical dead space in the lungs?
|
150 ml of air in the tracheobronchial tree that does not participate in gas exhange
|
|
Describe the 3 types of alveoli.
|
I-epithelial cells that form alveoli walls
II-alveolar cells that are metabolically active III-alveoli cell macrophages |
|
Describe oxygen transport
|
o2 diffuses from capillary walls to interstitual fluid then into the membrane of the tissue cells
|
|
What happens during tissue capillary exchange?
|
blood enters veins into pulmonary circulation, o2 diffuses from alveoli into blood, CO2 diffuses from blood to alveoli
|
|
What things may alter the bronchial diameter?
|
-contraction of bronchial smooth muscle- asthma
-thickening of broncial mucosa- chronic brochitis -obstruction of airway-tumor, foreign body -loss of lung elasticity-emphysema |
|
What is compliance?
|
measure of elasticity, expandability, distensibility of the lungs and thoracic structures
|
|
What causes increased or high compliance?
|
thorax is overextened and lungs have lost their elasticity--emphasema
|
|
What causes decreased or low compliance?
|
stiff lungs or thorax- pneumothorax, hemothorax, pleural effusion, pulmonary edema, atelectasis, pulmonary fibrosis, ARDS
|
|
Define tidal volume
|
volume of air inhaled and exhales with each breath
-approx 500ml -measured by spirometer |
|
Define inspiratory reserve volume
|
max vol of air that can be inhaled after a normal inhalation
--3000ml |
|
define expiratory reserve volume
|
max volume of air that can be exhaled forcibly after a normal exhalation
1100ml |
|
define residual volume
|
vol of air remaining in the lungs after a max exhalation
1200ml |
|
define vital capacity
|
max vol of air exhaled from the point of max inspiration
4600ml -measured with spirometer |
|
define inspiratory capacity
|
max vol of air inhaled after normal exp
3500 ml |
|
define functional residual capacity
|
vol of air remaining in the lungs after a normal expiration
2300 ml |
|
define total lung capacity
|
vol of air in the lungs after a max inspiration
5800 ml |
|
define pulmonary perfusion and what factors influence it
|
actual blood flow thru pulmonary circulation
-pulmonary artery pressure, gravity, alveolar pressure |
|
describe pulmonary circulation
|
pumped into lungs by right ventricle-pulmonary artery, alveolar gas exchange occurs
|
|
What is the systolic pressure and diastolic pressure in the pulmonary artery?
|
systolic- 20-30ml
diastolic- 5-15 ml |
|
What happens when the ventilation-perfusion ratio is imbalanced?
|
shunting of the blood results in hypoxia
-severe hypoxia when shunting is >20% |
|
atmospheric pressure at sea level is?
|
760 mm Hg
|
|
How is oxygen transported in the blood?
|
hemoglobin==== oxyhemoglobin
|
|
What is the partial pressure of oxygen hemoglobin is 100% saturated? Or 70% saturated?
|
PaO2 = 150 mm Hg
PaO2 = 40 mm Hg |
|
What is the normal level of PaO2?
|
80-100 mm Hg = 95-98% sat
|
|
What is the normal level of PaCO2?
|
35-45 mm Hg
|
|
What controls ventilation (neuro)?
|
phrenic nerve
medulla oblongata (inspiration) and pons (rate) -peripheral chemoreceptors in aortic arch, carotid arteries, Hering-Breur reflex (alveoli) |
|
What are the gerontologic changes that occur in our respiratory system?
|
alveoli loose elasticity, loss of chest wall mobility, dead space increases, dec ability to move air in and out of lungs, dec mucosa and cilia, dec cough and gag reflex, dec in airway size, dec surface area of capillary membrane
|
|
What are major s/s of respiratory disease?
|
dyspnea (shortness of breath), cough, sputum production, chest pain, wheezing, clubbing of fingers, hemoptysos (spitting up blood), cyanosis
|
|
What might sudden dyspnea in a health person mean?
|
pneumothorax, ARDS, acute resp obstruction
|
|
Dyspnea in the following people may indicate what:
immoble, orthopnea, with expiratory wheezing? |
immoble- pulmonary embolism
orthopnea- heart disease, COPD exp wheezing- COPD |
|
What are the risk factors for respiratory disease?
|
smoking, secondhand smoke, family history of lung disease, genetics, allergens and environmental pollutants, rec and occupational exposure
|
|
what relief measures should be used for dyspnea?
|
id cause, high fowlers, oxygen admin
|
|
What can cause a dry irritative cough?
|
upper resp tract viral infection of side effect of ACE inhibitor
|
|
What can cause an irritative high pitched cough? brassy cough? severe or changing cough?
|
irritative high pitched-laryngotracheitis
brassy- tracheal lesion severe or changing- bronchogenic carcinoma |
|
If a cough causes pleuritic chest pain what does this indicate?
|
pleural or chest wall (musculoskeletal) involvment
|
|
What might coughing at night indicate? morning with sputum? supine position? recent onset? with food?
|
night- left sided heart failure or bronchial asthma
morning with sputum- bronchitis supine- postnasal drip recent onset- acute infection food- aspiration into tracheobronchial tree |
|
What is meant by a acute, subacute and chronic cough?
|
acute - <3 weeks
subacute - 3-8 weeks chronic - > 8 weeks |
|
What does purulent (thick yellow, green or rust color) sputum indicate?
|
bacterial infection
|
|
What does thin, mucoid sputum indicate?
|
viral bronchitis
|
|
what does gradual increase of sputum over time indicate?
|
chronic bronchitis, bonchiectasis
|
|
What might pink tinged sputum indicate?
|
lung tumor
|
|
What might profuse, frothy, pink material welling up in the throat indicate?
|
pulmonary edema
|
|
What might foul-smelling sputum and bad breath indicate?
|
lung abscess, brochiectasis, fusospirochetal infection or anaerobic cause infection
|
|
What relief measures should be followed for a cough?
|
adequate hydration to thin sputum allowing it to come up, inhalation thru aerosolizing solutions, not smoking, adequate oral hygiene, wise selection to encourage food intake, citris drink before eating may increase palatability of meal
|
|
What does pleuric pain feel like and ways to relieve it?
|
sharp and catching on inspiration (knife stabbing), have patient lie on the effective side and NSAIDS
|
|
What are the most common causes of hemoptysis?
|
pulmonary infection, carcinoma of the lung, abnormalities of heart or blood vessels, pulmonary artery or vein abnormalities, pulmonary embolism and infarction
|
|
What is cyanosis? When does it occur? how is central cynosis assessed?
|
bluish coloring of the skin, late indicator of hypoxia (but not totally reliable), usually occurs when 5 g/dl of hemoglobin become unoxygenated, centeral cynosis is ***** by observing color of tongue and lips
|
|
What are the 4 main chest deformaties associated with respiratory disease?
|
barrel chest, funnel chest, pigeon chest, kyphoscoliosis
|
|
Describe barrel chest.
|
overinflation of the lungs, caused by emphysema, chest in thick front to back
|
|
Describe funnel chest.
|
depression of lower portion of sternum, may compress heart and great vessels resulting in murmurs, caused by marfan's syndrome or rickets
|
|
what is rickets and marfan's syndrome?
|
rickets- lack of vit D/calcium resulting in softening of the bones
marfan's syndrome-genetic defect of connective tissue |
|
Describe pigeon chest
|
displacement of sternum, increase in front to back, may occur with rickets, marfan's, severe hyphoscoliosis
|
|
Describe kyphoscoliosis
|
s-shaped spine, elevated scapula, limits lung expansion within thorax, may occur in osteoporosis and other skeletal disorders
|
|
Define eupenea
|
normal patterened respiration,
12-18 per minute |
|
Define bradypnea and causes
|
<12 breaths per minute, caused by increased ICP, brain injury, durg OD
|
|
define tachypnea and causes
|
>24 breaths per minute, caused by pneumonia, pulmonary edema, metabolic acidosis, septicemia, severe pain, rib fracture
|
|
define hypoventilation
|
shallow irregular breathing
|
|
define hyperpnea
|
increase depth of respiration
|
|
define hyperventilation
|
increased in both rate and depth that results in decreased arterial PaCO2
-severe acidosis of diabetic or renal origin, Kussmaul's respirations |
|
define apnea
|
varying periods of cessation of breathing
|
|
define Cheyne-Stokes respirations. what might cause this?
|
alternating between apnea (20 secs) and deep shallow breathing
-heart failure, damage to respi center (drug induced, trauma, tumor) |
|
define Biot's respirations. what might cause it?
|
cluster breathing, cycles of breathing that have varying periods of apnea
-central nervous system disorders |
|
What does bulging of intercostal spaces during expiration imply? retraction of inspiration, with asymmetry?
|
bulging- obstruction of air flow-emphasema
retraction-blockage of a branch of the respiratory tree asymmetry- pressure in pleural cavity or pleural space (pneumothorax, pleural effusion) |
|
What could cause decreased chest excursions? Asymmetric excursion?
|
chronic fibrotic disease
Asymmetric-splitting secondary to pleurisy, fractured ribs, trauma, unilateral bronchial obstruction |
|
what causes diminished or absent lung sounds?
|
atelectasis (bronchial obstruction), pleural effusion (fluid), obesity (tissue)
-emphasema |
|
what do crackles sound like and what may cause them?
|
-soft high pitched discontinuous popping sounds during inspiration
-discrete, noncontinuous sounds from delayed reopening of deflated airways -inflammation, congestion, pleural friction rub (pneumonia, bronchitis, heart failure, bronchiectasis, pulmonary fibrosis) |
|
what do wheezes sound like and what may cause them?
|
-whistle like
-bronchospasm, asthma, secretion build up |
|
describe vesicular breath sounds
|
soft, insp is longer than exp
|
|
describe broncho-vesicular sounds
|
insp = exp
|
|
describe bronchial sounds
|
loud, esp > insp
|
|
describe tracheal
|
loud, insp = exp
|
|
what are findings of consolidation (pneumona)?
|
bronchial breath sounds, crackles, bronchophony, egophony
|
|
what are the finds of bronchitis?
|
wheezes
|
|
what are the breath sounds of asthma?
|
wheezes
|
|
what are the breath sounds of pulmonary edema?
|
crackles at lung bases
|
|
what are the breath sounds of pleural effusion?
|
absent or diminished sounds
|
|
what are the breath sounds of pneumothorax?
|
absent breath sounds
|
|
what are the breath sounds of atelectasis?
|
decreased or absent breath sounds
|
|
what can prolonged hypoventilation cause?
|
alveolar collapse
|
|
what are the risk factors for hypoventilation?
|
-limited neurological impulses (spinal cord trauma, CVA, tumors, myasthenia gravis, Guillain-Barre, polio, durg OD)
-depressed respiratory center (anesthesia, sedation, drug OD) -limited thoracic movement (kyphoscoliosis), limited lung movement (pleural effusion, pneumothorax), reduced functional lung tissue (chronic pulmonary disease, severe pulmonary edema) |
|
when will a patient require resp. assistance based on vital capacity?
|
10 mL/kg
|
|
how is normal inspiratory pressure measured? What is normal? when is mechanical ventilation required?
|
manometer
100 cm H2O vent at 25 cm H2O |
|
what is PaO2?
|
arterial oxygen tension, degree of oxygenation of the blood
-75-100 mm Hg |
|
what is PaCO2?
|
arterial carbon dioxide, indicates adequate alveolar ventilation
-35-45 mm Hg |
|
SpO2
|
oxygen saturation with pulse oximetry
-95-100% |
|
SaO2
|
oxygen saturation of hemoglobin
|
|
how is sputum collection done?
|
clear nose and throat, rinse mouth, take a few deep breaths, using diaphragm cough expectorate into sterile container
-deliver within 2 hours |
|
what is fluoroscopy used for?
|
biopsy, movement of chest wall
|
|
when is pulmonary angiography used?
|
suspected thromboembolic disease
|
|
how is a V/Q scan performed? What can it help diagnose?
|
-radioactive agent injected into peripheral vein to assess perfusion thru lungs, pulmonary vessesls
-brochitis, asthma, inflam fibrosis, pneumonia, emphysema, lung cancer |
|
describe a bronchoscopy and what is the purpose?
|
-direct inspection of larynx, trachea, bronchi
-exam tissues or collect secretions, remove foreign object, excise lesion, insert stents for airway obstruction |
|
what are the nursing interventions for a bronchoscopy?
|
consent form, NPO for 6 hours before, watch for resp depression with sedation, remove dentures, NPO after until cough reflex returns, VS, dyspnea, bleeding
|
|
describe thoracoscopy
|
pleural cavity is examined with endoscope thru intercostal space
-may aspirate fluid and add chest tube for drainage -evaluate pleural effusion, pleural disease, tumor staging |
|
describe thoracentesis
|
aspiration of pleural fluid under ultrasound guidance
-may do needle biopsy too -may instill medication |
|
what are the nursing interventions for thoracentesis?
|
consent, sedation admin, allergy, position, expose chest, apply pressure after with sterile airtight dressing, bed rest, record total amount of fluid, monitor VS
|