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123 Cards in this Set
- Front
- Back
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What is the viscural plura
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lines the lungs
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What is the functional unit of the lung
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Alveoli
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What is the parietal plura
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lines the chest cavity
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What is the Plural space
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the Area btw the viscural plural and the parietal plura
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What are the leading cause of morbidity and mortality
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Post operative pulmonary complications
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What are the 4 things to reduce post op pulmonary complications
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1. Deep breathing
2. Smoking Cessation 3. Early ambulation 4. Pain control |
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What does a high temp mean (typically)
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Bacterial infections
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What does a low grade temp usually mean?
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Viral infection or Atelactais
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What is Atelactais
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Collapsed alveoli, not good air movement
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What are the 7 risks associated with Chronic tobacco use
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1. COPD
2. Cancer (Lung and Bladder) 3. Lipid profile changes 4. Cataract development 5. Gum Disease 6. Sexual DIsfunction 7. Delayed healing and recovery after surgery |
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What are the 5 parts of the nose?
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1. External nose
2. Nares 3. Frontal and maxillary sinuses 4. Floor of nose 5. Internal nose |
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Olfactory cells
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form connections to CN I and give sense of smell
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What is the Kiesselbach's area
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front of nasal septum that contains a rich supply of blood vessels
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Lateral walls of the nose
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turbinates to warm, humidify, and filter the air
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What are the purposes of the nose?
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Collect debris and bacteria, warm air, and smell
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What nerve receptors are located in the upper part of the nasal cavity and septum
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CN I
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What are sinuses?
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Air-filled cavities within the skull that are lined with mucous membranes and cilia....that open into the nasal cavity...
Decrease the weight of the skull |
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How many pairs of Sinuses?
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4
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What are the 4 major functions of the respiratory system
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1. Supply oxygen
2. Remove CO2 3. Maintain homeostasis 4. Maintain heat exchange |
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What is ventiliation
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Movement of air back and forth from the deepest reaches of the alveoli to the outside
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What is diffusion and perfusion
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gas exchange across the alveolarpulmonary capillary membranes
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Circulatory system
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transport of oxygen to the periphery, carbon dioxide from the peripheral body
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Chemical recptors in the medulla oblongata
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respond to changes in hyrdrogen ion concentration in the blood
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Peripherally chemical receptors in the ......also respond to changes
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Carotid body
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Excess levels of CO2 stimulate
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the rate and depth of respiration
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That are the anterior parts of the chest? (4)
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Sternum, manubrium (connects laterally with the clavicles 7 first 2 pairs of ribs), xiphoid process and costal cartilages
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Costal cartilages
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connect the ribs to the sternum
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What vertebrae are connected to the ribs
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T1-T12
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Hypercapnea
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drive because of increase in CO2
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Which are the floating ribs
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11 and 12
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Which ribs are connected to the sternum by cartilage only that connects to 7
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8-10
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What are the muscles of respiration....and the accessory muscles
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1. Diaphragm
2. intercostal muscles Accessory 3. Sternocleiodmastoid 4. Trapezius 5. Abdominal |
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AP diameter
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the width of the chest (front to back)
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Cinnamon smell to breath
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Pulmonary TB
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Sweet fruity breath
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DKA
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Fishy, ammonia breath
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increased ammonia, uremia
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Musty, fish, clover breath
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hepatic failure
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Ileus
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Digestive system stops
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Fecal smell to breath
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intestinal obstruction or ileus
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Foul breath
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infection, foreign body, cancer, empyema
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What is Empyema
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lung abscess
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Halotosis
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respiratory infection, tonsillitis, gingivitis or gerd
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Barrel chest
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ribs more horizontal, associated with emphysema, lung hyperinflation, and chronic asthma
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Pigeon chest
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forward protrustion of the sternum causing the adjacent ribs to slob backward
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Funnel chest
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Sternum appears to be displaced posteriorly, "sunken chested" ....typically congenital malformation
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Kyphosis
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curvature of the thoracic spine
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When observing respirations note
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rate, pattern, chest expansion symmetry, depth, and inspiration/expiration ratio
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Paroxysmal noctural dyspnea
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(PND_ sudden onset of SOB while sleeping
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What question do you use to see if pt has orthopnea?
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How many pillows do you need to sleep?
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Platypnea
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dyspnea inc when sitting upright
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Kussmaul breathing
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metabolic acidosis, deep rapid, breathing
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Hypopnea
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abnormally shallow respirations, causes plural pain
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Cheyne-stokes repiration....
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periods of apnea. Typicall drug induced or brain damage (ab to die)....regular breathing pattern....with breaks
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Biot's respiration
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Inc in cranial pressure, damage to medulla oblongata, respirations comprimise with Drug overdose...irregular breathing pattern....with breaks
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During palpation look for ...4
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1. Tenderness, bulging,symmetry
2. Sternum, or xyphoid inflexible 3. Sensations (Crepitus, vibrations) 4. Tactile Fremitus |
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Crepitus
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Air trapped in subcut tissue, crackling
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Vibrations
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pleural friction rub....coarse, grating on inspiration
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What is the test for Tactile Fremitus
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Put ulnar surface of hands to feel ribs....have pt say 99
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To tell diff btw tactile fremitus and cardiac friction rub
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tell pt to hold breath....if still feel friction then its cardiac friction
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2 causes of Tactile Fremitus
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1. Lung Consolidation
2. Pleural fluid |
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Lung Consolidation
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FREMITUS MORE PRONONCED. lung parenchyma engorged with fluid or tissue. Alters the transmission of sound and air
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Pleural Fluid
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FREMITUS DECREASED BC the lung is compressed!!!. Pleural effusion. Fluid collects in the pleural space, displaces the lung upwards.
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What is the palpation test for thoracic expansion
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Stand behind. Palms at 10th ribs, thumbs at costal margins at xyphoid process....watch thumb divergence
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In Percussion the denser the medium...
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quieter the tone
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Normal Resonance
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heard over all the lung areas...loud, low pitched
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Hyperresonance
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hyper inflation, emphysema, loud boom, like low pitch
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Dullness
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flat, over bone, organ, or atelactasis area
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Where the are the apices of the lungs
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Extend 3-4 cm above the inner third of the clavicle
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Bronchial
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Heard over the trachea. High pitch, loud and long expiration, slightly longer than inspiration
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Broncho- vescicular
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Heard over the main bronchus and upper right posterior lung field. Medium pitch. Expiration = inspiration
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Look at page
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315
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Vesicular
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heard over most lung fields, short and soft expirations
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What are the 3 adventitious sounds
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1. Crackles
2. Rhonchi 3. Wheeze |
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Crackles are not
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Cleared with a cough
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Rhonchi
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loud, low, coarse, continuous, may clear with cough
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Wheeze
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Musical noise, squeak, louder during expiration
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Pleural friction rub
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dry rubbing, grating, inflammation of the pleural structures
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Listen when they say '99'... a healthy lung is a muffled indistinct
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Bronchophony
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Listen when they say E. If you hear A thats where the consolidation is
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Egophony
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Listen when they whisper 1,2,3....if its clear then consolidation
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Whispered pectoriloquy
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Pulse oximeter
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O2 sats
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Vital Capacity (VC)
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max ins followed by max exp
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Listen when they say '99'... a healthy lung is a muffled indistinct
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Bronchophony
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Listen when they say E. If you hear A thats where the consolidation is
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Egophony
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Listen when they whisper 1,2,3....if its clear then consolidation
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Whispered pectoriloquy
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Pulse oximeter
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O2 sats
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Vital Capacity (VC)
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max ins followed by max exp
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Peak expiratory flow rate (PEFR)
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max flow achieved during expiration
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Forced Vital Capacity (FVC)
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Forced exhale, hold breath count the seconds and multiply by 50....thats the mL of FVC
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Mediastinum
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btw the lungs, contains the trachea, esophagus,heart and great vessels
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Each lung is limited in its expansion by
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the pleura
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Where does the trachea begin?
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the level of cricoid cartilage, and is approx 10-12 cm long
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Where does the bronchi bifurcate?
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sternal angle
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Where is a pt more likely to aspirate?
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R lung bc of the branches of bronchi
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What is cricoid pressure
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When you intubate some one...pressure on cricoid
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Where is the bottom of the RUL of the lung
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sternum at the 4th rib
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What thoracic vertebrae does the spineous process not hang?
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T1-T4
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At 32 weeks gestation
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adequate amount of surfactant is present in the air sacs
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What closes approx 2 hours after birth
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ductus arteriosus
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Inc risk of what with aging
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pulmonary complications from immobility or post op
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How calc pack years?
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packs per day * years smoked
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histoplasmosis
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fungal infections of the lung in midwesterners
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How do you assess patency
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Close 1 nostril and breath out the other
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What is the tripod?
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Barrel chest, hands on knees while sitting
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Signs of central hypoxia
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Drowsiness, anxiety, restlessness, irritability
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When are pursed lips seen
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with inc respirations,
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Supervicial veneious
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vascular obstruction or cardiovascular disorders
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What are the characteristics of respirations
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rate, rhythm and depth
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5 things that affect a pts bp
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cardiac output, dislensibility of arteries, blood volume, blood velocity and blood viscosity
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Cardiac output
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bp inc with inc cardiac output and dec with dec cardiac output
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Distensibility of the arteries
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bp inc when more effort is required to push blood through stiffened arteries
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Blood volume
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bp inc with inc volume and decreases with dec volum
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Vellus hair
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short, pale, fine
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Terminal hair
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scalp and eye brows
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pollor
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loss of color
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acanthosis nigricans
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roughening and darkening of skin in localized areas, suggests type 2 diabetes
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butterfly patch across nose
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lupus erythematosis
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If there is a blue green flourescence on lesion
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fungal infection
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zosteriform
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linear lesions along the nerve route
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Hypothyroidism skin is often
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rough, flaky, dry
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very thin skin is often seen with
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arterial insufficiency or steroid therapy
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Onycholysis
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detachment of the nail bed
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Beaus lines
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horizontal lines in nail bed....signal acute illness
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