Respirtory Exam 1 Bcc

Front 1

Wheeze

Back 1

Hallmark for Asthma. It is a high pitched, musical sound similar to a squeak. More common in expiration, however, can be heard during inspiration. It is heard in narrowed airway diseases such as asthma and emphysema.

Front 2

Stridor

Back 2

Crowing sound. A high pitched, piercing sound that occurs secondary to an Upper Airway obstruction (trachea or larynx) such as a croup, foreign body obstruction, large airway tumor.

Front 3

Rhonchi (Sonorous wheeze)

Back 3

low-pitched, coarse, loud, low snoring or moaning sound. Heard primarily during expiration, may also be heard during inspiration. Narrowing of large airways or an obstruction of the bronchus.

Front 4

Rales (fine crackles)

Back 4

High pitched, short, crackling, popping sounds heard during the end of inspiration and NOT cleared by coughing. The inhaled air collides with previously deflated airways and the airways suddenly POP open, creating a crackling sound as gas pressure between the two compartments equalizes.

Front 5

Coarse Crackles

Back 5

loud, low pitched, bubbling/gurgling sounds that starts in early inspirations and may extend into first part of expiration. Sounds like Velcro. Inhaled air collides with secretions in the trachea and large bronchi. Occurs in pulmonary edema, pneumonia, pulmonary fibrosis, and terminally ill with depressed cough reflex.

Front 6

Bronchovesicular Breath Sound

Back 6

moderate pitched, medium intensity breath sound with inspiration equal to expiration (1:1 ratio). Normally heard and 1st and 2nd ICS at the sternal border at T4 to scapula. ABNORMAL IF HEARD over the peripheral lung fields.

Front 7

Bronchial Breath Sound

Back 7

a harsh, high pitched, low intensity breath sound with expiration longer than inspiration (I<E; 1:2). Sound is normal over the trachea but ABNORMAL if heard over the peripheral lung fields. If heard evidence of consolidation of the lungs such as pneumonia patients.

Front 8

Right lung has how many lobes

Back 8

3

Front 9

The left lung has how many lobes

Back 9

2

Front 10

You hear most abnormal lung sounds in the...

Back 10

posterior lower lobes because nothing it the way and gravity.

Front 11

The apex of the lung is above the

Back 11

Clavicle.
Landmark is C-7

Front 12

The base of the lung at

Back 12

level of lower 6th rib

Front 13

Objective assessment of the lungs

Back 13

Inspection, palpation (symmetrical chest expansion and Tactile Fremitus), Percussion, Auscultation (which gives the greater amount of information).

Front 14

If there no symmetrical chest expansion then it indicates

Back 14

a possible pneumothorax, atelectasis (collapsed alveoli also used interchangeably with pneumothroax), fractured rib, pneumonia.

Front 15

Percussion sounds

Back 15

Tympany (loud intenisty, high pitched), resonance, hyperresonance (moderate to loud with low pitch), dullness (slow/moderate, high pitch), flatness (soft high pitch).

Front 16

Normal breath sounds are

Back 16

Bronchial, tracheal, bronchovesicular, vesicular

Front 17

Vesicular

Back 17

(I>E) peripheral lung fields (posterior). Normal breath sound.

Front 18

Normal HCO-3 (bi-carb)

Back 18

22-26 mEq/L

Front 19

Normal CO2

Back 19

35-45 mmHg

Front 20

When decreased CO2 the HCO-3 should also

Back 20

Decrease to compensate

Front 21

Diminished pCO2 level is due to?

Back 21

Hyperventilation-the faster you breathe the greater CO2 is eliminated.

Front 22

After a Central Venous line is inserted what s/s is of concern and requires the physician to be called and a Chest X-Ray ordered

Back 22

Increased Heart Rate (HR) and Increased Respiratory Rate (RR).

Front 23

Why are COPD patients often underweight and what nursing intervention should be done to correct this issue?

Back 23

They are underweight due to the fatigue associated with under eating. They require a calorie dense diet that is low on carbs, high in protein. (carbs help to hold onto CO2).

Front 24

In later stages of COPD what labs are seen

Back 24

decreased pH, increased pCO2, decreased PO2, increased HCO-3

Front 25

Secondary polycythemia developes as COPD occurs in response to

Back 25

chronic hypoxemia

Front 26

Impaired gas exchange is related to

Back 26

hypoxia

Front 27

Primary function of the respiratory system

Back 27

Exchange of O2 and CO2, delivery of O2 to tissues, Elimination of CO2, and Maintain ABB (acid base balance).

Front 28

Respiration is the

Back 28

exchange of O2 and CO2 at the alveoli level

Front 29

Ventilation

Back 29

movement of air in and out of the lungs

Front 30

T/V (tidal volume, aka T/V)

Back 30

relates to ventilation assistance. It is measurable. Amount (volume) inspired or exhaled during a ventilation. Average is: 500-700 cc (adult).

Front 31

Residual Volume

Back 31

Amount left in the lungs

Front 32

Diffusion

Back 32

transport of O2 to pulmonary capillary to pulmonary veins and blood stream.

Front 33

Hallmarks of Hypoxia (cells being deprived of O2).

Back 33

agitation, mild confusion, mild anxiety, tachycardia, tachypnea, increased pulse rate, flaring nostrils, heaving, capillary refill greater than 3 seconds, cynasosis, cool skin.

Front 34

Hypoxemia

Back 34

get the levels from ABG's that PAO2 should measure between 80-100, if lower than 80 indicates an issue.

Front 35

Normal SAO2 is (affinity for O2 and hemoglobin saturation)

Back 35

95-100

Front 36

On the Oxyhemoglobin disassociation curve (affinity curve) a shift right means...

Back 36

more readily available O2 for cells and tissue

Front 37

On the Oxyhemoglobin dissociation curve a shift left means...

Back 37

less O2 readily available for cells and tissue and more O2 flow in lungs.

Front 38

What is a critical value PAO2

Back 38

60

Front 39

Cilia

Back 39

capture dust and moves things upper (mucus).

Front 40

Goblet cells make

Back 40

mucus.

Front 41

Perfusion problem occurs at the

Back 41

pulmonary capillary level

Front 42

A ventilation problem occurs at the

Back 42

some sort of obstruction...will lead to a perfusion problem if not fixed.

Front 43

Alveoli is where gas exchange takes place and they also secrete

Back 43

surfactant which is a protein that is responsible for the decrease in surface tension and maintaining alveolar patency.

Front 44

Intra-pleural pressure is

Back 44

airtight and negative in pressure

Front 45

Atmospheric pressure is

Back 45

positive pressure

Front 46

The pleural space has fluid (10-20cc only) between the visceral sac (inner) and parietal sac (outer), a pleural friction rub sounds like

Back 46

sand paper.

Front 47

Pulmonary arteries deliver blood to the

Back 47

lungs for oxygenation

Front 48

Pulmonary veins deliver

Back 48

oxygenated blood to the heart

Front 49

Upper Respiratory Disorders

Back 49

Rhinitis, Pharyngitis, Laryngitis, Tonsillitis, Epiglottitis, Influenza, Sinusitis.

Front 50

Caudwell Luc procedure

Back 50

on maxillary sinus, incision under the upper lip to drain.

Front 51

Laryngectomy

Back 51

Removal of Larynx and post-op concerns are ariway, nutrition (possible PEG tube), body image, speech rehab (esophageal speech-burp speech) and TEP.

Front 52

Lower Respiratory disorders

Back 52

Bronchitis, Pneumonia, Bronchiectasis

Front 53

Bronchodilators are used to

Back 53

relax the smooth muscles and dilate bronchi. used for bronchitis.

Front 54

Clinical manifestations of bronchitis

Back 54

productive cough that lasts several months throughout the year. Dry hacking ("smokers cough") cough, ronchi/rales, SOB

Front 55

Cor Pulmonale is a cardiac problem with a

Back 55

respiratory etiology. Right sided heart failure, right sided hypertrophy (lg. size), complication/result of prolonged hypoxemia and pulmonary hypertension), causes cardiac deficit.

Front 56

Polycythemia

Back 56

increase in circulation RBC (secondary to hypoxemia).

Front 57

Consolation

Back 57

looks like "white snow storm" indicates pneumonia.

Front 58

Pneumonia is caused by

Back 58

bacteria, viral. can be acquired by community or nosocomial. there are infection and non-infectious types.

Front 59

Pneumonia is 70-75% caused by... the clinical manifestations are

Back 59

Streptococcus bacteria. cough, SOB, pleuritic (inhale) pain, increase tactile fremitus, rales/rhonchi, fever, chills, malaise.

Front 60

Pneumonia vaccine the CDC recommends anyone over the age of 65 get a

Back 60

booster every 5 years. Prior to 65 ok. Cannot be immunocompromised at the time.

Front 61

PCP is

Back 61

Pneumocystis Carinni Pneumonia secondary to AIDS.

Front 62

Bronchiectasis is

Back 62

chronic dilation of Large Sized bronchioles. Destruction of the bronchial walls accompanied by infection caused by infection, TB, fungi, cystic fibrosis, lung abscess. HALLMARK is excess amounts of mucous (thick, gluey) and occludes and can't bring it up.