Assessment - Respiratory

Front 1

What does surfactant do for alveoli?

Back 1

Surfactant is the substance that lowers the surface tension inside alveoli and prevents their walls from being drawn together. Adequate surfactant levels are key to preventing alveolar collapse and allowing alveolar expansion during breathing.

Front 2

What is the difference between ventilation and respiration?

Back 2

Ventilation and respiration have the following differences:

Ventilation is the movement of air into and out of the lungs through the act of breathing.
Respiration is gas (carbon dioxide and oxygen) exchange.

Front 3

Does poor peripheral perfusion increase risk for hypoxemia?

Back 3

No, poor peripheral perfusion increases the risk for tissue hypoxia.

Front 4

Which gas (oxygen or carbon dioxide) is more diffusible through capillary membranes?

Back 4

Carbon dioxide

Front 5

The level of which gas (oxygen or carbon dioxide) is the primary stimulant for breathing?

Back 5

Carbon dioxide

Front 6

What is the importance of diastole to perfusion of the heart?

Back 6

During diastole, the coronary arteries are the only arteries in the body that fill.

Front 7

When is a cough significant? What aspects of a cough should be assessed?

Back 7

cough generally becomes significant when it persists, is recurring, or is productive. A persistent or recurring cough is indicative of ongoing or recurring airway irritation. A cough that lasts more than 3 weeks and cannot be explained should be medically evaluated. The following aspects of a cough should be evaluated:


Type of cough (e.g., dry, productive, hacking, etc)
Duration of cough
Timing of cough
Appearance of sputum (if any)
Exacerbating factors
Alleviating factors
Types of treatments used to date and their effects
Associated symptoms

Front 8

Identify at least five signs that you may observe in a patient experiencing dyspnea.

Back 8

Answers may include any five of the following signs of dyspnea:

Nasal flaring
Head bobbing
Retractions
Grunting
Orthopnea
Inability to speak complete sentences without stopping to breathe
Stridor
Wheezing

Front 9

Identify normal PO2, SaO2, and PCO2 levels.

Back 9

Normal levels are as follows:

PO2, 80 to100 mm Hg
SaO2, 95 to 100%
PCO2, 35 to 45 mm Hg

Front 10

What does a pulse oximetry reading tell you?

Back 10

Pulse oximetry is a noninvasive estimate of arterial blood oxygen saturation (SaO2 ). SaO2 reflects the percentage of hemoglobin molecules carrying oxygen. The normal value is 95 to 100%.

Front 11

Identify at least three nursing interventions to promote optimal respiratory function in a hospitalized patient with chronic lung disease.

Back 11

Answers may include any three of the following nursing interventions that promote optimal respiratory function:

Annual influenza vaccination
Annual pneumonia vaccination
Frequent position changes to keep all areas of lungs well ventilated
Incentive spirometry 10 to 20 times per hour
Positioning upright for meals

Front 12

What to assess for breathing

Back 12

12-20/min, regular, quiet, inspiration ½ as long as expiration
AP diameter < transverse diameter
subcostal angle @ 90 degrees (widens upon inspiration)
no use of accessory muscles
men use abdomen (diaphragm)/women use costal cage
Respiratory rate, depth, rhythm, pattern
Fremitus prominent over large bronchi, varies with voice pitch/intensity and chest wall thickness/structure

Front 13

Respiratory distress Inspection Warnings

Back 13

Anxious expression
Nasal flaring
Cyanosis around mouth (circumoral)
Sternocleidomastoid muscle contraction
Suprasternal notch/ intercostal, and substernal retraction
Abnormal chest expansion (hyperexpansion)

Front 14

Adventitious Breath Sounds

Back 14

Rales
Sibilant wheezes (wheezes)
Sonorous wheezes (rhonchi)
Course crackles
Stridor
Friction rubs
Mediastinal crunch

Front 15

Bronchitis Characteristic findings

Back 15

Dyspnea, productive cough (white, gray or yellow), use of accessory breathing muscles, cyanosis, finger clubbing, barrel chest, pedal edema, neck vein distention, wheezing, decreased breath sounds, increased expiratory time, tachypnea, elevated temperature

Front 16

Asthma Characteristic findings

Back 16

Pursed lip breathing, prolonged expiration, use of accessory muscles, trouble speaking more than a few words, increased AP diameter, cyanosis, confusion, lethargy, vocal fremitus, hyperresonance, decreased diaphragmatic excursion, hyperlinflated lungs, inspiratory/expiratory wheezing, diminished breath sounds, tachycardia, tachypenea, mild systolic hypertension

Front 17

Emphysema Characteristic findings

Back 17

Barrel chest, forward leaning position, pursed lip breathing, dyspnea, cough, expiratory wheeze, finger clubbing, use of accessory muscles, emaciation, restlessness and anxiety, decreased tactile fremitus, hyperresonance, decreased diaphragmatic excursion, wheezing, decreased breath and heart sounds, decreased voic sounds, prolonged expiration, increased temperature/heart rate/respiratory rate, decreased blood pressure,

Front 18

Airway obstruction Clinical findings

Back 18

Distressed look, panic, inability to speak, adventitious breath sounds over large airways (stridor, rhonchi, wheezing), decreased or absent breath sounds, use of accessory muscles, nasal flaring, cyanosis, hypoxemia, cardiac dysrhythmias

Front 19

Tension pneumothorax Clinical findings

Back 19

Sudden SOB with tachypnea, tachycardia, anxiety, asymetrical chest wall movement with mediastinal shift to affected side, diminished breath sounds on affected side, hyperresonance on the affected side, distended neck veins