Med Surg Chapter 21 Respiratory

Front 1

What does the upper resp tract do?

Back 1

warms and filters inspired air

Front 2

What does the lower resp tract do?

Back 2

(lungs) gas exchange- O2 to tissues via blood stream and expelling waste gases (CO2) during expiration

Front 3

What is the resp system responsible for?

Back 3

ventilation and diffusion

Front 4

What makes up the upper resp tract?

Back 4

nose, sinuses (frontal, ethmoidal, spenoidal, maxillary), nasal passages, pharynx (throat), tonsils, adenoids, larynx (voice organ), trachea (wind pipe)

Front 5

What makes up the lower resp tract?

Back 5

lungs, bronchial and alveolar

Front 6

Does the inspiratory or expiratory phase require energy?

Back 6

inspiratory requires energy, expiratory is normally passive except for COPD

Front 7

Describe pleura- viseral and parietal.

Back 7

visceral pleura lines the lungs, pariental pleura lines the thorax, pleural fluid is between to lubricate thorax and lungs

Front 8

What is the mediastrinum?

Back 8

middle of the thorax, all thoraic tissue between vertebral column and sternum expect for the lungs

Front 9

describe the left and right lungs.

Back 9

left: upper and lower lobe
right: upper, middle, and lower lobe

Front 10

Describe the bronchi, bronchioles, alveolar

Back 10

bronchi--bronchioles (contain submucosal glands) both covered with cilia--respiratory bronchioles--alveolar ducts--alveolar sacs (gas exchange)

Front 11

what is physioloical dead space in the lungs?

Back 11

150 ml of air in the tracheobronchial tree that does not participate in gas exhange

Front 12

Describe the 3 types of alveoli.

Back 12

I-epithelial cells that form alveoli walls
II-alveolar cells that are metabolically active
III-alveoli cell macrophages

Front 13

Describe oxygen transport

Back 13

o2 diffuses from capillary walls to interstitual fluid then into the membrane of the tissue cells

Front 14

What happens during tissue capillary exchange?

Back 14

blood enters veins into pulmonary circulation, o2 diffuses from alveoli into blood, CO2 diffuses from blood to alveoli

Front 15

What things may alter the bronchial diameter?

Back 15

-contraction of bronchial smooth muscle- asthma
-thickening of broncial mucosa- chronic brochitis
-obstruction of airway-tumor, foreign body
-loss of lung elasticity-emphysema

Front 16

What is compliance?

Back 16

measure of elasticity, expandability, distensibility of the lungs and thoracic structures

Front 17

What causes increased or high compliance?

Back 17

thorax is overextened and lungs have lost their elasticity--emphasema

Front 18

What causes decreased or low compliance?

Back 18

stiff lungs or thorax- pneumothorax, hemothorax, pleural effusion, pulmonary edema, atelectasis, pulmonary fibrosis, ARDS

Front 19

Define tidal volume

Back 19

volume of air inhaled and exhales with each breath
-approx 500ml
-measured by spirometer

Front 20

Define inspiratory reserve volume

Back 20

max vol of air that can be inhaled after a normal inhalation
--3000ml

Front 21

define expiratory reserve volume

Back 21

max volume of air that can be exhaled forcibly after a normal exhalation
1100ml

Front 22

define residual volume

Back 22

vol of air remaining in the lungs after a max exhalation
1200ml

Front 23

define vital capacity

Back 23

max vol of air exhaled from the point of max inspiration
4600ml
-measured with spirometer

Front 24

define inspiratory capacity

Back 24

max vol of air inhaled after normal exp
3500 ml

Front 25

define functional residual capacity

Back 25

vol of air remaining in the lungs after a normal expiration
2300 ml

Front 26

define total lung capacity

Back 26

vol of air in the lungs after a max inspiration
5800 ml

Front 27

define pulmonary perfusion and what factors influence it

Back 27

actual blood flow thru pulmonary circulation
-pulmonary artery pressure, gravity, alveolar pressure

Front 28

describe pulmonary circulation

Back 28

pumped into lungs by right ventricle-pulmonary artery, alveolar gas exchange occurs

Front 29

What is the systolic pressure and diastolic pressure in the pulmonary artery?

Back 29

systolic- 20-30ml
diastolic- 5-15 ml

Front 30

What happens when the ventilation-perfusion ratio is imbalanced?

Back 30

shunting of the blood results in hypoxia
-severe hypoxia when shunting is >20%

Front 31

atmospheric pressure at sea level is?

Back 31

760 mm Hg

Front 32

How is oxygen transported in the blood?

Back 32

hemoglobin==== oxyhemoglobin

Front 33

What is the partial pressure of oxygen hemoglobin is 100% saturated? Or 70% saturated?

Back 33

PaO2 = 150 mm Hg
PaO2 = 40 mm Hg

Front 34

What is the normal level of PaO2?

Back 34

80-100 mm Hg = 95-98% sat

Front 35

What is the normal level of PaCO2?

Back 35

35-45 mm Hg

Front 36

What controls ventilation (neuro)?

Back 36

phrenic nerve
medulla oblongata (inspiration) and pons (rate)
-peripheral chemoreceptors in aortic arch, carotid arteries, Hering-Breur reflex (alveoli)

Front 37

What are the gerontologic changes that occur in our respiratory system?

Back 37

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

Front 38

What are major s/s of respiratory disease?

Back 38

dyspnea (shortness of breath), cough, sputum production, chest pain, wheezing, clubbing of fingers, hemoptysos (spitting up blood), cyanosis

Front 39

What might sudden dyspnea in a health person mean?

Back 39

pneumothorax, ARDS, acute resp obstruction

Front 40

Dyspnea in the following people may indicate what:
immoble, orthopnea, with expiratory wheezing?

Back 40

immoble- pulmonary embolism
orthopnea- heart disease, COPD
exp wheezing- COPD

Front 41

What are the risk factors for respiratory disease?

Back 41

smoking, secondhand smoke, family history of lung disease, genetics, allergens and environmental pollutants, rec and occupational exposure

Front 42

what relief measures should be used for dyspnea?

Back 42

id cause, high fowlers, oxygen admin

Front 43

What can cause a dry irritative cough?

Back 43

upper resp tract viral infection of side effect of ACE inhibitor

Front 44

What can cause an irritative high pitched cough? brassy cough? severe or changing cough?

Back 44

irritative high pitched-laryngotracheitis
brassy- tracheal lesion
severe or changing- bronchogenic carcinoma

Front 45

If a cough causes pleuritic chest pain what does this indicate?

Back 45

pleural or chest wall (musculoskeletal) involvment

Front 46

What might coughing at night indicate? morning with sputum? supine position? recent onset? with food?

Back 46

night- left sided heart failure or bronchial asthma
morning with sputum- bronchitis
supine- postnasal drip
recent onset- acute infection
food- aspiration into tracheobronchial tree

Front 47

What is meant by a acute, subacute and chronic cough?

Back 47

acute - <3 weeks
subacute - 3-8 weeks
chronic - > 8 weeks

Front 48

What does purulent (thick yellow, green or rust color) sputum indicate?

Back 48

bacterial infection

Front 49

What does thin, mucoid sputum indicate?

Back 49

viral bronchitis

Front 50

what does gradual increase of sputum over time indicate?

Back 50

chronic bronchitis, bonchiectasis

Front 51

What might pink tinged sputum indicate?

Back 51

lung tumor

Front 52

What might profuse, frothy, pink material welling up in the throat indicate?

Back 52

pulmonary edema

Front 53

What might foul-smelling sputum and bad breath indicate?

Back 53

lung abscess, brochiectasis, fusospirochetal infection or anaerobic cause infection

Front 54

What relief measures should be followed for a cough?

Back 54

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

Front 55

What does pleuric pain feel like and ways to relieve it?

Back 55

sharp and catching on inspiration (knife stabbing), have patient lie on the effective side and NSAIDS

Front 56

What are the most common causes of hemoptysis?

Back 56

pulmonary infection, carcinoma of the lung, abnormalities of heart or blood vessels, pulmonary artery or vein abnormalities, pulmonary embolism and infarction

Front 57

What is cyanosis? When does it occur? how is central cynosis assessed?

Back 57

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 asses by observing color of tongue and lips

Front 58

What are the 4 main chest deformaties associated with respiratory disease?

Back 58

barrel chest, funnel chest, pigeon chest, kyphoscoliosis

Front 59

Describe barrel chest.

Back 59

overinflation of the lungs, caused by emphysema, chest in thick front to back

Front 60

Describe funnel chest.

Back 60

depression of lower portion of sternum, may compress heart and great vessels resulting in murmurs, caused by marfan's syndrome or rickets

Front 61

what is rickets and marfan's syndrome?

Back 61

rickets- lack of vit D/calcium resulting in softening of the bones
marfan's syndrome-genetic defect of connective tissue

Front 62

Describe pigeon chest

Back 62

displacement of sternum, increase in front to back, may occur with rickets, marfan's, severe hyphoscoliosis

Front 63

Describe kyphoscoliosis

Back 63

s-shaped spine, elevated scapula, limits lung expansion within thorax, may occur in osteoporosis and other skeletal disorders

Front 64

Define eupenea

Back 64

normal patterened respiration,
12-18 per minute

Front 65

Define bradypnea and causes

Back 65

<12 breaths per minute, caused by increased ICP, brain injury, durg OD

Front 66

define tachypnea and causes

Back 66

>24 breaths per minute, caused by pneumonia, pulmonary edema, metabolic acidosis, septicemia, severe pain, rib fracture

Front 67

define hypoventilation

Back 67

shallow irregular breathing

Front 68

define hyperpnea

Back 68

increase depth of respiration

Front 69

define hyperventilation

Back 69

increased in both rate and depth that results in decreased arterial PaCO2
-severe acidosis of diabetic or renal origin, Kussmaul's respirations

Front 70

define apnea

Back 70

varying periods of cessation of breathing

Front 71

define Cheyne-Stokes respirations. what might cause this?

Back 71

alternating between apnea (20 secs) and deep shallow breathing
-heart failure, damage to respi center (drug induced, trauma, tumor)

Front 72

define Biot's respirations. what might cause it?

Back 72

cluster breathing, cycles of breathing that have varying periods of apnea
-central nervous system disorders

Front 73

What does bulging of intercostal spaces during expiration imply? retraction of inspiration, with asymmetry?

Back 73

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)

Front 74

What could cause decreased chest excursions? Asymmetric excursion?

Back 74

chronic fibrotic disease
Asymmetric-splitting secondary to pleurisy, fractured ribs, trauma, unilateral bronchial obstruction

Front 75

what causes diminished or absent lung sounds?

Back 75

atelectasis (bronchial obstruction), pleural effusion (fluid), obesity (tissue)
-emphasema

Front 76

what do crackles sound like and what may cause them?

Back 76

-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)

Front 77

what do wheezes sound like and what may cause them?

Back 77

-whistle like
-bronchospasm, asthma, secretion build up

Front 78

describe vesicular breath sounds

Back 78

soft, insp is longer than exp

Front 79

describe broncho-vesicular sounds

Back 79

insp = exp

Front 80

describe bronchial sounds

Back 80

loud, esp > insp

Front 81

describe tracheal

Back 81

loud, insp = exp

Front 82

what are findings of consolidation (pneumona)?

Back 82

bronchial breath sounds, crackles, bronchophony, egophony

Front 83

what are the finds of bronchitis?

Back 83

wheezes

Front 84

what are the breath sounds of asthma?

Back 84

wheezes

Front 85

what are the breath sounds of pulmonary edema?

Back 85

crackles at lung bases

Front 86

what are the breath sounds of pleural effusion?

Back 86

absent or diminished sounds

Front 87

what are the breath sounds of pneumothorax?

Back 87

absent breath sounds

Front 88

what are the breath sounds of atelectasis?

Back 88

decreased or absent breath sounds

Front 89

what can prolonged hypoventilation cause?

Back 89

alveolar collapse

Front 90

what are the risk factors for hypoventilation?

Back 90

-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)

Front 91

when will a patient require resp. assistance based on vital capacity?

Back 91

10 mL/kg

Front 92

how is normal inspiratory pressure measured? What is normal? when is mechanical ventilation required?

Back 92

manometer
100 cm H2O
vent at 25 cm H2O

Front 93

what is PaO2?

Back 93

arterial oxygen tension, degree of oxygenation of the blood
-75-100 mm Hg

Front 94

what is PaCO2?

Back 94

arterial carbon dioxide, indicates adequate alveolar ventilation
-35-45 mm Hg

Front 95

SpO2

Back 95

oxygen saturation with pulse oximetry
-95-100%

Front 96

SaO2

Back 96

oxygen saturation of hemoglobin

Front 97

how is sputum collection done?

Back 97

clear nose and throat, rinse mouth, take a few deep breaths, using diaphragm cough expectorate into sterile container
-deliver within 2 hours

Front 98

what is fluoroscopy used for?

Back 98

biopsy, movement of chest wall

Front 99

when is pulmonary angiography used?

Back 99

suspected thromboembolic disease

Front 100

how is a V/Q scan performed? What can it help diagnose?

Back 100

-radioactive agent injected into peripheral vein to assess perfusion thru lungs, pulmonary vessesls
-brochitis, asthma, inflam fibrosis, pneumonia, emphysema, lung cancer

Front 101

describe a bronchoscopy and what is the purpose?

Back 101

-direct inspection of larynx, trachea, bronchi
-exam tissues or collect secretions, remove foreign object, excise lesion, insert stents for airway obstruction

Front 102

what are the nursing interventions for a bronchoscopy?

Back 102

consent form, NPO for 6 hours before, watch for resp depression with sedation, remove dentures, NPO after until cough reflex returns, VS, dyspnea, bleeding

Front 103

describe thoracoscopy

Back 103

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

Front 104

describe thoracentesis

Back 104

aspiration of pleural fluid under ultrasound guidance
-may do needle biopsy too
-may instill medication

Front 105

what are the nursing interventions for thoracentesis?

Back 105

consent, sedation admin, allergy, position, expose chest, apply pressure after with sterile airtight dressing, bed rest, record total amount of fluid, monitor VS