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WVC IGGY chp 29
WVC Iggy chpt 29
| Question | Answer |
|---|---|
| The purpose of breathing | (1) to provide oxygen for tissue perfusion so that cells have enough oxygen to take part in metabolism and (2) to remove carbon dioxide, the major waste product of metabolism. |
| The respiratory system also influences | acid-base balance, speech, sense of smell, fluid balance, and temperature control. |
| The upper airways consist of the | nose, the sinuses, the pharynx (throat), and the larynx (voice box) |
| Smell is the cranial nerve | I olfactory |
| The purposes of the sinuses are to provide | resonance during speech and to decrease the weight of the skull. |
| The throat is divided into the | nasopharynx, the oropharynx, and the laryngopharynx |
| Located above the trachea, just below the throat at the base of the tongue, is the | larynx |
| The cricoid cartilage contains the | vocal cords, lies below the thyroid cartilage |
| This site is used in an emergency for access to the lower airways | cricothyroid membrane |
| cricothyroidotomy | tracheotomy |
| Attached at the back ends of the vocal cords, work with the thyroid cartilage in vocal cord movement | arytenoid |
| The glottis is the | opening between the true vocal cords |
| The epiglottis | opens during breathing and coughing. Its hingelike action prevents food from entering the trachea (aspiration) by closing over the glottis during swallowing |
| The lower airways consist of the | trachea; two mainstem bronchi; lobar, segmental, and subsegmental bronchi; bronchioles; alveolar ducts; and alveoli |
| The lower respiratory tract (also called the tracheobronchial tree) is an | inverted treelike structure consisting of muscle, cartilage, and elastic tissues. |
| Gas exchange takes place in the lung | parenchyma between the alveoli and the lung capillaries. |
| It can be accidentally intubated when an endotracheal tube is passed. | right bronchus, also food gets caught there |
| The mainstem bronchi each branch into | five secondary (lobar) bronchi that enter each of the five lobes of the lung. |
| The cartilage of these lobar bronchi is | ring-shaped and resists collapse |
| Bronchi are lined with a | ciliated, mucus-secreting membrane. |
| Divide into smaller and smaller tubes, which are the terminal and respiratory bronchioles | bronchioles |
| The bronchioles depend on | elastic recoil of the lungs to remain patent |
| Do the terminal bronchioles participate in gas exchange | NO |
| Basic units of gas exchange are | alveolar sacs |
| Acinus is a term for the | structural unit consisting of a respiratory bronchiole, an alveolar duct, and an alveolar sac. |
| About 60% to 65% of respiratory function occurs in the | right lung. Any problem with the right lung interferes with oxygenation to a greater degree than a problem in the left lung. |
| The hilum is the point at which the | primary bronchus, blood vessels, nerves, and lymphatics enter each lung |
| The chest wall is innervated by the | phrenic (diaphragm) and intercostal (pleura, ribs, and muscles) nerves |
| The bronchi are innervated by the | vagus nerve. |
| The lung parenchyma is | not innervated. |
| Membranes of the lung | pleura, visceral pleura, parietal pleura |
| Blood flow in the lungs occurs through two separate systems | bronchial and pulmonary |
| Blood needed to meet the metabolic demands of the lungs | bronchial system |
| Oxygen-poor blood travels from the right ventricle of the heart into the pulmonary artery, which eventually branches into arterioles that form capillary networks | pulmonary system |
| The upright position minimizes | ventilation perfusion mismatching. |
| Respiratory changes related to aging | Residual volume increases, vital capacity decreases, efficiency of oxygen and carbon dioxide exchange decreases. |
| How many levels are in Gordon's Functional Health Patterns | 5. 0-5 |
| How do you document cigarette smoking | pack years: the number of cigarettes smoked per day multiplied by the number of years smoked |
| Childhood illnesses to ask the patient about | Asthma, Pneumonia, Communicable diseases, |
| Other illnesses | Hay fever, Allergies, Eczema, Frequent colds, Croup, Cystic fibrosis, allergies |
| Adult illnesses to ask about | Pneumonia, Sinusitis, Tuberculosis, HIV and AIDS, Lung disease such as emphysema and sarcoidosis, Diabetes, Hypertension, Heart disease, allergies |
| Patients with tuberculosis, pulmonary infarction, bronchial adenoma, or lung abscess may have grossly | bloody sputum |
| Paroxysmal nocturnal dyspnea (PND), is | intermittent dyspnea during sleep |
| Orthopnea, | is a shortness of breath that occurs when lying down but is relieved by sitting up |
| These two conditions (orthopnea & PND) often occur with | chronic lung disease and left-sided heart failure. |
| In PND, the patient has a sudden onset of breathing difficulty that is severe enough | to awaken him or her from sleep. |
| Tactile (vocal) fremitus is | a vibration of the chest wall produced when the patient speaks. |
| Fremitus is increased with pneumonia and abscesses because they | increase the density of the thorax and enhance transmission of the vibrations. |
| Normal breath sounds are produced as air vibrates while moving through the | passages from the larynx to the alveoli. |
| Harsh hollow sounds heard over the trachea and mainstem bronchi | bronchial |
| Soft rustling sound heard in the periphery over small bronchioles | vesicular |
| Describe breath sounds as | normal, increased, diminished, or absent. |
| Percussion produces five different note | resonance, hyperresonance, flatness, dullness, tympany |
| Pitch | low, medium, high |
| Flatness percussed over the lung fields may indicate a | massive pleural effusion. |
| Dullness can be percussed over an | atelectatic lung or a consolidated lung. |
| Over the lung, a tympanic note usually indicates a | large pneumothorax |
| Hyperresonance indicates | the presence of trapped air, so it is commonly heard over an emphysematous or asthmatic lung and occasionally over a pneumothorax. |
| Resonance is characteristic of | normal lung tissue |
| When bronchial breath sounds are heard at the lung edges, they are | abnormal |
| When heard over an abnormal area, bronchovesicular breath sounds may indicate | normal aging or an abnormality such as pulmonary consolidation and chronic airway disease. |
| Adventitious sounds are additional breath sounds superimposed on normal sounds, and they indicate | pathologic changes in the lung |
| Crackle, wheeze, rhonchus, and pleural friction rub | adventitious sounds |
| A vibration of the chest wall produced when the patient speaks | Tactile (vocal) fremitus |
| Crepitus | (air trapped in and under the skin, also known as subcutaneous emphysema) is felt as a crackling sensation beneath the fingertips. |
| The diaphragm side of the stethoscope is designed to detect | high-pitched sounds. |
| When heard in an abnormal location, bronchovesicular breath sounds may indicate | normal aging or an abnormality such as pulmonary consolidation and chronic airway disease. |
| Normal breath sounds (3) | bronchial, bronchovesicular, vesicular |
| Over peripheral lung fields where air flows through smaller bronchioles and alveoli (the normal sound is called) | vesicular |
| The sounds over major bronchi where fewer alveoli are located; posterior, between scapulae (especially on right); anterior, around upper sternum in first and second intercostal spaces | bronchovesicular |
| Over Trachea and larynx | bronchial |
| (early or late inspiration) Popping, discontinuous sounds caused by air moving into previously deflated airways; sounds like hair being rolled between fingers near the ear | fine rales or crackles |
| “Velcro” sounds late in inspiration usually associated with restrictive disorders | high-pitched rales |
| Associations with crackles or rales | Asbestosis, Atelectasis, Interstitial fibrosis, Bronchitis, Pneumonia, Chronic pulmonary diseases |
| More common on expiration but may be present early in inspiration. Lower-pitched, coarse, discontinuous rattling sounds caused by fluid or secretions in large airways; likely to change with coughing or suctioning | Coarse crackles, Low-pitched crackles |
| Coarse, low-pitched crackles are associated with | Bronchitis, Pneumonia, Tumors, Pulmonary edema |
| Squeaky, musical, continuous sounds, audible during either inspiration, expiration, or both | wheezes |
| Lower-pitched, coarse, continuous snoring sounds, arising from the large airways: audible during both inspiration and expiration but commonly more prominent on expiration | rhonchi/rhonchus |
| Loud, rough, grating, scratching sounds, heard during both inspiration and expiration, generally at the end of inspiration and the beginning of expiration | pleural friction rub |
| Wheezes are associated with | Inflammation, Bronchospasm, Edema, Secretions, Pulmonary vessel engorgement (as in cardiac “asthma”) continuous |
| Diseases associated with pleural friction rub | Pleurisy, Tuberculosis, Pulmonary infarction, Pneumonia, Lung cancer |
| Diseases/conditions associated with rhonchus | Thick, tenacious secretions; Sputum production; Obstruction by foreign body; Tumors |
| Voice sounds (vocal resonance) through the normally air-filled lung produce a | muffled, unclear sound |
| When the sound travels through a solid tissue or liquid, the sounds get | louder and more distinct |
| The presence of a consolidated area of the lung, pneumonia, atelectasis, pleural effusion, tumor, or abscess causes (vocal sounds) | increased vocal resonance. |
| Normal Pao2 | 80-100 ↑indicate possible excessive oxygen administration.↓levels indicate possible COPD, asthma, chronic bronchitis, cancer of the bronchi and lungs, cystic fibrosis, respiratory distress syndrome, anemias, atelectasis, or any other cause of hypoxia. |
| Normal PaCO2 | 35-45 Elevations indicate possible COPD, asthma, pneumonia, anesthesia effects, or use of opioids (respiratory acidosis). Decreased levels indicate hyperventilation/respiratory alkalosis. |
| Normal SPO2 | 95%-100% Decreased levels indicate possible impaired ability of hemoglobin to release oxygen to tissues. |
| Normal pH | 7.35-7.45 |
| Alveolar ventilation | partial pressure of arterial carbon dioxide [PaCO2] |
| Lab tests used for respiratory problems | CBC, hemoglobin, Hematocrit, WBC, differential WBC, arterial blood gasses |
| Elevations indicate possible COPD, asthma, or allergies: Decreased levels indicate pyogenic infections. | eosinophils |
| ↑indicate possible inflammation; seen in chronic sinusitis, hypersensitivity reactions. ↓levels may be seen in an acute infection. | basophils |
| ↑indicate possible viral infection, pertussis, and infectious mononucleosis. Decreased levels may be seen during corticosteroid therapy. | Lymphocytes |
| ↑: see Lymphocytes; also may indicate active tuberculosis. ↓levels: see Lymphocytes | monocytes |
| ↑indicate possible acute bacterial infection (pneumonia), COPD, or inflammatory conditions (smoking).↓levels indicate possible viral disease (influenza) | neutrophils |
| ↑levels (polycythemia) may be due to the excessive production of erythropoietin, which occurs in response to a hypoxic stimulus, as in COPD, and from living at a high altitude. ↓levels indicate possible anemia, hemorrhage, or hemolysis. | RBC’s |
| ↑indicate possible acute infections or inflammations, pneumonia, meningitis, tonsillitis, or emphysema. ↓levels may indicate an overwhelming infection, an autoimmune disorder, or immunosuppressant therapy. | WBC leucocytes |
| Imaging assessments used for respiratory are | x-ray, ct, digital imaging, Ventilation and perfusion scanning (V/Q scan, this test uses an injected or inhaled radionuclide followed by scanning.) |
| Ideal normal pulse oximetry values are | 95% to 100% |
| Pulse oximetry can detect desaturation before | manifestations (e.g., dusky skin, pale mucosa, pale or blue nail beds) occur |
| Causes for low SaO2 readings include | patient movement, hypothermia, decreased peripheral blood flow, ambient light (sunlight, infrared lamps), decreased hemoglobin, edema, and fingernail polish |
| When the Spo2 is below _______body tissues have a difficult time becoming oxygenated. | 85%, |
| Changes in PETCO2 reflect | changes in breathing effectiveness and may occur before hypoxia can be detected using pulse oximetry. Norm is 20-40 |
| Capnometry and capnography are methods | that measure the amount of carbon dioxide present in exhaled air, which is an indirect measurement of arterial carbon dioxide levels. |
| When performed while the patient exercises, PFTs help determine | whether dyspnea is caused by lung or cardiac dysfunction or by muscle weakness. |
| FVC (forced vital capacity) records the maximum amount of air | that can be exhaled as quickly as possible after maximum inspiration. |
| FVC gives an indication of respiratory | muscle strength and ventilatory reserve. FVC is often reduced in obstructive disease (because of air trapping) and in restrictive disease. |
| FEV1 (forced expiratory volume in 1 sec) records the maximum amount of air that can be | exhaled in the first second of expiration. |
| FEV1 is effort dependent and declines | normally with age. It is reduced in certain obstructive and restrictive disorders. |
| FEV1/FVC is the | ratio of expiratory volume in 1 sec to FVC. |
| FEV1/FVC ratio provides a much more sensitive indication of | obstruction to airflow. This ratio is the hallmark of obstructive pulmonary disease. It is normal or increased in restrictive disease. |
| FEF(25%-75%) records the | forced expiratory flow over the 25%-75% volume (middle half) of the FVC. |
| FEF measure provides a more sensitive index of obstruction in the | smaller airways. |
| FRC (functional residual capacity) is the amount of | air remaining in the lungs after normal expiration. |
| FRC test requires use of the | helium dilution, nitrogen washout, or body plethysmography technique. |
| Increased FRC indicates hyperinflation or air trapping, which may result from | obstructive pulmonary disease. |
| FRC is normal or decreased in | restrictive pulmonary diseases. |
| TLC (total lung capacity) is the amount of air in the lungs at the | end of maximum inhalation. |
| Increased TLC indicates air trapping associated with | obstructive pulmonary disease. |
| Decreased TLC indicates | restrictive disease. |
| RV (residual volume) is the amount of air remaining in the lungs | at the end of a full, forced exhalation. |
| RV is increased in obstructive pulmonary disease such as | emphysema. |
| DlCO (difusion capacity of carbon monoxide) reflects the | surface area of the alveolocapillary membrane. |
| How is DICO performed | The patient inhales a small amount of CO, holds for 10 sec, and then exhales. The amount inhaled is compared with the amount exhaled. |
| DlCO is reduced whenever the | alveolocapillary membrane is diminished, such as occurs in emphysema, pulmonary hypertension, and pulmonary fibrosis. |
| DICO is increased with exercise and in conditions such as | polycythemia and congestive heart disease. |
| (Endoscopic Examinations) the insertion of a flexible tube through the chest wall just above the sternum into the area of the upper chest between the lungs | mediastinoscopy |
| (Invasive Diagnostic Assessment) the insertion of a tube in the airways, usually as far as the secondary bronchi, for the purpose of viewing airway structures and obtaining tissue samples for biopsy or culture. | bronchoscopy. It is used to diagnose and manage pulmonary diseases. |
| (Invasive Diagnostic Assessment)most useful to assist with cancer staging and removal of secretions that are not cleared with normal suctioning procedures | bronchoscopy |
| Name the invasive diagnostic tests | mediastinoscopy & bronchoscopy |
| In preparation for invasive diagnostic tests, the patients throat may be sprayed with | Benzocaine spray as a topical anesthetic to numb the oropharynx. |
| Benzocaine spray is dangerous and can cause a condition called | methemoglobinemia |
| Methemoglobinemia is | the conversion of normal hemoglobin to methemoglobin. It is altered iron state that does not carry oxygen, resulting in tissue hypoxia. Other topical anesthetic sprays, such as lidocaine, appear less likely to induce this problem. |
| ___________________should be suspected if a patient becomes cyanotic after receiving a topical anesthetic, if he or she does not respond to supplemental oxygen, and if blood is a characteristic chocolate-brown in color. Notify the Rapid Response Team | Methemoglobinemia. |
| Methemoglobinemia can be reversed with | supplemental oxygen and IV administration of 1% methylene blue (1 to 2 mg/kg). |
| Thoracentesis | is the aspiration of pleural fluid or air from the pleural space |
| pneumothorax and mediastinal shift | possible complications from thoracentisis |
| Pneumothorax resulting from surgery can occur within | within the first 24 hours |
| Manifestations of a pneumothorax | •Pain on the affected side that is worse at the end of inhalation and the end of exhalation•Rapid heart rate & shallow respirations•air hunger•Prominence if the affected side that does not move in and out with respiratory effort •Trachea slanted more to t |
| Transbronchial biopsy (TBB) and transbronchial needle aspiration (TBNA) are | performed during bronchoscopy to biopsy tissue for disease detection |
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