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Respiratory lect 1
G Mcgregor lecture 1, respiratory
| Question | Answer |
|---|---|
| Neonatal Respiratory System: Lungs begin to form in | 4th week of gestation |
| Week 17-28 the | bronchioles develop with multiple saccules |
| Alveoli develop between | 32 and 36 weeks |
| A special lung liquid fills the air spaces in the lungs (when) | 2-3 days prior to birth. |
| Airway that close after birth | ductus arteriosis, closes after birth (invirto) |
| Nose and Sinuses | start of airway (olefactory #1) |
| The upper respiratory consists of | Nares, nostrils, septum, turbinates increases area that air is warmed, nasopharynx, Lips, tongue, tonsils, epiglottis, oropharynx, sinuses, trachea |
| Sinuses consist of | Frontal, ethmoid, sphenoid and maxillary. Humidifies the air and resonance for speech, decreases the weight of the head |
| Gateway to the Lungs | epiglottis (controlled by cranial nerve#9). At base of tounge (vocal cords on both sides |
| The Trachea sits below | vocal cords and begins below the laryngopharynx at the level of the cricoid |
| The trachea is located in front and anterior to the | esophagus |
| The Trachea is composed of | 6 to 10 C-shaped cartilaginous rings, smooth muscle. |
| The trachea b | ranches into the left and right bronchus at the level of the carina |
| Bronchi composed of some | cartilage, smooth muscle & cilia |
| Bronchioles have little cartilage, are composed of | smooth muscle, less cilia (airways b/c smaller. |
| Mucus is produced by | goblet cells. |
| The further in the bronchioles, less | cilia but more constriction to move things out |
| Bronchioles are very reactive | bronchodilation or bronchoconstriction |
| The Lungs are | spongy, elastic organs encased within the pleura |
| The apex (top) of each lung extends above the | clavicle |
| The base (bottom) of each lung sits just above the | diaphragm |
| The hilum the pt where the | primary bronchi (BV, nerves lymphs that enter the lungs), visceral plueral, plueral space (50 mL’s, if fluid is excessive, plueral effusion) parital pleural |
| The right lung is larger and has | 3 lobes |
| The left lung is narrower to accommodate | the heart and has 2 lobes |
| The lobes are separated by | fissures. |
| Alveoli increases the surface area for | exchanges to take place. |
| Alveolar ducts and Alveoli branch from | the bronchioles. |
| Acini or acinus: | a little sac that contains aveoli and BV that are needed. |
| Clusters of grapes (alveolar sacs) are where | gasses are exchanged surfactant |
| Alveolar sacs contain | clusters of alveoli |
| Type II pnuemocytes | secrete surfactant (keeps the alveoli from closing in on its self. |
| Suractant is | a fatty protein, keeps alveoli free of fluid and open |
| Where gas is exchanged | in the alveoli |
| Surfactant reduces | the surface tension |
| Atalectasis | collapse of aveli- pop at the end of inspiration- not taking a big enough breath- decreases the work of the lungs |
| Alveolar-Capillary Membrane is at | the end of bronchioles are the alveoli |
| Encased in a web of vessels | venous & arterial |
| Oxygen & CO2 are exchanged across the | Alveoar-Capillary membrane |
| O2 and CO2 are exchanged by | diffusion |
| CO2 is expired from | the lungs |
| Oxygen diffuses into the blood, carried by | pulmonary vein (carries oxygenated blood) back to the heart |
| Gas Transport | pulmonary vein (carries oxygenated blood) back to the heart |
| Delivery of O2 to the body | Ventilation, thru hrt, diffustion of O2 to capil ,O2 binds to hemoglobin to rt heart to body |
| A person who has Cor pleura has an increased risk for | MI |
| Removal of CO2 from the body | ventilation, diffusion from alveoli to capillary blood, perfusion, diffusion from capillaries to cells O2 binds w/hemo til fully diffused then the rest…. |
| CO2 diffuses into the RBC with the help of | carbonic anhydrase |
| C02 combines with water to form | carbonic acid which quickly dissociates into hydrogen and bicarbonate ions |
| The hydrogen ions bind to the hemoglobin where it is buffered and the | HCO3 moves out of the RBC and into the plasma |
| Carbon Dioxide Transport | even people that are hypoxic do not retain Co2 |
| CO2 is 20 times more soluble than | O2 and diffuses easily from tissue cells into the blood. |
| The amount of CO2 able to enter the blood is enhanced by the | diffusion of O2 out of the blood and into the cells |
| As O2 dissociates from the hemoglobin, CO2 is able to | attach for transport back to the capillaries and out of the body via the lungs |
| Pulmonary Circulation | Facilitates gas exchange/nutrients,circulation/waste removal |
| Cardiac output goes from | right ventricle to the lungs |
| Bronchial circulation | feeds the lung tissue itself |
| Pulmonary circulation pressure is lower than systemic circulation because it | supports diffusion of gases |
| Bronchial circulation is part of | systemic circulation, |
| Bronchial circulation does not involve | gas exchange. |
| Bronchial circulation provides circulation to | airway structures themselves. |
| FiO2 | Fraction of inspired oxygen. % of oxygen in the air being breathed in. |
| PaO2 or PO2 | Partial pressure of arterial oxygen. The amount of oxygen dissolved in arterial blood. |
| SaO2 | Oxygen saturation. % of hemoglobin saturation by oxygen |
| PaCO2 of CO2 | Partial pressure of arterial CO2. The amount of CO2 in arterial blood. |
| Tidal Volume | amount of air inhaled & exhaled during normal respiration |
| Ventilation | respiration (moving air in/out of lungs) |
| The amount of effective ventilation is calculated by | Rate X Volume equals liters/minute |
| Pulmonary Function Tests measure the effectiveness of ventilation | Rate X Volume equals liters/minute |
| The respiratory center of the brain is located in the | medulla of the brain stem |
| Rate and respiratory pattern is controlled in the | pneumotaxic center on the pons |
| Elastic recoil | recoil after respiration. Depends on equalibrium. |
| Compliance is | relative ease in which the chest wall can be stretched. Scars/holes effect |
| Increase in compliance means | easy-good brain waves |
| compliance/decrease means more | difficult (aging, emphasema, flailed chest, pneumonis, firocysts.) |
| Tidal Volume | normal respiration |
| Reserve Volume | (in and blow out as much as you can. Allows for stressors) maximal air in or out. Is 3 times more than TV. |
| Tidal Volume + Reserve Volume | Vital Capacity |
| Residual Volume | air that cannot be exhaled, gas exchange takes place |
| In order to get oxygen to the tissues | oxygen must first reach the lungs. (Airway) |
| In order for gas exchange to take place, the lower airways, | alveoli and A-C membrane must be free to function (Airway & Breathing) |
| Interventions aimed at airway & breathing | Ambulation, Coughing, Turning, positioning, Suctioning, Deep breathing, Hydration, Incentive spirometer |
| The Role of Hemoglobin | give 02 into tiss and remove co2 |
| Oxygen & CO2 attach to receptor sites for exchange at the | A-C membrane & tissue capillaries |
| Anemia can have 100% sat, but not have enough | hemo to get it into the tissues |
| Avoid anemia by: | Maintain nutrition, Limit blood draws, Administer PRBCs if necessary |
| Decreased cardiac output means less | oxygenated blood going to the tissues |
| Can be caused by | pump failure, irregular rhythm, too rapid rhythm ( Afib) (hypovolemia)-can cause circulatory colapse |
| Interventions for decreased cardiac output | Maximize hemodynamics (rt pressure in rt places) |
| Fluid balance, Pump performance, Decrease resistance (afterload), BP | Maximize hemodynamics (rt pressure in rt places) |
| Oxyhemoglobin Dissociation Curve shows the relationship between | Oxygen saturation of the hemoglobin and the PaO2. |
| At 98% O2 saturation, the PaO2 is about | |
| However, an O2 sat of 90% would correlate to a | PaO2 of 70, 85% correlates to a PaO2 of 60 NOT OK TO GET BELOW 90% |
| PA02 s/b 75%-100% (ideally >90%) | PaO2 of 70, 85% correlates to a PaO2 of 60 NOT OK TO GET BELOW 90% |
| Oxygen is carried to the tissues and gas exchange takes place | according to body needs |
| If tissue consumption decreases then | less oxygen delivery is needed. If it increases then more would be needed. |
| Things that increase tissue oxygen needs | activity, stress, fever, sympathetic nervous system stimulation |
| If potential for tissue hypoxia, will need to decrease oxygen need by | rest, decreasing anxiety, maintaining normal body temperature, decreasing or controlling sympathetic response. |
| rest, decreasing anxiety, maintaining normal body temperature, decreasing or controlling sympathetic response. | |
| Changes Related to Aging | ↓alveolar surface, elastic recoil, diffusion capacity, Efficiency of O2 & CO2 transfer ↓,Repse to hypoxia/hypercapnia ↓ |
| The Focused Assessment | , Insp, palp, percuss, auscu, hist, prior illnesses |
| Risk factors | Smoking, Medications, Allergies, Current Health Problems - Cough, dyspnea, chest pain or sputum production |
| Assessment of the Nose & Sinuses | Ext/int inspection, drainage, Septum, px on palp-sinus, transill of sinus, Post-nasal drainage |
| Assessment of the Upper Airway | Mouth,Tongue,Soft palate,Tonsils,Palpation of neck and lymph nodes,Palpation of the trachea |
| Assessment of the lungs Inspection: | Note rate/rhythm/depth of inspiration,symmetrical , (pursed lip),diaphragm breathing, shape, palp |
| Assess thoracic expansion | masses, lesions, bruises or swelling over the rib cage |
| Palpate for crepitus | subcutaneous air. ( Sounds like rice krispies) |
| Tactile Fremitus- | check with palm of hand or base of fingers at the apex and base of both lungs. Auscultate by having the person say |
| Percussion | Checking for pulmonary resonance |
| Place the middle finger of the non-dominant hand over | the intercostal space to be percussed Posteriorly begins at apex and works to base of both lungs |
| Percussion: check for | diaphragmatic excursion |
| Auscultation:Listening for normal breath sounds | Have client breath through their mouth slowly and deeply while sitting upright. |
| Describe as | normal, increased, decreased or absent |
| Crackles and Rales | heard in lower airways during inspiration, may change with coughing (in the lower alveoli-like hair rubbing together)Popping or rattling |
| Rhonchi | most prominent in expiration, arise from larger airways (Lower-pitched, coarse, continuous snoring sounds) |
| Wheezes | arise from small airways, can be heard during inspiration or expiration or both |
| Pleural Rub | heard during inspiration & expiration (pleuritis) |
| Stridor | upper airway obstruction, louder on inspiration. (don’t need steth to diagnose. Very loud) |
| Epiglotisis prevents | food from going down the wrong path |
| Voice Sounds (listening in the lungs is normally muffled. If liq in lungs its | increased |
| Bronchophony | If fluid is compressing the lung, the vibrations from the client's voice are transmitted to the chest wall and the sound becomes clear (consolidation of pneumonia) |
| Types of voice sounds include | bronchophony, egophony, and pectoriloquy |
| Whispered pectoriloquy | say 99 (refers to an increased loudness of whispering noted during auscultation with a stethoscope on the lung fields on a patient's back) |
| Whispered pectoriloquy is done to assess | for the presence of lung consolidation, which could be caused by cancer or pneumonia. |
| Egophony | (EEE high pitched sounds like AAA) a change in the voice sound of a patient with pleural effusion or pneumonia as heard on auscultation |
| (EEE high pitched sounds like AAA) a change in the voice sound of a patient with pleural effusion or pneumonia as heard on auscultation | |
| Diagnostics | Laboratory Tests, Radiographic Exam, Pulmonary Function Tests, Exercise Tolerance, Skin Tests |
| Invasive Diagnostics | Endoscopic, thoracentesis and biopsy |
| Laboratory Tests | Blood Tests: CBC, ABG, Sputum Test: Gram stain, C & S, Acid-fast stain, cytology |
| Arterial Blood Gases | Gives information about oxygenation, acid-base balance |
| Acid-Base Balance: | pH 7.35-7.45 |
| Oxygenation: PaO2 | 75- 100 mm Hg; Compare to Oxygen Saturation 96-100% |
| Carbon Dioxide Retention: | 35-45 mm Hg |
| HCO3: | 22-26 mEq/L |
| Compensation occurs to maintain acid-base balance. It will always be from the | opposing system. |
| Pulmonary Function Tests (PFT) Look at | lung function and capacity |
| Forced Vital Capacity (FVC) | records the maximum amount of air that can be exhaled as quickly as possible after maximum inspiration. |
| Forced Expiratory Volume in 1 second (FEV1) | records the maximum amount of air that can be exhaled in the first second of expiration. |
| Functional Residual Capacity (FRC) | 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. |
| Total Lung Capacity (TLC) | is the amount of air in the lungs at the end of maximum inhalation. |
| Residual Volume (RV) | is the amount of air remaining in the lungs at the end of a full, forced exhalation. |
| Exercise Tolerance is to | assess functional capacity, determine reason for exercise limitation & changes due to disease |
| Pulmonary rehab is Rx’d if | respiratory rate is under 88% & supplemental oxygen required |
| Skin Tests are used | Identify infectious diseases(Tuberculosis, Viral illness, Fungal illness, Allergies, Invasive Diagnostics |
| Endoscopic exams | Thoracentesis, Biopsy (look at with cytology |
| Endoscopic Exams include | Bronchoscopy, Larygoscopy, Mediastinoscopy |
| Endoscopic Exams are u | sed for actual visualization and collection of biopsy for diagnosis. Can be used to retrieve a foreign body from the airway. |
| Lung Biopsy | To obtain tissue for histologic analysis. By bronchoscopy, needle aspiration or open lung biopsy during surgery |
| Risk of pneumothorax | Thoracentesis |
| Aspiration of fluid from the pleural space | Microscopic examination of the pleural fluid Relieving pulmonary compression |
| Oxygen Therapy | Considered a medication |
| The goal of O2 therapy is to use the | lowest amount of oxygen to obtain acceptable oxygenation |
| Oxygen Delivery Systems | Nasal Cannula, Simple Face Mask, Non-rebreather mask (just b4 u intibate), Venturi mask (Face Tent or aerosol mask- little kids), Positive Pressure ventilation –obstructed airways, Ventilator |
| Low Flow Oxygen O2 in room | 21% |
| Nasal Cannula | 25-40% FiO2 at 1-6 L/min |
| Face Mask | 40-60% FiO2 at 5-8 L/min |
| Partial rebreather mask | 60-75% FiO2 at 6-11 L/min |
| Non-rebreather mask | 80-95% FiO2 |
| Compressed into tank or cylinder (humidifiers added for comfort) | Liquid oxygen in a reservoir |
| Oxygen concentrator | @home. Takes O2 from air and concentrates it. More cost effective |
| Non-rebreather mask | Delivers highest FiO2, Reservoir bag must be inflated about 2/3 |
| In a non-rebreather mask, valves should open during exhalation and | close during inhalation |
| Non-rebreather is one step | before intubation |
| High Flow Oxygen | Venturi Mask, Face Tent, Trach collar, T-piece, Intubation and ventilator support |
| Bi-level positive airway pressure BiPAP- | delivers set inspiratory positive pressure during inhalation, lower during exhalation |
| Continuous positive airway pressure CPAP- | delivers a set positive pressure during both inhalation and exhalation |
| Endotracheal Tubes | Used to protect patient airway, Surgical use, Emergency use in hypoxia, Emergency use in trauma |
| Ventilator | Patient is being supported by the ventilator, May require sedation or paralytics |
| Priority for ventilator | protect the ET tube, secure |
| Oxygen Toxicity | Related to concentration, duration and degree of lung disease present. |
| Oxygen given at 50% continuously for more than | 48 hrs can damage lungs |
| Initial symptoms of oxygen toxicity | non-productive cough, chest pain, GI upset, dyspnea |
| More severe symptoms of O2 toxicity are related to | damaged lung tissue and resemble acute respiratory distress syndrome (ARDS) |
| Toxicity is difficult to treat, | PREVENTION is key |
| Suctioning | Sterile procedure for trachea, Pre-oxygenate |
| Do not apply suction longer than | 10-15 seconds or suction more than 3 times |
| If patient becomes hypoxic, heart rate decreases (vagal) or increases this would indicate need to | stop suctioning |
| Complications of suctioning | Bleeding, Obstruction, Vagal stimulation and bronchospasm, Tissue trauma, Hypoxia, Infection |
| Complications of suctioning | Bleeding, Obstruction, Vagal stimulation and bronchospasm, Tissue trauma, Hypoxia, Infection |
| Toxicity is difficult to treat, | PREVENTION is key |
| Suctioning | Sterile procedure for trachea, Pre-oxygenate |
| Do not apply suction longer than | 10-15 seconds or suction more than 3 times |
| If patient becomes hypoxic, heart rate decreases (vagal) or increases this would indicate need to | stop suctioning |
| Complications of suctioning | Bleeding, Obstruction, Vagal stimulation and bronchospasm, Tissue trauma, Hypoxia, Infection |
Created by:
Jillzs
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