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Ch. 21, Assessment of Respiratory Function. Sources: textbook, PPT, class notes.

temporary cessation of breathing apnea
abnormal increase in clarity of transmitted voice sounds bronchophony
direct examination of larynx, trachea, and bronchi using an endoscope bronchoscopy
short hairs that provide a constant whipping motion that serves to propel mucus and foreign substances away from the lung toward the larynx cilia
measure of the force required to expand or inflate the lungs compliance
soft, high-pitched, discontinuous popping sounds during inspiration caused by delayed reopening of the airways crackles
exchange of gas molecules from areas of high concentration to areas of low concentration diffusion
labored breathing or shortness of breath dyspnea
abnormal change in tone of voice that is heard when auscultating lungs ("E" sounds like "A") egophony
vibrations of speech felt as tremors of chest wall during palpation fremitus
expectoration of blood from the respiratory tract hemoptysis
decrease in arterial oxygen tension in the blood hypoxemia
decrease in oxygen supply to the tissues and cells hypoxia
temporary absence of breathing during sleep secondary to transient upper airway obstruction obstructive sleep apnea
inability to breathe easily except in an upright position orthopnea
percentage of hemoglobin that is bound to oxygen oxygen saturation
portion of the tracheobronchial tree that does not participate in gas exchange physiologic dead space
blood flow through the pulmonary vasculature pulmonary perfusion
gas exchange between atmospheric air and the blood and between the blood and cells of the body respiration
low-pitched wheezing or snoring sound associated with partial airway obstruction, heard on chest auscultation rhonchi
harsh high-pitched sound heard on inspiration, usually without need of stethoscope, secondary to upper airway obstruction stridor
abnormally rapid respirations tachypnea
volume of air inspired and expired with each breath during normal breathing tidal volume
movement of air in and out of airways ventilation
continuous musical sounds associated with airway narrowing or partial obstruction wheezes
Name the structures of the lower respiratory system. Lungs, pleura, mediastinum, bronchi and bronchioles, alveoli
How many lobes does the left lung have? 2; upper and lower
How many lobes does the right lung have? 3; upper, middle, lower
Where does gas exchange take place? Alveoli
Inspiration is normally how big of a part (in a fraction) of the respiratory cycle? 1/3
Expiration is normally how big of a part (in a fraction) of the respiratory cycle? 2/3
During respiration, exchange of gases occurs because of differences in what? Partial pressures
______ diffuses from the air into the blood at the alveoli to be transported to the cells of the body. Oxygen
______ _______ diffuses from the blood into the air at the alveoli to be removed from the body. Carbon dioxide
the filling of the pulmonary capillaries with blood perfusion
occurs when there is an imbalance of ventilation and perfusion; results in hypoxia shunting
the maximum volume of air that can be inhaled forcibly after a normal inhalation inspiratory reserve volume (IRV)
the maximum volume of air that can be exhaled forcibly after a normal exhalation expiratory reserve volume (ERV)
the volume of air remaining in the lungs after a maximum exhalation residual volume
the maximum volume of air exhaled from the point of maximum inspiration vital capacity
What is the formula for vital capacity? VC = TV + IRV + ERV (Vital Capacity = Tidal Volume + Inspiratory Reserve Volume + Expiratory Reserve Volume)
volume exhaled forcefully over time in seconds; time is indicated as a subscript usually 1 second forced expiratory volume (FEV)
measures volumes of air exhaled and is used to assess lung capacities spirometer
True or False: Tidal volume varies from breath to breath. TRUE, so measure several breaths.
What is the normal value for inspiratory pressure? appoximately 100 cm H2O; force of less than 25 cm usualy requires mechanical ventilation.
measurment of arterial oxygenation and carbon dioxide levels; used to assess the adequacy of alveolar ventilation and the ability of the lungs to provide oxygen and remove carbon dioxide; also assesses acid base balance arterial blood gases (ABGs)
a noninvasive method to monitor the oxygen saturation of the blood; normal levels are 95-100% pulse oximetry (may be unreliable; does not replace ABGs)
Name the functions of the respiratory system. oxygen transport, respiration, ventilation, gas exchange
The pulmonary circulation is considered a low-pressure system because the systolic BP in the pulmonary artery is __ to __ mm Hg, and the diastolic pressure is __ to __ mm Hg. systolic BP: 20 to 30 mm Hg; diastolic BP: 5 to 15 mm Hg
When a person is in an upright position, the pulmonary artery pressure is not great enough to supply blood to the ____ of the lung against the force of gravity. apex
When a person is upright, the lung may be considered to be divided into three sections: an upper part with _____ blood supply, a lower part with _____ blood supply, and a section between the two with an _____ supply of blood. poor; maximal; intermediate
When a person who is laying down turns to one side, more blood passes to the _______ lung. dependent
What factors determine the patterns of perfusion? pulmonary artery pressure, gravity, alveolar pressure
What factors may alter ventilation? airway blockages, local changes in compliance, gravity
The _______ _______ _______ shows the relationship between the partial pressure of oxygen (PaO2) and the percentage of saturation of oxygen (SaO2). oxyhemoglobin dissociation curve
An increase in factors that affect the percentage of saturation (carbon dioxide, hydrogen ion concentration, temperature, and 2,3- diphosphoglycerate) shifts the oxyhemoglobin dissociation curve to which side? The right side, so that less oxygen is picked up in the lungs, but more oxygen is released to the tissues, if PaO2 is unchanged.
A decrease in factors that affect the percentage of saturation (carbon dioxide, hydrogen ion concentration, temperature, and 2,3- diphosphoglycerate) shifts the oxyhemoglobin dissociation curve to which side? The left side, making the bond between oxygen and hemoglobin stronger. If the PaO2 is still unchanged, more oxygen is picked up in the lungs, but less oxygen is given up to the tissues.
At the same time that oxygen diffuses from the blood into the tissues, carbon dioxide diffuses from tissue cells to blood and is transported to the _____ for excretion. lungs
Although the many processes involved in respiratory gas transport seem to occur in intermittent stages, the changes are _____, _____, and _____. rapid, simultaneous, continuous
_______ _______ is the result of cyclic excitation of the respiratory muscles by the phrenic nerve. Resting respiration
The inspiratory and expiratory centers in the medulla oblongata and pons control the _____ and _____ of ventilation to meet the body’s metabolic demands. rate, depth
The apneustic center in the lower pons stimulates the inspiratory medullary center to promote _____, _____ inspirations. deep, prolonged
The pneumotaxic center in the upper pons is thought to control the _____ of respirations. pattern
Central chemoreceptors respond to an increase or decrease in the _____ and convey a message to the lungs to change the depth and then the rate of ventilation to correct the imbalance. pH
The _____-_____ _____ is activated by stretch receptors in the alveoli. When the lungs are distended, inspiration is inhibited; as a result, the lungs do not become overdistended. Hering-Breuer reflex
Proprioceptors in the muscles and joints respond to body movements, such as exercise, causing a/an _______ in ventilation. increase
Baroreceptors respond to an increase or decrease in arterial blood pressure and cause reflex _______ or _______. hypoventilation, hyperventilation
The vital capacity of the lungs and strength of the respiratory muscles peak between __ and __ years of age and decrease thereafter. 20, 25
With aging (__ years and older), changes occur in the alveoli that reduce the surface area available for the exchange of oxygen and carbon dioxide. 40
Respiratory changes at approximately __ years of age: alveoli begin to lose elasticity, decrease in vital capacity r/t loss of chest wall mobility which restricts tidal flow of air, increase in respiratory dead space, decreased diffusion capacity for O2. 50
Examples of age-related _______ changes: Decrease in # of cilia, mucus, size of airway, elasticity of alveolar sacs; Increase in diameter of alveolar ducts, collagen of alveolar walls, thickness of alveloar membranes. structural
Examples of age-related _______ changes: Decrease in protection against foreign particles and aspiration, response to hypoxia, exercise capacity, expiratory flow rates; Increase in airway resistance, pulmonary compliance, dead space, risk for fatigue. functional
Examples of age-related ___&___ findings: Decrease in cough reflex, mucus, IRV, ERV, FVC; Increase in infection rate, RV, FRC, AP diameter, abdominal and diaphragmatic breathing; + skeletal changes, kyphosis, barrel chest, SOB, URI, LRI, COPD, pneumonia. history & physical
Name the common signs and symptoms you will see during respiratory assessment. dyspea, cough, sputum production, chest pain, wheezing, clubbing of the fingers, hemoptysis, cyanosis
In general, _____ diseases of the lungs produce a more severe grade of dyspnea than do _____ diseases. acute, chronic
Sudden dyspnea in a healthy person may indicate what? pneumothorax (air in the pleural cavity), acute respiratory obstruction, allergic reaction, or myocardial infarction
In immobilized patients, sudden dyspnea may indicate what? pulmonary embolism
Dyspnea and tachypnea accompanied by progressive hypoxemia in a person who has recently experienced lung trauma, shock, cardiopulmonary bypass, or multiple blood transfusions may signal what? acute respiratory distress syndrome (ARDS)
Orthopnea (inability to breathe easily except in an upright position) may be found in patients with _____ _____ and occasionally in patients with _____. heart disease, COPD
Dyspnea with an expiratory wheeze occurs with _____. COPD
Noisy breathing may result from a _____ of the airway or localized _____ of a major bronchus by a tumor or foreign body. narrowing, obstruction
The high-pitched sound heard (usually on _______) when someone is breathing through a partially blocked upper airway is called stridor. inspiration
The presence of both inspiratory and expiratory wheezing usually signifies _____ if the patient does not have heart failure. asthma
a reflex that protects the lungs from the accumulation of secretions or the inhalation of foreign bodies cough
What factors may impair the cough reflex? weakness or paralysis of the respiratory muscles, prolonged inactivity, the presence of a nasogastric tube, or depressed function of the medullary centers in the brain (eg, anesthesia, brain disorders)
What conditions/problems might a cough indicate? serious pulmonary disease, cardiac disease, smoking, gastroesophageal reflux disease, or medication reactions to amiodarone [Cordarone] or ACE inhibitors.
What words might you use to describe a cough? dry, hacking, brassy, wheezing, loose, or severe
A dry, irritative cough is characteristic of an upper respiratory tract _____ of viral origin, or it may be a side effect of ___ _____ therapy. infection; ACE inhibitor
An irritative, high-pitched cough can be caused by _______. laryngotracheitis
A brassy cough is the result of a _____ _____. tracheal lesion
A severe or changing cough may indicate _____ ______. bronchogenic carcinoma
Pleuritic chest pain that accompanies coughing may indicate _____ or _____ _____(musculoskeletal) involvement. pleural, chest wall
Coughing at _____ may indicate the onset of left-sided heart failure or bronchial asthma. night
A cough in the _____ with sputum production may indicate bronchitis. morning
A cough that worsens when the patient is _____ suggests postnasal drip (rhinosinusitis). supine
Coughing after food intake may indicate _____ of material into the tracheobronchial tree. aspiration
A cough of recent onset is usually from a/an _____ infection. acute
Violent coughing causes bronchial spasm, obstruction, and further irritation of the bronchi and may result in _____. syncope (fainting)
A patient who coughs long enough almost invariably produces _____. sputum
Sputum production is the reaction of the lungs to any constantly recurring _____. It also may be associated with a _____ discharge. irritant, nasal
A profuse amount of purulent sputum (thick and yellow, green, or rust colored) or a change in color of the sputum is a common sign of a _____ _____. bacterial infection
Thin, mucoid sputum frequently results from _____ _____. viral bronchitis
A gradual increase of sputum over time may occur with _____ _____ or _____. chronic bronchitis, bronchiectasis
Pink-tinged mucoid sputum suggests a _____ _____. lung tumor
Profuse, frothy, pink material, often welling up into the throat, may indicate _____ _____. pulmonary edema
_____-smelling sputum and _____ breath point to the presence of a lung abscess, bronchiectasis, or an infection caused by fusospirochetal or other anaerobic organisms. Foul, bad
Chest pain or discomfort may be associated with _____ or _____ disease. pulmonary, cardiac
Chest pain associated with _____ conditions may be sharp, stabbing, and intermittent, or it may be dull, aching, and persistent. pulmonary
The pain usually is felt on the side where the pathologic process is located, but it may be _____ elsewhere— for example, to the neck, back, or abdomen. referred
What are some pulmonary conditions in which chest pain may occur? pneumonia, pulmonary embolism with lung infarction, pleurisy, or as a late symptom of bronchogenic carcinoma
In carcinoma, the pain may be _____ and ______ because the cancer has invaded the chest wall, mediastinum, or spine. dull, persistent
True or False: Lung disease always causes pain. FALSE, Lung disease does not always cause thoracic pain because the lungs and the visceral pleura lack sensory nerves and are insensitive to pain stimuli.
Pleuritic pain from irritation of the _____ _____ is sharp and seems to “catch” on inspiration; patients often describe it as being “like the stabbing of a knife.” parietal pleura
Patients with lung disease are more comfortable when they lay on the _____ side because this splints the chest wall, limits expansion and contraction of the lung, and reduces the friction between the injured or diseased pleurae on that side. affected
Pain associated with cough may be reduced manually by _____ the rib cage. splinting
Wheezing is a high-pitched, musical sound heard mainly on expiration with _____ or inspiration with _____. asthma, bronchitis
_____ is often the major finding in a patient with bronchoconstriction or airway narrowing. Wheezing
Depending on their location and severity, wheezing and _____ may be heard with or without a stethoscope. rhonchi
The onset of hemoptysis is usually _____, and it may be intermittent or continuous. sudden
Signs of _____ vary from blood-stained sputum to a large, sudden hemorrhage. hemoptysis
What are the most common causes of hemoptysis? pulmonary infection, carcinoma of the lung, abnormalities of the heart or blood vessels, pulmonary artery or vein abnormalities, pulmonary embolus and infarction
What types of diagnostic evaluation are used to determine the cause of hemoptysis? chest x-ray, chest angiography, bronchoscopy, and a careful history and physical examination
Bloody sputum from the _____ or the _____ is usually preceded by considerable sniffing, with blood possibly appearing in the nose. nose, nasopharynx
Blood from the _____ is usually bright red, frothy, and mixed with sputum. lung
Initial symptoms of blood in the lung include a _____ sensation in the throat, a _____ taste, a burning or bubbling sensation in the chest, and perhaps chest pain, in which case the patient tends to splint the bleeding side. tickling, salty
Blood arising from a pulmonary hemorrhage has an alkaline pH _____ than 7.0, while blood arising from a hemorrhage in the stomach has an acidic pH _____ than 7.0. greater, less
Since many lung disorders are related to or exacerbated by _____ _____, smoking history (including exposure to second-hand smoke) should be obtained. tobacco smoke
Smoking history is usually expressed in _____-_____, which is number of packs of cigarettes smoked per day times the number of years the patient smoked. pack-years
_____ factors that may affect the patient include: anxiety, role changes, family relationships, financial problems, employment status, and the strategies the patient uses to cope with them. Psychosocial
Many respiratory diseases are ____ and progressively debilitating and disabling. chronic
_____ of the fingers is a sign of lung disease that is found in patients with chronic hypoxic conditions, chronic lung infections, or malignancies of the lung; manifested initially as sponginess of the nail bed and loss of the nail bed angle. Clubbing
Cyanosis, a bluish coloring of the skin, is a very _____ indicator of hypoxia. late
Cyanosis appears when there is at least __ g/dL of unoxygenated hemoglobin. 5
Name some risk factors for respiratory disease. Smoking (#1), exposure to secondhand smoke, personal or family history of lung disease, genetic makeup, exposure to allergens and environmental pollutants, exposure to certain recreational and occupational hazards
A patient with _____ rarely manifests cyanosis, and a patient with _____ may appear cyanotic even if adequately oxygenated. Therefore, cyanosis is not a reliable sign of hypoxia. anemia, polycythemia
Assessment of cyanosis is affected by room lighting, the patient’s _____ _____, and the distance of the blood vessels from the surface of the skin. skin color
In the presence of a pulmonary condition, central cyanosis is assessed by observing the color of the _____ and _____. tongue, lips
Peripheral cyanosis results from decreased blood flow to the body’s periphery (fingers, toes, or earlobes), as in _____ from exposure to cold, and does not necessarily indicate a central systemic problem. vasoconstriction
_____ _____ occurs as a result of overinflation of the lungs. There is an increase in the anteroposterior diameter of the thorax. Barrel chest
_____ _____ occurs when there is a depression in the lower portion of the sternum. This may compress the heart and great vessels, resulting in murmurs; may occur with rickets or Marfan’s syndrome. Funnel chest
_____ _____ occurs as a result of displacement of the sternum. There is an increase in the anteroposterior diameter; may occur with rickets, Marfan’s syndrome, or severe kyphoscoliosis. Pigeon chest
_______ is characterized by elevation of the scapula and a corresponding S-shaped spine. This deformity limits lung expansion within the thorax; may occur with osteoporosis and other skeletal disorders that affect the thorax. Kyphoscoliosis
12 to 18 breaths per minute; except for occasional sighs, respirations are regular in depth and rhythm eupnea
When apneas occur repeatedly during sleep, secondary to transient upper airway blockage, the condition is called _____ _____ _____. obstructive sleep apnea
Bulging of the intercostal spaces during expiration implies obstruction of expiratory airflow, as in _____. emphysema
Marked retraction on inspiration, particularly if _____, implies blockage of a branch of the respiratory tree. asymmetric
Asymmetric bulging of the intercostal spaces, on one side or the other, is created by an increase in pressure within the hemithorax. This may be a result of what conditions? pneumothorax or pleural effusion
Respiratory _____ is an estimation of thoracic expansion. excursion
_____ chest excursion may be caused by chronic fibrotic disease. Decreased
_____ excursion may be due to splinting secondary to pleurisy, fractured ribs, trauma, or unilateral bronchial obstruction. Asymmetric
The increase in subcutaneous tissue associated with _____ may affect fremitus. obesity
Patients with _____, which results in the rupture of alveoli and trapping of air, exhibit almost no tactile fremitus. emphysema
A patient with consolidation of a lobe of the lung from _____ has increased tactile fremitus over that lobe. pneumonia
Slower than normal rate (less than 10 breaths/min), with normal depth and regular rhythm; associated with increased intracranial pressure, brain injury, and drug overdose bradypnea
rapid, shallow breathing (greater than 24 breaths/min); associated with pneumonia, pulmonary edema, metabolic acidosis, septicemia, severe pain, or rib fracture tachypnea
shallow, irregular breathing hypoventilation
increased depth of respirations hyperpnea
increased rate and depth of breathing that results in decreased PaCO2 level; inspiration and expiration are nearly equal in duration hyperventilation
hyperventilation associated with diabetic ketoacidosis or renal origin Kussmaul’s respirations
period of cessation of breathing; time duration varies; may occur briefly during other breathing disorders, such as with sleep apnea; life-threatening if sustained apnea
regular cycle where the rate and depth of breathing increase, then decrease until apnea (usually about 20 seconds) occurs; associated with heart failure and damage to the respiratory center (drug-induced, tumor, trauma) Cheyne-Stokes
Periods of normal breathing (3–4 breaths) followed by a varying period of apnea (usually 10–60 seconds); also called cluster breathing; associated with some nervous system disorders Biot’s respiration
When assessing for tactile fremitus, what phrases might you ask the patient to repeat? “ninety-nine”; “one, two, three,”; “eee, eee, eee”
When percussing the female patient, it may be necessary to displace the _____ for an adequate examination. breasts
True or False: Dullness noted during percussion to the left of the sternum between the third and fifth intercostal spaces is a normal finding. TRUE, because that is the location of the heart.
True or False: Dullness noted during percussion in the right thorax, from the fifth intercostal space to the right costal margin at the midclavicular line is a normal finding. TRUE, because that is the location of the liver.
Dullness over the lung occurs when air-filled lung tissue is replaced by _____ or solid tissue. fluid
Maximal excursion of the diaphragm may be as much as 8 to 10 cm in healthy, tall young men, but for most people it is usually __ to __ cm. 5, 7
Decreased diaphragmatic excursion may occur with _____ _____ and _____. pleural effusion, emphysema
What are some conditions that may account for a diaphragm that is positioned high in the thorax? pregnancy, obesity, ascites (conditions in which there is an increase in intra-abdominal pressure)
During thoracic auscultation, repeated deep breaths may result in symptoms of _____, such as lightheadedness. hyperventilation
_______ sounds are divided into two categories: discrete, noncontinuous sounds (crackles) and continuous musical sounds (wheezes.) Adventitious
Bronchophony and egophony are indicative of _____, such as occurs in pneumonia, or pleural effusion. consolidation
_____ _____, distinctly hearing words that seem to come from the spot being auscultated, is a very subtle finding, which is heard in the presence of rather dense consolidation of the lungs. Whispered pectoriloquy
_____ of the thorax provides information about the musculoskeletal structure, the patient’s nutritional status, and the respiratory system. Inspection
The nurse _____ the thorax for tenderness, masses, lesions, respiratory excursion, and vocal fremitus. palpates
The nurse uses _____ to determine whether underlying tissues are filled with air, fluid, or solid material; also used to estimate the size and location of certain structures within the thorax (diaphragm, heart, liver.) percussion
_____ is useful in assessing the flow of air through the bronchial tree and in evaluating the presence of fluid or solid obstruction in the lung. Auscultation
Name some signs of respiratory distress. agitation, restlessness, nasal flaring, excessive use of intercostals and accessory muscles, uncoordinated movement of the chest and abdomen, and a report by the patient of shortness of breath
The nurse must note changes in the patient’s _____ _____ and evidence of _____ _____ and report the changes to the physician, because they may indicate that mechanical ventilation is ineffective or that the patient’s status has deteriorated. vital signs, hemodynamic instability
It is necessary to assess the position of the mechanically ventilated patient to be certain that the head of the bed is elevated to prevent _______, especially if the patient is receiving enteral feedings. aspiration
For the ventilated patient, lethargy and somnolence may be signs of increasing _____ _____ levels and should not be considered insignificant, even if the patient is receiving sedation or analgesic agents. carbon dioxide
If the patient is recumbent, failure to examine the dependent areas of the lungs can result in missing the findings associated with disorders such as _____ or _____ _____. atelectasis, pleural effusion
Tests of the patient’s respiratory status are easily performed at the bedside by measuring what? the respiratory rate, tidal volume, minute ventilation, vital capacity, inspiratory force, and compliance
Testing respiratory status is particularly important for what types of patients? patients who are at risk for pulmonary complications: those who have undergone chest or abdominal surgery, had prolonged anesthesia, have preexisting pulmonary disease, the elderly, the obese; also mechanically ventilated patients
Which patients will inhale and exhale a low volume of air (referred to as low tidal volumes)? those limited by external restrictions such as obesity or abdominal distention; those who cannot breathe deeply because of postoperative pain or sedation
Prolonged _______ at low tidal volumes can produce alveolar collapse (atelectasis). hypoventilation
Which patients are more prone to alveolar collapse? patients who have preexisting pulmonary diseases, the elderly, patients whose airways are less compliant (small airways may collapse during expiration), the obese, patients who have relatively low tidal volumes even when healthy
True or False: The nurse can rely only on visual inspection of the rate and depth of a patient’s respiratory excursions to determine the adequacy of ventilation. FALSE, Respiratory excursions may appear normal or exaggerated due to an increased work of breathing, but the patient may actually be moving only enough air to ventilate the dead space.
How do you measure tidal volume if the patient is breathing through an endotracheal tube or tracheostomy? The spirometer is directly attached to it and the exhaled volume is obtained from the reading on the gauge.
How do you measure tidal volume in a normal patient? The spirometer is attached to a face mask or a mouthpiece positioned so that it is airtight, and the exhaled volume is measured.
Name some conditions that cause limited neurologic impulses to be transmitted from the brain to the respiratory muscles, increasing risk for hypoventilation. spinal cord trauma, cerebrovascular accidents, tumors, myasthenia gravis, Guillain-Barré syndrome, polio, and drug overdose
Name factors that cause depressed respiratory centers in the medulla, increasing risk for hypoventilation. anesthesia, sedation, and drug overdose
List some other factors that increase risk for hypoventilation. Limited thoracic movement (kyphoscoliosis), limited lung movement (pleural effusion, pneumothorax), or reduced functional lung tissue (chronic pulmonary diseases, severe pulmonary edema)
volume of air expired per minute; equal to the product of the tidal volume in liters multiplied by the respiratory rate or frequency minute ventilation
When the minute ventilation falls (as a result of _______), alveolar ventilation in the lungs also decreases, and the PaCO2 increases. hypoventilation
_____ _____ is measured by having the patient take in a maximal breath and exhale fully through a spirometer; the normal value depends on the patient’s age, gender, body build, and weight. Vital capacity
Most patients can generate a vital capacity twice the volume they normally breathe in and out. If the vital capacity is less than 10 mL/kg, the patient will be unable to sustain _____ _____ and will require respiratory assistance. spontaneous ventilation
_____ _____ evaluates the effort the patient is making during inspiration. It does not require patient cooperation and therefore is a useful measurement in the unconscious patient. Inspiratory force
Normal inspiratory pressure is __ cm H2O. Negative pressure registered after 15 seconds of occluding the airway of less than __ cm H2O: mechanical ventilation is needed (patient lacks muscle strength for deep breathing or effective coughing.) 100, 25
performed to assess respiratory function and to determine the extent of dysfunction; include measurements of lung volumes, ventilatory function, and the mechanics of breathing, diffusion, and gas exchange Pulmonary function tests (PFTs)
PFTs are useful as screening tests in potentially hazardous industries, such as _____ _____ and those that involve exposure to _____ and other noxious fumes, dusts, or gases. coal mining, asbestos
Prior to surgery, PFTs are used to screen patients who are scheduled for thoracic and upper abdominal _____ procedures, patients who are _____, and symptomatic patients with a history suggesting high risk. surgical, obese
Forced vital capacity is often reduced in COPD because of _____ _____. air trapping
Maximal voluntary ventilation is an important factor in _____ _____. exercise tolerance
ABG studies aid in assessing the ability of the lungs to provide adequate _____ and remove ______ _____ and the ability of the kidneys to reabsorb or excrete _____ ions to maintain normal body pH. oxygen, carbon dioxide, bicarbonate
Serial ABG analysis is a sensitive indicator of whether the lung has been damaged after _____ _____. chest trauma
ABG levels are obtained through an arterial puncture at the _____, _____, or _____ artery or through an indwelling arterial catheter. radial, brachial, femoral
Name some conditions in which SpO2 values obtained by pulse oximetry are unreliable. cardiac arrest, shock, sepsis, PVD, hypothermia, when vasoconstrictor meds have been used, anemia, abnormal hemoglobin, high carbon monoxide level, use of dyes such as methylene blue, dark skin, nail polish, bright light, movement, supplemental oxygen
Throat cultures may be performed to identify organisms responsible for _____ or infection of the lower respiratory tract. pharyngitis
Periodic sputum examinations may be necessary for patients receiving _____, _____, and _____ _____ for prolonged periods because these agents are associated with opportunistic infections. antibiotics, corticosteroids, immunosuppressive medications
When obtaining a sputum specimen, the patient takes a few deep breaths, _____ (rather than spits), using the diaphragm, and expectorates into a sterile container. coughs
Normal pulmonary tissue is radiolucent; therefore, densities produced by fluid, tumors, foreign bodies, and other pathologic conditions can be detected by _____ examination. x-ray
Chest x-rays are usually taken after full inspiration (a deep breath) because the lungs are best visualized when they are _____ _____. well aerated
If taken on expiration, x-ray films may accentuate an otherwise unnoticed _____ or obstruction of a major artery. pneumothorax
_____ _____ _____ yields a much more detailed diagnostic image than CT; magnetic fields and radiofrequency signals are used. Magnetic Resonance Imaging (MRI)
MRI is used to characterize pulmonary nodules, help stage _____ _____ (assessment chest wall invasion), and evaluate inflammatory activity in interstitial lung disease, acute pulmonary _____, and chronic thrombolytic pulmonary hypertension. bronchogenic carcinoma, embolism
_____ is used to assist with invasive procedures (chest needle biopsy, transbronchial biopsy) performed to identify lesions; used to study the movement of chest wall, mediastinum, heart, and diaphragm; detect diaphragm _____; locate lung masses. Fluoroscopy, paralysis
_____ _____ is most commonly used to investigate thromboembolic disease of the lungs, such as pulmonary emboli, and congenital abnormalities of the pulmonary vascular tree. Pulmonary angiography
Pulmonary angiography involves the rapid injection of a _____ agent into the vasculature of the lungs for radiographic study of the pulmonary vessels. radiopaque
Name 3 lung scans that are used to assess normal lung functioning, pulmonary vascular supply, and gas exchange. V/Q scan, gallium scan, and positron emission tomography (PET) scan.
A _____ _____ is used clinically to measure the integrity of the pulmonary vessels relative to blood flow and to evaluate blood flow abnormalities, as seen in pulmonary emboli. V/Q scan
A _____ _____ may be helpful in the diagnosis of bronchitis, asthma, inflammatory fibrosis, pneumonia, emphysema, and lung cancer. V/Q scan
A _____ _____ is used to detect inflammatory conditions, abscesses, adhesions, and the presence, location, and size of tumors; used to stage bronchogenic cancer and document tumor regression after chemotherapy or radiation. gallium scan
In a gallium scan, _____ is injected intravenously, and scans are taken at intervals (eg, 6, 24, and 48 hours) to evaluate uptake by the pulmonary tissues. gallium
PET can detect and display metabolic changes in tissue, distinguish normal tissue from diseased tissue (such as in _____), differentiate viable from dead or dying tissue, and show regional blood flow. cancer
_____ _____ _____ is more accurate in detecting malignancies than CT and has equivalent accuracy in detecting malignant nodules when compared with invasive procedures such as thoracoscopy. Positron emission tomography (PET)
With bronchoscopy, the _____ scope is used more frequently in current practice. fiberoptic
2 purposes of diagnostic bronchoscopy are: (1) to examine tissues or collect secretions, (2) to determine the location and extent of the pathologic process and to obtain a tissue sample for diagnosis. List 2 more purposes. (3) to determine whether a tumor can be resected surgically, and (4) to diagnose bleeding sites (source of hemoptysis).
2 purposes of therapeutic bronchoscopy are: (1) remove foreign bodies from the tracheobronchial tree, (2) remove secretions obstructing the tracheobronchial tree when the patient cannot clear them. List 2 more purposes. (3) treat postoperative atelectasis, and (4) destroy and excise lesions. (Also used to insert stents to relieve airway obstruction that is caused by tumors or miscellaneous benign conditions or that occurs as a complication of lung transplantation.)
What are some possible complications of bronchoscopy? a reaction to the local anesthetic, infection, aspiration, bronchospasm, hypoxemia (low blood oxygen level), pneumothorax, bleeding, and perforation
Before bronchoscopy, food and fluids are withheld for __ hours before the test to reduce the risk of aspiration when the cough reflex is blocked by anesthesia. 6
Why are preoperative medications (usually atropine and a sedative or opioid) administered before a bronchoscopy? to inhibit vagal stimulation (thereby guarding against bradycardia, dysrhythmias, and hypotension), suppress the cough reflex, sedate the patient, and relieve anxiety.
Sedation given to patients with respiratory insufficiency may precipitate _____ _____. respiratory arrest
After bronchoscopy, it is important that the patient takes nothing by mouth until the _____ _____ returns, because the preoperative sedation and local anesthesia impair the protective laryngeal reflex and swallowing for several hours. cough reflex
After bronchoscopy, the nurse monitors the patient’s _____ _____ and observes for hypoxia, hypotension, tachycardia, dysrhythmias, hemoptysis, and dyspnea. Report any abnormality promptly. respiratory status
_______ is primarily indicated in the diagnostic evaluation of pleural effusions, pleural disease, and tumor staging. Biopsies of the lesions can be performed under visualization for diagnosis. Thoracoscopy
_____-_____ thoracoscopy (VATS) may be used in the diagnosis and treatment of empyema, pleural effusion, and other respiratory disorders. Video-assisted
If a chest tube was inserted during a thoroscopy, monitoring of the chest drainage system and chest tube _____ _____ is essential. insertion site
Follow-up care after thoroscopy involves monitoring the patient for shortness of breath (which might indicate a _____) and minor activity restrictions, which vary depending on the intensity of the procedure. pneumothorax
aspiration of fluid or air from the pleural space; performed for diagnostic or therapeutic reasons thoracentesis
Purposes of thoracentesis include removal of fluid and air from the pleural cavity, _____ of pleural fluid for analysis, pleural biopsy, and _____ of medication into the pleural space. aspiration, instillation
When thoracentesis is performed under _____ guidance, it has a lower rate of complications than when it is performed without it. ultrasound
_____, the excision of a small amount of tissue, may be performed to permit examination of cells from the pharynx, larynx, and nasal passages. Biopsy
_____ _____ is performed when there is pleural exudate of undetermined origin or when there is a need to culture or stain the tissue to identify tuberculosis or fungi. Pleural biopsy
Name some nonsurgical lung biopsy techniques that are used because they yield accurate information with low morbidity. transcatheter bronchial brushing, transbronchial lung biopsy, and percutaneous (through-the-skin) needle biopsy
_____ _____ _____ is useful for cytologic evaluations of lung lesions and for the identification of pathogenic organisms (eg, Nocardia, Aspergillus, Pneumocystis jiroveci); especially useful in the immunologically compromised patient. transcatheter bronchial brushing
_____ _____ _____ is indicated when a lung lesion is suspected and the results of routine sputum samples and bronchoscopic washings are negative. Transbronchial lung biopsy
Possible complications of percutaneous needle biopsy include _____, pulmonary _____, and _____. pneumothorax, hemorrhage, and empyema.
Nursing care after _____ _____ involves monitoring the patient for shortness of breath, bleeding, and infection. lung biopsy
In preparation for discharge after lung biopsy, the patient and family are instructed to report pain, shortness of _____, visible _____, _____ of the biopsy site, or purulent _____ (pus) to the health care provider immediately. breath, bleeding, redness, drainage
_____ _____ _____ drain the lungs and mediastinum and may show histologic changes from intrathoracic disease; if palpable on physical examination, a biopsy may be performed. Scalene lymph nodes
A scalene node biopsy may be performed to detect spread of pulmonary disease to the lymph nodes and to establish a diagnosis or prognosis in such diseases as Hodgkin _____, _____, fungal disease, _____, and carcinoma. lymphoma, sarcoidosis, tuberculosis
_______ is the endoscopic examination of the mediastinum for exploration and biopsy of mediastinal lymph nodes that drain the lungs; does not require a thoracotomy. Mediastinoscopy
A/An _____ _____ is thought to provide better exposure and diagnostic possibilities than a mediastinoscopy. anterior mediastinotomy
Postprocedure care after lymph node biopsy focuses on providing adequate _____, monitoring for _____, and providing _____ relief. oxygenation, bleeding, pain
Anxiety about the potential findings of a biopsy may impact a patient's abilty to monitor for changes in _____ _____ postprocedure. respiratory status
During thoracentesis, the upright position of the patient facilitates the removal of fluid that usually localizes at the _____ of the thorax. base
During thoracentesis, encourage the patient to refrain from _____ because sudden and unexpected movement by the patient can traumatize the visceral pleura and lung. coughing
If air is in the pleural cavity, the thoracentesis site is usually in the _____ or _____ intercostal space in the midclavicular line because air rises in the thorax. second, third
After thoracentesis, why is pressure applied over the puncture site and a small, airtight, sterile dressing fixed in place? Pressure helps to stop bleeding, and the airtight dressing protects the site and prevents air from entering the pleural cavity.
_____ _____ or _____ _____ can occur after a sudden shift in mediastinal contents when large amounts of fluid are aspirated by thoracentesis. Pulmonary edema, cardiac distress
What are some NANDA nursing diagnoses for the patient with respiratory disorders? Ineffective airway clearance; impaired gas exchange; ineffective breathing pattern; risk for aspiration.
What is the overall goal when managing care of patients with respiratory disorders? Return to functional baseline status, stabilization of, or improvement in airway patency, gas exchange, and ventilation.
A normal digit has a nail angle of ___ degrees; early clubbing is noted with a ___-___ degree angle; advanced clubbing is noted with an angle greater than ___ degrees. 160; 160-180; 180
The _____ _____ may be used to identify clubbing of the fingers; involves checking for a window between 2 nail angles pressed together. Schamroth Technique
What data would you gather when assessing the past history of a respiratory patient? childhood diseases, immunizations, medications, allergies, family history, occupation, environment, genetics, habits, exercise, nutrition
When assessing for barrel chest, an increased A-P diameter that is equal to the transverse diameter is related to _____, as a result of overinflation. COPD
_____ makes lung expansion difficult, and may be related to a congenital defect, spinal TB, arthritis, or poor posture. Kyphoscoliosis
Both funnel chest and pigeon chest may be related to _____ syndrome. Marfan's
Normal breath sounds include _____ (soft, low-pitched), _____ (medium loudness/pitch), and _____ (louder, higher pitched- like air through a hollow pipe). vesicular, bronchovesicular, bronchial
In a negative pressure room, a sign on the door that reads "AFB precautions" indicates what? Isolation precautions are in place for acid-fast bacilli (tuberculosis.)
The _____ _____ is a diagnostic tool for tuberculosis. Mantoux test
Normal pH is between ___ - ___. 7.35 - 7. 45
Normal PaCO2 is between ___ - ___. 35 - 45
Normal HCO3 is between ___ - ___. 22 - 26
Before a pulmonary angiography, asses for allergies to _____ or _____. iodine, shellfish
Positron emission tomography distinguishes between benign and malignant nodules with "_____ _____." hot spots
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