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68C 2014 P2 Test 5

Introduction to the Respiratory System

Adventitious abnormal sounds superimposed on breath sounds.
Atelectasis collapse of alveoli, preventing the respiratory exchange of carbon dioxide and oxygen.
Bronchoscopy visual examination of the larynx, trachea, and bronchi, using a standard rigid, tubular flexible fiberoptic bronchoscope.
Coryza acute inflammation of the mucous membranes of the nose and accessory sinuses, usually accompanied by edema of the mucous membranes and nasal discharge.
Crackles short, discrete, interrupted crackling or bubbling sounds; most commonly heard upon inspiration.
Cyanosis slightly bluish, gray, or dark purple discoloration of the skin, resulting from the presence of abnormally reduced amounts of oxygenated hemoglobin in the blood.
Dyspnea shortness of breath or difficulty in breathing; may be caused by disturbances in the lungs, certain heart conditions, and hemoglobin deficiency.
Embolism obstruction of blood vessel by a foreign substance; blood clot, fat, or air.
Empyema accumulation of pus in a body cavity, especially the pleural space, as a result of an infection.
Epistaxis hemorrhage of the nose; nosebleed.
Exacerbation an increase in the severity of a disease or disorder, marked by an increase in signs and symptoms.
Extrinsic caused by external factors
Hypercapnia greater than normal amounts of carbon dioxide in the blood.
Hypoventilation an abnormal condition of the respiratory system that occurs when the volume of air inhaled is not adequate for the metabolic needs of the body.
Hypoxia an inadequate, reduced tension of cellular oxygen.
Intrinsic caused by internal factors.
Orthopnea an abnormal condition in which a person must sit or stand in order to breathe comfortably or deeply (often measured by how many pillows a patient needs to sleep at night).
Pleural Friction Rub low-pitched, grating or creaking lung sounds that occur when inflamed pleural surfaces rub together during respiration.
Pneumothorax collection of air or gas in the pleural cavity which causes the lung to collapse.
Sibilant wheeze musical, high-pitched, squeaking or whistle-like sound caused by rapid movement of air through narrowed bronchioles.
Sonorous wheeze low-pitched, loud, coarse, snoring sound.
Stertorous pertaining to respiratory effort that is strenuous and struggling, this creates a snoring sound.
Tachypnea: an abnormal rapid rate of breathing.
Thoracentesis surgical perforation of the chest wall and pleural space with a needle for the aspiration of fluid for diagnostic or therapeutic purposes.
Virulent power of microorganism to produce disease.
External Respiration Exchange of oxygen and carbon dioxide between the lungs and the environment
Internal Respiration Exchange of oxygen and carbon dioxide at the cellular level.
Passive Transport Oxygen enters the cells while carbon dioxide leaves the cells via _______________.
Turbinates Three scroll-like bones located laterally to the nasal cavities.
Turbinates Cause the air to move over a larger surface area. This allows more time for warming and moisturizing
Nose Mucus Membranes Are highly vascular (provides warmth and moisture): secretes approximately 1 liter per day
Nasal septum separates the nares
Nose Contains hairs which trap dust and other foreign particles and prevents them from entering the lower respiratory tract
Nose Function Air is filtered, moistened and warmed as it enters the two nares.
Sinus Types frontal, maxillary, sphenoid and ethmoid
Sinuses Hollow areas which make the skull lighter. Believed to give resonance to the voice. Lined with mucous membranes continuous with the nasal cavity.
Smell Receptor Location Located in the mucosa of the nasal cavity.
Smell Receptor Nerve Endings Nerve endings of the olfactory nerve (CN I).
Nasolacrimal ducts (tear ducts) Communicate with the upper nasal chamber. Hence, when a person cries, his/her nose runs.
Pharynx: throat (a) Passageway for air and food. (about 5 inches long extending from base of the skull to the esophagus).
Pharynx Three Subdivisions Nasopharynx, Oropharynx, Laryngopharynx
Nasopharynx most superior portion and contains the adenoids.
Oropharynx posterior to mouth and contains the tonsils
Laryngopharynx directly superior to larynx.
Eustachian Tube Location Enter either side of the nasopharynx, connecting it to the middle ear
Why can an infection in the pharynx easily spread to the ear? Inner lining of the pharynx continuous with the eustachian tube
Larynx: voicebox Connects the pharynx with the trachea and contains the vocal cords: opening between the vocal cords is the glottis
nine rings of cartilage The larynx is supported by _________________
thyroid cartilage(Adam's Apple Largest area composed of two fused plates called the __________________
Puberty Same size in men and women until _______________
Epiglottis Large leaf shaped area that protects the larynx when swallowing. Covers the larynx tightly to prevent food from entering the trachea and directs food to the esophagus
Trachea: windpipe Tubelike structure, containing C-shaped cartilaginous rings, that extends to the midchest where it divides into the right and left bronchi. Lies anterior to the esophagus and connects the larynx with the bronchi.
Why does the trachea's open portion of C-shaped cartilage faces the posterior? allowing the esophagus to expand while swallowing, but maintaining patency of the trachea (necessary for uninterrupted breathing).
Trachea Lined with mucous membranes and cilia that direct dust and debris up towards the nasal cavity. Large particles will stimulate the cough reflex, a protective mechanism that aids in the evacuation of foreign material.
Lower Respiratory Tract consist of: Bronchial Tree: Right Bronchus, Left Bronchus, Bronchioles, Terminal Bronchioles, Alveoli,
Right Bronchus 1) Enters the right lung. 2) Larger in diameter and more vertical in descent than the left. 3) Aspirated objects often enter right bronchus.
Left Bronchus 1) Enters the left lung. 2) Smaller in diameter and slightly horizontal in position, compared to the left
Bronchioles smaller branches of the bronchi.
Terminal Bronchioles (alveolar ducts) smaller tubelike structures lined with ciliated mucous membranes.
Alveoli 1) Terminal structure of the bronchial tree where gas exchange occurs. 2) Effective in gas exchange because they are thin-walled. 3) Lies in contact with a capillary to facilitate diffusion of gases. 4) Lined with surfactant to reduce surface tension
Thoracic Cavity Composition: Lungs occupy almost all of the thoracic cavity, except the mediastinum (which contains the heart and great vessels).
Thoracic Cavity Cavity is called the intrapleural space and is enclosed by the sternum, ribs and thoracic verterbrae
Lungs Large, paired, spongy cone-shaped organs.
Right Lung Has 3 Lobes
Left Lung Has 2 Lobes
Where do the lungs receive blood from? Pulmonary Arteries
How does gas exchange in the lungs occur? Via diffusion
Visceral Pleura thin, moist serous membrane that covers the surface of each lung.
Parietal Pleura thin, moist serous membrane that covers the thoracic cavity.
Pleural Cavity Airtight vacuum that contains negative pressure that helps keep the lungs inflated
The air in the lungs is at what type of pressure? Atmospheric Pressure
Is the pressure in the lungs lower or higher than the pressure inside the pleural cavity? Higher
pleural effusion 3) Visceral and parietal pleura produce a serous secretion that allows the lungs to slide over the walls of the thorax while breathing. Too much accumulation of this fluid can result in a ______________ that may need to be drained by a thoracentesis).
Medulla oblongata and pons are responsible for the basic rhythm and depth of respiration (rhythm can be modified to meet the demands of the body).
Chemoreceptors are located In the carotid and aortic bodies
Chemoreceptors are sensitive to blood carbon dioxide, oxygen and pH levels
7.35-7.45 Normal arterial blood pH range is __________.
Function of the respiratory system is gas exchange (oxygen and carbon dioxide) at the alveolar/capillary level. This depends on the lungs capacity for contraction and expansion to produce respiration.
Patients requiring a more extensive respiratory assessment (1) Chronic respiratory or cardiac conditions. (2) History of respiratory impairment related to trauma or allergic reactions. (3) Recent surgery or anesthesia.
Physical and emotional responses are often correlated, therefore the nurse should inquire about stress and anxiety.
Respiratory Assessment Subjunctive Data (1) Shortness of Breath (SOB). (2) Dyspnea on Exertion (DOE). (3) Cough
Assessing Cough Productive or non-productive; Harsh, dry or hacking; Color and amount of mucous.
Respiratory Objective Data Chest movement and expansion; Assess respiratory rate and oxygen saturation; Clues of distress; Flaring nostrils; Retractions of chest wall between the ribs and under the clavicle during inspiration; Orthopnea; Auscultation
Clues of distress such as wide-eyed, anxious look may indicate fear of suffocating.
Flaring nostrils late sign of respiratory distress
Sibilant wheeze (wheeze) musical, high-pitched, squeaking or whistling sounds, caused by rapid air movement through narrowed bronchioles.
Sonorous wheeze (rhonchi) low-pitched, loud, coarse, snoring sounds; heard on expiration.
Crackles (rales) short, discrete, interrupted crackling or bubbling sounds that are heard during inspiration
Pleural friction rub low-pitched, grating or creaking lung sounds that occur when inflamed pleural surfaces rub together during respiration
hypoxia s/s Apprehension, anxiety, restlessness, decreased LOC; Decreased ability to concentrate; Disorientation; Increased fatigue; Vertigo; Increased pulse;
hypoxia s/s Increased rate and depth of respiration; Elevated blood pressure; Cardiac dysrhythmias; Pallor, cyanosis; Clubbing; Dyspnea.
s/s as hypoxia progresses Bradycardia; Shallow, slow respirations; Hypotension with continuing oxygen deficiency; cyanosis is often a late severe sign
Clubbing bulbous swelling of the terminal phalanges of the fingers and toes, giving them a “club” appearance; the normal 160° angle between the nailbed and the digit increases to 180°
Chest Radiographs Uses (1) Used to visualize the lungs, clavicles, humeri, scapulae, vertebrae, heart, and major thoracic vessels
Chest Radiograph provides information on alterations in size and location of the pulmonary structures.
Chest Radiograph Identifies the presence of lesions, infiltrates, foreign bodies or fluid.
Chest Radiograph can distinguish if a disorder involves the parenchyma or interstitial spaces: can confirm pneumothorax, pneumonia, pleural effusion and pulmonary edema
Chest Radiograph Patient instructions Patients should be instructed to remove jewelry and wear a hospital gown.
Computed Tomography (CT) (1) Scans the lungs in small layers, usually to identify pulmonary lesions. Views can be diagonal or cross-sectional. Painless and non-invasive
Computed Tomography (CT) Patient Teaching Requires patient teaching to decrease anxiety (esp. with claustrophobic patients).
Pulmonary Function Test (PFT) (1) Performed to assess the presence and severity of disease in the large and small airways. One of the most important tools for diagnosing respiratory diseases is the capacity for carbon dioxide to be diffused.
Pulmonary Function Test (PFT) Composition (2) Composed of various procedures to obtain information on lung volume, ventilation, pulmonary spirometry and gas exchange.
(a) Lung Volume or Vital Capacity (VC) a measurement of the volume of air that can be completely and slowly exhaled after maximum inhalation
Inspiratory Capacity (IC) the largest amount of air that can be inhaled in one breath.
Total Lung Capacity (TLC) calculated to determine the volume of air in the lung after maximal inhalation.
Ventilation tests evaluate the volume of air inhaled or exhaled in each respiratory cycle.
Pulmonary spirometry evaluates the amount of air that can be forcefully exhaled after maximum inhalation
Mediastinoscopy Surgical endoscopic procedure to obtain lymph nodes for biopsy for tumor diagnosis.
Laryngoscopy allows for direct or indirect visualization of larynx. Indirect most common used for assessment of respiratory difficulties: can be used for biopsy or polyp removal
Laryngoscopy requires local or general anesthesia.
Bronchoscopy Bronchoscope is passed into the trachea and bronchi with either a flexible fiberoptic bronchoscope (most commonly used) or a rigid bronchoscope to visualize the larynx, trachea, and bronchi
Bronchoscopy Observes the tracheobronchial tree for: Abnormalities. Tissue biopsy. Secretions for cytological or bacteriological studies
Nursing Interventions - bronchoscopy Informed consent must be signed before procedure. Patient is NPO until gag reflex returns; approximately 2 hours post procedure. Patient placed in semi-fowlers position and turned to one side to facilitate removal of secretions.
Nursing Interventions - bronchoscopy Patient is monitored for signs of laryngeal edema or spasms (dyspnea or stridor). If biopsy is taken, sputum is monitored for signs of hemorrhage (blood-tinged sputum can be expected for several days after biopsy).
Sputum Specimen These examinations are most frequently the gram stain, and culture and sensitivity
Sputum Specimen For a sputum specimen to be used clinically, proper procedure must be followed when obtaining the specimen. It is a nursing responsibility to ensure a proper sample is obtained.
Thoracentesis Surgical perforation of the chest wall and pleural space with a needle for the aspiration of fluid
Thoracentesis Diagnostic Purposes 1) Examined for specific gravity, WBCs, RBCs, protein and glucose. Cultured for pathogens and checked for abnormal or malignant cells. Gross appearance, quantity drained and location of puncture site should be recorded
Biopsy of the pleura Removal of fluid for patient comfort or well-being (can significantly decrease lung expansion). Instillation of medication (may be done for an empyema or for a lung that will not stay inflated after a pneumothorax).
Nursing Interventions Thoracentesis Explain the procedure and obtain informed consent; Procedure performed at patient's bedside with patient sitting upright leaning over a bedside table or with patient on side with affected side up and HOB at 30 degrees;
Nursing Interventions Thoracentesis Monitor vital signs, general appearance and respiratory status throughout procedure; Risk for subsequent pulmonary edema due to fluid shifts if > 1300 mL removed within a 30 minute period;
Nursing Interventions Thoracentesis Place patient on unaffected side after procedure; CXR often obtained to rule out pneumothorax after procedure
Arterial Blood Gas (ABG) analysis is an essential tool for diagnosing and monitoring patients with respiratory disorders
ABG measures the lungs ability to exchange oxygen, carbon dioxide and the body's acid-base balance, which is controlled by the lungs and the kidneys
Normal ABG Values pH: 7.35-7.45. PaCO2: 35-45 mmHg. PaO2: 80-100 mmHg. HCO3: 21-28 mEq/L. SaO2: >95%.
Oxygen dissolved in plasma expressed as PaO2
Oxygen combined with hemoglobin expressed as SaO2 represents the amount of oxygen bound to hemoglobin compared to the amount of oxygen the hemoglobin is capable of carrying.
Respiratory component of the acid-base balance measured by the partial pressure of CO2 in the blood.
As CO2 rises, pH decreases (CO2 will rise if a patient is taking fewer and/or more shallow breaths).
As CO2 drops, pH rises (CO will drop if a patient is hyperventilating): the CO2 is elevated in primary respiratory acidosis and decreased in primary respiratory alkalosis.
The respiratory system will respond to alterations in the pH due to a metabolic condition (i.e. lactic acidosis) by "blowing off" or retaining CO2 as needed to normalize pH.
The lungs will compensate for primary metabolic acidosis by increasing respiratory rate and depth and blowing off excess CO2, thereby raising the pH. In the event of metabolic alkalosis the lungs attempt to compensate by retaining CO2.
The HCO3 is a measure of the metabolic (renal) component of the acid-base balance.
As the HCO3 increases the pH rises
As the HCO3 decreases the pH drops- HCO3 is elevated in metabolic alkalosis and decreased in metabolic acidosis
The kidneys will respond to alterations in the pH due to a respiratory condition (i.e. respiratory alkalosis) by wasting or retaining HCO3
The ABG is performed at the bedside using a heparinized syringe and needle to withdraw 3 to 5 ml from an artery (usually the radial artery, although the femoral or brachial artery may also be used).
The Allen’s test is performed to check ulnar circulation before a radial artery stick (confirms collateral circulation).
After the ABG sample is obtained pressure is held at the puncture site for five minutes; longer if the patient is anti-coagulated
After the ABG sample is obtained The syringe is capped, labeled, placed in ice water, and immediately sent for analysis.
Pulse Oximetry Non-invasive method for continuous monitoring of the SaO2 (saturation of oxygen).
Pulse Oximetry (1) Allows the nurse to continually assess for small changes in the respiratory status. (2) Probe emits a beam of infrared light and measures the amount of light being absorbed by oxygenated and deoxygenated blood and displays a percentage value
An SaO2 of 90-100% is needed to adequately replenish the oxygen in the plasma
The ability of hemoglobin to feed oxygen to the blood weakens significantly when the SaO2 drops below 85%
An SaO2 below 70% is life threatening
Pulse Oximetry: Severe circulatory problems may diminish oximetry results
Pulse Oximetry: Do not attach probe to an extremity with diminished circulation (i.e. blood pressure cuff or arterial catheter).
Pulse Oximetry: Place probe over pulsating vascular bed
Pulse Oximetry: to ensure accuracy Avoid excess patient movement
Pulse Oximetry: Hypothermia, hypotension and vasoconstriction can affect readings
Pulse Oximetry: Strong light (sunlight) can alter readings
Created by: 68C2014
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