Respiratory function assessment
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| What are the stuctures of the upper respiratory system? | Nose, paranasal sinuses, pharynx, tonsils, adenoids, larynx, and trachea.
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| What are the structures of the lower respiratory system? | Lungs, pleura, mediastinum, bronchi, bronchioles
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| What are the divisions of the bronchi and bronchioles within the lungs? | Lobar bronchi; Segmental bronchi; Subsegmental bronchi; Bronchioles; Terminal bronchioles; Respiratory bronchioles; Alveolar ducts; Alveolar sacs; Alveoli
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| What is the function of the respiratory system? | Oxygen transport, respiration, ventilation, gas exchange.
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| What are the mechanics of ventilation? | Air pressure variances, resistance to airflow, and lung compliance.
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| What are air pressure variances? | Air flows from a region of higher pressure to a region of lower pressure. Inspiration = lower pressure inside the thorax than atmospheric pressure. Expiration = higher pressure inside the thorax than atmospheric pressure.
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| What is airway resistance? | Resistance is determined by the size of the airway, by lung volumes, and by airflow velocity. Any process that changes the bronchial diameter or width affects airway resistance and alters the rate of airflow. Increase resistance = more respiratory effort
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| What are causes of increased airway resistance? | Contraction of bronchial smooth muscle (asthma)
Thickening of bronchial mucosa (chronic bronchitis)
Obstruction of the airway (mucus, tumor, foreign body)
Loss of lung elasticity (emphysema)
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| What are factors that determine lung compliance? | Surface tension of the alveoli
Connective tissue and water content of the lungs
The elasticity and expandability of the lungs and thoracic structures.
Compliance of the thoracic cavity
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| What is high or increased lung compliance? | The lungs have lost their elastic recoil and become overdistended (as in emphysema)
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| What is decreased lung compliance? | The lungs and thorax are stiff (morbid obesity, pneumothorax, hemothorax, pleural effusion, pulmonary edema, atelectasis, pulmonary fibrosis, and ARDS). Require greater-than-normal energy expenditure to achieve normal ventilation.
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| What are categories of lung volume? | Tidal volume
Inspiratory reserve volume
Expiratory reserve volume
Residual volume
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| What are categories of lung capacity? | Vital capacity
Inspiratory capacity
Functional residual capacity
Total lung capacity
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| Tidal volume (TV or VT) | The volume of air inhaled and exhaled with each breath
Normal value 500mL or 5-10mL/kg (in healthy men. Women are 20-25% less)
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| Inspiratory reserve volume (IRV) | The maximum volume of air that can be inhaled after a normal inhalation. Normal value 3,000mL (in healthy men. Women are 20-25% less)
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| Expiratory reserve volume (ERV) | The maximum volume of air that can be exhaled after a normal exhalation. Normal value 1,100mL (in healthy men. Women are 20-25% less)
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| Residual volume (RV) | The volume of air remaining in the lungs after a maximum exhalation. Normal value 1,200mL (in healthy men. Women are 20-25% less)
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| Vital capacity (VC) | The maximum volume of air exhaled from the point of maximum inspiration: VC=TV+IRV+ERV Normal value 4,600mL
(in healthy men. Women are 20-25% less)
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| Inspiratory capacity (IC) | The maximum volume of air inhaled after normal expiration: IC=TV+IRV Normal value 3,500mL (in healthy men. Women are 20-25% less)
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| Functional residual capacity (FRC) | The volume of air remaining in the lungs after a normal expiration: FRC=ERV+RV Normal value 2,300mL (in healthy men. Women are 20-25% less)
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| Total lung capacity (TLC) | The volume of air in the lungs after a maximum inspiration TLC=TV+IRV+ERV+RV Normal value 5,800mL (in healthy men. Women are 20-25% less)
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| What can cause decreased IRV? | Restrictive conditions (obesity, ascites, pregnancy)
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| What can cause increased RV? | Obstructive disease
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| What can cause decreased VC? | Neromuscular disease, generalized fatigue. atelectasis, pulmonary edema, COPD, and obesity.
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| What can cause decreased IC? | Restrictive disease (atelectasis, pneumonia), obesity.
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| What can cause increased FRC? | COPD
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| What can cause decreased FRC? | ARDS, obesity
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| What can cause decreased TLC? | Restrictive disease (atelectasis, pneumonia)
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| What can cause increased TLC? | COPD
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| What is pulmonary diffusion? | The process by which oxygen and carbon dioxide are exchanged from areas of high concentration to areas of low concentration at the air-blood interface (alveolar-capillary membrane).
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| What is pulmonary perfusion? | The actual blood flow through the pulmonary vasculature. Patterns of perfusion are determined by pulmonary artery pressure, gravity, and alveolar pressure.
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| What are the possible ventilation-perfusion (V/Q) states? | Normal ratio
Low (V/Q) Ratio: Shunts
High (V/Q) Ratio: Dead Space
Absence of ventilation and perfusion: Silent Unit
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| What is normal ratio? | The amount of blood passes an alveolus and is matched with an equal amount of gas. The ratio is 1:1 (ventilation matched perfusion)
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| What is low ventilation-perfusion (V/Q) ratio? | When perfusion exceeds ventilation, a shunt exists. Blood bypasses the alveoli without gas exchange occurring. (Blockage of alveolus such as penumonia, atelectasis, tumor, or mucus plug)
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| What is high ventilation-perfusion (V/Q) ratio? | When ventilation exceeds perfusion, dead space results The alveoli do not have an adequate blood supply for gas exchange to occur. (Blockage of blood vessel, such as pulmonary emboli, pulmonary infarction, and cardiogenic shock)
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| What is silent unit? | The absence of both ventilation and perfusion or limited ventilation and perfusion. Seen in pneumothorax and severe acute respiratory distress syndrome.
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| What are structural age-related changes to defense mechanisms? | Decreases number of cilia, mucus, and cough/gag reflex. Loss of surface area @ capillary membrane. Lack of a uniform/consistent ventiliation and/or blood flow.
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| What are functional age-related changes to defense mechanisms? | Decreased protection against foreign particles and aspiration. Decreases antibody response to antigens. Decreased response to hypoxia and hypercapnia (chemoreceptors)
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| What are age-related changes history and physical findings of defense mechanisms? | Decreased cough reflex and mucus. Increased infection rate. History of respiratory infections, COPD, pneumonia. Risk factors: smoking, environmental exposure, exposure to TB.
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| What are structural age-related changes to the lungs? | Decreased size of airway. Increased diameter of alveolar ducts. Increased collagen of alveolar walls. Increased thickness of alveolar membranes. Decreased elasticity of alveolar sacs.
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| What are functional age-related changes to the lungs? | Increased: airway resistance, pulmonary compliance, dead space, air trapping, and AP diameter. Decreased: expiratoy flow rate, oxygen diffusion capacity, exercise capacity. Premature closure of airways. Ventilation-perfusion mismatch.
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| What are age-related history and physical findings of the lungs? | Unchanged TLC. Increased: RV, FRC, carbon dioxide. Decreased: IRV, ERV, FVC, VC, and partial pressure of oxygen.
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| What are structural age-related changes of the chest wall and muscles? | Calcification of intercostal cartilages. Arthritis fo costovertebral joints. Decreased: continuity of diaphragm and muscle mass. Osteoporotic changes. Muscle atrophy.
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| What are functional age-related changes of the chest wall and muscles? | Increased: rigidity/stiffness of thoracic cage, work of breathing, and risk for inspiratory muscle fatigue. Decreased: respiratory muscle strength, capacity for exercise, and peripheral chemosensitivity.
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| What are age-related history and physical findings of the chest wall and muscles? | Kyphosis, barrel chest. Skeletal changes. Shortness of breath. Increased: AP diameter, abdominal and diaphragmatic breathing. Decreased maximum expiratory flow rates.
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| What are major signs/symptoms of respiratory disease? | Dyspnea, cough, sputum production, chest pain, wheezing, and hemoptysis.
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| What are signs/symptoms of ARDS? | Dyspnea, tachypnea, hypoxemia.
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| What are signs/symptoms of COPD? | Dyspnea with an expiratory wheeze and occasionally orthopnea.
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| What questions can be asked to determine the circumstance that produces dyspnea? | How much exertion triggers SOB? Does it occur with exercise or at rest? Is the SOB related to other symptoms? Is a cough present? Was onset sudden or gradual? At what time of day or night does the SOB occur? Is SOB worse when lying flat? How severe is SOB
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| Onset and time of cough | At night = left-sided heart failure or bronchial asthma
In morning with sputum = bronchitis
Worsens while suppine = postnasal drip
After food intake = aspiration into tracheobronchial tree
Recent onset = usually from an acute infection.
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| What is the nature of sputum of a bacterial infection? | Profuse amount of purulent (thick yellow/green/rust colored) or a change in color.
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| What is the nature of sputum of a viral infection? | Thin, mucoid sputum
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| What is the nature of sputum of bronchitis or bronciectasis? | A gradual increase over time.
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| What is the nature of sputum of a lung tumor? | Pink-tinged mucoid sputum.
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| What is the nature of sputum of pulmonary edema? | Profuse, frothy, pink material often welling up into the throat.
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| What is the nature or sputum of a lung abscess, bronchietasis, or an infection caused by fusospirochetal or other anaerobic organisms? | Foul-smelling sputum and bad breath.
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| 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.
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| What are the risk factors of respiratory disease? | Smoking; exposure to second-hand smoke; personal or family history of lung disease; genetic makeup; exposure to: allergens and environmental pollutants; certain recreational and occupational hazards; vitamin D deficiency; obesity; excessive exposure to ac
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| Nursing assessment for respiratory function | Onset, location, duration, character, aggravating and alleviating factors, radiation, and timing of the presenting problems and associated symptoms. Health history - common symptoms; past health, social, and family history
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| What are common symptoms of respiratory disease? | Dyspnea, cough, sputum production, chest pain, wheezing, and hemoptysis.
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| Physical assessment of the respiratory system | General appearance: clubbing of the fingers, cyanosis. Upper resp structures: nose/sinuses, mouth/pharynx, trachea. Lower resp structures and breathing: positioning, thoracic inspection, chest configuration, use of accessory muscles, palpation, percussion
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| What are diagnostic tests for respiratory diseases? | Pulmonary function tests, ABGs, pulse oximetry, cultures, sputum studies, imaging studies, endoscopic procedures, biopsies.
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| What are common pulmonary function tests? | Forced vital capacity (FVC), forced expiratory volume (FEV1), ratio of timed forced expiratoryt volume to forced vital capacity (FEV1/FVC%), forced expiratory flow (FEF200-1200), forced midexpiratory flow (FEF25-75%), forced end expiratory flow (FEF75-85%
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| What are common imaging studies for respiratory disease? | Chest x-ray, computed tomography (CT), magnetic resonance imaging (MRI), flouroscopic studies, pulmonary angiography, radioisotope diagnostic procedures (lung scans).
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| What are common endoscopic studies for respiratory disease? | Bronchoscopy. thoracoscopy, thoracentesis
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| What are common biopsies for respiratory disease? | Pleural biopsy, lung biopsy, lymph node biopsy
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| Broncophony | Abnormal increase in clarity of transmitted voice sounds heard when auscultating the lungs
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| Bronchoscopy | Direct examination of the larynx, trachea, and bronchi using an endoscope
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| Cilia | Short hairs that ;provide a constant whipping motion that serves to propel mucus and foreign substances away from the lung toward the larynx
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| Compliance | Measure of the force required to expand or inflate the lungs
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| Crackles | Soft, high-pitched, discontinuous popping sounds during inspiration caused by delayed reopening of the airways
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| Dyspnea | Subjective experience that describes difficulty breathing; shortness of breath
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| Egophony | Abnormal change in tone of voice that is heard when auscultating the lungs
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| Fremitus | Vibrations of speech felt as tremors of the chest wall during palpation
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| Hemoptysis | Expectoration of blood from the respiratory tract
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| Hypoxemia | Decrease in arterial oxygen tension in the blood
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| Hypoxia | Decrease in oxygen supply to the tissues and cells
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| Obstuctive sleep apnea | Temporary absence of breathing during sleep secondary to transient upper airway obstruction
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| Orthopnea | Inability to breathe easily except in an upright position
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| Oxygen saturation | Percentage of hemoglobin that is bound to oxygen
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| Physiologic dead space | Portion of the tracheobronchial tree that does not participate in gas exchange
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| Pulmonary diffusion | Exchange of gas molecules (oxygen and carbon dioxide) from areas of high concentration to areas of low concentration
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| Pulmonary perfusion | Blood flow through the pulmonary vasculature
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| Respiration | Gas exchange between atmospheric air and the blood and between the blood and cells of the body
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| Rhonchi | Low-pitched wheezing or snoring sound associated with partial airway obstruction, heard on chest auscultation
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| Stridor | Harsh high-pitched sound heard on inspiration, usually without need of a stethoscope, secondary to upper airway obstruction
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| Tachypnea | Abnormally rapid respirations
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| Tidal volume | Volume of air inspired and expired with each breath during normal breathing
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| Ventilation | Movement of air in and out of the airway
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| Wheezes | Continuous musical sounds associated with airway narrowing or partial obstruction
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| Whispered pectoriloquy | Whispered sounds heard loudly and clearly upon thoracic auscultation
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| Epiglottis | A valve flap of cartilage that covers the opening to the larynx during swallowing
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| Glottis | The opening between the vocal cords in the larynx
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| What are the normal breath sounds, and where are they heard? | Vesicular - Entire lung field except over the upper sternum and between the scapulae
Bronchovesicular - In the 1st and 2nd interspaces anteriorly and between the scapulae (over the main bronchus)
Bronchial - Over the manubrium (if heard at all)
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| Friction rubs | Harsh, crackling sound, like two pieces of leather being rubbed together; secondary to inflammation and loss of lubricating pleural fluid.
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| What are Arterial Blood Gas studies? | Aid in assessing the ability of the lungs to provide adequate oxygen and remove carbon dioxide, which reflects ventilation, and the ability of the kidneys to reabsorb or excrete bicarbonate ions to maintain normal body pH, which reflects metabolic states.
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