Respiratory System Ch 25
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| Primary purpose of the respiratory system | gas exchange; the transfer of O2 and CO2 between the atmosphere and blood
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| Normal tidal volume | 500ml - volume of air exchanged with each breath
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| Alveoli | small sacs that form the functional unit of the lungs
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| Surfactant | a lipoprotein that lowers teh surface tension in the alveoli, reduces the amount of pressure needed to inflate the alveoli and decreases the tendency of alveoli to collapse
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| What two types of circulation do the lungs have | pulmonary and bronchial
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| Pulmonary circulation | provides the lungs with blood for gas exchange
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| Bronchial circulation | provides oxygen to the bronchi and other pulmonary tissue
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| How many ribs are in a human body | total of 24 - 12 on each side
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| Thoracic cages refers to | the ribs and sternum
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| Parietal pleura | a membrane that lines the chest cavity
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| Visceral pluera | the membrane that lines the lungs
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| Which pleura does not have nerve endings or afferent pain fibers | visceral pleura
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| Which pleura has afferent pain fibers | parietal pleura
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| Intrapleural space | the space between the pleural layers
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| What is the purpose of the intrapleural space | provides lubrication, allowing the layers of the pleura to slide over each other during breathing; it increases cohesion between the pleural layers
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| How much fluid is normally in the pleural space | 20-25ml
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| Empyema | purulent pleural fluid with bacterial infection
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| The major muscle of respiration | diaphragm
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| What is the flow of gas | from an area of higher pressure (atmospheric) to one of lower pressure (intrathoracic)
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| Elastic recoil | the tendency for the lungs to recoil after being stretched of expanded
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| Compliance (distensibility) | a measure of the elasticity of the lungs and thorax
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| What happens when compliance is decreased | the lungs are more difficulty to inflate
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| Diffusion | How O2 and CO2 are moved back and forth across the alveolar capillary membrane
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| PaO2 | arterial oxygen tension
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| PaO2 represents what | The amount of oxygen disolved in the plasma
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| SaO2 | arterial oxygen saturation
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| SaO2 represents what | The amount of oxygen bound to hemoglobin in comparison with the amount of oxygen the hemoglobin can carry
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| PaO2 is expressed in | millimeters of mercury (mm Hg)
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| SaO2 is expressed in | %
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| ABG analysis includes the measurement of | PaO2, PaCO2, acidity (pH), and bicarbonate (HCO3-) in arterial blooc
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| Blood for ABG's can be obtained by | arterial puncture or from an aterial catheter in the radial or femoral artery
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| pH | 7.35-7.45
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| PaO2 | 80-100 mm Hg
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| SaO2 | >95%
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| HCO3- | 22-26 mEq/L
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| S/S of inadequate oxygenation on the CNS | unexplained apprehension, restlessness/irritability, confusion/lethargy (early or late), Combativeness (late), Coma (late)
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| S/S of inadequate oxygenation on the respiratory system | Tachypnea, Dyspnea on exertion, Dyspnes at rest (late), Use of accessory muscles (late), Retraction of interspaces on inspiration (late), Pause for breath between sentences/words (late)
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| S/S of inadequate oxygenation on the Cardiovascular system | Tachycardia, Mild HTN, Arrhythmias (ex:PVC'S)(early or late), Hypotension (late), Cyanosis (late), Cool / clammy skin (late)
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| Other S/S of inadequate oxygenation | Diaphoresis (early or late), Decreased urinary output (early or late), Unexplained fatigue (early or late)
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| Normal SpO2 | >95%
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| SpO2 | the oxygen saturation value obtained by pulse oximetry
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| Sites of pulse oximetry | finger, toe, ear, forehead , or bridge of nose
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| Hypoxemia | an abnormal deficiency in the concentration of oxygen in arterial blood
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| Hypoxia | abnormally low oxygen availability to the body or an individual tissue or organ
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| What is the first evidence of hypoxemia | apprehension, restlessness or irritability
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| The mechanism that stimulates the release of surfactant is | alveolar stretch from deep breathing
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| During inspiration, air enters the thoracic cavity as a result of | decreased intrathoracic pressure relative to pressure at the airway
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| The ability of the lungs to adequately oxygenate the arterial blood is determined by examination of the | aretiral oxygen tension
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| The most important respiratory defense mechanism distal to the respiratory bronchioles is the | alveolar macroophage
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| A rightward shift of the oxygen-hemoglobin dissociation curve | facilitates release of oxygen at the tissue level
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| During the respiratory assessment of the older adult, the nurse would expect to find | increased anteroposterior chest diameter
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| When assessing activity-exercise patterns related to respiratory health, the nurse inquires about | dyspnea during rest or exercise
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| The vibration of tactile fremitus is best assessed using the nurse's | palms
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| Which of the following finding is an abnormal assessment finding of the respiratory system? | presence of rhonchail fremitus
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| A diagnostic procedure done to remove pleural fluid for analysis is | thoracentesis
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| Hypercapnia | excess CO2 in the blood
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| Structural changes r/t aging | dec. Elastic recoil, dec. Chest wall compliance, Inc. Anteroposterior diameter, dec. Functioning aveoli
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| Defense mechanism changes r/t aging | dec cell-mediated immunity, dec specific antibodies, dec. cilia function, dec. cough force, dec. alveolar macrophage function
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| Respiratory control r/t aging | dec. response to hypoxemia, dec. response to hypercapnia
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| If a patient is a smoker, sputum is usually | clear to gray with occasional specks of brown
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| If patient has COPD, sputum may be | clear, whitish, or slightly yellow, especially in the morning on rising
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| Normal sputum is | clear to slightly whitish; odorless
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| These respiratory conditions can cause chest pain | pleurisy, fractured ribs, and costochondritis
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| Description of pleuritic pain | sharp, stabbing pain associated with movement or deep breathing
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| Description of fractured rib pain | localised sharp pain asssociated with breathing
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| Description of costochondritis pain | along the the borders of the sternum and is associated with breathing
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| Assessment of the nose | mucous mem should be pink and moist, with no evidence of edema (bogginess), exudate or bleeding
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| Assessment of the pharynx | should be smooth and moist with no evidence of exudate, ulcerations, swelling or postnasal drip
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| Gagging response indicates that | cranial nerves IX (glossopharyngeal) and X (vagus) are intact
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| Assessment of the neck | symmetry an dpresence of any tender or swollen areas; palpate the lymph nodes
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| Normal respiratory rate | 12-20 breaths per minute
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| Normal respiratory rates in the elderly | 16-25 breaths per minute
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| Kussmaul | rapid, deep breathing
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| Cheyne-Stokes | abnormal patterns of respiration characterized by alternating periods of apnea and deep, rapid breathing
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| Biot's | irregular breathing with apnea every 4-5 cycles
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| Cyanosis is best observed where in dark-skinned people | conjuctiva, lips, palms, and soles of feet
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| Causes of cyanosis | hypoxemia or decreased cardiac output
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| Clubbing | an increase in the angle between the base of the nail and the fingernail - usually accompanied by sponginess of the end of the finger
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| What is normal tracheal position | midline
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| Resonance | low-pitched sound heard over normal lungs
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| Hyperresonance | loud, lower-pitched sound than normal resonance heard ofver hyperinflated lungs, such as in chronic obstructive lung disease and acute asthma
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| Tympany | Drumlike, loud, empty quality heard over gas-filled stomach or intestines, or pneumothorax
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| Dull | Medium-intensity pitch and duration heard over areas of "mixed" solid and lung tissue, such as over the top area of the liver, partially consolidated lung tissue (pneumonia) or fluid-filled pleural space
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| Flat | Soft, high-pitch sound of short duration heard over very dense tissue where air is not present
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