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Nursing > 208 Concept: Gas exchange: topic thorax and lungs assessment > Flashcards

208 Concept: Gas exchange: topic thorax and lungs assessment Flashcards

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1
Q

Define gas exchange.

A

Gas exchange is defined as the process by which oxygen is transported to cells and carbon dioxide is transported from cells.

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2
Q

Scope of gas exchange.

A

Optimal gas exchange—–Impaired gas ——-No gas exchange

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3
Q

What are the population risk factors for gas exchange?

A
  • Populations at greatest risk are infants, young children, and older adults.
  • Infants are at risk because they have fetal hemoglobin.
  • Infants and young children are at risk for impaired gas exchange because they have less alveolar surface area for gas exchange, as well as narrow branching of peripheral airways that are easily obstructed by mucus, edema, or foreign objects.
  • Older adults are at risk for impaired gas exchange because of anatomic and physiological changes that are expected with advanced age.
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4
Q

What are individual risk factors for gas exchange?

A
  • Nonmodifiable risk factors include age, air pollution, and allergies.
  • Tobacco use is the single most preventable cause of death and disease
  • Risk for aspiration is increased during an altered state of consciousness, such as from a chemical alteration (e.g., alcoholism, drug overdose, and anesthesia) or from a neurologic disorder (e.g., head injury, seizure, and stroke).
  • Patients requiring tracheal intubation are at risk because of the bypassing of protective mechanisms for the alveoli.
  • Bed rest and prolonged immobility reduce thoracic expansion, which can increase the risk for atelectasis and pneumonia.
  • Chronic diseases, such as cystic fibrosis, COPD, or heart failure, increase risk because of mucus and fluid accumulation in the airways and alveoli. - Immunosuppression alters the body’s natural ability to fight infection, whether it is from a systemic disorder (e.g., aplastic anemia), a cancer (e.g., leukemia), or a treatment regimen (e.g., cancer chemotherapy)
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5
Q

What are the anterior thoracic landmarks?

A
  • suprasternal notch
  • sternum (the manubrium, the body, the xiphoid process)
  • the sternal angle
  • costal angle
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6
Q

What are the posterior thoracic landmarks?

A
  • vertebra prominens: C7 and T1
  • spinous processes
  • inferior border of the scapula
  • twelfth rib
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7
Q

What are the reference lines related to the anterior and posterior thorax?

A
  • midsternal line
  • midclavicular line
  • vertebral line
  • scapular line
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8
Q

What are the reference lines related to the lateral chest?

A
  • anterior axillary line
  • posterior axillary line
  • midaxillary line
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9
Q

Which lung is shorter: the left of the right? And why?

A

The right is shorter because of the underlying liver.

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10
Q

Which lobes does the anterior chest contain?

A
  • primarily upper and middle lobes
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11
Q

Which lobes does the posterior chest contain?

A
  • almost all lower lobe
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12
Q

What aspect is unique to the right lateral chest?

A

Contain the right middle lobe

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13
Q

What mediates the involuntary control of respiration?

A

The pons and medulla in the brain.

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14
Q

True or false: The respiratory system in an infant does nor function until birth.

A

True. The cord is cut and blood flows to the pulmonary circulation. Foramen ovale (opening in the atrial septum) closes in the heart just after birth and the ductus arteriosus (linking the pulmonary artery and the aorta) closes several hours later.

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15
Q

What age group represents the single largest group of smokers?

A

20-24 year olds

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16
Q

What might fine crackles be a sign of?

A
  • pneumonia
  • heart failure
  • chronic bronchitis
  • asthma
  • COPD
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17
Q

What might coarse crackles be a sign of?

A
  • same as the fine crackles but usually more advanced disease
  • pulmonary edema
  • pulmonary fibrosis
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18
Q

What might a wheeze be a sign of?

A
  • asthma
  • COPD
  • heart failure
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19
Q

What might rhonchi be a sign of?

A
  • obstructed trachea
  • bronchitis
  • pneumonia
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20
Q

What might pleural friction be a sign of?

A
  • pleurisy
  • pericarditis
  • pericardial effusion
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21
Q

What effect does the enlarging uterus have on the diaphragm?

A

elevates it by 4 cm during pregnancy

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22
Q

What percentage increase is there in tidal volume during pregnancy?

A

40%

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23
Q

What is physiologic dyspnea during pregnancy?

A

Affect 75% of women; increased awareness of the need to breathe

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24
Q

What happen to the mobility of the thorax in older adults and why?

A

The costal cartilages become calcified and this reduces the mobility of the thorax.

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25
Q

What significant change occurs in the lungs of older adults?

A

There is a decrease in elastic properties within the lungs, making them less distensible and lessens their tendency to contract and recoil. Overall, the aging lung is a more rigid structure that is harder to inflate.

26
Q

True of false: In older adults, there is an increase in vital capacity and a decrease in residual volume.

A

False. There is a decrease in vital capacity and an increase in residual volume.

27
Q

Do older adults have more or less surface are for gas exchange?

A

Less due to gradual loss of intra-alveolar septa and a decreased number of alveoli)

28
Q

What is a barrel chest often a sign of?

A

emphysema - can’t expel all the air

29
Q

Is the sound dull, resonant or flat over the scapula?

A

flat

30
Q

Is the sound dull, resonant or flat at the lung apex and intercostals?

A

resonant

31
Q

Is the sound dull, resonant or flat over the liver and visceral organs?

A

dull

32
Q

What do fine crackles sound like?

A

high-pitched popping

33
Q

What does a sibilant wheeze sound like?

A

high-pitched musical squeaking

34
Q

What does a sonorous wheeze sound like?

A

low-pitched, musical snore

35
Q

What do coarse crackles sound like?

A

low-pitched, gurgling and bubbling

36
Q

What does pleural friction rub sound like?

A

low-pitched, grating

37
Q

What does stridor sound like?

A

high pitched, crowing

38
Q

What are the normal respirations per minute for an adult?

A

10 - 20

39
Q

What are the normal respirations per minute for a newborn?

A

30 - 40

40
Q

What are the normal respirations per minute for a 1 year old?

A

20 - 40

41
Q

What are the normal respirations per minute for a 2 year old?

A

25 - 32

42
Q

What are the normal respirations per minute for a 4 year old?

A

23 - 30

43
Q

What are the normal respirations per minute for a 8 - 10 year old?

A

20 - 26

44
Q

What are the normal respirations per minute for a 12 - 14 year old?

A

18 - 22

45
Q

What are the normal respirations per minute for a 16 year old?

A

12 - 20

46
Q

What end of the stethoscope would you use to hear lung sounds?

A

The diaphragm because most are high-pitched.

47
Q

What aspects of health history would you ask about?

A 
Cough
Shortness of breath
Chest pain with breathing
History of respiratory infections
Smoking history
Environmental exposure
Self-care behaviours (e.g. immunizations)
48
Q

How long does an acute cough last?

A

2 or 3 weeks

49
Q

How long does a chronic cough last?

A

more than 2 months

50
Q

What s hemoptysis?

A

coughing up blood

51
Q

When would you have white or clear mucoid?

A

cold, bronchitis, viral infection

52
Q

When would you have yellow or green mucoid?

A

bacterial infection

53
Q

When would you have rust coloured mucoid?

A

pneumococcal pneumonia

54
Q

When would you have pink, frothy sputum?

A

pulmonary edema

55
Q

What is orthopnea?

A

difficulty breathing in the supine position

56
Q

What is paroxysmal nocturnal dyspnea?

A

Awakening from sleep with shortness of breath and needing to be upright to achieve comfort.

57
Q

What occupations may have higher risk of environmental exposure?

A
  • farmers

- coal miners

58
Q

What additional health history questions for children?

A
  • Illness
  • Allergy
  • Chronic respiratory illness
  • Safety
  • Environmental tobacco smoke
59
Q

What additional health history for older adults?

A
  • changes in SOB or fatigue with ADLs?
  • physical activity
  • Hx of resp. conditions
  • Chest pain with breathing
60
Q

When might you see a barrel chest and hypertrophies neck muscles?

A

COPD

61
Q

When might chest expansion be unequal?

A
  • atelectasis
  • pneumonia
  • fractured ribs
  • pneumothorax
62
Q

When might pain accompany deep breathing?

A

when pleurae are inflammed

Nursing (29 decks)

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