25 - Assessment: Respiratory System Flashcards
upper respiratory
nose mouth pharynx epiglottis larynx trachea carina (the v)
lower respiratory
mainstem bronchi (not in lungs) bronchi bronchioles alveolar ducts alveoli
small flab behind the tongue that closes over the larynx during swallowing
piglottis
olfactory nerve is found ___
within the mucose of the upper part of the nasal cavity
which lung has 3 lobes?
the right lung
tidal volume
volume of air exchanged w each breath
average tidal volume
500 mL
of each tidal volume, how much is anatomical dead space?
150 mL
primary site of gas exchange
alveoli
atelectasis
collapsed alveoli
why are post of patients at risk for atelectasis
- decr mobility
- effects of anesthesia
- pain changes breathing pattern
how does ARDS lead to atelactasis
decr surfactant
surfactant
lipoprotein
-decr the surface tension needed to inflate
pulmonary circulation vs bronchial circulation
pulmo: gas exchange
bronchial: perfuses lungs
major muscle of respiration
diaphragm
oxygenation
process of obtaining O2 fr atmosphere + making it available to tissues/organs
how is the lung’s ability to oxygenate arterial blood evaluated by?
PaO2
SaO2
partial pressure of arterial blood?
PaO2
PaO2
dissolved O2 in blood
SaO2
amount of O2 bound to hemoglobin
Ventilation vs Respiration
vent: inspiration + expiration
resp: gas exchange
compliance
measure of ease of expansion
-low compliance> harder it is for lungs to expand
resistance
any obstacle of airway
- main factor is change in diameter (i.e. asthma)
- can be caused by excessive mucus/thickening of mucus
respiratory center
medulla
chemoreceptor
responds to change in chem compostn
- PaCO2, pH
- CENTRAL chemoreceptors are in medulla
mechanical receptor
found in conduction upper airways, chest wall, diaphragm, alveoli capillaries
-stim by physio factors (irritants, muscle stretch, alveolar wall distortn)
an incr in H
incr respiration + tidal volume
an incr in PaCO2
more CO2 combines w H2O to make H2CO3 (carbonic acid)
- low pH of cerebrospinal fluid
- incr respiration + tidal volume
Respiratory defense mechanisms
1 filtration of air 2 incr air turbulance in phrnx + lrnx 3 mucociliary escalator 4 ciliary beat 5 cough reflex 6 bronchoconstriction 7 alveolar macrophage
alveoli macrophage is impaired by
cigarette smoke
common side effect of ACE inhibitors
cough
hemptysis
coughiing blood
-may be confused for hematemesis (vomit bld)
wheezing indicates
airway obstruction
-asthma
anorexia may be caused by
resp meds
fatigue may be caused by
- hypoxemia
- incr work of breathing
dehydration can cause
thickening of sputum> obstruction
ppl w chronic cough, esp women, may have _____ during paroxysm of coughin
urinary incontinence
s/s hypoxia vs hypoxemia
hypoxia: restlessness, agitation
hypoxemia: inability to learn + retain info
Subjective Data
- SOB
- dyspnea
- cough
- sputum production (color quality)
- wheezing
Objective Data
- resp rate, quality, pattern
- accessory muscle use
- mouth or nose breathing
- trachea positioning
- shape, symmtr, mvmt of chest wall
- skin + nails
- palpate chest + back
- lung sounds
Diagnostics
- ABG
- chest xray
- hemoglobin
- hematocrit
2 methods to assess efficiency of gas transfer in lungs + tissue oxygenation
1 pulse ox
2 ABGs
SpO2 vs SaO2
both is amt of O2 attached to hemoglobin
-SpO2 is by pulse ox
what is in an ABG
PaO2
PaCO2
pH
SaO2
arterial catheter is usually inserted into
radial or femoral artery
how to obtain ABG
before: indicate if pt is using O2. avoid changes in O2 therapy 15 min before obtaining sample
during: assist w positioning ( palm up hyperextended). collect blood in heparinized syringe. expel air bubbls
after: apply pressure for atleats 5 min to prevent hematoma
what kind of syringe is used for ABG
heparinized syringe
mild hypoxemia manifestations
- restless
- tachycardia
- dysrhythmia
- dyspnea
- HYPERtension
mod hypoxemia manifestations
- HYPOtension
- confusion
- lethargy
- dysrhythmia
- resp distress
- accessory muscle use
severe hypoxemia manifestations
- cyanosis
- coma
- resp arrest
- cardiac arrest
does a positive TB skin test mean that pt. has TB?
no
-it just means that pt has been exposed to antigen
neg results in TB skin test could indicate
- no exposure to TB
- depressed cell-mediated immunity
- —ie HIV
TB skin test directions
- use intradermal NOT subQ
- circle injection site
- do not remove circle mark
- when charting, draw forearm + circle mark
- when reading test results, check all 4 sides of the induration
- DO NOT measure redded, flattened areas
PFT spirometer use
- insert mouthpiece
- inhale as deep as possible
- exhale as hard + fast +long as possible
spirometer may be done before + after giving bronchodilators to determine ____
is airway obstruction is reversible
