assessment of resp function Flashcards
A+P overview
what is included in the upper resp tract
- nose
- paranasal sinsuses
- pharynx, tonsils, and adenoids
- larynx
- trachea
A+P overview
what is the function of the upper resp tract
warms and filters inspired air
A+P overview
what is included in the lower resp tract
lungs
- pleura
- mediastinum
- brinchi/bronchioles
- alveoli
A+P overview
what is the function of the lower resp tract
responsible for gas exchange
what does the nose do
filters impurities and humidifies and warms the air as it is inhaled
what are the four paranasal sinuses
and what is their function
- frontal
- ethmoid
- sphenoid
- maxillary
a prominant function is to serve as a resonating chamber in speech and they are a common site for infection
what do the pharynx, tonsils, and adenoids do
important links in the chain of lymph nodes gaurding the body from invasion by organisms
what does the larynx do
altough the major function is vocalization, it also protects the lower airway from foreign substances and facilitates coughing
what does the trachea do
serves as the passage between the larynx and the right and left main stem bronchi
how many lobes does each lung have
right has 3 and left has 2
describe the pleura
- serous membrane that lines the lungs
- the visceral pleura covers the lungs and parietal lines the thoracic cavity
- surfactant is in between to help lubricate and prevent rubbing
what is the mediastinum
chest cavity that houses the lungs, heart, thymus, thymus, aorta, and esophagus
describe bronchi
2 large airways
describe the bronchioles
smaller branches off of the bronchi that extend throughout the lung. they contain mucus and are lined with cilia
what do alveoli do
they are the site of gas exchange
name and describe the 3 types of alveoli
- type 1: account for 95% of the alveolar surface are
- type 2: accout for the other 5% and produce type 1 and surfactant
- type 3: alveolar macrophages which ingest foreign materials we breathe in, work as defense mechanism
describe oxygen transport
oxygen is supplied to, and carbon dioxide is removed from, cells by the way of circulating blood through the thin walls of the capillaries
describe respiration
- takes place at the cellular level
- gas exchange between atmospheric air and the blood and bewteen the blood and cells of the body
describe ventilation
movement of air in and out of the airways
what may alter ventilation
asthma, COPD, bronchitis, inflammation
describe pulmonary diffusion
exchange of gas molecules fromareas of high concentration to areas of low concentration at the air-blood interface
describe pulmonary perfusion
- blood flow through the lungs
- altered by changes in pressure and gravity
ventailation and ____ must match
perfusion
what is used to measure ventilation and perfusion balance/imbalance
VQ scan
used for suspected pulmonary embolism
how is gas exchange measured
measured with ABG
which diffuses easier? co2 or o2
co2
describe carbon dioxide transport
at the same time o2 diffuses from the blood into the tissues, co2 diffuses from the tissues to the blood and is transported to the lungs for excretion
neurologic respiratory control
mechanisms work to…
match CO2 removal and supply of O2 for metabolic needs
what parts of the CNS work for neurologic respiratory control
medulla and pons
which are in the brain stem
how does the phrenic nerve in the CNS work for neurologic respiratory control
excites muscles to keep breathing
are there multiple respiratory centers in the brain?
yep
what do chemoreceptors respond to
pH changes
responds to blood being alkalytic or acidotic
whats involved in peripheral control of neurologic respiratory control
- chemoreceptors respod to pH changes
- mechanoreceptors
- proprioreceptors
- baroreceptors
what do mechanoreceptors do
- act in lungs
- detect stretch and foreign stuff
what do proprioceptors do
- located in the muscles and chest wall
- respond to body movements
what do barorreceptors do
- in aortic arch and carotid arteries
- respond to increase and decrease in arterial blood pressure
what are some gerontologic considerations
- gradual decline in respiratory function in mid adulthood
- vital capacity changes
- strength of respiratory muscles decrease
- alveolar changes
- loss of chest wall mobility
- increased dead space
- decreased diffusion capacity
- decreased ability to rapidly move air in and out of lungs
what alveolar changes occur with older adulthood
decreased surfae area and loss of elasticity
what health history is included in assessment of the respiratory system
- common symptoms
- past health history
- social history
- family history
what are some common respiratory symptoms assessed
- dyspnea
- cough (productive or nonproductive)
- sputum assessment
- chest pain
- wheezing
- hemoptysis
what past health history may be included in respiratory assessment
- smoking
- cystic fibrosis
- bronchitis
- occupational exposures
- childhood illnesses
- immunizations
- injuries
- allergies
what social history may be included in respiratory assessment
- occupational
- living environment
- smoking
what family history may be included in respiratory assessment
- lung CA
- exposure to TB
- resp issues
whats included in the physical assessment of resp system
clubbing, cyanosis, dusky appearance
what are some findings that may occur in physical assessment of upper resp structures
- broken nose
- deviated septum
what are some findings that may occur in physical assessment of lower resp structures and breathing
- positioning
- barrel chest
- funnel chest (depressed chest bone)
- pigeon chest (upper chest flares out)
- breathign pattern
- rr
- using accessory muscles to breathe
what is dead space
- portion of the lung that does not participate in gas exchange
- decreases volume of lungs
what are some indications of respiratory problems
- tachypnea (or bradypnea)
- PaO2/FIO2 ratio
- abnormal chest xray
- restlessness/anxiety
- dyspnea
- tachycardia
name some different diagnostic evaluation tests for the respiratory system
- pulmonary function tests (PFTs)
- arterial blood gases (ABGs)
- venous blood gases (VBGs)
- pulse oximetry
- end-tidal carbon dioxide
- cultures/sputum studies
- imaging
- endoscopic procedures
- biopsy
describe pulmonary function tests (PFTs)
- routinely used in patients with chronic respiratory disorders
- performed to assess respiratory function and determine the extent of dysfunction
- also used prior to surgery to screen
describe ABGs
measures gas exchange at cellular level
describe VBGs
reflect the value between the amount of oxygen used by tissues and the amount returning to the right side of the heart
describe pulse oximetry
measures O2 saturation of tissues
describe end-tidal carbon dioxide
- noninvasive
- measures CO2 and end exhalation
describe cultures
identify pathogens responsible for respiratory infections
describe sputum studies
- require a deep specimen
- do it before getting antibiotics
what kind of imaging may be used to assess the respiratory system
- chest xray
- CT
- MRI
- fluoroscopy
- pulmonary angiography
describe nursing interventions for CT
with contrast? -> check kidney function and allergies and any med incompatibilites
whats required before plmonary angiography
- informed consent
- coagulation studies
- allergies
- renal function tests
- NPO 6-8hrs
what is required after pulmonary angiography
- monitor site
- check distal pulses
- monitor skin color and temp
- VS
- LOC
what is required for MRI
ask questions about metal
-open heart surgery
-pacemaker
-prosthetics/replacements
what are some endoscopic procedures used for the respiratory system
- bronchoscopy
- thoracoscopy
describe thoracoscopy
- goes through the ribs
- looking at thoracic cavity
- requires informed consent, NPO, respiratory status, presence of infection?
- after: usually replaced with chest tube
describe bronchoscopy
- NPO before, informed consent
- possibly premedicate or give prophylactic antibiotics
- remove dentures and partial plates
- numb throat
- NPO until gag reflex returns
- no hot liquids for 24 hours after
what may happen after a biopsy of resp system
- pain
- coughing up blood
decreased ventilation leads to…
increased CO2 and resp acidosis
may be caused by narcotics or anesthesia
causes lethargy, flushed appearance, hot with no fever, severe HA, narcosis
increased ventilation leads to…
decreased CO2 and resp alkalosis
may be caused by hyperventilation and anxiety
causes increased neuromuscular irritation and heart arryhtmias
describe hypoxia
descreased oxygen supply to cells and tissues
may lead to change in mental status, tachycardia, diaphoresis, HTN, dusky color
what are the 4 types of hypoxia
- hypoxemia
- circulatory
- anemia
- histotoxic
describe hypoxemia
decreased O2 in blood
describe circulatory hypoxia
inadequate capillary circulation
describe anemic hypoxia
lack of Hgb to carry O2
describe histotoxic hypoxia
poisoning interfering with tissues ability to use O2
may be seen with nitroprusside
normal range for pH
7.35-7.45
normal range for CO2
35-45
normal range for HCO3
22-26
