Ch 29: Resp System

Question 0

The pharynx is divided into three spaces. what are they

Answer 0

Nasopharynx, oropharynx, laryngopharynx

Question 1

The upper airways consist of what structures

Answer 1

Nose, sinuses, pharynx, larynx

Question 2

The cricoid cartilage is located where

Answer 2

The larynx. And contains the vocal chords

Question 3

The lower airways are made up of what structures

Answer 3

The trachea; 2 mainstem bronchi;lobar, segmental, and subsegmental bronchi; bronchioles; alveolar ducts; and alveoli

Question 4

Where discuss exchange take place in the lung tissue

Answer 4

Between the alveoli and the lung capillaries, not in the airways

Question 5

What is unique about the right bronchus

Answer 5

Is slightly wider, shorter, and more vertical than the left. Can be accidentally intubated when an ET tube is passed. Also when a foreign object is aspirated from the throat, it usually enters the right bronchus.

Question 6

Why is gas exchange reduced in atelectasis

Answer 6

Because Alveolar surface area is reduced

Question 7

Surfactant

Answer 7

Fatty protein that reduces surface tension in the alveoli. Without it atelectasis occurs. Secreted by the Alveolar walls that have cells called type II pneumocytes

Question 8

Describe the position of the lungs in the thorax

Answer 8

The apex extends above the clavicle, the base lies just above the diaphragm

Question 9

Right versus left lung

Answer 9

Rt lung is larger, divided into 3 lobes.

Lt lung is narrower and smaller, divided into 2 lobes

Question 10

60 to 65% of lung function occurs in which lung

Answer 10

Right lung. Problems here interfere with oxygenation to a greater degree than problems in the left.

Question 11

What is the order of pulmonary circulation

Answer 11

Oxygen poor blood travels from the right ventricle into the pulmonary artery which eventually branches into arterioles that form capillary networks. Freshly oxygenated blood travels from the capillaries to the pulmonary veins then to the lt atrium. then into the lt ventricle where it is pumped throughout the systemic circulation

Question 12

What are the accessory muscles of respiration

Answer 12

Scalene, sternocleidomastoid, trapezius and pectoralis. Back and abdominal muscles are used when the work of breathing is increased

Question 13

What does oxygen bind to in the RBC

Answer 13

Hemoglobin. Each molecule can bind 4 oxygen molecules

Question 14

How do you calculate pack-years?

Answer 14

Number of packs smoked per day multiplied by number of years the patient has smoked

Question 15

Mucoid sputum

Answer 15

Smokers with chronic bronchitis

Question 16

Excessive pink frothy sputum

Answer 16

Common with pulmonary edema

Question 17

Rust colored sputum

Answer 17

Bacterial pneumonia

Question 18

Foul smelling sputum

Answer 18

Often occurs with a lung abscess

Question 19

Hemoptysis

Answer 19

Most often seen in patients with chronic bronchitis or lung cancer

Question 20

Grossly bloody sputum

Answer 20

Patients with tuberculosis, pulmonary infarction, bronchial adenoma, or lung abscess

Question 21

Normal cardiac pain is usually

Answer 21

Intense and crushing. May also radiate to the arm shoulder or neck.

Question 22

Pulmonary pain

Answer 22

Varies depending on the cause. Being described as rubbing inside is more common. Pulmonary pain is not made worse by touching or pressing over the area

Question 23

Is dyspnea subjective or objective

Answer 23

Subjective

Question 24

What is PND

Answer 24

Paroxysmal nocturnal dyspnea; intermittent dyspnea during sleep

Question 25

PND and orthopnea often occur with what two conditions

Answer 25

Chronic lung disease and left-sided heart failure

Question 26

Tender nodes that are movable suggest

Answer 26

Inflammation

Question 27

Nodes that are hard and do not move with palpation suggest

Answer 27

Malignancy

Question 28

What common conditions push the trachea away from the affected area

Answer 28

Tension pneumothorax, large plural effusion, mediastinal mass, and tumors

Question 29

Common conditions that pull the trachea toward the affected area

Answer 29

Pneumonectomy, fibrosis, and atelectasis

Question 30

Decreased tracheal mobility may occur with

Answer 30

Cancer or fibrosis of the mediastinum

Question 31

Crepitus

Answer 31

Air trapped in and under the skin, aka subcutaneous emphysema. felt as a crackling sensation beneath the fingertips. Document when occurs around a wound site or tracheostomy site or if a pneumothorax is suspected

Question 32

Name the five notes of percussion

Answer 32

Resonance ,hyperresonance, flatness, dullness, Tympany

Question 33

Normal breath sounds are known as

Answer 33

Bronchial or tubular, broncovesicular, and vesicular

Question 34

Words used to describe breath sounds

Answer 34

Normal, increased, diminished, or absent

Question 35

Where is it abnormal to hear bronchial breath sounds

Answer 35

at the lung edges

Question 36

When Bronchovesicular breath sounds are heard in an abnormal location it may indicate

Answer 36

Normal aging or an abnormality such as pulmonary consolidation and chronic airway disease

Question 37

Find crackles fine rales and high-pitched rales are associated with what conditions

Answer 37

Asbestosis, atelectasis, interstitial fibrosis, bronchitis, pneumonia, chronic pulmonary diseases

Question 38

Coarse crackles and low pitched crackles are associated with what conditions

Answer 38

Bronchitis, pneumonia, tumors, pulmonary edema

Question 39

Wheezing is associated with what conditions

Answer 39

Inflammation, bronchospasm, edema, secretions, pulmonary vessel engorgement

Question 40

Ronchi are associated with what conditions

Answer 40

Thick, tenacious secretions, sputum production, obstruction by foreign body, tumors

Question 41

Pleural friction rub is associated with what conditions

Answer 41

Pleurisy, TB, pulmonary infarction, pneumonia, lung cancer

Question 42

What size is a normal intercostal space and what causes an increase in this space?

Answer 42

One finger breadth, or 2 cm. the distance increases in disorders that cause air trapping such as emphysema

Question 43

When might retractions occur

Answer 43

When the patient is working hard to inhale around an obstruction

Question 44

Normal PaO2

Answer 44

80-100 mm Hg

Question 45

Normal PaCO2

Answer 45

35-45 mm Hg

Question 46

Normal pH up to 60 yrs? 60-90 yrs? >90 yrs?

Answer 46

7. 35-7.45 7. 31-7.42 7. 26-7.43

Question 47

Normal HCO3

Answer 47

21-28 mEq/L

Question 48

Normal SpO2

Answer 48

95-100% | Older adults: values may be slightly lower

Question 49

Important question to ask before CT with contrast

Answer 49

Known allergies to iodine or shellfish

Question 50

When patients have any degree of impaired peripheral blood flow the most accurate place to test oxygen saturation is

Answer 50

On the forehead

Question 51

SpO2 Results lower than ____ are an emergency and require immediate assessment and treatment

Answer 51

91% (and certainly below 86%)

Question 52

Two methods that measure the amount of carbon dioxide present in exhaled air

Answer 52

Capnometry and capnography

Question 53

Capnometry and capnography measure

Answer 53

End-tidal carbon dioxide levels ETCO2

Question 54

The normal pressure of end-tidal carbon dioxide (PETCO2) ranges? and changes mean??

Answer 54

20-40 mm Hg; changes reflect changes in breathing effectiveness and may occur before hypoxia can be detected using pulse oximetry

Question 55

Increased PETCO2 levels?

Answer 55

Reflect inadequate oxygenation such as fever, hypoventilation, partial airway obstruction and rebreathing exhaled air

Question 56

Decreased PETCO2 levels?

Answer 56

Reflect poor ventilation such as hypothermia,poor cardiac output, hypertension, hypovolemia, pulmonary embolism, apnea, total airway obstruction, and tracheal extubation

Question 57

What is the most common reason PFTs are performed

Answer 57

To determine the cause of dyspnea

Question 58

Common things to prepare a patient for PFTs

Answer 58

No smoking for 6-8 hours before testing, bronchodilator drugs may be withheld for 4-6 hours before the test. Help reduce anxiety by describing what will happen

Question 59

What to monitor the patient after PFTs for

Answer 59

Observe for increased dyspnea or bronchospasm

Question 60

Use of benzocaine spray to numb the oropharynx may induce

Answer 60

Methemoglobinemia

Question 61

Major characteristic and treatment of methemoglobinemia

Answer 61

Blood is a characteristic chocolate brown in color. Can be reversed with oxygen and IV injection of 1% methylene blue

Question 62

Care following bronchoscopy

Answer 62

Assess breath sounds every 15 minutes for the first two hours

Question 63

To prevent reexpansion pulmonary edema, usually no more than ____ of fluid is removed at one time during a thoracentesis

Answer 63

1000mL

Question 64

Important things for care after a thoracentesis

Answer 64

Chest x-ray is performed to rule out pneumothorax and mediastinal shift. Urge pt to breathe deeply to promote expansion of the lung. Teach about manifestations of a pneumothorax which can occur within the first 24 hours.

Question 65

Serious complications of needle biopsy and open lung biopsy

Answer 65

Pneumothorax. Report reduced or absent breast sounds immediately. Monitor for hemoptysis. Monitor breath sounds at least every 4 hours for 24 hours