Ch. 39 Flashcards
What is the upper airway composed of and what is its function?
It’s composed of the nose, pharynx, larynx, and epiglottis
It’s main function is to warm, filter, and humidify inspired air
The respiratory system performs it’s functions through pulmonary ventilation, respiration, and perfusion. Normal functioning depends on what 3 factors?
- The integrity of the airway system to transport air to and from the lungs
- A properly functioning alveolar system in the lungs to oxygenate venous blood and to remove carbon dioxide from the blood
- A properly functioning cardiovascular and hematologic system to carry nutrients and wastes to and from body cells
What is the lower airway composed of and what is its function?
The lower airway…also known as the tracheobronchial tree, is composed of the trachea, right and left main stem bronchi, segmental bronchi, and terminal brochioles.
It’s main function is the conduction of air, mucocilary clearance, and production of pulmonary surfactant
What are cilia?
Cilia, are microscopic hair like projections, that propel trapped material and accompanying mucus toward the upper airway so they can be removed by coughing.nremoval is facilitated when mucus is watery in consistency
Describe the lungs
Each lung is divided into lobes. The right lung has 3 lobes, the left has 2. Each lobe is subdivided into segments/lobules. The right lung has 10 segments the left has 8.
What are alveoli?
At the end of the terminal bronchioles there are clusters of alveoli, small sacs. The alveoli are the site of gas exchange. The average adult has more than 300 million alveoli.
What is surfactant?
Surfactant, a detergent like phospholipid, reduces the surface tension between the moist membranes of the alveoli, preventing their collapse. When surfactant production is reduced, the lungs become stiff and alveoli collapse.
The lungs and thoracic cavity are lined with a serous membrane called pleura. What type lines each?
Lungs : visceral pleura
Thoracic cavity: parietal pleura
True or false pressure within the plural space is always subatmospheric/negative. This constant negative intrapleural pressure, along with the plural fluid, holds the lungs in an expanded position
True
What is pulmonary ventilation?
Pulmonary ventilation refers to the movement of air into and out of the lungs
What is respiration?
Respiration involves gas exchange between the atmospheric air in the alveoli and blood in the capillaries
What is perfusion?
Perfusion is the process by which oxygenated capillary blood passes through body tissues
The process of ventilation has two phases, inspiration and expiration. Describe them
Inspiration, the active phase, involve movement of muscles and a thorax to bring air into the lungs
Expiration, the passive phase, is the movement of air out of the line
Boggles law
According to Boyles law, the volume of a gas at a constant temperature varies inversely with the pressure. This means that less pressure in the lungs facilitate the movement of more air into the lungs. The pressure within the lines decreases as the volume of the lungs increase
Describe inhalation
During inspiration, the following events occur, the diaphragm contracts and descends, lengthening the thoracic cavity, that external intercostal muscles contract, lifting the ribs upward and outward, and the sternum push forward, enlarging the chest from front to back. This combination of an increase lung volume and decreased intro pulmonary pressure allowed atmospheric air to move from an area of greater pressure into an area of lesser pressure
Describe expiration
The relaxation of these structures then results in expiration. The diaphragm relaxes and moves up, the ribs move down, and the sternum drops back into position. This causes a decreased volume in the lungs and an increase in intrapulmonic pressure. As a result air in the lungs moves from an area greater pressure to one of lesser pressure and is expired
What helps maintain respiratory movements at times when breathing is difficult?
The accessory muscle of the abdomen, neck and back are used to maintain respiratory movements at times when breathing is difficult. These muscles are used to facilitate breathing, the movement is called retractions. The most common retractions involved intercostal, scalene, sternocleidomastoid, trapezius, and pectoralis muscles.
Where does respiration occur?
Respiration occurs at the terminal alveolar capillary system. Gases are exchanged between the air and blood via the dense network of capillaries in the respiratory portion of the lungs and he thin alveolar walls
Gas exchange occurs via diffusion. What is diffusion?
Diffusion is the movement of gas the particles from areas of higher pressure or concentration to areas of lower pressure concentration. In respiration diffusion refers to the movement of oxygen and carbon dioxide between the air in the alveoli and the blood in the capillaries.
What is atelectasis?
Atelectasis is incomplete lung expansion or the collapse of alveoli, it prevents pressure changes and exchange of gas by diffusion in the lungs
True or false
Atelectasis areas of the lung cannot fulfill the function of respiration
True
What are some examples that can predispose a patient to have atelectasis?
Obstruction of the airway by foreign bodies, mucus, airway constriction, tumors, and large blood vessels, and immobility.
If a problem exists in ventilation, respiration, or perfusion, hypoxia may occur. What is hypoxia?
Hypoxia is a condition in which an in adequate amount of oxygen is available to cells.
What are common symptoms of hypoxia?
The most common symptoms of hypoxia are dyspnea,(difficulty breathing) and elevated blood pressure with the small pulse pressure, increased respiratory and pulse rate, pallor, and cyanosis.
Anxiety, restlessness, confusion, and drowsiness also are common signs of hypoxia
What causes hypoxia?
Hypoxia is often caused by hypoventilation which is a decreased rate or death of air movement into the lines. Hypoxia can also be a chronic condition.
What is vital for the exchange of gases?
An adequately functioning cardiovascular system
Describe the heart
Atria: upper chambers receives blood from veins
Ventricles: lower chambers force blood out through the arteries
How is oxygen carried?
Oxygen is carried via plasma and red blood cells. It is dissolved in plasma, but because oxygen is insoluble in liquids, little oxygen is carried in this way. The majority of oxygen is carried by the red blood cells. The hemoglobin and red blood cells have a strong affinity for oxygen. Therefore most oxygen about 97% is carried in the body by red blood cell
What is internal respiration?
Internal respiration is the exchange of oxygen and carbon dioxide between circulating blood and the tissue so
Who are prime candidates for compromised respiratory functioning?
People with renal or cardiac disorders often have compromised respiratory functioning because of fluid overload and impaired tissue perfusion
What can anemia result in?
Diminished carbon dioxide exchange
Describing infants respiration
The respiratory rate is more rapid in infants than any other age. Respiratory activity is primarily abdominal in infants
Describe an adult chest
Normally, the adult chest contour is slightly convex, with no sternal depression. The anteroposterior diameter should be less than the transverse diameter.
Describe an infant chest
The infants chest wall is so thin and has so little musculature that the ribs, sternum, and xiphoid process are seen easily. Infants have a rounded chest wall which the anterior posterior diameter equals the transverse diameter.
What is tachypnea?
Rapid breathing
What is Bradypnea ?
Slow breathing
What are adventitious breath sounds?
Adventitious breath sounds, or abnormal lung sounds, are categorized as either discontinuous or continuous sounds
What are Crackles?
Crackles, frequently heard on inspiration, are soft, high-pitched discontinuance popping sound. They are produced by fluid in the airways or alveoli and delayed reopening of collapsed alveoli. They occurred due to inflammation or congestion and are associated with pneumonia, congestive heart failure, bronchitis, and COPD
Fine crackles vs. Coarse crackles
Fine crackles: brief sounds, similar to the sound of hair rubbing together between the fingers
Coarse crackles: someone louder, moist, bubbling sound
True or false
Occasional fine crackles at the end of deep inspiration heard on auscultation of the infant thorax are normal
True
What are wheezes?
Wheezes are continuance, musical sounds, produced at air passes through airways constricted by swelling, narrowing, secretions, or tumors.
How are wheezes classified ?
As sibilant or sonorous
Sibilant wheezes: originate in smaller airways and are high-pitched and whistling
Sonorous wheezes: can be heard over larger airways and sound like a snore
Where do you hear wheezes?
In patients with asthma, tumors, or buildup of secretions
What is a pleural friction rub?
Pleural friction rub is a continuance, dry grating sound. Pleural friction rub is caused by inflammation of plural surfaces and loss of lubricating plural fluid. It resembles the sound made by rubbing two leather services together
What is pulse oximetry?
Pulse oximetry is a noninvasive technique that measures arterial oxyhemoglobin saturation of arterial blood. Pulse oximetry is useful for monitoring patients receiving oxygen therapy, Montring those at risk for hypoxia, and monitoring post operative patients.
True or false
Pulse oximetry replaces arterial blood gas analysis
False
What is thoracentesis?
Thoracentesis is the procedure of puncturing the Chest wall and aspirating plural fluid
True or false
Patients can help keep their secretion thin by drinking 2 to 3 quarts (1.9-2.9 liters) of clear fluids daily
True
What can be used to overcome hypoventilation?
Deep breathing exercises can be used to overcome hypoventilation
Patients who experience dyspnea and feelings of panic can often reduce these symptoms by doing what?
Pursed lip breathing
The respiratory secretion expelled by coughing or clearing the throat is called what
Sputum
Nonproductive cough versus productive cough
A cough that is dry is termed a nonproductive cough
A cough that produces respiratory secretions turned a productive cough
What are expectorants?
Expectorants are drugs that facilitate the removal of respiratory tract secretions by reducing the viscosity of the secretions
What is hypoxemia ?
Insufficient oxygen in the blood
What should you supply before suctioning in airway?
Oxygen, because suctioning irritates the mucosal and removes oxygen from the respiratory tract possibly causing hypoxemia
Administering inhale medications
Inhaled medications may be administered to open narrow airways (bronchodilators), too liquefy or loosen thick secretions (mucolytic agents), or to reduce inflammation in airways (corticosteroids). These medications typically are administered via nebulizer, metered dose inhaler, or dry powder inhalers
What are nebulizers?
Nebulizers disburse fine particles of liquid medication into the deeper passages of the respiratory tract, where absorption occurs.
What is a metered dose inhaler?
A metered dose inhaler delivers a controlled dose of medication with each compression of the canister
What are dry powder inhalers?
Dry powder inhalers are another type of delivery method for inhaled medications. Dry powder inhalers are breath activated. Dry powder inhalers require less manual dexterity then does a metered dose inhaler. Dry powder inhalers are actuated by the patient’s inspiration says there’s no need to coordinate the delivery puffs with inhalation
What is the most commonly used device to deliver oxygen?
A nasal cannula or nasal prongs
Chest tubes
Patients with fluid (pleural effusion), blood (hemothorax), or air (pneumothorax) in the pleural space require a chest tube to drain these substances and allow the compressed lug to expand
What is an endotracheal tube?
A polyvinylchloride airway that is inserted through the nose or the mouth into the trachea, using a laryngoscope as a guide. It is used to administer oxygen by mechanical ventilator, two suction secretions easily, or to bypass upper airway obstructions.
