Chapter 10 Flashcards
1
Q
———— is the process of gas exchange that occurs between the alveoli, the pulmonary capillaries, between the body’s cells and their adjacent capillaries as well as the use of glucose and oxygen during normal metabolism within the cells.
A
Respiration
2
Q
The terms ——— and ——— refer to moving air in and out of the lungs, these are sometimes used as if they are synonyms for respiration.
A
Ventilation and Breathing
3
Q
Respiration can be broken down into 4 distinct components, what are they?
A
-Pulmonary ventilation
-External respiration
-Internal respiration
-Cellular respiration and metabolism
4
Q
———-, or simply ventilation or breathing, is the mechanical process of moving air in and out of the lungs. It is related to minute ventilation and alveolar ventilation.
A
Pulmonary ventilation
5
Q
———- is the gas exchange process that occurs between the alveoli and the surrounding pulmonary capillaries, can also be referred to as alveoli/capillary exchange, serves to oxygenate blood and eliminate carbon dioxide in the lungs.
A
External respiration
6
Q
———-is the gas exchange process that occurs between the cells and the systemic capillaries. this is also known as cell/capillary gas exchange, is responsible for delivering oxygen to the cells and removing carbon dioxide from the cell.
A
Internal respiration
7
Q
————, also known as aerobic metabolism, occurs in the cell. The process breaks down glucose in the presence of oxygen, produces high amounts of energy in the form of ATP, and releases carbon dioxide from the cell.
A
Cellular respiration and metabolism
8
Q
The ———- takes oxygen from air that is breathed in, transports it to the alveoli where the oxygen crosses over into the capillary, and attaches the oxygen to the hemoglobin in the red blood cell or dissolves it in the plasma of the blood.
A
Respiratory system
9
Q
If oxygen supply is decreased by an obstructed airway, inadequate breathing, ineffective oxygen exchange in the lungs, or an inadequate delivery system to the cells, the body cells will become ——— (low in oxygen) and eventually die.
A
Hypoxic
10
Q
The ———- extends from the nose and mouth to the cricoid cartilage, the most inferior portion of the larynx.
A
Upper airway
11
Q
What structures do the nasal cavity contain?
A
-Superior, middle, and inferior turbinates
-Hard and soft palates
12
Q
What structures do the nasopharynx contain?
A
-Tonsils/adenoids
-Uvula
13
Q
What structure does the oropharynx contain?
A
-Tongue
14
Q
What structures do the laryngopharynx (hypopharynx) contain?
A
-Vallecula
-Epiglottis
15
Q
What structures do the larynx contain?
A
-Esophagus
-Trachea
16
Q
Air normally enters the body through the nostrils. It is warmed, moistened, and filtered as it flows over the damp, sticky ———- lining the nose.
A
Mucous membranes
17
Q
What is a common cause of airway obstruction in a patient with an altered mental status?
A
The tongue
18
Q
Air entering the body through the mouth and nostrils travels into the ———- (throat).
A
Pharynx
19
Q
Air from the nasal passages enter through what is referred to as the ———
A
Nasopharynx
20
Q
Air entering through the mouth travels through the ———-
A
Oropharynx
21
Q
What are the two passageways found at the lower end of the pharynx?
A
-Trachea
-Esophagus
22
Q
The trachea is protected by a small, leaf shaped flap of cartilaginous tissue called the ————
A
Epiglottis
23
Q
Just superior to (above) the trachea and just inferior to (below) the epiglottis is the ———-, or voice box, which contains the vocal cords.
A
Larynx
24
Q
The anterior portion of the larynx is composed of the large bulky ————, which can be felt at the front of the throat (adams apple).
A
Thyroid cartilage
25
The ———, which forms the most inferior portion of the larynx and is the only completely circular cartilaginous ring of the upper airway, is found at the lower portion of the larynx just below the thyroid cartilage.
Cricoid cartilage
26
The ———- extends from the cricoid cartilage at the lower edge of the larynx to the alveoli of the lungs.
Lower airway
27
The ———-, commonly known as the windpipe, is the passageway for air entering the lungs.
Trachea
28
The trachea extends from the larynx to the ———-, the point at which the trachea splits into right and left mainstream bronchi.
Carina
29
The right and left mainstream ———, which are the two major branches of the trachea, extend from the carina into the lungs, where they continue to divide into smaller sections or branches known as ———.
-Bronchi
-Bronchioles
30
The bronchioles terminate in millions of tiny air sacs in the lungs, these are called?
Alveoli
31
Each alveoli is wrapped in a web of thin walled capillaries referred to as the ————. This is the site for gas exchange between the alveoli and the blood in the capillaries.
Pulmonary capillaries
32
The lungs are surrounded by two layers of connective tissue called the ———
Pleura
33
The ———— is the innermost covering of the lung.
Visceral pleura
34
The ———- is a thicker, more elastic layer of connective tissue that adheres to the inner portion of the chest wall.
Parietal pleura
35
Between the two layers of pleura is the ———-, a small space that is at negative pressure
Pleural space
36
The pleural space contains a small amount of ——— that acts as a lubricant to reduce friction when the layers of the pleura rub against each other during breathing
Serous fluid
37
The ——— is a muscle that separates the chest cavity from the abdominal cavity, it is the major muscle used in breathing.
Diaphragm
38
The diaphragm is responsible for what percentage of the effort of ventilation?
60-70%
39
If contraction of the diaphragm is ineffective because of trauma or illness, the patient may show signs of ———— from inadequate breathing.
Significant respiratory distress
40
——- or ——- is the process of breathing air in
Inhalation or inspiration
41
——— or ——— is the process of breathing air out
Exhalation or expiration
42
During inhalation, the diaphragm and the external ———, or muscles between the ribs, contract.
Intercostal muscles
43
Inhalation is an ———- because it requires energy to contract the muscles
Active process
44
In some respiratory diseases affecting the lower airway such as ———-, the patient has a difficult time moving air out of the lungs because of an increased resistance in the airways or diseased lung tissue.
Asthma
45
The ——— (DRG), ———-(VRG), and ———- (pneumotaxic center) in the brain stem are respiratory rhythm centers that control the impulses being sent to the respiratory muscles.
-Dorsal respiratory group
-Ventral respiratory group
-Pontine respiratory center
46
The ———— continuously monitor levels of oxygen, carbon dioxide, and PH in the arterial blood and stimulate and increase or decrease in impulses from the respiratory rhythm centers to control the rate and depth of ventilation.
Chemoreceptors
47
The ———— located in the medulla are the most sensitive to changes in the blood PH and carbon dioxide, whereas the ———- located in carotid arteries and aortic arch are more sensitive to changes in arterial oxygen.
-Central chemoreceptors
-Peripheral chemoreceptors
48
The respiratory system responds primarily to changes in the ———- levels.
Carbon dioxide
49
If the carbon dioxide level in the arterial blood increases, the chemoreceptors sense the increase and the brainstem sends impulses to the respiratory muscles to ——— the rate and depth of respiration.
Increase
50
When the carbon dioxide level decreases in the blood, the chemoreceptors sense this and send signals to the respiratory muscles to ——— the respiratory rate and depth and the respirations return to normal.
Slow down
51
——- is much less of a stimulus for breathing in healthy people
Oxygen
52
In patients with a category of conditions known as COPD, which includes emphysema and chronic bronchitis, the carbon dioxide level in arterial blood is typically chronically ——— because of the disease process.
Elevated
53
——— is the process by which the blood and the cells become saturated with oxygen
Oxygenation
54
———- is a low oxygen content in the arterial blood, typically occurs from a ventilation-perfusion mismatch
Hypoxemia
55
A ————- occurs when there is a lack of available oxygenated air in the alveoli even though perfusion (blood flow) to the alveoli is adequate, or when the alveoli are adequately oxygenated but perfusion to alveoli is poor, or when there is a combo of of both poor ventilation and poor perfusion in the alveolar-capillary structures
Ventilation-perfusion mismatch
56
——- refers to an inadequacy in the amount of oxygen being delivered to the cells
Hypoxia
57
What are the mild to moderate signs of hypoxia?
-tachypnea (increased respiratory rate)
-dyspnea (shortness of breath)
-pale, cool, clammy skin (early)
-tachycardia (increase in heart rate)
-elevation in blood pressure
-restlessness and agitation
-disorientation and confusion (from high carbon dioxide levels in the blood)
-headache
58
What are the signs of severe hypoxia?
-tachypnea
-dyspnea
-cyanosis
-tachycardia that may lead to dysrhythmias and eventually bradycardia
-severe confusion
-loss of coordination
-slow reaction time
-altered mental status
-seizure
59
When carbon dioxide builds up in the blood this is known as?
Hypercarbia
60
What are two signs of hypercarbia that typically appear with hypoxemia or hypoxia?
-sleepy appearance (from high carbon dioxide levels in the brain)
-head bobbing (head bobs upwards with inhalation and downward with exhalation as if falling asleep while sitting upright) with droopy eyelids
61
In a newborn, ———- may be an early sign of hypoxia
Bradycardia
62
A heart rate of 80 bpm, which is normal in an adult, may be an indication of ———- in a week old infant where a heart rate of 100-180 bpm is normal.
Hypoxia
63
———-, a bluish gray color, is a late sign of hypoxia and may be found in and around several areas of the body, including the lips, mouth, nose, fingernail beds, the bottom of the eyelid, and oral mucosa
Cyanosis
64
———- occurs when adequate amounts of oxygen are no longer attached to the hemoglobin molecules.
Cyanosis
65
What is the process of forcing air into a patients lungs?
Positive pressure ventilation (PPV)
66
The blood moving into the capillaries is ——-, that is, it has low oxygen concentration, but high carbon dioxide
Deoxygenated
67
The blood in the capillaries is ———, that is, with high oxygen concentration and low carbon dioxide
Oxygenated
68
———-, found in the cytoplasm of the red blood cells, is responsible for picking up most oxygen in the blood, approx 97 percent of total oxygen content in the blood, and carrying it through the arterial system to the capillaries throughout the body.
Hemoglobin
69
What are the differences in children’s/ infants airways?
- nose and mouth are smaller
-larger tongue takes up more space in the pharynx
-epiglottis is u-shaped and protrudes into the pharynx
-cricoid cartilage is less rigid and less developed
-trachea is narrower, softer, and more flexible
70
What are the common changes in the elderly airway?
-tooth decay
-decrease in flexibility of the neck
-oropharyngeal tumors
-loss of muscle around the lips and mouth in the dentulous mouth make creating a mask seal for BVM difficult
-higher incidence of COPD, increases incidence of a faster onset of hypoxia
-obstructive sleep apnea
-increase in gastroesophageal reflux disease, increased risk of aspiration of gastric contents
-dementia and confusion
-lower functional residual volume in the lungs
71
An open airway is commonly referred to as?
A patent airway
72
What are the signs of an open airway?
-air can be felt and heard moving in and out of the mouth and nose
-the patient is speaking in full sentences or with little difficulty
-the sound of the voice is normal for the patient
73
What are some sounds that can indicate airway obstruction?
-snoring
-the sound of a crow cawing
-gurgling
-stridor (harsh, high pitched sound heard during inspiration)
74
What are the signs of a blocked or inadequate airway?
-abnormal upper airway sound (stridor, snoring, crowing, gurgling)
-an awake patient who is unable to speak
-evidence of a foreign body airway obstruction
-swelling to the mouth, tongue, or oropharynx
75
What are the steps of conducting the crossed fingers technique when opening the mouth?
1. Kneel above and behind the patient
2. Cross the thumb and forefinger of one hand
3. Place the thumb on the patients lower incisors or your forefinger on the upper incisors
4. Use a scissors motion or finger snapping motion to open the mouth
76
What are the manual airway maneuvers used to maintain a patent airway?
- head tilt, chin lift, maneuver
-jaw thrust maneuver
77
What are the mechanical airway maneuvers used to maintain a patent airway?
-oropharyngeal airway (OPA or oral airway)
-nasopharyngeal airway (NPA or nasal airway)
78
If you suspect that a patient has suffered a spinal injury, then use the ——- maneuver in conjunction with spine motion restriction
Jaw thrust
79
This type of catheter is a rigid plastic tube. It is called a hard catheter or a yankauer catheter and is commonly referred to as a “tonsil tip” or “tonsil sucker” what is this type of catheter?
Rigid catheter
80
The ——— catheter should be used to suction the mouth and oropharynx of an unresponsive patient.
Rigid catheter
81
The soft suction catheter consists of flexible tubing. It is also called a French catheter, what is this type of catheter?
Soft catheter
82
The ———- catheter should be used when suctioning the nose and nasopharynx and in other situations where the rigid catheter cannot be used.
Soft catheter
83
In adults, suctioning should last for no more than —— seconds at a time.
15 seconds
84
In infants and children, suctioning should last for no more than —- seconds at a time.
5 seconds
85
——— is defined as the air remaining in the lungs after a maximal exhalation.
Residual volume
86
The ———-, also known as the oral airway or OPA, is a semicircular device of hard plastic or rubber that holds the tongue away from the back of the airway.
Oropharyngeal airway
87
The ———, also known as the nasal airway or NPA is a curved hollow tube of soft plastic or rubber with a flange or flare at the top end and a bevel at the distal end
Nasopharyngeal airway
88
——— is the amount of air moved in and out of the lungs in one respiration
Tidal volume
89
———- is the amount of air moved in and out of the lungs in one minute
Minute volume
90
What is the formula for minute volume?
Minute volume= tidal volume x respiratory rate
91
A normal minute volume in a healthy individual at rest is about ———
5 to 8 L/minute
92
What is the best method to assess for tidal volume?
Look for adequate chest rise and to feel and listen for air movement from the nose and mouth
93
——- is the amount of air breathed in that reaches the alveoli
Alveolar ventilation
94
What is the formula for alveolar ventilation?
Alveolar ventilation= (tidal volume - dead air space) x respiratory rate
95
When inspecting the chest, look for ——-, or pulling inward of the intercostal muscles of the chest.
Retractions
96
What is the term used when referring to both sides?
Bilateral
97
What are the signs of adequate breathing?
-adequate respiratory rate
-clear and equal breath sounds bilaterally
-adequate air movement heard and felt from nose and mouth (tidal volume)
-good chest rise and fall with each ventilation (tidal volume)
98
What is the normal respiratory rate/minute in adults and adolescents 12-15 years?
12-20 respirations per minute
99
What is the normal respiratory rate/ minute in a school age child 6-11 years?
18-25 respirations per minute
100
What is the normal respiratory rate / minute in a preschooler 3-5 years?
20-28 respirations per minute
101
What is the normal respiratory rate / minute in a toddler 1-2 years?
22-37 respirations per minute
102
What is the normal respiratory rate / minute in infants 1-12 months?
30-53 respirations per minute
103
What is the normal respiratory rate / minute in neonate birth 1 month
40-60 respirations per minute
104
———- is a condition in which the patient is working harder to breathe
Respiratory distress
105
——— occurs when the respiratory rate and or tidal volume is insufficient
Respiratory failure
106
———, also called apnea, occurs when the patient completely stops breathing
Respiratory arrest
107
What are the common causes of respiratory failure or respiratory arrest?
-stroke
-myocardial infarction
-drug overdose
-toxic inhalation
-electrocution and lightening strike
-suffocation
-traumatic injuries to the head, spine, chest, or abdomen
-infection to the epiglottis
-airway obstruction by a foreign body
108
——— respirations are gasping type breaths, may be seen in cardiac arrest patients
Agonal respirations
109
——— is an excessively rapid breathing rate and may indicate inadequate oxygenation and breathing, especially in an adult
Tachypnea
110
———- is an abnormally slow breathing rate and an ominous sign of inadequate breathing and oxygenation in infants and children
Bradypnea
111
Adequate respiratory rate and an adequate tidal volume with each breath equals?
Adequate breathing
112
Inadequate respiratory rate and an adequate tidal volume equals?
Inadequate breathing
113
Adequate respiratory rate and an inadequate tidal volume equals?
Inadequate breathing
114
A ——— is a surgical opening in the front of the neck through which the patient breathes air into the trachea
Stoma
115
What is the volume of oxygen in a D cylinder?
350 L
116
What is the volume of oxygen in an E cylinder?
625 L
117
What is the volume of oxygen in an M cylinder?
3,000 L
118
What is the volume of oxygen in a G cylinder?
5,300 L
119
What is the volume of oxygen in an H cylinder?
6,900 L
120
Gas flow from an oxygen cylinder is controlled by a ———- that reduces the high pressure in the cylinder to a safe range, from 30 to 70 PSI, and controls the flow of oxygen from 1 to 15 LPM
Pressure regulator
121
What are the two types of regulators that may be attached to an oxygen cylinder?
-high pressure regulator
-therapy regulator
122
The ———- can provide 50 PSI to power a flow restricted, oxygen powered ventilation device
High pressure regulator
123
The ——— can administer oxygen from 0.5 LPM up to 25 LPM
Therapy regulator
124
It is possible to add moisture to the oxygen by attaching an —— to the regulator
Oxygen humidifier
125
The method for delivering a high concentration of oxygen in the prehospital setting is with a ——-
Nonrebreather mask
126
The preferred device to deliver oxygen in most medical patients is a ——-
Nasal cannula
127
The liter flow for the nasal cannula should be at no less than —— lpm and no greater than —— lpm
-1 LPM
-6 LPM
128
The liter flow for the nonrebreather mask should be typically set at —— lpm
15LPM
129
A —— has no reservoir and can deliver up to 60 percent oxygen, depending on the patients tidal volume and oxygen flow rate
Simple face mask
130
The ——- looks similar to the nonrebreather mask but is equipped with a two way valve that allows the patient to rebreathe about 1/3 of his exhaled air.
Partial rebreather mask
131
Both the partial rebreather mask and the simple face mask has a flow rate that is usually set at —- LPM but should be set no lower than —- LPM
-10 LPM
-6LPM
132
The ———- mask is a low flow oxygen system that provides precise concentrations of oxygen through an entrainment valve connected to the face mask. Commonly used on patients with a history of COPD
Venturi mask
133
The ——- mask is used to deliver aerosolized medication, bland aerosol therapy, or oxygen to a patient with a tracheostomy tube
Tracheostomy mask
134
If the patient breathes adequately but has other signs of early respiratory distress, administer oxygen to maintain an SpO2 of ——% or greater
94%
135
If the patient is unresponsive, not breathing and has no pulse, perform ——
CPR
136
If the patient is unresponsive but adequately breathing, insert appropriate airway adjunct and apply oxygen via a ——-
Nonrebreather mask
137
An unresponsive 24 year old male with shallow breathing at 4 breaths per minute would require what?
Positive pressure ventilation with supplemental oxygen
138
A 42 year old female complaining of difficulty breathing who can only speak one or two words at a time. She is breathing 30 times per minute with normal rise and fall of the chest. Her pulse oximeter is 92%. What type of oxygen is needed?
Nonrebreather mask at 15 LPM
139
A 26 year old female tripped over her dog and fell fracturing her wrist. Her skin is warm and dry. She is breathing 18 times per minute and normal tidal volume what type of oxygen does she need, if any?
No oxygen required
140
An 83 year old female contacts EMS complaining of abdominal pain. She denies difficulty breathing or any history of respiratory problems. She is breathing 20 times per minute with a normal rise and fall of the chest. Her pulse oximeter is 93% on room air. What type of oxygen does she need, if any?
Nasal cannula at 2 LPM
141
An unresponsive 24 year old male with shallow breathing at 4 breaths per minute, what type of oxygen does he need?
Positive pressure ventilation with supplemental oxygen
