chapter 28 respiratory system - week 2

Question 1

what is the primary purpose of the respitory system

Answer 1

The primary purpose of the respiratory system is gas exchange, which involves the
transfer of oxygen and carbon dioxide from the atmosphere to the blood.

Question 2

how mnay lobes are in the left and right lung

Answer 2

The right lung is divided into three lobes (upper, middle, and lower) and the left lung
into two lobes (upper and lower).

Question 3

what is included in the upper respistory tract and what is it’s purpose

Answer 3

The upper respiratory tract includes the nasal cavity, pharynx, adenoids, tonsils,
epiglottis, larynx, and trachea.

The nose warms, cleanses, and humidifies air before it enters lungs.
Vibrational sounds originating in the larynx lead to vocalization.

Question 4

what is tidal volume and what is normal in an adult

Answer 4

• In adults, a normal tidal volume, or volume of air exchanged with each breath, is
  about 500 mL.

Question 5

what is surfactant

Answer 5

Surfactant is a lipoprotein that helps to keep the alveoli open, thus preventing
alveolar collapse

Question 6

what is the purpose of the diaphram

Answer 6

Contraction of the diaphragm, the major muscle of respiration, results in decreased
intrathoracic pressure, allowing air to enter the lungs.

Question 7

what is ventialtion

Answer 7

• Ventilation involves inspiration (movement of air into the lungs) and expiration
  (movement of air out of the lungs).

Question 8

inspiration

Answer 8

Inspiration is an active process, involving muscle contraction

Question 9

expiration

Answer 9

Expiration is a passive process. When elastic recoil is reduced, expiration
becomes a more active, laboured process

Question 10

what is compliance and what happens if it is decreased

Answer 10

When compliance, or a measure of the elasticity of the lungs and thorax,
is decreased, the lungs are more difficult to inflate.

Question 11

what is the purpose of measuring ABGs

Answer 11

Arterial blood gases (ABGs) are measured to determine oxygenation status and acid–
base balance. ABG analysis includes measurement of the PaO2, PaCO2, acidity (pH),
and bicarbonate (HCO3) in arterial blood.

Question 12

what is the respitory center in the body

Answer 12

The respiratory centre in the brainstem medulla responds to chemical and mechanical
signals from the body

Question 13

chemoreceptor

Answer 13

A chemoreceptor is a receptor that responds to a change in the chemical composition
(PaCO2 and pH) of the fluid around it.

Question 14

what are mechanical receptors

Answer 14

Mechanical receptors (juxtacapillary and irritant) are stimulated by a variety of
physiological factors, such as irritants, muscle stretching, and alveolar wall distortion.

Question 15

what are the respiratory defense mechanisms

Answer 15

The respiratory defense mechanisms include filtration of air, the mucociliary
clearance system, the cough reflex, reflex bronchoconstriction, and alveolar
macrophages.

Question 16

age related considerations

Answer 16

Age-related changes in the respiratory system can be divided into alterations in
structure, defense mechanisms, and respiratory control.

Question 17

general considerations

Answer 17

There is much variability in the extent of these changes in persons of the same age.
The older adult patient who has a significant smoking history, is obese, and has a
chronic illness is at greatest risk of adverse outcomes

Question 18

past heath history for respirtory system assessment

Answer 18

 Types of respiratory illnesses that the patient experienced during
childhood (e.g., croup, respiratory syncytial virus, asthma,
pneumonia, frequent colds)

 Frequency of upper respiratory problems (e.g., colds, sore throats,
sinus problems, allergies) and whether weather changes exacerbate
these problems

 Precipitating factors of allergies such as medications or exposure
to pollen, smoke, or animal dander, and characteristics of the
allergic reaction—e.g., runny nose, wheezing, scratchy throat, or
sensation of tightness in the chest—and the severity of the reaction
should be documented.

 Frequency of asthma exacerbations and cause

 History of lower respiratory tract problems, such as asthma,
COPD, pneumonia, and tuberculosis

 History of other health problems in addition to those involving the
respiratory system, e.g., patients with cardiac dysfunction may
experience dyspnea (shortness of breath)

o Medications
o Surgery or other treatments
o Current and family health history
o Psychosocial history

Question 19

physical assessments for respirtory system

Answer 19

During nursing assessment, a cough should be evaluated by the quality of the cough
(weak or strong; productive or nonproductive of secretions) and sputum (amount,
colour, consistency, and odour).

• During physical examination, the nose, mouth, pharynx, neck, thorax, and lungs
  should be assessed and the respiratory rate, depth, and rhythm should be observed.
• When listening to the lung sounds, there are three normal breath sounds: vesicular,
  bronchovesicular, and bronchial.
• Adventitious sounds are extra breath sounds that are abnormal and include crackles,
  wheezes, and pleural friction rub.

Question 20

oximetry

Answer 20

Oximetry is used to noninvasively monitor SpO2 and SvO2.

Question 21

sputum studies purpose

Answer 21

Sputum studies are examined to identify infecting organisms or to confirm a
diagnosis.

Question 22

skin tests purpose in resp diseases

Answer 22

• Skin tests are performed to test for allergic reactions or exposure to tuberculosis or
  fungi.

Question 23

what is the purpose of a. chest x-ray in relation to resp disease

Answer 23

A chest x-ray is the most commonly used test for assessment of the respiratory
system, as well as the progression of disease and response to treatment.

Question 24

what is a bronchoscopy

Answer 24

Bronchoscopy is a procedure in which the bronchi are visualized through a fibre-optic
tube and may be used for diagnostic purposes to obtain biopsy specimens, assess
changes resulting from treatment, and remove mucous plugs or foreign bodies

Question 25

what is a thoracentesis

Answer 25

Thoracentesis is the insertion of a needle through the chest wall into the pleural space to obtain specimens for diagnostic evaluation, remove pleural fluid, or instill medication into the pleural space.

Question 26

what are pulmonary function tests (PFTs)

Answer 26

Pulmonary function tests (PFTs) use a spirometer to measure lung volumes and airflow. The results of PFTs are used to diagnose pulmonary disease, monitor disease progression, evaluate disability, and evaluate response to bronchodilators. o In the acute setting, more specific PFT parameters are used to determine the need for and liberation (weaning) from mechanical ventilation.

Question 27

what is the purpose of excersie testing for resp diseases

Answer 27

Exercise testing is used in diagnosis, measuring functional capacity and response to treatment, and determining level of activity tolerance.

Question 28

major structures of the lower respirotry

Answer 28

The major structures of the lower respiratory tract are the bronchi, the bronchioles, the alveolar ducts, and the alveoli.

Question 29

pulmonary circulation

Answer 29

The pulmonary circulation provides the lungs with blood for gas exchange. The pulmonary artery receives deoxygenated blood from the right ventricle of the heart and branches so that each pulmonary capillary is directly connected with many alveoli. Oxygen–carbon dioxide exchange occurs at this point. The pulmonary veins return oxygenated blood to the left atrium of the heart.

Question 30

bronchoial circulation

Answer 30

The bronchial circulation starts with the bronchial arteries, which arise from the thoracic aorta. The bronchial circulation provides oxygen to the bronchi and other pulmonary tissues. Deoxygenated blood returns from the bronchial circulation through the azygos vein into the left atrium.

Question 31

normal abg values

Answer 31

pH - 7.35-7.45 partial pressure of oxygen (pa02)- 75-100mmHg partial pressure of carbon dioxide (paCO2)- 35-45mmHg HCO3--21-35mmol/L

Question 32

sign and symptoms of inadquate oxygenation

Answer 32

**Central Nervous System** Unexplained apprehension Early Unexplained restlessness or irritability Early Unexplained confusion or lethargy Early or Late Combativeness Late Coma Late **Respiratory System** Tachypnea Early Dyspnea on exertion Early Dyspnea at rest Late Use of accessory muscles Late Retraction of interspaces on inspiration Late Pause for breath between sentences, words Late **Cardiovascular System** Tachycardia Early Mild hypertension Early Dysrhythmias (e.g., premature ventricular contractions) Early or late Hypotension Late Cyanosis Late Cool, clammy skin Late **Other Body Systems** Diaphoresis Early or late Decreased urinary output Early or late Unexplained fatigue

Question 33

cough reflex

Answer 33

The cough is a protective reflex action that clears the airway by a high- pressure, high-velocity flow of air. It is a backup for mucociliary clearance, especially when this clearance mechanism is overwhelmed or ineffective. Coughing is effective in removing secretions only above the subsegmental level (large or main airways).

Question 34

reflex bronchoconstriction

Answer 34

Another defence mechanism is reflex bronchoconstriction. In response to the inhalation of large amounts of irritating substances (e.g., dusts, aerosols), the bronchi constrict in an effort to prevent entry of the irritants. In conditions of hyperreactive airways, such as asthma, bronchoconstriction occurs after inhalation of cold air, perfume, or other strong odours.

Question 35

pursed lip breathing description and signifance

Answer 35

Exhalation through mouth with lips pursed together to slow exhalation COPD, asthma; suggests ↑ breathlessness; strategy taught to slow expiration, reduce dyspnea

Question 36

tripod position; inablity to lie flat description and signicane

Answer 36

Learning forward with arms and elbows supported on overbed table COPD, asthma in exacerbation, pulmonary edema; indicates moderate to severe respiratory distress

Question 37

accessory muscle use; intercosal retractions description and possible cause

Answer 37

Neck and shoulder muscles used to assist breathing; muscles between ribs pull in during inspiration COPD, asthma in exacerbation, secretion retention; indicates severe respiratory distress, hypoxemia

Question 38

spliting desciption and possible cause

Answer 38

↓ Inspiratory effort (or ↓ in tidal volume) as a result ofsharp pain upon inspiration Thoracic or abdominal incision; chest trauma, pleurisy

Question 39

increase anteroposterior diameter description and possible cause

Answer 39

Anteroposterior chest diameter equal to transverse diameter; slope of ribs more horizontal (90 degrees) to spine COPD, asthma, cystic fibrosis; lung hyperinflation; advanced age

Question 40

trachpnea description and possible cause

Answer 40

Rate >20 breaths/min; >25 breaths/min in older adults Fever, anxiety, hypoxemia, restrictive lung disease; ↑ above normal respiratory rate reflects increased work of breathing

Question 41

kussmaui's respirations descriptioni and significance

Answer 41

Regular, rapid, and deep respirations Metabolic acidosis; ↑ in rate aids body in ↑ CO2 excretion

Question 42

cyanosis descrription and possible cause

Answer 42

Bluish coloration of skin, best seen in earlobes, under the eyelids, or in nail beds ↓ Oxygen transfer in lungs, ↓ cardiac output; nonspecific, unreliable indicator

Question 43

clubbing description and possible cause

Answer 43

↑ Depth, bulk, sponginess of distal digit of finger Chronic hypoxemia; cystic fibrosis, lungcancer, bronchiectasis

Question 44

abdominal paradox description and possible causeu

Answer 44

Inward (rather than normal outward) movement ofabdomen during inspiration Inefficient and ineffective breathing pattern; nonspecific indicator of severe respiratory distress

Question 45

tracheal deviation descriotion and possible cause

Answer 45

Leftward or rightward movement of trachea from normal midline position Nonspecific indicator of change in position of mediastinal structures; medical emergency if caused by tension pneumothorax

Question 46

allterared tacile fremitus description and possble cause

Answer 46

Increase or decrease in vibrations ↑ In pneumonia, pulmonary edema; ↓ in pleural effusion, lung hyperinflation; absent in pneumothorax, atelectasis

Question 47

alteraered tactile fremitus decription and possible cause

Answer 47

Diminished movement (can be asymmetrical or symmetrical) of two sides of chest with inspiration Asymmetrical movement caused by atelectasis, pneumothorax, pleural effusion, splinting; symmetrical but diminished movement caused by barrel shape of chest, restrictive disease, neuro-muscular disease

Question 48

hyper resonance (percussion) description and possible cause

Answer 48

Loud, lower-pitched sound over areas that normally produce a resonant sound Lung hyperinflation (COPD), lung collapse (pneumothorax), air trapping (asthma)

Question 49

dullness (percussion) decsription and possible cause

Answer 49

Medium-pitched sound over areas that normally produce a resonant sound ↑ Density (pneumonia, widespread atelectasis), ↑ fluid pleural space (pleural effusion)

Question 50

fine crackle description and possible cause

Answer 50

Series of short, explosive, high-pitched sounds heard just before the end of inspiration; rapid equalization of gas pressure when collapsed alveoli or terminal bronchioles suddenly snap open; sounds similar to rolling hair between fingers just behind ear Interstitial fibrosis (asbestosis), interstitial edema (early pulmonary edema), alveolar filling (pneumonia), loss of lung volume (atelectasis), early phase of heart failure

Question 51

course crackle description and possible cause

Answer 51

Series of short, low-pitched sounds on inspiration and sometimes expiration; air passing through airway intermittently occluded by mucus, unstable bronchial wall, or fold of mucosa; sounds similar to blowing through straw under water (increase in bubbling quality with more fluid) Heart failure, pulmonary edema, pneumonia with severe congestion, COPD

Question 52

wheeze description and possible cause

Answer 52

Continuous high-pitched squeaking sound caused by rapid vibration of bronchial walls; first evident on expiration; possibly evident on inspiration as obstruction of airway increases; possibly audible without stethoscope Bronchospasm (caused by asthma), airway obstruction (caused by foreign body; tumour; viscous, thick increased secretions), COPD, pneumonia, bronchiectasis

Question 53

stridor desciprtion and possible cause

Answer 53

Continuous musical sound of constant pitch; result of partial obstruction of larynx or trachea Croup, epigloitis, vocal cord edema after extubation, foreign body

Question 54

absence od breath sounds description and possible cause

Answer 54

No sound evident over entire lung or area of lung Pleural effusion, mainstem bronchi obstruction, widespread atelectasis, pneumonectomy, lobectomy, severe acute asthma (i.e., silent chest)

Question 55

pleural friction rub description and possible cause

Answer 55

Creaking or grating sound occurs when roughened, inflamed surfaces of pleura rub together; evident on inspiration, expiration, or both; no change with coughing; usually painful, especially on deep inspiration Pleurisy, pneumonia, pulmonary infarct