Chapter 40: Respiratory Practice Test Flashcards
What body system controls ventilation regulation?
Central nervous system
What do these two chemicals control?
O2 transport
C02 transport
ventilation regulation
What is the purpose of the circulatory system?
Deliver oxygen
This is regulated by these four factors?
Afterload
Preload
Cardiac output (CO)
Contractility
Blood flow
These are the four most common defining characteristics of problems with what body system?
Decreased CO
Ischemia
Heart failure
Hypovolemia
Circulatory
With a patient with COPD receive oxygen via NC ?
No because their lungs work on a CO2 drive. Oxygen can cause COPD patient to stop breathing.
These four factors affect what part of the respiratory system?
Decrease in O2 carrying capacity of the red blood cell
Decreased inspired O2 concentration in the alveoli
Increased metabolic rate
Chest wall movement
Oxygenation
These four major factors affect what body system? History Risk factors Fatigue Pain
Respiratory
What are the four areas you would assess in regards to respiratory during a physical examination?
Breathing patterns
Cough
Respiratory infection
Medications
Activity intolerance Ineffective breathing pattern Ineffective airway clearance Risk for infection Impaired gas exchange Decreased cardiac output Acute pain Fatigue This is what part of the nursing process?
Diagnosis
Providing a patent airway Improving oxygenation Increasing level of independence Set priorities based on the patient’s tolerance level Collaborative care
This is what part of the nursing process?
Planning
Health promotion
Dyspnea management
Safety precautions with oxygen therapy
Mobilization of pulmonary secretions
This is what part of the nursing process?
Implementation
Common disorders of the upper and lower airway include?
Upper Airway: Viruses
Lower Airway: pneumonia, TB, Valley Fever, Aspiration, flu
This requires coordination of respiratory, cardiovascular, and hematological systems
Oxygenation
Ventilation or breathing
Alveolar-capillary gas exchange
Transporting O2 & CO2 between tissues & lungs
Moving O2 & CO2 between systemic capillaries and tissues by diffusion.
This is what process?
Oxygenation
What defense mechanisms are present in respiratory system to prevent entry of foreign bodies, irritants, microorganisms?
Cough
Cillia
This includes inspiration & expiration
Ventilation
Breathing
Adequate ventilation is dependent on?
Clear airway
Intact CNS & respiratory centers in medulla and pons of brainstem
Intact thoracic cavity which expands and contracts
Pulmonary compliance (expansion) and recoil
O2 & CO2 are exchanged through diffusion at the ______?
alveolar capillary membrane
Efficient gas exchange depends on balance between?
Ventilation (V) or air flow & Perfusion (Q) or blood flow
Blood flow to lungs may be normal, but ventilation is reduced ( VQ ratio)
What might reduce airflow, block airway?
Check Module 8 Voiceover
Areas ventilated, but not perfused (VQ ratio)
What might impair perfusion of oxygenated blood?
Check Module 8 Voiceover
This type of patients adjust to higher CO2 levels & breathing is may be controlled with hypoxic drive.
Must be kept slightly hypoxic.
Current research shows only a small % of these pts. have depressed CO2 receptors.
COPD Patient
To control ventilation Keep ____ liter flow & _______ levels as prescribed by physician .
O2
Pulse Oximeter
Receptors in coratid bodies and aortic arch respond to ___ O2 to control ventilation.
decrease
Chemoreceptors in medulla oblongata responds to _____ CO2 or ___ pH to ____ rate/depth of respirations to control ventilation.
increase
decrease
increase
6 Lifestyle Factors affecting oxygenation?
Nutrition, exercise, smoking, BP management, drug abuse, stress
3 Environmental factors affecting oxygenation?
urban pollution, occupational exposure to toxins, diseases
Four physiological factors affecting oxygenation?
Pulmonary or cardiac disease
Musculoskeletal or neuromuscular alterations affecting chest wall movement
Decreased O2 carrying capacity due to anemia or toxins (CO)
Hypovolemia due to blood or fluid loss
Developmental factors due to the aging process that affects oxygenation?
Stiffening of elastin and collagen connective tissue supporting lungs leads to chest wall stiffness.
Decreased Elastic recoil
Osteoporosis alters shape of thorax
Altered alveolar shape decreased surface area
Cilia function decreases
cough reflex
Decreased immune function. Increased risk of pneumonia, flu, TB.
This is an example of what type of body system change that could affect pulmonary function?
Cardiovascular
Does pt. c/o chest pain or difficulty breathing? Possible causes? Is airway patent?
Is skin pale, diaphoretic, dusky, or cyanotic?
This is what part of the nursing process?
Respiratory Assessment
What are VS & pulse oximetry readings?
Is the patient using accessory muscles to breathe? Such as?
This is what part of the nursing process?
Respiratory Assessment
Has the patient’s LOC changed?
Is the patient confused, anxious, or agitated?
Does the patient change position to facilitate breathing? E.g. tripod position
Are they orthopneac?
This is what part of the nursing process?
Respiratory Assessment
Chief Complaint – onset, course, duration of respiratory sx.
Current symptoms possibly R/T Respiratory problem such as?
Respiratory Assessment
Patient/Family History of Lung/Heart Problems
Asthma Emphysema Bronchitis
PE
COPD
TB
Bronchiectasis Allergy hx, exposure
Infections
Lifestyle, med use.
This is what part of the nursing process?
Respiratory Assessment
What conditions may cause this type ofpain?
Can you differentiate between cardiac, pulmonary, & muscular chest pain?
What lung conditions may cause this type of pain?
Chest Pain Assessment
Pulmonary (pleuritic) pain may be Sharp, stabbing, and intermittent May increase with breathing, coughing Dull, aching, and persistent Usually felt on affected side, may be referred May radiate to scapula.
This is what part of the nursing process?
Chest Pain Assessment
What is a cough? Dry? Productive?
Purpose of cough?
What do you want to document about a cough?
Check module 8 Respiratory Voiceover
Present and past work experiences (Why?) Smoking habits Activities of daily living tolerance Cardiac risk factors Stress level Dietary habits Relationship with significant others Recreational habits
This is what part of the nursing process?
Respiratory Assessment
Respiratory effort
How can you tell if a patient is having trouble breathing?
What are S/Sx hypoxia?
Note: Cyanosis doesn’t occur until later hypoxia
This is what part of the nursing process?
Physical Assessment
Lung sounds – adventitious
Crackles, wheezing, rhonchi, stridor
What do these indicate?
This is what part of the nursing process?
Physical Assessment
Fluid status – s/sx dehydration, over-hydration
Why is this significant?
This is what part of the nursing process?
Physical Assessment
Observe facial expression & LOC
Note respiratory rate, rhythm, pattern, depth
This is what part of the nursing process?
Assessment:
Inspection
Inspect anterior and posterior thorax for symmetry
What might it indicate if one side larger or smaller than the other?
This is what part of the nursing process?
Assessment:
Inspection
Observe general condition and musculoskeletal development.
This is what part of the nursing process?
Assessment:
Inspection
This has an elliptical shape and causes the ribs to slope down?
Normal Chest Shape
This occurs when width & depth equal, and causes the ribs to become horizontal.
This can be R/T chronic lung hyperinflation (emphysema)
This is normal w/aging and in infants
Barrel chest Shape
What questions do you ask to assess ventilatory patterns?
What are these breathing patterns & what may cause?
Eupnea Dyspnea Orthopnea Bradypnea Tachypnea Hypoventilation Hyperventilation Apnea These are examples of what?
Irregular breathing patterns
Regular pattern of increased respirations followed by progressively more shallow respirations until apnea occurs.
This is defined as?
Cheyne-Stokes
3-4 normal breaths with irregular periods of apnea.
This is defined as?
Biot’s
This is a symptom of chronic hypoxia due to pulmonary or cardiac disease. what is this defined as?
Clubbing nails
This is a late sign of hypoxia. PO2<40 (norm 80-100) What is this defined as?
Cyanosis
Central: tongue, soft palate, conjunctiva most indicative.
Peripheral: (nailbeds, earlobes) often sign of vasoconstriction.
Use these locations to check for?
Cyanosis
Besides hypoxia, what conditions may increase respiratory rate?
Check Module 8 Respiratory voiceover
When you assess a patient you are checking for skin that is dusky, cool & clammy – why?
Check Module 8 Respiratory voiceover
Splinting of respirations can occur due to?
Pain
Abnormal sounds that are superimposed on underlying breath sounds.
What is this defined as?
Adventitious Sounds
Name three examples of adventitious blood sounds?
Crackles (Rales)
Wheezes
Rhonchi (Gurgles)
COPD, chronic bronchitis occur with what kind of crackles? what disease process is this common in?
Early inspiratory crackles in obstructive disease
pneumonia, CHF occur with what kind of crackles? what disease process is this common in?
Late inspiratory in restrictive disease
This type of abnormal breath sound occurs due to narrow airways?
Wheezes
This type of abnormal breath sound occurs primarily during expiration.
Coughing may clear.
Ronchi (Gurgles)
10 types of diagnostic tests for respiratory issues?
EKG Chest X-Ray CBC Sputum Skin Tests ABGs Pulmonary Function Tests (PFTs) Computerized Tomography (CT scan) Bronchoscopy Lung Scan
Why would you order an EKG in a patient with respiratory issues?
to rule out cardiac etiology.
Why would you order an Chest X-Ray in a patient with respiratory issues?
to diagnose emphysema, tumors,
valley fever, TB
Why would you order a CBC in a patient with respiratory issues?
anemia, polycythemia, infection, allergies
Why would you order a sputum sample in a patient with respiratory issues?
C&S to ID organism
Why would you order an ABG in a patient with respiratory issues?
measure oxygenation, CO2 levels, ventilation, acid-base balance
Why would you order a skin test in a patient with respiratory issues?
TB (PPD) & Valley fever (coccidiomycosis)
Why would you order a Pulmonary Function Test in a patient with respiratory issues?
Measures lung volumes, airspeed & ease of airflow.
Strength of respiratory muscles.
Why would you order a Computerized Tomography (CT Scan) in a patient with respiratory issues?
To diagnose COPD, PE, lung cancer,
What is the difference between a CT scan and a spherical CT scan?
CT: 2D
Spherical CT: 3D
Why would you order a Bronchoscopy in a patient with respiratory issues?
examine tissue, biopsy, remove mucous plugs, collect sputum
What is important to remember when performing a bronchoscopy ?
NPO until gag reflex returns
Why would you order a Lung Scan (Nuclear Medicine) in a patient with respiratory issues?
Measure VPS or V/Q (Ventilation/Perfusion)
Diagnose or Rule Out Pulmonary Embolism
Ineffective airway clearance Ineffective Breathing Pattern Impaired Gas Exchange Activity Intolerance, Self-care deficit Anxiety Fatigue Powerlessness, Social Isolation This is what part of the nursing process?
Diagnosis
Maintain patent airway.
Improve comfort and ease of breathing.
This is what part of the nursing process?
Goals (Outcomes)
Maintain or improve ventilation and oxygenation.
Reduce/prevent risks associated with oxygenation problems such as skin and tissue breakdown, syncope, acid-base imbalance, hopelessness, isolation.
This is what part of the nursing process?
Goals (Outcomes)
Assessment
Therapeutic
Educational
Referral
Interventions for respiratory patients?
See Module 8 Respiratory Voiceover
What are possible complications of URI?
See Module 8 Respiratory Voiceover
Examples of Upper Respiratory Infection includes?
Common cold
Acute Viral rhinitis
Upper Respiratory Infection commonly occur because of these two reasons?
Bacteria/virus invades upper airway.
Immune/inflammatory Response
Immune/inflammatory Response occurs due to?
Swelling of infected tissue, increased mucous.
What are s/sx that a Bacteria/virus has invaded a patient’s upper airway?
See Module 8 Respiratory Voiceover
What are three common interventions for all URIs?
Rest
Fluid & nutrition
Meds
What should be documented & reported when using interventions for URIs?
See Module 8 Respiratory Voiceover
Why is rest an important intervention for a URI?
See Module 8 Respiratory Voiceover
Influenza Virus:
What are S/Sx?
How long do sx last if uncomplicated?
What complications may occur?
See Module 8 Respiratory Voiceover
Who should get a yearly flu shot?
What type of treatment is needed for Influenza Virus?
See Module 8 Respiratory Voiceover
This illness has a significant morbidity and mortality with most deaths occurring in people over 60.
36,000 deaths per year in 2008.
Influenza Virus
_________ results from beta-hemolytic streptococcal invasion.
Strep throat
What are s/sx strep throat (pharyngitis) ?
What are possible complications if untreated?
See Module 8 Respiratory Voiceover
For URI’s:
Warm salt water gargles, lozenges
Throat culture, antibiotics if bacterial only (Why?)
This is what part of the nursing process?
Intervention
See Module 8 Respiratory Voiceover
Acute inflammation of pharynx (pharyngitis)
Cause & signs and symptoms?
See Module 8 Respiratory Voiceover
Laryngitis is caused by?
Virus
S/S: Hoarseness, Sore throat, Nasal congestion.
Self limiting without long-term harm.
Treat symptoms with voice rest, fluids, and humidified air
This is common is what illness?
Laryngitis
May also be caused by bacteria: Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, or dental infections.
If not treated may cause meningitis, brain abscess and/or osteomyelitis
This occurs in what illness?
Acute Sinusitis
Frequently develops as a result of an URI (particularly viral)
What are common s/sx?
Acute Sinusitis
See Module 8 Respiratory Voiceover
This is what part of the nursing process?
Finished at Page 36 on Module 8 Respiratory
