Exam 1

Question 1

Define ventilation

Answer 1

Ventilation: movement of air in and out of the airways

Question 2

Name the 6 structures of the larynx

Answer 2

Epliglottis, glottis, thyroid cartilage, cricoid cartilage, arytenoid cartilage, vocal cords

Question 3

Name 3 functions of the larynx

Answer 3

Vocalization
Protects the lower airway from foreign substances
Facilitates coughing

Question 4

Describe pleura

Answer 4

A serous membrane that lines the lungs and wall of the thoracic cavity.
Visceral pleura lines the thoracic cavity (lateral wall of the medistinium, diaphragm and inner aspect of the ribs).
There is pleura fluid between the Visceral and parietal pleura that serves to lubricate the thorax and the lungs to permit smooth motion of the lungs within the thoracic cavity during inspiration and expiration

Question 5

Name the 3 types or alveolar cells

Answer 5

Type 1, type 2. Type 3

Question 6

Describe the functions of the 3 types or alveolar cells

Answer 6

Type 1: account for 95% of alveolar surface area and serve as a barrier between air and alveolar surface.
Type 2: accounts for only 5% of this are responsible for producing type 1 cells and surfactant (surfactant reduces surface tension, improving overall lung function)
Type 3: are alveolar macrophages which are phagocytic cells that ingest foreign matter, providing an important defense mechanism.

Question 7

Define dypsnea

Answer 7

Subject experience that describes difficulty breathing. SOB

Question 8

Orthopnea

Answer 8

SOB when king flat; relieved by sitting or standing

Question 9

Clubbing

Answer 9

Changes in the normal nail bed. Appears as sponginess of the nail bed and loss of nail bed angle. Sign of lung disease in patients with chronic hypoxic conditions, chronic lung infections or malignancies of the lungs. Also seen in CHF and other chronic infections and inflammatory conditions

Question 10

Barrel chest

Answer 10

Occurs as a result of over inflation of the lungs, which increases the anerposterior diameter of the thorac. Occurs with aging and is a hallmark sign of emphysema and COPD.

Question 11

Bradypnea

Answer 11

Slower than normal rate (less than 10bpm), with normal depth and regular rhythm. Associated with increased ICP , brain injuries and drug OD.

Question 12

Hyperpnea

Answer 12

Increased depth of respirations

Question 13

Kussmaul

Answer 13

Hyperventilation with very deep, unlabored respiration. Compensation for metabolic acidosis. Commonly due to DKA

Question 14

Apnea

Answer 14

Period of cessation of breathing. Time varies. May occur briefly during other breathing disorders. Life threatening if sustained

Question 15

Cheyne-stokes

Answer 15

Regular cycle where the rate and depth of breathing increases, then decreases until apnea (usually 20 seconds) occurs. Duration of apnea may vary and progressively in length, therefore it is timed and reported. Associated with HF and damage to the respiratory center (drug induced, tumor, trauma)

Question 16

What are the 4 types of sputum and what do they reflect?

Answer 16

Purulent: consisting of containing or discharging pus. Sign of bacterial infection.
Pink-tinged: suggest lung tumor.
Frothy, pink: may indicate pulmonary edema
Foul smelling: may indicate lung abscess, bronchiectasis, or an infection caused by fusospirochetal or other anaerobic organisms

Question 17

Describe the genetic influences on the respiratory system. Identify the single most important contributor to lung disease

Answer 17

Genetic influences on the respiratory system: asthma, COPD, cancer, cystic fibrosis, alpha 1 anyitrypsin deficiency, primary cilia dyskinesia, pulmonary fibrosis. Pulmonary hypertension, tuberose sclerosis.

Smoking is the single most important contributer to lung disease

Question 18

respiratory acidosis

Answer 18

pH: 7.35 below
PaCO2: above 45

Question 19

respiratory akalosis

Answer 19

pH above 7.45

PaCO2: below 35

Question 20

metabolic acidosis

Answer 20

pH: less than 7.35
HCO3: less than 22

Question 21

Metabolic alkalosis

Answer 21

pH: above 7.45
HCO3: above 26

Question 22

respiratory acidosis signs and symptoms

Answer 22

hypoventilation-hypoxia
lethargy
dizziness
confusion/delerium
SOB, RR decreased to <12 BPM
hyperkalemia, dysrhythmias
decrease BP

Question 23

Respiratory acidosis interventions

Answer 23

raise head of bed to 30 degrees (except with Spinal cord injuries)
apply O2 ( nasal canula, BiPAP, CPAP)
mechanical vent
bronchodilators
hydration
abx for pneumonia
hold drugs that cause respiratory depression
monitor potassium levels

Question 24

respiratory alkalosis signs and symptoms

Answer 24

tachycardia, tachypnea/hyperventilation, dizziness, light headedness, hypokalemia, tetany, anxiety, irriitability, seizures

Question 25

respiratory alkalosis interventions

Answer 25

slowing respirations- teach breathing techniques
kidneys will compensate with time
breathe into a paper bag to rebreathe CO2
tranquilizers, fever reducers, monitor potassium and calcium, make sure mechanical vent settings are correct

Question 26

Allen test

Answer 26

used to assess patency of radial and ulner arteries.

make a fist, press on ulner and radial arteries to obstruct blood flow

Question 27

pH normal values

Answer 27

7.35-7.45

Question 28

PaCO2 normal values

Answer 28

35-45

Question 29

HCO3 normal values

Answer 29

22-26

Question 30

metabolic acidosis signs and symptms

Answer 30

diarrhea, kussmaul respirations, fruity breath, shock, hypotensive-decreased BP, headache, warm-flushed skin

Question 31

metabolic alkalosis signs and symptoms

Answer 31

slow shallow breathing, vomiting, fatigue, tetany, ekg changes

Question 32

metabolic acidosis interventions

Answer 32

treat the dka treat dehydration, monitor potassium levels, watch for respiratory distress,

Question 33

metabolic alkalosis interventions

Answer 33

treat vomiting, d/c NG suctioning, stop diuretics, restore fluid volume

Question 34

antihistamines

Answer 34

action: block histamines release during allergic reaction, reducing mucous secretions.
example: benadryl, claritin, allegra
side effects: sedation, anticholinergic effects ( dry mouth, constipation, urinary retention), avoid hazardous activities, alcohol, do not use in the 3rd trimester or breastfeeding

Question 35

expectorants

Answer 35

Action: liquefies secretion by increasing mucous production allowing expectoration of secretions.
example: guaifenesin (mucinex)
side effects: GI upset, drowsiness, allergic reaction
Teaching: increase fluid intake, take with food, consult with physician if breastfeeding

Question 36

mucolytics

Answer 36

Action: liquefies secretions and facilitates cough
Example: acetylctsteine ( mucomyst)
side effects: bronchospasms-use cautiously in asthma patients, may aspirate with oral dose
teaching: can also be used for acetaminophen overdose, smells like rotten eggs

Question 37

non-opioid antitussives

Answer 37

Action: derived from opioids, so suppresses cough through its action on the CNS
Example: Robitussin
Side Effects: few- may cause dizziness
teaching: some formulations may contain alcohol and/or sucrose

Question 38

opioid Antitussives

Answer 38

action: suppresses cough through its action on the CNS
Examples: codiene, hydrocodone
Side Effects: CNS depression, respiratory depression, constipations, risk for abuse, dizziness,
Teaching: avoid hazardous activities, avoid alcohol and other CNS depressants, take with food, safety precautions if dizzy, change postitions slowly

Question 39

glucocorticoids

Answer 39

Action: prevention inflammation, suppress mucous production
Example: inhaled: beclomethasone Oral: prednisone
Side Effects: candidiasis, adrenal gland suppression, bone loss, hyperglycemia, PUD, infection, hypokalemia, fluid retention
teaching: inhaled: rinse mouth after use to prevent candidiasis
Oral: taper dose, use cautiously with NSAIDS