Exam 2 Flashcards
Explain the mechanics of respiration:
- Bronchi split at base of trachea with one entering each lung and divide into tiny passages called bronchioles
*Alveoli’s (air sacs) at the end of each bronchiole have capillaries filled with RBC’s containing hemoglobin
*Diffusion occurs between O2 in alveoli and CO2 in capillaries
*O2 rich hemoglobin is transported though the bloodstream
*CO2 is exhaled
*Lung infections
*SOB
*Low oxygen level
*Abnormal breathing patterns
What subjective data would you collect regarding respiratory health?
*PQRSTU: Provocation, quality, region, severity, timing, understanding
*Cough
*SOB
*Chest pain
*History of respiratory health
*Smoking history
*Environmental conditions
*Self-care behaviors
*Privacy considerations
How do you protect client modesty during a respiratory assessment?
*Keep them as covered as possible during examination
*Maintain privacy
What is a normal breathing pattern?
10-20 breathes per minute with even pattern
What are the abnormal breath sounds (Adventitious Sounds)?
*Crackles
*Pleural Friction Rub
*Wheeze
*Stridor
What are crackles?
Popping sound heard over inspiration when there’s fluid in the lungs
*Fine Crackles: Short, high pitched crackling not cleared by coughing and heard during early or late inspiration
*Course Crackles: Loud, low pitched bubbling and gurgling early in inspiration
What is a pleural friction rub?
Course, low pitched with grating quality of two pieces of leather rubbing together. Heard on inspiration and expiration when pleurae become inflamed and lose normal lubricating fluid.
What is wheezing?
*High Pitched Wheezing: During expiration and caused by diffuse airway obstruction from acute asthma of chronic emphysema.
*Low Pitched Wheezing: During expiration, somewhat cleared by coughing and caused by bronchitis or single bronchus obstruction from airway tumor.
What is stridor?
High pitched inspiratory crowing sound that is louder in neck than over chest. Comes from larynx or trachea and is upper airway obstruction from swollen inflamed tissues or legged foreign object.
Tachypnea:
Rapid shallow breathing with respiratory rate of 24 breaths per minute or faster.
*Normal response to fever, fear, or exercise or with respiratory insufficiency, pneumonia, alkalosis, pleurisy, lesions
Bradypnea:
Respiratory rate less than 10 breaths per minute
*Can be from drug induced depression of respiratory center of medulla, increased intracranial pressure, or diabetic coma
Hyperventilation:
Increased rate and depths of breathing. Occurs with fear, anxiety, diabetic ketoacidosis, hepatic coma, salicylate overdose, lesions of the midbrain, alteration in blood gas concentration
Hypoventilation:
Irregular shallow breathing pattern caused by overdose, narcotics, anesthetics, prolonged bed rest or splinting of chest
Cheyenne-Stokes:
Respirations gradually wax and wane in regular pattern increasing in rate and depth then decreasing. Breathing periods last 30-45 seconds with apnea up to 20 seconds. Common cause is heart failure, renal failure, meningitis, drug overdose, increased intracranial pressure.
Chronic Obstructive Breathing:
Normal inspiration and prolonged expiration to overcome increased airway resistance.
*Chronic Obstructive Lung Disease: Any situation calling for increased heart rate may lead to dyspneic episodes because person doesn’t have enough time for full expiration.
What are the different chest shapes and their clinical significance?
*Elliptical Shape: Normal
*Barrel Shape: Ribs horizontal instead of downward slope - aging, COPD, asthma - hyperinflation of the lungs
*Kyphosis: Exaggerated posterior curvature of thoracic spine (humpback) - aging, postmenopausal osteoporotic women
*Scoliosis: S shaped curvature of thoracic and lumbar spine
What is a healthy percussion note?
*Low pitched, clear, hollow sound for healthy lung tissue
*Flat sound over scapula
*Dull over organs
Bronchial Sounds:
*Heard over trachea and larynx
*Expiration is heard longer than inspiration and are not heard on the posterior side
Bronchiovesicular Sounds:
*Heard over the main bronchi
*Inspiration and expiration are about equal in loudness and time
Vesicular Sounds:
*Heard over peripheral lung fields where air flows through the smaller bronchi
*Inspiration is heard louder and longer than expiration
Pleural Effusion:
Excess fluid in inter pleural space with compression of overlying lung tissue
CM: Dyspnea, increased respirations, absent breath sounds, crackle or pleural rub, dull percussion
Pulmonary Embolism:
Undissolved material that originates in leg or pelvis, detaches, and travels in venous system occluding pulmonary vessels.
CM: Chest pain worse on inspiration, dyspnea, restless, anxiety, mental status change, cyanosis, tachypnea, cough, pulse oximetry less than 80%, crackles, and wheezing
Heart Failure:
CM: Increased respiratory rate, dyspnea on exertion, orthopnea, paroxysmal, nocturnal dyspnea, nocturia, ankle edema, pallor - S3 sounds and crackles
Vital Capacity:
Maximum amount of air a person can expel from lungs after first filling the lungs to maximum
Tidal Volume:
Amount of air that moves in or out of lungs with each respiratory cycle
Inspiratory Volume:
Amount of air that can be forcibly exhaled after a normal tidal volume
Blood flow through the heart:
*Body
*To Superior and inferior vena cava returning unoxygenated blood
*To right atrium
*Through tricuspid valve
*To right ventricle
*Through pulmonary valve
*To pulmonary arteries
*To the lungs
*To pulmonary vein which returns oxygenated blood
*To left atrium
*Through mitral valve
*To left ventricle
*Through aortic valve
*To Portia
*To body
What are the phases of the cardiac cycle?
Diastole and Systole
What is the protodiastolic phase?
First part of diastole, when all chambers of the heart are relaxed and blood fills the ventricles with passive filling. AV (Tricuspid and Mitral) valves are open and semilunar valves (Aortic and Pulmonary Valves) are closed - S3 sound
What is diastole?
Occurs when ventricles relax and fill with blood
*Made up of Protodiastolic phase and Atrial Systoles of Pre-Systole Phase
What are the atrial systoles of the pre systole phase?
Second part of diastole, when atria contract and push last amount of blood into ventricles. Active filling. AV valves open and semilunar valves closed - S4 sound.
What is systole?
Heart muscle contracts and pumps blood from the chambers to the arteries.
What are the phases of systole?
*Begins when blood pressure in ventricles causes AV valves to shut - creating S1 sound.
*Ventricular isovolumetric contraction: When all 4 valves are closed ventricles begin to contract which raises ventricular pressure even more until pressure is high enough to open semilunar valves.
*Ejection: When semilunar valves open and blood is ejected from ventricles to body via aortic valve and aorta or to the lungs via pulmonic valve and pulmonary artery. Come blood falls back towards semilunar valves triggering them to shut, this ends systole - S2 sound heard.
What subjective data would you gather in cardiovascular assessment?
*Chest pain
*Cough
*Fatigue
*Cyanosis
*Pallor
*Nocturia
*Past Cardiac History
*Risk Factors
*Family History
S1 Heart Sound:
When A/V valves close at the beginning of systole - lub sound loudness at apex of heart
S2 Heart Sound:
When semilunar valves close at end of systole - dub sound loudest at base of heart - split S2 can be normal