gas exchange

Question 1

Thorax

Answer 1

Thorax Extends from the base of the
neck superiorly to the level of the
diaphragm inferiorly
Thoracic cavity contains the
respiratory components

Question 2

sternum

Answer 2

lies in the center of the chest
anteriorly
has three parts:
* Manubrium, the body, xiphoid
process
12 pairs of ribs—thoracic cage

Question 3

lungs

Answer 3

Apex-extends slightly above the
clavicle
Base- level of the diaphragm
Right lung has 3 lobes
Left lung has 2 lobes
Trachea-air is transported to and
from lungs

Question 4

pleura

Answer 4

thin, double-layered serous membrane that lines the thoracic cavity

Question 5

mediastinum

Answer 5

central area in the thoracic cavity

Question 6

anterior chest

Answer 6

midsternal, right and left midclavicular lines

Question 7

posterior thorax

Answer 7

vertebral line, right and left scapular lines

Question 8

lateral thorax

Answer 8

midaxillary line, anterior and posterior axillary lines

Question 9

breathing

Answer 9

–Automatic
–Diaphragm-primary muscle of inspiration

Question 10

inspiration

Answer 10

Inspiration -muscles contract and thorax expands

Question 11

expiration

Answer 11

Expiration – muscles relax, thorax contracts

Question 12

accessory muscles

Answer 12

used when there is
extra work of breathing required
 Sternocleidomastoids
 Scalenes
 Abdominal muscles

Question 13

structures that make up the gas exchange system

Answer 13

 Trachea: Lined with ciliated and mucus-
producing epithelium
 Bronchi are the two branches of the trachea
that attach to the right and left lung
 Bronchioles are lined with muscles that
control the flow of air into the alveoli.
 Lungs are multi-lobed organs that are the
center of the respiratory system
 Alveoli are the primary site of gas exchange

Question 14

primary site of gas exchange

Answer 14

alveoli

Question 15

trachea

Answer 15

lined with ciliated mucous producing epithelium

Question 16

what are the two main branches of the trachea

Answer 16

bronchi

Question 17

are lined with muscles that control the flow of air into the alveoli

Answer 17

bronchioles

Question 18

order of assessment

Answer 18

1. History
2. Inspection/Observations
    Subjective
    Objective
3. Palpation
   Tactile fremitus
   Symmetric Chest Expansion
4. Percussion

Question 19

subjective data collection

Answer 19

History of present health concern—COLDSPA
 Dyspnea: difficulty breathing
 When did it start? gradual onset may signify lung changes
 Is it continuous? may represent copious sputum
 You do need to sleep on more then one pillow? Is there fluid in the lung
 Orthopnea- difficulty breathing when laying flat- may signal heart failure (CHF)
 Do you snore? May signal sleep apnea
 Other symptoms –
 Cough – productive or non-productive
 Sputum – what color and consistency?
 Fatigue – worse with activity?
 Chest pain – emergency until proven otherwise

Question 20

past health history

Answer 20

Surgeries – can change lung expansion
and lung sounds
allergies – may have S/S of cough, SOB,
hoarseness
Medications or treatments- breathing
treatments, oxygen
* Some meds may cause cough: beta
blockers, ACE inhibitors

Question 21

family history

Answer 21

Lung disease?
Smokers in the home – secondary
smoke increases risk of lung cancer

Question 22

lifestyle

Answer 22

Smokers in the home
Work environment – exposure to
inhalants, paint, pollution, asbestos

Question 23

tripod position

Answer 23

 Tripod position seen in COPD
 Client leans forward
 Uses arms to support weight
 Lifts chest to increase breathing capacity

Question 24

inspection-general/posterior

Answer 24

 Observe color of face, lips and nailbeds- observe for pallor or cyanosis
 Inspect for nasal flaring or pursed lips – may indicate dyspnea
 Inspect posterior thorax first:
 With patient sitting and arms at side:
 Position of scapulae and the shape and configuration of the chest wall
 Deviation of spine may indicate scoliosis
 Barrel chest- may indicate emphysema

Question 25

inspection

Answer 25

Observe quality and
pattern of respiration
Breathing
characteristics: rate,
rhythm, and depth
Labored and noisy
breathing
Inspect intercostal
spaces.
Ask the client to
breathe normally and
observe the intercostal
spaces.
Observe for use of
accessory muscles.

Question 26

anterior inspection

Answer 26

Have the patient sit with arms at sides and assess chest for:
 Symmetry – should be equal
 Equal rise and fall of the chest
 Respiration – should be easy and regular rhythm
 Accessory muscle use- neck muscles or intercostal muscles
(ABNORMAL)

Question 27

palpation

Answer 27

 Tenderness and sensation
 Crepitus: crackling sensation (seen when air
escapes lung and is in the subcutaneous
space)
 Palpate in a systematic sequence

Question 28

palpation of lower thorax

Answer 28

 Place hands on posterior chest wall
at the level of T9-T10 and feel for equal rise
and fall of the chest.
 Unequal chest rise and fall could indicate
Pneumonia, trauma or lung collapse.

Question 29

tactile fremitus

Answer 29

 Vibrations felt by hand during palpation
 Place open palm edge on skin
 client repeats 99
 Should feel equal vibration bilaterally
 Decreases if sound transmission is obstructed by consolidation (pneumonia or sputum)

Question 30

auscultation of the lungs

Answer 30

Auscultate for breath sounds
Auscultate posteriorly first.
Do not attempt to listen through clothing or other materials.
Always begin with the diaphragm of the stethoscope.
Ask the patient to breathe deeply through the mouth.
Always listen to ONE complete respiratory cycle at each location.
If you note adventitious breath sounds, have the patient cough and re
-listen.

Question 31

posterior auscultation

Answer 31

Listen for a full respiratory
cycle at each site.
 Be aware of the patient
getting dizzy due to
breathing patterns.
 Are sounds normal or
abnormal (adventitious).

Question 32

palpation of anterior thorax

Answer 32

 Tenderness and sensation
 Crepitus: crackling sensation (seen when air escapes lung and is
in the subcutaneous space)
 Palpate in a systematic sequence

Question 33

percussion

Answer 33

 Percussion is an assessment technique where the examiner produces sounds by tapping on the
patient’s chest wall.
 Percussion can help to determine if the underlying tissues are filled with fluid, air or solid material.
 Utilized in advanced health assessment.

Question 34

tracheal lung sounds

Answer 34

very loud high pitched, heard over the trachea. inspiratory and expiratory lung sounds equal

Question 35

bronchial lung sounds

Answer 35

loud relatively high pitched, over the manubrium, inspiratory sound shorter than expiratory

Question 36

bronchovesticular

Answer 36

medium loudness, sounds equal, between the sternum and scapula

Question 37

vesticular

Answer 37

soft low pitch, inspires longer than expires, most of lung fields

Question 38

Rales

Answer 38

• Otherwise known as CRACKLES
• Small clicking, bubbling or rattling sounds
• Occurs when air passes through fluid or mucous

Question 39

rhonchi

Answer 39

• Snoring sound more continuous then rales
• Occurs when air passes through narrow passage with secretions /

Question 40

wheezes

Answer 40

:
* High pitched sound produced by narrowed airways
* May be inspiratory or expiratory

Question 41

stridor

Answer 41

• Loud, high pitched wheeze in the upper airway
• Seen in children with croup, epiglottitis, pertussis
• Many times may be heard without a stethoscope

Question 42

kussmaul

Answer 42

Kussmaul is
typically seen in
diabetic
ketoacidosis.
fruity breath
Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis

Question 43

biots

Answer 43

abnormal breathing pattern

Question 44

cheyne stokes

Answer 44

periods of apnea The pattern involves a period of fast, shallow breathing followed by slow, heavier breathing and moments without any breath at all, called apneas.

Question 45

lung cancer risk factors

Answer 45

Cigarette
smoking/sec
ond-hand
smoke
Genetic
predispositio
n
Exposure to
toxins
History of
previous
lung cancer
Gender
Asbestos,
radon, and
environment
al exposure
Workplace
pollutants
History of
Hodgkin
disease

Question 46

what is the leading cause of death in the united states and europe

Answer 46

Cigarette
smoking/sec
ond-hand
smoke
Genetic
predispositio
n
Exposure to
toxins
History of
previous
lung cancer
Gender
Asbestos,
radon, and
environment
al exposure
Workplace
pollutants
History of
Hodgkin
disease

Question 47

lung cancer prevelaince

Answer 47

More men than women affected Black men have higher
incidence and mortality rates
than white males
In 2011, 82% of those living
with lung cancer were 60 years
or older

Question 48

reduce risk of lung cancer

Answer 48

Avoid smoking cigarettes or
join a tobacco cessation
program if you do smoke.
Check for occupational or
home exposure to asbestos
or radon (have a radon
check of your house or office
if necessary).
Avoid second-hand smoke
exposure.
Seek a medical assessment
for respiratory symptoms
such as prolonged cough or
pain in the chest area

Question 49

risks of exposure to smoke

Answer 49

 Children and Infants:
 Frequent and severe asthma attacks, respiratory infections, ear
infections, and sudden infant death syndrome (SIDS).
 Pregnancy:
 Maternal cigarette smoking correlates with an increased incidence of
perinatal mortality, preterm delivery, premature rupture of
membranes, abruptio placentae, stillbirth, and bleeding during
pregnancy,
 In the fetus: decreased fetal size, low birth weight, and SIDS
 Adults:
 Nasal irritation, coronary heart disease, stroke, and lung cancer
 Breathing secondhand smoke can have immediate adverse
effects on your blood and blood vessels, increasing the risk of
having a heart attack.

Question 50

chronic heart failure or CHF

Answer 50

Dyspnea Cough with pink,
frothy sputum Orthopnea Crackles Low oxygen
saturation Pitting edema
Assessment
CAD / MI Cardiomyopathy (enlarged
heart) Valvular disease Hypertension
Causes:
Left-sided: left ventricular failure Right-sided: right ventricular failure
Inability of the heart to pump sufficient blood resulting in fluid backup in the lungs

Question 51

pneumonia

Answer 51

Inflammation of the lung caused by infection or
viruses

Fever Chest pain (pleuritic) Dyspnea with
tachypnea
Purulent sputum /
productive cough
Assessment:Assessment:
Infection Virus May be community acquired
or hospital acquired

Question 52

risk of pneumonia

Answer 52

 People most at risk are infants and young children, adults 65 or older
 Chronic lung diseases such as COPD, bronchiectasis, or cystic fibrosis that make the lungs more
vulnerable
 Heart disease, diabetes and sickle cell disease.
 Difficulty swallowing
 due to stroke, dementia, Parkinson’s disease, or other neurological conditions, which can result in aspiration of
food, vomit or saliva into the lungs that then becomes infected.
 Hospitalizations
 Smoking
 Drug and ETOH abuse
 Exposure to certain chemicals, pollutants or toxic fumes

Question 53

tuberculosis

Answer 53

TB is an airborne bacterial infection caused by the organism Mycobacterium tuberculosis that primarily
affects the lungs
 In the United States, TB is much less common and can almost always be treated and cured if you take
medicine as directed
 Can lead to long-lasting permeant lung damage
S/S include:
 weakness, weight loss, fever, and night sweats, coughing, chest pain, and the coughing up of blood
Immunization:
 Bacille Calmette-Guérin (BCG) is a vaccine for tuberculosis (TB) disease
 BCG vaccination should only be considered for children who have a negative TB test and who are continually
exposed, and cannot be separated from adults
 Healthcare workers who care for a large percentage of TB pts.

Question 54

asthma

Answer 54

Assessment
Allergies Airway irritants Stress
Common in children
Dyspnea Cough Wheezing – airway
constriction
Dyspnea Cough Wheezing – airway
constriction
common in children
airway irritation

Question 55

RSV

Answer 55

Fever Runny nose Chest congestion Dyspnea / Wheezing /
Retractions
common lower respiratory tract virus in children
very contagious

Question 56

older adult considerations

Answer 56

Tenderness or pain at the costochondral junction of
the ribs is seen with fractures, especially in older
clients with osteoporosis.
Older adults may experience dyspnea with certain
activities related to aging changes of the lungs (loss
of elasticity, fewer functional capillaries, and loss of
lung resiliency).
Chest pain related to pleuritis may be absent in older
clients because of age-related alterations in pain
perception.
The ability to cough effectively may be decreased in
the older client because of weaker muscles and
increased rigidity of the thoracic wall.

Question 57

health history in pediatric clients

Answer 57

*Does your infant become fatigued or short of breath during
feedings? May be a sign of congenital heart defect
*Has your child had vaccinations?
Influenza / Pertussis : have respiratory S/S
* Any exposure to secondhand smoke?

Question 58

physical exam in children

Answer 58

*Children under 7 are usually abdominal breathers
*Retraction or nasal flaring are clear signs of respiratory distress
*Children who are acutely ill many times present with respiratory
complaints
*Children compensate and appear well longer than adults do
however, when they de-compensate a child can rapidly decline.
*Respiratory distress in a child is always an EMERGENCY.
*Croup- common respiratory virus in children. Sounds like a “barking
seal”.