new test Flashcards
aging adults don’t have what? (the capacity stays the same)
decreased lung capacity
older adults - a decline in elasticity of the (thorax)
bony thorax
older - alveoli gas exchange and surface area?
decrease in alveolar gas exchange surface
older adult - compliance and elasticity?
an increase in parenchymal compliance decreasing elastic recoil of the lungs and ultimately a change in structure and function of the chest wall due to a loss of intervertebral spaces
older adult? do you feel stiff?
stiffening of the chest wall from changes in ribs, sternum and articular cartilages making the chest less expansible
bronchetitis caused by
Airway obstruction, pulmonary infections
Diffuse airway injury
Genetic disorders
Abnormal host defenses
Idiopathic causes
speaking trach - cuff deflated or not?
deflate cuff
cuffless tracheostomy
tube does not have a cuff (balloon like feature) at the end of the tube. If the patient does not require that the air from the ventilator is monitored and measured and is able to tolerate cuff deflation without respiratory distress, then a cuffless tracheostomy tube may be place
fenestrated tracheostomy tube
fenestrated tracheostomy tube is a type that has an opening in the tube above the cuff, which allows air to enter so that the patient is able to speak with the tube in place.
cuff is inflated if
It is used if the patient is at risk of aspiration or needs mechanical ventilation.
use cuffless
When the patient can protect the airway from aspiration and does not require mechanical ventilation.
Diaphragmatic excursion
5-7 cm
Dullness - purcussion
Dullness → pneumonia
Flatness → percussion (effusion is lying flat)
Flatness → pleural effusion
Hyperresonance → (hollow, nothing there)
emphysema, pneumothorax
crackles (HF and edema crack me up)
Associated w/ heart failure and pulmonary edema
course crackles (of course Rhonda is obstructing the door)
Obstructive pulmonary disease
Fine crackles (I was fine with pneumonia, but restricted)
Fine crackles: soft high pitched, interstitial pneumonia, restrictive pulmonary disease
wheezing (wheezy has bronchitis)
partially obstructed airway + chronic bronchitis or bronchiectasis
Bronchophony (bronchophony on blast)
Bronchophony → vocal resonance that is more intense and clearer than norma breath sounds, pneuomia or atelectisis
egophony →
egophony → voice sounds that are distorted
left sided heart failure
Increased pressure in the pulmonary veins causes congestion and interstitial edema (around the alveoli); bronchial mucosa may become edematous.
left sided heart failure lung sounds (left-sided HF cracks me up)
crackles
COPD
Slowly progressive disorder in which the distal airspaces enlarge and lungs become hyperinflated.
during asthma attack what do the lungs do?
air flow decreases lungs hyperinflate.
broncoscopy - when to withhold food?
Food and fluids witheld 4-8 hrs prior to reduce aspiration risk
broncoscopy post procedure - and in older pts?
VS, O2 sat, breath sounds, observe LOC, airway, sputum, gag/cough reflex prior to any oral intake → ice chips → fluids. In older pts assess for lethargy and confusion
early symptoms of hypoxemia
Early: mental status changes, altered LOC, increased RR, HR, BP
Tripod position can help expand lungs
late symptoms of hypoxemia
Late signs of hypoxemia:
Rapid RR and HR progresses to cardiopulmonary arrest
Cyanosis
Loss of mm control
atalectisis symptoms (addy spits with a fever)
slow and gradual: increasing dyspnea, cough, sputum production, low grade fever, tachycardia, tachypnea, pleural pain, central cyanosis
atalectisis sounds
Decreased breath sounds and crackles
asthma patho (I’ME MEB)
Allergen sensitizes IGE antibody
Mast cells are activated: eosinophils follow
Mediators are released
Edema and bronchospasm are result
what causes empyemas?
Most empyemas occur as complications of bacterial pneumonia or lung abscess.
empyemas lung sounds
Chest auscultation demonstrates decreased or absent breath sounds over the affected area, and there is dullness on chest percussion as well as decreased fremitus.
empyema diagnosis
The diagnosis is established by chest CT. Usually, a diagnostic thoracentesis is performed, often under ultrasound guidance.
