NUR 240 E3 ch 17 resp assessment Flashcards
4 functions of respiratory system
Oxygen transport
respiration
ventilation
gas exchange
the two tracts:
Upper respiratory tract: warms and humidifies air
lower respiratory tract: (lungs) gas exchange
both tracts are responsible for ventilation
paranasal sinuses
frontal, ethmoid, sphenoid, maxillary
function: serve as a resonating chamber in speech
Pharynx, tonsils and adenoids
Pharynx (throat) is divided into three regions: nasopharynx (posterior to nose, above soft palate), oropharynx (houses the palatine tonsils), laryngopharynx (extends from hyoid bone to cricoid cartilage
adenoids: pharyngeal tonsils, located on the roof of the nasopharynx
epiglottis forms the entrance to the larynx
Larynx (voice box) structures
connects the pharynx and trachea
Epiglottis: a valve flap of cartilage that covers the opening to the larynx during swallowing
Glottis: the opening between the vocal cords in the larynx
Thyroid cartilage: the largest of the cartilage structures; part of it forms the Adam’s apple
Cricoid cartilage: the only complete cartilaginous ring in the larynx (located below the thyroid cartilage)
Arytenoid cartilages: used in vocal cord movement with the thyroid cartilage
Vocal cords: ligaments controlled by muscular movements that produce sounds; located in the lumen of the larynx
Larynx function
produces sound, protects the lower airway from foreign substances and facilitates coughing
“watchdog of the lungs”
Lower respiratory tract structures
two lungs:
- right lung: 3 lobes
- left lung: 2 lobes
pleura (visceral-lungs, parietal-thoracic cavity): lubricates thorax and lungs
Mediastinum: middle of the thorax, between pleural sacs that contain the lungs
Bronchi and bronchioles
Alveoli- oxygen and CO2 exchange takes place here
Is it better to listen to the lungs anteriorly or posteriorly?
posteriorly
Oxygen transport
oxygen diffuses from the capillary through capillary wall to the interstitial fluid
CO2 moves from cell to the blood
respiration
process of gas exchange between air and the blood and between the blood and the cells
oxygen diffuses from alveoli to the blood
CO2 diffuses from blood to alveoli
ventilation
movement of diaphragm which increases or decreases the capacity of the chest
Ventilation: Air pressure variances
air flows from higher pressure to lower pressure.
inspiration- movement of diaphragm and intercostal muscles lowers pressure, draws air through the trachea and bronchi to the alveoli
expiration: diaphragm relaxes, lungs recoil, increases pressure, air flows from lungs to air
ventilation: airway resistance
with increased resistance, greater-than-normal respiratory effort is required to achieve normal levels of ventilation
ventilation: compliance
elasticity and expandability of the lungs and thoracic structures
factors that determine compliance: surface tension of alveoli, connective tissue and water content of lungs, and compliance of the thoracic cavity
pulmonary diffusion
process by which oxygen and carbon dioxide are exchanged from areas of high concentration to areas of low concentration
oxygen and CO2 diffuse across alveolar-capillary membrane
pulmonary perfusion
blood flow through the pulmonary vasculature
Inspiratory reserve volume (IRV)
The extra volume of air that can be inspired with maximal effort after reaching the end of a normal, quiet inspiration.
expiratory reserve volume ERV
the volume of air that can be forcefully exhaled after a normal resting expiration, leaving only the RV in the lungs.
residual volume RV
the volume of air left in the lungs at maximal expiration
tidal volume
Total amount of air inhaled and exhaled with one breath during normal breathing
vital capacity
maximum amount of air exhaled after maximum inspiration
inspiratory capacity
The maximum volume of air that can be inspired after reaching the end of a normal, quiet expiration
functional residual capacity
volume remaining in lungs after a normal, passive exhalation
total lung capacity
the volume of air in the lungs upon the maximum effort of inspiration
healthy= about 6 liters
ventilation-perfusion ratio
shows imbalance between ventilation and perfusion
imbalance causes shunting of blood –> Hypoxia
normal VQ ratio (1:1)
low VQ ratio: shunt
high VQ ratio (dead space)
silent unit- absence of ventilation and perfusion
put patient on supplemental O2
low VQ ratio indicates
when perfusion exceeds ventilation, a shunt exists, blood bypasses alveoli with gas exchange occurring
pneumonia, atelectasis, tumor, mucous plug
high VQ ratio
when ventilation exceeds perfusion, dead space results. alveoli do not have adequate blood supply for gas exchange to occur
pulmonary embolism, pulmonary infarction, cariogenic shock
Silent unit (VQ ratio)
limited or absent ventilation perfusion
pneumothorax, severe acute respiratory distress
the amount of ___ in transit is one of the major determinants of the _____ balance of the body
carbon dioxide
acid-base
Neurological control of ventilation
inspiratory and expiratory centers in the medulla and pons control the rate and depth of ventilation
receptors for neurological control of ventilation
central and peripheral chemoreceptors
mechanoreceptors
proprioceptors
baroreceptors
central chemoreceptors
respond to CSF changes
respond to an increase or decrease in the pH and message the lungs to change depth and rate to correct imbalance
peripheral chemoreceptor
responds first to changes in PaO2 then to partial pressure of PaCO2, and pH
mechanoreceptors
include stretch, irritant, and juxtacapillary receptors
respond to changes in resistance by altering breathing patterns
Proprioceptors
respond to body movements causing an increase in ventilation
ROM exercises can stimulate breathing
baroreceptors
respond to an increase of decrease in arterial blood pressure and cause reflex hypoventilation or hyperventilation
major signs and symptoms of respiratory disease are
dyspnea, cough, sputum production, chest pain, wheezing, and hemoptysis
general appearance that gives clue to respiratory status
clubbing of the fingers
skin color (cyanosis)- late indicator of hypoxia
Barrel chest
occurs as a result of overinflation
hallmark signs of emphysema and COPD
normal anteroposterior diameter ratio
1:2
Funnel chest (Pectus Excavatum)
depression in the lower portion of the sternum
Pigeon chest (pectus carinatum)
outward protrusion of the sternum
result of anterior displacement of the sternum
increases anteroposterior diameter
Kyphoscoliosis
elevation of the scapula and a corresponding s-shaped spine
limits lung expansion
normal breathing pattern
eupnea
wheezing is common in patients with
asthma
crackles
nonmusical, discontinuous
usually heard on inspiration
wheezes
continuous musical
usually heard on expiration
Rhonchi
a type of wheezing, are lower-pitched continuous sounds heard over the lungs in partial airway obstruction
Bronchophony
vocal resonance that is more intense and clear than normal
voice sounds
normal physiology- the sounds are faint and indistinct.
Pathology that increases lung density- pneumonia and pulmonary edema- alters this normal physiologic response and may result in bronchophony or egophony
egophony
voice sounds are distorted due to consolidation
pt says E and you listen and it sounds like A
Respiratory diagnostic tests
pulmonary function tests
arterial blood gases
venous blood gas studies
pulse oximetry
end-tidal carbon dioxide
cultures
sputum studies
imaging studies
pleurisy
inflammation of the pleura
sharp like pain (knife into chest)
___ are most helpful in protecting against respiratory infection
tonsils
pleural effusion
a buildup of fluid between the layers of tissue that line the lungs and chest cavity
A client presents to the ED reporting severe coughing episodes. The client states that “the episodes are more intense at night.” The nurse should suspect which of the following conditions based on the client’s primary report?
left sided heart failure
cardinal sign of chronic hypoxia
clubbing of the finger nails
Which of the following is an age-related change associated with the lung?
Increased thickness of the alveolar membranes
Increased elasticity of alveolar sacs
Decreased diameter of alveoli ducts
Decreased collagen of alveolar membranes
Increased thickness of the alveolar membranes
A nurse is assessing a client’s respiratory system. Which alveolar cells secrete surfactant to reduce lung surface tension?
Type II
Type IV
Type I
Macrophages
type II
A nurse is concerned that a client may develop postoperative atelectasis. Which nursing diagnosis would be most appropriate if this complication occurs?
Ineffective airway clearance
Impaired gas exchange
Decreased cardiac output
Impaired spontaneous ventilation
impaired gas exchange
The nurse auscultates crackles in a patient with a respiratory disorder. With what disorder would crackles be commonly heard?
collapsed alveoli
increased or high compliance
emphysema
A client arrives at the physician’s office stating dyspnea; a productive cough for thick, green sputum; respirations of 28 breaths/minute, and a temperature of 102.8° F. The nurse auscultates the lung fields, which reveal poor air exchange in the right middle lobe. The nurse suspects a right middle lobe pneumonia. To be consistent with this anticipated diagnosis, which sound, heard over the chest wall when percussing, is anticipated?
dull
The nurse auscultated a patient’s middle lobe of the lungs for abnormal breath sounds. To do this, the nurse placed the stethoscope on the:
Anterior surface of the right side of the chest, between the fourth and fifth rib.
respiration
gas exchange between atmospheric air and the blood and between the blood and cells of the body
ventilation
movement of air in and out of the lungs
pulmonary diffusion
exchange of gas molecules (oxygen and carbon dioxide) from areas of HIGH concentration to areas of LOW concentration
pulmonary perfusion
blood flow through the pulmonary vasculature
