Pneumonia

Question 1

What is diffusion?

Answer 1

exchange of gas molecules (oxygen and carbon dioxide) from areas of high concentration to low concentration.

Question 2

Why is the post op patient at risk for atelectasis?

Answer 2

because of the effects of anesthesia and restricted brathing with pain
-In ARDS lack of surfactant contributes to widespread atelectasis

Question 3

Explain bronchial circulation?

Answer 3

arises from thoracic aorta
bronchial circulation prvides oxygen to the bronchi and other pulmonary tissues.
-deoxygenated blood returns from the bronchial circulation through the azygos vein into the superior vena cava

Question 4

Explain assessment of the respiratory system?

Answer 4

• symmetry of chest expansion: hands at tenth rib, thumbs meet spine, deep breath, thumbs should move 1 inch
• Trachea: place index finger just above suprasternal notch and gently press, trachea should be at midline
• Palpate fremitus: vibration of chest wall produced by vocalization, most intesnse adjacent to sternum, and between scapulae, not increase, decrease, or absence of fremitus
• auscultate in planned sequence, have patient breathe through the mouth, if patient is in respiratory distress or will tire easily start at the bases

Question 5

What are the 3 normal breath sounds?

Answer 5

• bronchial: high pitched, air blowing through a hollow pipe, heard alongside trachea
• bronchovesicular: medium pitch and intensity, heard anteriorly over mainstem bronchi on eitherside of sternum and posteriorly between scapulae
• vesicular: soft, low pitched, gentle, rustling sounds, heard all over lung areas except major bronchi

Question 6

Adventitious breath sounds?

Answer 6

fine and course crackles
wheezes
stridor
pleural friction rub

Question 7

Fine crackles (formerly rales):

Answer 7

-short duration, discontinuous, high pitcjed, heard just before end of inspiration

Question 8

Course crackles?

Answer 8

long duration, discontinuous, evident on inspiration and at times expiration

Question 9

Stridor?

Answer 9

partial obstruction of larynx or trachea

Question 10

Pleural friction rub?

Answer 10

harsh sound like two peices of leather being rubed together

Question 11

Egophony?

Answer 11

is positive (abnormal) - when person says E but it is heard as A

Question 12

Bronchophony?

Answer 12

is positive (abnormal) - when a person says 99 and the words are easily understood through the stethscope

Question 13

What happens when the conditions that increase lung density or when the lung is consolidated (pneumonia)?

Answer 13

there will be positive (abnormal) voice sounds

Question 14

What do you inspect the finger for?

Answer 14

Clubbing: causes of cyanosis include hypoxemia or decreased cardiac output
>180

Question 15

Why is sputium obtained?

Answer 15

• for analyisis to identify pathogenic organisms and to determine whether malignant cell are present.
• before antimicrobial therapy is initiated or evaluate effectiveness of medications already given

Question 16

How can sputum samples be obtained?

Answer 16

expectoration (if patient can’texpectorate inhalation of irritating aerosol, usually hypertonic saline this is called sputum induction.)
tracheal suction
bronchoscopy

Question 17

How do you observe the sputum?

Answer 17

color
volume
viscosity
presence or absence of blood

Question 18

When should sputum be tested for C&S (culture and sensitivity)?

Answer 18

• before antimicrobial therapy is initiated
• identify infecting organsism
• confirm diagnossi

Question 19

Test results and clinical significance?

Answer 19

• bacterial infection - pneumonia
• viral infection
• atypical bacterial infection (TB)
• fungal infection

Question 20

Sputum for cytologic exam?

Answer 20

• if diagnosis of cancer is considered
• abnormal chest x-ray film result
• productive cough and nothing visible on bronchoscopy
• monitor smokers with atypical changes

Question 21

Sputum Test results:

-benign cellular changes

Answer 21

most commonly related to infection (bronchiectasis), exposure (asbestosis), or viral pneumonitis

Question 22

What do astham patients often have from sputum test results?

Answer 22

increased eosinophils

Question 23

What are ABG’s used for and what are they?

Answer 23

• used to monitor patients on ventilators, critically ill nonventilator patients, establish preoperative baseline parameters, and regulate electrolyte therapy.
• pH, Pco2, HCO3, Po2, O2

Question 24

ABG:

What is pH?

Answer 24

hydrogen ion concentration int he blood

Question 25

ABG:

What is Pco2?

Answer 25

partial pressure of CO2 in the blood. A measurement of ventilation.

Question 26

ABG:

What is HCO3?

Answer 26

bicarbonate ion measures the metabolic (renal) component of the acid base equilibrium.

Question 27

ABG:

What is Po2?

Answer 27

indirect measurement of the O2 content in the arterial blood

Question 28

ABG:

What is O2 saturation?

Answer 28

an indication of the % of hemoglobin saturated with O2