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Trachs and Vents > Quiz 1 > Flashcards

Quiz 1 Flashcards

1
Q

What are the 3 parts of the upper respiratory tract?

A

Nasal cavity
oral pharynx
larynx

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2
Q

What are the 3 parts of the lower respiratory tract?

A

Trachea
Bronchi
Lungs

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3
Q

What separates the left and right side of the lower respiratory tract?

A

Mediastinum

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4
Q

What type of cells is the inner surface of the trachea lined with?

A

Ciliated epithelial columnar cells with scattered specialized goblet cells

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5
Q

What is the function of goblet cells?

A

mucus-secreting that function as a protective and cleansing mechanism for the respiratory tract

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6
Q

Alveoli

A

Ventilation occurs, blood-oxygen exchange. Have a predisposition to collapse

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7
Q

Surfactant

A

coating that prevents alveoli from collapsing

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8
Q

Atelectasis

A

Collapsed alveoli

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9
Q

Visceral pleura

A

outermost layer of lungs

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10
Q

Parietal pleura

A

innermost layer of chest wall cavity

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11
Q

Pleural Cavity

A

Lungs are housed in

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12
Q

Pleural linkage

A

negative pressure sucks the visceral pleura to parietal pleura, allowing the lungs to expand with chest wall expansion

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13
Q

Pneumothorax

A

Collapsed lung

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14
Q

How much of the movement of the thoracic cavity is the diaphragm responsible for?

A

75%

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15
Q

What nerve innervates the diaphragm?

A

phrenic nerve

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16
Q

Internal intercostals

A

exhalation

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17
Q

External intercostals

A

inhalation

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18
Q

Minor respiratory muscles (5)

A 
Pectoralis Major
Pectoralis Minor
Abdominal Musculature
Sternocleidomastoid
Scalene
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19
Q

From what spinal nerves does the phrenic nerve originate?

A

C3, C4, C5

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20
Q

Does the phrenic nerve provide motor, sensory, or both to the diaphragm?

A

Both

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21
Q

Quiet breathing

A

Active inspiration/passive expiration

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22
Q

Forced breathing

A

active inspiration (using accessory inspiratory muscles) and active expiration using abdominal muscles

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23
Q

Speech breathing

A

Active inspiration and active expiration against the resistance of a modulated upper respiratory tract, primary the vocal folds

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24
Q

Where does resistance come from in speech breathing?

A

vocal folds and articulators

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25
Q

Total lung capacity

A

total amount of air in the lungs

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26
Q

Tidal volume

A

amount of air inhaled and exhaled during normal quiet breathing

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27
Q

Average tidal volume

A

500ml

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28
Q

Inspiratory reserve volume

A

amount of air that can be inhaled beyond a normal tidal inspiration

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29
Q

Average inspiratory reserve volume

A

2.5 liters

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30
Q

Expiratory reserve volume

A

amount of air that can be exhaled beyond a normal tidal expiration

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31
Q

average expiratory reserve volume

A

1.5 liters

32
Q

Residual volume

A

amount of air that remains in the lungs beyond maximum forced expiration

33
Q

Average residual volume

A

1.5 liters

34
Q

Functional residual capacity

A

amount of air that remains in the lungs beyond a normal tidal expiration

35
Q

average functional residual capacity

A

3 liters - add expiratory reserve volume and residual volume

36
Q

Vital capacity

A

amount of air maximally exhaled after a maximum inspiration. reflects inspiratory/expiratory muscle strength

37
Q

Average vital capacity

A

4.5 liters

38
Q

Minute volume

A

amount of air that is inspired and expired per minute

39
Q

average minute volume

A

6-9 liters per minute

40
Q

Does inspiration create positive or negative pressure in the lungs?

A

negative. this way, air rushes from the atmosphere into the lower pressure of the alveoli

41
Q

Is expiration during quiet breathing active or passive?

A

passive

42
Q

What impacts passive expiratory forces or relaxation pressures?

A

Gravity
Torque created by the ribs
Elastic Recoil

43
Q

During expiration lung pressure is positive or negative?

A

Positive.

44
Q

Define ventilation

A

process of gas exchange in and out of the lungs

45
Q

Normal respiratory rate during quiet breathing

A

12-20 breaths per minute

46
Q

Respiratory control center located where in the brain?

A

reticular formation of the brainstem - medulla oblongata and pons

47
Q

Chemoreceptors for breathing located….

A

O2 and CO2 located in respiratory control center

48
Q

Stretch receptors for breathing are located where?

A

located in smooth muscles of the airway that respond to the expansion and deflation of the lungs

49
Q

COPD

A
  • Chronic obstructive pulmonary disease
  • Irreversible airway obstruction caused by destruction of lung tissue
  • chronic bronchitis
  • emphysema
50
Q

Complications of restrictive lung disorders

A
  • involves combination of respiratory muscle weakness or paralysis and mechanical factors involving the lungs and chest wall
  • inability to take deep breaths - chronic hypoventilation
  • typically involves reduced lung volumes and decreased lung compliance
  • compliance - amount of elasticity of the lung and chest wall (patients with good lung compliance are easier to wean from the vent)
  • pneumonia is a restrictive lung disorder
51
Q

example of connective tissue disorders

A
  • scleroderma

- systemic lupus

52
Q

Neuromuscular diseases and conditions

A

ALS, MS, MD, Guillain-Barre syndrome, polimyelitis

CVA, BI, SCI

53
Q

How long does it take to decide if someone can be off the ventilator or needs a trach tube placed?

A

10-14 days

54
Q

Indications for an artificial airway? (8)

A
  • Edema (trauma, burns, infection, anaphylaxis)
  • Mechanical ventilation due to respiratory failure
  • Prophylaxis - prep for extensive head and neck surgery
  • To provide pulmonary toilet
  • Sever sleep apnea
  • to bypass obstruction
  • neck trauma
  • facial fractures
  • There are no absolute contraindications existing to tracheostomy
55
Q

Tracheal suctioning procedure

A

go down to 16cm, occlude lever with finger and make a circular motion as you pull out. NEVER suction going in, and wait 30-60 seconds between each passage

56
Q

Complications of suctioning (4)

A
  • mucosal tearing
  • cardiac arrythmias
  • deoxygenation
  • laryngospasms
57
Q

Non-invasive airway clearance (4)

A
  • diaphragmatic assisted cough
  • mechanical exsufflation (cough machine, gives breath in that causes person to cough)
  • Incentive spirometry (take deep breath, hold for 3 seconds)
  • Postural drainage techniques
58
Q

Complications following endotracheal tube

A
  • sore throat
  • paranasal sinusitis
  • vocal cord paralysis/ glottic incompetence
  • laryngeal tracheal ulceration
  • hoarseness
  • arytenoid subluxation/dislocation
  • post-extubation dysphagia
  • pressure necrosis
  • granulomas
  • stenosis
  • laryngeal web
  • tracheal trauma
59
Q

How soon following extubation should you do a swallow eval?

A

24 hours

60
Q

Length of endotracheal intubation that is considered prolonged

A

greater than 48 hours

61
Q

Swallowing following prolonged endotracheal intubation

A

increased risk of aspiration

62
Q

Define tracheotomy

A

Surgical procedure in which an opening is made in the trachea

63
Q

Tracheostomy

A

Opening in neck itself

64
Q

Tracheotomy Tube

A

A small tube inserted into the windpipe. It maintains the hole in the skin of the neck that connects with the windpipe.

65
Q

Where is a tracheostomy placed?

A

BELOW the larynx, between the 2nd and 3rd and 3rd and 4th tracheal rings

66
Q

Is there a direct one to one relationship between a trach and aspiration?

A

No

67
Q

Granulation tissue

A

irritated, calloused tissue cause by intubation tube resting on the vocal folds

68
Q

Stoma site breakdown

A

normally stoma closes within 24-48 hours, but it may not close. Tell patient to occlude the stoma when voicing to promote healing

69
Q

Scar band

A

Band of scar tissue that forms across the vocal folds

70
Q

Tracheomalacia

A

Tracheal rings are loose and flexible instead of rigid

71
Q

False passage

A

Trach has healed and there is a false passage between the skin and trachea

72
Q

Percutaneous Tracheotomy

A

done in ICU in patient who can’t safely be transported to the OR. do serial dilitation to gradually open tube up. Has same complication rate and same outcomes as open procedure

73
Q

Open Tracheotomy

A

Traditional procedure, go to OR, have vertical incision

74
Q

Cricothyroidotomy

A

Trach placed at level of cricoid

Only done in extreme situations when trach is not possible. more complications and more voice and swallowing problems.

75
Q

Tracheotomy tube change

A
  1. wash your hands
  2. prepare the clean tracheostomy tube
    a. remove the inner cannula
    b. attach the tracheostomy ties to the outer cannula
    c. place the obturator in the outer cannula
    d. apply a thick coat of water-soluble lubricant to the outside of the clean tracheostomy tube
  3. Loosen the ties of the old tracheostomy tube
  4. With a smooth, quick motion, slide the old trach forward and out
  5. insert the clean tube into your tracheostomy stoma using a gentle, inward motion. If it is difficult to insert the cannula into the stoma, lift the chin up. This may better align the stoma with the hole in the trachea
  6. Stabilize the neck plate of the outer cannula with one hand and immediately remove the obturator with the other hand
  7. Tie the neck ties to one side in a square knot
  8. Replace the inner cannula and lock in place
  9. Wash your hands
76
Q

Emergency loss of airway in trach

A
  • remove any speaking valve or cap,
  • be suspicious of a mucous plug and always suction the trach and oral cavity
  • remove trach if needed
  • establish ventilation through the easiest and most efficient opening possible (bag mask OVER STOMA)

Trachs and Vents (1 decks)

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