Respiration (1) Flashcards
What are the primary functions of the breathing system?
Breathing process.
Exchange of oxygen and carbon dioxide.
Enable speech production.
What is external respiration?
Exchange of gases between the lungs and the atmosphere.
Where does external gas exchange occur?
In the pulmonary capillaries.
What is internal respiration?
Exchange of gases within cells of the body organs and tissues.
In the human respiratory system, what is the purpose of the nose?
Passage of air
In the human respiratory system, what is the purpose of the mouth?
Passage for food and air.
In the human respiratory system, what is the purpose of the epiglottis?
Covers the larynx during swallowing. This decides if things go into the lungs or the digestive system as it covers the Larynx.
What type of membrane lines the lungs and chest cavity?
Pleural membrane
In the human respiratory system, what is the purpose of the pleural membrane?
Covers the lungs and lines the chest cavity.
In the human respiratory system, what is the purpose of the lungs?
Organ of gas exchange
In the human respiratory system, what is the purpose of diaphragm?
Skeletal muscle of respiration.
In the human respiratory system, what is the purpose of the nasal cavity?
Filters, warms and moistens air.
In the human respiratory system, what is the purpose of the pharynx?
Common passageway for air, food and liquid.
In the human respiratory system, what is the purpose of Larynx ?
Produces sound (voice box). AND Maintains an open airway, routes food and air appropriately.
In the human respiratory system, what is the purpose of the trachea?
Main airway to transport air to and from the lungs.
In the human respiratory system, what is the purpose of the bronchi?
Branching airways carrying gases to the alveoli.
In the human respiratory system, what is the purpose of the alveoli?
Air sacs for gas exchange.
What happens to the diaphragm, internal and external intercostal muscles during inhalation?
The diaphragm contracts and pulls downwards.
The internal intercostal muscles relax and the external intercostal muscles contract to pull the ribcage upwards and outwards.
What happens to the diaphragm, internal and external intercostal muscles during expiration?
When you exhale, the diaphragm relaxes and movs upwards.
The internal intercostal muscles contract and the external intercostal muscles relax to pull the ribcage inwards and downwards.
What are the constituents of the upper respiratory tract?
Nasal cavity, pharynx, larynx.
What are the two parts of the pleura membrane?
Parietal pleura (inner) and the visceral pleura (outer)
What is the pleural space ?
The space between the inner and outer pleural membrane that is pushed out when the lungs contract and expand.
What is the lubricating fluid in terms of the pleural membrane?
When the lungs expand, they rub against the rib cage, this prevents damage to the lungs caused by friction against the ribs.
What does the diaphragm muscle separate?
The chest wall and abdomen
During inspiration, what does the diaphragm do and what is the purpose of this?
Diaphragm contracts and increases the thoracic space allowing air to flow in down a pressure gradient.
During expiration, what does the diaphragm do and what is the purpose of this?
Diaphragm relaxes and decreases the thoracic space allowing air to move our of the lungs down a pressure gradient.
What is the purpose of the phrenic nerve?
Nervous control of inspiration and expiration.
What blood vessel does deoxygenated blood enter the lungs by?
The pulmonary artery
By what blood vessel does oxygenated blood travel from the lungs back to the heart?
Pulmonary vein
What is the tidal volume in terms of respiration?
The volume of air inhaled and exhaled per respiratory cycle.
What is the dead space volume in terms of respiration?
The air that remains in the airways and does not participate in gaseous exchange.
What is the purpose of the dead volume space in terms of respiration?
It is vital to keeping the lungs open and prevents the walls of the lungs touching when the lungs contract.
What is vital capacity in terms of respiration?
The maximum volume that can be exhaled after maximum inhalation.
What is the inspiratory reserve volume in terms of respiration?
The amount of air that can be inhaled beyond the tidal volume.
What is the expiratory reserve volume?
The amount of air that can be forcibly exhaled beyond the tidal volume.
What is the residual volume in terms of respiration?
The amount of air remaining in the lungs, even after a forceful maximum expiration.
in what units does a spirometer measure?
Litres
How can oxygen be transported?
Bound to Hb in red blood cells or dissolved in blood plasma.
How is carbon dioxide transported around the body?
Dissolved in the blood plasma, bound to Hb or in the plasma bicarbonate.
Outline the brief steps of how breathing is regulated.
The respiratory centre establishes a pattern of breathing.
- Receptor cells near the respiratory centre respond to changes in cerebrospinal fluid H+ caused by an increase in arterial carbon dioxide.
- Receptor cells in the carotid and aortic bodies respond to large decrease in arterial oxygen.
- Higher centres in the cortex can exert conscious control over respiration.
What is the main purpose of the medulla oblongata in terms of respiration?
Ensures we breathe all the time and stimulates an increase in breathing in certain scenarios.
What is the purpose of the respiratory centre?
Establishes the basic breathing pattern.
What do chemical receptors respond to control respiration?
CO2, H+ and oxygen
What chemical changes are the carotid and aortic bodies sensitive to ?
CO2, pH and oxygen levels
What are the 4 respiratory processes?
- Breathing - air into and out of the lungs.
- External respiration - gas exchange between the air and blood.
- Internal respiration - gas exchange between blood and tissues.
- Cellular respiration - oxygen used to produce ATP, CO2 is waste.
What is the main purpose of a respiratory assessment ?
To determine the adequacy of gaseous exchange.
How frequently should respiratory assessments occur?
Routinely on admission of all patients.
If a patient develops a respiratory condition or symptoms.
What should be included in the a respiratory assessments ?
Patient history Inspection Observation Palpitation Percussion Auscultation Adjuncts can also be used.
What is the purpose of taking a history when doing a respiratory assessment on a patient?
May provide clues to the stability of the condition of the patient.
What is sputum?
A thick mucus
What does green, thick and foul smelling sputum being produced by a patient suggest?
Infection
What does the production of blood stained sputum by a patient suggest?
TB, PE, Lung cancer
What does white, thick mucous sputum with no obvious infection suggest about a patient?
COPD
Asthma
What does pink frothy sputum suggest about a patient?
Pulmonary oedema
Heart failure
What does brown or brick colour sputum suggest about a patient?
TB
Infection
What is Eupnoea in terms of breathing?
10-17 breaths per minute
What is Tachypnoea in terms of breathing?
More than 18 breaths per minute
What is Bardypnoea in terms of breathing?
Less than 10 breaths
What is Hyponoea?
Abnormally shallow breaths
What is the purpose of using Palpation in a respiratory assessment?
Used to access bilateral movements across the chest and is very useful indicator that can indicate lung abnormalities.
How does pleural effusion alter the percussion a respiratory assessment?
Causes low percussion notes
How does asthma change chest percussion during a respiratory assessment?
Causes a tympanic drum like sound.
What percussion sounds will a healthy chest have?
Resonant or hollow percussion
How can diseases change chest percussion?
Can cause hyper-resonant or flat percussion notes.
What is Auscultation in terms of a respiratory assessment and what is the purpose of this?
Listening to the chest with a stethoscope for vesicular breath sounds. This allows a nurse to detect air entry throughout all files and identify where air entry is reduced or where there are extra sounds.
What are the possible causes of adventitious sounds in a respiratory assessment?
Constricted airways Narrowed airways Partial obstruction Fluid in lung field Inflammation
In terms of adventitious breath sounds, What are the conditions associated with crackles?
Caused by fluid in the alveoli such as in pulmonary oedema, CCF and pneumonia.
In terms of adventitious breath sounds, What are the conditions associated with Rhonchi?
Caused by fluid in the alveoli such as in pulmonary oedema, CCF and pneumonia.
In terms of adventitious breath sounds, What are the conditions associated with silent chest?
Lift threatening exacerbations of asthma
In terms of adventitious breath sounds, What are the conditions associated with wheezing?
Asthma, COPD, tracheal oedema
In terms of adventitious breath sounds, What are the conditions associated with stridor ?
Laryngeal issues
In terms of adventitious breath sounds, what are crackles?
Similar to sound of rubbing 2 strands of hair in fingertips
In terms of adventitious breath sounds, what is Ronchi ?
Low pitch gurgling in upper airways which may be cleared by coughing.
In terms of adventitious breath sounds, what is silent chest?
Bronchoconstriction so serve that little or no air enters.
In terms of adventitious breath sounds, what is wheezing ?
High or low pitches which can be on inspiration or expiration and secretions may occur.
In terms of adventitious breath sounds, what is stir?
High pitched rasping on inspiration.
What is Pulse oximetry?
Positioning any vascular bed between a 2 way light source and detector. The detector measures the amount of red and infrared light that is absorbed by the haemoglobin molecule in arterial blood and reports it as a % of oxygen saturation.
What does a pulse oximetry reading mean that has a lower % O2 reading and what causes this?
There is less oxygen on the Hb molecule so less light is absorbed and respiratory issues are indicate.
What are the possible issues with pulse oximetry?
It is a sensitive tool and is reliant upon several factors to make accurate recordings.
Certain conditions, especially related to acute illness, can affect the reliability of saturations.
Thickened skin can inhibit conduction and affect results.
Poor perfusion or vasoconstriction can prevent pulsatile recording and reduce accuracy.
Dark skin pigmentation, nicotine staining, nail varnishes etc can cause it to be come ineffective.
Flooding of light can lead to false results.
Incorrect sized probe and probe position can cause false results.
more in notes…
What is Penumbra?
The area surrounding an ischemic event such as thrombotic or embolic stroke. Immediately following the event, blood flow and therefore oxygen transport is reduced locally, leading to hypoxia of the cells near the location of the original insult.
What is Spirometry and what does it measure?
Various methods of testing different sorts of lung volume - peak expiratory flow rate, vital capacity and pulmonary function tests.
What are chest X-rays useful for?
Identifying and diagnosing lung problems such as; areas of poor ventilation, areas of infection, pulmonary oedema and consolidation.
What is a blood gas?
Describes a set of values that may be of use in practice in assessing the individuals ability to maintain normal cellular function or homeostasis.
What is 10KPa in mmHg
10KPa = 75mmHG
What is a blood gas useful for ?
Indicator of respiratory function.
Metabolic environment of the body.
Gives indication of bodies ability to maintain homeostasis.
Allows differentiation of metabolic and respiratory problems.
What are the limitations of blood gases?
They cannot be considered in isolation, the patient medical history, clinical symptoms and a clinical examination is needed.
What two values are provided for the blood gas in terms of O2?
SaO2 - saturated oxygen
PaO2 - partial pressure of oxygen
What is usually the cause of COPD?
Smoking, industrial particles.
What is Emphysema?
The air spaces become enlarged and there is obstruction of airways. This also causes destruction of the lung tissue. Gas exchange can’t occur even if sufficient oxygen is taken in because the tissue is damaged.
What is chronic obstructer bronchitis?
Obstruction of small airways.
What are the symptoms of asthma?
Bronchospasms, parosysmal, productive cough
What is parosysmal?
Sudden attack of symptoms
What are the different treatments of Asthma?
Mucolytics, bronchodilators, steroid treatments.
What do steroid treatments do to treat asthma ?
They reduce inflammation and help open the airways.
What do bronchodilators do to treat asthma?
They help open the airways
How will the bronchioles of a patient with asthma appear compared to an unaffected person?
The bronchioles will be inflamed and therefore have reduced lumen size.
What are the symptoms of chronic bronchitis?
Mucousal swelling, productive cough, ches pain
What are the treatments of chronic bronchitis?
Expectorants, bronchodilators, steroids
What are the symptoms of Emphysema?
Barrel chest, dyspnea and orthopnea
How will the histology of a patient with Emphysema show?
The tissue will have been destroyed showing limited area of lung tissue. This limits the amount of gas exchange that can occur.
What causes influenza and how is it caused?
A virus - it moves into the lungs and triggers a build-up of mucus and inflammatory response. This reduces the ability to breathe in and out.
What are the symptoms of influenza?
Fever, chills, headaches, myalgia, no longer interested in food or eating, temperature.
What are the possible treatments for influenza?
Steroids or bronchodilators.
What is the difference between asthma and influenza?
Once you get rid of Influenza, your airways will return to normal, this is not always the case with Asthma.
What are pleural effusions?
Build-up of fluid between the inner and outer pleura which can lead to a restrictive effect on the breathing as the lungs can no longer expand as much and the lung capacity is reduced.
What are the causes of pleural effusions?
Lung and heart disorders
What are the symptoms of pleural effusions?
Shortness of breath and lungs cannot expand properly.
What is the treatment of pleural effusion?
The excess fluid may need to be drained.
What is a pulmonary embolism?
The blood supply is being potentially blocked. These embolisms can sometimes burst and lead to a build-up of blood within the lungs. This again reduces the lung capacity.
What are the possible causes of Tuberculosis?
Aerosol transmission
What are the possible treatments of Tuberculosis?
Drug resistant stains - very hard to treat.
Describe the histology of a patient with Tuberculosis?
Inflammation and build up reduces the air that can enter the lungs.
What is bronchopneumonia?
inflammation of the bronchioles.
What are the possible causes of bronchopneumonia?
Consolidation, haemoptysis, penumocystis
What is Penumocystis ?
A bacteria that can cause disease in those areas, this is flighted off by blood cells in the area. Blood them builds-up and lavages may be required to measure the amount of fluid.
What is cystic fibrosis?
A hereditary disorder affecting the exocrine glands.
How is cystic fibrosis caused?
Viscous mucus blocks the bronchioles leading to impaired gas exchange.
What is infant respiratory distress syndrome?
Membranes become rigid and prevent alveoli expanding and contacting.
How does surfactant help the lungs?
It decreases surface tension of the alveoli and is needed for the alveoli to fill with the air and expand. Allows compliance.
What causes acute respiratory distress syndrome?
Damage to the alveolar walls and capillaries is caused by polymorphonuclear neutrophils.
Pulmonary oedema also occurs.
This leads to impaired gas exchange and further infections may also occur.
What is pulmonary oedema?
Increased leakiness of blood vessels leading to fluid accumulation.
What are the possible causes of acute respiratory distress syndrome?
Inhalation of toxins
lung bruising
Oxygen toxicity caused by reactive free radicals
What is the leading cause of all types of lung cancer?
Smoking
What is the most common site of oncology (lung cancer)?
Epithelium of the bronchi
What happens to cause oncology (lung cancer)?
Bronchogenic Carcinoma
Masses form and block the air passages.
Metastasises frequent to the lymph nodes, liver, bones, brain and kidneys.
Describe the histology of a person with smokers lung.
Black deposits of tar and inflammation caused by foreign deposits.
Describe the histology of a patient with lung cancer.
Small cells within the lungs built-up with tumour which restricts the airways and non-small cells fill up the air spaces and further reduce the ability for gas exchange.
What is endotracheal intubation?
Passage of a tube through the mouth, pharynx and larynx into the trachea to establish an airway.
Describe what is meant by the anatomical term ‘right pectoral region’
The right pectoral region is located on the right side of the anterior chest wall and contains four muscles.
Describe what is meant by the anatomical term ‘right axillary region’
The area of the upper chest surround the axilla, lateral to the pectoral region.
What would the blood gas of an individual with a pneumothorax show?
Decreased partial pressure and saturation of oxygen.
Increase carbon dioxide.
What would the X-ray of an individual with a Pneumothorax show? and what is the knock on effect of this?
The lung with the pneumothorax will appear smaller thus meaning that less oxygen can be absorbed.
What is meant by the term pneumothorax?
A collapsed lung condition that occurs when air enters the space between the chest wall and the lung (pleural space).
What histological changes are caused by a pneumothorax?
The wall of the rib may be damaged, possible tissue damage and fibrosis.
What is the likely treatment of a large pneumothorax?
Needle aspiration or chest drain.
What is needle aspiration?
Inserting a needle into the air-filled space and sucking the air out via a thin tube.
What is a chest drain?
A flexible plastic tube is inserted through the chest wall and allows air out but to back in. This allows the lung to re-inflate.
What mechanisms prevent lung collapse in a healthy individual?
The rib-cage prevents the lungs breathing in beyond a certain volume of oxygen and therefore prevents the lungs bursting.
Describe the pathophysiology and symptoms of COPD
Chronic obstruction in the small airways.
Breathlessness, persistent chesty cough, chest infections, wheezing.
What methods could be employed to assess lung function of a patient?
Spirometry test
Blood gas sample
Pulse Oximetry
Percussion
What histological changes may be found in a patient with chronic bronchitis?
A lot of inflammation and therefore reduced lumen size in the airways.
Server fibrosis.
Black spots - tar.
What lifestyle modifications may benefit a patient with COPD and explain why.
Stop smoking - prevents the COPD worsening.
Stay active with light exercise - improves oxygen efficiency and shortness of breath without over stressing the lungs.
Maintain a healthy weight - reduces stress on lungs and shortness of breath.
What treatments may benefit a patient with COPD and how do they help?
Bronchodilators in inhalers or tablets- makes breathing easier by relaxing and widening the airways. Can help relax the muscles lining the airways.
Steroid inhalers - reduce inflammation of the airways.
Mucolytics - make the phlegm in the throat thinner and easier to cough up.
How would the spirometry readings of an individual with COPD vary from a healthy individual?
Would be lower.
