Respiration Flashcards
Trachea
*Airway
• Carries air through the neck and upper chest
• Divides the left and right main bronchi
Alveoli
Type 1: gas exchange
Type 2: produce surfactant to reduce surface tension to allow inflation
Pleura
• Reduces friction during respirations via serous secretions
Diaphragm
- Promotes inhalation by contracting downward letting lungs expand
- Promotes expiration by relaxing upwards compressing lungs
Pulmonary Ventilation: Inhalation
• Expansion of chest cavity and lungs creates negative pressure in lungs which draws air in
Pulmonary Ventilation: Exhalation
- Diaphragm and intercostals relax–> chest and lungs return to normal size–> pressure rises past atmospheric–> forces air out
- Requires no energy or effort
Respiration/Diffusion
- Movement of CO2 and oxygen between air in alveoli and blood in capillaries
- CO2= flows blood to lungs
- Oxygen= flows lungs to blood
Transport/Perfusion
- Oxygenated blood passing through body tissues
* CO2 returning to lungs from blood
Where is Breathing Controlled?
RESPIRATORY CENTERS in brainstem that use feed back from:
• Chemoreceptors
• Lung receptors
Chemoreceptors
• Detect changes in blood pH, O2, and CO2
• Respiratory centers increase/decrease ventilation in response
*Blood CO2 levels= PRIMARY STIMULUS for breathing
*Low blood CO2= secondary stimulus
Lung Receptors
• Sensitive to breathing patterns, lung expansion/compliance, airway resistance, respiratory irritants
Factors Affecting Pulmonary Function: Developmental: Adults
- Smoking
- Lack of exercise
- Decreased: lung expansion, alveolar inflation, ventilation, immune response, cough, chemoreceptor response
- Gastroesophageal reflux disease
Factors Affecting Pulmonary Function: Environmental
- Stress: catecholamines (↑ blood clots, ↓ inflammatory/immune response)
- Allergic Reactions: Hay Fever (histamine; nasal congestion/swelling); Asthma (anaphylaxis; bronchoconstriction, edema, spasms)
- Air Quality: Air pollution
- Altitude: High altitudes= hypoxemia/hypoxia; ↑ ventilation, RBC, hemoglobin, lung vol/pulmonary vasculature, vascularity of body tissues
Factors Affecting Pulmonary Function: Lifestyle
- Pregnancy: ↑ oxygen/respiratory rate
- Occupational: airway irritants, cancer
- Nutrition: poor= ↓ ventilatory muscle strength
- Obesity: respiratory Infections (poor ventilation/secretions not removed); Apnea (fat leads to obstructive sleep apnea)
- Substance abuse: respiratory depressants (opioids, sedatives, anti-anxiety), alcohol, illicit drugs
Factors Affecting Pulmonary Function: Smoking
- Constriction of bronchioles, ↑ fluid secretions into airway, inflammation, paralyzes cilia
- Continued smoking= chronic bronchitis, emphysema, obstruction of bronchiole/alveolar walls
Factors Affecting Pulmonary Function: Medications
- Respiratory depressants: anesthetics, opioids, anti-anxiety, sedative-hypnotics, neuromuscular blockers, magnesium sulfate
- Good meds: anti-inflammatory (expectorants, decongestants, cough suppressants, corticosteroids), bronchodilators
Impaired Gas Exchange: URIs, Influenza, Pneumonia
• URIs: sneezing, stuffy nose, sore throat, mild fever, tearing, cough
• Influenza: fever/high fever, fatigue, weakness, muscle pain, nasal inflammation/discharge, headache, exhaustion (upper respiratory)
• Pneumonia: dyspnea, discolored sputum, fever, chills, cough, elevated WBC, malaise, pleural pain (lower respiratory infection)
-Treatment: anti-pyretics, expectorants, rest, humidity, hydration
Impaired Gas Exchange: Structural Pulmonary Abnormalities
- Limited movement of the chest wall
* Lungs cannot expand/inflate
Impaired Gas Exchange: Airway Inflammation and Obstruction
- Allergic reactions (asthma), irritants (smoke)
* Food, object, spasms, swollen tonsils/epiglottis
Impaired Gas Exchange: Alveolar-Capillary Membrane Disorders
- Alveoli become stiff–> impaired gas exchange
* Pulmonary edema/fibrosis, ARDS
Impaired Gas Exchange: Pulmonary Embolus and Pulmonary Hypertension
*poor blood flow (pulmonary circulation)=impaired gas exchange
• Embolus: obstruction (clot, air, fat)
• Hypertension: ↑ pressure= ↑ workload–>right sided heart failure
Impaired Gas Exchange: CNS and Neuromuscular Abnormalities
*CNS problem–> messes with breathing–> impaired gas exchange
• Stroke, trauma
*NM problem–> messes with breathing/movement of muscles–> impaired gas exchange
• Stroke, trauma, spinal cord injury
Focused Assessment of Respiratory System: Cough
- Dry, productive, hacking
- Worsens/betters
- When it occurs/how long
- Meds/side effects
- Other clinical findings
- Sputum color/odor/timing/amount
Focused Assessment of Respiratory System: Sputum Color
- White/clear: viral infection (cold)
- Yellow/green: infection
- Black: dust, smoke, soot
- Rust: pneumonia, TB, blood
- Hemoptysis: coughing up blood
- Pink/frothy: pulmonary edema
- Foul-smelling: bacterial infection (pneumonia, lung abscess)
Focused Assessment of Respiratory System: Chest Pains
- Pain affects rate/depth of respirations
- Patient in pain is at risk for atelectasis due to shallow breathing
- Medicate–> reassess–> encourage coughing/deep breathing
Focused Assessment of Respiratory System: Dyspnea
- Closed questions/yes or no answers
- Sudden/gradual onset
- Severity
- Getting better/worse
- Sleep/conversational dyspnea
- Stridor (high pitched inhale, immediate attention)
- Wheezing (musical, obstruction, asthma)
Inspection of Pulmonary System: What to Be Aware of When Assessing Breathing Patterns
- Pain affects rate/depth of respirations
- Patient in pain is at risk for atelectasis due to shallow breathing
- Medicate–> reassess–> encourage coughing/deep breathing
Inspection of Pulmonary System: What to Be Aware of When Assessing Breathing Patterns
- Closed questions/yes or no answers
- Sudden/gradual onset
- Severity
- Getting better/worse
- Sleep/conversational dyspnea
- Stridor (high pitched inhale, immediate attention)
- Wheezing (musical, obstruction, asthma)
- Look for: grunting, retraction, body position, nasal flaring, body position, accessory muscle use
Percussion
sound
Palpate
touching
Auscultation of Breath Sounds: Patient Position?
• Sitting, upright
Auscultation of Breath Sounds: Stethoscope prior to auscultating?
• Clean and warm it
Auscultation of Breath Sounds: Instructions to patient?
•
Auscultation of Breath Sounds: How to record findings?
•
Normal: Bronchial
- Location: trachea
- Description: hollow, tubular, low-pitched
- Ratio/Predominance: 1:3/expiration
Normal: Bronchovesicular
- Location: mid-chest, between scapulas
- Description: normal, combo of bronchial and vesicular
- Ratio/Predominance: 1:1/expiration
Normal: Vesicular
- Location: most lung area (louder at base/periphery)
- Description: soft, low-pitched; MOST COMMON
- Ratio/Predominance: 3:1/
Adventitious: Fine Crackles
- Cause: Early I/E (chronic bronchitis); Late I (CHF, atelectasis, pneumonia)
- Description: Higher-pitched vs. coarse crackles, brief, discontinuous, popping
Adventitious: Coarse Crackles
- Cause: air bubbling in airway
* Description: Louder/higher-pitched/longer vs. fine crackles, brief, discontinuous popping
Adventitious: Wheezing
- Cause: narrowing of airway
* Description: musical, high/low pitch
Adventitious: Stridor
- Cause: obstruction in airway
* Description: high-pitch, noise, inspiratory
Adventitious: Rhonchi
- Cause: obstruction/secretion in airway
* Description: low-pitch, rattling, snoring
Adventitious: Pleural Friction Rub
- Cause: Rubbing of inflamed surfaces
* Description: low-pitch, creaky, grating
Adventitious: Absent or Diminished
• Cause: Obesity, Hyperinflation, Hypoventilation
Adventitious: Absent or Diminished
• Cause: Obesity, Hyperinflation, Hypoventilation
Arterial Blood Gas (ABG)
- O2/CO2 in arterial blood
- pH, PO2/PCO2, SaO2, HCO3 (bicarbonate)
- Hemoglobin, PO2, SaO2= best measures of oxygen in tissues
Pulse Oximetry
- Measures SaO2
- Percentage of hemoglobin molecules carrying oxygen
- 95%-100%
Spirometry
- Air moving in/out of lungs
* Lung volume/capacity varies with body size, age, and exercise
Why/How we Collect Sputum Samples
• To precisely diagnose Expectorated 1. Verify test being done 2. Position patient in semi/high fowlers 3. Mouth rinse 4. Pad any abdominal incisions 5. Ask patient to breathe deep and cough into container 6. Gloves 7. Label with test name, date, time 8. Plastic bag 9. Lab
