Respiratory

Question 1

Oxygen transport

Answer 1

Nose –> pharynx –> larynx –> trachea –> main stem bronchus –> main bronchi –> lobar/secondary bronchi –> segmental/tertiary bronchi –> terminal bronchioles –> respiratory bronchioles –> alveolar ducts –> alveolar sacs –> alveoli

Question 2

Subjective assessment - upper airways

Answer 2

1. Ear, nose, throat discharge
2. Blocked nose
3. Sinus pain
4. Trauma
5. Epistaxis (nosebleeds)
6. Allergies
7. Smell
8. Mouth/throat pain
9. Sores/lesions/ulcers
10. Hoarseness/change in voice
11. Lumps/swelling in neck, mouth, throat
    Medication use, smoking, environment

Question 3

Objective assessment - upper airways

Answer 3

1. General inspection
   - colour of skin/mucus membranes
   - ease of breathing/voice
2. Inspect & palpate external nose
   - deformity, asymmetry, deviated septum
   - patency of nostrils (close one)
3. Inspect the mouth
   - lip moisture, swollen tongue, mucus production
4. Inspect the throat
   - tonsils, infection
   - pharyngeal wall (lesions, exudate)

Question 4

Right lung vs left lung

Answer 4

Right: 
- shorter (liver) 
- 3 lobes (upper, middle, lower) 
- shorter, wider, more vertical bronchus
Left: 
- narrower (heart) 
- 2 lobes (upper, lower)

Question 5

Subjective assessment - lower airways

Answer 5

1. SOB
2. Chest pain with breathing
3. Cough (phlegm, sputum, blood)
4. History of respiratory infection
5. smoking history
6. Environmental exposure (work/cigarette smoke)

Question 6

Peripheral vs central cyanosis

Answer 6

Peripheral
- bluish discolouration of nails 
- arterial/venous obstruction, reduced CO = lack of oxygenated blood reaching periphery
Central
- bluish discolouration of lips 
- gross lack of oxygen 
- emergency

Question 7

Objective assessment - lower airways

Answer 7

1. General inspection
   - colour of face, nailbeds, lips, mouth, earlobes
   - quality of breathing
2. Inspect, palpate, auscultate posterior chest
   - shape, position to breathe, colour, bruising
   - symmetrical chest expansion, tenderness
3. Inspect, palpate, auscultate anterior chest
   - accessory muscle use, intercostal space, RR
4. Pulmonary function
   - forced expiratory time
   - pulse oximetry

Question 8

Respiratory rate

Answer 8

Eupnoea: 12-20 breaths per minute 
Tachypnoea: >20
Bradypnoea: <12
Apnoea: no respiration for >10 secs
Orthopnoea: difficulty breathing when lying flat (supine)

Question 9

Cheyne-Stokes

Answer 9

Breathing pattern involving fast shallow breathing, followed by slow heavier breathing, and then moments of apnoea.

Question 10

Auscultation of lungs

Answer 10

• Lower lobes heard best at back
• Upper lobes best at front
• Middle lobe (right) only heard from front

Question 11

Stridor

Answer 11

• Turbulent air moving through upper airway obstruction
• Generally on inspiration
• more common in children

Question 12

Nursing management of respiratory distress

Answer 12

• Positioning: Fowler’s/High Fowler’s/Tripod
• Encourage deep breathing and coughing
• Encourage hydration
• Suctioning
• Oxygen therapy

Question 13

Oxygen therapy indications & precautions:

Answer 13

Indications: 
- correcting tissue hypoxia SaO2 <95%
- antidote for CO poisoning
Precautions: 
- Patients who are not hypoxic (>95%)
- End-stage COPD (SaO2 88-92% target)

Question 14

Define consolidation

Answer 14

Increased areas of density due to fluid, mucous and oedema on chest X-ray

Question 15

Define haemoptysis

Answer 15

Coughing bloody sputum