Respiratory Function Flashcards
temporary cessation of breathing
apnea
abnormal increase in clarity of transmitted voice sounds heard when auscultating the lungs
bronchophony
direct examination of the larynx, trachea, and bronchi using an endoscope
bronchoscopy
measure of the force required to expand or inflate the lungs
compliance
shortness of breath
dyspnea
abnormal change in tone of voice that is heard when auscultating the lungs
egophony
vibrations of speech felt as tremors of the chest wall during palpation
fremitus
decrease in arterial oxygen tension in the blood
hypoxemia
temporary absence of breathing during sleep secondary to transient upper airway obstruction
obstructive sleep apnea
shortness of breath when lying flat; relieved by sitting or standing
orthopnea
percentage of hemoglobin that is bound to oxygen
oxygen saturation
portion of the tracheobronchial tree that does not participate in gas exchange
physiologic dead space
exchange of gas molecules (oxygen and carbon dioxide) from areas of high concentration to areas of low concentration
pulmonary diffusion
blood flow through the pulmonary vasculature
pulmonary perfusion
deep, low-pitched snoring sound associated with partial airway obstruction, heard on chest auscultation
rhonchi
continuous, high-pitched, musical sound heard on inspiration, best heard over the neck; may be heard without use of a stethoscope, secondary to upper airway obstruction
Stridor
volume of air inspired and expired with each breath during normal breathing
tidal volume
whispered sounds heard loudly and clearly upon thoracic auscultation
whispered pectoriloquy
Upper airway structures consist of
the nose; paranasal sinuses; pharynx, tonsils, and adenoids; larynx; and trachea.
A prominent function of the sinuses is to serve as
a resonating chamber in speech.
Part of the larynx:
a valve flap of cartilage that covers the opening to the larynx during swallowing
Epiglottis
Part of the larynx:
the opening between the vocal cords in the larynx
Glottis
the middle of the thorax, between the pleural sacs that contain the two lungs
The mediastinum
the conducting airways contain about 150 mL of air in the tracheobronchial tree that does not participate in gas exchange
physiologic dead space
The whole process of gas exchange between the atmospheric air and the blood and between the blood and cells of the body is called
respiration
General appearance may give clues to
respiratory status
Peripheral circulation problems S/S
Clubbing of the fingers
Skin color (cyanosis)
Tool used in routine examination of the upper airway structures
Penlight
Common phenomena that may alter bronchial diameter, which affects airway resistance, include the following:
Contraction of bronchial smooth muscle—as in
asthma
Common phenomena that may alter bronchial diameter, which affects airway resistance, include the following:
Thickening of bronchial mucosa—as in
chronic bronchitis
Common phenomena that may alter bronchial diameter, which affects airway resistance, include the following:
Obstruction of the airway—by
mucus, a tumor, or a foreign body
Common phenomena that may alter bronchial diameter, which affects airway resistance, include the following:
Loss of lung elasticity—as in
emphysema
Condition characterized by connective tissue encircling the airways, thereby keeping them open during both inspiration and expiration
emphysema
the systolic blood pressure in the pulmonary artery is
20 to 30 mm Hg
the diastolic pressure is
5 to 15 mm Hg.
Adequate gas exchange depends on an
adequate ventilation–perfusion (V./Q.) ratio.
low level of cellular oxygen
hypoxia
The air we breathe is a gaseous mixture consisting mainly of
nitrogen (78%), oxygen (21%), argon (1%), and trace amounts of other gases
PACO2 =
Partial pressure of alveolar carbon dioxide
Normal levels—PaO2
> 70 mm Hg
Relatively safe levels of PaO2—
45–70 mm Hg
Dangerous levels—PaO2
<40 mm Hg
a normal value for PaO2
80 to 100 mm Hg
Normal SaO2 level
95% to 98%
A nurse assesses a client’s respiratory status. Which observation indicates that the client is having difficulty breathing?
Use of accessory muscles
A client has been newly diagnosed with emphysema. The nurse should explain to the client that by definition, ventilation:
is breathing air in and out of the lungs.
The nurse is in the radiology unit of the hospital. The nurse is caring for a client who is scheduled for a lung scan. The nurse knows that lung scans need the use of radioisotopes and a scanning machine. Before the perfusion scan, what must the client be assessed for?
Iodine allergy
The nurse is caring for a client who is to undergo a thoracentesis. In preparation for the procedure, the nurse places the client in which position?
Sitting on the edge of the bed
A client has recently been diagnosed with malignant lung cancer. The nurse is calculating the client’s smoking history in pack-years. The client reports smoking two packs of cigarettes a day for the past 11 years. The nurse correctly documents the client’s pack-years as
22
The nurse assessed a 28-year-old woman who was experiencing dyspnea severe enough to make her seek medical attention. The history revealed no prior cardiac problems and the presence of symptoms for 6 months’ duration. On assessment, the nurse noted the presence of both inspiratory and expiratory wheezing. Based on this data, which of the following diagnoses is likely?
Asthma
The nurse auscultates lung sounds that are harsh and cracking, sounding like two pieces of leather being rubbed together. The nurse would be correct in documenting this finding as
pleural friction rub.
The term for the volume of air inhaled and exhaled with each breath is
tidal volume.
The nurse is caring for a client diagnosed with asthma. While performing the shift assessment, the nurse auscultates breath sounds including sibilant wheezes, which are continuous musical sounds. What characteristics describe sibilant wheezes?
They can be heard during inspiration and expiration.
A physician has ordered that a client with suspected lung cancer undergo magnetic resonance imaging (MRI). The nurse explains the benefits of this study to the client. What is the reason the client with suspected lung cancer would undergo magnetic resonance imaging (MRI)?
MRI can view soft tissues and can help stage cancers.
The nursing instructor is teaching students about the respiratory system. The instructor knows the teaching has been effective when a student makes which statement?
“Ventilation is the movement of air in and out of the respiratory tract.”
Perfusion refers to blood supply to the lungs, through which the lungs receive nutrients and oxygen. What are the two methods of perfusion?
The two methods of perfusion are the bronchial and pulmonary circulation.
The nurse is assessing the lungs of a patient diagnosed with pulmonary edema. Which of the following would be expected upon auscultation?
Crackles at lung bases
A client has just undergone bronchoscopy. Which nursing assessment is most important at this time?
Level of consciousness
While auscultating the lungs of a client with asthma, the nurse hears a continuous, high-pitched whistling sound on expiration. The nurse will document this sound as which of the following?
Wheezes
The nurse is caring for a client diagnosed with pneumonia. The nurse assesses the client for tactile fremitus by completing which action?
Asking the client to repeat “ninety-nine” as the nurse’s hands move down the client’s thorax
A nurse is discussing squamous epithelial cells lining each alveolus, which consist of different types of cells. Which type of alveolar cells produce surfactant?
Type II cells
Which term will the nurse use to document the inability of a client to breathe easily unless positioned upright?
Orthopnea
The nurse is caring for a client who is in respiratory distress. The physician orders arterial blood gases (ABGs) to determine various factors related to blood oxygenation. What site can ABGs be obtained from?
A puncture at the radial artery
A patient diagnosed with diabetic ketoacidosis would be expected to have which type of respiratory pattern?
Kussmaul respirations
A nurse enters a client’s room and observes a container with sputum. Upon questioning about the specimen, which information from the client would necessitate the nurse to obtain a new specimen?
“I coughed that up about 8 hours ago.”
What finding by the nurse may indicate that the client has chronic hypoxia?
Clubbing of the fingers
A nurse is concerned that a client may develop postoperative atelectasis. Which nursing diagnosis would be most appropriate if this complication occurs?
Impaired gas exchange
When assessing a client, which adaptation indicates the presence of respiratory distress?
Orthopnea
Which hollow tube transports air from the laryngeal pharynx to the bronchi?
trachea
The nurse is caring for a patient with a pulmonary disorder. What observation by the nurse is indicative of a very late symptom of hypoxia?
Cyanosis
an estimation of thoracic expansion and may disclose significant information about thoracic movement during breathing.
Respiratory excursion
describes vibrations of the chest wall that result from speech detected on palpation
Tactile fremitus
describes the ability to clearly and distinctly hear whispered sounds that should not normally be heard.
Whispered pectoriloquy
The volume of each breath is referred to as
the tidal volume
is measured by having the patient take in a maximal breath and exhale fully through a spirometer.
Vital capacity
evaluates the effort the patient is making during inspiration.
Inspiratory force
These studies aid in assessing the ability of the lungs to provide adequate oxygen and remove carbon dioxide, which reflects ventilation, and the ability of the kidneys to reabsorb or excrete bicarbonate ions to maintain normal body pH, which reflects metabolic states.
Arterial blood gas (ABG)
These studies reflect the balance between the amount of oxygen used by tissues and organs and the amount of oxygen returning to the right side of the heart in the blood.
Venous blood gas (VBG)
Imaging studies
Chest Xray, CT, Pulmonary Angiography, MRI
Radioisotope procedures (lung scans)
V/Q, Gallium scan, PET
Endoscopic procedures
Bronchoscopy, Thoracoscopy
Biopsies
Pleural, Lung, lymph node
Test that PRECEDES ALL OTHER STUDIES
CHEST X-RAY
Densities produced by fluid, tumors, foreign bodies, and other pathologic conditions can be detected by
X-ray
used for monitoring during special procedures: catheter insertion, bronchoscopy, thoracentesis, and chest tube placement.
Fluoroscopy
gives definition of small or questionable lesions and is useful for determining whether a lesion has calcification within it.
CT Scan
Test that can distinguish tumors from other structures
MRI
Used to investigate Thromboembolic diseases of the lungs.
Pulmonary angiography
Radioisotope injection usually to detect pulmonary emboli
Ventilation-perfusion lung scan (V/Q Scan)
Test that examines pulmonary fluid
Ultrasonography:
Tests lung volumes and capacities. Commonly used for asthma.
Pulmonary function: (PFTs)
Test that does a direct examination of larynx
Bronchoscopy
Direct examination of pleural cavity through Intercostal space via endoscope-
Thoracoscopy
Fluid and specimens from thoracentesis are examined for:
cell counts, protein and LDH, glucose, amylase, pH, Gram stain for bacteria, cytology for malignant cells, and microorganisms.
stiffness of the neck or inability to bend the neck
nuchal rigidity
sometimes used to describe rapid onset, severe, and persistent asthma that does not respond to conventional therapy
status asthmaticus
increase in the red blood cell concentration in the blood; in COPD, the body attempts to improve oxygen-carrying capacity by producing increasing amounts of red blood cells
polycythemia
measured by having the patient take in a maximal breath and exhale fully through a spirometer.
Vital capacity
When the vital capacity is exhaled at a maximal flow rate, the _______________ is measured.
forced vital capacity (FVC)
Most patients can exhale at least 80% of their vital capacity in 1 second (forced expiratory volume in 1 second, or ________)
FEV1
A reduction in FEV1 suggests
abnormal pulmonary airflow
If the patient’s FEV1 and FVC are proportionately reduced, maximal lung expansion is .
restricted in some way
If the reduction in FEV1 greatly exceeds the reduction in FVC (FEV1/FVC less than 85%), the patient may have
some degree of airway obstruction.
alternative modes of speaking that do not involve the normal larynx; used by patients whose larynx has been surgically removed
alaryngeal communication
impaired ability to use one’s voice due to disease or injury to the larynx
aphonia
rebound nasal congestion commonly associated with overuse of over-the-counter nasal decongestants
rhinitis medicamentosa
drainage of a large amount of fluid from the nose
rhinorrhea
inflammation of the nares and paranasal sinuses, including frontal, ethmoid, maxillary, and sphenoid sinuses; replaces the term sinusitis
rhinosinusitis
dryness of the mouth
xerostomia
Rhonchi is the only lung sound that requires
suctioning
COPD/asthma med that causes jitteriness, nausea if taken with caffeine
theophylline
COPD/asthma med that smoking and caffeine can interfere with absorption
theophylline
Percentage of O2 in room air
21%
Patients must be weaned from high O2 to
normal room air
PEEP
positive end expiratory pressure
represents the volume of ventilated air that does not participate in gas exchange.
Dead space
measures amount of CO2 that is being expelled
End tidal CO2
If end tidal O2 is low, pt is
not blowing off enough CO2 (causing acidosis)
For renal pt receiving contrast, pre-hydrate and know
allergies and renal function
Another word for pus
empyema
High Lactate dehydrogenase can indicate
infection
Low glucose can indicate
TB
Medication that can be instilled in pleural space
doxycycline
compression of the heart resulting from fluid or blood within the pericardial sac.
Cardiac tamponade
ARDS
acute respiratory distress syndrome
is a clinical syndrome characterized by a severe inflammatory process causing diffuse alveolar damage that results in sudden and progressive pulmonary edema, increasing bilateral infiltrates on chest x-ray, hypoxemia unresponsive to oxygen supplementation regardless of the amount of PEEP, and the absence of an elevated left atrial pressure
ARDS
Often difficult to identify the extent of blunt thoracic trauma due to
generalized/vague symptoms
5th through 9th rib fractures can be associated with
spleen and liver injury
Organ where the blood goes to be cleaned (very vascular)
spleen
3 or more broken ribs increases
mortality
pneumonia because of shallow breathing leading to
atelectasis
ribs take ______ weeks to heal depending on injury
3-6 weeks
describes when the chest wall or the abdominal wall moves in when taking a breath and moves out when exhaling.
Paradoxical breathing
CO2 retention =
Respiratory acidosis
Flail chest treatment
Vent, suction, pain meds
Common chest tube sizes
16-18fr
If there is no venous access such as in cardiovascular collapse assess can be obtained through
bone
hemorrhage is treated simultaneously as
other injuries
is performed by a forceful attempt of exhalation against a closed airway,
The Valsalva maneuver
blood in the chest cavity due to torn intercostal vessels, lacerations of the lungs or injured lung into the pleural cavity
HEMOTHORAX
required to maintain lung inflation
negative pressure
what is heard when auscultating a collapsed lung
little or absent sound
in collapsed lung, breath sounds could be heard in upper lobes but
absent in lower
air pressure builds to the point of compressing the heart and other structures, causing circulation problems
Tension pneumothorax
An open pneumothorax can become
a tension pneumothorax
S/S of tension pneumothorax
BP changes
Tachycardia
chest pain
SOB
an abnormal passageway between the bronchial tubes and the pleural space in the lungs
A bronchopleural fistula
air-filled cysts that form on the lung pleura, tend to be asymptomatic
Lung blebs
Fistula can also be caused by
cancer
Too high PEEP pressure can cause too much positive pressure to go in, same can happen with
CPR bag/rescue breathing
Difference between BiPAP and CPAP
Continuous positive airway pressure (CPAP) machines release a constant level of air pressure. Bilevel positive airway pressure (BiPAP or BPAP) machines release air at two different pressure levels, one for breathing in and one for breathing out.
Severity of pneumothorax depends on the size and the _______
cause
hyperresonance can also be cause by
emphysema
A small fr.28 at the 2nd lCS for pneumothorax because
it is the thinnest part of the skin, minimizes nerve contact, and less visible scar
Fr.32 for hemothorax in the
fourth or fifth ICS
The heart, the great vessels, and the trachea shift toward the unaffected side of the chest
mediastinal shift
If kidneys shut down they do not make erythropoietin eventually leading to
Anemia
PEA
Pulseless electrical activity
refers to cardiac arrest in which the electrocardiogram shows a heart rhythm that should produce a pulse, but does not.
Pulseless electrical activity (PEA)
Difference between open pneumo and tension pneumo
Open = compresses but swings
Closed = compression continues to build
refers to an exaggerated fall in a patient’s blood pressure during inspiration by greater than 10 mm Hg
Pulsus paradoxus
Systolic is falling while diastolic is rising coming together
Narrowing pulse pressure
Narrowing pulse pressure is caused by
fluid build up
Removes a section of the pericardium to relieve pressure
pericardiotomy
Chest tube drainage:
dry suction, wet seal
Closed drainage system
works opposite from incentive spirometer, inspiration will lower ball
Pleur-Sac
max pressure for dry system
80
a disposable, single-use chest drainage system with 30-mL collection volume. Used when minimal volume of chest drainage is expected.
One-way (Heimlich) valve
true or false:
Fluid fluctuation in the water seal chamber of a chest drainage system will stop when the lung has re-expanded.
True
If drainage migrates from the collection chamber, .
replace the unit
DVT can cause a PE but
not the other way around
BUBBLING - check for air leaks. Large amount of bubbling indicates
a blockage. Clamp tube momentarily at various points to find blockage
TIDALING -Normal fluctuation is
5 to 10cm. Fluctuation diminishes as the lung re-expands
NEGATIVE PRESSUE- water in the tube remains at the level in the chamber of
2 cm. The units automatically maintains this.
Water suction unit: Loud bubbling indicates external suction source is
too high
Water level in the suction chamber regulates
suction intensity
(Dry Suction Unit) Indicator (Bellow/bladder) is visible in
suction chamber window
Breaking of long bones can cause
Fat embolism
an inflammatory process that causes a blood clot to form and block one or more veins, usually in the legs.
Thrombophlebitis
D-dimer assay
blood test for evidence of blood clots
Clot buster meds
tPA Activase, reteplase
Test for coumadin
INR-PT
Test for heparin
PTT
normal INR-PT level
0.8-1.2
therapeutic range for INR is
2–3.5
Normal aPTT levels
22-35
Therapeutic aPTT levels
1.5-2.5 times baseline
Patients who present with a PE die within
one hour
An umbrella filter is in place in the ___________________ to prevent PE
inferior vena cava
ARDS resembles
Pulmonary edema
PaO2 < 50
Hypoxemia
For ARDS, patients are put in this position
Prone
50-60% of head an neck cancers are
laryngeal
false vocal cords above
Supraglottic
true vocal cords
Glottic
below vocal cords
Subglottic
True or False:
An early sign of cancer of the larynx in the glottic are is enlarged cervical nodes and foul breath
False, it is a late sign. Hoarseness, cough, or sore throat, and voice changes are early
Treatment for laryngeal cancer
combo of radiation and chemo (methotrexate)
Surgical treatment of laryngeal cancer:
pt usually retains voice
trach tube for 4-5 days
Partial Laryngectomy
Surgical treatment of laryngeal cancer:
pt loses voice
permanent trach stoma
Total Laryngectomy
Surgical treatment of laryngeal cancer:
total laryngectomy with laryngoplasty
loss of neck muscles
loss of lymph nodes
loss of jaw bones
may learn esophageal speech
Radical Neck Dissection
Check gastric residual when
administering tube feedings
Medical emergency:
Mispositioned end of trach pushes against
artery causing trach to move with pulse
Must have a sign in the room alerting of
passy muir valve patient
passy-muir valve care
must not sleep with it
remove to clean
deflate cuff completely
for passy muir, patient must have
vocal cords
inner cannula care at home
clean technique
The decision to perform any pulmonary resection is based on the patient’s ___________ and _________ reserve.
Cardio status and pulmonary reserve
Surgery usually for lung abscesses, bronchiectasis, or extensive unilateral tuberculosis.
pneumonectomy
In pneumonectomy, usually no drains are used because
the accumulation of fluid in the empty hemithorax is the desired end result because the volume of accumulated fluid prevents media sternal shift.
POST-OPERATIVE pneumonectomy: Turn every hour from back to operative side and
should not be completely turn to the inoperative side
Lung surgery usually done for bronchogenic carcinoma, giant emphysematous blebs, benign tumors, metastatic malignant tumors, bronchiectasis, and fungus infections.
lobectomy
POST-OPERTIVE lobectomy care:
Chest tube drains
may be turned to either side
Lesions are located in only one segment of the lung. Disease processes may be limited to a single segment.
SEGMENTAL RESECTION
Post op SEGMENTAL RESECTION care:
not to turn onto operative side unless the surgeon prescribes this position
This procedure is performed for diagnostic lung biopsy and for the excision of small peripheral nodules
Wedge resection
Endotracheal intubation is used up to ____ days
14-21 days max
If patient has PaO2 below 50-55%
needs vent
Negative-pressure ventilators (e.g., “iron lungs,” chest cuirass)
are older modes of ventilatory support that are rarely utilized today.
types of positive-pressure ventilators:
ventilators deliver a preset volume of air with each inspiration
Volume cycled
types of positive-pressure ventilators:
delivers a flow of air (inspiration) until it reaches a preset pressure
Pressure cycle
types of positive-pressure ventilators:
delivers very high RR to open the airway; small, quick O2 to refresh oxygen
High-frequency oscillatory support
refers to injuries caused by increased air or water pressure, such as during airplane flights or scuba diving
Barotrauma
Alveoli rupture, may need chest tube
Barotrauma
Fighting the ventilator term
bucking the machine
weaning of ventilator may involve switching to
BiPAP or CPAP
When weaning off ventilator, ABG’s must be drawn within
30 minutes
criteria for weaning off ventilator
must have spontaneous respirations
have to be hemo and physiologically stable
underlying condition resolved
must have cough
Stable ABG’s
