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NSG 2321 > Respiratory Function and Dysfunction > Flashcards

Respiratory Function and Dysfunction Flashcards

1
Q

What is the primary purpose of the respiratory system?

A

Gas exchange, which involves the transfer of oxygen and carbon dioxide from the atmosphere to the blood

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1
Q

What are the components of the upper respiratory tract?

A
  • Nasal Cavity
  • Oropharynx
  • Laryngopharynx
  • larynx
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2
Q

What is the benefit of nasal breathing rather than mouth breathing?

A
  • Breathing through the narrow nasal passage rather than mouth breathing provides protection for the lower airway
  • The nose is lined with mucous membrane and small hairs
  • Air enters the nose and is warmed by the body temperature and is humidified and filtered
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3
Q

What does the trachea bifurcate into?

A

The trachea bifurcates into the right and left mainstem bronchi at the point of the carina

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4
Q

What is our concern with the right bronchus?

A

The right bronchus is more horizontal

The right bronchus is shorter
The right Bronchus is wider

If our patient is at risk for aspiration pneumonia, it will go into the right lung (we will hear adventitious sounds such as crackles in the right lung)

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5
Q

What are the components of the lower respiratory tract?

A

Once air passes the carina it is in the lower respiratory tract

  • The mainstem bronchi, the pulmonary vessels, and the nerves enter the lungs
  • Alveoli
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6
Q

How many lobes are in the right lung?

A

3

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7
Q

How many lobes are in the left lung?

A

2

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8
Q

What are alveoli?

A

Alveoli are small sacs that form a functional unit of the lungs

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9
Q

Alveoli: What is surfactant?

A

deep breaths stretches the alveoli and promotes surfactant secretion

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10
Q

What can occur when surfactant is insufficient?

A

Atelectasis

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11
Q

Alveoli: Blood Supply

Pulmonary Circulation

Bronchial Circulation

A

1) Provides lungs with gas exchange

2) provides blood supply to the pulmonary tissues

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12
Q

What are the structures inside the chest wall?

A

Thoracic cage, the pleura, and the respiratory muscles

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13
Q

Chest Wall: What is the parietal Pleura?

A

The chest cavity is lined with this

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14
Q

Chest Wall: Visceral Pleura

A

the lungs are lined with this membrane

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15
Q

Chest Wall: Intrapleural Space

A
  • the space between the pleural layers
  • Provides Lubrication
  • Allows layers of the pleura to slide over each other when breathing
  • Fluid is normally drained from the pleural space by lymphatic circulation
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16
Q

Do the pleura join and form a closed double walled sac?

A

True

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17
Q

Chest Wall:

What is a pleural effusion?

A

An increase in the fluid in the pleural space fluid causes pleural effusions (these are caused by heart failure and an imbalance of intravascular and oncotic pressure)

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18
Q

Chest Wall:

What is empyema?

A

The presence of purulent fluid with bacterial infection within the pleural space

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19
Q

Chest Wall:

What is a pneumothorax?

A

Air in the pleural space`

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20
Q

Chest Wall:

What is a hemothorax?

A

blood in the pleural space that can result in a complete collapse of the lung

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20
Q

What does our chest wall do in inspiration and expiration?

A
  • Expand and Contract
  • Lungs are elastic
  • NO usage of accessory muscles should occur on normal inspiration and expiration
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20
Q

Is expiration an active or passive process?

A

passive

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20
Q

What is the diaphragm?

A

Major muscle of respiration

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20
Q

Is inspiration an active or passive process?

A

active

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21
Q

What does the diaphragm do on inspiration?

A

During Inspiration the diaphragm contracts, pushing abdominal contents to move downward so the lungs can inflate

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21
Q

Physiology of Respiration:

Diffusion

A
  • Oxygen and Carbon dioxide move across the alveolar capillary membrane by diffusion
  • Oxygen moves from alveolar gas in the arterial blood
    Carbon dioxide from arterial blood in the alveolar gas
    Diffusion continues into equilibrium is reached
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21
Q

Physiology of Respiration:

Control of Respirations

A

Medulla oblongata responds to chemical and mechanical signals from the body
Impulses are sent from the medulla oblongata to the respiratory muscles

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21
Q

What does an increase in H+ concentration cause the medulla to do?

A

Acidosis causes the medulla to increase the respirator rate

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21
Q

What is diagnostic lab that we can do to determine if adequate diffusion is occurring?

A

ABG’s

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21
Q

Physiology of Respiration:
Ventilation

A

Involves the movement of air with inspiration and expiration (our lungs have compliance because they are elastic)

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21
Q

What is an example of a non-invasive test that can be done to determine adequate diffusion?

A

Oxygen Saturations

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21
Q

Physiology of Respiration:

Chemoreceptors

A

Is a receptor that responds to change in the chemical composition (PaCO2 and pH) of the fluid around it

Central chemoreceptors are located in the medulla and respond to change in hydrogen (H+) concentration

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22
Q

What does a decrease in H+ concentration tell the medulla to do?

A

Alkalosis causes the medulla to decrease respiratory rate

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23
Q

Physiology of Respiration:

Where are mechanical receptors located?

A

Lungs
upper airways
the chest wall
diaphragm

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24
Q

Physiology of Respiration:

What are the mechanical receptors stimulated by?

A

Irritants (ie., cold or warm air)
Muscle Stretching
Alveolar wall distortion

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25
Q

Physiology of Respiration:

What is the role of the respiratory defence mechanism?

A

Protecting the lungs from inhaled particles, microorganisms, and toxic gasses

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26
Q

Physiology of Respiration:
How is the air filtrated in the respiratory defence mechanism?

A
  • Nasal hairs filter the inspired air
  • Bacteria and particles contact the mucosa lining the nasopharynx and the larynx and most particles are removed
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27
Q

Physiology of Respiration:

What is the role of the mucociliary clearance system in the respiratory defence mechanism?

A

Ciliated cells are in the large airways and move mucus out of these airways into the mouth

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28
Q

What occurs to the cilia in chronic bronchitis and cystic fibrosis?

A

Cilia are often destroyed by chronic bronchitis and cystic fibrosis results in impaired secretion clearance, and chronic productive cough, and frequent upper respiratory infections

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29
Q

How does ciliary action become impaired?

A

Ciliary action is impaired due to dehydration, smoking, inhalation of high oxygen concentrations, infection, cocaine

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30
Q

Physiology of Respiration:

What is the cough reflex in the respiratory defence mechanism?

A

The cough is a protective reflex action that clears the airway- it is a backup for mucociliary clearance

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31
Q

Physiology of Respiration:

What is reflex bronchoconstriction in the respiratory defence mechanism?

A

In response to the inhalation of large amounts of irritating substances (ie., dusts, aerosols), the bronchi constrict in an effort to prevent entry of the irritants

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32
Q

Physiology of Respiration:

What is the role of alveolar macrophages in the respiratory defence mechanism?

A

Rapidly phagocytize inhaled foreign particles such as bacteria

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33
Q

Where do you begin to auscultate on the chest when performing a respiratory assessment?

A

Above the clavicle on the apices of the lungs down to the bases

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34
Q

Bronchial Sounds

A

Loud, high-pitched, around the trachea

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35
Q

Bronchovesicular Sounds

A

Medium, high pitched, over major bronchi (normally over 1st and 2nd intercostal spaces)

36
Q

Vesicular Sounds

A

Soft, low-pitched, normal air filled lungs, over most lung fields

37
Q

Crackles

A

excess mucus, fluid filled alveoli

38
Q

Wheezes

A

Musical snoring sound, high pitched sound that occurs on exhale

39
Q

Diagnostic Studies of the Respiratory System:

ABG’s

A

Acid- Base balance, ventilation status and the need for oxygen therapy

40
Q

Diagnostic Studies of the Respiratory System:

Hematocrit

A

Reflects the ratio of red blood cells- Fluid volume status

41
Q

Diagnostic Studies of the Respiratory System:

Hemoglobin

A

How much CO2 and O2 can be transported in the blood

42
Q

Diagnostic Studies of the Respiratory System:

Sputum Studies

A

Obtained by expectoration and are examined by culture and sensitivity to identify the microorganism

43
Q

Diagnostic Studies of the Respiratory System:

Skin Tests

A

Cytology - looking for cells, specifically cancer cells that may be growing in the specimen

TB/Mantoux Test- areas of erythema without induration are not considered significant

44
Q

Diagnostic Studies of the Respiratory System:

CT Chest

A
  • Cross section of the entire body
  • With or without Dye (the dye allows a different representation)
  • Ask about allergies (specifically to shellfish or iodine)
45
Q

Diagnostic Studies of the Respiratory System:

Ventilation Perfusion Scan (VQ Scan)

A

​​Ventilation perfusion scan

Patient is injected with radioisotopes

Outlining circulation with regards to the lungs

46
Q

Diagnostic Studies of the Respiratory System:

PET Scan

A

Looks for areas that have an increase in glucose uptake are typically cancer cells

47
Q

What is a bronchoscopy?

A
  • Inserted through the nose or through the mouth
  • Patient is given conscious sedation
  • Spray something to numb the gag reflex
  • Can pull out large mucous plugs doing this

When they come back from the test…
- We need to make sure they can swallow
- They might have mild sang tinged sputum when they cough afterwards

48
Q

What is a mediastinoscopy?

A

A cut is made at the suprasternal notch and lymph nodes are looked at and sampled

49
Q

What is thoracentesis?

A
  • Fluid is sitting in the pleural space- a needle is inserted through the chest wall to obtain a specimen
  • Fluid is drained and sampled
50
Q

What are pulmonary function tests?

A

Measure lung volumes and air flow

Usually used to diagnose pulmonary disease, monitor disease progression etc.,

51
Q

What are the systemic symptoms of Influenza?

A
  • Cough
  • Fever
  • Myalgia
  • Headache
  • Sore Throat
52
Q

What is a complication of Influenza?

A

Pneumonia can be a complication of influenza (Pneumonia is one of the leading causes of sepsis in the older adult population alongside UTIs)

53
Q

What type of respiratory tract infection is Influenza?

A

Upper respiratory tract infection

54
Q

What are some nursing considerations for preventing the spread of pneumonia?

A
  • Regular Handwashing
  • Annual Influenza vaccination especially for those who are at risk populations
  • The primary goal in nursing management are supportive measures directed towards relief of symptoms and prevention of secondary infection
55
Q

What is the primary thing to remember about the treatment of Influenza?

A

Treatment is supportive

(Care plan Ideas: Risk for dehydration as evidenced by concentrated urine, diaphoresis, fever and diarrhea)

56
Q

What are 2 common medications to treat influenza?

A
  • Oseltamivir (Tamiflu) - Agents for Influenza A and respiratory viruses
  • Zanamivir (Relenza)- Agents for Influenza A and respiratory viruses
57
Q

What is pneumonia caused by?

A

Caused by an acute inflammation of the lung parenchyma caused by a microbial agent

58
Q

Is pneumonia an upper or lower respiratory tract infection?

A

Lower respiratory tract infection

59
Q

What are medications that treat pneumonia?

A

sulfa medications and penicillin was pivotal in the treatment in pneumonia

Antibiotics (Bacterial pneumonia)
- Cephalosporins (Cefazolin, Cefaclor, Ceftriaxone)

If it is viral, you would give antivirals and supportive care

60
Q

What are some factors predisposing someone to pneumonia?

A

Pneumonia is more likely to result when defense mechanisms become incompetent or are overwhelmed by the virulence or quantity of infectious agents

Decreased LOC depresses the cough and epiglottal reflexes which may allow for aspiration to occur

The mucociliary escalator mechanism is impaired by air pollution, smoking, viral respiratory infections, and normal changes with aging

Malnutrition

Certain diseases such as alcoholism and diabetes

61
Q

What are 3 ways to acquire pneumonia?

A

1) Aspiration

2) Inhalation: of microbes in the air (ie., viral or fungal)

3) Hematogenous: spread from the primary infection elsewhere in the body (ie., Staph)

62
Q

Types of Pneumonia:

Community Acquired Pneumonia

A

Onset is within the community or during the first two days of hospitalization

63
Q

Types of Pneumonia:

Hospital Acquired Pneumonia

A

Pneumonia occurring 48 hours or longer after admission into the hospital and not at the time of hospitalization

64
Q

Types of Pneumonia:

Aspiration Pneumonia

A

The abnormal entry of secretions or substances into the lower airway- usually follows aspiration of material from the mouth or stomach in the trachea and subsequently into the lungs

65
Q

Types of Pneumonia:

Opportunist Pneumonia

A

Patients with altered immune response are highly susceptible to respiratory infections (ie., people with severe caloric malnutrition, immune deficiencies, immunocompromised, transplants, those being treated with chemotherapy etc.,)

66
Q

What is the main virus that causes pneumonia?

A

Pneumococcal pneumonia is the most common cause of bacterial pneumonia

67
Q

4 Phases of Pneumonia:

Congestion

A

After the pneumococcus organism reaches the alveoli. The organisms multiply in the serous fluid and the infection spreads - Outpouring of fluid and blood that is coming to the alveoli to fight off infection - you will hear crackles here

68
Q

4 Phases of Pneumonia:

Red Hepatization

A

Massive dilation of the capillaries, and the alveoli are filled with organisms, neutrophils, RBCs, and fibrin- sputum is often sang tinged here because there is lots of blood going to the lungs

69
Q

4 Phases of Pneumonia:

Grey Hepatization

A

Blood flow decreases, and leukocytes and fibrin consolidate in the affected area of the lung- sputum is green, yellow, or brown tinged

70
Q

4 Phases of Pneumonia:

Resolution

A

Complete resolution of the infection

71
Q

What are the clinical manifestations of pneumonia?

A

Sudden onset of fever, chills, a cough producing purulent sputum, and pleuritic chest pain (chest wall pain when the patient breathes in and out)

SOB, muscle pain, fatigue, thready pulse, decreased SPO2, diarrhea, vomiting, decreased urine output, accessory muscle use, low energy, dry oral mucosa, cyanosis

72
Q

What is a a clinical manifestation of pneumonia in an older person?

A

Confusion and stupor (possibly related to hypoxia)

73
Q

What are some physical clinical manifestations in your assessment of a patient with pneumonia?

A

Dullness on percussion - consolidation

Increased fremitus

Bronchial breath sounds

Crackles

74
Q

What are some clinical manifestations of viral pneumonia?

A

Highly variable

Characterized by chills, fever, dry cough nonproductive, and extrapulmonary symptoms

75
Q

Complications of Pneumonia:

Pleurisy

A

Inflammation of the pleura

76
Q

Complications of Pneumonia:

Pleaural Effusion

A

sometimes it may need to be aspirated by a thoracentesis

77
Q

Complications of Pneumonia:

Atelectasis

A

collapsed airless alveoli

78
Q

Complications of Pneumonia:

Delayed Resolution

A

results from persistent infection and is seen in an x-ray with residual consolidation

79
Q

Complications of Pneumonia:

Lung Abscess

A

collection of pus that is sitting inside the lung- can be drained or removed by a bronchoscopy

80
Q

Complications of Pneumonia:

Empyema

A

accumulation of purulent exudate in the pleural cavity

81
Q

Complications of Pneumonia:

Pericarditis

A

results from the spread of infecting organism from the infected pleura to the pericardium (the lining around the heart)

82
Q

Complications of Pneumonia:

Bacteremia

A

can occur with older patients when the bacteria of the lungs has entered the circulatory system

83
Q

Complications of Pneumonia:

Meningitis

A

If the patient presents with confusion or disorientation, a lumbar puncture needs to be completed to determine if meningitis is present

84
Q

Complications of Pneumonia:

Endocarditis

A

can develop when the organisms attack the endocardium and the valves of the heart

85
Q

What is the age that a person can get the pneumococcal vaccine?

A

65 years of age or older

86
Q

What is some nutritional therapy for someone with Pneumonia?

A

Protein

Minimum of 1500 calories or more depending on the dietitians order

Fluids - minimum of 3L/day of water

Time to heal- 6-8 weeks post discharge until a client starts to feel more towards their baseline

87
Q

What is an example of a nursing diagnosis for someone with Pneumonia?

A

Risk for impaired gas exchange

88
Q

What is COPD?

A

Preventable disease, characterized by persistent airflow limitation that is usually progressive

It is associated with an enhanced chronic inflammatory response in the airways and lungs, caused primarily by cigarette smoke and other noxious particles and gasses

89
Q

What is emphysema?

A

describes ONE pathological change in COPD: destruction of the alveoli

90
Q

What is chronic bronchitis?

A

the presence of chronic productive cough for 3 months in 2 successive years

91
Q

What are the causes of COPD?

A

Tobacco Smoke

Occupational Chemicals and Dusts

Infection

Heredity

Aging

92
Q

Why is aging a cause of COPD?

A

Changes in the lung structure and respiratory muscles that cause a gradual loss of the elastic recoil of the lungs

As a result the lungs become smaller and stiffer and the loss alveolar supporting structures

93
Q

What are the 2 defining features of COPD?

A

1) airflow limitations during forced exhalation that are caused by loss of elastic recoil and are not fully reversible

2) airflow obstruction caused by mucus hypersecretion, mucosal edema, and bronchospasm

94
Q

Initially COPD is confined to the lungs… However when the disease progresses…

A
  • Skeletal muscle dysfunction
  • Right sided Heart Failure
  • Secondary Polycythemia (Due to the compensation for lack of O2)
  • Increased heart rate –> due to the increased RBCs which increased the blood viscosity in the circulatory system
  • Depression
  • Altered nutrition is commonly observed due to them not being able to eat well because they cannot breathe while they are eating
95
Q

What are some of the main symptoms of COPD?

A
  • **Dyspnea is a subjective experience and the most disabling in COPD

Difficulty breathing

SOB

Limitations in activity

96
Q

What is the pathophysiology of COPD?

A

Air Trapping

Gas Exchange Abnormalities

Mucus Hyper secretion

Barrel Chest

As the disease progresses abnormal gas exchange may occur resulting is hypoxemia (decreased oxygen in blood) and hypercapnia (increased carbon dioxide)

As the air trapping worsens, the alveoli are destroyed

97
Q

What is the problem of the barrel chest with COPD?

A

the patient is trying to breath when the chest is chronically “overinflated” therefore the patient appears dyspneic
- we can get someone to breathe with pursed lips so they have longer expiration

98
Q

What are some complications of COPD?

A

1) Chronic Productive Cough

2) Vasoconstriction= Pulmonary HTN

99
Q

What does pulmonary HTN results in?

A

the small pulmonary arteries undergo vasoconstriction as a consequence of hypoxemia, and their structures change, which results in the thickening of the vascular smooth muscle as the disease advances→ pulmonary HTN

Pulmonary HTN results in the hypertrophy of the right side of the heart which can lead to right sided heart failure

100
Q

Complications of COPD:

Cor pulmonale

A

hypertrophy of the right side of the heart, with ot without heart failure that is a result of pulmonary hypertension

101
Q

Complications of COPD:

Acute Exacerbation of COPD

A

defined as a sustained worsening COPD symptoms

102
Q

Complications of COPD:

Acute Respiratory Failure

A

Leads to a decline in overall lung function, deterioration in health status, and risk of death

103
Q

Complications of COPD:

Depression and Anxiety

A

Depression may be related to feelings of hopelessness, social isolation, and grief accompanying the progression of the disease

NSG 2321 (6 decks)

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