Respiratory Function and Dysfunction Flashcards
What is the primary purpose of the respiratory system?
Gas exchange, which involves the transfer of oxygen and carbon dioxide from the atmosphere to the blood
What are the components of the upper respiratory tract?
- Nasal Cavity
- Oropharynx
- Laryngopharynx
- larynx
What is the benefit of nasal breathing rather than mouth breathing?
- 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
What does the trachea bifurcate into?
The trachea bifurcates into the right and left mainstem bronchi at the point of the carina
What is our concern with the right bronchus?
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)
What are the components of the lower respiratory tract?
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
How many lobes are in the right lung?
3
How many lobes are in the left lung?
2
What are alveoli?
Alveoli are small sacs that form a functional unit of the lungs
Alveoli: What is surfactant?
deep breaths stretches the alveoli and promotes surfactant secretion
What can occur when surfactant is insufficient?
Atelectasis
Alveoli: Blood Supply
Pulmonary Circulation
Bronchial Circulation
1) Provides lungs with gas exchange
2) provides blood supply to the pulmonary tissues
What are the structures inside the chest wall?
Thoracic cage, the pleura, and the respiratory muscles
Chest Wall: What is the parietal Pleura?
The chest cavity is lined with this
Chest Wall: Visceral Pleura
the lungs are lined with this membrane
Chest Wall: Intrapleural Space
- 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
Do the pleura join and form a closed double walled sac?
True
Chest Wall:
What is a pleural effusion?
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)
Chest Wall:
What is empyema?
The presence of purulent fluid with bacterial infection within the pleural space
Chest Wall:
What is a pneumothorax?
Air in the pleural space`
Chest Wall:
What is a hemothorax?
blood in the pleural space that can result in a complete collapse of the lung
What does our chest wall do in inspiration and expiration?
- Expand and Contract
- Lungs are elastic
- NO usage of accessory muscles should occur on normal inspiration and expiration
Is expiration an active or passive process?
passive
What is the diaphragm?
Major muscle of respiration
Is inspiration an active or passive process?
active
What does the diaphragm do on inspiration?
During Inspiration the diaphragm contracts, pushing abdominal contents to move downward so the lungs can inflate
Physiology of Respiration:
Diffusion
- 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
Physiology of Respiration:
Control of Respirations
Medulla oblongata responds to chemical and mechanical signals from the body
Impulses are sent from the medulla oblongata to the respiratory muscles
What does an increase in H+ concentration cause the medulla to do?
Acidosis causes the medulla to increase the respirator rate
What is diagnostic lab that we can do to determine if adequate diffusion is occurring?
ABG’s
Physiology of Respiration:
Ventilation
Involves the movement of air with inspiration and expiration (our lungs have compliance because they are elastic)
What is an example of a non-invasive test that can be done to determine adequate diffusion?
Oxygen Saturations
Physiology of Respiration:
Chemoreceptors
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
What does a decrease in H+ concentration tell the medulla to do?
Alkalosis causes the medulla to decrease respiratory rate
Physiology of Respiration:
Where are mechanical receptors located?
Lungs
upper airways
the chest wall
diaphragm
Physiology of Respiration:
What are the mechanical receptors stimulated by?
Irritants (ie., cold or warm air)
Muscle Stretching
Alveolar wall distortion
Physiology of Respiration:
What is the role of the respiratory defence mechanism?
Protecting the lungs from inhaled particles, microorganisms, and toxic gasses
Physiology of Respiration:
How is the air filtrated in the respiratory defence mechanism?
- Nasal hairs filter the inspired air
- Bacteria and particles contact the mucosa lining the nasopharynx and the larynx and most particles are removed
Physiology of Respiration:
What is the role of the mucociliary clearance system in the respiratory defence mechanism?
Ciliated cells are in the large airways and move mucus out of these airways into the mouth
What occurs to the cilia in chronic bronchitis and cystic fibrosis?
Cilia are often destroyed by chronic bronchitis and cystic fibrosis results in impaired secretion clearance, and chronic productive cough, and frequent upper respiratory infections
How does ciliary action become impaired?
Ciliary action is impaired due to dehydration, smoking, inhalation of high oxygen concentrations, infection, cocaine
Physiology of Respiration:
What is the cough reflex in the respiratory defence mechanism?
The cough is a protective reflex action that clears the airway- it is a backup for mucociliary clearance
Physiology of Respiration:
What is reflex bronchoconstriction in the respiratory defence mechanism?
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
Physiology of Respiration:
What is the role of alveolar macrophages in the respiratory defence mechanism?
Rapidly phagocytize inhaled foreign particles such as bacteria
Where do you begin to auscultate on the chest when performing a respiratory assessment?
Above the clavicle on the apices of the lungs down to the bases
Bronchial Sounds
Loud, high-pitched, around the trachea
Bronchovesicular Sounds
Medium, high pitched, over major bronchi (normally over 1st and 2nd intercostal spaces)
Vesicular Sounds
Soft, low-pitched, normal air filled lungs, over most lung fields
Crackles
excess mucus, fluid filled alveoli
Wheezes
Musical snoring sound, high pitched sound that occurs on exhale
Diagnostic Studies of the Respiratory System:
ABG’s
Acid- Base balance, ventilation status and the need for oxygen therapy
Diagnostic Studies of the Respiratory System:
Hematocrit
Reflects the ratio of red blood cells- Fluid volume status
Diagnostic Studies of the Respiratory System:
Hemoglobin
How much CO2 and O2 can be transported in the blood
Diagnostic Studies of the Respiratory System:
Sputum Studies
Obtained by expectoration and are examined by culture and sensitivity to identify the microorganism
Diagnostic Studies of the Respiratory System:
Skin Tests
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
Diagnostic Studies of the Respiratory System:
CT Chest
- Cross section of the entire body
- With or without Dye (the dye allows a different representation)
- Ask about allergies (specifically to shellfish or iodine)
Diagnostic Studies of the Respiratory System:
Ventilation Perfusion Scan (VQ Scan)
Ventilation perfusion scan
Patient is injected with radioisotopes
Outlining circulation with regards to the lungs
Diagnostic Studies of the Respiratory System:
PET Scan
Looks for areas that have an increase in glucose uptake are typically cancer cells
What is a bronchoscopy?
- 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
What is a mediastinoscopy?
A cut is made at the suprasternal notch and lymph nodes are looked at and sampled
What is thoracentesis?
- Fluid is sitting in the pleural space- a needle is inserted through the chest wall to obtain a specimen
- Fluid is drained and sampled
What are pulmonary function tests?
Measure lung volumes and air flow
Usually used to diagnose pulmonary disease, monitor disease progression etc.,
What are the systemic symptoms of Influenza?
- Cough
- Fever
- Myalgia
- Headache
- Sore Throat
What is a complication of Influenza?
Pneumonia can be a complication of influenza (Pneumonia is one of the leading causes of sepsis in the older adult population alongside UTIs)
What type of respiratory tract infection is Influenza?
Upper respiratory tract infection
What are some nursing considerations for preventing the spread of pneumonia?
- 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
What is the primary thing to remember about the treatment of Influenza?
Treatment is supportive
(Care plan Ideas: Risk for dehydration as evidenced by concentrated urine, diaphoresis, fever and diarrhea)
What are 2 common medications to treat influenza?
- Oseltamivir (Tamiflu) - Agents for Influenza A and respiratory viruses
- Zanamivir (Relenza)- Agents for Influenza A and respiratory viruses
What is pneumonia caused by?
Caused by an acute inflammation of the lung parenchyma caused by a microbial agent
Is pneumonia an upper or lower respiratory tract infection?
Lower respiratory tract infection
What are medications that treat pneumonia?
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
What are some factors predisposing someone to pneumonia?
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
What are 3 ways to acquire pneumonia?
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)
Types of Pneumonia:
Community Acquired Pneumonia
Onset is within the community or during the first two days of hospitalization
Types of Pneumonia:
Hospital Acquired Pneumonia
Pneumonia occurring 48 hours or longer after admission into the hospital and not at the time of hospitalization
Types of Pneumonia:
Aspiration Pneumonia
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
Types of Pneumonia:
Opportunist Pneumonia
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.,)
What is the main virus that causes pneumonia?
Pneumococcal pneumonia is the most common cause of bacterial pneumonia
4 Phases of Pneumonia:
Congestion
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
4 Phases of Pneumonia:
Red Hepatization
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
4 Phases of Pneumonia:
Grey Hepatization
Blood flow decreases, and leukocytes and fibrin consolidate in the affected area of the lung- sputum is green, yellow, or brown tinged
4 Phases of Pneumonia:
Resolution
Complete resolution of the infection
What are the clinical manifestations of pneumonia?
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
What is a a clinical manifestation of pneumonia in an older person?
Confusion and stupor (possibly related to hypoxia)
What are some physical clinical manifestations in your assessment of a patient with pneumonia?
Dullness on percussion - consolidation
Increased fremitus
Bronchial breath sounds
Crackles
What are some clinical manifestations of viral pneumonia?
Highly variable
Characterized by chills, fever, dry cough nonproductive, and extrapulmonary symptoms
Complications of Pneumonia:
Pleurisy
Inflammation of the pleura
Complications of Pneumonia:
Pleaural Effusion
sometimes it may need to be aspirated by a thoracentesis
Complications of Pneumonia:
Atelectasis
collapsed airless alveoli
Complications of Pneumonia:
Delayed Resolution
results from persistent infection and is seen in an x-ray with residual consolidation
Complications of Pneumonia:
Lung Abscess
collection of pus that is sitting inside the lung- can be drained or removed by a bronchoscopy
Complications of Pneumonia:
Empyema
accumulation of purulent exudate in the pleural cavity
Complications of Pneumonia:
Pericarditis
results from the spread of infecting organism from the infected pleura to the pericardium (the lining around the heart)
Complications of Pneumonia:
Bacteremia
can occur with older patients when the bacteria of the lungs has entered the circulatory system
Complications of Pneumonia:
Meningitis
If the patient presents with confusion or disorientation, a lumbar puncture needs to be completed to determine if meningitis is present
Complications of Pneumonia:
Endocarditis
can develop when the organisms attack the endocardium and the valves of the heart
What is the age that a person can get the pneumococcal vaccine?
65 years of age or older
What is some nutritional therapy for someone with Pneumonia?
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
What is an example of a nursing diagnosis for someone with Pneumonia?
Risk for impaired gas exchange
What is COPD?
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
What is emphysema?
describes ONE pathological change in COPD: destruction of the alveoli
What is chronic bronchitis?
the presence of chronic productive cough for 3 months in 2 successive years
What are the causes of COPD?
Tobacco Smoke
Occupational Chemicals and Dusts
Infection
Heredity
Aging
Why is aging a cause of COPD?
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
What are the 2 defining features of COPD?
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
Initially COPD is confined to the lungs… However when the disease progresses…
- 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
What are some of the main symptoms of COPD?
- **Dyspnea is a subjective experience and the most disabling in COPD
Difficulty breathing
SOB
Limitations in activity
What is the pathophysiology of COPD?
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
What is the problem of the barrel chest with COPD?
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
What are some complications of COPD?
1) Chronic Productive Cough
2) Vasoconstriction= Pulmonary HTN
What does pulmonary HTN results in?
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
Complications of COPD:
Cor pulmonale
hypertrophy of the right side of the heart, with ot without heart failure that is a result of pulmonary hypertension
Complications of COPD:
Acute Exacerbation of COPD
defined as a sustained worsening COPD symptoms
Complications of COPD:
Acute Respiratory Failure
Leads to a decline in overall lung function, deterioration in health status, and risk of death
Complications of COPD:
Depression and Anxiety
Depression may be related to feelings of hopelessness, social isolation, and grief accompanying the progression of the disease
