Respiratory System (part 1) Flashcards
1
Q
how many lobes are in the left lung?
A
2
2
Q
how many lobes are in the right lung?
A
3
3
Q
where are the lungs located in the body?
A
the thoracic cage
4
Q
What does the trachea divide into?
A
two main bronchi
5
Q
What do the two main bronchi branch into?
A
smaller bronchioles, alveolar ducts, and alveoli
6
Q
What is included in the anatomy of the lungs? (9)
A
1) Trachea
2) Superior lobe of left lung
3) Superior lobe of right lung
4) Right main (primary) bronchus
5) Lobar (secondary) bronchus
6) Segmental (tertiary) bronchus
7) Middle lobe of right lung
8) Inferior lobe of left lung
9) Inferior lobe of right lung
7
Q
The respiratory system consists of two major components, known as what?
A
The conducting airway & the respiratory airway
8
Q
What is the conducting airway composed of?
A
the upper respiratory tract
9
Q
The upper respiratory tract from the nose to the trachea helps do what?
A
filter air
10
Q
what is included in the upper respiratory tract? (6)
A
1) Nose
2) Mouth
3) Pharynx
4) Larynx
5) Trachea
6) Bronchi
11
Q
What does the lower respiratory tract consist of? (2)
A
lobules and alveoli
12
Q
what is the respiratory airway responsible for?
A
gas exchange
13
Q
What do the lobules of the lungs in the respiratory airway consist of? (4)
A
1) Bronchiole
2) Arteriole
3) Pulmonary capillaries
4) Veins
14
Q
The conducting airway is the process of what?
A
ventilation
15
Q
What does ventilation do to the atmospheric air that we breathe in?
A
warms, moistens and filters it
16
Q
What kind of lining does the conducting airway have?
A
epithelial lining
17
Q
what does the epithelial lining contact?
A
goblet cells & cilia
18
Q
what do goblet cells produce?
A
mucus
19
Q
List the sequence of ventilation
A
Nose → sinuses → nasal cavity → pharynx → larynx → bronchi
20
Q
What does cilia do?
A
Helps filter & capture the foreign substances we breathe in before they get down into lower respiratory tract (where we don’t want them)
21
Q
What are the defense mechanisms for the lungs? (4)
A
1) Alveolar macrophages
2) Neutrophils
3) Mast cells
4) Cough reflex
22
Q
How is the cough reflex a defense mechanism?
A
it expels “bad guys”
23
Q
what are alveoli known as?
A
respiratory sacs
24
Q
where are alveoli located?
A
at the end of the bronchioles
25
what does the alveoli form?
the respiratory membrane
26
what are alveoli?
the functional units of the lungs where gas exchange occurs
27
what do type II cells in the alveoli produce?
surfactant
28
the lungs are separated by the _________
mediastinum
29
what does the mediastinum contain? (5)
1) Heart
2) Esophagus
3) Thymus gland
4) Blood vessels
5) Nerves
30
what kind of blood do the alveoli receive?
Deoxygenated blood from the right ventricle via the pulmonary artery
31
what is the mucocilliary apparatus?
a specialized cellular mechanism within the bronchioles
32
what does the mucocilliary apparatus consist of? (2)
1) Ciliated pseudostriated columnar epithelial cells
2) Goblet cells
33
regarding the mucocilliary apparatus, what does the wave-like movement enable?
The movement of mucus downward to the throat
and the upward movement of the cilia moves mucus from the bronchioles to the throat, where it is swallowed
34
what is the mucocilliary apparatus affected by? (2)
1) smoking
2) respiratory infections
35
How does smoking affect the mucocilliary apparatus?
It vasoconstricts & paralyzes the apparatus, failing to capture foreign substances we are breathing in
36
during gas exchange, where does oxygen enter and where does it go?
Oxygen enters the alveolus and moves across the alveolar membrane into the blood
37
during gas exchange, what happens with carbon dioxide?
Carbon dioxide diffuses from the blood into the alveolus to be excreted by exhalation
38
during gas exchange, what does oxygen combine with and why?
Oxygen combines with the heme portion of hemoglobin to form oxyhemoglobin
39
ventilation is the process of ________ and ________ of air
inspiration and expiration
40
what controls ventilation?
the respiratory center in the brain
41
where does the respiratory center in the brain receive input from?
from chemoreceptors and lung receptors (stretch and irritant receptors)
42
what stimulates the diaphragm to contract?
the vagus nerve
43
how is perfusion defined?
the movement of blood through the pulmonary circulation
44
what is the ventilation-perfusion ratio (V-Q Ratio)?
the ratio of the amount of oxygen reaching the alveoli to the amount of blood reaching the alveoli
45
What do we ideally want to see in the V-Q ratio?
ideally, want both to be equal
46
An imbalance in ventilation-perfusion leads to a decrease in what?
gas exchange
47
what is a dead space?
an area where there is no perfusion
48
What is O2-hemoglobin dissociation curve measured by?
Pulse oximetry (norm being greater than or equal to 95%)
49
List 7 pulmonary function tests (PFTs)
1) Forced vital capacity (FVC)
2) Forced expiratory volume (FEV, FEV1)
3) Peak expiratory flow (PEF)
4) Total lung capacity (TLC)
5) Functional residual capacity (FRC)
6) Residual volume (RV)
7) Tidal volume (TV)
50
What are the common sx of respiratory conditions? (6)
1) Dyspnea
2) Cough
3) Hemoptysis
4) Atelectasis
5) Hypoxia
6) Hypoxemia
51
What is the most common sign of a pulmonary problem?
dyspnea (shortness of breath)
52
What could sudden SOB indicate? (2)
1) asthma attack
2) pneumothorax
53
Cough is an involuntary response to what?
mechanical or chemical stimulation of the bronchial tree
54
coughs serve as a mechanism to do what?
eliminate stimulant
55
What are the two diff types of coughs?
productive and non-productive
56
a productive cough contains what?
WBCs
57
what is hemoptysis?
coughing up blood (frank red/pink)
58
What respiratory issues is hemoptysis associated with? (3)
1) Tuberculosis
2) Lung cancer
3) Infection
59
what is atelectasis?
the collapse of alveoli, resulting in decreased gas exchange
60
when does atelectasis commonly occur? when else can it occur?
commonly occurs post-op
also can occur due to compression by a mass
61
how is hypoxia defined?
the oxygen level in blood is inadequate to meet needs of the tissue
62
what PaO2 value indicates hypoxia?
PaO2 less than 60 mg Hg
63
what is hypoxemia?
Insufficient amount of oxygen in blood
64
when/how is erythropoietin secreted?
secreted by the kidneys in response to low oxygen levels
65
erythropoietin secretion leads to stimulation of what? why?
Leads to stimulation of the bone marrow to increase the production of Red blood cells
66
Any disorder that causes hypoxia will stimulate what?
List examples of this (3)
will stimulate the production of erythropoietin
1) COPD
2) high altitudes
3) cardiac disease
67
What causes the common cold?
Caused by several viruses which invade the upper respiratory tract leading to an inflammatory response (release of histamine and prostaglandins)
68
how long does the common cold typically last?
about 5-7 days
69
when someone has the common cold, what happens to mucus membranes?
they are engorged
70
when someone has the common cold, what is increased?
mucus production
71
list the sx of the common cold (7)
1) Sinus Pain
2) Nasal Congestion
3) Runny nose
4) Sneezing
5) Watery eyes
6) Scratchy throat
7) Headache
72
what should be taught to pts to prevent the common cold?
hand hygiene
73
what should be avoided with the common cold?
antibiotics
74
what is rhinitis?
inflammation and congestion of the nasal mucosa
75
what is hay fever?
seasonal rhinitis → inflammatory response to a specific allergen
76
list the sx of rhinitis (4)
1) nasal congestion
2) sneezing
3) stuffiness
4) watery eyes
77
what is sinusitis?
inflammation of the mucus membranes lining the para sinuses
78
what are the types of sinusitis?
Can be acute, subacute, or chronic:
- Viral
- Allergies
- Bacterial
79
viral sinusitis lasts how long?
7-10 days
80
how long can bacterial sinusitis last?
up to 4 weeks
81
list the sx of sinusitis (5)
1) headache
2) pain over sinus area
3) pressure
4) nasal congestion
5) purulent discharge
82
When sinusitis works its way down the respiratory tract it can cause _____
bronchitis
83
how should one interpret "rhinosinusitis" ?
the pathology of both rhinitis & sinusitis are similar but they affect different structures
84
list 3 common clinical manifestations of rhinosinusitis
1) nasal congestion
2) cough
3) bronchial secretions
85
what causes the nasal passage to become blocked when someone has rhinosinusitis? (3)
what does this lead to?
1) swollen membranes
2) inflamed blood vessels
3) increased mucus secretion
leads to nasal congestion
86
when a person with rhinosinusitis has a cough, it is a forceful expulsion of what? what type of reflex is this?
air from the lungs
protective reflex
87
in pts with rhinosinusitis, what does a cough help remove? (3)
1) foreign bodies
2) irritants
3) accumulated secretions
88
in pts with rhinosinusitis, what can bronchial secretions result from?
numerous disorders → both pulmonary & non-pulmonary
89
in pts with rhinosinusitis, excessive bronchial secretions may do what?
impair respirations
90
in pts with rhinosinusitis, we use pharmacologic management to tx _____ ________ and _______
what might this look like? (3)
nasal congestion & cough
1) May be Over-the-Counter preparations
2) May be prescription
3) Analgesic drugs (acetaminophen or ibuprofen)
91
what classes of medications might be used to tx rhinosinusitis? (5)
1) Nasal decongestants
2) Antitussives
3) Antihistamines
4) Expectorants
5) Mucolytics
92
nasal decongestants are used to relieve what?
nasal obstruction and discharge
93
nasal decongestants are what type of meds?
Adrenergic (Sympathomimetic) drugs
94
Adrenergic (Sympathomimetic) drugs are most commonly used to do what?
Cause vasoconstriction → leading to decreased edema and inflammation of the nasal membranes
95
what routes of admin are available for nasal decongestants? (3)
1) oral
2) topical (nasal sprays)
3) steroid
96
list drugs in nasal decongestant class (5)
1) Pseudoephedrine (Sudafed)
2) Oxymetazoline (Afrin)
3) Phenylephrine (Vazculep; Neo-synephrine)
4) Fluticasone (Flonase)
5) Triamcinolone (Nasacort)
97
list the adverse effects of nasal decongestants (5)
1) Local stinging and burning
2) Rebound congestion
3) increase HR (SNS effect)
4) increase BP (SNS effect)
5) urinary retention (SNS effect)
98
nasal decongestants are contraindicated in pts with a hx of what? (7)
1) allergy to drugs
2) glaucoma
3) hypertension
4) diabetes
5) thyroid disease
6) coronary disease
7) prostate problems
99
pts taking nasal decongestants should not use the drug for more than how long?
more than 5 days unless instructed
100
pts taking nasal decongestants should be taught to use caution with what?
other OTC drugs
101
what are antitussives used for?
to suppress non-purposeful coughing
102
what do antitussives depress?
the coughing center in the brain or the cough receptors in the throat, trachea, or lungs
103
list drugs in the antitussive class (4)
1) Benzonate (Tessalon Perles)
2) Dextromethorphan (Delsym)
3) Codeine
4) Hydrocodone bitartrate
104
what is the route of admin for antitussives?
oral
105
list the adverse effects of antitussives (4)
1) drying of mucus membranes
2) headache
3) drowsiness
4) dizziness
106
list the adverse effects of dextromethorphan (4)
1) nausea
2) drowsiness
3) rash
4) difficulty breathing
107
who are antitussives contraindicated in? (3)
1) history of allergy to drugs
2) those with a head injury
3) those who could be impaired by CNS depression
108
when should caution be used with antitussives? (3)
1) asthma pts
2) COPD pts
3) children with atopic syndrome
109
when should use of dextromethorphan be avoided?
with alcohol and several psych drugs
110
pts taking antitussives should not use the drug for more than how long?
more than 5 days unless instructed
111
pts taking antitussives should be taught to use caution with what?
OTC drugs
112
What do expectorants do? How? (2)
They increase productive cough to clear the airway by:
1) Liquifying lower respiratory tract secretions
2) Decreasing the viscosity of secretions
113
what drug is considered an expectorant?
Guaifenesin (Mucinex)
114
what is the onset of Guaifenesin (Mucinex)?
what is the duration?
onset → 30 mins
duration → 4-6 hrs
115
how is Guaifenesin (Mucinex) administered?
orally
116
list the adverse effects of expectorants (5)
1) rash
2) headache
3) nausea
4) vomiting
5) dizziness
117
who are expectorants contraindicated in? (3)
1) history of allergy to drugs
2) those w persistent cough due to smoking, asthma, emphysema
3) those w productive cough lasting more than 1 week
118
what do mucolytics do?
Breakdown and liquefy of respiratory tract secretions
119
mucolytics are used to tx what? (5)
1) cystic fibrosis
2) asthma
3) bronchiectasis
4) COPD
5) chronic bronchitis
120
list drugs in mucolytic class (2)
1) Acetylcysteine (Acetadote, parvolex)
2) Dornase alfa (Pulmozyme)
121
Acetylcysteine (Acetadote, parvolex) has fast onset via what?
nebulizer
122
list the routes of admin for mucolytics (3)
1) oral
2) nebulization
3) IV
123
what drugs are pregnancy category C? (4)
which one is also category D & when?
1) all nasal decongestants
2) antitussives → category D during labor
3) expectorants
4) mucolytics
124
list the adverse effects of mucolytics (7)
1) GI upset
2) Stomatitis
3) Rhinorrhea
4) Bronchoconstriction
5) Bronchospasm
6) Urticaria
7) Rash
125
who are mucolytics contraindicated in? (2)
1) History of allergy to drugs
2) Presence of acute bronchospasm
126
what patient education would be provided regarding mucolytics?
how to use nebulizer
127
herbal preparations have been used as what?
cold remedies
128
list the types of herbal remedies (3)
1) Echinacea
2) Vitamin C
3) Zinc Sulfate
129
Echinacea has different _________
preparations
130
Echinacea are no better than a ______
placebo
131
What does vitamin C do?
decreases incidence & severity of colds and influenza
132
regular use of vitamin C appears to do what?
to play a role in the defense mechanisms of the respiratory system
133
what does zinc sulfate do?
decreases incidence & severity of cold symptoms in adults
134
the use of nasal zinc sulfate can lead to what?
loss of smell
135
what is histamine?
the first chemical mediator releases in immune and inflammatory responses
136
what is histamine released by?
mast cells and basophils
137
how many types of receptors are there for histamine?
3 main types of receptors → histamine 1, histamine 2, histamine 3
138
histamine 1 receptors are mainly located on what? where? (3)
on smooth muscle cells in:
1) blood vessels
2) respiratory
3) GI tract
139
what is allergic rhinitis? what causes it?
Inflammation of the nasal mucosa → caused by a type 1 hypersensitivity reaction to inhaled allergens
140
what is allergic rhinitis characterized by? (4)
1) nasal congestion
2) itching
3) sneezing
4) watery discharge
141
what are the types of allergic rhinitis? (2)
1) seasonal disease (hay fever)
2) perennial
142
seasonal allergic rhinitis, or hay fever, produces acute sx in response to what?
protein components of airborne pollens
143
when does seasonal allergic rhinitis, or hay fever, mainly occur?
in spring & fall
144
who are at higher risk for seasonal allergic rhinitis, or hay fever?
Those with a personal or family history of other allergies
145
when does perennial allergic rhinitis occur?
year-round
146
what causes perennial allergic rhinitis? (3)
1) dust mites
2) animal dander
3) molds
147
what is the mechanism of action of antihistamines?
Block the release or action of histamine at the histamine-1 receptor sites
148
what do antihistamines decrease? (2)
capillary permeability & saturation (runny nose & eyes)
149
what other effects do antihistamines have?
anticholinergic and antipruritic effects
150
what are antihistamines used for?
the relief of sx associated with allergic responses
151
what issues might call for the use of antihistamines bc of their sx associated with allergic responses? (4)
1) seasonal allergies
2) angioedema
3) motion sickness
4) allergic reactions
152
who are antihistamines contraindicated in? (4)
1) pregnant pts
2) lactating pts
3) those with a history of arrhythmias
4) those with a history of prolonged QT intervals
153
list the adverse effects of antihistamines (10)
1) Drowsiness
2) Sedation
3) Drying of respiratory and GI mucus membranes
4) GI upset
5) Nausea
6) Arrhythmias
7) Dysuria
8) Urinary hesitancy
9) Dizziness
10) Impaired mental status
154
what type of histamines have the highest incidence of causing sedation?
first generation antihistamines
155
what type of histamines do most people take & why?
Second generation → they don’t cause as much drowsiness
156
List the first generation antihistamines we need to know (2)
1) Diphenhydramine (Benadryl)
2) Hydroxyzine (Vistaril)
157
List the second generation antihistamines we need to know (2)
1) Certirzine (Zyrtec)
2) Loratadine (Alavert, Claritin)
158
List the third generation antihistamine we need to know
Fexofenadine (Allegra)
159
what antihistamine has multiple drug interactions?
zyrtec
160
why should pts be educated to drink plenty of fluids when taking antihistamines?
bc they may cause dryness of mucus membranes and thickening of secretions
161
how should pts be instructed to take antihistamines?
take with meals to avoid GI upset
162
what should pts NOT do/avoid when taking antihistamines bc of their adverse effects? (5)
1) Do not smoke
2) Do not drive or operate heavy equipment after taking
3) Avoid other medications that also cause sedation
4) Do not take more than one antihistamine at a time
5) Avoid prolonged exposure to sunlight
163
why should pts taking antihistamines NOT take more than one antihistamine at a time? (2)
1) Many OTC cold and “nighttime” or “PM” sinus and allergy medications contain an antihistamine
2) Also OTC sleep aids contain Diphenhydramine (Benadryl)
164
A common mucolytic used to liquefy mucus in the resp tract is:
A) Acetylcysteine
B) Dextromethorphan
C) Ipratropium
D) Pseudoephedrine
A) Acetylcysteine
165
Which of the following herbal preparations appears to play a role in the defense mechanisms of the resp system in adults (SATA)
A) Echinacea
B) Valerian
C) Vitamin C
D) Zinc sulfate
A) Echinacea
C) Vitamin C
D) Zinc sulfate
166
Cold remedies listed as “Non-drowsy” or “daytime” formulas do NOT contain…
A) Nasal decongestant
B) Antihistamine
C) Mucolytic
D) Pain reliever
B) Antihistamine
167
Which of the following medications are first generation antihistamines (SATA)
A) Diphenhydramine (Benadryl)
B) Certirizine (Zyrtec)
C) Fexofenadine (Allegra)
D) Hydroxyzine (Vistaril)
E) Loratadine (Alavert, Claritin)
A) Diphenhydramine (Benadryl)
D) Hydroxyzine (Vistaril)
168
On the oxygen-hemoglobin dissociation curve, which shift indicates increased affinity for O2? decreased?
Left shift → increased affinity for O2
Right shift → decreased affinity for O2
169
On the oxygen-hemoglobin dissociation curve, what indicates a left shift? (5)
1) ↓ pCO2
2) ↓ H+
3) ↓ 2,3-DPG
4) ↓ temp
5) HbF
170
On the oxygen-hemoglobin dissociation curve, what indicates a right shift? (4)
1) ↑ pCO2
2) ↑ H+, ↓ pH
3) ↑ 2,3-DPG
4) ↑ temp
