respiratory specific Flashcards
of lobes on the left and right lungs
2 left
3 right
what direction does the diaphragm move during inhalation
moves down, pressure drops
diaphragm moves in what direction during exhalation
moves up, pressure increases
ribs 1-7
true ribs; attached
ribs 8-10
false ribs
ribs 11 and 12
floating ribs– especially dangerous if fractured– can puncture organs
three main spaces
right space, pleural space, mediastinum
visceral membrane
inner membrane of the lung
parietal membrane
outer membrane of the lung
potential space
the potential space between the parietal and visceral membrane that are supposed to be stuck together at all times
normal pressure in the potential space
negative
pneumothorax
a condition where air builds up in the potential space of the lung
pleural effusion
increase of fluid buildup – lung will collapse
major organs in mediastinum
heart, esophagus, trachea, thymus
what are trachea
cartilage rings to keep airway open
bronchi
carina (source of cough reflex)
bronchioles
instead of cartilage rings, has smooth muscle encircling it
alveolar ducts
small passage ways in the lungs that connect bronchioles to alveolar sacs
what are alveoli
tiny air sacs at the end of bronchioles, and are surrounded by capillaries; where gas exchange happens
right mainstem bronchus
- larger and more vertically angled
- increased risk for aspiration
- inserted ETT too far if it goes in because then only one side gets air
intercostal retractions
skin sinks between the muscles of the ribs during inhalation. common in babies and children– indicates reduced air pressure
substernal retractions
when the skin sinks below the breastbone during inhalation– indicates difficulty breathing
normal respirations
12-20/min in adults
use of accessory muscles indicates?
labored or increased WOB
cyanosis
blueish purple discoloration of the skin or mucous membranes– sign of acute hypoxia
nail bed clubbing
causes fingernails or toenails to enlarge and curve downward
- sign of chronic hypoxia
“barrel chest”
increased anterior posterior diameter d/t lungs chronically overinflated with air
pectus excavatum
inward dent in the chest
pectus carinatum (pigeon chest)
protrusion caused by excess cartilage growth – happens at puberty or after open chest surgery
crepitus
- crackling or popping sensation (rise krispies)
- may be d/t air leak from lungs into chests subcutaneous tissue
monitor what for crepitus
airway obstruction
tracheal displacement
when the trachea shifts out of its normal position in the chest and neck – usually d/t increased pressure in the lungs
crepitus medical term
subcutaneous emphysema
crepitus and tracheal dispalecement both seen in..?
pneumothorax
tactile fremitus
repeating a word over and over again, feeling for vibrations coming off as they speak
increased tactile fremitus indicates?
consolidation in the lungs– pneumonia, fluid, tumor
conditions with hyperresonance
emphysema, asthma, pneumothorax
decreased tactile fremitus indicates?
hyperinflated lungs
diaphragmatic excursion
movement of diaphragm on full inspiration compared to full expiration
vesicular
normal over most of the lung, soft low pitch, inspiration to expiration sound ration is 3:1
hyperinflation and distended abdomen both result in what
decreased movement to diaphragm
abnormal lung sounds
rhonchi
wheezes
crackles
pleural friction rub
rhonchi
low pitched
on inspir. and expir.
over the upper bronchi; pathways filled with mucus
heard in upper center of chest
wheezing
high pitched squeak/whistle (musical)
mostly on expiration
lower airway constriction (i.e. asthma)
what does a sudden disappearance of a wheezing noise indicate
no air getting through (very bad)
crackling sound
moist bubbling sound (d/t exudates or fluid in alveoli)
on inspir. mostly (fine vs. coarse)
esp heard over lower posterior bases
does not clear with cough
pleural friction rub
dry, rubbing, grating sound (d/t exudates or fluid in alveoli)
esp heard over lower anterior bases
seen with pleurisy, TB, lung cancer
vocal resonance
test to assess density of lung tissue– lung consolidation
bronchophony
increased loudness of spoken sounds
lung consolidation causes?
bronchophony
whispered pectoriloquy
egophany
whispered pectoriloquy
extreme brochophony= loud and clearer
egophany
nasal quality
E’s sound like A’s
the worse noise to hear
stridor
harsh, high pitched croaking sound on inspir. (initially)
can be heart w/o steth
caused by upper airway obstruction in trachea or larynx
serious condition– entire airway could close off
hyperventilation
rapid and deep breaths– blowing off more CO2 than normal
pertussis
whooping cough
what does hyperventilation cause
decreasing CO2 blood lvls – hypocapnia
hypercapnic blood
not enough CO2 in the blood. happens when holding breath for too long.
CO2 in blood = ?
acid
hyperventilation is blowing off ?
CO2
what does hypeerventilation decrease in the blood
acid– makes blood more alkaline and causes pH to increase
abnormal blood pH
> 7.45
hypoventilation = ?
retaining CO2 (i.e. acid)
if body pH is already < 7.45 due to a non-respiratory problem… (ex. diabetic ketoacidosis)
brain medulla wants to help and triggers compensatory mechanism
compensatory mechanism
= breathe fast and deep to blow off CO2 which helps increase pH back up toward normal
kussmaul respiration
medical emergency
rapid, deep, labored breathing that is difficult to control
cheyne stokes
abnormal breathing pattern characterized by a crescendo decrescendo
ataxic (biot)
abnormal breathing pattern characterized by irregular rate, rhythm, and depth
assessing if chest pain is respiratory or cardiac
ask pt to take a deep breath, if pain worsens– indicates respiratory
atelectasis
partial if not total lung collapse causing SOB
cause of atelectasis
incomplete expansion or collapse of alveoli, hypoventilation
surfactant and premature babies
if born prematurely, could have no surfactant formed but can be injected supplementally
surfactant
chemical that decreases surface tension and helps keep alveoli air sacs open
etiologies
shallow breathing
obstruction
compression
PA findings
diminished breathing sounds
decreased O2 sat
- <92-95%
dull percussion
incentive spirometer is for
deep INHALATION
TC&DB
turn cough and deep breathe
ease coughing with surfactant issue by–
splinting chest with a pillow– squeeze tightly
COPD
chronic obstructive pulmonary disease– causes irreversible obstruction of air exiting the lungs (causes hyperinflation) AKA air trapping
hypoxia
increased RBC/hematocrit (polycythemia)
COPD: chronic bronchitis
increased cough and sputum
COPD: emphysema
dyspnea but minimal cough
alveolar walls are destroyed- less surface area for gas exchange
normal stimulus to breathe
high CO2
COPD stimulus to breathe
low O2
COPD oxygen flow caution
do not exceed 2L/min
keep SpO2 between 88-92%
PA findings for COPD
diminished BBS
exertional dyspnea (DOE)
accessory muscle use
clubbing
prolonged expirations
barrel chest
⬇ tactile vibrations
hyperresonance
CXR
exertional dyspnea
the feeling of not being able to breathe quickly enough during physical activity
COPD nursing interventions
nursing interventions
O2 administration less than 2L per min
Pursed lip breathing
asthma
intermittent inflammation
pneumonia
inflammation of alveolar air sacs due to infection
PA findings for asthma
wheezing
SOB
coughing–> esp at night
chest tightness
⬇ tatcile fremitus
hyperresonance
types of pneumonia
bacterial
viral
fungal (uncommon but in immunosupression)
allergy related asthma
hypersensitive immune system
3 things in the airway r/t asthma
walls swell, fill with mucus, bronchoconstriction
vaping causes…?
popcorn pneumonia
PA findings
fever
crackles
dyspnea tachypnea
chest pain
pleurisy
diminished BS
dull percussion
⬆ tactile fremitus
productive cough
– green sputum
C2-3 spinal cord injury can result
myasthenia gravis, gulian barre
rust colored sputum indicates
blood
