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MCN 109 Pre-finals > Respiratory System > Flashcards

Respiratory System Flashcards

1
Q

All structures function in air distribution, except:

A

ALVEOLI
- gas exchange of oxygen and carbon dioxide

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2
Q

Upper Airway Structures

A
  1. oronasopharynx
  2. pharynx
  3. larynx
  4. eustachian tube and sinuses
  5. upper part of trachea
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3
Q

Lower Airway Structures

A
  1. trachea
  2. bronchi
  3. bronchioles
  4. alveoli
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4
Q

Diameter of Infant’s Trachea

A
  • approx 4 mm
  • presence of edema = increased mucus = bronchospasm = air passage diminished = air flow resistance = increased work of breathing
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5
Q

Diameter of Adult’s Trachea

A

20 mm

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6
Q

Nose

A
  • nose breathers until 4 weeks
  • little mucus (cleansing agent) = susceptible to infection
  • very small nasal passage = excess mucus = airway obstruction
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7
Q

Sinuses

A

INFANTS: born with maxillary and ethmoid sinuses

6-8 YEARS OLD: develop frontal and sphenoid sinus = young children are less susceptible to sinus infection
- frontal sinus = assoc. with infection

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8
Q

Throat

A

INFANT: tongue relative to oropharynx = larger than adults
- posterior displacement of tongue = severe airway obstruction

EARLY SCHOOL AGE: enlarged tonsillar and adenoidal tissue even in absence of illness = increased incidence of airway obstruction

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9
Q

Cricoid Cartilage

A
  • hyaline cartilage ring that fully encircles trachea

LESS THAN 10 YEARS OLD: underdeveloped = narrowing of larynx
- mucus and edema = air flow resistance = increased effort

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10
Q

Larynx and Glottis

A

placed higher in the neck = increased chance of aspiration of foreign material in lower airways

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11
Q

Muscles Supporting the Airway of Children

A
  • less functional than adults
    = large amount of soft tissues surrounding trachea and mucus membranes lining the airway = less securely attached compared to adults
  • increases risk of airway edema and obstruction
  • upper airway obstruction = tracheal collapse during inspiration
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12
Q

Bifurcation of Trachea

A
  • contributes to risk of aspiration

CHILDREN: 3rd thoracic vertebra
ADULT: 6th thoracic vertebra

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13
Q

Bronchi and Bronchioles

A

narrower in infants and children compared to adults = increased risk of airway obstruction (bronchitis/ asthma)

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14
Q

Alveoli

A
  • develop at app. 24 weeks of gestation

TERM INFANT: 50 million alveoli
AFTER BIRTH: growth slows until 3 months of age
7-8 YEARS OLD: 300 million (same with adult)

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15
Q

Chest Wall

A
  • highly compliant (pliable) and fail to support lungs adequately
  • respiratory effort diminished = functional residual capacity of lungs greatly reduced
  • lack of support, tidal volume of infants and toddlers = independent to diaphragm
  • diaphragm movement impaired = intercostal muscles cannot lift chest wall = respiration further compromised
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16
Q

Metabolic Rate and Oxygen Need

A
  • children have higher metabolic rate than adults
  • resting respiratory rate = faster
  • demand for oxygen = higher
  • respiratory distress = develop hypoxemia faster than adults
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17
Q

Fetal Lung Development: Week 4

A

laryngotracheal groove forms on floor foregut

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18
Q

Fetal Lung Development: Week 5

A

left and right lung buds push into pericardioperitoneal canal (primordial of pleural cavity)

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19
Q

Fetal Lung Development: Week 6

A
  • descent of heart and lungs into thorax
  • pleuroperitoneal foramen closes
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20
Q

Fetal Lung Development: Week 7

A

lung buds divide into secondary and tertiary bronchi

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21
Q

Fetal Lung Development: Week 24

A

bronchi divide 14 more times and respiratory bronchioles develop

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22
Q

Fetal Lung Development: Birth

A

additional 7 division of bronchi

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23
Q

Fetal Lung Histology: Stage 1

A

PSEUDOGLANDULAR PERIOD (5-17 weeks)
- all major elements of lungs formed except those involved with gas exchange (alveoli)

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24
Q

Fetal Lung Histology: Stage 2

A

CANALICULAR PERIOD (16-25 weeks)
- bronchi and terminal bronchioles increase in lumen size and lungs become vascularized

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25
Q

Fetal Lung Histology: Stage 3

A

TERMINAL SAC PERIOD (24 weeks- birth)
- more terminal sacs developed with capillaries lined with type I alveolar cells/ pneumocytes
- type II pneumocytes (defenders) secrete surfactant = decrease surface tension forces and aids with expansion of terminal sacs

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26
Q

Fetal Lung Histology: Stage 4

A

ALVEOLAR PERIOD (late fetal period- 8 years)
- 95% of mature alveoli develop after birth

NEWBORN: only 1⁄6 to 1⁄8 of the adult number of alveoli and lungs appear denser on x-ray

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27
Q

Defenses of RS

A
  • filtering particles
  • warming and humidifying inspired air
  • absorbing noxious gases in vascular upper airway
28
Q

Defense: Lymphoid Tissues

A
  • includes focal, lingual and adenoid = form protective circle around entrance
  • localizes and contains invading organisms so that they could be destroyed
29
Q

Defense: Mucous Blanket

A

secretes sticky mucus where organisms adhere

30
Q

Defense: Ciliary Action

A

carry microorganisms and foreign agents away from lungs to be coughed out or swallowed by px

31
Q

Defense: Epiglottis Reflex

A
  • protect RT from invading foreign materials including infectious exudates from URT
  • prevent microorganisms from being aspirated from LRT
32
Q

Defense: Cough Reflex

A
  • expulsive force
  • propels foreign materials our of LRT
33
Q

Defense: Tracheobronchial Dynamics

A

TRACHEOBRONCHIAL TREE: elongates, dilates on inspiration and shortens narrows during expiration

34
Q

Defense: Position Changes

A

helps in draining tracheobronchial passage which gives problem in airway obstruction)

35
Q

Defense: Lymphatics

A

DRAINING TERMINAL BRONCHIOLES: invades foreign microorganisms which are filtered and destroyed in the regional lymph nodes

36
Q

Defense: Humoral Defenses

A

removed or destroyed by phagocytes immunoglobins (immunoglobin A: secreted by bronchial epithelium)

37
Q

Physical Assessment of Respiratory Illness

A
  1. cough
  2. rate. depth of respirations
  3. retractions
  4. restlessness
  5. cyanosis
  6. clubbing of fingers
  7. adventitious sounds
  8. chest diameter
38
Q

PA: Retractions

A
  • sinking in of soft tissues relative to the cartilaginous bony thorax
  • nose flaring
39
Q

PA: Stridor

A

high pitched noisy respiration

40
Q

PA: Grunting

A
  • occurs on expiration
  • might occur with alveolar collapse
  • sign of pain in older children
  • suggest pneumonia
41
Q

PA: Wheezing

A

continuous musical sound originating from vibrations in narrowed airways

42
Q

PA: Clubbing

A

proliferation of tissues on terminal phalanges

43
Q

PA: Cough

A
  • protective mechanism
  • indicator of irritation
44
Q

Auscultation: Wheezing

A

CLEARS WITH COUGH: secretion in lower trachea

DOES NOT CLEAR WITH COUGH: obstruction of bronchioles

45
Q

Auscultation: Rales

A
  • crackling sound
  • alveoli filled with fluid
46
Q

Percussion

A
  • note for non-resonant sounds

FLAT OR DULL: percussed over partially consolidated lung tissue like pneumonia

TYMPANY: percussed with pneumothorax, air in pleural cavity

47
Q

Palpation

A
  • palpate sinuses for tenderness in children
  • enlargement or tenderness of lymph nodes of head and neck

ALTERATION IN TACTILE FREMITUS: decreased in barrel chest, absent in atelectasis

COMPARE CENTRAL AND PERIPHERAL PULSES: weak = poor perfusion
- central pulses in carotid in femoral artery (middle of body: neck and groin)

48
Q

Lab: Arterial Blood Gas Analysis (ABG)

A

measures oygen and carbon dioxide

49
Q

Lab: Arterial Blood Gas Analysis (ABG)

A

measures oygen and carbon dioxide

50
Q

Lab: Pulse Oximetry

A

estimate arterial oxygen saturation: 95-100%

51
Q

Lab: Transcutaneous Oxygen Monitoring

A

monitor oxygenation and ventilation

52
Q

Respiratory Alcalosis

A

cause hyperventilation

53
Q

Respiratory Acidosis

A

cause hypoventilation, trapping carbon dioxide in alveoli

54
Q

Lab: Nasopharyngeal Culture

A

provide information on microorganisms causing the diseases in URT

55
Q

Lab: Pulmonary Function Test

A
  • non-invasive test that show how well lungs are working
  • measures lung volume, capacity, flow rate, and gas exchange
56
Q

Lab: Sputum Analysis

A

ask older children to breathe in and out several times, cough deeply, and cough out mucus they have raised into a sterile specimen container

57
Q

Lab: Xray, CT Scan, MRI

A
  • evaluates respiratory tract
  • shows areas of infiltration or consolidation in lungs

MRI: detailed image of chest cavities
- when done in children, it requires sedation for best results

58
Q

Therapeutic: Humidification

A
  • method of artificial warming and humidifying of RT for mechanically ventilated px

NEBULIZER: aims to deliver computed amounts of drug aerosols

STEAM INHALATION: warm steaming that helps loosed thick mucus, making it easier for child to cough

59
Q

Therapeutic: Expectorant Therapy

A
  1. coughing
  2. mucus clearing devices
  3. chest physiotherapy: postural drainage in combination with other techniques (manual percussion, vibration)
60
Q

Therapeutic: Improve Oxygenation

A
  1. oxygen admn
  2. pharmacologic
  3. incentive spirometry
  4. breathing techniques
  5. tracheostomy: emergency intubation, suctioning technique
  6. endotracheal intubation: assisted ventilation
  7. lung transplantation: prolong life expectancy improve QOL of px
61
Q

Therapeutic: Oxygen Delivery Systems

A
  1. venturi mask
  2. hudson mask
  3. trauma mask
  4. nasal cannula
62
Q

Nursing Care Management of Pediatric Client with Mechanical Ventilator

A
  • prevent accidental/ unplanned extubation
  • positioning for optimum ventilation
  • suctioning airway prn
  • monitor for potential SE of mechanical ventilator
  • prevent infection
  • ensure adequate humidification
  • provide support, comfort, and reassurance to child and family
63
Q

Nursing Care Management of Pediatric Client with Mechanical Ventilator

A
  • prevent accidental/ unplanned extubation
  • positioning for optimum ventilation
  • suctioning airway prn
  • monitor for potential SE of mechanical ventilator
  • prevent infection
  • ensure adequate humidification
  • provide support, comfort, and reassurance to child and family
64
Q

Acute Nasopharyngitis

A
  • common cold
  • most frequent infectious (toddler: 10-12/yr ; school age and adolescent: 4-6/yr)
  • incubation period: typically 2-3 days
  • most common during rainy season, fall, and winter
65
Q

AN Causes

A
  1. rhinovirus
  2. coxsackie virus
  3. respiratory syncytial virus
  4. adenovirus
  5. parainfluenza
  6. influenza virus
  7. stress factors
66
Q

AN Assessment

A

MCN 109 Pre-finals (1 decks)

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