Respiratory System (part 1) Flashcards
Where do the lungs sit in the body?
The thoracic cage
List 9 parts of lung anatomy
1) Trachea
2) Superior lobe of Lt lung
3) Superior lobe of Rt lung
4) Rt main (primary) bronchus
5) Lobar (secondary) bronchus
6) Segmental (tertiary) bronchus
7) Inferior lobe of Lt lung
8) Middle lobe of Rt lung
9) Inferior lobe of Rt lung
Where does the URT start and end?
Nose to trachea
The lobules & alveoli are part of which respiratory tract?
Lower resp. tract
How many lobes are on each lung?
Right → three lobes
Left → two lobes
What does the trachea divide into?
Two main bronchi which branch into smaller bronchioles, alveolar ducts, and alveoli
List the 2 major components the respiratory system consists of
1) Conducting airway
2) Respiratory airway
What does the conducting airway consist of? Hint: 6
URT → nose, mouth, pharynx, larynx, trachea, & bronchi
What is the respiratory airway responsible for?
GAs exchange
What do the lobules of the lungs in the resp airway consist of? Hint: 4
1) Bronchiole
2) Arteriole
3) Pulmonary capillaries
4) Veins
Conducting airway is the process of ____
Ventilation
Describe the process of ventilation
Changes the quality of atmospheric air we breathe in (Warms, moistens, & filters)
What kind of lining does the conducting airway have?
Epithelial lining → contacts goblet cells that produces mucus, as well as cilia
Why is cilia important?
Helps filter & capture the foreign substances we breathe in before they get down into LRT where we don’t want them
List the process of ventilation
Nose → sinuses → nasal cavity → pharynx → larynx → bronchi
List the 4 defense mechanisms for the lungs
1) Alveolar macrophages
2) Neutrophils
3) Mast cells
4) Cough reflex → expels “bad guys”
Where are the alveoli (respiratory sacs) located?
At the end of the bronchioles & form the respiratory membrane
What do alveoli do? Hint: 2
1) Functional units of the lungs where gas exchange occurs
2) Surfactant is produced by type II cells in the alveoli
What are the lungs separated by?
Mediastinum
List 5 things the mediastinum contains
1) Heart
2) Esophagus
3) Thymus gland
4) Blood vessels
5) Nerves
What kind of blood do the alveoli receive?
Deoxygenated blood from RV via the pulmonary artery
ALL blood circulates through the ____
lungs
Pulmonary perfusion plays a role in which airway
Respiratory airway
What is the mucociliary apparatus?
A specialized cellular mechanism within the bronchioles
List 2 things the mucociliary apparatus consists of
1) Ciliated pseudostriated columnar epithelial cells (Cilia)
2) Goblet cells (mucus)
What does the wave like movement of the mucociliary apparatus enable?
The movement of mucus downward to the throat & the upward movement of the cilia moves mucus from bronchioles to the throat, where it’s swallowed
List 2 things the mucociliary apparatus is affected by
1) smoking
2) respiratory infections
How does smoking affect mucociliary apparatus?
It vasoconstricts as well as paralyzes the apparatus; failing to capture foreign substances we are breathing in
Explain the process of gas exchange Hint: 3
1) O2 enters the alveolis & moves across the alveolar membrane into blood
2) CO2 diffuses from blood into the alveolus to be excreted by exhalation
3) O2 combines with the heme portion of Hgb to form oxyhemoglobin
What is ventilation?
The process of inspiration & expiration of air
What is ventilation controlled by?
The resp center in the brain which receives input from chemoreceptors & lung receptors (stretch & irritant receptors)
How is the vagus nerve involved in ventilation?
Stimulates the diaphragm to contract
What is perfusion?
The movement of blood through the pulmonary circulation
What is the ventilation-perfusion (V-Q) ratio?
The ratio of the amount of O2 reaching the alveoli to the amount of blood reaching the alveoli
List 3 important things to remember about ventilation-perfusion ratio
1) Ideally, we want both to be equal
2) An imbalance in ventilation-perfusion leads to a decrease in gas exchange
3) Dead space → area where theres no perfusion
What does the oxygen-hemoglobin dissociation curve look at?
Looks at % of Hgb saturated by the O2
O2-hemoglobin dissociation curve:
Left shift Hint: 6
Increased affinity for O2
1) ↓ pCO2
2) ↓ H+
3) ↓ 2,3-DPG
4) ↓ temp
5) HbF
O2-Hemoglobin dissociation curve:
Right shift Hint: 5
Decreased affinity for O2
1) ↑ pCO2
2) ↑ H+, ↓ pH
3) ↑ 2,3-DPG
4) ↑ temp
What is O2-hemoglobin dissociation curve measured by?
Pulse oximetry → normal level =/> 95%
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)
List 6 main clinical manifestations of respiratory conditions
1) Dyspnea
2) Cough
3) Hemoptysis
4) Atelectasis
5) Hypoxia
6) Hypoxemia
What is the most common sign of a pulmonary problem?
Dyspnea (SOB)
List 2 things sudden SOB could indicate
1) Asthma attack
2) Pneumothorax
Cough is an involuntary response to…
Mechanical or chemical stimulation of the bronchial tree; serves as mechanism to eliminate stimulant
List 2 types of cough
1) Productive → contains WBCs
2) Non-productive
What is hemoptysis?
Coughing up blood → frank red/ pink frothy
List 3 resp infection hemoptysis is associated with
1) Tuberculosis
2) Lung cancer
3) Infection
What is atelectasis?
Collapse of alveoli, resulting in decreased gas exchange
List 2 times atelectasis occurs
1) Commonly post-op
2) Compression by a mass
What is our job as the nurse to prevent atelectasis?
Promote coughing & deep breathing
What is hypoxia?
O2 level in blood inadequate to meet needs of tissue
**PaO2 < 60 mmHg
What is hypoxemia?
Insufficient amount of O2 in blood
How is erythropoietin secreted?
By the kidneys in response to low O2 levels
What does hypoxia lead to?
Stimulation of the bone marrow to increase production of RBCs (erythropoietin)
List 3 disorders resulting in hypoxia that cause erythropoietin
1) COPD
2) High altitudes
3) Cardiac disease
What is the common cold caused by?
Several viruses which invade the URT leading to an inflammatory response (release of histamine & prostaglandins)
How long does the common cold usually last?
5-7 days
How does the common cold affect mucus & mucus production?
1) Mucus membranes become engorged
2) Increases mucus production
List 7 Sx of common cold
1) Sinus pain
2) Nasal congestion
3) Runny nose
4) Sneezing
5) Watery eyes
6) Scratchy throat
7) H/A
What is the big prevention factor to avoid the common cold?
Hand Hygiene!!
Patients Dx with the common cold should avoid which medications?
Antibiotics
What is rhinitis?
Inflammation & congestion of nasal mucosa
Seasonal rhinitis is considered what?
Hay fever
→ Inflammatory response to a specific allergen
List 4 Sx associated with rhinitis
1) Nasal congestion
2) Sneezing
3) Stuffiness
4) Watery eyes
What is sinusitis?
Inflammation of the mucus membranes lining the para sinuses
List 6 types of sinusitis
1) Acute
2) Subacute
3) Chronic
4) Viral (7-10 days)
5) Allergies
6) Bacterial (up to 4 wks)
List 5 Sx associated with sinusitis
1) H/A
2) Pain over sinus area
3) Pressure
4) Nasal congestion
5) Purulent discharge
When sinusitis works its way down the resp tract it can cause _____
Bronchitis
How do rhinitis & sinusitis differ?
Pathology of both are similar but they affect different structures
List 3 common clinical manifestations of Rhinosinusitis
1) Nasal congestion
2) Cough
3) Bronchial secretions
Define nasal congestion
Nasal passage becomes blocked due to swollen membranes, inflamed blood vessels, & ↑ mucus secretion
Define cough
Forceful expulsion of air from lungs
What kind of reflex is coughing? & What does it help with?
Protective reflex → helps to remove foreign bodies, irritants, or accumulated secretions
What can bronchial secretions result from?
Numerous disorders: both pulmonary & non-pulmonary
What may impair respirations?
Excessive secretions
Tx of nasal congestions & cough Hint: 2
1) May be OTC preparations/ Rx
2) Analgesic drugs (acetaminophen/ ibuprofen)
List 5 medications classes of drugs used to Tx common cold/ rhinosinusitis
1) Nasal decongestants
2) Antitussives
3) Antihistamines
4) Expectorants
5) Mucolytics
What are nasal decongestants used for?
To relieve nasal obstruction & discharge
Nasal decongestants:
Adrenergic (sympathomimetic) drugs are most commonly used to…
Cause vasoconstriction, leading to ↓ edema & inflammation of the nasal membranes
List 3 routes for nasal decongestants
1) oral
2) topical (nasal sprays)
3) Steroidal
What pregnancy category are ALL nasal decongestants?
Category C
List 5 drugs in nasal decongestant class
1) Pseudoephedrine (sudafed)
2) Oxymetazoline (afrin)
3) Phenylephrine (Vazculep; Neosynephrine)
4) Fluticasone (Flonase)
5) Triamcinolone (Nasacort)
What is the problem with nasal decongestants?
They can cause rebound congestion
List 5 adverse effects of nasal decongestants
1) Local stinging & burning
2) Rebound congestion
3) SNS effects
4) ↑ HR & BP
5) urinary retention
List 7 contraindications to nasal decongestants
1) Hx of allergy to drug
2) Glaucoma
3) HTN
4) Diabetes
5) Thyroid disease
6) Coronary disease
7) Prostate problems
Why are nasal decongestants contrainindicated with cardiac pts?
B/c of the adrenergic effect
List 3 patient teaching points when using nasal decongestants
1) Should NOT use for > 5 days unless instructed
2) Caution when using other OTC drugs
3) Should NOT be used for children < 4 yrs
What are antitussives used for?
Used to suppress non-purposeful coughing (non-productive)
What do antitussives depress?
The coughing center in the brain or the cough receptors in throat, trachea, or lungs
List 4 meds considered antitussives
1) Benzonate (Tessalon perles)
2) Dextromethorphan (delsym)
3) Codeine
4) Hydrocodone Bitartrate
Routes of admin for antitussives
Oral
What pregnancy category are antitussives? & What category during labor?
Category C
→ Category D during labor
List 4 general adverse effects of antitussives
1) Drying of mucus membranes
2) H/A
3) Drowsiness
4) Dizziness
List 4 adverse effects of the antitussive Dextromethorphan
1) Nausea
2) Drowsiness
3) Rash
4) Difficulty breathing
List 3 contraindicated for antitussive use
1) Hx of allergy
2) Those with head injury
3) Impaired by CNS depression
List 3 pt populations to use antitussives with caution in
1) Those with asthma
2) Those with COPD
3) Children w/ atopic syndrome
What needs to be avoided with use of dextromethorphan Hint: 2
1) Alcohol
2) Several psych drugs
List 2 patient education points for antitussives
1) Should NOT use for > 5 days unless instructed
2) Caution use with other OTC drugs
How do expectorants work?
Increase productive cough to clear airway by
List 2 ways expectorants increase productive cough
1) Liquify LRT secretions
2) Decrease viscosity of secretions to allow person to cough it up or not
List an expectorant drug
Guaifenesin (Mucinex)
What is the onset & duration for Guaifenesin (mucinex)
Onset: 30 min
Duration: 4-6 hrs
Route of admin for expectorants
Oral
What pregnancy category are expectorants?
Category C
List 4 adverse effects of expectorants
1) Rash
2) H/A
3) N/V
4) Dizziness
List 3 contraindications of expectorants
1) Hx of allergy to drugs
2) Persistent cough due to smoking, asthma, emphysema
3) Productive cough lasting > 1 wk
Patient education for expectorants
Use cautiously in children
How do mucolytics work?
Breakdown & liquify respiratory tract secretions
List 5 disorders mucolytics are used to treat
1) Cystic fibrosis
2) Asthma
3) Bronchiectasis
4) COPD
5) Chronic bronchitis
List 2 drugs considered mucolytics
1) Acetylcysteine (Acetadote, Parvolex)
2) Dornase Alfa (pulmozyme)
List 3 routes of administration for mucolytics
1) Oral
2) Nebulizer
3) IV
What pregnancy category are mucolytics?
Category C
List 7 adverse effects of mucolytics
1) GI upset
2) Stomatitis
3) Rhinorrhea
4) Bronchoconstriction
5) Bronchospasm
6) Urticaria
7) Rash
List 2 contraindications of mucolytics
1) Hx of allergy to drugs
2) Presence of acute bronchospasm
Patient education for mucolytics
1) How to use a nebulizer
What OTC preparations have been used as cold remedies?
Herbal preparations
List 3 herbal remedies
1) Echinacea
2) Vitamin C
3) Zinc sulfate
Which herbal remedy is no better than a placebo?
Echinacea
How does vitamin C work Hint: 2
1) Decrease incidence & severity of cold & flu
2) regular use appears to play a role in defense mechanisms of resp system
How does zinc sulfate work? Hint: 2
1) Decreases incidence & severity of cold Sx in adults
2) Can lead to loss of smell w nasal zinc
What is histamine?
First chemical mediator releases in immune & inflammatory responses
List the 3 main types of receptors for histamine
1) Histamine 1
2) Histamine 2
3) Histamine 3
What is histamine released by?
Mast cells & Basophils
Where are H1 receptors located?
Mainly on smooth muscle cells in blood vessels, respiratory & GI tract
What is allergic rhinitis?
Inflammation of the nasal mucosa caused by a type 1 hypersensitivity reaction to inhaled allergens
Allergic rhinitis is characterized by what 4 things
1) Nasal congestion
2) Itching
3) Sneezing
4) Watery discharge
List 2 types of allergic rhinitis
1) Seasonal disease
2) Perennial
Allergic rhinitis:
Seasonal disease
Hay fever
→ Produced acute Sx in response to protein components of airborne pollens
When does seasonal allergic rhinitis occur?
Mainly in spring & fall
Who is at a higher risk for seasonal allergic rhinitis?
Those with a personal or family Hx of other allergies
Allergic rhinitis:
Perennial Hint: 2
1) Occurs year-round
2) Caused by dust mites, animal dander, & molds
How do antihistamines work?
Block release or action of histamine at the H1 receptor sites by inhibiting smooth muscle
What kind of effects do antihistamines have? Hint: 2
1) Anticholinergic
2) Antipruritic
What are antihistamines used for?
Relief of Sx associated w allergic responses
i.e. seasonal allergies, angioedema, motion sickness, allergic reactions
List 4 contraindications of antihistamines
1) Pregnancy
2) Lactation
3) Hx of arrhythmias
4) Prolonged QT intervals
List 8 adverse effects of antihistamines
1) Drowsiness
2) Sedation
3) Drying of resp & GI mucus membranes
4) GI upset
5) Nausea
6) Arrhythmias
7) Dysuria
8) Urinary hesitancy
What do antihistamines decrease? Hint: 2
Capillary permeability & saturation (runny nose & eyes)
What generation antihistamines have the highest incidence of causing sedation?
First generation
What generation antihistamines do most people take & why?
Second generation → they don’t cause as much drowsiness
List 2 first generation antihistamines
1) Diphenhydramine (Benadryl)
2) Hydroxyzine (Vistaril)
List 2 second generation antihistamines
1) Certirzine (Zyrtec)
2) Loratadine (Alavert, Claritin)
List 1 third generation antihistamine
Fexofenadine (Allegra)
Which antihistamine has multiple drug interactions?
Zyrtec
Why should patients taking antihistamines drink lots of fluid?
B/c they can cause dryness of mucus membranes & thickening of secretions
Why should patients take antihistamines with meals?
To avoid GI upset
List 5 teaching points about antihistamines causing drowsiness, dizziness, or impaired mental alertness
1) Do NOT smoke
2) Do NOT drive/ operate heavy machinery
3) Avoid other meds that also cause sedation
4) Do NOT take more than one at a time
5) Avoid prolonged exposure to sunlight
Where can we find antihistamines?
Many OTC cold & “nightime” or “PM” sinus & allergy meds & OTC sleep aids contain benadryl
Question 1:
A common mucolytic used to liquefy mucus in the resp tract is:
A) Acetylcysteine
B) Dextromethorphan
C) Ipratropium
D) Pseudoephedrine
A) Acetylcysteine
Question 2:
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
Question 3:
Cold remedies listed as “Non-drowsy” or “daytime” formulas do NOT contain…
A) Nasal decongestant
B) Antihistamine
C) Mucolytic
D) Pain reliever
B) Antihistamine
Question 4:
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)
