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NUR 2102 > Test 3 > Flashcards

Test 3 Flashcards

1
Q

Lung Structures-
Left Lobe (2) LL
Right Lobe (3)

A

Left Lung (LL)- Superior & Inferior
Right Lung (3)- Superior, Middle, & Inferior

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2
Q

What is the mediastinum?

A

The space between both lungs inside chest cavity

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3
Q

Structures within the Thorax

A

Mediastinum
Right pleural cavity (3 Lobes)
Left pleural cavity (2 Lobes)
3 lobes right
2 lobes left

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4
Q

External Thorax

A

12 thoracic vertebrae
12 pairs of rubs
Sternum
Xyphiod Process- bottom of sternum (gets broken during cpr)

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5
Q

The parietal hair, the chest wall, and diaphragm are protected in

A

The visceral (outer lining) as the lungs protect it

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6
Q

Why is it important for there to be a small amount of fluid around the structures within the thorax?

A

It lubricates the space between these to reduce friction

If fluid is lost, gets inflamed, then it becomes thick like molasses and we can hear sounds of it rubbing against the side of chest wall or lungs

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7
Q

What are the major functions of the respiratory system?

A
  1. Supplies O2 to the body for energy
  2. Removes CO2 as a waste product
  3. Maintains acid-base balance of our body/blood (blows off or retains acid for balance)
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8
Q

Respiratory Physiological Functions

A

Ventilation
Inspiration/Expiration
Pulmonary Circulation
Oxygen transport
Diffusion
Carbon Dioxide Transport

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9
Q

What is ventilation?

A

Process of moving gases into and out of the lungs during inspiration

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10
Q

What is inspiration and expiration?

A

Active process stimulated by chemical receptors in the aorta and a passive process for expiration

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11
Q

What is pulmonary circulation?

A

Moves blood to and from the alveolar capillary membranes for gas exchange

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12
Q

What is diffusion?

A

Exchange of respiratory gases in the alveoli and capillaries
O2 & CO2 go from high to low concentration

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13
Q

Where does oxygen transport happen?

A

Lungs- transfer O2 from atmosphere to the alveoli where the blood is, exchange the O2 or O2 is exchanged for CO2

Cardiovascular System-
Brings RBC containing HGB w/ O2 to area and diffuse the exchange of gasses bt environment/blood

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14
Q

What happens during active phase of inspiration?

A

Diaphragm contracts pushing abdominal contents down
Intercostal muscles move/push chest forward

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15
Q

What happens during passive phase of expiration?

A

Body expels the gas/CO2

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16
Q

Costal Margin & Angle

A

Teepee shaped
When people are sick the costal angle tends to increase because more air is trapped inside

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17
Q

Thoracic Reference Lines

A

(Front)
Midsternal
Midclavicular
Anterior axillary

(Back)
Scapular Line
Vertebral Line

(Side)
Anterior Axillary
Posterior axillary
Midaxillary

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18
Q

Assessment: Nursing History
What type of questions should you ask?

Find out client’s ability to meet the O2 demands that the body needs

A

Pain (OLD CARTS)

Dyspnea- (shortness of breath)

Wheezing/ cough (air thru narrow airway) (ask duration, production)

Respiratory infections (how often, vaccines)

Health risks (family history)

Smoking(direct vs indirect), years

Fatigue (scale 0-10)

Environmental/ Geographic exposures (work etc.)

Allergies

Medications (all types)

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19
Q

Pack Year History Calculation

A

Pack per day X number of years

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20
Q

How can we help our patient quit smoking?

A

Advising them to quit

Offering brief counseling

Prescribing cessation medications

Connecting them to additional resources, like a quitline

Following up with continued support to help prevent relapse

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21
Q

Routine Respiratory Assessment

A

INSPECT client for general appearance, posture, & breathing (skin, clothes, tiredness etc.)

OBSERVE respirations for rate, quality & depth (fast/slow, labored/unlabored, shallow/deep)

INSPECT the client’s nails, skin, & lips (color, uniformed, clubbing, smooth, cracked, lesions)

INSPECT the thorax

AUSCULTATE the thorax

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22
Q

Inspection for Respiratory

A

Level of consciousness (LOC)

Facial expression (scared, anxious, calm)

Color (pale, warm, red)

Respiratory rate (12-20)

Shape and configuration of chest wall (AP Diameter (1/2 of lateral), if square then chest is pushed out

Respiratory pattern (regular, irregular)

Positioning

Use of accessory muscles ( shoulders involved to help breathing)

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23
Q

INSPECT Client for General Appearance, Posture, & Breathing

Normal:

Appearance relaxed -upright, breathing w/o difficulties

Posture relaxed-straight not hunched

Posture upright
Breathing effortless

A

INSPECT Client for General Appearance, Posture, & Breathing

Abnormal:

Apprehension, restless-anxious when blood oxygen drops and need to breathe from nose

Nasal flaring- opening up to get more air

Use of accessory muscles- shoulder involvement

Tripod position -bending to breathe

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24
Q

OBSERVE Respirations for Rate, Quality & Depth
Normal:

Appropriate rate
Smooth pattern
Even depth
Chest wall rises & expands symmetrically without effort

A

OBSERVE Respirations for Rate, Quality & Depth
Abnormal:
Chest retraction
Frequent sighing
Abnormal breathing patterns (next slide)

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25
Q

Abnormal Breathing Patterns

A

Bradypnea- regular slow inspiration/expiration <12 rate

Tachypnea- regular, not full inspiration >20permin rate

Hyperventilation- Full inhale/exhale, fast, increase depth/rate

Kussmaul’s- Ketoacidosis (high blood sugar, fruity sugar smell,

Cheyne-Stokes- regular periods of crescendo (accelerates)/decrescendo (slows), then apnea (nothing)
Fast, slow, nothin

Biot- Bizarre, no pattern (high low, none), everywhere, (major injury), end of life or very sick (the other stokes)

Air Trapping- Coastal angle expand (COPD, alveoli do not get rid of air like it should)
Rapid inhale, slow exhale

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26
Q

INSPECT the Client’s Nails, Skin, & Lips
Normal

General color consistent with color for that individual

A

Abnormal

Cyanosis (blue)/Pallor (pale, reduced # of HGb) of nails, skin, or lips
Clubbing of nails (long term low oxygen)

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27
Q

What is cyanosis?

A

Cyanosis is a LATE sign of hypoxia and is not a reliable measure of O2 status.

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28
Q

What causes clubbing of nails?

A

Long term of low oxygen

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29
Q

INSPECT the Thorax
Normal:
Thorax symmetrical- Ribs slope down
Spinous processes in a straight line
Scapulae bilaterally symmetrical

A

Abnormal

Asymmetry or unequal muscle development
Skeletal deformities

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30
Q

Inspection: Shape/Configuration of Chest Wall
AP Diameter vs Transverse(lateral)

A

Normal vs Barrel Chest
Front to back=1/2 distance of transverse (normal)

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31
Q

Inspection: Shape/Configuration of Chest Wall

Pectus Excavatum- pressing on heart

A

Pectus Carinatum- doesn’t affect body

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32
Q

Scoliosis- lungs are getting squished and can’t fully inflate

A

Kyphosis- aging, thoracic spine is sticking out and getting pushed further away, getting convex (can’t hear lungs)

33
Q

AUSCULTATE the Thorax

Normal

Bilaterally clear
Vesicular, bronchovesicular, & bronchial sounds heard in various parts of the thorax

A

Abnormal

Adventitious breath sounds
Absent
Diminished
Stridor (trachea closing)

34
Q

Location of Breath Sounds

Anterior

A

Posterior

35
Q

Adventitious Breath Sounds

A

Crackles- cracking or popping (inspiration, fluid in lungs)

Wheezes- high pitched musical (squeak), common during expiration (small airway, asthma), lower abdomen

Rhonchi- snoring or moaning sound (low pitched), during expiration mainly (mucus blocking bronchi) (ask patient to cough to clear it)

Pleural Friction Rub- coarse rubbing/grating sounds (heard in both)
Stridor- up in trachea, things are closing need help asap

36
Q

Where are bronchial sounds heard?

A

Over the main airway (Trachea)
Sounds raspy like darth vader

37
Q

Where are vesicular sounds heard?

A

Outside, all the way down the back and at the bottom, more from boobs down (nice & breezy), not in major airway area

38
Q

Where are bronchovesicular sounds heard?

A

Around the sternum and spine in the back (in btween)
Breezy and deep sounds

39
Q

Auscultating Breath Sounds
Use diaphragm
Compare sounds in each lung field to opposing lung field (latter pattern)

A

Lower lobes best heard in back

40
Q

Where you hear sounds in the sounds.

Generally, from the lower lungs (Right Middle Lobe from the front best)

A
41
Q

Special Circumstances or Advanced Practice Techniques for Anterior & Posterior Thorax

Normal:
PALPATE anterior & posterior thoracic muscles of tenderness, bulges, & symmetry

A

Abnormal
Crepitus: crinkly/crackly sensation under your fingers (air leak)
Pleural friction rub: coarse, grating sensation during inspiration
Asymmetrical thorax: indication of thoracic disorder (ex. fractured ribs)

42
Q

Techniques for Anterior & Posterior Thorax

Normal:
PALPATE the anterior & posterior thoracic wall for vocal (tactile-touch) fremitus
“99”

A

Abnormal
Unequal vibrations
Decreased or absent fremitus
Lung is collapsed

43
Q

PALPATE the trachea for position

Normal: Midline

A

Abnormal: Not midline

44
Q

Acute or Traumatic Conditions

Both will need chest tubes for lungs to reinflate

Collapsed Lung (Pneumothorax)- air in space

A

Hemothorax- air w/blood in space

45
Q

Atelectasis- Collapsed avelioi
from tumor, fluid, air in pleura spaces
caused by hypoventilating patients
Don’t fully breath (post ops)

A

Diff btween pneumothorax and atelactasis

A- not lungs- just avelio
P- whole lungs

46
Q

Lung cancer- presenting sign persistent dry cough
Hemoptysis

A

-tobacco
-Radition
abestos

47
Q

\Normal Air filled lungs
-vesicular predominantly
-Tactile fremitus (vibrations) normal

A

Lobar Pneumonia- we’ll hear bronchial or bronchv over area where we should hear vesicular
tells us they have pneumonia
Increased tf due to fluids
air acs now have fluid pus

48
Q

Diagnostic Testing ABG (Arterial Blood Gas) (invasive)

  • provide valuable information in assessment and managing a patient’s respiratory & metabolic acid-base & electrolyte homeostasis

Assess oxygenation (how well it moves O2)

-Info on respiratory, cardiac, and renal (kidney) system

-Pulmonology- determines the gas exchange levels in the blood related to lung function

A

Normal Findings:
pH: 7.35-7.45
PCO2: 35-45
HCO3: 22-26
PO2: 80-100

Acid Base Disturbances:
Respiratory Acidosis
Metabolic Acidosis
Respiratory Alkalosis
Metabolic Alkalosis

-Procedure: during drawn from artery

-Indicates how efficient lungs provide O2 to the body and how it removes CO2
-Measures the blood pH

49
Q

Diagnostic Testing: Chest X-Ray
-Creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels

-taken anterior, posterior, and laterally

A
  • can identify tumors, inflammation of lungs, fluids, fractures, location of central line
    ex. pneumonia
    -patient can be lying, sitting, standing
50
Q

Expected/Normal Findings
-Nail bed angle 160 degrees
-Respiratory Rate 12-20/minute
-Trachea midline
-Vesicular breath sounds in lung periphery
-Coastal angle <90 degrees

A

Unexpected/Abnormal Findings
-Unilateral chest wall movement w/ inhalation
-Frequent sighing
-Respiratory rate >20/min
-AP to lateral diameter 2:1 ratio
-Bronchovesicular sounds heard over the trachea

51
Q

Diagnostic Testing: Chest CT

-Evaluate suspected disease in the chest

-Questionable or vague abnormalities on the routine chest x-ray can be more thoroughly evaluated

A

-more specific
-helps diagnose tumors, abscessess, pleural effusion (w/ and w/o contrast)
-spiral ct- identify clots pulmonary embolus

52
Q

Diagnostic Testing: Bronchoscopy

-Permits endoscopic visualization of the larynx, trachea, and bronchi by either a flexible fiberoptic or rigid bronchoscope

A

-Can take out/clean things while in there

53
Q

Diagnostic Testing: Lung Biopsy
-Determines the nature of a pulmonary nodule that has been identified on plan chest x-ray or CT scan
Obtain tissue sample

A
54
Q

Diagnostic Testing: Lung V/Q Scan

-Helps to diagnosis pulmonary embolism & identifies blood perfusion defects within the lung
-Nuclear medicine procedure

A

-study air flow (ventilation) and how well blood is coming in to provide oxygen (perfusion) of lungs
-Procedure: inject substance into veins that travels to pulmonary arteries where it illuminates and pictures are taken

55
Q

Diagnostic Testing: Sputum Culture & Sensitivity (c&s)

-Growth on dish and see what drugs work/don’t

-Can distinguish between fungus, bacteria, or virus

-1-3 days to complete
-sterile procedure, best in morning (cough up sample)

A

Indicated for any patients with (persistent, productive, coughs, fever, hemoptysis coughing blood, infections)

-can diagnose pneumonia, respiratory infections, bronchitis

-

56
Q

Diagnostic Testing: Sputum Cytology

-looking for cancers

A

Indicated for any patient in which the diagnosis of cancer of the lung is considered

57
Q

Diagnostic Testing: Tuberculin Skin Test (TST)

-Interdermal
-read between 48-72 hrs for accuracy

-measured in area of indirection (raised area)

-don’t measure redness (erythema)

A

Preformed in individuals suspected of having TB
-aka PPD testing

-negative: generally <5mm but will vary depending on pt

-once positive, pt is + for life

58
Q

Respiratory: Age Considerations for older adults

A

Costal cartilages become calcified (not able to expand as well)

Respiratory muscle strength declines after age 50 years and continues to decrease into the 70s

The elastic properties within the lungs decrease, making them less distensible and lessening their tendency to collapse and recoil.

Decreased number of _alveoli_______
Cough reflex decreases

59
Q

Respiratory: Age Considerations for infants/children

A

Use a pediatric stethoscope with small diaphragm

Infants have a round thorax with an equal AP and lateral diameter

Infants are obligate nose breathers until 3 months

Sneezing– normal newborn reflex

Infants have irregular breathing pattern– apnea is abnormal

Respiratory distress-stridor/ grunting/ sternal or supraclavicular retractions and nasal flaring (abnormal)

60
Q

Considerations for Hospitalized Patient

A

Patient using a nasal cannula: Make sure it is in their nose and watch the O2 sat

Assessment of the nasal cannula—patency, rate and flow—assess O2 saturations

Patient using a Oxygen Mask: Humidify wetness, so we must watch for skin breakdowns/irritants

Using a ventimask—assess skin of face and ears for redness or indentation—assess correct O2 percentage

Patient with a tracheostomy:
Requires suctioning, evaluate secretions, lung sounds, skin near site with dressing changes

Patient with chest tubes:
Assess dressing at site and amount/color of drainage that collects in container—assess lung sounds to know it hasn’t collapsed

61
Q

Documentation of expected respiratory findings

A

Breathing quiet and effortless.
Rate 16.
Skin, nails, lips appropriate color for race.
Thorax symmetrical with ribs sloping downwards at about 45 degrees
No tenderness noted on palpation.
Thoracic expansion symmetrical bilaterally.
Spinous process in alignment.
AP diameter 1:2.
Trachea midline.
Breath sounds clear and equal bilaterally to bases. No accessory muscle use

62
Q

WBC- normal 5,000-10,000 (no infection)

HGb- normal 12-15 F normal (carrying normal o2/co2 thru blood)

HCT- 40% normal F (has right amount of rbc)

D-Dimer- positive = higher d-dimer level possible blood clots (free flowing protein that broke up from clot)

ABG-
pH-7.44 normal
PCO2- 22=low (increased ventilation)
PO2- 48=LOW- not receiving enough O2
HCO3= 23 NORMAL acid base balance

V/Q Mismatch- lung is receiving O2 W/O BLOOD FLOW OR VICE VERSA (OBSTRUCTED AIRWAY MAYBE)

A

Case Study:

Pt 68 yrs old
hip fracture and repaired but on 6th day post op she c/o acute onset of right sided chest pain, shortness of breath, and palpitations

Protentional issue: Pt is experiencing blood clots and obstruction of airway which results in shortness of breath and palpitations

Respiratory acidosis

63
Q

How does the heart work?

A
64
Q

Normal Vascular System: Arterial
Blood going away from heart and into the organs/tissues

Full of oxygen (red)

A

High-pressure vessels
Largest is the aorta
Function to deliver blood to various tissues for nourishment and temperature regulation

65
Q

Normal Vascular System: Venous

Blood going back to the heart
-oxygen has been used (blue)

A

Large diameter, thin-walled vessels
Some contain valves to regulate one-way flow
Functions to return blood from capillaries to the right atrium for circulation and acts as a reservoir for blood volume

66
Q

How is circulation and blood flow of the heart regulated?

A

By pressure, resistance, velocity, and compliance

67
Q

What is circulation and blood flow?

A

Blood flow is the amount of blood moved per unit of time though a vessel, organ, or entire circulated system

68
Q

What is pressure?

A

Stroke Volume X Heart Rate = Cardiac Output (SV X HR = CO)
Cardiac Output X Systemic Vascular Resistance = Blood Pressure
(CO x SVR = BP)

69
Q

What is resistance?

A

determined by viscosity (thick), length of vessel, and diameter of the vessel

70
Q

What is velocity?

A

Distance that the blood travels in the unit of time

71
Q

What is compliance?

A

The degree that the vessel will accomodate

72
Q

Heart Pumping Function- blood flow through the heart

A

3 structures involved w/ pumping:
Endocardium
Myocardium
Epicardium

73
Q

Coronary Blood Supply

A
74
Q

What is stroke volume?

A

Amount of blood ejected from the heart w/ each contraction (how much it puts out)

75
Q

Systemic Vascular Resistance

A

Dilation/constriction amount

76
Q

4 Chambers of the Heart

A

Upper-
Left atrium (LA)and right atrium (RA

Lower- Right ventricle (RV) and Left Ventricle (LV)

77
Q

Which structures of the heart carries oxygenated blood to the right atrium?

A

Superior and Inferior vena cava

78
Q

Blood flow of right side

A

Enters:
Super/inferior vena cava- right atrium-right ventricle- tricuspid valve (closes when ventricles are full)-
Leaves- pulmonary valve into pulmonary artery for oxygenation

79
Q

Blood flow of left side

A

NUR 2102 (3 decks)

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