Unit VIII Flashcards
What does the epiglottis do?
Prevents aspiration
What is the major role of the respiratory system?
Provide oxygen for tissue perfusion & remove carbon dioxide
Orthopnea
Positional breathing
Paroxysmal nocturnal dyspnea
Sudden difficulty breathing at night
Hair like structure that moves particles
Cilia
What happens to inhaled air by tissue lining nasal cavity
Moistened
Warmed
Cleansed
What are the major structure of the respiratory system
Nose Nasal cavity Mouth Pharynx Larynx
What are the major functions of upper airway?
Air conduction
Protection
Warming filtration
Humidification
From normally midline septum protrudes more to one side of nasal passage
Deviated septum
Deviate ion reconstructed & aligned with minimal cartilage & bone removal
Septoplasty
Removal of deviated section of cartilage & bone
Sub mucosal resection
Epitaxis
Nosebleed
Complications of nasal packing
Septal hematoma
Septal pressure necrosis
Sinusitis
Toxic shock syndrome
What is the cause of the common cold
Virus
Common cold aka
Rhinitis
Incubation time of rhinitis
18-48 hours
Reaction of nasal mucosa to allergen
Allergic rhinitis
Influenza symptoms have a ______ onset of respiratory symptoms
Abrupt
What is a serious implication of influenza
Bacterial pneumonia
Zanamivir and amantadine do what for influenza
Prevent & treats
Infection of more than one sinus
Pan sinusitis
What sinus is most effected
Largest sinus
Maxillary sinus
What sinus can cause brain & ear infections
Frontal sinus
Chronic
Last more than one month, reoccurring
Antitussives are used for
Dry hacking cough
Persistent infection associated with allergies and nasal polyps
Chronic sinusitis
What are contraindications of giving a nasal decongestants
Blow nose after medication is given
Benign mucous membrane masses
Polyps
Inflammation of pharyngeal walls may include tonsils, palate and uvula
Acute pharyngitis
Absence of breathing
Apnea
Shallow slow respirations
Hypopnea abnormally
Increased PaCO2
Hypercapnia
Decreased PaO2
Hypoxemia
Snoring
Morning HA
Personality changes, irritability
Frequent awakening
Sleep apnea
Polysomnography
Sleep study
Prevents food from entering lungs
Closes over glottis during swallowing
Epiglottis
Larynx is composed of 3 cartilages
Thyroid
Cricoid
Epiglottis
Inflammation of mucous membranes in lining of larynx
Laryngitis
What is the most common symptom of laryngeal polyps
Hoarseness
Examination of larynx with a lighted speculum
Direct laryngoscopy
What may happen to patients with laryngitis
Change in appearance that may be devastating
Partial removal one vocal cord
Cordectomy
Removal vocal cord or part requires temporary trach
Hemilarynectomy
Removal of structures above the cords
Supraglottic laryngectomy
A total laryngectomy is the removal of
Epiglottis Thyroid cartilage Cricoid cartilage 1-4 tracheal rings Resection hyoid bone Hypopharynx muscles reconstructed
What surgery decreases lymphatic spread (matestasis)
Radical neck dissection
Concentrated localized method of radiation to target area
Brachytherapy
What is the most important thing to do post op
Assess breath sounds
Leave call bell in reach
Fistula
Abnormal opening
Lower respiratory tract structures are
Trachea Lung Right & left mainstem bronchi 5 secondary bronchi Bronchioles Alveoli Alveolar sacs
Where does the exchange of oxygen and carbon dioxide take place
Capillary bed of the alveolar sacs
Windpipe
Trachea
Top of lung
Apex
Bottom of lung
Base
Normal tidal volume
500 mL
Tidal volume is
Capacity of air in lungs
Is there oxygen and carbon dioxide exchange at the terminal bronchioles
No
Decrease in diameter of airways
Bronchoconstriction
Increase of diameter of airway
Bronchodilation
What does the pores of Kohn allow
Air movement from alveolus to alveolus
Alveolar surface composed of cells that provide
Structures & cells that secrete surfactant
What stimulates the production of surfactant
Deep breathing
Atelectasis
Collapsed airless alveoli
What is the waste product of tissue metabolism
Carbon dioxide
Ventilation
Amount of air in aveoli
Perfusion
Amount of blood in capillaries
What determines the effiency of gas exchange
Relationship between ventilation & perfusion
Decrease pH
Increased CO2
Respiratory acidosis
Decreased pH
Decreased HCO3
Metabolic acidosis
Increased pH
Decreased CO2
Respiratory alkalosis
Increased pH
Increased HCO3
Metabolic alkalosis
Obstruction of bronchioles
Decreased gas exchange
Increase exudate
Pneumonia
Fatigue anorexia Pleuritic chest pain Chronic cough Night sweats Hemoptysis
Tuberculosis
Orthopenic Digital clubbing Barrel chest Wheezing Pursed lip breathing Dyspneic
COPD
Pink puffer
Increase CO2 retention
Anxious
Prolonged expiratory time
Emphysema
Blue bloater
Hypoxia
Hypercapnia
Increase RR
Chronic bronchitis
Tachypnea
Fast breathing
Bradypnea
Slow breathing
Tachypnea Hypoxia Dyspneic Tachycardia Hemoptysis Sudden sharp chest pain
Pulmonary embolus
Air in the pleural cavity resulting in lung collapse
Pneumothorax
Membrane covering the lungs
Visceral pleura
Collection of blood within the pleural space
Hemothorax
Cloudy fluid
Exudate
Watery substance clear in color
Transudate
Inner layer of the pleura which attaches its self to the lungs
Visceral pleural
Outer layer of pleural which connects to the chest wall
Parietal pleural
Removal of fluid from the pleural cavity through a needle inserted between ribs
Thoracentesis
Collection of fluid between lining of lung and wall of chest cavity
Pleural effusion
Bloody vomitus
Hematemesis
Bloody sputum
Hemoptysis
Ventilation is normal but perfusion is reduced or absent
Dead space ventilation
Pulmonary circulation is normal but not enough oxygen is available
Shunt
Absence of ventilation & perfusion
Silent shunt
Breathing in is a ______ process
Active
Breathing out is a ______ process
Passive
Elastic recoil happens during
Expiration
Regular rhythm but breathing is deeper and may be slow or fast
Body’s response to acidosis
Kussmaul’s respirations
Where ate the pores of kohn found
Aveoli
Normal ventilation to perfusion ratio
4-5
If you have a pt with right sided pneumonia what side would you lay them on
Left
If you had a pt with bilateral pneumonia what side would you lay them on
Right
Ball park pulmonary pressures
25/10
Space between lungs
Mediastinum
Which ribs attach directly to sternum
1-7
Which ribs attach to cartilage to proceeding rib
8-10
Which ribs are floating
11 & 12
Which pleura has pain fibers
Parietal pleural
Inter pleural pressure is
Negative
During inspiration the diaphragm
Contracts
When inspiration is difficult which muscles ate used
Scalenus
Tendency for lungs to recoil after being stretched or expanded
Elastic recoil
Restricted movement of lungs
Pleural effusion
Increase fluid in lungs
Pulmonary edema
Make lung tissue less elastic
Pulmonary fibrosis
The respiratory center of the CNS is located where
Medulla
As lungs inflate the pulmonary stretch receptors activate inspiratory center to inhibit further expansion , or over distention
Hearing Breuer reflex
Respiratory defense mechanisms
Filtration of air Cough reflex Reflex bronchoconstruction Cilia Etc
Handle like superior part of sternum joins clavicle
Manubrium
Paroxysmal
Irregular
What is the most common respiratory symptom
Cough
Mucupurulent
Pus
Expectorant of blood originating from respiratory Tracy below pharynx
Hemoptysis
Inspection
CRAMP chest wall symmetry RR & pattern Accessory muscle use Masses or scars Paradoxical movement
Cyanosis to fingers toes tip of nose
Peripheral cyanosis
Is cyanosis a late or early sign?
Late
Normal RR
12-20
Rapid breathing but pause between each breath
Biot’s
Increase deep breaths, periods of apnea
Cheyne-stokes
Resonance low pitch hollow sound
Normal lung
What are normal breath sounds sound like
Soft & breezy
Bubbling non musical high pitched crackling sound on inspiration
Not cleared through cough
Crackles
Musical sound high pitched squeaky
Wheeze
Continuous rumbling snoring rattling
May clear with cough
Rhonchi
High pitched crowing
Obstructed upper airway
Stridor
Creaking low pitched grating
Painful
Inhalation & exhalation
Pleural friction rub
Normal WBC
5-10 thousand
What dies hemoglobin do
Transports o2
Normal hemoglobin
Male 13-18
Female 12-16
Non invasive device that measures arterial blood oxygen saturation
Pulse ox
Normal SaO2 pulse ox
95-100
Culture & sensitivity
Sterile container
Taken in am
If pt’s on metformin must wait 48 hours for contrast or will end up with
Renal failure
Maximum amount of air that can be inhaled & exhaled
Vital capacity
Acute bronchitis is most commonly
Virus
Inflammation of lower respiratory tract that involves lung parenchyma, “friendly killer”
Pneumonia
Pneumonia onset in community or 1st 2 hospital days
Community acquired pneumonia
Streptococcus is common cause
Pneumonia that occurs 48 hours or longer after admission
Hospital acquired pneumonia
What has the highest mortality rate of nonsocomical infections
Hospital acquired pneumonia
Pneumonia that found in pt’s that are on steroids, ca pt’s, HIV pt’s
Fungal
Pneumonia caused by Abnormal entry of secretions into lower airway
Aspiration pneumonia
Pneumonia caused by immune deficiencies, transplant recipients
Opportunistic pneumonia
What is the most common cause of bacterial pneumonia
Streptococcus pneumonia
Massive dilation of capillaries alveoli fill with organisms
Lungs apper red
Red hepatization
Blood flow decreases pleuritic pain, sputum may be purulent
Gray hepatization
Mycoplasma pneumonia
Walking pneumonia
Legionella
Droplet spread
Sudden onset chills, fever, cough
Pneumonia
Empyema
Pus in drainage
Teaching for pneumonia
Space activities so pt does not over do it
Bacterial infectious disease transmitted by mycobacterium tuberculosis
Tuberculosis
What kills more world wide than any other infectious disease
Tuberculosis
How is TB spread
Droplet nuclei
Spread of TB requires
Close frequent prolonged exposure
Symptoms of pulmonary TB
Night sweats
What test provides confirmation of positive TB test
Acid fast bacilli
What is used in combination to treat TB
INH (kills actin), rifampin (kills slow growing), pyrazinamide, ethambutol (inhibits RNA)
What should you emphasize with TB teaching
Need for follow up for liver testing
Amphotericine
Very toxic
Used for pulmonary fungal infections
What is he best test for fungal infections
Sputum
Symptom of bronchiectasis
Chronic productive cough
Greater 20 mL purulent sputum (hemoptysis)
Bacteria reaches lung, leads to necrosis of tissue
Lung abscess
With a lung access your body try lies to
Wall off the infection
Collection of excess fluid in pleural space
Pleural effusion
Purulent pleural effusion containing pus
Empyema
Inflammation of pleura
Pleurisy
Hear a friction rub
Loudest on inhalation
Pleurisy
Viral infectious disease of the respiratory system
Atypical inflammation of lungs caused by coronavirus
Severe acute respiratory syndrome SARS
Prevention of SARS
Hand washing
Cleaning contaminated surfaces
Isolation
Tissue for cough or sneeze
The pressure of a gas is inversely proportional to the volume of its container.
Boyle’s law
Space between parietal & visceral pleura
Intrapleural space
20-25 mL fluid
What is the function of the fluid between the lungs & chest wall
Lubrication
Cohesion
Is intrapleural pressure positive or negative
Negative
When would the intrapleural pressure become positive?
Tear in pleura (lung collapse)
Inspiration & expiration as result of intrathoracic pressure changes
Gas flows from higher to lower pressure area
Ventilation
Movement from area of higher concentration to area of lower concentration
Diffusion
Low pitched hollow normal lung
Resonance
Where are crackles most commonly heard
Bases of lower lungs
What is the pulmonary function test used for?
Measures vital capacity
Normal pH
7.35-7.45
Normal HCO3
22-26
Normal CO2
35-45
How many lobes does the right and left lungs have
Right 3 lobes
Left 2 lobes
