week 10 : gas exchange Flashcards
what are the concepts that are related to gas exchange
anxiety
acid base balance
perfusion
fatigue
mobility
nutrition
define if this is a true statement or not.
carbon dioxide travelling to hemoglobin and back, alveoli C02 is released in Alveoli
when you are breathing out, initially you are removing C02.
this is true
define if this is a true process of gas exchange in the first step
Atmosphere (21% oxygen):
* The process begins with the air we breathe, which consists of approximately 21% oxygen and other gases.
this is true
define the function of medulla in the process of gas exchange :
- Medulla:
The medulla oblongata in the brainstem plays a crucial role in regulating involuntary processes, including breathing. It monitors the levels of oxygen and carbon dioxide in the blood.
define if this is a true statement within the process of gas exchange
Thorax, Intact, Diaphragm Contracts:
* The diaphragm, a muscle separating the thoracic and abdominal cavities, contracts. This action increases the volume of the thoracic cavity, reducing air pressure in the lungs.
this is true
true or false. Reducing air pressure in the lungs plays a crucial role in the process of breathing. When the diaphragm contracts and the thoracic cavity expands, it creates a decrease in air pressure within the lungs. This change in pressure is essential for drawing air into the respiratory system
this is true
is this a true statement ? * Nose, Trachea, Bronchi:
Air enters the cardiovascular system through the nose and travels through the trachea (windpipe) and bronchi (airways that branch off the trachea) to reach the lungs.
false, IT IS NOT cardiovascular but rather respiratory
What is this describing in terms of the process of gas exchange, specifically what are we using ?
* The bronchi further divide into smaller tubes called bronchioles, which eventually lead to tiny air sacs. These are the primary sites for gas exchange in the lungs
alveoli
true or false. does this fall into the process of gas exchange?
Pulmonary Capillaries with Hemoglobin to Carry Oxygen:
* Oxygen diffuses across the thin walls of the alveoli and into the surrounding pulmonary capillaries. Hemoglobin, a protein in red blood cells, binds with oxygen to form oxyhemoglobin.
yes it does.
Define if these are all true according to the process of gas exchange.
* Cell Metabolism:
Within the cells, oxygen is used in cellular metabolism, a process that produces energy for the cell’s functions.
*Perfusion to Transport Hemoglobin from Cells:
Hemoglobin, now carrying carbon dioxide (a waste product of cellular metabolism), returns to the bloodstream.
* Pulmonary Capillaries with Hemoglobin Carrying Carbon Dioxide:
The deoxygenated blood, carrying carbon dioxide, returns to the lungs through the pulmonary arteries.
* Alveoli, Bronchi, Trachea, Nose:
Carbon dioxide diffuses from the blood in the pulmonary capillaries into the alveoli. The carbon dioxide is then expelled from the body as we exhale, following the reverse path of inhalation.
*Thorax, Intact, Diaphragm Relaxes:
The diaphragm relaxes, decreasing the volume of the thoracic cavity, and air is expelled from the lungs.
* Atmosphere:
The cycle repeats as we inhale again from the atmosphere, taking in fresh oxygen to support cellular activities.
yes it is true
here is a better and compressed explanation of the process of gas exchange :
inhaling Air (Atmosphere, 21% oxygen):
We start by breathing in air, which contains around 21% oxygen.
Brain Monitoring (Medulla):
The brain’s medulla monitors oxygen and carbon dioxide levels in the blood, helping regulate breathing.
Breathing Action (Thorax, Intact, Diaphragm Contracts):
The diaphragm contracts, expanding the chest cavity and reducing air pressure in the lungs, allowing air to be drawn in.
Airway Passage (Nose, Trachea, Bronchi):
Air travels through the nose, trachea, and bronchi to reach the lungs.
Gas Exchange (Alveoli):
In the lungs, air reaches tiny sacs called alveoli, where oxygen moves into the bloodstream and binds with hemoglobin.
Oxygen Transport (Pulmonary Capillaries):
Oxygen-rich blood is pumped by the heart to tissues and organs, releasing oxygen to support cell functions.
Cell Energy (Cell Metabolism):
Oxygen is used in cell metabolism to produce energy within cells.
Carbon Dioxide Pickup (Perfusion from Cells):
Hemoglobin, now carrying carbon dioxide, returns to the bloodstream.
Carbon Dioxide Transport (Pulmonary Capillaries):
Deoxygenated blood, carrying carbon dioxide, returns to the lungs.
Exhaling (Alveoli, Bronchi, Trachea, Nose):
Carbon dioxide moves from the blood to the alveoli and is expelled as we exhale.
Relaxing Phase (Thorax, Intact, Diaphragm Relaxes):
The diaphragm relaxes, reducing the chest cavity volume, and air is pushed out of the lungs.
Repeat (Atmosphere):
The breathing cycle repeats as we inhale fresh oxygen from the atmosphere to support cellular activities.
!!!! get it together and we must know it before the finals !!!!!
what is ventilation ?
process of inhaling oxygen into lungs and exhaling carbon dioxide from lungs
Impaired ventilation may occur :
The statement lists several potential causes of impaired ventilation:
( name examples )
inadequate bone/muscle nerve function to move air into the lungs such as rib fracture, spinal cord injury
true or false. When having a rub fracture, it is suggested to take a deep breathe to better airflow going into your lungs.
hell no! you do not take deep breathes, this is going to disrupt your whole shat !!!! not recommended.
this is when your diaphragm is paralyzed ( impaired), therefore your ventilation may be impaired as well, what type of injury is this ?
spinal cord injury
Impaired ventilation may occur :
The statement lists several potential causes of impaired ventilation:
( name examples )
recall we already know : inadequate bone/muscle nerve function to move air into the lungs such as rib fracture, spinal cord injury
are some examples. Name more.
narrowed airways( asthma)
poor gas diffusion ( pneumonia)
What is this describing ?
Availability of hemoglobin and its ability to carry oxygen from alveoli to cells for metabolism and carry carbon dioxide produced by cellular metabolism from cells to alveoli to be eliminated
transport
What is transport in gas exchange?
Availability of hemoglobin and its ability to carry oxygen from alveoli to cells for metabolism and carry carbon dioxide produced by cellular metabolism from cells to alveoli to be eliminated
impaired transport may occur : name some examples how transport can be impaired
insufficient rbcs to carry oxygen
low hemoglobin ( anemia)
true or false. Patients who are anemic, tends to have a problem with their hemoglobin. Concluding that no oxygen or carbon dioxide to carry in the body
true
what is this describing ?
Ability of blood to transport oxygen containing hemoglobin to cells and return carbon dioxide containing hemoglobin to the alveoli
perfusion
what is perfusion in gas exchange ?
Ability of blood to transport oxygen containing hemoglobin to cells and return carbon dioxide containing hemoglobin to the alveoli
true or false. If you have a massive clot= emboli, this could be completely blocking blood, therefore can cause issues with breathing ( exchange )
true
having a decreased in your cardiac output can also cause what ?
can cause to have a low volume of blood ( hypovolemia)
impaired perfusion may occur if:
there is a decreased in cardiac output
thrombi, emboli, blood loss
Impaired gas exchange : clinical manifestations. What could occur during a mild impairment
- Fatigue
- Heart rate increase
- Respiratory rate increase
Impaired gas exchange : clinical manifestations. What could occur during a moderate impairment ?
- Respiratory acidosis
——— Ventilation problem - Metabolism acidosis ( there is too much acid in the body fluid)
———transport or perfusion problem
Impaired gas exchange : clinical manifestations. What could occur during a severe impairment?
- Cellular ischemia
- Necrosis
- Death
Impaired Gas Exchange:
Risk Factors
populations
1.infants
2.young children
3.older adults
individuals
1. Nonmodifiable
–> Tobacco Use
2. Altered LOC
3. Bed Rest/ Prolonged immobility
4. Chronic diseases
5. Immunosuppression
bed rest/prolonged immobility are high risk for …..?
pneumonia (SOB, alveoli collapsed)
individuals who uses tobacco are high risk for ….?
aspiration
Impaired gas exchange : Ventilation/perfusion/transport
what are the two categories under diagnostics?
laboratory
radiologic
what undergoes laboratory when doing a diagnostics
ABGs ( arterial blood gas)
cbc
sputum examination
skin tests
pathologic analysis
why are we looking at abg, cbc and skin tests when performing a diagnostic ( lab work)
abg–> poor imbalances ( retaining a lot of C02 or removing )
cbc- rbc’s, hgb, hct, ( do they have red blood cells, are they anemic)?
skin tests - mantou test –> tb test
do we start from most evasive to least evasive when doing a radiologic diagnostic ?
false, we go from least to most invasive
what undergoes radiologic ?
chest xray
ct scan
vq scan
pet scan
why do we use chest xray ?
infiltrations, tb, tumours, edema, pleural effusions
why do we use ct scan ?
tumours, emboli
why do we use vq scan ?
diagnose perfusion or ventilation
why do we use pet scan ?
malignant nodules
impaired gas exchange : clinical management
primary
secondary
what are we looking upon when doing a primary clinical management with a patient who has an impaired gas exchange
primary
1. infection control
2. smoking cessation
3. immunizations
4. postoperative
what are we looking upon when doing a secondary clinical management with a patient who has an impaired gas exchange
pharmacotheraphy
1. drugs that affect upper airways
2.lower airway brochodilators
3.agents to help cough up mucus
4.cough superposants
5.antimicrobials ( if they have infectious process)
6. agents to aid smoking cessation
oxygen therapy
nutrition
positioning
Impaired ventilation:
COPD name different types that falls under this category
asthma
chronic bronchitis
emphysema
panacinar or panlobular
centriacinar or centrilobular emphysema
the airways overreact to common stimuli with bronchospasm edematous swelling of the mucous membranes, and copious production of thick, tenacious mucus by abundant hypertrophied mucuos glands. Airway obstructio is usually intermitent.
Out of all the COPD category which one is this describing?
asthma
define what centriacinar or centrilobular emphysema
affects the respiratory bronchioles most severely. It is usually more severe in the upper lung
define what panacinar or panlobular emphysema affects ?
it affects the entire acinar unit. It usually more severe in the lower lung
What is this describing ? lung proteases collapse the walls of bronchioles and alveolar air sacs. As these walls collapse, the bronchioles and alveoli transform from a number of small elastic structures with great air exchanging surface area into fewer,larger, inelastic structures with little surface area. Air is trapped in these distal structures, especially during forced expiration such as coughing, and the lungs hyper inflate. The trapped air stagnates and can no longer supply needed oxygen to the nearby capillaries.
emphysema
In _______, infection or bronchial irritants cause increased secretions, edema, bronchospasms, and impaired mucociliary clearance, inflammation, of the bronchial walls causes them to thicken. This thickening, together with excessive mucus, blocks the airways and hinders gas exchange
chronic bronchitis
what chronic obstructive pulmonary disease ?
this is irreversible collection of lower airway disorders that interfere with airflow and gas exchange leading to inflammation, airway obstruction, and air trapping
this is an alveolar issue ?
emphysema
what is emphysema ?
destructive problem of lung elastic tissue that reduces its ability to recoil after stretching, leading to hyperinflation of the lung
problem: an elastic tissue has a problem to recoil in stretching - reinspire get smaller and collapsed completely
emphysema
what category does this undergo to?
* Enzymes (proteases) destroy foreign particles from breathing. Smoking stimulates synthesis of proteases which damage alveoli and small airways by breathing down elastin.
- Air is trapped in lungs
emphysema
true or false. Emphysema : Enzymes (proteases) destroy foreign particles from breathing. Smoking stimulates synthesis of proteases which damage alveoli and small airways by breathing down elastin.
true
true or false. Smoking a ton- produces chemicals in our airway?
yes this is true, and this can lead into emphysema
What is proteases?
cleans up ( destroy foreign particles)
(Airway Issue) Inflammation of the bronchi and bronchioles caused by exposure to irritants (cigarette smoke). Irritants trigger inflammation, vasodilation, mucosal edema, congestion, bronchospasm
chronic bronchitis
what’s an example of airway issue ?
chronic bronchitis
define what chronic bronchitis means?
(Airway Issue) Inflammation of the bronchi and bronchioles caused by exposure to irritants (cigarette smoke). Irritants trigger inflammation, vasodilation, mucosal edema, congestion, bronchospasm
Chronic inflammation increases the number and size of mucus-secreting glands producing thick mucus. Bronchial walls thicken and impair airflow. What category does this undergo to ?
chronic bronchitis
with chronic bronchitis patients, why would gas exchange be affected?
because mucus plugs and inflammation narrow airways. Low arterial oxygen and high carbon dioxide ( respiratory acidosis)
What is this describing ? Gas exchange is affected by increased of breathing and loss of alveolar tissue : patients adjust by increasingly respiratory rate ( ABGS may not be normal unless advanced)
emphysema
Chronic Obstructive Pulmonary Disease genetic risk and etiology
cigarette smoking
alpha 1 antitrypsin deficiency ( AAT) ( rare factors, keeps our lungs intact)
Asthma –> 12x greater
chronic obstructive pulmonary disease
( clinical manifestations )
underweight with loss of muscle mass in the extremities/neck muscles enlarged
slow moving/fatigue
chronic cough with excess sputum
rapid shallow respirations
Rapid shallow respirations with abnormal breathing pattern
Use of accessory muscles in abdomen or neck
Wheezes and abnormal sounds
Dyspnea (SOB vs. SOBOE)
Barrel chest (1:1 rather than 1:1/5)
Cyanotic, dusky appearance & excessive sputum production (chronic bronchitis)
Clubbing
- Psychosocial:
- Isolated
- Fear & Anxiety
Define why these clinical manifestations may be apparent in a COPD patient
- Slow moving/fatigue
2.Chronic cough with excess sputum
3.rapid shallow respirations with abnormal breathing pattern
4.wheezes and abnormal sounds
harmful trying to reserve what they can
tieing to that chronic bronchitis patients ( alot of mucus will be apparent)
high risk of cardiac arrest
tons of mucus built pup
COPD : complications
increase in severity of disease with worsening clinical manifestations
exacerbations
cardiac failure : cor pulmonale ( right sided heart failure pulmonary disease)
dysrhythmias - form hypoxemia, acidosis, cardiac disease
respiratory failure - story of patient’s with parkinson’s
COPD we use laboratory and imaging to see further analyzation in a patient
this is true
what are we looking at when we are using laboratory
ABGs : hypoxemia, hypercapnia, when oxygen levels in the blood are lower than normal
Sputum samples : culture and sensivity
wbc: infection
cbc : hemoglobin, and hemocrit (polycythemia )
electrolytes : hyperkalemia
Imaging
—> chest x-ray : rule out other lung disease or check prognosis with infections/chronic disease
other : PFT (pulmonary function tests ) -> mild to severe
COPD : what is the goal
the goal is improving gas exchange and reduce carbon dioxide retention
what are some examples to help with our goal in improving gas exchange and reduce carbon dioxide retention
drug therapy
breathing technique
- pursed lip
positioning
-tripod
effective coughing
oxygen therapy
exercise conditioning
suctioning
hydration
recall : goal is to improve gas exchange and reduce carbon dioxide retention when dealing with a COPD patient what else do we think we need to consider for patients?
preventing weight loss
minimizing anxiety
preventing respiratory infections
True or false. Preventing weight loss : we can look upon
- Four to six small meals a day
- Positioning and Breathing Techniques
- High Calorie, high protein
all true
select all that applies : Goal: Minimizing Anxiety
* Clear plan in place during acute episode
* Support
* Severe cases: Anti anxiety therapy
all true
21select all that applies : Goal: Preventing Respiratory Infections
* Avoid crowds
* Vaccinations
all true
what can COPD cause ?
it can cause heart failure ( right sided)
What else can COPD cause disease?
re-call we know it can lead into heart failure ( right sided )
it leads to hypoxia and acidosis and hypercapnia
True or false. COPD can lead to reduction of pulmonary vascular bed
true
what ca hypoxia lead into when dealing with a copd ?
it can lead into polychthemia and pulmonary vasoconstriction
what can polycethemia cause lead into ?
hyperviscosity
what does pulmonary vasoconstriction x2 cause ( reference to the digram given slide 21)
increase pulmonary vasculature resistance
hyper viscosity can cause….?
pulmonary hypertension
this is when chronic disease in which reversible acute airway obstruction occurs intermittently, reducing airflow
asthma
describe what asthma is
chronic disease in which reversible acute airway obstruction occurs intermittently, reducing airflow
this is an airway obstruction that occurs by both inflammation and airway tissue sensitivity with bronchoconstriction
this is asthma
describe what asthma is
airway obstruction occurs by both inflammation and airway tissue sensitivity with bronchoconstriction
inflammation triggers an attack due to variety of reasons ( allergens, irritants, GERD )–> this is apart of what characteristics
asthma
asthma can lead into what
wheezing, dyspnea, coughing which can exacerbate o respiratory failure
true or false. Often noted in children ( will learn more about 4th year ) and seen in ER if severe ( status asthmaticus )
true
true or false. asthma is treated similar to COPD patients
true
Pharmacotherapy :
Two main classes : anti-inflammatory agents & bronchodilators
define what undergoes in both categories
principle anti-inflammatory: glucocorticoids
principle bronchodilators : beta 2 agonists
For stable COPD/asthma :
1. How are glucocorticoids administered ?
2. How are beta 2 agonists administered
- glucocorticoids are administered on fixed schedule by inhalation
- beta 2 agonists may be administered on fixed schedule ( long term control ) or PRN ( acute attack ) by inhalation
DRUG CARD anti- inflammatory drugs : Fluticasone
decrease airway inflammation- Flovent
- MOA: Decreased synthesis and release of proinflammatory hormones, decrease infiltration and activity of inflammatory cells, decrease edema of the airway mucosa
- Indications: Control inflammation of asthma and COPD
- Adverse Effects: Oral thrush (rinse mouth with water after administration)
- Controller drug
Maintenance use Cannot stop an acute episode and should not be used alone - Exacerbations
May change to oral or IV steroids if severe enough
true or false. anti- inflammatory drugs : fluticasone : this is non controller drug and non maintenance use
no, it’s the opposite
DRUG CARD : Bronchodilators : Salbuterol and salmeterol
Provide symptomatic relief by causing bronchiolar smooth muscle relaxation but =have no affect on inflammation
- MOA: Sympathomimetic drugs that activate beta2-adrenergic receptors promoting bronchodilation and relieving bronchospasm
- Indication: Provide short term and rapid symptomatic relief for patients with asthma and COPD
- Shortacting(Salbuterol/Ventolin):TakenPRNforongoingSOB * Rescue/Reliever Drug
- Long acting (Salmeterol): long term control – fixed schedule (stable COPD)
- Onset of Action: Short acting is almost immediately, duration 5hrs
- Adverse Effects: Short acting (tachycardia, angina, tremor) Long acting (never use as first line therapy for prolonged control or alone)
how does salbutamol work ?
binds to beta2 adrenergic receptors in airway smooth muscle, which relaxes airway smooth muscle
if salbuterol is taken away from the patient this can cause the patient to have anxiety attack
true
are these administration accurate : administration of salbutamol
shake inhaler well, allow for 1 min rest between inhalations
inhaler use should be done with proper techniqe to get appropriate dosages
MDI with spacer or DPI
may be used scheduled and NOT PRN
3rd one is wrong ( MDI with/without spacer or DPI )
FALSE!!, may be scheduled and PRN
can these be a contraindications for salbutemol ?
hypersensivity
cardiac disease and glaucoma
yes all of the above
SELECT ALL THE THINGS WE should assess with a patient who are taking salbutamol :
Assess lungs sounds, pulse and BP
*Note color and character of sputum if productive cough *Monitor potassium with frequent use
*Note for increased wheezing (Paradoxical bronchospasm)
all
CNS: nervousness, restlessness, tremor
Resp: Paradoxical bronchospasm
CVS: Chest pain, palpitations Hypokalemia
are these an accurate statement of side effects of salbutamol
yes
what are the indications of salbutamol ?
Treatment or prevention of bronchospasm in asthma or COPD
Rescue breather
DRUG CARD : Anticholinergic Drugs: Ipratropium &
Tiotropium
Improve lung function by blocking parasympathetic nervous system in bronchi
* MOA: blocks muscarinic cholinergic receptors in the bronchi preventing bronchoconstriction
* Short Acting: Ipratropium (Atrovent)
* Onset of Action: Within 30 seconds, duration 6hrs * Adverse Effects: Dry mouth, irritation to pharynx
* Long Acting: Tiotropium (Spiriva)
* Onset of Action: 30 minutes, duration 24hrs
* Indications: Maintenance therapy of bronchospasm associated with COPD * Adverse Effects: Dry mouth
what is the biggest side effect of ipratripium and tiopium and when do we take this?
dry mouth and taken once a day
what are two combination drugs ?
Glucocorticoid/Long-Acting Beta 2 Agonist (Symbicort/Advair)
Beta 2 Adrenergic Agonist/Anticholinergic (Combivent)
what are some advantages to inhalers?
Therapeutic effects enhanced by delivering directly to site of action
Systemic effects minimized
Relief of acute attacks is rapid
what are the four types of inhalation devices?
- Metered dose inhalers (MDIs): fine liquid spray
- Respimats: very fine mist
- Dry powder inhalers (DPIs): fine powder
- Nebulizers: Converts drug solution to a mist
what is the purpose fo spacers with inhalers?
makes the drug more effective - higher percentage administered to lungs
what should you be teaching the client in regards to drug therapy?
correct admin of drug - use MDI w/spacer easier and improves inhalation of drug
DPI(dry powder inhaler) required less manual dexterity and coordination.
what is pneumonia - impaired ventilation?
Infection in the lungs causing excess fluid in the lungs from inflammatory response
Exudate develops, inflamed alveolar walls
what is the ethology of pneumonia?
Organisms from environment, invasive devices, equipment, supplies
what is the risk factors of pneumonia?
Older adult
Unvaccinated
Chronic disease
Smoking
Altered LOC
Dysphagia
Reduced immunity
what are the signs and symptoms of pneumonia?
Flushed cheeks
Anxious
Chest pain or discomfort Myalgia
Headache
Chills
Fever
Cough
Tachycardia
Dyspnea
Hemoptysis
Sputum Production
Tripod Position
Severe chest muscle weakness
Varied breath sounds
Chest expansion diminished
Hypotensive
what are some labs and imaging used for pneumonia?
clinical manifestations:
positive sputum culture and sensitivity
CBC: elevated WBC’s
ABG’s
Imaging
Chest xray
select all that is true regarding clinical management - pneumonia:
Improve Gas Exchange
Oxygen therapy
Preventing Airway Obstruction
Deep breathe and cough every 2 hours Hydration
Drug Therapy
Bronchodilators when bronchospasm present
Glucocorticoids
Preventing Sepsis
Anti-infectives
true
what is oxygen therapy prescribed for ?
hypoxemia
hypoxia
conditions that increase need for o2 therapy
atmosphere gas an88-92%d drug:
physicians order
standard order: keep SpO2 over 94%
COPD (if CO2 retainer) keep SpO2
true or false: Oxygen therapy :
Uses lowest fraction of inspired oxygen (FiO2) to have acceptable blood oxygen level without causing harmful side effects
Oxygen improves PaO2 and cures the cause
second one false - does NOT cure
true or false regarding oxygen safety and toxicity:
Combustion: Education for smokers who have oxygen therapy Humidity: If receiving 4L/min or more
Skin Assessment: Ears, back of neck, face
true
oxygen toxicity:
With high oxygen levels, ——- is diluted causing alveoli collapse.
Related to concentration of oxygen delivered, duration of therapy and degree of lung disease present —- oxygen therapy can cause stress on cells leading to cell damage and —-
Reason why we titrate oxygen therapy when >94%.
nitrogen, excess, death
what is found in the anterior thoracic landmarks ? (anatomy heheeeee)
suprasternal notch
sternum
sternal angle
costal angle
what is found in the posterior thoracic landmarks ?
vertebra prominens
spinous processes
inferior border of scapula
twelfth rib
review: what is anterior, posterior and lateral?
anterior - front
lateral - side
posterior - back
whats found in the posterior> anterior ? lateral? (the lobes)
anterior: right and left upper lobe, right middle lobe, right and left lower limb
lateral: left and right upper lobe, left and right lower lobe and right middle lobe
back - left and right upper and lower lobe
what is visceral and parietal pleura?
visceral - lines outside of lung
parietal - lines inside of chest
Potential space filled with a few millimeters of fluid
* vacuum or negative pressure which hold lungs against the walls
true or false - Trachea/Bronchi – dead space
* Lined with goblet cells (mucus & cilia)
* Defense mechanism
true
select all that is true regarding physiology of respiratory system?
1. Supplying oxygen to the body for energy production
2. Removing carbon dioxide as a waste product of energy reactions
3. Maintaining homeostasis (acid-base balance)
true
what is humoral regulation?
hypercapnia, increase in C02 stimulus to breathe; hypoxia, decreased 02 can increased respirations but is less effective
what is some subjective data regarding respiratory system?
Cough
Shortness of breath
Chest pain with breathing
History of respiratory illness
Smoking history
Environmental exposure
Self-care behaviors
what falls under inspection - resp system?
Shape and configuration: symmetrical; anteroposterior to transverse diameter (1:2; abnormal e.g. barrel chest)
Breathing position: (relaxed posture; abnormal e.g. tripod position)
Quality of respirations: (automatic, regular, even and no noise)
Work of breathing: (effortless, even rhythm; abnormal e.g. accessory muscle use, pursed lip breathing, uneven rhythm)
Oxygen use
Symmetrical chest expansion
Visible distress, LOC, color (cyanosis, pale), lumps/masses
what does normal resp patterns look like?
Even, regular Inspiration < expiration 10 – 20 breaths/minute
cause: living
what are some abnormal patterns of breathing?
tachypnea: rapid shallow, regular over 24 breaths per min
cause - fever, fear, exercise, pneumonia
hyperventilation: rapid deep, regular >24 breaths/minute, >24 breaths/minute
cause: Extreme conditions (e.g. panic attack)
Diabetic ketoacidosis (DKA)
Bradynea: Slow, regular, <10 breaths/minute
cause: Increased intracranial pressure
Hypoventilation: Irregular, shallow
cause: narcotics
Cheyenne-stokes respirations: irregular, rapid increased depth followed by apneic period
cause: end of life (severe heart failure)
what are you palpated in resp system> this is not tested !
systemic chest expansion: Thumbs @ T9/T0
“deep breath”, Assess: moves symmetrically apart
tactile vocal fremitus: Sounds transmitted as vibrations Ball of hand
“99” or “blue moon”
Assess: symmetrical vibrations
Tenderness, skin temperature, lumps/masses
resp assessment auscultation tips:
Patient sitting, learning forward slightly Side to side comparison
‘take a breath every time you feel my stethoscope; slightly deeper than normal’
Ask not to talk, or pause to listen to the patient
Practice, practice, practice
what are some questions to ask for ausculatating breath sounds?
Do you hear normal breath sounds? (B, BV, V)bronchovesicular, vesicular and bronchial
Do you equal air entry bilaterally to the bases?
‘Decreased AE to LLL’ (e.g. plural effusions)
‘Silent chest’: no air movement (MEDICAL EMERGENCY)
e.g. Obstruction (mechanical – chocking; inflammatory – croup)
Do you hear any adventitious breath sounds?
Document in flowsheet: Good bilateral A/E with not adventitia noted
is this a normal or abnormal finding?
If Bronchial or Bronchovesicular sounds are heard over the Vesicular areas
abnormal finding
true or false: shorter active inspiration and a longer passive expiration (1:2)
true
what does bronchial, bronchiovescular and vesicular sound like?
b- loud - high pitch
bv - moderate
v - quiet - soft; low pitch
what are the common adventitious breath sounds?
fine or course crackles, high or low pitched wheeze, stridor and pleural rub
what is the sound and common cause of fine or course crackles?
Non – musical, non – continuous
Fine: high-pitched, popping Course: low- pitched , gurgling
Fine: Pneumonia, asthma, COPD (Atelectatic – alveoli popping open – not pathological)
Course: Secretions in the airways, pulmonary edema
what is the sound and common cause of High or Low pitched Wheeze?
Musical whistling, continuous
High: multiple sounds, mainly during expiration
Low: single note, inspiration or expiration
High: COPD, Asthma
Low: Bronchitis, single bronchial obstruction
what is the sound and common cause of stridor?
Musical, loud, high-pitched
Obstruction in the upper airway: croup, foreign body
what is the sound and common cause of pleural rub?
Non – musical , superficial, low pitch, leathery
Inflamed pleura rub against each other
