week 7 Flashcards
function of respiratory system
Supplying oxygen to the body for energy production
Removing carbon dioxide as a waste product of energy reactions
Maintaining homeostasis (acid-base balance) of arterial blood
By supplying oxygen to blood and eliminating excess carbon dioxide, respiration maintains pH or acid-base balance of blood.
Maintaining heat exchange
what is included in the upper resp
nose: filter and humidify air
mouth: tongue- taste/ secrete saliva, moistens food, starts digestion
pharynx- respiratory and digestive pathway
larynx- sound production/upper opening of the trachea/ resp pathway
subjective data on upper respiroty
nose: discharge, frequent colds, sinus pain, allergies,
mouth and throat:lesions, soreness, bleeding gums, toothache, dysphagia, smoking consumtption
what is dysphagia
difficulty swallowing
lower resp system includes
thoracic cage- sternum, 12 pair of ribs and thoracic vertebrae
reference lines
Anterior chest: note midsternal and midclavicular line
Posterior chest: note vertebral (midspinal) line and scapular line.
Lift up the person’s arm 90 degrees, and divide lateral chest by three lines (Anterior axillary line; Posterior axillary line & Midaxillary line
developmental considerations of infants/children, pregnant women and ageing adult
Infants and children
Development in utero with birth demanding instant performance
Increased vulnerability of respiratory system: Associated with environmental tobacco smoke (ETS) exposure include
sudden infant death syndrome, negative behavioural and cognitive functioning, and increased rates of adolescent smoking.
Pregnant woman
Impact of enlarging uterus
Impact of physiologic dyspnoea
Aging adult
Decreased vital capacity and increased residual volume based on structural changes
Histologic changes lead to decreased gas exchange.
lungs and pleurae
Right and left pleural cavities contain lungs.
Note lung borders at apex, base, lateral and posterior positions.
Lobes of lungs
Lungs are paired but not precisely symmetric structures.
Right lung shorter than left because of underlying liver
Left lung narrower than right because heart bulges to left
Right lung has three lobes, and left lung has two lobes.
Pleurae
Visceral pleura
Pleural cavity normally has a vacuum, or negative pressure, which holds lungs tightly against chest wall.
Space is filled with only a few millilitres of lubricating fluid.
where does the trachea lie and function
Trachea lies anterior to esophagus and is 10 to 11 cm long in the adult.
Right main bronchus is shorter, wider, and more vertical than the left main bronchus.
Trachea and bronchi transport gases between the environment and lung parenchyma.
objective data for respirtory system
Inspection
Thoracic cage, respirations, skin colour, and condition
A person’s facial expression, and LOC
Palpation
Confirm symmetric expansion and tactile fremitus.
Detection of any lumps, masses, or tenderness
Percussion
Lung fields and estimate diaphragmatic excursion
Auscultation
Assess breath sounds, and note any abnormal/adventitious breath sounds.
Perform bronchophony, whispered pectoriloquy, or egophony as needed.
subjective data for resp system
Cough
Shortness of breath
Chest pain with breathing
History of respiratory infections
Smoking history
Environmental exposure
what are some abnormal findings during a resp assesemnt
-Configurations of the thorax
Barrel chest
Pectus excavatum
Pectus carinatum
Scoliosis
-Respiration patterns
Tachypnoea
Hyperventilation
Bradypnea
Hypoventilation
lung sounds
Discontinuous sounds
Crackles—fine
Crackles—course
Atelectatic crackles
Pleural friction rub
Continuous sounds
Wheeze
Stridor
what are inhaled medications
Types of inhaled medications
SABA – short acting beta -2 receptor agonist (e.g. salbutamol)
LABA – long short acting beta -2 receptor agonist (e.g. Salmeterol)
Salbutamol
Drug class:
Beta -2 receptor antagonist
Dose and frequency:
Asthma: 1–2 inhalations (100–200 micrograms) when required, or 5–15 minutes before exercise – TDS or QID
COPD: 4–8 inhalations (400–800 micrograms) every 1–6 hours.
MOA- relaxes bronchial smooth muscles
adverse affects: tremor/ headcache/ palpatation
examples of resp distress
Dyspnoea
Respirations equal to or below 5/min (all age groups)
Respirations equal to or above 36 (all age groups) - tachypnoea
Head bobbing and nasal flaring (infant)
Tracheal tugging (all age groups)
Increased effort of breathing - Intercostal and suprasternal & sternal recession (all age groups)
Changes in behaviour
chest pain
persistant cough
hypotention
function of the skin
Skin is waterproof, protective, and adaptive
Protection from environment
Prevents penetration
Barrier from bacteria & viruses
Sensory Perception
Temperature regulation
Wound repair
Absorption and excretion
Production of vitamin D
Insulation
delevelopmenta considerations of integritity system under adults
Newborn infants
Lanugo: fine downy hair of newborn infant
Vernix caseosa: thick, cheesy substance
Sebum: holding water in the skin producing milia
Children
Epidermis thickens, darkens, and becomes lubricated.
Hair growth accelerates.
Adolescents
Secretions from apocrine sweat glands increase.
Subcutaneous fat deposits increase.
Secondary sex characteristics
delevelopmenta considerations of integritity system for adults
Skin breakdown due to multiple factors
Cell replacement is slower and wound healing is delayed. Decreased subcutaneous fat.
Elasticity
Degeneration of elastic fibres & collagen stiffening - Loss of skin elasticity; skinfolds and sagging of skin.
Sweat and sebaceous glands
Decrease in number and function/activity, leaving skin dry
Hair matrix
Functioning melanocytes decrease, leading to gray fine hair
what is the ABCDEF skin assessmnet
Teach patients skin self-examination using the ABCDEF rule to detect suspicious lesions
A: asymmetry
B: border irregularity
C: color variations
D: diameter greater than 6 mm
E: elevation or evolution
F: funny looking—“ugly duckling” —different from others
what is psoriasis and systemtoms
Autoimmune condition – build up of skin cells , which causes white – silver scaling on the skin in thick red patches.
Redness, inflammation and itchy thick red patches of skin.
what is eczema and sysmtoms
Inherited, inflammatory skin condition. Skin affected by eczema is more vulnerable to infections such as impetigo, cold sores and warts. Dry skin with red and scaly areas on the front of the elbows and the back of the knees.
what is alopecia
Hair loss to a single or multiple areas on the scalp and/or body. Three different types.
gradual circular patches of hair loss and buring feeling
what is nail clubbing
Overgrowth of the soft tissue of the fingertip, resulting in increased curvature of the nail plate/bed. Caused by chronic low blood-oxygen levels by conditions such as lung cancer, cystic fibrosis, bronchiectasis etc.
PHARMACOLOGY: what is hydrocoristone
it is topical
Drug class – corticosteroid
Mode of action – Anti-inflammatory, immunosuppressive and antimitotic activity against cutaneous fibroblasts and epidermal cells. They are also vasoconstrictive.
Dose (adults & children 12+ years) – once or twice daily. Dosage - ‘fingertip unit’ method.
Adverse effects - transient burning, stinging or pain on application, folliculitis, steroid rosacea, perioral dermatitis, skin atrophy, delayed wound healing, striae, purpura, depigmentation.
Contraindications - ulcerative skin conditions, untreated skin infections, rosacea, acne vulgaris or areas with impaired circulation.
subjective data for a skin assesment
Past history of skin disease, allergies, hives, psoriasis, or eczema?
Change in pigmentation?
Change in mole (size or color)?
Excessive dryness or moisture?
Pruritus?
Excessive bruising?
Rash, sores/wounds or lesions?
Medications?
Hair loss?
Change in nail
