ch 25 Respiratory assessment

Question 1

is gas exchange

Answer 1

respiratory system

Question 2

transfer of oxygen (O2) and carbon dioxide (CO2) between the atmosphere and blood.

Answer 2

respiratory system

Question 3

the upper respiratory tract and the lower respiratory tract

Answer 3

respiratory system is divided into 2 parts:

Question 4

the nose, mouth, pharynx, epiglottis, larynx, and trachea.

Answer 4

upper respiratory tract includes

Question 5

the nose

Answer 5

Air enters the respiratory tract through

Question 6

bone and cartilage

Answer 6

nose is made of

Question 7

divided into 2 nares by the nasal septum

Answer 7

nose

Question 8

inside of the nose is shaped into 3 passages by projections called

Answer 8

turbinates

Question 9

increase the surface area of the nasal mucosa that warms and moistens the air as it enters the nose

Answer 9

turbinates

Question 10

with the pharynx

Answer 10

nasal cavity connects

Question 11

the nasopharynx, oropharynx, and laryngopharynx

Answer 11

nasal cavity connects with the pharynx.
- It is a tubular passageway that is subdivided into 3 parts:

Question 12

to protect the lower airway by warming and humidifying air and filtering small particles before air enters the lungs.

Answer 12

nose functions

Question 13

, found within the mucosa of the upper part of the nasal cavity, is responsible for the sense of smell.

Answer 13

olfactory nerve

Question 14

Air moves through the oropharynx to the laryngopharynx. It then travels through the epiglottis to the larynx before moving into the trachea.

Answer 14

Route of air through nose to ody

Question 15

is a small flap behind the tongue that closes over the larynx during swallowing

Answer 15

epiglottis

Question 16

prevents solids and liquids from entering the lungs.

Answer 16

epiglottis function

Question 17

are in the larynx

Answer 17

vocal cords location

Question 18

(the opening between the vocal cords) and into the trachea.

Answer 18

air passes through the glottis

Question 19

U-Shaped cartilages keep the trachea open but allow the adjacent esophagus to expand for swallowing.

Answer 19

trachea

Question 20

into the right and left mainstem bronchi at a point called the carina.

Answer 20

trachea bifurcates

Question 21

is located at the angle of Louis, which is at the level of the 4th and 5th thoracic vertebrae.

Answer 21

carina

Question 22

this area during suctioning causes vigorous coughing

Answer 22

Stimulation of carnia

Question 23

Once air passes the carina, it is in the

Answer 23

considered lower respiratory tract

Question 24

bronchi, bronchioles, alveolar ducts, and alveoli

Answer 24

lower respiratory tract consists

Question 25

Except for the right and left mainstem bronchi,

Answer 25

all lower airway structures are found within the lungs.

Question 26

-upper, middle, and lower

Answer 26

right lung is divided into 3 lobes

Question 27

-upper and lower

Answer 27

left lung into 2 lobes

Question 28

mainstem bronchi, pulmonary vessels, and nerves enter the lungs through a slit called the

Answer 28

hilus

Question 29

is shorter, wider, and straighter than the left mainstem bronchus

Answer 29

right mainstem bronchus

Question 30

is shorter, wider, and straighter than the left mainstem bronchus.

Answer 30

right mainstem bronchus vs left

Question 31

right mainstem bronchus is shorter, wider, and straighter than the left mainstem bronchus.

Answer 31

aspiration is more likely to occur in the right lung than in the left lung.

Question 32

several times to form the lobar, segmental, and subsegmental bronchi.Further divisions form the bronchioles.

Answer 32

mainstem bronchi subdivide

Question 33

the respiratory bronchioles.

Answer 33

most distant bronchioles are

Question 34

are encircled by smooth muscles that constrict and dilate in response to variousstimuli.

Answer 34

bronchioles

Question 35

to a decrease or increase in the diameter of the airways caused by contraction or relaxation of these muscles

Answer 35

bronchoconstriction and bronchodilation refer

Question 36

act as a pathway to conduct gases to and from the alveoli

Answer 36

trachea and bronchi

Question 37

volume of air in the trachea and bronchi is called the
-This air does not take part in gas exchange.

Answer 37

anatomic dead space (VD)

Question 38

is about 500mL (in a 150-lb man). Of each 500 mL inhaled, about 150mL is VD.

Answer 38

adults, normal tidal volume (VT), or volume of air exchanged with each breath,

Question 39

are small sacs in the lungs that are the primary site of gas exchange for O2 and CO2

Answer 39

Alveoli

Question 40

They allow movement of air from alveolus to alveolus

Answer 40

alveoli are interconnected by pores of Kohn

Question 41

air movement through these pores and helps move mucus out of the respiratory bronchioles.

Answer 41

Deep breathing promotes

Question 42

can also move through these pores, spreading infection to previously uninfected areas.

Answer 42

Bacteria (alveoli)

Question 43

of about 2500 mL with a surface area for gas exchange that is about the size of a tennis court.

Answer 43

Alveoli have a total volume

Question 44

, where the alveoli come in contact with pulmonary capillaries

Answer 44

Gases are exchanged across the alveolar-capillary membrane

Question 45

excess fluid fills the interstitial space and alveoli, markedly reducing gas exchange.

Answer 45

pulmonary edema

Question 46

is a lipoprotein that lowers the surface tension in the alveoli
-prevents alveoli collapse

Answer 46

Surfactant

Question 47

reduces the amount of pressure needed to inflate the alveoli and makes them less likely to collapse

Answer 47

Surfactant

Question 48

each person takes a slightly larger breath, termed a sigh, after every 5 or 6 breaths. This sigh stretches the alveoli and promotes surfactant secretion.

Answer 48

sigh

Question 49

refers to collapsed, airless alveoli.

Answer 49

atelectasis

Question 50

because of the effects of anesthesia, decreased mobility, and pain, which can alter breathing and lung expansion.

Answer 50

postoperative patient is at risk for atelectasis

Question 51

, lack of surfactant contributes to widespread atelectasis and collapse of lung tissue

Answer 51

acute respiratory distress syndrome (ARDS)

Question 52

pulmonary and bronchial

Answer 52

lungs have 2 different types of circulation:

Question 53

provides the lungs with blood that takes part in gas exchange

Answer 53

Pulmonary circulation

Question 54

receives deoxygenated blood from the right ventricle of the heart and delivers it to pulmonary capillaries that lie directly alongside the alveoli.

Answer 54

pathology of pulmonary artery

Question 55

starts with the bronchial arteries, which arise from the thoracic aorta

Answer 55

Bronchial circulation

Question 56

but provides O2 to the bronchi and other lung tissues. Deoxygenated blood returns from the bronchial circulation through the azygos vein into the superior vena cava.1

Answer 56

Bronchial circulation does not take part in gas exchange

Question 57

is shaped, supported, and protected by 24 ribs (12 on each side

Answer 57

chest wall (description)

Question 58

which consists of the ribs and sternum, protect the lungs and the heart from injury.

Answer 58

thoracic cage function

Question 59

is the space in the middle of the thoracic cavity.

Answer 59

mediastinum

Question 60

It contains the major organs of the chest, including the heart, aorta, and esophagus.

Answer 60

mediastinum consists

Question 61

chest cavity is lined with a membrane called the

Answer 61

parietal pleura

Question 62

lungs are lined with a membrane called the

Answer 62

visceral pleura

Question 63

join to form one continuous membrane.

Answer 63

parietal and visceral pleurae join

Question 64

does not have any sensory (pain) fibers or nerve endings.

Answer 64

visceral pleura consists

Question 65

This is why irritation or inflammation of the parietal pleura can cause pain with each breath.

Answer 65

parietal pleura has pain fibers.

Question 66

is the space between the pleural layers
-Normally this space contains 10 to 20 mL of fluid.

Answer 66

intrapleural space

Question 67

(1) it provides lubrication, allowing the pleural layers to slide over each other during breathing
(2) it increases unity between the pleural layers. This promotes expansion of the pleurae and lungs during inspiration.

Answer 67

intrapleural space (fluid ) serves 2 purposes:

Question 68

via lymphatic circulation

Answer 68

Fluid drains from the pleural space

Question 69

Several pathologic conditions may cause the accumulation of greater amounts of fluid, termed

Answer 69

pathology of pleural effusion.

Question 70

-Pleural fluid may accumulate because of blockage of lymphatic drainage (e.g., from cancer)
- an imbalance between intravascular and oncotic fluid pressures, as in heart failure. —–Purulent pleural fluid with bacterial infection is called empyema.

Answer 70

cause of pleural effusion.

Question 71

Purulent pleural fluid with bacterial infection is called

Answer 71

empyema.

Question 72

is the major muscle of respiration

Answer 72

Diaphragm

Question 73

, moves downward, and increases intrathoracic volume.

Answer 73

During inspiration the diaphragm contracts

Question 74

At the same time, the internal intercostals relax and the external intercostal muscles contract. This increases the lateral and anteroposterior (AP) dimension of the chest

Answer 74

During inspiration the diaphragm contracts

Question 75

, each innervated by the right and left phrenic nerves

Answer 75

diaphragm is made up of 2 hemidiaphragms

Question 76

the spinal cord between C3 and C5, the 3rd and 5th cervical vertebrae

Answer 76

phrenic nerves arise from

Question 77

in hemidiaphragm paralysis on the side of the injury. Complete spinal cord injuries above the level of C3 result in total diaphragm paralysis and dependence on a mechanical ventilator.

Answer 77

Injury to the phrenic nerve results

Question 78

refers to the process of obtaining O2 from the atmospheric air and making it available to the organs and tissues of the body

Answer 78

Oxygenation

Question 79

by partial pressure of O2 in arterial blood (PaO2), arterial O2 saturation (SaO2)

Answer 79

lungs’ ability to oxygenate arterial blood adequately is evaluated

Question 80

dissolved O2 and hemoglobin-bound O2

Answer 80

O2 is carried in the blood in 2 forms:

Question 81

the amount of O2 dissolved in the plasma

Answer 81

PaO2 represents

Question 82

is the amount of O2 bound to hemoglobin in comparison with the amount of O2 the hemoglobin can carry.

Answer 82

SaO2 (defined)

Question 83

-Unexplained apprehension
-Unexplained restlessness or irritability
-Unexplained confusion or lethargy (can be early or late)

Answer 83

Early signs of inadequate Oxygen (CNS)

Question 84

-Combativeness
-Coma

Answer 84

Late signs of inadequate Oxygen (CNS)

Question 85

-Tachypnea
Dyspnea on exertion

Answer 85

Early signs of inadequate Oxygen (respiratory)

Question 86

-Dyspnea at rest
-Use of accessory muscles
-Retraction of intercostal spaces on inspiration
-Pause for breath between sentences, words

Answer 86

Late signs of inadequate Oxygen (respiratory)

Question 87

-Tachycardia
-Mild hypertension
-Dysrhythmias (can be early or late)

Answer 87

Early signs of inadequate Oxygen (cardiovascular)

Question 88

-Hypotension
-Cyanosis
-Cool, clammy skin

Answer 88

Late signs of inadequate Oxygen (cardiovascular)

Question 89

-Diaphoresis
-Decreased urine output
-Unexplained fatigue

Answer 89

can be early or late signs of inadequate Oxygen

Question 90

involves inspiration, or inhalation (movement of air into the lungs), and expiration, or exhalation (movement of air out of the lungs)

Answer 90

Ventilation

Question 91

from an area of higher pressure (atmospheric) to one of lower pressure (intrathoracic).

Answer 91

Gas(o2 & Co2) flows

Question 92

occurs, neck and shoulder muscles, as well as other accessory muscles of respiration, can aid the effort

Answer 92

dyspnea (shortness of breath)

Question 93

is passive

Answer 93

expiration

Question 94

is the tendency for the lungs to return to their original size after being stretched or expanded.

Answer 94

Elastic recoil

Question 95

is due to the elastin fibers found in the alveolar walls and surrounding the bronchioles and capillaries.

Answer 95

elasticity of lung tissue

Question 96

allows the chest to passively decrease in size (volume). When intrathoracic pressure rises, air moves out of the lun

Answer 96

elastic recoil of the chest wall and lungs

Question 97

expiration to become an active, labored process

Answer 97

Exacerbations of asthma or chronic obstructive pulmonary disease (COPD) cause

Question 98

Abdominal, intercostal, and accessory muscles (e.g., scalene, trapezius) help expel air during labored breathing.

Answer 98

body parts help expel air during labored breathing

Question 99

is a measure of the ease of expansion of the lungs

Answer 99

Compliance (distensibility)

Question 100

-This is a product of the elasticity of the lungs and elastic recoil of the chest wall

Answer 100

Compliance (distensibility)

Question 101

, it is harder for the lungs to inflate

Answer 101

compliance is decreased

Question 102

when there is destruction of alveolar walls and loss of tissue elasticity, as in COPD.

Answer 102

Compliance increases

Question 103

occurs with conditions that increase fluid in the lungs (e.g., pulmonary edema, ARDS, pneumonia), make lung tissue less elastic or distensible (e.g., pulmonary fibrosis, sarcoidosis), or restrict lung movement (e.g., pleural effusion)

Answer 103

cause of compliance when it’s decreased

Question 104

refers to any obstacle to airflow during inspiration and/or expiration

Answer 104

resistance

Question 105

is changes in the diameter (size) of the airways

Answer 105

main factor affecting airway resistance

Question 106

patient with an acute asthma attack has narrowed airways, resulting in
- presence of secretions in the bronchi

Answer 106

example of increased resistance.

Question 107

decreases resistance by increasing the diameter of the bronchi, promoting air entry.

Answer 107

bronchodilators

Question 108

Changes in compliance and/or resistance can seriously

Answer 108

affect both oxygenation and ventilation.

Question 109

responds to chemical and mechanical signals

Answer 109

Located in the brainstem, the respiratory center (the medulla)

Question 110

sends impulses to the respiratory muscles through the spinal cord and phrenic nerves.

Answer 110

medulla (function)

Question 111

is a receptor that responds to a change in the chemical composition (PaCO2 and pH) of the fluid around it

Answer 111

chemoreceptor

Question 112

are found in the medulla.

Answer 112

Central chemoreceptors (located)

Question 113

They respond to changes in the hydrogen ion (H+) concentration.
-An increase in the H+ concentration (acidosis) causes the medulla to increase the respiratory rate and VT.
-A decrease in H+ concentration (alkalosis) has the opposite effect.

Answer 113

Central chemoreceptors (function)

Question 114

causes the medulla to increase the respiratory rate and VT.

Answer 114

An increase in the H+ concentration (acidosis) // chemoreceptors

Question 115

has the opposite effect

Answer 115

A decrease in H+ concentration (alkalosis) // chemoreceptors

Question 116

primarily by their effect on the pH of the cerebrospinal fluid.

Answer 116

Changes in PaCO2 regulate ventilation

Question 117

This lowers the cerebrospinal fluid pH and stimulates an increase in respiratory rate.

Answer 117

PaCO2 level is increased, more CO2 is available to combine with H2O and form carbonic acid (H2CO3).

Question 118

are found in the carotid bodies at the bifurcation of the common carotid arteries and in the aortic bodies above and below the aortic arch.

Answer 118

Peripheral chemoreceptors

Question 119

and may result in chronically elevated PaCO2 levels.
- largely because of a hypoxic drive from the peripheral chemoreceptors

Answer 119

COPD change lung function

Question 120

are found in the conducting upper airways, chest wall, diaphragm, and capillaries of the alveoli.

Answer 120

Mechanical receptors (location)

Question 121

They are stimulated by a variety of physiologic factors, such as irritants, muscle stretching, and alveolar wall distortion.

Answer 121

Mechanical receptors (stimulated)

Question 122

are irritant, stretch, and juxtacapillary (J) receptors

Answer 122

3 major types of mechanical receptors

Question 123

are found in the conducting airways.

Answer 123

Irritant receptors (location)//(type of mechanical receptors)

Question 124

sensitive to inhaled particles and aerosols and, when stimulated, initiate the cough reflex.

Answer 124

Irritant receptors (effect)//(type of mechanical receptors)

Question 125

, in the smooth muscle of the airways, aid in the control of respiration.

Answer 125

Signals from stretch receptors//(type of mechanical receptors)

Question 126

lungs inflate, stretch receptors activate the inspiratory center to inhibit further lung expansion. This is called the Hering-Breuer reflex, and it prevents overdistention of the lungs.

Answer 126

stretch receptors (function)// (type of mechanical receptors)

Question 127

prevents overdistention of the lungs.

Answer 127

Hering-Breuer reflex (from stretch receptor)

Question 128

found in the capillaries of the alveoli, occurs with increased pulmonary capillary pressure. This causes rapid, shallow respiration (tachypnea) seen in pulmonary edema

Answer 128

Stimulation of J receptors//(type of mechanical receptors)

Question 129

are efficient in protecting the lungs from inhaled particles, microorganisms, and toxic gases

Answer 129

Respiratory defense mechanisms

Question 130

air filtration, mucociliary clearance system, cough reflex, reflex bronchoconstriction, and alveolar macrophages.

Answer 130

Respiratory defense mechanisms include

Question 131

filter inspired air

Answer 131

Nasal hairs ( air filtration)

Question 132

the abrupt changes in direction of airflow that occur as air moves through the nasopharynx and larynx increase air turbulence.
-causes particles and bacteria to contact the mucosa lining these structures.
-particles (greater than 5 μm) are less dangerous

Answer 132

abrupt changes in direction of airflow ( air filtration )

Question 133

velocity of airflow slows greatly after it passes the larynx, facilitating the deposition of smaller particles (1 to 5 μm). They settle out the way that sand does in a river, a process termed sedimentation.
- smaller particles (1 to 5 μm)

Answer 133

velocity of airflow slows greatly after it passes the larynx,( air filtration ) aka sedimentation.

Question 134

e are too small to settle in this manner and are deposited in the alveoli. An example of small particles that can build up is coal dust, which can lead to pneumoconiosis

Answer 134

Particles less than 1 μm in siz (dangerous)

Question 135

Below the larynx, the mucociliary clearance system, also called the

Answer 135

mucociliary escalator

Question 136

, is responsible for the movement of mucus.

Answer 136

mucociliary escalator (function)

Question 137

continually secrete mucus at a rate of about 100 mL/day. This mucus forms a blanket that contains the impacted particles and debris from distal lung areas

Answer 137

Goblet cells and submucosal glands

Question 138

helps protect against bacteria and viruses.

Answer 138

Secretory immunoglobulin A (IgA) in the mucus

Question 139

cover the airways from the level of the trachea to the respiratory bronchioles

Answer 139

Cilia

Question 140

about 200 cilia. They beat rhythmically about 1000 times per minute in the large airways, moving mucus toward the mouth.
-We normally swallow the mucus without noticing.

Answer 140

Each ciliated cell has

Question 141

the tracheobronchial tree. As a result, we remove particles that penetrate more deeply into the airways less rapidly.

Answer 141

ciliary beat is slower further down

Question 142

Dehydration, smoking, inhalation of high O2 concentrations, infection, and drugs, such as atropine, anesthetics, alcohol, or cocaine,

Answer 142

causes of impair ciliary action

Question 143

Patients with COPD and cystic fibrosis often have repeated lower respiratory tract infections. These conditions are associated with destroyed cilia, resulting in impaired secretion clearance, a chronic productive cough, and chronic colonization by bacteria. These lead to frequent respiratory tract infections.

Answer 143

conditions are associated with destroyed cilia,

Question 144

is a protective reflex that clears the airway by a high-pressure, high-velocity flow of air. It is a backup for mucociliary clearance, especially when this clearance mechanism is overwhelmed or ineffective.

Answer 144

cough

Question 145

especially when this clearance mechanism is overwhelmed or ineffective. =COUGH

Answer 145

backup for mucociliary clearance,

Question 146

Coughing is effective in removing secretions only above the subsegmental level (large or main airways)

Answer 146

Coughing is effective in removing secretions ONLY above the subsegmental level

Question 147

Secretions below this level must be moved upward by the mucociliary mechanism before we can remove them by coughing.

Answer 147

Secretions below subsegmental level

Question 148

another defense mechanism

Answer 148

Reflex bronchoconstriction is

Question 149

response to the inhalation of large amounts of irritating substances (e.g., dusts, aerosols), the bronchi constrict to prevent entry of the irritants

Answer 149

Reflex bronchoconstriction (function)

Question 150

, such as a person with asthma, may have bronchoconstriction after inhalation of triggers, such as cold air, perfume, or other strong odors.

Answer 150

hyperreactive airways ex asthma

Question 151

Because there are no ciliated cells below the level of the respiratory bronchioles, the primary defense mechanism at the alveolar level is

Answer 151

alveolar macrophages

Question 152

rapidly phagocytize inhaled foreign particles, such as bacteria. The debris is moved to the level of the bronchioles for removal by the cilia or removed from the lungs by the lymphatic system.

Answer 152

Alveolar macrophages

Question 153

tend to remain in the lungs for indefinite periods and can stimulate inflammatory responses

Answer 153

Particles (e.g., coal dust, silica) that cannot be adequately phagocytized

Question 154

Because alveolar macrophage activity is impaired by cigarette smoke, the smoker who is employed in an occupation with heavy dust exposure (e.g., mining, foundries) is at an especially

Answer 154

high risk for lung disease

Question 155

can be divided into alterations in structure, defense mechanisms, and respiratory control

Answer 155

Age-related changes in the respiratory system

Question 156

Structural changes include calcification of the costal cartilages, which can interfere with chest expansion. The outward curvature of the spine is marked, especially with osteoporosis, and the lumbar curve flattens

Answer 156

Structural changes in elder

Question 157

chest may appear barrel shaped, and

Answer 157

chest shape elder

Question 158

the older person may need to use accessory muscles to breathe. Respiratory muscle strength progressively declines after age 50. Overall, the

Answer 158

lungs in the older adult are harder to inflate.

Question 159

Chest wall stiffening
Costal cartilage calcification
↑ Anteroposterior diameter
↓ Elastic recoil
↓ Chest wall compliance
↓ Functioning alveoli
↓ Respiratory muscle strength

Answer 159

Changes in structure of elder

Question 160

↓ Cell-mediated immunity
↓ Specific antibodies
↓ Cilia function
↓ Cough force
↓ Alveolar macrophage function
↓ Sensation in pharynx

Answer 160

Changes in defense mechanism of elder

Question 161

↓ Response to hypoxemia
↓ Response to hypercapnia

Answer 161

Changes in Respiratory Control of elder

Question 162

dyspnea can occur if their activity exceeds their normal exercise.

Answer 162

older adults have less tolerance for exertion

Question 163

because of a decline in both cell-mediated and humoral immunity (ability to produce antibodies).

Answer 163

older adults, respiratory defense mechanisms are less effective

Question 164

for aspiration.

Answer 164

older adult is at greater risk

Question 165

resulting in a more gradual response to changes in blood O2 or CO2 level.

Answer 165

aging process alters respiratory control,

Question 166

if respiratory distress is severe, only obtain pertinent information and defer a thorough assessment until the patient’s condition stabilizes.

Answer 166

physical assessment= if respiratory distress is severe

Question 167

lower respiratory problems, such as asthma, COPD, pneumonia, and tuberculosis (TB).

Answer 167

ask about lower history problems

Question 168

such as medications, pollen, smoke, mold, or pet exposure.

Answer 168

Ask the patient with allergies about possible precipitating factors or triggers,

Question 169

such as runny nose, wheezing, scratchy throat, or chest tightness.

Answer 169

Record the characteristics and severity of the allergic reaction, example

Question 170

Determine the frequency of asthma exacerbations.

Answer 170

frequency of asthma

Question 171

. Cough is a common side effect

Answer 171

effect of angiotensin-converting enzyme (ACE) inhibitors.

Question 172

, dyspnea and decreased exercise tolerance may occur very quickly.

Answer 172

effect of upper respiratory tract infection is superimposed on a chronic problem

Question 173

in the presence of mold, or with changes in temperature or air pollution.

Answer 173

asthma, symptoms may occur or worsen during exercise,

Question 174

occurs with secretions

Answer 174

loose-sounding cough

Question 175

may mean an airway irritation or obstruction.

Answer 175

dry, hacking cough

Question 176

suggests upper airway obstruction from inhibited vocal cord movement due to subglottic edema.

Answer 176

harsh, barky cough

Question 177

amount, color, consistency, and odor
-Quantify the amount of sputum per day.

Answer 177

If the patient has a productive cough, evaluate the following characteristics of sputum:

Question 178

clear or slightly whitish.

Answer 178

Sputum is normally

Question 179

is usually clear to gray with occasional specks of brown.

Answer 179

If a patient is a cigarette smoker, the sputum

Question 180

may have clear, whitish, or slightly yellow sputum, especially in the morning on rising.

Answer 180

patient with COPD sputum

Question 181

suspect pulmonary complications

Answer 181

If the patient reports any change from baseline color of sputum

Question 182

any changes in consistency of sputum to thick, thin, or frothy and pink tinged.

Answer 182

sputum may indicate dehydration, postnasal drip or sinus drainage, or possible pulmonary edema

Question 183

suggests an infectious process.

Answer 183

foul odor or exceptionally bad breath or taste in the mouth

Question 184

spitting or coughing up blood

Answer 184

hemoptysis

Question 185

(vomiting blood).

Answer 185

hematemesis

Question 186

such as pneumonia, TB, lung cancer, and severe bronchiectasis.

Answer 186

Hemoptysis occurs with a variety of conditions

Question 187

are musical sounds that can be audible

Answer 187

wheezes

Question 188

some degree of airway obstruction, such as asthma, foreign body aspiration, and emphysema.

Answer 188

Wheezing indicates

Answer 189

Respiratory problems that have a strong genetic link

Question 190

is the most important risk factor for COPD and lung cancer.

Answer 190

Smoking

Question 191

Do this by multiplying the number of cigarettes smoked per day by the number of years smoked

Answer 191

Quantify smoking habits in pack-years

Question 192

prior residence in China, India, Africa, the former Soviet Republics, Latin America, or any developing country.

Answer 192

Risk factors for TB include

Question 193

exposure to people with high rates of TB transmission, such as the homeless, injection drug users, and people with HIV infection

Answer 193

other Risk factors for TB include

Question 194

those exposed to bird and rodent feces or polluted water, those working closely with the soil, and immunocompromised patients.

Answer 194

Risk factors for fungal lung infections include

Question 195

can be a symptom of respiratory disease

Answer 195

Weight loss (resp disease)

Question 196

are common in patients with COPD, lung cancer, TB, and chronic severe infection (bronchiectasis)

Answer 196

Anorexia, weight loss, and chronic malnutrition

Question 197

Determine if weight loss was intentional, and, if not, if food intake is changed by anorexia (from medications), fatigue (from hypoxemia, increased work of breathing), or feeling full quickly (from lung hyperinflation).

Answer 197

cause of weight loss

Question 198

can cause sputum to thicken and obstruct the airway

Answer 198

Dehydration (effect airway)

Question 199

from fluid retention may impair gas exchange.

Answer 199

Rapid weight gain ( (effect airway)

Question 200

of limited mobility, which can cause constipation.

Answer 200

Dyspnea can be the cause

Question 201

leading to atelectasis or pneumonia.

Answer 201

Immobility and sedentary habits are risk factors for hypoventilation

Question 202

with chest tightness, wheezing, or coughing. This suggests a need for adjunct therapy or other medication changes

Answer 202

patient with asthma or COPD may awaken (symptoms)

Question 203

and may cause sleep apnea

Answer 203

Excess weight interferes with normal ventilation

Question 204

while awake or asleep

Answer 204

Extremely obese persons may hypoventilate

Question 205

snoring, insomnia, abrupt awakenings, daytime drowsiness, and early morning headaches.

Answer 205

Manifestations of sleep apnea include

Question 206

of TB.

Answer 206

Night sweats may be a sign

Question 207

hypoxia can cause neurologic symptoms, ask the patient about apprehension, restlessness, irritability, and memory changes.

Answer 207

indicate inadequate cerebral oxygenation

Question 208

pleurisy, fractured ribs, and costochondritis .

Answer 208

cause chest pain

Question 209

Hobbies, such as woodworking (sawdust) or pottery (silica), and animal exposure (allergies) can

Answer 209

work environments cause respiratory problems.

Question 210

Because of hyperreactive airways, exposure to fumes, smoke, and other chemicals may

Answer 210

trigger an attack in the patient with asthma.

Question 211

perform good pulmonary hygiene (bronchodilators, coughing, deep breathing) before intimacy. They may need to use O2 therapy equipment during intercourse just like they would with any strenuous physical activity.

Answer 211

strategies improving sexual activity

Question 212

Check each nare for air patency with respiration while briefly occluding the other nare. Tilt the patient’s head backward and push the tip of the nose upward

Answer 212

how to assess pts nose

Question 213

mucous membrane should be pink and moist, with no evidence of edema (bogginess), exudate, or bleeding.
-Some septal deviation is normal in an adult.

Answer 213

Normal nose observation description

Question 214

, which are abnormal, fingerlike projections of swollen nasal mucosa. Polyps may result from long-term irritation of the mucosa (e.g., from allergies)

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turbinates for polyps (definition)

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could occur with a foreign body.

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Purulent and malodorous discharge (nose)

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could be related to allergies or from cerebrospinal fluid.

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Watery discharge (nose)

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could be from trauma or dryness.

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Bloody discharge (nose)

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could mean an infection

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Thick mucosal discharge (nose)

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should be smooth and moist, with no evidence of exudate, ulcerations, swelling, or postnasal drip.

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normal pharynx

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that cranial nerves IX (glossopharyngeal) and X (vagus) are intact and that the airway is protected.

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normal response (gagging) means

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while the patient is sitting erect with the neck slightly flexed

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how to Palpate the lymph nodes

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Tender, hard, or fixed nodes

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abnormal feeling of node

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small, mobile, nontender nodes (shotty nodes)

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normal feeling of lymph node

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in a well-lit, warm room with measures taken to ensure the patient’s privacy

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Chest examination is best done (environment)

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It is best to begin on the posterior chest, particularly with female patients

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chest examination best done on

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, ask the patient to lean forward with arms folded. This position moves the scapulae away from the spine, exposing more of the area you need to examine.

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assessing the posterior chest

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have the patient sit upright or position the patient supine with the head of the bed elevated to 30 degrees (semi-Fowler’s position)

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assessing the anterior chest,

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should be less than the side-to-side or transverse diameter
-AP ratio is 1:2.

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anterior-posterior (AP) diameter normal

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(e.g., barrel chest) may be due to normal aging or result from lung hyperinflation.

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increase in (anterior-posterior) AP diameter cause

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(e.g., pectus carinatum [a prominent protrusion of the sternum]) and pectus excavatum (an indentation of the lower sternum above the xiphoid process)

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abnormalities in the sternum

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include kyphosis, scoliosis, and kyphoscoliosis.

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Spinal curvatures that affect breathing

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Inspiration (I) should take half as long as expiration (E) (I/E ratio = 1:2)

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Inspiration duration vs expiration normally

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rapid, deep breathing

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Kussmaul

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abnormal respirations characterized by alternating periods of apnea and deep, rapid breathing

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Cheyne-Stokes (like dog)

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irregular breathing with apnea every 4 to 5 cycles respirations.

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Biot’s (increase Co2-sound like running fast)

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, a late sign of hypoxemia, is best seen in light-skinned patients as a bluish tinge to the mucous membranes, lips, and palms of the hands.

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Cyanosis ( best seen in light-skinned patients )

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may be seen as a gray or white discoloration in the conjunctivae or around the mouth.

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In dark-skinned persons, cyanosis

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include hypoxemia or decreased cardiac output.

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Causes of cyanosis

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increase in the angle between the base of the nail and the fingernail to 180 degrees or more

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Clubbing

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occurs away from the side of a tension pneumothorax or a neck mass, but toward the side of a pneumonectomy or lobar atelectasis.

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Tracheal deviation

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occurs when air entry is limited by conditions involving the lung (e.g., atelectasis, pneumothorax) or the chest wall (e.g., incisional pain)

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Unequal expansion

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occurs in conditions that produce a hyperinflated or barrel chest or in neuromuscular diseases (e.g., amyotrophic lateral sclerosis, spinal cord lesions)

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Equal but decreased expansion in chest

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over a pleural effusion, an atelectasis, or a pneumothorax.

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chest Movement may be absent or unequal due to

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is the vibration of the chest wall made by vocalization.

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Fremitus

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is most intense by the sternum and between the scapulae because these areas are closest to the major bronchi

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Tactile fremitus

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occurs when the lung becomes filled with fluid or is denser.

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Increased fremitus

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This happens with pneumonia, lung tumors, thick bronchial secretions, and above a pleural effusion (the lung is compressed upward).

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condition with voice that moves through a dense tissue or fluid, you can feel that the vibration is increased.

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if the hand is farther from the lung (e.g., pleural effusion) or the lung is hyperinflated (e.g., barrel chest)

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Fremitus is decreased

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may occur with pneumothorax or atelectasis

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Absent fremitus

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is harder to palpate for fremitus because of the large muscles and breast tissue

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anterior of the chest

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is used to assess the density or aeration of the lungs

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Percussion

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area over lung tissue should be resonant, except for the area of cardiac dullness

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anterior chest resonant

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over lung tissue to the level of the diaphragm

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posterior chest should be resonant

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should proceed from the lung apices to the bases, comparing opposite areas of the chest

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Auscultation begin

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or you think the patient will tire easily, start at the bases

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If the patient is in mild respiratory distress (start from base)

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are bronchial, bronchovesicular, and vesicular.

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3 normal breath sounds

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are loud, high-pitched sounds that resemble air blowing through a hollow pipe

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Bronchial sounds

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have an inspiratory to expiratory (I/E) ratio of 2:3, with a gap between inspiration and expiration

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Bronchial sounds

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have a medium pitch and intensity.

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Bronchovesicular sounds

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best heard anteriorly between the first and second intercostal space and posteriorly between the scapulae.
- have a 1:1 ratio, with inspiration equal to expiration.

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Bronchovesicular sounds

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are relatively soft, low-pitched, gentle, rustling sounds.
-They are heard over all lung areas except the major bronchi.
- 3:1 ratio, with inspiration 3 times longer than expiration.

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Vesicular sounds

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normal and abnormal (adventitious).

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classify breath sounds into 2 main categories:

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crackles (fine and coarse), wheezes, stridor, and pleural friction rub

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Adventitious breath sounds include

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is used to evaluate the status of previously identified respiratory problems and to monitor for signs of new problems.

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focused assessment

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-Arterial blood gases
-Chest x-ray
-Hemoglobin
-Hematocrit

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objective Diagnostic

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Interstitial edema

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early pulmonary edema

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alveolar filling

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pneumonia

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loss of lung volume (alveoli deflate)

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atelectasis

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(1) pulse oximetry and (2) analysis of arterial blood gases (ABGs)

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Two methods are used to assess the efficiency of gas transfer in the lung and tissue oxygenation:

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patient with impaired cardiac output or hemodynamic instability (e.g., altered level of consciousness, changes in heart rate and rhythm, low BP) may have inadequate tissue O2 delivery and/or abnormal O2 consumption.

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evaluate a mixed venous blood gas.

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Values obtained by pulse oximetry are less accurate if the SpO2 is less than 70%
-may display a value that is ±4% of the actual value

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less accurate value of pulse Ox

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hemoglobin variants (e.g., carboxyhemoglobin, methemoglobin) are present

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Pulse oximetry is inaccurate if

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motion, low perfusion, anemia, cold extremities, bright fluorescent lights, intravascular dyes, thick acrylic nails, and dark skin color.

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Other factors that can alter the accuracy of pulse oximetry include

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, obtain an ABG analysis to verify the values.

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if there is doubt about the accuracy of the SpO2 reading

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are obtained to determine oxygenation status and acid-base balance.

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ABGs (function)

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measurement of the PaO2, PaCO2 (the partial pressure of CO2 in arterial blood), acidity (pH), bicarbonate (HCO3−), and SaO2

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ABG analysis includes

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can be obtained by arterial puncture or from an arterial catheter, which is usually inserted into the radial or femoral artery.

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Blood for ABG analysis

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arterial catheter permits ABG sampling without repeated arterial punctures.

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arterial catheter vs arterial puncture

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Sensor may be attached to an adaptor on endotracheal or tracheostomy tube. A nasal cannula with a sidestream capnometer can be used in patients without an artificial airway.

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how to measure End-tidal CO2(PetCO2) (capnography)

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is 2–5 mm (dead space)
-if it increases= pulmonary embolism

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Normal difference between PaCO2 and PetCO2

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transcutaneous CO2 (PtCO2) and end-tidal CO2 (PetCO2) capnography

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CO2 can be monitored using

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is a noninvasive method of estimating arterial pressure of CO2 (PaCO2) using an electrode placed on the skin

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Transcutaneous measurement of CO2

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is the noninvasive measurement of alveolar CO2 during exhalation when CO2 concentration is at its peak

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PetCO2

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is a flow-directed catheter

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pulmonary artery (PA) catheter

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Blood drawn from a PA catheter is called a

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mixed venous blood gas (SvO2)

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(1) it consists of venous blood that has returned to the right side of the heart from all parts of the body and (2) it samples blood just before blood enters the lungs to be oxygenated. Normal SvO2 is 60% to 80%.

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mixed venous blood gas (SvO2) (function)

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intermittently by obtaining a blood sample from the PA catheter or continuously via a fiberoptic sensor as part of a specific central line with SpO2 monitoring capability.

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SvO2 can be monitored

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in cardiac output or tissue O2 delivery.

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Changes in SvO2 provide an early warning of a change

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that less O2 is being delivered to the tissues or that more O2 is being consumed.

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A decrease in SvO2 suggests

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expectoration, tracheal suction, or bronchoscopy.

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obtain a sputum sample by

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if pt is unable to expectorate spontaneously, sputum may be collected by inhaling an irritating aerosol, usually hypertonic saline. This is called

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sputum induction

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that the patient has been exposed to the antigen. It does not mean that the patient has TB

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a positive result on a TB skin test means

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either no exposure or a depression of cell-mediated immunity, which occurs in HIV infection.

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negative TB result means

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be sure that the injection is intradermal and not subcutaneous

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prevent a false-negative reaction, (TB)

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is a procedure in which the bronchi are visualized through a fiberoptic tube

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Bronchoscopy

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diagnostic purposes (obtain biopsy specimens) and for treatment (e.g., to remove mucous plugs, foreign bodies).

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Bronchoscopy may be used for

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Laser therapy, electrocautery, cryotherapy, and stents may be placed through a bronchoscope to

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ways to achieve patency of an airway that has been partially or nearly fully obstructed by tumors

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can be done in an outpatient procedure room, in a surgical suite, or at the bedside in the critical care unit or on a medical-surgical unit.

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Bronchoscopy performed (environement)

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patient may be positioned supine, in low-Fowler’s, or even be seated.

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position of patient during Bronchoscopy

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HCP inserts the bronchoscope through the nose or mouth. Depending on the approach, the nasopharynx or oropharynx is anesthetized with local anesthetic spray.

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insertion of bronchoscopy

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is coated with water-soluble lubricant and inserted down into the airways. Small amounts (30 mL) of sterile saline may be injected through the scope and withdrawn and examined for cells, a technique termed bronchoalveolar lavage (BAL)

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bronchoscope (how its used)/ termed bronchoalveolar lavage (BAL)

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Bronchoscopy can be done through the endotracheal tube of a mechanically ventilated patient.

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Bronchoscopy can be done through the endotracheal tube

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(1) transbronchially, (2) percutaneously or via transthoracic needle aspiration (TTNA), (3) by video-assisted thoracic surgery (VATS), or (4) as an open lung biopsy

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Lung biopsy may be done

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is to obtain tissue, cells, and/or fluid for evaluation.

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purpose of a lung biopsy

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involves passing a forceps or needle through the bronchoscope for a specimen.

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Transbronchial biopsy (lung biopsy)

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is used to distinguish infection and rejection in lung transplant recipients.

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A combination of transbronchial lung biopsy and BAL

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involves inserting a needle through the chest wall, usually under bedside ultrasound or CT guidance. Because of the risk for a pneumothorax, a chest x-ray is done after TTNA.

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percutaneous or TTNA biopsy

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a rigid scope with a lens is passed through a trocar placed into the pleura via 1 or 2 small incisions in the thoracic cavity. The HCP views the lesions in the pleura or peripheral lung on a monitor directly via the scope and can obtain biopsy specimens. A chest tube is kept in place until the lung expands. VATS is much less invasive than open lung biopsy. It is associated with shorter hospital stays and reduced mortality.13 It is ideal for pleural biopsy and resecting lung nodules.

Answer 308

VATS, (lung biopsy)

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is used when other procedures cannot diagnose pulmonary disease. With the patient under anesthesia, the chest is opened with a thoracotomy incision and a biopsy specimen is obtained. Postprocedure care is the same as after thoracotomy

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open lung biopsy

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is the insertion of a large-bore needle through the chest wall into the pleural space to obtain specimens for diagnostic evaluation, remove pleural fluid, or instill medication

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Thoracentesis

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patient is positioned sitting upright, leaning on an overbed table with feet supported. The skin is cleansed and a local anesthetic (lidocaine) is injected subcutaneously. A percutaneous catheter may be left in to allow further drainage of fluid

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Thoracentesis procedure

Question 312

measure lung volumes and airflow.

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Pulmonary function tests (PFTs)

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can diagnose pulmonary disease, monitor disease progression, assess response to bronchodilators, and evaluate disability.

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results of PFTs (Pulmonary function tests)

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Airflow measurement is obtained by trained personnel using a spirometer.

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Pulmonary function tests Airflow measurement

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are 80% to 120% of the predicted valu

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Pulmonary function test normal value

Question 316

Volume of air inhaled and exhaled with each breath. Only a small proportion of total capacity of lungs

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Tidal volume (Vt)

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may be used to monitor lung function in people with asthma, cystic fibrosis, or COPD, as well as before and after lung transplantation or other thoracic surgeries

Answer 317

Home spirometry

Question 318

changes can warn of early lung transplant rejection or infection.

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Spirometry