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Med-Surg Spring 2024 > Chapter 27 - Assessment: Respiratory System- Exam 2 > Flashcards

Chapter 27 - Assessment: Respiratory System- Exam 2 Flashcards

1
Q

The nose protects the lower airway by

A

warming and humidifying air and filtering small particles before air enters the lungs

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2
Q

the _________nerve, found within in the nasal cavity is responsible for sense of smell. Which CN # is it?

A

olfactory
cranial nerve 1

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3
Q

epiglottis funciton

A

small flap behind tongue that closes over larynx during swallowing. this prevents solids and liquids from entering the lungs

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4
Q

Bronchi and bronchioles

A

the mainstem bronchi subdivide several times to form the lobar, segmental, and subsegmental bronchi, further divisions form the bronchioles, the most dstanct bronchioles are the respiratory bronchioes.

the bronchioles are encircled by smooth muscles taht constrict and dilate in response to various stimuli

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5
Q

what is tidal volume

A

the amount of air that moves in or out of he lungs with each respiratory cycle

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6
Q

what is oxygenation

A

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

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7
Q

What is ventilation

A

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

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8
Q

what is compliance (ie lung compliance)

A

the ability of the lungs to expand. this is a result of the elasticity of the lungs and elastic recoil of the chest wall.
with decreased compliance it is harder for the lungs to inflate.

(e.g., pulmonary edema, pneumonia)

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9
Q

what is resistance (ie lung resistance)

A

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

the main factor affecting airway resistance is changes in the diameter of the airways

eg asthma

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10
Q

what is a chemoreceptor (lungs)

A

pg 519

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

chemoreceptors are found in the medulla, they respond to changes in the hydrogen ion H+ concentration.
too much acid, increased respiratory rate

changes in paCO2 regulate ventilatoin by their effect on the pH of the cerebrospinal fluid

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11
Q

what is a mechanical receptor

A

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

They are stimulated by irritants, muscle stretching, alveolar wall distortion.

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12
Q

explain the process of air filtration

A

nasal hairs filter air as well as mucosa as air in inhaled and exhaled

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13
Q

mucociliary clearance

A

“MUCOCILIARY ESCALATOR”

responsible for the movement of mucus. goblet cells and submucosal glands continually secrete mucous; this mucus forms a blanket containing all the impacted partcles and debris

cilia cover the trachea and continually move mucus away from lungs and towards mouth

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14
Q

explain the cough reflex

A

protective reflex that clears the airway by high pressure high velocity air

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15
Q

what is bronchoconstriction

A

a defense mechanisim, as we inhale large amounts of irritating substances the bronchi constrict to prevent entry of the irritants

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16
Q

what is a alveolar macrophage

A

primary defense mechanism at the alveolar level (no cilia here)
alveolar macrophages rapidly phagocytize inhaled foreign particles.

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17
Q

what is partial pressure

A

portion of the total pressure exerted by the presence of a single gas molecule

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18
Q

what is the normal range of pH

A

7.35-7.45

anything less than 7.35 acidic
anything more than 7.45 basic

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19
Q

what is the normal range of PaCO2

A

35-45

respiratory

*****REMEMBER THIS IS BACKWARDS
anything less than 35 is basic and anything more than 45 acidic

https://www.youtube.com/watch?v=URCS4t9aM5o&ab_channel=RegisteredNurseRN

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20
Q

what is the normal range for HCO3

A

22-26

metabolic

anything less than 22 acidic
anything more than 26 basic

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21
Q

what are adventitious breath sounds?

A

abnormal; crackles, wheezes, stridor, rubbing

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22
Q

what is compliance

A
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23
Q

What is dyspnea

A
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24
Q

what is fremitus

A
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25
Q

What is a mechanical receptor

A
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26
Q

what is oximetry?

A
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27
Q

what is oxygenation

A
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28
Q

what is resistance

A
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29
Q

what is surfactant

A
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30
Q

what is tidal volume (Vt)

A
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31
Q

what is ventilation

A
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32
Q

what are wheezes?

A
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33
Q

what is the primary purpose of the respiratory system?

A

gas exchange

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34
Q

What gases are involved in gas exchange? what action between these two gases takes place?

A

oxygen and carbon dioxide

This involves the TRANSFER of oxygen and carbon dioxide between the atmosphere and the blood

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35
Q

What does the upper respiratory tract include?

A

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

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36
Q

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

A

turbinates

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

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37
Q

The pharynx divides into 3 parts, what are they?

A

nasopharynx, oropharynx, laryngopharynx

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38
Q

the vocal cords are in the _______

A

larynx

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39
Q

The trachea divides into the r and l mainstem bronchi at the point called the _______________

A

carina

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40
Q

the carina is located at the angle of _________, which is at the level of the 4th and _____th thoracic vertebrae

A

louis, 5th

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41
Q

the _______is HIGHLY sensitive. Stimulation of this area during __________ causes vigorous __________

A

carina, suctioning, coughing

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42
Q

The lower respiratory tract consists of

A

bronchi, bronchioles, alveolar ducts, and alveoli

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43
Q

except for the r and l mainstem bronchi, all lower airway structures are found within the _______

A

lungs

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44
Q

the right lobe is divided into ____lobes and the left lobe is divided into ______ lobes. why?

A

3,2, location of the heart

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45
Q

The bronchioles are encircled by _______ muscles that constrict and __________ in response to various stimuli

A

smooth, dilate

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46
Q

Beyond the bronchioles lie the _________ducts and _____________

A

alveolar ducts, alveoli

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47
Q

In adults, a normal tidal volume, or volume of air ___________ with each breath is about ________mL

A

exchanged, 500mL

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48
Q

the __________are the final part of the respiratory tract

A

alveoli

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49
Q

the alveoli are small sacs in the lungs that are the __________site of _______exchange for O2 and CO2

A

primary, gas

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50
Q

________ breathing promotes air movement through alveoli and helps move ________out of respiratory bronchioles

A

deep, mucus

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51
Q

Alveoli have a total volume of about ________mL, with a surface area for gas exchange the size of a tennis court

A

2500mL

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52
Q

Because alveoli are unstable they have a natural tendency to ______

A

collapse

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53
Q

alveolar cells secrete __________

A

surfactant

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54
Q

surfactant is a __________ that makes the alveoli less likely to collapse

A

lipoprotein

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55
Q

when there is not enough __________ the alveoli collapse. The term ___________ refers to collapsed, airless alveoli

A

surfactant, atelectasis

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56
Q

The __________patient is at risk for atelectasis because of the effects of _________, decreased _________ ,and __________, which can alter breathing and lung expansion

A

post op, anesthesia, mobility, pain

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57
Q

in acute _______ _________ syndrome (ARDS), lack of surfactant contributes to widespread __________ and collapse of lung tissue

A

respiratory distress, atelectasis

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58
Q

The lungs have 2 different types of circulation: ____________and ___________

A

pulmonary, bronchial

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59
Q

__________ circulation provides the lungs with blood that takes part in gas exchange

A

pulmonary

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60
Q

____________circulation starts with the bronchial arteries. Bronchial circulation does not take part in gas exchange but provides O2 to teh bronchi and oter lung tissues

A

bronchial

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61
Q

the chest wall is shaped, supported and protected by 24 ____

A

ribs

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62
Q

the ___________ is the space in the middle of the thoracic cavity

A

mediastinum

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63
Q

the mediastinum contains which major organs of the chest?

A

heart, aorta, esophagus

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64
Q

the chest cavity is lined with a membrane called the _______pleura

A

parietal

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65
Q

the lungs are lined with a membrane called the

A

visceral pleura

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66
Q

the _______space is the space between the pleural layers. normally this space contains 10 to ____mL of fluid

A

intrapleural, 20

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67
Q

fluid in the intrapleural space serves 2 purposes:
1. it provides __________, allowing sliding during breathing
2. it increases unity between the layers. this promotes ______

A

lubrication; expansion

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68
Q

fluid drains from the pleural space via ___________circulation

A

lymphatic

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69
Q

several conditions may cause pleural effusion, or excess fluid in the plueral space. such as?

A

blocked lymphatic drainage (from cancer)
imbalance between intravascular and oncotic fluid pressures (heart failure)
pneumonia
pulmonary embolisim

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70
Q

purulent pleural fluid with bacterial infection is called

A

empyema

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71
Q

the _________is the major muscle of respiration

A

diaphram

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72
Q

Complete spinal cord injuries above the level of c3 result in diaphragm __________ and dependence on a _____________ventilator

A

paralysis, mechanical

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73
Q

oxygenation refers to the process of

A

obtaining o2 from the atmosphereic air and making it avaliable to the organs and tissues of the body

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74
Q

o2 and co2 move back and forth across the alveolar capilarry membrane by

A

diffusion

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75
Q

ventilation requires __________and ___________

A

inspiration, expiration

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76
Q

what is dyspnea

A

shortness of breath

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77
Q

which parts of the body can aid in ventilation when patient has dyspnea

A

neck, shoulder, other accessory muscles

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78
Q

Some conditions such as ______ fractures and _______ disease may limit diaphragm or chest wall movement

A

rib fractures, neuromuscular disease

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79
Q

These traumas to the chest wall may cause patient to breath with smaller _______volumes. As a result the lungs do not fully __________ and _________ exchange may be impaired

A

tidal, inflate, gas

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80
Q

in contrast to inspiration, expiration is ________

A

passive

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81
Q

________recoil is the tendency of the lungs to return to their original size

A

elastic

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82
Q

Exacerbations of _________or _________ cause expiration to become an active, labored process

A

asthma, copd

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83
Q

changes in compliance and or resistance can affect both _________and ventilation

A

oxygenation

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84
Q

compliance refers to

A

the ability of the lungs to expand

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85
Q

compliance of the lungs depends on the _________of the lungs

A

elasticity

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86
Q

with decreased compliance it becomes harder for the lungs to

A

inflate

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87
Q

compliance becomes an issue with conditions that ________fluid in the lungs

A

increase

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88
Q

conditions that cause fluid to accumlate in the lungs include

A

pulmonary edema, ards, pneumonia

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89
Q

conditions that make the lungs less elastic include

A

pulmonary fibrosis, sarcoidosis

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90
Q

resistance refers

A

to any obstacle to airflow during inspiration and or expiration

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91
Q

and obstacle that distorts airflow during inspiration and or expiration

A

resistance

92
Q

the main factor affecting airway reistance is changes in the ___________of the airways

A

diameter

93
Q

a patient with an acute asthma attack has narrowed airways, resulting in

A

resistance

94
Q

giving ___________dilators increases the diameter of the bronchi

A

bronchodilators

95
Q

the _______ of secretions in the bronchi also increases __________

A

presence, resistance

96
Q

the respiratory center, the medulla, responds to _______and ________signals

A

chemical and mechanical

97
Q

conditions such as copd change lung function and may result in chronically elevated

A

PaCO2 levels

98
Q

Gerontologic assessment differences page 520:
what are some structural changes in relation to respiration we may find in an older patient

A

increased anteroposterier diameter
decreased chest wall compliance
chest wall stiffening
decreased elastic recoil
decreased functioning alveoli
decreased respiratory muscle strength

99
Q

gerontologic assessment page 520:
a nurse will notice that structural changes manifest as

A

barrel chest appearance
kyphotic posture
decreased chest wall movement
decreased deep breathing
decreased cough effectiveness
decresed vital capacity
decreased breath sounds

100
Q

gerontologic assessment pg 520:

because of decreased efficiency in defense due to: decreased alveolar macrophage function, cilia function, cough force, sensation in pharynx, antibodies

a nurse may notice

A

decreased cough effectiveness, decreased secretion clearance, thickened mucus, increased risk for upper resp infection/flu/pneumonia,

101
Q

we consider age related changes in the resp system as alertations in

A

structure, defense mechanisims, and repiratory control

102
Q

changes in structure include _______ of the costal cartilages, which can interfere with chest wall expansion

A

calcification

103
Q

with age alveoli become less _______

A

elastic

104
Q

Respiratory problems with a strong genetic link include:

A

cystic fibrosis, COPD from a1-antitrypsin deficiency, asthma

105
Q

subjective data:
health history - what can we ask?

A

frequency of upper resp infections
seasonal changes influence problems
history of lower resp problems?
precipitating factors/triggers?
characteristics?
severity?

106
Q

during a health history, why might we ask about other health problems?

A

respiratory problems are often a manifestation of problems that involve other body systems.
eg a patient with heart problems might have dyspnea because of heart failure
hiv patient may have frequent resp infections because of compromised immunity

107
Q

what do we ask about current medicaitons?

A

dose, frequency, time, side effects, reason

108
Q

if a cough is present, assess its quality. for example, a loose-sounding cough occurs with ________
a dry, hacking cough may mean airway irritation or __________

A

secretions, obstruction

109
Q

evaluate these characteristics of sputum

A

amount, color, consistency, odor

110
Q

note any changes in consistency of sputum to thick, thin, or frothy and pinkish. this may indicate

A

a pulmonary embolism, dehydration, post nasal drip

111
Q

percussion sounds: dull

A

medium intensity pitch and duration heard over areas of mixed solid and lung tissue, such as top area of liver, partially consolidated lung tissue (pneumonia) or fluid filled pleural space

112
Q

percussion sounds: flat

A

soft, high pitched sound of short duration heard over very dense tissue where air is not present, such as posterior chest below level of diaphram

113
Q

percussion sounds: hyperresonance

A

loud, lower pitched sound than normal resonance heard over hyperinflated lungs such as in copd and acute asthma

114
Q

resonance

A

low pitched sound heard over normal lungsty

115
Q

tympany

A

drum like, loud, empty quality sound heard over pneumothorax

116
Q

accessory muscle use may indicate

A

copd, asthma exacerbatoin, secretion retention

117
Q

increased AP diameter may indicate

A

copd, asthma, cystic fibrosis, lung hyperinflation, advanced age

118
Q

pursed lip breathing may indicate

A

copd, asthma, suggests increasing breathlessness

119
Q

tripod position indicates

A

copd, asthma exacerbation, pulmonary edema, moderate to severe respiratory distress

120
Q

wheezes may indicate

A

bronchospasm (r/t asthma), airway obstruction, copd

121
Q

coarse crackles may indicate

A

excess fluid in lungs, heart failure, pumonary edema, pneumonia severe congestion, copd

122
Q

two methods are used to assess the effectiveness of gas transfer in the lungs and tissue oxygenation

A

oximetry and analysis of arterial blood gases ABGS

123
Q

these two methods are primarily used to assess for

A

hypoxia

124
Q

ABGs: description, purpose, nursing responsibility

A

arterial blood is obtained through radial or femoral artery. done to assess acid-base balance, oxygenation/ventilation status, need for or change of o2 therapy

assist with positioning, collect blood, apply pressure to radial artery, send sample to lab

125
Q

a pulse oximeter is non invasive measurement of arterial o2 saturation which represents

A

how much 02 hemoglobin is carrying compared to how much it should carry

126
Q

the key anatomic landmark that separates the upper resp from the lower is
a. carina
b. larynx
c. trachea
d. epiglottis

A

a. pg 516, the carina is located at the angle of louis, the carina is highly sensitive,

127
Q

a patient asks “ how does air get into my lungs” the nurse bases their answer on knowledge that air moves into and out of lungs because of
a. positive intrathoracic pressure
b. contraction of the accessory abdominal muscles
c. stimulation of the resp muscles by chemoreceptors
d. a decrease in intrathoracic pressure from an increase in thoracic cavity size

A

d.pg 518 air moves in and ot of the lungs because intrathoracic pressure changes in relation to pressure that the airway opening

128
Q

the nurse can best determine adequate arterial oxygenation of the blood by assessing
a. hr
b. hemoglobin level
c. arterial oxygen partial pressure
d. arterial carbon dioxide partial pressure

A

c.

129
Q

defense mechanisims that help protect the lung form inhaled particles and mircroorganisims include the
a. cough reflex
b. mucociliary escalator
c. alvelor marophages
d. reflex bronchoconstriction
e. alveolar capillary membrane

A

abcd

130
Q

a student asks the nurse what can be measured by ABGS. it can measure
a. acid-base balance
b. bicarbonate
c. mixed venous
d. compliance and resistance
e. partial pressure of o2

A

abe

131
Q

to detect early signs or symptoms of inadequate oxygenation, the nurse would examine the patient for
a. dyspnea and hypotension
b, apprehension and restlessness
c. cyanosis and cool, clammy skin
d. increased urine output and diaphoresis

A

b, change in mental status

132
Q

during the resp assessment of an older adult, the nurse would expect to find
a. vigorous cough reflex
b. increased chest expansion
c. increased residual volume
d. decreased lung sounds at the base of lungs
e. increased ap chest diameter

A

cde

133
Q

when assessing subjective data related to the respiratory health of a patient with emphysema, the nurse would ask
a. date of last chest xray
b. dyspnea during rest or exercise
c. pulmonary function test results
d. ability to sleep through the entire night
e. prescription or otc meds

A

bde

134
Q

when auscultating the chest of an older patient in mild resp distress, it is best to
a. begin listening at the apices
b. listen at lung bases
c. begin listening at the anterior chest
d. ask the patient to breath through the nose with mouth closed

A

b. this is because auscultation of the lung bases allows for better detection of abnormal breath sounds such as crackles that may indicate conditions like pneumonia, hf, or pulmonary edema

135
Q

which respiratory assessment finding does the nurse interpret as abnormal
a. inspiratory chest expansion of 1 inch
b. symmetric chest expansion and contraction
c. resonance over the lung bases
d.bronchial breath sounds in the lower lung fields

A

d

136
Q

what is residual volume

A

amount of air that remains in lungs after a maximal exhalation.
residual volume is important because it helps to keep the alveoli open and prevents lung collapse, also ensures there is a continuous exchange of gases

137
Q

age related changes r/t respiratory system’s defenses (structure and function)

….what should the nurse be mindful of

A

structure: dec cilia, dec mucus clearance, dec cough and gag

function: dec protection against foreign invaders

RN will be mindful that older patients have a -p[0higher risk for upper respiratory infections ,such as peumonia. they may also be more severe

138
Q

aged related changes to respiratory system r/t the lungs structure and function

what might the nurse notice upon inspection

A

structure: narrowing airways, including thickness of alveoli, decreased elasticity

function: increased airway resistance

rn may notice barrel chest appearence, kyphotic posture,

139
Q

manifestations of inadequate oxygenation:
r/t cardiovascular

A

cool, clammy skin
cyanosis
dysrhythmias
mild hypertension
tachycardia

140
Q

manifestations of inadequate oxygenation r/t CNS

A

apprehension
coma
combativeness
confusion
lethargic
restlessnesss
irritability

141
Q
A
142
Q

manifestations of inadequate oxygenation r/t respiratory

A

dyspnea on exertion
dyspnea at rest
pause for breath between sentences
tachypnea
use of accessory muscles

143
Q

manifestations of inadequate oxygenation r/t miscellaneous

A

diaphresis
fatigue
decreased urine output

144
Q

what are we looking for while palpating during a physical assessment r/t the chest

A

tracheal position midline
symmetry of chest expansion
normal chest expansion is 1 inch
equal chest movement

145
Q

what is hyperresonance

A

loud, lower pitched sound than normal resonance heard over hyperinflated lung, such as in copd and acute asthma

146
Q

what is tympany

A

drum like, loud, empty quality sound heard over pneumothorax

147
Q

what the hell are ABGS and what do they test for

A

“arterial blood gases” are obtained to determine oxygenation status and acid base balance. ABG analysis insludes measurement of the paO2 and PaCO2, acidity, bicarbonate, and SaO2

148
Q

normal pH?

A

7.35-7.45

149
Q

normal partial pressure of CO2?

A

35-45

150
Q

Normal partial pressure of O2

A

80-100

151
Q

normal range bicarbonate

A

22-26

152
Q

normaloxygen saturation?

A

95-100%

153
Q

common lab test: albumin range

A

3.5-6

154
Q

common lab test: alkaline phosphatase normal range

A

40-130

155
Q

what is a bronchoscopy

A

procedure in which the bronchi are seen through a fiberoptic tube. may be used for diagnostic purposes and for treatment `(biopsy, remove mucous plugs, foreign bodies)

156
Q

what is the nurses role during a bronchoscopy

A

obtain signed consent
pt NPO for 6-12 hours before the test.
give sedative as ordered
keep patient NPO until gag reflex returns, monitor recovery from sedation
if biopsy was done, monitor for hemorrhage and pneumothorax

157
Q

what is a thoracoscopy

A

a minimally invasive surgical procedure used to visualize, diagnose and treat conditions inside the chest cavity, partifularly within hte pleural space surrounding the lungs

158
Q

what is a thoracentesis

A

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

159
Q

what is the nurses role during thoracentesis

A

explain, consent, observe for signs of hypoxia and pneumothorax and verify breath sounds in all fields, encourage deep breathing to expand lungs.

160
Q

what is a pulmonary function test

A

measures lung volumes and airflow, results can diagnose pulmonary disease, monitor disease progression, assess response to bronchodilators

161
Q

how is a pulmonary function test done

A

spriometer, the pt inserts mouthpiece, inhales, and exhales as hard and fast as possible

162
Q

what is tidal volume

A

volume of air inhaled and exhaled with each breath. only a small portion of total capacity of lungs

163
Q

what is forced vital capactiy

A

volume of air a person can exhale forcefully and completely after taking a deep breath

164
Q

what is forced expiratory volume in first second

A

amount of air exhaled in first second of forced vital capacity

165
Q

what is peak expiratory flow rate

A

maximum airflow rate during forced expiration. aids in monitoring bronchoconstriction in asthma. can be measured with peak flow meter

166
Q

tell me about sputum studies

A

acid-fast bacteria smear and culture
culture and sensitivity
cytology (tests for abnormal cells)
gram stain

observe color, volume, viscosity, blood, test for infection

167
Q

nursing responsibilities r/t CT

A

before contrast medium given assess renal function, allergies to shellfish, patient may need to be NPO for 4 hours prior to study,warn patient they may feel warm or flushed, encourage patient to drink fluids

168
Q

nursing responsibilities r/t MRI

A

prior to test check for pregnancy, allergies, renal function. no metal, assess claustraphobia, pt must be still for scan

169
Q

nursing responsibilities r/t PET scan

A

IV
patients should be NPO 4 hours prior except water and meds, hold glucose containing iv solutions and change to normal saline, check blood glucose levels, patient must be still, encourage fluids after procedure

170
Q

what is a pulmonary angiogram? nursing responsibilities?

A

visualize pulmonary vasculature and locate obstruction or pathologic conditions e.g. PE, contrast medium injected through cathetor threaded into pulmonary artery

assess for allergies, NPO 6-12 hours prior, give sedative if ordered. monitor BP, pulse and circulation distal to injection site. place compression device over site. maintian iv or fluid intake

171
Q

what is a V/Q scan? nursing responsibilities?

A

ventilation-perfusion scan, assesses ventilation and perfusion of the lungs. IV radioisotope given to assess perfusion. patient inhales radioactive gas that outline alveoli

same respnsibilities as an xray, radioactive gas disappates quickly

172
Q

what does a PET scan help diagnose

A

distinguish benign and malignant nodules

173
Q

which test wil the nurse anticipate the HCP to order following a transthoracic needle aspiration

A

chest xray

174
Q

which term will the nurse document when percussion results in a moderately low pitched sound over chest

A

resonance

175
Q

which condition will the nurse associate with wheezing

A

copd

176
Q

which mucus characteristic will the nurse expecta in a patient with pulonary edema

A

large amounts of frothy pink-tinged sputum

177
Q

which pattern will the nurse use to auscultate the chest of a patient in respiratory distress

A

start at lung bases

178
Q

which assessment finding will the nurse expect in a patient with pulmonary fibrosis

A

normal percussion

179
Q

which radiology study will the nurse expect the HCP to order for a patient with a suspected pulmonary embolisim

A

ct scan

180
Q

which conditions will the nurse suspect when auscultating a pleural friction rub

A

pleurisy, pneumonia, pulmonary infart

181
Q

which condition will the nurse associate with tachypnea and clubbing of fingers

A

chronic hypoxemia

182
Q

which findings will lead the nurse to suspect inadequate oxygenation

A

cyanosis, tachypnea, diaphoresis

183
Q

coarse crackles are often auscultated in patients diagnosed with

A

pneumonia or heart failure

184
Q

rhonchi are auscultated in patients diagnoised with

A

cystic fibrosis

185
Q

The upper respiratory tract includes…..

A

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

186
Q

The lower respiratory tract consists of….

A

bronchi and bronchioles, mediastinum, pleura, lungs, and alveoli

187
Q

the intrapleural space is the space between the pleural layers. Normally this space contains 10 to _____mL of fluid

what 2 purposes does this fluid serve

A

20 ml

  1. lubrication
  2. unity between the pleural layers
188
Q

When the lungs lose elasticity and recoil the lungs are no longer as _______ as they used to be

A

compliant

189
Q

What conditions cause lung compliance issues ie loss of lung expansion

A

pneumonia, ards, pulmonary edema

190
Q

The main factor affecting airway resistance is changes in

A

the diameter (size) of the airway

191
Q

Peripheral chemoreceptors are found in

A

the carotid arteries and in the aortic arch

192
Q

where do we find mechanical receptors

A

in the conducting upper air ways, chest wall, diaphragm, and capillaries of the alveoli

193
Q

the 3 major types of mechanical receptors are

A

irritant, stretch, juxtacapillary

194
Q

Reflex bronchoconstriction is another defense mechanisim. A person with hyperactive airways such as person with asthma may have _______ after inhalation of triggers such as cold air, perfume, strong odors

A

bronchoconstriction

195
Q

Since there are no cilliated cells below the level of the respiratory bronchioles, the primary defense mechanisim at the alveolar level is

A

alveolar macrophages

196
Q

what type of activity might cause impairment of alveolar macrophage activity

A

smoking

197
Q

we consider age-related changes in the respiratory system as alterations in 3 things what are hey

A

structure
defense mechanisms
respiratory control

pg 520

198
Q

the respiratory defense mechanisms of an elderly person basically all go to shit

decreased cilia,, decreased mucus, dec cough and gag reflex

what is the consequence of this

A

decreased protection against invaders

199
Q

In r/t structure how might an older patients chest look upon inspecti

A

barrel chested, might have kyphotic posture

200
Q

when assessing a patient’s oxygen use for a breathing problem record these things

A

concentration
flow rate
method of administration
number of hours used per day
effectiveness of therapy

201
Q

what clue does wheezing tell us about a patient airway

A

there is some type of obstruction
this could be asthma, foreign body aspiration, emphysema

202
Q

the patient with heart disease my sleep with the head elevated on several pillows to avoid

A

breathing problems

203
Q

hypoxia can cause neurologic symptoms such as

A

apprehension, restlessness, irritability, and memory changes

204
Q

what does kussmal breathing sound like

A

rapid breathing

205
Q

what does biot’s breathing sound like

A

irregular breathing with apnea every 4 to 5 respirations

206
Q

what is hyperresonance

A

loud, lower pitched sound than normal resonance heard over hyperinflated lungs, such as in copd and acute asthma

207
Q

what is tympany

A

drum like, loud, empty quality sound heard over pneumothorax

208
Q

ABGs (arterial blood gases) provide a description and their purpose

A

arterial blood is obtained through puncture of radial or femoral artery or thru arterial catheter.

done to assess ACID-BASE balance, OXYGENATION/VENTILATION STATUS, need for and/or change in O2 therapy or change in ventilator settings

209
Q

after the blood is obtained for an abg test, what is very important for the nurse to do

A

apply pressure to wound site

210
Q

Arterial Blood Gases
Provide the values:
- pH
- Part pressure co2
- part pressure o2
- bicarbonate
- oxygen saturation

A
  • ph 7.35-7.45
  • co2: 35-45
  • o2: 80-100
  • bicarbonate: 22-26
  • oxy sat: 95-100%
211
Q

ABGs analysis includes measurement of

A

CO2, pH, HCO3

212
Q

okay, provide a simple description of a bronchoscopy procedure

what is the nurse’s responsibility before the procedure?

A

a procedure in which the bronchi are seen thru a fiberoptic tube

signed consent, patient NPO for 6-12 hours prior, give sedative as ordered

213
Q

after a bronchoscopy, a patient must remain _____ until gag reflex returns

A

NPO

214
Q

how is a thoracentesis procedure performed

A

insertion of a large-bore needle thru the chest wall into the pleural space to obtain specimens for diagnostic eval, remove pleural fluid, or instill meds

215
Q

what is the nurse’s responsibility before during after thoracentesis

A

consent, explanation, position patient sitting upright leaning over a table, tell patient not to talk or cough, observe fore signs of hypoxia and pneumothorax, verify breath sounds in all fields, encourage deep breaths

216
Q

Pulmonary function test measure lung volumes and airflow, the results can help us diagnose ___________, monitor disease _______, assess in response to ________, and evaluate disability

A

pulmonary disease, progression, bronchodilators

217
Q

For PFTs airflow measurement is obtained using a

A

spirometer

218
Q

home spirometry may be used to monitor lung function in peole with asthma. A ____________ is the hand-held instrument used at home. Data provides important feedback on effectiveness of treatment

A

peak flow meter

219
Q

okay diagnostic studies ugh, first up

cultures/sputum

obviously we are obtaining sputum for identification….what is the nurse’s responsiblity in obtaining a sample

A

obtain specimen in early morning after mouth care because secretions collect during night. have patient spit into container after coughing deeply

220
Q

what would a chest x ray be used for

A

screen, diagnose, and evaluate changes in repiratory sx

221
Q

CT scan provide a description and purpose

what is the nurses responibility

what do we ALWAYS ask before giving a patient contrast medium

A

diagnose suspicious lesions difficult to assess such as the mediastinum, pluera.

evaluate patients renal function, ask if patient is allergic to shellfish since the contrast is iodine based!

222
Q

CT scans that require contrast dye may cause the patient to feel like

A

warm and flushed or like they made need to pee

223
Q

an MRI is used for indepth diagnosis of lesions difficult to assess by CT scan such as lung apex, and for differentiating vascular from nonvascular structures

True or false: it is totally fine for a patient to wear a ton of metal jewelry during an mir

A

false!

224
Q

okay lets hurry this up

a PET scan description and purpose

A

GLUCOSE containing tracer injected taken up metabolically by cells,
follow up scan shows different colored tissues based on metabolic rate,
cancer cells have an INCREASED UPTAKE of GLUCOSE, “hot spots” reflecting increased glucose consumption indicate the presence of active cancer cells

225
Q
A

Med-Surg Spring 2024 (12 decks)

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