Chapter 27 - Assessment: Respiratory System- Exam 2 Flashcards
(225 cards)
1
Q
The nose protects the lower airway by
A
warming and humidifying air and filtering small particles before air enters the lungs
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
3
Q
epiglottis funciton
A
small flap behind tongue that closes over larynx during swallowing. this prevents solids and liquids from entering the lungs
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
5
Q
what is tidal volume
A
the amount of air that moves in or out of he lungs with each respiratory cycle
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
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)
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)
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
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
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.
12
Q
explain the process of air filtration
A
nasal hairs filter air as well as mucosa as air in inhaled and exhaled
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
14
Q
explain the cough reflex
A
protective reflex that clears the airway by high pressure high velocity air
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
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.
17
Q
what is partial pressure
A
portion of the total pressure exerted by the presence of a single gas molecule
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
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
20
Q
what is the normal range for HCO3
A
22-26
metabolic
anything less than 22 acidic
anything more than 26 basic
21
Q
what are adventitious breath sounds?
A
abnormal; crackles, wheezes, stridor, rubbing
22
Q
what is compliance
A
23
Q
What is dyspnea
A
24
Q
what is fremitus
A
25
What is a mechanical receptor
26
what is oximetry?
27
what is oxygenation
28
what is resistance
29
what is surfactant
30
what is tidal volume (Vt)
31
what is ventilation
32
what are wheezes?
33
what is the primary purpose of the respiratory system?
gas exchange
34
What gases are involved in gas exchange? what action between these two gases takes place?
oxygen and carbon dioxide
This involves the TRANSFER of oxygen and carbon dioxide between the atmosphere and the blood
35
What does the upper respiratory tract include?
nose, mouth, pharynx, epiglottis, larynx, and trachea
36
The inside of the nose is shaped into 3 passages by projections called ________
turbinates
The turbinates increase the surface area of the nasal mucosa that warms and moistens the air as it enters the nose.
37
The pharynx divides into 3 parts, what are they?
nasopharynx, oropharynx, laryngopharynx
38
the vocal cords are in the _______
larynx
39
The trachea divides into the r and l mainstem bronchi at the point called the _______________
carina
40
the carina is located at the angle of _________, which is at the level of the 4th and _____th thoracic vertebrae
louis, 5th
41
the _______is HIGHLY sensitive. Stimulation of this area during __________ causes vigorous __________
carina, suctioning, coughing
42
The lower respiratory tract consists of
bronchi, bronchioles, alveolar ducts, and alveoli
43
except for the r and l mainstem bronchi, all lower airway structures are found within the _______
lungs
44
the right lobe is divided into ____lobes and the left lobe is divided into ______ lobes. why?
3,2, location of the heart
45
The bronchioles are encircled by _______ muscles that constrict and __________ in response to various stimuli
smooth, dilate
46
Beyond the bronchioles lie the _________ducts and _____________
alveolar ducts, alveoli
47
In adults, a normal tidal volume, or volume of air ___________ with each breath is about ________mL
exchanged, 500mL
48
the __________are the final part of the respiratory tract
alveoli
49
the alveoli are small sacs in the lungs that are the __________site of _______exchange for O2 and CO2
primary, gas
50
________ breathing promotes air movement through alveoli and helps move ________out of respiratory bronchioles
deep, mucus
51
Alveoli have a total volume of about ________mL, with a surface area for gas exchange the size of a tennis court
2500mL
52
Because alveoli are unstable they have a natural tendency to ______
collapse
53
alveolar cells secrete __________
surfactant
54
surfactant is a __________ that makes the alveoli less likely to collapse
lipoprotein
55
when there is not enough __________ the alveoli collapse. The term ___________ refers to collapsed, airless alveoli
surfactant, atelectasis
56
The __________patient is at risk for atelectasis because of the effects of _________, decreased _________ ,and __________, which can alter breathing and lung expansion
post op, anesthesia, mobility, pain
57
in acute _______ _________ syndrome (ARDS), lack of surfactant contributes to widespread __________ and collapse of lung tissue
respiratory distress, atelectasis
58
The lungs have 2 different types of circulation: ____________and ___________
pulmonary, bronchial
59
__________ circulation provides the lungs with blood that takes part in gas exchange
pulmonary
60
____________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
bronchial
61
the chest wall is shaped, supported and protected by 24 ____
ribs
62
the ___________ is the space in the middle of the thoracic cavity
mediastinum
63
the mediastinum contains which major organs of the chest?
heart, aorta, esophagus
64
the chest cavity is lined with a membrane called the _______pleura
parietal
65
the lungs are lined with a membrane called the
visceral pleura
66
the _______space is the space between the pleural layers. normally this space contains 10 to ____mL of fluid
intrapleural, 20
67
fluid in the intrapleural space serves 2 purposes:
1. it provides __________, allowing sliding during breathing
2. it increases unity between the layers. this promotes ______
lubrication; expansion
68
fluid drains from the pleural space via ___________circulation
lymphatic
69
several conditions may cause pleural effusion, or excess fluid in the plueral space. such as?
blocked lymphatic drainage (from cancer)
imbalance between intravascular and oncotic fluid pressures (heart failure)
pneumonia
pulmonary embolisim
70
purulent pleural fluid with bacterial infection is called
empyema
71
the _________is the major muscle of respiration
diaphram
72
Complete spinal cord injuries above the level of c3 result in diaphragm __________ and dependence on a _____________ventilator
paralysis, mechanical
73
oxygenation refers to the process of
obtaining o2 from the atmosphereic air and making it avaliable to the organs and tissues of the body
74
o2 and co2 move back and forth across the alveolar capilarry membrane by
diffusion
75
ventilation requires __________and ___________
inspiration, expiration
76
what is dyspnea
shortness of breath
77
which parts of the body can aid in ventilation when patient has dyspnea
neck, shoulder, other accessory muscles
78
Some conditions such as ______ fractures and _______ disease may limit diaphragm or chest wall movement
rib fractures, neuromuscular disease
79
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
tidal, inflate, gas
80
in contrast to inspiration, expiration is ________
passive
81
________recoil is the tendency of the lungs to return to their original size
elastic
82
Exacerbations of _________or _________ cause expiration to become an active, labored process
asthma, copd
83
changes in compliance and or resistance can affect both _________and ventilation
oxygenation
84
compliance refers to
the ability of the lungs to expand
85
compliance of the lungs depends on the _________of the lungs
elasticity
86
with decreased compliance it becomes harder for the lungs to
inflate
87
compliance becomes an issue with conditions that ________fluid in the lungs
increase
88
conditions that cause fluid to accumlate in the lungs include
pulmonary edema, ards, pneumonia
89
conditions that make the lungs less elastic include
pulmonary fibrosis, sarcoidosis
90
resistance refers
to any obstacle to airflow during inspiration and or expiration
91
and obstacle that distorts airflow during inspiration and or expiration
resistance
92
the main factor affecting airway reistance is changes in the ___________of the airways
diameter
93
a patient with an acute asthma attack has narrowed airways, resulting in
resistance
94
giving ___________dilators increases the diameter of the bronchi
bronchodilators
95
the _______ of secretions in the bronchi also increases __________
presence, resistance
96
the respiratory center, the medulla, responds to _______and ________signals
chemical and mechanical
97
conditions such as copd change lung function and may result in chronically elevated
PaCO2 levels
98
Gerontologic assessment differences page 520:
what are some structural changes in relation to respiration we may find in an older patient
increased anteroposterier diameter
decreased chest wall compliance
chest wall stiffening
decreased elastic recoil
decreased functioning alveoli
decreased respiratory muscle strength
99
gerontologic assessment page 520:
a nurse will notice that structural changes manifest as
barrel chest appearance
kyphotic posture
decreased chest wall movement
decreased deep breathing
decreased cough effectiveness
decresed vital capacity
decreased breath sounds
100
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
decreased cough effectiveness, decreased secretion clearance, thickened mucus, increased risk for upper resp infection/flu/pneumonia,
101
we consider age related changes in the resp system as alertations in
structure, defense mechanisims, and repiratory control
102
changes in structure include _______ of the costal cartilages, which can interfere with chest wall expansion
calcification
103
with age alveoli become less _______
elastic
104
Respiratory problems with a strong genetic link include:
cystic fibrosis, COPD from a1-antitrypsin deficiency, asthma
105
subjective data:
health history - what can we ask?
frequency of upper resp infections
seasonal changes influence problems
history of lower resp problems?
precipitating factors/triggers?
characteristics?
severity?
106
during a health history, why might we ask about other health problems?
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
what do we ask about current medicaitons?
dose, frequency, time, side effects, reason
108
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 __________
secretions, obstruction
109
evaluate these characteristics of sputum
amount, color, consistency, odor
110
note any changes in consistency of sputum to thick, thin, or frothy and pinkish. this may indicate
a pulmonary embolism, dehydration, post nasal drip
111
percussion sounds: dull
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
percussion sounds: flat
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
percussion sounds: hyperresonance
loud, lower pitched sound than normal resonance heard over hyperinflated lungs such as in copd and acute asthma
114
resonance
low pitched sound heard over normal lungsty
115
tympany
drum like, loud, empty quality sound heard over pneumothorax
116
accessory muscle use may indicate
copd, asthma exacerbatoin, secretion retention
117
increased AP diameter may indicate
copd, asthma, cystic fibrosis, lung hyperinflation, advanced age
118
pursed lip breathing may indicate
copd, asthma, suggests increasing breathlessness
119
tripod position indicates
copd, asthma exacerbation, pulmonary edema, moderate to severe respiratory distress
120
wheezes may indicate
bronchospasm (r/t asthma), airway obstruction, copd
121
coarse crackles may indicate
excess fluid in lungs, heart failure, pumonary edema, pneumonia severe congestion, copd
122
two methods are used to assess the effectiveness of gas transfer in the lungs and tissue oxygenation
oximetry and analysis of arterial blood gases ABGS
123
these two methods are primarily used to assess for
hypoxia
124
ABGs: description, purpose, nursing responsibility
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
a pulse oximeter is non invasive measurement of arterial o2 saturation which represents
how much 02 hemoglobin is carrying compared to how much it should carry
126
the key anatomic landmark that separates the upper resp from the lower is
a. carina
b. larynx
c. trachea
d. epiglottis
a. pg 516, the carina is located at the angle of louis, the carina is highly sensitive,
127
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
d.pg 518 air moves in and ot of the lungs because intrathoracic pressure changes in relation to pressure that the airway opening
128
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
c.
129
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
abcd
130
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
abe
131
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
b, change in mental status
132
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
cde
133
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
bde
134
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
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
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
d
136
what is residual volume
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
age related changes r/t respiratory system's defenses (structure and function)
....what should the nurse be mindful of
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
aged related changes to respiratory system r/t the lungs structure and function
what might the nurse notice upon inspection
structure: narrowing airways, including thickness of alveoli, decreased elasticity
function: increased airway resistance
rn may notice barrel chest appearence, kyphotic posture,
139
manifestations of inadequate oxygenation:
r/t cardiovascular
cool, clammy skin
cyanosis
dysrhythmias
mild hypertension
tachycardia
140
manifestations of inadequate oxygenation r/t CNS
apprehension
coma
combativeness
confusion
lethargic
restlessnesss
irritability
141
142
manifestations of inadequate oxygenation r/t respiratory
dyspnea on exertion
dyspnea at rest
pause for breath between sentences
tachypnea
use of accessory muscles
143
manifestations of inadequate oxygenation r/t miscellaneous
diaphresis
fatigue
decreased urine output
144
what are we looking for while palpating during a physical assessment r/t the chest
tracheal position midline
symmetry of chest expansion
normal chest expansion is 1 inch
equal chest movement
145
what is hyperresonance
loud, lower pitched sound than normal resonance heard over hyperinflated lung, such as in copd and acute asthma
146
what is tympany
drum like, loud, empty quality sound heard over pneumothorax
147
what the hell are ABGS and what do they test for
"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
normal pH?
7.35-7.45
149
normal partial pressure of CO2?
35-45
150
Normal partial pressure of O2
80-100
151
normal range bicarbonate
22-26
152
normaloxygen saturation?
95-100%
153
common lab test: albumin range
3.5-6
154
common lab test: alkaline phosphatase normal range
40-130
155
what is a bronchoscopy
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
what is the nurses role during a bronchoscopy
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
what is a thoracoscopy
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
what is a thoracentesis
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
what is the nurses role during thoracentesis
explain, consent, observe for signs of hypoxia and pneumothorax and verify breath sounds in all fields, encourage deep breathing to expand lungs.
160
what is a pulmonary function test
measures lung volumes and airflow, results can diagnose pulmonary disease, monitor disease progression, assess response to bronchodilators
161
how is a pulmonary function test done
spriometer, the pt inserts mouthpiece, inhales, and exhales as hard and fast as possible
162
what is tidal volume
volume of air inhaled and exhaled with each breath. only a small portion of total capacity of lungs
163
what is forced vital capactiy
volume of air a person can exhale forcefully and completely after taking a deep breath
164
what is forced expiratory volume in first second
amount of air exhaled in first second of forced vital capacity
165
what is peak expiratory flow rate
maximum airflow rate during forced expiration. aids in monitoring bronchoconstriction in asthma. can be measured with peak flow meter
166
tell me about sputum studies
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
nursing responsibilities r/t CT
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
nursing responsibilities r/t MRI
prior to test check for pregnancy, allergies, renal function. no metal, assess claustraphobia, pt must be still for scan
169
nursing responsibilities r/t PET scan
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
what is a pulmonary angiogram? nursing responsibilities?
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
what is a V/Q scan? nursing responsibilities?
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
what does a PET scan help diagnose
distinguish benign and malignant nodules
173
which test wil the nurse anticipate the HCP to order following a transthoracic needle aspiration
chest xray
174
which term will the nurse document when percussion results in a moderately low pitched sound over chest
resonance
175
which condition will the nurse associate with wheezing
copd
176
which mucus characteristic will the nurse expecta in a patient with pulonary edema
large amounts of frothy pink-tinged sputum
177
which pattern will the nurse use to auscultate the chest of a patient in respiratory distress
start at lung bases
178
which assessment finding will the nurse expect in a patient with pulmonary fibrosis
normal percussion
179
which radiology study will the nurse expect the HCP to order for a patient with a suspected pulmonary embolisim
ct scan
180
which conditions will the nurse suspect when auscultating a pleural friction rub
pleurisy, pneumonia, pulmonary infart
181
which condition will the nurse associate with tachypnea and clubbing of fingers
chronic hypoxemia
182
which findings will lead the nurse to suspect inadequate oxygenation
cyanosis, tachypnea, diaphoresis
183
coarse crackles are often auscultated in patients diagnosed with
pneumonia or heart failure
184
rhonchi are auscultated in patients diagnoised with
cystic fibrosis
185
The upper respiratory tract includes.....
nose, mouth, pharynx, epiglottis, larynx, and trachea
186
The lower respiratory tract consists of....
bronchi and bronchioles, mediastinum, pleura, lungs, and alveoli
187
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
20 ml
1. lubrication
2. unity between the pleural layers
188
When the lungs lose elasticity and recoil the lungs are no longer as _______ as they used to be
compliant
189
What conditions cause lung compliance issues ie loss of lung expansion
pneumonia, ards, pulmonary edema
190
The main factor affecting airway resistance is changes in
the diameter (size) of the airway
191
Peripheral chemoreceptors are found in
the carotid arteries and in the aortic arch
192
where do we find mechanical receptors
in the conducting upper air ways, chest wall, diaphragm, and capillaries of the alveoli
193
the 3 major types of mechanical receptors are
irritant, stretch, juxtacapillary
194
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
bronchoconstriction
195
Since there are no cilliated cells below the level of the respiratory bronchioles, the primary defense mechanisim at the alveolar level is
alveolar macrophages
196
what type of activity might cause impairment of alveolar macrophage activity
smoking
197
we consider age-related changes in the respiratory system as alterations in 3 things what are hey
structure
defense mechanisms
respiratory control
pg 520
198
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
decreased protection against invaders
199
In r/t structure how might an older patients chest look upon inspecti
barrel chested, might have kyphotic posture
200
when assessing a patient's oxygen use for a breathing problem record these things
concentration
flow rate
method of administration
number of hours used per day
effectiveness of therapy
201
what clue does wheezing tell us about a patient airway
there is some type of obstruction
this could be asthma, foreign body aspiration, emphysema
202
the patient with heart disease my sleep with the head elevated on several pillows to avoid
breathing problems
203
hypoxia can cause neurologic symptoms such as
apprehension, restlessness, irritability, and memory changes
204
what does kussmal breathing sound like
rapid breathing
205
what does biot's breathing sound like
irregular breathing with apnea every 4 to 5 respirations
206
what is hyperresonance
loud, lower pitched sound than normal resonance heard over hyperinflated lungs, such as in copd and acute asthma
207
what is tympany
drum like, loud, empty quality sound heard over pneumothorax
208
ABGs (arterial blood gases) provide a description and their purpose
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
after the blood is obtained for an abg test, what is very important for the nurse to do
apply pressure to wound site
210
Arterial Blood Gases
Provide the values:
- pH
- Part pressure co2
- part pressure o2
- bicarbonate
- oxygen saturation
- ph 7.35-7.45
- co2: 35-45
- o2: 80-100
- bicarbonate: 22-26
- oxy sat: 95-100%
211
ABGs analysis includes measurement of
CO2, pH, HCO3
212
okay, provide a simple description of a bronchoscopy procedure
what is the nurse's responsibility before the procedure?
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
after a bronchoscopy, a patient must remain _____ until gag reflex returns
NPO
214
how is a thoracentesis procedure performed
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
what is the nurse's responsibility before during after thoracentesis
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
Pulmonary function test measure lung volumes and airflow, the results can help us diagnose ___________, monitor disease _______, assess in response to ________, and evaluate disability
pulmonary disease, progression, bronchodilators
217
For PFTs airflow measurement is obtained using a
spirometer
218
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
peak flow meter
219
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
obtain specimen in early morning after mouth care because secretions collect during night. have patient spit into container after coughing deeply
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what would a chest x ray be used for
screen, diagnose, and evaluate changes in repiratory sx
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CT scan provide a description and purpose
what is the nurses responibility
what do we ALWAYS ask before giving a patient contrast medium
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!
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CT scans that require contrast dye may cause the patient to feel like
warm and flushed or like they made need to pee
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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
false!
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okay lets hurry this up
a PET scan description and purpose
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
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