EXAM 1

Question 1

Alveoli

Answer 1

Balloon-shaped air sacs located at the end of the bronchioles in the lungs. Primary site of gas exchange between the lungs and the bloodstream.

Question 2

Tidal volume

Answer 2

Amount of air left in the alveoli after a full expiration. Variations are associated with patient’s health status or activity (pregnancy, exercise, obesity, obstructive/restrictive conditions of the lungs)

Question 3

Adventitious breath sounds

Answer 3

Abnormal breath sounds –> wheezing, crackles, ronchi

Question 4

Wheezing

Answer 4

Occurs during expiration, inspiration, or both. Continuous, high-pitched musical sound caused by high-velocity movement of air through a narrowed airway. Associated with asthma, acute bronchitis, or pneumonia.

Question 5

Crackles

Answer 5

Discontinuous sounds of various pitch, most often heard during inspiration. The result of disruption of the small respiratory passages and cannot be cleared through coughing. Associated with pneumonia, emphysema, or chronic bronchitits. Check for precipitating factors (respiratory infection, allergens, exercise, stress).

Question 6

Ronchi

Answer 6

Deeper sounding pitch than crckles, and are often heard during expiration. Sonorous wheezes. Reflects the presence of thick secretions or muscle spasms in the airway. Often cleared with coughing. Associated with asthma or pneumonia.

Question 7

Bradypnea

Answer 7

Less than 12 breaths/min

Question 8

Tachypnea

Answer 8

Greater than 20 breaths/min

Question 9

Apnea

Answer 9

Absence of respirations for 15-20 seoncds or longer

Question 10

Hyperventilation

Answer 10

Often determined by arterial blood gas analysis. The state of ventilation in which the lungs remove CO2 faster than it is produced by cellular metabolism. Induced by severe anxiety, infection, drugs (chemically induced), or acid based imbalance.

Question 11

Hyperventilation – infection

Answer 11

Increased body temp (fever) increases the metabolic rate, thereby increasing CO2 production. The increased CO2 level stimulates an increase in the patient’s rate and depth of respiration, leading to hyperventilation.

Question 12

Hyperventilation – drug induced

Answer 12

EX: aspirin poisoning and amphetamine use result in excess CO2 production, stimulating the respiratory center to compensate by increasing the rate and depth of respiration

Question 13

Hypoventilation

Answer 13

Occurs when the alveolar ventilation is inadequate to meet the oxygen demand of the body or to eliminate sufficient cardon dioxide.

Question 14

Compliance

Answer 14

The ability of the lungs to distend/expand. Relies of intrathoracic pressure changes

Question 15

Work of breathing

Answer 15

Effort to expand and contract lungs (inspiration and expiration process). Expected: quiet, minimal effort (lungs should have elastic recoil and surfactant). Determined by rate and depth (eval. accessory muscle use). Decreased compliance, increased airway resistance, and/or increased accessory muscle use = increased work of breathing

Question 16

Hypercarbia

Answer 16

Level of CO2 in the blood is higher than normal. Can be caused by hypoventilation, lung dz (asthma, COPD, pneumonia), sleep apnea, neuromuscular disorders, medications. Symptoms: shortness of breath, confusion, drowsiness.

Question 17

Hypocarbia

Answer 17

Level of CO2 in the blood is lower than normal. Can be caused by hyperventilation, increased oxygen consumption (exercise, fever, hypoxia), or certain medications. Symptoms: dizziness, lightheadedness, headache, confusion.

Question 18

Atelectasis

Answer 18

Collapsed alveoli (deflated or fill with fluid) which prevents normal gas exchange. Associated with immobility (12-18 hrs), obesity, sleep apnea, and chronic lung conditions. Can lead to lung collapse –> resp. distress syndromes/pneumonias/resp. failure

Question 19

Hypoxia

Answer 19

Results from a deficiency in oxygen delivery or oxygen use at the cellular level. If left untreated, can cause fatal cardiac dysrhythmias.

Question 20

Cyanosis

Answer 20

Blue discoloration of the skin and mucous membranes caused by the presence of desaturated hemoglobin in capillaries. Considered a late stage of hypoxia. Not a reliable measure of oxygen status. Central (tongue, soft palate, and conjuntiva) indicates hypoxemia. Peripheral (extremities, nail beds, earlobes) is a result of vasoconstriction and stagnant blood flow.

Question 21

Barrel Chest

Answer 21

Associated with conditions such as COPD due to overuse of accessory muscles and air trapping

Question 22

Clubbing

Answer 22

Occurs in patients with chronic oxygen deficincy (hypoxia) such as cystic fibrosis and congenital heart defects.

Question 23

Dyspnea

Answer 23

Subjective sensation of difficult or uncomfortable breathing or observed labored breathing with shortness of breath. Usually associated with exercise or excitement. Is associated with many conditions such as pulmonary dz, cardiovascular dz, neuromuscular dz, and anemia. Occurs during the final months of pregnancy. Enviromental factors can worsen (cold air, pollution, smoking)

Question 24

Sputum

Answer 24

Material coughed up from hte lungs that a patient swallows or expectorates. Contains mucus, cellular debris, microorganisms, and sometimes pus or blood. Inspect color, consistency, odor, and amount.

Question 25

Cascade cough

Answer 25

Take a slow, deep breath, hold for 1-2 seconds, opens the mouth and preforms a series of coughs throughout exhalation. Often used in patients with large amounts of sputum (CF)

Question 26

Huff cough

Answer 26

Stimulates a natural cough reflex and is generally used to help move secretions to larger airways. Inhale deeply, hold breath for 2-3 sec, forcefully exhale while opening glottis by saying the word 'huff'

Question 27

Quad cough

Answer 27

AKA manually assisted cough. Utilized in patients without abdominal muscle control (spinal cord injuries). While the patient breathes out with a maximal expiratory effort, the patient or nurse pushes inward and upward on the abdominal muscles toward the diaphragm

Question 28

Chest physiotherapy

Answer 28

Goal is to mobilize pulmonary secretions. External chest wall manipulation using percussion, vibration, or high frequency chest wall compression. Utilized in patients with retained secretions who cannot expectorate those secretions (CF). KNOW VS AND COGNITIVE FXN, ASSESS RESP. Contraindicated in spinal cord injuries, abdominal aneurysm, increased intracranial pressure, pregnancy, chest injuries, bleeding disorders, osteoporosis. Be aware of pt's tolerance (fatiguing).

Question 29

Postural drainage

Answer 29

Component of pulmonary hygiene; it consists of drainage, positioning, and turning, and is sometimes accompanied by chest percussion and vibration. Aids in improving secretion clearance and oxygenation. Some patients do not require postural draining in all lung segments (EX: CF pt V. pt with L lower lobe atelectasis)

Question 30

FiO2

Answer 30

Fraction of inspired oxygen, refers to the concentration of oxygen in the gas mixture a person inhales. RA FiO2 = 21%

Question 31

Bubbler/bubble humidifier

Question 32

Hyperventilation -- metabolic acidosis

Answer 32

EX: diabetic patient in ketoacidosis produces large amounts of metabolic acids. The respiratory system tries to correct the acid-base balance by over breathing. Ventilation increases to reduce the amount of CO2 available to form carbonic acid.

Question 33

Hyperventilation signs and symptoms

Answer 33

rapid respirations, sighing breaths, numbness and tingling of hands/feet, light-headedness, and loss of consciousness

Question 34

Causes of hypoxia:

Answer 34

(1) Decreased hemoglobin level and lowered O2 carrying capacity of the blood (2) Diminished concentration of inspired oxygen (high altitudes) (3) inability of tissues to extract O2 from the blood (cyanide poisoning) (4) decreased diffusion of O2 from alveoli to the blood (pneumonia or PE) (5) poor tissue perfusion with oxygenated blood (shock) (6) impaired ventilation (chest trauma)

Question 35

Why is COPD O2 levels lower?

Answer 35

Excessive O2 can result in hypoventilation. These patients have adapted to high carbon dioxide levels, so their carbon dioxide chemoreceptors do not function normally.

Question 36

Signs/symptoms of hypoventilation

Answer 36

Mental status changes, dysthymias, and potential cardiac arrest. If left untreated, the aptient's status rapidly declines leading to convulsions, unconsciousness, and death.