[Exam 2] Chapter 20: Assessment of Respiratory Function (Page 480-499, 502-504) Flashcards
(154 cards)
1
Q
What is the respiratory system?
A
DElivery oxygen to and expel carbon dioxide from the body, works in conjunction with the circulatory system
2
Q
Purpose of upper respiratory tract?
A
Warms and filters inspired air
3
Q
Purpose of lower respiratory tract?
A
Accomplishes gas exchange
4
Q
Structures of upper respiratory tract?
A
Nose, Sinuses and Nasal Passages, Pharynx, Tonsils and ADenoids, Larynx, Trachea, and Cilia.
5
Q
Lobes in left and right lung?
A
Left: Upper and Lower
Right: Upper, Middle, Lower
6
Q
Components of Lower Respiratory System
A
Two Lungs Pleura Mediastinum Bronchi and Bronchioles Alveoli
7
Q
The bronchioles contain submucosal glands which produce
A
mucus that covers the inside lining of the airways
8
Q
Function of the Respiratory System - Ventilation: What happens when the capacity is increased?
A
Air enters through the trachea (inspiration) and moves into the bronchi, alveoli, and infaltes the lung
9
Q
Function of the Respiratory System - Ventilation: What happens when the lungs return to their normal position?
A
Expiration, lungs recoil and force air out of lungs.
10
Q
Function of the Respiratory System - Ventilation: What is the thoracic cavity and diaphragm considered to be?
A
An airtight chamber, with the diaphragm being the floor of this chamber.
11
Q
Function of the Respiratory System - Ventilation: What happens during inspiration ?
A
Diaphragm and Intercostal Muscle contacted. Intrathoracic pressure lowered and air enters to inflate lungs
12
Q
Function of the Respiratory System - Ventilation: What happens during expiration?
A
Relaxation of diaphragm, relaxation of enternal intercostal muscles increasing intrathoracic pressure and air exits
13
Q
Inspiration and Expiration take how long of a respiration cycle?
A
Inspiration: 1/3 Respiratory Cycle
Expiration: 2/3 Resp cycle
14
Q
What is compliance?
A
Elasticity and expandability of the lungs and thoracic structures.
Allows lung volume to increase
15
Q
What are aveoli?
A
Where gas exchange takes place. It is a alveolar-capillary membrane-surface area
16
Q
What is Pulmonary Diffusion?
A
Process where oxygen and carbon dioxide are exchanged in areas of high concentration to areas of low concentrations
17
Q
What is Pulmonary Perfusion?
A
Actual blood flow through the pulmonary vasculatore.
Pumped into lungs.
18
Q
What is Tidal Volume (TV)?
A
Volume of air inhaled and exhaled with each breath (500 mL)
19
Q
What is Inspiratory Reserve Volume ? (IRV)
A
MAximum volume of air that can be inhaled after normal inhalation (3000 mL)
20
Q
What is Expiratory Reserve Volume (ERV)?
A
Maximum volume of air that can be exhalled forcible after normal exhalation (1100 mL)
21
Q
What is Residual Volume? (RV)
A
VOlume of air remaining in lungs after a maximum exhalation (1200 mL)
22
Q
What is Vital Capacity? VC
A
Maximum volume of air exhaled from the point of maximum inspiration.
TV + IRV + ERV = 4600 mL
23
Q
What is Inspiratory Capacity IC
A
Maximum volume of air inhaled after normal expiration
IC = TV + IRV = 3500 mL
24
Q
What is Functional Residual Capacity? (FRC)
A
VOlume of air remaining in lungs after normal expiration
FRC = ERV + RV = 2300 mL
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What is Total Lung Capacity? TLC
Volume in lungs after maximum inspiration
TV + IRV + ERV + RV = 5800 mL
26
How does O2 diffuse?
From areas of higher partial pressure to areas of lower partial pressure , which is why supplemental oxygen is given
27
How does CO2 Transport work?
Crosses the alveolar-capillary membrane into venous blood by diffusion , perfusion carries deoxygenated blood back to the lungs
28
What does the medulla oblongata control?
Control rate and depth of ventilation to meet the body's metabolic demands
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Assessment, Health History: Focus on the patients whaat?
Presenting problem adn associated symptoms
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Assessment, Health History: Nurses should explore what of the patients?
Their health, medical conditiions, injuries, hospitalizations, surgeries, allergies, and current medications
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Major signs and symptoms of respiratory disease are
dyspnea, cough, sputum p roduction, chest pain, wheezing, and hemoptysis
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Assessment, Health History and Dyspnea: What is Dyspnea?
Subjective feeling of difficult or labored breathing, breathlessnes, and shortness of breath
Occurs because of decreasedd lung compliance or increased airway resistance
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Assessment, Health History and Dyspnea: Dyspnea and Tachypnea accompanied by progressive hypoxemia in person may signal what?
Acute Respiratory Distress Syndrome, ARDS
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Assessment, Health History and Dyspnea: Orthopnea is associated with those with COPD and Heart Disease, and this is?
Shortness of breath when flying flat, relieved by sitting or standing
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Assessment, Health History and Dyspnea: Stridor may be heard with Dyspnea. What is this?
High pitched sound heard when someone is breathing through a partically blocked upper airway
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Assessment, Health History and cough: May be impaired when?
By weakness or paralysis of the respiratory muscles, prolonged inactivity, presence of NG tube, or depressed function of medullary centers
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Assessment, Health History and cough: Cough results from what?
Mucous membranes anywhere in the respiratory tract associated with multiple pulmonary disorders
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Assessment, Health History and cough: Coughing at night may indicate what?
Left sided heart failure
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Assessment, Health History and cough: A cough in the morning with sputum production indicate
bronchitis
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Assessment, Health History and cough: COugh when patient is supine suggests
postnasal drip
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Assessment, Health History and cough: Dry, irritative cough is characteristic of
upper respiratory tract infection of viral origin, or may be a side effect of ACE inhibitor therapy
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Assessment, Health History and cough: Irritative, high pitched caugh can be caused by
laryngotrachetitis
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Assessment, Health History and cough: Brassy cough is a result of
tracheal lesions
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Assessment, Health History and cough: SEvere or changing cough may indicate
bronchogenic carcinoma
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Assessment, Health History and Sputum Production: Sputum production is the reaction of lungs to
any constantly recurring irritant and often results from persistent coughing
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Assessment, Health History and Sputum Production: Profuse amount of purulent sputum or change in color of sputum is a common sign of
bacterial infection
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Assessment, Health History and Sputum Production: Thin, mucoid sputum results from
viral bronchitis
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Assessment, Health History and Sputum Production: Gradual increase of sputum over time may occur with
chronic bronchitis or bronchiectasis
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qAssessment, Health History and Sputum Production: Pink tinged mucoid sputum suggests
a lung tumor
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Assessment, Health History and Sputum Production: Profuse pink-tinged mucoid sputum suggests
pulmonary edema
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Assessment, Health History and Sputum Production: Foul-smelling sputum and bad breath point to the presence of
lung abscess, bronchiectasis, or an infection
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Assessment, Health History and Chest Pain: Signs when associated with pulmonary conditions?
Sharp, stabbing or intermittent or may be dull aching and persistent.
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Assessment, Health History and Chest Pain: Pain felt where?
On the side where the pathologic process is located
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Assessment, Health History and Chest Pain: Lung disease and Thoracic pain
Doesn't always cause thoracic pain because lungs and visceral pleura lack sensory nerves
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Assessment, Health History and Chest Pain: Pleura and pain information
Parietal pleura have a rich supply of sensory nerves that are stimulated by inflammation and sretching
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Assessment, Health History and Chest Pain: How to relieve Pleural pain?
Lay on the affected side because the position splints the chest wall, limiting expansion of the wall
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Assessment, Health History and Wheezing: What is wheezing?
A high pitched muscle sound hard on either expiration (asthma) or inspiration (bronchitis).
Major find in those with bronchoconstriction or air-way narrowing
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Assessment, Health History and Hemoptysis: What is this?
Expectoration of blood from the respiratory tract. Usually sudden
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Assessment, Health History and Hemoptysis: Most common causes?
Pulmonary Infection
Carcinoma of the lungs
Abnormalities of heart
Pulmonary artery or vein abnormalities
PE or Infarction
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Assessment, Health History and Hemoptysis: What does blood from the lung look like?
Bright red, frothy, and mixed with sputum.
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Assessment, Health History and Hemoptysis: What does blood from the stomach look like?
Mixed with food , is vomitted, and usually much darker
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Physical Assessment of the Respiratory System, Clubbing of the Fingers: This is a sign of
lung disease that is found in patients with chronic hypoxic conditions, chronic lung infections, or malignancies of the lung
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Physical Assessment of the Respiratory System, Clubbing of the Fingers: This is a sign of what, not related to the respiratory system?
Congenital Heart Disease and inflammatory conditions like endocarditis.
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Physical Assessment of the Respiratory System, Cyanosis: What does this indicate?
Late indicator of hypoxia.
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Physical Assessment of the Respiratory System, Cyanosis: How is this determined?
By amount of unoxygenated hemoglobin there is in the blood.
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Physical Assessment of the Respiratory System, Cyanosis: When does this appear?
Where there is at least 5 g/dL of unoxygenated hemoglobin
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Physical Assessment of the Upper Respiratory Structures, Nose and Sinuses: Tenderness in either the frontal sinuses or maxillary sinuses suggests
Inflammation
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Physical Assessment of the Upper Respiratory Structures, Mouth and Pharynix: What does the nurse look for here?
Color, Symmetry, and signs of
exudate, ulceration, or enlargement
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Physical Assessment of the Lower Respiratory Structures and Breathing, Positioning: To ass posterior thorax and lungs, patient should be positioned how?
Sitting position with arms crossed in front of chest and hands placed on the opposite shoulders.
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Physical Assessment of the Lower Respiratory Structures and Breathing, Chest Configurations: What is Barrel Chest?
This occurs as result of overinflation of the lungs, which increases teh anteroposterois diameter of the thorax.
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Physical Assessment of the Lower Respiratory Structures and Breathing, Chest Configurations: When does Barrel Chest occur?
Occurs with aging , and is a sign of emphysema and COPD
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Physical Assessment of the Lower Respiratory Structures and Breathing, Chest Configurations: How does Barrel Chest appear for someone with Emphysema?
RIbs are more widely spaced and the intercostal spaces tend to bulge on expiration
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Physical Assessment of the Lower Respiratory Structures and Breathing, Chest Configurations: What is Funnel Chest?
Occurs when there is depression in the lower portion of the sternum. Compresses heart and vessels, causing murmurs.
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Physical Assessment of the Lower Respiratory Structures and Breathing, Chest Configurations: What is Pigeon Chest?
Result of the anterior displacement of the sternum, which increases the anteroposterior diameter
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Physical Assessment of the Lower Respiratory Structures and Breathing, Chest Configurations: What is Kyphoscoliosis?
Elevation of the scapula and a corresponding S-shapes spine. Limits lung expansion
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Physical Assessment of the Lower Respiratory Structures and Breathing, Breathing Patterns and RR: Normal adults resting respiratory rate is ?
14-20 breaths per minutes.
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Physical Assessment of the Lower Respiratory Structures and Breathing, Breathing Patterns and RR: What is eupnea?
When respirations are quiet and regular in depth
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Physical Assessment of the Lower Respiratory Structures and Breathing, Breathing Patterns and RR: Crackles heard indicates what?
Fluid
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Physical Assessment of the Lower Respiratory Structures and Breathing, Breathing Patterns and RR: Wheezing heard indicate what?
Narrowed airway
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Physical Assessment of the Lower Respiratory Structures and Breathing, Breathing Patterns and RR: Friction rub heard indicates what?
Increase in pleural fluid, swellingq
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Physical Assessment of the Lower Respiratory Structures and Breathing, Breathing Patterns and RR: Diminished sounds heard means what?
Atelectaisis
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Physical Assessment of the Lower Respiratory Structures and Breathing: Nurse palpates the thorax for
tenderness, massess, lesions, and respiratory excursion and vocal fremitus
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Physical Assessment of the Lower Respiratory Structures and Breathing, Thoracic Palpation: What is Respiratory Excursion?
Elimination of thoracic expansion and may disclose significant information about thoracic movement and breathing
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Physical Assessment of the Lower Respiratory Structures and Breathing, Tactile Fremitus: What is this?
Describes vibrations on the chest wall that result from speech detected on aplpation.
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Physical Assessment of the Lower Respiratory Structures and Breathing, Tactile Fremitus: This is influenced by what?
Thickness of chest wall,
subcutaneous tissue assocaited with obesity.
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Physical Assessment of the Lower Respiratory Structures and Breathing, Breathing Patterns and RR: What is Bradypnea?
Slower than normal rate <10 bpm with normal depth
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Physical Assessment of the Lower Respiratory Structures and Breathing, Breathing Patterns and RR: What is Tachypnea?
Rapid, shallow breathing at >24 bpm
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Physical Assessment of the Lower Respiratory Structures and Breathing, Breathing Patterns and RR: What is Hyperventilation?
Increased rate and depth of breathing that results in decreased PaCO2 levels
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Physical Assessment of the Lower Respiratory Structures and Breathing, Breathing Patterns and RR: What is Apnea?
Period of cessation of breathing time
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Physical Assessment of the Lower Respiratory Structures and Breathing, Breathing Patterns and RR: What is Cheyne Strokes?
Regular cycle where rate and depth in breaths increase, and then decrease until apnea.
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Physical Assessment of the Lower Respiratory Structures and Breathing, Breathing Patterns and RR: Biot's Respiration?
Periods of normal breathing (3-4 breaths), followed by varying periods of apnea.
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Physical Assessment of the Lower Respiratory Structures and Breathing, Breathing Patterns and RR: What is obstructive breathing?
Prolonged expiratory phase of respiration
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Physical Assessment of the Lower Respiratory Structures and Breathing, Thoracic Percussion: What does percussion allow you to do?
Produces audible and tactile vibrations that allow the nurse to determine whether the underlying tissues are filled with air, fluid, or solid material
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Physical Assessment of the Lower Respiratory Structures and Breathing, Thoracic Percussion: Why does dullness in a lung occur?
When air-filled lung tissue is replaced by fluid or solid tissue
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Physical Assessment of the Lower Respiratory Structures and Breathing, Thoracic Percussion: What direction do you move when performing thi stest?
You start at the top and then begin to move downward
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Physical Assessment of the Lower Respiratory Structures and Breathing, Diaphragmatic Excursion: How to assess position and motion of diaphragm?
Ask patient to take a deep breath and hold while maximum descent of diaphragm is percussed.
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Physical Assessment of the Lower Respiratory Structures and Breathing, Thoracic Auscultation: How do you proceed in this?
Start at the very top and move your way down the front and back
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Physical Assessment of the Lower Respiratory Structures and Breathing, Breath Sounds: Breath sounds are identified by
vesicular, bronchovesicular, and bronchial (tubular)
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Physical Assessment of the Lower Respiratory Structures and Breathing, Breath Sounds: When airflow is decreased by bronchial obstruction, or when fluid or tissue separates the air passages from stethoscope, breath sounds are what?
Diminished or absent
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Physical Assessment of the Lower Respiratory Structures and Breathing, Breath Sounds: Bronchial and bronchovesicular sounds that are audible anywhere except over main bronchus signify
pathology, usually indicating consolidation in the lung (pneumonia, heart failure)
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Physical Assessment of the Lower Respiratory Structures and Breathing, Adventitious Sounds: What is this?
Abnormal condition that affects the bronchial tree and alveoli. Divided into crackles and wheezes.
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Physical Assessment of the Lower Respiratory Structures and Breathing, Breath Sounds: Duration of Vesicular sounds?
Inspiratory sounds last longer than expiratory ones
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Physical Assessment of the Lower Respiratory Structures and Breathing, Breath Sounds: Duration of bronchovesciaulr sounds?
Inspiratory and expiratory sounds are equal
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Physical Assessment of the Lower Respiratory Structures and Breathing, Breath Sounds: Bronchial sounds duration?
Expiratory sounds last longer than inspiratory ones
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Physical Assessment of the Lower Respiratory Structures and Breathing, Breath Sounds: TRacheal sound duration?
Inspiratory and expiratory sounds are about equal
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Diagnostic Test for Respiratory Function?
```
PFT
Arterial Blood Gases
Sputum Tests
Chest XRay
CT / MRI
Radioisotope Procedure
Bronchoscopy
Thoracentesis
Biopsies
```
107
Pulmonary Function Tests (PFTs): These are used routinely in patients with
chronic respiratory disorders to aid diagnosis
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Pulmonary Function Tests (PFTs): Why are they performed?
To assess the respiratory function and to determine the extent of dysfunction, response to therapy, and as screening tests in potentially hazardous industries
Also used prior to surgery for those scheduled for thoracic and upper abdominal surgical procedures
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Pulmonary Function Tests (PFTs): Tests include measurements of
lung volumes, ventilatory funcition, and the mechanics of breathing, diffusion, and gas exchange
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Pulmonary Function Tests (PFTs): GEnerally are performed by a technician using a
spirometer that has a volume-collecting device attached to a recorder that demonstrates volume and time simultaneously
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Pulmonary Function Tests (PFTs): Results are interpreted on the basis of the degree of deviation from
normal, taking into consideration the patients unique traits such as weight and height
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Arterial Blood Gas Studies: Aid in assessing
the ability of the lungs to provide adequate oxygen adn remove carbon dioxide, which reflects ventilation, and the ability of the kidneys to reasborb or excrete bicarbonate ions to maintain normal pH
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Arterial Blood Gas Studies: ABG levels obtained though
an arterial puncture at the radial, brachial, or femoral artery or through an indwelling arterial catheter.
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Venous Blood Gas Studies: They provide what?
Additional data on oxygen delivery and consumption. Reflect balance between the amount of oxygen used by tissues and organs and the amount of oxygen returning to the right side of the heart
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Venous Blood Gas Studies: What are mixed venous oxygen saturation levels?
The most accurate indicator of this balance, obtained through pulmonary artery catheter
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Venous Blood Gas Studies: This closely approximates what other lab value?
O2 Levels
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Venous Blood Gas Studies: REcommended for who?
Guide goal-direced herapy in postoperative patietns at risk fo rhemodynamic instability or patietns with septic shock
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Pulse Oximetry: Some cases of inaccurate pulse oximetry include
anemia, abnormal hemoglobin, high carbon monoxide level, use of dyes or if wearing nail polish
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Cultures: What can cultures identify?
Pathogens responsible for respiratory infection such as pharyngitis.
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Cultures: Throat cultures performed in adults with severe or ongoing
sore throats,s accompanied by fever and lymph node enlargement and can detect strep throat
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Cultures: What can be identified through nasal or nasopharyngeal cultures??
S. Aureus or Influenza
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Sputum Studies: Why are they obtained?
For analysis to identify pathogenic organisms and to determine whether malignant cells are present
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Sputum Studies: Periodic examination may be necessary for patietns who are
receiving antibiotics, corticosteroids, adn immunosuppressive medications for prolonged periods
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Sputum Studies: When is the ideal time to collect thiese?
Early in the morning before patient has time to eat or drink
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Sputum Studies: What to do if patient cannot produce sputum by coughing?
Administer an aerosolized hypertonic solution via a nebulzier
126
Chest X-Ray: Normal pulmonary tissue is radiolucent because
it consists mostly of air and gases therefore easily showing masses that should not be there
127
Chest X-Ray: What part of the breathing cycle are the x-rays taken and why?
After full inspiration because they are best visualized when they are well aerated . Also diaphragm is at its lowest level.
128
Chest X-Ray, Nursing Interventions: Patient instructions for X-Ray?
Let patient know that they must be able to take a deep breath and hold it without discomfort
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Computed Tomography: What can a CT scan show that an XRay cannot?
It can distinguish fine tissue density.
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Computed Tomography: Why might this be used?
Define pulmonary nodules and small tumors adjacent to the pleural surffaces that are not visible on routine xray.
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Computed Tomography: Contraindications of who should not use this include...
Allergy to dye, pregnancy, claustrophobia and morbid obesity.
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Computed Tomography, Nursing Interventions: What should the nurse notify the patient?
Remain supine and still for less than 30 minutes.
133
Magnetic Resonance Imaging: Why is this better than a CT?
Better able to distinguish between normal and abnormal tissues than CT.
134
Magnetic Resonance Imaging: Why is an MRI used?
To characterize pulmonary nodules
Help stage bronchogenic carcinoma,
Evaluate inflammatory activity in interstitial lung disease
135
Magnetic Resonance Imaging: WHo should not get this?
Morbid Obesityy People
Those with Claustrophobia
And those with confusion
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Magnetic Resonance Imaging, Nursing Interventions: What should nurse check for before procedure?
Assess for presence of implanted metal devices
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Magnetic Resonance Imaging, Nursing Interventions: Instructions for procedure?
Lie flat and remain still for 30-90 minutes. They will hear a loud thumping noise
138
Pulmonary Angiography: Why is this used?
To investiage congential abnormalities of the pulmonary vascular tree
139
Pulmonary Angiography: How do you visualize the vessels?
Radiopaque agent is injected through a catheter, which is in the vein, then threaed into the pulmonary artery
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Pulmonary Angiography: Who should not have this done?
Allergy to radiopaque dye, pregnancy, and bleeding abnormalities.
141
Pulmonary Angiography, Nursing Interventions: What to check for before test?
Allergy to shellfish
NPO 6-8 hours beforehand
142
Pulmonary Angiography, Nursing Interventions: Patients may experience what feeling?
A warm flushing sensation in the chest.
143
Radioisotope Diagnostic Procedures (Lung Scans): How is a V/Q scan performed?
By injected radioactive agent intoa peripheral vein and then obtaining a scan of the chest to detect radiation
144
Radioisotope Diagnostic Procedures (Lung Scans): Where do the isotopes past by in a V/Q scan?
Past byy the heart and are distributed to the lungs.
145
Radioisotope Diagnostic Procedures (Lung Scans): Why is the V/Q scan done?
Used to clinically measure the integrity of the pulmonary vessels relative to blood flow and to evaluate blood flow abnoralities
146
Radioisotope Diagnostic Procedures (Lung Scans), V/Q Scan: How long does this take?
20-40 minutes, while patient lies under camera with mask fitted over nose
147
Radioisotope Diagnostic Procedures (Lung Scans), V/Q Scan: Patient takes a deep breature of what?
Mixture of oxygen and radioactive gas, which diffuses through lungs
148
Radioisotope Diagnostic Procedures (Lung Scans), Gallium Scan: What is this?
Radioisotope lung scan used to detect inflammatory conditions, adhesions, and tumors
149
Radioisotope Diagnostic Procedures (Lung Scans), Gallium Scan: How is test done?
Gallium injected intravenously and scans are obtained at intervals to evaluate gallium uptake
150
Radioisotope Diagnostic Procedures (Lung Scans), PET Scan: What is this?
Can detect and display metabolic changes in tissue, distinguish different tisue, and show blood flow
151
Bronchoscopy: What is this?
Direct inspection and examination of the larynx, trachea and bronchi thorugh flexible fineroptic bronchoscope
152
Bronchoscopy: Purposes of this?
Visualize tissue and determine extent of pathologic process.
2. Collect secretions for analysis
Determine whether a tumor cna be resected
153
Bronchoscopy: Therapeutic Bronchoscopy is used to
remove foreign bodies
Control bleeding
Treat postoperative atelectasis
Destroy lesions
154
Bronchoscopy: What does the fiberoptic bronchoscope allow for?
ALlows increases visualiztion of the peripheral airways and is ideal for diagnosing pulmonary lesions
