Quiz 1 Flashcards
(76 cards)
1
Q
What are the 3 parts of the upper respiratory tract?
A
Nasal cavity
oral pharynx
larynx
2
Q
What are the 3 parts of the lower respiratory tract?
A
Trachea
Bronchi
Lungs
3
Q
What separates the left and right side of the lower respiratory tract?
A
Mediastinum
4
Q
What type of cells is the inner surface of the trachea lined with?
A
Ciliated epithelial columnar cells with scattered specialized goblet cells
5
Q
What is the function of goblet cells?
A
mucus-secreting that function as a protective and cleansing mechanism for the respiratory tract
6
Q
Alveoli
A
Ventilation occurs, blood-oxygen exchange. Have a predisposition to collapse
7
Q
Surfactant
A
coating that prevents alveoli from collapsing
8
Q
Atelectasis
A
Collapsed alveoli
9
Q
Visceral pleura
A
outermost layer of lungs
10
Q
Parietal pleura
A
innermost layer of chest wall cavity
11
Q
Pleural Cavity
A
Lungs are housed in
12
Q
Pleural linkage
A
negative pressure sucks the visceral pleura to parietal pleura, allowing the lungs to expand with chest wall expansion
13
Q
Pneumothorax
A
Collapsed lung
14
Q
How much of the movement of the thoracic cavity is the diaphragm responsible for?
A
75%
15
Q
What nerve innervates the diaphragm?
A
phrenic nerve
16
Q
Internal intercostals
A
exhalation
17
Q
External intercostals
A
inhalation
18
Q
Minor respiratory muscles (5)
A
Pectoralis Major Pectoralis Minor Abdominal Musculature Sternocleidomastoid Scalene
19
Q
From what spinal nerves does the phrenic nerve originate?
A
C3, C4, C5
20
Q
Does the phrenic nerve provide motor, sensory, or both to the diaphragm?
A
Both
21
Q
Quiet breathing
A
Active inspiration/passive expiration
22
Q
Forced breathing
A
active inspiration (using accessory inspiratory muscles) and active expiration using abdominal muscles
23
Q
Speech breathing
A
Active inspiration and active expiration against the resistance of a modulated upper respiratory tract, primary the vocal folds
24
Q
Where does resistance come from in speech breathing?
A
vocal folds and articulators
25
Total lung capacity
total amount of air in the lungs
26
Tidal volume
amount of air inhaled and exhaled during normal quiet breathing
27
Average tidal volume
500ml
28
Inspiratory reserve volume
amount of air that can be inhaled beyond a normal tidal inspiration
29
Average inspiratory reserve volume
2.5 liters
30
Expiratory reserve volume
amount of air that can be exhaled beyond a normal tidal expiration
31
average expiratory reserve volume
1.5 liters
32
Residual volume
amount of air that remains in the lungs beyond maximum forced expiration
33
Average residual volume
1.5 liters
34
Functional residual capacity
amount of air that remains in the lungs beyond a normal tidal expiration
35
average functional residual capacity
3 liters - add expiratory reserve volume and residual volume
36
Vital capacity
amount of air maximally exhaled after a maximum inspiration. reflects inspiratory/expiratory muscle strength
37
Average vital capacity
4.5 liters
38
Minute volume
amount of air that is inspired and expired per minute
39
average minute volume
6-9 liters per minute
40
Does inspiration create positive or negative pressure in the lungs?
negative. this way, air rushes from the atmosphere into the lower pressure of the alveoli
41
Is expiration during quiet breathing active or passive?
passive
42
What impacts passive expiratory forces or relaxation pressures?
Gravity
Torque created by the ribs
Elastic Recoil
43
During expiration lung pressure is positive or negative?
Positive.
44
Define ventilation
process of gas exchange in and out of the lungs
45
Normal respiratory rate during quiet breathing
12-20 breaths per minute
46
Respiratory control center located where in the brain?
reticular formation of the brainstem - medulla oblongata and pons
47
Chemoreceptors for breathing located....
O2 and CO2 located in respiratory control center
48
Stretch receptors for breathing are located where?
located in smooth muscles of the airway that respond to the expansion and deflation of the lungs
49
COPD
- Chronic obstructive pulmonary disease
- Irreversible airway obstruction caused by destruction of lung tissue
- chronic bronchitis
- emphysema
50
Complications of restrictive lung disorders
- involves combination of respiratory muscle weakness or paralysis and mechanical factors involving the lungs and chest wall
- inability to take deep breaths - chronic hypoventilation
- typically involves reduced lung volumes and decreased lung compliance
- compliance - amount of elasticity of the lung and chest wall (patients with good lung compliance are easier to wean from the vent)
- pneumonia is a restrictive lung disorder
51
example of connective tissue disorders
- scleroderma
| - systemic lupus
52
Neuromuscular diseases and conditions
ALS, MS, MD, Guillain-Barre syndrome, polimyelitis
| CVA, BI, SCI
53
How long does it take to decide if someone can be off the ventilator or needs a trach tube placed?
10-14 days
54
Indications for an artificial airway? (8)
- Edema (trauma, burns, infection, anaphylaxis)
- Mechanical ventilation due to respiratory failure
- Prophylaxis - prep for extensive head and neck surgery
- To provide pulmonary toilet
- Sever sleep apnea
- to bypass obstruction
- neck trauma
- facial fractures
* There are no absolute contraindications existing to tracheostomy
55
Tracheal suctioning procedure
go down to 16cm, occlude lever with finger and make a circular motion as you pull out. NEVER suction going in, and wait 30-60 seconds between each passage
56
Complications of suctioning (4)
- mucosal tearing
- cardiac arrythmias
- deoxygenation
- laryngospasms
57
Non-invasive airway clearance (4)
- diaphragmatic assisted cough
- mechanical exsufflation (cough machine, gives breath in that causes person to cough)
- Incentive spirometry (take deep breath, hold for 3 seconds)
- Postural drainage techniques
58
Complications following endotracheal tube
- sore throat
- paranasal sinusitis
- vocal cord paralysis/ glottic incompetence
- laryngeal tracheal ulceration
- hoarseness
- arytenoid subluxation/dislocation
- post-extubation dysphagia
- pressure necrosis
- granulomas
- stenosis
- laryngeal web
- tracheal trauma
59
How soon following extubation should you do a swallow eval?
24 hours
60
Length of endotracheal intubation that is considered prolonged
greater than 48 hours
61
Swallowing following prolonged endotracheal intubation
increased risk of aspiration
62
Define tracheotomy
Surgical procedure in which an opening is made in the trachea
63
Tracheostomy
Opening in neck itself
64
Tracheotomy Tube
A small tube inserted into the windpipe. It maintains the hole in the skin of the neck that connects with the windpipe.
65
Where is a tracheostomy placed?
BELOW the larynx, between the 2nd and 3rd and 3rd and 4th tracheal rings
66
Is there a direct one to one relationship between a trach and aspiration?
No
67
Granulation tissue
irritated, calloused tissue cause by intubation tube resting on the vocal folds
68
Stoma site breakdown
normally stoma closes within 24-48 hours, but it may not close. Tell patient to occlude the stoma when voicing to promote healing
69
Scar band
Band of scar tissue that forms across the vocal folds
70
Tracheomalacia
Tracheal rings are loose and flexible instead of rigid
71
False passage
Trach has healed and there is a false passage between the skin and trachea
72
Percutaneous Tracheotomy
done in ICU in patient who can't safely be transported to the OR. do serial dilitation to gradually open tube up. Has same complication rate and same outcomes as open procedure
73
Open Tracheotomy
Traditional procedure, go to OR, have vertical incision
74
Cricothyroidotomy
Trach placed at level of cricoid
| Only done in extreme situations when trach is not possible. more complications and more voice and swallowing problems.
75
Tracheotomy tube change
1. wash your hands
2. prepare the clean tracheostomy tube
a. remove the inner cannula
b. attach the tracheostomy ties to the outer cannula
c. place the obturator in the outer cannula
d. apply a thick coat of water-soluble lubricant to the outside of the clean tracheostomy tube
3. Loosen the ties of the old tracheostomy tube
4. With a smooth, quick motion, slide the old trach forward and out
5. insert the clean tube into your tracheostomy stoma using a gentle, inward motion. If it is difficult to insert the cannula into the stoma, lift the chin up. This may better align the stoma with the hole in the trachea
6. Stabilize the neck plate of the outer cannula with one hand and immediately remove the obturator with the other hand
7. Tie the neck ties to one side in a square knot
8. Replace the inner cannula and lock in place
9. Wash your hands
76
Emergency loss of airway in trach
- remove any speaking valve or cap,
- be suspicious of a mucous plug and always suction the trach and oral cavity
- remove trach if needed
- establish ventilation through the easiest and most efficient opening possible (bag mask OVER STOMA)
