Respiratory

Question 1

How many lobes are in the lungs?

Answer 1

5 lobes -
Left lung - upper and lower lobes
Right lung - upper, middle and lower lobes

Question 2

Explain the differences between hypo and hyper ventilation

Answer 2

lungs help maintain pH of blood by adjusting level of carbon dioxide through respiration

Hypoventilation - slow, shallow breathing - causes carbon dioxide to build up in the blood

Hyperventilation - rapid deep breathing causes carbon dioxide to be blown off

Question 3

Where is involuntary control of respirations mediated?

Answer 3

The respiratory center in the brainstem (pons, medulla)

-humoral regulation or change in carbon dioxide and oxygen - major feedback loop
hypercapnia - increased CO2 in blood

Question 4

Development of lungs: Infants and Children

Answer 4

During the first five weeks of gestation the primitive lung bud emerges
By 16 weeks gestation conducting airways same number as adult - same volume
At 32 weeks surfactant - present in adequate amounts

Question 5

What are the risks of second hand smoke (SHS)?

Answer 5

lower birth weight
decreased head growth
SIDS (sudden infant death syndrome)
upper and lower respiratory infections
otitis media
asthma
tooth decay
hearing loss
metabolic syndrome
ADHD
learning disabilities

Question 6

Development of lungs: Pregnant Woman

Answer 6

40% increase in tidal volume - growing fetus increases oxygen demands
physiologic dyspnea - affects 75% of women - increased awareness in need to breathe (does not alter ADLS, not associated with cough, wheezing or exercise)

Question 7

Development of lungs: Aging Adult

Answer 7

After 50 years old - respiratory muscle strength declines
Aged lungs are more more rigid (less elastic) - harder to inflate
Increased risk for postoperative pulmonary complications and dyspnea
infection from decreased ability to cough
loss of protective airway reflexes
increased secretions

Question 8

What is Atelectasis?

Answer 8

air sacs cannot recoil, crackles

dev. continues throughout childhood and adolescents

Question 9

What is dyspnea?

Answer 9

difficulty breathing

Question 10

What is orthopnea?

Answer 10

difficulty breathing while supine

Question 11

What is paroxysmal nocturnal dyspnea?

Answer 11

wake up bc shortness of breath, needs to sit up

Question 12

What are some clinical manifestations of respiratory infection?

Answer 12

Cough; Sputum
SOB - dyspnea, orthopnea, paroxysmal nocturnal dyspnea
Chest Pain with breathing
Adventitious (abnormal) lung sounds upon ascultation
Abnormal respiratory pattern

Question 13

Diagnostic Studies for Respiratory?

Answer 13

Chest X-ray
Sputum culture: allows to detect bacteria or fungi in lungs (indicator of lung function, need a sterile container)
WBC: indicator of infection
ABG: pH - 7.35-7.45
pCO2: 35-45
HCO3: 22-26
O2 Sat: greater than 94%

Question 14

What are some nursing interventions for respiratory?

Answer 14

ABC's - airway, breathing, circulation
O2 therapy
Med therapy
Elevated head of bed (HOB)
Monitor O2 Sat
Encourage pursed lip breathing
Coughing and deep breaths
Incentive Spirometry

Question 15

Nasal Canula (Oxygen Therapy)

Answer 15

Low O2 - 1-6 L/min
Most common
Need to humidify (dries nasal pathway

Question 16

High Flow Nasal Cannula (Oxygen Therapy)

Answer 16

Up to 60L/min

Humidity very important (usually heated humidity)

Question 17

Simple Face Mask (Oxygen Therapy)

Answer 17

6-12 L/min

Often used for mouth breathers; harder to eat and drink with

Question 18

Non re-breather (Oxygen Therapy)

Answer 18

10-15 L/min ]

Displaces CO2 if not at 10 L/min minimum

Question 19

Venturi mask

Answer 19

specific percentage of O2 administered (correlated to room air)
normal oxygen someone breathes is 21%
venturi offers 24-50%
advantage: can adjust to specific flow rate
common for trach patients

Question 20

Hood/Tent

Answer 20

Used for peds

Advantage: pt is comfy and cooperative

Question 21

O2 Therapy/Safety Protocol

Answer 21

Need a physcian's order to apply O2
Watch for Skin breakdown
Monitor
Fire hazard
Bacterial Contamination (keep tubes clean)

Question 22

Health Promotion Protocol (Respiratory)

Answer 22

Prevent: hand hygiene, cover mouth when coughing, sneezing
Smoking Cessation
Immunization: Flu shot, pneumonia shot

Question 23

What are some questions when performing respiratory assessment?

Answer 23

Health History Questions: family history, asthma, meals, etc.
SOB, pain?
Environmental Exposures? Allergies? Work Exposure?
Productive Cough? Sputum?
Order of Assessment: Inspect, palpate, percuss, auscultate

Question 24

Inspection (Respiratory)

Answer 24

Level of Consciousness
Facial Expression
Skin Color and Condition
Rates and Rhythm (regular vs. irregular)
Trachea and thorax (shape, symmetry, expansion)
Peds: respiratory distress
flarred nostrils
retractions: labored breathing, can see m. outlines

Question 25

Palpation (Respiratory)

Answer 25

Symmetric chest expansion
Tactile fremitus: feeling for a vibration
Palpate chest wall

Question 26

Percussion (Respiratory)

Answer 26

Make side to side comparison
Hollow sound filled with air or fluids (lungs and abdomen)
Solid sound (solid organs, bone)

Question 27

Auscultation

Answer 27

Have patient sit up if possible
Don’t listen over clothes
Deep breaths
Listen in each area for a full inspiration and expiration

Question 28

crackles

Answer 28

bubble, popping sound

Question 29

ronchi

Answer 29

loud, low pitched rumbling

Question 30

wheezes

Answer 30

high pitched (expirations and inspirations)

Question 31

Pleural friction rub

Answer 31

dry rubbing, grateing quality

Question 32

stridor

Answer 32

high pitched brassy sound, hard on inspiration