Respiratory

Question 1

Lung major function

Answer 1

Provides continuous gas exchange

Question 2

Three processes in lungs

Answer 2

Ventilation
Perfusion
Diffusion

Question 3

Upper airway filters what?

Answer 3

Airborne particles, humidifies & warms inspired gases

Question 4

Lower airway serves?

Answer 4

for gas exchange

Question 5

Respiration is controlled by

Answer 5

brainstem

Question 6

Accessory muscles of inspiration

Answer 6

SCM
Scalene
Intercostals

Question 7

Expiration is

Answer 7

passive

Question 8

Diaphragm is what?

Answer 8

primary muscle of inspiration

Question 9

Diaphragm contracts

Answer 9

moves down

Exhale: moves up

Question 10

Before beginning exam (4 things)

Answer 10

Quiet environment
Proper positioning
Bare skin for auscultation
Patient comfort

Question 11

Observe pt breathing patterns

Answer 11

Rate
Depth
Effort

Question 12

Assess what else?

Answer 12

A-P diameter

patients color

Question 13

Pertinent History

Answer 13

Chronic conditions
Exposure to a new medication
Recent change in diet
Substance abuse/overdose
Prior DVT, PE
Recent trauma to chest

Question 14

Abnormal retractions of interspaces during respiration

Answer 14

Retractions: sinking in of soft tissues
Lower interspaces
Supraclavicular in acute asthma exacerbation

Question 15

Impaired respiratory movement

Answer 15

Flail Chest & paradoxical

Question 16

i. Put thumbs about 2 in apart on back
ii. Have them take a breath
iii. The thumbs should move up symmetrically

Answer 16

Chest excursion

Question 17

1. Sounds waves when you talk cause vibrations

2. Use ulnar surface of hand

Answer 17

vocal or tactile remits (palpable vibrations)

Question 18

Percussion helps to identify

Answer 18

Underlying tissues are air-filled, fluid-filled, or solid

Question 19

when fluid or solid tissue replaces air containing lung

Answer 19

Dullness

Question 20

Examples of dullness sounds

Answer 20

i. Pleural Effusions
ii. Hemothorax (blood in one cavity of lung)
iii. Tumor

Question 21

Example of Unilateral Hyperresonance

Answer 21

Pneumothorax

Question 22

More air

Answer 22

Hyperresonance

Question 23

Example of generalized hyperresonance

Answer 23

COPD

Question 24

Ausculation: how many locations

Answer 24

8 anterior, 8 lateral

10 posterior

Question 25

Where do you start auscultating?

Answer 25

posteriorly & symmetrically

Question 26

Should listen to at least

Answer 26

6 locations anteriorly and posteriorly

Question 27

Normal breath sounds

Answer 27

Bronchial Bronchovesicular Vesicular

Question 28

1. heard over trachea, high-pitched | 2. expiration > inspiration

Answer 28

i. Bronchial

Question 29

1. heard over major bronchi, between the scapulae, around the sternum, medium-pitched 2. inspiration = expiration

Answer 29

ii. Bronchovesicular

Question 30

1. heard over peripheral lung fields, soft-pitched | 2. inspiration > expiration

Answer 30

Vesicular

Question 31

Abnormal Sounds

Answer 31

Absent Decreased Bronchial (if heard in other locations of lung)

Question 32

1. Discontinuous, intermittent, nonmusical, brief sounds heard with inspiration more at bases

Answer 32

Crackles

Question 33

Crackles caused by

Answer 33

air moving through secretions and collapsed alveoli

Question 34

Associated conditions with crackles

Answer 34

1. pulmonary edema and early heart failure, pneumonia, fluid

Question 35

1. Continuous, high pitched, musical sound, longer than crackles heard greater with expiration

Answer 35

Wheeze

Question 36

Associated conditions with wheezing

Answer 36

a. Asthma, (COPD) chronic obstructive pulmonary disease

Question 37

1. Loud, low pitched, snoring quality, rough sound 2. Heard high up, over trachea & bronchi Acute bronchitis

Answer 37

Rhonchi

Question 38

1. Inspiratory musical wheeze 2. Loudest over trachea 3. Suggests obstructed trachea or larynx

Answer 38

Stridor

Question 39

a. Created by turbulent air flow loudest during inspiration softest during expiration

Answer 39

normal breath sounds

Question 40

i. Air moves to smaller airways hitting walls | ii. More turbulence, Increased sound

Answer 40

inspiration

Question 41

i. Air moves toward larger airways | ii. Less turbulence, Decreased sound

Answer 41

expiration

Question 42

Causes of decreased of absent breath sounds

Answer 42

``` Asthma COPD Pleural Effusion Pneumothorax Adult Respiratory Distress Syndrome (ARDS) Atelectasis ```

Question 43

early RAT (hypoxia)

Answer 43

Restless Anxiety Tachycardia/tachypnea

Question 44

late to BED (hypoxia)

Answer 44

i. Bradycardia ii. Extreme restlessness iii. Dyspnea

Question 45

In pediatrics: FINES (hypoxia)

Answer 45

i. F: Feeding difficulty ii. I: Inspiratory Stridor iii. N: Nares Flare iv. E: Expiratory grunting v. S: Sternal Retractions

Question 46

i. Encourages pt post-operatively ii. Want lungs to expand iii. Providing pain medication prior iv. 5-10x an hour

Answer 46

a. Incentive Spirometry

Question 47

i. Helps clear lungs of mucous ii. Vibrates iii. Cystic fibrosis

Answer 47

b. Acapella Device

Question 48

a. Group of tests that measure how well the lungs take in & release air

Answer 48

R. Pulmonary Function Test (PFT)

Question 49

S. Assessment Methods

Answer 49

Peak flow meter pulse ox sputum collection (best in AM)

Question 50

Positioning

Answer 50

High Fowlers

Question 51

very precise amount | i. 1-6L/min

Answer 51

nasal cannula

Question 52

i. Never less than 5L/min – can retain CO2

Answer 52

face mask

Question 53

see most often) | 1. 6-12L/min

Answer 53

simple mask

Question 54

10-15 L/min

Answer 54

partial rebreather non rebreather

Question 55

4-10L/min; most precise flow concentration

Answer 55

Venturi Mask