HCC PTA Respiratory – Flashcards
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a chemical released during allergic reactions that causes dilation of capillaries, contraction of smooth muscle and stimulation of acid gastric secretions.
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Histamines
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Respiration Rate (Adolescent,11-16 years)
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12-20
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Respiration Rate (Adult)
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12-20
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Respiratory Rate (Children)
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15-30
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Respiration Rate (Newborn)
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30-60
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Respiration Rate (Infant)
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25-50
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Tongue partially blocking the upper airway at the level of the pharynx
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Snoring
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Constriction of the bronchioles in the lungs
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Wheezing
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Fluid in the upper airway
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Gurgling
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Partial obstruction of the upper airway at the level of the larynx
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Stridor
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a condition that occurs when the lungs cannot remove all of the carbon dioxide the body produces. This disrupts the body's acid-base balance. Body fluids become too acidic.
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Respiratory Acidosis
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is a condition marked by low levels of carbon dioxide in the blood due to breathing excessively.
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Respiratory Alkalosis
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True
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Air in lungs is 100% humidity
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R-superior, middle, inferior L-superior, inferior
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Lungs have right and left lobes
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diaphragm,external intercostals, scalene, pec maj&min,trap, serratus anterior
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Muscles of respiration / Inspiratory
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Internal intercostals, transversus thoracis, abdonminal muscles
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muscles of respiration / Expiiratory
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from atmosphere to lungs, removal of carbon dioxide from air spaces, absorption of O2 from air spaces
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External respiration
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removal of carbon dioxide from tissue cells, absorption of O2 from tissue cells
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Internal respiration
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12-18 breaths per minutes
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respiratory rate
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volume moved in or out of the lungs during a respiratory cycle
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Tidal volume
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volume that can be inhaled during forced breathing in addition to resting tidal volume
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Inspiratory reserve volume
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volume that can be exhaled during forced breathing in addition to resting tidal volume
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Expiratory reserve volume
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Volume that remains in the lungs at all times
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Residual volume
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maximum volume of air that can be inhaled following exhalation of resting tidal volume
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Inspiratory capacity
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volume of air that remains in the lungs following exhalation of resting tidal volume
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Functional residual capacity
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maximum volume of aire that can be exhaled after taking the deepest breath possible
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Vital capacity
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total volume of air that the lungs can hold
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Total lung capacity
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CO2 levels increase
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What is the stimulus to breat for a client with normal lung function?
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low oxygen
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What is the stimulus to breatH for a client with elevated pCO2 levels?
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O2 levels in blood, respiratory rate, respiratory effort, airway patency, lunch sounds, color of lips, lactile frenitis, vitals, cough
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What should a nurse assess on a patient who has pneumonia and is receiving oxygen therapy?
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crackling sounds, 10-20 beaths per minutes, shortness of breath, SpO2 >92%
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What would you expect to find on a patient with pneumonia and on oxygen therapy?
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O2 is not making it to his blood
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If a patient with pneumonia and oxygen therapy had a SpO2 of 88% and respiratory rate of 30 / minutes what would you know?
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cough, shortness of breath, cheast pain with breathing, history of respiratory infections, smoking, environmental exposure, self care behaviors
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What is subjective data that we can obtain on the respiratory system?
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Is it productive? What color? Smelly? Bloody? how much blood? when did it start? Has it been continuous or intermittant? On medication?
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What would you ask about a patient's cough to obtain more information?
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to the side and three feet away
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Where should you stand when you have a patient coughing?
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ausculation, palpation, inspection, percussion
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How can we assess the respiratory system
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Chest wall, barrel chest, spinal deformities, scars, wounds, scoliosis, kyphosis, respiratory pattern, accessory muscle use, skin, nails, lips, cyanosis, clubbing of nails, nasal flaring
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What can you inspect?
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abnormal posterior curvature in spine. humpback
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What is kyphosis
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breathing regular? how deep?
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What will you look for with the respiratory pattern?
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...
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What accessory muscles are you looking at?
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hypoxia, inadequate oxygen levels inside body. Indicated by white nail beds and blue skin.
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what is cyanosis
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chronic hypoxia
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What causes nail clubbing?
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Nasal flaring or sternal indentation
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What may you find on children who are struggling to breathe?
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no
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Can you use a pulse ox on a patient with poor circulation?
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tenderness, bulges or deptressions, crepitus, subcutaneous emphysema, tracheal position, thoracic expansion
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What are you looking for when you palpate?
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crackling that you feel with your finger tips. It can be caused by broken ribs
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What is crepitus?
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air that has been trapped in the tissues and skin layers, feels like crispies, identify borders, can cause pressure on trachea
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What is subcutaneous emphysema
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pneumothorax, bleeding after surgery, air pressure in lunch space.
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What could a deviated trachea mean?
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condition of low oxygen
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what is hypoxia
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low oxygen in the blood
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What is hypoxemia?
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You can put your hands on their chest and/or back and ask them to inhale. See if your hands move symmetrically.
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How can you check to see if a patient is breathing symmetrically?
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posteriorly at T10 or anteriorly at 6th rib
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Where is the best place to put your stethoscope to listen to the lower lobes?
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upper range of lung
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What can you hear at T3
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on the right anteriorly at 4th - 6th rib
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Where do you listen to the middle lobe?
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To compare left to right sounds, they should sound alike, top and bottom sounds should not.
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When you auscultate you should go left to right, why?
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above clavicle
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Where do you listen to the anterior upper lobes?
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6th rib
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Where do you listen to the anterior lower lobes?
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above scapula
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Where do you listen to the posterior upper lobs?
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T2-T10
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Where do you listen to posterior lower lobes?
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Shortness of breath
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What is dyspnea?
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What causes it? duration? position? is it on exersion (DOE)?
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What do we ask when someone is experiencing dyspnea?
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suddenly stopping and starting breathing at night.
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What is Paroxysmal nocturnal dyspnea (PND)?
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difficulty breathing when in supine, how many pillows do you need?
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What is orthopnea?
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Head elevated and straight through their thorax
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What position optimizes a patient's breathing?
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muscle waisting
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what is cachexia
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put chin up and see if snoring continues
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What should you do with a patient who has 12 breaths per minute, snoring sounds and was just sedated?
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97-99%
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What are normal SpO2 numbers?
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10-20, may be different in children
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What is a normal respiratory rate?
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respiratory rate greater than 24 breaths per minute
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What is tachypnea
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exercise, stress, anxiety, pain
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What can cause tachypnea?
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Respiratory rate lower than 10 breaths per minute
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what is bradypnea?
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sedation, abnormality in brain
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What can cause bradypnea?
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sedation, bed rest - may not breathe as deeply
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What can cause hypoventilation?
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variable tidal volume and rate, can become fast then slow with periods of apnea. normal in infants and aging adults during sleep
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Describe Cheyne Stokes
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Renal failure, heart failure, drug overdose
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what can be some causes of Cheyne STokes?
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low pitched and soft and rustling, most lunch sounds
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What do vesicular sounds sound like?
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high pitched and loud and hollow
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What do bronchial (tracheal) sounds sound like?
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moderately pitched and medium amplitude
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What do bronchialvesicular lung sounds sound like?
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abnormal lung sounds
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What are adventitous sounds?
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describe them, locate them are they on expiration or inspiration and document
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What do you do if hear adventitous lung sounds?
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Wheezes, crackles, stridor, friction rub
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What are some adventitous sounds?
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loud low pitch gurgling, sounds like velcro
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What are course crackles?
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inspiratory or expiratory
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What phase can course crackles be in?
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sputem, secretions or fluid in small airways
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What can cause course crackles?
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intermttent, high pitched soft popping sounds, sounds like rolling a piece of hair between your fingers
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What are fine crackles?
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inspiratory
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What phase are fine crackles on?
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no
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Can fine crackles be cleared by coughing?
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normal sounds from when previously deflated airways are popping open. Alveolis are closed from lack of use, then pop open when used again. sounds like moistening your thumb and index finger and serparating them near your ear.
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What are atelectatic crackles?
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inspiratory
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What phase is atelectatic crackles on?
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bed rest, aging adults, after a night of sleep
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What can cause atelectatic crackles?
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high or low pitched continuous sounds, can be musical
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What are wheezes?
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narrowed airways, swelling, tumor, obstructive disease, asthma
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What causes wheezes
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expiratory
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What phase are wheezes on?
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loud, grating, low pitched sound
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What is pleural friction rub?
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if there is are inflammed pleural surfaces rubing together
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When does pleural friction rub occur?
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inspiratory or expiratory
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What phase is pleural friction on?
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yes
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Is Pleural friction painful?
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Have patient hold their breath and see if you still hear it.
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How do you determin if pleural friction is pleural or cardiac in origin?
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inflammation of the upper airways resulting in a high pitched crowing sounds. Can be life threantening.
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What is Stridor?
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Inspiratory
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What phase in stridor on?
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croup, epigottitis, coming off intibation, foreign body in airway, swelling, inflammation, spasms
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What are some causes or stridor?
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resonance - loud, hollow low-pitched sounds
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What are you sounds are you looking for when you percuss?
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lower pitched becuase too much air, dense because no air
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What are abnormal sounds when percussing?
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Their respiratory rate is faster, they have smaller airways, thinner chest wall, breath sounds are louder and harsher, abdominal breathers, systems not fully developed, more prone to infections.
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Whate are some characteristics of breathing in children?
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decreased gas exchange, increased work of breathing, kyphosis, may have fewer functioning alveoli
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What are some characteristics of breathing in aging adults?
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people should be able to walk 300 m in 6 minutes
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What is the 6 minute distance walk?
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restlessness, agitation, irritability, confusion, drowsiness, loss of consciousness
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What are the clinical neurological signs of respiratory failure?
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tachycardia, dysrhythmis, hypertension, chest pain, palpitations, hypercapnia (skin flushing), hypotension (if acidosis is present)
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what are the clinical cardiovascular signs of respiratory failure?
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tachypnea, SOB, accessory muscleuse, increased abdominal use, intercostal retractions, nasal flaring, trachea tugging
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What are the clinical respiratory signs of respiratory failure?
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one inspiration followed by one expiration
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breathing cycle
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used to determine respiratory volumes by producing a graphic record of air volumes being exchanged
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spirometer
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contraction of internal intercostal muscles pull ribs down and inward, while contraction of abdominal muscles force abdominal viscera and lungs upward
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forceful expiration
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diaphragm and external intercostal muscles relax and thoracic cavity and lungs return to normal size
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expiration
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movement of air in and out of the lungs
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ventilation
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the overall process of gas exchange between atmosphere and body cells
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respiration
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gas exchange between air and blood in lungs by diffusion (transport of gases between lungs and body cells)
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external respiration
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gas exchange between blood and body by diffusion
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internal respiration
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allow air to enter and leave nose, contain hairs
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external nares and nostrils
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interior nose chamber, palate separates it from the oral cavity
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nasal cavity
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divides the cavity into R and L sides
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nasal septum
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three projections from the lateral wall of the nose, increasing the surface area
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nasal conchae
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lined with pseudostratified ciliated columnar epithelium
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nose
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passageway posterior to nasal and oral cavities, extending to larynx and esophagus, is a muscular wall covered in a mucous membrane, from auditory tubes
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pharynx
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nasopharynx, oropharynx, laryngopharynx
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three pharynx parts
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located in the nose epithelium and produce mucous
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goblet cells
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air filled cavities in the bones around the nasal cavity which lighten the skull and have sound resonating chambers
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paranasal sinuses
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found in the ethmoid, frontal, maxillary, and sphenoid bones
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sinuses
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folds of mucous membranes that are relaxed during breathing; contract and vibrate to produce sounds
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vocal chords
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opening between the vocal cords
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glottis
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cartilagenous, boxlike structure that is the passageway for air between the pharynx and the trachea; supported by ligaments that extend from hyoid bone
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larynx
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flap that prevents food from entering the larynx
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epiglottis
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muscles lift larynx upward and the epiglottis folds over to cover the glottis so that food is directed to the esophagus and blocked from entering the pharynx
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swallowing
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clumps of lymphatic tissues at opening to pharynx; sites of immune responses
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tonsils
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palantine, pharyngeal (adnoids), lingual
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three sets of tonsils
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tube that extends from the larynx into the thoracic cavity and branches to form primary bronchi
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trachea
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support the trachea, holding the airway open during breathing, allowing the esophagus to expand during swallowing
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c-shaped cartilagenous rings
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very small tubes lacking cartilage, possessing smooth muscle and lined with simple cuboidal epithelium
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bronchioles
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formed at the end of terminal bronchioles, they terminate in alveoli
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alveolar ducts
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300 million/lung, holds about 6 liters of air and are the site of respiratory gas exchange
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alveoli
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prevents alveolar collapse during exhalation by reducing the attraction between water molecules
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surfactant
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O2 + glucose = ATP + CO2 + heat
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cellular respiration
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can ONLY happen in the capillaries
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gas exchange
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from High pressure to Low pressure
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direction of air movement
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process that exchanges air between atmosphere and alveoli
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breathing
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cone-shaped and separated by heart and mediastinum; surrounded by serous membranes (visceral and parietal pleura)
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lungs
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LEFT has 2 lobes; RIGHT has 3 lobes
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lobes of the lungs
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potential space between the two pleurae; filled with serous fluid to reduce friction
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pleural cavity
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volume of air exchanged during quiet breathing (normal respiration)
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tidal volume
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maximum volume of air that can be forcefully inhaled after a tidal inspiration
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inspiratory reserve volume
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maximum volume of air forcefully exhaled after a tidal expiration
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expiratory reserve volume
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volume of air remaining in lungs after ERV; can not be measured and function to keep the alveoli open, preventing lung collapse
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residual volume
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maximum amount of air that can be forcefully exchanged ( does NOT include residual volume)
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vital capacity
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TV + IRV + ERV
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VC
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VC + RV
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total lung capacity
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body temperature; chemicals recognized by chemoreceptors in aortic arch, carotid sinus, and respiratory center (including CO2, O2, H+ ions)
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factors influencing breathing
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changes in CO2 and H+
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respiratory homeostasis
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the more CO2 you have, the more H+ you have as well; the respiratory pH is controlled by the breathing pattern
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CO2&H+ relationship
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connect the middle ear to the nasopharynx to balance pressure
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auditory tubes
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A group of intrinsic disorders of the lung that are characterized by obstruction to expiratory airflow
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COPD (Chronic Obstructive Pulmonary Disease)
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Air flow blockage, dyspnea, precipitated by cigarette smoking, flattened diaphragm, 30% diaphragmatic and 70% accessory muscles
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Characteristics of COPD
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A disorder characterized by an abnormal destruction and collapse of the terminal bronchiolar airways or the destructive enlargement of the alveoli, these changes trap air within the alveoli and produce abnormally large air spaces that remain filled during expiration
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Emphysema
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Dyspnea, barrel chest appearance, minimal coughing or sputum production
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Characteristics of Emphysema
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Disorder characterized by bronchial inflammation, excessive secretion of bronchial mucus, and airway narrowing, accompanied by a productive cough that lasts for at least three months of the year for 2 consecutive years
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Chronic Bronchitis
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chronic bronchitis, 10-25% of the u.s. has a mild form of this disease
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Smokers Cough
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chronic cough and wheezing, shortness of breath, accessory respiratory muscles active, pulmonary hypertension
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Characteristics of Chronic Bronchitis
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- A disorder characterized general, episodic airway narrowing due to increased airway inflammation and hypersensitivity to a variety of stimuli
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Asthma
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Environmental; food, drink, pollen, animals, molds, cigarette smoke, Emotional, exercise: up to 90% have exercise induced
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Causes of Asthma
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An inherited disease that results in respiratory failure due to airway blockage secondary to thick mucosal secretions and chronic infections
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Cystic Fibrosis
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Thick mucus secretions are produced, chronic cough, frequent respiratory infections.
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Characteristics of Cystic Fibrosis
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An acute infection and inflammation of the alveoli
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Pneumonia
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Fever, dry cough, malaise(tired), angina, dyspnea, hemoptysis
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Characteristics of Pneumonia
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These diseases comprise a group of disorders characterized by decreased lung or chest wall compliance
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Restrictive lung diseases
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Scoliosis, ankylosing spondylitis, morbid obesity, and pleural effusion
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Restrictive Causes of Lung Diseases
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A multidisciplinary program of care for patients with chronic respiratory impairment that is individually tailored and designed to optimize physical and social performance and autonomy
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Pulmonary Rehab Program
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Technique used for acute dyspnea: COPD, emphysema, and asthma; relax, breathe in nose for 2 counts and out through puckered lips for 4 sec with hand 4-6 inches away from mouth
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Pursed Lip Breathing
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Patient lies on their back in hook lying position, hand on chest and hand on stomach, breath moving only the stomach keeping chest still. Perform 5-10 min about 3-4 times per day
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Diaphragmatic Breathing Technique
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Severe hemoptysis, acute heart conditions, arrhythmia, severe hypertension, rib fracture, or head injury
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Contraindications for Postural Drainage
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Cup hands and slap on certain part to knock mucus loose from the lungs.
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Percussion Technique
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the mechanical flow of air into and out of the lungs
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Breathing
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the process of gas exchange in the body, what we count
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Respiration
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the exchange of gases between the air spaces of the lungs and the blood
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External Respiration
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the exchange of gases between the blood and the tissue cells
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Internal Respiration
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The actual utilization of O2 by the cell for its various life processes
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Cellular Respiration
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Nose, Pharynx, Larynx
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Upper Respiratory Tract
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Trachea, Bronchi, Lungs, and Pleural Membrane(protect the lungs)
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Lower Respiratory Tract
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Tiny, thin walled sacs (exchange O2 and CO2)
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Alveoli
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Removes fine dust particles and debris
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Macrophages
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Surface tension to keep it from collapsing
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Surfactant
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Diaphragm, external intercostals, scalenes, sternocleidomastoid
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Deep Forced Inspiration Muscles
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Internal intercostals, all abdominals
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Deep Forced Expiration Muscles
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Increased volume=decreased pressure, increased pressure=decreased volume, ex. Holding your breath
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Boyle's Law
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Surface tension of alveolar fluid, lung compliance, airway resistance
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3 Factors that Affect Pulmonary Ventilation
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medulla oblongata and pons
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Respiratory Control Center
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breathing is too rapid and deep for normal gas exchange
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Hyperventilation
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Breathing is too slow and shallow to maintain normal blood gas levels
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Hypoventilation
