Adult Health Chapter 17 Assessment of Respiratory Function

The nurse is caring for a client with an exacerbation of COPD and scheduled for pulmonary function studies using a spirometer. Which client statement would the nurse clarify?

"I will breathe in through my mouth and out through my nose." -During a pulmonary function test using a spirometer, a nose clip prevents air from escaping through the client's nose when blowing into the spirometer.

A nurse is instructing the client on the normal sensations that can occur when contrast medium is infused during pulmonary angiography. Which client statement demonstrates an understanding of the teaching?

"I will feel warm and may have chest pain"

The nursing instructor is teaching students about the respiratory system. The instructor knows the teaching has been effective when a student makes which statement?

"Ventilation is the movement of air in and out of the respiratory tract."

Orthopnea

(inability to breathe easily except in an upright position) may be found in patients with heart disease and occasionally in patients with chronic obstructive pulmonary disease (COPD).

Dyspnea

(subjective feeling of difficult or labored breathing, breathlessness, shortness of breath) is a multidimensional symptom common to many pulmonary and cardiac disorders, particularly when there is decreased lung compliance or increased airway resistance.

A nurse is instructing a client who is scheduled for a perfusion lung scan. What teaching should the nurse include in the information about the procedure? Select all that apply.

- A mask will be placed over the nose and mouth during the test. - The client will be expected to lie under the camera. - The imaging time will amount to 20 to 40 minutes.

Symptoms of Respiratory Disease

- Cough - Sputum Production - Chest Pain - Wheezing - Hemoptysis

A client has suspected fluid accumulation in the pleural space of the lungs and is scheduled for a thoracentesis. The nurse will implement which of the following for this procedure? Select all that apply.

- Educate the client about the need to cleanse the thoracic area. - Apply pressure to the puncture site after the procedure. - Complete a respiratory assessment after the procedure.

Gerontologic Considerations

- Gradual decline in respiratory function - Changes in alveoli, reduction in surface area, elasticity changes - Amount of respiratory dead space increases - Loss of chest wall mobility - All lead to decreased oxygen levels in circulation

The nurse is taking a respiratory history for a patient who has come into the clinic with a chronic cough. What information should the nurse obtain from this patient? (Select all that apply.)

- Previous history of lung disease in the patient or family - Occupational and environmental influences - Previous history of smoking

Sputum Production

- Reaction of lungs to constant irritant, may result from persistent cough - Profuse amount of purulent sputum (thick, yellow, green, rust color) or change in color may mean bacterial infection. - Thin, mucoid sputum may be viral infection - Pink tinged may be a lung tumor - Profuse, frothy, pink material may indicate pulmonary edema - Foul smelling sputum & bad breath may indicate lung abscess, bronchiectasis or infection.

If cough occurs after food intake it may be

- aspiration (perform swallow evaluation) - reflux

Causes of Dry cough :

- asthma - cold - GERD - Sleep apnea - vocal cord dysfunction - allergies - COVID

Lower Respiratory Tract Structures Bronchi & Bronchioles

- branches to bronchioles - Bronchioles have no cartilage in walls. Must have alveolar pressure and elastic recoil of surrounding smooth muscle tissue - Contain glands that produce mucus , cilia propels it to larynx. - terminal bronchioles have no glands or cilia. - gas exchange happens in alveoli

If cough is violet it may cause ....

- bronchial spasm - obstruction - further irritation ➔ syncope (fainting)

Causes of wet cough :

- cold - flu - lung infection - cystic fibrosis - COPD - Acute bronchitis - Bronchiectasis

If cough occurs at night it may be ...

- left side heart failure - asthma

V/Q ratio

- may have inadequate ventilation - inadequate perfusion - or both

Ventilation-Perfusion Ratio (V/Q ratio) Low ratio - called shunting

- perfusion > ventilation - blood bypasses alveoli without gas exchange - pneumonia, tumor, mucus plug

If cough is wet it may be

- productive - pneumonia, post-nasal drip check for fever

Mediastinum

- space between the lungs contains: the heart, thymus gland, portions of the esophagus and trachea, aorta and vena cava other structures, Widening can indicate disease.

Ventilation-Perfusion Ratio (V/Q ratio) High ratio - dead space

- ventilation > perfusion - alveoli don't have enough blood supply for gas exchange - pulmonary emboli, pulmonary infarction, cardiogenic shock

If the cough is dry it may be ....

- viral URI - ACE inhibitor

Tachypnea is rapid breathing with a rate greater than

24 breaths per minute.

Upper Respiratory Tract Structures Paranasal sinuses -

4 pairs of bony cavities. Resonating chamber for speech

What is the purpose of the vascular and ciliated mucous lining of the nasal cavities?

463 and humidify inspired air

Cyanosis appears when there is at least

5 g/dL of unoxygenated hemoglobin.

type II cells account for only

5% of this area, but are responsible for producing type I cells and surfactant.

An oxygen saturation value of less than _____%, using pulse oximetry, indicates that tissues are not receiving enough oxygen.

90

Type I cells account for

95% of the alveolar surface area and serve as a barrier between the air and the alveolar surface;

Egophony

A change in vocal resonance in the presence of a lung consolidation condition in which the transmission of the "eee" sound becomes a nasal "ay" sound.

A nurse would question the accuracy of a pulse oximetry evaluation in which of the following conditions?

A client experiencing hypothermia

tachypnea (rapid respirations) + hypoxemia ➔

ARDS acute respiratory distress syndrome

A nurse working in the radiology clinic is assisting with a client after an unusual arterial procedure. What assessment should the nurse notify the health care provider about?

Absent distal pulses

Your client is scheduled for a bronchoscopy to visualize the larynx, trachea, and bronchi. What precautions would you recommend to the client before the procedure?

Abstain from food for at least 6 hours before the procedure.

Ventilation and Perfusion Balance (and Imbalance)

Adequate gas exchange depends on adequate ventilation/perfusion (V/Q)

Which is a true statement regarding air pressure variances?

Air is drawn through the trachea and bronchi into the alveoli during inspiration. -Air flows from a region of higher pressure to a region of lower pressure. During inspiration, movement of the diaphragm and other muscles of respiration enlarge the thoracic cavity, thereby lowering the pressure inside the thorax to a level below that of atmospheric pressure.

A patient visited a health care clinic for treatment of upper respiratory tract congestion, fatigue, and sputum production that was rust-colored. Which of the following diagnoses is likely based on this history and inspection of the sputum?

An infection with pneumococcal pneumonia

The nurse auscultated a patient's middle lobe of the lungs for abnormal breath sounds. To do this, the nurse placed the stethoscope on the:

Anterior surface of the right side of the chest, between the fourth and fifth rib.

The nurse is caring for a client with recurrent hemoptysis who has undergone a bronchoscopy. Immediately following the procedure, the nurse should complete which action?

Assess the client for a cough reflex. -After the procedure, the client must take nothing by mouth until the cough reflex returns, because the preoperative sedation and local anesthesia impair the protective laryngeal reflex and swallowing. Once the client demonstrates a cough reflex, the nurse may offer ice chips and eventually fluids.

The nurse assessed a 28-year-old woman who was experiencing dyspnea severe enough to make her seek medical attention. The history revealed no prior cardiac problems and the presence of symptoms for 6 months' duration. On assessment, the nurse noted the presence of both inspiratory and expiratory wheezing. Based on this data, which of the following diagnoses is likely?

Asthma

A client presents to the emergency department with fluid overload. The nurse is concerned about fluid accumulation in the lungs. On which of the following areas would the nurse focus the lung assessment?

Bilateral lower lobes - Assessment of the anterior and posterior lungs is part of the nurse's routine evaluation. Fluid overload should be monitored for accumulation in the lungs. Dependent areas must be assessed for breath sounds. The bases of the lungs are considered dependent areas. Fluid in the lungs will usually produce the adventitious sounds of crackles, most frequently auscultated in the bilateral bases of the lungs.

A client appears to be breathing faster than during the last assessment. Which of the following actions should the nurse perform?

Count the rate of respirations. - Observing the rate and depth of respiration is an important aspect of a nursing assessment. The normal adult resting respiratory rate is 12 to 18 breaths per minute.

The nurse is assessing the lungs of a patient diagnosed with pulmonary edema. Which of the following would be expected upon auscultation?

Crackles at lung bases

The nurse is caring for a patient with a pulmonary disorder. What observation by the nurse is indicative of a very late symptom of hypoxia?

Cyanosis

Which groups of receptors assist in the brain's control of the respiratory system? A) Chemoreceptors B) Mechanoreceptors C) Proprioceptors D) All of the above

D. All of the above Rationale: - Chemoreceptors located in the medulla respond to chemical changes in the cerebrospinal fluid and work to maintain balance through increased or decreased respiratory rate. - Mechanoreceptors are located in the lungs and respond to changes in resistance by altering inflation of the lungs. - Proprioceptors are in the muscles and chest wall and respond to body movements to stimulate breathing.

Which ventilation-perfusion ratio is exhibited in a client diagnosed with a pulmonary embolus?

Dead space

The nurse enters the room of a client who is being monitored with pulse oximetry. Which of the following factors may alter the oximetry results?

Diagnosis of peripheral vascular disease

Which of the following clinical manifestations should a nurse monitor for during a pulmonary angiography, which indicates an allergic reaction to the contrast medium?

Difficulty in breathing

A client arrives at the physician's office stating dyspnea; a productive cough for thick, green sputum; respirations of 28 breaths/minute, and a temperature of 102.8° F. The nurse auscultates the lung fields, which reveal poor air exchange in the right middle lobe. The nurse suspects a right middle lobe pneumonia. To be consistent with this anticipated diagnosis, which sound, heard over the chest wall when percussing, is anticipated?

Dull

High or increased compliance occurs in which disease process?

Emphysema

Cyanosis is a reliable and early sign of hypoxia.

FALSE

(T/F) The only function of the larynx is vocalization.

False -Rationale: Another name for the larynx is the voice box, and a primary function is to create vocal sounds. The larynx also serves as a barrier to foreign substances entering the lower respiratory tract and facilitates coughing.

A client with sinus congestion complains of discomfort when the nurse is palpating the supraorbital ridges. What sinus is the client referring?

Frontal -The nurse may palpate the frontal and maxillary sinuses for tenderness. Using the thumbs, the nurse applies gentle pressure in an upward fashion at the supraorbital ridges (frontal sinuses) and in the cheek area adjacent to the nose (maxillary sinuses).

___________________ is the expectoration of blood from the respiratory tract.

Hemoptysis

A client seeks medical attention for new onset of a cough and sputum production. The client is producing sputum that is yellowish-green in color. The nurse anticipates which action for these types of symptoms?

Immediate admission -Cough results from irritation or inflammation of the mucous membranes anywhere in the respiratory tract and is associated with multiple pulmonary disorders.

A nurse is concerned that a client may develop postoperative atelectasis. Which nursing diagnosis would be most appropriate if this complication occurs?

Impaired gas exchange

What would the instructor tell the students purulent fluid indicates?

Infection

The nurse is in the radiology unit of the hospital. The nurse is caring for a client who is scheduled for a lung scan. The nurse knows that lung scans need the use of radioisotopes and a scanning machine. Before the perfusion scan, what must the client be assessed for?

Iodine allergy

During a pulmonary assessment, the nurse observes the chest for configuration. She identifies the findings as normal. Which of the following would be consistent with normal assessment?

Lateral diameter greater than anteroposterior diameter -Inspecting the thorax is part of assessment of the respiratory system. Normally, the ratio of the anteroposterior diameter to the lateral diameter is 1:2. Chest deformities are associated with respiratory disease.

Lower Respiratory Tract Structures Two lungs, five lobes

Left: upper and lower Right: upper, middle, and lower in thoracic cage, is an airtight chamber

A client has just undergone bronchoscopy. Which nursing assessment is most important at this time?

Level of consciousness

________________ tract accomplishes gas exchange

Lower respiratory

A client has a nursing diagnosis of "ineffective airway clearance" as a result of excessive secretions. An appropriate outcome for this client would be which of the following?

Lungs are clear on auscultation.

Upper Respiratory Tract Structures

Nose, Paranasal sinuses , pharynx

A nurse practitioner diagnosed a patient with an infection in the maxillary sinuses. Select the area that the nurse palpated to make that diagnosis.

On the cheeks below the eyes

The nurse is performing an assessment for a patient with congestive heart failure. The nurse asks if the patient has difficulty breathing in any position other than upright. What is the nurse referring to?

Orthopnea

When assessing a client, which adaptation indicates the presence of respiratory distress?

Orthopnea

A patient comes to the emergency department complaining of a knifelike pain when taking a deep breath. What does this type of pain likely indicate to the nurse?

Pleurisy -Pleuritic pain from irritation of the parietal pleura is sharp and seems to "catch" on inspiration; patients often describe it as being "like the stabbing of a knife."

What is the primary function of the larynx?

Producing sound

The clinical finding of pink, frothy sputum may be an indication of which condition?

Pulmonary edema

A patient exhibited signs of an altered ventilation-perfusion ratio. The nurse is aware that adequate ventilation but impaired perfusion exists when the patient has which of the following conditions?

Pulmonary embolism

The client has just had an invasive procedure to assess the respiratory system. What does the nurse know should be assessed on this client?

Respiratory distress -After invasive procedures, the nurse must carefully check for signs of respiratory distress and blood-streaked sputum. Masses in the pleural space are a condition that affects fremitus. General examination of overall health and condition includes assessing the consciousness of a client.

A client with chronic bronchitis is admitted to the health facility. Auscultation of the lungs reveals low-pitched, rumbling sounds. Which term should the nurse document?

Rhonchi

Which ventilation-perfusion ratio is exhibited by acute respiratory distress syndrome (ARDS)?

Silent unit

The nurse is caring for a client who is to undergo a thoracentesis. In preparation for the procedure, the nurse places the client in which position?

Sitting on the edge of the bed - If possible, it is best to place the client upright or sitting on the edge of the bed with the feet supported and arms and head on a padded over-the-bed table. Other positions in which the client could be placed include straddling a chair with arms and head resting on the back of the chair, or lying on the unaffected side with the head of the bed elevated 30 to 45 degrees (if the client is unable to assume a sitting position).

Lungs with decreased compliance require greater-than-normal energy expenditure by the patient to achieve normal levels of ventilation.

TRUE

Older adults have a decreased ability to move air in and out of the lungs rapidly.

TRUE

On assessment, the nurse would describe coarse crackles as discontinuous popping sounds heard during early inspiration.

TRUE

Rhonchi are deep and low-pitched snoring sounds associated with partial airway obstruction.

TRUE

For which reason does gas exchange decrease in older adults?

The alveolar walls contain fewer capillaries.

A client arrives at the physician's office stating 2 days of febrile illness, dyspnea, and cough. Upon assisting the client into a gown, the nurse notes that the client's sternum is depressed, especially on inspiration. Crackles are noted in the bases of the lung fields. Based on inspection, which will the nurse document?

The client has a funnel chest. -A funnel chest, known as pectus excavatum, has the sternum depressed from the second intercostal space, and it is more pronounced on inspiration.

The client is returning from the operating room following a bronchoscopy. Which action, performed by the nursing assistant, would the nurse stop if began prior to nursing assessment?

The nursing assistant is pouring a glass of water to wet the client's mouth. -When completing a procedure which sends a scope down the throat, the gag reflex is anesthetized to reduce discomfort. Upon returning to the nursing unit, the gag reflex must be assessed before providing any food or fluids to the client. The client may need assistance following the procedure for activity and ambulation but this is not restricted in the post procedure period.

In relation to the structure of the larynx, which describes the cricoid cartilage?

The only complete cartilaginous ring in the larynx

A client experiences a head injury in a motor vehicle accident. The client's level of consciousness is declining, and respirations have become slow and shallow. When monitoring a client's respiratory status, which area of the brain would the nurse realize is responsible for the rate and depth?

The pons

Which side of the lungs has three lobes?

The right side.

A nurse is assessing a client's respiratory system. Which alveolar cells secrete surfactant to reduce lung surface tension?

Type II

A nurse is discussing squamous epithelial cells lining each alveolus, which consist of different types of cells. Which type of alveolar cells produce surfactant?

Type II cells

__________________ tract warms and filters air

Upper respiratory

A nurse assesses a client's respiratory status. Which observation indicates that the client is having difficulty breathing?

Use of accessory muscles

A nurse caring for a patient with a pulmonary embolism understands that a high ventilation-perfusion ratio may exist. What does this mean for the patient?

Ventilation exceeds perfusion.

What is the difference between respiration and ventilation?

Ventilation is the movement of air in and out of the respiratory tract.

While auscultating the lungs of a client with asthma, the nurse hears a continuous, high-pitched whistling sound on expiration. The nurse will document this sound as which of the following?

Wheezes

Cyanosis,

a bluish coloring of the skin, is a very late indicator of hypoxia. The presence or absence of cyanosis is determined by the amount of unoxygenated hemoglobin in the blood.

During a pulmonary angiography,

a contrast medium is injected into the femoral circulation. When the medium is infused, the client will feel warm and flushed, with a possibility of chest pain. The client will feel pressure when the catheter is inserted.

A hyper resonant sound is an

abnormal lower pitched sound that occurs when free air exists in disease processes such as pneumothorax.

Tachypnea is

abnormally rapid respirations.

Bradypnea is

abnormally slow respirations.

Pulmonary perfusion -

actual blood flow - influenced by patient positioning, pulmonary artery pressure and alveolar pressure

Ventilation is the

actual movement of air in and out of the respiratory tract.

If the cough is a recent onset it may be an ...

acute infection

Air pressure variances

air flows from region of higher pressure to region of lower pressure

Ventilation is the actual movement of

air in and out of the respiratory tract.

Tidal volume is the volume of

air inhaled and exhaled with each breath.

noisy breathing ➔

airway narrowing (tumor, foreign body, croup)

PAO2 is the abbreviation used for the partial pressure of ______________ oxygen.

alveolar

There are three types of

alveolar cells.

Type I and type II cells make up the

alveolar epithelium.

To palpate the maxillary sinuses, the nurse should

apply gentle pressure in the cheek area below the eyes, adjacent to the nose.

Assessment of the lower respiratory structures includes inspection, palpation, percussion, and ___________________ of the thorax.

auscultation

Purulent sputum, or thick yellow-green in color is a common sign of a

bacterial infection which would require antibiotic therapy.

The sphenoidal sinuses are

behind the nose between the eyes.

Ventilation-Perfusion Ratio (V/Q ratio) Normal ratio

blood flow matches gas exchange (1:1 ratio)

Airflow is decreased with atelectasis, which is a

bronchial obstruction from collapsed lung tissue. - If there is an obstruction, there is limited or no gas exchange in this area. Impaired gas exchange is thus the most likely nursing diagnosis with atelectasis.

If cough occurs in the morning with sputum it may be ...

bronchitis

If cough is severe or changing it may be

bronchogenic carcinoma

The larynx, or voice box, is a

cartilaginous framework between the pharynx and trachea. - Its primary function is to produce sound. While the larynx assists in protecting the lower airway, this is mainly the function of the epiglottis. Facilitating coughing is a secondary function of the larynx. Preventing infection is the main function of the tonsils and adenoids.

The central sulcus is a fold in the cerebral cortex called the

central fissure.

Respiratory System Works in conjunction with the

circulatory system

atelectasis

collapsed lung; incomplete expansion of alveoli

Upper Respiratory Tract Structures Pharynx -

connects nasal/oral cavity to larynx, passage for respiratory & digestive tracts

oropharynx -

contains tonsils tonsils - part of lymph system, fights infection

Wheezes, usually heard on expiration, are

continuous, musical, high pitched, and whistle-like sounds caused by air passing through narrowed airways. - Often, wheezes are associated with asthma.

Sibilant wheezes are

continuous, musical, high-pitched, whistle-like sounds heard during inspiration and expiration.

reflex that protects lungs from accumulation of secretions or inhalation of foreign bodies?

cough

Diagnostic clue

cough reflex suppressed by weakness, paralysis of respiratory muscles, prolonged inactivity, NG tube, depressed brain function cough stimulated by mucus, pus, blood, airborne irritant common causes: asthma, GERD, infection, side effects of medications (ACE inhibitors)

A patient with pulmonary edema would be expected to have

crackles in the lung bases, and possible wheezes.

Pleural friction rub is a

creaking or grating sound not affected by coughing.

When ventilation exceeds perfusion a

dead space exists. - An example of a dead space is a pulmonary emboli.

Sonorous wheezes are

deep, low-pitched rumbling sounds heard primarily during expiration.

Rhonchi or sonorous wheezes are

deep, low-pitched, rumbling sounds heard usually on expiration. - The etiology of rhonchi is associated with chronic bronchitis.

a sedative or narcotic is given to

depress the vagus nerve.

When monitoring clients after a pulmonary angiography, nurses must notify the health care provider about

diminished or absent distal pulses, cool skin temperature in the affected limb, and poor capillary refill.

atropine is given to

dry secretions

In carcinoma, the pain may be

dull and persistent because the cancer has invaded the chest wall, mediastinum, or spine.

Lung consolidation such as in pneumonia or fluid accumulation produces the

dull sound.

Compliance:

elasticity and ability of lungs to expand - increased in emphysema

High or increased compliance occurs if the lungs have lost their elasticity and the thorax is overdistended, as in

emphysema.

Respiration is the

exchange of oxygen and CO2 between atmospheric air and the blood and between the blood and the cells.

The frontal lobe completes

executive functions and cognition.

Upper Respiratory Tract Structures Nose -

filters, humidifies, warms

For at least 6 hours before bronchoscopy, the client must abstain from

food or drink to decrease the risk of aspiration. - Risk is increased because the client receives local anesthesia, which suppresses the reflexes to swallow, cough, and gag.

laryngopharynx -

from hyoid bone to cricoid cartilage

4 Paranasal Sinuses

frontal, ethmoid, sphenoid, maxillary

Orthopnea A symptom of underlying disease caused by

heart failure, lung disease, COPD

stridor =

high pitched sound from partially blocked airway, usu. inspiration - Stridor = Emergency

A tympanic sound is a

high-pitched sound commonly heard over the stomach or bowel.

Bronchial sounds are relatively

high-pitched sounds.

if V/Q imbalance - can result in

hypoxemia.

When a blood clot exists in a pulmonary vessel (embolus),

impaired perfusion results.

Orthopnea is the

inability to breathe easily except when upright. This positioning can mean while in bed and propped with a pillow or sitting in a chair.

The vascular and ciliated mucous lining of the nasal cavities warms and humidifies

inspired air. .

A client has been newly diagnosed with emphysema. The nurse should explain to the client that by definition, ventilation:

is breathing air in and out of the lungs.

symptoms of allergic reactions to the contrast medium are

itching, hives, or difficulty in breathing.

___________ presents as the elevation of the scapula and a corresponding S-shaped spine.

kyphoscoliosis

The thyroid cartilage is the

largest of the cartilage structures; part of it forms the Adam's apple.

If cough is high pitched it may be ....

laryngotracheitis (croup)

A dull percussed sound, heard over the chest wall, is indicative of

little or no air movement in that area of the lung.

A dull percussed sound, heard over the chest wall, is indicative of

little or no air movement in that area of the lung. Lung consolidation such as in pneumonia or fluid accumulation produces the dull sound.

Foul-smelling sputum and bad breath may indicate a

lung abscess,

bronchogenic carcinoma

lung cancer; cancer originating in the bronchi

The client may need to hold his or her breath for short periods during

lung scans and for bronchoscopy.

Pink-tinged mucoid sputum is associated with a

lung tumor, and profuse,

Vital capacity is the

maximum volume of air exhaled from the point of maximum inspiration.

Expiratory reserve volume is the

maximum volume of air that can be exhaled after a normal inhalation.

Following bronchoscopy, level of consciousness is the

most important assessment because changes in the client's level of consciousness may alert the nurse to serious neurologic problems.

A Black client with asthma seeks emergency care for acute respiratory distress. Because of this client's dark skin, the nurse should assess for cyanosis by inspecting the:

mucous membranes.

It is the function of the cilia alone to move

mucus in the nasal cavities and filter the inspired air

Pulse oximetry is a

noninvasive method of monitoring oxygen saturation of hemoglobin. A probe is placed on the fingertip, forehead, earlobe, or bridge of nose. Inaccuracy of results may be from anemia, bright lights, shivering, nail polish, or peripheral vascular disease.

A resonant sound is noted over

normal lung tissue.

The ethmoidal sinuses are located between the

nose and eyes.

The cricoid cartilage is the

only complete cartilaginous ring in the larynx (located below the thyroid cartilage).

Diffusion is the exchange of

oxygen and CO2 through the alveolar-capillary membrane.

When a blood clot exists in a pulmonary vessel (embolus), impaired

perfusion results.

Egophony may occur in patients diagnosed with

pleural effusion.

The nurse auscultates the lung sounds of a client during a routine assessment. The sounds produced are harsh and cracking, sounding like two pieces of leather being rubbed together. The nurse would be correct in documenting this finding as

pleural friction rub.

Sputum that is rust colored suggests infection with

pneumococcal pneumonia.

A low ventilation-perfusion ratio exists in

pneumonia or with a mucus plug.

Bronchial breath sounds occur in consolidation, such as

pneumonia.

A silent unit occurs in

pneumothorax or ARDS.

A silent unit occurs in

pneumothorax or acute respiratory distress syndrome.

Conditions associated with decreased compliance include

pneumothorax, pleural effusion, and acute respiratory distress syndrome (ARDS).

Absent breath sounds occurs in

pneumothorax.

nasopharynx -

posterior to nose, above soft palate, contains adenoids adenoids - part of lymph system

If cough is worse when supine it may be ...

postnasal drip (rhinosinusitis)

Pulmonary perfusion refers to the

provision of blood supply to the lungs.

frothy pink sputum may indicate

pulmonary edema, which would require immediate admission.

Pink, frothy sputum may be an indication of

pulmonary edema.

Profuse frothy, pink material, often welling up into the throat, may indicate

pulmonary edema.

Bronchitis usually yields a small amount of

purulent sputum.

Bronchiectasis and a lung abscess usually are associated with

purulent thick and yellow-green sputum.

The inspiratory and expiratory centers in the medulla oblongata and pons control the

rate and depth of ventilation. When injury occurs or increased intracranial pressure results, respirations are slowed.

If a client cannot breathe easily while lying down, there is an element of

respiratory distress.

The middle lobe of the lung is only found on the

right side of the thorax and can only be assessed anteriorly. It is located at the fourth rib, at the right sternal border and extends to the fifth rib, in the midaxillary line.

A pleural friction rub is heard

secondary to inflammation and loss of lubricating pleural fluid.

When the contrast medium is infused, the client will

sense a warm, flushed feeling.

airway resistance

size of airway, lung volume , airflow velocity

Trachea -

smooth muscle, C-shaped rings of cartilage at regular intervals, prevent collapse. passage between larynx and bronchi

Crackles are

soft, high-pitched, discontinuous popping sounds that occur during inspiration.

The Wernicke's area is the area linked to

speech.

Surfactant reduces

surface tension, thereby improving overall lung function.

Alveolar macrophages, the

third type of alveolar cells, are phagocytic cells that ingest foreign matter and, as a result, provide an important defense mechanism.

The arytenoid cartilages are used with the

thyroid cartilage in vocal cord movement.

The term for the volume of air inhaled and exhaled with each breath is

tidal volume.

Diaphragmatic and pursed-lip breathing are

two controlled breathing techniques that help the client conserve energy.

A mechanical ventilator assists patients who are

unable to breathe on their own.

The epiglottis is the

valve flap of cartilage that covers the opening to the larynx during swallowing.

A dead space exists when

ventilation exceeds perfusion (high ventilation-perfusion ratios). - An example of a dead space is a pulmonary embolus, pulmonary infarction, and cardiogenic shock.

A high ventilation-perfusion rate means that

ventilation exceeds perfusion, causing dead space. The alveoli do not have an adequate blood supply for gas exchange to occur. This is characteristic of a variety of disorders, including pulmonary emboli, pulmonary infarction, and cardiogenic shock.

Thin mucoid sputum is associated with

viral bronchitis which would require no use of antibiotics due to viral origin.

Larynx -

voice box. Connects pharynx and trachia -Epiglottis - valve flap covers opening to larynx when swallowing Glottis - the opening between vocal cords Thyroid cartilage - part forms Adams apple, used in vocal cord movement Cricoid cartilage - only complete cartilage ring Arytenoid cartilages - used in vocal cord movement Vocal cords - ligaments in lumen of larynx, produce sounds

Residual volume is the

volume of air remaining in the lungs after a maximum expiration.

Lower Respiratory Tract Structures Pleura

•visceral pleura - cover the lungs •parietal pleura - lines the thoracic cavity, mediastinum, diaphragm, inner ribs. •small amount of pleural fluid between lubricates, helps with smooth motion