Chapter 20 - Assessment of Respiratory Function

You are caring for a client admitted with chronic bronchitis. The client is having difficulty breathing, and the family asks you what causes this difficulty. What would be your best response?

"Conditions such as chronic bronchitis cause thickening of the bronchial mucosa so it makes it harder to breathe."

The nurse is instructing the client on the normal sensations, which can occur when contrast medium is infused during pulmonary angiography. Which statement, made by the client, demonstrates an understanding?

"I will feel warm and an urge to cough."

What are some other diagnostic tests?

- Bronchoscopy

What are the adventitious breath sounds?

- Crackles

What are the major signs and symptoms of respiratory disease?

- Dyspnea

What are the structures of the lower respiratory system?

- Lungs

What are risk factors for respiratory disease?

- Smoking

What are the check that indicate successful placement?

- Symmetrical rise and fall of the chest

The nurse is instructing the patient on the collection of a sputum specimen. What should be included in the instructions? (Select all that apply.)

-Initially, clear the nose and throat.

Causes of Hemoptysis?

-Pulmonary infection

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

...

Bronchoscopy purpose:

1) to visualize tissues and determine the nature, location, and extent of the pathologic process

How many breaths does an adult take when resting comfortably?

12-18

What should the cuff pressures of an endotracheal tube be?

15-20mmHg

The lungs contain how many alveoli?

300 million

How many lobes of the lungs are there?

5 (3 on the right and 2 on the left)

average tidal volume of young adult is -

500 mL

Air is a mixture of which gases?

78.6% nitrogen

A nurse understands that a safe but low level of oxygen saturation provides for adequate tissue saturation while allowing no reserve for situations that threaten ventilation. What is a safe but low oxygen saturation level for a patient?

95%

Normal SpO2 values:

95%-100%

What is the normal pulse oximetry level?

95-100%

What is cyanosis?

A bluish colouring of the skin, it's a very LATE indicator of hypoxia.

What is one of the earliest indicators of the need for oxygen therapy?

A change in the patient's respiratory status.

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

A client experiencing hypothermia

What is hypoxia?

A decrease in oxygen supply to the tissues.

What is hypoxemia?

A decrease in the arterial oxygen tension in the blood.

What aides the endotracheal tube placement?

A laryngoscope

The nurse is caring for a patient diagnosed with pneumonia. The nurse will assess the patient for tactile fremitus by completing which of the following?

Asking the patient to repeat "ninety-nine" as the nurse's hands move down the patient's thorax

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

Assess the patient for a cough reflex

A cough in the morning may indicate what?

Bronchitis

How are ABG's obtained?

By arterial puncture (radial, brachial, femoral or indwelling arterial catheter)

What is kyphoscoliosis?

Characterized by elevation of the scapula and a corresponding S-shaped spine.

The bronchi and bronchioles are also lined with cells that have surfaces covered with what?

Cilia, that keep mucous and foreign substances away from the lungs

What finding by the nurse may indicate that the patient has chronic hypoxia?

Clubbing of the fingers

What are Biot's respirations?

Cluster breathing, cycles of breaths that vary in depth and have varying periods of apnea.

Function of trachea

Connects pharynx to the larynx to the lungs, allowing the passage of air

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

Count the rate of respirations

A client arrives in the emergency department reporting shortness of breath. She has 3+ pitting edema below the knees, a respiratory rate of 36 breaths per minute, and heaving respirations. The nurse auscultates the client's lungs to reveal coarse, moist, high-pitched, and non-continuous sounds that do not clear with coughing. The nurse will document these sounds as which type?

Crackles

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

A son brings his father into the clinic, stating that his father's color has changed to bluish around the mouth. The father is confused, with a respiratory rate of 28 breaths per minute and scattered crackles throughout. The son states this condition just occurred within the last hour. Which of the following factors indicates that the client's condition has lasted for more than 1 hour?

Cyanosis

The nurse is assessing a patient in respiratory failure. What finding is a late indicator of hypoxia?

Cyanosis

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 of the following is a late sign of hypoxia?

Cyanosis

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

For air to enter the lungs (process of ventilation), the intrapulmonary pressure must be less than atmospheric pressure so air can be pulled inward. Select the movement of respiratory muscles that makes this happen during inspiration.

Diaphragm contracts and elongates the chest cavity

What is dyspnea?

Difficult or laboured breathing, shortness of breath.

Syncope

Fainting

Why must ventilation/perfusion (V./Q.) be balanced?

For adequate gas exchange

Why does the respiratory system depend on the cardiovascular system?

For perfusion, or blood flow through the pulmonary system

Paranasal sinuses

Four bony cavities lined with nasal mucosa and pseudostratisfied columnar epithelium

What does clubbing of the fingers indicate?

Lung disease - patients with chronic hypoxic conditions, chronic lung infections, and malignancies of the lung.

Coughing after food intake?

May indicate aspiration of material into the tracheobronchial tree.

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

A patient describes his chest pain as knife-like on inspiration. Which of the following is the most likely diagnosis?

Pleurisy

Sudden dyspnea in a healthy person may indicate what?

Pneumothorax

Depending on the type of V./Q., how is hypoxia eliminated?

Supplemental oxygen

What is a tracheostomy?

Surgical procedure in which an opening is made into the trachea and a tube is inserted.

The nurse is admitting a client who just had a bronchoscopy. Which assessment should be the nurse's priority?

Swallow reflex

Total Lung Capacity (TLC)?

The volume of air in the lungs after a maximum inspiration

A _________ is performed by injecting a radioactive agent into a peripheral vein and then obtaining a scan of the chest to detect radiation. The isotope particles pass through the right side of the heart and are distributed into the luna in proportion to the regional blood flow, making it possible to trace and measure blood perfusion to the lung.

V/Q lung scan

What is apnea?

Varying periods of cessation of breathing usually lasting >20 seconds.

What is the difference between respiration and ventilation?

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

What is the most reliable and accurate method for delivering precise concentration of oxygen through noninvasive means?

Venturi Mask

What causes bronchial spasms?

Violent coughing

Bronchi divides into smaller branches known as

bronchioles

hypoxemia

decrease in arterial oxygen tension in the blood

A ________ is a radioisotope lung scan used to detect inflammatory conditions; abscesses; adhesions; and the presence, location, and size of tumors.

gallium scan

rhonchi

low-pitched wheezing or snoring sound associated with partial airway obstruction, heard on chest auscultation

rhonci

low-pitched wheezing or snoring sound associated with partial airway obstruction, heard on chest auscultation

lower respiratory tract consists of

lungs

Physiologic dead space

portion of the tracheobronchial tree that does not participate in gas exchange

physiologic dead space

portion of the tracheobronchial tree that does not participate in gas exchange

A cough that worsens when the patient is supine suggests -

postnasal drip (rhinosinusitis)

cilia

short, fine hairs that provide a constant whipping motion that serves to propel mucus and foreign substances away from the lung toward the larynx.

orthopnea

shortness of breath when lying down that is relieved by sitting or standing

apnea

temporary cessation of breathing

Dry, irritative cough is characteristic of -

upper respiratory tract infection of viral origin, or side effect of ACE inhibitor therapy.

The respiratory system is composed of the _____ and _____ tract & are responsible for _______.

upper; lower; ventilation

Sputum studies

used to identify pathogens and/or determine if malignant cells are present.

pulmonary angiography

used to investigate congenital abnormalities of the pulmonary vascular tree

fremitus

vibrations of speech felt as tremors of the chest wall during palpation

______ ______ covers the lungs

visceral pleura

Larynx is also known as

voice box

The pulmonary circulation is considered a what kind of system?

A low-pressure system because the systolic blood pressure in the pulmonary artery is 20 to 30 mm Hg and the diastolic pressure is 5 to 15 mm Hg.

Pink-tinged muccoid sputum suggests?

A lung tumor

What is pulse oximetry?

A noninvasive method to monitor the oxygen saturation of the blood (may be unreliable)

What ensures a thorough auscultation assessment of the lungs?

A systematic assessment with listening to 2 inspirations/expiration cycles.

What are friction rubs?

A type of crackle secondary to inflammation and loss of lubricating pleural fluid.

The nurse working in the radiology clinic is assisting with a pulmonary angiography. The nurse knows that when monitoring clients after a pulmonary angiography, what should the physician be notified about?

Absent distal pulses

_______ dyspnea is more severe than _______.

Acute; chronic

where does oxygen and carbon dioxide exchange take place?

Alveoli

What is barrel chest?

An increase in the anteroposterior diameter of the thorax caused by over-inflation of the lungs.

What is hyperpnea?

An increase in the depth of respirations.

What are wheezes?

Associated with bronchial wall oscillation and changes in airway diameter.

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

Causes of increased airway resistance

Asthma - contraction of bronchial smooth muscle

Which of the following is a deformity of the chest that occurs as a result of over inflation of the lungs?

Barrel chest

If concern exists about fluid accumulation in a client's lungs, what area of the lungs will the nurse focus on during assessment?

Bilateral lower lobes

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

What are crackles?

Discrete, non-continuous sounds that result from delayed reopening of deflated airways. They are usually heard on inspiration.

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

When are sputum cultures collected?

Early in the morning before food or drink.

During a preadmission assessment, for what diagnosis would the nurse expect to find decreased tactile fremitus and hyperresonant percussion sounds?

Emphysema

How does air flow?

From a region of higher pressure to a region of lower pressure

A patient with sinus congestion complains of discomfort when the nurse is palpating the supraorbital ridges. The nurse knows that the patient is referring to which sinus?

Frontal

What are the 4 types of paransal sinuses? (named by location)

Frontal, ethmoid, sphenoid, maxillary

lower respiratory tract responsibility

Gas exchange (diffusion)

What does gas exchange involve?

Gas exchange involves delivering oxygen to the tissues through the bloodstream and expelling waste gases, such as carbon dioxide, during expiration.

What are Kussmaul's respirations?

Hyperventilation that is marked by an increase in rate and depth, associated with seer acidosis of diabetic or renal origin.

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

Silent Unit (D)

In the absence of both ventilation and perfusion or with limited ventilation and perfusion, a condition known as a silent unit occurs (D). This is seen with pneumothorax and severe respiratory distress syndrome.

Normal Ratio (A)

In the healthy lung, a given amount of blood passes an alveolus and is matched with an equal amount of gas. The ratio is 1:1 (ventilation matches perfusion)

What is orothpnea?

Inability to breath easily except in an upright position.

Low Ventilation-Perfusion Ratio: Shunts (B)

Low ventilation-perfusion states may be called shunt-producing disorders. When perfusion exceeds ventilation, a shunt exists (B). Blood bypasses the alveoli without gas exchange occurring. This is seen with obstruction of the distal airways, such as with pneumonia, atelectasis, tumor, or a mucus plug.

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

A physician has ordered that a client with suspected lung cancer undergo magnetic resonance imaging (MRI). The nurse explains the benefits of this study to the client. Included in teaching would be which of the following regarding the MRI?

MRI can view soft tissues and can help stage cancers

What is stridor?

Narrowing of the airway, due to inflammation or obstruction, possible airway emergency.

Upon palpation of the sinus area, what would the nurse identify as a normal finding?

No sensation during palpation

The upper respiratory tract consists of

Nose, paranasal sinuses, pharynx, tonsils and adenoids, larynx, trachea.

Upper airway structures consist of what?

Nose, paranasal sinuses; pharynx, tonsils, and adenoids; larynx; and trachea.

What is funnel chest?

Occurs when there is a depression in the lower portion of the sternum.

When is wheezing heard most often?

On expiration

How are VBGs obtained?

Only by blood sample from pulmonary artery catheter.

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

Orthopnea

Which of the following terms will the nurse use to document the inability of a patient to breathe easily unless positioned upright?

Orthopnea

_________is radioisotope study with advanced diagnostic capabilities that is used to evaluate lung nodules for malignancy. It can detect and display metabolic changes in tissue, distinguish normal tissue from diseased tissue(cancer), differentiate viable from dead or dying tissue, show regional blood flow, and determine the distribution and fate of medications in the body.

PET scan

Function of the nose

Passageway for air to pass to and from the lungs; filters, humidifies and warms air.

What is the pleura and it's purpose?

Pleura lines the lungs and the wall of the thoracic cavity are lined with a serous membrane and serves to lubricate the thorax and lungs.

A cough that worsens when the patient is supine suggests what?

Postnasal Drip (Rhinosinusitis)

What is expiratory grunting?

Premature closure of the glottis in an attempt to increase the physiologic end expiratory pressure (often heard in children).

Foul-smelling sputum and bad breath point to what?

Presence of a lung abscess, bronchiectasis, or an infection.

A 53-year-old client sees the physician because he has had laryngitis for 2 weeks. After a thorough examination, the doctor orders medications and instructs the client to follow-up in 1 week if his voice has not improved. What is the primary function of the larynx?

Producing sound

Although the major function of the larynx is vocalization, what else does it do?

Protects the lower airway from foreign substances & facilitates coughing; referred to as "watchdog of the lungs."

What is oxygen therapy used for?

Provide adequate transport of oxygen in the blood, to decrease the work of breathing, and to reduce stress on the myocardium.

Profuse, frothy, pink material, often welling up into the throat?

Pulmonary Edema

___________is used to investigate congenital abnormalities of the pulmonary vascular tree and thromboembolic disease of the lungs, such as pulmonary emboli, when less invasive testing is inconclusive or catheter-based interventions such as angioplasty are anticipated. To visualize the pulmonary vessels, a radiopaque agent is injected through a catheter, which has been initially inserted into a vein and then threaded into the pulmonary artery.

Pulmonary angiography

The nurse is caring for a client whose respiratory status has declined since shift report. The client has tachypnea, is restless, and displays cyanosis. Which diagnostic test should be assessed first?

Pulse oximetry

A nurse is reviewing arterial blood gas results on an assigned client. The pH is 7.32 with PCO2 of 49 mm Hg and a HCO3−of 28 mEq/L. The nurse reports to the physician which finding?

Respiratory acidosis

The nurse is caring for a client with chronic obstructive pulmonary disease. The client calls the doctor and states having difficulty breathing and overall feeling fatigued. The nurse realizes that this client is at high risk for which condition?

Respiratory acidosis

A client with chronic bronchitis is admitted to the health facility. Auscultation of the lungs reveals low-pitched, rumbling sounds. Which of the following describes these sounds?

Rhonchi

What lines the lungs and the wall of the thoracic cavity?

Serous membrane

Function of the paranasal sinuses

Serves as a resonating chamber in speech

In which position should the patient be placed for a thoracentesis?

Sitting on the edge of the bed

The nurse is caring for a patient who is to undergo a thoracentesis. In preparation for the procedure, the nurse will position the patient in which of the following positions?

Sitting on the edge of the bed

What is airway resistance determined by?

Size of the airway through which air is flowing and lung volumes and airflow velocity

What is the definition of bradypnea?

Slow breathing

The nurse receives an order to obtain a sputum sample from a client with hemoptysis. When advising the client of the physician's order, the client states not being able to produce sputum. Which suggestion, offered by the nurse, is helpful in producing the sputum sample?

Take deep breaths and cough forcefully

What is a pulmonary function testing (spirometry)?

Test to assess respiratory function and to determine the extent of dysfunction. It measure lung volumes, ventilatory function, mechanics of breathing, diffusion and gas exchange.

What is oxygen therapy?

The administration of oxygen at greater than 21% (the concentration of oxygen in room air).

What is hemoptysis?

The expectoration of blood from the respiratory tract.

The nurse answers the call light of a male patient. The patient is complaining of an irritating tickling sensation in the throat, a salty taste, and a burning sensation in the chest. Upon further assessment, the nurse notes a tissue with bright red, frothy blood at the bedside. The nurse can assume the source of the blood is likely from which of the following?

The lungs

Vital Capacity (VC)?

The maximum volume of air exhaled from the point of maximum inspiration Normal Volume: 4,600 ML

Inspiratory Capacity (IC)?

The maximum volume of air inhaled after normal expiration Normal Volume: 3,500 mL

Expiratory reserve volume (ERV)?

The maximum volume of air that can be exhaled forcibly after a normal exhalation. Normal Volume: 1,100 ML

Inspiratory reserve volume (IRV)?

The maximum volume of air that can be inhaled after a normal inhalation. Normal Volume: 3,000 ML

What is arterial blood gases studies?

The measurement of arterial oxygenation and carbon dioxide levels. It is used to assess the adequacy of alveolar ventilation and the ability of the lungs to provide oxygen and remove carbon dioxide.

What does the nose serve to do?

The nose serves as a passage way for air to pass to and from the lungs. Filters and humidifies and warms the air as it is inhaled.

Coughing at night may indicate what?

The onset of left-sided heart failure or bronchial asthma.

What is endotracheal intubation?

The placement of a tube to provide a patent airway for mechanical ventilation and for removal of secretions.

What is the definition of respiration?

The process of gas exchange between atmospheric air and the blood at the alveoli, and between the blood cells and the cells of the body.

What are Cheyne-Stokes?

The rate and depth of breathing increase, then decrease until apnea occurs.

Tidal Volume (TV)?

The volume of air inhaled and exhaled with each breath.

Residual Volume (RV)?

The volume of air remaining in the lungs after a maximum exhalation. Normal Volume: 1,200 ML

What is a tidal volume?

The volume of each breath.

Why is the patient with an altered level of consciousness from any cause is at risk for airway obstruction?

There is a loss of the protective reflexes (cough and swallowing) and the tone of the pharyngeal muscles, which causes the tongue to fall back and block the airway.

What is pigeon chest?

There is an increase in the anteroposterior diameter caused by displacement of the sternum.

The nurse is caring for a client diagnosed with asthma. While performing the shift assessment, the nurse auscultates breath sounds including sibilant wheezes, which are continuous musical sounds. What characteristics describe sibilant wheezes?

They can be heard during inspiration and expiration

Why must cough suppressants be used with caution?

They may prevent the patient from clearing mucus from the airway and result in a delay in seeking indicated health care.

A client with a suspected pulmonary disorder undergoes pulmonary function tests. To interpret test results accurately, the nurse must be familiar with the terminology used to describe pulmonary functions. Which term refers to the volume of air inhaled or exhaled during each respiratory cycle?

Tidal volume

What is a prominent function of the sinuses?

To serve as a resonating chamber in speech.

What is oxygen toxicity?

Too high a concentration of oxygen (greater than 50%) is administered for an extended period (longer than 48 hours).

Knowing respiratory physiology is important to understand how the disease process can work within that system. Which hollow tube transports air from the laryngeal pharynx to the bronchi?

Trachea

A 53-year-old male is a regular client in the respiratory group where you practice nursing. As with all adults, millions of alveoli form most of the pulmonary mass. The squamous epithelial cells lining each alveolus consist of different types of cells. Which type of the alveoli cells produce surfactant?

Type II cells

A dry irritative cough is characteristic of what?

Upper respiratory tract infection of viral origin

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

The nursing instructor is teaching a pre-nursing pathophysiology class. The class is covering the respiratory system. The instructor explains that the respiratory system is comprised of both the upper and lower respiratory system. The nose is part of the upper respiratory system. The instructor continues to explain that the nasal cavities have a vascular and ciliated mucous lining. What is the purpose of the vascular and ciliated mucous lining of the nasal cavities?

Warm and humidify inspired air

The nurse is caring for a client with a decrease in airway diameter causing airway resistance. The client experiences coughing and mucus production. Upon lung assessment, which adventitious breath sounds are anticipated?

Wheezes

The nurse is performing chest auscultation for a patient with asthma. How does the nurse describe the high-pitched, sibilant, musical sounds that are heard?

Wheezes

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

When does cyanosis appear?

When there is 50g/L of unoxygenated hemoglobin.

High Ventilation-Perfusion Ratio: Dead Space (C)

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

CT scan

a series of x-ray photographs taken from different angles and combined by computer into a composite representation of a slice through the body.

what is the pharynx? (throat)

a tubelike structure that connects the nasal and oral cavities to the larynx. Divided into three regions: nasal, oral, and laryngeal

egophony

abnormal change in tone of voice that is heard when auscultating the lungs

Bronchophony:

abnormal increase in clarity of transmitted voice sounds heard when auscultating the lungs

bronchophony

abnormal increase in clarity of transmitted voice; sounds heard when auscultating the lungs

Tachypnea

abnormally rapid respirations

tachypnea

abnormally rapid respirations

Bronchi (one for each lung)

air passages to the lungs

Alveoli

air sacs that allow for gas exchange

Factors that may alter ventilation -

airway blockage, changes in compliance, gravity

fluoroscopic studies

allows for live x-ray images via camera to a video screen.

Third type of alveolar cells are known as

alveolar macrophages

Thoracentesis

aspiration of fluid and air from the pleural space.

Coughing after food intake may indicate -

aspiration of material into the tracheobronchial tree.

arterial blood gas studies (ABGs)

assess the ability of the lungs to provide adequate oxygen delivery & removal of carbon dioxide

pulmonary perfusion

blood flow through the pulmonary vasculature

pulmonary perfusion

blood flow throughout the pulmonary vasculature

cyanosis

bluish coloring of the skin due to increased levels of unoxygenated hemoglobin in the blood

Proprioreceptors in the muscles and chest wall respond to -

body movements, causing an increase in ventilation.

Characteristics of blood from the lungs:

bright red, frothy, and mixed with sputum. Alkaline pH greater than 7.

A cough in the morning with sputum production may indicate -

bronchitis

A high pitched cough?

can be caused by laryngotrachetis.

Sudden dyspnea in a healthy person -

concern for pneumothorax (air in pleural cavity) obstruction, allergic reaction, or myocardial infarction (MI).

Sudden dyspnea in immobilized patients -

concern for pulmonary embolism (PE).

wheezes

continuous musical sounds associated with airway narrowing or partial obstruction

A very late indicator of hypoxia is -

cyanosis

A shift to the left of the oxyhemoglobin dissociation curve indicates -

decrease in factors; bond between oxygen and hemoglobin grows stronger.

hypoxia

decrease in oxygen supply to the tissues and cells

Thoracoscopy

diagnostic procedure in which the pleural cavity is examined with an endoscope and fluid and tissues can be obtained for analysis.

inspiration

diaphragm and intercostal muscles enlarge thoracic cavity

expiration

diaphragm relaxes, lungs recoil

bronchophony

direct examination of the larynx, trachea, and bronchi using an endoscope

bronchoscopy

direct examination of the larynx, trachea, and bronchi using an endoscope

bronchoscopy

direct inspection and examination of the larynx, trachea, and bronchi through either a flexible fiberoptic bronchoscope or a rigid bronchoscope.

lung compliance

elasticity and expandability of the lungs and thoracic structures

clubbing of fingers

enlargement of the tips of the fingers

Thoracoscopy nursing interventions

ensure informed consent NPO pre procedure

bronchoscopy nursing interventions

ensure informed consent obtained

Severe hypoxia results when the amount of shunting -

exceeds 20%

pulmonary diffusion

exchange of gas molecules (oxygen and carbon dioxide) from areas of high concentration to areas of low concentration

hemoptysis

expectoration of blood from the respiratory tract

What are the four pairs of bony cavities of the paranasal sinuses?

frontal, ethmoid, sphenoid, and maxillary

What is the function of the pharynx?

functions as a passageway for the respiratory and digestive tracts.

respiration

gas exchange between atmospheric air and the blood and between the blood and cells of the body

what does the low respiratory tract serve to do?

gas exchange or diffusion

Greater resistance =

greater respiratory effort required

stridor

harsh high-pitched sound heard on inspiration, usually without need of a stethoscope, secondary to upper airway obstruction

Wheezing

high-pitched, musical sound heard mainly on expiration (asthma) and inspiration (bronchitis)

air flows from _____ pressure to _____ pressure

higher, lower

A nurse interviewing a patient who says he has a dry, irritating cough that is not "bringing anything up," should ask -

if patient is taking ACE inhibitors.

orthopnea

inability to breath easily except in an upright position

ventilation/perfusion (V./Q.) imbalance occurs as a result of

inadequate ventilation, inadequate perfusion, or both.

A shift to the right of the oxyhemoglobin dissociation curve indicates -

increase in factors; less oxygen being picked up in the lungs, but more oxygen released to the tissues.

Baroreceptors, located in aortic and carotid bodies, respond to an -

increase or decrease in arterial blood pressure, causing reflex hypoventilation or hyperventilation

The sinuses are a common site of _____

infection

To determine cause of cough, the nurse must -

inquire about onset, precipitating factors, assess character and associated symptoms.

An irritative, high pitched cough can be caused by -

laryngotracheitis

increased compliance

loss of elastic recoil (over distended)

Clubbing of fingers is a sign of -

lung disease found in patients with chronic hypoxic conditions, chronic lung infections, or malignancies of the lung.

decreased compliance

lungs and thorax are stiff

normal compliance

lungs and thorax easily stretch

What does the lower respiratory tract consist of?

lungs which contain the bronchial and alveolar structures needed for gas exchange

Type I and type II alveolar cells

make up the alveolar epithelium

compliance

measure of the force required to expand or inflate the lungs

vital capacity

measured by having the patient take in a maximal breath & exhale fully through a spirometer.

The rhythm of breathing is controlled by what?

medulla oblongata and pons control the rate and depth of ventilation to meet the body's metabolic demands.

tidal volume x respiratory rate =

minute ventilation

Conditions associated with decreased compliance:

morbid obesity, pneumothorax, hemothorax, pleural effusion, pulmonary edema, atelectasis, pulmonary fibrosis, and acute respiratory distress syndrome

Ventilation

movement of air in and out of the airways

ventilation

movement of air in and out of the airways

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

pulse oximetry

non-invasive continuous monitoring of oxygen saturation of hemoglobin (SaO2)

The respiratory system performs by facilitating life-sustaining processes such as

oxygen transport, respiration, ventilation, gas exchange

The oxyhemoglobin dissociation curve shows the relationship between -

partial pressure of oxygen (PaO2) and the percentage of saturation of oxygen (SaO2).

The amount of dissolved oxygen is directly proportional to the -

partial pressure regardless of how high the oxygen pressure becomes.

oxygen saturation

percentage of hemoglobin that is bound to oxygen

What do alveolar macrophages do?

phagocytic cells that ingest foreign matter and provide important defense mechanism

The bronchioles contain submucosal glands that do what?

produce mucus that covers the inside lining of the airways

cough

protects the lungs from accumulation of secretions and inhalation of foreign bodies.

Factors that may alter perfusion -

pulmonary artery pressure, alveolar pressure, gravity

What determines the patterns of perfusion?

pulmonary artery pressure, gravity, and alveolar pressure

Pink frothy sputum may be an indication of:

pulmonary edema

The most common causes of hemoptysis include -

pulmonary infection, carcinoma of the lung, abnormalities of the heart or blood vessels, pulmonary artery or vein abnormalities, PE or infarction

Chest pain may be associated with -

pulmonary, cardiac, gastrointestinal, musculoskeletal disease or anxiety.

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

rate and depth of ventilation to meet the body's metabolic demands.

venous blood gas studies

reflects the balance between oxygen used by the tissues/organs and the amount returning to the right side of the heart.

V./Q. imbalance causes

shunting of blood resulting in hypoxia (low level of cellular oxygen)

MRI

similiar to CT scan except magnetic fields and radiofrequency signals are used instead of radiation.

crackles

soft, high-pitched discontinuous popping sounds during inspiration caused by delayed reopening of the airways

crackles

soft, high-pitched, discontinuous popping sounds during inspiration caused by delayed reopening of the airways

tidal volume can be measured using a -

spirometer

The apneustic center in the lower pons -

stimulates the inspiratory medullary center to promote deep, prolonged inspirations.

Dyspnea

subjective experience that describes difficulty breathing; shortness of breath

dyspnea

subjective experience that describes difficulty breathing; shortness of breath

thoracentesis

surgical puncture to remove fluid from the pleural space

obstructive sleep apnea

temporary absence of breathing during sleep secondary to transient upper airway obstruction

The higher the PaO2 -

the greater the amount of oxygen dissolved

The volume of oxygen physically dissolved in the plasma is measured by

the partial pressure of oxygen in the arteries (PaO2)

The trachea/windpipe serves as what?

the passage between the larynx and the right and left main stem bronchi, which enter the lungs through an opening called the hilus

The pneumotaxic center in the upper pons is thought to control -

the pattern of respirations.

The larynx/voice box connects what?

the pharynx and the trachea

Partial pressure is

the pressure exerted by each of the gases that make up air

What is another name for the larynx?

the voice box

Functional Residual Capacity (FRC)?

the volume of air remaining in the lungs after a normal expiration

what is the function of the bronchi?

these structures facilitate effective postural drainage in the patient

What does the parietal pleura line?

thoracic cavity, lateral wall of the mediastinum, diaphragm, and inner aspects of the ribs

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

tidal volume

The amount of air inspired and expired with each breath is called:

tidal volume.

Larynx/voice box main purpose?

vocalization, also protects the lower airway from foreign substances and facilitates coughing. "watchdog of the lungs"

tidal volume

volume of air inspired and expired with each breath during normal breathing

tidal volume

volume of each breath

What is the main purpose of the upper respiratory tract?

warms and filters inspired air

upper respiratory tract responsibility

warms and filters inspired air

whispered pectoriloquy

whispered sounds heard loudly and clearly upon thoracic auscultation

The trachea is commonly called the?

windpipe