Chapter Thirteen - Respiratory

When auscultating the lungs of a patient with respiratory distress, you hear adventitious sounds. This means that the patient has:

abnormal breath sounds.

In a healthy individual, the brain stem stimulates breathing on the basis of:

increased carbon dioxide levels.

bronchiolitis

inflammation of the bronchioles.

croup

inflammation of the larynx and trachea in children, associated with infection and causing breathing difficulties.

bronchitis

inflammation of the mucous membrane in the bronchial tubes. It typically causes bronchospasm and coughing.

Dyspnea is MOST accurately defined as:

shortness of breath or difficulty breathing.

pandemic

(of a disease) prevalent over a whole country or the world.

Which of the following is MOST characteristic of adequate breathing?

24 breaths/min with bilaterally equal breath sounds and pink skin

pulmonary embolism

A condition in which one or more arteries in the lungs become blocked by a blood clot.

metered-dose inhaler (MDI)

A device that delivers a measured amount of medication as a mist the patient can inhale. A MDI consists of a pressurized canister of medication in a case with a mouthpiece. MDIs are portable, efficient and convenient. People with asthma, chronic obstructive pulmonary disease (COPD), chronic bronchitis, and emphysema.

Which of the following statements regarding anaphylaxis is correct?

Anaphylaxis is characterized by airway swelling and hypotension.

chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible.

methicillin-resistant Staphyloccus aurues (MRSA)

Methicillin-resistant Staphylococcus aureus is a bacterium responsible for several difficult-to-treat infections in humans. It is also called oxacillin-resistant Staphylococcus aureus.

chronic bronchitis

Inflammation and swelling of the lining of the airways, leading to narrowing and obstruction generally resulting in daily cough. The inflammation stimulates production of mucus, which can cause further blockage of the airways. Obstruction of the airways, especially with mucus, increases the likelihood of bacterial lung infection. Chronic bronchitis is common in persons who have smoked for extended periods.

pneumonitis

Inflammation of the lung

vesicular breath sounds

Normal. The bronchial breath sounds over the trachea has a higher pitch, louder, inspiration and expiration are equal and there is a pause between inspiration and expiration. The vesicular breathing is heard over the thorax, lower pitched and softer than bronchial breathing.

severe acute respiratory syndrome (SARS)

Potentially life-threatening viral infection that usually starts with flulike symptoms

Which of the following statements regarding pulse oximetry is correct?

Pulse oximetry measures the percentage of hemoglobin that is saturated with oxygen, but does not measure the actual hemoglobin content of the blood.

anaphylaxis (anaphylactic shock)

an acute allergic reaction to an antigen (e.g., a bee sting) to which the body has become hypersensitive

Which of the following statements regarding severe acute respiratory syndrome (SARS) is correct?

SARS is a viral infection that often begins with flulike symptoms.

dyspnea

Shortness of breath or difficulty breathing.

oxygenation

Specifically used to describe interventions that provide greater oxygen supply to lungs and thus the circulation.

bronchial breath sounds

The bronchial breath sounds over the trachea has a higher pitch, louder, inspiration and expiration are equal and there is a pause between inspiration and expiration. The vesicular breathing is heard over the thorax, lower pitched and softer than bronchial breathing.

respiration

The exchange of oxygen and carbon dioxide.

Which of the following statements regarding the hypoxic drive is MOST correct?

The hypoxic drive stimulates a person to breathe on the basis of low oxygen levels.

influenza type A

Virus that has crossed the animal/human barrier and has infected humans, recently reaching a pandemic level with the H1N1 strain.

embolus

a blood clot, air bubble, piece of fatty deposit, or other object that has been carried in the bloodstream to lodge in a vessel and cause an embolism.

carbon monoxide

a colorless, odorless toxic flammable gas formed by incomplete combustion of carbon.

common cold

a common viral infection in which the mucous membrane of the nose and throat becomes inflamed, typically causing running at the nose, sneezing, a sore throat, and other similar symptoms

pulmonary edema

a condition caused by excess fluid in the lungs. This fluid collects in the numerous air sacs in the lungs, making it difficult to breathe. In most cases, heart problems cause pulmonary edema.

emphysema

a condition in which the air sacs of the lungs are damaged and enlarged, causing breathlessness.

hyperventilation

a condition in which you suddenly start to breathe very quickly. Healthy breathing occurs with a healthy balance between breathing in oxygen and breathing out carbon dioxide.

small-volume nebulizer

a device for dispensing liquid in a fine spray

epiglottis

a flap of cartilage at the root of the tongue, which is depressed during swallowing to cover the opening of the windpipe.

hypoxic drive

a form of respiratory drive in which the body uses oxygen chemoreceptors instead of carbon dioxide receptors to regulate the respiratory cycle.

stridor

a harsh vibrating noise when breathing, caused by obstruction of the windpipe or larynx

pertussis (whooping cough)

a highly contagious respiratory disease. It is caused by the bacterium Bordetella pertussis. Pertussis is known for uncontrollable, violent coughing which often makes it hard to breathe.

asthma

a respiratory condition marked by spasms in the bronchi of the lungs, causing difficulty in breathing. It usually results from an allergic reaction or other forms of hypersensitivity.

meningoccal meningitis

a severe bacterial infection of the bloodstream and meninges (a thin lining covering the brain and spinal cord).

allergen

a substance that causes an allergic reaction.

respiratory syncytial virus (RSV)

a virus that causes infections of the lungs and respiratory tract. It's so common that most children have been infected with the virus by age 2. Respiratory syncytial (sin-SISH-ul) virus can also infect adults.

epidemic

a widespread occurrence of an infectious disease in a community at a particular time.

Adventitious breath sounds

abnormal sounds that are heard over a patient's lungs and airways. These sounds include abnormal sounds such as fine and coarse crackles (crackles are also called rales), wheezes (sometimes called rhonchi), pleural rubs and stridor.

You are dispatched to a residence for a 67-year-old female who was awakened by shortness of breath and sharp chest pain. Her husband tells you that she was recently discharged from the hospital after having hip surgery. Your assessment reveals dried blood around her mouth, facial cyanosis, and an oxygen saturation of 88%. This patient's presentation is MOST consistent with:

acute pulmonary embolism.

An alert patient presents with a regular pattern of inhalation and exhalation and breath sounds that are clear and equal on both sides of the chest. These findings are consistent with:

adequate air exchange.

When administering supplemental oxygen to a hypoxemic patient with a chronic lung disease, you should:

adjust the flow rate accordingly until you see symptom improvement, but be prepared to assist his or her ventilations.

hyperventilation syndrome

also chronic hyperventilation syndrome (CHVS) and dysfunctional breathing hyperventilation syndrome is a respiratory disorder, psychologically or physiologically based, involving breathing too deeply or too rapidly (hyperventilation).

In what area of the lungs does respiration occur?

alveoli

pleural effusion

an abnormal amount of fluid around the lung.

rales

an abnormal rattling sound heard when examining unhealthy lungs with a stethoscope.

diptheria

an acute, highly contagious bacterial disease causing inflammation of the mucous membranes, formation of a false membrane in the throat that hinders breathing and swallowing, and potentially fatal heart and nerve damage by a bacterial toxin in the blood. It is now rare in developed countries because of immunization.

hay fever

an allergy caused by pollen or dust in which the mucous membranes of the eyes and nose are itchy and inflamed, causing a runny nose and watery eyes.

alkalosis

an excessively alkaline condition of the body fluids or tissues that may cause weakness or cramps.

Acidosis

an increased acidity in the blood and other body tissue (i.e. an increased hydrogen ion concentration). If not further qualified, it usually refers to acidity of the blood plasma.

tuberculosis (TB)

an infectious bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs. It is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease.

pleuritic chest pain

an inflammation of the membrane that surrounds and protects the lungs (the pleura). Inflammation occurs when an infection or damaging agent irritates the pleural surface. As a consequence, sharp chest pains are the primary symptom of pleurisy.

carbon dioxide retention

any increased body stores of carbon dioxide resulting from impaired carbon dioxide elimination in conditions such as alveolar hypoventilation, strangulation, apnea, and ventilation-perfusion abnormalities. Respiratory acidosis may result from carbon dioxide retention.

A 62-year-old man with a history of congestive heart failure presents with severe respiratory distress and an oxygen saturation of 82%. When you auscultate his lungs, you hear widespread rales. He is conscious and alert, is able to follow simple commands, and can only speak in two- to three-word sentences at a time. You should: Select one:

apply a continuous positive airway pressure (CPAP) device, monitor his blood pressure, and observe him for signs of improvement or deterioration.

While auscultating an elderly woman's breath sounds, you hear low-pitched "rattling" sounds at the bases of both of her lungs. With which of the following conditions is this finding MOST consistent?

aspiration pneumonia

You receive a call for a 70-year-old female with respiratory distress. Her husband tells you that she has congestive heart failure; however, he does not think that she has been taking her medications as prescribed. The patient is laboring to breathe, appears tired, and has cyanosis around her lips. You should:

assist her ventilations with a bag-mask device.

wheezing

breathe with a whistling or rattling sound in the chest, as a result of obstruction in the air passages.

The respiratory distress that accompanies emphysema is caused by:

chronic stretching of the alveolar walls.

Paroxysmal nocturnal dyspnea (PND), rales, and dependent edema are clinical indicators of:

congestive heart failure.

A young female is unconscious after intentionally ingesting a large amount of aspirin. You will MOST likely find her respirations:

deep and rapid.

hypoxia

deficiency in the amount of oxygen reaching the tissues.

A 30-year-old male presents with acute shortness of breath, widespread hives, and facial swelling. He denies any past medical history and takes no medications. During your assessment, you hear wheezing over all lung fields. His blood pressure is 90/50 mm Hg and his heart rate is 110 beats/min. In addition to giving him 100% oxygen, the MOST important treatment for this patient is:

epinephrine

At the onset of an acute asthma attack, patients commonly experience difficulty breathing and:

expiratory wheezing.

You are dispatched to an apartment complex where a 21-year-old female has apparently overdosed on several narcotic medications. She is semiconscious and has slow, shallow respirations. You should:

insert a nasopharyngeal airway and begin assisted ventilation.

The two processes that occur during respiration are:

inspiration and expiration.

pneumonia

lung inflammation caused by bacterial or viral infection, in which the air sacs fill with pus and may become solid. Inflammation may affect both lungs ( double pneumonia ), one lung ( single pneumonia ), or only certain lobes ( lobar pneumonia ).

In order for efficient pulmonary gas exchange to occur:

oxygen and carbon dioxide must be able to freely diffuse across the alveolar-capillary membrane.

A 60-year-old male presents with acute respiratory distress. He is conscious and alert, has pink and dry skin, and has respirations of 24 breaths/min with adequate depth. Which of the following treatment modalities is MOST appropriate for this patient?

oxygen via nonrebreathing mask and a focused secondary assessment

atelectasis

partial or complete collapse of the lung.

A 22-year-old female patient is complaining of dyspnea and numbness and tingling in her hands and feet after an argument with her fiancé. Her respirations are 40 breaths/min. You should:

provide reassurance and give oxygen as needed.

rhonchi

rattling, continuous and low-pitched breath sounds that are often hear to be like snoring. Rhonchi are also called low-pitched wheezes. They are often caused by secretions in larger airways or obstructions.

When the level of arterial carbon dioxide rises above normal:

respirations increase in rate and depth.

Which of the following conditions would LEAST likely result in hypoxia?

severe anxiety

When assessing for fluid collection in the lungs during auscultation of lung sounds, you should:

start at the lower lung fields and determine at which level you start hearing clear breath sounds.

Common signs and symptoms of acute hyperventilation syndrome include:

tachypnea and tingling in the extremities.