RESPIRATORY ASSESSMENT CHAPTER 17

What is the difference between sibilant and sonorous wheezes?

Sibilant - Hissing or whistling Sonorous - Full and deep

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?

Sibilant wheezes

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

Silent Unit

If the vital capacity of a patient is less than _________________, the patient will be unable to sustain spontaneous ventilation and will require respiratory assistance.

10 mL/kg

Normally, approximately what percentage of the blood pumped by the right ventricle does not perfuse the alveolar capillaries?

2%

What is the systolic blood pressure in the pulmonary artery?

20-30 mmHg

Cyanosis appears when there is at least _____________ of unoxygenated hemoglobin

5 g/dL

What is the diastolic pressure in the pulmonary artery?

5-15 mmHg

Tachypnea is rapid, shallow breathing at a rate of

>24 breaths/min

Fremitus

A palpable vibration of speech felt against the chest wall

A decrease in inspiratory capacity may indicate what type of disease?

A restrictive disease

A nurse interviewing a patient who says they have a dry, irritating cough that is not "bringing anything up" should ask whether they are taking _____________________

ACE Inhibitors

Egophony

Abnormal chance in the tone of voice that is heard when auscultating the lungs.

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 diagnosis is likely?

Asthma

Perfusion refers to blood supply to the lungs, through which the lungs receive nutrients and oxygen. What are the two methods of perfusion?

Bronchial and Pulmonary Circulation

What sign is often found in chronic hypoxic conditions/infections and congenital heart disease?

Clubbing of the fingers

How do restrictive conditions such as obesity, ascites, and pregnancy affect the expiratory reserve volume (ERV)?

ERV volume is decreased

A client is seen in the emergency room for a case of diabetic acidosis with the presence of Kussmaul respirations. What client condition is associated with the presence of Kussmaul respirations?

Hyperventilation

Hemoptysis

Coughing or spitting up blood from the respiratory tract

Barrel chest is a hallmark sign of what two conditions?

Emphysema and COPD

What structures does the larynx consist of?

Epiglottis, glottis, thyroid cartilage, cricoid cartilage, arytenoid cartilage, and vocal cords

True or False: The nurse can rely on visual inspection of the rate and depth of a patient's respiratory excursions to determine the adequacy of ventilation.

False. Explanation: Respiratory excursions may appear normal or exaggerated due to an increased work of breathing, but the patient may actually be moving only enough air to ventilate the dead space.

Which imaging study will view the thoracic cavity while in motion?

Fluoroscopy

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

Frontal Sinus

Cheyne-Stokes is associated with

HF and damage to the respiratory center of the brain

Visceral Pleura

Inner layer that covers the lungs

Which respiratory volume is the maximum volume of air that can be inhaled after a normal exhalation?

Inspiratory Reserve Volume

A patient with metabolic acidosis, renal failure, or diabetic ketoacidosis is likely to experience what breathing pattern?

Kussmal resppirations

What medication should be withhold the day of a CT?

Metformin. This prevents lactic acidosis from developing.

Parietal Pleura

Outer layer of the pleura that lines the thoracic cavity, lateral wall of the mediastinum, diaphragm, and inner aspects of the ribs

What arterial blood gas measurement beset reflects the adequacy of alveolar ventilation?

PaCO2

PO2

Partial Pressure of Oxygen

PaO2

Partial pressure of arterial oxygen

PCO2

Partial pressure of carbon dioxide

Biot's Respiration

Periods of normal breathing, followed by a varying period of apnea

Silent units are seen with ____________________ and ________________

Pneumothorax and severe ARDS

Physiologic Dead Space

Portion of the tracheobronchial tree that does not participate in gas exchange.

Cheyne-Stokes Respiration

Regular cycle where the rate and depth of breathing increase, then decrease until apnea occurs

How may obstructive diseases affect the residual volume (RV)?

Residual volume may be increased as not all the air can be exhaled.

Funnel Chest (Pectus Excavatum) may occur with which two conditions?

Rickets and Marfan Syndrome

Pigeon Chest (Pectus Carinatum) may occur with what 3 conditions?

Rickets, Marfan Syndrome, or Severe Kyphoscoliosis

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

Ronchi

Immediate intervention is warranted when what breath sounds is observed?

Stridor

To best visualize the lungs, what teaching should the nurse provide the patient getting a chest x-ray?

Take a deep breath and hold it without discomfort.

What happens to the alveoli as adults age that decreases gas exchange?

The alveolar walls contain fewer capillaries

Compliance

The force required to inflate the lungs

Pectus Carinatum

The sternum protrudes and the ribs are sloped backwards. Also known as pigeon chest.

A nurse is caring for a client who has frequent upper respiratory infections. Which structure is most helpful in protecting against infection?

Tonsils

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

Type II

The nurse documents breath sounds that are soft, with inspiratory sounds longer than expiratory and found over the periphery of the lungs. Which of the following will the nurse chart? Bronchial, Vesicular, or Bronchovesicular?

Vesicular

Bronchoscopy

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

Bronchophony

Voice sound that can be heard during auscultation when lung consolidation is present. An abnormal increase in the clarity of transmitted voice sounds.

Whispered Pectoriloquy

Whispered voice sounds heard loudly and clearly when auscultating the lungs

Pink-tinged sputum suggests

a lung tumor

If a contrast agent is required for a CT scan, the nurse should assess the patient for

allergies to iodine or shellfish

Thick and yellow, green, or rust colored sputum is a common sign of

bacterial infection

Biot's respirations are often seen in cases of __________ insult

brain

Cheyne-Stokes respirations are often seen in cases of ___________ insult

cardiac

gradual increase of sputum over time may indicate what condition(s)?

chronic bronchitis or bronchiectasis

Biots Respirations are associated with respiratory depression resulting from

drug overdose and brain injury (typically at the medulla)

Hyperventilation is associated with

exertion, anxiety, and metabolic acidosis

Crackles in general are often caused by

fluid in the airways or alveoli

What densities in the lungs can be seen on a chest x-ray?

fluid, tumors, and foreign bodies

In emphysema, _______________ compliance can be observed

increased

Bradypnea is associated with

increased intracranial pressure, brain injury, and drug overdose

Fine crackles are associated with

interstitial pneumonia and restrictive pulmonary diseases

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

Coarse crackles are associated with

obstructive pulmonary disease

Kyphoscoliosis may occur with

osteoporosis and other skeletal disorders that affect the thorax

Barrel chest occurs as a result of

overinflation of the lungs

Shunts are often seen with obstruction of the distal airways, such as with

pneumonia, atelectasis, tumor, or a mucus plug

Chest x-rays are contraindicated in

pregnant women

profuse, frothy, pink material expectorated often indicates

pulmonary edema

In absence of both ventilation and perfusion or with limited ventilation and perfusion, a condition known as a _____________________ occurs

silent unit

What factors determine lung compliance?

surface tension of the alveoli, connective tissue and water content, and compliance of the thoracic cavity

The term "Adams Apple" is used to refer to a laryngeal prominence called the

thyroid cartilage

thin, mucoid sputum is a common sign of

viral bronchitis

Tidal Volume

volume of air inhaled and exhaled with each breath