Upper Respiratory
What is the voice box/vocalization and protects the lower airway from foreign substances and facilitates coughing?
(hint: sometimes known as the "watchdog of the lungs")
Larynx
NOTE: connects the pharynx and the trachea
True or False
ABG is the MOST accurate measurement of the concentration of oxygen in the patients blood
TRUE
What is the difference between ventilation and perfusion?
Ventilation (breathing): movement of walls of the thoracic cage and diaphragm (inspiration/expiration)
Perfusion: exchange of oxygen and CO2 between RBC and bodies tissues
What nursing measures can be used to prevent atelectasis?
frequent turning (every 2 hours), early mobilization, cough/deep breathing, incentive spirometry (10x/hr), HOB elevation, suctioning
How is a sputum sample obtained?
sputum sample obtained by having pt RINSE mouth with water to minimize contamination by normal oral flora, breathe deeply several times, cough deeply, and expectorate the raised sputum into a sterile container.
NOTE: sputum is green-yellow --> give fluids to thin secretions
Chest configuration: what is the ratio of the anteroposterior diameter to the lateral diameter?
1:2
what is the percentage range of oxygen bound to Hgb as compared with the total amount that can be possibly carried? (in other words what is the standard % level of SaO2)
What is the normal ventilation-perfusion ratio of adequate gas exchange?
0.8 - 1.2
what is heard during lung auscultation?
decreased breath sounds and CRACKLES heard over the affected area
What are the two types of vaccine given to prevent pneumonia?
pneumococcal conjugate vaccine (PCV13)
pneumococcal polysaccharide vaccine (PPSV23)
NOTE: vaccination reduces the incidence of pneumonia, hospitalization for cardiac conditions and death in older adults
What are four main deformities of the chest associated with respiratory disease? (describe each one)
Barrel chest: result of over inflation of the lungs with increases the anteroposterior diameter of the thorax (hallmark sign of emphysema and COPD)
Funnel chest: occurs when there is a depression in the lower portion of the sternum
Pigeon chest: occurs as a result of anterior displacement of the sternum which also increases the anteroposterior diameter
kyphoscoliosis: characterized by elevation of the scapula and corresponding S shaped spine
what are the ranges for pH, PaCO2, HCO3?
pH: (acidosis) 7.35 - 7.45 (alkalosis)
PaCO2: 35 - 45 (respiratory)
HCO3: 22-28 (metabolic)
What does it mean when a patient has a LOW gas exchange of V/Q?
perfusion EXCEEDS ventilation
may cause hypoxia
NOTE: disorders that can arise - pneumonia, atelectasis, tumor, mucus plug
In atelectasis, what type of gas exchange is occurring ...
a. perfusion exceeds ventilation (shunting)
b. ventilation exceeds perfusion (dead space)
a. perfusion EXCEEDS ventilation (shunting) (Q>V)
NOTE: atelectasis refers to the closure of alveoli
In pneumonia, what type of gas exchange is occurring ...
a. perfusion exceeds ventilation (shunting)
b. ventilation exceeds perfusion (dead space)
a. perfusion EXCEEDS ventilation (shunting)
NOTE: inflammation of the lung parenchyma caused by various microorganisms
When there is an increase in lung density, such as pneumonia and pulmonary edema, it results in what three abnormal voice sounds?
bronchophony: describes vocal resonance that is more intense and clearer than normal (LOUD&CLEAR)
egophony: describes voice sounds that are distorted (repeat E)
whispered pectoriloquy: describes the ability to clearly hear whispered sounds that should not be heard
What does uncompensated, partially compensated, compensated mean?
uncompensated: CO2 or HCO3 normal
partially compensated: NOTHING is normal
compensated: pH is normal (7.4 neutral)
What does it mean when a patient has a HIGH gas exchange of V/Q?
DEAD SPACE occurs
ventilation EXCEEDS perfusion
alveoli do NOT have adequate blood supply for gas exchange to occur
NOTE: disorders that can arise - P. emboli, P. infarction, cardiogenic shock
What are the hallmarks or LATE signs of atelectasis?
tachypnea, dyspnea, mild-to-moderate hypoxemia
Patients status must be assessed ______ hours after initiation of therapy and antibiotics should be discontinued or modified based on culture results.
72 hours
What is each breath sound indicative of and how is it described?
crackles, wheezes, friction rubs, ronchi, stridor
crackles: PE due to heart failure, RDS // popping sounds
wheezes: asthma, pneumonia, HF // high-pitched whistling
friction rub: pleurisy // harsh, crackling sound; leather, subsides when pt holds breath
ronchi: associated with secretions or tumor // deep, lower-pitched rumbling; snoring quality
stridor: narrowing of upper respiratory // continuous high pitched musical sound
What does ROME mean and describe if the pH & PCO2 are increased or decreased and if its alkalosis or acidosis (each one)
R - respiratory - pH increase PCO2 decreased - alkalosis
O - opposite - pH decreased PCO2 increased - acidosis
M - metabolic - pH increased PCO2 increased - alkalosis
E - equal - pH decreased PCO2 decreased - acidosis
What are the lung volumes and describe them
tidal volume: normal breathing/ in & out
inspiratory reserve volume: max volume of air that can be inhaled
expiratory reserve volume: max volume of air that can be exhaled forcefully
residual volume: volume of air remaining in the lungs after a max exhalation
total lung capacity: volume of air in lungs after max inspiration (sum of TV, IRV, ERV, RV)
What txts are given to pts with atelectasis?
chest physiotherapy
nebulizer txt with bronchodilator
bronchoscopy
thoracentesis
What three complications can arise from pneumonia?
atelectasis, septic shock, ARDS