Respiratory assessment Flashcards

arterial blood
Terms Definitions
Physical Assessment
Patient historyInspectionPalpationPercussionAuscultation
Symmetry of chest expansionFremitusTendernessCrepitusTracheal position
Continuous, high-pitched, squeaky musical sounds. Best heard on EXPIRATION. Not usually altered by coughing. Can be heard over all lung fields.
The act of breathing.
Chest shape and sizeSpinal deformitiesSkin color, scars, lesionsType of breathingUse of accessory muscleRespiratory rate, depth and rhythmClubbing
Substernal retraction
Indrawing beneath the breastbone.
Intercostal retractions
Indrawing between the ribs.
What is torr?
Millimeters of mercury.
Gurgles (rhonchi)
Continuous, low-pitched, coarse, gurgling, harsh, louder sounds with a moaning or snoring quality. May be altered by coughing. Predominantly heard over the trachea and bronchi.
Red blood cells or RBC's
Coughed up material. Ex: phlegm
Overexpansion of the lungs characterized by deep and rapid respirations.
Tachypnea or polypnea
Abnormally fast respirations.
Patient History (Lower Respiratory)
Lower Airwaydyspneachest paincough/sputum productionwheezingcurrent medications
Patient Assessment
Percussion- assesses density or aeration of the lungs.Dull/ResonanceDiaphragm position and movementAuscultationCracklesWheezesRhonchiPleural friction rub- creaking or grating sound from roughened, inflamed pleural surface
What is normal SaO2?
95% to 100%
Crackles (rales)
Fine, short, interrupted crackling sounds; alveolar rales are high pitched. Best heard on INSPIRATION but can be heard on expiration. Most commonly heard in the bases of the lower lung lobes.
How is respiratory rhythm described?
-regular -irregular
A series of vigorous quiverings produced by hands that are placed flat against the client's chest wall. Vibration is used after percussion to increase the turbulence of the exhaled air and thus loosen thick secretions.
Arterial Blood Gases
Assess adequacy of oxygenation.Assess alveolar ventilationAssess acid-base balanceMonitor patients on ventilatorsEstablish pre-op baseline parametersEnlighten electrolyte therapy
Neurochemical Control of Ventilation
Respiratory center— transmits impulses to the respiratory muscles causing them to contract and relax.Chemoreceptors– central and peripheralCentral – monitor arterial blood indirectly by sensing changes in the ph.Peripheral- primarily sensitive to O2 levels in arterial blood.
Pectus carinatum
Pigeon chest- a permanent deformity that may be caused by rickets. A narrow traverse diameter anteroposterior diameter, and a protruding sternum characterize pigeon chest.
A musical or drumlike sound produced form an air-filled stomach.
Vesicular breath sounds
Best heard on INSPIRATION. Soft-intensity, low pitched, "gentle sighing" sounds created by air moving through smaller airways (bronchioles and alveoli).
Nasal cannula
Nasal prongs. Most common and inexpensive. It delivers 24% to 45% at flow rates of 2 to 6 L per minute.
Bluish discoloration of the skin and mucous membranes caused by reduced O2 in the blood.
The presence of blood in the sputum.
Not produced in the normal body. BOOMING sound that can be heard over an emphysematous lung.
Diaphragmatic (abdominal) breathing
Breathing that involves the contraction and relaxation of the diaphragm, and it is observed by the movement of the abdomen, which occurs as a result of the diaphragm's contraction and downward movement.
A thudlike sound produced by dense tissue such as the liver, spleen or heart.
Arterial Oxygenation
PaO2- amount of O2 dissolved in plasma; Partial pressure exerted by O2 as it diffuses across the alveolocapillary membrane.SaO2- Percentage of O2 bound to Hg. Changes in Hg concentration affect oxygenation.
Pectus excavatum
Funnel chest- a congenital defect, is the opposite of pigeon chest in that the sternum is depressed, narrowing the anteroposterior diameter.
Respiratory rhythm
The regularity of the expirations and the inspirations.
Barrel chest
The ratio of the anteroposterior to transverse diameter is 1 to 1, is seen in clients with thoracic kyphosis (excessive convex curvature of the thoracic spine) and emphysema.
What some causes of decreased respiratory rate?
-decreased environmental temperature-certain medications-increased intracranial pressure.
What is surfactant?
A lipoprotein produced by specialized alveolar cells. It acts like a detergent, reducing the surface tension of alveolar fluid. Without surfactant, lung expansion is exceedingly difficult and the lungs collapse.
Postural drainage
The drainage by gravity of secretions from various lung segments. Postural drainage treatments are scheduled two or three times daily, depending on the degree of lung congestion. The best times include before breakfast, before lunch, in the late afternoon and before bedtime.
Tactile fremitus
Fremitus is a palpable vibration on the human body. Ex: ask the client to repeat the work 99 and palpate the vibrations on the back.
Pulse oximeter
A noninvasive device that estimates a client's arterial blood oxygen saturation (SaO2) by means of a sensor attached to the client's finger, toe, nose, earlobe, or forehead. The pulse oximeter can detect hypoxemia before clinical signs and symptoms develop.
Respiratory membrane?
The alveolar and capillary walls form the respiratory membrane. Gas exchange occurs b/w the air on the alveolar side and the blood on the capillary side.
A condition in which the elastic and muscular tissues of the arteries are replaced with fibrous tissue.
Upper Respiratory Tract
Nose and sinuses- warm, moisten and filter air; promote vocal resonancePharynx and Tonsil- filter bacteria or foreign matterLarynx- major function is vocalizationTrachea- -or windpipe serves as the passage between the larynx and the bronchi
Terminology for Ventilatory Insufficency
Hypoxia- deficiency of O2. Anoxia- without O2.Hypercapnia- increased amount of CO2 in blood. Cheyne-Stokes- period of apnea followed by increasing depth and frequency or resp.Kussmaul breathing- abnormally deep, very rapid sighing respirations.OrthopneaDyspnea
Patient History (Upper Respiratory)
Upper Airwayhx of mouth breathinghx of sinus surgery and/or sinusitispain on swallowingpresence of nasal discharge, allergychange in voice: hoarsenesshx of smoking/alcohol use
Tidal volume
The volume of air that is normally inhaled and exhaled.
Partial rebreather mask
The oxygen reservoir mask that is attached allows the client to rebreathe about the first 1/3 of the exhaled air in conjunction with O2. The bag must not totally deflate during inspiration to avoid CO2 buildup. It delivers 60% to 90% at liter flows of 6 to 10 per minute.
Broncho-vesicular sounds
Can be heard on both INSPIRATION AND EXPIRATION. Moderate-intensity and moderate -pitched "blowing" sounds created by air moving through larger airway (bronchi).
Nonrebreather mask
One-way valves on the mask and between the reservoir bag and the mask prevent the room air and the client's exhaled air from entering the bag so only the O2 in the bag is inspired. The bag must not deflate to prevent CO2 buildup. It delivers 95% to 100% at liter flows of 10 to 15 L per minute.
What is intrapleural pressure?
Pressure in the pleural cavity surrounding the lungs. It is always slightly negative in relation to atmospheric pressure. This negative pressure is essential bc it creates the suction that holds the visceral pleura and the parietal pleura together as the chest cage expands and contracts. It also causes the pleura to adhere together.
What is partial pressure?
The pressure exerted by each individual gas in a mixture according to its % concentration in the mixture.
Interpreting ABGs (answer)
PaO2= 56: SaO2=88% PaO2 < 80 and SaO2 <93% indicate hypoxemia2. pH=7.32= (Acid) Acidosis PCO2=50= (Acid) Acidosis HCO3=24=Normal3. pH and PCO2 match= respiratory acidosis4. pH is abnormal and HCO3 is normal= no compensation.
Respiratory quality or character
Those aspects of breathing that are different from normal, effortless breathing such as the amount of effort a client must exert to breathe and the sound of breathing.
Which sinuses are present at birth?
The ethmoid and maxillary sinuses.
Systolic pressure
The pressure of the blood as a result of contraction of the ventricles, that is, the pressure of the height of the blood wave.
Purposes of the Respiratory System
Gas exchange- transfer of oxygen and CO2 between the atmosphere and blood.Maintain acid-base balanceSpeechSense of smellFluid balanceThermoregulation
What is the parietal pleura?
The parietal pleura lines the thorax and surface of the diaphragm.
What do mucosal epithelium produce?
They produce a thin layer of mucus, the "musous blanket," that traps pathogens and microscopic particulate matter.
Where is the angle of Louis located?
The junction between the body of the sternum (breastbone) and the manubrium (the handlelike superior part of the sternum that joins with the clavicles).
At what age do the lungs reach full inflation?
At about 2 weeks of age.
Diagnostic studies
BronchoscopyMediastinoscopyLung BiopsyThoracentesisPulmonary Function tests
Abnormally slow respirations.
The absence of breathing.
Components of ABGs
pH 7.35-7.45PaCO2 35-45 mm HgHCO3 22-26 mEq/LPaO2 80-100 mm HgSaO2 93-100%
Lower Respiratory Tract
BronchiBronchioles LungsAlveolar ducts and alveoliFunctions:Filter dust and bacteriaWarm air to body temperatureHumidify airSurfactant production by alveoli
Kussmaul's breathing
Hyperventilation that accompanies metabolic acidosis in which the body attempts to compensate (give off excess body acids) by blowing off CO2 through deep and rapid breathing.
Suprasternal retraction
Indrawing above the clavicles.
Adventitious breath sounds
Abnormal breath sounds.
SNORING or SONOROUS respiration, usually due to a partial obstruction of the upper airway.
Reduced O2 in the blood.
How is respiratory depth described?
Underexpansion of the lungs characterized by shallow respirations.
Acid-Base Balance
pH: 7.35-7.45Regulated by chemical, respiratory and renal mechanismsChange in ph will cause:Hormone and electrolyte changes, alterations in membrane response and drug uptake.Acidosis- pH <7.35Alkalosis- pH >7.45
ABG Analysis
Determine the extent of compensation. -Complete= pH is normal -Partial= pH is abnormal, the value that does not match the PH is not normal. -Absent= pH is abnormal and the component that does not match the pH is normal (i.e. no compensation occurring yet.)
The compound of oxygen and hemoglobin.
A condition of insufficient O2 anywhere in the body, from the inspired gas to the tissues.
Uncompensated respiratory acidosis (Nursing Dx)
Conclusion: Uncompensated respiratory acidosis.Nursing Dx: Ineffective airway clearance; Impaired Gas ExchangeInterventions: O2; remove secretions to maintain airway patency; HOB elevated for maximum lung expansion.
Physiology of Respiration
Pulmonary circulation or perfusion (blood flow through the pulmonary circulation)RV---PA ( R and L)—Alveolar-capillary membrane (gas exchange or diffusion)– PV- LA- LV
Devices that add water vapor to inspired air.
What lines the trachea and bronchi?
mucosal epithelium
The movement of gases or other particles from an area of greater pressure or concentration to an area of lower pressure or concentration.
Friction rub
Superficial grating or creaking sounds heard during INSPIRATION and EXPIRATION. Not relieved by coughing. Usually heard in areas of greatest thoracic expansion.
Productive cough
A cough accompanied by expectorated secretions.
Pulse pressure
The difference between the diastolic and the systolic pressures.
A SHRILL, HARSH sound heard during INSPIRATION with laryngeal obstruction.
What controls respiration?
Respiration is controlled by:1. Respiratory centers in the medulla oblongata and the pons of the brain2. Chemoreceptors located centrally in the medulla and peripherally in the carotid and aortic bodies. -These centers and receptors respons to changes in the concentrations of O2 , CO2 and hydrogen in the arterial blood.
What are some factors that affect pulse ox (SaO2)?
-Hemoglobin-Circulation-Activity-Carbon monoxide poisoning
An extremely dull sound produced by very dense tissue, such as muscle or bone.
Hypercarbia (hypercapnia)
A condition in which CO2 accumulates in the blood.
Huff cough
When the client leans forward and exhales sharply with a ''huff'' sound. This technique helps keep your airways open while moving secretions up and out of the lungs.
Costal (thoracic) breathing
Breathing that involves the external intercostal muscles and other accessory muscles, such as the sternocleidomastoid muscles.
Face mask
Covers the client's nose and mouth; may be used for oxygen inhalation. Exhalation ports on the sides of the mask allow exhaled carbon dioxide to escape. It delivers 40% to 60% at liter flows of 5 to 8 L per minute.
What is atelectasis?
A condition that occurs when ventilation is decreased and pooled secretions accumulate in a dependent area of a bronchiole and block it; collapsed portion of the lung.
Ventilation-Perfusion (V/Q)
Ventilation is the movement of gas in and out of the lungs (V).Perfusion is the filling of the pulmonary capillaries with blood (Q).Normal V/Q ratio is 1:1.
Diagnostic Studies of the Respiratory System
Blood studies- CBC, ABGsOximetrySputum studies--Gram stain, C and S, AFB, cytology Skin testsRadiologic studiesChest X-ray V/Q Scan CT scan/MRI Pulmonary AngiographyPET (Positron Emission Tomography)
Inhalation or inspiration
The intake of air into the lungs.
Incentive spirometer
Device that measures the flow of air inhaled through the mouthpiece and are used to: improve pulmonary ventilation, counteract the effects of anesthesia or hypoventilation, loosen respiratory secretions, facilitate respiratory gaseous exchange and expand collapsed alveoli.
Venturi mask
Has a wide bore tubing and color-coded jet adapters that correspond to a precise O2 concentration and liter flow. It delivers 24% to 40% or 50% at liter flows of 4 to 10 L per minute.
What is pleural fluid?
A serous lubricating solution that prevents friction during the movements of breathing and serves to keep the layers adherent through its surface tension.
What is lung compliance?
The expansibility or stretchability of lung tissue. It plays a significant role in the ease of ventilation.
What is one cause of hypoxia?
Clubbed fingers and toes.
Factors the Affect the Mechanics of Breathing
Major and accessory muscles—diaphragm and external intercostal muscles.Elastic properties of the lung and chest wall.Elastic recoil- tendency of the lungs to return to the resting state after being stretched or distended.Compliance– measure of lung and chest wall distensibility. It represents the relative ease with which these structures can be stretched.Airway Resistance- edema, obstruction, bronchospasm.
The process of exhalation
1. The diaphragm relaxes.2. The ribs move downward and inward.3. The sternum moves inward, thus decreasing the size of the thorax as the lungs are compressed.
How long does a normal adult inspiration last?
1 to 1.5 seconds
The movement of air in and out of the lungs.
When do the sphenoid sinuses begin to develop?
Later in childhood.
Patient History (Use of Oxygen)
Use of OxygenNasal cannula- 1-6 l/min (24%-44%)Simple mask- 40%-60%. Minimum flow rate 5l/min to prevent rebreathing of exhaled air.Partial rebreather mask- 60-75% with flow rate of 6-11 l/min.Nonrebreather mask- >90%Venturi mask- high flow system; delivers the most accurate O2 concentration-24%-100%
What is lung recoil?
The tendency of lungs to collapse away from the chest wall.
What 3 components does the process of respiration involve?
1. Pulmonary ventilation or breathing2. Gas exchange, which involves diffusion of O2 and CO2 b/w the alveoli and pulmonary capillaries.3. Transport of O2 from the lungs to the tissues, and CO2 from the tissues to the lungs.
What factors affect the rate of O2 transport from the lungs to the tissues?
1. Cardiac output2. # of erythrocytes and blood hematocrit3. Exercise
During a normal inspiration and expiration, how much air does an adult take in?
500 mL of air; this is called tidal volume
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