CHS 20 & 21 Respiratory

Why are right sided lung infections more common than left sided?

because the bronchus is angled down in the right lung, so if someone were to aspirate food/liquid, it’s easier to enter into the right lung, vs the left where the bronchus is angled straight across

What is normal flora?

it’s good bacteria that naturally lives on/in parts of the body that helps fight infections

what happens if the mucociliary apparatus is damaged?

a person can be at higher risk of infection if this mechanism is damaged because there is nothing to help clear mucus and pathogens from the airways

where does gas exchange happen?

in the alveoli

oxyhemoglobin

is a complex of oxygen and hemoglobin in red blood cells that facilitates oxygen transport in the bloodstream.

what does it mean if it says “Sa” before something?

saturation

what does it mean if it says “Pa” before something?

blood

what is the relationship between low O2 levels and erythropoietin?

Low O2 levels stimulate the kidneys to produce erythropoietin, which then signals the bone marrow to create new RBCs

which nerve starts at C3 of the spine?

the phrenic nerve, which controls the diaphragm

what would happen if there was a spinal injury at C4 or above? Why?

the signal to breathe would be interrupted because the phrenic nerve would be damaged

when does pulmonary vasoconstriction happen?

PVC happens in the presence of hypoxia

What is the sequence of events that causes hypoxia to lead to RVH?

chronic hypoxia (which can happen with COPD pts) can lead to PVC, which then leads to pulmonary htn, which forces the right ventricle to work harder

what is the purpose of the central chemoreceptors in the medulla?

they monitor CO2 levels and sense changes in pH

what do the central chemoreceptors do when a person becomes hypercapnic?

They cause an increase the rate and depth of respiration to expel more CO2

What happens if the central chemoreceptors are chronically exposed to too much CO2?

they become less sensitive to abnormal pH levels and can no longer regulate CO2 properly, so the peripheral chemoreceptors take over

where are the peripheral chemoreceptors located?

in the aorta and the carotid arteries

what do the peripheral chemoreceptors in the aorta and carotids do?

they sense decreased arterial O2

what is hypoxic drive?

the trigger that causes the body to breathe

what is the primary signal that stimulates breathing?

hypercapnia

dyspnea

difficulty breathing/shortness of breath

orthopnea

difficulty breathing when lying flat; these people often sleep with multiple pillows or sitting up

productive cough

wet cough that brings up lung secretions (phlegm, aspirations, etc)

nonproductive cough

a dry cough that does not produce anything from the lungs

expectoration

the act of coughing up lung secretions

hemoptysis

when pink/red sputum is brought up; usually means there’s a vascular problem

hematemesis

blood in the GI tract; person vomits up coffee ground looking blood (old blood)

atelectasis

when the alveoli collapses; maybe because something is obstructing it (like a mucus plug or tumor) or if there’s a hard force (like a rib fracture); very common post-op

what type of illness is a person more at risk for with atelectasis?

pneumonia because mucous can be trapped in the lungs

hypoxemia

insufficient O2 in the blood

what happens during respiratory failure?

the body is unable to oxygenate the blood or remove CO2 from the blood, which leads to hypercapnia; may happen due to PE

what is PaO2 during respiratory failure?

below 60

what would PaCO2 be during respiratory failure

above 50

early signs and symptoms of hypoxia/hypercapnia

restlessness, anxiety, behavioral changes, drowsiness, headache, confusion

late signs and symptoms of hypoxia/hypercapnia

cyanosis of skin and lips

risk factors for pulmonary disorders

smoking, occupation, hobbies (coal miner, firefighter woodworking, etc.)

What assessment acronym should be used for assessing pulmonary disorders?

Onset
Location
Duration
Characteristics
Aggravating factors
Relieving factors
Treatment

what is the nurse looking for during inspection for pulmonary assessment?

breathing pattern (tachy or brady), clubbed fingers, and barrel chest

why does a barrel chest develop?

due to chronic lung conditions that require use of accessory muscles to breathe

what does the nurse do during palpation for pulmonary assessment? Why?

the nurse puts her fingers on the pt’s back and has them repeat “99.” if she can feel vibrations (tactile fremitus) it indicates pneumonia

what does the nurse do during percussion for a pulmonary assessment? Why?

the nurse puts two fingers on the pt’s chest and taps them with the two fingers of her other hand. if the sound is resonance (filled with air), it’s normal; if the sound is dull (solid sounding), it is filled with fluid; if there’s hyperresonance, lungs are overinflated (like with emphysema)

what should it sound like when the stethoscope is over the trachea?

loud, tubular, and high pitched; expiratory sounds should be longer

what does it sound like when the stethoscope is over the bronchi?

intermediate; expiratory and inspiratory sounds are the same

what do the peripheral lungs sound like through the stethoscope?

low pitched, breezy (vesicular sounds); inspiratory sounds are longer

what are adventitious breath sounds?

abnormal; means there’s extra sounds

examples of adventitious breath sounds

crackles, wheezes, ronchi, friction rub

crackles

aka rales; sounds like rice krispies after pouring milk; may be noncontinuous (can’t hear it with every ins/expiration

• means alveoli could be deflated and are closing against fluid

wheezes

musical sounds that mean there’s constriction in the airways

ronchi

sounds like snoring through the scope; means the bronchi are inflamed (could be coated with mucous but usually clears up when pt coughs)

friction rub

a grating/scratching sound that means there’s inflammation of the pleural surfaces (lining of the lungs)

diagnostic testing for respiratory problems include…

ABGs, PFT, pulse ox, XRay/CT/MRI (to assess fluid, tumors, masses), bronchoscopy (go into lungs w/camera, maybe take biopsy), thoracentesis (to remove fluid from pleural space for culture), & culture/sensitivity of sputum

obstructive disorders

cause resistance to airflow include : Emphysema, Chronic bronchitis, Bronchiectasis, asthma

restrictive disorders

something causes lung tissue to not expand fully include : Pulmonary fibrosis, pneumoconiosis, thoracic cage deformities

what are the bad guys that cause problems and bronchoconstriction?

leukotrienes and histamines

what is the motto for sympathetic nervous system?

fight or flight

what is the motto for parasympathetic nervous system?

rest and digest

pleural effusion

when fluid gets into pleural space

how is the level of O2 we give a pt determined?

its titrated according to the person’s respiratory distress

pack years

measure of smoking

# of years smoked * # of packs/day