Med Surg: Respiratory Function, Chapter 17 and NCLEX

apnea

Temporary cessation of breathing.

Bronchophony

Abnormal increase in clarity of transmitted voice sounds heard when auscultating the lungs.

Bronchoscopy

Direct examination of the larynx, trachea, and bronchi using an endoscope.

Cilia

short, fine hairs that constantly move to propel mucus and foreign substances away from the lung toward the larynx.

Compliance

Measure of the force required to expand or inflate the lungs.

Crackles

Nonmusical, discontinuous popping sounds during inspiration caused by delayed reopening of the airways; heard on chest auscultation.

Dyspnea

subjective experience of uncomfortable or painful breathing, either at rest or with activity; also called shortness of breath.

Egophony

Abnormal change in tone of voice heard when auscultating the lungs

Fremitus

Vibrations of speech felt as tremors of the chest wall during palpation

Hemoptysis

Expectoration of blood from the respiratory tract

Hypoxemia

Decrease in arterial oxygen tension in the blood.

Hypoxia

Decrease in oxygen supply to tissues and cells.

Obstructive Sleep Apnea

Temporary absence of breathing during sleep due to transient upper airway obstruction

Orthopnea

Shortness of breath when lying flat; relieved by sitting or standing

Oxygen Saturation

Percentage of hemoglobin bound to oxygen.

Physiologic Dead Space

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

Pulmonary Diffusion

Exchange of oxygen and carbon dioxide between areas of high and low concentration.

Pulmonary Perfusion

Blood flow through the pulmonary vasculature.

Respiration

Gas exchange between atmospheric air and the blood, and between the blood and body cells.

Rhonchi

Deep, low-pitched snoring sound associated with partial airway obstruction; heard on chest auscultation.

Stridor

Continuous, high-pitched, musical sound heard on inspiration (best over the neck); may be heard without a stethoscope; indicates upper airway obstruction.

Tachypnea

Abnormally rapid respirations.

Tidal Volume

Volume of air inspired and expired with each normal breath.

Ventilation

Movement of air in and out of the airways.

Wheezes

Continuous musical sounds associated with airway narrowing or partial obstruction

Whispered Pectoriloquy

Whispered sounds heard loudly and clearly upon thoracic auscultation

Warms and filters inspired air so the lower respiratory tract (lungs) can perform gas exchange.

what is the function of the Upper Respiratory Tract?

Lungs carry out diffusion (gas exchange) by delivering oxygen to tissues and removing carbon dioxide.

what is the function of the lower respiratory tract?

The respiratory system depends on the cardiovascular system for perfusion (blood flow through the pulmonary system).

How are the respiratory and cardiovascular systems connected?

It serves as a passageway for air, filters impurities, humidifies and warms inspired air.

What is the function of the nose in respiration?

Nasal bones and cartilage support the external nose; the anterior nares (nostrils) are the openings

What supports the external nose and what are the openings called?

Divided by the septum and separated into passageways by turbinate bones (conchae), which increase surface area.

How are the nasal cavities structured?

To trap dust and organisms, warm and moisten air, detect odors, and trigger sneezing.

What is the function of nasal mucosa?

They continuously secrete mucus, which is moved toward the nasopharynx by cilia.

What is the role of goblet cells in the nose?

Frontal, ethmoid, sphenoid, and maxillary; they serve as resonating chambers for speech and are common sites of infection.

What are the four pairs of paranasal sinuses, and what is their main function?

Nasopharynx (behind nose, above soft palate), oropharynx (houses palatine tonsils), and laryngopharynx (hyoid bone → cricoid cartilage).

What are the three divisions of the pharynx?

A flap of cartilage that covers the laryngeal opening during swallowing to prevent aspiration.

What is the role of the epiglottis?

glottis

The opening between the vocal cords in the larynx.

The cricoid cartilage.

What is the only complete cartilaginous ring in the larynx?

The arytenoid cartilages (working with thyroid cartilage).

Which laryngeal structures are involved in vocal cord movement?

Prevents foreign substances from entering the airway and facilitates coughing; also called the "watchdog of the lungs."

Besides vocalization, what are two protective functions of the larynx?

C-shaped cartilaginous rings.

What structures keep the trachea from collapsing?

The hilus.

Through what structure do the mainstem bronchi enter the lungs?

Right lung: 3 (upper, middle, lower). Left lung: 2 (upper, lower).

How many lobes are in each lung?

The visceral pleura covers lungs; parietal pleura lines the thoracic cavity. Pleural fluid lubricates for smooth lung movement.

What is the role of the pleural membranes and fluid?

Heart, thymus, great vessels (aorta, vena cava), and esophagus (all thoracic tissues outside lungs).

What does the mediastinum contain?

~150 mL of air in the conducting airways that does not participate in gas exchange.

What is physiologic dead space?

Type I: 95% of alveolar surface, barrier for gas exchange.

Type II: 5%, produce surfactant and Type I cells.

Alveolar macrophages: phagocytose foreign matter for defense.

What are the three types of alveolar cells and their functions?

Reduces alveolar surface tension, preventing collapse and improving lung compliance.

What is the function of surfactant?

The first third. Expiration is the latter two-thirds (normally passive).

During which part of the respiratory cycle does inspiration occur?

Thoracic cavity expansion lowers intrathoracic pressure below atmospheric pressure.

What causes air to flow into the lungs during inspiration?

Bronchospasm (asthma),

thickened mucosa (chronic bronchitis), airway obstruction (mucus, tumor, foreign body),

loss of elasticity (emphysema).

What are four causes of increased airway resistance?

Severe obesity, pneumothorax, hemothorax, pleural effusion, pulmonary edema, atelectasis, pulmonary fibrosis, ARDS.

What conditions decrease lung compliance ("stiff lungs")?

Tidal volume, inspiratory reserve volume, expiratory reserve volume, residual volume.

What are the four lung volumes?

Upper lung = poor blood supply;

lower lung = maximal supply;

middle = intermediate.

In upright position, how is lung perfusion distributed?

Shunting of blood (low V/Q).

What is the main cause of hypoxia after surgery or in respiratory failure?

Between 20 and 25 years of age.

At what age do lung vital capacity and respiratory muscle strength peak?

Reduced surface area for gas exchange.

What changes occur in the alveoli after age 40?

Calcified cartilage, arthritis, osteoporosis, muscle atrophy, ↑ thoracic cage rigidity.

What skeletal and muscular changes occur in the chest wall with aging?

The presenting problem and associated symptoms (onset, duration, character, aggravating/alleviating factors, timing, impact on ADLs).

What should a respiratory health history explore first?

Pneumothorax, acute airway obstruction, allergic reaction, or myocardial infarction.

What conditions may cause sudden dyspnea in a healthy person?

Pulmonary embolism (PE).

What does sudden dyspnea in an immobilized patient suggest?

Heart disease or sometimes COPD.

What condition is indicated by orthopnea (dyspnea lying flat)?

COPD

What does dyspnea with an expiratory wheeze suggest?

coughing

Prevents accumulation of secretions or aspiration of foreign bodies.

Left-sided heart failure or asthma.

What condition does nighttime coughing suggest?

Bacterial infection.

What does profuse purulent sputum (yellow, green, or rust) suggest?

lung tumor

What does pink-tinged sputum suggest?

Lying on the affected side (splints chest wall, reduces friction).

What position reduces pleuritic pain?

hemoptysis

The expectoration of blood from the respiratory tract.

Sudden onset, intermittent or continuous, ranging from blood-stained sputum to large hemorrhage.

hildhood illnesses, immunizations, medical conditions, hospitalizations, surgeries, allergies, medications (including OTC/herbals), diet, exercise, sleep, recreational habits, religion, and psychosocial factors.

What information should be obtained in a respiratory health history?

Pack-years = packs per day × years smoked.

What unit is used to describe smoking history?

asthma, cystic fibrosis, COPD, alpha1-antitrypsin deficiency, primary ciliary dyskinesia, pulmonary fibrosis, pulmonary hypertension, tuberous sclerosis.

What respiratory disorders are known to have genetic or familial associations?

Clubbing of fingers, skin color changes/patches, angiofibromas or ungual fibromas.

What physical signs may suggest genetic respiratory disorders?

Chronic hypoxia, chronic lung infections, lung malignancy, congenital heart disease, or chronic infections (e.g., endocarditis, IBD).

What does clubbing of the fingers indicate?

Bluish skin due to ≥5 g/dL of unoxygenated hemoglobin; late sign of hypoxia.

What is cyanosis, and when does it appear?

Aging, emphysema, COPD (due to lung overinflation).

What conditions cause barrel chest?

Depression of lower sternum; may compress heart/vessels → murmurs.

What is funnel chest, and what can it cause?

pigeon chest

Anterior displacement of sternum; seen in rickets, Marfan syndrome, kyphoscoliosis.

12-20 breaths/min, regular and quiet (eupnea).

What is the normal adult respiratory rate at rest?

nspiration: sternocleidomastoid, scalene, trapezius.

Expiration: abdominal, internal intercostals.

What accessory muscles are used during inspiration and expiration?

bradypnea

<10 breaths/min, normal depth/rhythm; associated with ↑ intracranial pressure, brain injury, and drug overdose.

tachypnea

Rapid, shallow breathing (>24 breaths/min); seen in pneumonia, pulmonary edema, metabolic acidosis, septicemia, severe pain, rib fracture.

hypoventilation

Shallow, irregular breathing.

hyperpnea

Increased depth of respirations (also see hyperventilation).

Biot's (ataxic) respirations

Irregular cycles: 3-4 normal breaths → apnea (10-60s); associated with drug overdose and medullary brain injury.

Resonance

What percussion sound is normal over healthy lung tissue?

Fluid or solid replacing air (e.g., pneumonia, tumor).

What causes dullness on percussion?

stridor

Continuous, high-pitched sound heard over the neck; indicates upper airway narrowing → medical emergency.

rhonchi

Low-pitched wheezes due to partial airway obstruction.

wheezes

Continuous musical sounds from narrowed airways (asthma, COPD, bronchitis).

Oxygen delivery and consumption balance.

What do venous blood gas (VBG) studies measure?

When arterial blood gases (ABGs) cannot be obtained.

When are VBGs used?

Oxygen saturation of hemoglobin (SpO₂).

What does pulse oximetry measure?

Motion, nail polish, dark skin, low perfusion, hypothermia.

What factors can give false readings on pulse oximetry?

Before antibiotics are started.

When should cultures be collected?

To detect infection or malignancy.

Why are sputum studies done?

early morning before eating or drinking

When should sputum samples be collected?

Answer D

Rationale: NPO status is required before surgery to prevent aspiration.

NCLEX: A nurse is performing preoperative teaching for a client scheduled for abdominal surgery. Which statement by the client indicates the need for further teaching?A. "I should stop taking my aspirin 7 days before surgery."B. "I will remove all jewelry before going into the operating room."C. "I can have a small snack the night before surgery."D. "I should eat breakfast the morning of surgery to have energy."

Answer: A

Rationale: Airway is always priority (ABC). Repositioning may relieve obstruction.

NCLEX: A nurse is caring for a client in the PACU who is difficult to arouse, with a respiratory rate of 8 breaths/min, shallow, and oxygen saturation of 85%. The first priority action is:A. Reposition the client's head and neck.B. Call the surgeon immediately.C. Increase the IV fluid rate.D. Administer pain medication.