Respiratory Assessment, Techniques, Monitoring Systems, and Altered Ventilatory Function

Comprehensive Question and Answer flashcards covering respiratory assessment, breath sounds, arterial blood gas interpretation, mechanical ventilation settings and modes, airway management adjuncts, respiratory failure, PE, ARDS, COPD, pneumonia care bundles, CURB-65, and COVID-19.

What are the main structural components of the upper respiratory tract?

The upper respiratory tract consists of the nose (sinuses and nasal passages), pharynx, tonsils, adenoids, and larynx (epiglottis, glottis, vocal cords, and cartilages).

What structures comprise the lower respiratory system?

The lower respiratory system includes the lungs, pleura, mediastinum, lung lobes (left: upper and lower; right: upper, middle, and lower), bronchi, bronchioles, and alveoli.

What fraction of the respiratory cycle is dedicated to inspiration versus expiration?

Inspiration constitutes $1/3$ of the respiratory cycle, whereas expiration constitutes $2/3$ of the respiratory cycle.

Where on the chest wall are bronchial breath sounds normally auscultated?

Bronchial breath sounds are normally heard during exhalation just above the clavicles on each side of the sternum.

How are bronchovesicular and vesicular breath sounds distinguished during auscultation?

Bronchovesicular sounds are continuous during inhalation and exhalation next to the sternum between the scapulae. Vesicular sounds are prolonged during inhalation, shortened during exhalation, and heard over the remainder of the lungs.

What characterises wheezes and during which phase of respiration are they primarily heard?

Wheezes are high-pitched musical adventitious breath sounds that are typically heard during expiration.

What physiological mechanism causes a pleural friction rub?

A pleural friction rub results from the movement of inflamed and roughened pleural surfaces against one another during chest wall movement.

How are Forced Vital Capacity (FVC) and Functional Residual Capacity (FRC) defined in spirometry?

Forced Vital Capacity (FVC) is the maximum amount of air a person can inhale after a forceful exhalation. Functional Residual Capacity (FRC) is the volume of air remaining in the lungs after a normal, passive exhalation.

According to spirometry, what are the standard normal volumes for Tidal Volume (TV), Inspiratory Reserve Volume (IRV), and Expiratory Reserve Volume (ERV)?

Standard volumes are Tidal Volume (TV) = $500\,\text{mL}$, Inspiratory Reserve Volume (IRV) = $3100\,\text{mL}$, and Expiratory Reserve Volume (ERV) = $1200\,\text{mL}$.

What level of inspiratory force indicates that a client likely requires mechanical ventilation?

Normal inspiratory pressure is approximately $100\,\text{cm H}_2\text{O}$. An inspiratory force of less than $25\,\text{cm}$ usually requires mechanical ventilation.

How do arterial blood gas parameters change in Respiratory Acidosis compared to Respiratory Alkalosis?

In Respiratory Acidosis, $\text{pH}$ is low ($< 7.35$), $\text{PaCO}_2$ is elevated ($> 45\,\text{mmHg}$ or $> 48\,\text{mmHg}$), and $\text{HCO}_3$ is normal. In Respiratory Alkalosis, $\text{pH}$ is high ($> 7.45$), $\text{PaCO}_2$ is low ($< 35\,\text{mmHg}$), and $\text{HCO}_3$ is normal.

What nursing intervention can help an anxious patient with respiratory alkalosis and a $\text{PaCO}_2 < 35\,\text{mmHg}$?

Encourage the patient to breathe into a brown paper bag to re-inspire $\text{CO}_2$ (carbonic acid).

What emergency intravenous treatment is indicated for severe cases of metabolic acidosis?

Intravenous administration of sodium bicarbonate (keeping sodium bicarbonate ampules readily available for emergency use).

What is the normal expected oxygen saturation range measured by pulse oximetry?

The normal oxygen saturation level is $95\text{--}100\%$.

What are key nursing responsibilities when caring for a patient with an Oropharyngeal Airway (OPA)?

Frequently assess the lips and tongue for pressure areas, and remove the OPA at least every $24\,\text{hours}$ to check for pressure tissue injury and perform oral hygiene.

What size range is used for a Nasopharyngeal Airway (NPA) and what complications are associated with its use?

Nasopharyngeal airways are sized French $26\text{--}35$. Potential complications include bleeding, sinusitis, and erosion of the mucous membranes.

How is proper Endotracheal (ET) tube placement verified at the bedside and confirmed definitively?

Bedside verification requires bilateral breath sounds, equal lung chest excursion during inspiration, absence of breath sounds over the stomach, and a $\text{PETCO}_2$ of $35\text{--}40\,\text{mmHg}$. Definitive verification is confirmed via a chest X-ray (CXR).

Why is a tracheostomy indicated if intubation is required beyond $10\text{--}14\,\text{days}$?

Prolonged endotracheal intubation increases the risk of vocal cord paralysis, laryngeal and tracheal damage, laryngospasm, and infection. ET tubes should not be used longer than $3\,\text{weeks}$.

How does Assist-Control Ventilation (ACV) differ from Synchronized Intermittent Mandatory Ventilation (SIMV)?

ACV delivers a preset volume at a preset rate whenever the patient initiates a breath (used for weak respiratory muscles). SIMV delivers a preset volume and rate synchronized with patient effort while allowing spontaneous unassisted breaths between ventilator breaths (used for weaning).

How does Positive End-Expiratory Pressure (PEEP) improve oxygenation, and what adverse effect occurs when levels exceed $10\,\text{cmH}_2\text{O}$?

PEEP maintains positive pressure in the alveoli during expiration to prevent alveolar collapse and increase Functional Residual Capacity (FRC). PEEP levels above $10\,\text{cmH}_2\text{O}$ increase intrathoracic pressure, which decreases venous return and cardiac output, leading to hypotension.

What are the standard initial ventilator settings for Tidal Volume ($V_t$) and Fraction of Inspired Oxygen ($\text{FiO}_2$)?

Tidal Volume ($V_t$) is set at $5\text{--}15\,\text{mL/kg}$ (average $10\,\text{mL/kg}$) and Fraction of Inspired Oxygen ($\text{FiO}_2$) is set between $21\%$ and $100\%$.

What do low pressure and high pressure mechanical ventilator alarms indicate?

Low pressure alarms indicate a leak or disconnection in the ventilator circuit. High pressure alarms indicate that Peak Inspiratory Pressure (PIP) has exceeded a safe limit, putting the patient at risk for Ventilator-Induced Lung Injury (VILI).

How are volutrauma, barotrauma, and atelectrauma defined?

Volutrauma is lung tissue injury caused by over-distension of alveoli. Barotrauma is lung injury from excessive pressure on the airway. Atelectrauma is VILI resulting from low intra-alveolar pressure causing repeated alveolar collapse.

What three clinical factors compose Virchow's triad in Pulmonary Embolism?

Virchow's triad consists of venous stasis, hypercoagulation problems, and vessel wall injury.

What classic radiological finding on a chest X-ray indicates Acute Respiratory Distress Syndrome (ARDS)?

A chest X-ray reveals bilateral "white out" lungs due to diffuse inflammation and increased alveolocapillary membrane permeability.

What arterial blood gas threshold levels define Acute Respiratory Failure (ARF)?

Acute Respiratory Failure is defined as a $\text{pO}_2 < 50\,\text{mmHg}$, a $\text{pCO}_2 > 50\,\text{mmHg}$, and a $\text{pH} < 7.30$.

How do Type I (Hypoxemic) and Type II (Hypercapnic) Acute Respiratory Failure differ in blood gas parameters and causes?

Type I (Hypoxemic) involves lung failure with $\text{PaCO}_2 < 60\,\text{mmHg}$ and normal or decreased $\text{PaO}_2$, caused by acute lung diseases (e.g., pulmonary edema, ARDS, pneumonia). Type II (Hypercapnic) involves pump/ventilatory failure with $\text{PaCO}_2 > 50\,\text{mmHg}$, caused by drug overdose, neuromuscular disease, chest wall deformity, or COPD.

What target oxygen saturation range should be maintained during oxygen therapy for a client with an acute COPD exacerbation?

Supplemental oxygen therapy should maintain oxygen saturation levels in the range of $88\text{--}92\%$.

What clinical criteria indicate that a COPD client is appropriate for Non-Invasive Ventilation (NIV)?

Criteria include persistent respiratory acidosis ($\text{pH} < 7.35$, $\text{PaCO}_2 > 6\,\text{kPa}$) despite maximal medical therapy, a Glasgow Coma Scale (GCS) score $> 8$, ability to protect the airway, alertness/cooperativeness, hemodynamic stability, and absence of excessive respiratory secretions.

What is the most common bacterial microorganism responsible for pneumonia cases?

Streptococcus pneumoniae, which causes $90\%$ of pneumonia cases.

What are the 6 evidence-based care bundle elements for preventing Ventilator-Associated Pneumonia (VAP)?

1. Head of bed elevation to $30\text{--}45^\circ$.
2. Daily sedation level assessment and sedation hold.
3. Oral hygiene with chlorhexidine ($\ge 1\text{--}2\%$) q6h and tooth brushing q12h.
4. Subglottic secretion aspiration every $1\text{--}2\,\text{hours}$ if intubated $> 72\,\text{hours}$.
5. Cuff pressure maintained at $20\text{--}30\,\text{cmH}_2\text{O}$ checked q4h.
6. Stress ulcer prophylaxis.

What are the components and scoring interpretations of the CURB-65 pneumonia severity assessment?

Scoring ($1$ point each): Confusion, Urea $> 7\,\text{mmol/L}$, Respiratory rate $\ge 30$, Blood pressure ($\text{SBP} \le 90\,\text{mmHg}$ or $\text{DBP} \le 60\,\text{mmHg}$), Age $> 65$. Interpretation: $0\text{--}1$ = low risk ($1.5\%$ mortality, home treatment); $2$ = moderate risk ($9.2\%$ mortality, consider admission); $\ge 3$ = high risk ($17\text{--}22\%$ mortality, admission as severe).

What is the incubation period for COVID-19 and what are its three most common clinical manifestations?

The incubation period is $2\text{--}14\,\text{days}$ (symptoms usually appear around the $5\text{th}$ day). The most common symptoms are fever ($83\text{--}99\%$), dry cough ($59\text{--}92\%$), and shortness of breath ($31\text{--}40\%$).

Which corticosteroid medication is recommended by WHO to reduce ventilator duration and mortality in severe and critical COVID-19 illness?

Dexamethasone.