N206Le Exam #2

What is the function of the upper airway?

Warm, filter, and humidify inspired air

What structures make up the upper airway?

Nose, pharynx, larynx, and epiglottis

What are the functions of the lower airway?

Conduction of air, mucociliary clearance, and production of pulmonary surfactant

What structures make up the lower airway?

Trachea, right and left mainstem bronchi, segmental bronchi, terminal bronchioles, and alveoli

Where does gas exchange occur?

Alveoli

Where do the lungs extend from?

From the base of the diaphragm to the apex above the first rib

How many lobes does the right lung have?

3 lobes

How many lobes does the left lung have?

2 lobes

What substance in the lungs decreases surface tension?

Surfactant

What structures/materials are listed as making up the elastic tissue of the lungs?

Alveoli, surfactant, and pleura

What lung system must function properly for normal respiratory function?

The alveolar system

What happens to venous blood during normal respiratory functioning?

It is oxygenated

What gas must be removed from the blood during normal respiratory functioning?

Carbon dioxide

What other systems must function properly for normal respiratory function?

Cardiovascular and hematologic systems

What do the cardiovascular and hematologic systems carry to and from body cells?

Nutrients and wastes

Pulmonary ventilation

Movement of air into and out of the lungs

Inspiration

The active phase of ventilation

What happens to the diaphragm during inspiration?

It contracts and descends

What happens to the thoracic cavity when the diaphragm descends during inspiration?

It lengthens

What happens to the external intercostal muscles during inspiration?

They contract

What happens to the sternum during inspiration?

It is pushed forward

What happens to the chest from front to back during inspiration?

It enlarges

Why does air enter the lungs during inspiration?

Air moves from greater pressure outside the lungs to lesser pressure inside the lungs

Expiration

The passive phase of ventilation

What are the three processes involved in gas exchange?

Respiration, diffusion, and perfusion

Respiration

Exchange between air and alveoli

Diffusion

Movement of oxygen and carbon dioxide between air and blood

Perfusion

Passage of oxygenated blood through body tissues

What does diffusion depend on?

Available surface area, membrane thickness, partial pressure, solubility, and molecular weight

Atelectasis

Collapse of alveoli

How can atelectasis affect available surface area for diffusion?

Collapsed alveoli decrease available surface area

What membrane characteristic affects diffusion?

Thickness of the alveolar-capillary membrane

What pressure factor affects diffusion?

Partial pressure

What gas properties affect diffusion?

Solubility and molecular weight

How is oxygen transported in the blood?

In plasma and red blood cells

What percentage of oxygen is carried by red blood cells according to the slide?

97%

What does oxygen combine with in red blood cells?

Hemoglobin

What is oxygen bound to hemoglobin called?

Oxyhemoglobin

What else does hemoglobin carry according to the slide?

Carbon dioxide

What term does the slide use for carbon dioxide carried by hemoglobin?

Carboxyhemoglobin

Internal respiration

Gas exchange between circulating blood and tissue cells

Where does internal respiration occur?

Between circulating blood and tissue cells

What are the two types of respiratory regulation?

Neural regulation and chemical regulation

What does neural regulation maintain?

Respiratory rhythm and depth

What provides voluntary control of respirations?

Cerebral cortex

What provides involuntary control of respirations?

Medulla oblongata

What provides chemical regulation of respirations?

Chemoreceptors

What changes do chemoreceptors respond to?

O2, CO2, and H+

What factors affecting oxygenation are listed on the slide?

Physiologic, developmental, lifestyle, and environmental factors

What physiologic conditions can affect oxygenation?

Anemia, toxic gas inhalation, cardiovascular conditions, airway obstruction, weakness, high altitude, fever, and musculoskeletal impairments

How can anemia affect oxygenation according to the professor's annotation?

Decreased RBCs means decreased oxygen-carrying capacity

What toxic gas did the professor annotate as an example affecting oxygenation?

Carbon monoxide

What did the professor annotate about carbon monoxide and oxygen?

Carbon monoxide competes with oxygen

What cardiovascular issue did the professor connect with impaired oxygenation?

Impaired blood flow/perfusion

How can weakness affect oxygenation?

It can interfere with respiratory function

What blood values did the professor annotate as being higher in people living at high altitude?

Hemoglobin and hematocrit

Why did the professor say hemoglobin and hematocrit are higher at high altitude?

To compensate for decreased oxygen

How does fever affect oxygen needs?

Fever increases metabolic and oxygen demands

Why does increased metabolism increase oxygen demand?

The body needs more nutrients and oxygen

What musculoskeletal factor can affect oxygenation?

Musculoskeletal impairments

What lifestyle factors affecting oxygenation are listed in the slides?

Nutrition, exercise, medications, smoking, substance abuse, and anxiety

What types of medications did the professor annotate as affecting oxygenation?

Analgesics, opioids, and pain medications

How can anxiety affect respirations according to the professor's annotation?

It can cause faster breathing

What happens to CO2 when a person breathes too fast from anxiety?

CO2 is lost

What symptoms did the professor associate with losing CO2 from rapid breathing?

Numbness and tingling

What acid-base imbalance did the professor connect with anxiety and rapid breathing?

Respiratory alkalosis

What example of trauma did the professor connect with impaired breathing?

Rib fractures

What disease states affecting oxygenation are listed?

Pulmonary fibrosis, COPD, pulmonary edema, asthma, and emphysema

What did the professor annotate about patients after surgery and oxygenation?

After surgery, organs may not be working as well

What respiratory rate is listed for an infant?

20-40 breaths/min

What respiratory rate is listed for a child age 1-5?

25-32 breaths/min

What respiratory rate is listed for a child age 6-12?

18-26 breaths/min

What respiratory rate is listed for someone older than 12?

16-24 breaths/min

What did the professor emphasize about respiratory rate and age?

Pay attention to the patient's age when determining whether the respiratory rate is normal

What did the professor annotate about respiratory rates and the exam?

Respiratory rate by age will be on the exam

Hypoxia

Inadequate amount of oxygen available to the cells

Dyspnea

Difficulty breathing

Hypoventilation

Decreased rate or depth of air movement into the lungs

What happens to the lungs at birth?

They transform from fluid-filled structures to air-filled organs

What infant characteristics increase respiratory risk?

Small chest and short airways

Why does the slide identify aspiration as a risk in infants?

Infants have short airways

What respiratory pattern is normal in infants?

Rapid respiratory rate with primarily abdominal respiratory activity

Where is respiratory activity primarily seen in an infant?

The abdomen

What may be given to an infant to help reopen alveoli?

Synthetic surfactant

Why may synthetic surfactant be given to an infant?

To help reopen alveoli

Can crackles at the end of a deep respiration be normal in infants according to the slide?

Yes

What did the professor annotate that crackles usually indicate?

Fluid

What developmental respiratory changes occur from infancy through childhood?

Lungs and chest structures continue to grow and develop

What happens to the number of alveoli during childhood?

The number of alveoli increases

What happens to respiratory rate as a child grows?

Respiratory rate gradually decreases

What developmental changes occur in the respiratory system during adolescence?

Lungs and airways continue to mature and increase in size

What respiratory changes occur with aging?

Respiratory muscles weaken, chest wall becomes stiffer, and lung elasticity decreases

What happens to the chest wall with aging?

It becomes stiffer

What happens to respiratory muscles with aging?

They weaken

What happens to lung elasticity with aging?

It decreases

What happens to the cough reflex/ability with aging?

It becomes less effective

Why are older adults at increased risk for respiratory problems?

Age-related changes decrease respiratory reserve and airway clearance

What should be included in a nursing assessment of oxygenation?

Health history and physical assessment

What respiratory symptoms should be assessed in the health history?

Cough, sputum, dyspnea, chest pain, and activity tolerance