MEDSURG EXAM CERTIFICATION

How many lungs? # of lobes in each lung?

2 lungs; right lung has 3 lobes, left has 2 lobes

What is the Hilum?

The region where blood vessels, bronchi, lymph vessels and nerves enter and exit the lung.

What is pleura?

A covering that protects the lungs (a double-layered serous membrane to reduce friction of lung movement).

What is visceral pleura?

inner layer of pleura lying closer to the lung tissue that covers the lungs, blood vessels, nerves, and bronchi.

What is the parietal pleura?

The outer layer of pleura that attaches to the chest wall and overs the thorax, mediastinum, and diaphragm.

What is the pleural cavity?

the pleural space between visceral and parietal pleura; where a pleural effusion occurs

Upper airway components?

nose, sinuses, pharynx, larynx

Lower airway components?

trachea, bronchial airways, and lungs

respiratory zone components?

terminal and respiratory bronchioles, alveolar sacs

what are type I alveolar cells?

where gas exchange occurs in a semipermeable membrane

what are type II alveolar cells?

surfactant producing cells preventing alveolar collapse

What do capillaries need to reach in order to promote gas exchange?

alveoli

what is inspiration? what type of pressure is created?

air enters airways and lungs; creates a negative pressure

what is expiration? what type of pressure is created? active or passive?

forcing air out of airways; muscle relaxation creates positive pressure; passive

respiratory muscles?

diaphragm and intercostal muscles

what does the diaphragm do during insp and exsp?

contracts during inhalation; relaxes during exhalation

what do intercostal muscles do?

contract during inhalation

what does the decrease in intrapulmonary pressure during inhalation cause?

air to force out of lungs until intrapulmonary and atmospheric pressure equalize

where in the brain is the respiratory center?

medulla and pons in BRAINSTEM

What does the parasympathetic nervous system do in bronchioles?

bronchoconstricts

what does the sympathetic nervous system do in the bronchioles?

bronchodilates

another name for the parasympathetic response?

cholinergic response

another name for the sympathetic response?

adrenergic response

what does surfactant do? (two answers)

1. reduces surface tension 2. keeps alveoli open

where does gas exchange occur in respiratory system?

capillary/alveoli level

where does gas exchange occur in the body tissues?

at the capillary/tissue level

where are the vocal cords?

larynx

what are "unbound" oxygen molecules? what should the PaO2 be?

oxygen molecules dissolved in the blood to use for cellular metabolism; 80-100 mmHg

what are "bound" oxygen molecules? where is this reflected?

oxygen molecules bind to hemoglobin (4 per Hgb); SpO2 is the measurement of the percentage of oxygen molecules attached to hgb (>90%)

what is carbon dioxide a waste product of?

cellular metabolism

what is the carbon dioxide excretion process?

1. diffuses from tissues into the systemic circulation 2. carried to lungs and diffuses across capillaries to alveoli 3. alveoli carry to upper airway to be excreted via exhalation

what are the 3 forms of CO2?

1. dissolved (exhaled)

2. bound to hemoglobin

3. carbonic acid (helps to regulate body's acid/base balance)

What does end tidal CO2 measure? appropriate level?

Carbon dioxide in exhaled air and ventilation; 35-45

what formula is used to find minute ventilation?

tidal volume x RR

PCO2

35-45 mmHg

which scan is the most accurate to show immediate changes in lungs demonstrating aspiration?

chest CT scan

how long might it take for CXR to show aspiration?

up to 2 days

what are the 4 methods for feeding tube insertion placement verification?

1. assess resp distress

2. capnography

3. pH of aspirate

4. appearance of aspirate

only way to confirm placement of NGT?

ABD XR

lung secretion pH and color?

mucous-like; pH > 6

small bowel pH and color?

pH > 6; bile-ish green/brown

stomach pH and color?

grassy-green/yellow to clear with a little mucous; pH < 5

complications of aspiration?

lung abscess; empyema; pneumonia; ARDS

COPD 4 key features

1. chronic inflammatory response 2. hyperinflation 3. mucous production 4. alveolar destruction

what are simple carbs high in?

co2

what is the standard tool for COPD staging?

GOLD (1-4) (mild-very sever)

Beta-adrenergic agonists short acting

albuterol, pirbuterol

Beta-adrenergic agonists long acting

salmeterol

anticholinergics for COPD?

Spiriva and ipratropium (aka enlarge bronchioles)

inhaled corticosteroid?

Fluticasone (Flovent)

combo inhalers

budesonide/formoterol (Symbicort), fluticasone/salmeterol (Advair)

side effects of beta agonists administered by inhalation?

HA, dizziness, tachycardia, tremor, hyperglycemia

what stimulates the drive to breathe freely?

co2 levels

what can a spacer do for a patient who uses inhalers?

can improve delivery

when is an oral corticosteroid used in COPD patients?

acute exacerbation

what is dangerous about theophylline?

narrow therapeutic range

Theophylline toxicity

Tremor

Heart dysrhythmias

Electrolyte imbalance (hypokalemia)

O

Pain in ABD and N/V

Head (HA, insomnia, seizures)

asthma key factors

1. chronic hyper-reactive airway disease

2. airway inflammation

3. reversible bronchial constriction

4. increased WOB

5. leads to lung hyperinflation

what is status asthmaticus?

An acute exacerbation of asthma that does not respond to standard treatments of bronchodilators and steroids.

what lung sounds are an ominous sign on status asthmaticus?

wheezing to silent chest

long term management on asthma meds?

Montelukast and singulair

airway inflammation in asthma?

submucosal infiltration with WBCs and mast cells, edema, vascular engorgement

symptoms of asthma

chest tightness, cough, wheezing, SOB

what test is used to diagnose asthma?

PFTs

symptoms of OSA?

depression, memory difficulties, morning HA, poor concentration, personality changes, restless sleep, frequently waking up in night, snoring

OSA screening tool?

STOPBANG

consequences of chest trauma?

bony thorax fractures, contusion, rib fractures

Pneumothorax definition

accumulation of air in the pleural space; as air accumulates, lung collapses.

tension pneumo

Accumulation of air in pleural space that is so great it compresses contents of the chest cavity to one side or another (a simple pneumo can become this)

tension pneumo can lead to what type of shock?

obstructive shock

what side does trachea deviate in left sided pneumo?

tracheal deviation away from affected side so will shift towards right side

what does the BP do in a pneumo?

decrease

virchow's

venous stasis, endothelial injury, hypercoagulable state; PE AND DVT

frontal lobe

judgement, foresight, smell, voluntary movement, critical thinking

sensory cortex

pain, heat, and other sensations; in parietal lobe

parietal lobe

language comprehension

Broca's area

L side

speech expression

frontal lobe

motor cortex

movement

temporal lobe

intellectual and emotional functions, hearing

wernicke

speech comprehension

left side of brain

temporal lobe

occipital lobe

vision

brainstem

swallowing, involuntary functions (RR)

cerebellum

coordination and balance

nervous system two parts

CNS and PNS

central nervous system

brain and spinal cord

peripheral nervous sytem

somatic and autonomic

somatic nervous

Enables voluntary actions to be undertaken due to its control of skeletal muscles.

autonomic nervous system

SNS, PNS; involuntary

right sided stroke

left-sided hemiplegia, left-side neglect, short attention span, impulsive, impaired judgement, impaired concept of time, spatial deficits

left sided stroke

right-sided hemiplegia, impaired speech, impaired R/L discrimination, slow and cautious, impaired understanding of math, language, depression, anxiety

thrombotic agent for stroke

alteplase

BP limits for alteplase

keep < 180-185

risk for re-bleeding period in hemorrhagic stroke

24 hours

what can you prevent vasospasm in SAH with?

calcium channel blocker nimodipine

triple H therapy in vasospasm in SAH

HTN, Hypervolemia, hemodilution

two signs of men

Kernig's sign

Brudzinski's sign

kernig's

pain and spasm when extend/lift patient's leg (cannot fully extend knee) (meningitis)

kernig=cankle, knee

Brudzinski's sign

hips and knees flex when neck is flexed (meningitis)

Brudzinski= pray to budda (head is flexed)

bacterial meningitis?

rash, nuchal rigidity, fever

bacterial CSF meningitis

cloudy/milky, inc. WBC, inc. protein, dec. glucose