Chapter 23: Assessment of Respiratory Function

What are the main divisions of the respiratory system?

The respiratory system is divided into the upper airway (nose, mouth, sinuses, pharynx, larynx) and the lower airway (trachea, bronchi, bronchioles, and lungs).

What is the primary site for gas exchange in the lungs?

Gas exchange occurs in the alveoli, which are tiny air sacs in the lungs.

What layers encase each lung?

Each lung is encased in a double-layered membrane called the pleura (visceral pleura covers the lungs, parietal pleura lines the chest wall).

What is the primary muscle responsible for respiration?

The diaphragm is the primary muscle of respiration.

How does the diaphragm function during breathing?

When the diaphragm contracts, it expands the chest cavity and draws air into the lungs; when it relaxes, the chest cavity volume decreases, pushing air out.

What is the primary function of the respiratory system?

To supply oxygen to the body and remove carbon dioxide.

Define ventilation. Why is it important?

Ventilation is the movement of air into and out of the lungs; it is important for gas exchange and maintaining adequate oxygenation.

What is diffusion in the context of the respiratory system?

Diffusion is the movement of gases across the alveolar-capillary membrane.

What is the V/Q ratio?

The V/Q ratio is ventilation/perfusion ratio, indicating the relationship between air (ventilation) reaching the alveoli and blood (perfusion) reaching the alveoli.

What role do central chemoreceptors play in respiration?

Central chemoreceptors in the medulla sense changes in CO₂ and increase breathing if CO₂ levels are high.

What indicates hypoxic drive in patients with chronic CO₂ retention?

In patients with chronic high CO₂ (e.g., COPD), low O₂ levels become a significant respiratory drive, also known as hypoxic drive.

What should you assess during a respiratory inspection?

Observe the patient's work of breathing, respiratory rate, rhythm, use of accessory muscles, and signs of distress.

What are common signs of respiratory distress?

Signs include use of accessory muscles, intercostal retractions, nasal flaring, pursed-lip breathing, and audible breathing like wheezing.

What is cyanosis?

Cyanosis is a bluish discoloration of the lips, face, or nail beds, indicating inadequate oxygenation.

What should be assessed during palpation of the chest?

Palpate for tenderness, crepitus, masses, chest expansion, and tactile fremitus.

What does dullness to percussion indicate in lung assessment?

Dullness to percussion may indicate fluid or solid tissue replacing air, such as in pneumonia or pleural effusion.

How are normal breath sounds classified?

Normal breath sounds include vesicular (soft, low-pitched), bronchovesicular (moderate pitch), and bronchial (loud, high-pitched).

What are crackles (rales)?

Crackles are discontinuous popping sounds heard on inspiration, indicating fluid in the alveoli.

What causes wheezes in lung sounds?

Wheezes are high-pitched musical sounds caused by air passing through narrowed airways.

Define stridor. What does it indicate?

Stridor is a loud, high-pitched crowing sound heard on inspiration, indicating upper airway obstruction.

What indicates a pleural friction rub during auscultation?

A pleural friction rub is a grating sound caused by inflamed pleural layers rubbing together, often localized and can be painful.

What subjective information is key when assessing respiratory symptoms?

History of present illness, past respiratory issues, onset and duration of dyspnea, cough characteristics, chest pain, and any constitutional symptoms.

What are Pulmonary Function Tests (PFTs)?

PFTs measure lung volumes and airflow to diagnose and monitor lung diseases.

What does Forced Vital Capacity (FVC) measure?

FVC measures the total volume of air a person can exhale forcefully after a full inhalation.

What does a low FEV₁/FVC ratio indicate?

A low FEV₁/FVC ratio indicates obstructive lung disease, such as asthma or COPD.

What does arterial blood gas analysis measure?

ABG analysis measures acidity, oxygenation, and gas levels in arterial blood.

What are normal arterial blood gas values at sea level?

Normal values: pH 7.35-7.45, PaO₂ 75-100 mmHg, PaCO₂ 35-45 mmHg, HCO₃⁻ 22-26 mEq/L, and SaO₂ 95-100%.

What does the acronym ROME stand for in ABG interpretations?

ROME stands for Respiratory Opposite, Metabolic Equal, describing the relationship between pH and other values.

What is important when monitoring supplemental oxygen therapy?

Oxygen is a medication, so it should be titrated carefully to maintain appropriate saturation levels.

Why should COPD patients receive careful monitoring of oxygen levels?

Too much oxygen can suppress their respiratory drive, as they often rely on low O₂ levels to stimulate breathing.

What is a priority intervention for acute respiratory distress?

Ensure the patient has an open airway and is adequately breathing.

How should a patient in severe respiratory distress be positioned?

The patient should be positioned upright to improve ventilation.

What techniques are useful for managing anxiety in patients with respiratory issues?

Calm reassurance and breathing techniques such as pursed-lip breathing can help manage anxiety.

What should be done if a patient shows signs of airway obstruction?

Immediate actions may include preparing for intubation or calling for emergency assistance.

What is the benefit of administering nebulized bronchodilators?

Bronchodilators relax airway smooth muscle and improve airflow, especially during acute asthma attacks.

You are assessing a patient with COPD. They report increased shortness of breath and a productive cough. What should be your immediate nursing intervention?

The immediate nursing intervention should be to ensure the patient has an open airway and is adequately breathing.

A patient presents with signs of respiratory distress and has a history of asthma. What position should you place them in to facilitate better breathing?

The patient should be positioned upright to improve ventilation.

During a respiratory assessment, you notice that a patient has a dry cough and low oxygen saturation. What is a possible cause you should consider?

A possible cause could be increased airway resistance due to an obstructive lung disease like asthma.

A patient with pneumonia presents with dullness to percussion in the right lung field. What does this indicate?

Dullness to percussion may indicate fluid or solid tissue replacing air, characteristic of an infection or pleural effusion.

In a patient experiencing acute asthma exacerbation, what is the benefit of administering nebulized bronchodilators?

Nebulized bronchodilators relax airway smooth muscle and improve airflow, alleviating symptoms during an acute asthma attack.

During auscultation of a patient’s lungs, you hear wheezes. What does this suggest about the patient's airway status?

Wheezes suggest that the airways may be narrowed, indicating bronchoconstriction or obstruction.

A patient with chronic CO₂ retention is receiving oxygen therapy. What crucial aspect must you monitor closely?

You must monitor the oxygen levels closely to avoid suppressing their hypoxic drive to breathe.

When assessing a patient for signs of respiratory distress, which symptoms should you specifically look for?

Look for signs such as use of accessory muscles, intercostal retractions, nasal flaring, pursed-lip breathing, and audible wheezing.

If a patient presents with stridor during inspiration, what does this indicate?

Stridor indicates upper airway obstruction and may signify a serious condition requiring immediate intervention.

What specific subjective information is critical to gather when assessing a patient with respiratory symptoms?

Gather details such as history of present illness, past respiratory issues, onset and duration of dyspnea, cough characteristics, chest pain, and any constitutional symptoms.