Med Surg Ch 29
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Med Surg Ch 29
What are the two functions of the respiratory system?
Gas exchange between the air and blood at the alveoli
movement of air into and out of the lungs
what is nasal mucosa made out of and what's it's function?
Ciliated epithelium - highly vascular
warms and moistens inhaled air
What produces mucus that traps dust and microorganisms and sweeps them backward down the pharynx?
What are the paranasal sinuses lined with?
What are the three parts of the pharynx?
Nasopharynx, oropharynx, laryngopharynx
The nasopharynx is a passage way for ____ and is located _____
Air, above the soft palate
The _____ tubes from the middle ear cavities open into the nasopharynx
The oropharynx is a passage way for ___ and is located ___
Air and food, posterior to the oral cavity
the laryngopharynx is a passage way for _____ and is located ___
Air and food, opens anteriorly into the larynx and posteriorly into the esophagus
what is the voice box?
The larynx is the air between ____ and ____
pharynx and trachea
the larynx is lined with ____ to trap pathogens
What is the function of the epiglottis and where is it located
covers the larynx like a flap when the larynx is elevated during swallowing
How is speech produced?
the vocal cords are vibrated by exhales air
How long is the trachea and where does it extend to?
4-5 inches in length
extends from the larynx to the primary bronchi
What keeps the trachea open?
C shaped pieces of cartilage in the wall
where does dust and microorganisms found in the larynx go?
Swept upward by cilia toward the pharynx and are usually swallowed
T or F: Bronchioles have cartilage in the walls to maintain patency
false: bronchioles have no cartilage
T or F: Bronchioles may be closed completely by contraction of their smooth muscle
the ___ membranes are the serous membranes of the thoracic cavity
the ___ is the membrane that covers the lungs
the ___ lines the chest cavity
___ prevents friction and adheres the membranes together during breathing
what is the functional unit of the lungs
what are alveoli
air sacs that are the site of gas exchange (respiration)
alveoli & alveolar capillaries are made of ___
simple squamous tissue
only one cell thick
diffusion of gases
lipoprotein that mixes with the tissue fluid and decreases the surface tension to permit inflation
alveoli are alveolar macrophages. define alveolar macrophage
phagocytize pathogens or fine dust particles and debris that have not been trapped and swept out by the cilia
movement of air into and out of the alveoli
what are the two respiratory centers?
what are the main respiratory muscles?
diaphragm inferior to the lungs
external and internal intercostal muscles between the ribs
define intrapleural pressure
potential pleural space between the pleural membranes
the pressure in the potential pleural space is always ___ atmospheric pressure
called negative pressure
define intrapulmonic pressure
pressure inside the alveoli and bronchial tree
fluctuaes below and above atmospheric pressure during each cycle of breathing
define inhalation / inspiration
occurs when motor impulses from the medulla cause contraction of the respiratory muscles
what happens during inhalation?
intercostal nerves -> external intercostal muscles -> rib ^ and out -> expanded chest cavity
as the lungs expand, ___ pressure falls below ___ pressure and air enters the nose and respiratory passages
define normal exhalation
passive process that begins when motor impulses from the medulla decrease and the diaphragm and external intercostal muscles relax
describe the normal exhalation process
alveolar pressure rises above atmostpheric pressure and air is forced out of the lungs until the two pressures are again equal
t or f: engery is required for exhalation
false, the elasticity of the lungs causes recoil and forces air out
where is oxygen carried?
in the blood by iron in the hemoglobin of the red blood cells
how is carbon dioxide carried?
in the blood in the form of bicarbonate ions in the plasma
How is respiration regulated?
by nervous and chemical mechanisms
What type of center does the medulla oblongata contain?
inspiratory centers and expiratory center
t or f: normal breathing is essentially a reflex
true. but becuase the respiratory muscles are skeletal muscles, it is possible to force changes
What is the major regulator of respiration
carbon dioxide because even small changes in its blood level change the pH
What does the chemical regulation of respiration involve?
blood levels of the oxygen and carbon dioxide
what detects a decreased blood oxygen level?
chemoreceptors in the carotid body and aortic body
What is the response by the medulla when decreased blood oxygen level is detected?
increase respiration to take more air into the lungs
what detects and increased blood carbon dioxide level or a decrease in pH?
central chemoreceptors in the medulla and peripheral chemoreceptors
what is the bodys response to an increased blood carbon dioxide level?
increased respiration to exhale more carbon dioxide which raises pH back to normal
Any decrease in the rate or efficiency of respiration permits what?
excess carbon dioxide to accumulate in the blood
when the decreased rate of respiration cuases excess hydrogen ions and lowers pH
occurs when the rate of respiration increases, eliminating the exhlaed co2 very rapidly.
decreased co2 -> decreased hydrogen ions -> increased pH
What is in an important question to ask pts who screen them for TB?
have you recently experienced night sweats, chills, or fevers
use of accessory muscles for breathing
indicates respiratory distress
occurs when airways are obstructed
when a chest is more rounded
associated with trapped air in the lungs
Ausculatation can be done in what position if a pt can not sit straight?
side lying position
abnormal breath sounds
what is the job of the LPN when an ABG is performed?
hold the site for five minutes
what is a cbc
measurement of rbc and hemoglobin
Describe what causes course crackles and list associated disorders
fluid in the airways
pulmonary edema, bronchitis, and pneumonia
why would a doctor order a sputum for afb?
when tb is suspected
why is a throat culture performed?
to determine the presence of viral or bacterial pathogens in the pharynx
Oxygen saturation test
simple noninvasive way to measure aterial oxygenation
what does and o2 sat test measure?
the percentage of hemoglovin that is saturated with oxygen
identifies pathogens present in the sputum. the sensitivty test determines which antibiotics will be effective against those pathogens
what should you instruct the pt to do when collecting a sputum culture?
take several deep breaths and cough sputum into the container
the process of meauring a person's exhaled carbon dioxide level
what is the normal pH level of blood?
increased in res. alkalosis
decreased in res. acidosis
ventilation perfusion scan
a radioactive substance is injected IV and a sacan is done to view blood flow to the lungs
radioactive substance is then inhaled and scanning shows how well o2 is distributed into the lungs
what does a ventilation perfusion scan detect>
air inspired and expired in one normal breath
What should you check on a pt who just had a bronchoscopy before offering fluids or food?
gag reflex by checking the pharynx with a cotton swab
involves the use of a flexible endoscope to examine the larynx, trachea, and bronchial tree
why is a bronchoscopy performed?
for visualization or to obtain a biopsy specimen for examination
After anigography, what position is the pt placed in and for how long?
flat in bed for 3 to 8 hrs to prevent bleeding
xray examination of the pulmonary vessels after iv admin of radiopaque dye through a PICC line
why is a pulmonary angiography performed?
help diagnose pulmonary embolism or other pulmonary vessel disorders
purpose of pursed lip breathing
promotes co2 excretion
forces max air to be expelled
when is a pt usually placed on supplemental o2?
when o2 sat falls below 90% on room air
when is a nasal cannula most effective?
when pt is breathing through his or her nose
one or both side vents closed to limit the mixing of room air and o2
how much o2 should a COPDer be placed on?
no more than 1 to 2 L of o2 per minute
used for pt who requires percentages of oxygen
how often is a nebulized mist treatment ordered?
q 4 to 6 hr or prn
metered dose inhalers
administer topical medications directly into the lungs, minimizing systemic side effects
why is it important to not overuse bronchodilator inhalers?
has a rebound effect and could even cuase death
how often should a pt use incentive spirometry?
10 times q 1 hr
involves the insertion of needle into the pleural space, most commonly to sapirate fluid in the pts with pleural effusion
what position should a pt be placed in for thoracentesis?
sittioin position, bending over a bedside table
how much fluid is usually removed when thoracentesis is performed?
as much as 2L, immediate reduction of dyspnea
what does a doctor usually order after a thoracentesis procedure?
chest xr to make sure the lung was not punctured