Laryngectomy test 1
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The upper respiratory tract extends from the _______ to the inferior border of the _______ at the ________ cartilage.
The upper respiratory tract contains (3):
- Nasal cavity
- oral pharynx
The lower respiratory tract includes (3):
Trachea, bronchi and lungs
How might you observe the upper respiratory tract?
Through a fiberoptic endoscopic evaluation (flexible scope is inserted through nose)
How might you observe the lower respiratory tract?
Bronchoscopy (must be asleep)
vital functions of the nose (3):
secondary functions (2):
- Filter the air
- Warm the air
- humidify the air
- adds resonance to speech
- contains olfactory nerves for taste and smell
In the nasal cavity there are ____ that line and filter. The bony structures of the nose are called _______ which cause turbulence and resistance to airflow (aiding the in filtering). Blood supply to these structures aid in _______.
- warming the air
The _____ and ______ separate the nasal and oral cavities.
The oral cavity begins at the ____ and ends at the ______ ______. It aids in ________ (5)
- Hard palate
- soft palate
- faucial arches
- mastication, digestion, swallowing, resonance, articulation
The tongue asserts the _______ impact on moving air. It functions in (3). The intrinsic muscles of the tongue control _______ and the extrinsic muscles control the __________
- chewing, bolus movement, speech production
- fine motor movements
- gross motor movements (attach tongue to other structures)
Saliva is secreted by 3 glands:
Serves as 3 agents:
Helps in digestion and coats articulators
- Sublingual, submandibular, and parotid glands
- antibacterial, antifungal, antiviral
What is Xerostomia?
extreme dry mouth (common in trach patients)
The pharynx is a ______ ______ that is used for ______ and ________. The ________ tubes are also connected to the pharynx.
- muscular tube
In the pharynx, breathing functions and swallowing functions are separated in the ___________. NG/OG tubes pass this area to reach the _________.
The Gag reflex is _____ _______ of a safe swallow.
Major functions of the Larynx (3):
- Airway protection (folds)
- pressure valving (cough)
The cough has 4 phases
- Irritation by stimulus
- Deep inspiration
- compression (contraction of muscles)
- Expulsion (vocal folds open and pressure is released)
The cough facilitates:
defecation, vomiting, and heavy lifting
Can intubated patients cough?
The larynx is suspended by the ______ _____ and is supported by the _______ and ________ cartilages and the __________.
- Hyoid bone
- Cricoid, thyroid
The cricoid cartilage is ______ shaped and forms the ____ of the trachea and the _____ or the larynx.
The thyroid cartilage is _____ shaped, the anterior prominence forms the ______ ______
The cricothyroid joint:
Lengthens and shortens the vocal folds
rest on cricoid cartilage and have two processes for muscle attachment
- Allows arytenoids to rock/glide
- abduct/adduct vocal folds
- below vocal folds
- true vocal folds
- above vocal folds (laryngeal ventricle specifically)
Intrinsic Muscles of the larynx serve in:
Finer adjustments needed for vocal fold movement (abduct, adduct, lengthen, shorten, alter tension)
The true vocal folds are large muscles called _________ there are internal and external. The internal muscles are the ______________.
- true vocal folds
The vocal folds are ________ to damage during __________ __________ ___________ and some __________.
- airway management procedures
Laryngeal movements are secondary to _______ _______ movement.
Extrinsic muscles of the larynx (3):
THese muscles are responsible for changes in the __________ of the larynx during speech and voice production
- Raise, lower, stabilize
The intrinsic and extrinsic muscles of the larynx allow for _______.
Intubated/trached patients do not have the _______ ________ from foreign bodies of the upper airway, nor do they have access to the structures for ______ and ________.
- Added protection
The lower airways consist of the ________ and the _________ _________, and is divided into two zones:
- descending airways
trachea is made up ____________ _______ that expand and flex due to the ____________ _________ in between the rings.
- Cartilaginous rings
- fibroelastic membrane
trachea diameter changes with _________ and ___________. Dilation occurs with ___________ and constriction occurs with ___________.
In an adult:
Number of rings:
cells in the trachea excrete _________ which functions as a __________ and __________ mechanism.
_______ is the place of bifurcation for the trachea, it is also the place for eliciting a _______ ________. The trachea divides into left and right.
The left mainstem bronchi (which branches from the trachea) has a ______ degree angle
The right mainstem bronchi (which branches from the trachea) has a ________ degree angle. And has a ________ diameter than the left bronchi.
Which lung is easier to aspirate into?
The right (less of an angle, so more of a straight shot for food/liquid)
The bronchi divide into lobar and segmental groups.
Bronchi - ______ - _______ _________ - _________ _____ _____
- terminal bronchioles
- alveolar air sacs
_____ sweep debris at a a rate of _____-______ tpm. This moves debris to the upper airway where it can be ______ more effectively. ________ paralyzes these ______.
- Trachea to the terminal bronchioles
- Tobacco smoke
The respiratory zone includes:
It functions in:
Bronchioles, alveolar ducts, alveolar sacs, pulmonary capillaries
The delivery of oxygen and the removal of carbon dioxide
The thoracic cavity contains:
The thorax _______
The thoracic cavity is divided by ________ which contains:
- 12 thoracic vertebrae, sternum, rib cage
- the mediastinum
- the heart, blood vessels, nerves, and esophagus
ribs attach to _______ and the ______ except for the ________ ribs
Deoxygenated blood returns via the ______ _______ heart pumps blood to lungs via ________ ________ where it is then _____________ and heads back to the heart to be dispersed by the _______
- vena cava
- pulmonary artery
right lung has __ lobes
left lung has __ lobes
Surfactant is a ________ that maintains ________ ________ aiding the lungs so they don't __________
- surface tension
THe collapse of the alveolar air sacs
Lungs are housed in _______ _______
and similarly _______ ________ lines the thorax
- visceral pleurae
- Parietal pleurae
________ pressure allows the visceral and parietal pleurae to stick together, in this way they are connected, which is called _______ __________. A __________ occurs when the airtight seal between pleurae is broken (resulting in _______ ________)
- pleural linkage
- lung collapse
allows thorax to move _______ and ________
What is the major muscle of inspiration?
This muscle separates the ________ and _______
- anteriorly, laterally
- the diaphragm
- thorax, abdomen
contracting and flattening the diaphragm _________ the volume of the thorax and _________ the volume of the abdomen.
Contraction of _________ muscles ________ thoracic volume by _________ the ribs
- (external) intercostal
Accessory muscles to expiration:
these are active during ________ expiration
- Rectus abdominis
- interanal/external obliques
- transversus abdominis
Accessory muscles to inspiration:
These muscles are activated when normal recoil of the lungs is not functional, for example:
- pectoralis major musles
- dysfunctional diaphragms
recurrent laryngeal nerve: intrinsic laryngeal muscles (except for the cricothyroid), provides sensory innervation to sublottic region
Superior laryngeal nerve: cricothyroid movement and supraglottic sensation
Pharyngeal: motor innervation of the pharynx/soft palate. Facilitates speech and swallowing
Since the diaphragm is innervated by the phrenic nerves (c3, c4, c5) then a high SCI will most likely result in the need for ____________
O2 is carried in ____ _____ _____ whose main component is ____________.
- red blood cells
At the _______ _________ gas exchange takes place as _____ enters the alveoli and is exhaled from the body by the lungs
- active inspiration, passive expiration
- active inspiration, active expiration
- active inspiration, active expiration (against added resistance of vocal folds)
Volume of air inhaled and exhaled during normal quiet breathing
Inspiratory Reserve volume:
amount of air that can be inhaled beyond a normal tidal inspiration
Expiratory reserve volume:
amount of air that can be exhaled beyond a normal tidal expiration
Volume of air that remain in the lungs beyond a maximum forced expiration (prevents lung collapse)
Functional Residual capacity:
volume of air that remains in the lungs beyond a normal tidal expiration
amount of air which can be maximally expelled from the lungs after a maximum inspiration
amount of air that is inspired and expired per minute
What is the normal respiration rate?
12-20 breaths per minute
Pulmonary function tests involve a ____________
Pressure and flow
1. Diaphragm contracts:
2. Alveolar pressure becomes ________
3. When the flow of air into the lungs stops:
4. ventilation is the:
- 1. alveolar pressure drops
- 2. negative
- 3. alveolar pressure becomes positive
- 4. constant adjusting system of flow and pressure
In speech breathing, the inspiratory cycle is _______ compared to the expiratory cycle
shorter (quick inhalation, slow exhalation). Longer phrases need larger volume. Shorter phrases need less volume with more frequent inhalations
Respiratory is located in the __________ _________ of the brainstem. The _________ is the major control center, balancing _____ and ____
- Reticular formation
- CO2 and O2
Regulation of breathing requires _______ ________ of the _________ makeup of the blood. Chemoreceptors detect low __ in blood.
- constant analysis
Arterial blood gases:
measures the levels of acids and bases
__________ ___ are the main base in the blood, when it combines with ______ ____ it forms carbonic acid. Carbonic acid is another way in which ___ is carried through the blood.
- bicarbonate ions
- hydrogen ions
Respiratory system regulates ____ ______
Renal system regulates amount of _________ in the blood
lungs provide too much ventilation and eliminate too much CO2 from the body
Inadequate ventilation and the body retains CO2
(Can't get air out)
Chronic Obstructive pulmonary disease:
- irreversible airway obstruction caused by damage to lung tissue
- The presence of a productive cough for a minimum of 3 months a year for 2 consecutive years
caused by chronic inhalation of irritants, bronchoconstriction, cyanosis, increased respiratory efforts, wheezing, increased secretions
Obstructive Diseases Cont:
- Deterioration of lung tissue (alveolar walls)
- loss of elastic recoil
- use of accessory muscles for inspiration
- work of breathing increased
Restrictive Lung Diseases
Reduced lung volumes (can't get air in)
Reduced lung compliance (lungs can't fully expand)
- systematic lupus
- intersitial fibrosis
- Acute infection and inflammation involving the gas exchange regions of the lungs.
- Fever, shortness of breath
- can be viral or bacterial
- Common in dysphagia
- severe aspiration can cause cardiopulmonary arrest
- repeated aspirations can result in decreased lung compliance
Neuromuscular Disease: ALS
- UMN and LMN affected
- hypoventilation (weakened muscles/diaphragm paralysis)
- progressive deterioration occurs
- intact eye muscles and cognition
- Needs: AAC, PEG, Trach/Vent
- Breathing difficulties/aspiration leading cause of death
Neuromuscular Disease: Multiple Sclerosis
- Demyelinating disease
- deterioration - speech, swallowing, cognitive-linguisitic, physical-motor
- respiratory issues
- pharyngeal dysphagia
- silent aspiration
Neuromuscular Disease: Muscular Dystrophy
- progressive muscle deterioration
- affects striated muscles (heart, diaphragm)
Neuromuscular Disease: Gillian-Barre Syndrome
- acute onset, rapid deterioration
- may see complete recovery
- speech/swallowing problems when respiratory involvement is present
- (viral infection, surgery, immunization, immunologic disorder)
Neuromuscular Disease: Stroke
- can have a brainstem stroke
- this can cause respiration problems
- mechanical ventilation may be needed in this instance
- anarthria and dysphagia
- some may require trach for pulmonary hygiene
Neuromuscular Disease: Poliomyelitis
- severe muscle weakness
- associated respiratory failure
- postpolio syndrome includes respiratory insufficiency, progressive muscle weakness, dysphagia
Neuromuscular Disease: Spinal Cord Injury
- above the 4th cervical vertebrae: respiratory musculature nonfunctional with partial or full paralysis of diaphragm
- below the 4th cervical vertebrae: spares diaphragm, muscles of inspiration and expiration are impaired
- quadriplegic patient is unable to use forced breathing (ineffective cough)
successful gas exchange is dependent on circulation of blood to the alveoli
- Efficient circulation is often impaired in cardiovascular conditions either because blood is not circulating or because intravascular fluids congest the lungs (pulmonary adema)
- could effect either or both ventricles of the heart
- congestive heart failure: occurs when heart cannot pump out sufficient amounts of blood, and fluid collects in the lungs
Adult respiratory distress syndrome:
- damage to the area of oxygen transfer, results in severe impairment of the gas exchange function
- fluid leakage into alveoli
- loss of surfactant
- severe atelectasis
- Hypoxemia: deficiency of oxygen in arterial blood
- Hypoxia: lack of oxygen at level of the body (brain damage)
- Increased Work of Breath (WOB)
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