| What is the difference between External Respiration and Internal Respiration | External Respiration is the exchange of oxygen and carbon dioxide between the lungs and the environment.
Internal Respiration is the exchange of oxygen and carbon dioxide at the cellular level |
| What is the purpose of the respiratory system? | To provide a continuous supply of oxygen to the cells necessary to carry out their specialized functions and to avoid rapid cell death via oxygen starvation |
| Upper Respiratory Tract | Comprises of the nose, pharynx, larynx and trachea |
| What function does the nose serve in respiratory function? | Air passes through the nares and is warmed, moistened and filtered as it passes through the nasal septum. |
| List the Paranasal sinuses | Frontal, Maxillary, Sphenoid and Ethmoid Cavities |
| What purpose do the paranasal sinuses serve? | They make the skill lighter and are believed to give resonance to the voice. |
| What function does the pharynx serve? | The pharynx serves as the passageway for air and food |
| What are the subdivisions of the pharynx? | Nasopharynx, Oropharynx and laryngopharynx |
| Olfactory Nerve | 1st cranial nerve responsible for sense of smell, located in the mucosa of the naval cavities |
| Glottis | The opening between the vocal cords |
| What function does the trachea serve? | It contains tiny cilia which sweep debris upward toward the nasal cavity and serves as the branching point into the bronchi |
| Anatomical differences between the left lung and right bronchi | The left bronchi is smaller in diameter and slightly horizontal in position. The right bronchi is larger in diameter and more vertical in position. |
| Anatomical progression of the bronchial tree | The trachea enters the lungs dividing into the right and left bronchi. The bronchi divide further into the bronchioles which divide further into terminal bronchioles or alveolar ducts. The end structures of the bronchial tree are the alveoli. |
| What function do alveoli serve in respiratory function? | Alveoli are small grape-like structures surrounded by blood capillaries. Alveoli serve to diffuse carbon and oxygen into the cardiovascular system |
| What purpose does surfactant serve which covers each alveolus? | The surfactant serves to reduce surface tension and prevents alveoli from collapsing after each breath. |
| What is the thoracic cavity? | The space in which the lungs heart and greater vessels are housed. The interpleural space is its centermost area and contains the heart and greater vessels. |
| What is the average weight of the right lung? The left lung? | Right lung weighs 625g and the left lung weighs 570g |
| How many lobes make up the right lung? The left? | 3 lobes make up the right lung and only 2 lobes make up the left |
| Describe the respiratory process of the lower respiratory tract | Blood supply to the lungs is received directly from the pulmonary arteries. Blood in the lung capillaries has little oxygen and air in the alveoli is rich in oxygen. Oxygen diffuses from areas of high oxygen concentration to areas of low oxygen concentration. Carbon dioxide is diffused from the lung capillaries in a similar fashion and expelled in breathing |
| Visceral Pleura | Thin moist serous membrane which covers the surface of each lung |
| Parietal Pleura | Thin, moist serous membrane which covers the walls of the thoracic cavity |
| What purpose does pleura serve? | It forms a vacuum that contains negative pressure. As the lungs are at atmospheric pressure(Higher pressure), this assists in keeping the lungs inflated. Pleura also secretes serous fluid which allows the lungs to slide over the walls of the thorax while breathing |
| Pleural Effusion | An overproduction in serous secretions of the pleura. Which accumulates in the pleural space causing distention, dyspne. |
| How is pleural effusion treated? | The provider may decide to remove fluid by way of throracentesis |
| Normal Respiratory Rate for newborn | 40-60 breaths/min |
| Normal Respiratory Rate for early-school age | 22-24 breaths/min |
| Normal Respiratory Rate for teenager | 20-22 breaths/min |
| Normal Respiratory Rate for Adult | 14-20 breaths/min |
| What parts of the brain are responsible for breathing depth and rhythm? | The medulla oblongata and pons |
| Percentage of O2 in room air | 21% |
| What are some nursing considerations to ensure an accurate o2 sat reading | Ensure digits are warm, Check capillary refill, check nails for nail polish or thick nails |
| Normal PH Range | 7.35-7.45 |
| Nurses first priority following anesthesia | maintain airway |
| Hypoxia | Inadequate, reduced tension of cell oxygen |
| Sleep Apnea co-morbidities | Systemic Hypertension, Cardiac Dysrhythmia, Right sided Heart Failure from Pulmonary Hypertension and stroke |
| Pleural Friction Rub | Low Pitched, Grating or Creaking Lung Sounds that occur when inflamed pleural surfaces rub together during respiration |
| Thoracentesis | Inserting a needle-like instrument into the pleural space to remove fluid |
| Cor Pulmonale | Abnormal cardiac condition characterized by hypertrophy of right ventricle of the heart as a result of hypertension of the pulmonary circulation(Late complication of emphysema) |
| Signs and Symptoms of Cor Pulmonale | Edema of lower extremities and sacral and perineal areas, distended neck veins and enlarged liver with ascites |
| Pneumothorax | Collapsed lung due to collection of gas in the pleural space(This may be due to ruptured bleb such as in emphysema or a severe coughing episode) |
| Sleep Apnea Risk Factors(6) | Gender(Twice as many men are diagnosed with sleep apnea as women)
Age(Risk increased for individuals over the age of 60)
Obesity(Airway may be infiltrated with fat and tongue and soft palate may be enlarged, Short thick neck also increases risk)
Nasal Conditions(Allergies, polyps, or septal deviation decrease diameter of the pharynx)
Receding Chin(May have limited room in the pharynx for the tongue)
Pharyngeal Structural Abnormalities(Enlarged tonsils, elongated uvula, long tongue or soft palate may obstruct the pharynx) |
| Amount of fluid recommended for patient with pneumonia | 3L/day |
| Common Signs and Symptoms of Tuberculosis | Recurring fever, weight loss, weakness, productive cough, chills, night sweats, hemoptysis(Coughing blood) |
| Sleep Apnea | Obstruction of airway which occurs when the tongue or soft palate fall backwards and obstruct the pharynx |
| Signs and Symptoms of Sleep Apnea | Frequent awakening at night, insomnia, excessive sleepiness during day, witnessed apneic episodes, headache, personality changes, irritability, reports from partner of loud snoring |
| Polysomnography | (Sleep Study) records brainwaves, blood O2 levels, heart rate and breathing as well and limb and eye movement to help determine quality of rest and diagnose sleep disorders such as sleep apnea |
| Mortality Rate of Legionnaire's Disease | 1/10 |
| Isolation Length for Patient with SARs-COV | 10 days |
| Nursing Considerations for Legionnaire's Disease | Maintain bedrest with head at 30*
Monitor I&O's
Educate Patient and family on importance of respiratory support
Control Fluid and temperature status |
| Treatment of Legionnaire's disease | Oxygen Therapy(Mechanical Ventilation possible)
IV Fluid Therapy to maintain fluid and electrolyte balance(Renal Dialysis possible with extreme cases)
Antibiotics(Erythromycin IV in early treatment and orally(Rifampin) for prolonged periods to treat infection
Antipyretics to help reduce fever
Vasopressors(Dopamine and Dobutamine) and Analgesics to treat shock symptoms and promote comfort |
| Ways of Diagnosing Legionnaire's disease | Urine Testing
Blood Testing
Sputum Sample
Pulmonary Tissue Sample
Fluid Culture |
| Signs and Symptoms of Legionnaire's disease | Fever(102*-105*), Headache, nonproductive cough, diarrhea, general malaise, dyspnea, chest pain, crackles and/or wheezing on auscultation, tachycardia, signs of shock and hematuria(blood in urine) |
| Legionnaire's disease | (Legionella Pneumophila) Gram negative bacillus which thrives in water reservoirs which is transmitted by airborne route. Results in life threatening pneumonia that causes lung consolidation and alveolar necrosis. It progresses rapidly and may result in renal failure, respiratory failure, bacteremia, shock and death |
| Pleural Effusion | Fluid accumulation in the pleural space due to too much serous secretions |
| pleurisy | Inflammation of the pleural lining |
| BiPAP | (Bilevel Positive Airway Pressure)Capable of producing high level pressure during inspiration and lower pressure on expiration |
| nCPAP | (Nasal Continuous Positive Airway Pressure) Used in severe sleep apnea, high powered blower adjusted to positive pressure of 5-15cm H2O to prevent airway collapse |
| Normal Ranges of O2 Sat? Desired? When does the ability of hemoglobin to feed oxygen significantly diminish? When is it considered life threatening? | 90-100%
95-100%
85%
70% |
| Tonsillectomy and Adenoidectomy Nursing Considerations | Post-op hemostasis(Large volume blood loss with no signs or symptoms of bleeding is common)
Use of analgesics, antipyretics and antibiotics to manage infection and comfort of patient
Meticulous oral care and warm saline gargles to prevent infection and promote healing
Observe and report frequent swallowing indicative of bleeding
Maintain fluid intake(IV fluids necessary if nausea is present)
Avoid Spicy Foods
Avoid heat which promotes vasodilation due to risk of bleeding
Instruct Patient to complete the full course of antibiotics |
| atelectasis | collapse of the alveoli preventing CO2 and O2 exchange |
| Empyema | Pus accumulation in the pleural space |
| Hypercapnia | Greater than normal amounts of CO2 in the bloodstream |
| Diagnosing Tonsillitis | Throat Culture(To identify microorganism)
CBC(To determine WBC Normal range 4500-11000 ) |
| Tonsillitis Signs and Symptoms | Sore Throat, fever, chills, anorexia, enlarged tonsils, purulent discharge, Increased WBC, enlarged lymph nodes |
| Acute Follicular Tonsillitis | Acute inflammation of the tonsils resultant of airborne or foodborne bacterial infection(most common Streptococci group A) |
| Pneumonia | Inflammatory process of the respiratory bronchioles and alveolar space, caused by infection, over-sedation or inadequate ventilation |
