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NUR 2502 / NUR2502: Multidimensional Care III / MDC 3 Exam 2 (Latest 2021/2022) Rasmussen

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hyperventilation, if someone is blowing off too much CO2 they become more Alkaline, respiratory alkalosis if a patient's lung are not functioning very well and they are unable to remove or blow off CO2 very well, the CO2 will build up in their system becoming acidic, respiratory acidosis Perfusion is adequate arterial blood flow through the peripheral tissues (peripheral perfusion) and blood that is pumped by the heart to oxygenate major body organs (central perfusion) upper respiratory tract nose, sinuses, pharynx, larynx Lower respiratory tract Lungs,Trachea, two mainstem bronchi, lobar, segmental, and subsegmental bronchi; bronchioles; alveolar ducts; alveoli common cause of respiratory ailments Cigarette smoke Nursing care of a patient experiencing upper respiratory system disorders maintaining a patent airway to allow adequate ventilation and oxygenation. Along with a focused respiratory assessment, the nurse will utilize information obtained from the patient and family during the admission history interview. Information regarding the patient's history of upper respiratory disorders, smoking, and environmental exposures will be utilized to determine the necessary testing and treatment

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hyperventilation, if someone is blowing off too much CO2 they become more

Alkaline, respiratory alkalosis

if a patient's lung are not functioning very well and they are unable to remove or blow off CO2 very well,
the CO2 will build up in their system becoming

acidic, respiratory acidosis

Perfusion

is adequate arterial blood flow through the peripheral tissues (peripheral perfusion) and blood that is
pumped by the heart to oxygenate major body organs (central perfusion)

upper respiratory tract

nose, sinuses, pharynx, larynx

Lower respiratory tract

Lungs,Trachea, two mainstem bronchi, lobar, segmental, and subsegmental bronchi; bronchioles;
alveolar ducts; alveoli

common cause of respiratory ailments

Cigarette smoke

Nursing care of a patient experiencing upper respiratory system disorders

maintaining a patent airway to allow adequate ventilation and oxygenation.
Along with a focused respiratory assessment, the nurse will utilize information obtained from the patient
and family during the admission history interview. Information regarding the patient's history of upper
respiratory disorders, smoking, and environmental exposures will be utilized to determine the necessary
testing and treatment

Normal Changes in Aging Adults

Alveoli function decreases
Ability to cough decreases
Lungs loose residual volume, vital capacity and gas exchange decreases.
Respiratory muscles atrophy
Vascular resistance increases, capillary flow decreases
Susceptibility to infection increases.

The turbinates

three bones that protrude into the nasal cavities from the internal portion of the nose
increase the total surface area for filtering, warming, and humidifying inspired air before it passes into
the nasopharynx.

The paranasal sinuses

, air-filled cavities within the bones that surround the nasal passages
Lined with ciliated membrane, the sinuses provide resonance to speech, decrease the weight of the
skull, and act as shock absorbers in the event of facial trauma..

Fremitus refers to vibratory tremors that can be felt through the chest by palpation, Increased fremitus
may indicate

compression or consolidation of lung tissue, as occurs in pneumonia.

Lung sounds

Bronchial
Bronchovesicular
Vesicular

Adventitious sounds

Crackles
Wheezes
Rhonchus
Pleural friction rub

Other Indicators of Respiratory Adequacy

Cyanosis, decreased capillary refill, clubbing of nails in fingers, level of consciousness, Chest
Circumference, Anxiety, Dyspnea Orthopnea, General Appearance

Diagnostic Assessment of lungs

Laboratory assessment
- RBC
- ABG- is a blood gas and this tells us the acid base balance of the patient
- Sputum- can tell us if microorganisms are growing in the lung - describe color, clarity, and any odor

Imaging assessment
- x-rays-Xrays show us areas of opaque which usually indicate pneumonia/consolidation of fluid
-CT- computed tomography. Lung nodules, areas of fluid buildup

Other noninvasive diagnostic assessments

- Pulse oximetry-circulating O2- tells us oxygen levels in the tissues- usually fingers, toes, or earlobes

- Capnometry and capnography-how much CO2 is leaving the lungs.
-PFTs-Lung function- tell us how well the lungs function at moving air in and out
- Exercise testing-Exercise tolerance

Invasive Diagnostic Assessment

-Endoscopic examinations
-Bronchoscopy- is a camera that looks at the airway passages

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