NR351 Week 5 exam with answers - A grade

Chapter 38- Oxygenation and Perfusion - Performs its functions through pulmonary ventilation, respiration and perfusion - Normal functioning depends on: o Integrity of the airway system to transport air to & from lungs o Oxygenate venous blood; remove carbon dioxide from blood o Properly functioning cardiovascular system to carry nutrients - Upper airway o Function: warm, filter, humidify inspired air o Nose, pharynx, larynx, epiglottis - Lower airway o Function: conduction of air, mucociliary clearance, production of pulmonary surfactant o Trachea, primary and secondary bronchi, and tertiary bronchioles - Anatomy of lungs o Located within thoracic cavity o Right lung: three lobes and 10 bronchopulmonary segments o Left lung: two lobes and 8 bronchopulmonary segments o Lungs are composed of elastic tissue (alveoli, surfactant (low surfactant, alveoli collapse), pleura- fluid between lungs and sac) o Pleural cavity- negative pressure Pulmonary Ventilation- the movement of air into and out of the lungs - Inspiration- the active phase of ventilation- air into lungs - Expiration- the passive phase of ventilation- air out of lungs - Respiration- involves gas exchange between the atmospheric air in the alveoli and blood in the capillaries - Perfusion- the process by which oxygenated capillary blood passes through body tissues Process of Ventilation - During Inspiration - Diaphragm contracts and descends, lengthening thoracic cavity - External intercostals muscles contract, lifting the ribs upward and outward - Sternum is pushed forward, enlarging the chest from front to back - Increased lung volume and decreased intrapulmonic pressure allow air to move from an area of greater pressure (outside lungs) to lesser pressure (inside lungs) - Relaxation of these structures results in expiration Gas Exchange- refers to the intake or oxygen and release of carbon dioxide - Four factors o Change in surface area available o Thickening of alveolar-capillary membrane o Partial pressure o Solubility and molecular weight of the gas - Atelectasis- incomplete lung expansion; obstruction of airway by foreign bodies Transport of Respiratory Gases - Oxygen is carried in the body via plasma and RBC’s - Most oxygen is carried by RBC’s in the form of oxyhemoglobin - Hemoglobin carries carbon dioxide in the form of carboxyhemoglobin - Alterations in Respiratory function: o Hypoxia- inadequate amount of oxygen available to the cells (can be chronic- headache, chest pain, enlarged heart, clubbing) o Dyspnea- difficulty breathing o Hypoventilation- decreased rate or depth of air movement into the lungs - Factors affecting Respiratory function o Levels of health- acute and chronic illnesses o Medications o Alteration in muscle function- obesity, scoliosis Cardiovascular System- vital for exchange of gases - Composed of the heart and blood vessels o Heart- cone shaped, muscular pump divided into four hollow chambers  Upper chambers: receive blood from the veins  Lower chambers: force blood out of the heart - Alterations o Dysrhythmia or arrhythmia- abnormality to heart rhythm o Myocardial ischemia- decrease of oxygen to heart; impaired oxygen to tissues o Angina- temporary imbalance of oxygen to heart o Myocardial infarction- acute, coronary syndrome characterized by decrease in heart tissue o Heart failure- unable to pump sufficient blood supply Respiratory Activity - Infant o Lungs go from fluid-filled to air-filled o Respiratory rate is rapid (30-55 breaths/min) and primarily abdominal o Crackles heard at end of deep respiration is normal - Child o Immune system protects from most infections o Subcutaneous fat is deposited on the chest wall - Older adult o Bony landmarks are more prominent due to fat loss o Kyphosis (hump back) o Barrel chest- 1:1 AP diameter o Increased risk for disease Sounds Heard On Percussion - Resonance- normal lungs - Hyper resonance- emphysematous lungs (normal for child) - Flatness- over bone, heavy muscle (thigh) or tumor - Dullness- the liver or spleen - Tympany- stomach and intestines Breath Sounds - Vesicular- inspiration > expiration, heard over most longs - Bronchial (tracheal)- inspiration < expiration, heard over trachea and larynx - Bronchovesicular- inspiration = expiration, heard over upper anterior chest and intercostals area Abnormal Breath Sounds - Crackles/rales- pneumonia, CHF, bronchitis and COPD o Classified as fine, medium or coarse - Wheezes/rhonchi- swelling, secretions, asthma or tumors o Classified as sibilant or sonorous Arterial blood gas and pH analysis - pH- 7.35-7.45 - PCO2- 35-45 mmHg - PO2- 80-100 mmHg - HCO3- 22-26 mEq/L Common Diagnostic Methods to assess Cardiopulmonary Function - Echocardiogram- noninvasive sonogram of heart - Endoscopic studies- used to examine larynx, bronchus, trachea- used to see lesions - Holter monitor- noninvasive recording of heart 24-48 hours - Skin tests- TB/PPD - Radiography Values Measured from Pulmonary Function - Tidal Volume (TV) - Vital Capacity (VC) - Forced Vital Capacity (FVC) - Forced Expiratory Volume (FEV) - Total Lung Capacity (TLC) - Residual Volume (RV) - Peak Expiratory Flow Rate (PEFR)