Carbon Dioxide (CO2)
The waste gas created in the tissues that moves from the blood into the alveoli so that it can be exhaled
Purposes of breathing
* Provides O2 for tissue perfusion so that cells have enough O2 to take part in metabolism
* Removes CO2, the major waste product of metabolism
Upper Airways
Nose
Sinuses
Pharynx
Larynx
Turbinates
3 bony projects that protrude into the nasal cavities from the walls of the interior portion of the nose; They increase the total surface are for filtering, heating, & humidifying inspired air
Nasopharynx
Contains the adenoids & the opening of the eustachian tube
Oropharynx
Contains the palatine tonsils
Laryngopharynx
Extends from base of tongue to esophagus; it is the critical dividing point where solid food & fluids are separated from air
Larynx
the "voice box"; located above the trachea
Cricothyroid membrane
The site used in an emergency for access to the lower airways (aka a tracheostomy)
Lower Airways
Trachea
Bronchi
Bronchioles
Alveolar ducts
Alveoli
When a foreign object is aspirated from the throat, where does it usually enter?
The right bronchus
Lobar bronchi
*Cartilage is ring-shaped and RESISTS collapse
*Lined with a ciliated, mucus-secreting membrane
Bronchioles
Have no cartilage and depend entirely on the elastic recoil of the lung to remain patent
Alveoli
The basic units of gas exchange
Surfactant
A fatty protein that reduces surface tension in the alveoli; without it, atelectasis occurs
Right Lung
*Responsible for about 60-65% of respiratory function
*Any problem with this lung inteferes with oxygenation to a greater degree than a problem in the other lung
Formula for calculation of "pack years
# of packs smoked per day X # of yrs. pt. has smoked
A cough can be a side of effect of this group of prescribed drugs
ACE inhibitors
Histoplasmosis and Coccidioidomycosis
Fungal diseases
What is a main sign of lung disease?
Cough
Normal amount of sputum production per day
3 ounces (90mL)
Hemoptysis
Blood in the sputum; Most often seen in patients with chronic bronchitis or lung cancer
Paroxysmal nocturnal dyspnea
Intermittent dyspnea sleep; The pt. has a sudden onset of breathing difficulty severe enough to awaken them from sleep; Often occurs with chronic lung disease & left-sided heart failure
Orthopnea
Shortness of breath that occurs when lying down but is relieved by sitting up; Often occurs with chronic lung disease & left-sided heart failure
Appearance of nasal mucous membrane in patient with Allergic Rhinitis
Pale, engorged, and bluish gray
Septal deviation
Some degree of it is common in most adults & appears as an S shape, tilting toward 1 side or the other
Perforated Septum
A condition commonly found in cocaine users; It is present if a light shines through the perforation into the opposite nostril upon assessment
Nasal Polyps
A common cause of obstruction; Pale, shiny, gelatinous lumps or "bags" attached to the turbinates; Assess by blocking 1 naris at a time to check whether air moves through the unblocked side easily
Tender lymph nodes in neck
Usu. movable & suggest inflammation
Malignant lymph nodes in neck
Often hard & are fixed to the surrounding tissue
These disorders push the trachea AWAY from the affected area
*Tension pneumothorax
*Large pleural effusion
*Mediastinal mass
*Neck tumors
These disorders pull the trachea TOWARD the affected area
**Pneumonectomy
**Fibrosis
**Atelectasis
Pneumothorax
Partial or complete collapse of the lung due to air or gas in the pleural space
Crepitus
Air trapped in & under the skin aka as subcutaneous emphysema; it is FELT as a crackling sensation beneath the fingertips
Tactile (vocal) fremitus
A vibration of the chest wall produced with the pt. speaks; This vibration is increased w/pneumonia & abscesses
Adventitious sounds
Additional breath sounds superimposed on normal sounds; indicate pathologic changes in the lung
PaO2
80-100 mm Hg
pH
7.35 - 7.45
PaCO2
35-45
HCO3
21-28 mEq/L
SpO2
95% - 100%
Pulmonary embolism
The blockage of a pulmonary artery by fat, air, tissue tumor, or a thrombus that usu. arises from a peripheral vein
Pulmonary Function Tests (PFTs)
These tests evaluate lung function & breathing problems; During these tests the patient breaths through the mouth only
Functional Residual Capacity
A PFT to determine the amount of air remaining in the lungs after NORMAL EXpiration
Total Lung Capacity
A PFT to determine the amount of air in the lungs at the end of MAXIMUM INhalation
Residual Volume
A PFT to determine the amount of air remaining in the lungs at the end of a full, FORCED EXhalation
Bronchoscopy
An invasive diagnostic assessment; Used to diagnose & manage pulmonary diseases
Methemoglobin
-Normal blood level is less than 1%
-Cyanosis occurs w/levels between 10-20%
-Anxiety, tachycardia, and lethargy develop at 20-50%
-Death can occur when levels reach 50-70%
Methemoglobinemia
The conversion of normal hemoglobin to methemoglobin, an altered iron state that does not carry O2 resulting in tissue hypoxia
Treatment for Methemoglobinemia
Supplemental oxygen & IV adm. of 1% methylene blue
Benzocaine spray
A topical anesthetic to numb the oropharynx that is used cautiously, if at all, because it can induce methemoglobinemia
When to suspect methemoglobinemia?
If patient becomes cyanotic after receiving a topical anesthetic, does not respond to supplemental O2, & blood is a characteristic chocolate brown in color
Thoracentesis
An invasive diagnostic assessment involving the aspiration of pleural fluid or air from the pleural space; Can be used for diagnosis or treatment
Which of these clients will the charge nurse on the medical unit assign to an RN who has floated from the postanesthesia care unit (PACU)?
A. Client with allergic rhinitis scheduled for skin testing
B. Client with emphysema who needs teaching about pulmon
Client with pleural effusion who has had 1200 mL removed by thoracentesis
An RN and an LPN/LVN are working together to provide care for a client hospitalized with dyspnea who requires all of these nursing actions. Which of these actions is best accomplished by the RN?
A. Administer the purified protein derivative (PPD) for tube
Plan client and family teaching regarding upcoming pulmonary function testing.
A client has returned to the postanesthesia care unit (PACU) after a bronchoscopy. Which of these nursing tasks is best for the charge nurse to delegate to the experienced nursing assistant working in PACU?
A. Assess breath sounds.
B. Check gag reflex.
C.
Monitor blood pressure and pulse.
The RN has received report about all of these clients. Which client needs the most immediate assessment?
A. Client with acute asthma who has an oxygen saturation of 89% by pulse oximetry
B. Client admitted 3 hours ago for a scheduled thoracentesis in 30 m
Client with acute asthma who has an oxygen saturation of 89% by pulse oximetry
The home health nurse is assigned to visit all of these clients when a change in agency staffing requires that one of the clients should be rescheduled for a visit on the following day. Which of these clients would be best to reschedule?
A. Client with em
Client with emphysema who has been on home oxygen for a month and has SPO2 levels of 91% to 93%
Which of these assessment findings will be of greatest concern when the nurse is assessing a client with emphysema?
A. Barrel-shaped chest
B. Bronchial breath sounds heard at the bases
C. Hyperresonance to percussion of the chest
D. Ribs lying horizontal
Bronchial breath sounds heard at the bases
People involved in which occupations or activities are encouraged to wear masks and to have adequate ventilations? Select all that apply.
A. Bakers
B. Coal miners
C. Electricians
D. Furniture refinishers
E. Plumbers
F. Potters
Bakers
Coal miners
Furniture refinishers
Potters
Which nursing intervention is the priority in preparing the client for pulmonary function testing (PFT)?
A. Administer bronchodilator medication on call.
B. Encourage clear fluid intake 12 hours before the procedure.
C. Ensure no smoking 6 hours before th
Ensure no smoking 6 hours before the test.
The nurse is performing a client assessment for the client's potential employer. The client reports dyspnea when climbing stairs but is not dyspneic at rest. Which dyspnea classification does the nurse assign to this client in the report to the employer?
Class II, can perform desk job
A client comes to the emergency department with a productive cough. Which symptom does the nurse look for that will require immediate attention?
A. Blood in the sputum
B. Mucoid sputum
C. Pink frothy sputum
D. Yellow sputum
Pink frothy sputum
A client with asthma reports shortness of breath. What is the nurse assessing when auscultating this client's chest?
A. Adventitious breath sounds
B. Fremitus
C. Oxygenation status
D. Respiratory excursion
Adventitious breath sounds
Four clients are sent back to the emergency department from triage at the same time. Which client requires the nurse's immediate attention?
A. Client with acute allergic reaction
B. Client with dyspnea on exertion
C. Client with lung cancer with cough
D.
Client with acute allergic reaction
The nurse auscultates popping, discontinuous sounds over the client's anterior chest. How does the nurse classify these sounds?
A. Crackles
B. Rhonchi
C. Pleural friction rub
D. Wheeze
Crackles
In the older adult client, which respiratory change does not require further assessment by the nurse?
A. Increased anteroposterior (AP) diameter
B. Increased respiratory rate
C. Shortness of breath
D. Sputum production
Increased anteroposterior (AP) diameter
In assessing the client's respiratory status, blood gas test results reveal pH of 7.50, PaO2 of 99, PaCO2 of 29, and HCO of 22. What action does the nurse need to take first?
A. Call the physician.
B. Encourage the client to slow his breathing rate.
C. No
Encourage the client to slow his breathing rate.
The client returns to the medical unit after a therapeutic bronchoscopy. Which intervention does the nurse apply first?
A. Assess the puncture site for drainage.
B. Implement NPO (nothing by mouth) status.
C. Monitor for signs of anaphylaxis.
D. Perform a
Implement NPO (nothing by mouth) status.
Why are the turbinates important?
A. They decrease the weight of the skull on the neck.
B. They increase the surface area of the nose for heating and filtering.
C. They move inspired particles from nose to throat for removal.
D. They separate two nasal pa
They increase the surface area of the nose for heating and filtering.
A client is having surgery. He asks his nurse, "When they put that tube in my throat, where does it really go?" What is the name of the opening of the vocal cords?
A. Arytenoid cartilage
B. Epiglottis
C. Glottis
D. Palatine tonsils
Glottis
Where does gas exchange occur?
A. Acinus
B. Alveolus
C. Bronchus
D. Carina
Alveolus
The client has a fever of 40� C. In which direction, if any, will this shift the oxyhemoglobin dissociation curve?
A. Down
B. To the left
C. To the right
D. Will not shift
To the right
Which of the components of a client's family history are of particular importance to the home health nurse who is assessing a new client with asthma?
A. Brother is allergic to peanuts.
B. Father is obese.
C. Mother is diabetic.
D. Sister is pregnant.
Brother is allergic to peanuts.
Four clients arrive in the emergency department simultaneously with chest pain. The client with which type of chest pain requires immediate attention by the nurse?
A. Client with pain on deep inspiration
B. Client with pain on palpation
C. Client with pai
Client with pain radiating to the shoulder
The nurse is working in an urgent clinic. Which of these four clients needs to be evaluated first by the nurse?
A. Client who is short of breath after walking up two flights of stairs
B. Client with soreness of the arm after receiving purified protein der
Client who is speaking in three-word sentences and has SaO2 of 90% by pulse oximetry
A client is admitted to the medical floor with a new diagnosis of lung cancer. How can the nurse assist the client initially with the anxiety associated with the new diagnosis?
A. Encourage client to ask questions and verbalize concerns.
B. Leave client a
Encourage client to ask questions and verbalize concerns.
A client is admitted to the surgical floor with chest pain, shortness of breath, and hypoxemia after having a knee replacement. What diagnostic test will the nurse teach the client about to help confirm the diagnosis?
A. Bronchoscopy
B. Chest x-ray
C. Com
Computed tomography (CT) scan
You are a charge nurse on a surgical floor. The LPN/LVN informs you that a new client who had an earlier bronchoscopy has the following vital signs: heart rate 132, respiratory rate 26, and blood pressure 98/50. The client is anxious and his skin is cyano
Administer oxygen.
A client had a thoracentesis 1 day ago. He calls the home health agency and tells the nurse that he is very short of breath and anxious. What is the major concern of the nurse?
A. Abscess
B. Pneumonia
C. Pneumothorax
D. Pulmonary embolism
Pneumothorax