N517 Respiratory
Terms
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- What are the surface markings for the lobes of the lungs?
- 4th rib mid clavicular 5th rib midaxilary, 6th rib posteriorly.
- What is the difference between pneumothorax, hemothorax, and pleural effusion?
- Pneumothorax is a popped bullae/bleb which causes a collapsed lung (sudden onset SOB), a hemothorax is the presence of blood in the pleural space, a pleural effusion is fluid in the intrapleural space.
- What is in the 3 columns of a chest tube?
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1. Drainage
2. Water seal, bubble on cough=air leak
3. Suction, determined by water level - What is the role of the medullary chemoreceptors and chemoreceptors in the aortic arch and carotid bodies?
- They are sensitive to changes in PCO2 and PH in CSF
- Intrapleural pressure is always _________.
- Subatmospheric.
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A person's Vital capacity (lungs) is comprised of what?
VC=A+B+C -
expiratory reserve volume (1200cc)
Tidal volume (500cc)
Inspiratory reserve volume (3100cc)
A residual volume of 1200cc remains which is not counted in the VC. - Sometimes the FEV (forced expiratory volume) is decreased in people with lung disorders. What is this?
- FEV is the percent of the vital capacity that is expelled in the first second. N=75%
- What is the difference between restrictive and obstructive lung disorders?
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Restrictive = can't get air in
Obstructive = can't get air out - What is fremetis and what does it indicate?
- Fremitis is the increase of vocal vibration in the lungs found on palpation. It indicates a consolidation in the lungs (sputum, tumor)
- What does hyperesonance upon percussion of the lungs indicate?
- It indicates air associated with Pneumothorax or emphesema
- Your pt presents with increased fremetis, dull sounds upon percussion and crackles, egophony, whispered pectoriloquy and tubular breath sounds upon auscultation. What is your potenial diagnosis?
- There is evidence of consolidation. Either pneumonia, pleural effusion, or atelectasis.
- If your pts lungs are resonant on percussion and you hear normal to decreased breath sounds and wheezes, what could this be?
- Asthma or bronchitis
- If your patient has decreased fremitus, hyperresonance upon percussion and dereased breathsounds with prolonged expiration, what could this be?
- Emphysema
- You hear crackles at bases, some wheezes at end inspiration, nomral fremitus and resonant lungs. You think this could be what?
- Pulmonary edema (fluid in the aveoli).
- You hear no fremitis, dull percussion, decreased or absent breath sounds, egophony, whispered pectoriloquy of certain areas. This could be...
- Pleural effusion
- You hear decreased fremitus, hyperresonance, and absent breath sounds, what is this?
- Pneumothorax
- What are the first signs of hypoxia?
- Restlessness and anxiety.
- Okay, what are the rest?
- apprehension, headache, angina, confusion, hypotension, tachycardia tachypnea, cyanosis, dyspnea
- A chest tube drains fluid from _________?
- The pleural space
- What are the s/s of a pulmonary embolism
- Dyspnea, tachypnea, fever, changes in lung sounds, hypotension, chest px, apprehension, tachycardia
- How will you treat a PE?
- O2, heparin, thrombolytics
- What are the s/s of emphysema?
- Pink Puffers: dyspnea, tachypnea, pursed lips, some cough, barrel chest, diminished breath sounds and wheezing, hypercarbia, orthopnea, cachectic
- How will you treat the pt with emphysema?
- low flow O2, bronchodilators, steroids, stop smoking, conserve energy, nutritional support,
- What are the s/s of bronchitis?
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Daily productive cough esp on awakening
Dyspnea, cyanosis
clubbing of fingers
"blue bloater" - How will you treat the pt with bronchitis?
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Hydration
Humidified O2
Bronchodilators
Corticosteriods
breathing techniques - What are some s/s of asthma?
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Bronchospasm+inflammation+mucous=wheezing
SOB, tightness, tachycardia, tachypnea, cough, central cyanosis, flaring nostrils, hypoxemia, hypercapnea - TB is a gram __ organism.
- Positive
- What are the s/s of TB?
- fatigue, anorexia, fever, night sweats, mild wt loss, cough