NURS 272 Final Exam Questions and Answers - Respiratory System , CV System , Musculoskeletal Disorders , Sleep and Health Disparities Explain the anatomical components of the respiratory system. ✅> respiratory zone muscles - major muscle = diaphragm *controlled by the phrenic nerve (C3 -C5 of the neck), so any pt w an injury to the spine/phrenic nerve will require ventilatory support! - accessory muscles = intercostals, abdominals, trapezius, sternocleidomastoid To move air into the lungs...respiratory muscles generate negative intrapleural pressure = allows air inflowing via the pressure gradient btwn atmospheric pressure at the mouth (zero pressure) & alveolar pressure (negative pressure) > conduction zone muscles = trachea, bronchi & bronchioles - influenced by SNS' B2 -adrenergic receptors (relaxation) & acetylcholine receptors (constriction) > gas exchange surfaces = alveoli - chronic smoking & chewing tobacco = decr alveoli surface area *important to ask abt smoking history! - atelectasis = alveoli collapse resulting from trapped air or fluid buildup (ex: pts who are bedridden *important to encourage mobility & coughing) What are some of the risk factors for pulmonary disease? ✅> pollution & travel > 2nd hand/3rd hand smoke > chemical exposure > freq respiratory infections > pre -existing/congenital conditions (ex: CF, chest injury, living in confined environs) What are some of the common diagnostics used to screen for respiratory disease? ✅1) chest X -ray (CXR) = 2 view X -ray of PA (posterior & anterior) & Lateral (side) to help produce an accurate image of the pt's heart/lungs/BV/bones > looking for inflation of the lungs (COPD), fluid build up (pneumonia & HF), atelectasis, broken bones (ribs), heart size (cardiomyopathy = enlarged heart), foreign bodies - most common! cheap & inexpensive 2) CT scan (contrast) = uses contrast dye to produce more detailed images of soft tissue damage/injuries > looking for lesions, blood clots, etc - make sure to flush dye out to ppx kidney toxicity! 3) Pulse Oximeter = measures SaO2 > SaO2 = amt of O2 attached to Hgb/how much O2 being perfused via the blood - factors that influence readings = dark nail polish, long nails, acrylics, cold temp, bright lights, & anything that decr circulation to the finger - pts w darker skin, will have falsely high readings even when desaturating 4) Pulmonary function tests > looking for lung functioning in cases of COPD & asthma 5) Sputum Culture > looking for lung infection? 6) ABGs > looking for acid -base imbalances? & desaturation? 7) Bronchoscopy/Thoracoscopy = uses endoscopy to view respiratory structures > collecting biopsies & cultures - broncho (via mouth) & thoraco (via chest tube) - performed in ICU or OR w minimal sedation 8) Thoracentesis > pulling fluid build up in pleural lining off - important to assess baseline coagulation (order sets) to ppx excessive post -op bleeding 9) V/Q Scan = looks at ventilation (pt uses inhaler) vs. perfusion (radioactive substance is injected into blood) > detecting PE = indicated by altered V/Q - no longer commonly used 10) Mantoux test = ID injection > testing for TB What are the various components of a respiratory assessment? ✅1) lung sounds = use systematic approach! (ex: R > L moving down) - clear? bilateral? 2) breathing patterns = rate & quality - tachypnea? dyspnea? SOB? - difficulty breathing? shallow? 3) O2 saturation = 95 -99% expected 4) accessory muscle usage = indicates acute respiratory distress 5) hypoxia S/Sx - early.= restlessness, anxiety, confusion, <95% SaO2 - compensation = tachypnea, tachycardia, SOB - later = bradypnea, bradycardia, hypotension, decr LOC, cyanosis, & pallor 6) Crepitus (SQ emphysema) = air trapped in/under the skin - caused by chest injury, blunt force trauma, etc... - palpable as rice krispies under the skin 7) percussion = using 2 fingers tapping on 2 fingers - good for assessing w limited resources - dull sound (compromised lung) vs. resonate sound (healthy lung) What are some examples of abnormal breath sounds commonly heard during lung auscultation? ✅> fine crackles/rales = air moving into deflated airways, "popping, velcro, rolled hair" - ex: atelectasis, pneumonia, COPD > coarse crackles = "lower pitched rattling" *have pt cough to see if they can clear their airway - ex: pneumonia, flu, COVID, COPD, tumors > wheeze = narrowed airway w inflammation/secretions, "squeeky, musical" - ex: asthma, COPD, bronchospasms > rhonchi = obstruction, "low pitched wheeze, snore" - ex: anatomical (enlarged tonsils or adenoids), nasal congestion, thick secretions, tumor > stridor = something stuck in the trachea, "harsh grating" - ex: physical obstruction > pleural rub = inflamed pleural surfaces rubbing together, "loud, rough, grating, scratching" - ex: TB, pneumonia, lung cancer > decr breath sounds = over inflation of the lung or airway blockage - ex: pneumonia, HF, pleural effusion (fluid build up around pleural lining) T or F: New onset of confusion in older adults is often associated with underlying infection. ✅T confusion is often used as an indicator of infection in older adults bc fever & weakness are no longer reliable measures ex: UTI or pneumonia What are the various respiratory interventions/treatments used to support pts w respiratory conditions? ✅> O2 therapy > suctioning > Inhaled Medications > Pulmonary Toileting = Percussion Vest (HFCWO) > Positioning What are some of age related changes of respiratory system? ✅1) Alveolar = changes in surface area, diffusion, & elasticity > impaired gas exchange 2) Lungs = incr residual volume, barrel chest, decr gas exchange & elasticity 3) Pharynx & Larynx = muscle atrophy, slackened vocal cords 4) Pulmonary Vasculature = incr SVR, decr pulmonary capillary blood flow, & decr perfusion 5) decr Activity Tolerance = decr O2 & incr CO2 > incr HR & RR to compensate/tolerate activity 6) decr Muscle Strength = decr ability to cough 7) Chest Wall changes = incr AP diameter, kyphosis, shrinking thorax, decr cilia > incr risk for respiratory conditions Explain the different types of O2 therapy available. ✅*Low O2 therapy devices* > COPD or pneumonia 1) Nasal Cannula = 24 -44% O2, 1 -6L > PRN or continuous tx - Nursing Considerations = lubricate nares (water -based lubricant), assess skin integrity, change tubing regularly, & document 2) Simple Mask = 24 -44% O2, 6 -8L > short term & emergency tx - do NOT administer <5L = risk for CO2 retention - Considerations = assess skin integrity, monitor for N/V (aspiration risk), perform food trials w meals (monitoring pts on nasal cannula O2 while they eat) *Rebreathers* > unstable pts who may require intubation or ICU transfer 3) Partial Non -Rebreather = 60 -75% O2, 6 -11L > 2 valves + reservoir bag (allows for rebreathing of ⅓ of exhaled air that is high in O2) - Considerations = ensure bag is ⅓ -½ inflated w each breath (to ensure adequate amt of air for rebreathing) 4) Non -Rebreather = 80 -95%, 10 -15L > 1 way valve btwn mask & reservoir bag w flaps (allow exhaled air to be released & prevent backflow of air) - high O2 conc but low flow *High O2 therapy devices* 5) Face Tent = 24 -100%, 10L minimum > facial trauma, burns, & surgery = promotes healing & decr pain - O2 w high humidity 6) Intubation (T - piece) = 24 -100%, 10L minimum > tube placed in pts trachea for airway maintenance *Non -invasive positive pressure ventilation* > sleep apnea & COPD exacerbation
