Tiêu đề NCM 112 MIDTERMS ✅

NCM 112 MIDTERMS by TONS and MADS 1. 4 pairs of bony cavities that lined with nasal mucosa and ciliated pseudostratified columnar epithelium connected by series of ducts that drain pinto nasal cavity. 2. Serve as resonating chamber in speech. 3. Common site of infection. D. Pharynx (throat) 1. Tubelike structure that connects nasal and oral cavities to larynx. 2. Passageway for respiratory & digestive tracts 3. 3 regions: nasal, oral, and laryngeal. a) Nasopharynx: posterior to nose and above soft palate. b) Oropharynx: faucial or palatine tonsils. c) Llaryngopharynx extends from hyoid bone to cricoid cartilage. 4. Adenoids or pharyngeal tonsils a) Roof of nasopharynx b) Important links in chain of lymph nodes guarding from invasion by organisms entering nose and throat 5. Trachea (Part of Upper in Book) - windpipe a) composed of smooth muscle with C-shaped rings of cartilage at regular intervals. b) cartilaginous rings incomplete on posterior surface give firmness to the wall of trachea, preventing it from collapsing. c) Passage between larynx and bronchi. II. LOWER RESPIRATORY TRACT A. Trachea B. Mainstream Bronchi C. Alveolar Ducts & Alveoli - basic unit of gas exchange D. Lungs 1. Divided into 5 lobes a) 3 in Right: RU, right middle (RML), RL lobe b) 2 in Left 2. Paired elastic structures enclosed in thoracic cage, which is an airtight chamber with distensible walls. 3. Lobes - subdivided into 2-5 segments separated by fissures, which are extensions of pleura E. Pleura 1. Serous membrane that lines the lungs and wall of the thorax a) Visceral pleura covers lungs b) Parietal pleura lines thorax. 2. Pleura and small amount of pleural fluid between two membranes lubricate thorax and lungs and permit smooth motion of lungs within thoracic cavity w/ each breath. F. Mediastinum - in middle of thorax, between pleural sacs that contain two lungs. 1. Contains all thoracic tissue outside lungs (heart, thymus, certain large blood vessels [aorta, vena cava], and esophagus). G. Bronchi and Bronchioles 1. Lobar bronchi (3 in right and 2 in left lung). a) Divide into segmental bronchi (10 on right and 8 on left) 2. Segmental bronchi - structures identified when choosing most effective postural drainage position for a given patient a) Divide into subsegmental 3. Subsegmental bronchi a) Surrounded by connective tissue that contains arteries, lymphatics, and nerves. b) Branch into bronchioles 4. Bronchioles a) have no cartilage in walls; Patency depends on elastic recoil of surrounding smooth muscle and alveolar pressure. b) Contain submucosal glands, which produce mucus that covers inside lining of airways. c) Bronchi and bronchioles are lined with cells that have surfaces covered w/ cilia which create constant whipping motion that propels mucus and foreign substances away from lungs toward the larynx. d) Bronchioles branch to terminal bronchioles, which do not have mucus glands or cilia. 5. Terminal (respiratory) bronchioles a) transitional passageways between conducting and gas exchange airways. b) Conducting airways contain about 150mL air in tracheobronchial tree that does not participate in gas exchange “physiologic dead space” 6. Respiratory bronchioles → alveolar ducts and sacs → alveoli (O2 and CO2 exchange). H. Alveoli 1. 300 million arranged in clusters of 15-20; would cover 70sqm (tennis court) 2. 3 types koooo k2
NCM 112 MIDTERMS by TONS and MADS a) I: epithelial cells that form alveolar walls. b) II: metabolically active, secrete surfactant c) III: macrophages, large phagocytic cells ingest foreign matter; defense mechanism. III. Accessory Muscles of Respiration A. Scalene – Elevate first 2 ribs B. Sternocleidomastoid – Raises sternum during inhalation. C. Trapezius & Pectoralis – Fix the shoulder. VENTILATION 1. Inspiration - Occurs during first 3rd of respiratory cycle a. When capacity of chest is increased, air enters through trachea (inspiration) because of lowered pressure within and inflates the lungs. b. Requires energy 2. Expiration - during the later two thirds a. When chest wall and diaphragm return to their previous positions (expiration), lungs recoil and force air out through the bronchi and trachea. b. In respiratory diseases, such as COPD, expiration requires energy c. Passive, requiring very little energy PERFUSION - availability & movement of capillary blood for exchange of gasses, nutrients, and cellular metabolites. RESPIRATORY ASSESSMENT I. Health History - focuses on physical & functional problems, effects on ADLs, usual work and family activities A. Severe dyspnea: modify or abbreviate questions and timing of health history to avoid increasing breathlessness & anxiety. B. Identifying chief reason for seeking health care C. Determine when it started, how long it lasted, if it was relieved and how relief was obtained. D. Obtain information on precipitating factors, duration, severity, and associated factors or symptoms. E. Common (Major) Signs & Symptoms 1. Dyspnea (subjective feeling of difficult or labored breathing, breathlessness, SOB) a) Common to many pulmonary and cardiac disorders: decreased lung compliance or increased airway resistance; Right ventricle affected because it pump blood through lungs against greater resistance. b) Associated w/ neurologic/neuromuscular disorders (myasthenia gravis, GBS, muscular dystrophy, post polio syndrome) that affect respiratory function. c) After physical exercise in people w/o disease d) Common at end of life. e) Acute diseases of lungs produce more severe grade of dyspnea than chronic f) Sudden dyspnea in healthy px: acute respiratory obstruction, pneumothorax, allergic reaction, or MI. (1) In immobilized patients, sudden dyspnea → pulmonary embolism. g) ARDS: Dyspnea and tachypnea with progressive hypoxemia from lung trauma, shock, cardiopulmonary bypass, or multiple blood transfusions. h) Heart disease/COPD: Orthopnea (inability to breathe easily except upright position) (1) COPD: Dyspnea w/ expiratory wheeze i) Noisy breathing from narrowing of airway or localized obstruction of major bronchus by tumor or foreign body. (1) Stridor: High-pitched sound heard (usually inspiration; partially blocked upper airway) (2) Asthma: Inspiratory and expiratory wheezing if no HF. j) Ask: (1) How much exertion triggers SOB? Does it occur at rest? With exercise? Running? Climbing stairs? (2) Is there an associated cough? (3) Is SOB related to other symptoms? (4) Was onset of SOB sudden/gradual? (5) What time of day/night SOB occur? (6) Is SOB worse when laying flat? (7) Is SOB worse while walking? If so, when walking how far? How fast? (8) How severe is SOB? Ccale of 1-10, if 1 is breathing w/o any effort and 10 is breathing difficult as it could be, how hard is it to breathe? k) Visual analogue or other scales to assess changes in severity of dyspnea 2. Cough - reflex; protects lungs from accumulation of secretions or inhalation of foreign bodies. a) Presence/absence: diagnostic clue (some disorders cause or suppress coughing ) b) Reflex impaired by weakness or paralysis of respiratory muscles, NGT, prolonged koooo k3