Tiêu đề NCM 112 MIDTERMS ✅

NCM 112 MIDTERMS by TONS and MADS 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 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 2
NCM 112 MIDTERMS by TONS and MADS 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 inactivity, depressed function of medullary centers (anesthesia, brain disorders). c) Irritation of mucous membranes anywhere in respiratory tract → COUGH d) Stimulus that produces cough: infectious process or airborne irritant (smoke, smog, dust, gas) e) Persistent frequent cough → exhausting, pain. f) May indicate serious pulmonary disease, cardiac disease, medication reactions (amiodarone, ACE inhibitors, smoking, GERD) g) To determine cause, describe the cough: (1) Dry, irritative cough: URTI viral or side effect of ACE inhibitor. (2) Irritative high-pitched cough: laryngotracheitis (3) Brassy cough: tracheal lesion (4) Severe or changing cough: bronchogenic carcinoma. (5) Pleuritic chest pain w/ coughing: pleural/chest wall (musculoskeletal) involvement. h)Inquire about onset & time of coughing. (1) Coughing at night: onset of left-sided HF or bronchial asthma. (2) Cough in morning with sputum production: bronchitis. (3) Cough worsens when supine: postnasal drip (rhinosinusitis). (4) Coughing after food intake: aspiration in tracheobronchial tree. (5) Cough of recent onset: acute infection. i) Persistent cough → embarrassment, exhaustion, inability to sleep, and pain. j) Violent coughing → bronchial spasm, obstruction, further irritation of bronchi → syncope (fainting). k) Severe repeated nonproductive uncontrolled cough → exhausting harmful. 3. Sputum Production a) coughs long enough → produces sputum. b)reaction of lungs to constantly recurring irritants. c) may be associated w/ nasal discharge. d) Nature of sputum is indicative of its cause. (1) Profuse purulent (thick, yellow, green, or rust-colored) or change in color: bacterial infection. (2) Thin mucoid: viral bronchitis (3) Gradual increase of sputum: chronic bronchitis or bronchiectasis (4) Pink Tinged mucoid: lung tumor. (5) Profuse, frothy, pink material, often welling up into throat: pulmonary edema. (6) Foul-smelling sputum & bad breath: lung abscess, bronchiectasis, or infection caused by fusospirochetal or other anaerobic organisms. 4. Chest Pain or Discomfort a) If associated with pulmonary conditions: (1) Sharp, stabbing, intermittent; or (2) Dull, aching, and persistent. b) Pain usually on the side where pathologic process is located, but may be referred elsewhere (neck, back, or abdomen) c) May occur with pneumonia, pulmonary embolism with lung infarction, pleurisy, or late symptom of bronchogenic carcinoma. d) Carcinoma: pain dull & persistent because cancer invaded chest wall, mediastinum, or spine. e) Lung disease does not always cause thoracic pain because lungs and visceral pleura lack sensory nerves and insensitive to pain stimuli. (1) Parietal pleura has rich supply of sensory nerves stimulated by inflammation & stretching of membrane → Pleuritic pain (sharp and seems to “catch” on inspiration) “like the stabbing of a knife.” 3