Tiêu đề NCM 112 MIDTERMS ✅

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