MCN 109 Pre-finals > Respiratory System > Flashcards

Respiratory System Flashcards

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1
Q

All structures function in air distribution, except:

A

ALVEOLI
- gas exchange of oxygen and carbon dioxide

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2
Q

Upper Airway Structures

A
  1. oronasopharynx
  2. pharynx
  3. larynx
  4. eustachian tube and sinuses
  5. upper part of trachea
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3
Q

Lower Airway Structures

A
  1. trachea
  2. bronchi
  3. bronchioles
  4. alveoli
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4
Q

Diameter of Infant’s Trachea

A
  • approx 4 mm
  • presence of edema = increased mucus = bronchospasm = air passage diminished = air flow resistance = increased work of breathing
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5
Q

Diameter of Adult’s Trachea

A

20 mm

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6
Q

Nose

A
  • nose breathers until 4 weeks
  • little mucus (cleansing agent) = susceptible to infection
  • very small nasal passage = excess mucus = airway obstruction
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7
Q

Sinuses

A

INFANTS: born with maxillary and ethmoid sinuses

6-8 YEARS OLD: develop frontal and sphenoid sinus = young children are less susceptible to sinus infection
- frontal sinus = assoc. with infection

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8
Q

Throat

A

INFANT: tongue relative to oropharynx = larger than adults
- posterior displacement of tongue = severe airway obstruction

EARLY SCHOOL AGE: enlarged tonsillar and adenoidal tissue even in absence of illness = increased incidence of airway obstruction

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9
Q

Cricoid Cartilage

A
  • hyaline cartilage ring that fully encircles trachea

LESS THAN 10 YEARS OLD: underdeveloped = narrowing of larynx
- mucus and edema = air flow resistance = increased effort

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10
Q

Larynx and Glottis

A

placed higher in the neck = increased chance of aspiration of foreign material in lower airways

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11
Q

Muscles Supporting the Airway of Children

A
  • less functional than adults
    = large amount of soft tissues surrounding trachea and mucus membranes lining the airway = less securely attached compared to adults
  • increases risk of airway edema and obstruction
  • upper airway obstruction = tracheal collapse during inspiration
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12
Q

Bifurcation of Trachea

A
  • contributes to risk of aspiration

CHILDREN: 3rd thoracic vertebra
ADULT: 6th thoracic vertebra

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13
Q

Bronchi and Bronchioles

A

narrower in infants and children compared to adults = increased risk of airway obstruction (bronchitis/ asthma)

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14
Q

Alveoli

A
  • develop at app. 24 weeks of gestation

TERM INFANT: 50 million alveoli
AFTER BIRTH: growth slows until 3 months of age
7-8 YEARS OLD: 300 million (same with adult)

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15
Q

Chest Wall

A
  • highly compliant (pliable) and fail to support lungs adequately
  • respiratory effort diminished = functional residual capacity of lungs greatly reduced
  • lack of support, tidal volume of infants and toddlers = independent to diaphragm
  • diaphragm movement impaired = intercostal muscles cannot lift chest wall = respiration further compromised
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16
Q

Metabolic Rate and Oxygen Need

A
  • children have higher metabolic rate than adults
  • resting respiratory rate = faster
  • demand for oxygen = higher
  • respiratory distress = develop hypoxemia faster than adults
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17
Q

Fetal Lung Development: Week 4

A

laryngotracheal groove forms on floor foregut

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18
Q

Fetal Lung Development: Week 5

A

left and right lung buds push into pericardioperitoneal canal (primordial of pleural cavity)

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19
Q

Fetal Lung Development: Week 6

A
  • descent of heart and lungs into thorax
  • pleuroperitoneal foramen closes
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20
Q

Fetal Lung Development: Week 7

A

lung buds divide into secondary and tertiary bronchi

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21
Q

Fetal Lung Development: Week 24

A

bronchi divide 14 more times and respiratory bronchioles develop

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22
Q

Fetal Lung Development: Birth

A

additional 7 division of bronchi

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23
Q

Fetal Lung Histology: Stage 1

A

PSEUDOGLANDULAR PERIOD (5-17 weeks)
- all major elements of lungs formed except those involved with gas exchange (alveoli)

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24
Q

Fetal Lung Histology: Stage 2

A

CANALICULAR PERIOD (16-25 weeks)
- bronchi and terminal bronchioles increase in lumen size and lungs become vascularized

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25
Fetal Lung Histology: Stage 3
TERMINAL SAC PERIOD (24 weeks- birth) - more terminal sacs developed with capillaries lined with type I alveolar cells/ pneumocytes - type II pneumocytes (defenders) secrete surfactant = decrease surface tension forces and aids with expansion of terminal sacs
26
Fetal Lung Histology: Stage 4
ALVEOLAR PERIOD (late fetal period- 8 years) - 95% of mature alveoli develop after birth NEWBORN: only 1⁄6 to 1⁄8 of the adult number of alveoli and lungs appear denser on x-ray
27
Defenses of RS
- filtering particles - warming and humidifying inspired air - absorbing noxious gases in vascular upper airway
28
Defense: Lymphoid Tissues
- includes focal, lingual and adenoid = form protective circle around entrance - localizes and contains invading organisms so that they could be destroyed
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Defense: Mucous Blanket
secretes sticky mucus where organisms adhere
30
Defense: Ciliary Action
carry microorganisms and foreign agents away from lungs to be coughed out or swallowed by px
31
Defense: Epiglottis Reflex
- protect RT from invading foreign materials including infectious exudates from URT - prevent microorganisms from being aspirated from LRT
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Defense: Cough Reflex
- expulsive force - propels foreign materials our of LRT
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Defense: Tracheobronchial Dynamics
TRACHEOBRONCHIAL TREE: elongates, dilates on inspiration and shortens narrows during expiration
34
Defense: Position Changes
helps in draining tracheobronchial passage which gives problem in airway obstruction)
35
Defense: Lymphatics
DRAINING TERMINAL BRONCHIOLES: invades foreign microorganisms which are filtered and destroyed in the regional lymph nodes
36
Defense: Humoral Defenses
removed or destroyed by phagocytes immunoglobins (immunoglobin A: secreted by bronchial epithelium)
37
Physical Assessment of Respiratory Illness
1. cough 2. rate. depth of respirations 3. retractions 4. restlessness 5. cyanosis 6. clubbing of fingers 7. adventitious sounds 8. chest diameter
38
PA: Retractions
- sinking in of soft tissues relative to the cartilaginous bony thorax - nose flaring
39
PA: Stridor
high pitched noisy respiration
40
PA: Grunting
- occurs on expiration - might occur with alveolar collapse - sign of pain in older children - suggest pneumonia
41
PA: Wheezing
continuous musical sound originating from vibrations in narrowed airways
42
PA: Clubbing
proliferation of tissues on terminal phalanges
43
PA: Cough
- protective mechanism - indicator of irritation
44
Auscultation: Wheezing
CLEARS WITH COUGH: secretion in lower trachea DOES NOT CLEAR WITH COUGH: obstruction of bronchioles
45
Auscultation: Rales
- crackling sound - alveoli filled with fluid
46
Percussion
- note for non-resonant sounds FLAT OR DULL: percussed over partially consolidated lung tissue like pneumonia TYMPANY: percussed with pneumothorax, air in pleural cavity
47
Palpation
- palpate sinuses for tenderness in children - enlargement or tenderness of lymph nodes of head and neck ALTERATION IN TACTILE FREMITUS: decreased in barrel chest, absent in atelectasis COMPARE CENTRAL AND PERIPHERAL PULSES: weak = poor perfusion - central pulses in carotid in femoral artery (middle of body: neck and groin)
48
Lab: Arterial Blood Gas Analysis (ABG)
measures oygen and carbon dioxide
49
Lab: Arterial Blood Gas Analysis (ABG)
measures oygen and carbon dioxide
50
Lab: Pulse Oximetry
estimate arterial oxygen saturation: 95-100%
51
Lab: Transcutaneous Oxygen Monitoring
monitor oxygenation and ventilation
52
Respiratory Alcalosis
cause hyperventilation
53
Respiratory Acidosis
cause hypoventilation, trapping carbon dioxide in alveoli
54
Lab: Nasopharyngeal Culture
provide information on microorganisms causing the diseases in URT
55
Lab: Pulmonary Function Test
- non-invasive test that show how well lungs are working - measures lung volume, capacity, flow rate, and gas exchange
56
Lab: Sputum Analysis
ask older children to breathe in and out several times, cough deeply, and cough out mucus they have raised into a sterile specimen container
57
Lab: Xray, CT Scan, MRI
- evaluates respiratory tract - shows areas of infiltration or consolidation in lungs MRI: detailed image of chest cavities - when done in children, it requires sedation for best results
58
Therapeutic: Humidification
- method of artificial warming and humidifying of RT for mechanically ventilated px NEBULIZER: aims to deliver computed amounts of drug aerosols STEAM INHALATION: warm steaming that helps loosed thick mucus, making it easier for child to cough
59
Therapeutic: Expectorant Therapy
1. coughing 2. mucus clearing devices 3. chest physiotherapy: postural drainage in combination with other techniques (manual percussion, vibration)
60
Therapeutic: Improve Oxygenation
1. oxygen admn 2. pharmacologic 3. incentive spirometry 4. breathing techniques 5. tracheostomy: emergency intubation, suctioning technique 6. endotracheal intubation: assisted ventilation 7. lung transplantation: prolong life expectancy improve QOL of px
61
Therapeutic: Oxygen Delivery Systems
1. venturi mask 2. hudson mask 3. trauma mask 4. nasal cannula
62
Nursing Care Management of Pediatric Client with Mechanical Ventilator
- prevent accidental/ unplanned extubation - positioning for optimum ventilation - suctioning airway prn - monitor for potential SE of mechanical ventilator - prevent infection - ensure adequate humidification - provide support, comfort, and reassurance to child and family
63
Nursing Care Management of Pediatric Client with Mechanical Ventilator
- prevent accidental/ unplanned extubation - positioning for optimum ventilation - suctioning airway prn - monitor for potential SE of mechanical ventilator - prevent infection - ensure adequate humidification - provide support, comfort, and reassurance to child and family
64
Acute Nasopharyngitis
- common cold - most frequent infectious (toddler: 10-12/yr ; school age and adolescent: 4-6/yr) - incubation period: typically 2-3 days - most common during rainy season, fall, and winter
65
AN Causes
1. rhinovirus 2. coxsackie virus 3. respiratory syncytial virus 4. adenovirus 5. parainfluenza 6. influenza virus 7. stress factors
66
AN Assessment
MCN 109 Pre-finals
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