HA Exam 3

• The respiratory system consists of structures such as the upper respiratory system which includes the nose, sinuses, pharynx, and larynx, and the lower respiratory system which includes the trachea, bronchi, and lungs.
• The pleura and pleural space assist with gas exchange.
• The left lung is narrower with two lobes, while the right lung is larger overall but has three lobes.
• Acute Respiratory Distress Syndrome (ARDS) results from trauma or shock.
• Acute Respiratory Distress Syndrome (ARDS) has a rapid onset.
• ARDS results in persistent hypoxemia.
• Increased permeability of pulmonary capillaries leads to significant pulmonary edema.
• ARDS causes frothy sputum.
• ARDS causes restlessness and severe dyspnea.
• Thoracic landmarks include the suprasternal notch, sternal angle, costal angle, vertebra prominens, and intercostal spaces.
• The anterior lobe of the lungs is mostly located in the upper and middle lobe, while the posterior lobe is mostly located in the lower lobe.
• The 5th intercostal space, left midclavicular line is the best placement for monitoring an apical pneumothorax.
• Health history questions related to the lungs include allergies, medications, vaccines, and smoking history.
• Wait for the end of expiration during a physical examination of the respiratory system.
• Observe respirations during a physical examination of the respiratory system.
• Bell is not used for lung sounds during a physical examination of the respiratory system.
• In a physical examination of the respiratory system, it is important to inspect the overall appearance, posture, and breathing effort of the patient.
• Auscultate using the diaphragm of the stethoscope, placed firmly on the skin during a physical examination of the respiratory system.
• Percuss from apices to bases during a physical examination of the respiratory system.
• Inspect the anterior and posterior thorax during a physical examination of the respiratory system.
• Instruct the client to take a deep breath in and out through the mouth every time the stethoscope is placed on them during a physical examination of the respiratory system.
• Assess the nails, skin, and lips as part of a physical examination of the respiratory system.
• Cough can be dry, congested, barking, hacking, productive, or frothy, indicating pulmonary edema (CHF, ARDS).
• Shortness of breath (dyspnea) can be present or be exacerbated by exertion (DOE).
• Orthopnea is a condition where pillows are needed due to shortness of breath.
• Chest pain can be of respiratory, cardiac, musculoskeletal, or neurological origin.
• Pneumonia is characterized by the consolidation of alveoli with pus or exudate, which is infectious or aspiration-related.
• Clinical findings of pneumonia include fever, chills, tachycardia, malaise, cough, pleuritic pain, and dyspnea.
• Pulmonary Tuberculosis (TB) is a contagious, bacterial infection that can cause fatigue, anorexia, weight loss, low-grade fevers, night sweats, crackles in apices, dyspnea, chronic cough with hemoptysis, and nail clubbing.
• Clinical findings of atelectasis include dyspnea, hypoxia, diminished breath sounds, and if large, a mediastinal shift towards the affected side.
• Lung Cancer is the most fatal of all cancers, caused by tobacco smoking, and can present with a persistent cough, chest pain, fatigue, weight loss, hemoptysis, dyspnea, and nail clubbing.
• Chronic Obstructive Pulmonary Disease (COPD) includes chronic bronchitis, characterized by hypersecretion of mucus in the trachea and bronchi, and emphysema, which is the destruction of alveoli causing air trapping.
• Asthma, also known as reactive airway disease (RAD), is characterized by bronchoconstriction, mucus production, and inflammation, with triggers including allergies, exercise, pollutants, GERD, and upper or lower respiratory infections.
• Atelectasis is a small airway collapse due to hypoinflation, which can be caused by tumor, fluid, foreign body, or general surgery.
• Pneumothorax is the partial or complete lung collapse resulting from air in pleural spaces, which can be spontaneous or traumatic, and can vary in severity from dyspnea, anxiety, decreased chest wall movement, hyperresonance on percussion, breath sounds ↓ on affected side, and tracheal displacement towards unaffected side.
• Pleural effusion is the accumulation of fluid in the pleural space, commonly caused by heart failure or cancer, and can lead to dyspnea, decreased chest wall movement, sharp pleuritic pain, decreased fremitus over the effusion, dullness to percussion over the effusion, and decreased breath sounds.
• Calcified costal cartilages and lungs are more rigid in older adults, lungs do not recoil as well, vital capacity decreases, lung bases become less ventilated, alveoli become closed off, and fewer alveoli and less surface area are available for gas exchange.
• Infants and children should be obligate nose breathers until about 3 months due to nasal congestion causing inability to feed and possible respiratory distress.
• Auscultating Voice Sounds (PRN) can be enhanced by consolidation.
• Rales (crackles) are discontinuous, high-pitched crackling, popping sounds that do not diminish with cough or suctioning and are caused by fluid-filled alveoli (pneumonia, pulmonary edema).