scc 4th semester pul onary review

a. Right Lung: 3 lobes
i. Right Upper Lobe
ii. Right Middle Lobe
iii. Right Lower Lobe
b. Left Lung: 2 Lobes
i. Left Upper Lobe
ii. Left Lower Lobe

a. Trachea: part of upper respiratory tract; extends from the cricoid cartilage at the top to the carina (also called the tracheal bifurcation). C-shaped cartilage rings reinforce and protect the trachea to prevent it from collapsing.
b. Bronchi: part of lower respiratory tract; the primary bronchi begin at the carina. The right mainstem bronchus – shorter, wider, and more vertical than the left – supplies air to the right lung. The left mainstem bronchus delivers air to the left lung. The mainstem bronchi divide into the five lobar bronchi (secondary bronchi). Along with blood vessels, nerves, and lymphatics, the secondary bronchi enter the pleural cavities and the lungs at the hilum. Each lobar bronchus enters a lobe in each lung. Within its lobe, each of the lobar bronchi branches into segmental bronchi (tertiary bronchi). The segments continue to branch into smaller and smaller bronchi, finally branching into bronchioles.
c. Bronchioles: part of lower respiratory tract; smaller branches of the bronchi. Includes terminal bronchioles and the acinus (the chief respiratory unit for gas exchange). Terminal bronchioles branch into smaller respiratory bronchioles which feed directly into alveoli at sites along their walls.
d. Alveoli: part of lower respiratory tract; alveolar ducts terminate in clusters of capillary-swathed alveoli called alveolar sacs. Gas exchange takes place through the alveoli.

a. Gas exchange occurs very rapidly in the millions of tiny, thin-membraned alveoli within the respiratory units. Inside these air sacs, oxygen from inhaled air diffuses into the blood while carbon dioxide diffuses from the blood into the air and is exhaled. Blood then circulates throughout the body, delivering oxygen and picking up carbon dioxide. Finally, the blood returns to the lungs to be oxygenated again.

a. It is the partial pressure of carbon dioxide that stimulates the respiratory centre. Receptors sensitive to carbon dioxide are found in the medulla and are bathed in cerebrospinal fluid, which has fewer proteins than plasma and little buffering ability so any minute changes in the partial pressure of carbon dioxide are rapidly sensed at the receptors and prompt changes in the respiratory pattern.
A low partial pressure of oxygen in the blood (PaO 2 ) will stimulate breathing only via the peripheral chemoreceptors (carotid and aortic bodies) when the PaO 2 is less than 8kPa. The arterial oxygen levels are then well below the safety range for adequate tissue oxygenation. This is a last ditch attempt used by the body to stimulate breathing

a. When you breathe, air travels through your nose, down the trachea and into smaller and smaller airways called bronchi. These bronchi branch into smaller passages called bronchioles and finally into small thin fragile sacs called alveoli. During inspiration the alveoli in the lungs are filled with air. It is here that oxygen is exchanged for carbon dioxide. Blood cells absorb oxygen from the capillaries in the alveoli. As carbon dioxide waste product is released back into the lungs from the veins. During expiration the Carbon Dioxide is expelled through the body. Oxygen rich blood then travels to the heart so it can be pumped back to the body where it is needed.

a. Inspiration: (an active process) Inspiratory sound is usually longer than expiratory.
b. Expiration: (a relatively passive process)

a. The lungs help maintain acid-base balance in the body by maintaining external respiration (gas exchange in the lungs) and internal respiration (gas exchange in the tissues). Oxygen collected in the lungs is transported to the tissues by the circulatory system, which exchanges it for the carbon dioxide produced by cellular metabolism. Because carbon dioxide is 20 times more soluble than oxygen, it dissolves in the blood, where most of it forms bicarbonate (base) and smaller amounts form carbonic acid (acid).
b. The lungs control bicarbonate levels by converting bicarbonate to carbon dioxide and water for excretion. In response to signals from the medulla, the lungs can change the rate and depth of ventilation. Such changes maintain acid-base balance by adjusting the amount of carbon dioxide that’s lost. For example, in metabolic alkalosis, which results from excess bicarbonate retention, the rate and depth of ventilation decrease so that carbon dioxide is retained. This increases carbonic acid levels. In metabolic acidosis (a condition resulting from excess acid retention or excess bicarbonate loss), the lungs increase the rate and depth of ventilation to exhale excess carbon dioxide, thereby reducing carbonic acid levels.

Agitation

This test would be classed as negative. A 3-mm raised area would be a positive result if a client had a recent close contact with someone diagnosed with or suspected of having infectious TB. Follow-up should be done with this client, and a chest x-ray should be ordered.

Low oxygen level

Clients who are economically disadvantaged, malnourished, and have reduced immunity, such as a client with a history of alcoholism, are at extremely high risk for developing TB.

Although fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest pain are the common symptoms of pneumonia, elderly clients typicall first display an altered mental status and dehydration. This is due to a blunted immune response.

The patient is NPO for 6-8 hours

Ethambutol (Myambutol)

Clear breath sounds

Active infection

o determine the extent of lesions

Vesicular breath sounds in right base

Pneumococcal or streptococcal pneumonia is caused by Streptococcus pneumoniae and is the most common cause of community-acquired pneumonia. Haemophilus influenzae is the most common cause of infection in children. Klebsiella species is the most common gram-negative organixm found in the hospital setting. Staphylococcus aureus is the most common cuase of hospital-acquired pneumonia.

An inflammatory pulmonary response is the common feature of all types of pneumonia