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Chest/Respiratory
Chest/Respiratory System
56
Nursing
Graduate
05/30/2012

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Cards

Term
When do alveolar cells begin secretion of surfactant?
Definition
By 24 to 26 weeks gestation
Term
Surfactant
Definition
Acts to prevent the alveolar sacs from collapsing during the expiratory phase of respiration.
Term
Breathing movements first occur...
Definition
In utero
Term
Breathing movements in utero
Definition
  • Are irregular 
  • Range from 30-70 breaths per minute
  • Become more rapid as gestation advances
Term
Gas exchange first occurs
Definition
  • Via the placenta.
  • Movement in/out of the potential air spaces conditions the resp. muscles and stimulates lung development.
Term
Lungs fill with air the first time...
Definition
  • At birth.
  • The lungs take on the role of ventilation and oxygenation.
  • The fluid in the lung moves into the tissues surrounding the alveoli
  • The fluid is absorbed into the lymphatic system.
  • Gas exchange occurs through diffusion across the alveolar-pulmonary capillary membranes.
Term
Thorax
Definition
  • The thorax is the bony cage that surrounds the heart and lungs.
  • Composed of the manubrium, sternum, xiphoid process, & ribs.
Term
The Sternum
Definition
Is a flat narrow bone composed of highly vascular vissues enclosed by dense bone.
Term
The manubrium
Definition
  • Is roughly triangular and attaches to the first and second ribs. 
  • It provides a place of attachment for the sternocleidomastoid and pectoralis major muscles.
Term
The xiphoid process
Definition
  • The small, thin, cartilaginous end of the sternum
  • Varies greatly in shape and prominence in infants and children because of the influence of heredity, intrauterine environment, and nutrition. 
Term
Pectus carinatum
Definition
  • "Pigeon Breast"
  • The abnormal protrusion of the xiphoid process and sternum
Term
Pectus Excavatum
Definition
  • "Funnel Chest"
  • The abnormal depression of the sternum
Term
Mediastinum
Definition
The middle portion of the chest cavity
Term
Ribs
Definition
  • 12 pairs in all
  • First 7 pairs attach anteriorly via their corresponding costal cartilages to the sternum.
  • 8-10 attach to the costal cartilage on the rib above them.
  • 11-12 do not attach anteriorly.
  • All 12 pairs attach posteriorly to the thoracic vertebrae.
Term
Intercostal Muscles
Definition
  • 11 anteriorly and posteriorly
  • 8 thoracic mucles
  • All help to increase the volume of the rib cage with inspiration and decrease the thoracic volume with expiration.
Term
Upper Respiratory Tract Anatomy
Definition
Nasal cavity, pharynx, larynx
Term
Lower Respiratory Tract Anatomy
Definition
Lungs, trachea, bronchi, bronchioles, alveolar ducts and sacs, and alveoli
Term
Bronchus
Definition
  • Right mainstem bronchus is shorter and more vertical than the left
  • More susceptible to aspiration of foreign bodies in the young child
Term
Bronchioles
Definition
3 branches on the right and 2 on the left
Term

Termination of the Respiratory Tract

 

Definition
  • Terminates with the alveolar ducts, alveolar sacs, and alveoli where gas exchange takes place.
Term
Bronchial Arteries
Definition
  • Branch from the aorta and supply blood to the lung parenchyma.
  • Blood supply is returned primarily by the pulmonary veins.
Term
Upper portion of the Lungs
Definition

Apex; which extend above the clavicals

 

Term
Left side lung anatomy
Definition
Tongue shaped projection (lingula) that extends from the LUL
Term
Bottom portion of the Lungs
Definition
Base; marked by T10 or T12 depending on insp/exp.
Term
Principle function of the lungs
Definition
Maintain an acid-base balance by supplying oxygen to organs and tissue and eliminating CO2.
Term
Nasal passages
Definition

examined for the presence of rhinitis, any nasal secretions, polyps, or nasal obstruction.

Observe for postnasal drip and tonsillar size.

Term
Clubbing
Definition
The bulbous shaped enlargement of the soft tissue of the distal phalanges
Term
AP to transverse ratio
Definition
  • Normal =1 : 2
  • Infant<2yoa=1 : 1 (barrel chest)
  • >6 yoa=1 : 1.36

**barrel chest also seen w/ CF

Term
Periodic Breathing
Definition
  • Rapid breathing followed by periods of apnea, cessation of breathing. 
  • Normal first few hours of life in healthy full term NB. 
  • More common in preterm but episodes of apnea should improve as approach term age.
Term
Paradoxical breathing
Definition

"Seesaw breathing"

Often seen in newborns and infants because they use abdominal muscles more than intercostal muscles.

Term
Cheyne-Stokes Breathing
Definition
  • Characterized by cycles of increasing and decreasing tidal volume separated by apnea.
  • Occurs  with CHF and increased ICP.
Term
Stridor
Definition
  • High pitched, loud, inspiratory sound produced by upper airway obstruction.
  • Causes: Edema status post intubation; subglottic stenosis, laryngotracheobronchitis; foreign body aspiration.
Term
Grunting
Definition
Low pitched expiratory sound caused by a partial closure of the glottis
Term
Snoring
Definition
  • A rough, snorting sound that can be present on inspiration or expiration. 
  • Present during sleep in healthy children who have an upper respiratory infection, respiratory distress, chest pain.
  • Often heard in the presence of Nasal polyps, T&A hypertrophy, congenital facial anomolies.
Term
Nasal Flaring
Definition

Mild nasal flaring in newborns is normal because they are preferential nose breathers in the first month of life.

Increased flaring is a sign of resp distress

Term
Retractions
Definition
The chest of a newborns is more compliant than that of older children, making them more prone to retractions
Term
Head Bobbing
Definition

A sign of respiratory distress

Due to the contraction of the scalene and sternocleidomastoid muscles.

Term
I:E Ratio
Definition

Infant=1:2 seconds

Newborn=variable

Restrictive diseases=1:1

Upper airway obstruction=2:2 or 4:2

Term
Voice Auscultation
Definition

If you hear voice sounds or cry loud and clear=Bronchophony

Speak word "ee" & sounds like "ay"=egophony.

Term
Whispered Pectoriloquy
Definition
If the child whispers a word and it is heard loudly
Term
Vesicular lung sounds
Definition
  • Soft sound heard over entire surface of lungs 
  • Inspiration louder, longer, higher pitched than experation
  • Insp>Exp
Term
Bronchovesicular lung sounds
Definition
  • Loud, high pitched sounds heard over intrascapular area
  • Inspiration =Experation
Term
Bronchial lung sounds
Definition
  • "Tubular"
  • Very loud over trachea near suprasternal notch
  • Inspiration <Expiration
Term
Assessing chest excursion
Definition
  • Thoracic expansion
  • Note symmetry of the chest excution on inspiration done anteriorly and posteriorly
  • Could indicate diphragmatic hernia; pneumothorax, mass, foreign body, abnormal chest wall shape
Term
Shift in Trachea
Definition
  • Pneumothorax or Pleural Effusion
  • Occurs when there is a difference in volume or pressure between the two sides of the chest

 

Term
Tactile Fremitis
Definition
  • Palpation portion of exam
  • Increased or decreased fremitis could indication consolidation or pneumothorax
Term
Acute Bronchiolitis
Definition
  • Inflammatory obstruction of the small airways
  • Caused by edema, mucus plugging
  • Occurs during 1st 2 years of life, peaking at 6 mos
  • 50% Caused by RSV
Term
Acute Epiglottitis
Definition
  • Obstructive inflammatory porcess of airway that is supraglottic
  • Abrupt onset of high fever, sore throat, drooling, dysphagia, dyspnes, increasing airway obstruction
  • Occurs between 2-7 yoa
  • Bacterial, decreased incidence due to Flu vaccine
Term
Asthma/Reactive Airway Disease
Definition
  • Inflammatory process initiated by irritability/hyperreactivity of airway to variety of stimuli, obstruction/bronchoconstriction
  • Inflammation plays KEY role in factors leading to cough, wheezing, tachypnea, dyspnea with prolonged expiration
Term
Croup/Laryngotracheobronchitis
Definition
  • Acute upper airway obstruction; inflammation, edema of airway
  • Leads to hoarse, barking cough, intermittent stridor, respiratory distres occurs in some cases, which is worse at night
  • Most common between 3 mos-5 yoa
  • 75% is parainfluenza virus etiology
Term
Cystic Fibrosis
Definition
  • Inherited Autosomal recessive trait
  • Causing multisystem disorder in children
  • Characterized by obstruction, infection of airways caused by dysfunction of epithelial surface leading to thick, retained secretions
  • 1:4 Births, caucasian.
Term
Foreign Body Aspiration
Definition
  • Lodging of object into larynx, trachea, bronchi with degree of obstruction
  • Hot dogs/bread most common causes of fatal aspiration
  • Possibility of foreign body must be considered in infants and young kids with acute respiratory distress regardless of history.
Term
GERD
Definition
  • A passive transfer/reflux of gastric contents across lower esophageal sphincter, which may lead to tissue damage causing GERD
  • May be associated with respiratory conditions such as bronchospasm, pneumonia.
Term
Laryngomalacia/tracheomalacia
Definition
  • "Floppy airway"
  • Congenital deformity of larynx or trachea 
  • Harsh noise, stridor on inspiration cuased by airway collapse
  • Onset early in neonatal period
  • Dx with laryngoscopy
Term
Pneumonia
Definition
  • Inflammation of parenchyma of lungs
  • Primary condition or may manifest from another illness
  • Etiology: Viral microorganisms (RSV, paraflu, adeno)
  • Bacterial less common but can be mycoplasma pneumoniae 70% of all pneumonias 9-15 yoa
Term
Respiratory Distress Syndrome
Definition
  • A condition related to developmental delay of maturation of lungs
  • Deficient production of surfactant
  • Inadequate pulmonary perfusion and ventilation develop resulting in long term respiratory complications.
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