NR 302 Exam 3 Study Guide

NR-302Physical Assessment
Study Guide – Exam 3
50 Questions – Multiple Choice, Select All That Apply, HOTSPOT, Multiple Sequences


Chapter 15 – Respiratory
4 major functions
 Supplying oxygen for energy
 Removing carbon dioxide
 Acid-base balance (homeostasis)
 Maintaining heat exchange
Control of respirations – normal stimulus, alternative stimulus and what condition
 Pons and medulla
 Normal stimulus (Hypercapnia)
 Decrease in O2 in blood (Hypoxemia)
 Inspiration (Active) expiration (passive)
Lower – bronchi, pleural membranes, muscles of respiration (normal, accessory)
 Bronchi- right main bronchus
 Pleural membranes- the parietal lines diaphragm and thoracic wall, the visceral lines outer surface
of lung, and pleural fluid acts as lubricant
 Muscles of inspiration- normal( intercostal muscles, diaphragm), accessory ( neck, abdomen,
chest)
Anterior Landmarks – sternum (Angle of Louis, sternal angle, 2ICS), clavicle, costal angle (normal)
 Costal angle < 90 degrees
Posterior Landmarks – vertebra prominens, spinous processes (T1 to T4), CVA tenderness
 Vertebra prominens- C7 (if 2 bumps equally prominent C7, T1)
 Spinous processes- aligned w/ same numbered rib to T4
 CVA tenderness- kidney problems
References Lines – anterior, posterior, and lateral thorax
 Anterior- sternal, midclavicular, anterior axillary
 Posterior- vertebral, scapular, posterior axillary
 Lateral- anterior axillary, midaxillary, posterior axillary
Lobes (3 on right, 2 on left), apex versus base
 Right- upper, middle, lower lobes
 Left- upper, lower lobes
 Apex (highest point) anterior and 3-4 cm above clavicle
 Base (lower border)
Pediatric (AP:Transverse diameter, abdominal breathing, role of surfactant)
 AP: transverse 1:1 ratio
 Abdominal breathing until 5-7 yrs
Pregnant (Diaphragmatic breathing, SOB, costal angle changes, lordosis)
 Muscles and cartilage of the ribs relaxes
o Diaphragm rises into chest to accommodate fetus
o Diaphragmatic breathing

, o Shortness of breath (SOB), dyspnea, increase awareness of breathing in last trimester
 Total oxygen demand can increase 20%
 Costal angle widens
 Deeper breathing, respiratory rate unchanged
 Lordosis or swayback, “waddling” gait
Geriatric (overall aging changes to respiratory rate and depth, vital capacity, alveoli); cough ability, kyphosis
 Aging lung is more rigid, harder to inflate
o Decrease vital capacity, increased residual volume
o Decreased number of alveoli
o Decreased in respiratory depth
o Slight increase in respiratory rate
 Decrease in cough ability
o Weakening of the chest muscles, decrease cilia
o Compromises airway clearance
 Kyphosis “hunchback”
Subjective
Cough – differences between acute versus chronic; time of day; productive versus non-productive;
color of phlegm or sputum; descriptions and meaning; associated symptoms; possible treatments
 Acute (lasts 2 or 3 weeks), chronic (over 2 months)
 Often? Time of day?
o Continuous – acute illness, respiratory infection
o Afternoon/evening – may irritants at work
o Night – postnasal drip
o Early morning – chronic bronchial inflammation, smokers
 Productive or non-productive? Phlegm or sputum?
o Hemoptysis (blood), frank blood versus streaks of blood
o White or clear – colds, bronchitis, viral infections
o Yellow or green – bacterial infections
o Rust colored – TB, pneumonia
o Pink, frothy – pulmonary edema, medications
 Describe your cough?
o Hacking – pneumonia
o Dry – early congestive heart failure (CHF)
o Barking – croup
o Congested – colds, bronchitis, pneumonia
 Associated?
o Activity? Position (lying)? Fever? Congestion? Talking? Anxiety?
 Treatment?
o OTC medications? Vaporizer? Rest? Position change?
 Brings on anything?
o Chest pain? Ear pain? Tiring? Concern?

SOB – with exertion or at rest; position – orthopnea, PND; associated symptoms