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116 Cards in this Set
- Front
- Back
air enters primairily through?
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nares (nostils)
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nares lined with
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nasal hairs serve as filiters
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external nares sperated by
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nasal septum
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after passing thru nares air is pulled over
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turbinates ridges of tissue that are covered with mucous membrane and contain many blood vessesles which mucous membrane traps more particulate matte and the large surface of the turbinates warms and humidifies the air
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intubation or tracheostomy aloow inhaled air to skip this trip
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bypasing the humidifiaction an filering
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because turbinites contain many blood vessesles
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they easily swell causing stuffy nose or bleed epistasis
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bean ectomies
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removal of foriegn objects from nose
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mouth (oropharynx) also contain many blood vessels and covered by mucous membrane
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swelling can be extreme and potentially dangerous
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angioedema
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allergic reaction that may cause sever swelling of the tongue and lips
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oropharynx and nasopharynx meet
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in the back of the throat at the hypopharynx (gag reflex most promient here
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gag reflex can cause
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vagal bradycardia slow hb caused by vagal nerve stimulation and increased intracranial pressure
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larynx
glottis |
voicbox
opening at top of trachea are typically considered the dividgin line between the upper and lower airway |
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thryoid carilage is the most
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obvious sign external landmark of the larynx
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several cartaliges may be visiable when intubatio
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support the vocal cords
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arytenoid cartilages
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appear as two pearly white lumps at the end of each vocal cord
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either side of the glottis
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tissue forms a pocket called the piriform fossa sometimes ng tubes or et tubes will get stuck here casuing tenting that visiable externally on the neck must be with drwqan a few inches and reinserted
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glotting opeing covered by
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epiglottis (many people aspirate around it )
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cricoid cartialage
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just below the th thytoid cart can be palpated . forms complete ring and maintains the trachea in an ope position
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pressin on the anterior portion of the ring compresse the esophagous while keeping the trachea open
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sellick maneuver (appyling pressure to cricoid cartilage
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small space between the thyroid cart and cricoid cart
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cricothyroid membrane doesnt contain many blood vessels and is covered only by skin and minimal subcutaneous tissue
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trauma or swelling of any of the laryngeal structures ccan create
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life threatening airway obstruction
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tracheostoma
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a surgical lopeing into the trachea
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wasted ventilation is called
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anatomic dead space about 1ml per pound avg 150ml based on 150pd person
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average breath (tidal volume)
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700ml subtact 150ml from that equals 550ml that would participate in ventilation at the alveolar level the other would fill tube and never be exposed to blood flow
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truck of these tubes called
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thracheobronchial tree is the trachea about 10-13 cm long extends from the sixth cervical verebra to its point of bifurcation (carina) at roughly the fifth thoracic vertabrea nipple level
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carina
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point of bifurcation of the right and left mainstem bronchi , located at 5th intercostal space nipple level! (where trachea seperates!)
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mainstem bronchi branch into
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lobar bronchi segmetal bronchi, and bronchioles (account for 15 branchings of the airway and are lined with ciliated epithelium (cilia) )
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cilia
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little hair like structures that rythmically wave in a pattern that helps move particulate mautter up and out of the airway
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if anything gets deeper into the lungs than level 15 there is no
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mechanism to get it back out
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goblet cells
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cells produce a blanket of mucus that covers the entire lining of the conducting airways the mucus covers the cilia and forms a two layered blanket that is thick at the surface (gel layer) and thin and watery next to the cilia sol layer gel floats over sol layer
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cilia constantly push the
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gel layer up and out of the airway where it is either swallowed or expectorated
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dehydrated pesons or medicated persons such as antihistamines that dry normal secrtions
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the sol layer will begin to dry up and the cilia will not be able to move secretions
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overhydrated pt
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the cilia will wave meaNINGLESSLY IN A DEEP WATER LAYER WITH OUT EVER AFFECTING THE THICK GEL LAYER
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smooth muscle
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surronds the conducting airways down to the subsegemnatl level
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bronchoconstriction occurs
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wehn the smooth muscle contricts around the these larger airways
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below th smooth muscle level
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bronchodialator meds have lilttle effect upon the airways wheezing
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wheezing resloved by bronchodialator meds
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probably cause by constriction of the smooth muscles
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wheezing not resloved by brochondialor meds
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may be caused by a variety of pathologic conditions deeper in the tracheobronchial tree
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terminal airways and alveoli
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include branches 16 - 24 (terminial brchioles )
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the tracheobronchical tree ends with
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alveoli
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alveoli cluster around
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terminal bronieoles
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capillaries cover the laveoli and brnchil tubes from level
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16 -24
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the alveoli and terminal bronchioles
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actually make up the majority of the lung mass
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gass exchange is probaly most efficeint where
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in the alveoli but a significant amount of gas is also exhanged across respiratory bronchioles
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teminal bronchiloes are
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very thin and have little structure whch is helpfulf for gas exhange but means the lac k cilia mucous blanket smooth muscle or rigid structures
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part of the lung collectively know n as the lung parenchyma
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terminal bronchiols and alveoli forigen material gets in to the it typically never comes out
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empysema may affect the parenchyma ( terminal bronchioles and alveoli
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destroying what structures components that are present when that happens th terminal branches of the trach tree become so weak that they collapse during exhalaiton and trap air in the alveoli
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alveloi lined with
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substance known as surfactant which reduces surface tension and helps keep them expanded
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atelectasis
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surfactant is decreased or the alveoli are not infalted the allveoli collapse which result in a a condition known as telectasis
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smoking or diessaes destroys certain types of cells
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in the alveolus it cannaot repair itself
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alveoli can repair itself if
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certain types of cells survive an illness
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pulmonary circulation begins at the
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right ventricle where the pulmonary artery branches into increasingly smaller vessels wutil the pulmonary capillary bed surrounds the alveoli and terminal bronchioles there is more circuliaton to lung bases than lung apices
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most infectins and pathologic conditions affect what part of lungs?
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bases because of gravity
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pulmonary cappilaries
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very narrow and typically only allow red blood cells single file thru
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polycythemia
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surplus of redblood cells over time often caused by chronic lung disease and chronc hypoxia
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cor pulmonale
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right heart failure secondary to chronic lung diesease pushing thicker than normal blood thru the tiny pulmonary capillaries can put a significant strain on right side of heart when alveol are distened by COPD they push agains the cap bed further narriong the caps and straiing right side of heart
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hypoventelating
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not mving adequate volumes of gas
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hypercapnic
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too much carbon dioxide in blood
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guillan barre syndrome
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spinal cord injury) problems iwth muscles and nerves that make breathing work
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negative pressure breathers
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air suckers
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thorax is
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airtight box with flexiable diaphargm ( the major muschles of breathing ) at the bottom and open tube at top (trachea)
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holes in thorax
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sucking chest wound
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multiple ribs brokene in more than on place
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flail chest free floating sections of the thorax gets sucked in when you breathe limiting the amount of air that can be sucked in the trachea
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exhalation
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passive process usually unless in asth m a retractive airway disease or copd may need to use abdomnial muschles to push air out no longer passive process
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apneustic breathing
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resulsts from damage to apneustic center shor brisk inhalation with long pause before exhalaiton (severe pressure in cranium or direct trauma to brain)
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biot respiration
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center that contols breathing rythm is damaged pattern grossly irregular sometime lengthy apenic periods
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chyne stokes resp
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high brain function depth of breathing (volume of snoring ) crecendo decresendo increase deccrease followed by apenic period exaggerated cheyne stokes may be seen in pts who have a severe brain injury
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hering breuer reflex
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stretch receptors in lungs are respnsible this reflex. which causes you to cough if you take too deep a breahth
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respiration
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is the process by which 02 is taken into the body dirtibuted to the cells and used byth cells to make energy
respiration takes place in each cell involves using 02 and glucose to make envergy taht allows the cell to do its work |
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failure to deliver 02 efficeintly results in
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cellular hypoxia
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hpoxia kills
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cells making it impossiable to make energy to do their work and cause acidosis
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ph
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an expression of how many free ions are in a solution
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carbon dioxide not efficiently disposed of
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accumlates with water to form bicarbonate result is acidoises
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hyperventnilation
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person breaths too effectively and blows oof more co2 than usual resulting in alkalossis
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anxiety can be a early sign of
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hypoxia
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confusion lethargy an coma
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late signs of hypoxia
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medulla controls most resp fucntions
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in brain damgage to it causes a variety ogrepiratory abnorms
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right side of heart pumps blood to
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lungs
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left side of heart
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recieves blood from the lungs and pumps around the body
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severe hypoxia causes
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bradycardia
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uncorreceted hypoxic insult
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may result in letha lcardia arrhythmias suacha vdib or vtach
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changes in fluid balance
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right heart puping pressures or left heart pumping pressure can cause various forms of chf
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seeking a sitting postion when short of breath
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orthopnea
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fluid balance acid bas balance and bp are
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controlled in part by kidneys
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pts with sever renal disease
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often present with respirtaoty sings and symptos
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emphysema
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barrel chest prused lip breathing tachypneic do not typically present with profound hypoxia and vyanosis x(pink puffer)
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chroinc bronchitits
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obese , often encountered in chair or recliner where they sleep in upright positon surrounded by tissue they spit into overflowing ashtray urinial so they dont have to get up for frequent trips to restroom
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tall thin young adults
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predisposed to spontanoues pnemothorax
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women who smoke and take birth control pills
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predisposed to pulimonary embolism
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beware the pt who in respiratory distress
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who is willing to lie flat ie sign of sudden deterioration
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bony retractions
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most common in infants and small children rigid structue of the thoraxi is still flexiabale on inhalation may pull strnum ito the chest visble deformity
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soft tissue retractions
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soft tissue is pulled in around the bones inhalation the spraclavicular intercosatan subziphonied areas
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nasal flaring
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the nostils are pulled wid e open on inhaltion
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tracheal tugging
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thyroid carliage is pulled upward and the are just aboue the sternal nothc is sucked inward with inhalaiton
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paradoxiacal respiratory movement
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epigastrium is pulle din with inhalation while the abdoemn pusehs out creating a se saw qappearace as two move in opposing directins
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pulsus paradoxus
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profound intrathosci pressure changes cause the peripheral pulses to weaken or disaperar on inspiration
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minute volume (mv)
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rate times tidal volume (rXvt)
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quiet tachypenea
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prompt you to consider shcok
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decline in PaO2 hypoxemia
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will maifest initially as restlessnes confusion and worst case as combactive behavior
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increase in PaO2
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USUALLY HAS SEDATIVE effects makin pt sleepy and hard to rouse
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pulsus paradoxus
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profound intrathosci pressure changes cause the peripheral pulses to weaken or disaperar on inspiration
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minute volume (mv)
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rate times tidal volume (rXvt)
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quiet tachypenea
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prompt you to consider shcok
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decline in PaO2 hypoxemia
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will maifest initially as restlessnes confusion and worst case as combactive behavior
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increase in PaCO2
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USUALLY HAS SEDATIVE effects makin pt sleepy and hard to rouse
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mucous membarane
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tissue inside pts mouth under eyelids under nail beds is usually same pink color in all healthy pts
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normal hemoglobin level
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hempglobin level of 12-14g/dl
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cyanosis
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blue discoloration
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chocholate brown skin
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high levels of methemoglobin derived from nitrates and some toxic exposure s typically more evidednt in pts vnous blood than the skin and mucous membnranes
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pale skin
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caused by a reduction of blood flow to the small vessels near the surcace of the skin caused by hypoxia shock catecholalomine release such as epi or norepi or cold enviroment
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signs of dehydration
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dry cracked lips a dry furrowed ongue and dry sunken eyes skin assesment mab be of less value in some older people
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paroxysmal nocturnal dyspnea
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dyspnea that comes on suddely in the middle of the night is an omnious sign may signal left heart failure worsening copd or both occours because of accumulation of fluid in the alveoli or pooling of secretions in the bronchi during sleep
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heptojugular reflux
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occurs when mild pressure on the patients liver causes the jugular veins to engorge further thjis a specifi sign of right heart failure
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jvd
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common all the time in patients who have obstuctive lung disease suach as asthma or copd cardiac tamponade pnemothorz hear failure and copd can all cause jvd
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tactile fremitus
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chest vibrations secretions in the larfe airways usually easy to feel and to hear
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listen for et tube placment
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midaxiallary line
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