Ch. 32 OXYGENATION Flashcards
1
Q
To achieve the process of R, there must be
1.
2.
3.
A
- ventilation
- diffusion
- perfusion
2
Q
The movement of gases between the alveoli in lungs and bloodstream is known as
A
Diffusion
3
Q
Movement of blood into and out of the capillary beds surrounding the alveoli to the organs/tissue of the body is known as:
A
Perfusion
4
Q
The respiratory system includes the following structures:
1.
2.
3.
A
- airways and lungs (pulmonary system)
- bony thorax
- respiratory muscles
5
Q
What are the four components of the upper airway and what is the function?
A
Nasopharynx, Oropharynx, Laryngopharynx, and Larynx
Function: lined with ciliated mucosa with very rich vascular supply; muscosa lining warms, humidifies, filters inspired air before it passes through to the lungs
6
Q
This structure connects the upper and lower airways
A
Larynx
7
Q
This structure houses the vocal chords
A
Larynx
8
Q
The laryngeal box is formed of 3 large cartilages:
A
- epiglottis
- thyroid
- cricoid
9
Q
The lower airway consists of these two components:
A
- conducting airways
- acinus
10
Q
The conducting airways are part of the _________ airway.
A
The conducting airways are part of the LOWER airway.
11
Q
The conducting airways include these four structures:
A
- trachae
- R/L mainstem bronchi
- secondary bronchi
- brochioles
12
Q
Is the acinus part of the upper or lower airway?
A
lower
13
Q
The acinus are the _____________ units and include these two structures:
A
The acinus are the GAS EXCHANGE units and include these two structures:
- respiratory bronchioles
- alveoli
14
Q
Thorax boundaries
A
- sternum
- 12 ribs
- 12 thoracic vertebrae
15
Q
Muscles of respiration:
Primary:
1.
2.
Accessory:
1.
2.
3.
A
Muscles of respiration:
Primary:
- DIAPHRAGM
- INTERCOSTALS
Accessory:
- ABDOMINAL
- STERNOCLEIDOMASTOID
- PECTORAL MUSCLES
16
Q
Lobes of the lungs (explain why there is a difference R/L)
A
Right = 3 lobes
Left = 2 lobes (due to proximity to heart)
17
Q
- The lungs are lined by the ________________
- The chest wall is lined by the ______________
- In between these two layers is called the _____________________
A
The lungs are lined by the VISCERAL PLEURA
The chest wall is lined by the PARIETAL PLEURA
In between these two layers is called the PLEURAL SPACE
18
Q
Why does the pleural space have negative pressure?
A
To prevent lungs from separating from chest wall
19
Q
What are the key structures in gas exchange?
A
alveoli
20
Q
What are pneumocyte II cells and what do they do?
A
Great alveolar or septal cells manufacture surfactant which acts to lower the surface tension of the alveoli and prevent collapse of the alveoli, which is called atelectasis
21
Q
What is surfactant and what does it do?
A
A surface agent produced in the alveoli that decreases the surface tension of the fluid lining the alveoli, permitting expansion and preventing atelectasis
22
Q
What is atelectasis and what is it often related to?
A
a collapse of some or all of the alveoli in the lungs. This is often related to a disease process or hypo-inflation of lung tissue
23
Q
Gas exchange takes place across the ________-________ membrane
A
alveolar-capillary membrane
24
Q
Describe the alveolar-capillary membrane and what it does.
A
Gas exachange takes place here. It is a thin membrane with an immense surface area that
promotes the alveolar ducts
diffusion of oxygen from the alveoli into the blood
diffusion of carbon dioxide out of the blood and into the alveoli to be exhaled.
25
Differentiate between respiration and ventilation.
respiration is the mechanical process of breathing-inhaling oxygen and exhaling carbon dioxide.
ventilation refers to the adequacy of respiratoin or breathing--the movement of air into and out of the lungs
26
Which brain areas are responsible for ventilation?
pons and medulla (brainstem)
27
Which will stimulate faster and deeper ventilation to a lesser degree?
a. decrease in pH in body fluids
b. decrease in blood oxygen concentration (hypoxemia)
c. increase in carbon dioxide in the blood
decrease in blood oxygen concentration (hypoxemia)
28
Which will lead to faster and deeper ventilation?
a. increase in pH in body's fluids
b. decrease in pH in blody's fluids
b. decrease in pH in blody's fluids
29
How is inhalation of air initiated? (muscle)
the diaphragm contracts, pulling downward --increasing the size of the thoracic space
external muscles contract which elevate and separate the ribs and move the sternum forward
30
What is the effect of increasing space inside the thorax during inspiration?
decrease intrathoracic pressure, allowing the atmospheric air to fill the lungs
31
Explain what causes the cessation of inhalation
the stretch receptors in the lung tissue send signals back to the brain to cause it to stop, preventing over distension of the lungs
32
Explain how exhalation occurs
it occurs when the resp. muscles relax, thereby reducing the size of the intrathoracic space, increasing the intrathoracic pressure, and forcing air to exit the lungs
33
Under normal circumstances, exhalation is a ___________ process:
a. active
b. passive
b. passive
34
What may a patient have to do when the movement of air is impeded (muscular)
use additional muscles to increase the ventilatory effort
35
What muscles must a patient use when the movement of air is impeded?
accessory muscles:
sternocleidomastoid
abdominal
internal intercostals
36
When accessory muscles are required for breathing, the work of breathing is said to be:
a. passive
b. impaired
c. increased
d. active
e. decreased
c. increased
37
What is the exchange of oxygen from the alveoli into the pulmonary capillary blood called?
External respiration
38
What happens during external respiration?
oxygen diffuses across the alveolar membrane in response to a concentration gradient
- from higher concentration (alveoli) to lower (pulmonary capillary blood)
carbon dioxide difusses from the blood to the alveolar space, also in response to a concentration gradient
39
During alveolar gas exchange, oxygen and carbon dioxide diffuse across the alveolar-capillary membrane in response to what?
a concentration gradient
40
What happens to the oxygen molecules once the diffusion of oxygen across the alveolar-capillary membrane occurs?
oxygen is dissolved in the blood plasma
41
Three factors that influece the capacity of the blood to carry oxygen:
1. the amount of dissolved oxygen in the plasma
2. the hemoglobin level
3. the tendency of the hemoglobin to bind with oxygen
42
What percentage of the total oxygen is carried in the plasma?
1% to 5%
43
The presence of what greately enhances the oxygen-carrying capacity of the blood?
the presence of hemoglobin in the RBCs (erythrocytes)
44
What are the two ways that the amount of oxygen carried in a sample of blood is measured?
1. Partial pressure of oxygen (PaO2) = the oxygen dissolved in plasma
2. the % of hemoglobin that is saturated with oxygen (SaO2) = the amount of oxygen bound to hemoglobin
45
What is PaO2?
The oxygen dissolved in the plasma is expressed as the partial pressure of oxygen.
46
What is the normal PaO2 in arterial blood?
The normal PaO2 in arterial blood is 80 - 100 mmHg
47
What is SaO2?
the % of hemoglobin that is saturated with oxygen.
48
What value reflects the hemoglobin being fully saturated?
100%
49
What is the normal saturation of arterial blood?
96-98%
50
Once bound to hemoglobin, where is the oxygen delivered? By process of what?
Delivered to the cells of the boyd for tissue perfusion by process of circulation
51
Circulation of the blood is the function of these two structures:
heart
blood vessels
52
These allow for the unidirectional blood flow through the chambers of the heart
valves
53
A single cycle of atrial and ventricular contraction and relaxation
The cardiac cycle
54
The cardiac cycle is both a ______________ and _____________ event
electrical and mechanical event
55
What does the electrical acitivity of the heart involve?
the generation and transmission of electrical current by special cells known as the cardiac conduction system
56
special cells that are responsible for the generation and transmission of electrical current in the heart
cardiac conduction cells
57
What is the intrinsic pacemaker of the heart and where is it located
The SA node and it is located in the right atrium
58
Describe the flow of electrical current in the heart from the SA node.
The impulses of the SA node travel along specialized internodal pathways to spread throughout the atria resulting in the mechanical contraction of the atria
the impulse is then transmitted down to the ventricles through the AV node
From the AV node, it spreads to the bundle of His, right and left bundle branches, and the Purkinje fibres.
59
Where is the AV node located?
lower part of the right atrium
60
SA node impulse ------\> ________ ------\>AV node stimulation-----\>\_\_\_\_\_\_\_\_\_------\>\_\_\_\_\_\_\_\_\_-----\>\_\_\_\_\_\_\_\_
SA node
travel along internodal pathways that spread through the atria
mechanical contraction of atria
transmitted down the centricles through the AV node
spreads to bundles of His,
right and left bundle branches
Purkinje fibres
Mechanical contraction of ventricles
61
What is an essential factor in the cyclical filling and emptying of the chambers of the heart, which produce circulation
sequential contraction and relaxation of the atria and ventricles
62
How many times per minute does the cardiac cycle occur?
The number of times depends on three patient factors:
60-100
age, gender, condition
63
The process of chamber filling is referred to as \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
The provess of emptying is referred to as \_\_\_\_\_\_\_\_\_\_\_\_\_
diastole
systole
64
Right atrial diastole vs. left atrial diastole
Right - occurs as the right atrium fills from the blood that returns to the heart from the superior and inferior vena cava
Left- occurs as they left atrium fills from the blood that returns to the heart from the pulmonary veins
65
What are the two contributers to ventricular filling?
1. as the pressure rises in the atria, the valves separating the atrium and ventricles (tricuspid/mitral) open, letting blood flow into the ventricles = PASSIVE FILLING
2. contraction of the atrium (atrial systole) - this further ventricular filling is called the atrial kick
66
What % of two components of ventricular filling contribute to cardiac output
1. passive filling (pressure as atria fill, valves open) = 70%
2. atrial kick (contraction of the atrium-atrial systole) = 30%
67
Right atrial diastole
RA fills with blood the returns to heart from SVC/IVC
68
Left atrial diastole
LA fills with blood that returns to heart from pulmonary veins
69
Atrial Systole
(30%) of cardiac output
- contraction of the atria that helps with the filling of the ventricles
- "Atrial kick"
70
Ventricular Systole
- when semilunar valves open and contraction of ventricular walls proceeds, blood is forced out of the ventricles into circulation
71
Two branches off the ventricles
Aorta and pulmonary artery
72
Starting from the Right atrium
Right atrium --\> tricuspid valve --\> Right ventricle --\> pulmonic valve --\> pulmonary artery --\> branch to R/L pulmonary arteries
---\> pulmonary capillaries that surround alveoli --\> alveolar-capillary gas exchange ---\> oxygenated blood from the pulmonary capillaries --\> pulmonary veins --\> left atria --\> mitral valve --\> left ventricle --\> aortic valve --\> aorta --\> aorta divides
73
What drives blood flow through the arterial system?
What two other factors influence blood flow?
The pressure generated during ventricular systole
volume and thickness of blood, resistance within the arterial system
74
The redistribution of blood flow to the areas of greatest need is called
autoregulation
75
How is blood flow autoregulated?
blood flow to specific organs/tissues may be increased or reduced by the relaxation or contraction of precapillary sphincters that regulate blood flow
76
These structures increase or decrease blood flow to specific organs and tissues
precapillary sphincters
77
How does the lower pressure venous system ensure that blood returns to the heart?
Valves that prevent backflow
veins are compressed by their surrounding skeletal muscles and blood is forced to the vena cava
78
What happens when oxygenated blood reaches the tissues?
Gas exchange takes place by diffusion in response to concentration gradients
Oxygen diffuses from blood (where concentrations are higher) to the tissues
Carbon dioxide diffuses from the tissues to the blood
The blood is then oxygenated by the lungs
INTERNAL RESPIRATION
79
What is internal respiration?
When the oxygenated blood reaches the tissues, gas exchange happens. Diffusion in response to concentration gradient. Oxygen goes from blood to tissue and carbon dioxide goes from tissue to blood. The lungs then oxygenate that blood.
80
Internal respiration vs. External respiration
External - exchange of oxygen from the alveoli into the pulmonary capillary blood
Internal - exchange of oxygen from the blood to the tissues
81
Assessment of respiratory system involves two parts:
1. Taking a focused health history
2. Physical assessment
82
What five pieces of information should you note when taking a docused health history?
- symptoms
- history of respiratory illness
- history of smoking or drug abuse
- level of pain and fatigue
- treatments or medications used to date
83
What is involved in the physical assessment of the respiratory system?
- Inspection of the respiratory system: rate, depth, and regularity of breathing
- palpation
- percussion
- ausculation of breath sounds
84
What must you take into account when doing a physical assessment related to the respiratory system?
The age and current condition of the patient
85
What 3 things should you pay attention to when doing the "inspection" component of the physical assessment of the repiratory system?
rate, depth, and regularity
86
Three common respiratory symptoms
Wheezing
Cough
Dyspnea
87
What is wheezing? Why does it happen? When is it heart? What is wheezing associated with?
It is a high-pitched musical noise
Produced as a result of air movement through a narrowed airway
It is often heard on inspiration but may also be hear on expiration
It is often associated with asthma but can be associated with airway obstruction
88
What is a cough?
an abrupt discharge of air from the lungs to clear the trachea bronchi and lungs from some type of irritant
89
When a patient reports a cough, what should the nurse ask about and why?
Ask about the quality of the cough (congested, harsh, dry) because some illnesses have a characteristic cough
Ask if the patient is expectorating any sputum, and if so, how often this is occuring. Ask if sputum is blood tinged or has any detectable colour
90
A cough that is continuous throughout the day and night usually indicates
a respiratory infection
91
A cough that occurs only in the morning may be due to this condition
Explain.
Sinusitis;
coughing clears the airways from discharge that has accumulated during sleep
92
If a patient has a respiratory infection, what will their cough be like?
continuous throughout the day and night
93
Mr. Blank comes in complaining that everymorning when he wakes up, he has a cough. He also says that the cough goes away later in the day. What may this be due to?
Sinusitis
94
What is dyspnea? What is it a clinical sign of?
Dyspnea is the subjective feeling of uncomfortable or difficulty breathing. It is a clinical sign of hypoxia
95
What is dyspnea often due to?
What other conditions can it also occur with?
Often due to underlying heart disease, or pulponary diseases such as COPD or asthma
Others: acute conditions including repiratory infections such as pneumonia or pulmonary emboli
96
Patients who have challenges with oxygenation often have a history of difficulty with:
respiratory infections or other conditions
97
Patients who have trouble with oxygenation may have a history of 3 lower respiratory tract ilnesses or 1 infectious lung disease. Identify these conditions.
Lower respiratory tract ilnesses: asthma, COPD, pneumonia
Infectioius lung disease: TB
98
That is pneumonia?
inflammation of the lungs usually due to infection
99
Other than respiratory conditions, what other diseases can cause respiratory symptoms?
CHF, pleural effusion, anemia, or certain cancers
100
What is pleural effusion
an excessive of fluid that accumulates in the pleural space
101
What is a common risk factor in many respiratory and CV ilnesses as well as cancers?
Smoking
102
Cigarette smoking is a common risk factor for which three conditions?
R and CV ilnesses, and certain types of cancer
103
During a respiratory assessment, you need to note history of smoking. What 4 questions will you ask?
1. If the patient currently smokes
2. How much he or she smoke
3. the number of packs per day (PPD)
4. the number of years he or she has smoked
104
What % of the Canadian population age 15 years and older are smokers?
18%
105
What important role do nurses and the health-care team have in regards to smoking according the best practice guidelines?
nurses and the HCT have an important role in motivating and supporting patients to stop smoking in a sensitive, nonjudgemental manner.
106
What does the evidence suggest would happen if HCPs implemented smoking cessation interventions?
it would reduce the number of smokers and decrease the related tobacco diseases
107
What is the aim of RNAO best practice guidelines around smoking cessation?
to have nurses create opportunities to encourage smoking cessation through brief counselling and minimal interventions with patients
108
List 5 interventions suggested by the RNAO evidence-based best practice guidelines around smoking cessation that a nurse can implement
1. while obtaining a health history from a patient who smokes, part of the interaction should include documenting amount of tobacco use and assessing the patient's readiness to quit smoking
2. referall to the Canadian Cancer Society Helpline
3. Offer support and self-help resources, like booklets
4. Inform about or refer to community stop smoking service or clinic
5. Refer to other HCP
109
What are two ways that chronic alcohol/drug abuse can affect the respiratory system?
person often has poor nutritional intake, which can lead to anemia, the result being decreased oxygen-carrying capacity, futher leading to other ilnesses that affect the RS
excessive intake of drugs/alcohol can depress the R centre, which in turn reduces the rate and depth of respiration and reduces the amount of inhaled oxygen
110
What effect can chronic substance abuse from inhaling crack cocaine or fumes have on the RS?
can cause direct damage to the tissues of the lungs that can lead to permanent lung damage and reduced lung capacity
111
What is an important clue to diagnoses and treatment that you should inquire about?
the patient's subjective experience of pain and discomfort
112
When doing a respiratory assessment, what 8 questions should you ask about pain?
1. is the pt experiencing any chest pain when breathing?
2. is the pain sharp or dull?
3. Does it occur on inspiration or expiration?
4. Does the pain radiate?
5. What does it feel like?
6. when did the pain start?
7. is it getting better or worse?
8. have any measures been taken to relieve the pain (heat, cold, medication, rest, etc.)
113
What can fatigue be an indication of?
inadequate oxygenation
114
What three questions should you ask when assessing fatigue?
1. Has the pt been experiecing fatigue or having interrupted sleep patterns from breathing difficulties?
2. Does the pt have difficulty lying flat or require more than one pillow to sleep comfortably
3. Specifically inquire about fatigue when performing ADLs
115
What should you review/inquire about when asking if the patient has done anything to treat his or her symptoms? Why?
Medication: revie wwhat meds the pt takes on an ongoing/regular basis, including prescribed and natural remedies, OTC preparations.
Patients who take medications regularly should be screened for medication toxicity as many meds can quickly rise to toxic levels. (eg. theophylline)
116
What are four newborn and pediatric variations that must be taken into account during physical respiratory assessment?
1. one of the greatest adaptations, transition from in utero to newborn extra uterine life is moving from lungs filled with fluid to lungs that quickly fill with air
2. newborns' chests are small, and their airways are short
3. apiration is a risk during the immediate newborn stage
4. newborns have rapid respiratory rate (30 to 60 breaths/min), use abdominal muscles to aid in respiration, and are obligate nose breathers
117
What is one of the greatest adaptations a newborns' respiratory system must undergo?
transition from in utero to newborn extra unterine life is moving from lungs filled with fluid to lungs filled with air
118
Anitomically speaking, what are two characteristics of newborns' respiratory systems?
chests are small
airways are short
119
What is a risk during the immediate newborn stage?
Aspiration
120
What are three characteristics of newborns respiratory function?
rapid respiratory rate (30 to 60 breaths/min)
use abdominal muscles to aid with respiration
obligate nose breathers
121
Physical Ax of the RS requires knowledge of what three things?
anatomy and surface landmarks
underlying structures
ventilatory and respiratory functions of the lungs
122
What techniques are used during respiratory physical Ax
inspection
palpation
percussion
auscultation
123
What is hypoxia and what are the three primary causes?
a state of insufficient oxygen levels in the blood
hypoventilation, hyperventilation, or airway obstruction
124
