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NURS 1415 > Ch. 32 OXYGENATION > Flashcards

Ch. 32 OXYGENATION Flashcards

1
Q

To achieve the process of R, there must be

1.

2.

3.

A
  1. ventilation
  2. diffusion
  3. perfusion
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2
Q

The movement of gases between the alveoli in lungs and bloodstream is known as

A

Diffusion

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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

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4
Q

The respiratory system includes the following structures:

1.

2.

3.

A
  1. airways and lungs (pulmonary system)
  2. bony thorax
  3. respiratory muscles
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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

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6
Q

This structure connects the upper and lower airways

A

Larynx

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7
Q

This structure houses the vocal chords

A

Larynx

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8
Q

The laryngeal box is formed of 3 large cartilages:

A
  1. epiglottis
  2. thyroid
  3. cricoid
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9
Q

The lower airway consists of these two components:

A
  1. conducting airways
  2. acinus
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10
Q

The conducting airways are part of the _________ airway.

A

The conducting airways are part of the LOWER airway.

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11
Q

The conducting airways include these four structures:

A
  • trachae
  • R/L mainstem bronchi
  • secondary bronchi
  • brochioles
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12
Q

Is the acinus part of the upper or lower airway?

A

lower

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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:

  1. respiratory bronchioles
  2. alveoli
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14
Q

Thorax boundaries

A
  • sternum
  • 12 ribs
  • 12 thoracic vertebrae
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15
Q

Muscles of respiration:

Primary:

1.

2.

Accessory:

1.

2.

3.

A

Muscles of respiration:

Primary:

  1. DIAPHRAGM
  2. INTERCOSTALS

Accessory:

  1. ABDOMINAL
  2. STERNOCLEIDOMASTOID
  3. PECTORAL MUSCLES
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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)

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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

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18
Q

Why does the pleural space have negative pressure?

A

To prevent lungs from separating from chest wall

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19
Q

What are the key structures in gas exchange?

A

alveoli

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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

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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

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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

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23
Q

Gas exchange takes place across the ________-________ membrane

A

alveolar-capillary membrane

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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.

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25
Q

Differentiate between respiration and ventilation.

A

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

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26
Q

Which brain areas are responsible for ventilation?

A

pons and medulla (brainstem)

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27
Q

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

A

decrease in blood oxygen concentration (hypoxemia)

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28
Q

Which will lead to faster and deeper ventilation?

a. increase in pH in body’s fluids
b. decrease in pH in blody’s fluids

A

b. decrease in pH in blody’s fluids

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29
Q

How is inhalation of air initiated? (muscle)

A

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

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30
Q

What is the effect of increasing space inside the thorax during inspiration?

A

decrease intrathoracic pressure, allowing the atmospheric air to fill the lungs

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31
Q

Explain what causes the cessation of inhalation

A

the stretch receptors in the lung tissue send signals back to the brain to cause it to stop, preventing over distension of the lungs

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32
Q

Explain how exhalation occurs

A

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

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33
Q

Under normal circumstances, exhalation is a ___________ process:

a. active
b. passive

A

b. passive

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34
Q

What may a patient have to do when the movement of air is impeded (muscular)

A

use additional muscles to increase the ventilatory effort

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35
Q

What muscles must a patient use when the movement of air is impeded?

A

accessory muscles:

sternocleidomastoid

abdominal

internal intercostals

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36
Q

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

A

c. increased

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37
Q

What is the exchange of oxygen from the alveoli into the pulmonary capillary blood called?

A

External respiration

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38
Q

What happens during external respiration?

A

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

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39
Q

During alveolar gas exchange, oxygen and carbon dioxide diffuse across the alveolar-capillary membrane in response to what?

A

a concentration gradient

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40
Q

What happens to the oxygen molecules once the diffusion of oxygen across the alveolar-capillary membrane occurs?

A

oxygen is dissolved in the blood plasma

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41
Q

Three factors that influece the capacity of the blood to carry oxygen:

A
  1. the amount of dissolved oxygen in the plasma
  2. the hemoglobin level
  3. the tendency of the hemoglobin to bind with oxygen
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42
Q

What percentage of the total oxygen is carried in the plasma?

A

1% to 5%

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43
Q

The presence of what greately enhances the oxygen-carrying capacity of the blood?

A

the presence of hemoglobin in the RBCs (erythrocytes)

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44
Q

What are the two ways that the amount of oxygen carried in a sample of blood is measured?

A
  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
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45
Q

What is PaO2?

A

The oxygen dissolved in the plasma is expressed as the partial pressure of oxygen.

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46
Q

What is the normal PaO2 in arterial blood?

A

The normal PaO2 in arterial blood is 80 - 100 mmHg

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47
Q

What is SaO2?

A

the % of hemoglobin that is saturated with oxygen.

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48
Q

What value reflects the hemoglobin being fully saturated?

A

100%

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49
Q

What is the normal saturation of arterial blood?

A

96-98%

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50
Q

Once bound to hemoglobin, where is the oxygen delivered? By process of what?

A

Delivered to the cells of the boyd for tissue perfusion by process of circulation

51
Q

Circulation of the blood is the function of these two structures:

A

heart

blood vessels

52
Q

These allow for the unidirectional blood flow through the chambers of the heart

A

valves

53
Q

A single cycle of atrial and ventricular contraction and relaxation

A

The cardiac cycle

54
Q

The cardiac cycle is both a ______________ and _____________ event

A

electrical and mechanical event

55
Q

What does the electrical acitivity of the heart involve?

A

the generation and transmission of electrical current by special cells known as the cardiac conduction system

56
Q

special cells that are responsible for the generation and transmission of electrical current in the heart

A

cardiac conduction cells

57
Q

What is the intrinsic pacemaker of the heart and where is it located

A

The SA node and it is located in the right atrium

58
Q

Describe the flow of electrical current in the heart from the SA node.

A

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
Q

Where is the AV node located?

A

lower part of the right atrium

60
Q

SA node impulse ——> ________ ——>AV node stimulation—–>_________——>_________—–>________

A

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
Q

What is an essential factor in the cyclical filling and emptying of the chambers of the heart, which produce circulation

A

sequential contraction and relaxation of the atria and ventricles

62
Q

How many times per minute does the cardiac cycle occur?

The number of times depends on three patient factors:

A

60-100

age, gender, condition

63
Q

The process of chamber filling is referred to as ________________

The provess of emptying is referred to as _____________

A

diastole

systole

64
Q

Right atrial diastole vs. left atrial diastole

A

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
Q

What are the two contributers to ventricular filling?

A
  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
Q

What % of two components of ventricular filling contribute to cardiac output

A
  1. passive filling (pressure as atria fill, valves open) = 70%
  2. atrial kick (contraction of the atrium-atrial systole) = 30%
67
Q

Right atrial diastole

A

RA fills with blood the returns to heart from SVC/IVC

68
Q

Left atrial diastole

A

LA fills with blood that returns to heart from pulmonary veins

69
Q

Atrial Systole

A

(30%) of cardiac output

  • contraction of the atria that helps with the filling of the ventricles
  • “Atrial kick”
70
Q

Ventricular Systole

A
  • when semilunar valves open and contraction of ventricular walls proceeds, blood is forced out of the ventricles into circulation
71
Q

Two branches off the ventricles

A

Aorta and pulmonary artery

72
Q

Starting from the Right atrium

A

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
Q

What drives blood flow through the arterial system?

What two other factors influence blood flow?

A

The pressure generated during ventricular systole

volume and thickness of blood, resistance within the arterial system

74
Q

The redistribution of blood flow to the areas of greatest need is called

A

autoregulation

75
Q

How is blood flow autoregulated?

A

blood flow to specific organs/tissues may be increased or reduced by the relaxation or contraction of precapillary sphincters that regulate blood flow

76
Q

These structures increase or decrease blood flow to specific organs and tissues

A

precapillary sphincters

77
Q

How does the lower pressure venous system ensure that blood returns to the heart?

A

Valves that prevent backflow

veins are compressed by their surrounding skeletal muscles and blood is forced to the vena cava

78
Q

What happens when oxygenated blood reaches the tissues?

A

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
Q

What is internal respiration?

A

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
Q

Internal respiration vs. External respiration

A

External - exchange of oxygen from the alveoli into the pulmonary capillary blood

Internal - exchange of oxygen from the blood to the tissues

81
Q

Assessment of respiratory system involves two parts:

A
  1. Taking a focused health history
  2. Physical assessment
82
Q

What five pieces of information should you note when taking a docused health history?

A
  • symptoms
  • history of respiratory illness
  • history of smoking or drug abuse
  • level of pain and fatigue
  • treatments or medications used to date
83
Q

What is involved in the physical assessment of the respiratory system?

A
  • Inspection of the respiratory system: rate, depth, and regularity of breathing
  • palpation
  • percussion
  • ausculation of breath sounds
84
Q

What must you take into account when doing a physical assessment related to the respiratory system?

A

The age and current condition of the patient

85
Q

What 3 things should you pay attention to when doing the “inspection” component of the physical assessment of the repiratory system?

A

rate, depth, and regularity

86
Q

Three common respiratory symptoms

A

Wheezing

Cough

Dyspnea

87
Q

What is wheezing? Why does it happen? When is it heart? What is wheezing associated with?

A

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
Q

What is a cough?

A

an abrupt discharge of air from the lungs to clear the trachea bronchi and lungs from some type of irritant

89
Q

When a patient reports a cough, what should the nurse ask about and why?

A

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
Q

A cough that is continuous throughout the day and night usually indicates

A

a respiratory infection

91
Q

A cough that occurs only in the morning may be due to this condition

Explain.

A

Sinusitis;

coughing clears the airways from discharge that has accumulated during sleep

92
Q

If a patient has a respiratory infection, what will their cough be like?

A

continuous throughout the day and night

93
Q

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?

A

Sinusitis

94
Q

What is dyspnea? What is it a clinical sign of?

A

Dyspnea is the subjective feeling of uncomfortable or difficulty breathing. It is a clinical sign of hypoxia

95
Q

What is dyspnea often due to?

What other conditions can it also occur with?

A

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
Q

Patients who have challenges with oxygenation often have a history of difficulty with:

A

respiratory infections or other conditions

97
Q

Patients who have trouble with oxygenation may have a history of 3 lower respiratory tract ilnesses or 1 infectious lung disease. Identify these conditions.

A

Lower respiratory tract ilnesses: asthma, COPD, pneumonia

Infectioius lung disease: TB

98
Q

That is pneumonia?

A

inflammation of the lungs usually due to infection

99
Q

Other than respiratory conditions, what other diseases can cause respiratory symptoms?

A

CHF, pleural effusion, anemia, or certain cancers

100
Q

What is pleural effusion

A

an excessive of fluid that accumulates in the pleural space

101
Q

What is a common risk factor in many respiratory and CV ilnesses as well as cancers?

A

Smoking

102
Q

Cigarette smoking is a common risk factor for which three conditions?

A

R and CV ilnesses, and certain types of cancer

103
Q

During a respiratory assessment, you need to note history of smoking. What 4 questions will you ask?

A
  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
Q

What % of the Canadian population age 15 years and older are smokers?

A

18%

105
Q

What important role do nurses and the health-care team have in regards to smoking according the best practice guidelines?

A

nurses and the HCT have an important role in motivating and supporting patients to stop smoking in a sensitive, nonjudgemental manner.

106
Q

What does the evidence suggest would happen if HCPs implemented smoking cessation interventions?

A

it would reduce the number of smokers and decrease the related tobacco diseases

107
Q

What is the aim of RNAO best practice guidelines around smoking cessation?

A

to have nurses create opportunities to encourage smoking cessation through brief counselling and minimal interventions with patients

108
Q

List 5 interventions suggested by the RNAO evidence-based best practice guidelines around smoking cessation that a nurse can implement

A
  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
Q

What are two ways that chronic alcohol/drug abuse can affect the respiratory system?

A

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
Q

What effect can chronic substance abuse from inhaling crack cocaine or fumes have on the RS?

A

can cause direct damage to the tissues of the lungs that can lead to permanent lung damage and reduced lung capacity

111
Q

What is an important clue to diagnoses and treatment that you should inquire about?

A

the patient’s subjective experience of pain and discomfort

112
Q

When doing a respiratory assessment, what 8 questions should you ask about pain?

A
  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
Q

What can fatigue be an indication of?

A

inadequate oxygenation

114
Q

What three questions should you ask when assessing fatigue?

A
  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
Q

What should you review/inquire about when asking if the patient has done anything to treat his or her symptoms? Why?

A

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
Q

What are four newborn and pediatric variations that must be taken into account during physical respiratory assessment?

A
  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
Q

What is one of the greatest adaptations a newborns’ respiratory system must undergo?

A

transition from in utero to newborn extra unterine life is moving from lungs filled with fluid to lungs filled with air

118
Q

Anitomically speaking, what are two characteristics of newborns’ respiratory systems?

A

chests are small

airways are short

119
Q

What is a risk during the immediate newborn stage?

A

Aspiration

120
Q

What are three characteristics of newborns respiratory function?

A

rapid respiratory rate (30 to 60 breaths/min)

use abdominal muscles to aid with respiration

obligate nose breathers

121
Q

Physical Ax of the RS requires knowledge of what three things?

A

anatomy and surface landmarks

underlying structures

ventilatory and respiratory functions of the lungs

122
Q

What techniques are used during respiratory physical Ax

A

inspection

palpation

percussion

auscultation

123
Q

What is hypoxia and what are the three primary causes?

A

a state of insufficient oxygen levels in the blood

hypoventilation, hyperventilation, or airway obstruction

124
Q
A

NURS 1415 (2 decks)

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