Ch 39: Oxygenation and perfusion Flashcards
What does the integrity of an airway allow
(2 things)
What is the area of a system in the lungs remove and what does it oxygenate
Integrity of an airway allows
- Transportation of air to and from lungs
- Properly functioning alveolar system in lungs
Aveolar system in the lungs removes carbon dioxide from blood And oxygenates venous blood
Why is a properly functioning cardiovascular and hematologic system needed
Proper cardiovascular and hematologic system needed to:
-Carry nutrients/wastes to and from body
What is the function of the upper respiratory system name the components
What is an example of an interruption in the upper respiratory airway
- what can these people not do
- how do they protect their trachea
Upper respiratory system function:
-warm filter humidify air
Components: nose pharynx larynx
 upper respiratory airway interruption =tracheostomy
- those were tracheostomies cannot warm filter humidify air
-  for this reason they must wear something over the trachea to protect it

What is the function of the lower airway
Nina components of the lower airway
Lower airway:
- conduction of air
- where gas exchange occurs
- mucociliary clearance : sweeping of irritance an excess mucus out
- and production of surfactant
Trachea ➡️bronchi➡️ bronchioles ➡️alveoli
What are the lungs composed of
What is the only location in the body that arteries carries deoxygenated blood
Name the blood type:
Pulmonary arteries
pulmonary veins
Lungs composed of elastic tissue (Aveloi, surfactant, pleura)
The pulmonary circulation is the only place in the body that arteries carry deoxygenated blood
Pulmonary arteries: deoxygenated
Pulmonary veins: oxygenated
If person is not in distress/having difficulty with the respiratory system how is pulmonary ventilation described
What phase of ventilation is inspiration
What phase of ventilation is  expiration
If not distress/difficulties respiration system or pulmonary ventilation is automatic
Inspiration: active phase of ventilation
Expiration: passive phase of ventilation
Describe the process of ventilation in simple terms
Diaphragm descends lengthening thoracic cavity
External intercostal muscles contract lifting ribs up and out
Sternum pushed forward enlarging of chest
➡️ increase in thoracic cavity decrease in intrapulmonary pressure as cavity expands and 02 enters 


What is gas exchange (respiration) referred to as
What makes gas exchange (respiration) possible
Define diffusion (where does oxygen move to) 
Define profusion
Gas exchange (respiration): intake of 02 release of CO2
Gas exchange possible by respiration and perfusion
Diffusion:
-movement of O2 from inspired area ➡️circulatory system ➡️ aveloi ➡️ expiration
Perfusion:
-blood supply From capillary blood through the body tissues

Where does gas exchange occur
How many walls do Avioli and capillaries have and why
Gas exchange occurs in the alveoli
Alveoli and capillaries have 1 cell thick wall
-thin walls allow for exchange of gases
What influences diffusion of gases in the lungs
Change in surface area available:
-Excess mucus decreases aveloi function/pneumonia
 thickening of areolar capillary membrane
Partial pressure: MUST HAVE PRESS GRADIENT
Solubility and molecular weight of gas
 what carries oxygen in the body
- name oxygen carried by RBC
-  name CO2 carried by hemoglobin
What does it mean to say internal respiration between circulating blood and tissue cells must occur
Goes
Give and take
Plasma and RBCs carry oxygen in body
- RBC caring O2 = oxyhemoglobin
- hemoglobin carrying CO2 = carboxyhemoglobin
To say internal respiration must occur is to say that:
- circulatory System takes oxygenated blood to tissues and cells
- takes oxygen gives CO2 to be expired
Define 
- hypoxia + reasons
- dyspnea
- hypoventilation + Reasons
1. Hypoxia: inadequate oxygen Reasons -excess mucus -higher elevation -Pneumothorax
- dyspnea: difficulty breathing
- hypoventilation: decrease rate or depth of air into lung 
Reasons
-OD
-metabolic imbalances: to conserve CO2
What must function well for the respiratory system to function
Why must The cardiovascular system be at peak function
The cardiovascular system must function well for the respiratory system to function
Unless cardiovascular system is at peak function fluid will build up and back up
Alterations in the cardiovascular system
How does Dysrhythmia/arrhythmia affect the blood supply
What does myocardial ischemia lead to
What does heart failure lead to in reference to blood
Name the five issues that affect the function of the respiratory system
(2 already mentioned) 
Dysrhythmias and arrhythmias affect blood supply by
-shortening gas exchange
Leading to impaired tissue perfusion
Myocardial ischemia leads to lack of heart blood flow due to weakness
Heart failure leads to ineffective pumping and blood backing up
- Dysrhythmia/arrhythmia
- Myocardial ischemia
- Angina
- MI
- Heart failure

What are a few factors affecting cardio pulmonary function and oxygenation
- General level of health
- development considerations
- medications
- lifestyle considerations
- environmental
- psychological/health considerations
How does the lungs transform in infants
Describe an infants chest and what a potential problem may be because of their chest characteristics
How do you describe the respiratory rate of an infant and where does the activity come from
What is normally heard at the end of respiration for infants
Lungs are transformed from fluid filled to airfield organs in infants
Infants chest characteristics: - small - short airways -don’t cough ! Due to characteristics ASPIRATION is a potential problem!
Respiratory rate is rapid
respiratory activity is from abdominal
At the end of respirations in INFANT CRACKLES ARE NORMAL
 what is surfactant needed to do ?
when does surfactant usually develop
-what can you do for preemies
 surfactant is needed to keep lungs open (expended)
Surfactant usually develops 34–36 weeks gestation
• can be given synthetically to preemies to open aveloi
In children:
Why are landmarks less prominent
What is elongated and less angular
What are children most prone to and what can help decrease this
At the end of late childhood what does the immune system protect from
Landmarks less prominent due to subcutaneous fat deposited in chest wall
Estacion tubes, bronchi, bronchioles are elongated and less angular
Children are more prone to otitis media and colds So good hygiene and tissue etiquette are encouraged
 at the end of late childhood immune system protect V most infections
In your older adults:
Why are landmarks more prominent
What are two major older adult considerations that affect (decrease) how well the respiratory muscles work
What do tissues and airways become how does the diaphragm move
What is the most common disease in your elderly respiratory tract 
Older:
Landmarks more prominent due to loss of subcutaneous fat
Kyphosis and barrel chest both decrease how well the respiratory muscles work
Tissues/always become rigid diaphragm moves less effectively
* PNEMONIA * is most common in older

When obtaining a nursing history regarding the cardio pulmonary system
Why do you want to determine what kind of care is needed
What actions do you want to identify by the patient
What do you want to make use of and why
When obtaining a nursing history
- you want to determine what kind of cares needed to meet any sufficient intake of air
- identify actions performed by the patient for meeting respiratory needs
- Make use of aids to improve in take a favor and effects on lifestyle
Describe the following breath sounds
Bronchial
broncovesicular
vesicular
Bronchial: LOUD high pitched
- over trachea
Bronco vesicular: medium pitch
-over bronchial tree /intercostal area
Vesicular: NORMAL!!!
Low, soft pitched
-over most of lung
Define crackles
How are crackles classified
Define wheezes
How are wheezes classified
Crackles: CONTAINING FLUID intermittent • classified: fine medium or coarse  Wheezes: continuous musical sounds by air passing through constricted narrowed airways (swollen) • classified as: -sibilant (musical) -sonorous (snoring)
Diagnostic methods to assess Carter pulmonary function
What is the first cardiac test done defined it
 If first cardiac test indicates low blood what is the next describe it
#1 cardiac test is Cardiac stress test
:  shows if heart show signs of distress
If low blood then cardiac coronary catheterization done
- shows how Well coronary arteries fill
- shows constrictions and non-perfusing side

Common diagnostic methods to assess cardio pulmonary function (other)
Echocardiogram (ECG) endoscopic studies Holter monitor lung scan  skin test radiography
ECG
- ultrasound of heart
- looks at valves, blood flow, leaks
Holter monitor
-Records heart activity for days used to look at specific intervals
Lung scan
-Insurers lung perfusion and new occlusions
Skin test: PPD
Radiography = X RAY

Define tidal volume
Define vital capacity
Define forced vital capacity
-using what

Define forced expiratory volume
Tidal volume
: total amount of air inhaled/exhaled in 1 breath
Vital capacity
: maximum amount of air exhaled after maximum inhalation
Forced vital capacity
:Maximum amount of air that can be forcefully exhaled
***BEST OF 3 using Peak flow
Forced expiratory volume
: amount of air exhaled in a specific time interval

Define total lung capacity
define residual volume
define peak expiratory flow rate (PEFR)
Total lung capacity
: amount of air in lung with maximum inspiration
Residual volume
:out of air left in lung after MAX expiration
Peak expiratory flow rate
:maximum flow obtained during forced vital capacity
*** FIN # POST 3 cycles
What are nursing interventions we want to promote for adequate respiratory function
- pollution free environment NO SMOKING
- promote optimal functioning
- promote comfort
-promote proper breathing:
•INCENTIVE SPIROMETRY
• pursed lip breathing,
•diaphragmatic breathing
- meeting oxygenation needs with medication
- encourage home cleanliness
What are great ways to promote proper breathing
Using deep breathing/diaphragmatic breathing
Use incentive spirometry
Pursed lip breathing: COPD
Where are chest tubes inserted between what do chest tubes remove from the lung cavity
What do you want to monitor in someone with a chest tube
How should the dressing of someone with the chest tube be
What is most vital to maintain when using a chest tube
Chest tubes inserted between chess wall and lung
Chest tubes remove air or long that has gotten into cavity
Monitor respiratory status and vital signs
Check the dressing is tight not allowing air to escape
Most vital!
MAINTAIN PATENECY AND INTEGRITY Of drainage system
When should cough suppressant be used
What are expectorants used for
-what is achieved
what are lozenges used for primarily
Cough suppressants used if dry hacking cough with pain and chest/stomach 
Expectorant used to cough up mucus
-achieve better breathing
Lozenges primarily used for sorethroat
Give the three simple steps in the Coughing mechanism
Air in
Freshly send air out
Dislodge secretions
What does sitting patient up straight make sure
what does it help with
when do you sit a patient up
Makes sure patient is receiving oxygen
Sitting a patient up straight helps with secretions
Set a patient up when:
- feeding
- normal activities
- pneumonia
- breathing issues
What does the action of maintaining adequate fluid intake make easier
What are other ways to promote patient comfort
Maintaining adequate fluid intake makes mucco cellular action easier by making thin watery secretions
- Provide humidified air
- perform chest physiotherapy
Who is the primary audience to do chest physiotherapy on who do you avoid and what is chest physiotherapy
Chest physiotherapy primarily for cystic fibrosis
🚫 COPD
Chest physiotherapy: chest taps to move secretions (Lucian) to cough out
What is the function of: 
-bronchodilators
-nebulizers
-meter dose inhalers
-dry powder inhalers
Bronchodilators: open narrowed airways
Nebulizers: find particles a liquid (vapor) into deeper passages of respiratory tract
Metered dose inhaler‘s: deliver CONTROLLED dose of medication with compression
Dry powder inhaler’s: BREATH ACTIVATED delivery of med
🚫shake
Describe a nasal cannula
When is a simple mask used
Why would you use a partial rebreather mask
What is the percentage of oxygen given in a nonrebreather mask
What does a Venturi mask allow for
What oxygen delivery systems do you use in your younger children
Nasal cannula is oxygen entering through two prongs into 2 nares
Simple mask used if not maintaining oxygen with nasal cannula
-gives higher % of oxygen
Use a partial rebreather mask to give even higher percentage of oxygen v mask
Nonrebreather masks give 100% of
oxygen
Venturi mask a law suggesting of percentage of oxygen given
In children
- teng
- naso/transtracheal Catheter

When giving oxygen what do you want to avoid and place signs of
What do you want to check for for the risk of
What item do you want to avoid wearing that build up static electricity
what do you want to avoid using that ignites spontaneously in oxygen
When giving oxygen:
- AVOID 🚫 Open flames/smoking
- place sign V smoking
- check electrical equipment to avoid sparks
- avoid wearing synthetic fabrics that build up static electricity
-  Avoid using oils that ignite spontaneously and oxygen
What do you want to establish if you cannot get air into the patient with an Ambu bag
Establish in oral pharyngeal or nasopharyngeal airway if you cannot get air into the patient with an Ambu bag
When do you insert an endotracheal tube
If patient is unable to regain spontaneous respiration insert an endotracheal tube to ventilate
When is a tracheostomy in certain
Tracheostomies in certain if there is trauma above the trachea
How do you insert an artificial airways
What is an obturator and what Is its purpose
Insurance artificial airway by pulling the tongue out and out of the way opening a path for the air
An obturator Is a stiff deal that goes inside of a trach when you’re insulting to allow for insertion certain
What are the actions you will take if a patient needs cardiopulmonary resuscitation
CPR
1: check Pulse
Perform CAB patient needs CPR
•IF NO PULSE!
• if patient does not start breathing spontaneously after airway opening #4 B-reathing give two breaths lasting one second each
What are expected outcomes related to oxygenation perfusion
Expected outcomes:
Improved gas exchange in lungs by:
- no cyanosis
- no chest pain
- pulse ox +95
Relate the causet of factor and demonstrate adaptive method of coping
Preserve pulmonary function by maintaining optimal level of activity (encourage staying active)
Demonstrate self-care behaviors that provide relief from symptoms and prevent further problems
