Chapter 23- Ventilation & Gas Exchange Flashcards
Ventilation?
Movement of air between the atmosphere and respiratory portion of the lungs
MOVEMENT
Perfusion?
Flow of blood through the lungs
BLOOD FLOW
Diffusion?
Transfer of gases between the air filled spaces in the lungs and the blood
Examples of perfusion?
- thrombus in vessels
- severe anemia
When inserting an endotracheal tube, a medical professional will typically advance the tube where?
To the right, due to the nature of the trachea.
- Right side of trachea into the lungs is a wider angle
- left side of trachea into the lungs is a more narrow turn
Dissolved oxygen = _______ or _________?
PaO2 or PO2
What is the normal value of dissolved oxygen?
Normal value > 80mm Hg
Oxygen bound to hemoglobin = ?
Oxyhemoglobin
Normal Oxygen saturation value is ______ to _______?
94% to 100%
Dissolved carbon dioxide = _______ or _________?
PaCO2 or PCO2
Normal Carbon Dioxide value = ?
35-45 mm Hg
Carbon dioxide bound to hemoglobin =?
Carbaminohemoglobin
When you exhale you remove _______ from your blood?
CO2
- you also decrease the amount of carbonic acid, raising your blood PH
Hypoxemia?
Reduced oxygenation of the arterial blood
- PO2 <60mm Hg or Pox around 90%
What is Cyanosis?
Bluish discoloration
Of the skin & mucous membranes
Central Cyanosis is evident where?
In the tongue and lips
Peripheral Cyanosis is evident where?
On the extremities & tip of the nose and ears
Which is more serious, Peripheral cyanosis OR central cyanosis?
Central cyanosis
If a patient has hypoventilation, there building up _______ and not getting enough ________.
Building up: CO2
Not getting enough: O2
Signs and symptoms of Hypoxemia?
- Tachypneic (fast breathing)
- SOB
Ways to diagnose Hypoxemia?
- Pox
- Arterial blood gas (ABG)
- 92% —> nasal canula (2-3L/min)
- 74% —> oxymask ALL THE WAY UP (15L/min)
Treatment for Hypoxemia?
- Treat the underline cause
- Oxygen via nasal cannula, mask, or nonrebreather
If No Improvement
- continuous positive airway pressure (CPAP) (night)
- Bilevel positive airway pressure (BIPAP) (on 1st)
- Intubation
Atelectasis?
Incomplete expansion of the lung or portion of a lung
can be small segment or entire lung
Atelectasis is most commonly seen in who?
Postoperative patients
What are the two early signs & symptoms of Atelectasis?
- Tachypnea (fast breathing)
- Tachycardia (fast HR)
Atelectasis signs and symptoms?
- Tacypnea
- Tachycardia
- Dyspnea
- Cyanosis
- Absence of breath sounds
- Fever
- Signs of infection
Treatment for Atelectasis?
- incentive spirometry
- coughing
- deep breathing
What is Hypercapnia?
Increased carbon dioxide in the arterial blood
Hypercapnia is PCO2 of ___________?
> 50mm Hg
Signs & Symptoms of Hypercapnia?
- Hypoventilation
- decreased RR
- Altered mental status
________________ covers the lungs?
Visceral pleura
____________ lines the thoracic wall and superior aspect of the diaphragm?
Parietal pleura
Pleural cavity is what?
Space between the two layers
_________ contains a thin layer of serous fluid?
Pleural cavity
Pleuritic Chest Pain originates from where?
Originates from parietal pleura involvement
Signs & Symptoms of Pleuritic Chest Pain?
- Sharp
- Abrupt onset
- Unilateral
- Lower
- Can be referred to shoulder
- Worse with chest movement
(Cough, deep breathing, movement)
Pleuritic chest pain results in what?
Rapid, shallow breaths, reflex splinting
What is Pleural Effusion?
Fluid in the Pleural Cavity
Hydrothorax: ?
Serous fluid
What is the most common cause of Hydrothorax?
Congestive Heart Failure (CHF)
Empyema: ?
Pus; s/s of infection
Causes of Empyema?
- Direct infection of pleural space
- rupture of lung abscess
- invasion from subdiaphragmatic infection
- trauma
Hemothorax: ?
Blood
Causes of Hemothorax?
- Injury to chest
- surgery
- malignancy
- rupture of great vessel
Signs and symptoms of Pleural Effusion?
- Dyspnea
- Decreased breath sounds
- Pleuritic chest pain
- Mild Hypoxemia
- Shift in mediastinal structures
- Decreased lung expansion
Treatment of Pleural Effusion?
- directed towards cause
- Drainage of fluid
( chest tube or multiple chest tubes) - possibly surgery
What is Pneumothorax?
Air enters the pleural cavity
- Air takes up space, restricting lung expansion
- can be partial or complete collapse of the affected lung
What are 2 types of pneumothorax?
- Spontaneous pneumothorax
2. Traumatic pneumothorax
What is spontaneous pneumothorax?
An air-filled blister on the lung ruptured
What is traumatic pneumothorax?
Air enters through chest injuries
What are 2 types of traumatic pneumothorax?
- Tension pneumothorax
2. Open pneumothorax
What is Tension pneumothorax?
Air enters pleural cavity through the wound on inhalation, but cannot leave on exhalation
Life Threatening
What is Open pneumothorax?
Air enters pleural cavity through the wound on inhalation and leaves on exhalation
Air ________ in the lung?
Rises
Fun Fact:
In patients with Tension Pneumothorax
- place needle by 2nd rib. Pull out needle and the tubing serves as a way for air escape!
💉💉
Signs and symptoms of pneumothorax?
( and also Hemothorax)
- Depends on size and lung response
- Chest pain
- Tachypnea
- Tachycardia
- Asymmetry of chest movement
- Hypoxemia
- Tracheal deviation with tension pneumothorax
Asymmetry of chest movement is seen more with what?
Car accidents & Trauma
Treatment of pneumothorax?
- Depends in cause
- Removal of air with needle or chest tube
- surgery if necessary
Tension Pneumothorax = ?
Needle Decompression
What is Hemothorax?
Blood within the pleural space
Causes of Hemothorax?
- Trauma
- MVC
- Gun shot
- Stabbing
- Assault
- Fall
Where should a chest tube be placed in a patient with Hemothorax?
Lower in lung
- since blood is heavier than air!
Tension pneumothorax is associated with what?
Tracheal deviation
What are chronic obstructive airway diseases?
- Chronic bronchitis
- Emphysema
- Bronchiectasis
- Cystic Finrosis
What are Obstructive Airway Disorders?
- Bronchial asthma
- Chronic obstructive airway diseases
- Chronic bronchitis
- Emphysema
- Bronchiectasis
- Cystic fibrosis
Asthma is due to what?
Airway inflammation
___________ makes Asthma worse in 10% of individuals?
- Over the counter meds
(Anti-inflammatories)
AVOID—> ibuprofen, aleve, aspirin
Signs and symptoms of MILD asthma?
- Chest tightness
- Expiratory wheezing
Signs and symptoms of SEVERE asthma?
- Dyspnea
- Fatigue
- Loud inspiratory & expiratory wheezing
- accessory muscle use
- Tripod position
What symptoms would there be in a patients with asthma whose airflow has significantly decreased?
- Breath sounds inaudible
(Due to full occlusion) - Diminished wheezing
- will lead to respiratory failure/arrest
High CO2 levels will cause what in COPD patients?
Unresponsiveness
- All other assessments will be normal!
Vitals, etc.
What should you monitor with COPD patients?
CO2 Levels
In COPD patients they can’t get _____ in and cant blow off _______.
Can’t get O2 in
Can’t blow off CO2
In COPD patients there ABG will look _________ and there CO2 will be ________.
Good
Elevated
In COPD patients what does the saying Low & Slow mean?
Increase O2 1L at a time
- usually don’t go above 3L *
What is Emphysema?
Enlargement of air spaces and destruction of lung tissue
What is the problem with Emphysema?
Major mechanism of airflow is limited due to the loss of elastic recoil
( allows air in the lungs during inspiration and prevents collapsing on exhalation)
Causes of Emphysema?
- smoking 🚬
- genetics 🧬
What respiratory disease cause Mucus Hypersecretion ?
Chronic bronchitis
What is Chronic bronchitis?
- Chronic irritation, inflammation, and obstruction of airways
COPD & Chronic Bronchitis occur more in what sex?
More MEN
It can still occur in women, but it’s less likely
Chronic bronchitis occurs more in ______, __________, ___________________.
- Middle ages men
- Smokers
- Recurrent infection
What is a symptom of Chronic Bronchitis?
- Chronic, Persistent, productive cough
In somebody with COPD & Chronic Bronchitis, where do we want there Pox?
Where there Pox is normal, is where we want it to be!
Signs & Symptoms of Chronic Bronchitis ?
- Dyspnea
- Decreasing exercise tolerance
- Labored breathing (eventually even @ rest)
- Prolonged expiatory phase
- Hypoxemia
- Hypercapnia
- Cyanosis
Pursed Lips helps to do what?
Helps to blow off CO2 longer
Emphysema Signs & Symptoms
- Dyspnea
- Increased ventilatory effort
- use of accessory muscles
- Barrel chest
- Pursed lip breathing
What Labs to look for in COPD patients & why ?
- ABG
- CBC
- Low WBC’s = COPD exacerbation (breathing treat.)
High WBC’s = Pneumonia (Antibiotics)
What is a Pulmonary Embolism?
Something blocking a branch of a pulmonary artery and obstructs flow
(Thrombus, air, fat)
Pulmonary Embolisms almost always arise from ______________________________.
Deep Vein Thrombosis (DVT) OR Venous Thromboembolism (VTE)
What are complications of Pulmonary Embolisms?
- Pulmonary Hypertension
( increases pressure to try and push everything pass the blockage) - Right-sides heart failure develops
Fat emboli are common with what?
Common with large bone breaks
(Ex: Femur)
Pulmonary Embolism Signs & Symptoms ?
- Chest pain
- Dyspnea
- Tachycardia
- Tachypnea
- Low Pox
- Hypoxemia without CO2 retention
- Large emboli May be fatal
D-dimer testing can be used to diagnose what ?
Pulmonary Embolism
In patients with Pulmonary Embolisms, anticoagulants are used to prevent what ?
Prevents further growing of the thrombus
