Chapter 27 Flashcards
Intrinsic risk factors
Risk factors within or influenced by the patient: i.e. Genetic predisposition
What disease types allow blood to pool in the large veins of the pelvis and lower extremities causing pulmonary emboli?
Cardiac and circulatory diseases
Extrinsic risk factors
Factors that are external to the patient, I.e. Cigarette smoking
What are diseases commonly found among cigarette smokers?
Lung carcinoma, COPD, Pneumonia, Pulmonary emboli, and other cardiac diseases.
What are the three steps of gas exchange?
Ventilation, Diffusion, perfusion
Ventilation
Mechanical process of moving air in and out of the lungs.
Diffusion
The movement of molecules through the membrane from an area of greater concentration to an area of lesser concentration.
Perfusion
The circulation of blood through the capillaries
For ventilation to occur, What three body structures must be intact?
Chest wall, nerve pathways, diaphragm
What is the normal concentration of oxygen in the alveoli?
104 mmHg
What is a normal concentration of oxygen in the pulmonary arterial circulation?
40 mmHg
What is the concentration of carbon dioxide in the pulmonary capillaries?
45 mmHg
What is the concentration of carbon dioxide in the alveoli?
40 mmHg
For diffusion to occur, what three body structures must be intact?
Respiratory membrane, interstitial space, and endothelial lining.
What types of medications can be used to treat a patient suffering from fluid accumulation or inflammation?
Diuretic agent or anti-inflammatory drugs (corticosteroids, Antibiotics)
How does the oxygen disassociation curve work?
As oxygen molecules bind to hemoglobin other oxygen molecules more readily binds to that hemoglobin. Similarly, as oxygen bound hemoglobin begins to release oxygen, it more readily releases more oxygen.
For perfusion to occur, what four things must be in place?
Adequate volume of blood, pulmonary capillaries must be able to transport blood, vessels must not be occluded, and the heart must pump efficiently.
What three things can alter the oxygen disassociation curve?
Body temperature, blood pH, and PCO2.
In patients with acute pulmonary edema, what type of drug would be helpful?
A diuretic, because that reduces blood return to an inefficiently pumping heart and improves cardiac efficiency.
Respiration
The exchange of gases between a living organism and its environment.
Pulmonary respiration
Occurs in the lungs when the respiratory gases are exchanged between the alveoli and the red blood cells.
Cellular respiration
Involves the exchange of respiratory gases between the red blood cells and the various tissues.
What injuries cause loss of negative pressure with in the plural space?
Pneumothorax, hemothorax
Cheyne– Stokes respirations
What does it look like, and what does it indicate?
Progressively increasing title volume followed by a declining title volume, separated by periods of apnea
–Indicates brain injury and/ or often found older patients.
Kussmaul Respirations
What does it look like, and what does it indicate?
Deep, rapid breaths
–Indicates diabetic ketoacidosis which produces metabolic ketoacidosis
Central Neurogenic Hyperventilations
What does it look like, and what does it indicate?
Deep, rapid respirations
– Indicates strokes or injury to the brainstem.
Ataxic (Biot’s) Respiratons
What does it look like, and what does it indicate?
Repeated episodes of gasping ventilation separated by periods of apnea.
– Indicates increased intracranial pressure.
Apneustic Respirations
What does it look like, and what does it indicate?
Characterized by long, deep breaths that are stopped during the inspiratory phase and separated by periods of apnea.
– Indicates stroke or severe central nervous system disease.
Anemia
A condition in which the number of red blood cells or amounted in hemoglobin in them is below normal.
What are the five parts of getting a general impression of respiratory status?
Position, color, mental status, ability to speak, respiratory effort.
Asphyxia
A decrease in the amount of oxygen and an increase in the amount of carbon dioxide as a result of some interference with respiration.
Orthopnea
Dyspnea while lying supine
Paroxysmal nocturnal dyspnea
Short attacks of dyspnea that occur at night and interrupt sleep.
Ronchi
Rattling sounds in the larger airways associated excessive mucus or other material.
Wheezing
Whistling sound due to narrowing of the airways by edema, bronchoconstriction, or foreign materials.
Pulsus paradoxes
A drop in the systolic blood pressure of 10 mmHg or more with each respiratory cycle. Associated with COPD and cardiac tamponade.
Capnometry
The measurement of expired CO2
Capnography
A graphic recording or display of the capnometry reading over time
Capnograph
A device that measures expired CO2 levels
Capnogram
The visual representation of the expired CO2 waveform
End title CO2
The measurement of CO2 concentration at the end of expiration
PETCO2
The partial pressure of and title CO2 in a mixed gas solution
PaCO2
The partial pressure of CO2 in the arterial blood
What are common ailments associated with decreased ETCO2?
Shock, cardiac arrest, pulmonary embolism, bronchospasm, and incomplete airway occlusion.
What is phase one of a wave form?
Late inspiration phase
What is phase two of the waveform?
Appearance of CO2 in the exhaled gas.
What is the phase three of the waveform?
Plateau (Constant CO2)
What is phase four of the waveform?
rapid descent during inspiration
What part of the patient’s body is not functioning correctly in cardiogenic pulmonary edema?
The left ventricle of the heart
What are some obstructive lung diseases?
Asthma, emphysema, chronic bronchitis
Cor Pulmonale
Hypertrophy of the right ventricle resulting from disorders of the lung.
Blebs
Destroyed lung tissue
Polycythemia
Increased red blood cell production/ an excess of red blood cells
When do medical problems related to smoking usually develop?
When patients surpass a 20 pack/year history.
How do you calculate the pack per year history?
Multiply the number of packs smoked per day by the number of years the patient smoked
What does an asthmatic waveform look like?
Shark fin
Status Asthmaticus
Severe, prolonged asthma attack that cannot be broken by repeated doses of bronchodilators. Under this condition, recognize that respiratory arrest is imminent and be prepared for endotracheal intubation.
Pleuritic
Sharp or tearing, as a description of pain
Carboxyhemoglobin
Hemoglobin with carbon monoxide bound to it.
