Chapter 39 Oxygenation and Perfusion Flashcards
What are the 3 factors essential to normal functioning of the respiratory system?
- integrity of the airway system to transport air to and from the lungs
- properly functioning alveolar system in the lungs
- properly functioning cardiovascular and hematologic systems (blood supply)
Oxygen and carbon dioxide must move through the ___ as part of the oxygenation process.
alveoli
Function of respiratory system?
transport and exchange of oxygen and carbon dioxide
The airway begins and ends where?
Begins at nose and ends at terminal bronchioles
What are microscopic hair-like projections, that propel trapped material and accompanying mucus toward the upper airway so they can be removed by coughing?
Cilia
What is necessary for ciliary action and for the production of watery mucus normally present in the respiratory tract?
an adequate fluid intake
What is involved in the upper airway and what is the upper airway’s function?
- nose, pharynx, larynx, and epiglottis
- function: get the air in, filter it, and humidify inspired air
What is involved in the lower airway and what is the lower airway’s function?
- trachea, right/left mainstem bronchi, segmental bronchi, and terminal bronchioles
- function: conduction of air further down, mucociliary clearance, production of pulmonary surfactant
The lungs extend from the __ to the __.
From the base at the bottom of the diaphragm to the apex which is above the 1st rib.
Which lung has 3 lobes? 2 lobes?
3- right
2- left
What are smaller air sacs in the lungs?
alveoli
What is a detergent-like phospholipid, that reduces the tension between the moist membranes of the alveoli, preventing their collapse?
Surfactant
What is a serous membrane that lines the lungs and thoracic cavity?
Pleura
What pleura covers the lungs?
visceral
What pleura lines the thoracic cavity?
parietal
What is the movement of air into and out of the lungs?
Pulmonary Ventilation
What are the 2 phases of ventilation?
- inspiration
- expiration
What is the active phase of ventilation?
Inspiration
What is the passive phase of ventilation?
Expiration
What happens during the process of ventilation (inspiration)?
- the diaphragm contracts and descends, lengthening the thoracic cavity
- the external intercostal muscles contract, lifting the ribs upward and outward
- sternum is pushed forward, enlarging the chest
- Increased lung volume and decrease intrapulmonic pressure (allows air to move from high to low pressure)
What happens during the process of gas exchange (respiration)?
- intake of oxygen and release of carbon dioxide
- movement of oxygen and carbon dioxide between the air and blood via capillaries
- perfusion
- diffusion (movement of gas or articles from areas of higher pressure to lower)
The process of oxygenated capillary blood passing through the tissues of the body.
Perfusion
The movement of gas or particles from areas of higher pressure or concentration to areas of lower pressure or concentration.
Diffusion
Which respiratory organ is the site of gas exchange?
Alveoli
What 4 factors influence diffusion of gases in the lungs?
- change in surface area available
- thickening of alveolar-capillary membrane
- partial pressure
- solubility and molecular weight of the gas
What causes thickening of the alveolar-capillary membrane?
anything due to inflammation
-pneumonia, pulmonary edema, etc.
What causes a change in the surface area available?
-destroyed tissues from smoking, broken rib, bed rest, etc. (anything that prevents the lungs from expanding as good)
How is oxygen carried throughout the body?
via plasma and red blood cells.
Most oxygen (97%) is carried by red blood cells in the form of ___.
oxyhemoglobin
Hemoglobin also carries carbon dioxide in the form of ___.
carboxyhemoglobin
Internal respiration between the ___ and ___ cells must occur.
circulating blood and tissue
Pulmonary ventilation is the process by which oxygenated capillary blood passes through body tissues. T/F?
False. Perfusion.
What are 3 alterations in respiratory function?
Hypoxia
Dyspnea
Hypoventilation
What is an inadequate amount of oxygen available to the cells?
Hypoxia
What is difficulty breathing?
Dyspnea
What is a decreased rate or depth of air movement into the lungs?
Hypoventilation
How many chambers does the heart have?
4
upper- atria
lower- ventricles
What do the upper chambers of the heart do?
The atria receive blood from the superior and inferior vena cava and the left and right pulmonary veins.
What do the lower chambers of the heart do?
The ventricles force blood out of the heart through the left and right pulmonary arteries and the aorta.
What do one-way valves do? Where are they located?
They direct blood flow through the heart.
Located at the entrance (tricuspid and mitral valves) and exit (pulmonary and aortic valves) of each ventricle
Deoxygenated blood (low in oxygen, high in carbon dioxide) is carried from the ___ side of the heart to the lungs.
Right
What is a disturbance of the rhythm of the heart.
dysrhythmia or arrhythmia
What causes dysrhythmias?
- Caused by an abnormal rate of electrical impulse generation from the SA node, or from impulses originating from a site or sites other than the SA node.
- They can also be caused by the abnormal conduction of electrical impulses through the heart.
What can dysrhythmias cause disturbances in?
- Heart rate, heart rhythm or both.
- can affect the pumping action of the heart, can interfere with circulation, and can lead to alterations in oxygenation.
What is a myocardial ischemia?
Decreased oxygen supply to the heart caused by insufficient blood supply
What can myocardial ischemia lead to?
Impaired oxygenation of tissues in the body.
What is myocardial ischemia usually caused by?
-atherosclerosis
What is a temporary imbalance between the amount of oxygen needed by the heart and the amount delivered to the heart muscles, causing chest pain or discomfort?
Angina
What is one type of acute coronary syndrome characterized by the death of heart tissue due to lack of oxygen?
Myocardial infarction, or heart attack
What occurs when the heart is unable to pump a sufficient blood supply, resulting in inadequate perfusion and oxygenation of tissues.
Heart failure
What disease are these symptoms accompanied with: shortness of breath, edema (swelling), and fatigue. ?
Heart failure
What disease are these symptoms accompanied with: pain, anxiety, nausea, vomiting, indigestion, and shortness of breath.
Myocardial ischemia
What can be the result of many heart conditions, including chronic hypertension, coronary artery disease, and disease of the heart valves?
Heart failure
What factors affect cardiopulmonary functioning and oxygenation? (6)
- level of health
- developmental considerations
- medication considerations
- lifestyle considerations
- environmental considerations
- psychological health considerations
What are the 5 guidelines for obtaining a nursing history?
- determine why the patient needs nursing care?
- determine what kind of care is needed
- Identify current or potential health deviations
- Identify factions performed by the patient for meeting respiratory needs
- make use of aids of improve intake of air and effects on patient’s lifestyle/relationships
Low-pitched, soft sound during expiration heard over most of the lungs.
Vesicular
High-pitched and longer, heard primarily over the trachea
Bronchial
Medium pitch and sound during expiration, heard over the upper anterior chest and intercostal area
Bronchovesicular
Wheezes are continuous, musical sounds, produced as air passes through airways constricted by swelling, narrowing, secretions, or tumors. T/F?
True
What are the 3 types of adventitious lung sounds?
- crackles
- wheezes
- rhonchi
Intermittent sounds occurring when air moves through airways that contain fluid.
Crackles
continuous musical sounds heard on expiration and sometimes on inspiration as air passes through airways constricted by swelling, secretions, or tumors.
Wheezes
What are low pitched rattling sounds that can be considered course crackles?
Rhonchi
What is a cardiac coronary catheterization?
- Invasive procedure
- We put a probe through the femoral artery and it goes into the heart
- We need pressure on this site, monitory for bleeding, and no movement until the bleeding has stopped.
What is a cardiac exercise stress test?
We can: Put an EKG on a patient and have them walk or run on the treadmill.
- We watch how the heart and heart rhythm respond to it.
- We also can give them medication if they are not very active, and it will simulate stress from exercise.
- Noninvasive.
What is an echocardiogram?
Ultrasound of the heart where they look at the blood flow through the heart, in the heart and in the valves and into the chambers.
-noninvasive
What is an endoscopic study?
An endoscopic visualization
We go through the radial arterial line.
What is a holter monitor?
Patient can wear this for a few days
Noninvasive
Captures heart activity for a time period
What is a lung scan?
Nuclear imaging test
We look at air or blood movements through the blood
What does radiography look at?
Looking at chest x-ray
We look at size and structure and placement of heart
Total amount of air inhaled and exhaled with one breath.
Tidal volume
Maximum amount of air exhaled after maximum inspiration
Vital Capacity
Max amount of air that can be forcefully exhaled after a full inspiration
Forced Vital Capacity
The amount of air exhaled at a specific time interval; for example, in the first, second, and third seconds after a full inspiration
Forced Expiratory Volume
The amount of air contained within the lungs at maximum inspiration.
Total lung capacity
The amount of air left in the lungs at maximal expiration
Residual Volume
- The maximum flow attained during the FVC
- The speed at which the maximum flow is obtained during a forced expiratory maneuver.
- Indicator of how the patient is doing
Peak Expiratory Flow Rate
What are the 6 Nursing Interventions Promoting Adequate Respiratory Functioning?
- Teaching about a pollution-free environment
- Promoting optimal function
- Promoting comfort
- Promoting proper breathing
- Managing chest tubes
- Promoting and controlling coughing
When a cough does not occur as a result of reflex stimulation of the cough-sensitive areas
Voluntary Coughing
- Accompanies respiratory tract infections and irritations.
- Many times respiratory infections lead to the production of respiratory secretions.
- These secretions can trigger the cough mechanism. When the cough is productive, it helps clear the airway.
Involuntary Coughing
Depresses the function of the cough reflex
Medicines we use: codeine (most used), dextermorphan, etc.
Cough suppressants
Facilitates the removal of the secretions
Liquifying the secretions more so it is easier to cough up
Ex; guaifenesin
Expectorants
Contains a local anesthetic (benzocaine)
Mild affect
Suppress irritation that can cause the cough
Lozenges
What does suctioning the airway do?
Suctioning irritates the mucosa and removes oxygen from the respiratory tract, possibly causing hypoxemia (insufficient oxygen in the blood).
-you should preoxygenate the patient before suctioning.
Open narrowed airways
- A type of medication that make breathing easier by relaxing the muscles in the lungs and widening the airways (bronchi)
- ex; alb sterol
Bronchodilators
- Disperse fine particles of liquid medication into the deeper passages of the respiratory tract
- Changes medication from a liquid to a mist so you can inhale it into your lungs.
Nebulizers
Deliver a controlled dose of medication with each compression of the canister
meter-dose inhalers
Breath-activated delivery of medications
The medication is released only when you take a deep, fast breath in through the inhaler.
Dry powder inhalers
Nasal cannula:
The most commonly used oxygen delivery device.
The cannula is a disposable plastic device with two protruding prongs that are inserted
high flow
Nasopharyngeal catheter
A type of airway adjunct, a tube that is designed to be inserted into the nasal passageway to secure an open airway
Transtracheal catheter
- A small plastic catheter is surgically placed in your neck and sits in your windpipe (trachea).
- A method used to deliver oxygen directly to the lungs.
- It is used to treat chronic hypoxemia (low blood oxygen).
Simple mask
- Low flow
- Connected to oxygen tubing, a humidifier, and a flow meter, just like the nasal cannula.
- This mask has vents on its sides that allow room air to leak in at many places, thereby diluting the source oxygen.
- The vents also allow exhaled carbon dioxide to escape
- For someone that breathes through their mouth
Partial rebreather mask
- Low flow
- Similar to a simple face mask, but is equipped with a reservoir bag for the collection of the first part of the patient’s exhaled air.
- The remaining exhaled air exits through vents.
- The air in the reservoir is mixed with 100% oxygen for the next inhalation.
- Thus, the patient rebreathes about one third of the expired air from the reservoir bag.
- This type of mask permits the conservation of oxygen
- An additional advantage is that the patient can inhale room air through openings in the mask if the oxygen supply is briefly interrupted.
Nonrebreather
- Low flow
- Delivers the highest concentration of oxygen via a mask to a spontaneously breathing patient.
- It is similar to the partial rebreather mask except that two one-way valves prevent the patient from rebreathing exhaled air.
- The reservoir bag is filled with oxygen that enters the mask on inspiration.
- Exhaled air escapes through side vents
Venturi Mask
- High flow
- A medical device to deliver a known oxygen concentration to patients on controlled oxygen therapy
tent
-A tent-like device that is used in a medical setting to deliver high levels of oxygen to a bedridden patient.
What respiratory accommodations would you expect to observe in your patient due to COPD?
- Higher respirations bc of shallow rapid breathing
- They will be in a tripod position (hunched over holding himself up with one hand)
- Might use pursed-lip breathing- helps them inhale and exhale better
As her condition worsens, what effects would you expect her to develop?
- Fatigue
- Anxiety
- Cyanosis (blue skin)
- Finger clubbing
- Anorexia because they won’t have enough energy to breathe and eat at the same time
- Barrel chest
A person with COPD is at greatest risk for which illness?
Pneumonia
-Anyone with chronic lung disease, cystic fibrosis, asthma, COPD etc, are at higher risk for lung infections because their respiratory system is challenged and they can’t fight infections as well as a healthy person could.
How would your patient’s COPD impact her dietary needs?
- Need more high protein, calorie, and nutrition.
- They can’t sit and have a whole meal so their needs increase
- Increase fluid intake to break up secretions
Why is it important to monitor oxygen flow rate in patients with COPD?
- It can cause the respiratory affect to stop working, which results in hypoventilation, that results in respiratory failure
- We don’t want to keep bumping COPD patients up to like 12 or 15 on a daily basis bc that can lead to negative effects
