Exam 2- Oxygenation and Perfusion Flashcards
Kussmaul breathing
deep, labored breathing pattern indicating that the body has become too acidic
CO2 is the acid
Stridor
Described as a high pitched whistling sound
Obstructed airway
-chocking
-axaphylactic shock
Identify factors influencing respiratory function 4-5
- Age
- healthy vs. disease
- necessary for assessing, planning, intervening inpatient care
- Level of health
- developmental considerations
Respiratory function considerations for infant
- Surfactant is formed in utero 34-36 weeks, if baby born before that time may have collapsed alveoli due to insufficient surfactant
- Infants are abdominal breathers
- Crackles heard at the end of respiration are normal
- Infant has small chest, short airways, aspiration is a potential problem
Respiratory function considerations for children 4
- bronchi, bronchioles are elongated and less angular
- subq fat makes landmarks less prominent
- average number of colds decreases until child goes to daycare or school
- by end of late childhood, immune system functions appropriately to protect from illness
Respiratory function considerations for older adults 5
Tissues and airways of the respiratory tract becomes less elastic
- power of abdominal muscles is reduced
- chest is not able to stretch as much
- airways collapse easily
- increased risk for disease such as pneumonia and other chest infections
Explain Deep Breathing
- Can be used to overcome hypoventilation
- make each breath deep enough to move the bottom ribs
- breathe in through the nose and out slowly through the mouth
Explain use of incentive spirometry
- encourages patient to maximize lung inflation and reduce or prevent atelectasis
- exhale completely, place mouth on mouth piece and inhale through the mouth
Explain Pursed Lip breathing
- can reduce symptoms in patients experiencin dyspnea and feelings of panic
- exhaling through pursed lips creates a smaller opening for air movement, effectively slowing and prolonging expiration.
- Prolonged expiration is thought to result in decreased airway narrowing during expiration and prevent the collapse of small airways
- results in improved air exchange and decreased dyspnea
- helps patient to control rate and depth of respiration
Diaphragmatic breathing
- Pt places one hand on stomach and other on middle of the chest. breath in slowly through the nose, letting abdomen protrude as far as it will go, then breathe out through pursed lips while contracting abdominal muscles, with one hand pressing inward and upward on the abdomen
- Good to teach patients with COPD bc they usually breathe shallow and rapidly in an exhausting pattern
Why promote voluntary and involuntary coughing
- to remove secretions that can build up
- involuntary coughing occurs when there is a respiratory infection or irritation. secretions trigger coughing mechanism
Nasal Cannula
- low flow oxygen delivery system commonly used
- up to 6L/min
- high flow at 60l/min, usually for use up to 15L/min``
Simple Mask
low flow oxygen delivery
5-8L/min
monitor placement of mask frequently and check for skin breakdown from mask or moisture
often used for high concentrations of oxygen over short time
Partial rebreather mask
low flow 8-11L/min
similar to simple face mask but with reservoir bag for collection of the first part of patien’ts exhaled air and is mixed with 100% oxygen so patient is rebreathing 1/3 of resued air
Nonrebreather masl
low flow 10-15L/min
used for a spontaneously breathing patient
bag fills with oxygen and expired air leaves through side vents
Venturi mask
high flow 4-6L/min
delivers most precise concentration of oxygen
Purpose of chest physiotherapy
mobilize secretions and increase mucus clearance
PAP
positive airway pressure, provides mild air pressure to keep airways open
CPAP-continuous mild air pressure to keep airways open
BiPAP- bilevel positive airway pressure, changes air pressure while patient breathes in and out
alveoli
small air sacs at end of terminal bronchioles, site of gas exchange
surfactant
phospholipid that reduces the surface tension between the moist membranes of alveoli preventing their collapse
Respiration
gas exchange between the atmospheric air in the alveoli and the blood in capillaries
perfusion
process by which oxygenated capillary blood passes through body tissues
Inspiration
Active phase
diaphragm contracts and descends, lengthening the thoracic cavity, extern intercostal muscles contract, lifting the ribs upward and outward and the sternum pushed forward
Expiration
recoil from inspiraiton, diaphragm relaes and moves up, ribs move up and sternum drops back down, should be effortless and recoil
impact of age on respiratory system 6
Tissue and airway of respiratory tract become less elastic
respiratory and abdominal muscles are reduced- diaphragm moves less effciently
chest is unable to stretch as much
airway collapses easier
decrease ventilation and ineffective cough
decrease CO and ability to respond to stress
Physical assessment of respiratory system: Inspection
Pallor, Cyanosis
Anterioposterior diameter should be less than transverse diameter (if other way around pt has barrel chest indicative of COPD)
Adult contour of chest is slightly convex
kyphosis(limited respiratory ventilation)
Bardypnea
Tachypnea
Normal Breath sounds
Vesicular-low pitched soft sounds heard over peripheral lung field
Bronchovesicular- medium pitched blowing over major bronchi
Bronchial- loud, high pitched sounds heard primarily over trachea and larynx
Adventitious breath sounds
Crackles- popping, fine, medium, coarse
Wheezes- continual muscial sounds as air passes through airway, asthma has an expiratory wheeze. Croup, swelling, foreign bodies, obstruction have inspiratory wheezes
Pulmonary function test
group of tests used to assess respiratory function.
evaluation of the lung dysfunction, diagnose diseases, assess disease severity and evaluate respiratory interventions
Peak Expiratory Flow Rate
reflects changes in the size of pulmonary airways and is measured using a peak flow meter
refers to the highest point of flow during flow during forced expiration
Residual VOlume
amount of air left in lungs at maximum expiration
Total Lung Capacity
amount of air contained within the lungs at maximum inspiration
Vital Capacity
Amount of air displaced by maximum exhalation
Capnography
monitor ventilation and indirectly bloood flow through the lungs
exhaled air passes through a sensor that measures the amount of carbon dioxide exhaled in each breath
Thoracentesis
procedure of puncturing the chest wall and aspiration pleural fluid
used to obtain a specimen for diagnostic purposes or removes fluid that has accumulated in the pleural cavity and is causing respiratory difficult
Hypoxia
Condition where inadequate oxygen is available to the cells
signs are anxiety, restlessness, confusion, elevated BP w/small pulse pressure, increased respiratory and pulse rates, palor, cyanosis
Dyspnea
Difficulty breathing
Hyperventilation
decreased rate or depth of air movement into the lngs
Why are positioning and breathing techniques utilized
maximize patients sense of wellbeing promote comfort decreases work of breathing patient achieves more efficient and controlled ventilation corrects respiratory deficit paces activities
Signs and symptoms of heart failure
edema in lower extremities
shortness of breath
fatigue
Chest tube used in patients with
pleural effusion
blood in the pleural space
air in the pleural space
Bronchodilator function
Inhales-open narrowed airways
Corticosteroids
reduce inflammation in airways
Narcotics
expectorant, used to help liquefy or loosen thick secretions
Adminitering CPR: CABD
Chest compressions: CHeck pulse, if no pulse initiate compressions to provide artificial circulation
Airway: Tilt head and lift chin, check for breathing. The respiratory tract must be opened so that air can enter
Breathing: If pt does not start to breathe spontaneously after airway is opened, give two breathing lasting 1 second each.
Defibrillation: Apply AED as soon as available
Complete Blood Count
test is used to assist in evaluating the body response to illness
Coagulation students
measures bodies ability to clot and how long it will take, helps predict liklihood of thrombosis
Cardiac ENzymes
Creatine Kinase and Isoenzymes enzymes released due to injury to tissue, biomarkers used to monitor cardiac injury and MI
Troponin protein found in skeletal and cardiac muscle released during injury
Internal respiration
gas exchange between circulating blood and tissues
