Gas Exchange Flashcards
obstructive
increased resistance to airflow- bronchi, bronchioles, alveoli
restrictive
reduced expansion of lung tissue, decrease in total lung capacity- mechanical
compliance
flexibility of lung tissue to expand/contrast
pleural membrane
area between membrane lining- should only have surfactant in it to prevent friction, no other air or fluid
hypoxemia
lack of oxygen in the bloodstream
hypoxia
low O2 available to body tissues
hypercapnia
high CO2
major risk factors for pulmonary problems
- SMOKING
- genetics
- disease processes
- environmental/occupational exposure
How do we assess pulmonary function?
- auscultation
- rate and rhythm
- depth of breathing
- accessory muscle use
- cyanosis
- thoracic cage (barrel chest)
- adventitious breath sounds
- percussion
- clubbing of fingers
How do we diagnose pulmonary problems?
- PFT
- chest xray
- ABGs
How do we treat pulmonary problems in general?
- LABA
- SABA
- nebulizers
what makes nebulizers so special
they go deeper and will rescue pt faster than inhaler
Asthma
hyperreactive disease of the bronchioles
is asthma reversible
yes
why is asthma so concerning
everytime a pt has an attack, damage is left and it gets worse each time
symptoms of asthma
- T cells, IGEs, leukotrienes combine to make the bronchioles constrict
- histamines (inflammation)
- prolonged expiration
- wheezing
- cough
- dyspnea
- tachypnea
- use of tripoding
what is asthma diagnosed with? When?
PFT during an acute asthma attack (to measure forced expiratory volume)
- low pulmonary function result = worse asthma attack
asthma treatment
meds:
SABA: rescue
LABA: maintenance
teaching for asthma
- know your triggers and avoid them
- use your medication as prescribed
- no excessive use of SABAs
- call your provider if your maintenance meds aren’t working bc you may need a new regimen
status asthmaticus
- persistent bronchoconstriction despite attempts to reverse
- client will be hypercapnic and hypoxic/hypoxemic
- CAN BE FATAL
What is COPD
combination of chronic bronchitis, emphysema, and hyperreactive airways (in exacerbation)
major cause of COPD
SMOKING
chronic bronchitis
- hypersecretion of mucus
- mucus and edema
- cyanosis
-cannot get air IN - cough- 3 months of year for at least 2 years
- chronic hypoxia
- clubbing of fingers
- pulmonary arterial vasoconstriction
- nickname: BLUE BLOATER
emphysema
- over distension of alveoli
- air trapping
- cannot get air OUT
- chronic hypercapnia
- prolonged exhalation
- barrel shaped chest
- diaphragm pushed downward
- nickname: PINK PUFFER
how is COPD treated
similar to asthma, stepwise approach
education for COPD
- STOP SMOKING
- stay up to date on flu and pneumonia vaccines
- pursed lip breathing
why do you need to be careful with oxygen therapy (COPD)
easy to over over oxygenate and knocked out the pts drive to breathe
obstructive sleep apnea
- intermittent cessation of airflow from the nose and mouth during sleep
what does obstructive sleep apnea sound/look like
- sounds like choking,
- gasping
- looks like unrestful sleep
- daytime sleepiness
what worsens sleep apnea
- alcohol
- sedative- hypnotic medications
- educate to avoid these things
how is obstructive sleep apnea diagnosed
through a sleep study
treatment for obstructive sleep apnea
- WEAR CPAP
Why? prevents airway from closing
Pneumothorax
- collapsed lung
- air or fluid gets into the pleural space and puts pressure on the lung and then the lung collapses
symptoms of pneumothorax
- chest pain
- dyspnea
- increased RR
- chest may look asymmetrical upon observation
will lung sounds be heard on affected side of pneumothorax
no
primary spontaneous pneumothorax
lung just collapses, no disease process has anything to do with it
secondary spontaneous pneumothorax
lung collapses due to a disease process
traumatic pneumothorax
penetrating wound to thoracic cage and pleural membrane
tension pneumothorax
closed wound that allows air into the pleural cavity but not out, can be caused by trauma
iatrogenic pneumothorax
- caused by medical procedure complications
- can often be a “parting gift” from a central line insertion
Which types of pneumothorax are treated with chest tube with suction
- primary
- secondary
- open traumatic
- iatrogenic
what is a tension pneumothorax treated with
needle insertion to remove air
pleural effusion
- abnormal collection of fluid in pleural space
- fluid can be exudate, transudate, purulent, lymph, blood
what does pleural effusion result from
- heart failure
- severe pulmonary infections
s/s pleural effusion
- dyspnea
- tachypnea
- sharp pleuritic CP
- dullness to percussion
will breath sounds be present with pleural effusion
diminished breath sounds on affected side, maybe even absent breath sounds over area of effusion
treatment for pleural effusion
thoracentesis
thoracic cage deformity
- anything that structurally makes it hard for lungs to fully inflate
- kyphosis
- scoliosis
treatment for thoracic cage deformity
orthopedic brace
pulmonary fibrosis
- may be idiopathic
- repeated injury to alveoli, but the cause is unknown
- may be related to environmental particles
- coal dust, asbestos, silica, anthrax
- fibrotic changes decrease lung compliance; lungs become stiff because of repeated inflammation to the alveoli
s/s pulmonary fibrosis
- dyspnea
- tachypnea
- crackles
- eventual cyanosis
what will a chest xray of a patient with pulmonary fibrosis look like
“ground glass” appearance
treatment for pulmonary fibrosis
- try to decrease inflammation/inflammatory response and fibrotic changes
- may treat with O2
- bronchodilators, corticosteroids
pulmonary edema
- edema in the pulmonary veins
- often caused by heart failure
- blood backs up into the veins of the lungs, increases pressure
- when the pressure is too great, fluid is pushed into the alveoli of the lungs
pulmonary embolism
happens when a DVT dislodges and travels to lungs
pulmonary hypertension
- high blood pressure that affects arteries in the lungs, right side of heart
- walls of pulmonary arteries become thick and stiff and cannot expand very well to allow proper blood flow
adult respiratory distress syndrome
- injury to alveoli, pulmonary capillaries that causes sudden, progressive pulmonary edema called flash pulmonary edema
- arterial hypoxemia does not improve with administration of O2
- seen in critically ill patients
risk factors of ARDS
- SEPSIS
- trauma
- massive transfusion
- acute pancreatitis
- aspiration
treatment for ARDS
- intubation, sedation, and mechanical ventilation
- death common
