Module 5 Flashcards
Gas exchange
-O2 and CO2 are transported simultaneously and dissolved in combined with elements of blood.
-O2 is exchanged from the lungs to the blood, and CO2 is exchanged from the blood to the lungs.
Oxygenation
-the addition of oxygen
-low levels of cellular O2 are “hypoxia” and low levels of O2 in the blood are “hypoxemia”
Ventilation
movement of air from the atmosphere into the alveoli
Perfusion
blood flow to tissues and organs
Diffusion
exchange of O2 and CO2 at the alveolar-capillary membrane
Shunting
condition in which ventilation is impaired and perfusion is adequate
Atelectasis
the collapse of the alveoli, leading to loss of lung volume
Atelectasis cont.
it is classified by cause:
-Absorptive: occurs by surfactant inactivation
-Obstructive: mechanical obstruction of the airways
-Compressive: a result of external forces that compress pleural and or lung tissue
Atelectasis risk factors
post-op patients: hypoventilation, incisional pain, abdominal distention, immobility.
may also be concerned: with chronic lung disease, morbid obesity, and NG tube placement.
Atelectasis Manifestations
dyspnea, cough, leukocytosis, diminished breath sounds, sputum production, and a fever.
in small areas: crackles and decreased breath sounds, decreased fractile fremitus
in large areas: tracheal deviation, decreased fremitus, bronchial breath sounds, egophony, asymmetrical chest
If obstruction= wheezing, stridor
Significant respiratory distress can occur if untreated
Diagnosis of atelectasis and nursing management
-Xray, CT, ABG/CBG, noninvasive pulse oximetry
-incentive spirometer (deep breathing, with visual feedback from patients to inhale slowly and deeply), turning frequently, ambulating ASAP, a nebulized bronchodilator (dispensed aerosolized medications to a patient’s lungs) , and chest physiotherapy (postural drainage, vibration, chest percussion)
-oxygen therapy: nasal cannula (clear tubing), high flow nasal cannula (clear and green tubing), simple mask (), venturi mask (100% mask), non-rebreather mask No use of vaseline with supplemental O2!!
CPAP vs BiPAP
-continuous positive airway pressure: provides positive pressure to the airways through a respiratory cycle, prevents collapse, air pump+ nasal, oral, or combined mask and flexible tubing, it is the most effective treatment for OSA
-bilevel positive airway pressure: independent control of inspiratory and expiratory pressure while providing pressure-support ventilation
ETT vs Tracheostomy
endotracheal- short-term use, temporary airway, tube passes through the mouth or nose into the trachea
tracheostomy- surgical opening made into the trachea, long term, used to bypass the upper airway obstruction, sterile procedure, cant shower
Epidemiology of COPD and risk factors
-chronic airflow limitation that is not fully reversible, airflow limitation is progressive assoc. with inflammation response in the lungs
-smoking, tobacco use, infection, air pollution, dust, and chemicals, as well as alpha1-antitrypsin deficiency
Patho of emphysema
Patho of chronic bronchitis
Manifestations and management of COPD
-dyspnea, chronic cough, sputum production. The diagnostic criteria is FEV1 is less than 80% and FEV1/FVC ratio of less than 70%
-smoking cessation is a priority, bronchodilators, corticosteroids, oxygen therapy
-exacerbation has been linked to respiratory insufficiency, respiratory failure, respiratory acidosis, pneumonia, atelectasis
Epidemiology and characteristics of asthma
-inflammation, a genetic predisposition for the development of IgE-mediated response to allergens (atopy), most people have triggers from allergens.
-mast cells, neutrophils, eosinophils, and lymphocytes are involved
-common manifestations are cough, dyspnea, and wheezing in a pattern of excerabtion
Bronchodilators
beta adrenergic agonist: albuterol and salmeterol
anticholinergic: ipratropium
methylxanthines: theophylline
also antihistamines, glucocorticoids, mast cell stabilizers, leukotriene modifiers
Normal lungs
normal compliance- 1.0 L/cm H2O
Lung volumes ^^^
tidal volume: the amount of air inhaled and exhaled with each breath
minute ventilation: maximum volume of air exhaled from the point of maximum inspiration
vital capacity: the maximum volume of air exhaled from the point of maximum inspiration
residual volume: the amount of air left in the lungs after a maximum exhalation
total lung capacity: the volume of air in the lungs after maximum inhalation
FEV1: the amount of forced expiratory volume in the 1st second
Obstructive sleep apnea and manifestations
-a recurrent episodes of upper airway obstruction and reduction in ventilation, cessation of breathing during sleep
- you may see frequent loud snoring, breathing cessation of more than 10 seconds, insomnia, excessive daytime sleepiness
-Repetitive apneic events due to obstruction of the airway result in hypoxia and hypercapnia
This = sympathetic response (increased HR, increased tone/contractility of smooth muscle)
Chest tubes
-placement of tubes between the chest and lungs to remove air or fluid, and treatment for pneumothorax and hemothorax.
-monitor for leaking—continuous bubbling in the water seal chamber
-tidaling—or elevation of the water level with inhalation—is normal
Health promotion
-smoking cessation
-Vaccines
