Module 5

Question 1

Gas exchange

Answer 1

-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.

Question 2

Oxygenation

Answer 2

-the addition of oxygen
-low levels of cellular O2 are “hypoxia” and low levels of O2 in the blood are “hypoxemia”

Question 3

Ventilation

Answer 3

movement of air from the atmosphere into the alveoli

Question 4

Perfusion

Answer 4

blood flow to tissues and organs

Question 5

Diffusion

Answer 5

exchange of O2 and CO2 at the alveolar-capillary membrane

Question 6

Shunting

Answer 6

condition in which ventilation is impaired and perfusion is adequate

Question 7

Atelectasis

Answer 7

the collapse of the alveoli, leading to loss of lung volume

Question 8

Atelectasis cont.

Answer 8

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

Question 9

Atelectasis risk factors

Answer 9

post-op patients: hypoventilation, incisional pain, abdominal distention, immobility.
may also be concerned: with chronic lung disease, morbid obesity, and NG tube placement.

Question 10

Atelectasis Manifestations

Answer 10

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

Question 11

Diagnosis of atelectasis and nursing management

Answer 11

-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!!

Question 12

CPAP vs BiPAP

Answer 12

-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

Question 13

ETT vs Tracheostomy

Answer 13

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

Question 14

Epidemiology of COPD and risk factors

Answer 14

-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

Question 15

Patho of emphysema

Question 16

Patho of chronic bronchitis

Question 17

Manifestations and management of COPD

Answer 17

-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

Question 18

Epidemiology and characteristics of asthma

Answer 18

-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

Question 19

Bronchodilators

Answer 19

beta adrenergic agonist: albuterol and salmeterol
anticholinergic: ipratropium
methylxanthines: theophylline
also antihistamines, glucocorticoids, mast cell stabilizers, leukotriene modifiers

Question 20

Normal lungs

Answer 20

normal compliance- 1.0 L/cm H2O

Question 21

Lung volumes ^^^

Answer 21

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

Question 22

Obstructive sleep apnea and manifestations

Answer 22

-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)

Question 23

Chest tubes

Answer 23

-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

Question 24

Health promotion

Answer 24

-smoking cessation
-Vaccines