Notecards for all Flashcards
turbinates
3 bones that protrude in into the nasal cavity. They Increase the total surface area for filtering, heating, and humidying inspired air before it passes into the nasopharynx.
surfactant
Aveoli type II secrete surfactant (a fatty protein that reduces surface tension in the aveoli). Without this Atelectasis can occur (lung collapse)
arteries and veins carry blood where?
Vein carry oxygenated blood to the heart. Arteries carry deoxygenated away from the heart to the lungs, to re-oxygenate it.
ventilation
the process of moving air in and out of the lungs.
Require muscle and intact nerve intervention. (diaphragm -which is functioned by the phrenic nerve) and elastic properties.
perfusion
ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs
Diffusion
exchange of gases
From an area of high concentration to low concentration
movement of air in and out of the lungs
Move by pressure changes, for O2 to move into the lung there is a normal sub atmospheric pressure (negative pressure) causes the air to come in. Then it is no longer negative and will expire. It take effort to overcome the negative pressure, inspiration is active process and expiration is passive
Inspiration
Exhalation which is active and which is passive process
Inspiration~ active
Expiration~ passive
Inspiration
The active part uses the diaphragm and contracts the intercostal muscles contract and increases negative pressure which facilitates air entry into the lungs.
Pleura
continuous smooth membrane composed of two surfaces that totally enclose the lungs. The parietal pleura lines the inside of the chest cavity and the upper surface of the diaphragm. The visceral pleura covers the lung surfaces
What transports the gases
Hemoglobin
oxygen + hemoglobin
oxyhemoglobin
Carbon dioxide + hemoglobin
carboxihemoglobin
Carbon dioxide is also carried by bicarbonate
Control of Respiration
Medulla provides automatic control of respiration continuously. There are Chemoreceptors in the Medulla which are stimulated by high concentrations of CO2 and Hydrogen ion in the blood. Stimulated to a lesser degree by O2 in arterial blood.
Our drive is based on CO2 level. So when there is a High level of CO2 in our blood that’s our drive to breath to get more O2.
When COPD its the opposite, drive gets ruined because they have a high level of CO2 in their blood, so they respond to low O2 drive. So have to be careful the amount of O2 we give to a COPD patient.
Normal respiration
Normally when the Medulla is stimulated by high concentration of CO2, then the rate and depth of ventilation increases so that’s there’s more exhalation of CO2 and H+ and there’s more inhalation of the O2
Adequate fluid intake is essential to respiratory functioning
Ways it can be compromised
- helps function of cilia
- Mucous lining protect underlying tissue from irritation and infection, needs to be moist
- prevents friction in the visceral.
Ventilation depends on the extent of perfusion in the area
Ways it can be compromised
~Blood circulation in tissues
~Does depend on adequate blood supply. Not enough blood less O2 carried
~ If a person is anemic it effects carrying capacity
All living cells require oxygen, which the body cannot store
Ways it can be compromised
Deprived of O2 = confusion, tired
High altitude
environmental O2: The BODY has a 200 times greater attraction for CO2
The air passageways must remain patent for respirations to occur
Ways it can be compromised
Presence of CO2 Mucus, food, inhaled object, inflammation, tumors, Unconscious- tongue falls back muscles will constrict edema
Muscle movements provide the physical force essential for respiration
Ways it can be compromised
Accessory muscles: neck, back, diaphragm, intercostal
When breathing is labored you use accessory muscles
The pressure changes resulting from expansion and contraction of the thoracic cavity produce pulmonary gas exchange
Ways it can be compromised
~Atelectasis- part or complete collapse of lung
~ Immobility
~ Obstruction of the airway
~ Constriction
~ External Compression~ Tumor or Ascites fluid in abdomen pushing up and impinging on lungs
Hypoxia
Decreased amount of O2 available to cellls
There must be an exchange of oxygen and carbon dioxide between the blood and body cells.
Ways it can be compromised
~Aveolar capillary membrane is thicker Becomes a problem
~excess fluid in tissue impedes transfer to tissue
Hypoxemia
decreasedO2 in the blood. Increased Co2 in the blood.
Hypoventilation
Decreased in rate or depth of air movement into the lungs
Hyperventilation
Increased in rate and depth of ventilation
4 factors affecting Oxygenation
~ Developmental
~ Physiological
~ Lifestyle
~ Environmental
Physiological functions affecting oxygenation 7
~Alterations in Cardiac functions
~Alterations in Respiratory function
~Decreased O2-carrying capacity
~Decreased inspired O2 concentration
~Hypovolemia
~Increased metabolic rate
~Conditions affecting the chest wall movement
Alterations in Cardiac functions
~disturbances in electric conduction system
~conditions that decrease cardiac output
Alterations in Respiratory function
~hyperventilation- increase rate and depth of respiration which also involves blowing off more of Co2
~hypoventilation~ deceased rate and depth of respiration–> not blowing off less CO2 as normal (not uncommon for respirations to decreased to 8 or less)
~hypoxia- inadequate oxygenation at the cellular level–> causes–> decrease hemoglobin level–>decreased oxygen in inspired air as in high altitudes–> inability of tissues to extract oxygen from the blood as in edema–>decrease of transfer of oxygen at the aveolar level–>
Norms
PaCO2
PaO2
SaO2
PaCO2 (partial pressure of carbon dioxide)-
35-45 mmHg
PaO2 (partial pressure of oxygen)- 80-100 mm Hg
SaO2 (oxygen saturation)- 95-100% mm Hg
decreased O2-carrying capacity 2
~Anemia
~Inhalation of toxic substances (carbon dioxide)
Deceased inspired O2 concentration
2
~Airway obstruction
~Deceased environmental O2 (altitude)
Hypovolemia (2)
definition~Decreased blood volume
~shock
~severe dehydration
Increased metabolic rate
~fever
~exercise
~pregnancy
Conditions affecting chest wall movement 6
1) Pregnancy
2) Obesity
3) Musculoskeletal abnormalities
4) trauma
5) neuromuscular disease
6) central nervous system alterations
Pursed lips (breathing) does what?
the pursed lips create a resistance to the air flowing out of the lungs, which prolongs exhalation and maintains positive airway pressure, thereby maintaining an open airway and preventing airway collapse.
Signs of Hypoxia
Increased breathing and heart rate. Changes in level of consciousness. Restlessness. Cyanosis (bluish lips and nailbeds). Chest pain
Venturi mask
High Flow rate
Delivers oxygen concentrations of 24% to 60% with oxygen flow rates of 4 to 12 L/min, depending on the flow-control meter selected
v=Advantages
Controls the amount of specified oxygen concentration
Does not dry mucous membranes
Delivers humidity with oxygen concentration
Quiet
Ideal for CO2 retainers
Matches patients demands
Disadvantages
Hot and confining
Humidification can irritate skin
Decreased oxygen concentration if mask does not fit right
Interferes with eating , drinking and talking
Partial rebreather
Some face masks have reservoir bags also called partial rebreathing bags.
Provides higher concentrations of oxygen to the patient.
A portion of the patient’s expired air is directed into the bag.
Conserves oxygen by having patient rebreath exhaled air.
Because this air does not take part in gaseous exchange, its oxygen concentration remains high.
When this air is added to the inflow from the oxygen source, the patient will breath in air with greater oxygen concentration.
Non-rebreather masks (NRB)
Covers both nose and mouth
Has an attached reservoir bag
Reservoir bag connects to an external oxygen supply
Before an NRB is placed on the patient, the reservoir bag is inflated to greater than two-thirds full of oxygen, at a rate of 8–15 liters per minute (lpm).
Approximately ¹⁄₃ of the air from the reservoir is depleted as the patient inhales, and it is then replaced by the flow from the O2 supply.
If the bag becomes completely deflated, the patient will no longer have a source of air to breathe.
Exhaled air is directed through a one-way valve in the mask, which prevents the inhalation of room air and the re-inhalation of exhaled air.
The valve, along with a sufficient seal around the patient’s nose and mouth, allows for the administration of high concentrations of oxygen, 60–90% O2.
High concentrations of oxygen can be administered accurately
Oxygen flows into bag and mask during inhalation
Valves prevents expired air from flowing back into bag
Cannot be used with a high degree of humidity.
Partial Rebreather Mask
Conserves oxygen
Can be administered in concentrations of 40-60% using flow rates of 6-10L - This is useful when oxygen concentrations must be raised
Cannot be used with a high degree of humidity
Not recommended for COPD patients
Should NEVER be used with a nebulizer
Face tent
Ideal for post anesthesia
Not enclosed and claustrophobic
Only for low oxygen concentrations
Nasal Cannula
Simple, comfortable device for oxygen delivery
Oxygen delivered via cannulas with a flow rate of up to 6 L/min
Flow rates greater than 4 L/min not often used
Drying effect on nasal mucosa
Above 6 L/min the 02 is simply flushed out of the nose
Nasal cannula – Advantages Safe and simple Easily tolerated Delivers low concentrations while allowing patient to eat, speak, drink Does not impede eating or talking Inexpensive and disposable
Nasal cannula – Disadvantage Unable to use with nasal obstruction Drying to mucous membranes Can dislodge easily Patient’s breathing pattern will affect exact FIO2 Causes skin irritation or breakdown Nose, ears, cheeks, under chin
Oxygen Masks 4
Simple face mask
Venture mask
Partial rebreather mask
Non-rebreather mask.
Low and High flow devices
Low Flow: Nasal cannula Simple oxygen mask Non-rebreather mask Face tent High Flow: Venturi mask
Humidifying
nasal cannula 1-6 L/min
you only humidify for flow rates greater than 4
Simple mask starts at 5–>8
Venturi 4–>12
Developmental factors
1) Infants and toddlers-up to the age of 3, are especially susceptible to respiratory infection
2) School age children and adolescents
3) Young and middle-aged adults
4) Older adults
Lifestyle risks (5)
1) Nutrition
2) Exercise
3) Smoking
4) Substance abuse
5) Stress- (increase metabolic rate and O2 demand)
Environmental factors (2)
1) Air pollution
2) Occupational pollutants
Respiratory rates
Newborn————————-35-40
Infants (6 months)————-30-50
Toddler (2 yeas)—————-25-32
Child——————————-20-30
Adolescent———————–16-20
Adult——————————-12-20
7 types of Respirations
1) Eupnea
2) Tachypnea
3) Bradypnea
4) Cheyne-stoke
5) Kussmaul
6) Dyspnea
7) Orthopnea
Eunpnea
Normal relaxed breathing
Tachypnea
fast breathing rate, >20 respirations/minute
Bradypnea
slow breathing rate, <12 respirations/minute
Cheyne-stokes
Tidal volume waxes and wanes cyclically with recurrent periods of apnea.
Causes include CNS dysfunction, cardiac failure with low cardiac output, sleep, hypoxia, profound hypocapnia
Kussmaul
Deep, rapid respiration with no end-expiratory pause.
Causes profound hypocapnia
Seen in profound metabolic acidosis, i.e. diabetic ketoacidosis
Dyspnea
labored, possibly painful, feeling of breathlessness
Orthopnea
A abnormal condition in a person in which a person must sit or stand to breathe deeply or comfortably
CPR
CAB (Chest compression, Airway, Breathing)
Chest compression are first
Antitussives
Act by suppressing the cough reflex by direct action on the cough center in the medulla
Expectorant
Suppresses cough reflex by liquefying and reducing the viscosity of thick, tenacious secretions
Bronchodilator
Relaxes smooth muscle (lungs)
Mucolytics
Decrease the viscosity of secretions by breaking disulfide links of mucoproteins
Dissolve various chemical bonds within secretions
Corticosteroid
Long onset ( not a rescue inhaler) Increase capillary permeability
