Oxygenation Flashcards
Important Concepts
Oxygenation
Respiration
Ventilation
Respirations and ventilations oxygenate the blood
Oxygenation of the blood, and subsequently organs and tissues depends on an adequate ventilation
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Is the exchange of gases oxygen and carbon dioxide in the lungs
Respiration
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Is the movement of air in and out of the lungs through the act of breathing
Ventilation
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Refers to how well the cells in tissues and organs of the body are supplied with oxygen
Oxygenation
Anatomy
Airway
- Moisten
- Warm
- Filter
- Cilia
Upper Airway
- Pharynx
- Trachea
- Epiglottis
Lower Airway
- Trachea
- R&L Bronchi
- Bronchioles
Airway
In addition to allowing air to flow in and out of the lungs, the airway also moistens air - moist mucous membranes add water to the inhaled air
Warms air (body heat is transferred to passageways through blood flow), and filters air - cells secrete sticky mucous whose action is to filter foreign particles
___ - tiny, hair-like projections on the airway walls, that move like a sweeping motion and pick up trapped debris up and out of the airway
Cilia
Upper airway
Nasal passageways
Mouth
Pharynx (throat)
Trachea
___ (flap of tissue that closes off trachea during swallowing to prevent food from entering the trachea and opens during breathing to allow air into lungs)
Epiglottis
Lower airway (STERILE)
Trachea
Bronchi
Bronchioles
Walls of bronchi and bronchioles have ____ which can narrow the airway and obstruct blood flow with ___
layers of smooth muscles
bronchospasm
Lungs
- Are soft, spongy cone-shaped organs separated by the mediastinum
- The right lung has ___ lobes and the left lung has ___ lobes
- The ___ is the upper portion of the lung, usually extends upward above the clavicle
- The base of the lungs is the lower portion of the lungs that rests on the diaphragm
- ___ are tiny little air sacs with thin walls surrounded by a network of capillaries where gas exchange occurs
3; 2
apex
alveoli
Pulmonary System Functions - Pulmonary Ventilation
Ventilation is achieved through cycles of ___ and ___
___ is the expansion of the chest cavity and lungs creating negative pressure inside the lungs causing air to be drawn in through the nose or mouth and airways
___ occurs when the diaphragm and intercostal muscles relax allowing the chest and lungs to return to their normal resting size
inhalation; exhalation
Inhalation
Exhalation
The ___ is the major muscle of breathing
The ___ are small muscles around the ribs
The ___ covers the lungs and lung expansion creates a negative pressure to draw in air
diaphragm
intercostal muscles
pleural membrane
Respiratory rate is how fast you breathe
Respiratory depth is how much your lungs expand to allow room for air
___ occurs with a decreased rate or shallow breathing and it moves only small amounts of air into in and out of the lungs leading to ___ less oxygenated air reaches the alveoli
Hypoventilation
hypoxemia
___ occurs when a person breathes too fast so large amounts of air entered into the lungs causing too much carbon dioxide to be removed from the alveoli
Lung elasticity or lung recoil is the ability of elastic fibers to return to their original position; this allows the lung to inflate easily but inhibits deflation leaving air trapped in the alveoli - similar to the overstretching of an elastic band
Hyperventilation
Lung compliance is the ease of lung inflation - which should inflate easily
Airway resistance is the resistance to air flow within the airways - the larger the diameter of the airflow the easier the air moves through it
Respiration (Gas Exchange)
External - At the level of the ___ (alveoli)
Internal - At the level of the ___ and ___
lungs
tissues & organs
External respiration or alveolar-capillary gas exchange occurs in the alveoli of the lungs
Where oxygen diffuses across the capillary membrane into the blood of the pulmonary capillaries and carbon dioxide diffuses out of the blood and into the alveoli to be exhaled
Rate of diffusion is going to depend on the thickness of the membrane and the total surface of the lung tissue available for that lung exchange
* Conditions that slow diffusion include pleural effusion, pneumothorax, and asthma
If blood is not adequately oxygenated in the alveoli - hypoxemia (low blood oxygen levels) may occur
Internal respirations or capillary-tissue gas exchange occurs in body organs and tissues
So, oxygen diffuses from the blood through the capillary-cellular membrane into the cells where it’s used for metabolism and carbon dioxide (which is a waste product of cellular metabolism) diffuses from the cells through the capillary-cellular membrane into the blood and then it’s transported to the lungs where it’s going to be exhaled
What controls breathing?
Chemoreceptors
* Detect changes in pH, O2, & CO2 (increase or decrease in ventilation)
Lung receptors
* Sensitive to breathing patterns, lung expansion, lung compliance, airway resistance, and respiratory irritants
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Located in the middle of the brainstem, the carotid arteries, and aorta
Detect changes in blood pH, O2, and CO2 levels and send messages to the central respiratory system in the brainstem in response the respiratory system increases or decreases in ventilation to maintain normal blood levels of pH, pO2 and pCO2
Chemoreceptors
High levels of carbon dioxide stimulate breathing to eliminate that excess carbon dioxide - very important to know that blood carbon dioxide levels provide the primary stimulus to breathe; PRIMARY DRIVE TO BREATHE
Low blood oxygen levels stimulate breathing to get more oxygen into the lungs, so hypoxemia is a SECONDARY DRIVE TO BREATHE
___ - PRIMARY DRIVE TO BREATHE
___ - SECONDARY DRIVE TO BREATHE
CO2 blood levels
Hypoxemia
Lung receptors
Are located in the __ and ___
Are sensitive to breathing patterns, lung expansion, lung compliance, airway resistance, and respiratory irritants
For example, if lung receptors sense respiratory irritants like dust, cold, air, or tobacco smoke - that will trigger respiratory centers to constrict the airway and produce a more rapid, shallow pattern of breathing
lung & chest wall
External Factors Influencing Pulmonary Function
- Developmental stage
Changes in pulmonary A&P place OLDER ADULT at HIGHER RISK for RESPIRATORY INFECTIONS
- ↓ lung expansion and less alveolar inflation (d/t costal cartilage calcifications and reduction in chest wall movement during breathing)
- Loss of recoil and alveoli elasticity
- Drier mucus membranes and less cilia
External Factors Influencing Pulmonary Function cont’d
- Exhalation less efficient
- Decline in immune response
- GERD more common (leading to risk for aspiration)
- Slow chemoreceptor response (makes hypoxemia more likely)
All of these changes place the older adult at risk for respiratory infections
External Factors Influencing Pulmonary Function
Environment
* Stress
* Allergic reactions
* Air quality
* Altitude
* Temperature & humidity
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Is an example of an allergic reaction that affects the eyes, nose, or sinuses and it’s caused by the release of histamine that triggers an inflammatory response leading to the accumulation of nasal fluid, swollen nasal membranes, nasal congestion, itchy, swollen watery eyes
* Antihistamines are effective to combat it
Hay fever
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Is an allergic reaction that occurs in the bronchioles of the lungs where a slow reacting substance of anaphylaxis is released which causes bronchoconstriction in lower airway, edema, and spasms making breathing difficult and ineffective
Asthma
External Factors Influencing Pulmonary Function cont’d
Lifestyle
* Pregnancy
* Occupational hazards
* Nutrition
* Obesity (respiratory infections, sleep apnea)
* Exercise
* Substance abuse
* Smoking
Obesity
* May cause respiratory infections d/t pressure from excess abdominal fat on the diaphragm preventing full chest expansion and leading to hypoventilation and dyspnea on exertion; sleep apnea laying down limits chest expansion
Smoking
* Constricts bronchioles, increases fluid secretion in the airways, causes inflammation and swelling of the bronchial lining, and paralyzes cilia
Longer a person smokes and the more cigarettes they smoke the greater the risk of cancer and other chronic diseases
External Factors Influencing Pulmonary Function cont’d
Medications
- Decrease pulmonary function ⇒ respiratory depression
* General anesthetics, opioids, anti-anxiety drugs, sedative hypnotics, neuromuscular blocking agents, and magnesium sulfate
External Factors Influencing Pulmonary Function cont’d
Medications
- Improve pulmonary function
* Bronchodilators, anti-inflammatory agents like corticosteroids, cough suppressants, expectorants, and decongestants
Pathophysiological Conditions Affecting Gas Exchange
Types of Alterations in Gas Exchange
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Is inadequate oxygenation of organs and tissues and this results from either hypoxemia or circulatory disorders
Hypoxia
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Is low arterial blood oxygen levels, and this happens when there’s poor oxygen diffusion across the alveolar capillary membrane and into the blood
Hypoventilation can lead to this
Hypoxemia
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Is an excess of dissolved CO2 in the blood and can result from hypoventilation or it can result from an acute airway obstruction or drug overdose
Can lead to somnolence, coma and death
Hypercarbia (or hypercapnia)
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Is a low level of dissolved carbon dioxide in the blood and can result from hyperventilation and lead to some muscle twitching or spasms due to the stimulation of the nervous system and numbness and tingling of the face and lips
Hypocarbia (or hypocapnia)
Important to know… Box 36.2 p 964
Respiratory Infections
Upper respiratory infections (URI)
* Most commonly caused by ___
* COMMON COLD, rhino sinusitis, pharyngitis (sore throat)
* Stuffy nose, sore throat, cough, sneezing, tearing, & mild fever
viruses
Respiratory Infections
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- More severe than common cold
- Affects nose, throat, lungs
- Highly contagious VIRUS
- Spread by droplets in the air or by contact with droplets
- Cold symptoms and headache, muscle pain, fatigue, weakness, exhaustion, high fever, less common - vomiting & diarrhea
Influenza
Respiratory Infections
Influenza
* Prevention is key - annual influenza vaccination - 6 months and older
Treatment
- Swabs for culture (determine whether infection is viral or bacterial)
- Antiviral medications - Tamiflu (started within first 48 hours)
- OTC medications:
Antipyretics, antihistamines, decongestants, antitussives;
acetaminophen, ibuprofen, naproxen - body aches
Respiratory Infections - ASSESSMENT
Data Collection
- Risk factors
- Immunizations
- h/o fever & chills, hoarseness, laryngitis, sore throat, rhinitis, fatigue & malaise
Physical Assessment
- Inspect throat - look for redness
- Palpate for enlarged lymph nodes
- Assess fever, ↑ RR, skin turgor, fluid intake, auscultate lungs
Respiratory Infections - Interventions
Colds
- FLUIDS
- REST
- Medications
- Avoid tobacco smoke
- Saline nasal sprays
- Antipyretics, antihistamines, analgesics
Respiratory Infections - Interventions
Influenza
- FLUIDS
- Cough & deep breathing exercises
- Ambulate
- REST
- Positioning
Respiratory Infections - Lower respiratory infections (LRI) - Pneumonia
- Infection caused by bacteria, fungi, viruses
- Inflammatory response that leads to EDEMA in small airways and deposits debris and exudate in the alveoli
- Healthcare-associated pneumonia (HCAP)
- Ventilator-associated pneumonia (VAP)
Nursing Process - Assessment - Breathing Patterns
- Eupnea
- Tachypnea
- Bradypnea
- Kussmaul’s
- Biot’s
- Cheyne-Stokes (near-death)
- Apnea
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These analyze levels of oxygen and carbon dioxide in arterial blood
Arterial blood gases
It’s important to know that hemoglobin is the iron-containing pigment of red blood cells; this is called ___ that carries oxygen in the blood
oxyhemoglobin
Xanthines
Sympathomimetics
Anticholinergics
Inhaled steroids
Leukotriene Receptor Antagonists
Administering Medications - Antihistamines
- Prevents effects of histamine release
- Treats upper respiratory and nasal allergy symptoms
- e.g. diphenhydramine (Benadryl), chlorpheniramine, brompheniramine, loratidine (Claritin), fexofenadine (Allegra), cetirizine (Zyrtec)
* e.g. codeine, hydrocodone, dextromethorphan - act on medullary cough center of brain and suppress cough reflex
* Contraindicated in patients who need to cough to maintain airway like postoperative patients; asthma patients b/c cough suppression can lead to accumulation of secretions and further obstruct airways; sensitivity to narcotics - addiction; may cause sedation and drowsiness; avoid in pregnancy & lactation d/t crossing placenta & entering breast milk
* These agents are often found mixed together in one preparation to achieve both desirable effects with one medication
Oropharyngeal vs Nasopharyngeal
Oropharyngeal
Oropharyngeal vs Nasopharyngeal
Nasopharyngeal
Orotracheal vs Nasotracheal
Orotracheal
Orotracheal vs Nasotracheal
Nasotracheal
