Oxygenation Flashcards
mechanisms that facilitate or impair the body’s ability to supply oxygen to all of the cells of the body
oxygenation
what is the function of the respiratory system?
to obtain oxygen from atmospheric air > transport this air through the respiratory tract to the alveoli > and to diffuse oxygen into the blood that carries oxygen to all the cells in the body
process of moving air into and out of the lungs
ventilation
the exchange of gases between alveoli and the pulmonary capillaries
respiration
process of drawing air into the lungs to the alveoli
inspiration (inhaling)
process of pushing air out of the lungs and into the environment
expiration (exhaling)
how is ventilation measured?
tidal volume
the normal volume of air displaced between normal inhalation and exhalation when extra effort is not applied
tidal volume
what comprises the upper respiratory system?
begins with the nose and ends with the pharynx
what comprises the lower respiratory system?
begins with the epiglottis and ends with the alveoli
what is the functional portion/unit of the respiratory system?
alveoli
where does the exchange of oxygen and carbon dioxide take place in the respiratory system?
at the alveoli
pendulous tissue that covers the tracheal opening during swallowing or any time foreign matter contacts the glottis. a reflexive response.
epiglottis
makes up the part of the throat situated immediately posterior to the nasal cavity, posterior to the mouth and superior to the esophagus and larynx. it is conventionally divided into three sections. part of the respiratory and digestive systems.
pharynx
what is the purpose of the nares?
to warm, humidify and filter air as it is breathed in
what are the two protective mechanisms that the upper respiratory system has to protect the lower respiratory system?
sneezing & cilia
a reflexive action that clears the upper airways
sneezing
propel foreign matter into the pharynx to be coughed out or swallowed
cilia
the entrance way for air into the lungs, part of the lower respiratory tract
trachea
breathing within expected respiratory rates
eupnea
listening to the bodies sounds with a stethoscope
auscultation
which lung has 3 lobes
the right lung
which lung has 2 lobes
the left lung
what do the alveoli interface with?
the pulmonary capillaries
what are the trachea and bronchi supported by?
cartilage rings
what separates one lung from the other?
the pleural lining
respiratory structure that has two layers, with a minute amount of fluid between the layers so that the structures can glide across one another during respiration.
pleural lining
controls surface tension and keeps the alveoli from collapsing and sticking to itself. produced only with adequate oxygenation
surfactant
what immune function cells help the alveoli keep the lungs free of waste and microorganisms?
mast cells and microphages
the drive to breathe occurs because of…..
hypercarbia
an increased level of carbon dioxide in the blood that drives breathing
hypercarbia
where are the receptor sites that are sensitive to levels of carbon dioxide in the blood located?
the medulla and pons
elevated levels of carbon dioxide in the blood cause the medulla and pons to induce what?
inhalation of air into the lungs
a passive response to relaxation of the muscles of respiration
exhalation
what is the normal breathing rate in terms of the ratio between inspiration and expiration?
I:E = 1:2
inspiration is half as long as expiration
what is the normal respiratory rate? (breaths per minute..)
12-20 (or 10-20 depending on source)
how much air is typically inhaled during normal respiration?
500mL
what are the names of the two layers of pleura covering the lungs?
parietal and visceral pleura
an airway that is open and free of obstruction
patent airway
where are the receptor sites that are sensitive to levels of oxygen in the blood located?
aortic arch and carotid artery
with low levels of oxygen, the aortic arch and carotid artery receptors induce what?
inhalation of air into the lungs
the movement of oxygen across the alveolar-capillary membrane into a well-perfusing capillary
ventilation-perfusiong (V-Q)
what is dependent on:
- inflated and well oxygenated alveolus
- associated capillary
- free flowing blood at adequate BP
the ability of the respiratory system to deliver oxygen to the blood
a decreased level of oxygen - cyanosis is a late sign of this condition - commonly seen in COPD
hypoxemia
blue tinge to the skin in fair individuals, or a grey tinge to the skin in dark skinned individuals
cyanosis
what are some factors that may affect a healthy respiratory system?
- pollution of indoor or outdoor air
- airborne irritants
- infectious illnesses
- hemoglobin disorders
- lifestyle behaviours
- medications
- inflammation, infection, sputum production & compromised airflow
what are the methods suggested to improve or maintain a healthy respiratory system?
- managment of enviromental air quality
- vaccinations
a preventable, treatable disease of compromised airflow within the respiratory system. – it is a progressive disorder that alters the structures of the respiratory system over time. inflammation of the mucous membranes of the bronchial tubes occurs, as well as loss of elasticity in lung parenchyma
COPD (Chronic Obstructive Pulmonary Disorder)
the essential and distinctive tissue of an organ or an abnormal growth as distinguished from its supportive framework
parenchyma
chronic inflammatory disease of the airways. – presents with coughing, wheezing, shortness of breath, chest tightness, and sputum production. defined in relation to severity and control as well as to impairments and risk
asthma
a highly contagious lower respiratory infection that affects nearly 100% of children under 2. – repeated infections occur throughout lifespan, though subsequent infections tend to be milder
RSV (Respiratory Syncytial Virus)
what causes alterations in oxygenation?
- changing in breathing patterns
- patency in airways
- interference with gas exchange
why is the potential for alterations in oxygenation greater for an infant?
- small diameter airway can be occluded by small amounts of sputum or swelling
- infants are obligatory nose breathers so stuffy nose can interfere with breathing process
why is the potential for alterations in oxygenation greater for toddlers?
-toddlers explore the world by putting things in their mouths which can be inhaled or swallowed and caught in air passages..
why is the potential for alterations in oxygenation greater for older adults?
- improper chewing/swallowing can allow food to become lodged and affect breathing
- cough reflex response is decreased
- increase in GERD
a respiratory rate greater than 20 breaths a minute
tachypnea
a respiratory rate of less than 10 breaths a minute
bradypnea
labored breathing or shortness of breath that is uncomfortable or painful
dyspnea
difficulty breathing in the supine position
orthopnea
absence of breathing
apnea
- breathing pattern caused by metabolic acidosis
- very deep rapid breathing
- rid the body of large amounts of CO2
kussmaul’s breathing
- breathing pattern characterized by alternating periods of deep rapid breathing, slow shallow breathing, and apnea
- associated with CHF, increased intracranial pressure or drug overdose
cheyne-stokes respirations
- breathing pattern characterized by alternating periods of shallow breathing and periods of apnea
- seen in CNS disorders
biot’s respirations
- partial lung collapse resulting from air or gas collecting in the lung or pleural space that surrounds the lungs
- s&s: sharp sudden pleuritic pain, pain worsened by coughing or breathing, asymmetrical chest wall movement, shortness of breath, cyanosis
pneumothorax (spontaneous pneumothorax has no apparent cause, while tension pneumothorax is caused by injury)
high pitched sound within the trachea and larynx that suggests narrowing of the tracheal passages
stridor
- high pitched popping sounds (like rice crispies and milk) that are heard on inspiration
- due to fluid associated with or resulting from inflammation or exudates
crackles
- collapse of lung tissue affecting all or part of a lung
- impacts exchange of O2 and CO2
- primary cause is obstruction of bronchus serving area affected
atelectasis
- long low pitched sound that continues throughout inspiration
- suggests a blockage of large airway passages
- can sometimes be cleared with coughing
rhonchi
- high pitched whistling sound most often heard on expiration (can also be heard on inspiration)
- caused by narrowing of the bronchi
wheezing
- low pitched grating sound that occurs primarily on inspiration, but also on expiration
- caused by inflamed surfaces rubbing
pleural rub
what factors regarding breathing do you evaluate during an exam of a client?
- posturing
- number of words/sentences in a breat
- raspy voice, difficulty breathing
what is the normal ratio between the anteroposterior and transverse diameter?
1:2
what diagnostic tests can be run to determine respiratory function?
-sputum specimen
-ABGs
-pulse oximetry
-pulmonary function tests (incentive spirometry, flow rate)
-chest xray
-pulmonary angiogram
bronchoscopy
-thoracentesis
-CT, MRI
-V-Q scan
what is the ABG normal range for pH?
7.35 to 7.45
what is the ABG normal range for CO2?
35-45 mmHg
what is the ABG normal range for PaO2?
80-100 mmHg
what is the ABG normal range for HCO3?
22-26 mEq/L
what does PaO2 indicate?
the amount of O2 dissolved in blood serum
what does SaO2 indicate?
the amount of O2 bound to hemoglobin
what is the normal range for SaO2?
> 95%
what does a pH value of less than 7.35 indicate?
acidosis
what does a pH value of greater than 7.45 indicate?
alkalosis
what does a CO2 value of less than 35 mmHg indicate?
alkalosis
what does a CO2 value of greater than 45 mmHg indicate?
acidosis
what does a HCO3 value of less than 22 mEq/L indicate?
acidosis
what does a HCO3 value of greater than 26 mEq/L indicate?
alkalosis
altering individual components (HCO3 or CO2) within the acid-base balance
compensation
- noninvasive method of assessing arterial blood oxygenation
- clip or adhesive device with infrared probe analyzes blood as it perfuses past the view of two opposing sensors of the probe
pulse oximetry
a device that measures the depth of breath taken in to the lungs
incentive spirometer
- device used to monitor the ability of an individual to exhale a specific volume of air related to an individuals age, gender, height and weight
- allows asthma sufferers to monitor reactivity of their lungs
peak expiratory flow monitor (flow monitor)
at what life span period are respiratory rates highest and most variable?
infant
what is the respiratory rate of a newborn?
40-80/min
what is the average respiratory rate of an infant?
30/min
what is the average respiratory rate of a preschooler?
25/min
at what point do children reach adult level of respiratory rate?
late adolescence
which respiratory conditions are older adults at increased risk for?
pneumonia, emphysema, chronic bronchitis, COPD
a scan that uses radioactive isotopes to identify defects of ventilation and perfusion
ventilation-perfusion scan (V-Q scan)
- procedure that allows direct visualization of the lungs
- usually performed by pulmonologist (or PCP or ER physician)
- scope is inserted orally into trachea and advanced to the bronchi bifurcation
- sedation is necessary for client comfort
bronchoscopy
- both an intervention and a test
- performed to drain excessive pleural fluid from between pleural linings
- fluid can be analyzed for blood, fiber and microbe content
thoracentesis
what can a CXR reveal?
presence of fluids, exudates or masses within the thoracic cavity
what can a CT or MRI reveal?
provide more detailed information than a CXR about the structures within the thoracic cavity
respiratory med:
-relaxes the muscles around the airway, improves air flow
bronchodilator
what is another name for a short acting bronchodilator?
short acting beta agonist (SABA)
respiratory med:
- aids in reducing inflammation of the air passageways
- have a number of side effects
corticosteroids
respiratory med:
- long acting bronchodilator
- used for people with chronic respiratory conditions ie COPD and asthma
- used in conjunction with corticosteroids
long acting beta agonist (LABA)
machine that aerosolizes a solution of medication so that it can be directly inhaled via mouthpiece or mask
nebulizer
respiratory med:
-relaxes smooth muscles of airways and decreases mucous secretions by blocking parasympathetic effect
anti-cholinergics
respiratory med:
- cause small airway dilation, increased heart rate and renal blood flow
- used to treat asthma, chronic bronchitis, emphysema
- narrow therapeutic range, potential serious side fx
xanthines
how does tobacco smoke impact the airways?
- increased mucous production
- reduced cilia action
- prolonged use causes declined overall function
what are some methods of clearing pulmonary secretions?
- coughing
- suction
- postural drainage
how is the selection of an oxygen delivery device ascertained?
determined by the amount of O2 needed to relieve hypoxemia
what is the purpose of a non-rebreather oxygen mask?
ensures appropriate levels of O2 are inhaled with no CO2 from exhaled gases
NOTE
O2 flow rates for various masks —-
nasal cannula 1-6 L/min 24-44%
oxymizer 1-6 L/min 24-88%
vapotherm 1-40 L/min 24-100%
face mask 5-10 L/min 30-50%
non rebreather 10-15 L/min > 60%
venturi mask can set rate 24-40%
- chest tube used to treat conditions in which fluid enters the pleural cavity, causing lung collapse
- usually stays in place 2-5 days
thoracic catheter
