Oxygenation and Perfusion Flashcards
Exam 4/Final
Factors essential to normal functioning of the respiratory system
- Integrity of the airway system to transport air to and from lungs
- Properly functioning alveolar system in lungs
- Properly functioning cardiovascular and blood supply
Properly functioning alveolar system in lungs means:
- Oxygenates venous blood
- Removes carbon dioxide from blood
Properly functioning cardiovascular and blood supply means
Carry nutrients and wastes to and from body cells
Function of the upper airways
Function: warm, filter, humidify inspired air
Components of the upper airways
Nose
Pharynx
Larynx
Epiglottis
Functions of the lower airways/tracheobronchial tree:
Functions: conduction of air, mucociliary clearance, production of pulmonary surfactant
Components of the lower airways/tracheobronchial tree
Trachea
Right and left mainstem bronchi
Segmental bronchi
Terminal bronchioles
What are the main organs of respiration?
Lungs
How does the lungs exist in the body?
Extend from the base of the diaphragm to the apex above the first rib
How many lobes does the lungs have:
Right lung: 3 lobes
Left lung: 2 lobes
What are the lungs composed of?
The lungs are composed of elastic tissue
Alveoli
small air sacs where gas exchange occurs
Surfactant
reduces the surface tension between alveoli, preventing their collapse
Pleura
serous membrane lining the lungs (visceral) and thoracic cavity (parietal)
Respiratory function includes:
- Pulmonary ventilation
- Respiration
- Perfusion
PULMONARY VENTILATION
is the movement of air into and out of the lungs (inspiration and expiration)
RESPIRATION
involves gas exchange between the atmospheric air in alveoli and the blood in the capillaries
PERFUSION
is the process by which oxygenated capillary blood passes through body tissues Inspiration: the active phase of ventilation
Pulmonary ventilation is mostly controlled by what?
Diaphragm
What influences breathing
Parasympathetic and sympathetic nervous systems
Process of Ventilation
The diaphragm contracts and descends, lengthening the thoracic cavity.
The external intercostal muscles contract, lifting the ribs upward and outward.
The sternum is pushed forward, enlarging the chest from front to back
Increased lung volume and decreased intrapulmonic pressure allow air to move from an area of greater pressure (outside lungs) to lesser pressure (inside lungs).
The relaxation of these structures results in expiration.
During inspiration, what does the diaphragm do?
The diaphragm contracts and descends, lengthening the thoracic cavity.
During inspiration, what does the external intercostal muscles do?
The external intercostal muscles contract, lifting the ribs upward and outward.
During inspiration, what does the sternum do?
The sternum is pushed forward, enlarging the chest from front to back
What allows air into lungs?
Increased lung volume and decreased intrapulmonic pressure allow air to move from an area of greater pressure (outside lungs) to lesser pressure (inside lungs).
What results in expiration?
Relaxation of sternum, external intercostal muscles and diaphragm
Gas exchange (respiration) refers to what?
Refers to the intake of oxygen and release of carbon dioxide
What is gas exchange made possible by:
Made possible by respiration and perfusion
How does gas exchange occur?
Occurs via diffusion (movement of oxygen and carbon dioxide between the air and blood)
Factors Influencing Diffusion of Gases in the Lungs
Change in surface area available
Thickening of alveolar–capillary membrane
Partial pressure
Solubility and molecular weight of the gas
How is oxygen carried in the body?
Oxygen is carried in the body via plasma and red blood cells.
How is most oxygen carried? What percent?
Most oxygen (97%) is carried by red blood cells in the form of oxyhemoglobin.
Carboxyhemoglobin
Hemoglobin also carries carbon dioxide in the form of carboxyhemoglobin.
What must occur between circulating blood and tissue cells?
Internal respiration between the circulating blood and tissue cells must occur.
Alterations in Respiratory Function
Hypoxia
Dyspnea
Hypoventilation
Hypoxia
inadequate amount of oxygen available to the cells
Dyspnea
Difficulty breathing
Hypoventilation
decreased rate or depth of air movement into the lungs
What is the main organ of circulation?
heart
What structures make up the heart
The heart is the main organ of circulation, composed of two upper atria and two lower ventricles
What two things does hemoglobin carry?
Oxygen is carried predominantly via red blood cells due to binding between the hemoglobin in RBCs and oxygen
Hemoglobin also carries carbon dioxide
What controls contraction of the heart?
Electrical impulses control contraction of the heart muscles
What are the electrical impulses that control contraction of the heart muscles called?
Sinoatrial (SA) node,
atrioventricular (AV) node,
atrioventricular bundle
Alterations in the Cardiovascular System
Dysrhythmia or arrhythmia
Myocardial ischemia
Angina
Myocardial infarction
Heart failure
Factors Affecting Cardiopulmonary Functioning and Oxygenation
Level of health
Developmental considerations
Medication considerations
Lifestyle considerations
Environmental considerations
Psychological health considerations
Respiratory Activity in the Infant: How are lungs transformed for infants?
Lungs are transformed from fluid-filled structures to air-filled organs.
How are infants chest, airways? What does this raise a problem for?
The infant’s chest is small
Airways are short
Aspiration is a potential problem
How are the respiratory rate and activity of infants?
Respiratory rate is rapid and respiratory activity is primarily abdominal.
What is given to infants to open alveoli
Synthetic surfactant can be given to the infant to reopen alveoli.
What is normal to be heard in infants upon auscultation?
Crackles heard at the end of deep respiration are normal.
What age do kids get all their alveoli?
7 years old
Respiratory Activity in the Child: What makes landmarks less prominent?
Some subcutaneous fat is deposited on the chest wall, making landmarks less prominent.
How are the airways of children?
Eustachian tubes, bronchi, and bronchioles are elongated and less angular.
What are the number of routine colds in children?
The average number of routine colds and infections decreases until children enter daycare or school.
By the end of late childhood, how is a child’s immune system?
By the end of late childhood, the immune system protects from most infections.
Respiratory Functioning in the Older Adult: How are the landmarks?
Bony landmarks are more prominent due to loss of subcutaneous fat.
What in older adults leads to the appearance of leaning forward?
Kyphosis contributes to appearance of leaning forward.
Barrel chest deformity results in what?
Barrel chest deformity may result in increased anteroposterior diameter.
How are the airways in older adults?
Tissues and airways become more rigid; diaphragm moves less efficiently.
How are older adults risk of disease?
Older adults have an increased risk for disease, especially pneumonia.
Nursing History
Usual patterns of respiration
Medications
Health history
Recent changes
Lifestyle and environment
Cough or sputum
Pain or dyspnea
Fever or fatigue
Physical Assessment of the Respiratory System: What is the order of operations?
- Inspect
- Palpate
- Percuss
- Auscultate
Physical Assessment of the Respiratory System: Inspect
Inspect for general appearance, color (cyanosis, pallor), structural abnormalities of the chest, respiratory rate, rhythm and depth
Physical Assessment of the Respiratory System: Palpate
Palpate for temperature, chest expansion, tenderness, masses, pulsations
Physical Assessment of the Respiratory System: Percuss
Percuss to assess the position of the lungs, density of lung tissue
Physical Assessment of the Respiratory System: Auscultate
Auscultate breath sounds
Normal Breath Sounds
Vesicular
Bronchial
Bronchovesicular
Normal Breath Sounds: Vesicular
low-pitched, soft sound during expiration heard over most of the lungs
Normal Breath Sounds: Bronchial
high-pitched and longer, heard primarily over the trachea
Normal Breath Sounds: Bronchovesicular
medium pitch and sound during expiration, heard over the upper anterior chest and intercostal area
Abnormal (Adventitious) Breath Sounds
Crackles
Wheezes
Crackles
Intermittent sounds occurring when air moves through airways that contain fluid
How are crackles classified as?
Fine
Medium
Coarse
Wheezes:
continuous sounds heard on expiration and sometimes on inspiration as air passes through airways constricted by swelling, secretions, or tumors
How are wheezing classified as?
Sibilant
Sonorous
Common Diagnostic Methods to Assess Cardiopulmonary Function:
Electrocardiography
Pulmonary function studies
Capnography
Thoracentesis
Lab Studies:
Common Diagnostic Methods to Assess Cardiopulmonary Function: Pulmonary Function studies include:
- Spirometry
- Peak expiratory flow rate
- Pulse oximetry
Common Diagnostic Methods to Assess Cardiopulmonary Function: Lab studies include
arterial blood gas,
cardiac biomarkers,
CBC,
cytologic studies
Values Measured from Pulmonary Function Tests
Tidal volume (TV)
Vital capacity (VC)
Forced vital capacity (FVC)
Forced expiratory volume (FEV)
Total lung capacity (TLC)
Residual volume (RV)
Peak expiratory flow rate (PEFR)
Promoting Optimal Function:
Healthy lifestyle choices and behaviors
Vaccinations
Important vaccinations for respiratory health?
Influenza
Pneumococcal disease
COVID-19
Promoting Optimal Function
Teaching about a pollution-free environment
Reducing anxiety
Maintaining good nutrition
Promoting comfort
Promoting proper breathing
Promoting and controlling coughing
Performing chest physiotherapy
Meeting oxygen needs with medications
How to promote proper breathing?
Deep breathing
Using incentive spirometry
Pursed-lip breathing
Diaphragmatic breathing
Medications
For cough
Bronchodilators
Mucolytic agents
Corticosteroids
Antihistamines
Leukotriene receptor antagonists
Medications for cough:
Suppressants
Expectorants
Lozenges
Administering Inhaled Medications: What is used?
Bronchodilators
Nebulizers
MDI
DPI
Bronchodilator
Bronchodilators: open narrowed airways
Nebulizers:
disperse fine particles of liquid medication into the deeper passages of the respiratory tract
Meter-dose inhalers:
deliver a controlled dose of medication with each compression of the canister
Dry powder inhalers:
breath-activated delivery of medications
Providing Supplemental Oxygen involves:
Source of oxygen
Flow rate
Humidification
Delivery Systems
Delivery Systems for supplemental oxygen
Nasal cannula (high or low flow)
Simple mask
Nonrebreather
Venturi mask
Managing Chest Tubes steps:
- Assist
- Monitor
- Check
- Maintain
Managing Chest Tubes steps: Assist
Assist with insertion and removal of the chest tube.
Managing Chest Tubes steps: Monitor
Monitor the patient’s respiratory status and vital signs
Managing Chest Tubes steps: Check
Check the dressing
Managing Chest Tubes steps: Maintain
Maintain the patency and integrity of the drainage system.
Precautions for Oxygen Administration
- Avoid open flames in the patient’s room
- Place no smoking signs in obvious areas
- Check to see that electrical equipment in the room is in good working order
- Avoid wearing and using synthetic fabrics (builds up static electricity)
- Avoid using oils in the area
Type of Artificial Airways
Oropharyngeal and nasopharyngeal airway
Endotracheal tube
Tracheostomy tube
Nursing Skills to Support Respiration
Tracheal suctioning
Assisting ventilation with mechanical ventilator
Clearing an obstructed airway
Administering cardiopulmonary resuscitation