PP - GAS OXYGENATION Flashcards
bronchodilation
(expansion of the airway in the lungs) and
The respiratory system is comprised of the nose, oropharynx, larynx, trachea, bronchi, bronchioles, and lungs.
the nose, oropharynx, larynx, trachea, bronchi, bronchioles, and lungs.
ØThe upper airway consists of
the nasopharynx or nose, oropharynx or mouth, and the larynx.
ØThe lower airway includes
the trachea, bronchi, bronchioles and alveoli of the lungs.
ØThe right lung is made up
of three lobes.
ØThe left lung is made up
of two lobes.
ØThe lungs are responsible for
bronchodilation (expansion of the airway in the lungs) and bronchoconstriction (restriction of the airway in the lungs).
bronchoconstriction
(restriction of the airway in the lungs).
ØThe lungs are also linked with the nervous system by both the
parasympathetic and sympathetic systems.
ØVentilation
is the flow of air inside or outside of the alveoli. / Oxygen is transported into the alveoli and carbon dioxide is taken out.
ØPerfusion
is the flow of blood by the cardiopulmonary system into the alveolar capillaries. / ØOxygenated blood is directed into the capillaries and deoxygenated blood is returned to the lungs.
ØOxygenated blood is directed into the ________ and deoxygenated blood is returned to ____
capillaries / the lungs.
•Ischemia
•Insufficient blood flow of oxygenated blood to the tissues that can result in injury or death
•Hypoxia
•Insufficient oxygen reaching the cells
•Anoxia
•Total lack of oxygen in body tissues
•Hypoxemia
•Reduced oxygenation of arterial blood
ØWhen a person inhales, the diaphragm and intercostal muscles
contract, creating a negative pressure inside the lungs, and the thorax increases in size for inhalation.
ØWhen a person exhales, the diaphragm
relaxes, the intercostal muscles contract, and exhalation occurs.
ØSurfactant
, a lubricant made in the lungs, keeps the alveoli from collapsing.
AGE RELATED DIFFERENCES •Babies born after 30 weeks gestation have
sufficient surfactant to prevent the alveoli from collapsing
AGE RELATED DIFFERENCES •Infants are
nose breathers until about 3 months
AGE RELATED DIFFERENCES •Respiratory patterns in newborns may be
irregular with brief pauses (usually not more than 10-15 seconds
AGE RELATED DIFFERENCES •Respiratory muscle strength decreases →
maximal inspiratory and expiratory force
AGE RELATED DIFFERENCES •Alveoli less elastic and more
fibrous → dyspnea
AGE RELATED DIFFERENCES •Decrease in erythrocytes →
anemia → ↓ ability to transport oxygen
ØHypoxemia
is when there is a limited amount of oxygen in the blood.
ØRetraction
s are when the muscles are pulled inward and occur between the ribs when inspiration occurs. Intercostal retractions are a sign that the airway is blocked.
ØHypoxia
is a lack of oxygen at the cellular level.
ØLung compliance
is the point to which a lung can expand in response to increased pressure within the alveoli (intraalveolar).
ØAirway resistance
is the pressure that exists when the diameter of the airway is narrowed.
ØLung compliance and airway resistance increase * the work of breathing which
results in accessory muscle use.
an increase in the work of breathing leads to
Accessory muscles use is an indication of
Accessory muscles use is an indication of
respiratory distress.
deoxygenated blood enters thr heart through the
IVC / SVC inferior vena cava / superior vena cava
ØDeoxygenated blood leaves the right * and is routed to _______ into what valve
Atrium and is routed to the right ventricle through atrioventricular (tricuspid) valve.
Deoxygenated blood then flows from the right ventricle through which valve
pulmonary valve (a semilunar valve)
after the pulmonary valve, blood goes to the
to the pulmonary artery / trunk
once blood is in the pulmonary artery / trunk it goes Ø into the
R /L lungs. Carbon dioxide is eliminated.
ØThe alveoli are
the very small air sacs where the exchange of oxygen and carbon dioxide takes place.
CAPILLARIES are
blood vesselsin the walls of the alveoli.
ØOxygenated blood then flows
into the pulmonary veins (4 - two from each lung)
The pulmonary veins empty into the
left atrium
after the left atrium blood flows through which valve
The mitral valve (/ˈmaɪtrəl/), also known as the bicuspid valve or left atrioventricular valve. The heart valves are all one-way valves allowing blood flow in just one direction.
the mitral valve allows blood to pass into the
left ventricle
from the left ventricle blood then passes through which valve
aortic valve (semilunar valve). It is also called aortic semilunar due to its semilunar shape. ensure that oxygen-rich blood does not flow back into the left ventricle.
blood flows from the left ventricle through the aortic valve to the
aorta / aortic arch
from the aorta- Systemic circulation carries
oxygenated blood to the capillaries in the tissues of the body.
Pulmonary circulation carries
Pulmonary circulation is the system of transportation that carries de-oxygenated blood from the heart to the lungs to be re-saturated with oxygen before being dispersed into the systemic circulation
Causes of Impaired Gas Exchange
Acute respiratory illness
Airway obstructions (tumors, thick secretions, foreign body, swollen airways)
Neurologic conditions that effect the brain and spinal cord
Cardiovascular conditions that affect blood flow
Hematologic conditions especially anemia
Lung problems (atelectasis, hypoventilation, chronic lung disease)
High altitudes
•Pleural effusion
•Fluid in the chest cavity
•Pneumothorax
•Air leaking into the pleural cavity
•Tension pneumothorax
•Air is trapped in pleural cavity collapsing the lungs
•Crepitus
Air in the subcutaneous tissues
•Hypoxia
•Decrease oxygen to the tissues
•Hypoxemia
•Decrease oxygen in the blood
•Atelectasis
•Collapsed lung or partial collapse of the lung
•Cyanosis
•Bluish color of lips or skin related to decreased oxygen levels in the tissues
Normal Breath Sounds
bronchial, bronchovesicular, vesicular
Breath sounds are normal when they are heard where
they are supposed to be heard
•Bronchial normal if
heard over the sternum
which breath sound is •Loudest on inspiration
bronchial
•Bronchovesicular heard when the stethoscope is .
s partly on the sternum and partly on the chest wall
•If bronchovesicular sounds are heard in the periphery of the lung can be indicative of
consolidation beginning (pneumonia or atelectasis)
•Vesicular
•Soft blowing sounds best heard on inspiration
vesicular is always a normal sound as
it is not heard anywhere else
•Crackles
•Associated with inflammation, infection, or fluid of the small bronchi, bronchioles, and alveoli.
Crackles best heard on •Best heard on
inspiration.
Can be fine (like
rubbing hair between your fingers), medium or course (like pulling Velcro apart)
•Rhonchi
•Louder sounds heard best on expiration
•Rhonchi•Denotes
obstruction to outflow of air in the large bronchi, usually thick secretions
Rhonchi •Can be cleared with
coughing
•Wheezes
•May be heard on inspiration and expiration
Wheezing •Means
consolidation in the airways or caused by air moving through airways narrowed by constriction or swelling of airway or partial airway obstruction
•Friction rub
•Low-pitched, grating, or creaking sounds that occur when inflamed pleural surfaces rub together during respiration
•Pleural friction rub is easy to confuse with a
pericardial friction rub.
To determine whether the sound is a pleural friction rub or a pericardial friction rub, ask the patient to
hold his breath briefly. If the rubbing sound continues, its a pericardial friction rub
Pericardial friction rub because
because the inflamed pericardial layers continue rubbing together with each heart beat - a pleural rub stops when breathing stops.
a pleural rub stops when
breathing stops.
Changes in Vital Signs
increased respiratory rate / decreases oxygen stauation / increased heart rate / increased temperature
•Increased respiratory rate
•Increased work of breathing
•Decreased SaO2 (oxygen saturation)
•Not enough oxygen transported on the hemoglobin
•Increased heart rate
•Anxiety due to SOB
•Need for more perfusion of oxygen
•Increased temperature
•Usually relates to infection such as pneumonia or respiratory syncytial virus (RSV) - LOOK IT UP
•Usually relates to infection such as
pneumonia or respiratory syncytial virus (RSV)
Abnormal Inspection
Position to ease work of breathing (sitting leaning forward)
Anxious
Impaired mental status
Use of accessory muscles
Pursed lip breathing
Paleness of skin and lips
Cyanosis clubbing of the nails
Barrel chest
Asymmetric thorax
Scoliosis
Trachea deviation
Abnormal Inspection - infants / toddlers
Infants/toddlers
Flaring of the nares
Chest wall retractions
Grunting with inspiration
Cyanosis when sucking
Need to stop feeding to breathe
Diagnostic Tests
Labs
Pulmonary Function Studies
Bronchoscopy
Peak Flow
ABG
Radiographic Studies
Diagnostic Labs
Arterial Blood Gas (ABG)
CBC
Sputum examination
Skin tests
Radiographic Studies
CXR
Computed tomography (CT)
Ventilation-perfusion scans
Positron Emission Tomography (PET)
Clinical management - Primary
Infection Control
Smoking Cessation
Immunizations
Preventing post-op pulmonary complications
Clinical management - Secondary
Screening for risk factors
Early diagnosis
Prompt treatment of existing health problems
Clinical management - Collaberative Intervention
Smoking cessation
Pharmacologic therapy
Airway management and support
Chest physiotherapy and postural drainage
Nutrition Therapy
Positioning
Clinical management - Invasive Procedures
Chest tube
Thoracentesis
Bronchoscopy
Clinical management - Collaberative Intervention - Pharmacology Therapy
Drugs that affect upper airway
Lower airway bronchodilators
Mucolytic and expectorants
Cough suppressants
Antimicrobials
Aids for smoking cessation
Clinnical Management - Collaberative Interventions - Positioning
High Fowlers or semi-fowlers
Tripod positioning or leaning forward over a table to sleep
Lying horizontally (hypoxic with acute lung disease)
High Fowlers or semi-fowlers
Uses gravity to move the diaphragm away from the lungs
Lying horizontally (hypoxic with acute lung disease)
•Ventilation and profusion are effected by gravity.
Clinical Management - Other Interventions
Alternate activity with periods of rest
Increase air circulation, especially in the COPD patient.
Offer to listen how they are coping with impaired gas exchange and how it has changed their lives.
Call case management if there is a need for additional resources.
Conditions That Increase the Need for More Oxygen
Activity
Fever
Pain
Asthma
Pneumonia
Sleep disorders Bronchitis
Bronchitis
COPD
Severe Allergies
Anemia
Heart Failure
Neurological disorders like stroke
Nursing Interventions for Patients with Impaired Oxygenation
Turn, cough, and deep breathe
Incentive spirometry
Nebulizer treatments
Chest physical therapy
Supplemental oxygen
