Repiratory Assessment (Gas#1) Flashcards by Rachel Cloke

Definition of Hypoxemia and what can it lead to?

low partial pressure of oxygen in the BLOOD; it can lead to hypoxia

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Hypoxia

shortage of oxygen in TISSUES

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What 2 things can cause hypoxemia?

inadequate ventilation (ex. trauma) & decreased perfusion (ex. decreased cardiac output, pulmonary embolism)

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What can cause hypoxia?

Atelectasis, Anemia (no O2 carrying capacity), decreased cardiac output & toxic substances

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S/s of Acute Hypoxemia

Increased HR, Increased RR, Anxiety/Restlessness

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Example of Acute Hypoxemia

pneumothorax

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S/s of Chronic Hypoxia

Fatigue, decreased level of consciousness, cyanosis, clubbing of finger & toes

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Example of Chronic Hypoxia

COPD

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Ventilation

movement of air in and out of the lungs and the exchange of gases

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3 things that affect Ventilation

1.) Resistance 2.) Compliance 3.) Diffusion

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Resistance affects what and what is it?

It effects ventilation it is determine by airway size. The narrower the airway, the greater the resistance

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Compliance affects what and what is it?

It effects ventilation and determines how easily the lung can stretch. Increased compliance= decreased elasticity; decreased capacity= lungs/thorax are stiff

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Diffusion affects what and what is it?

It affects ventilation and is the movement of gas from an area of greater concentration to lesser concentration.

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example of problems that cause a decreased compliance

pneumothorax, hemothorax, pleural effuision. pulmonary edema, ARDS, atelectasis

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Ventilation perfusion ratio

the ratio of the amount of AIR reaching the alveoli to the amount of BLOOD reaching the alveoli

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Shunt

Ventilation is impaired but perfusion is adequate. The % amount of blood passing through the lung not oxygenated

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Shunting& dead space leads to ?

hypoxemia

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Severe hypoxemia = what shunt percentage?

> 20% and requires mechanical ventilation or PEEP

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Dead Space

Ventilated but perfusion is decreased

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When are ventilation and perfusion both absent?

Atelectasis

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Pneumothorax

A collection of air or gas in the pleural cavity. Gas enters following a perforation though the chest wall, e.g. chest trauma

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Atelectasis

A collapsed or airless condition of the lung

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Consolidation

Alveolar space contains the fluid instead of air; you cant stick needle in & extract fluid because you’ll collapse the lung. you can suck it out through a broncioscope

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Pleural effusion

Fluid accumulates between the pleura and the chest wall. This impairs breathing, limiting the expansion of the lungs.

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Fluids that accumulate in the pleural space

Serous fluid, blood, pus-empyema

Fluids that can accumulate in the alveolar space

Edema, Exudate, Pus, Inhaled water, blood

Pleural effusions can be caused by

kidney disease, HF, cirrhosis, peritoneal dialysis, pneumonia, cancer TB

If you have a pleural effusion because of HF what treatment would you receive?

Diuretics

If you have a malignant effusion what treatment would you receive?

chemo or radiation or a sclerosing agent (induces scarring)

1 pack a day for a year means/ 40 pack years means/ 5 pack years

1 pack year/ 1 pack a day for 40 years/1/2 pack for 5 years

Funnel Chest

Sternum is closer to spinal column

How do you figure out if patient has a barrel chest?

look at arm in comparison to back. Barrel=more than 2 inches

Pigeon chest

sternum is far from spinal cord

Tactile Fremitus

sounds generated by the larynx which can be felt as a vibration on chest wall

Subcutaneous emphysema

air in subcutaneous tissue. It appears with chest trauma, chest tubes

Diaphraagmatic excursion

the movement of the diaphram from its level during full exhalation to its level during full inhalation

Wheezes

high pitched sound. Bronchitis=wheezes on inspiration

Course wheezes

low pitched b/c there is a partial airway obstruction due to secretions

Stridor

high pitched sounds. ex. croup

Crackles/Rales

pooping sound heard on inspiration ex. fluid overload

Pleural friction rub

dry, rubbing, grating

Frothy pink sputum will be present in

pulmonary edem

Mucopurulent (mucus and pus) & blood streaked sputum will be present in

pneumonia, chronic bronchitis, bronchietias

Blood streaked sputum will be present in

Trauma by suctioning

Blood streaked sputum with clots will be present in

pulmonary embolism

Grossly bloody sputum will be present in

TB, cancer, chest trauma

when should a Sputum collection be done and how much of a specimen do you need?

Morning, obtain about 15 ml. You can use postural drainage or sputum from suctioning or expectoration

What should you tell your patient to do prior to sputum collection?

Rinse mouth with water, take several deep breaths and cough deeply to obtain sputum

What id Dr looking for with a chest xray?

to see if lungs are fully inflated

postural drainage

used to loosen mucus in the airway so that it can be coughed out

MRI vs CT scan

MRI doesnt involve radiation. MRI=brain/skeletin; CT=chest

Perfusion can

radioactive substance is injected into a vein in the arm

ventilation scan

a radioactive tracer gas is inhaled into the lungs. Too much air retained in lungs=bright/"hot" spots. Not retaining enough inflation=dark/"cold" spots

Tidal volume

amount of air moved in & out with normal breath sounds. Normal=500ml

Inspiratory Reverse Volume (IRV)

amount of air forcibly inhaled over the tidal volume. Normal 2-3 liters. ("breath in until you cant breath in anymore) Old people have less than normal of this

Expiratory Reserve Volume (ERV)

amount of air that can be forced out over the tidal volume. Normal 1 liter. ("breath out until you cant breath out anymore") Old people have less than normal of this

Residual Volume (RV)

amount of air that remains in the lungs after a forced Expiratory Reserve Volume (ERV). This is what keeps the alveoli open. Old people have double the amount of this

Vital Capacity

Tidal Volume + Inspiratory Reverse Volume + Expiratory Reserve Volume

Forced Expiratory Volume in 1 second (FEV1)

an important predictor of operative risk. COPD=decreased FEV1

Bronchoscopy procedure

NPO, meds to decrease anxiety, spray throat to decrease gag reflex, nothing to drink until gag reflex comes back after procedure, they are awake the whole time

Sweat test

to test for cystic fibrosis. electrical currents causes sweat production, paper collects sweat chloride >60=cystic fibrosis, if >60 then do pancreatic function

Thoracentesis

can be used to aspirate fluid.

Primary responsibility after a thoracentesis

listen to lung sounds

pH, CO2, HCO3 levels

7.35-7.45, 35-45, 22-26

In old people, does mucus production increase or decrease?

decreases which causes cilia to be less effective and causes them to be more susceptible to respiratory infections

does the elasticity of the lungs increase or decrease in old people?

decreases and stiffens which makes breathing harder

What happens to the diaphragm and intercostal muscles in old people?

it loses elasticity which limits chest expansion

Surfactant

matures lung