TOPIC 7 Flashcards
respiration
the exchange of oxygen and carbon dioxide during cellular metabolism
what are the three steps in the process of oxygenation?
ventilation, perfusion, and diffusion
ventilation
the process of moving gases into and out of the lungs
perfusion
the ability of the cardiovascular system to pump oxygenates blood to the tissues and return deoxygenated blood to the lungs
diffusion
exchange of respiratory gases in the alveoli and capillaries
inspiration
an active process, stimulated by chemical receptors in the aorta.
expiration
a passive process that depends on the elastic recoil properties of the lungs, requiring little or no muscle work.
surfactant
a chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing.
atelectasis
a collapse of the alveoli that prevents normal exchange of oxygen and carbon dioxide. (collapsed lung)
compliance
the ability of the lungs to distend or expand in response to increased interalveolar pressure.
when does compliance of the lungs decrease?
in diseases such as pulmonary edema, interstitial and pleural fibrosis, and congenital or traumatic structural abnormalities such as kyphosis or fractured ribs.
airway resistance
the increase in pressure that occurs as the diameter of the airways decreases from mouth/nose to alveoli.
increased vs decreased airway resistance
increased: bronchoconstriction
decreases: bronchdilation
prolonged use of accessory muscles….
does not promote effective ventilation and causes fatigue.
where do you see the use of accessory muscles in a patient
During assessment observe for elevation of the patient’s clavicles during inspiration, which can indicate ventilatory fatigue, air hunger, or decreased lung expansion.
tidal volume
is the amount of air exhaled following a normal inspiration.
residual volume
is the amount of air left in the alveoli after a full expiration.
forced vital capacity
the maximum amount of air that can be removed from the lungs during forced expiration
blood moves to and from the ______ for gas exchange
alveloar capillary
What affects the rate of diffusion?
thickness of membrane (increased. thickness takes gases longer to transfer across the membrane)
Three things influence the capacity of the blood to carry oxygen:
-the amount of dissolved oxygen in the plasma,
-the amount of hemoglobin,
-the ability of hemoglobin to bind with oxygen.
hemoglobin
which is a carrier for oxygen and carbon dioxide, transports most oxygen (approximately 97%).
neural regulation includes…
central nervous system control of respiratory rate, depth, and rhythm.
what does the cerebral cortex regulate?
the voluntary control of respiration by delivering impulses to the respiratory motor neurons by way of the spinal cord.
chemical regulation maintains…
the appropriate rate and depth of respirations based on changes in carbon dioxide (CO2), oxygen (O2), and hydrogen ion (H+) concentrations (pH) in the blood.
what are factors that decrease the oxygen carrying capacity of the blood
anemia and inhalation of toxic substances (CO)
what can cause hypovolemia and why?
shock and severe dehydration because extracellular fluid loss and reduces circulating blood volume
decreased circulating blood volume causes
hypoxia to the body
the HR increases to increase volume of blood being returned to the heart (increasing CO)
With the decline of the concentration of inspired oxygen…
the oxygen-carrying capacity of the blood decreases.
anemia
(e.g., a lower-than-normal hemoglobin level) is a result of decreased hemoglobin production, increased red blood cell destruction, and/or blood loss.
hypoventilation
Alveolar ventilation inadequate to meet the body’s oxygen demand or to eliminate sufficient carbon dioxide
signs and symptoms of hypoventilation
mental status changes, dysrhythmias, and potential cardiac arrest
hyperventilation
Ventilation in excess of that required to eliminate carbon dioxide produced by cellular metabolism
what can induce hyperventilation
Severe anxiety, infection, drugs, or an acid-base imbalance
signs and symptoms of hyperventilation
rapid respirations, sighing breaths, numbness and tingling of hands/feet, light-headedness, and loss of consciousness
hypoxia
Inadequate tissue oxygenation at the cellular level
Causes of hypoxia include
(1) a decreased hemoglobin level and lowered oxygen-carrying capacity of the blood
(2) a diminished concentration of inspired oxygen, which occurs at high altitudes
(3) the inability of the tissues to extract oxygen from the blood, as with cyanide poisoning
(4) decreased diffusion of oxygen from the alveoli to the blood, as in pneumonia
(5) poor tissue perfusion with oxygenated blood, as with shock; and
(6) impaired ventilation, as with multiple rib fractures or chest trauma.
The clinical signs and symptoms of hypoxia include
apprehension, restlessness, inability to concentrate, decreased level of consciousness, dizziness, and behavioral changes.
hypoxemia
Refers to a decrease in the amount of arterial oxygen.
cyanosis
Blue discoloration of the skin and mucous membranes caused by the presence of desaturated hemoglobin in capillaries, is a late sign of hypoxia.
Central cyanosis
observed in the tongue, soft palate, and conjunctiva of the eye where blood flow is high, indicates hypoxemia.
Peripheral cyanosis
seen in the extremities, nail beds, and earlobes, is often a result of vasoconstriction and stagnant blood flow.
Factors influencing oxygenation:
- Developmental (cardiac and respiratory changes throughout the aging process)
- Lifestyle (nutrition/obesity, exercise, cigarette smoking, excessive alcohol use, anxiety and other stresses)
- Environmental (smoggy, urban areas, pollutants, etc)
Pleuritic chest pain results from…
inflammation of the pleural space of the lungs, the pain is peripheral and radiates to the scapular regions.
dyspnea
difficult or labored breathing
orthopnea
ability to breathe only in an upright position (a patient uses multiple pillows when reclining to breathe easier or sits leaning forward with arms elevated.)
wheezing
a high-pitched musical sound caused by high-velocity movement of air through a narrowed airway. It is associated with asthma, acute bronchitis, and pneumonia.
what will a patient complain of when they have CO poisoning
general malaise, flulike symptoms, and excessive sleepiness.
pulse oximetry
provides an instant feedback about the patient’s level of oxygenation.
capnography
Also known as end title CO2 monitoring, provides instant information about the patient’s ventilation (how effectively CO2 is being eliminated by the pulmonary system), perfusion (how effectively CO2 is being transport through the vascular system), as well as how effectively CO2 is produced by cellular metabolism
Normal respiratory rate
12-20 breaths per minute
bradypnea
slow breathing <12 breaths/min
tachypnea
rapid breathing >20 breaths/min
Kussmaul respirations
very deep and rapid respirations to compensate by decreasing carbon dioxide levels
apnea
absence of breathing lasting or 15 seconds or longer
Cheyne-Stokes respiration
pattern of breathing characterized by a gradual increase of depth and sometimes rate to a maximum level, followed by a decrease, resulting in apnea
Occurs when there is decreased blood floe or injury to the brainstem
what conditions cause the chest to go into a “barrel” shape?
emphysema, advancing age, and COPD
percussion of the chest wall detects..
the presence of abnormal fluid or air in the lungs.
auscultation of the chest wall
Identification of normal and abnormal heart and lung sounds. lung sounds involves listening for movement of air throughout all lung fields
normal WBC count
5,000-10,000
normal RBC count: male
4,000,000-6,000,000
normal RBC count: female
4,000,000-5,000,000
normal Hgb level: male
14-18g/dL
normal Hgb level: female
12-16 g/dL
normal Hct: male
42-52%
normal Hct: female
37-47%
what color should mucus be
clear
white mucus indicates…
-allergy or sinus infection
-cold temperature or low humidity climates
yellow mucus indicates…
a sign that your body may be starting to fight off infection
green mucus indicates…
sure sign of viral or bacterial infection
pink mucus indicates…
pink frothy secretions are always a sign of pulmonary edema
red or brown mucus indicates…
blood mixed with mucus
black mucus indicates…
patient is a smoker or has been breathing polluted air
what diet should a patient eat to maintain a healthy weight for their height
a healthy low-fat, high-fiber diet; monitor their cholesterol, triglyceride, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) levels; reduce stress; exercise
what treatment can reduce dyspnea associates with exercise and hypoxia
oxygen therapy
airway maintenance requires…
-hydration to prevent thick, tenacious secretions.
-Proper coughing techniques remove secretions and keep the airway open.
-A variety of interventions, such as suctioning, chest physiotherapy, and nebulizer therapy
humidification
process of adding water to gas
nebulization
adds moisture or medications to inspired air by mixing particles of varying sizes with the air
During chest percussion what is the expected outcome
The procedure should produce a hollow sound and should not be painful.
vibration
A gentle, shaking pressure applied to the chest wall to shake secretions into larger airways. This technique increases the velocity and turbulence of exhaled air, facilitating secretion removal. Vibration increases the exhalation of trapped air, shakes mucus loose, and induces a cough.
while the patient is awake how often should they deep breathe and cough
every 2 hours
if a patient is on bed rest how often should the client ambulate/change positions
ambulate 10 to 15 minutes every 8 hours, and encourage him to sit up in a chair as often as he is able to tolerate.
for airway management, the nurse should encourage the client to increase their fluid intake to
2800mL/24hours
Immobility is a major factor in developing _______
atelectasis
what is the most effective position for promoting lung expansion and reducing pressure from the abdomen on diaphragm
45-degree semi-Fowler’s
incentive spirometry
Method of encouraging voluntary deep breathing by providing visual feedback to patients of the inspiratory volume they have achieved.
Assist Control
delivers a set tidal volume (VT) with each breath, regardless if the breath was triggered by the patient or the ventilator.
Synchronized intermittent mandatory ventilation
delivers a minimum number of fully assisted breaths per minute that are synchronized with the patient’s respiratory effort. Any breaths taken between volume-cycled breaths are not assisted; the volume of these breaths are determined by the patient’s strength, effort, and lung mechanics.
Pressure Support mode is often combined with SIMV mode
inspiratory pressure is added to spontaneous breaths to overcome the resistance of the endotracheal tube or to help increase the volume of the patient’s spontaneous breaths.
Volutrauma
occurs as a result of alveolar overdistention secondary to the mechanical ventilation.
Ventilator-associated pneumonia (VAP)
a significant potential complication because the artificial airway tube bypasses many of the lung’s normal defense mechanisms.
Noninvasive ventilation
Continuous positive airway pressure (CPAP) is used for
patients with obstructive sleep apnea, patients with heart failure, and preterm infants with underdeveloped lungs.
Continuous positive airway pressure (CPAP) includes
includes a mask that fits over the nose or both nose and mouth and a CPAP machine that delivers air to the mask The smallest mask with the proper fit is the most effective.
what is important about the CPAP and proper fit?
Because straps hold the mask in place, it is important to assess for excess pressure on the patient’s face or nose that could cause skin breakdown or necrosis.
Complications of noninvasive ventilation include
facial and nasal injury and skin breakdown, dry mucous membranes and thick secretions, and aspiration of gastric contents if vomiting occurs during ventilation.
Pneumothorax
a collection of air in the pleural space.
Hemothorax
an accumulation of blood in the pleural space.
Oxygen therapy
The goal of oxygen therapy is to prevent or relieve hypoxia by delivering oxygen at concentrations greater than ambient air (21%).
nasal cannula
A device that delivers low concentrations of oxygen through two prongs that rest in the patient’s nostrils.
a device that fits over the patient’s nose and mouth and delivers oxygen, humidity, and/or heated humidity
a device that fits over the patient’s nose and mouth and delivers oxygen, humidity, and/or heated humidity
ina patient with COPD what needs to be considered
COPD be careful not to over oxygenate otherwise their breathing may slow down. They are used to not having as much oxygen
Cardiopulmonary rehabilitation
Controlled physical exercise; nutrition counseling; relaxation and stress management; medications; oxygen; compliance; systemic hydration
Pursed-lip breathing
Involves deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse. While sitting up, instruct the patient to take a deep breath and exhale slowly through pursed lips as if blowing through a straw. Have him or her blow through a straw into a glass of water to learn the technique.
Diaphragmatic breathing
Useful for patients with pulmonary disease, postoperative patients, and women in labor to promote relaxation and provide pain control. The exercise improves efficiency of breathing by decreasing air trapping and reducing the WOB.
nasal canula FiO2
1-6 L/min
24-44%
simple face mask FiO2
6-12 L/min
35-50%
Partial and nonrebreather masks FiO2
10-15 L/min
60%-90%
