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NURS2500 Patho/Pharma > week 10 : gas exchange > Flashcards

week 10 : gas exchange Flashcards

1
Q

what are the concepts that are related to gas exchange

A

anxiety
acid base balance
perfusion
fatigue
mobility
nutrition

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2
Q

define if this is a true statement or not.
carbon dioxide travelling to hemoglobin and back, alveoli C02 is released in Alveoli

when you are breathing out, initially you are removing C02.

A

this is true

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3
Q

define if this is a true process of gas exchange in the first step

Atmosphere (21% oxygen):
* The process begins with the air we breathe, which consists of approximately 21% oxygen and other gases.

A

this is true

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4
Q

define the function of medulla in the process of gas exchange :

A
  • Medulla:
    The medulla oblongata in the brainstem plays a crucial role in regulating involuntary processes, including breathing. It monitors the levels of oxygen and carbon dioxide in the blood.
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5
Q

define if this is a true statement within the process of gas exchange
Thorax, Intact, Diaphragm Contracts:
* The diaphragm, a muscle separating the thoracic and abdominal cavities, contracts. This action increases the volume of the thoracic cavity, reducing air pressure in the lungs.

A

this is true

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6
Q

true or false. Reducing air pressure in the lungs plays a crucial role in the process of breathing. When the diaphragm contracts and the thoracic cavity expands, it creates a decrease in air pressure within the lungs. This change in pressure is essential for drawing air into the respiratory system

A

this is true

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7
Q

is this a true statement ? * Nose, Trachea, Bronchi:
Air enters the cardiovascular system through the nose and travels through the trachea (windpipe) and bronchi (airways that branch off the trachea) to reach the lungs.

A

false, IT IS NOT cardiovascular but rather respiratory

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8
Q

What is this describing in terms of the process of gas exchange, specifically what are we using ?
* The bronchi further divide into smaller tubes called bronchioles, which eventually lead to tiny air sacs. These are the primary sites for gas exchange in the lungs

A

alveoli

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9
Q

true or false. does this fall into the process of gas exchange?
Pulmonary Capillaries with Hemoglobin to Carry Oxygen:
* Oxygen diffuses across the thin walls of the alveoli and into the surrounding pulmonary capillaries. Hemoglobin, a protein in red blood cells, binds with oxygen to form oxyhemoglobin.

A

yes it does.

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10
Q

Define if these are all true according to the process of gas exchange.
* Cell Metabolism:
Within the cells, oxygen is used in cellular metabolism, a process that produces energy for the cell’s functions.
*Perfusion to Transport Hemoglobin from Cells:
Hemoglobin, now carrying carbon dioxide (a waste product of cellular metabolism), returns to the bloodstream.
* Pulmonary Capillaries with Hemoglobin Carrying Carbon Dioxide:
The deoxygenated blood, carrying carbon dioxide, returns to the lungs through the pulmonary arteries.
* Alveoli, Bronchi, Trachea, Nose:
Carbon dioxide diffuses from the blood in the pulmonary capillaries into the alveoli. The carbon dioxide is then expelled from the body as we exhale, following the reverse path of inhalation.
*Thorax, Intact, Diaphragm Relaxes:
The diaphragm relaxes, decreasing the volume of the thoracic cavity, and air is expelled from the lungs.
* Atmosphere:
The cycle repeats as we inhale again from the atmosphere, taking in fresh oxygen to support cellular activities.

A

yes it is true

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11
Q

here is a better and compressed explanation of the process of gas exchange :
inhaling Air (Atmosphere, 21% oxygen):

We start by breathing in air, which contains around 21% oxygen.
Brain Monitoring (Medulla):

The brain’s medulla monitors oxygen and carbon dioxide levels in the blood, helping regulate breathing.
Breathing Action (Thorax, Intact, Diaphragm Contracts):

The diaphragm contracts, expanding the chest cavity and reducing air pressure in the lungs, allowing air to be drawn in.
Airway Passage (Nose, Trachea, Bronchi):

Air travels through the nose, trachea, and bronchi to reach the lungs.
Gas Exchange (Alveoli):

In the lungs, air reaches tiny sacs called alveoli, where oxygen moves into the bloodstream and binds with hemoglobin.
Oxygen Transport (Pulmonary Capillaries):

Oxygen-rich blood is pumped by the heart to tissues and organs, releasing oxygen to support cell functions.
Cell Energy (Cell Metabolism):

Oxygen is used in cell metabolism to produce energy within cells.
Carbon Dioxide Pickup (Perfusion from Cells):

Hemoglobin, now carrying carbon dioxide, returns to the bloodstream.
Carbon Dioxide Transport (Pulmonary Capillaries):

Deoxygenated blood, carrying carbon dioxide, returns to the lungs.
Exhaling (Alveoli, Bronchi, Trachea, Nose):

Carbon dioxide moves from the blood to the alveoli and is expelled as we exhale.
Relaxing Phase (Thorax, Intact, Diaphragm Relaxes):

The diaphragm relaxes, reducing the chest cavity volume, and air is pushed out of the lungs.
Repeat (Atmosphere):

The breathing cycle repeats as we inhale fresh oxygen from the atmosphere to support cellular activities.

A

!!!! get it together and we must know it before the finals !!!!!

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12
Q

what is ventilation ?

A

process of inhaling oxygen into lungs and exhaling carbon dioxide from lungs

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13
Q

Impaired ventilation may occur :
The statement lists several potential causes of impaired ventilation:
( name examples )

A

inadequate bone/muscle nerve function to move air into the lungs such as rib fracture, spinal cord injury

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14
Q

true or false. When having a rub fracture, it is suggested to take a deep breathe to better airflow going into your lungs.

A

hell no! you do not take deep breathes, this is going to disrupt your whole shat !!!! not recommended.

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15
Q

this is when your diaphragm is paralyzed ( impaired), therefore your ventilation may be impaired as well, what type of injury is this ?

A

spinal cord injury

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16
Q

Impaired ventilation may occur :
The statement lists several potential causes of impaired ventilation:
( name examples )

recall we already know : inadequate bone/muscle nerve function to move air into the lungs such as rib fracture, spinal cord injury
are some examples. Name more.

A

narrowed airways( asthma)
poor gas diffusion ( pneumonia)

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17
Q

What is this describing ?
Availability of hemoglobin and its ability to carry oxygen from alveoli to cells for metabolism and carry carbon dioxide produced by cellular metabolism from cells to alveoli to be eliminated

A

transport

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18
Q

What is transport in gas exchange?

A

Availability of hemoglobin and its ability to carry oxygen from alveoli to cells for metabolism and carry carbon dioxide produced by cellular metabolism from cells to alveoli to be eliminated

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19
Q

impaired transport may occur : name some examples how transport can be impaired

A

insufficient rbcs to carry oxygen
low hemoglobin ( anemia)

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20
Q

true or false. Patients who are anemic, tends to have a problem with their hemoglobin. Concluding that no oxygen or carbon dioxide to carry in the body

A

true

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21
Q

what is this describing ?
Ability of blood to transport oxygen containing hemoglobin to cells and return carbon dioxide containing hemoglobin to the alveoli

A

perfusion

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22
Q

what is perfusion in gas exchange ?

A

Ability of blood to transport oxygen containing hemoglobin to cells and return carbon dioxide containing hemoglobin to the alveoli

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23
Q

true or false. If you have a massive clot= emboli, this could be completely blocking blood, therefore can cause issues with breathing ( exchange )

A

true

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24
Q

having a decreased in your cardiac output can also cause what ?

A

can cause to have a low volume of blood ( hypovolemia)

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25
Q

impaired perfusion may occur if:

A

there is a decreased in cardiac output
thrombi, emboli, blood loss

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26
Q

Impaired gas exchange : clinical manifestations. What could occur during a mild impairment

A
  • Fatigue
  • Heart rate increase
  • Respiratory rate increase
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27
Q

Impaired gas exchange : clinical manifestations. What could occur during a moderate impairment ?

A
  • Respiratory acidosis
    ——— Ventilation problem
  • Metabolism acidosis ( there is too much acid in the body fluid)
    ———transport or perfusion problem
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28
Q

Impaired gas exchange : clinical manifestations. What could occur during a severe impairment?

A
  • Cellular ischemia
  • Necrosis
  • Death
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29
Q

Impaired Gas Exchange:
Risk Factors

A

populations
1.infants
2.young children
3.older adults

individuals
1. Nonmodifiable
–> Tobacco Use
2. Altered LOC
3. Bed Rest/ Prolonged immobility
4. Chronic diseases
5. Immunosuppression

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30
Q

bed rest/prolonged immobility are high risk for …..?

A

pneumonia (SOB, alveoli collapsed)

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31
Q

individuals who uses tobacco are high risk for ….?

A

aspiration

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32
Q

Impaired gas exchange : Ventilation/perfusion/transport

what are the two categories under diagnostics?

A

laboratory
radiologic

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33
Q

what undergoes laboratory when doing a diagnostics

A

ABGs ( arterial blood gas)
cbc
sputum examination
skin tests
pathologic analysis

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34
Q

why are we looking at abg, cbc and skin tests when performing a diagnostic ( lab work)

A

abg–> poor imbalances ( retaining a lot of C02 or removing )
cbc- rbc’s, hgb, hct, ( do they have red blood cells, are they anemic)?
skin tests - mantou test –> tb test

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35
Q

do we start from most evasive to least evasive when doing a radiologic diagnostic ?

A

false, we go from least to most invasive

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36
Q

what undergoes radiologic ?

A

chest xray
ct scan
vq scan
pet scan

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37
Q

why do we use chest xray ?

A

infiltrations, tb, tumours, edema, pleural effusions

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38
Q

why do we use ct scan ?

A

tumours, emboli

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39
Q

why do we use vq scan ?

A

diagnose perfusion or ventilation

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40
Q

why do we use pet scan ?

A

malignant nodules

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41
Q

impaired gas exchange : clinical management

A

primary
secondary

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42
Q

what are we looking upon when doing a primary clinical management with a patient who has an impaired gas exchange

A

primary
1. infection control
2. smoking cessation
3. immunizations
4. postoperative

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43
Q

what are we looking upon when doing a secondary clinical management with a patient who has an impaired gas exchange

A

pharmacotheraphy
1. drugs that affect upper airways
2.lower airway brochodilators
3.agents to help cough up mucus
4.cough superposants
5.antimicrobials ( if they have infectious process)
6. agents to aid smoking cessation

oxygen therapy
nutrition
positioning

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44
Q

Impaired ventilation:
COPD name different types that falls under this category

A

asthma
chronic bronchitis
emphysema
panacinar or panlobular
centriacinar or centrilobular emphysema

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45
Q

the airways overreact to common stimuli with bronchospasm edematous swelling of the mucous membranes, and copious production of thick, tenacious mucus by abundant hypertrophied mucuos glands. Airway obstructio is usually intermitent.

Out of all the COPD category which one is this describing?

A

asthma

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46
Q

define what centriacinar or centrilobular emphysema

A

affects the respiratory bronchioles most severely. It is usually more severe in the upper lung

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47
Q

define what panacinar or panlobular emphysema affects ?

A

it affects the entire acinar unit. It usually more severe in the lower lung

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48
Q

What is this describing ? lung proteases collapse the walls of bronchioles and alveolar air sacs. As these walls collapse, the bronchioles and alveoli transform from a number of small elastic structures with great air exchanging surface area into fewer,larger, inelastic structures with little surface area. Air is trapped in these distal structures, especially during forced expiration such as coughing, and the lungs hyper inflate. The trapped air stagnates and can no longer supply needed oxygen to the nearby capillaries.

A

emphysema

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49
Q

In _______, infection or bronchial irritants cause increased secretions, edema, bronchospasms, and impaired mucociliary clearance, inflammation, of the bronchial walls causes them to thicken. This thickening, together with excessive mucus, blocks the airways and hinders gas exchange

A

chronic bronchitis

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50
Q

what chronic obstructive pulmonary disease ?

A

this is irreversible collection of lower airway disorders that interfere with airflow and gas exchange leading to inflammation, airway obstruction, and air trapping

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51
Q

this is an alveolar issue ?

A

emphysema

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52
Q

what is emphysema ?

A

destructive problem of lung elastic tissue that reduces its ability to recoil after stretching, leading to hyperinflation of the lung

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53
Q

problem: an elastic tissue has a problem to recoil in stretching - reinspire get smaller and collapsed completely

A

emphysema

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54
Q

what category does this undergo to?
* Enzymes (proteases) destroy foreign particles from breathing. Smoking stimulates synthesis of proteases which damage alveoli and small airways by breathing down elastin.

  • Air is trapped in lungs
A

emphysema

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55
Q

true or false. Emphysema : Enzymes (proteases) destroy foreign particles from breathing. Smoking stimulates synthesis of proteases which damage alveoli and small airways by breathing down elastin.

A

true

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56
Q

true or false. Smoking a ton- produces chemicals in our airway?

A

yes this is true, and this can lead into emphysema

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57
Q

What is proteases?

A

cleans up ( destroy foreign particles)

58
Q

(Airway Issue) Inflammation of the bronchi and bronchioles caused by exposure to irritants (cigarette smoke). Irritants trigger inflammation, vasodilation, mucosal edema, congestion, bronchospasm

A

chronic bronchitis

59
Q

what’s an example of airway issue ?

A

chronic bronchitis

60
Q

define what chronic bronchitis means?

A

(Airway Issue) Inflammation of the bronchi and bronchioles caused by exposure to irritants (cigarette smoke). Irritants trigger inflammation, vasodilation, mucosal edema, congestion, bronchospasm

61
Q

Chronic inflammation increases the number and size of mucus-secreting glands producing thick mucus. Bronchial walls thicken and impair airflow. What category does this undergo to ?

A

chronic bronchitis

62
Q

with chronic bronchitis patients, why would gas exchange be affected?

A

because mucus plugs and inflammation narrow airways. Low arterial oxygen and high carbon dioxide ( respiratory acidosis)

63
Q

What is this describing ? Gas exchange is affected by increased of breathing and loss of alveolar tissue : patients adjust by increasingly respiratory rate ( ABGS may not be normal unless advanced)

A

emphysema

64
Q

Chronic Obstructive Pulmonary Disease genetic risk and etiology

A

cigarette smoking
alpha 1 antitrypsin deficiency ( AAT) ( rare factors, keeps our lungs intact)
Asthma –> 12x greater

65
Q

chronic obstructive pulmonary disease
( clinical manifestations )

A

underweight with loss of muscle mass in the extremities/neck muscles enlarged

slow moving/fatigue

chronic cough with excess sputum

rapid shallow respirations

Rapid shallow respirations with abnormal breathing pattern

Use of accessory muscles in abdomen or neck

Wheezes and abnormal sounds

Dyspnea (SOB vs. SOBOE)

Barrel chest (1:1 rather than 1:1/5)

Cyanotic, dusky appearance & excessive sputum production (chronic bronchitis)

Clubbing

  • Psychosocial:
  • Isolated
  • Fear & Anxiety
66
Q

Define why these clinical manifestations may be apparent in a COPD patient

  1. Slow moving/fatigue
    2.Chronic cough with excess sputum
    3.rapid shallow respirations with abnormal breathing pattern
    4.wheezes and abnormal sounds
A

harmful trying to reserve what they can

tieing to that chronic bronchitis patients ( alot of mucus will be apparent)

high risk of cardiac arrest

tons of mucus built pup

67
Q

COPD : complications
increase in severity of disease with worsening clinical manifestations

A

exacerbations
cardiac failure : cor pulmonale ( right sided heart failure pulmonary disease)

dysrhythmias - form hypoxemia, acidosis, cardiac disease

respiratory failure - story of patient’s with parkinson’s

68
Q

COPD we use laboratory and imaging to see further analyzation in a patient

A

this is true

69
Q

what are we looking at when we are using laboratory

A

ABGs : hypoxemia, hypercapnia, when oxygen levels in the blood are lower than normal

Sputum samples : culture and sensivity

wbc: infection

cbc : hemoglobin, and hemocrit (polycythemia )

electrolytes : hyperkalemia

Imaging
—> chest x-ray : rule out other lung disease or check prognosis with infections/chronic disease

other : PFT (pulmonary function tests ) -> mild to severe

70
Q

COPD : what is the goal

A

the goal is improving gas exchange and reduce carbon dioxide retention

71
Q

what are some examples to help with our goal in improving gas exchange and reduce carbon dioxide retention

A

drug therapy
breathing technique
- pursed lip
positioning
-tripod
effective coughing
oxygen therapy
exercise conditioning
suctioning
hydration

72
Q

recall : goal is to improve gas exchange and reduce carbon dioxide retention when dealing with a COPD patient what else do we think we need to consider for patients?

A

preventing weight loss
minimizing anxiety
preventing respiratory infections

73
Q

True or false. Preventing weight loss : we can look upon

  • Four to six small meals a day
  • Positioning and Breathing Techniques
  • High Calorie, high protein
A

all true

74
Q

select all that applies : Goal: Minimizing Anxiety
* Clear plan in place during acute episode
* Support
* Severe cases: Anti anxiety therapy

A

all true

75
Q

21select all that applies : Goal: Preventing Respiratory Infections
* Avoid crowds
* Vaccinations

A

all true

76
Q

what can COPD cause ?

A

it can cause heart failure ( right sided)

77
Q

What else can COPD cause disease?
re-call we know it can lead into heart failure ( right sided )

A

it leads to hypoxia and acidosis and hypercapnia

78
Q

True or false. COPD can lead to reduction of pulmonary vascular bed

A

true

79
Q

what ca hypoxia lead into when dealing with a copd ?

A

it can lead into polychthemia and pulmonary vasoconstriction

80
Q

what can polycethemia cause lead into ?

A

hyperviscosity

81
Q

what does pulmonary vasoconstriction x2 cause ( reference to the digram given slide 21)

A

increase pulmonary vasculature resistance

82
Q

hyper viscosity can cause….?

A

pulmonary hypertension

83
Q

this is when chronic disease in which reversible acute airway obstruction occurs intermittently, reducing airflow

A

asthma

84
Q

describe what asthma is

A

chronic disease in which reversible acute airway obstruction occurs intermittently, reducing airflow

85
Q

this is an airway obstruction that occurs by both inflammation and airway tissue sensitivity with bronchoconstriction

A

this is asthma

86
Q

describe what asthma is

A

airway obstruction occurs by both inflammation and airway tissue sensitivity with bronchoconstriction

87
Q

inflammation triggers an attack due to variety of reasons ( allergens, irritants, GERD )–> this is apart of what characteristics

A

asthma

88
Q

asthma can lead into what

A

wheezing, dyspnea, coughing which can exacerbate o respiratory failure

89
Q

true or false. Often noted in children ( will learn more about 4th year ) and seen in ER if severe ( status asthmaticus )

A

true

90
Q

true or false. asthma is treated similar to COPD patients

A

true

91
Q

Pharmacotherapy :
Two main classes : anti-inflammatory agents & bronchodilators

define what undergoes in both categories

A

principle anti-inflammatory: glucocorticoids
principle bronchodilators : beta 2 agonists

92
Q

For stable COPD/asthma :
1. How are glucocorticoids administered ?
2. How are beta 2 agonists administered

A
  1. glucocorticoids are administered on fixed schedule by inhalation
  2. beta 2 agonists may be administered on fixed schedule ( long term control ) or PRN ( acute attack ) by inhalation
93
Q

DRUG CARD anti- inflammatory drugs : Fluticasone

A

decrease airway inflammation- Flovent

  • MOA: Decreased synthesis and release of proinflammatory hormones, decrease infiltration and activity of inflammatory cells, decrease edema of the airway mucosa
  • Indications: Control inflammation of asthma and COPD
  • Adverse Effects: Oral thrush (rinse mouth with water after administration)
  • Controller drug
    Maintenance use Cannot stop an acute episode and should not be used alone
  • Exacerbations
    May change to oral or IV steroids if severe enough
94
Q

true or false. anti- inflammatory drugs : fluticasone : this is non controller drug and non maintenance use

A

no, it’s the opposite

95
Q

DRUG CARD : Bronchodilators : Salbuterol and salmeterol

A

Provide symptomatic relief by causing bronchiolar smooth muscle relaxation but =have no affect on inflammation

  • MOA: Sympathomimetic drugs that activate beta2-adrenergic receptors promoting bronchodilation and relieving bronchospasm
  • Indication: Provide short term and rapid symptomatic relief for patients with asthma and COPD
  • Shortacting(Salbuterol/Ventolin):TakenPRNforongoingSOB * Rescue/Reliever Drug
  • Long acting (Salmeterol): long term control – fixed schedule (stable COPD)
  • Onset of Action: Short acting is almost immediately, duration 5hrs
  • Adverse Effects: Short acting (tachycardia, angina, tremor) Long acting (never use as first line therapy for prolonged control or alone)
96
Q

how does salbutamol work ?

A

binds to beta2 adrenergic receptors in airway smooth muscle, which relaxes airway smooth muscle

97
Q

if salbuterol is taken away from the patient this can cause the patient to have anxiety attack

A

true

97
Q

are these administration accurate : administration of salbutamol

shake inhaler well, allow for 1 min rest between inhalations

inhaler use should be done with proper techniqe to get appropriate dosages

MDI with spacer or DPI

may be used scheduled and NOT PRN

A

3rd one is wrong ( MDI with/without spacer or DPI )

FALSE!!, may be scheduled and PRN

97
Q

can these be a contraindications for salbutemol ?
hypersensivity
cardiac disease and glaucoma

A

yes all of the above

97
Q

SELECT ALL THE THINGS WE should assess with a patient who are taking salbutamol :

Assess lungs sounds, pulse and BP
*Note color and character of sputum if productive cough *Monitor potassium with frequent use
*Note for increased wheezing (Paradoxical bronchospasm)

A

all

98
Q

CNS: nervousness, restlessness, tremor
Resp: Paradoxical bronchospasm
CVS: Chest pain, palpitations Hypokalemia

are these an accurate statement of side effects of salbutamol

A

yes

99
Q

what are the indications of salbutamol ?

A

Treatment or prevention of bronchospasm in asthma or COPD

Rescue breather

100
Q

DRUG CARD : Anticholinergic Drugs: Ipratropium &
Tiotropium

A

Improve lung function by blocking parasympathetic nervous system in bronchi
* MOA: blocks muscarinic cholinergic receptors in the bronchi preventing bronchoconstriction
* Short Acting: Ipratropium (Atrovent)
* Onset of Action: Within 30 seconds, duration 6hrs * Adverse Effects: Dry mouth, irritation to pharynx
* Long Acting: Tiotropium (Spiriva)
* Onset of Action: 30 minutes, duration 24hrs
* Indications: Maintenance therapy of bronchospasm associated with COPD * Adverse Effects: Dry mouth

101
Q

what is the biggest side effect of ipratripium and tiopium and when do we take this?

A

dry mouth and taken once a day

102
Q

what are two combination drugs ?

A

Glucocorticoid/Long-Acting Beta 2 Agonist (Symbicort/Advair)

Beta 2 Adrenergic Agonist/Anticholinergic (Combivent)

103
Q

what are some advantages to inhalers?

A

Therapeutic effects enhanced by delivering directly to site of action
Systemic effects minimized
Relief of acute attacks is rapid

104
Q

what are the four types of inhalation devices?

A
  1. Metered dose inhalers (MDIs): fine liquid spray
  2. Respimats: very fine mist
  3. Dry powder inhalers (DPIs): fine powder
  4. Nebulizers: Converts drug solution to a mist
105
Q

what is the purpose fo spacers with inhalers?

A

makes the drug more effective - higher percentage administered to lungs

106
Q

what should you be teaching the client in regards to drug therapy?

A

correct admin of drug - use MDI w/spacer easier and improves inhalation of drug
DPI(dry powder inhaler) required less manual dexterity and coordination.

107
Q

what is pneumonia - impaired ventilation?

A

Infection in the lungs causing excess fluid in the lungs from inflammatory response
Exudate develops, inflamed alveolar walls

108
Q

what is the ethology of pneumonia?

A

Organisms from environment, invasive devices, equipment, supplies

109
Q

what is the risk factors of pneumonia?

A

Older adult
Unvaccinated
Chronic disease
Smoking
Altered LOC
Dysphagia
Reduced immunity

110
Q

what are the signs and symptoms of pneumonia?

A

Flushed cheeks
Anxious
Chest pain or discomfort Myalgia
Headache
Chills
Fever
Cough
Tachycardia
Dyspnea
Hemoptysis
Sputum Production
Tripod Position
Severe chest muscle weakness
Varied breath sounds
Chest expansion diminished
Hypotensive

111
Q

what are some labs and imaging used for pneumonia?

A

clinical manifestations:
positive sputum culture and sensitivity
CBC: elevated WBC’s
ABG’s

Imaging
Chest xray

112
Q

select all that is true regarding clinical management - pneumonia:

Improve Gas Exchange
Oxygen therapy

Preventing Airway Obstruction
Deep breathe and cough every 2 hours Hydration
Drug Therapy
Bronchodilators when bronchospasm present
Glucocorticoids

Preventing Sepsis
Anti-infectives

A

true

113
Q

what is oxygen therapy prescribed for ?

A

hypoxemia
hypoxia
conditions that increase need for o2 therapy

atmosphere gas an88-92%d drug:
physicians order
standard order: keep SpO2 over 94%
COPD (if CO2 retainer) keep SpO2

114
Q

true or false: Oxygen therapy :
Uses lowest fraction of inspired oxygen (FiO2) to have acceptable blood oxygen level without causing harmful side effects

Oxygen improves PaO2 and cures the cause

A

second one false - does NOT cure

115
Q

true or false regarding oxygen safety and toxicity:
Combustion: Education for smokers who have oxygen therapy Humidity: If receiving 4L/min or more
Skin Assessment: Ears, back of neck, face

A

true

116
Q

oxygen toxicity:
With high oxygen levels, ——- is diluted causing alveoli collapse.
Related to concentration of oxygen delivered, duration of therapy and degree of lung disease present —- oxygen therapy can cause stress on cells leading to cell damage and —-
Reason why we titrate oxygen therapy when >94%.

A

nitrogen, excess, death

117
Q

what is found in the anterior thoracic landmarks ? (anatomy heheeeee)

A

suprasternal notch
sternum
sternal angle
costal angle

118
Q

what is found in the posterior thoracic landmarks ?

A

vertebra prominens
spinous processes
inferior border of scapula
twelfth rib

119
Q

review: what is anterior, posterior and lateral?

A

anterior - front
lateral - side
posterior - back

120
Q

whats found in the posterior> anterior ? lateral? (the lobes)

A

anterior: right and left upper lobe, right middle lobe, right and left lower limb

lateral: left and right upper lobe, left and right lower lobe and right middle lobe

back - left and right upper and lower lobe

121
Q

what is visceral and parietal pleura?

A

visceral - lines outside of lung

parietal - lines inside of chest

Potential space filled with a few millimeters of fluid
* vacuum or negative pressure which hold lungs against the walls

122
Q

true or false - Trachea/Bronchi – dead space
* Lined with goblet cells (mucus & cilia)
* Defense mechanism

A

true

123
Q

select all that is true regarding physiology of respiratory system?
1. Supplying oxygen to the body for energy production
2. Removing carbon dioxide as a waste product of energy reactions
3. Maintaining homeostasis (acid-base balance)

A

true

124
Q

what is humoral regulation?

A

hypercapnia, increase in C02 stimulus to breathe; hypoxia, decreased 02 can increased respirations but is less effective

125
Q

what is some subjective data regarding respiratory system?

A

Cough
Shortness of breath
Chest pain with breathing
History of respiratory illness
Smoking history
Environmental exposure
Self-care behaviors

126
Q

what falls under inspection - resp system?

A

Shape and configuration: symmetrical; anteroposterior to transverse diameter (1:2; abnormal e.g. barrel chest)

Breathing position: (relaxed posture; abnormal e.g. tripod position)

Quality of respirations: (automatic, regular, even and no noise)

Work of breathing: (effortless, even rhythm; abnormal e.g. accessory muscle use, pursed lip breathing, uneven rhythm)

Oxygen use

Symmetrical chest expansion

Visible distress, LOC, color (cyanosis, pale), lumps/masses

127
Q

what does normal resp patterns look like?

A

Even, regular Inspiration < expiration 10 – 20 breaths/minute

cause: living

128
Q

what are some abnormal patterns of breathing?

A

tachypnea: rapid shallow, regular over 24 breaths per min
cause - fever, fear, exercise, pneumonia

hyperventilation: rapid deep, regular >24 breaths/minute, >24 breaths/minute
cause: Extreme conditions (e.g. panic attack)
Diabetic ketoacidosis (DKA)

Bradynea: Slow, regular, <10 breaths/minute
cause: Increased intracranial pressure

Hypoventilation: Irregular, shallow
cause: narcotics

Cheyenne-stokes respirations: irregular, rapid increased depth followed by apneic period

cause: end of life (severe heart failure)

129
Q

what are you palpated in resp system> this is not tested !

A

systemic chest expansion: Thumbs @ T9/T0
“deep breath”, Assess: moves symmetrically apart

tactile vocal fremitus: Sounds transmitted as vibrations Ball of hand
“99” or “blue moon”
Assess: symmetrical vibrations
Tenderness, skin temperature, lumps/masses

130
Q

resp assessment auscultation tips:

A

Patient sitting, learning forward slightly Side to side comparison
‘take a breath every time you feel my stethoscope; slightly deeper than normal’
Ask not to talk, or pause to listen to the patient
Practice, practice, practice

131
Q

what are some questions to ask for ausculatating breath sounds?

A

Do you hear normal breath sounds? (B, BV, V)bronchovesicular, vesicular and bronchial

Do you equal air entry bilaterally to the bases?
‘Decreased AE to LLL’ (e.g. plural effusions)
‘Silent chest’: no air movement (MEDICAL EMERGENCY)
e.g. Obstruction (mechanical – chocking; inflammatory – croup)

Do you hear any adventitious breath sounds?
Document in flowsheet: Good bilateral A/E with not adventitia noted

132
Q

is this a normal or abnormal finding?
If Bronchial or Bronchovesicular sounds are heard over the Vesicular areas

A

abnormal finding

133
Q

true or false: shorter active inspiration and a longer passive expiration (1:2)

A

true

134
Q

what does bronchial, bronchiovescular and vesicular sound like?

A

b- loud - high pitch

bv - moderate

v - quiet - soft; low pitch

135
Q

what are the common adventitious breath sounds?

A

fine or course crackles, high or low pitched wheeze, stridor and pleural rub

136
Q

what is the sound and common cause of fine or course crackles?

A

Non – musical, non – continuous
Fine: high-pitched, popping Course: low- pitched , gurgling

Fine: Pneumonia, asthma, COPD (Atelectatic – alveoli popping open – not pathological)
Course: Secretions in the airways, pulmonary edema

137
Q

what is the sound and common cause of High or Low pitched Wheeze?

A

Musical whistling, continuous
High: multiple sounds, mainly during expiration
Low: single note, inspiration or expiration

High: COPD, Asthma
Low: Bronchitis, single bronchial obstruction

138
Q

what is the sound and common cause of stridor?

A

Musical, loud, high-pitched

Obstruction in the upper airway: croup, foreign body

139
Q

what is the sound and common cause of pleural rub?

A

Non – musical , superficial, low pitch, leathery

Inflamed pleura rub against each other

NURS2500 Patho/Pharma (16 decks)

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