Week 2: Gas Exchange & Respiratory Function Flashcards
what is the upper respiratory tract made up of? (5)
nose, paranasal sinuses, pharnx, tonsils, adenoids, larynx, trachea
function of the nose
filters, warms, & moistens air
what are the sphenoid sinuses? (4)
frontal, ephnoid, spenoid, maxillary
function of the pharynx, tonsils, & adenoids
filter the immune system; epiglottis blocks food from going into the trachea
function of the trachea
warms & filters inspired air
what is contained in the lower respiratory tract?
lungs (pleura), mediastinum, bronchi / bronchioles, alveoli
what is the function of the lungs?
site of gas exchange
different between the visceral pleura & priorital pleura
visceral: hugs the actual lung
priorital: outside of the lung
what is the mediastinum? what does it house? (5)
chest cavity; houses the lungs, heart, thymus gland, aorta, vena cava, & esophagus
what is bronchi / bronchioles?
large airways that come off trachea & attach to the lung / smaller branches that go throughout the lungs (contain mucus, lined w cilia)
where does gas exchange occur?
the alveoli
what do macrophages do?
ingest foreign materials that we breathe in (part of our defense mechanism)
respiration takes place at the ___ level
cellular
difference between inspiration & expiration (what type of processes are they? is energy being used?)
inspiration: active process, uses energy
expiration: passive process, no energy used
what is ventilation? what can it be altered by? (4)
air moving in & out
can be altered by: asthma, bronchitis, COPD, inflammation
difference between diffusion & perfusion
diffusion: oxygen and blood are exchanged at the air-blood interface
perfusion: blood flow through the pulmonary circulation (lungs)
ventilation & perfusion must….
“match”
what diffuses more easily than oxygen?
carbon dioxide
VQ scan
- which type of patients is it for?
- what does it measure?
- how does it work?
for patients suspected of having pulmonary emboli; measures ventilation and perfusion (inject dye to light up, breath in radioactive gas)
what is gas exchange measured by?
ABGs
where is CO2 exchanged? where is it transported?
capillaries; transported from tissues to blood & transported to lungs
where is oxygen transported?
from the blood into the tissue
which nerve excites muscles to keep you breathing? where is it located?
phrenic nerve; respiratory centers in the brain
central chemical receptors
in medulla respond to change in CSF from chemical changes in blood from high to low in pH to correct imbalance
peripheral chemical receptors
in aortic arch and carotid arteries first responders to changes in PaO2, then to PaCO2 and pH
mechanoreceptors
include stretch, irritant, juxta capillary receptors
Respond to changes in resistance
proprioceptors
in muscles and chest wall respond to body movements = increased respiration
baroreceptors
in aortic arch and carotid bodies respond to increase & decrease in arterial blood pressure and cause either hypo or hyperventilation
resting respirations
excitation of the muscles by the phrenic nerve
what does increased CO2 levels do to pH?
decreases pH
what is the dead space?
area in the lungs where nothing is happening
what does sharp stabbing chest pain mean on inspiration?
pleurisy
what does wheezing indicate?
airway constriction (asthma)
what is hemoptysis? what does it indicate?
coughing up blood; could indicate a blood clot, cancer, or pneumonia
what does it mean when a patient’s skin is dusky?
blueish, gray color skin
which type of patients are often positioned a specific way to expand their lungs?
emphysema patients
what does a barrel chest indicate?
chronic overinflation of alveoli due to emphysema
what does a funnel chest indicate?
depressed breast bone caused by heart surgery
what does a pigeon chest indicate?
upper chest flares out caused by abnormal bone growth
what is seen when a patient is using their accessory muscles to breathe?
large abdominal breaths & using everything in their neck trying to breathe
pulmonary function tests
- what does it measure?
aids in diagnosis & assessment of respiratory function; how well we can breathe in & out, measure tidal volume & vital capacity
list the arterial blood gas values (4)
PaCO2: 35-45
pH: 7.35-7.45
PaO2 (oxygen in arteries): should be greater than 80
Bicarb: 22-26
venous blood gasses
- what does it measure?
measures the balance of oxygen used by tissues & amount of oxygen returning to right side of the heart (deoxygenated blood on rt. Side of the heart) - goes through pulmonary arteries!
pulse oximetry
- what does it measure?
noninvasive measures O2 saturation of hemoglobin <90% (tissues not getting enough O2)
end-tidal carbon dioxide
- what does it measure?
non-invasive method of monitoring partial pressure of CO2 at end exhalation
what is important when getting a culture / sputum collection?
need to make sure to get a deep specimen - not saliva! Get specimen before starting any antibiotics!
what is an image study?
chest x-ray (PA & lateral (side view), posterior / anterior, looking for densities in lungs; primarily pneumonia
CT scan
- done w contrast or w out?
- what should be checked before contrast media?
may be done w & w/out contrast; check patient’s kidney function before contrast media!!
pulmonary angiography
- what does it go into?
- pretest (5) how to educate / prep the patient
- post procedure (6) what to monitor for as a nurse
- going into artery
- pretest: Need informed consent, check allergies, Coagulation studies, Monitor renal function d/t dye, usually NPO for 6-8 hours before. May get warm flushed feeling with administration of the dye.
- post procedure: Monitor for bleeding, check pulses distal to site, monitor skin color / temperature, VS, level of consciousness, O2 sat.
MRI
- what does it look at?
- what should you ask patients?
Looking at tissues in a more detailed manner; ask patient if they’ve had any pieces of metal in body or eyes or have had open heart surgery
Fluoroscopy
- what does it show & look at?
- what may be expected from a patient afterwards?
Tells how lungs are working – Looks at the various parts of the respiratory tract in a live X-ray via video screen. Assists with biopsies
May expect some pain & coughing up blood
VQ scan
- what should be done before?
- how does this procedure work?
Do chest X-ray before; Inject radioactive dye in the vein (Perfusion) / Takes 20-40 minutes; Then inhale radioactive gas with oxygen (Ventilation)
what does a gallium scan assess for?
inflammation
PET scan
- what does it look at?
- pretest (5)
- post test (1)
Looks at nodules
Pretest: Avoid caffeine, alcohol, tobacco for 24 hours before; NPO 4 hours before; Need to empty bladder
Posttest: Encourage fluids
bronchoscopy
- pretest (5)
- posttest (4)
- Signed Consent
- Pretest: NPO 4-8 hours before, pre-op meds to calm patient / May need prophylactic antibiotic to prevent a bacterial infection. Remove dentures or partial plates
- Posttest: NPO until gag reflex returns; Start with ice chips. Then cold water then applesauce or pudding, then a sandwich. NO HOT liquids for 24 hours due to throat being numbed
thoracoscopy
- where is this placed?
- pretest (7)
- post test (1)
Scope placed in the intercostal space to examine pleural cavity.
going in through the ribs & examining the thoracic cavity or chest
Pretest: Consent; NPO; Monitor VS, pain, respiratory status, bleeding, signs of infection
Posttest: May have chest tube after
thoracentesis
- what does it do?
- what should nurses obtain specimens of fluid for?
- what position is the patient in?
Removal of fluid / air from the pleural space. Obtain specimen of fluid for: gram stain, Culture and Sensitivity (C & S), cytology, pH, total protein, glucose, cancer markers.
- Patient leans over bedside table or on their side curled up in a ball on the bed
what can a thoracentesis also be used for?
may be used to instill medication
what is a biopsy?
- what are the 3 types?
Excision of small amount of tissue for examination of cells
- Pleural biopsy
- Lung biopsy
- Lymph node biopsy
hypercapnea R/T ABGs
- what is it considered?
- what are S/Sx (4)
- what are some causes? (3)
- respiratory acidosis
- S/Sx: Lethargy, flushed dry skin, headache, narcosis
- causes: narcotics, anesthesia, high CO2 level
hypocapnia R/T ABGs
- what is it considered?
- what are s/sx (2)
- causes (1)
- respiratory alkalosis
- s/sx: Increased neuromuscular irritability, cardiac arrhythmias due to hyperventilation & anxiety
- causes: decreased CO2
as respiratory rate & depth change, what also changes?
CO2 levels
difference between hypoxemia & hypoxia
- what are they & what are they measured by?
hypoxemia: decreased O2 in blood; ABGs
Hypoxia: decreased O2 to tissue & cell; pulse ox
list some s/sx of hypoxia (5)
- change in mental status
- tachycardia or bradycardia
- diaphoresis
- hypertension
- dusky color
what is circulatory hypoxia?
inadequate capillary circulation
what is anemia hypoxia?
lack of hemoglobin to carry oxygen
what is histotoxic hypoxia?
given cyanide interfere w tissues ability to use oxygen (cyanide poisoning)
what is tidal volume?
the volume of air that normally moves in and out of the lungs in one quiet breath
what is inspiratory reserve volume?
the maximum volume of air that can be inhaled after a normal tidal volume inhalation
what is expiratory reserve volume?
the maximum volume of air that can be exhaled after a normal tidal volume exhalation
what is residual volume?
the amount of air remaining in the lungs after maximum exhalation; air that cannot be exhaled
what is vital capacity?
the maximum volume of air that can be exhaled after a maximum inspiration
what is inspiratory capacity?
the volume of air that can be inhaled after a normal exhalation;
what is functional residual capacity?
the volume of air remaining in the lungs after normal exhalation
what is total lung capacity?
the maximum amount of air that the lungs can accommodate
lung volume & capacity vary with… (4)
age, race, height, & gender
what type of infection of rhinitis?
viral
what is rhinosinusitis?
- which population is it common in?
scared sinuses & less airflow
common in elderly population
what can rhinosinusitis not be treated w?
antibiotics
what is pharyngitis?
sore throat
what is tonsillitis / adenoiditis?
collecting garbage
what is peritonsillar abscess?
tonsils can touch each other
what is laryngitis?
vocal chords get inflamed and you can’t talk
what is Epistaxis?
nose bleed
what can a nasal obstruction be caused by? (5)
polyps, deviated septum, food, dentures, tumor (cancers)
is oxygen therapy considered a medication?
yes! needs an order (usually is a standing order)
what can occur if a COPD patient is given too much O2? (O2 toxicity)
- list 3 S/Sx
respiratory alkalosis
- lethargic, agitated, can stop drive to breathe
when teaching patients to use an incentive spirometer, what is a good analogy?
smell the flowers, blow out the candles
what does a small-volume neubulizer do?
delivers medication down deep into their lungs
what does postural drainage do in chest physiotherapy?
patient puts head downward and pounds on their back to cough up drainage
what does chest percussion / vibration do? what type of patients is this commonly seen in?
pounding on back to cough up drainage; vest to loosen secretions; seen in a lot of cystic fibrosis patients
what does pulmonary rehabilitation treatment do?
build endurance; have patient walk around
how does an endotracheal intubation work?
blow up balloon past vocal cord, at lip line
what is the bottom piece of a tracheostomy called & what is it used for?
obturator: kept at bedside if the patient accidently pulls out the trach
what is the purpose of mechanical ventilation?
will breathe for the patient; can be set at different settings (intermittent or if patient stops breathing all together)
difference between a trachoetomy & tracheostomy
tracheotomy: surgical procedure in which an opening is made into the trachea
tracheostomy: the actual opening
how often should trach care be done?
Q8
to prevent infection, patients w trachs should do sterile or clean care?
sterile care while in hospital
clean care at home
how do prevent accidental decannulation in a patient w a trach? (3)
monitor pulse ox
- give O2 before and between suction attempts
- do not instill NS into trach to stimulate cough
do not attempt to change or remove trach tubing until stoma is established which is usually when?
> 96 hours
what is obstructive sleep apnea?
- what are patients at risk for? (3)
Recurrent episodes of upper airway obstruction & a reduction in ventilation during sleep
at risk for: HTN, MI, stroke
what is the biggest increased risk for a patient when they have sleep apnea?
pulmonary hypertension
what is a common accident in patients w sleep apnea?
increased insulin resistance (type 2 diabetes)
what is the difference between CIPAP & BIPAP?
CIPAP: continuous positive airway pressure
BIPAP: bilevel positive airway pressure
what is the common med used for sleep apnea? how does it help these patients? what is it also used for?
Modafinil; used for excessive daytime sleepiness
used for narcolepsy as well
how should sleep apnea patients sleep?
on their side
atelectasis
a collapsed lung because alveoli has sticky mucus
trachobronchitis
inflammation in the trachea & bronchus
pneumonia
- what can prevent it? (3)
fluid in the lungs; incentive spirometry, ambulating, deep breathing can all prevent
aspiration
- what is the defense mechanism?
“something going down the wrong pipe”; coughing is the defense mechanism
what is pulmonary TB caused by?
a mycobacterium
which type of patients have an increased risk for atelectasis?
surgical patients
what is community acquired pneumonia?
out in public, symptoms have occured 48 hours less than admitted
what is healthcare associated pneumonia?
in non hospital areas like nursing homes, rehab centers, long term acute care centers, acquired in another health care setting
what is hospital-acquired pneumonia?
happens after 48 hours after admission; blamed on hospital
what is ventilation associated pneumonia?
48 hours after patient was intubated
Oneymonia in the immunocompromised host: HIV, AIDs, cancer patients
what is aspiration pneumonia?
water down in the lungs, couldn’t get it out
name 4 s/sx of pneumonia
pulse ox low, hemoglobin levels low, WBC count high, green sputum
what should always be checked before giving antibiotics, antifungals, or antivirals?
cultures!!
what is pleural effusion?
too much fluid in this space; prevents the lung from expanding properly
what is a CBC differential?
WBC count broken into different types of white blood cells
if a patient has covid, what are they at a higher risk of developing?
bloot clots
is WBC is low, what can that indicate?
chronic stress or a viral infection
is WBC is high, what can this indicate?
bacterial infection or acute stress
patients w pulmonary TB should be placed in which kind of environment?
negative pressure room
what are 3 serious s/sx of pulmonary TB? how is this tested? when do these s/sx occur after exposure?
- night sweats, “rust” colored sputum, weight loss
- tested by sputum specimen (acid fast bacillus smear)
- s/sx occur 2-10 days after exposure
the TB blood test is preferred for which patients?
patients who received BCG vaccine – Results in 24-36 hours
what is the interferon-gamma release assay test used for?
if a patient is positively infected w TB and needs further testing
QuantiFERON-TB Gold (QFT-Plus) test
best test!!
detects TB or if it’s just an antibody
mantoux testing
does not tell us if patients have active TB, only tells us if they were exposed!!
- intradermal infection of PPD
positive = induration (hardening) at site
prophylaxis
isoniazid given; most common treatment for TB; pt. also given vitamin B6 because it prevents neuritis
what 4 drugs are given for treatment of TB? how long is the treatment?
INH, Rifampin, Pyrazinamide (PZA), ethambutol
- treatment for 8 weeks
after 8 weeks of treatment for TB, which two drugs are used and for how much longer?
INH & rifampin
- used for 4-7 months more
what is the #1 side effect of INH? which organ is it also hard on?
polyneuropathy or neuritis; very hard on liver as well
what is the #1 side effect of Rifampin? what is important to be monitored?
orange urine, secretions, stain contacts
monitor liver function!!!
what is the #1 side effect of ethambutol? what should be monitored?
optic neuritis (monitor for vision changes) & monitor renal & liver function
what is the #1 side effect of pyrazinamide (PZA)? what should be monitored?
joint pain; monitor uric acid because it can cause hyperuricemia & AST/ALT & monitor liver function!!
what is pleurisy?
sharp stabbing pain on inhalation
what is pleural effusion?
too much fluid in that space; does not allow lungs to expand
what could a pneumothorax cause?
pressure on the heart or tracheal deviation
heimlich valve
comes outside of chest wall; one way valve, does not come back into the chest cavity (emergent)
thoracotomy
- what is it?
- what is it used for?
surgical opening into the thoracic cavity
used to diagnose, cure, treat lung disease, chest disease, or obtain a biopsy
what is done pre op for thoracic surgery? (6)
- assess functional reserve
- determine likelihood of recovery & survival
- ensure optimal condition for surgery
- determine baseline
- prep-op testing
what is done post-op for thoracic surgery? (5)
- may be on ventilator / may have chest tube
- promote airway clearance
- manage pain
- maintain fluid volume
- monitor for complications
list some complications of a thoractomy (6)
- immobility
- bleeding
- pneumothorax
- infection
- respiratory and or HF
- fistula formation
chest tubes
- purpose
- where they are placed
- nursing management (4)
- complications
drain fluid, air, blood
placed in pleural space
(upper for air removal & lower for fluid / blood removal)
nursing management: must be one way system to allow air or fluid out of cavity and none back in, keep below level of chest, site assessment, pain control!!, assess & maintain patency (do not rely on bubbling), caution before clamping, assess and manage pain,
complications (atelectasis, infection, re-accumulation of air in pleural space)
-
what is the leading cause of cancer death & 2nd most common cancer in both men & women?
lung cancer
what is a pneumothorax?
list some s/sx
tx
Occurs when the pleural space is exposed to positive atmospheric pressure
s/sx: acute distress, gasping for air, absent breath sounds on the side where the lung collapsed, using accessory muscles
tx: chest tube & O2 for tension pneumothorax
what is the A on the chest tube mean?
suction chamber; should be very gentle bubbling (not boiling fluid); will lose suction; water up to 2 cm of suction
what is the B on a chest tube?
– water seal: you should see water from arow down, patient breathes, will see fluid going up and down (tidaling) up and down
if there’s blank in ___ of the chest tube, something is leaking
C
what is D on the chest tube?
3 columns = the drainage that’s coming out of patient (measured every shift)
Drainage: sanquaneous, sarosanquneous, serous
what is a pulmonary embolism associated w? (7)
Associated with trauma, surgery, pregnancy, heart failure, >50 years, hypercoagulable states, & prolonged immobility
what is a pulmonary embolism associated w? (7)
Associated with trauma, surgery, pregnancy, heart failure, >50 years, hypercoagulable states, & prolonged immobility
how to prevent pulmonary embolisms? (3)
active leg exercises, early ambulation, anti-embolism hose
