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