topic 7 300

inhale 

air → trachea→ bronchi→bronchioles→alveoli

gas exchange

in alveoli, oxygen moves INTO the blood, and CO2 LEAVES

exhale

CO2 LEAVES the body

diaphragm

the muscle under the lungs, it flattens to pull air IN and relaxes to push air OUT

when its hard to move your chest __

factors such as obesity, pregnancy, or trauma make it harder to breathe 

work together

heart and lungs

right side of the heart

SENDS BLOOD TO LUNGS TO GET OXYGEN

left side of the heart 

OXYGEN RICH BLOOD TO THE BODY 

the coronary arteries 

feed oxygen to the heart muscle itself 

left sided heart failure

blood backs up into lungs causing crackles (liquid in alveoli), cough, PINK FROTHY SPUTUM

right sided heart failure

blood backs up into the body causing swelling, JVD< and edema

oxygen travels attached to ___ in RBC

hemoglobin

if hemoglobin is low ___

it leads to factors such as anemia or bleeding which makes less oxygen get to the tissues 

the brain controls breathing automatically via

CO2 levels, if it is high there will be faster breathing

low oxygen carrying capacity-affects oxygenation 

from anemia or CO poisoning

hypovolemia-affects oxygenation

blood loss or dehydration → not enough volume to deliver oxygen

low inspired o2-affects oxygenation

high altitude, airway obstruction

increased metabolic rate-affects oxygenation

fever or exercises o2 demand

hypoventilation

too little air in

high co2, low o2

confusion

hyperventilation

too much air out

dizziness, tingling, low co2

hypoxia

low o2 in tissues

restlessness → cyanosis (late sign) 

which are early signs of hypoxia

RAT IS EARLY BED IS LATE

early: restlessness, anxious, tachycardia 

late: bradycardia, extreme restlessness, dyspnea (cyanosis) 

what to ask and observe during an assessment

ask: 

pain: chest pain or tightness? 

fatigue: how quickly tired? 

dyspnea: trouble breathing?

cough: productive or dry?

what to ask and observe during an assessment

look:

skin color: pale or blue

respirations: fast? labored?

auscultate: crackles = fluid, wheezes = narrowing 

nursing diagnoses

ineffective airway clearance

impaired gas exchange

decreased cardiac output 

activity intolerance 

fatigue 

planning goals

maintain airway

improve o2 levels 

reduce dyspnea/fatigue 

planning teamwork 

work with RT, provider, dietitian, Pt, etc. 

Nursing Implementation- what nurses do

dyspnea management

sit patient up (semi or high fowlers)

encourage slow, deep breathing 

administer o2 if ordered 

mobilize secretions 

hydration 

number 1 intervention → thins mucus 

mobilize secretions

humidified oxygen

keeps airway moist

mobilize secretions

nebulizer 

loosens mucus 

mobilize secretions

chest physiotherapy 

helps clear mucus 

nasal cannula

1-6 L/min

low flow, comfy 

simple mask

6-12 L/min

minimum 6 to flush co2

venturi mask

precise % o2

for copd 

nonrebreather

10-15 L/min

highest o2 before administration 

safety for oxygen therapy 

oxygen = flammable 

no smoking, no petroleum products, avoid sparks 

use water-based lubricant for lips 

which statement needs more teaching 

I can use vaseline with oxygen 

pursed lip breathing

inhale through nose, exhale through pursed lips (slows breathing)

diaphragmatic breathing

deep belly breathing

incentive spirometer

expands lungs, prevents atelectasis (10 times/hour while awake)

evaluation

signs you met goals 

RR 16-24 

SpO2 > 90% 

clear lung sounds 

sputum clear/thin 

pt reports easier breathing 

more ABG interpretation

high co2 = respiratory acidosis

low co2 = respiratory alkalosis