Lecture 10

Respiratory activity

Controlled in the respiratory center located in the medulla in the brain stem

Pulmonary ventilation

Movement of air in to and out of the lungs

During inspiration

Diaphragm contracts and lowers, increasing length of thoracic cavity

Intercostal muscles contract and lift ribs und sternum

Intrapulmonic pressure lowers allowing air into the lungs

During expiration

Thoracic components relax, moving diaphragm upward & increasing pulmonic pressures

Air is forced out of the lungs

Accessory muscles are recruited when there is difficulty breathing-movement to these muscles is called..

Retraction

Cardiovascular issues that can affect oxygenation include:

Anemia, dysrhythmias, ischemia, heart failure

Adventitious

Breath sounds that are abnormal

Atelectasis

Incomplete lung expansion or collapse of alveoli

Orthopena

Difficulty breathing when lying flat/down

Perfusion

The process that moves oxygenated blood through the tissues of the body

Pulmonary function tests

Test lung compliance (strechyness) and respiratory disease presence/ progression

Blood tests (ABG's, chemistry)

Monitor blood oxygen, pH, CO 2 levels

Spirometry

Measures volumes of inhaled/exhaled air; post-op

Peak expiratory flow rate

Useful with asthma and other constructive diseases

Pulse oximetry

noninvasive method of measuring saturation of O2 in blood

Capnography

Measures exhaled CO2 levels; can be used in CPR

Signs and symptoms of impaired oxygenation

Anxiety, restlessness, tachypena, bradypena, decreased pulse oximetry, pale or blue tinge to lips or fingertips, increased heart rate, altered mental status, difficulty speaking due to dyspnea, activity intolerance, use of accessory muscles, adventitious breath sounds

Symptoms of hypoxia

Early: restlessness, anxiety, tachycardia/tachypnea

Late: Bradycardia, extreme restlessness, dyspnea (severe)

Beta2-adrenergic agonist (bronchodilator)

Assist to open narrow airways (albuterol sulfate, Levalbuterol)

Side effects: tachycardia, tremors, anxiety

Inhaled anticholinergic

Block receptors in the bronchi leading to bronchodilation

Ipratropium

Side effects: dry mouth, hoarseness

Rinse mouth to prevent dry mouth

Corticosteroids/glucocorticoids

Prevent or reduce inflammation of airways

Prednisone, fluticasone, methyl prednisone

Side effects: increased blood sugar, yeast infection

Methylxanthines

Relaxes smooth muscle of respiratory tract leading to bronchodilation

Theophylline

Side effects: upset stomach, dysthymias

Mucolytic

Thin and enhance the flow of respiratory secretions

Acetylcysteine

Side effects: bronchospasm, dizziness, hypotension

Expectorants

Promote sputum mobilization

Guaifenesin

Side effects: upset stomach, dizziness

Non pharmacologic treatment

Incentive spirometey, pursed lip breathing, diaphragmatic breathing, deep breathing and coughing, postural drainage, supplemental oxygen, suctioning

Remember when using supplemental oxygen..

Not an independent intervention, can be skin breakdown on ears, face, no smoking or flames, oxygen tubing can be a fall hazard

Use cautiously in pt with COPD - can cause further build up of CO2 and decompensation, may be normal for COPD pt O2 sat to be <90%