Gas Exchange and Oxygenation

Bronchoconstriction

Tightening of the bronchus
due to the contraction of the
smooth muscle

Bronchodilation

Expansion of airway in bronchial cavity

Pleural Cavity

The space or cavity between
the visceral and parietal
layers of the lung

Pleura

A protective layer or membrane
covering the lungs

Diaphragm

A muscle that separates the chest
cavity from the abdominal cavity and
innervated by nerves

Surfactant

A lubricant made in the lungs to
keep the alveoli from collapsing
during exhalation

Atelectasis

Collapse of airways and small
sections of the lung as a result of
shallow breathing. The collapsing of
the lung during expansion

Ventilation

The flow of air inside or outside of
the alveoli

Respirations

The amount of breaths per
minute

Perfusion

The flow of blood by the
cardiopulmonary system into the
alveolar capillaries where
deoxygenated blood is exchanged
for oxygenated blood in the heart
and delivered to the rest of the body

EXERCISE

30-60 minutes per day

DIETARY HABITS

Diet rich in vegetables, fruits,
fiber, whole grains, and omega-3
fatty acids
● DASH diet
● Mediterranean diet

SMOKING

-Nicotine – causes
vasoconstriction
-Cigarettes – increase
COPD, emphysema, and
lung cancer risk

STRESS

● Increases blood pressure
● Increases heart rate
● Increases cortisol levels
● Enhances fight-or-flight
response

ENVIRONMENT

• Dust
• Second-hand smoke
• Construction
• Chemicals

INSPECTION

-Barrel chest is seen in COPD
-Tripod position – helps with breathing
-JVD – increased workload in right
side of the heart

PALPATION/ASSESSMENT

• Symmetrical lung expansion
• Pain with breathing
• Pleural effusion
• Pneumothorax
• Edema
• Capillary refill time
• Pulse assessment

Hypoxemia

● Confusion
● Irritability
● Restlessness
● Dyspnea
● Tachypnea
● Tachycardia
● Hypertension
● Cyanosis (blue/purple discoloration)
● Accessory muscle use
● Pursed lip breathing
● Hyperventilation
● Hypoventilation

Crackles

Caused by fluid filling the air sacs
that sound like music or a whistling
noise heard on exhalation

Wheezing

A high-pitched noise creating a
whistling sound due to air going
through narrowed airways

Rhonchi

Obstruction of the airway that
sounds like rattling

Stridor

Narrowing of the airway heard
on inhalation that sounds like
music or whistling

ATRIAL FIBRILLATION

○ Atria quiver and cause blood clots
○ May have chest discomfort/palpitations or
asymptomatic
○ Patients need blood thinners to prevent
heart attack/stroke

VENTRICULAR TACHYCARDIA

○ Heart chambers are unable to fill
with blood
○ May not have a pulse or have
chest pain, dizziness, and
shortness of breath

LEFT-SIDED HEART FAILURE

○ Affects left ventricle
○ Blood backs up into pulmonary
veins instead of being carried
away
○ Hypoxia, crackles, and shortness
of breath

RIGHT-SIDED HEART FAILURE

○ Heart is unable to pump blood to the
lungs
○ Congests into the peripheral
circulation
○ Fluid leaves veins and causes
peripheral edema
○ Edema occurs in the lower
extremities, genitals, organs, and
abdomen, JVD
○ Limit fluids

VALVULAR HEART DISEASE

○ Stenosis and Regurgitation
○ Leads to backflow of blood

HYPOPERFUSION

○ Usually caused by
hypotension
○ Chest pain, syncope,
decreased urine output,
dysrhythmias

ANGINA PECTORIS

○ Reduction in blood flow & oxygen to
heart
○ Tightness, squeezing, heaviness in
the chest, burning, fullness,
pressure
○ Treatment: rest, nitroglycerin,
aspirin
○ Stress, anxiety, excessive exertion
can trigger pain

MYOCARDIAL INFARCTION

○ Irreversible damage to the heart from
decreased oxygen supply
○ Irregular heart rate (tachyarrhythmias),
diaphoresis, anxiety, lightheadedness,
tachypnea, and chest pain with radiation
to back/shoulders
○ Nitroglycerin does NOT relieve chest
pain

OBSTRUCTIVE SLEEP APNEA

○ Soft tissue relaxes during sleep
and blocks the airway
○ Patient may quit breathing 5-100s
of times per night
○ Apneic episodes last longer than
10 seconds
○ Morning headache, excessive
daytime sleepiness, loud snoring,
restlessness
○ May need BiPAP to force airway
open

CHRONIC
OBSTRUCTIVE
PULMONARY DISEASE

o Most common cause is smoking
o Can be genetic
o Includes bronchitis and emphysema
o Emphysema: alveoli become damaged from
trapped air
■ Blebs in lungs
■ Air becomes trapped and causes
“barrel chest”

CHRONIC
OBSTRUCTIVE
PULMONARY DISEASE

o Bronchitis: mucus and inflammation in the
airway
o Tripod position helps with air hunger
o Teach patient how to perform pursed-lip
breathing for trapped air
o These patients live with lower O2 saturations
(around 88%)
o Chronic CO2 retention
o Do NOT over oxygenate!

ASTHMA

o Common
o Airways become narrow and inflamed
o If patient has severe asthma attack
with severe wheezing...
Bronchodilators
ASAP!

PNEUMONIA

o Congestion, infiltrates, bacteria in
lungs
o Can be from hospital or environment
o Prevention!
o Ambulate!
o Turn, cough, deep breathe
o Incentive spirometer
o Humidify oxygen if needed
o Promote fluids
o Suction secretions

Nasal Cannula

❖ Least intrusive and most comfortable
❖ Should be started first if patient O2 barely below normal
❖ 1-6 LPM or 24%-44%
❖ Watch for skin breakdown
❖ Can be humidified

Simple Face Mask

❖ May cause claustrophobia
❖ Not for Co2 retention
❖ 5-10 LPM, 35%-60%

Partial Rebreather

❖ Similar to a simple mask, but with a reservoir bag
❖ 10-15 LPM, 60%-90%
❖ Has holes on the side
❖ Inhalation: air is drawn into holes; Exhalation: gases are
sent into air or bag
❖ O2 & CO2 are mixed

Nonrebreather

❖ Gasses are not mixed
❖ Bag fills with O2 and patient only breathes from the bag
❖ Make sure bag is completely inflated with oxygen BEFORE
placing on patient
❖ 10-15L, 80%-95%

Venturi Mask

❖ 4-15L/min, 24%-60%
❖ Different barrels used to deliver precise amount

Aerosol Device

❖ Nebulized solutions
❖ Medications change from liquid to mist
❖ Breathing treatments
❖ Corticosteroids & bronchodilators

Continuous Positive Airway Pressure (CPAP)

❖ Machine with hose
❖ Constant flow of air
❖ Positive pressure to keep the airway open
❖ Main use is obstructive sleep apnea

Bilevel Positive Airway Pressure (BiPAP)

❖ Pressures higher when inhaling and lower when exhaling
❖ For patients whose airway collapses when sleeping
❖ Also used for muscle weakness

Toxicity

○ High partial pressures lead to damage to cellular membranes
○ Acute Toxicity: Central nervous system damage
■ Twitching of hand muscles, nausea, convulsions, dysphoria, tinnitus (TNCDT)
○ Chronic Toxicity: Pulmonary system damage
■ Atelectasis, coughing, dyspnea, pleuritic chest pain, substernal
heaviness (ACDPS)

Toxicity

○ Symptoms lessen within 4 hours once O2 is discontinued
○ Avoid stress, cold, fatigue
○ Use as little O2 as possible

Patient Education

○ No smoking
○ No open flames
○ Keep heat sources away
○ Keep away flammable liquids
○ Do not use petroleum-based lotion/lip balm
○ No aerosol hairspray
○ Do not use if your hands are wet from sanitizer
○ 100% cotton bedding
○ Keep tanks upright
○ Keep tubing under 50 feet
○ Keep concentrators away from curtains or walls
○ Keep fire extinguisher

SPUTUM SPECIMEN COLLECTION

• Collect preferably in the morning before eating or
drinking
• Instruct the client to take several deep breaths to
loosen the secretions
• Force a deep cough to move mucus
• Cough 1 to 2 teaspoons of mucus into a sterile
specimen cup
• Nurses may perform chest physiotherapy to promote
sputum collection
• May need to deep NT suction if cough not effective

CHEST PHYSIOTHERAPY

• Percussion of the chest, vibration, and postural
drainage
• Enhances the clearance of secretions from the lungs
• Can be used in combination with aerosolized
medications, suctioning, and incentive spirometry
• Can humidify O2 if patient is having difficulty
coughing secretions

COUGH AND DEEP BREATHE

• Splint abdomen and chest with pillow to avoid
dehiscence
• Take a deep breath, hold, exhale x 5
• Deep cough
• Repeat every 1-2 hours
• Huff coughing: inhaling & holding, then
forcefully exhaling, making “huff” sound

SUCTIONING

• Oropharyngeal
• Nasopharyngeal
• Nasotracheal
• Endotracheal

CHEST TUBES

➢ Want gentle tidaling
➢ Bubbling is BAD! Air leak!
➢ Keep system BELOW patient’s chest
➢ Do not remove!
➢ Document drainage amount, color,
consistency each shift
➢ Keep patient upright
➢ Patient can ambulate with chest tube per
physician order