GAS EXCHANGE AND OXYGENATION

love has come again-wynd chymes

pleura

a protective layer or membrane covering the lungs

surfactant

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

ventilation

the flow of air inside or outside the alveoli

respirations

the amount of breaths per minute

cardiopulmonary assessment

assess things such as dietary habits (should be rich in veggies, fruits, fiber, wholegrain, and omega-3s), exercise (30-60 min a day), smoking habits (nicotine can cause vasoconstriction, cigarettes increase COPD, emphysema, and lung cancer risk), stress (can increase BP, HR, cortisol levels, and enhance the flight or flight response), and ones environment (dust, second hand smoke, construction, and chemicals can be harmful). also use inspection and palpation and note any unexpected findings.

hypoxemia

low amount of oxygen in the blood. s/s include confusion/irritability, restlessness, dyspnea, tachypnea, tachycardia, hypertension, cyanosis, accessory muscle use, pursed lip breathing, and either hyper or hypo ventilation.

a-fib

the quivering of atria as a result of signals coming from outside the SA node that can lead to blood clots. these clots can travel to other parts of the body and block blood flow to other organs. patient may have chest discomfort/palpitations or be asymptomatic. patient should be on blood thinners permanently to prevent heart attack or stroke.

v-tach

heart chambers are unable to fill with blood, which results in blood not being pumped to the lungs and the body. client may not have a pulse or have chest pain, dizziness, and SOB. a lethal rhythm.

left ventricular failure (LVF)

causes blood to back up into the pulmonary veins instead of being carried to the body via the aorta. can show s/s of hypoxia due to low perfusion, crackles in lungs due to pulmonary edema, and SOB.

right ventricular failure (RVF)

heart is unable to pump blood to the lungs and it backs up into the peripheral circulation, causing peripheral edema. edema can show in the lower extremities, g3nitals, organs, and abdomen. JVD can also be present. should limit fluid intake in these patients.

valvular heart disease

stenosis (stiffening) or regurgitation (leaky; inability to close) of valves. can lead to back flow of blood (both), ventricular hypertrophy (stenosis) and s/s of right or left sided HF (both).

hypoperfusion

a reduction in blood flow to tissues usually caused by hypotension. damage caused by this reduction can be irreversible. can lead to chest pain, syncope, oliguria, lactic acidosis, and dysrhythmias.

angina pectoris

a reduction in blood flow and oxygen to the heart precipitated by exertion or stress. can lead to a tightness or squeezing/heavy feeling in the chest that can radiate to the jaw, neck, or arm. can also cause a feeling of burning, fullness, and pressure. can be treated with rest, nitroglycerin, and aspirin. stress, anxiety, and exertion can increase pain; manifestations usually last less than 15 minutes.

myocardial infarction (MI)

irreversible damage to the heart from decreased oxygen supply marked by pain unrelieved by rest or nitroglycerine that lasts for longer than 15 minutes. associated with nausea, epigastric distress, dyspnea, anxiety, diaphoresis, an irregular heart rate (tachydysrhythmias), and chest pain that radiates to the back/shoulders. females can have atypical s/s with pain in-between their shoulder blades, jaw pain, indigestion, or a sensation of choking with exertion.

obstructive sleep apnea (OSA)

occurs when the soft tissue of the throat relaxes during sleep and blocks the airway. patient with this disorder may stop breathing (🧛) 5-100 times a night, with apneic episodes lasting longer than 10 seconds. these patients can show s/s of a morning headache, excessive daytime sleepiness, loud snoring, and restlessness. may need a BiPAP to force airway open.

chronic obstructive pulmonary disease (COPD)

irreversible disease that encompasses emphysema (destruction of the alveoli leading to a decreased surface area for gas exchange, CO2 retention, and respiratory acidosis) and chronic bronchitis (inflammation of the bronchi and bronchioles due to chronic exposure to irritants). patient will show a barrel chest due to air being trapped in the lungs. SPo2 levels are naturally low (~88-92%) and are the primary drive for breathing as the body has adjusted to high CO2 levels. tripod position and pursed lip breathing can help with air hunger and trapped air. do not over oxygenate as it can diminish their drive to breathe.

asthma

a chronic disorder of the airways that results in intermittent and reversible obstruction of bronchioles. obstruction can occur either by inflammation or hyperresponsiveness. shows mucosal edema, bronchoconstriction, dyspnea, chest tightness, anxiety/stress, and excessive mucus production. if patient is having an attack with severe wheezing, administer bronchodilator ASAP. a cessation of wheezing during an attack is an emergency.

nasal cannula

delivers oxygen to clients through prongs inserted into the nares. least intrusive and most comfortable. held at 1-6 LPM (24%-44% oxygen). watch for skin breakdown due to the drying of mucus membranes; can be avoided by humidified air.

simple face mask

can deliver oxygen at a medium concentration based on the depth and rate of the client’s breathing. held at 5-10 LPM (35-60%). may cause claustrophobia; not recommended for clients at risk for CO2 retention.

partial rebreather mask

similar to the simple face mask but this mask has a reservoir bag. oxygen is delivered at a higher flow rate (10-15 LPM/60-90%). during inhalation, the client’s air is drawn into the holes of the mask; on exhalation, the gases are sent to the reservoir or out through the holes in the mask. mixes oxygen and CO2. reservoir bag must remain inflated to prevent retention of carbon dioxide that the client exhales.

nonrebreather mask

has valves going into the reservoir bag and holes in the mask that ensure that exhaled gases are not returned to the bag. held at 10-15 LPM/80-95%. bag fills with oxygen and the patient breathes only from that bag'; be sure bag is completely filled with oxygen before placing on the patient. not recommended for clients with COPD or respiratory failure for long-term use due to risk of oxygen toxicity.

venturi mask

fixed-performance device that delivers oxygen at high concentrations (4-12 LPM, 24%-70%). used when precise control of the percentage of oxygen delivered is necessary. best for COPD patients.

aerosol mask

administers nebulized solutions. used as a breathing treatment to administer meds that transform from a liquid to a mist that the client inhales.

continuous positive airway pressure device (CPAP)

has a hose and delivers a constant and steady flow of air, creating positive pressure to keep the airway open and improve the amount of oxygen in the client’s blood. used in OSA.

bilevel positive airway pressure (BiPAP)

air moves through a tube into a mask that fits over the client’s nose; pressures are higher when inhaling and lower when exhaling. recommended for clients whose airway collapses when they are sleeping or those with muscle weakness that inhibits breathing.

complications of oxygen therapy

prolonged exposure to high or low concentrations of oxygen can cause cellular damage or damage to pulmonary function. acute toxicity can show CNS effects such as twitching of the hands and muscles, nausea, convulsions, dysphoria, and tinnitus. chronic toxicity can show atelectasis, coughing, dyspnea, pleuritic chest pain, and heaviness substernally. symptoms should lessen within 4 hours of discontinuing therapy. avoid stress, cold, and fatigue as these are aggravating factors; use as little CO2 as possible.

sputum collection

involves obtaining a sample of sputum to be examined by the lab. it is imperative that the client’s specimen is collected with the correct equipment and using the proper technique to reduce the risk of transmission of infectious organisms to the staff and prevent contamination of the specimen. the nurse should instruct the client to take several deep breaths to loosen the secretions and force a deep cough to move mucus from the lower respiratory tract. The client should then cough 1 to 2 teaspoons of mucus into a sterile specimen cup. CPT and deep suction can help with collecting the sample.

chest physiotherapy (CPT)

consists of percussion of the chest, vibration, and postural drainage. enhances the clearance of secretions from the lungs through the use of external mechanical maneuvers. beneficial for clients who have COPD, cystic fibrosis, or pneumonia, and for other clients who are unable to expectorate thick, copious secretions. results in the expansion of the alveoli within the lungs, decreased risk of infection, and strengthening of the respiratory muscles. can be used in combination with aerosolized medications, suctioning, and incentive spirometry. humidification of oxygen can help pass secretions.

chest tube

inserted into the pleural or mediastinal space of the thorax of a client to allow for drainage of blood, fluid, or air. facilitates lung expansion restores normal intrapleural pressure. has a collection chamber, a water seal chamber, and a suction chamber. absence of tidaling in the water seal chamber indicates that normal intrapleural pressure has been reached and that the chest tube may be ready for removal. If the water in the chamber begins continuously bubbling, then an air leak may be present. keep system below the patient’s chest and do not remove it. keep the patient upright as well; ambulate per physicians orders.