oxygenation extended

Primary function of the respiratory system

Gas exchange: bringing oxygen into the body and removing carbon dioxide.

Respiratory regulation of blood pH

Adjusting the amount of carbon dioxide retained or exhaled.

Effect of carbon dioxide retention on blood pH

Blood becomes more acidic and pH decreases.

Effect of excessive carbon dioxide exhalation on blood pH

Blood becomes more alkaline and pH increases.

Protective mechanisms of the respiratory system

Cilia, mucus, and the cough reflex trap and remove pathogens and irritants.

Functions of the nose and nasal cavity

Filtering, warming, and humidifying incoming air, and providing the sense of smell.

Pharynx

A muscular passageway for both air and food.

Larynx

Structure that produces voice and helps protect the airway during swallowing.

Trachea

Airway structure that conducts air from the larynx to the bronchi.

Structure keeping the trachea open

C-shaped cartilage rings.

Function of the bronchi and bronchioles

Distributing air throughout the lungs.

Alveoli

Microscopic air sacs where oxygen and carbon dioxide are exchanged with pulmonary capillaries.

Diaphragm

The primary muscle of inspiration; contraction increases thoracic volume to draw air into the lungs.

Intercostal muscles

Muscles that assist with expansion and contraction of the chest during breathing.

Diaphragm movement during inspiration

Contracts and moves downward, increasing thoracic volume.

Diaphragm movement during normal expiration

Relaxes and moves upward as air leaves the lungs.

Chest X-ray

Diagnostic imaging that visualizes the lungs, heart, and chest structures to identify abnormalities.

Pre-chest X-ray nursing actions

Remove jewelry and interfering metal objects, and assess pregnancy status when appropriate.

Pregnancy contraindication for chest X-ray

Not an absolute contraindication; medically necessary X-rays can be performed with appropriate precautions.

Purpose of a sputum specimen

Identifies infectious organisms or abnormal cells in respiratory secretions.

Best time to collect a sputum specimen

Early morning, preferably before eating and before starting antibiotics.

Methods for collecting a sputum specimen

Deep coughing and expectoration, or suctioning when indicated.

Pre-sputum collection verifications

Verify the correct specimen container and specific laboratory tests ordered.

Bronchoscopy

Direct visualization of the larynx, trachea, and bronchi using a flexible or rigid scope.

Pre-bronchoscopy nursing interventions

Verify consent, maintain prescribed NPO status, establish IV access, and review coagulation studies.

Priority post-bronchoscopy assessment

Monitor airway, respiratory status, oxygenation, and potential complications.

Post-bronchoscopy oral intake criteria

Return of gag and swallowing reflexes, with patient sufficiently alert.

Post-bronchoscopy positioning

Semi-Fowler's position, unless otherwise ordered.

Bronchoscopy complications

Bronchospasm, bleeding, hypoxemia, and pneumothorax.

Thoracentesis

Removal of fluid or air from the pleural space using a needle or catheter.

Purpose of thoracentesis

Improves breathing by removing pleural fluid and obtains specimens for diagnostic testing.

Pre-thoracentesis nursing assessments

Verify consent, assess respiratory status, review coagulation results, and confirm procedure site.

Patient positioning for thoracentesis

Sitting upright and leaning forward over a bedside table, or in a side-lying position.

Intra-procedure nursing responsibilities for thoracentesis

Maintain positioning, monitor patient, assist provider, and correctly label specimens.

Post-thoracentesis monitoring priorities

Respiratory status, oxygen saturation, puncture site, and signs of pneumothorax or bleeding.

Pulmonary function tests (PFTs)

Diagnostic tests that evaluate airflow, lung volumes, and overall pulmonary function.

Medication management prior to pulmonary function testing

Bronchodilators may be held if specifically instructed by the provider or lab.

Purpose of a chest CT scan

Provides detailed cross-sectional chest images and can diagnose pulmonary embolism when contrast is used.

Assessments required prior to CT scan with IV contrast

Previous contrast reactions, kidney function, and IV access adequacy.

Metformin management after IV contrast

Holding depends on kidney function, acute kidney injury risk, and contrast procedure type.

Purpose of a V/Q scan

Evaluates ventilation and perfusion of the lungs, often to investigate pulmonary embolism.

Indication for V/Q scan over CT pulmonary angiography

Used when iodinated contrast is contraindicated or CT pulmonary angiography is unsuitable.

Arterial blood gases (ABGs)

Measurements of pH, PaCO2, PaO2, and bicarbonate to evaluate oxygenation, ventilation, and acid-base balance.

Purpose of the Allen test

Assesses collateral circulation to the hand before radial artery puncture.

Post-arterial puncture nursing interventions

Apply firm pressure for required duration and assess for bleeding and adequate circulation.

Transport protocol for ABG specimens

Transport promptly according to lab protocol; some samples require placement on ice.

Asthma

A chronic inflammatory airway disorder characterized by variable, often reversible airflow obstruction.

Pathophysiological changes in asthma airways

Bronchoconstriction, airway inflammation, and increased mucus production.

Key risk factors for asthma

Family history, allergies, smoke exposure, obesity, and environmental irritants.

Common asthma attack triggers

Pollen, dust mites, mold, pet dander, smoke, infections, cold air, exercise, and strong odors.

Medications triggering asthma in susceptible patients

Aspirin, certain NSAIDs, and beta blockers.

Asthma exacerbation

An acute period of worsening asthma symptoms and airflow obstruction.

Status asthmaticus

A severe, life-threatening asthma exacerbation that fails to respond adequately to initial treatment.

Complications of status asthmaticus

Respiratory failure, severe hypoxemia, and pneumothorax.

Diagnostic methods for asthma

History, physical examination, and pulmonary function testing showing variable airflow obstruction.

Most characteristic lung sound in asthma

Wheezing.

Mechanism behind asthma wheezing

Air forced through narrowed, constricted airways.

Common clinical manifestations of asthma

Wheezing, coughing, chest tightness, and shortness of breath.

Diurnal pattern of asthma coughing

Symptoms are often worse at night or early in the morning.

Significance of diminished or absent breath sounds in asthma

Indicates dangerously reduced airflow requiring immediate assessment and intervention.

Clinical signs of a worsening asthma exacerbation

Increasing respiratory rate, tachycardia, restlessness, dyspnea, and falling oxygen saturation.

Late signs of severe respiratory compromise in asthma

Cyanosis, exhaustion, altered consciousness, and markedly diminished breath sounds.

Four traditional classifications of asthma severity

Intermittent, mild persistent, moderate persistent, and severe persistent.

Characteristics of intermittent asthma

Symptoms no more than twice weekly, brief exacerbations, minimal activity limitation.

Characteristics of mild persistent asthma

Symptoms more than twice weekly but not daily.

Characteristics of moderate persistent asthma

Daily symptoms with activity limitations and frequent exacerbations.

Characteristics of severe persistent asthma

Symptoms throughout the day, frequent exacerbations, major activity limitations.

Peak flow meter

Handheld device measuring peak expiratory flow rate to monitor airway narrowing.

Green zone on a peak flow meter

Usually $80\text{--}100\%$ of personal best; indicates good asthma control.

Yellow zone on a peak flow meter

Usually $50\text{--}79\%$ of personal best; signals caution and need for action plan steps.

Red zone on a peak flow meter

Usually below $50\%$ of personal best; indicates a medical alert requiring immediate action.

Optimal position during an acute asthma attack

High-Fowler's or another upright position that facilitates breathing.

Priority medication for acute bronchospasm

Inhaled rapid-acting bronchodilator, commonly albuterol.

Role of corticosteroids in asthma exacerbations

Reduces airway inflammation and helps prevent continued or recurrent worsening.

Adjunctive IV treatment for severe, unresponsive asthma

IV magnesium sulfate.

Priority nursing assessments before and after asthma therapy

Lung sounds, respiratory effort, respiratory rate, heart rate, and oxygen saturation.

Chronic Obstructive Pulmonary Disease (COPD)

Chronic, progressive lung disease with persistent airflow limitation that is not fully reversible.

Two major clinical conditions comprising COPD

Chronic bronchitis and emphysema.

Chronic bronchitis

Chronic bronchial inflammation with excessive mucus production and persistent productive cough.

Emphysema

Destruction of alveolar walls and loss of elastic recoil, causing air trapping and hyperinflation.

Primary risk factors for COPD

Smoking, secondhand smoke, occupational dusts, air pollution, and genetic susceptibility.

Common clinical manifestations of COPD

Progressive dyspnea, chronic cough, sputum production, wheezing, and reduced exercise tolerance.

Cause of barrel chest in COPD

Chronic air trapping and lung hyperinflation increasing anterior-posterior chest diameter.

Reason for prolonged expiration in COPD

Airflow limitation and loss of elastic recoil preventing complete exhalation.

Orthopnea

Difficulty breathing while lying flat.

Purpose of tripod positioning in COPD

Improves respiratory muscle mechanics and eases breathing effort.

Cor pulmonale

Right-sided heart dysfunction caused by pulmonary hypertension associated with lung disease.

Primary acid-base imbalance in advanced COPD

Respiratory acidosis due to chronic carbon dioxide retention.

COPD exacerbation

Acute worsening of respiratory symptoms beyond normal day-to-day variation.

Essential nursing assessments for COPD

Respiratory effort, lung sounds, oxygen saturation, sputum, vital signs, and activity tolerance.

Target oxygen saturation in acute COPD with hypercapnia risk

$88\text{--}92\%$, unless individually prescribed otherwise.

Oxygen administration principle for hypoxemic COPD patients

Do not withhold oxygen; administer appropriately titrated oxygen and monitor status and CO2.

Pursed-lip breathing technique

Inhaling through the nose and exhaling slowly through puckered or nearly closed lips.

Physiological benefit of pursed-lip breathing

Prolongs exhalation, keeps small airways open, and reduces air trapping.

Chest physiotherapy (CPT)

Airway clearance techniques, including percussion and postural drainage, to mobilize secretions.

Dietary strategy for COPD patients with elevated metabolic needs

Small, frequent, nutrient-dense meals high in calories and protein.

Clinical significance of changed sputum in COPD

Increased volume or purulence signals potential exacerbation or respiratory infection.

Pharmacologic classes used in COPD management

Bronchodilators, selected inhaled corticosteroids, and maintenance therapies.

Preventive health measures for COPD

Smoking cessation, recommended immunizations, hand hygiene, and early symptom recognition.

Goal of pulmonary rehabilitation in COPD

Improves exercise tolerance, symptom management, and overall quality of life.