NSG 300: TOPIC 7 Questions and answers with 100% accuracy(GUARANTEED SUCCESS)

respiration

the exchange of oxygen and carbon dioxide during cellular metabolism

what are the three steps in the process of oxygenation?

ventilation, perfusion, and diffusion

ventilation

the process of moving gases into and out of the lungs

perfusion

the ability of the cardiovascular system to pump oxygenates blood to the tissues and return deoxygenated blood to the lungs

diffusion

exchange of respiratory gases in the alveoli and capillaries

inspiration

an active process, stimulated by chemical receptors in the aorta.

expiration

a passive process that depends on the elastic recoil properties of the lungs, requiring little or no muscle work.

surfactant

a chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing.

atelectasis

a collapse of the alveoli that prevents normal exchange of oxygen and carbon dioxide. (collapsed lung)

compliance

the ability of the lungs to distend or expand in response to increased interalveolar pressure.

when does compliance of the lungs decrease?

in diseases such as pulmonary edema, interstitial and pleural fibrosis, and congenital or traumatic structural abnormalities such as kyphosis or fractured ribs.

airway resistance

the increase in pressure that occurs as the diameter of the airways decreases from mouth/nose to alveoli.

increased vs decreased airway resistance

increased: bronchoconstriction

decreases: bronchdilation

prolonged use of accessory muscles....

does not promote effective ventilation and causes fatigue.

where do you see the use of accessory muscles in a patient

During assessment observe for elevation of the patient's clavicles during inspiration, which can indicate ventilatory fatigue, air hunger, or decreased lung expansion.

tidal volume

is the amount of air exhaled following a normal inspiration.

residual volume

is the amount of air left in the alveoli after a full expiration.

forced vital capacity

the maximum amount of air that can be removed from the lungs during forced expiration

blood moves to and from the ______ for gas exchange

alveloar capillary

What affects the rate of diffusion?

thickness of membrane (increased. thickness takes gases longer to transfer across the membrane)

Three things influence the capacity of the blood to carry oxygen:

-the amount of dissolved oxygen in the plasma,

-the amount of hemoglobin,

-the ability of hemoglobin to bind with oxygen.

hemoglobin

which is a carrier for oxygen and carbon dioxide, transports most oxygen (approximately 97%).

neural regulation includes...

central nervous system control of respiratory rate, depth, and rhythm.

what does the cerebral cortex regulate?

the voluntary control of respiration by delivering impulses to the respiratory motor neurons by way of the spinal cord.

chemical regulation maintains...

the appropriate rate and depth of respirations based on changes in carbon dioxide (CO2), oxygen (O2), and hydrogen ion (H+) concentrations (pH) in the blood.

what are factors that decrease the oxygen carrying capacity of the blood

anemia and inhalation of toxic substances (CO)

what can cause hypovolemia and why?

shock and severe dehydration because extracellular fluid loss and reduces circulating blood volume

decreased circulating blood volume causes

hypoxia to the body

the HR increases to increase volume of blood being returned to the heart (increasing CO)

With the decline of the concentration of inspired oxygen...

the oxygen-carrying capacity of the blood decreases.

anemia

(e.g., a lower-than-normal hemoglobin level) is a result of decreased hemoglobin production, increased red blood cell destruction, and/or blood loss.

hypoventilation

Alveolar ventilation inadequate to meet the body's oxygen demand or to eliminate sufficient carbon dioxide

signs and symptoms of hypoventilation

mental status changes, dysrhythmias, and potential cardiac arrest

hyperventilation

Ventilation in excess of that required to eliminate carbon dioxide produced by cellular metabolism

what can induce hyperventilation

Severe anxiety, infection, drugs, or an acid-base imbalance

signs and symptoms of hyperventilation

rapid respirations, sighing breaths, numbness and tingling of hands/feet, light-headedness, and loss of consciousness

hypoxia

Inadequate tissue oxygenation at the cellular level

Causes of hypoxia include

(1) a decreased hemoglobin level and lowered oxygen-carrying capacity of the blood

(2) a diminished concentration of inspired oxygen, which occurs at high altitudes

(3) the inability of the tissues to extract oxygen from the blood, as with cyanide poisoning

(4) decreased diffusion of oxygen from the alveoli to the blood, as in pneumonia

(5) poor tissue perfusion with oxygenated blood, as with shock; and

(6) impaired ventilation, as with multiple rib fractures or chest trauma.

The clinical signs and symptoms of hypoxia include

apprehension, restlessness, inability to concentrate, decreased level of consciousness, dizziness, and behavioral changes.

hypoxemia

Refers to a decrease in the amount of arterial oxygen.

cyanosis

Blue discoloration of the skin and mucous membranes caused by the presence of desaturated hemoglobin in capillaries, is a late sign of hypoxia.

Central cyanosis

observed in the tongue, soft palate, and conjunctiva of the eye where blood flow is high, indicates hypoxemia.

Peripheral cyanosis

seen in the extremities, nail beds, and earlobes, is often a result of vasoconstriction and stagnant blood flow.

Factors influencing oxygenation:

- Developmental (cardiac and respiratory changes throughout the aging process)

- Lifestyle (nutrition/obesity, exercise, cigarette smoking, excessive alcohol use, anxiety and other stresses)

- Environmental (smoggy, urban areas, pollutants, etc)

Pleuritic chest pain results from...

inflammation of the pleural space of the lungs, the pain is peripheral and radiates to the scapular regions.

dyspnea

difficult or labored breathing

orthopnea

ability to breathe only in an upright position (a patient uses multiple pillows when reclining to breathe easier or sits leaning forward with arms elevated.)

wheezing

a high-pitched musical sound caused by high-velocity movement of air through a narrowed airway. It is associated with asthma, acute bronchitis, and pneumonia.

what will a patient complain of when they have CO poisoning

general malaise, flulike symptoms, and excessive sleepiness.

pulse oximetry

provides an instant feedback about the patient's level of oxygenation.

capnography

, also known as end title CO2 monitoring, provides instant information about the patient's ventilation (how effectively CO2 is being eliminated by the pulmonary system), perfusion (how effectively CO2 is being transport through the vascular system), as well as how effectively CO2 is produced by cellular metabolism

Normal respiratory rate

12-20 breaths per minute

bradypnea

slow breathing <12 breaths/min

tachypnea

rapid breathing >20 breaths/min

Kussmaul respirations

very deep and rapid respirations to compensate by decreasing carbon dioxide levels

apnea

absence of breathing lasting or 15 seconds or longer

Cheyne-Stokes respiration

pattern of breathing characterized by a gradual increase of depth and sometimes rate to a maximum level, followed by a decrease, resulting in apnea

Occurs when there is decreased blood floe or injury to the brainstem

what conditions cause the chest to go into a "barrel" shape?

emphysema, advancing age, and COPD

percussion of the chest wall detects..

the presence of abnormal fluid or air in the lungs.

auscultation of the chest wall

Identification of normal and abnormal heart and lung sounds. lung sounds involves listening for movement of air throughout all lung fields

normal WBC count

5,000-10,000

normal RBC count: male

4,000,000-6,000,000

normal RBC count: female

4,000,000-5,000,000

normal Hgb level: male

14-18g/dL

normal Hgb level: female

12-16 g/dL

normal Hct: male

42-52%

normal Hct: female

37-47%

what color should mucus be

clear

white mucus indicates...

-allergy or sinus infection

-cold temperature or low humidity climates

yellow mucus indicates...

a sign that your body may be starting to fight off infection

green mucus indicates...

sure sign of viral or bacterial infection

pink mucus indicates...

pink frothy secretions are always a sign of pulmonary edema

red or brown mucus indicates...

blood mixed with mucus

black mucus indicates...

patient is a smoker or has been breathing polluted air

what diet should a patient eat to maintain a healthy weight for their height

a healthy low-fat, high-fiber diet; monitor their cholesterol, triglyceride, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) levels; reduce stress; exercise

what treatment can reduce dyspnea associates with exercise and hypoxia

oxygen therapy

airway maintenance requires...

-hydration to prevent thick, tenacious secretions.

-Proper coughing techniques remove secretions and keep the airway open.

-A variety of interventions, such as suctioning, chest physiotherapy, and nebulizer therapy

humidification

process of adding water to gas

nebulization

adds moisture or medications to inspired air by mixing particles of varying sizes with the air

During chest percussion what is the expected outcome

The procedure should produce a hollow sound and should not be painful.

vibration

A gentle, shaking pressure applied to the chest wall to shake secretions into larger airways. This technique increases the velocity and turbulence of exhaled air, facilitating secretion removal. Vibration increases the exhalation of trapped air, shakes mucus loose, and induces a cough.

while the patient is awake how often should they deep breathe and cough

every 2 hours

if a patient is on bed rest how often should the client ambulate/change positions

ambulate 10 to 15 minutes every 8 hours, and encourage him to sit up in a chair as often as he is able to tolerate.

for airway management, the nurse should encourage the client to increase their fluid intake to

2800mL/24hours

Immobility is a major factor in developing _______

atelectasis

what is the most effective position for promoting lung expansion and reducing pressure from the abdomen on diaphragm

45-degree semi-Fowler's

incentive spirometry

Method of encouraging voluntary deep breathing by providing visual feedback to patients of the inspiratory volume they have achieved.

Assist Control

delivers a set tidal volume (VT) with each breath, regardless if the breath was triggered by the patient or the ventilator.

Synchronized intermittent mandatory ventilation

delivers a minimum number of fully assisted breaths per minute that are synchronized with the patient's respiratory effort. Any breaths taken between volume-cycled breaths are not assisted; the volume of these breaths are determined by the patient's strength, effort, and lung mechanics.

Pressure Support mode is often combined with SIMV mode

inspiratory pressure is added to spontaneous breaths to overcome the resistance of the endotracheal tube or to help increase the volume of the patient's spontaneous breaths.

Volutrauma

occurs as a result of alveolar overdistention secondary to the mechanical ventilation.

Ventilator-associated pneumonia (VAP)

a significant potential complication because the artificial airway tube bypasses many of the lung's normal defense mechanisms.

Noninvasive ventilation

Continuous positive airway pressure (CPAP) is used for

patients with obstructive sleep apnea, patients with heart failure, and preterm infants with underdeveloped lungs.

Continuous positive airway pressure (CPAP) includes

includes a mask that fits over the nose or both nose and mouth and a CPAP machine that delivers air to the mask The smallest mask with the proper fit is the most effective.

what is important about the CPAP and proper fit?

Because straps hold the mask in place, it is important to assess for excess pressure on the patient's face or nose that could cause skin breakdown or necrosis.

Complications of noninvasive ventilation include

facial and nasal injury and skin breakdown, dry mucous membranes and thick secretions, and aspiration of gastric contents if vomiting occurs during ventilation.

Pneumothorax

a collection of air in the pleural space.

Hemothorax

an accumulation of blood in the pleural space.

Oxygen therapy

The goal of oxygen therapy is to prevent or relieve hypoxia by delivering oxygen at concentrations greater than ambient air (21%).

nasal cannula

A device that delivers low concentrations of oxygen through two prongs that rest in the patient's nostrils.

oxygen mask

a device that fits over the patient's nose and mouth and delivers oxygen, humidity, and/or heated humidity