U3: Gas exchange and oxygentaion

Bronchocontriction

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

Bronchodilation

Expansion of the airway in the bronchus

Pleural Cavity

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

Pleura

A protective layer or membrane covering the lungs

Cardiopulmonary Assessment- Dietary Habits

-Diet rich in veggies, fruits, fiber, whole grains, an omega-3 fatty acids

-DASH diet

-Mediterranean Diet

How long should you exercise for?

30-60 minutes per day

smoking

Nicotine-causes vasocontriction

Cigarettes- Increase COPD, emphysema, and lung cancer risk

Stress

-Increases BP

-Increases HR

-Increases Cortisol Levels

-Enhances fight-or-flight response

environment

-dust

-second-hand smoke

-construction

-chemicals

Inspection

-Barrel chest is seen in COPD

-Tripod Postion helps with breathing(lean forward with arms crossed on the table

-JVD is increased workload in right side of the heart

Palpation/Assessment

-Symmetrical Lung expansion

-Pain when breathing

-Pleural effusion(fluid trapped in the pleural)

-Pneumothroax (air trapped in the pleural)

-Edema

-Cap Refill Time

-Pulse assessment

Crackles in the lungs

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

Wheezing in the lungs

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

Rhonci in the lungs

Obstruction of the airway that sounds like rattling

Stridor in the lungs

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

S/S of hypoxemia

-confusion

-irritability

-restlessness

-dyspnea

-tachypnea

-tachycardia

-hypertension

-Cyanosis

-Accessory muscle use

-Pursed lip breathing

-hyper and hypo ventilation

Atrial Fibrillation

Atria quiver can cause blood clots

-May have chest discomfort

-Patients need to be on blood thinners to prevent HA/Stroke

What is ventricular Tachycardia?

Heart chambers are unable to fill with blood and they may have a pulse or have chest pain, dizziness, and SOB

What is left sided heart failure?

This affects the left ventricle where blood backs up into the pulmonary veins instead of being carried away

• think: respiratory and neuro

what are s/s of left-sided HF?

hypoxia, crackles, and SOB

what is right-sided heart failure?

Heart is unable to pump blood into the lungs and congests into the peripheral circulation where fluid leaves veins and causes peripheal edema, edema occurs in the lower extremities, genitials, organs, and abdomen, JVD, and you should limit fluids

think: swollen veins, swollen extremities

valvular heart disease

stenosis and regurgitation and leads to backflow of blood

hypoperfusion

usually caused by hypotension

s/s of hypoperfusion

chest pain, syncope, decreased urine output, dysrhythmias

angina pectoris

reduction in blood flow and oxygen to heart, tightness, squeezing, heaviness in the chest, burning, fullness, pressure

treatment for angina pectoris

rest, nitroglycerin, aspirin

what can cause angina pectoris

stress, anxiety, excessive exertion can trigger pain

myocardial infarction

irreversible damage to the heart from decreased oxygen supply, irregular heart rate, diaphorisis, anxiety, lightheadedness, tachypnea, and chest pain with radiation to back'/shoulders

Nitroglycerin does NOT relieve chest pain (true or false)

true

obsructive sleep apnea

-soft tisue 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

COPD

-most common cause of smoking

-can be genetic

-includes bronchitis and emphysema

-tripod postion helps with air hunger

-teach patient how to perform pursed-lip breathing for trapped air

-these patients live with lower O2 saturations

-Chronic O2 retention

-Do NOT over oxygenate

use a venturi mask for this pt.

Emphysema

-alveoli become damaged from trapped air

-blebs in lungs

-air becomes trapped and causes "barrel chest"

bronchitis

mucous and inflammation in the airway

asthma

-common

-airways become narrow and inflamed

-if patient has severe asthma attach with severe wheezing

-bronchodialators ASAP

pneumonia

-congestion, infiltrates, bacteria in lungs

-can be from hospital or environment

-can be from hospital or environment

-prevention!

-ambulate! 1st priority

-turn, cough, deep breathe 2nd priority

-incentive spirometer 2nd priority

-humidify oxygen if needed

-promote fluids

-suction secretions

nasal cannula

-least instrusive 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

-similiar to simple mask, but with resorvoir 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 and CO2 are mixed

nonrebreather

-gasses are not mixed

-bag fills with O2 and patient only breathes from the bag

-make sure bag is completly inflated with oxygen BEFORE placing on patient

-10 - 15 80% - 95%

venturi mask

-4 - 15 L/min, 24% - 60%

-different barrels used to deliver precise amount

aerosol device

-nebulized solutions

-medications change from liquid to mist

-breathing treatments

-corticosteroids and bronchodilators

continous positive airway pressure (CPAP)

-machine with hose

-constant flow of air

-medications change from liquid to mist

-breathing treatments

-main use is obstructive sleep apnea

bilevel positive airway pressure (BiPAP)

-pressure higher when inhaliing and lower when exhaling

-for patients whose airway collapses when sleeping

-also used for muscle weakness

-most invasive

toxicity

high partial pressures lead to damage to cellular membranes

acute toxicity

-central nervous system damage

-twitching of hand muscles, nausea, convulsions, dysphoria, tinnitus

chronic toxictiy

-pulmonary system damage

-atelectasis, couging, dyspnea, pleuritic chest pain, substernal heaviness

-symptoms lessen within 4 hours once O2 is discontinued

-avoid stress, cold, fatigue

-use as little as O2 as possible

patient education for home oxygen therapy

-no smoking

-no open flames

-keep heat sources away

-keep away flammable liquids

-do not use petroleum- bases lotio/lip balm

-no aerosal 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 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 1-2 teaspoons of mucous 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 clearence of secretions from the lungs

-can be used in combination with aerosolized medications, suctioning, and incentive spirometer

-can humidify O2 if patient is having difficulty coughing secretions

nursing actions to improve oxygenation

-incentive spirometer- know how to use

-purse-lip breathing- know how to use

chest tubes

-want gentle tidaling

-bubbling is BAD! (air leak) check the tubing first

-keep system below patients chest

-do NOT remove

-document drainage amount, color, consitency each shift

-keep patient upright

-patient can ambulate with chest tube per physician order