Fundamentals Exam 4

ischemia

an inadequate blood supply to an organ or part of the body (especially the heart muscles)

hypoxia

a condition in which an inadequate amount of oxygen is available

signs & symptoms of early stages of hypoxia

dyspnea, tachypnea, anxiety, restlessness, hypertension

signs & symptoms of late stages of hypoxia

pallor, cyanosis, bradycardia, confusion

diffusion

the process for the exchange of respiratory gases in the alveoli of the lungs and the capillaries of the body tissues

perfusion

the passage of fluid through the lymphatic system or blood vessels to an organ or a tissue

cyanosis

a bluish coloration of the skin and mucous membranes; caused by vasoconstriction of the peripheral blood vessels or oxyhemoglobin

(late sign of hypoxia)

hyperventilation

rapid and deep breathing (get rid of too much CO2)

hypoventilation

breathing at an abnormally slow rate, resulting in an increased amount of carbon dioxide (CO2) in the blood (traps CO2 in the lungs)

atelectasis

a collapse of the alveoli that prevents normal exchange of oxygen and carbon dioxide

tidal volume

the amount of air exhaled following a normal inspiration / the volume of air moved between one normal inspiration and one normal expiration

residual volume

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

dyspnea

difficult or labored breathing

apnea

the absence of respirations lasting for 15 seconds or longer

what mechanisms are used to oxygenate blood?

ventilation, perfusion, and transport of respiratory gases

what controls the rate and depth of respiration in response to changing tissue oxygen demands?

neural and chemical regulators

what system provides the transport mechanisms to distribute oxygen to cells and tissues of the body?

the cardiovascular system

the exchange of respiratory gases occurs between the ____ and the ____

the environment and the blood

respiration

the exchange of oxygen and carbon dioxide during cellular metabolism

the airway of the lungs transfer oxygen from the ______ to the ________

from the atmosphere to the alveoli (this is where O2 is exchanged for CO2)

oxygen transfers FROM where TO where

through the alveolar capillary membrane, oxygen transfer to the blood

carbon dioxide transfers FROM where TO where

carbon dioxide transfers from the blood to the alveoli

inspiration and expirations is the effort to -

expand and contract the lungs

surfactant

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

compliance

the ability of the lungs to distend or expand in response to increased intra-alveolar pressure

airway resistance

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

pulmonary circulation

moves blood to and from the alveolar capillary membrane for gas exchange

respiratory gas exchange (diffusion)

diffusion is the process for the exchange of respiratory gases in the alveoli of the lungs and the capillaries of the body tissues

factors affecting oxygenation - physiological factors

decreased oxygen-carrying capacity, hypovolemia, decreased inspired oxygen concentration, increased metabolic rate

conditions affecting chest wall movement

pregnancy, obesity, neuromuscular disease, musculoskeletal abnormalities, trauma, CNS alterations

factors affecting oxygenation - developmental factors (infants and toddlers)

upper respiratory infections and nasal congestion

factors affecting oxygenation - developmental factors (school-aged children and adolescents)

respiratory infections and secondhand smoke, starting cigarette smoking

factors affecting oxygenation - developmental factors (young and middle-aged adults)

cardiopulmonary factors, unhealthy diet, lack of exercise, stress, smoking, illegal substances, OTC and prescription drugs

factors affecting oxygenation - developmental factors (older adults)

calcification of valves, osteoporosis, atherosclerosis, enlarged alveoli, trachea, and bronchi

factors affecting oxygenation - lifestyle factors

nutrition, dietary practices, exercise, cigarette smoking and secondhand smoke, excessive use of alcohol, high anxiety/stress environments/life

factors affecting oxygenation - environmental factors

pollution, occupational pollutants (e.g. asbestos, talcum powder, dust, airborne fibers)

rhonchi

caused by blockages in larges airways (sputum), will typically clear with cough

crackles

caused by the “popping open” of small airways and alveoli collapsed by fluid (FVE), cannot be cleared with cough

wheezes

caused by inflammation and narrowing of the airways in any location (e.g. asthma attacks)

pleural friction rub

occurs when the pleural layers have become inflamed and have lost it’s natural lubrication; sound caused by pleural lining rubbing

respiratory assessment questions to ask

is your cough productive (if so, what color is the sputum)?, do you smoke (if so, what do you smoke, how much, and how long have you smoked)?, are you SOB (if so, what makes it worse or better)?

respiratory assessment physical exam

inspection (breathing pattern, chest wall movement), palpation (chest, feet, legs, pulses), percussion (prescence of abnormal fluid or air, diaphragmatic excursion), auscultation (normal or abnormal heart and lung sounds)

tests used for cardiopulmonary functioning

blood specimens (ABGs), x-rays, sputum specimens (best time to collect is first thing in the morning), pulmonary function tests, peak expiratory flow rate

pulmonary function test

determines ability of the lungs to effectively exchange CO2 and O2

peak expiratory flow rate (PERF)

point of highest flow rate during maximum expiration (good predictor of airway resistance in asthma patients)

respiratory nursing diagnoses

activity intolerance, decreased cardiac output, fatigue, impaired gas exchange, impaired verbal communication, ineffective airway clearance, risk for aspiration, ineffective breathing pattern, ineffective health maintenance

assessments performed before and after breathing treatment

respiration rate, breath sounds, pulse rate

how long should you stay with a patient during a respiratory treatment?

the WHOLE time

incentive spirometry patient education

* perform exercises 10x/hr while awake
* changes positions frequently if on bed rest
* if able, ambulate 10-15 min/8hrs
* sit up in chair as often as possible if able
* increase fluid intake to 2800 mL/hr (unless contraindicated)
* avoid caffeinated and alcoholic beverages
* recommend water always

suctioning techniques - oropharyngeal and nasopharyngeal

used when the patient can cough effectively but is not able to clear secretions

suctioning techniques - orotracheal and nasotracheal

used when the patient is unable to manage secretions by coughing and does not have an artificial airway

suctioning techniques - tracheal

used with an artificial airway

suctioning methods

open (new sterile catheter each time suctioning is performed) and closed

artificial airways - oral airway

prevents obstruction of the trachea by displacement of the tongue into the oropharynx

(oropharyngeal airway - invert, insert, rotate, locate)

artificial airways - endotracheal and tracheal airways

short-term use to ventilate, relieve upper airway obstruction, protect against aspiration, clear secretions

artificial airways - tracheostomy

long-term assistance, surgical incision made into trachea (used for pts with blockages)

risks of suctioning a trachea

hypoxia, infection, tracheal tissue damage, dysrhythmias

what should be done prior to suctioning?

hyperoxygenation

we only suction as needed (PRN), why?

too much suctioning can lead to further secretions, trauma, and unnecessary O2 desaturation

equipment that should always remain at the bedside of a tracheostomy pt

suction equipment, tracheostomy obturator, ambu bag

maintenance and promotion of lung expansion

ambulation, increase fluid intake to thin secretions, positioning reduces pulmonary stasis and maintain and oxygenation / Fowler’s position is best for optimal lung expansion, incentive spirometry, invasive mechanical ventilation, noninvasive ventilation

examples of noninvasive ventilation

continuous positive airway pressure (CPAP) - inspiration, bilevel positive airway pressure (BiPAP) - inspiration and expiration (gives breaths)