Care of clients with problems in Oxygenation: Gas Exchange

Movement of air in and out of the lungs (alveoli) 

Ventilation

Movement of air between the alveoli (O2) and pulmonary capillaries (CO2)

Diffusion

This is dependent on airway resistance and lung compliance

Ventilation

Transport of oxygen and carbon dioxide in the blood and body fluids to body cells

Perfusion

It is also called internal respiration

Perfusion

Give the possible chief complaints for patients with problems in gas exchange

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* Shortness of breath - respiratory patterns
* Labored breathing
* Activity intolerance
* Easy fatigability
* Cough
* Chest pain
* Difficulty moving (doing ADL)

Who is often at risk of experiencing problems in gas exchange, and explain why?

* Older adults or extremes of age since they are immunocompromised
* Pediatric patients because they are smaller and have narrower airways

Process of breathing in and breathing out

Ventilation

Two questions frequently asked regarding smoker patients are:

* Packs per day
* For how many years has the patient been smoking, or at what age did the patient start smoking

It refers to non modifiable factors that has been there with the patient ever since.

Predisposing factors

It refers to the events or activities that triggered the attack to the patient

Precipitating factors

Problem of developing or third world countries

Tuberculosis

The number one reason why tuberculosis is one of the leading respratory diseases in the country.

Non-compliance leading to resistance

Triggers of dyspnea

* Activity
* Allergens
* Change in temperature

Difficulty of breathing during supine position

Orthopnea

Position of relief

upright position

Another term for dry or nonproductive cough

hacking

It is also called the barking cough

Brassy

Sputum present with bacterial infection

Purulent yellowish/pus

What kind of sputum is present with viral infection

clear, thin, mucoid

Conditions that might result to blood-tinged sputum

* Tuberculosis
* Lung cancer
* Laryngeal cancer
* Throat irritation (harmless)

Condition where sputum is profuse, frothy or pink.

pulmonary edema

Possible conditions where sputum is already foul-smelling.

* abscess
* rotten tissue
* necrotic tissue

What are the triggers of chest pain in a patient with respiratory problem

* Coughing
* Breathing

Characterized by __sudden and intense sharp__, stabbing, or burning pain in the chest when inhaling and exhaling.

Pleuritic pain

In what type of condition is pleuritic pain present?

Pneumonia

Inflammation of the lungs

Pneumonia

TRUE or FALSE:

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It is not always necessary for a person with chest pain to undergo an ECG.

FALSE

When assessing the general appearance of a patient, what factors should you take into consideration?

* Color
* Nails
* Respiratory Pattern

What do you call this type of cyanosis

Circumoral or central

What happens to the nails of patients with respiratory problem?

Clubbing or there is increased convexity

Clubbing is a response to ___________

chronic hypoxia

Conditions where clubbing of nails is usually present

* Pediatric - Congenital heart defects
* Adult - Chronic Obstructive Pulmonary Disease

One of the common position of individuals experiencing respiratory distress, aiming to expand their chest cavity

Orthopneic or tripod position

It means that accessory muscles are being used

Retractions

Possible areas where we can observe retractions

* Supraclavicular
* Suprasternal
* Intercostal
* Subcostal

In pediatric patients, where can we observe retrations

subcostal

Barrel chest is expected among patients with what condition

Patients with COPD because there is an enlargement in lungs.

What factors do we take into account when palpating a patient's chest?

* Chest expansion
* Fremitus
* Tenderness

In percussing the patient’s chest, you noticed that it is hyperresonant. This means that there is _______

too much air in the lungs

Hyperresont lungs usually occur in patients with ___________

COPD

Dull sound during percussion is usually heard in patients with ______

Pneumonia because there is too much sputum

This auscultation sound means that there is fluid in the lungs.

Crackles

Specific conditions where you expect crackles in the lungs

* Pneumonia
* Pulmonary edema

What lung sound do you expect when the fluid is in the airways

Rhonchi (low pitch)

It is lung sound also called as a snoring sound usually during expiration

Rhonchi

It is the common breath sound heard in patients with bronconstriction (e.g. asthma)

Wheezing sound

TRUE or FALSE: There could be a wheezing sound in patients with pneumonia

TRUE

What should be taken into consideration before conducting Pulmonary Function Tests?

* Don’t exercise before the test
* Avoid using bronchodilators before
* Avoid too much food intake

This pertains to the unit used for measuring oxygen saturation, also called the saturation of peripheral oxygen.

SpO2 or SaO2

Limitation of measuring the saturation of peripheral oxygen

When the patient has poor peripheral blood flow, specifically when he is on:

* Cardiac arrest/shock
* Severe anemia
* Vasoconstricting medications
* Nail polish
* High carbon dioxide

Two culture/antigen test for Tuberculosis Testing

* PPD: Purified Protein Derivative (skin test)
* **TST**: Tuberculin Skin Tests

How would you guide a patient to provide a good specimen?

Instruct the patient to take a deep breath, and at the highest point of inhalation, initiate a cough.

Nursing care before bronchoscopy

* NPO for 6 hours or night before the procedure
* Remove dentures
* Administer pre-operative medications

Why is anticholinergic drugs usually prescribed before bronchoscopy?

Anticholinergic medications act against parasympathetic reduce secretions that might interfere with the procedure.

Which medication inhibits the patient's gag reflex?

Lidocaine

Nursing care after bronchoscopy

* Watch out for bleeding/DOB
* NPO until gag reflex restores

Before permitting the patient to consume food following bronchoscopy, what initial assessment should the nurse perform?

Check for gag reflex

TRUE or FALSE: Atropine increases the salivation of the patient.

FALSE

Normal value of partial pressure of oxygen

PO2: 80 -100 mmHg

Most harmful effect of getting the ABG of the patient.

* It could puncture the arteries of the patient (through and through)

Test performed to check the patency of ulnar and radial artery

Allen’s Test

Centesis means ________

aspiration

Procedure of aspirating fluids or pus from the patient

Thoracentesis

This refers to a condition where fluid is present within the lungs.

Pulmonary edema

This refers to a condition where fluid is present outside the lungs or within the pleural space

Pleural effusion

Possible complication in performing thoracentesis.

Lung perforation

When conducting a thoracentesis on a patient, what position should the patient be in?

Orthopneic position

What is the recommended patient positioning after a thoracentesis procedure?

Side-lying: Unaffected side

Three basic considerations before performing nursing procedures.

CAN

* Consent
* Allergy
* NPO

It refers to a condition where there is an airway constriction or bronchoconstriction due to various stimuli

Bronchial Asthma

Give different triggers of asthma attack

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* Environmental factors 
* Change in temperature 
* Atmospheric pollutants
* Strong odors
* Allergens
* Stress or emotional upset
* Exercise

What does BA/AE means

Bronchial Asthma in Acute Exacerbation

Two examples of OBSTRUCTIVE LUNG DISEASES

* Bronchial Asthma
* COPD

Wheezing is usually heard during ________

Expiration

When conducting an assessment on a patient with bronchial asthma, what type of lung sounds would be heard during auscultation?

Wheezes

What does anticholinergic medication does with the airway?

Dilates can lead to bronchodilation

Salbutamol is usually combined with ______ to achieve bronchodilation

Ipratropium

Remember: Bronchodilator such as beta 2 agonist and anticholinergics can result to _____________

Tachycardia

Group of disorders characterized by progressive deterioration in pulmonary function

Chronic Obstructive Pulmonary Disease

Number one risk factor of **Chronic Obstructive Pulmonary Disease (COPD)**

Smoking

Protein in the lungs responsible for elastic recoil

Alpha1 - Antitrypsin

Two examples/conditions under Chronic Obstructive Pulmonary Disease (COPD)

* Pulmonary emphysema
* Chronic Bronchitis

Condition wherein there is a loss on the elastic recoil of the lungs, leads to alveolar hyperinflation

Pulmonary emphysema

This condition involves inflammation and excessive mucus production in the bronchial passages of the lungs.

Chronic Bronchitis

TRUE or FALSE: Chronic bronchitis and pulmonary emphysema can occur simultaenously

TRUE

Emphysema: ________

Chronic Bronchitis: Inflamed airways

CO2

TRUE or FALSE: COPD is reversible

FALSE

Possible breath sounds in patients with COPD.

* Wheezes
* Rhonchi
* Crackles

TRUE or FALSE: Chest X Ray is utilized to diagnose COPD

FALSE, it is only used as a contributing assessment in severe COPD cases

Elevation in the blood pressure of the patient’s pulmonary artery.

Pulmonary Hypertension

Also called as the right-sided heart failure

Cor pulmonale

This technique involves breathing to elevate pressure for the release of carbon dioxide.

Diaphragmatic pursed-lip breathing

It is the respiratory center of the body and responsible for breathing

Medula oblongata

_______ is the secondary stimulus for breathing

hypoxia

Medulla oblongata: Increased carbon dioxide

__________ : Hypoxia or decreased oxygen levels

Baroreceptors

The stimulus that assumes control when the medulla oblongata is inactive.

Hypoxia

Three cardinal movements of Chest-pulmo physiotherapy

* Percussion
* Vibration
* Drainage

_________ maintains osmotic pressure and keeps the blood or the plasma in the blood vessel

Albumin

Bronchodilators should be given ______ before meal

30 minutes