Gas exchange, upper year cards

nurs 232 final exam

ischemia

insufficient flow of oxygenated blood to tissues

what can ischemia result in

hypoxia and cellular injury

hypoxia

-oxygen reaching cells is insufficient
-causes inflammation

anoxia

total lack of oxygen in body tissues

diffusion

the transport process in which molecules distribute themselves evenly throughout a solution

hyperventilation

increased ventilation

hypoventilation

decreased ventilation

what is very important in gas exchange

RBCs

hypercapnia

-increase carbon dioxide in blood
- CO2 gets into CSF and lower pH and stimulates respiratory center
-CNS depression

where does increased depth of respirations in hypercapnia occur

medulla oblongata

when does hypercapnia usually occur

person has a head injury or overdose

intervention for hypercapnia

bagging (rebreather)

hypoxemia

-decrease in oxygen in blood (PAO2)
-chemoreceptors respond
-Important in those with COPD because there is a different drive for breathing

apnea

temporary cessation of breathing

dyspnea

difficulty breathing

tachypnea

rapid breathing

orthopnea

SOB when lying flat and can be due to heart failure or obesity

cheyne stokes

"death rattle" abnormal pattern of breathing near end of life

kussmaul

deep and labored breathing
-often seen in diabetic

why do diabetics have kussmaul respirations

there is a build up of metabolic acidosis and the lungs will try to deep breath CO2 at rapid rate

tidal volume

volume going in and out as you breath with no effort

FEV1

how much air a person can blow out in one second

total lung capacity

vital capacity plus residual volume

residual volume

volume of air still remaining in the lungs after the most forcible expiration possible

forced expiratory volume

measures how much air a person can exhale during a forced breath

vital capacity

The total volume of air that can be exhaled after maximal inhalation.

two major mechanisms implicated in impaired ventilation

compression of airways and disruption of the neuronal transmission needed to stimulate the airway

impaired ventilation

a problem of blocking airflow in and out of the lungs

impaired diffusion

Restricted transfer of oxygen and/or carbon dioxide across the alveolar capillary junction

what is impaired diffusion dependent upon

solubility and partial pressure of the gas, surface area and thickness of the membrane, adequate blood flow

what affects the PaO2

temperature, pressure, oxygen deprivation

when does PaCo2 increase

tissue metabolism (fever and exercise)

what happens to the surface area and thickness of membranes in impaired diffusion

damage to alveolar capillary membrane, diseases such as pneumonia, edema

ventilation perfusion leads to

hypoxemia
hypoxia
hypercapnia

whether altered ventilation or diffusion what can occur

high CO2, not enough oxygen in the blood, respiratory acidosis leading to cell death

what helps altitude sickness

slower breaths, decrease energy level

where does the issue with altered ventilation or diffusion begin

at the alveolar capillary junction and it has become too thick or has a partial pressure issue

what alters ventilation in the body

bronchoconstriction, inflammation, suffocation, blocked entrance

what alters diffusion

thickness at alveolar capillary junction or partial pressure issue

hyperthermic

causes issue with absorbability of oxygen and solubility of gases

manifestations of impaired ventilation/diffusion

cough, mucus, hemoptysis, dyspnea, orthopnea, adventitious lung sounds, chest pain, barrel chest

hemoptsysis

coughing sputum with blood in it

use of accessory muscles

squeezing shoulders up to get a breath

chest pain occurs by

lack of oxygen going to heart

systemic manifestations of impaired ventilation/diffusion

-fever, high WBC
-cyanosis (very late stage and need to intervene ASAP)
-finger clubbing (chronic low oxygen in blood or COPD)
-mental status change

lab tests done for impaired ventilation/diffusion

bronchoscopy, CT, MRI, x-ray, pulse oximetry, pulmonary function

peak flow meter measures what

forced expiratory volume in one second

how to read a peak flow meter

the lower the percentage the more impaired ventilation the person has

how to use peak flow meter

patient blows out all air and take in deep breathe and then blows out all the air as quickly as they can and the marker will move up. Do it 3x and use the highest result

what is normal reading of peak flow meter

80-20%

treating impaired ventilation and diffusion

-Remove obstruction and restore physical integrity of airways, lung tissues
-Decrease inflammation and mucus; treat infection
-Supplemental oxygen
-Mechanical ventilation

causes of altered ventilation and diffusion

pneumonia, TB, cystic fibrosis, COPD, asthma, pulmonary embolism

acute respiratory distress syndrome

-the lungs become stiff and cannot move
-even ventilator cannot help

where does pneumonia occur

bronchioles, interstitial lung tissue, alveoli

spread of pneumonia

respiratory droplet spread

pneumonia

-inflammation of the lungs
-accumulation and consolidation of debris causing decreased air entry

what do we want to hear in pneumonia

crackles and pops because we know the pneumonia is being broken down so that they can breathe

how does barrel chest occur

alveoli blow up and push on the chest

Which of the following symptoms of pneumonia is seen more often in elderly patients versus young individuals?
-confusion
-fever

confusion

Which of the following symptoms of pneumonia is seen more often in young patients versus older patients ?

fever

clinical manifestations of pneumonia

fever, chills, cough, fatigue, loss of appetite, dyspnea, tacky cardia, crackles

diagnosis of pneumonia

chest x ray
CBC
thoracic CT scan

treatment of pneumonia

supplemental oxygen, fluids, physiotherapy

what is normal lung tissue on X-ray fo lung

black

asthma

intermittent or persistant airway obstruction

asthma causes

airborne substances, respiratory infection, physical activity, cold air, air pollutants, strong emotions, GERD

how does an allergen react

IgE stimulates mast cells and histamines come along. Leukotrines are stimulated from the AA pathway and then narrows the airway.

manifestations of asthma

wheezing, tachypnea, coughing. chest tightness, excess sputum production, anxiety

immediate treatment of asthma

short acting beta agonists such as bronchodilators, Ventolin, corticosteroids

long term treatment of asthma

steroids such as leukotriene modifiers
-wash mouth after

why are antihistamines used in asthma

control allergic reaction

anticholinergic drugs

dry up all the secretions blocking the airways

epinephrine

used in emergencies to open up airways

most effective drug for asthma

beta 2 adrenergic agonists

short acting beta 2 adrenergic agonists

Albuterol
-can make people jittery, raises pulse

long acting beta 2 adrenergic agonists

-must use steroid along with it
-If used alone can lead To death

leukotriene modifiers

secondary drugs that stop leukotrienes

Anticholinergic drugs

-acetylcholine
-atrovent
-help open airways a bit but help get rid of secretions
-these are long acting and need to be combined with a steroid

Corticosteroids

-longterm control of airways

side effects of corticosteroids

oral fungus if mouths not rinsed after use

contraindication of corticosteroids

people with aids because they are more susceptible to opportunistic infections

who should not get corticosteroids

PUD and renal disease

what is epinephrine

adrenergic agonist

how does epinephrine work

-activates beta 2 receptors in the lungs so that vasodilation occurs to reduce wheezing
-stimulates heart rate
-reduces hives and swelling on face

what does COPS lead to

high arterial levels of CO2 and low levels of oxygen

what is the stimulus for ventilation in COPD managed by

peripheral chemoreceptors in the carotid bodies and aortic arch. These send messages to the medulla oblongata

what happens after low levels of oxygen stimulate chemoreceptors to send messages to the medulla oblongata?

respiratory rate increases with low oxygen levels and is reduced with high oxygen levels