Respiratory

Alterations in Gas Exchange

Learning Objectives

  • Pathophysiology for Gas Exchange

    • Understanding how gas exchange occurs in healthy states versus altered states.

  • Epidemiological and Etiological Risk Factors

    • Analyze risk factors contributing to alterations in gas exchange for clients.

  • Impact on Overall Health

    • Assess how alterations in gas exchange affect comprehensive client health.

  • Clinical Presentations

    • Differentiate signs and symptoms indicative of altered gas exchange in clients.

  • Role of the Nurse

    • Explore nursing responsibilities when caring for clients with gas exchange alterations.

  • Nursing Process Application

    • Implement clinical judgment functions throughout the care for these clients.

Respiratory System: Diagnostic Procedures

  • Pulmonary Function Tests (PFTs)

    • Measure various lung parameters:

    • Lung volumes and capacities.

    • Diffusion capacity and gas exchange.

    • Flow rates and airway resistance.

    • Instructions for Patients:

    • Smoking: No smoking 6 to 8 hours prior.

    • Inhalers: Withhold inhalers 4 to 6 hours prior to testing.

  • Bronchoscopy

    • Visualization tool for larynx, trachea, and bronchi.

    • Therapeutic uses:

    • Removal of foreign bodies and secretions.

    • Treatment for postoperative atelectasis.

    • Lesion destruction and excision.

  • Thoracentesis

    • Surgical perforation of the chest wall/pleural space using a large-bore needle.

    • Purposes:

    • Diagnostic specimen collection.

    • Medication instillation into pleural space.

    • Therapeutic relief from fluid or air (effusion).

  • Arterial Blood Gas (ABG) Analysis

    • Normal Values:

    • pH: 7.35-7.45

      • Lower -> Acidosis

      • Higher -> Alkalosis

    • PaCO2: 35-45 mmHg

    • HCO3-: 22-26 mEq/L

    • PaO2: 80-100 mmHg

Rhinitis and Sinusitis

  • Clinical Features

    • Rhinorrhea, pruritus of nose and eyes, low-grade fever, fatigue, sore throat.

  • Nursing Care

    • Encourage rest and hydration.

    • Minimize spread of infection.

    • Advise clients to seek care if symptoms do not improve or worsen.

  • Medications

    • Antihistamines, leukotriene modifiers, decongestants, expectorants, antipyretics, antibiotics.

Influenza

  • Types: Seasonal vs. Pandemic

  • Symptoms

    • Headache, muscle ache, chills, fatigue, weakness, fever, nausea/vomiting, cough.

  • Diagnosis

    • Rapid flu swab test.

  • Treatment

    • Antiviral medications (Oseltamivir, Zanamivir) should be administered within 48 hours of symptom onset.

    • Vaccination: Not preventative but reduces severity; administered yearly.

    • Contraindications: Live vaccines should not be given to immunocompromised individuals.

  • Possible Complications

    • Pneumonia and exacerbation of existing lung diseases.

Pneumonia

  • Pathophysiology

    • Lung infection caused by bacterial or viral pathogens:

    • Transmission via droplets or aerosols, pathogens colonize nasopharynx, travel to lungs and alveoli.

  • Epidemiology

    • Increased incidence among older adults and individuals with chronic lung diseases.

Impact on Overall Health

  • Physiological/Psychosocial Effects

    • Exacerbation of comorbid conditions, increased susceptibility to pneumonia in older adults and immunocompromised clients, and effects of immobility.

  • Types of Pneumonia

    • Community-acquired pneumonia (CAP): Common, often following influenza.

    • Healthcare-acquired pneumonia (HAP): Higher mortality, often antibiotic-resistant, develops after 48 hours of care exposure.

    • Ventilator-associated pneumonia (VAP).

Clinical Presentation

  • Manifestations

    • Symptoms include cough, dyspnea, pleuritic chest pain, abnormal lung sounds, fever, chills, flushed face, diaphoresis, production of yellow-tinged sputum, crackles, and wheezes.

  • Diagnostic Studies

    • Sputum Culture for sensitivity.

    • CBC with elevated WBC count (may not be present in the elderly).

    • ABGs showing hypoxemia (PaO2 < 80 mmHg).

    • Blood Cultures: To rule out bacteremia.

    • Serum Electrolytes: Indicate dehydration.

    • Chest X-ray: Shows consolidation in lungs.

Asthma

  • Definition

    • Chronic inflammatory disorder characterized by reversible airway obstruction from inflammation or airway hyperresponsiveness.

    • Inflammation results in mucosal edema, bronchoconstriction, and enhanced mucus production, possibly leading to airway remodeling.

  • Triggers

    • Various environmental and physiological factors.

Risk Factors

  • Family history of asthma, smoking, secondhand smoke exposure, environmental allergies, exposure to chemical irritants, gastroesophageal reflux disease.

Clinical Presentation

  • Symptoms

    • Dyspnea, chest tightness, anxiety or stress, coughing, wheezing, mucus production, accessory muscle usage, prolonged exhalation, low oxygen saturation (SaO2), barrel chest or increased chest diameter.

Diagnosis

  • Lab Tests & Diagnostic Studies

    • Arterial blood gases (ABGs): Indicate low O2 or high CO2 levels.

    • Sputum cultures: To identify bacterial infections.

    • Pulse oximetry.

    • Pulmonary function tests (PFTs), specifically measuring the forced expiratory volume in the first second (FEV1); increase in FEV1 by 12% after bronchodilator use is diagnostic for asthma.

  • Chest X-ray: Used to evaluate structural changes.

Nursing Care

  • Actions for Management

    • Positioning for better ventilation, administering prescribed oxygen, conducting proper assessments, and integrating rest in daily activities.

    • Vigilance for infections.

Medications

  • Bronchodilators (four types), corticosteroids, leukotriene modifiers, monoclonal antibodies, and phosphodiesterase-4 inhibitors.

  • Administration methods: Metered-dose inhaler (MDI), dry powder inhaler (DPI), nebulizers.

Patient Education

  • Stopping smoking, avoiding triggers, importance of vaccinations (influenza and pneumonia), proper medication administration, utilizing a peak flow meter, and maintaining regular exercise as part of asthma management.

Status Asthmaticus

  • Definition

    • Life-threatening episode of unresponsive airway obstruction characterized by extreme wheezing, labored breathing, accessory muscle use, distended neck veins, and high risk of cardiac/respiratory arrest.

  • Management

    • Preparations for emergency intubation, IV fluids, supplemental oxygen, bronchodilators, epinephrine, and initiation of systemic steroid therapy.

Obstructive Sleep Apnea

  • Causes

    • Nasopharyngeal tissue contraction leading to airway obstruction.

  • Symptoms

    • Snoring, cessation of breathing for 10 seconds or more, daytime sleepiness.

  • Risk Factors

    • Obesity (primary risk factor), male gender, advanced age, and diabetes.

Chronic Obstructive Pulmonary Disease (COPD)

  • Pathophysiology

    • Characterized by chronic bronchitis and emphysema:

    • Emphysema: Loss of lung elasticity and