gas exchange

Gas Exchange Study Guide Notes

Study Guides and Resources

  • Locate ATI Product:

    • ATI Review Modules 2023 PN

    • ATI Fundamentals for Nursing 11.0 (E-Book)

    • Read: Chapter 53 - Airway Management

  • Locate:

    • ATI Module - Engage Fundamentals PN 2.0

    • Choose: Physiological Concepts for Nursing Practice

    • Complete All Lesson and Tests:

      • Gas Exchange and Oxygenation

      • Complete all Lessons

  • Locate Skills:

    • Administering Oxygen

    • Performing Nasopharyngeal or Nasotracheal Suctioning

    • Preparing an Oxygen Cylinder

Student Learning Outcomes

  • Examine the anatomy, physiology, pathophysiology, and screening of clients experiencing alterations in respiratory function.

  • Collect and interpret subjective/objective data during a targeted assessment.

  • Differentiate the clinical presentation of clients experiencing alterations in respiratory function.

  • Apply the nursing process through the use of clinical judgment while providing care to clients experiencing alterations in respiratory function.

  • Explore the role of the nurse when caring for clients experiencing alterations in respiratory function.

Medical Terms and Definitions

  • Oxygen Saturation (SpO₂ / SaO₂):

    • Percentage of hemoglobin molecules carrying oxygen.

    • SpO₂: Measured by pulse oximeter.

    • SaO₂: Measured by arterial blood gas.

  • Hypoxia:

    • Low oxygen at the tissue or cellular level.

  • Hypoxemia:

    • Low oxygen in the blood (low PaO₂).

  • Hypercapnia:

    • Elevated carbon dioxide in the blood.

  • Hypocapnia:

    • Low carbon dioxide levels in the blood.

  • Work of Breathing (WOB):

    • Effort required to inhale and exhale.

    • Increases during respiratory distress.

Introduction to Gas Exchange and Oxygenation

Gas Exchange

  • Ventilation:

    • The process of moving air in and out of the lungs.

  • Oxygenation:

    • The process of absorbing oxygen into the bloodstream and delivering it to tissues.

Structure and Function of the Lung

Respiratory System Anatomy and Physiology

  • Upper Respiratory Tract:

    • Components include:

    • Nasopharynx

    • Oropharynx

    • Laryngopharynx

    • Epiglottis

    • Larynx

    • Trachea

  • Lower Respiratory Tract:

    • Includes:

    • Left bronchus

    • Right bronchus

    • Bronchioles

    • Alveoli

  • Inspiration and Exhalation:

    • Inspiration: Active process of diaphragm contraction, increasing thoracic cavity volume.

    • Exhalation: Typically a passive process where the diaphragm relaxes, decreasing thoracic cavity volume.

    • Surfactant: Substance that reduces surface tension in the alveoli, preventing collapse.

    • Atelectasis: Collapse of lung tissue affecting gas exchange.

Gas Exchange Process

  • Gas Exchange occurs in the lungs where carbon dioxide leaves the bloodstream and oxygen enters.

  • Alveoli: Air sacs where this exchange occurs efficiently due to their large surface area.

Oxygen Transport

  • Oxygen Transport:

    • The method by which oxygen is carried in the bloodstream to tissues.

Regulation of Respirations

  • Lung Volumes:

    • Various parameters measuring capacity, including Tidal Volume, Vital Capacity and Residual Volume.

Pulmonary Circulation

Pulmonary Circuit Components

  • Heart Function:

    • Movement of deoxygenated blood from the heart to the lungs:

    • Right pulmonary artery

    • Right pulmonary veins

    • Right atrium

    • Right ventricle

    • Left pulmonary veins

    • Left atrium

    • Left ventricle

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Respiratory System Considerations

Changes During Pregnancy

  • Maternal and fetal oxygen demands increase.

  • Total volume expansion of lungs is decreased.

  • Hyperventilation occurs, along with increased carbon dioxide production.

  • Increasing chest diameter for ease of respirations.

Pediatric Client Considerations

  • Shorter trachea and larger tongue.

  • Smaller airway passages and immature control of breathing.

Assessment of the Respiratory System

Recognizing Cues (Assessment)

  1. Observation:

    • Preliminary stats and observing the client's breathing position.

    • Expected findings include relaxed posture with no difficulty in breathing.

    • Unexpected findings include tripod position and intercostal muscle retractions.

  2. Level of Consciousness/Peripheral Circulation:

    • Expected: relaxed and comfortable.

    • Unexpected: anxiousness, agitation, confusion.

    • Peripheral Circulation issues: cool damp skin, cyanosis, clubbing, and pallor.

  3. Respiratory Rate and Oxygen Saturation:

    • Expected respiratory rate: 12-20 breaths per minute.

    • Expected oxygen saturation: greater than 95%.

    • Unexpected if saturation is less than 90%.

Detailed Respiratory Assessment

Anterior Chest Inspection and Auscultation

  • Inspection:

    • Chest shape and configuration should be symmetrical and relaxed.

    • Variations like scoliosis or barrel chest may occur.

  • Auscultation:

    • Listen for breath sounds to detect any abnormalities such as pleural friction rub, crackles, wheezes, rhonchi, and stridor.

Interventions for Respiratory Issues

Required Interventions for Shortness of Breath

  • Assessment:

    • Inspection of chest, nail beds, and mucous membranes.

    • Auscultation for breath sounds.

    • Measurements of oxygen saturation and respiratory rate.

  • Nursing Actions:

    • Positioning, oxygen therapy, and promotion of cough and deep breathing.

    • Incentive spirometry and pulmonary hygiene maintenance.

    • Importance of hydration.

Interventions for Minimal Air Movement

  • Assessment:

    • Check for oxygen saturation and respiratory depth, and rate.

    • Examine chest movement and symmetry, and breathing effort.

  • Nursing Actions:

    • Positioning to maximize airflow, use of oxygen supplementation, and thorough documentation.

Health Promotion Interventions

  • Social Habits:

    • Addressing tobacco use.

  • Education:

    • Importance of immunizations and health awareness for respiratory health.

Documentation Strategies

  • Subjective Data:

    • Information reported by the patient.

  • Objective Data:

    • Vital signs, physical examination findings.

  • Unexpected Findings:

    • Noting any anomalies observed during the assessment, to ensure a comprehensive health record.