Respiratory Care Ch. 28 (A&N Exam 2)

Chapter 28: Respiratory Care

1. The Mechanics of Breathing

• Diffusion:

  • Oxygen and carbon dioxide move across alveolar membranes into capillaries.

• Inhalation (Inspiration): The process of drawing air into the lungs.

• Exhalation (Expiration): The process of expelling air from the lungs.

2. Regulation of Respiration

• Control Mechanisms:

  • Controlled by nerves and a chemical control system.

  • Medulla: Automatically regulates inhalation.

  • Respiratory center: Influenced by chemoreceptors in carotid and aortic bodies and medulla.

• Chronic Lung Disease:

  • Patients may develop different breathing stimuli over time.

• External Respiration:

  • Occurs between alveoli and capillaries.

• Internal Respiration:

  • Occurs between bloodstream and body cells.

• Pleura:

  • Facilitates lung pressure maintenance and movement.

3. Impaired Oxygenation

3.1 Signs and Symptoms of Hypoxia

• Early Symptoms:

  • Agitation, Anxiety, Changes in consciousness, Disorientation, Headache, Irritability, Restlessness, Tachypnea.

• Late Symptoms:

  • Bradycardia, Cardiac dysrhythmias, Cyanosis, Decreased respiratory rate (bradypnea), Retractions.

3.2 Causes of Impaired Oxygenation

• Airway Obstruction:

  • Tumors, choking, thick mucus, swollen airways.

• Blood Conditions:

  • Anemia, atelectasis (collapsed lung), chronic lung disease.

• Environmental Factors:

  • High altitude, hypoventilation (due to anesthetics, sedatives, coma), poor peripheral circulation, pulmonary embolism.

4. Caring for Patients With Impaired Oxygenation

4.1 Assessment

• Skin Color and Mucous Membranes:

  • Check for cyanosis.

• Respiratory Effort:

  • Monitor for dyspnea or orthopnea.

• Cough Assessment:

  • Check for sputum.

4.2 Diagnostics

• Sputum Specimens:

  • Collect best in the morning through expectoration or suction.

• Arterial Blood Gases (ABGs):

  • Measures pH, PaO2, PaCO2, HCO3–, and SaO2.

• Pulmonary Function Tests:

  • Determine lung capacity, volume, and flow rates; diagnose obstructive/restrictive lung diseases.

• Chest X-ray:

  • Visualizes lung fields to identify issues like pneumonia, tumors, or effusions.

• Bronchoscopy:

  • For visualizing airways and obtaining biopsies or samples.

5. Nursing Interventions for Patients With Impaired Oxygenation

• Techniques:

  • Turn, cough, and deep breathe.

  • Use incentive spirometry.

  • Provide nebulizer treatments and chest physical therapy.

  • Perform postural drainage and percussion.

  • Administer supplemental oxygen and promote conservation of energy.

6. Supplemental Oxygen

• Room Air Composition:

  • Nitrogen 78%, Oxygen 21%, Other Gases >1%.

• Safety Precautions:

  • No smoking, open flames, and avoid petroleum products.

• Toxicity:

  • High oxygen levels can be toxic; aim to keep below 3L/min in chronic obstructive lung disease.

7. Oxygen Delivery Methods

7.1 Types of Oxygen Sources

• Oxygen Tanks:

  • Large green tanks for stationary use; E-cylinders for mobility.

• Oxygen Concentrator:

  • Concentrates oxygen from room air; requires electricity.

• Liquid Oxygen:

  • Lightweight and portable, can last several hours of use.

7.2 Oxygen Masks

• Types:

  • Nasal Cannula, Simple Face Mask, Partial and Non-rebreathing Masks, Venturi Mask, Face Tent, Tracheostomy Collar, T-piece.

8. Patients Needing Airway Assistance

• Pharyngeal Airway Types:

  • Oropharyngeal, Nasopharyngeal (nasal trumpet).

• Endotracheal Airway:

  • Ensures airway during ventilation.

• Tracheostomy:

  • Incision in trachea with a tube to facilitate breathing.

9. Chest Tubes

• Purpose:

  • To relieve pneumothorax and drain pleural fluid or blood.

• Chest Drainage System:

  • Comprises multiple chambers for air and fluid management.

10. Conclusion

• Monitoring and Assessing:

  • Continuously assess patient’s respiratory status, observe for complications, and maintain proper management techniques.