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When stiffer lungs are not able to expand causing collapse and the alveoli to collapse as well.
The tree branches off the bronchi which connect the larger conducting airways with the lung parenchyma.
breathing, the physical process of moving air into and out of the lungs so gas exchange can take place.
the process in which molecules move from an area of greater concentration or pressure to an area of lower concentration or pressure.
fine hairlike projections in the respiratory tract that help sweep away fluid and particles.
what transports oxygen to tissues
forced inspired oxygen transportation (FiO2) is
The percentage of O2 that humans breathe in at room temp".
the subjective feeling of labored breathing and breathlessness.
decreased amount of oxygen available to the tissues
below normal amount of oxygen in the blood.
grayish, bluish, purplish skin tone
breathing in excess of metabolic demands, resulting in removal of too much CO2 from the blood.
brething insufficient to meet metabolic demands and adequately remove CO2 from the blood.
- Continuous Positive Airway Pressure,
- uses oxygen under constant pressure
- used frequently at night for sleep apnea.
- Bilevel Positive Airway Pressure,
- uses a mechanical ventilator to assist with inspiration.
- pushes air into the lungs
- the positive pressure helps to prevent atelectasis by keeping the alveoli inflated.
- used frequently for CHF patients with fluid overload
Breathing delivers and facilitates
delivers air to the lungs and facilitates in gas exchange.
Major organs of the upper respiratory
major organs of the lower respiratory tract
ventilation is the
process of moving air into and out of the lungs
- diaphragm contracts (pulls downward)
- external intercostal muscles (pull outward)
- intrathoracic pressure drops
- air goes into the lungs
during inspiration you have a higher pressure
outside the body then inside the body
when you exhale (expiration) you have a higher pressure
insde the body than you do outside.
oxygen and carbon dioxide move between the
alveoli and the blood by diffusion.
molecules move away from the area
of greater concentration to the area of lower concentration.
the partial pressure of oxygen in alveoli is high while
the partial pressure of carbon dioxide is low.
most oxygen is transported to the tissues by
newborns breathe at breaths per minute
rapidly at 30-60 breaths per minute and have episodes of apnea.
toddlers and preschoolers breathe at breaths per minute
20-30 regular breaths per minute
school age and adolescent breath at breaths per minute
- 12-20 breaths per minute .
- this is the age that many become smokers
adults and older adults breathe at breaths per minute
- 12-20 breaths per minute
- thoracic walls stiffens
- lungs less able to stretch
- decreased ciliary activity
- gas exchange is affected PaO2 decreases and they have decreased response to hypercapnia (high CO2)
- These factors contribute to higher rates of pulmonary infections (pneumonia)
This body postion can allow for easier breathing and why?
- in an upright position because it allows for better lung expansion.
- harder to breath when lying down because abdomen push its contents upward towards the diaphragm.
The percentage of O2 that humans breath in "room air" is
21% and remains relatively constant.
Factors affecting lungs include
- air pollution
- 2nd hand smoke
- pollen and allergens
The body attempts to get rid of substances it perceives as harmful by
releasing chemicals that cause an inflammatory response.
Smokers are more likely to have
- chronic bronchitis
- lung cancer
- oral cancer
- cardiovascular disease
opiods and alcohol can depress
the central nervous system and cause a decrease in respirations thus impairing gas exchange
intoxication can cause vomiting increasing the risk of
aspiration of stomach contents into the lungs.
hydration keeps secretions
nutrients are needed to
keep the immune system healthy
chest movement causing the person to work harder to breathe
- collapse of alveoli
- decreases area for gas exchange
- respiratory muscles consume more O2 because of the amount of work they are doing.
causes for atelectasis
- smoke inhalation
- pulmonary fibrosis
- acute respiratory distress syndrome (ARDS)
- pain from abdominal surgery
- abdominal distension from gas or fluids
- abdominal or chest binders
- rib injuries or chest deformities
- neuromuscular disorders
A cough is a response to, can be triggered by and functions as
- response to irritants in the airway
- can be triggered by chemicals, smoke, physical conditions (hot, dry air) and some medications.
- the function is to clear the substance from the airway
sputum cause, type and origination
- irritation may be the cause
- a cough may be dry or deep to try and clear the mucous
- can originate in the nose versus the lungs access for color, consistency, volume
Shortness of Breath (SOB)
- is a subjective feeling breathlessness (dyspnea)
- most common cause of SOB is lung disease
- reduces gas exchange, altering O2 levels in the body
- causes include anxiety, congestive heart failure and COPD
Chest pain can be associated with
cardiac, respiratory or even GI
Accessory muscle uses to altered respiratory function
- client may lean forward to relieve dyspnea
- retractions (especially children)
- Barrel chested (COPD)
fine crackles are
- high pitched, short, popping sounds heard during inspiration.
- not cleared with coughing
- located in the alveoli
- pneumonia, congestive heart failure, and fluid in the lungs
- low pitched, bubbling, moist sounds heard throughout inspiration and exhalation. Located in the peripheral airways.
- pneumonia, pulmonary edema, pulmonary fibrosis, and fluid in the lungs.
wheezing (rhonchi) sonorous
- resonant: sounding with loud, deep, and clear tones.
- mucous in the upper airways
- low pitched snoring or moaning sounds
- located in the large airways, bronschitis, bronchial obstructions.
- made by directing a jet of air through a narrow channel in the vocal tract towards the sharp edge of the teeth.
- can be located in the large or small airways
- asthma or chronic emphysema
pleural friction rub
- low pitched, dry grating sound
- heard during inspiration and expiration
- created in the pleural surfaces. when the pleural surfaces are inflamed and rubbing together called pleuritis.
- most sever type of inspiratory wheezing
- more common in children with croup or epiglottitis
- if too severe they may need to be intubated.
objective data inspection
- observe the rate and rhythm of respirations
- very slow breathing can cause hypoxia (low O2 levels) and hypercapnia ( high CO2 levels) causing respiratory acidosis.
- fast breathing (hyperventilation) can cause your client to "blow off" too much CO2 (respiratory alkalosis)
objective data palpation
- the hands are used assess abnormalties such as tenderness or swelling
- expansion and contraction of the chest
- position of the trachea
objective data percussion
used to detect fluid or consolidation in the lungs
objecive data ausculation
- listening to breath sounds with a stethoscope
- are we hearing breath sounds thoughout all the fields
- should be equally loud on both sides
- what type of breath sounds are we hearing
- where are we hearing them
- normal is clear white, no odor, medium consistency
- thick and sticky that is hard to cough up can indicate poor hydration
- sputum form asthma clients is stringy like thickened egg whites
- pink frothy sputum indicates pulmonary edema
- yellow, green or foul smelling sputum indicates infection
- blood tinged sputum indicates airway inflammation usually is not serious can occur with severe coughing such as bronchitis
- hemoptysis is a sign of continuous bleeding and needs investigation.
the following prevent respiratory infections
- hand hygiene
- limit exposure
- sneeze and cough into sleeve
- smoking cessation
- reduce allergens
- monitor peak flow in asthmatics
- adequate hydration
- positioning and ambulation
- cough and deep breathing
- incentive spirometer
you can do the following to help clear bronchial secretions
- percussion- strike the chest rhythmically with cupped hands over the area where secretions are located
- vibration- similar to percussion- use the hands like a gentle jackhammer
- postural drainage - uses gravity to assist in the movement of secretions
a chestube is
- a drainage device that is placed by MD in the pleural space to drain fluid, air or blood
- it is sutured in place
- usually hooked up to suction.
diagnostic tests- chest x-ray
- detects abnormal fluid or air in the lungs
- pneumothorax (collapsed lung)
- consolidation ( pneumonia)
- underinflated lungs (atelectasis)
- used to determine position of central venous access devices (CVAD) and intubation tubes
- size of the heart
diagnostic tests- pulmonary function test
- specialized test measure lung size and airway patency
- helps determine the severity of lung problems
- tests: tidal volume, vital capacity, forced expiratory volume in one second
diagnostic tests sputum cultures
- gram stain is performed to determine specific agent
- appropriate antibiotics can be used
- usually treated with broad spectrum antibiotic until the culture and sensitivity report come back
diagnostic tests arterial blood gas (ABG)
- invasive procedure checks arterial blood level, oxygen, CO2 and pH
- Normal values
- PaO2 80-100
- PaCO2 35-45
- pH 7.35-7.45
- HCO3 22-26
- Base excess +/- 2
diagnostic tests levels of hypoxemia
- levels of hypoxemia
- mild PaO2 60-80 mm Hg
- moderate PaO2 40-60 mm Hg
- severe PaO2 less than 40
- These levels naturally decline with age by 1mm Hg per year over the age of 60
- ABG also determines how effectively the lungs remove CO2. hyperventilation show lower levels of CO2. hypoventilation would show high levels of CO2.
- ABG determines the acidity or alkalinity of the arterial blood: pH less than 7.35 is acidosis. pH higher than 7.45 is alkalosis
diagnosic tests pulse oximetry
- noninvasive way to determine clients O2 saturation
- infrared light that determines the percentage of hemoglobin that combines with oxygen. can be affected by blood flow, room lighting, temperature, dark nail polish, movement, smoking
aerosol therapy is
a suspension of microscopic liquid droplets in air or oxygen.
aerosol therapy can be given to
- add moisture to oxygen being delivered
- hydrate and thin mucous secretions
- administer medications via the airways (bronchodilators, antibiotics, and corticosteriods)
metered dose inhalers (MDIs) provide and used
- provides premeasured dose of medication
- usually self administered but the RN may be responsible
- patient needs to breath in the medication and hold their breath
hand held nebulizers
steady stream of medication
oxygen therapy is used when
a disease process may inhibit amount of O2 in the clients body. Oxygen therapy will help to reverse hypoxia.
goals of O2 therapy are:
- improve tissue oxygenation
- decrease work of breathing
- decrease the work of the heart
oxygen flow is expressed in
liters per minute
oxygen concentration is expressed as
a percentage or fraction of inspired oxygen.
the goal of oxygen therapy is
to maintain the PaO2 at 90 mm Hg or above or the SaO2 above 93%
- have 22%-44% oxygen capability
- can deliver fromm 1-6 liters of oxygen per minute
- if long term use then humidify with saline
- 24%-50% oxygen capability
- 3-8 liters per minute
- provides precise and consistent O2 delivery
- patient may feel claustrophobic
- 40-60% oxygen capability
- 6-10 L/min
- most common mid range delivery system
- must have a minimum of 5L/min to prevent client from rebreathing exhaled CO2
- not suitable for COPD patients because of the potential for delivering excessive oxygenation.
reservoir mask (partial re-breather)
- delivers up to 90%oxygen capacity
- 10-15 L/min
- used for critcally ill patients
- allows patient to re breath one third of their CO2
- delivers 80-100%
- 10-15 L/min
- has side valves to prevent CO2 from getting into the reservoir.
nursing interventions include
- health promotion
- adequate hydration
- positioning and ambulation
- cough and deep breathing
- pursed lip breathing
- pulmonary toileting
- oxygen administration
the primary function of the cardiovascular system is
to transport oxygen and nutrients to the tissues and transport waste to the appropriate organs for excretion.
cardiac output refers to
the amount of blood pumped by the heart each minute
in a normal adult the amount of cardiac output is
3.5 to 8 liters per minute
increased metabolic demands can increase
the cardiac output
stroke volume x heart rate
newborn and infant normal heart rate is
- 130-160 beats per minute
- anything less than 100 is not normal
toddler normal heart rate is
- 60-80 beats per minute
- blood pressure around 120/80
adult/older adult normal heart rate is
- 60-100 BPM
- many factors can affect the rate
diseases that affect Cardiac Output
- lack of exercise
- family history
- medications and drug use
altered cardiac function
- changes in vital signs:
- may be hypotensive (systolic of less than 90)
- can mean a decrease in cardiac output
- orthostatic hypotension
- hypertension can lead to kidney failure, congestive heart failure, and other problems
- diminished or absent pulses can indicate decreased blood flow.
altered cardiac function- a compensatory measure is
- increased heart rate
- body may need more oxygen
- blood pressure may be low
- the heart rate should return to baseline within 3 minutes of rest after activity
- a heart does not increase in rate with exercise may indicate that it is not able to compensate
altered cardian function respirations
may increase with cardiac effort and rate
altered cardiac function skin changes
- pale cool clammy if inadequate perfusion
- chronic heart disease may lead to skin lesions and tissue necrosis
decreased cardiac output can be caused by
- muscle damage, conduction problems or valve dysfunction can lead to decrease output
- myocardial infraction or heart attack is a decrease in blood flow to one of the coronary arteries. Once the muscle is damaged the tissue cannot be replaced
- heart enlargement hypertension can cause this.
- valve dysfunction can be damages from inflammation, infection, trauma or could be geneti cause
- conduction electrical impulse doesnt spread throughout the heart properly
dysrhythmias can occur with
- electrolyte imbalances
- dimish blood flow
- decreased O2 levels
alterations in blood flow include
- insufficient blood volume
- insufficient red blood cells
- arterial dysfunction such as atherosclerosis hypertension smoking hyperlipidemia
nursing diagnosis can include
- decreased cardiac output
- ineffective tissue perfusion
- decreased activity intolerance
cadiac interventions include
- lifestyle modifications
- effective coping
- adequate tissue perfusion
pain management chest pain MONA is
Morphine, Oxygen, Nitroglycerin, Aspirin
oxygenation in relation to the heart is all about
cardiac output. driver of the bus (hemoglobin)
infant heartrate below ____ you begin CPR
a clot that can develop in the arteries or veins