Card Set Information
Oxygenation - Carrow
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
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
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
acute respiratory distress syndrome (ARDS)
pain from abdominal surgery
abdominal distension from gas or fluids
abdominal or chest binders
rib injuries or chest deformities
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
: 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
sneeze and cough into sleeve
monitor peak flow in asthmatics
positioning and ambulation
cough and deep breathing
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
: 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
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
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
used for critcally ill patients
allows patient to re breath one third of their CO2
has side valves to prevent CO2 from getting into the reservoir.
nursing interventions include
positioning and ambulation
cough and deep breathing
pursed lip breathing
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
many factors can affect the rate
diseases that affect Cardiac Output
lack of exercise
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
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
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
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