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What is respiration?
Supplies the cells with oxygen and removes carbon dioxide
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What is ventilation?
- Mechanical movement of air to and from the atmosphere and the alveoli
- It is the actual work of breathing
- The amount of work that must be performed to overcome the elastic and resistive properties of the lungs
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Important aspects to assess in a respiratory system history
- Smoking hx
- Childhood illnesses-asthma, pneumonia, communicable diseases, hay fever, allergies, eczema, frequent colds, croup, cystic fibrosis
- Adult illnesses-pneumonia, sinusitis, tuberculosis, HIV/AIDS, emphysema, sarcoidosis, diabetes, hypertension, heart disease
- Vaccinations-influenza, pneumoccocal (pneumovax), BCG
- Surgeries of respiratory system
- Hospitalizations
- Date of last diagnostic test-chest x-ray, PFT, tuberculin test
- Recent weight loss
- Night sweats
- Sleep disturbances
- Lungs disease
- Family hx
- Recent travel
- Occupation
- Hobbies
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ABG measure
- pH: 7.35-7.45
- PaO2: 80-100
- PaCO2: 35-45
- HCO3: 22-26
- SaO2: 95-100
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Blood pH levels
- acidosis: < 7.35
- alkalosis: > 7.45
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Early S/S of hypoxemia
- Tachypnea
- Tachycardia
- Restlessness
- Pallor of skin & mucous membranes
- Elevated blood pressure
- Symptoms of respiratory distress-use of accessory muscles, nasal flaring, tracheal tugging, adventitous lung sounds
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Late S/S of hypoxemia
- Confusion and stupor
- Cyanosis of skin and mucous membranes
- Bradypnea
- Bradycardia
- Hypotension
- Cardiac dysrhythmias
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What is pulmonary toileting?
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What is CPAP?
Continuous Positive Airway Pressure
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What is BiPAP?
Bilevel Positive Airway Pressure
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What is PEEP?
Positive End-Expiratory Pressure
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Nasal cannula
- Provide 24-40% FiO2 (fraction of inspired oxygen)
- Flow rate 1-6 L/min
- Long term O2 therapy
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Simple face mask
- For increased flow rates
- Provide 40-60% FiO2
- Flow rate 5-8 L/min
- Minimum flow rate is 5 L/min to ensure flushing of CO2 from mask
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Non-rebreather mask
- High concentrations
- Provide 80-95% FiO2
- Flow rate 10-15 L/min
- For clients in respiratory distress who may require intubation
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S/S respiratory depression
- Decreased respiratory rate
- Decreased LOC
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Venturi mask
- Venti mask
- Deliver most accurate O2 concentration
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Bronchoscopy
Permits visualization of larynx, trachea, bronchi
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Therapeutic indications for bronchoscopy
- Control of bronchial bleeding
- Removal of aspirated foreign bodies
- Removal of mucous plugs
- Endobronchial brachytherapy
- Laser treatment of neoplastic obstruction
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Important lab values
- pH: 7.35-7.45
- PaO2: 80-100 mmHg
- PaCO2: 35-45 mmHg
- HCO3: 22-26 mEq/L
- BUN: 8-22 mg/dL
- APTT: 20-35 sec, anticougualtion therapy; 1.5-2.5 times normal
- PT: 10-13 sec, anticoagulation therapy; 1.5-2.0 times normal
- INR: 2.0-3.0
- HCT: male 40-54%, female 36-46%
- Hgb: male 13.5-17g/dL, female 12-15g/dL
- Platelet: 150,000-400,000/mm3
WBC: 4,500-11,000 cells/mm3
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PCO2
- Indicator of respiratory buffering
- < 35 mmHg indicates alkalosis
- > 45 mmHg indicates acidosis
- ex:
- pH<7.35+PCO2>45=respiratory acidosis
- pH>7.45+PCO2<35=respiratory alkalosis
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HCO3
- Indicator of metabolic buffering
- <22mEq/L indicates acidosis
- >26mEq/L indicates alkalosis
- ex:
- pH<7.35+HCO3<22=metabolic acidosis
- pH>7.45+HCO3>36=metabolic alkalosis
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Respiratory acidosis
- pH 7.2 = acidosis
- PCO2 50 = acidosis
- HCO3 24 = normal
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