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Review- How does the cardiovascular system contribute to oxygenation?
What are the three steps in the process of oxygenation? Be able to describe each.
- Ventilation: Mechanical process of moving gases into and out of the lung. Requires coordination of muscles and elastic properties of the lungs and thorax.
- Perfusion: The ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs.
- Diffusion: moves the respiratory gases from one area to another by concentrated gradients.
Describe the work of breathing. How does inspiration and expiration occur?
What is tidal volume and how is lung volume measured?
- Tidal Volume: Volume of inspired or expired air with each normal breath; equals dead space plus alveolar gas.
- The amount of air breathed in or out during normal respiration. The volume of air an individual is normally breathing in and out. 500mL
- Total Lung Volume: TLC = IRV + Vt + ERV + RV
- The volume of air contained in the lung at the end of maximal inspiration. The total volume of the lung. Values of between 80% and 120% of average value are considered normal.
- 1. Is the sum of all four lung volumes
- 2. Expressed as: TV + IRV + ERV + RVor VC + RV
- 3. Is the volume in the lungs after a maximal inspiration
- 4. Includes RV, so it cannot be measured directly with spirometry
- 5. Approx. 5800 ml
What is the primary function of pulmonary circulation?
To move blood to and from the alveolar capillary membrane for gas exchange; maintains adequate alveolar ventilation
What three things influence the capacity of blood to carry oxygen?
- 1. The amount of dissolved oxygen in the plasma
- 2. The amount of hemoglobin (carries O2 & CO2)
- 3. The tendency of hemoglobin to bind with oxygen
How is carbon dioxide transported in the body?
It diffuses into blood cells and is rapidly hydrated into carbonic acid (H2CO3) which then dissociates into hydrogen and bicarbonate (HCO3) ions. Hemoglobin buffers the hydrogen ion, and HCO3 diffuses into plasma. Reduced hemoglobin (deoxyhemoglobin) combines with CO2 and the venous blood transports majority of CO2 back to the lungs to be exhaled.
Describe the physiological processes of oxygenation (Box 40-1).
Hypovolemia, Decreased inspired O2 concentration, certain conditions, and increased metabolic rate.
What physiological factors affect the bodys ability to meet oxygen demands?
Any condition affecting cardiopulmonary functioning directly affects body's ability to meet oxygen demands - anemia, pregnancy, fever, infection, alteration affecting chest wall movement or CNS, impaired valvular function, myocaridal hypoxia cardiomyopathic conditions and peripheral tissue hypoxia.
What developmental factors affect oxygenation for:
- Infants and toddlers: Exposure to second hand smoke, immature immune system, and frequent upper respiratory infections (URI)."human petri dishes; teething causes nasal congestion and becomes infected with bacteria." Abdominal breathers until age 5.
- School-aged children and adolescents: Asthma, Allergies, Frequent URI's, Exposure to second hand smoke, and at risk for smoking (if starts there is an increased risk for cardiopulmonary disease, and cancer.), secondhand smoke.
- Young and middle-aged adults: Exposed to multiple cardiopulmonary risk factors: Unhealthy diets, Lack of exercise, Stress, OTC drugs, Prescription (Rx) drugs/Illicit drugs use/abuse, and smoking.
- Older adults: Respiratory infections, less effective cough, less cilia, decrease functioning Alveoli, enlarged trachea, Osteoporosis, Enlarged airway, and physical changes in cardiac and respiratory systems. Calcification of heart valves and signs and symptoms of atherosclerosis.
How do lifestyle factors such as Nutrition, exercise, smoking, substance abuse, and stress affect oxygenation?
- Severe obesity= more body tissue (increased oxygen demand), decrease in lung expansion
- Malnourished= weakened muscles, weakened cough, anemia
- Exercise: increases tidal volume, increases cardiac output, makes muscles more proficient
- Smoking: lung cancer, vasoconstriction (nicotine), COPD
- Substance abuse: malnourished, anemic
- Stress: increases metabolic rate, which increases oxygen demand
In what way do environmental factors affect oxygenation?
Pollution, workplace, allergies, altitude
What questions should the nurse ask during the health assessment related to cardiopulmonary functioning?
- Pg 831
- 1. Nature of cardiopulmonary problem
- 2. S&S
- 3. Onset & duration
- 4. Severity
- 5. Predisposing factors
- 6. Effect of symptoms on patient
How would the nurse perform a respiratory physical examination?
Inspection, palpation, percussion. auscultation
What diagnostic studies are conducted to evaluate ventilation and oxygenation? (Table 40-5) pg 837
Arterial Blood Gas
Pulmonary function tests
Peak expiratory flow rate (PER)
What interventions can the nurse utilize to maintain a patent airway?
How can humidification assist in be used to assist in oxygenation?
- Air or oxygen with a high relative humidity keeps the airways moist and loosens and mobilizes pulmonary secretions.
- Humidification is needed for pts receiving oxygen therapy greater than 4L/min. It might be needed if environmental air id dry and arid.
How is nebulization utilized in respiratory therapy?
It adds moisture or medications to inspired air by mixing particles of varying sizes with the air.
The moisture added through nebulization improves clearance of pulmonary secretions.
What different suctioning techniques are utilized to clear respiratory secretions from the airway?
- Oropharyngeal & Nasopharyngeal Suctioning: used when pt I able to cough effectively but unable to clear secretions by expectorating
- Orotracheal & Nasotracheal Suctioning: needed when pt with pulmonary secretions is unable to manage secretions by coughing & does not have an artificial airway present
- Tracheal Suctioning: done through artificial airway (endotracheal or tracheostomy tube).