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The process of oxygenation consists of 3 steps. What are they?
- ventilation: the process of moving gas into and out of lungs
- perfusion: blood flow to the lungs (pulmonary circulation)
- diffusion: the exchange of respiratory gases in alveoli and capillaries
List the structures of the upper respiratory tract
Mouth, nose, pharynx, larynx
List the structures of the lower respiratory tract
trachea, bronchi, bronchioles, alveoli, pulmonary capillary network, pleural membrane
What is the difference between compliance and resistance?
- Compliance is how open the air way is, the ability of lungs to distend and expand. This decreases is pulmonary edema, fractured ribs, interstitial and pleural fibrosis.
- Resistance is how closed the airway is.This increases due to airway obstruction, asthma, and tracheal edema.
What happens during inspiration
- Diaphragm and intercostals contract
- Thoracic cavity size increases
- Lung volume increases
- Intrapulmonary pressure decreases
- Air rushes in lungs to equalize pressure
What happens during expiration?
- Diaphragm and intercostals relax
- Intrapulmonary pressure rises
- Air is expelled
What could cause hypovolemia?
- vomiting, shock, severe dehydration.
- this increases heart rate and peripheral vasoconstriction
An example of a bronchiodialater is...
narcotics _________ respiratory rates
- circulating blood count
- if it is low... hypoxia
The peak flow meter tests...
What are 2 factors that can decrease the oxygen carrying capacity of blood
- anemia: result of decreased hemoglobin production, increased RBC destruction, or blood loss
- Carbon monoxide poisoning: CO strongly binds to hemoglobin, making the hemoglobin unavailable for O2 transport
What causes decreases in inspired oxygen concentration?
upper and lower airway obstructions, high altitudes, or drug overdoses
How do neuromuscular diseases affect oxygenation?
They affect the pts ability to expand and contract the chest wall
What 2 central nervous structures can impair breathing if they are traumatized?
Spinal cord and medulla oblongata
What can cause dysrhythmias?
Dysrhythmias occur as a primary conduction disturbance, such as in response to ischemia, valvular abnormality, anxiety, or drug toxicity; as a result of caffeine, alcohol, or tobacco use; or as a complication of acid-base or electrolyte imbalance
a transient imbalance between myocardial oxygen supply and demand. The condition results in chest pain that is aching, sharp, tingling, or burning, or that feels like pressure
- a heart attack. Infarction occurs because of ischemia (which is reversible) and necrosis (which is not reversible) of myocardial tissue.
- usually described as crushing, squeezing, or stabbing. The pain is often in the left chest and sternal area.
What can cause hyperventilation?
Anxiety, infections, drugs, or an acid-base imbalance induce hyperventilation, as well as hypoxia associated with pulmonary embolus or shock.
collapse of alveoli
hypoxia is caused by
- decreased hemoglobin
- diminished concentration of inspired o2
- the inability of the tissues to extract oxygen from the blood, as with cyanide poisoning;
- decreased diffusion of oxygen from the alveoli to the blood, as in pneumonia
- poor tissue perfusion with oxygenated blood, as with shock;
- impaired ventilation, as with multiple rib fractures or chest trauma.
What are the clinical signs of hypoxia?
- apprehension, restlessness, inability to concentrate, declining level of consciousness, dizziness, and behavioral changes.
- The client with hypoxia is unable to lie down and appears fatigued and agitated.
- Vital sign changes include an increased pulse rate and increased rate and depth of respiration.
is inadequate tissue oxygenation at the cellular level
Shortness of breath or difficulty breathing
inserting a needle into the chest wall and into the pleural space, usually to remove fluid for diagnostic or therapeutic purposes
When is an oralpharyngeal airway used
when pt can cough effectivly but cannot remove secretions
When is a nasopharyngeal airway used?
when pt is unable to manage secretions
a complete blood count. A CBC determines the number and type of red and white blood cells per cubic millimeter of blood.
What are sputum C and S tests used for?
Culture and Sensitivity test. Obtained to identify a specific microorganism or organism growing in the sputum. Identifies drug resistance and sensitivities.
What is the sputum AFB test used for?
- AFB= Acid Fast Bacillus
- Used to screen for the presence of AFB for detection of TB by early morning specimens on 3 consecutive days.
What is the sputum cytology test used for?
Obtained to identify abnormal lung cancer. Differentiates type of cancer cells (small cell, oat cell, large cell).
List some nursing diagnoses for alterations in oxygenation
Activity intolerance•Anxiety•Decreased cardiac output•Fatigue•Impaired gas exchange•Impaired spontaneous ventilation•Impaired verbal communication•Ineffective airway clearance•Ineffective breathing pattern•Ineffective health maintenance•Risk for imbalanced fluid volume•Risk for infection
What are some health promotion
- Annual influenza vaccines are recommended for children 6 to 59 months, adults over 50, and clients with chronic illnesses (especially of the heart, lung, or kidneys), diabetics and clients with immunosuppression or severe forms of anemia. also anyone with frequent contact with any of the above listed conditions.
- Pneumococcal vaccine is recommended for clients at increased risk of developing pneumonia, those with chronic illnesses or immunosuppression (such as HIV/AIDS), those living in nursing homes or the Native American population, and clients over the age of 65.
How does adequete hydration promote pulmonary health
prevents thick secretions
chest physiotherapy (CPT)
- a group of therapies used to mobilize pulmonary secretions. These therapies include postural drainage, chest percussion, and vibration
- recommended for clients who produce greater than 30 mL of sputum per day or have evidence of atelectasis by chest x-ray examination
Pursed Lip Breathing
involves deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse
What are the three basic breathing techniques?
- deep breathing and coughing exercises
- pursed lip breathing
- diaphragmatic breathing
A pneumothorax is a collection of air in the pleural space. The loss of negative intrapleural pressure causes the lung to collapse.