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NURS 2220 Cardio
Oxygenation, Ventilation, Diffusion Exam #1
| Question | Answer |
|---|---|
| Type of cellular metabolism that is necessary for sustaining life | aerobic -- requires OXYGEN |
| 3 components of oxygenation and breathing | Ventilation, Diffusion, Perfusion |
| Ventilation | movement of air in and out of the lungs |
| Diffusion | exchange of gas at the alveolar level |
| Perfusion | Carrying of oxygenated blood to tissues |
| Assessing ventilation | is the airway open? auscultation of the lungs. respiratory rate respiratory pattern use of accessory muscles chest shape |
| Adventitious lung sounds | wheezing, stridor, crackles |
| Conditions that affect ventilation | any lung disease (COPD, Reactive Airway Disease) Cystic fibrosis Sleep apnea smoking environmental exposure Airway obstruction acute bronchitis |
| Diagnostic tests used to assess ventilation | CXR, ABG (PaCo2), Bronchoscopy, Pulmonary function tests |
| Medications frequently used to treat ventilation disorders | Bronchodilators (dilates bronchioles), Mucolytic agents (loosens mucus), Reversal agents such as Narcan |
| Medications frequently associated with ventilation disorders | Analgesics (narcotics cause respiratory depression), anesthesia, sedatives, paralytics (paralyzes respiratory muscles) |
| Two types of acute respiratory failure | Hypoxemia and Hypercapnia. Can be acute or chronic. |
| Hypercapnia | Inadequate CO2 removal. Ventilatory failure. |
| Hypoxemia | Inadequate O2 transferred to the blood. Oxygenation failure. |
| Causes of respiratory failure | Airway/alveolar - related: asthma (acute), emphysema, chronic bronchitis, cystic fibrosis. CNS-related: drug overdose, brainstem infarction, spinal cord injury Chest wall issues: flail chest, fractures, mechanical restriction, muscle spasm Neuro: MS, |
| Clinical signs of respiratory distress | nasal flaring, pursed lipped breathing, tripod positioning, difficulty speaking, cough, use of accessory muscles, sternal retractions, intercostal retractions |
| Clinical signs of hypercapnia | headache, irritability, confusion, inability to concentrate, somnolence, bradypnea, tachycardia/dysrhythmias, hypotension, facial rubor |
| Interventions | Support ventilation Treat underlying cause NIPPV Mechanical ventilation |
| NIPPV | non-invasive positive pressure ventilation (CPAP, BiPAP) |
| Pneumothorax | air in the pleural space. May be open (sucking chest wound, usually associated with penetrating trauma), or closed (not associated with a wound) |
| Hemothorax | blood in the pleural space |
| pleural effusion | excess fluid in the pleural space |
| hemopneumothorax | blood and air in the pleural space |
| tension pneumothorax | complete collapse of the lung |
| Flail chest | occurs when 3 or more ribs are fractured in 2 or more places and are no longer attached to the thoracic cage. |
| status asthmaticus | severe, persistent asthma that does not respond to conventional therapies |
| Independent nursing actions that may be used to manage airway and ventilation | positioning, oral airway/nasal airway, suctioning, bag-valve mask/tube |
| Airway/ventilation interventions that require physician order | endotracheal intubation, tracheostomy, NIPPV, mechanical ventilation, chest tubes |
| Most common airway obstruction in an unconscious patient | tongue |
| oral airway | used only for unconscious patients; holds the tongue away from the airway |
| nasal airway | can be used for both conscious and unconscious patients; do not use if suspected skull fracture |
| endotracheal tube | tube inserted into the airway via the mouth |
| tracheostomy | tube inserted into the airway via the trachea, bypasses the upper airway completely. Usually done for longterm ventilation situation. |
| CPAP | Continuous Positive Airway Pressure |
| BiPAP | uses to different pressures (IPAP - inspiratory and EPAP - expiratory) |
| Mechanical ventilation | used for patients who cannot maintain adequate ventilation on their own. Last resort. Requires intubation. Cannot be used for patients with DNR/DNI orders. |
| Signs/symptoms of problems with diffusion | Mental status change (first indication of hypoxemia), cough, fatigue, inability to speak complete sentences |
| Conditions that frequently cause problems with diffusion | illnesses, cystic fibrosis, environmental/occupational (asbestos, black lung, allergies) |
| Diagnostic testing used for issues with diffusion | CXR, ABG (PaO2), Hgb, sputum analysis, lung biopsy |
| Pulse oximetry | measures SpO2 level, oxygenation. Is not a measure of ventilation. Normal SpO2 is 95+% |
| Oxyhemoglobin dissociation curve | small changes in SpO2 can result in big changes to PaO2. |
| Medications used to treat diffusion disorders | anti-infectives (if r/t pneumonia or infection), diuretics, mucolytics, anti-inflammatory/steroids, anti-hypertensives, anti-thrombolitics, fibrinolytics |
| Conditions associated with alteration in ventilation | pneumonia, pleural effusion, pulmonary edema, pulmonary fibrosis, influenza |
| Disorders that cause hypoxemic respiratory failure | COPD, pneumonia, asthma, atelectasis, pulmonary embolus, severe emphysema, pulmonary fibrosis, exercise-induced hypoxemia, anatomic shint, extreme V/Q mismatch |
| Clinical signs of hypoxemia | restlessness, confusion, lethargy, coma, tachycardia/dysrhythmias, tachypnea, dyspnea, use of accessory muscles, mild hypertension (early), hypotension (late), cyanosis |
| Interventions for hypoxemia | aggressive pulmonary toilet (TDBC), treat underling disease, supplemental oxygen, NIPPV, mechanical ventilation |
| amount of oxygen present in room air | 21% |
| Why supplemental oxygen? | Increases percentage of oxygen in alveoli and leads to greater diffusion pressure. |
| Acute Pulmonary edema | abnormal collection of fluid in the alveoli and interstitial spaces of the lungs. Often caused by heart failure |
| Pneumonia | can be community acquired or nosocomial. |
| Pulmonary emboli | blockage of pulmonary arteries by a thrombus, fat or air embolus, or tumor tissue |
| Acute Respiratory Distress Syndrome (ARDS) | extreme form of respiratory failure, most common cause is sepsis |
Created by:
pinklrt98
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