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NURS 2220 Cardio

Oxygenation, Ventilation, Diffusion Exam #1

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