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NUR 303--Fundamentals of Nursing

physiology of repiration pulmonary ventilation / pulmonary exchange of gases / transport of oxygen and carbon dioxide / tissue excahne of gases
pulmonary ventilation (breathing) movement of air between the atmosphere and alveoli of the lungs / includes phases of inspiration and expiration
pulmonary exchange of gases diffusion of oxygen and carbon dioxide between the alveoli and pulmonary capillaries
transport of oxygen and carbon dioxide via bloodstream to and from the tissues
tissue exchange of gases diffusion of oxygen and carbon dioxide between the capillaries and the body cells
structure of the upper repiratory system mouth / pharynx / nose / larynx
what happens to air as it passes throught the nose it is warmed, humidified, and filtered
after the nose, what other structures does air ass through? nasopharynx and oropharynx where lymphoid tissue (tonsils and adenoids) traps and destroys pathogens
structure of the lower respiratory system trahea / bronchi / broncioles / alveoli / pulmonary capillary network / pleural membranes
function the mucosal epithelium in the respiratory system? traps pathogens and other particulate matter
function of the cilia sweep debris upward toward the pharynx
what is the cough reflex? is stimulated by vagal nerve impulse to the medulla which initiates the cough and the expectoration of these secretions
where does gas exchange occur? at the junction f the alveolar and capillary walls
what is the respiratory membrane? consists of the thin-walled alveoli covered by a thick mesh of pulmonary capillaries
what is the outer surface of the covered with? parital and visceral pleura
what is the purpose of the potential space between the pleural layers? lubricated by serous fluid / prevents friction / promotes adherence
adequate pulmonary ventilation depends on: clear airways / intact CNS including the respiratory center in the medulla and pons / intact thoracic cavity capable of expanding and contacting / adequate pulmonary compliance and recoil
the act of breathing diaphragm and intercostal muscles contract / the diaphragm descends / thoracic cavity and lung volume increase / intrapulmonary pressure decreases causing air to rush in / as the diaphragm and itercostal muscles relax, intrapulmonary pressure increa
accessory muscles of respiration anterior neck muscles / intercostal muscles / abdominal muscles / retractions may be seen / indicates increaseed work of breathing / seen in COPD patients
work of breathing (WOB) is the effort required to expand and contract the lungs
the amount of energy expended on breathing depends on: the rate and depth of breathing / the ease in which the lungs can be expanded (compliance) / airway resistance
inspiration is an active process, stimulated by chemical receptors in the aorta
expiration is a passive process that depends on the elastic recoil properties of the lungs, requring little ot no nuscle work
surfactant is a chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing // decrease in surfactant production can lead to atelectasis
atelectasis is a collapse of the alveoli that prevents normal exchange of the oxygen and carbon dioxide
compliance is the ability of the lungs to expand or inflate // necessary for inspiration
what may cause the collapse of a lung? pneumothorax hemothorax
how would an MD treat a collapsed lung insert a chest tube
nursing responsibilities for compliance: assisting with insertion and removal of chest tube // monitoring the insertion site for air leaks // monitoring patency of the tubes // monitoring functioning of the grainage system
airway resistance is the increase in pressure that occurs as the diameter of the airway decreases from the mouth/nose to the alveoli
increased airway resistance leads to decreased amoutn of oxygen delivered to the alveoli
increased work of brathing leads to... decrease in lung compliance // increases in airway resitance // increase in use of accessory muscles
increased WOB leads to... increased energy expenditure
increased energy expenditure leads to... increased metabolic rate // increased need for more oxygen // increased need for elimination of carbon dioxide
incrased WOB in a patient with impaired ventilation can lead to... further deterioration of respiratory status and the ability to oxygenate adequately
recoil tendency of the lungs to move away from the chest wall after expansion // necessary for expiration and inflation of alveoli // surfactant reduces surface tension of the fluid lining the alveoli which aids their inflation and promotes lung recoil
partial pressure of oxygen (PO2) in the alveoli is... 100mgHG
partial pressure of oxygen (PO2) of venous blood in the pulmonary artery is... 60mmHG
partial pressure of carbon dioxide (PCO2) of venous blood entering the pulmonary capillaries is... 45mmHG
partial pressure of carbon dioxide (PCO2) in the alveoli is... 40mmHG
alveolar gas exchange gases move by diffusion from an area of greater pressure to an area of lower pressure
transport of oygen O2 combines with hemoglobin of RBCs and is carried to tissues as oxyhemoglobin
the rate of oxygen transport depends on: cardiac output (pumping ability of the heart) // the number of RBCs
decrease in H&H anemia
increase in H&H increase in H&H
transport of carbon dioxide inside of RBC as bicarbonate (HCO3) // combined with hemoglobin as carbaminohemoglobin // dissolved in plasma as carboinc acid
stimulant to breath increase in CO2 concentration
stimulant to breath in COPD patients decrease in O2 concentration = hypoxic drive // only low concentration of supplemental O2 (2L/min) shoud be administered to COPD patients
hypoxemia reduced O2 in the blood // low PAO2 // measured by drawing arterial blood gasses
hypoxia insufficient O2 anywhere in the body from the inspired gas to the tissues // can result from pulmonary edema, anemia, heart failure, embolism, COPD
O2 saturation the amount of oxygenated hemoglobin in arterial blood (SAO2)
normal SAO2 level 95-100% // below 70% is life threatening
hypoventilation inadequate pulmonary ventilation (excess CO2) // may be caused by disease of the respiratory muscles, drugs, and anesthesia // will lead to hypoxia
signs of hypoxia rapid pulse // rapid, shallow respirations // dyspnea // restlessness // lightheadedness // flaring of nostrils // substernal or intercostal retractions // cyanosis (late sign)
nursing interventions to promote oxygenation promote breathing // teach deep breathing techniques // teach effective coughing //provide hydration // administer medications // encourage use of incentive spirometer // provide chest physiotherapy // adminsiter oxygen therapy // insert ar
promote breathing position patient to allow maximum chest exansion (fowler's) // encourage frequent changes in position // encourage ambulation // implement comfort measure such as giing meds
deep breathing techniques abdominal / diaphragmatic breathing // purased lip breathing
abdominal / diaphragmatic breathing purse lips as if about the whistle and breathe out slowly and gently without puffing cheeks (keeps alveoli inflated // concentrate on feeling the abdomen fall // contract abdominal muscles while exhaling // count to 7
frquency of breathing exercises 5-10 minutes 4xday
effective coughing controlled coughing // huff coughing
controlled coughing inhale deeply and hold breathe for a few seconds // cough twice (the first loosen the second exspells)
huff coughing lean forward and exhale forcefully with a "huff" (helps keep airways open while mobilizing secretions) // inhale by taking rapid short breahts "sniffs" to prevent mucus from moving back into smaller airways // rest
provide hydration to help promote oxygenation fluid intake thins pulmonary secretions allowing them to be mobilized by cilia and expectorated // the environment should be humidified to keep secretions thin and prevent drying of mucous membranes // cool mist humidifiers, nebulizers, and humidified
administer medications bronchodilators // expectorants // cough suppressants
bronchodilators (albuterol) promote direct dilation of the bronchioles
teach patient proper use of metered dose inhalers place mouthpiece far enough into mouth to extend beyond teeth // inhale slowly and deeply through mouth while pressing down once on canister // continue to inhale for 2-3 seconds // hold breath for 5-10 seconds while removing inhaler from mouth //
expectorants (robitussin) thin secretions
cough suppressants (dextromephorphan, codeine) suppress cough reflex
why should you monitor respiratory status when giving narcotic analgesics (morphine, demerol) they depress the respiratory center in the medulla
encourage use of the incentive spirometer offers the patient an incentive to improve inhalation // measures the flow of inhaled air // loosens pulmonary secretions // expands alveoli // improves pulmonary ventilation and gas exchange
instruct patient how to use the incentive spirometer seal lips around mouthpiece // take in a slow, deep breath and hold for 2-6 seconds // remove mouthpiece and breathe normally // repeat 4-5 times an hour // try to increase depth of inhalation each time
chest physiotherapy percussion // vibration // postural drainage
percussion forcefull striking with cupped hands over congested lung fields (mechanically dislodges secretions) // cover area with towel // ask patient to breath slowly and deeply to romote relaxation // percuss each affected lung segment for 1-2 minutes
vibration used after percussion to increase turbulence of exhaled air and loosen secretions // place hands one on top of the other, palms down // ask patient to inhale deeply and exhale slowly through pursed lips // during exhalation, tense hand and arm muscl
postural drainage each position is assumed for 15 minutes // bronchodilator or nebulizer treatment may be given first // entire tratment is usually 30 minutes // nurse must auscultate lung sounds before and after treatment // nurse notes amount, color, characterist
secquence of postural drainage positioning // percussion // vibration // removal of secretions by coughing or suctioning
administeration of oxygen therapy the amount of O2 delivered is determined by regulating the flow rate using a flow meter // O2 must be humidified to prevent drying of mucous membranes if flow rate is over 2L/min
oxygen delivery systems nasal cannula // simple face mask // partial rebreather mask // non-rebreather mask // venturi mask // transtracheal cannula
nasal cannula 24-45% concentration // 2-6L/min
simple face mask 40-60% concentration // 5-8L/min
partial rebreather mask 60-90% concentration // 6-10L/min
non-rebreather mack 95-100% concentration // 10-15L/min
venturi mask 24-50% concnetration // 4-10L/min // most percise
transtracheal cannula small, narrow cannula surgically inserted through the trachea (0.5-2L/min) // must be flushed with NS and cleaned with rod
the rule of four for each liter of supplemental oxygen, the concentration is increased by 4% // room air is 20% oxygen
to calculate percentage of oxygen # liters x 4 + 20 = % oxygen
to calculate liters per minute % oxygen - 20 / 4 = liters per minute
artificial airways used to keep upper airways open when secretions or the tongue may obstruct them // oropharyngeal // nasopharyngeal // endotracheal tubes // tracheostomy
oropharyngeal used for patients with altered LOC due to general anesthesia, overdose, head injury // lubricate prior to insertion // insert with distal end pointed up, along to of tongue // rotate 180 degreess when soft palate is reached // slip just past uvula
nasopharyngeal inserted through nares // nurse should provide frequent oro-nasal care // reposition q8h to opposite nares
endotracheal tubes inserted by MD // used to administer general anesthesia // also used in ER when mechanical ventialtion is needed
tracheostomy surgical incision is made into the trachea just below to larynx // used for long term airway management // O2 is delivered va trach collar // patient may also be on mechanical ventilation
nursing responsibilities for a tracheostomy suctioning // providing trach care by cleaning the inner cannula // cleaning the peristomal skin // changing the dressing and ties
suctioning of secretions aspirate secretions using a catheter connected to a suction machine // use sterile technique // oro-naso pharyngeal suctioning clears the upper airways // endotracheal suctioning removes secretions from the trachea and bronchi
the nurse should assess the need for suctioning patient is SOB // has rattling or bubling breath sounds // has decreased SAO2 // is cyanotic // lungs should alsways be auscultated before and after suctioning
Created by: sevans89