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oxygenation the process of providing oxygen to all cells of the body
function of the respiratory system obtain oxygen from atmospheric air transport the air through the respiratory tract into the alveoli and ultimately diffuse oxygen into the blood to carry oxygen to all the cells of the body
ventilation inspiration and expiration
inspiration inhaling (allows for the transport of oxygen to the alveoli where oxygen is exchanged for carbon dioxide
expiration exhaling (carbon dioxide is expelled from the body)
respiration technically refers to the exchange of oxygen and carbon dioxide at the cellular level; commonly used synonymously with ventilation
eupnea normal breathing
Normal breathing finding muscular structures are relaxed, chest wall effortlessly rises and falls, equally spaced breaths, inspiration (1): expiration (2)
Auscultation listening to the body's sounds with a stethoscope important assessment method
alveoli compose the terminal (final) structures of the lower respiratory system/ sites of gas exchange specifically oxygen and carbon dioxide
surfactant controls surface tension and keeps the alveoli from collapsing and sticking to themselves
concentration of oxygen is greater in the alveoli than the blood in the capillaries so; oxygen diffuses across the membranes into the blood
concentration of carbon dioxide is greater in the blood so; it diffuses across the membrane into the alveoli
left lung 2 lobes upper and lower
right lung 3 lobes upper, middle, lower
pleural space region between visceral and parietal pleura
bronchial sounds loud, high pitched, heard over trachea longer on exhalation than inhalation
bronchovesicular sounds medium in loudness and pitch, heard on each side of the sternum and between the scapulae, typically equal in duration on inhalation and exhalation
vesicular sounds soft, low pitched sounds that are heard over the peripheral lung fields, prominently heard in lung bases, typically longer on inhalation than exhalation
drive to breathe depends largely on level of carbon dioxide on in arterial blood
patent airway an airway that is open and free of obstruction
ventilation-perfusion (V-Q) ratio movement of oxygen across the alveolar-capillary membrane into a capillary is represented by
hypoxemia refers to a decreased level of oxygen in the blood untreated may result in hypoxia
hypoxia decreased delivery of oxygen to the tissues
increase in hydrogen ions results in increase in blood CO2 results in decrease in blood pH ( blood becomes more acidic)
decrease in hydrogen ions results in decrease in blood CO2 results in increase in blood pH( blood becomes more alkaline)
COPD increased level of carbon dioxide in the blood; CO2 retention causes decreased blood oxygen levels
emphysema (form of COPD) alveolar damage limits the exchange of oxygen and carbon dioxide, these individuals retain carbon dioxide
retractions drawing in of the chest wall, early indicator of hypoxia
cyanosis bluish discoloration of the skin and mucous membranes, late sign of hypoxia
clubbed nail sign of chronic hypoxia
atelectasis collapse of the lung
tachypnea respiratory rate greater than 20BPM
hyperventilation rapid and deep inhalation and exhalation of air from the lungs
hypoventilation an abnormally slow respiratory rate leads to inadequate oxygen delivery to the lungs as well as increase in retention of carbon dioxide
bradypnea less than 10 BPM
respiratory arrest apnea- absence of breathing
dyspnea labored breathing or shortness of breath that is uncomfortable or painful, also occurs when breathing is insufficient to meet oxygen demand
othopnea difficulty breathing when in the supine position
Kussmaul breathing occurs in the presence of metabolic acidosis; results in very deep and rapid breaths
Cheyne-stokes deep, rapid breathing and slow shallow breathing, with periods of apnea (ICP, CHF, drug OD)
Biot respirations (ataxia) shallow breathing with periods of apnea (CNS disorders)
respiratory depression decrease in the depth and rate of breathing
sickle cell disease inherited blood disorder; impairs the transport of oxygen through the blood and can cause a variety of complications including organ failure
pneumothorax lung collapse resulting from collection of free air in the pleural space
S/S of pneumothorax sudden sharp pleuritic pain that is worse with breathing or coughing, decreased or absent breath sounds over the affected side, asymmetrical chest wall movement, SOB, cyanosis
spontaneous pneumothorax occurs w/o any identifiable cause risks include emphysema, cystic fibrosis, TB
tension pneumothorax typically results from traumatic injury , such as a lung puncture by rib fracture; life threatening requires immediate decompression through needle decompression or chest tube
respiratory acidosis decreased oxygen levels, CO2 increases, results in vasodilation of the vessels; Pt. experiences increased ICP and HR
acid-base balance increase CO2= vasodilation=increased ICP and HR Pt. S/S HA, irritability, decreased LOC, flushed skin
cellular regulation decrease in o2 increases systemic workload and shunts blood from periphery to vital organs Pt. s/s fatigue, pallor, jaundice, tachypnea
cognition decrease in o2 to brain can cause changes in cognition
comfort decrease in o2 to tissues manifest as pain Pt. s/s increased pulse, respirations, BP, restlessness, anxiety, diaphoresis, Pt. report of discomfort
perfusion decreased tissue perfusion creates oxygen deficit to organs Pt. assess pulses, nail beds, color, and body position for comfort and orientation, administer o2, monitor ABGs, medication
stress and coping ensure adequate oxygenation, promote balance between activity and rest, limit unnecessary environmental stressors, explain procedures, acknowledge Pt. feelings
Perfusion affected by decreased oxygenation decreased tissue perfusion creates oxygen deficit to organs, Pt. may exhibit change in pulse and BP due to increased workload on heart; color, cap refill, orientation may be affected because of decreased oxygenation to tissue
s/s of hypoxia increasing restlessness, irritability, unexplained sudden confusion, rapid heart rate accompanied by rapid respiratory rate
ask about current respiratory problems, history of respiratory disease, lifestyle, presence of cough, description of mucus, presence of chest pain, presence of risk factors, medication history
inspection visually observing the Pt.
palpation feel the areas related to the body system for symmetry
symmetry equality of the size, shape, or condition of opposite sides of the body
percussion method of tapping the chest or back to assess underlying structures, tones heard determine solid filled, or air filled spaces at the area
auscultation listening to the sounds, stethoscope facilitates hearing sounds
stridor high pitched sound within the trachea and larynx that suggests narrowing of the tracheal passage
crackles high pitched popping sounds, much like milk being poured on crisp rice cereal, often heard on inspiration, caused by fluid associated with or resulting from inflammation or exudates w/I the lung
atelectasis collapse of all or part of the lung affecting exchange of oxygen and carbon dioxide; obstruction is the primary cause
rhonchi coarse, low pitched sounds that continue throughout inspiration, may indicate a blockage of large airway passages, sometimes cleared by coughing
wheezing high pitched whistling sound most often heard on expiration and caused by the narrowing of bronchi, can also be heard on inspiration, not cleared by coughing
pleural friction rub pleural inflammation occurs when inflamed pleural surfaces slide across one another, present on inspiration and expiration
patient presentation self posturing, difficulty speaking, taking breaths in the middle of sentence, voice may be raspy, absence of productive cough
Arterial blood gas (ABG) provide a direct indication of oxygen and carbon dioxide exchange and the acid base balance within the blood; major chemical components monitored- hydrogen ions( pH), CO2, o2, bicarbonate
Normal ABG Values pH(7.35-7.45) PaCO2(35-45 mmHg)- carbon dioxide level PaO2 (75-100 mmHg) HCO3-(24-28 mEq/L)
SaO2 arterial blood oxygen saturation; should be greater than 95% in healthy individual measure of the percentage of hemoglobin that is carrying oxygen
PaO2 measure of the amount of oxygen dissolved in the arterial blood; interpreted by whether Pt. is on oxygen or not
hypercarbia (hypercapnia) increase in blood levels of carbon dioxide above 45mmHg
hypocarbia (hypocapnia) decrease in blood levels of carbon dioxide below 35 mmHg
kidneys help maintain acid base balance by excreting or reabsorbing acids and bases
homeostasis state of balance even in the presence of changing conditions, or dynamic equilibrium
blood pH less than 7.35 acidosis
blood pH greater than 7.45 alkolosis
pulse oximetry noninvasive method of assessing arterial blood oxygenation; should be 95% or greater
pulmonary function test (PFT) demonstrate changes in pulmonary health related to ventilation airflow, lung volume, and capacity, and the diffusion of gas
spirometry measures inhalation and exhalation, how much and how quickly an individual exhales air as measured by a spirometry is an indicator of the degree of pulmonary function deficit
Peak expiratory flow rate (PEFR) used to monitor the ability of an individual to exhale a specific volume of air related to the individuals age, gender, height, weight; allows individuals with asthma to measure the reactivity of their lungs and adjust asthma treatments according to plan
CXR anterior/posterior allows for 2 views of the contents of the thoracic cavity; reveal the presence of fluids, exudates, or masses within the thoracic cavity
Thoracic CT produces cross sectional images of the contents of the chest, may be used with dye to determine the presence of pulmonary embolism
MRI allows for assessment of pulmonary embolism without the use of dye and is best for visualizing soft tissue and vascular structures; contraindicated in Pt. with metal implants
Pulmonary angiography used to identify structural changes in the pulmonary vasculature; structural changes that could cause occlusions: blood clot, tumor, aneurysm, overinflated alveoli
ventilation-perfusion scan uses radioactive isotopes to identify defects of ventilation and perfusion; injected radioactive albumin helps identify defects of perfusion; inhaled radioactive gas identifies defects of ventilation
bronchoscopy procedure that allows direct visualization of the lungs; bronchoscope is inserted orally into the trachea and advanced to the bronchi bifurcation
thoracentesis both an intervention and a diagnostic test; performed to drain excessive fluid from between the pleural linings; fluid drained is often analyzed for blood, fiber, and microbe content
Pt. exhibiting signs of resp. difficulty
deep breathing exercise works of SNS to influence body's respiratory system; controlling effort of respiration can improve oxygenation
what position may benefit those experiencing alteration in oxygenation fowlers
suctioning the aspiration of secretions through a catheter connected to a suction machine of wall suction outlet
incentive spirometer breathing exercise using an incentive spirometer that helps patients breath deeply to expand the lungs, helps clear mucus secretions and increase the amount of oxygen delivered to the bronchi and alveoli; post-op Pt., pneumonia, pulmonary alterations
Created by: melsniv