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Chapter 28: Resp.
Chapter 28: Respiratory Care
| Term | Definition |
|---|---|
| Airway | the path that air takes as it enters and exits the lungs |
| Normal airway sequence | nostrils into the pharynx, into the trachea, and then to either the right or the left bronchus, which branches into the bronchioles that terminate into the alveoli |
| Patent Airway | When this pathway is unblocked and air is moving freely, it is referred to as a |
| Diffusion | Oxygen and carbon dioxide move across the alveolar cell membranes and the cell membranes of the capillaries surrounding the alveoli by the process of |
| When you can't breathe off the CO2 | acid and CO2 builds up in the body |
| Muscles required for breathing to occur | diaphragm and intercostals |
| When the diaphragm contracts | it moves downward, increases chest cavity, inhalation |
| when intercostal muscles contract | it moves the ribs up and out, which enlarges the chest cavity from side to side and front to back |
| when chest cavity size increases | causes the lungs to expand |
| when the pressure within the lungs drops below atmospheric pressure (negative pressure) | causes a vacuum, air is pulled into the lungs until pressure in the lungs equals pressure outside the body |
| inhalation | inspiration |
| as these muscles relax, chest cavity decreases... | ribs come inward, diaphragm rise upward and lungs are compressed, forcing air out |
| exhalation | expiration |
| the respiratory center is located | in the medulla |
| medulla is located in the | brainstem |
| elevated CO2 in the blood | the blood becomes more acidic |
| acidic blood results in | increased rate & depth of respirations |
| chemical regulation of respirations is influenced by chemoreceptors located in the | carotid and aortic bodies, and in the medulla of the brainstem |
| when these chemoreceptors detect a decrease in the oxygen of blood or change in blood pH | they send a message to the medulla, causes increase in rate and depth of respirations |
| when excess CO2 levels are "blown off" blood pH returns to | normal levels, rate and depth return to normal as well |
| rising carbon dioxide levels that cause acidic blood stimulate the brain | this is why you cannot hold your breath long, not because of low O2, but because of high CO2, prompts the brain |
| internal respiration | between bloodstream and body cells |
| external respiration | between alveoli and the capillaries |
| oxygen moves via | diffusion |
| diffusion | moving from an area of higher concentration to lower concentration |
| hemoglobin carries | oxygen |
| hypoxemia range | less than 95% o2 |
| hypoxemia | o2 levels in blood drop below normal range |
| hypoxia | blood cannot give enough oxygen to tissues during internal respiration |
| early signs of hypoxia | agitation, anxiety, changes in LOC, disorientation, headache, irritability, restlessness, tachypnea, confusion |
| late signs of hypoxia | bradycardia, cardiac arrhythmias, cyanosis, bradypnea, retractions |
| is trachea is blocked by secretions | coughing can clear them |
| is trachea is blocked by foreign body | coughing or Heimlich maneuver |
| if bronchioles are blocked by thick mucus or secretions | deep coughs and mucus thinning agents required |
| rhonchi | gurgles |
| crackles | fluid |
| narrow airways | wheezing |
| stridor | emergency |
| focused respiratory assessment | |
| dyspnea | difficulty moving air and out of the lungs |
| exertional dyspnea | difficulty breathing when ambulating brief distance |
| orthopneic position | sitting upright, leaning forward over table , increases intrathoracic area |
| productive cough | brings up sputum |
| nonproductive cough | dry cough |
| yellow/green sputum | bacterial infection |
| clear/white sputum | viral infection |
| rust-colored sputum | pneumonia, TB |
| pink frothy sputum | pulmonary edema |
| gray/black sputum | smoke, soot |
| mouth breathing does not have cilia like in the nose to catch | irritants, so it goes into throat then lungs |
| if you observe thick, tenacious, sticky mucus | encourage patient to drink more fluids to help thin the mucus |
| if you observe reactions when inhaling | late sign of hypoxia, emergency |
| pleural effusion | fluid in chest cavity |
| pneumothorax | when a hole allows air to enter pleural space |
| tension pneumothorax | air is trapped in the pleural cavity surrounding the lungs, compresses and collapses lungs, puts pressure on the heart/major blood vessels, causing them to shift. emergency |
| atelectasis | collapsed lung |
| crepitus | air in the subcutaneous tissue, feelings like crackling beneath the skin (usually felt beneath edema) |
| normal SaO2 range | 95% to 100% |
| normal blood pH | 7.35 - 7.45 |
| PaCO2 range | 35 - 45 mm Hg |
| HCO3 range | 22 - 26 |
| pulmonary function tests | determine lung capacity, volume, flow rates (used to diagnose obstructive or restrictive lung diseases, COPD/asthma) |
| peak flow | measures amount of air that can be exhaled with force (monitor effectiveness of medications) |
| chest x-ray | |
| tb skin test | |
| bronchoscopy | |
| PACO2 | respiratory/partial pressure |
| HCO3 | metabolic/bicarb |
| nasal cannula | 0-6 L O2 |
| nursing interventions for impaired oxygen | turn, cough, deep breath, incentive spirometry, nebulizer, chest physical therapy, supplemental oxygen, conservation of energy |
| simple face mask | 5-10 L/min, delivers O2 directly to face and mask |
| partial rebreathing mask | traps CO2 for rebreathing to lower pH, 6-15 L/min |
| nonrebreathing mask | prevents patient from rebreathing ANY exhaled air, 6-15 L/min |
| venturi mask | control precise mix of oxygen percentage (good for COPD) |
| face tent | used for patients who feel claustrophobic, allows for high humidity to be used |
| tacheostomy | incision into the trachea, held open with tube to promote breathing |
| CPAP | continuous positive airway pressure, sleep apnea |
| BiPAP | bilevel positive airway pressure, COPD |
| Yankauer suction catheter/Tonsil tip suction | suctioning the mouth / tonsils |
| suctioning longer than 15+ secs | can cause hypoxia |
| ONLY suction when you | withdrawal, DO NOT suction while inserting the catheter |
| endotracheal tube | tube inserted thru nose or mouth, intubation for surgery |
| outer cannula | with or without cuff, outer piece |
| obturator | removed once tube is placed, kept at bedside incase tube needs reinserted |
| inner cannula | cleaned or replaced every 8 hours |
| trach care is | sterile |
| replace soiled trach dressing | to protect skin breakdown |
| replace trach collar | to protect airway, sterile procedure |
| at bedside | bag valve mask, O2, obturator, spare trach same size, spare trach one size smaller, and suction equipment |
| sequence of changing trach | inner, dressing, then collar |
| during trach care | at least semi fowlers, and bed raised to comfy working height |
| trach care if unconscious | lateral position towards you |
| trach care sequence 1 | remove o2 source, stabilize with non domhand, use dom hand to press tabs and remove inner cannula. dispose, remove site dressing, dispose. next put on sterile gloves, put in new inner cannula gently, press tabs to stabilize, apply o2 source again. assess |
| trach care sequence 2 | assess trach site. remove 02 again, clean stoma under faceplate with saline soaked gauze, dry w sterile gauze. replace new outer collar using second nurse to hold tube in place. assess for skin breakdown. 1 finger fit between neck and collar. apply o2 |
| suctioning sequence | 100 - 120, dom hand sterile, nondom hand clean only to pour sterile water into cup, measure earlobe to nostril on tube. insert without suction. suction for less than 10 secs, rotate while removing. flush with saline. repeat as needed |
Created by:
hannamalec
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