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chapter 28 resp.
| Normal Pathway | through nostril, into pharnx, into trachea and then either right or left bronchus. which branches into bronchioles that terminate into alveoli |
| diffusion | oxygen and carbon dioxide move across aveolar cell membrane and cell memebrane of the capillaries surrounding the aveoli |
| hypoxemia | when oxygen level in the blood drop below normal range |
| hypoxia | blood cannot take adequate amount of oxygent to the tissue during internal respiration |
| Early signs and symptoms of hypoxia | agitation, anxiety, change of level of consciousness, disorientation, headache, irritability, restlessness and tachypnea |
| Late sign and symptom of Hypoxia | bradycardia, cardiac arrythmias, cyanosis, decreased respiratory rate (bradypnea) and retraction (difficult breathing) |
| effects of hypoxia on thinking | hypoxia to the brain can cause changes in mental function affecting judgment |
| Nose is block/ impaired oxygenation | if the nose is blocked because of mucus congestion the body uses an alternative path and mouth breathing occur |
| trachea blocked by secretion/ impaired oxy | If the trachea is blocked by secretion, coughing clear them |
| trachea block by foreign obj | if trachea is blocked by a foreign body such as food the HEIMLICH MANEUVAER can be performed to clear the airway |
| bronchi or bronchiole blocked by thick mucous | deep cough and possible mucous thinning agent (mucinex)are required to clear it |
| damaged aveoli due to copd | when alveoli are not fully functional, less oxygen can cross into the blood, and less carbon dioxide is able to leave the blood |
| low oxygen in blood | caused by a situation in which the the pt is unable to fully expand the lungs because of fluid or pus in the chest cavity or a blood clot in the lung preventing circulation to aveoli |
| atelectasis | if a lung is collapse. expansion does not occur, so air is not pulled into the lungs, can result by a knife wound to chest. also, blockage of airway into lung preventing expansion of the lung |
| causes of hypoxia and hypoximia | airway obstruction caused by tumor, choking forein body thick mucous anemia atelectasis (collapse lungs) chronic lung disease decreased cardia output high altitude hypoventilation caused by anesthetic, poor peripheral circ, pulmonary emb |
| caring for with impaired oxy | tell pt what you need them to do, help slow down breathing by repeating "breath in , breath out" at tempo you want pt to breath DO NOT LEAVE PATIENT IN ACUTE RESP. DISTRESS ALONE, EVEN IF YOU THINK IT ANXIETY |
| ASSESSING RESP. STATUS | color of skin and mucous membranes respiratory effort cough chest appearance oxygenation stat oxygen saturation |
| cyanosis | low oxygen causing bluish lips,tip of nose, top of ear and nailbed |
| dyspnea | when patient has difficulty breathing |
| suptum/ viral infection | sputum clear or white |
| sputum/ bacterial infection | sputum yellow or green |
| sputum/pneumonia and TB | sputum rusted color, indicate presence of blood |
| sputum/ inhaled smoke or soot | sputum is gray or black |
| sputum/pulmonary edema | pink amd frothy or bubbly, sputum indicates fluid and blood mixed together and is seen in a life threatening condition |
| observe consist. off sputum | thick, tenacious, sticky mucus is difficult to cough out. it tends to remain in the lungs and provide a medium for bacteria growth, encourage pt to drink more fluids to help thin the mucous making it easier to cough out |
| excursion | as Pt inhale and exhale determine wheather each side of the chest is moving equally diffrence in chest wall movement along with shortness of breathe can indicate a serious problem, such as airway obstruction, pneumothorax and pleural effusion |
| pleural effusion | fluid in chest cavity |
| pneumothorax | occurs when a hole allows air to enter the pleural space also termed pleural cavity, where there supposed to be negative pressure |
| tension pneumothorax | LIFE THREATING when this occurs air is trapped in the pleural cavity surrounding the lungs which not only compresses and collapses the lungs but also cause pressure on the heart and major blood vessels causing them to shift within the thorax |
| crepitus | air in the subcutaneous tissue, in chest wall, face and neck. when you gently press your fingertips onpatient skin, you will feel a crackle sensation like rice crispys becing crushed, usually felt beneath area of edema |
| diagnostic test/ PULMAONARY FUNCTION TEST | determine lung, capacity, volume and flow rate |
| diagnostic test/ PEAK FLOW | measure the amount of air that can be exhaled with force using a peak flowmeter. used to determine dosage and freq. of some resp. meds, can be used by pt. to monitor the effectiveness of med |
| diagnostic test/ xray | used to visualize lung field, air appears dark so it can be determined whether all lobe are filling with air. fluid, dense tissue and infiltrates appear white |
| diagnostic test/ TB test | to determine reaction to presents of tuberculin bacillus in skin layer |
| diagnostic test/ bronchoscopy | to visualize trachea and brochi, to obt. biopsies of abnormal tissue, and to obtain sample of lung cells, fluid and other material inside the air sacs |
| Sputum Specimens | best time to do this is first thing in the morning |
| two way to obtain sputum specimen | 1. patient coughs and brings up mucus from the lungs and expectorates it into a sterile specimen container 2. you suction the throat or trachea and trap the mucus in a specimen container attached to the suctioning tubing |
| Arterial blood Gases (ABG) | arterial blood gases are drawn from an artery rather than a vein, as are other blood test |
| Arterial blood Gases (ABG) | after testing collateral circulation the health care professional insert the needle into artery at a 90 degree angle, the pressure of the blood in the artery causes the plunger of the syringe to rise as blood enter the syringe |
| after placing pillow have pt follow | 1. breathe in through the nose and hold your breath for 3/5 sec. 2. slowly exhale though the mouth with the lips in the whistle postition 3. |
| incentive spirometry | one way to encourage patient to take frequent deep breaths is through the use of an incentive spirometer which is a device with one or more chamber and mouthpiece |
| PH | 7.35(acidosis)- 7.45(alkalosis) |
| Hco3/bicarb/metabolic | 22-26 |
| Paco2/respiratory | 35-45 |
| nebulizer | a medication delivery system containing an air compressor and mask or handheld mouthpiece |
| Inhalation | diaphragm contracts move downward, increase size chest cavity and lung expand |
| exhalation | lungs are being squeezed, chest cavity decreased, ribs come upward, diaphragm rise up and lungs are then compressed |
| carbon dioxide | elevated blood become acidic due to you holding in to much co2 causing anxiety and panic attack |
| hold breath | build up carbon dioxide, acid build up, ph change |
| external respiration | alveoli to capillary |
| internal respiration | bloodstream to body cell |
| chest physical therapy | To help drain mucus from the lobes of the lungs, chest physical therapy (CPT) may be ordered. This involved assisting the patient into different positions to encourage the drainage of mucus out of the lung. |
| chest physical therapy | it also involves using percussion to help loosen pooled mucus . in most hospitals, this will be performed by respiratory therapist however it is possible that in home health and LTC a practical nurse may have to help CPT |
| SAFETY FOR OXYGEN USE | No smoking ensure no open flames in same room as oxygen source check electrical devices for frayed wires use cotton gown to elemenate static electricity use water soluable or non petroleum based products |
| nasal cannula | 1-6L/min delivers oxygen into the nares |
| simple face mask | 5-10L/min delivers o2 directly to nose and mouth, pt may breathe through nose and mouth, flow rate less then 5L will cuse carbon dioxide accumulation in the mask |
| partial rebreather mask | 6-15L/min mask with mask attached that trap CO2 for rebreathing to loer ph level. port on side of mask allow most exhaled air to discharge |
| non rebreather mask | 6-15L/min prevents the patient from rebreathing and exhaled air;it escapes through a one way valve that does not allow room air to enter. the bag traps the oxygen as a reservoir for inhalation. ONLY delivery device that can provide 100% o2 when set 15L |
| Venturi mask | indicate the liter flow to use equal a specific percentage of o2. this gives more exact control inspired o2 especially with pt with COPD |
| FACE TENT | used for pt claustrophobia |
| bipap | set a timer of how pt breathe, if pt breath falls below desired number during sleep bipap will force pressurized air into lung to help open airway |
| how often should a pt be turned and asked to deep breath and cough | q2h while awake to promote lung expansion and prevent atelectasis (colapse avoli) mobilize and clear secretions reduce risk for pneumonia improve oxygenation and circulation |
| what is the purpose of delivering med through nebulizer | deliver med quickly and directly to respir. tract help open airway, reduce inflammation and loosen mucous brochodialator, corticosteroids, or mucolyics in pt with copd, asthma |
| why is conservation of energy imp. pt with chronic lung disease | reduce o2 demand and work of breathing help pt complete daily activities without exhaustion prevent respiratory distress and fatigue related hypoxia |
| endotracheal tube | placed through the mouth and into trachea with the cuff inflated to prevent air leak |
| tracheostomy | incision into the trachea that held open with a tube to promote breathing may be performed several reasons |
| three parts of tracheostomy tube | 1.outer cannula: w/or witout cuff. the cuff is inflated to prevent air leakage when patient on ventilator 2.obturator: fits inside the outer cannula and forms a smooth end for inserting the tracheostomy tube in tracheotomy |
| three parts of tracheostomy tube continue | 3. inner cannula inserted after obturator is removed. it may be a disposible tube or it may be designed to clean and replace q8h |
| nurse intervention chest tube | Its is imp. for you to assess for clots that might occlude the tubing preventing suctioning from maintain the vacuum neccessary to restore the neg. pressure within pleural space |
| nurse intervention chest tube | it is imp to know what to do if chest tube comes out. a special dressing impregnant with petroliumm jelly makes an occlusive barrier to cover opening to prevent ait from entering. |
Created by:
indiallano91