Question | Answer |
Where does gas exchange occur? | In the alveoli of the lungs. |
What is ventilation? | The body's ability to get air in and out; chest expansion |
What is compliance? | Ability to expand bronchioles and alveoli
Compliance is decreased by inflammation, infection, and increased mucus production which can be manifested by bronchospasms, mucus, CHF, pulmonary edema, and atelectasis |
What are factors that affect diffusion? | Decreased surface area
Thickness of alveoli membrane
Perfusion inadequate to alveoli
More vasculature in lower part of lungs because of gravity pulling blood downward |
What affects transportation of oxygen and carbon dioxide? | Decreased cardiac output
Decreased hemoglobin |
Is it ventilation compliance, diffusion or transportation? | Pneumonia (bacteria in alveoli) diffusion
Bronchitis (bronchials affected) compliance
Anesthesia (loss of sensation) Ventilation
Fractured ribs ventilation
Anemia Transportation
CHF Transportation and diffusion
Asthma compliance
PE transp/diffusion |
What are symptoms of acute hypoxia? | Agitated, confused
Respiratory rate increases
Pulse rate goes up |
What are symptoms of chronic hypoxia? | Fatigue and lethargy
Increased hemoglobin - makes blood thicker, so harder to breathe
Increased muscle use |
What are some assessment findings of respiratory status? | Tachypnea - fast breathing
Bradypnea - slow breating
Hyperventilation - faster, deeper breaths
Hypoventilation - slower, shallow breaths
SOB - shortness of breath
Dyspnea - difficulty breathing/objective
Orthopnea - cardiac patients; SOB while lay |
Breathing pattern symptoms of hypoxia are? | Rales occur in alveoli
Rhonci occur in bronchioles (mucus, fluid)
Wheezing - tubing system collapsing on itself |
What are some diagnostic tests for respiratory status? | PEFR - peak expiratory flow rate
Chest x-ray
Lung scan
Thoracentesis
Endoscopy
Pulse oximetry, < 86% emergency; < 80% life threatening
Arterial blood gases
Sputum specimens |
What are nursing interventions for respiratory distress? | Monitor - symptoms of hypoxia, breathing pattern, lung sounds, diagnostic tests
Actions - maintain open airway, elevate HOB, TC & DB, chest physiotherapy (massage), suctioning, nebulization |
Major causes of airway obstruction are? | Problems with compliance
Bronchial smooth muscle contraction
Mucus hypersecretion
Inflammation - chronic bronchitis, asthma
Infection - pneumonia |
What are medications used to improve respiratory function? | Antibiotics to treat bacterial infections
Bronchodilators
Glucocroticoid steroids |
How are inhaled medications classified? | Bronchodilators - selective beta-2-agonists
Metered dose inhaler (MDI), nebulizer
Relievers -SABA - immediate relief
Controllers - LABA - delayed onset |
What are ADRs of bronchodilators? | Increased pulse
Increased BP
Fine muscle tremors
Anxiety |
What is a glucocorticoid? | Inhaled steroid
Inhibits inflammation
First line of therapy for moderate to severe asthma |
What are ADRs of glucocorticoids? | Oropharyngeal candidiasis (fungal infection)
Dysphonia (hoarseness)
Promotes bone loss (less than oral steroids, though) |
What education should nurses give to patients about glucocorticoids? | Gargle after administration
Use a spacer
Take calcium with vitamin D
One minute between dosages
Hold breath after administration and breathe through pursed lips
Administer bronchodilator before steroid |
What is oral steroid therapy used for? | When symptoms not controlled with safer drugs
Used for rheumatoid arthritis, systemic lupus, inflammatory bowel disease, allergies |
What are primary uses of oral steroid therapy? | Anti-inflammatory
K+ loss
Na+ retention
Immunosuppressor
Too many side effects with long-term therapy |
What are nursing interventions with oral steroids? | Monitor for K+ levels (hypokalemia), fluid retention (retaining Na+), osteoporosis, gastric ulcers, infections
Actions - increase K+ intake, prevent infection, increase Ca2+ intake |
What must patients be taught about oral steroids? | Do not stop taking abruptly
Mood swings possible
Take with food
No NSAIDs - increase GI ulcer incidence |
What are some properties of methylxanthines? | Caffeine, theophylline (oral), aminophylline (IV)
Bronchodilators - relax smooth muscle of bronchi
Narrow TI
Toxicity - arrythmias and seizures
Early sign of ADR - nausea |