Oxygenation, Ventilation, Diffusion Exam #1
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| Type of cellular metabolism that is necessary for sustaining life | aerobic -- requires OXYGEN
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| 3 components of oxygenation and breathing | Ventilation, Diffusion, Perfusion
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| Ventilation | movement of air in and out of the lungs
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| Diffusion | exchange of gas at the alveolar level
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| Perfusion | Carrying of oxygenated blood to tissues
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| Assessing ventilation | is the airway open?
auscultation of the lungs.
respiratory rate
respiratory pattern
use of accessory muscles
chest shape
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| Adventitious lung sounds | wheezing, stridor, crackles
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| Conditions that affect ventilation | any lung disease (COPD, Reactive Airway Disease)
Cystic fibrosis
Sleep apnea
smoking
environmental exposure
Airway obstruction
acute bronchitis
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| Diagnostic tests used to assess ventilation | CXR, ABG (PaCo2), Bronchoscopy, Pulmonary function tests
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| Medications frequently used to treat ventilation disorders | Bronchodilators (dilates bronchioles), Mucolytic agents (loosens mucus), Reversal agents such as Narcan
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| Medications frequently associated with ventilation disorders | Analgesics (narcotics cause respiratory depression), anesthesia, sedatives, paralytics (paralyzes respiratory muscles)
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| Two types of acute respiratory failure | Hypoxemia and Hypercapnia. Can be acute or chronic.
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| Hypercapnia | Inadequate CO2 removal. Ventilatory failure.
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| Hypoxemia | Inadequate O2 transferred to the blood. Oxygenation failure.
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| Causes of respiratory failure | Airway/alveolar - related: asthma (acute), emphysema, chronic bronchitis, cystic fibrosis.
CNS-related: drug overdose, brainstem infarction, spinal cord injury
Chest wall issues: flail chest, fractures, mechanical restriction, muscle spasm
Neuro: MS,
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| Clinical signs of respiratory distress | nasal flaring, pursed lipped breathing, tripod positioning, difficulty speaking, cough, use of accessory muscles, sternal retractions, intercostal retractions
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| Clinical signs of hypercapnia | headache, irritability, confusion, inability to concentrate, somnolence, bradypnea, tachycardia/dysrhythmias, hypotension, facial rubor
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| Interventions | Support ventilation
Treat underlying cause
NIPPV
Mechanical ventilation
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| NIPPV | non-invasive positive pressure ventilation (CPAP, BiPAP)
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| Pneumothorax | air in the pleural space. May be open (sucking chest wound, usually associated with penetrating trauma), or closed (not associated with a wound)
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| Hemothorax | blood in the pleural space
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| pleural effusion | excess fluid in the pleural space
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| hemopneumothorax | blood and air in the pleural space
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| tension pneumothorax | complete collapse of the lung
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| Flail chest | occurs when 3 or more ribs are fractured in 2 or more places and are no longer attached to the thoracic cage.
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| status asthmaticus | severe, persistent asthma that does not respond to conventional therapies
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| Independent nursing actions that may be used to manage airway and ventilation | positioning, oral airway/nasal airway, suctioning, bag-valve mask/tube
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| Airway/ventilation interventions that require physician order | endotracheal intubation, tracheostomy, NIPPV, mechanical ventilation, chest tubes
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| Most common airway obstruction in an unconscious patient | tongue
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| oral airway | used only for unconscious patients;
holds the tongue away from the airway
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| nasal airway | can be used for both conscious and unconscious patients; do not use if suspected skull fracture
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| endotracheal tube | tube inserted into the airway via the mouth
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| tracheostomy | tube inserted into the airway via the trachea, bypasses the upper airway completely. Usually done for longterm ventilation situation.
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| CPAP | Continuous Positive Airway Pressure
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| BiPAP | uses to different pressures (IPAP - inspiratory and EPAP - expiratory)
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| Mechanical ventilation | used for patients who cannot maintain adequate ventilation on their own. Last resort. Requires intubation. Cannot be used for patients with DNR/DNI orders.
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| Signs/symptoms of problems with diffusion | Mental status change (first indication of hypoxemia), cough, fatigue, inability to speak complete sentences
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| Conditions that frequently cause problems with diffusion | illnesses, cystic fibrosis, environmental/occupational (asbestos, black lung, allergies)
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| Diagnostic testing used for issues with diffusion | CXR, ABG (PaO2), Hgb, sputum analysis, lung biopsy
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| Pulse oximetry | measures SpO2 level, oxygenation. Is not a measure of ventilation. Normal SpO2 is 95+%
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| Oxyhemoglobin dissociation curve | small changes in SpO2 can result in big changes to PaO2.
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| Medications used to treat diffusion disorders | anti-infectives (if r/t pneumonia or infection), diuretics, mucolytics, anti-inflammatory/steroids, anti-hypertensives, anti-thrombolitics, fibrinolytics
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| Conditions associated with alteration in ventilation | pneumonia, pleural effusion, pulmonary edema, pulmonary fibrosis, influenza
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| Disorders that cause hypoxemic respiratory failure | COPD, pneumonia, asthma, atelectasis, pulmonary embolus, severe emphysema, pulmonary fibrosis, exercise-induced hypoxemia, anatomic shint, extreme V/Q mismatch
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| Clinical signs of hypoxemia | restlessness, confusion, lethargy, coma, tachycardia/dysrhythmias, tachypnea, dyspnea, use of accessory muscles, mild hypertension (early), hypotension (late), cyanosis
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| Interventions for hypoxemia | aggressive pulmonary toilet (TDBC), treat underling disease, supplemental oxygen, NIPPV, mechanical ventilation
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| amount of oxygen present in room air | 21%
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| Why supplemental oxygen? | Increases percentage of oxygen in alveoli and leads to greater diffusion pressure.
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| Acute Pulmonary edema | abnormal collection of fluid in the alveoli and interstitial spaces of the lungs. Often caused by heart failure
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| Pneumonia | can be community acquired or nosocomial.
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| Pulmonary emboli | blockage of pulmonary arteries by a thrombus, fat or air embolus, or tumor tissue
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| Acute Respiratory Distress Syndrome (ARDS) | extreme form of respiratory failure, most common cause is sepsis
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