... Determinants and Assessment of Pulmonary...
...the conducting airways and the concept of...
...Discuss external respiration and pulmonary gas diffusion....
...Describe pulmonary perfusion and its components. 4....
...Differentiate between respiratory and metabolic acid-base imbalances...
...metabolic acid-base imbalances and levels of compensation....
...respiratory nursing history and assessment. 7. Describe...
...8. Discuss noninvasive and invasive methods of...
...monitoring gas exchange and applications. I. Mechanics...
...components: ventilation, diffusion, and perfusion. A. The...
...divided into conducting and respiratory airways. 2....
...move air to and from the atmosphere...
...from the atmosphere and alveoli. a) Protective...
...that removes pathogens and foreign materials. a)...
...the mucus layer and removes them through...
...can be swallowed and destroyed in the...
...the protective functions and placing patients at...
...risk of aspiration and ventilator associated pneumonia...
...trachea, with right and left bronchi. a)...
...is heavily enervated and very sensitive to...
...bronchus is shorter and larger in diameter...
...larger in diameter and at almost a...
...bronchus is longer and smaller in diameter...
...smaller in diameter and at a more...
...angle. d) Size and positioning of the...
...vulnerable to pathogens and foreign particles and...
...and foreign particles and misplacement of endotracheal...
...6. The trachea and bronchial walls contain...
...that gives structure and protection to larger...
...airflow through bronchoconstriction and bronchodilation. B. Ventilation...
...of airflow to and from the atmosphere...
...from the atmosphere and the alveoli. b)...
...nervous system control and adequate functioning of...
...of the lungs and conducting airways, thorax,...
...conducting airways, thorax, and ventilatory muscles. 2....
...to move in and out of the...
...between the visceral and parietal pleurae. 6....
...thoracic walls, diaphragm, and mediastinum. 8. The...
...Normally, the parietal and visceral pleurae act...
...the thorax increases and decreases in size,...
...the lungs increase and decrease in volume....
...lung volume (mL) and pressure (cm H2O)...
...in volume (mL), and deltaP is change...
...it becomes overexpanded and can burst. a)...
...4. Many pulmonary and extrapulmonary problems influence...
...work of breathing and causes a decreased...
...respiratory muscles weaken, and the anterior–posterior diameter...
...altered pulmonary mechanics, and air trapping. 3....
...has never smoked and has maintained normal...
...history of smoking and some degree of...
...symptomatic with aging and is at increased...
...Pulmonary Gas Exchange—Respiration and Diffusion A. Respiration...
...are supplied with oxygen and carbon dioxide...
...supplied with oxygen and carbon dioxide is...
...eliminated. 1. Internal and external respiration a)...
...for both external and internal respiration. 3....
...is very thin and offers little resistance...
...times faster than oxygen, but the oxygen...
...oxygen, but the oxygen tension decreases rapidly....
...a) Partial pressures and gradient b) Surface...
...determining affinity of oxygen to hemoglobin, affecting...
...molecules of nitrogen, oxygen, carbon dioxide, and...
...oxygen, carbon dioxide, and water vapor. a)...
...involves exchange of oxygen and carbon dioxide,...
...exchange of oxygen and carbon dioxide, which...
...air pressure. a) Oxygen in alveoli exerts...
...called PO2 or oxygen tension. (1) When...
...PO2 refers to oxygen in alveoli, it...
...abbreviations used for oxygen are also used...
...the tissues is oxygen-poor because the blood...
...its load of oxygen for the tissues’...
...between the alveoli and pulmonary capillary blood...
...pulmonary capillary blood and the systemic capillary...
...systemic capillary blood and tissues dictate which...
...of the gas and its solubility determine...
...that dissolves. a) Oxygen is not very...
...soluble in plasma, and only 3% of...
...3% of total oxygen content dissolves in...
...between the atmosphere and the alveoli and...
...and the alveoli and between the alveoli...
...between the alveoli and the pulmonary capillaries....
...pressure mechanical ventilation, and intermittent positive pressure...
...between the alveoli and the pulmonary capillaries,...
...is rich in oxygen and poor in...
...rich in oxygen and poor in carbon...
...are poor in oxygen and rich in...
...poor in oxygen and rich in carbon...
...between the PO2 and PCO2 in the...
...in the blood and cells cause oxygen...
...and cells cause oxygen to move from...
...the amount of oxygen and carbon dioxide...
...amount of oxygen and carbon dioxide that...
...functional surface area and consequently impairs gas...
...lung tumors, pneumothorax, and pneumonectomy—can significantly reduce...
...2. Diffusion of oxygen and carbon dioxide...
...Diffusion of oxygen and carbon dioxide requires...
...In healthy lungs, oxygen exchange is usually...
...primary carrier of oxygen in the blood....
...an affinity for oxygen molecules. 2. In...
...the pulmonary capillaries, oxygen binds loosely and...
...oxygen binds loosely and reversibly to hemoglobin,...
...a) Amount of oxygen that loads onto...
...hemoglobin saturation by oxygen (percent SaO2). 3....
...of hemoglobin for oxygen varies, depending on...
...pressure of arterial oxygen and hemoglobin saturation....
...of arterial oxygen and hemoglobin saturation. 5....
...although administering supplemental oxygen might significantly increase...
...administration of supplemental oxygen sufficient to increase...
...tissue level stimulates oxygen release from hemoglobin...
...bind with more oxygen. 10. Slight shifts...
...membrane thickness increases, and alveoli are destroyed...
...risk for hypoxemia and/or hypercapnia problems. 3....
...dead space ventilation, and terminal airways lose...
...the gas exchange and airway changes can...
...Pulmonary Gas Exchange—Respiration and Diffusion Slide 2...
...blood into tissues and organs. 2. Perfusion...
...through the lungs and back into left...
...of varying sizes and functions (5) Pulmonary...
...stroke volume (SV) and heart rate (HR):...
...is between 4 and 8 liters per...
...ventricular preload, afterload, and contractility. 4. Common...
...the brain, heart, and kidneys. c) Clinical...
...to organ ischemia and multiple organ dysfunction...
...Blood has weight and, therefore, is gravity...
...relationship between ventilation and pulmonary perfusion. Ventilation–Perfusion...
...of alveolar ventilation and pulmonary perfusion. 2....
...by the PAO2 and PACO2. 6. This...
...adequate diffusion of oxygen and carbon dioxide...
...diffusion of oxygen and carbon dioxide across...
...the alveolar-capillary membrane and movement of oxygen...
...and movement of oxygen into and carbon...
...of oxygen into and carbon dioxide out...
...into the bases and peripheral lung during...
...9. Because ventilation and perfusion are both...
...moderate alveolar ventilation and significantly reduced perfusion...
...the right heart and back into the...
...problems in ventilation and perfusion originate. 4....
...true shunts: anatomic and capillary Anatomic Shunt...
...from right heart and back into left...
...of the bronchial and several other veins...
...of anatomic shunt and capillary shunt is...
...is unaffected by oxygen therapy because it...
...very responsive to oxygen therapy. Venous Admixture...
...the left heart and out into the...
...blood. 3. The oxygen molecules remix in...
...include capillary recruitment and distention. a) Recruitment...
...to hypoxia, hypercapnia, and acidosis. a) Vasoconstriction...
...of the lungs and results in reduction...
...decreases their diameter and increases PVR. b)...
...function of pressure and flow. b) Pressure...
...pulmonary artery pressure and pulmonary capillary wedge...
...right ventricular hypertrophy and dilation secondary to...
...of both restrictive and obstructive pulmonary diseases....
...right heart failure and is a major...
...IV. Acid–Base Physiology and Disturbances 1. Acid-base...
...reacts with acids and bases to maintain...
...concentration lowers pH and increases acidity. b)...
...concentration increases pH and increases alkalinity. 7....
...include volatile acids and nonvolatile acids. a)...
...acid each day, and they respond slowly...
...in the proximal and distal tubules of...
...Balance: Buffer Systems and Compensation 1. Buffer...
...reactions between acids and bases to maintain...
...hydrogen ions (H+), and acids react with...
...because other buffer and regulatory mechanisms have...
...but body buffers and regulatory mechanisms have...
...the lungs (CO2) and kidneys (HCO3). 3....
...hemoglobin, serum proteins, and the phosphate system....
...reabsorption of hydrogen and bicarbonate ions in...
...loads, H+ elimination and bicarbonate reabsorption are...
...H+ is reabsorbed, and HCO3 is excreted....
...above 45 mmHg and the pH drops...
...cause of hypoventilation and correct it when...
...of the hyperventilation and providing the necessary...
...from cellular breakdown and anaerobic metabolism. 2....
...associated with shock and other severe physiologic...
...precedes decompensatory signs and can be an...
...trauma, diabetic ketoacidosis, and hepatic failure. Metabolic...
...pH > 7.45, and a base excess...
...1 Acid–Base Physiology and Disturbances Acid-base physiology...
...Balance: Buffer Systems and Compensation Metabolic (Renal)...
...on patient’s acid-base and oxygenation status. 2....
...of oxygenation status and interpretation of the...
...pressure of the oxygen dissolved in arterial...
...(3% of total oxygen) (normal value 80–100...
...total amount of oxygen available. 2. It...
...oxygenation because PaO2 and oxygen saturation (SaO2)...
...because PaO2 and oxygen saturation (SaO2) maintain...
...dissociation curve. SaO2 and SpO2 1. Oxygen...
...and SpO2 1. Oxygen saturation (SaO2) is...
...the percentage of oxygen combined with hemoglobin...
...the amount of oxygen available for delivery...
...composed of protein and heme, which contains...
...contains iron. 3. Oxygen binds to the...
...major carrier of oxygen in the blood...
...in the blood and is an important...
...room air (21% oxygen), and a blood...
...air (21% oxygen), and a blood temperature...
...with other values, and incorporated into the...
...level of compensation, and oxygenation status. 4....
...on patient’s need and person performing analysis...
...Status PaO2 SaO2 and SpO2 Slide 3...
...Respiratory Nursing History and Assessment 1. Many...
...assesses airway, breathing, and circulation, and the...
...breathing, and circulation, and the nurse immediately...
...as to etiology and chain of events...
...1. Assess tobacco and alcohol use. a)...
...smoked per day and number of years...
...problems of pulmonary and cardiovascular etiology. 2....
...interfere with sleep and rest. 2. If...
...interfere with sleep and rest. 4. Patients...
...discomfort. 6. Dyspnea and air hunger are...
...hunger are anxiety-producing and threatening experiences for...
...pain, cough, sputum, and hemoptysis. 2. Interview...
...family (subjective data), and perform a nursing...
...work of breathing and supply-and-demand imbalance. a)...
...of breathing and supply-and-demand imbalance. a) The...
...in both restrictive and obstructive pulmonary disorders....
...dyspnea is relieved, and the patient can...
...to the heart and lungs, causing a...
...whether it radiates, and the triggering and...
...and the triggering and alleviating factors. 2....
...Described as sharp and knifelike (2) When...
...is well innervated, and when inflammation occurs,...
...associated with pain, and increased blood pressure...
...increased blood pressure and pulse. Cough Subjective...
...congested), duration, triggers and pattern of occurrence,...
...pattern of occurrence, and alleviating factors. Objective...
...Observe strength, character, and frequency of cough....
...usual quantity, characteristics, and color, as well...
...regularly for quantity and characteristics. 2. Sputum...
...should be noted and documented. 3. Normal...
...secretions are thin and clear. Hemoptysis 1....
...causes: pulmonary embolism and cardiogenic pulmonary edema...
...includes color, consistency and quantity, and frequency...
...consistency and quantity, and frequency and duration....
...quantity, and frequency and duration. Objective data...
...consistency, quantity, frequency, and duration. Focused Respiratory...
...can be rapid and severe. 2. The...
...assessed baseline data and data trends. 3....
...observe lips, earlobes, and beneath tongue for...
...observed on lips and tongue. 3. Cyanosis...
...shape of chest, and observe chest movement...
...movement for symmetry and rate, depth, and...
...and rate, depth, and pattern of breathing....
...for tactile fremitus and chest expansion. 7....
...most breath sounds and comparing one lung...
...Vesicular, bronchial (tubular), and bronchovesicular. Abnormal Breath...
...other breath sounds and are never normal....
...nurse should assess and document location and...
...and document location and when in respiratory...
...Conditions include: atelectasis and pneumonia (2) Coarse...
...Conditions include: bronchitis and pulmonary edema Rhonchi...
...common during expiration and are auscultated over...
...inspiration or expiration and is of long...
...heard during breathing and ceases between breaths...
...pulmonary disease (COPD) and acute asthma, generalized...
...situation. Vital Signs and Hemodynamic Values 1....
...crucial baseline data and are important indicators...
...pressure, pulse rate and rhythm, respiratory rate...
...rhythm, respiratory rate and rhythm, and temperature....
...rate and rhythm, and temperature. 3. Pulse...
...mean arterial pressure, and cardiac output. 5....
...Respiratory Nursing History and Assessment Slide 2...
...12 Vital Signs and Hemodynamic Values VII....
...status 2. Implementation and interpretation of tests...
...provide baseline data and a means to...
...pulmonary volumes, capacities, and air flow. 6....
...associated with immobility and respiratory muscle fatigue....
...volume, vital capacity, and minute ventilation. a)...
...a) Tidal volume and vital capacity help...
...a respiratory spirometer and frequently are part...
...that moves in and out of lungs...
...hypoventilation becomes severe and results in hypercapnia....
...gender, height, weight, and age. 3. It...
...decreases with age and in the presence...
...from obstructive problems and measure airway resistance....
...(FEVs) VIII. Noninvasive and Invasive Monitoring of...
...as pulse oximetry and capnography are used....
...hemodynamics, measure arterial oxygen saturation, and provide...
...arterial oxygen saturation, and provide ready access...
...hemoglobin saturation (SpO2) and pulse rate. 2....
...differentiate between venous and arterial blood. 4....
...nose, or ear, and an oximeter provides...
...assessment of arterial oxygen saturation. 5. Fingers...
...the continuous arterial oxygen readings reflect the...
...patient’s oxygenation status and alert the clinician...
...measurements if acid–base and ventilation are not...
...of false alarms and inaccurate readings b)...
...Hemoglobin level affects oxygen content of blood....
...lower saturation reading, and alkalosis can cause...
...from distal sites and attached to a...
...ventilation in surgical and procedural anesthesia, postoperative...
...critical care units, and emergency departments (EDs)....
...guidelines for CPR and emergency care call...
...endotracheal tube placement and monitor the adequacy...
...for Healthcare Research and Quality (AHRQ) recommends...
...(using pulse oximetry and respiratory rate) and...
...and respiratory rate) and ventilation (using capnography)...
...mechanical ventilator problems and confirmation of enteric...
...assess ventilatory status and provide an early...
...correlation between Paco2 and etco2 can be...
...can be established and used for trending....
...a small tube and is analyzed in...
...the airway circuit, and continuous ETCO2 directly...
...by emergency squads and in ICU settings....
...given six breaths, and the device is...
...in the esophagus, and patient may have...
...precise etco2 data and therefore has limited...
...causing additional trauma and pain to the...
...acid–base imbalances. Compare and contrast the oxygenation...
...adult of 40, and an older adult...