...Objectives 1. Explain the conducting airways and...
...conducting airways and the concept of ventilation....
...and perfusion. A. The conducting airways 1....
...to and from the atmosphere and alveoli....
...captures them on the mucus layer and...
...foreign particles toward the pharynx, where they...
...and destroyed in the stomach. b) In...
...an artificial airway, the initial conducting airway...
...is bypassed, reducing the protective functions and...
...pneumonia (VAP). 5. The tracheobronchial tree consists...
...tree consists of the trachea, with right...
...left bronchi. a) The junction of the...
...The junction of the “Y” formed by...
...“Y” formed by the two primary bronchial...
...bronchial branches is the carina, which is...
...stimulation. (1) When the carina is touched...
...severe coughing. b) The right bronchus is...
...straight angle with the trachea. c) The...
...the trachea. c) The left bronchus is...
...and positioning of the right bronchus makes...
...endotracheal tube. 6. The trachea and bronchial...
...present down to the bronchiole level that...
...airways. 7. Toward the terminal end of...
...terminal end of the bronchial tree are...
...bronchial tree are the bronchioles, surrounded by...
...a) Bronchioles have the ability to regulate...
...1. Ventilation is the first of the...
...the first of the three components of...
...three components of the respiratory process. a)...
...is defined as the mechanical movement of...
...to and from the atmosphere and the...
...the atmosphere and the alveoli. b) Ventilation...
...b) Ventilation involves the actual work of...
...adequate functioning of the lungs and conducting...
...functioning of the lungs and conducting airways,...
...and out of the lungs as a...
...out of the lungs as a result...
...a result of the changing size of...
...changing size of the thorax caused by...
...activity. a) When the thorax enlarges, the...
...the thorax enlarges, the intrapulmonary pressure drops...
...then moves from the area of higher...
...higher pressure to the area of lower...
...lower pressure. c) The result is air...
...air flowing into the lungs (inspiration) until...
...flowing into the lungs (inspiration) until the...
...lungs (inspiration) until the pressure in the...
...the pressure in the lungs becomes slightly...
...pressure in the lungs becomes slightly higher...
...back out of the lungs (expiration) until...
...out of the lungs (expiration) until pressures...
...to collapse. a) The fluid lining of...
...fluid lining of the alveoli has a...
...II cells in the alveoli secrete a...
...action that reduces the surface tension of...
...surface tension of the fluid lining the...
...the fluid lining the alveolar sacs, decreasing...
...alveolar sacs, decreasing the tendency to collapse....
...to collapse. b) Lungs are composed of...
...elastic fibers. (1) The elastic force of...
...state. To maintain the lungs in an...
...To maintain the lungs in an inflated...
...an inflated state, the elastic forces must...
...opposing forces. 4. The thorax is the...
...The thorax is the primary opposing force...
...force that keeps the lungs expanded. 5....
...that keeps the lungs expanded. 5. The...
...lungs expanded. 5. The thoracic bony structure...
...framework that maintains the lungs in a...
...that maintains the lungs in a baseline...
...rest, because of the attraction between the...
...the attraction between the visceral and parietal...
...parietal pleurae. 6. The pleura is a...
...moist membrane. 7. The parietal pleura adheres...
...pleura adheres to the thoracic walls, diaphragm,...
...and mediastinum. 8. The visceral pleura adheres...
...pleura adheres to the lung parenchyma. a)...
...parenchyma. a) Normally, the parietal and visceral...
...membrane. 9. As the thorax increases and...
...size, so will the lungs increase and...
...so will the lungs increase and decrease...
...Lung Compliance 1. The ease with which...
...ease with which the lungs can be...
...with which the lungs can be expanded...
...burst. a) As the alveoli approach their...
...conditions that affect the lung’s tissues, particularly...
...tissues, particularly if the disorder causes a...
...sometimes called “stiff lungs”; it takes more...
...Decreased compliance increases the work of breathing...
...tidal volume. d) The breathing rate increases...
...to compensate for the decreased tidal volume....
...a person ages, the diaphragm flattens, the...
...the diaphragm flattens, the chest wall becomes...
...becomes more rigid, the respiratory muscles weaken,...
...muscles weaken, and the anterior–posterior diameter of...
...anterior–posterior diameter of the chest increases. a)...
...air trapping. 3. The lung’s functional ability...
...has maintained normal lungs might show little,...
...through aging. 5. The aging person with...
...Breathing—Ventilation Slide 2 The Conducting Airways Slide...
...A. Respiration is the process by which...
...process by which the body’s cells are...
...1. Diffusion is the second of the...
...the second of the three components of...
...three components of the respiratory process. 2....
...respiration. 3. Diffusion: the movement of gases...
...to diffusion. a) The membrane can thicken...
...diffusion is reduced, the carbon dioxide tension...
...than oxygen, but the oxygen tension decreases...
...sea level. 2. The respiratory process only...
...certain percentage of the total air pressure....
...tension. (1) When the PO2 refers to...
...called PCO2. c) The other abbreviations used...
...blood returning to the lungs from the...
...returning to the lungs from the tissues...
...the lungs from the tissues is oxygen-poor...
...is oxygen-poor because the blood has dropped...
...of oxygen for the tissues’ use. 4....
...for removal from the lungs. 5. The...
...removal from the lungs. 5. The differences...
...the lungs. 5. The differences in gas...
...partial pressures between the alveoli and pulmonary...
...capillary blood and the systemic capillary blood...
...flow based on the law of diffusion....
...will dissolve in the liquid. The partial...
...in the liquid. The partial pressure of...
...partial pressure of the gas and its...
...its solubility determine the amount that dissolves....
...pressures is called the pressure gradient. a)...
...gradient exists between the atmosphere and the...
...the atmosphere and the alveoli and between...
...alveoli and between the alveoli and the...
...the alveoli and the pulmonary capillaries. b)...
...pulmonary capillaries. b) The greater the pressure...
...b) The greater the pressure difference, the...
...the pressure difference, the more rapid the...
...the more rapid the flow of gases....
...factors can increase the gradient—for example, exercise,...
...d) Air enters the alveoli from the...
...the alveoli from the atmosphere because the...
...the atmosphere because the atmospheric air pressure...
...gradient exists between the alveoli and the...
...the alveoli and the pulmonary capillaries, causing...
...of gases across the alveolar-capillary membrane. f)...
...In internal respiration, the process is reversed....
...process is reversed. The arterial blood is...
...carbon dioxide, whereas the cells are poor...
...carbon dioxide. (1) The pressure differences between...
...pressure differences between the PO2 and PCO2...
...and PCO2 in the blood and cells...
...to move from the circulating hemoglobin into...
...circulating hemoglobin into the cells. (2) The...
...the cells. (2) The cells release carbon...
...carbon dioxide into the bloodstream. Lung Surface...
...surface area of the lung is very...
...very large. 2. The greater the available...
...2. The greater the available alveolar-capillary membrane...
...membrane surface area, the greater the amount...
...area, the greater the amount of oxygen...
...disorder that destroys the alveolar-capillary membrane. a)...
...This greatly reduces the functional surface area...
...1. Thickness of the alveolar-capillary membrane is...
...is important. 2. The thinner the membrane,...
...2. The thinner the membrane, the more...
...thinner the membrane, the more rapid the...
...the more rapid the rate of diffusion...
...a) Fluid in the alveoli or interstitial...
...inflammatory process involving the alveoli c) Lung...
...blood flows through the alveolar-capillary system in...
...is faster through the alveolar-capillary system. 4....
...5. In healthy lungs, oxygen exchange is...
...1. Hemoglobin is the primary carrier of...
...of oxygen in the blood. a) It...
...molecules. 2. In the pulmonary capillaries, oxygen...
...for transport to the tissues. a) Amount...
...(percent SaO2). 3. The affinity of hemoglobin...
...physiologic factors. 4. The oxyhemoglobin dissociation curve...
...dissociation curve represents the relationship of the...
...the relationship of the partial pressure of...
...hemoglobin saturation. 5. The percentage saturation of...
...direct relationship with the PaO2. 6. The...
...the PaO2. 6. The top portion of...
...top portion of the curve is flattened...
...this portion of the curve, a large...
...might significantly increase the patient’s PaO2, the...
...the patient’s PaO2, the resulting SaO2 increase...
...proportionally small. 7. The bottom portion of...
...bottom portion of the curve is steep....
...sufficient to increase the PaO2 should yield...
...Low PaO2 at the tissue level stimulates...
...High PaO2 at the pulmonary capillary level...
...life-threatening tissue hypoxia. The Effects of Aging...
...surface area decreases, the alveolar-capillary membrane thickness...
...decreased diffusion across the alveolar-capillary membrane, altering...
...alveolar-capillary membrane, altering the ventilation–perfusion relationship. 2....
...less efficient, placing the high-acuity older patient...
...3. Over time, the airways become larger,...
...trapping. a) Both the gas exchange and...
...Curve Slide 5 The Effects of Aging...
...A. Perfusion is the third component of...
...third component of the respiratory process. 1....
...Perfusion refers to the pumping or flow...
...ventricle, running through the lungs and back...
...running through the lungs and back into...
...adequate perfusion in the systemic system (3)...
...be approximated using the equation MAP =...
...organs, such as the brain, heart, and...
...dependent areas of the body. 3. Gravity...
...major influence on the relationship between ventilation...
...greatly affected by the PAO2 and PACO2....
...carbon dioxide across the alveolar-capillary membrane and...
...dioxide out of the alveoli. 7. When...
...naturally moves toward the diaphragm, which results...
...air movement into the bases and peripheral...
...perfusion greatest in the dependent areas of...
...dependent areas of the lungs. 9. Because...
...areas of the lungs. 9. Because ventilation...
...both greatest in the bases of the...
...the bases of the lungs, the greatest...
...bases of the lungs, the greatest amount...
...of the lungs, the greatest amount of...
...this portion of the lung fields. 10....
...10. In upper lungs, moderate alveolar ventilation...
...11. In lower lungs, there is a...
...V/Q ratio. 12. The clinical significance of...
...will shift from the lung bases to...
...area is in the dependent position while...
...be drawn toward the diaphragm. Pulmonary Shunt...
...shunt refers to the percentage of cardiac...
...that flows from the right heart and...
...and back into the left heart without...
...that flows through the lungs participates in...
...flows through the lungs participates in gas...
...of emptying of the bronchial and several...
...other veins into the lung’s own venous...
...Capillary shunt is the normal flow of...
...Blood flowing by the affected units will...
...or fluid in the alveoli. Absolute Shunt...
...Absolute Shunt 1. The combined amount of...
...absolute shunt. a) The total percentage of...
...true shunt because the shunting is not...
...admixture refers to the effect that pulmonary...
...shunt has on the contents of the...
...the contents of the blood as it...
...it drains into the left heart and...
...and out into the system as arterial...
...blood. 2. Beyond the shunted areas, the...
...the shunted areas, the fully reoxygenated blood...
...blood mixes with the completely or relatively...
...unoxygenated blood. 3. The oxygen molecules remix...
...molecules remix in the combined blood to...
...Intrapulmonary Shunt 1. The simplest way to...
...is by calculating the P/F ratio (PaO2/FIO2)....
...best used when the patient’s PaCO2 is...
...1. PVR measures the resistance to blood...
...blood flow in the pulmonary vascular system,...
...main factors determine the amount of pulmonary...
...pulmonary resistance: a) The length of the...
...The length of the vessels b) The...
...the vessels b) The radius of the...
...The radius of the vessels c) The...
...the vessels c) The viscosity of the...
...The viscosity of the blood (1) Of...
...Of these factors, the major determinant of...
...altered by: (a) The volume of blood...
...of blood in the pulmonary vascular system...
...vascular system (b) The amount of vasoconstriction...
...of vasoconstriction (c) The degree of lung...
...Factors related to the volume of blood...
...of blood in the pulmonary vascular system...
...most influential. (1) The small pulmonary capillaries...
...low (e.g., shock), the smaller capillaries can...
...(1) By distending, the capillaries can accommodate...
...capillaries can accommodate the increased flow. (2)...
...increased PVR in the high-acuity patient. b)...
...b) Hypoxia is the strongest stimulant for...
...an area of the lung becomes hypoxic,...
...functional areas of the lungs and results...
...areas of the lungs and results in...
...artery catheter. a) The calculation measures resistance,...
...gas exchange because lungs play critical role...
...is crucial to the effective functioning of...
...for excretion from the lungs. b) Nonvolatile...
...excretion from the lungs. b) Nonvolatile (metabolic)...
...be excreted through the kidneys. (1) The...
...the kidneys. (1) The kidneys are capable...
...are excreted in the proximal and distal...
...distal tubules of the kidneys in exchange...
...in pH. c) The buffering mechanisms are...
...2. Compensation a) The process whereby an...
...in terms of the degree or level...
...level to which the body has achieved...
...Uncompensated (acute) (a) The pH is abnormal...
...begun to correct the balance. (2) Partially...
...Partially compensated (a) The pH is abnormal,...
...Compensated (chronic) (a) The pH has returned...
...buffer system is the major buffering system...
...buffering system in the body. 2. Its...
...are regulated by the lungs (CO2) and...
...regulated by the lungs (CO2) and kidneys...
...serum proteins, and the phosphate system. 4....
...phosphate system. 4. The bicarbonate system is...
...to days. 5. The metabolic compensation mechanism...
...compensation mechanism controls the rate of elimination...
...bicarbonate ions in the kidney. 6. With...
...Compensation Mechanism 1. The respiratory buffer system...
...within minutes. 2. The lungs have two...
...minutes. 2. The lungs have two ways...
...in changes in the PaCO2. a) Normal...
...1. Occurs when the PaCO2 moves above...
...45 mmHg and the pH drops below...
...alveolar hypoventilation. a) The lungs are not...
...hypoventilation. a) The lungs are not blowing...
...over many years; the body can compensate...
...pH by elevating the bicarbonate. 6. Additional...
...alveolar hyperventilation. a) Lungs are eliminating too...
...treatment involves determining the cause of the...
...the cause of the hyperventilation and providing...
...hyperventilation and providing the necessary intervention. 5....
...alkalosis is uncommon. The same factors causing...
...chronic state if the problem remained uncorrected....
...A measure of the amount of buffer...
...required to return the blood to a...
...is present if the BE is greater...
...mEq/L. a) Signals the presence of a...
...mEq/L. a) Signals the presence of a...
...anaerobic metabolism. 2. The normal range for...
...oxygenation status. 2. The following section focuses...
...section focuses on the determinants of oxygenation...
...and interpretation of the entire ABG. A....
...1. This represents the partial pressure of...
...partial pressure of the oxygen dissolved in...
...80–100 mmHg), not the total amount of...
...is reflected in the oxyhemoglobin dissociation curve....
...saturation (SaO2) is the measure of the...
...the measure of the percentage of oxygen...
...hemoglobin compared with the total amount it...
...> 95%). 2. The degree of saturation...
...important in determining the amount of oxygen...
...for delivery to the tissues. Hemoglobin 1....
...or Hb is the major component of...
...Oxygen binds to the iron atoms on...
...iron atoms on the four heme groups...
...4. Hemoglobin is the major carrier of...
...of oxygen in the blood and is...
...approximately 25–30% (in the 30- to 80-year...
...and incorporated into the overall clinical picture....
...oxygenation status. 4. The severity of hypoxemia...
...or severe, but the exact associated PaO2...
...is admitted to the hospital in acute...
...in acute distress, the nurse initially assesses...
...and circulation, and the nurse immediately takes...
...feasible, information regarding the immediate events leading...
...events related to the current problem. 3....
...current problem. 3. The presence of severe...
...respiratory distress limits the amount of health...
...questions directed to the patient to reduce...
...rest. 2. If the respiratory problem is...
...to cause hypoxia, the patient often exhibits...
...inadequate oxygenation of the brain. 3. Pulmonary...
...disorders can increase the work of breathing,...
...obtain information about the most common respiratory...
...hemoptysis. 2. Interview the patient or family...
...1. Dyspnea is the feeling of having...
...supply-and-demand imbalance. a) The body’s ability to...
...state in which the patient assumes a...
...out of bed, the dyspnea is relieved,...
...is relieved, and the patient can resume...
...been congested in the lower extremities during...
...lower extremities during the day shift to...
...day shift to the heart and lungs,...
...the heart and lungs, causing a fluid...
...volume overload when the person becomes horizontal...
...minute, significantly increases the work of breathing....
...note how long the pain has been...
...it radiates, and the triggering and alleviating...
...between breaths or the breath is held,...
...be auscultated at the focal pain point...
...to pain. 4. The attached visceral pleurais...
...as well. 5. The parietal pleura is...
...Respiratory Assessment 1. The onset of acute...
...and severe. 2. The nurse should be...
...one lung with the other. Normal Breath...
...an area of the lungs. a) When...
...area of the lungs. a) When assessed,...
...nurse should document the location. b) In...
...is questioned. 6. The presence of pulmonary...
...and out of lungs with each normal...
...1. VC is the maximum amount of...
...age and in the presence of acute...
...Ventilation (VE) 1. The total amount of...
...to >10 L/minute, the work of breathing...
...out of their lungs at a normal...
...not conducted at the bedside. PowerPoint Slides...
...considered when choosing the best sensor location....
...status. 7. Ideally, the continuous arterial oxygen...
...oxygen readings reflect the patient’s oxygenation status...
...status and alert the clinician to subtle...
...factors can alter the accuracy of pulse...
...can compete with the pulse light source...
...of shifts in the oxyhemoglobin dissociation curve....
...1. Capnometry is the numeric measurement of...
...2. Capnography is the noninvasive measurement of...
...value measurement called the PETCO2 (partial pressure...
...A capnogram displays the capnometry measurements as...
...by breath, throughout the breathing cycle. 7....
...used to monitor the adequacy of ventilation...
...care call for the use of capnography...
...placement and monitor the adequacy of ventilation...
...of ventilation 3. The Agency for Healthcare...
...(PCA) to reduce the risk of potentially...
...Other applications include the detection of mechanical...
...neuromuscular diseases). 6. The usefulness of bedside...
...or ventilation–perfusion abnormalities, the etco2 may not...
...which may limit the usefulness of etco2...
...is diverted from the main airway circuit...
...chamber apart from the airway circuit. a)...
...as part of the airway circuit, and...
...Major disadvantage: requires the patient to be...
...color based on the patient’s exhaled pH...
...commonly used in the ED to assess...
...Also used in the field by emergency...
...is attached to the ET tube following...
...following tube insertion, the patient is given...
...six breaths, and the device is read...
...full-end expiration. 4. The device rapidly responds...
...rapidly responds to the patient’s exhaled CO2...
...(Nellcor, Boulder, CO), the detector device has...
...is not in the trachea (2) Color...
...may be in the esophagus, and patient...
...properly located in the trachea 5. While...
...has limited applications The Capnogram 1. The...
...The Capnogram 1. The pattern that is...
...is visible on the capnography screen. 2....
...arterial Paco2 at the end of the...
...the end of the plateau phase (the...
...the plateau phase (the end-tidal CO2). 3....
...a normal capnogram, the carbon dioxide concentration...
...is zero at the beginning of expiration,...
...a plateau. 4. The end-tidal carbon dioxide...
...carbon dioxide is the highest concentration at...
...highest concentration at the end of exhalation....
...is used in the clinical setting as...
...Gas Monitoring 1. The arterial catheter is...
...blood gases from the arterial line, is...
...and pain to the patient from repeated...
...Capnography Slide 5 The Capnogram Slide 6...
...Classroom Activities Discuss the different mechanisms the...
...the different mechanisms the body uses to...
...acid–base imbalances. Discuss the impact on the...
...the impact on the respiratory system when...
...implemented to reduce the risk factors for...
...Compare and contrast the oxygenation levels of...
...factors will change the findings between the...
...the findings between the generations? Wagner et...