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48 Cards in this Set

  • Front
  • Back
1. Pulmonary ventilation includes:
Inspiration (the active phase of ventilation); Involves the movement of muscles and thorax to bring air into lungs; Expiration (the passive phase of ventilation); Movement of air out of the lungs.
Gas Exchange (3)
1.Refers to the intake of oxygen and release of carbon dioxide.
2. Made possible by respiration and perfusion
3. Occurs via diffusion (movement of oxygen and carbon dioxide between the air and blood)
Factors affecting oxygenation:
1. Decreased Oxygen carrying capacity
1. Anemia
Factors affecting oxygenation (3)
1. Decreased oxygen carrying capacity (anemia, low hemoglobin)
2. decreased inspired oxygen concentration (bronchoconstriction, blebs)
3. Increased metabolic rate (fever, wounds)
1. Signs of anemia (3)
2. low hemoglobin is__
3. fever causes __% increase in BMR.
4. a patient with a stage 4 ulcer will be on ___.
1. increased heart rate, increased pulse, fatigue.
2. less than 10
3. 7%
4. oxygen
Conditions affecting chest wall movement (5)
1. musculoskeletal abnormalities (decreased expansion.
2. nervous system diseases (MS, ALS, changes in innervation.)
3. trauma (broken ribs, cardiothoracic surgery, abdominal surgery, pain)
4. Pain management
5. Chronic disease
Older adults and oxygenation problems (5)
1. bony landmarks are more prominent due to loss of subcutaneous fat.
2. Kyphosis contributes to appearance of leaning forward.
3. Barrel chest deformity may result in increased anteroposterior diameter.
4. Tissues and airways become more rigid; diaphragm moves less efficiently.
5. older adults have an increased risk for respiratory disease, especially pneumonia.
Lifestyle factors in oxygenation (6)
1. levels of health (immune system compromise)
2. developmental considerations (babies breath abdominally)
3. Medications (patient education; may use more than one pain patch)
4. Lifestyle (narcotics, smoking)
5. Environment (occupation)
6. Psychological health (anxiety, fear lead to higher breathing rate)
Alterations in cardiac functioning (locomotive problems) that affect oxygenation of the body (6)
1. disturbances in conduction
2. altered Cardiac output
3. myocardial ischemia
4. left-sided heart failure
5. right sided heart failure
6. impaired valve function
Left sided heart failure results in (blank); rights sided heart failure results in (blank).
pulmonary edema in left sided heart failure; jugular vein dystention in right sided heart failure.
Alterations in respiratory functioning (3)
1. hyperventilation (seen in sepsis, or may just be anxiety)
2. hypoventilation (not getting enough air, may be from drugs)
3. hypoxia results from tissues not getting enough oxygen. COPD patients are always hypoxic, their pulse ox will be 88 to 90.
Nursing Assessment for oxygenation (14)
Assess for:
1.risk factors (age)
2. fatigue (intercostals can fatigue)
3. pain, increases respirations and heart rate.
4. breathing patterns
5. orthopnea; ask pt. how many pillows used to sleep
6. wheezing (emergency...usually starts as expiratory, may progress to inspiratory which is more urgent)
7. cough
8. respiratory infections
9. medication use
10. Physical exam (look for clubbing, percuss, hyperresonance)
11. pulmonary function studies
12. peak expiratory flow rate
13. pulse oximetry (screening tool only)
14. Thoracentesis, may be palliative or diagnostic
Planning, goals for patient (5)
1. Absence of cyanosis or chest pain and a pulse oximetry of above 95%.
2. Patient will relate the causative factors and demonstrate adaptive method of coping. example, did they aspirate?, do they have tuberculosis, do they have risk factors?
3. patient will preserve pulmonary function by maintaining an optimal level or activity.
4. patient will demonstrate self-care behaviors that provide relief from symptoms and prevent further problems.
5. patient will obtain 250-700 milliliters of inspired air on incentive spirometer by end of shift.
Nursing implementation: Health promotion (3)
1. Influenza and Pneumococcal vaccine
2. Environmental modifications (get rid of allergens)
3. teaching about a pollution-free environment (use of air cleaners, changing furnace filters)
Nursing implementation: acute care (5)
The nurse will:
1. promote optimal function
2. promote proper breathing
3. promote and control coughing (teach quad cough, cascade cough, huff coughing, suctioning)
4. promote comfort
5. meet respiratory needs with medications.
Patient should get 10 milliliters per kilogram of air minimum.
Nursing interventions for:
1. crackles
2. Ronchi
3. wheeze
1. Turn and position, deep breathing, forced expiration, vibration and percussion, and diuresis (obtain order from doctor)
2. Deep breathing, cough, hydration, and mobilize. heard with pneumonia.
3. Bronchodilation, hydration, coughing.
Mobilization of pulmonary secretions accomplished by: (5)
1. hydration
2. humidification
3. bronchodilation
4. cough and deep breath!
5. mucolytics
Ways to maintain or promote lung expansion (5)
1. positioning
2. incentive spirometry done ten times every hour while awake,
3. chest physiotherapy
4. vibration
5. postural drainage
Nursing responsibilities with chest tubes (5)
1. Assist with insertion/removal of chest tube
2. respiratory status and vital signs
3. check the dressing
4. maintain the drainage system
5. If pulls out, cover with gloved hand, cover hole with palm and call for help.
Maintaining and promoting oxygenation (8)
1. use safety precautions with oxygen
2. make sure patient has adequate oxygen supply in tank.
3. know methods of oxygen delivery
4. positioning (fowler's, semi fowler's, tripod)
5. maintain adequate fluid intake
6. provide humidified air
7. perform chest physiotherapy
8. maintain good nutrition
Oxygen delivery systems (8)
1. nasal cannula (dial 1 to 6 liters, as patient fails bump up to next mode on dial.)
2. nasal catheter
3. transtracheal catheter
4. simple mask (at least 6L per minute setting)
5. partial rebreather mask and
6. non rebreather mask both on 10 liters per minute setting. If patient on nonrebreather has oxygen of 80-90% they are failing...go to CPAP.
7. Venturi mask
8. Tent
1. three types of positive pressure ventilation
1. CPAP, prevents atelectasis and increases o2
2. BiPAP, 2 levels of pressure (inspiration and expiration); decreases the work of breathing; prevents atelectasis and increases o2
3. Ventilator, improves inspiration and expiration; increases o2 and decreases co2.
Types of artificial airways (3)
1. oropharangeal and nasopharyngeal airway
2. endotracheal tube
3. tracheostomy tube
1. A pulse ox reading of below _% is bad news.
2. The oxygen saturation of hemoglobin is reported as
3. normal is
1. 90%
2. Spo2 (pulse ox reading) or the Sao2 (percentage of arterial oxygen saturation)
3. above 94%
1. The partial pressure of oxygen (PaO2) reflects...
2. with normal ranging from...
1. the oxygen dissolved in plasma
2. 80 to 100 mm Hg.
1.Acid comes from...
2. Acid is removed from the body by the...
3. a BASE is a__
4. alkalosis
1.Carbonic acid, exercise produces acid.
2. lungs, kidneys
3. hydrogen ion acceptor; it neutralizes acid
4. clinical condition in which there is less than normal amount of acid in relation to base. Body is too basic.
1. pH
2. pH of
a. blood
b. ICF
c. urine
d. CSF
e. Gastric Acid
f. Bile
1. percent hydrogen
2. a. 7.35-7.45
b. 6.9-7.2
c. 6.0
d. 7.35-7.45
e. 1.0-2.0
f. 5.0-6.0
1. The most important regulatory system
2. Bicarbonate buffers up__
3. Phosphate buffer
1. bicarbonate
2. carbonic acid and up to 90% of hydrogen ion in ECF
3. binds hydrogen and becomes pneumonia which gets excreted in the urine.
1. important intracellular buffers
2. The most important buffers in urine
1. phosphate
2. phosphate
1. Most plentiful buffer system, 75% of the buffer system
1. protein buffer. Binds to hydrogen. Works well until it becomes saturated. Slow buffer.
1. Physiologic buffers(4)
1. Lungs
2. second line of defense
3. twice as effective as chemical buffers because can handle twice the amount of acid and bases.
4. responds quickly but can restore only temporarily.
1. Respiratory control center is in the__.
2. Long term adjustments of pH are accomplished by the __. Takes how long to work?
3. Bicarb can be excreted in
1. medulla
2. kidneys
up to 4 days
1. The major diagnostic tool for evaluating acid-base balance and oxygenation.
2. the purpose of ABG is to show how
1. ABG's
2. effectively the lungs are delivering oxygen to the blood, how efficiently they are eliminating carbon dioxide, and how well the lungs and kidneys are interacting to maintain normal blood pH (acid base balance).
Procedure and after care of ABGs. (5)
1. Arterial stick with Allen's test first.
2. No sitting or air bubbles in sample
3. process right away
4. Hold pressure on site,
5. assess for hematoma or bruising
ABG Normal Values:
1. pH
2. PaO2
3. PaCO2
4. HCO3-
5. SaO2
6. critical range of pH
1. 7.35-7.45
2. 80-100 mmHg
3. 35-45 mmHg
4. 22-26 mEq/L
5. 97-100% (also known as SAT)
6. below 7.20 or above 7.55
PaCo2 (3)
4. Normal CO2 is
1. refers to the partial pressure of CO2 in arterial blood.
2.Indicates the effectiveness of ventilation (how well the lungs are blowing off caronic acid)
3. Provides the info about the respiratory component of acid-base balance
4. 35-45mmHG
HCO3- Bicarbonate (4)
1. normal is 22-26 mEq/L
2. Major Base
3. Reflects the activity of the kidneys in retaining or excreting bicarb.
4. Accomplished by kidneys conserving or excreting Hydrogen and hydrogen bicarbonate.
PaO2 (Anearobic Metabolism)(4)
1. Gives information about patient's oxygenation level.
2. Used to identify hypoxemia.
3. Anaerobic Metabolism
4. Normal PaO2 is 80-100 mmHg
1. Acidosis (or acidemia)
2. Alkalosis (or alkalemia)
3. A primary RESPIRATORY problem is determined if
4. A primary metabolic problem is when
1. occurs when pH drops below 7.35 (causing CNS depression)
2. occurs when the pH rises above 7.45 (causing CNS excitation).
3. the PaCO2 is less than 35 mmHg (alkalosis) or greater than 45 mmHg (acidosis)
4. the HCO3 is less than 22mEq/L (acidosis) or greater than 26mEq/L (alkalosis)
1. Respiratory acidosis means the patient is
2. Some of the common causes of the retention of carbon dioxide (respiratory acidosis) are
1. retaining CO2
2. Pneumonia, drug overdose, pulmonary edema, pneumothorax. (Less surface area, decreased respiratory rate, fluid in lungs)
Clinical manifestations of respiratory acidosis (6)
cardiac dysrhythmias, tachycardia, somnolence
decreased ventilation, decreased level of consciousness.
1. respiratory alkalosis is not enough
2. Some of the common causes of respiratory alkalosis (6)
3. first sign of pulmonary embolus is
1. CO2
2. Pain, fever, asthma, congestive heart failure, anxiety/fear, pulmonary embolus.
3. tachypnea
1. Clinical manifestations of respiratory alkalosis
1. N/V, tingling of fingers, excitatory symptoms.
1. Patients likely to get metabolic acidosis.
2. Reasons for metabolic acidosis
1. Kidney patients, C. Diff patients lose too much bicarb from diarrhea.
2. Kidneys are not escreting enough hydrogen produced by anaerobic metabolism; losing too much HCO3 by GI tract; drug overdose.
Clinical Manifestations of metabolic acidosis (5)
1. hyperkalemia; shift of acid to ICF and K+ to the ECF
2. anorexia, n/v
3. warm, flushed skin
4. cardiac dysrhythmias & CNS dysfunction (somnolence, decreased LOC)
5. h/a, diarrhea, tremors
Metabolic Alkalosis common causes (2)
1. Gain of base: increased ingestion of antacids or an excessive administration of sodium bicarb
2. Loss of metabolic acids: vomiting, nasogastric suctioning diuretics (loss of hydrogen)
Clinical manifestations of metabolic alkalosis (5)
cardia dysrhythmias
muscle twitching
Three questions plus one more:
1. First question
2. Second Question
3. Third Question
4. Fourth Question
1. Is the patient in a acidic or alkalotic state?
2. Is the CO2 normal?
3. Is the HCO3 normal?
4. Compensation?