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121 Cards in this Set
- Front
- Back
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4 events of respiration
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ventilation
diffusion transport regulation |
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ventilation
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between atmospher and alveli
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diffusion
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movement of 02 and c02 between alveli and blood
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transport
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movement of 02 and co2 to blood and body fluids
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regulation of respiration
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neural and chemical control
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low RBC will
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decrease the transportation of O2
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how does respiration occur?
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Respiration = lungs expand
(Neuro control tells the diaphragm to contract and move down, which creates a negative pressure in the chest which creates a space that causes MORE negative pressure. Allowing more air to come in from the nose and the mouth.) |
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how much room air is o2
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21%
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When humidity is added to air what happens
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nitrogen, oxygen and carbon dioxide will decrease with an increase in H2O.
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Normal Tidal Volume
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= 500-800 mL
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Inspiratory reserve volume
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how much air can I get into my lungs = 2100-3000 mL
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Experiatory reserve volume =
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how much air can I get out of my lungs = 800-1200 mL
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Reserve volume
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1000-1200 mL
(when the “wind is knocked out of you” is a forced release of RV) |
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diffusion goes from
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high pressure to low pressure
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Oxygen has
greater pressure |
in a gaseous state
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oxygen has lower pressure in
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pulmonary blood
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how does oxygen move and where does it move
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oxygen moves from alveoli to pulmonary blood bc of diffusion and change of pressure
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Carbon Dioxide
greater pressure in |
pulmonary blood
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carbon dioxide has lower pressure in
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alveoli
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carbon dioxide moves where
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pulmonary blood to alveoli
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where is oxygen transported
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97% of oxygen is transported in combination with hemoglobin in the red blood cell
3% is dissolved in the plasma |
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how do o2 molecules combine with hemoglobin?
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loosely and reversibly with hemoglobin so it can be released to tissue that needs itq
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where does diffusion occur
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capillary membrane.
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what happens when fluid is present in between the alveoli and capillary membrane,
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diffusion is harder to occur; could be impossible to occur if too much fluid is present**
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Transport of O2 =
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Oxyhemoglobin Dissociation Curve
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When pO2 in plasma is high what happens to the 02
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O2 binds with hemoglobin
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When pO2 in plasma is low what happens to 02
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O2 is released from the hemoglobin to oxygenate tissues
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, hemoglobin is
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a vehicle: It connects with the O2 in the lungs where there is a lot of O2 and then releases it in the tissues where O2 is needed
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O2 is let go when there is a PO2 of
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40
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what factors increases Affinity of hemoglobin for O2
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pH, temperature, 2,3 DPG
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when does Oxyhemoglobin Dissociation Curve shift to the right
and causes |
More O2 given to needy tissues
caused by: decrease of pH (acidosis) rise in body temperature increased 2,3 DPG - (anemia & chronic hypoxemia) |
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when does Oxyhemoglobin Dissociation Curve shift to the left
and causes (bad less o2 available) |
Less O2 given up to tissues
Caused by: increased pH (alkalosis) decrease in body temperature Less O2 is being given up but they do not require as much O2 low 2,3 DPG: usually from transfused blood. Transfused blood is low in 2,3 DPG |
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2, 3 Diphosphoglycerate
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Hemoglobin uses 2,3 DPG to control how much O2 is released once the blood gets out into the tissues.
The more 2, 3 DPG in the cell, the more O2 is delivered to the tissues. The less 2, 3 DPG in the cell the less O2 delivered |
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when is 2, 3 diphoshoglycerate important
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large blood transfusions because stored blood quickly looses 2, 3 DPG and its ability to deliver O2.
After transfusion, the red cells rebuild the 2, 3 DPG but it takes 24 hours to regain a normal level and normal hemoglobin function |
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Hemoglobin LOVES
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carbon monoxide!
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carbon monoxide has an Affinity for hemoglobin that is
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250 to 300 times greater than that of oxygen
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what happens when carbon monixde is inhalled
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When it is inhaled, all of the hemoglobin becomes saturated with CO NOT O2
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Classic sign of Carbon Monoxide Poisoning is
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a cherry pink face
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symptoms of CO poisoning
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CNS symptoms:
Appears intoxicated (cerebral hypoxia), headache, muscular weakness, palpitations, dizziness, confusion progressing rapidly to coma Skin Color: Pink > Cherry Red > Cyanotic….. Not reliable |
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CO and pulse ox
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Not valid because Hgb is well saturated – BUT not with Oxygen (with CO). Pulse Ox reads only that Hgb is saturated (can’t distinguish)
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treatment of CO poising
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Carboxyhemoglobin level
Treat until less than 5% Treat with 100% 02 (preferably hyperbaric) |
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arterial blood o2 saturation numbers
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pO2 of 95 - 100 (blood gas)
O2 saturation of 97 - 100% |
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venous blood o2 saturation numbers
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pO2 of 40
O2 saturation of 75% |
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what is pulse ox
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Measures amount of O2 carried by hemoglobin in arterial blood (SaO2)
Normal = 95 - 100% |
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Low pulse Ox =
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hypoxic
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Taking N-tidal CO2 helps do what?
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we will catch hypoxia issues earlier.
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where is ventilation regulated
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medulla and pons
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what adjusts rate and volume of ventilation
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Sensory tissues in aortic and carotid bodies
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where does co2 diffuse rapidly and what does it cause
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spinal fluid the pH changes (drops) rapidly
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what happens when The pH of cerebrospinal fluid drops
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the chemoreceptors react by increasing rate & volume
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The Primary Stimulus for Breathing is a
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Low pH in the CSF
This changes in seconds and stimulates breathing |
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02 breathers level that causes it to breath
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pO2 must drop to about 60 mmHg for this to kick in
Persons with chronically high levels of CO2 eventually cause the CO2 stimulus in the CSF to fail |
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normal o2 blood gas
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80 – 100
80 is normal at high elevations |
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normal pCO2
PH HCO3 |
pCO2 35 - 45
pH 7.35 - 7.45 HCO3 23 - 24 |
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what is the best indicator of alveolar ventilation
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pCO2
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what is the best indicator of alveolar ventilation
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pCO2
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on 100 percent o2 what should the p02 be if they dont need it
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300
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Acute Respiratory Acidosis ph, co2 and hco3
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pH = dec PCO2 = inc HCO3 = nl
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Acute Respiratory Alkalosis
ph co2 hco3 |
pH = inc PCO2 = dec HCO3 = nl
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Metabolic Acidosis
ph co2 hco3 |
pH = dec PCO2 = nl HCO3 = inc
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Metabolic Alkalosis
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pH = high PCO2 = nl HCO3 = high
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Compensated Respiratory Acidosis
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pH = nl or low PCO2 = high HCO3 = high
pH will never be higher than 7.41 |
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Compensated Respiratory Alkalosis
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pH = nl or high PCO2 = low HCO3 = low
pH will never be 7.38 or 7.39, always higher than 7.42 |
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Compensated Metabolic Acidosis
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pH = nl or low PCO2 = low HCO3 = low
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Compensated Metabolic Alkalosis
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pH = nl or high PCO2 = high HCO3 = high
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what has no impact on acid-base balance
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hypoxia
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correction vs compensation of pH problem
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Correction of a pH problem =
the system (resp or metabolic) causing the pH problem returns the pH to normal Example = Resp acidosis - fix the lungs Compensation of a pH problem the system (resp or metabolic) NOT causing the pH problem returns the pH toward normal Example = COPD - kidneys retain HCO3 |
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what happens to the pleura when you breath
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Visceral pleura and parietal pleura sit next to each other and when a breath is taken, they slide over each other
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Pneumothorax
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Air or fluid in the pleural space
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Open Pneumothorax
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air entering pleural space through hole in chest wall which results in a decrease in negative pressure
Gun shot wound Stick in the chest wall Pipe in chest Stab wound |
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what happens in a sucking chest wound
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air is drawn into the open wound and fills up the space of one lung and causes the lung to recoil.
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what happens in a tension pneumothorax
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With each breath taken in, the air leaks out into the pleural space and so on and so on. This causes an increase in the pressure on that side of the lungs resulting in the collapse of that lung. Even upon the collapse of the lung, air is still pushed into the pleural space causes great tension.
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what is in the Mediastinum
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= IVC, SVC, heart, esophagus, aorta
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what happens to the mediastinum with tension pnuemothorax
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When this occurs, the tension pushes the mediastinum to the unaffected side; called mediastinum shift. Esophagus, trachea, aorta are fine, however the real problem lies in the transportation of blood in the IVC and SVC.
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. If there is 100 cc of blood present in pleural space, what do you do for replacement
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times by 3 with fluids. So patient would get 300cc of fluid (ringers).
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where do you put the chest tubes and what does it do
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put chest tube high to pull out air, put low to pull out fluid however, one in the middle can do both
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what does a nurse do with a chest tube care
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sterile Vaseline gauze tightly around tube and pushed tightly to the skin to prevent air to leak around the chest tube
4x4 with cut in it ½ way to the middle Real tape Tape to prevent air from moving around the tube Pt should have a chest X-Ray ordered to check for placement of the chest tube |
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why do we use a three bottle system for chest tubes instead of one
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Possible problem is a raise in the level of fluid and sterile water which could result in the occlusion of the air tube. This will result in an increase in pressure in the bottle which now makes the open pneumothorax into a closed pneumothorax
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what determines the amount of suction of a patients chest tube
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The amount of water in the bottles determines the amount of suction that gets to the patient NOT THE AMOUNT OF MOTOR SUCTION ON THE WALL.
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what is the average water pressure in a chest tube
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usually 30cm of water pressure
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what does bubbling in the water with chest tube indicate
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Drainage will be present in the drainage bottle. Air bubbles present in the water seal compartment is an indication of a hole still present in the parenchyma. When the bubbling stops in the air compartment we know that the lungs are healed, tube is normally taken out after 24 hours.
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what determines if the leak is present in chest tube
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clamp chest tube close to the chest to determine if the leak is in the chest tube or the patient if bubbling stops, the leak is in the patient; if bubbling continues the leak is from the chest tube.
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Tidaling
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when you see the fluid in the chest tube move up in the column toward the patient on inhalation and away from the patient upon exhalation.
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what do you do if a chest tube comes out
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put patrolium jelly gauze on it or put hand over it to prevent sucking wound
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do you strip or milk chest tubes
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only milk bc stripping causes too much negative pressure in the chest
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how much drainage do you expect to see per hour
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less than 100 cc per hour
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nursing responsibilities for chest tubes
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Verify all connections are airtight and secure
Assess water seal is intact Keep pleurovac below patient’s chest level Keep air vent open when suction off |
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When do chest tubes come out?
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24-48 hours after the air leak has stopped. If taken a long time to heal it make take longer
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nursing actions for removing chest tubes
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Time pain medication to peak at time of removal
Cut suture, pull out with petroleum gauze (vaseline gauze) in other hand Immediately put vaseline gauze over whole in skin Then cover with 4X4 dressing and tape airtight with nonporous tape |
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what happens if you dont cover hole right after removing chest tubes
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get another pneumothorax bc they don’t like to open up and it’s a perfect chance for the lungs to recoil like they want to
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what do you need to give when giving oxygen
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humidity
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AquinOx
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High flow (up to 35 l/m)
Used to require mask to deliver Aquinox uses nasal cannula High humidity Better pt adherence to RX can use nasal canula with it instead of mask |
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how do you insert airway
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put in upside down and then turn it around
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When do you take out a person’s oral airway?
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when they cough it up
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what part of the mouth is important in maintaining an airway
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hard and soft palate
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what do you need to insert a Endotracheal Tube
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Need laryngoscope, stethoscope, adhesive tape
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how do you check for placement of ET tube
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Correct placement checked by auscultation & x-ray
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what should be a cuff pressure with ET tube and why do you need it?
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Cuff pressure should be 15-20 mmHg. If you don’t air will go to trachea and it will leak out back up around the tube and not go into the lung bc lungs don’t want to inflate if they don’t have to. Babies don’t have cuff. Use syringe not needle!! If too high it will erode tissue
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when do you put in a trachestomy instead of ET
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after 10 days
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what do you do with Ambu Bag with oxygen
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Plugged into o2-put it at the top and turn it as much as you can even if the ball isn’t moving anymore and can deliver 100 percent o2 from this
Give 500-800 tidal volume with each time you breath for it think about normal breaths and go at that speed-women tend to need two hands |
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Fenestrated Tracheostomy Tube
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Only when had surgery on trachea
If the trach tube will stay for extended period of time they may have this which will allow them to eat and talk. Talk when inner canula is out so air can go both ways so they can talk and breathe IF in ER< OR < or ICU you don’t want one bc you only want air going one way-just concerned with breathing. |
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Atalectasis =
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collapse of alveoli
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Pulmonary emboli =
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clot in pulmonary vasculature
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Pleural effusion =
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excess fluid in pleural space
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Thoracentesis =
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removal of fluid from pleural space by needle insertion
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Empyema =
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a pleural effusion with purulent material usually due to infection, cancer
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what do you uses with a Thoracentesis to avoid getting another pneumothorax
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stop cock
small needle |
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Flail chest =
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fracture of 2 or more adjacent ribs on the same side with each bone fractured
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what does flail chest cause?
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Flail Chest reduces the amount of air that can get into chest and also impairs pt’s ability to exhale.
Pt is hypoxic |
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what happens if flail chest gets too bad
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endotracheal intubation and mechanical ventilation is necessary to provide internal stabalization
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what happens with normal breathing compared to flail chest
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Negative pressure increases in chest when you breath normally
The ribs usually stays together If Flail chest-when you inhale the flail segment will go into, so you get a decrease in tidal volume. When you exhale, the flail segment goes out while normal ribs go in Can get pulsations so medial stinal protion motions back and forth that is very dangerous and painful!!! |
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dangers of blunt force trauma to chest
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Hypoxemia from disruption of airway or injury to lung
Hypovolemia from massive fluid loss from great vessels Cardiac failure from cardiac tamponade or contusion |
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assesment of blunt force trauma to chest
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Inspect airway, thorax, neck veins, breathing difficultly
Look for stridor, cyanosis, nasal flairing Palpate thorax for tenderness, crepitus, bruising Look for entrance or exit wounds, impaled items If large amt of bleeding, may go directly to OR |
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side effects of lung cancer when seen only in late stages
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dyspnea, wheezing, recurrent pneumonia, persistent cough, chest pain, hemoptysis
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Superior Vena Cava Syndrome
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tumor obstructs superior vena cava. Swelling, decreased venous return and decreased blood flow
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Stage II Lung Cancer involves
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lymph nodes
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Conventional thoracotomy-
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painful-spread ribs apart-this is when you need to splint to protect against pain when coughing up secretions, which they need to do!!!
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Video Assisted Thoracic Surgery
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Minimally invasive
Decreased postoperative pain Better preservation of pulmonary function Decreased impairment of immunological functioning Reduced tissue damage Older, sicker patients may benefit |
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what do you give with status asmaticus
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IV theophyllin
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Lung volume reduction surgery =
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surgical treatment of COPD - in experimental stage
removal of more heavily diseased segments of the lung |
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Pulmonary edema =
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excessive accumulation of serous fluid in the interstitial spaces
can advance to fluid inside alvioli |
