Problems Of Oxygenation

Front 1

Anatomical Dead Space:

Back 1

The area before the respiratory bronchioles as a pathway as an air filling space with every breath not available for gas exchange.

Front 2

Oxyhemoglobin:

Back 2

the oxygen carrying pigment of red blood cells that gives them their red color and serves to convey oxygen to the tissues

Front 3

Pleural Effusion:

Back 3

excess fluid that accumulates in the pleural cavity, the fluid- filled space that surrounds the lungs.

Front 4

Kussmauls Respirations:

Back 4

a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also renal failure. It is a form of hyperventilation, which is any breathing pattern that reduces carbon dioxide in the blood due to increased rate or depth of respiration. In metabolic acidosis, breathing is first rapid and shallow but as acidosis worsens, breathing gradually becomes deep, labored and gasping. It is this latter type of breathing pattern that is referred to as Kussmaul breathing.

Front 5

Rhinitis:

Back 5

inflammation of the mucous membrane of the nose, caused by a virus infection (e.g., the common cold) or by an allergic reaction

Front 6

Attenuated Vaccine:

Back 6

a vaccine created by reducing the virulence of a pathogen, but still keeping it viable (or "live"). Attenuation takes an infectious agent and alters it so that it becomes harmless or less virulent.

Front 7

Pharyngitis:

Back 7

inflammation of the pharynx, causing a sore throat.

Front 8

Ventilation:

Back 8

Inspiration and Expiration of air in and out of the lungs.

Front 9

Diffusion:

Back 9

Movement of molecules from a high concentration to an area of lower concentration.

Front 10

Apnea:

Back 10

temporary cessation of breathing, especially during sleep.

Front 11

Epistaxis:

Back 11

Nosebleed

Front 12

Rhinoplasty:

Back 12

plastic surgery performed on the nose

Front 13

Compliance:

Back 13

Measure of the ease of expansion in the lungs.

Front 14

Tidal Volume:

Back 14

Volume of air exchanged in each breath. In adults approx 500ml.

Front 15

Incidence:

Back 15

the occurrence, rate, or frequency of a disease

Front 16

Prevalence:

Back 16

is the proportion of a population found to have a condition

Front 17

Aspiration:

Back 17

breathing in a foreign object (such as sucking food into the airway).

Front 18

Perfusion:

Back 18

the process of a body delivering blood to a capillary bed in its biological tissue

Front 19

Coryza:

Back 19

A common cold (Acute Viral Rhinitis)

Front 20

ABG common with Asthma

Back 20

ABG results include hypoxemia (decreased Pa02, less than 80 mmHg), hypocarbia (decreased PaCO2, less than 35 mmHg), or hypercarbia (increased PaCO2, greater than 45 mmHg).

Front 21

ABG common with COPD

Back 21

ABG results include hypoxemia, hypercarbia, respiratory acidosis, or metabolic alkalosis compensation.

Front 22

ABG common with Pulmonary Embolism

Back 22

ABG results include hypoxemia due to respiratory alkalosis, but as hypoxemia progresses it results in respiratory acidosis.

Front 23

ABG common with Pneumothorax & Hemothorax

Back 23

ABG results include hypoxemia.

Front 24

Differentiate pulse oximetry findings from ABGs

Back 24

-Pulse Oximetry findings are much less invasive than ABGs but they both measure arterial oxygen saturation.
-Pulse oximetry is less accurate than the ABG because various factors can alter the readings of the probe.
-Changes are detected more quickly because measurements are taken more frequently.
-ABGs measure much more about the oxygenation status than just the saturation.
-The only other reading accomplished with pulse oximetry is the pulse rate.

Front 25

Ineffective Airway Clearance characteristics and interventions

Back 25

-Absent cough, adventitious breath sounds (rales, crackels, rhonchi, wheezes), changes in respiratory rate and rhythm, cyanosis, difficulity vocalizing, diminished breath sounds, dyspnea, excessive sputum, orthopnea, restlessness, wide-eyed
-Airway management, airway suctioning, cough enhancement

Front 26

Impaired Gas Exchange characteristics and interventions

Back 26

-Abnormal: arterial blood gases, arterial pH, breathing, skin color, Confusion, cyanosis, decreased carbon dioxide, diaphoresis, dyspnea, headache upon awaking, hypercapnia, hypoxemia, irritability, nasal flaring, restlessness, somnolence, tachycardia, visual disturbances
-Mechanical ventilation management: noninvasive, oxygen therapy, medication management, airway management

Front 27

Ineffective Breathing Pattern characteristics and interventions

Back 27

-Alterations in depth of breathing, altered chest excursion, assumption of three-point position, bradypnea, decreased expiratory pressure, decreased inspiratory pressure, decreased minute ventilation, decreased vital capacity, dyspnea, increased anterior-posterior diameter, nasal flaring, orthopnea, prolonged expiration phase, pursed-lip breathing, tachpnea, use of accessory muscles to breathe
-Airway management, respiratory monitoring

Front 28

Activity Intolerance characteristics and interventions

Back 28

-Abnormal blood pressure response to activity, abnormal heart rate in response to activity, EKG changes reflect arrhythmias, EKG changes reflects ischemia, exertional discomfort, exertional dyspnea, verbal report of fatigue, verbal report of weakness
-Activity therapy, energy management, exercise therapy: ambulation

Front 29

Fatigue characteristics and interventions

Back 29

-Compromised concentration, libido, decreased performance, disinterest in surroundings, drowsy, feelings of guilt for not keeping up with responsibilities, inability to maintain usual level of physical activity, inability to maintain usual routines, inability to restore energy even after sleep, increase in physical complaints, increase in rest requirements, introspection, lack of energy, lethargic, listless
-Energy management (including conservation and restoration)

Front 30

Social isolation, role changes, family processes: characteristics and interventions

Back 30

-Developmentally inappropriate interests, experiences feelings of differences from others, inability to meet expectations of others, anxiety
-Socialization enhancement, caregiver support, counseling, decision-making support, family process maintenance, family therapy, role enhancement

Front 31

Rhinitis-is inflammation of the nasal mucosa and often the mucosa in the sinuses that can be caused by infection (viral or bacterial) or allergens.
S&S

Back 31

-Subjective data: Excessive nasal drainage, runny nose, (rhinorrhea) and nasal congestion, Purulent nasal discharge, Sneezing and pruritus of the nose, throat and ears, Itchy watery eye, Sore, dry throat
-Objective data: Red, inflamed, swollen nasal mucosa, Low grade fever

Front 32

Sinusitis is an inflammation of the mucous membranes of one or more the sinuses, usually the maxillary or frontal sinus.
S&S

Back 32

-Subjective data- Nasal congestion, Headache, Facial pressure, or pain ( worse when head is tilted forward), cough, Bloody or purulent nasal drainage.
-Objective data- Tenderness to palpation of forehead, orbital and facial areas, Low-grade fever, CT or sinus x-ray

Front 33

Influenza
S&S

Back 33

-Subjective data: Severe headache, and muscle aches, Chills, Fatigues, weakness, Severe diarrhea and cough (avian flu)
-Objective data: Fever, Hypoxia, Diagnostic Procedure – H1N1 flu Test

Front 34

Pneumonia- Signs, tests

Back 34

-Subjective data-anxiety, fatigue, weakness, chest discomfort d/t coughing, confusion from hypoxia
-Objective data- Physical assessment findings such as fever, chills, flushed face, diaphoresis, SOB, Tachypnea, pleurtic chest pain (sharp), sputum production (yellow-tinged), crackles and wheezes, coughing, decreased o2 sat., purulent, bloody-tingled or rust-colored sputum, which may not always present.
-Lab test-Sputum culture, CBC, ABGs, Blood culture, serum electrolytes, chest x-ray

Front 35

Asthma is a chronic inflammatory disorder of the airways that results in intermittent and reversible airflow obstruction of the bronchioles.
S&S

Back 35

-Subjective data- dyspnea, chest tightness, anxiety and /or stress
-Objective data- assess for coughing, wheezing, mucus production, use of accessory muscles, prolonged exhalation, low o2 sat., barrel chest or increased chest diameter

Front 36

COPD- encompasses two diseases: emphysema and chronic bronchitis. COPD is irreversible. Signs/symptoms

Back 36

-Subjective data- chronic dyspnea
-Objective data- dyspnea upon exertion, productive cough that is most severe in AM, Hypoxemia, crackles and wheezes, rapid and shallow respirations, use of accessory muscle, barrel chest or increased chest diameter (with emphysema)

Front 37

Tuberculosis- is an infectious disease caused by Mycobacterium tuberculosis. Signs/symptoms

Back 37

-Subjective data- persistent cough lasting longer than 3 weeks, purulent sputum possible blood-streaked, fatigue and lethargy, weight loss and anorexia, light sweat and low grade fever in the afternoon.
-Objective data- alter mentation or unusual behavior, fever, anorexia, weight loss, quantiFERON-TB Gold, Mantoux test.

Front 38

Pulmonary embolism signs and symptoms and tests

Back 38

-Subjective: anxiety, feelings of impending doom, pressure in chest, pain upon inspiration and chest wall tenderness, dyspnea and air hunger
-Objective data- pleurisy, pleural fraction rub, tachycardia, hypotension, tachypnea, Adventitious breath sounds (crackles) and cough, Heart murmur in s3 and s4, diaphoresis, low-grade fever .
-Lab test ABG analysis, CBC analysis to monitor hemoglobin and hematocrit, D-dimer , Chest x-ray, CT, Ventilation-perfusion (V/Q) scan, pulmonary angiography.

Front 39

-A pneumothorax is the presence of air or gas in the pleural space that causes lung collapse.
-A Hemothorax – is an accumulation of blood in the pleural space.
Signs and symptoms

Back 39

-Subjective data- anxiety, pleuritic pain,
-Objective data- signs of respiratory disease, tracheal deviation to the unaffected side ( tension pneumothorax), reduced or absent breath sounds on the affected side, asymmetrical chest wall movement, dull percussion, subcutaneous emphysema, ABGs test, Chest x-ray.

Front 40

Flail chest is the inability of the injured side of the chest to expand adequately upon and contract upon exaltation. One side of the chest is typically affected due to multiple rib fractures. S&S

Back 40

-Subjective data- anxiety, chest pain.
-Objective data- unequal chest expansion, tachycardia, hypotension, dyspnea, cyanosis.

Front 41

Signs and symptoms related to pathophysiology and alterations of ventilation of a Cold

Back 41

Cold: Or acute viral rhinitis is caused by an adenovirus that invades the upper respiratory tract and is often accompanied by an acute upper respiratory infection. The patient with acute viral rhinitis typically first experience tickling, irritation, sneezing, or dryness of the nose or naso- pharynx, followed by copious nasal secretions, some nasal obstruction, watery eyes, elevated temperature, general malaise, and headache. With allergic rhinitis, the posterior ends of the turbinates can become so enlarged that they obstruct sinus aeration or drainage and result in sinusitis. The mucous impedes gas exchanges and harbors infection.

Front 42

Signs and symptoms related to pathophysiology and alterations of ventilation of Influenza

Back 42

In nature, the influenza virus can often be found in wild aquatic birds such as ducks and shorebirds. The virus mutates to allow it to infect different species. The viruses are classified into types A, B, and C, but only A and B infect humans. The onset of flu is usually abrupt, with symptoms of cough, fever, and myalgia often accompanied by a headache and sore throat. Milder symptoms similar to the common cold, may also occur. Physical findings are usually minimal, with normal assessment on chest auscultation. Dyspnea and diffuse crackles are usually a sign of pulmonary complications. Same as with a cold, the mucous would impede proper perfusion and ventilation. Constriction of the airways would slow gas exchange with the outside.

Front 43

Signs and symptoms related to pathophysiology and alterations of ventilation of Pneumonia

Back 43

An acute inflammation of the lung parenchyma that is most frequently caused by a micro organism. Regardless of the type of pneumonia, the patophysiology is similar. There are four characteristic stages: 1. Congestion. After the organism reaches the alveoli, there is an outpouring of fluid into the alveoli. the presence of fluid in the alveoli interferes with gas exchange. 2. Red hepatization. There is massive dilation of the capillaries, and alveoli are filled with micro organisms, neutrophils, red blood cells, and fibrin. The lungs appear red and granular, similar to the liver, which is why the process is called hepatization. 3. Gray hepatization. Blood flow decreases, and leukocytes and fibrin consolidate in the affected part of the lung. 4. Resolution. Complete resolution and healing occur if there are no complications. The exudate is lysed and is processed by the macro phages.. The normal lung tissue is restored, and the person’s normal gas-exchange ability is restored

Front 44

Signs and symptoms related to pathophysiology and alterations of ventilation of Tuberculosis

Back 44

is a very small droplet nuclei, once inhaled droplets lodge in alveoli in the small airways of the lungs, where it replicates slowly and spreads through the lymph system. Active TB disease may initially manifest with fatigue, malaise, anorexia, unexplained weight loss, low- grade fevers, and night sweats. Ineffective breathing pattern related to decreased lung capacity, imbalanced nutrition: less than body requirements related to chronic poor fatigue, and productive cough, activity intolerance related to fatigue, decreased nutritional status, and chronic febrile episodes, are some of the nursing diagnoses mentioned.

Front 45

Signs and symptoms related to pathophysiology and alterations of ventilation of Pneumothorax

Back 45

is air in the pleural space. As a result of air in the pleural space, there is a partial or complete collapse of the lung. As the volume of air increases, the lung volume decreases, decreasing the lungs total capacity for air exchange. Symptoms are dyspnea, decreased chest wall, diminished or absent breath sounds on the affected side, hyper resonance to percussion.

Front 46

Signs and symptoms related to pathophysiology and alterations of ventilation of Pleural effusion

Back 46

is a buildup of fluid between the layers of tissue that line the lungs and chest cavity. Chest pain, usually a sharp pain that is worse with cough or deep breath, Cough, fever, hiccups, rapid breathing, shortness of breath. Decreases lung expansion.

Front 47

Signs and symptoms related to pathophysiology and alterations of ventilation of Pulmonary edema

Back 47

Engorgement of the pulmonary vascular system is clinically associated with increase in respiratory rate. Clinical manifestations of pulmonary edema are distinctive. The patient is pale, anxious and possibly cyanotic. The skin is clammy and cold from vasoconstriction caused by stimulation of the SNS. The patient has severe dyspnea, as evidenced by the use of accessory muscles of respiration, a respiratory rate greater than 30 breaths per minute, and orthopnea. There may be wheezing and coughing with production of frothy, blood- tinged sputum. Auscultation of the lungs may reveal crackles, wheezes, and rhonchi throughout the lungs. Pulmonary edema interferes with gas exchange by causing an alteration in the diffusing pathway between alveoli and the pulmonary capillaries.

Front 48

Signs and symptoms related to pathophysiology and alterations of ventilation of Pulmonary embolism

Back 48

Blockage of pulmonary arteries by a thrombus, fat or air embolus, or tumor tissue. Eventually reaches a section of the pulmonary arterial vessels, lodges there and causes obstruction to perfusion. (powerpoint) The signs and symptoms are varied and non specific, making diagnosis difficult. The classic triad- dyspnea, chest pain, and hemoptysis- occurs in only about 20% of patients. A mild to moderate hypoxemia with a low PaCO2 is a common finding.

Front 49

Signs and symptoms related to pathophysiology and alterations of ventilation of Cor pulmonale

Back 49

Hypertrophy of the right side of the heart. Results from pulmonary hypertension, which is caused by diseases affecting the lungs or pulmonary blood vessels. Dyspnea is the most common symptom- due to the hyperinflation of the lungs in COPD

Front 50

Signs and symptoms related to pathophysiology and alterations of ventilation of ARDS/SIRS

Back 50

alveolar- capillary membrane damage allows fluid to accumulate in alveoli, there is a deficit of surfactant, increased alveolar tension, and aveoli collapse. Tachypnea and dyspnea, respiratory distress, hypoxemia not improving with oxygen therapy, PO2 < 50 mmHg, respiratory alkalosis progressing to acidosis are S/S off systemic inflammatory response syndrome. Increased fluid in alveoli inhibits gas exchange, and decreased surfactant increases efforts to breathe.

Front 51

Signs and symptoms related to pathophysiology and alterations of ventilation of Asthma

Back 51

Chronic inflammatory disorder of airways- Causes airway hyperesponsiveness leading to wheezing, breathlessness, chest tightness, and cough. Recurrent episodes of wheezing, breathlessness, cough, and tight chest; difficulty moving air can create a feeling of suffocation, increasing anxiousness. Bronchospasm, edema, and mucous in bronchioles narrow the airways, air takes longer to move out.

Front 52

Signs and symptoms related to pathophysiology and alterations of ventilation of Emphysema

Back 52

is an abnormal permanent enlargement of the air spaces distal to the bronchioles, accompanied by the destruction of their walls and without obvious fibrosis. Cough and sputum may precede airflow limitations and some patients may exhibit significant significant airflow limitation without having chronic cough and sputum production

Front 53

Pneumonea risk factors and Nursing Intervention

Back 53

-Smoking, Aging, Altered consciousness, Prolonged immobility, Malnutrition, Upper respiratory infection, Tracheal intubation
-Health promotion, Monitoring Vital Signs, Assessing risk for complications, Assessing O2 needs, Hydration, nutritional support, Therapeutic positioning, Medication administration, Bronchodilators, antibiotics

Front 54

Asthma Risk factors and nursing intervention

Back 54

-age (older adult), Family history of asthma, smoking, second hand smoke exposure, environmental allergies, exposure to chemical irritants, or dust, GERD.
-Watch the client for decreased immunity function, Monitor for hyperglycemia, Advice the client to report black, tarry stools, Observe for fluid retention and weight gain. This can be common, Monitor throat and mouth for aphthous lesions (canker sores)., Omalizumab can cause anaphylaxis

Front 55

COPD Risk factors and nursing interventions

Back 55

-advanced age, smoking(primary factor), Alpha,-antitrypsin (AAT), deficiency, exposure to air pollution.
-Position the client to maximize ventilation, Encourage effective coughing or suction to remove secretions, Encourage deep breathing and use of incentive spirometer, Administer breathing treatment and medication as prescribed, Monitor for skin breakdown around nose and mouth from the oxygen device, Promote adequate nutrition, Monitor weight, Instruct the client to practice breathing techniques to control dyspneic episodes

Front 56

Tuberculosis risk factors and nursing intervention

Back 56

-Frequent and close contact with an untreated individual, Lower socioeconomic status and homelessness, Immunocompromised status (HIV, chemotherapy, kidney disease, diabetes, Crohn’s disease), Poorly ventilated, crowded environments (prisons, long-term care facilities), Recent travel outside of united states where TB is endemic, Health care occupation that involves (performance of high risk activities (respiratory treatments, suctioning, coughing procedure)
-Administer heated and humidified oxygen therapy as prescribed, Prevent infection transmission using correct protective equipment., Teach the patient to cough and expectorate sputum into tissues that are disposed of by the client into provided sacks, Promote adequate nutrition, Provide emotional support

Front 57

Pulmonary embolism Risk factors and nursing intervention

Back 57

-long term immobility, use of oral contraceptive and estrogen therapy, pregnancy, tobacco use, hypercoagulability, obesity, surgery, heart failure or chronic atrial fibrillation, sickle cell anemia, long bone fractures, advanced age.
-Administer oxygen therapy as prescribed to relieve hypoxemia and dyspnea, Initiate and maintain IV access, Administer medication as prescribed, Provide emotional support and comfort to control client anxiety, Monitor changes in level of consciousness and mental status

Front 58

Influenza treatment

Back 58

antivirals oral inhalant – tablet tamiflu, and flu shot

Front 59

Pneumonia treatment

Back 59

–antibiotics penicillin cephosporins, lab test, chest xray, bronchodilators, anti-inflammatories,

Front 60

TB Treatment

Back 60

chest xray- lab test, combo of 4 drugs, Isoniazid, Rifampin, pyrazinamide, myambutol, streptomycin sulfate for infection

Front 61

Asthma treatment

Back 61

bronchodilators inhalers, anticholinergic meds atrovert, methylxanthine Theo-24, long acting beta2 agonist serevent, lab test, pulmoinaray function test, chest xray, steroids,

Front 62

Pulmonary embolism treatment

Back 62

anticoagulants, thrombolytic therapy, ABG analysis, CBC, V/Q scan, pulmonary angiography, embolectomy, vena cava filter.

Front 63

Pneumothorax treatment

Back 63

O2 intubation, chest tube insertion, benzodiazepines, opiods

Front 64

ARDS/SARS treatment

Back 64

Chest xray, ECG, hemodynamic monitoring, benzodiazepines, gen anesthesia, corticosteroids opiods, neuromuscular blocking agents,antibiotics, intubation, mechanical ventilation,

Front 65

Pleural Effusion treatment

Back 65

chest xray, CT scan, ultrasound, antibiotics for infection or diuretics is cardiac problem, could have a surgical intervention

Front 66

Pulmonary Edema treatment -

Back 66

O2, IV, diruetics, ABG, Electrolytes, morphine, vasodilators, antihypertensives, Inotropic agents digoxin to help improve cardiac output

Front 67

Cor Pulmonale Treatment

Back 67

–ABG, Serum and urine electrolytes, monitor ECG O2, xray, bronchodilators, diuretics, vasodilators, calcium channel blockers

Front 68

Chronic bronchitis treatment

Back 68

Short acting beta2 agonist, anticholinergic antagonist, methylxanthine, O2, chest xray, mucolytic

Front 69

Pneumonia progression

Back 69

-With treatment, most types of bacterial pneumonia will stabilize in 3–6 days. It often takes a few weeks before most symptoms resolve. X-ray findings typically clear within four weeks and mortality is low. In the elderly or people with other lung problems, recovery may take more than 12 weeks.
-A collection of fluid may form in the space around the lungs. In rare circumstances, bacteria in the lung will form a pocket of fluid that becomes an infected abcess.
-Pneumonia can cause respiratory failure by causing acute respiratory distress syndrom (ARDS). This results from the infection and the inflammatory response together. The lungs stiffen with this disease.

Front 70

Tuberculosis Progression

Back 70

-This is a common and many times fatal disease. Only a small amount of people infected with the infection develop and active form of the infection.
-This means that Mycobacterium tuberculosis is in the body, but the body has been able to fight off the infection. If not treated, it can lie dormant for several years and then become active as the individual becomes older or immunocompromised.
-Treatment is done through antibiotics. Treating this disease is difficult, because of the complex cell structure. The therapy may take several months. If the patient does not receive therapy, death is probable. The infection permeates the lungs and prevents gas exchange from occurring.

Front 71

Asthma Progression

Back 71

-This is a complicated a progressive disease. Asthma often progresses very slowly, and is a chronic disease. It can occasionally even go into long periods of remission. In mild-moderate cases it can improve over time and many adults even become symptom free. In some severe cases, adults may experience improvement depending on the degree of obstruction in the lungs and the timeliness and effectiveness of treatment. In about 10% of severe persistent cases, changes in the structure of the walls of the airways lead to progressive and irreversible problems in lung function, even in aggressively treated patients.
-Lung function declines faster than average in people with asthma, particularly in those who smoke and in those with excessive mucus production (an indicator of poor treatment control).
-Death from asthma is a relatively uncommon event, and most asthma deaths are preventable. It is very rare for a person who is receiving proper treatment to die of asthma. However, even whe

Front 72

Chronic Bronchitis/COPD Progression

Back 72

-In the beginning stages of COPD, there is minimal shortness of breath that might be noticed only during exercise. As the disease progresses, shortness of breath might worsen, and the pt might need to wear an oxygen device, and blood oxygen levels might drop, causing the need to wear an oxygen device.
-To help control other symptoms of COPD, the following treatments and lifestyle changes might be prescribed: Quitting smoking, Avoiding irritants.
-Medications including: Bronchodilators, anti-inflammatory agents, oxygen, antibiotics, Maintaining a healthy diet, Following a structured exercise program, Getting and intravenous infusion of an AAT preparation, Preventing respiratory infections, Controlling stress
If COPD progresses, the patient might be eligible to be evaluated for lung volume reduction surgery or lung transplantation. The doctor might also suggest that you enroll in a pulmonary rehabilitation program.
The patient might also be eligible to participa

Front 73

Emphysema Progression

Back 73

-Stage I, Mild emphysema: > 80% of normal
-Stage II, Moderate emphysema: < 80%, but > 50% of normal
-Stage III, Severe emphysema: < 50%, but > 30% of normal
-Stage IV, Very severe emphysema: < 30% of normal, OR < 50% of normal with low blood oxygen levels
-An emphysema prognosis is impossible to determine in any individual person. Staging can help identify the severity of emphysema, it can't predict the future.