Abnormal breath sounds heard over the lungs.
Small air sacs at the end of the terminal brochioles that are the site of gas exchange.
Absence of breathing.
Arterial Blood Gas (ABG)
Laboratory tests commonly used in the assessment & treatment of acid-base imbalance. It analyzes an arterial blood sample: the pH of plasma/blood indicates an imbalance or impending acidosis/alkalosis. Oxygen & Carbon Dioxide gas values are also reported showing effectiveness of the respiratory system.
Normal: 35-45 mmHg
Acid: >45 mmHg
Base: <35 mmHg
Normal: 22-26 mEq/L
Acid: <22 mEq/L
Base: >26 mEq/L
Incomplete expansion or collapse of a part of the lungs.
The volume of a gas at a constant temperature varies inversely with the pressure. Means: less pressure in the lungs facilitates the movement of more air into the lungs. The pressure within the lungs (intrapulmonic pressure) decreases as the volume of the lungs increases.
Slow rate of breathing.
Those heard over the trachea; high in pitch & intesity, with expiration being longer than inspiration.
Medication that relaxes contractions of smooth muscles of the bronchioles.
Noraml breath sounds heard over the upper anterior chest & intercostal area.
Listen carefully to the intensity & quality of each sound:
- Resonance: a loud, hollow, low-pitched sound, heard over normal lungs.
- Hyperresonance: a loud, low, booming sound typically heard over emphysematous lungs.
- Flatness: a sound detected over bone or heavy muscle.
- Dullness: a sound with medium pitch & intesity usually heard over the liver.
- Tympany: a high-pitched, loud, drum-like sound produced over the stomach.
AKA fremitus. The capacity to feel sound on the chest wall. Normally vibrations are equal bilaterally in different areas of the chest wall. Increased fremitus occurs in patients with pneumonia because solid tissue conducts sound well. Patient with COPD have decreased fremitus because air does not conduct sound as well.
Microscopic hairlike projections that propel mucus toward the upper airway so that it can be expectorated.
Fine crackling sounds made as air moves through wet secretions in the lungs, heard on inspiration.
Lung compliance refers to the ease with which the lungs can be inflated. The compliance of lung tissue affects lung volume. The ability of the lungs to adequately fill with air during inhalation is achieved by the normal elasticity of lung tissue, aided by the presence of suractant.
The movement of gas/particles from an area of higher pressure /concentration to areas of lower pressure/concentration.
A detergent-like phospholipid, reduces the surface tension between the movist membranes of the alveoli, preventing their collapse. When surfactant production is reduced, the lung becomes stiff & the alveoli collapse.
Gas exchange between the atomospheric air in the alveoli & blood in the capillaries.
Process by which oxygenated capillary blood passes through body tissues.
Breathing. The movement of air into & out of the lungs with inspiraton & expiration.
The passvie phase, the movement of air out of the lungs.
A chronic lung condition which decreases elasticity of lung tissue which in turn decreases compliance.
A condition in which an inadequate amount of oxygen is available to cells.
Common symptoms of Hypoxia
Dyspnea, elevated BP, increased respiratory & pulse rates, pallor, & cyanosis. Often caused by hypoventilation.
Decreased rate or depth of air movement into the lungs.
Hypoxia in body systems
Manifested as altered though processes, headaches, chest pain, enlarged heart, clubbing of fingers & toes, anorexia, constipation, decreased urinary output, decreased libido, weakness of extremity muscles, & muscle pain.
Is the respiratory center. It's stimulated by an increased concentration of carbon dioxide & hydrogen iions in arterial blood.
Increased rate & depth of ventilation, above the body's normal metabolic requirements.
Low-pitched, soft sounds heard over peripheral lung fields.
Continuous, muscial sounds, produced as air passes through airways constricted by swelling, narrowing, secretions, or tumors. Often heard in patients with asthma, tumors, or a buildup of secretions.
Pleural Friction Rub
A continuous, dry grating sound. Caused by inflammation of pleural surfaces & loss of lubricating pleural fluid. Sounds like rubbing two leather surfaces together.
An instrument that measures lung volumes & airflow. Used to measure the degree of airway obstruction & evaluates response to inhaled medications.
The active phase of ventilation that involves movement of muscles & the thorax to bring air into the lungs.
Peak Expiratory Flow Rate
PEFR. Teh point of highest flow during forced expiration. PEFR reflects changes in the size of pulmonary airways & is measured using a peak flow meter. Used for patients with moderate or severe asthma to measure the severity of the disease & degree of disease control.
Noninvasive technique that measures the arterial oxyhemoglobin saturation (SaO2/SpO2) or aterial blood. Useful for monitoring patients reveiving oxygen therapy, titrating oxygen therapy, monitoring those at risk for hypoxia, & postop. SpO2 values <85% indicate that oxygenation to the tissues is inadequate.
The puncturing of the chest wall & aspirating pleural fluid. Performed to obtain a specimen for diagnostic purposes or to remove fluid that has accumulated in the pleural cavity & is causing respiratory difficulty & discomfort.
A respiratory secretion expelled by coughing or clearing the throat.
Used to overcome hypoventilation. Breath deep enough to move the bottom ribs. Take deep ventialtions nasally then expire slowly through the mouth. Breathing through the nose humidifies & filters the air.
Provides visual reinforcement for deep breathing by the patient. It assists the patient to breathe slowly & deeply to sustain maximal inspiration. It encourages the patient to maximaize lung inflation & prevent/reduce atelectasis. Optimal gas exchange is supported & secretion can be cleared & expectorated.
Good for patients experiencing dyspnea & feelings of panic. Exhaling through pursed lips creates a smaller opening for air mvoement, effectively slowing & prolonging expiration. Thought to result in decreased airway narrowing during expiration & prevent the collapse of small airways. Results in improved air exchange & decreased dyspnea. Also helps patient to control the rate & depth of respiration, helping to reduce feelings of dyspnea. Enourages relaxation to gain control of dypnea & reduce panic. Good for COPD.
Reduces the respiratory rate, increases tidal volume, & reduces function residual capacity. Many people with COPD breathe in shallow, rapid & exhausting pattern leading to diaphragmatic breathing.
Is more effective with deep breathing. Coughing early in the morning after rising remvoes secretion that have accumulated during the night. Coughing before meals improves the tast of food & oxygenation. At bedtime, coughing remvoes any buildup of secretions & improves sleep patterns.
Often accompanies respiratory tract infections & irritations. When the cough is productive, it helps clear the airway. However, when the cough is nonproductive, it can be fatiguing & irritating.
Drugs that depresses body function of the cough reflex. Codien is considered the preferred cough suppressant ingredient. Side effect is drowsiness. An irritating, nonproductive cough in people without congestion may be treated with suppressants.
Drugs that facilitate the removal of respiratory tract secretions by reducing the viscosity of the secretions. Patients with extremely tenacious (thick) secretions may need the secretions liquefied for their cough to be effective. So the nonproductive cough of a person with lung congestion can become productive. Use of an expectorant by a peosn without congestion is inappropriate.
Mild, nonproductive coughs in people without congestion can often be relieved by a small, solid medication intended to be held in the mouth until it dissolves. Lozenges control coughs by the local anesthetic effect of benzocaine. The local anesthetic acts on sensory & motor nerves, controlling the primary irritation & inhibiting afferent & efferent impulses.
The movement of air into & out of the lungs. Breathing.
Insufficient oxygen in the blood.
Disperses fine particles of liquid medication into the deeper passages of the respiratory tract, where absorption occurs. The treatment continues until all the medication in the nebulaizer cup has been inhaled.
Delivers a controlled dose of medication with each compression of the canister.
Dry Powder Inhalers (DPI)
Breath activated delivery method for inhaled medications. A quick breath by the patient activates the flow of medication, eliminating the need to coordinate activating the inhaler (spraying the medicine) while inhaling the medicine at the same time.
A disposable plastic device with two protruding prongs that are inserted into the nostrils. The cannula is connected to an oxygen souce with a flowmeter & humidifier.
- Low Flow
1 - 6 L/min. = 24-44% FiO2
Simple Face Mask
Has vents on its sides that allow room air to leak in at many places, thereby ddiluting the source oxygen. The vents also allow exhaled carbon dioxide to escape. Often used when an increased delivery of oxygen is needed for short periods (less than 12 hrs). The mask should fit closely to the face to deliver this higher concentration of oxygen effectively. Skin breakdown is a possibility R/T the difficulty keeping the mask in position over the nose & mouth, pressure & moisture.
- Low Flow
6 - 10 L/min. (5 L/min. is the minimum setting) = 35-60% FiO2
Partial Rebreather Mask
Similar to a simple face mask but is equipped with a reservoir bag for the collection of the first part of the patient's exhaled air. The remaining exhaled air exits through vents. The air in the reservoir is mixed with 100% oxygen for the next inhalation. The patient rebreathes about 1/3 of the expired air from the reservoir bag. This type of mask permits the conservation of oxygen. an additional advantage is that the patient can inhale room air through openings in the mask if the oxygen supply room air through openings in the mask if the oxygen supply is briefly interrupted. Disadvantages: eating, talking are difficult, tight seal is required, potential for skin breakdown.
- Low flow
6-15 L/min. = 70-90% FiO2
Delivers the highest concentration of oxygen via a mask to a spontaneously breathing patient. Similar to the partial rebreather mask except two one-way valves prevent the patient from rebreathing exhaled air. The reservoir bag is filled with oxygen that enters the mask on inspiration. Exhaled air escapes through side vents. A malfunction of the bag could cause carbon dioxide buildup & suffocation. The mask can also be used to administer other gases, such as heliox.
- Low Flow
6-15 L/min. = 60-100% FiO2
Delivers the most precise concentrations of oxygen. The mask has a large tube with an oxygen inlet. As the tube narrows, the pressure drops, causing air to be sucked in through side ports. These ports are adjusted according to the prescription for oxygen concentration. Be sure the ports are always open. If these are occluded by linens, clothes, or patient rolling, the oxygen delivered might be at an unsafe concentration.
- High Flow
4-10 L/min. = 24-55% FiO2
Fluid in the pleural space that requires a chest tube to drain & allow the compressed lung to reexpand.
Blood in the pleural space that requires a chest tube to drain & allow the compressed lung to reexpand.
Air in the pleural space that requires a chest tube to drain & allow the compressed lung to reexpand.
Accumulation of fluid in extracellular spaces.
Passage of a solvent through a semipermeable membrane from an area of lesser concentration to an area of greater concentration until equilibrium is established.
fraction of inspired oxygen in a gas mixture.
The FiO2 is expressed as a number from 0 (0%) to 1 (100%). The FiO2 of normal room air is 0.21 (21%).
A patient's FiO2 may be varied through the use of different Venturi masks, in combination with varying oxygen flow rates. In addition, most mechanical ventilators have controls for adjusting FiO2. An increased FiO2 is necessary in managing adequate oxygenation in patients who are critically ill due to causes such as major surgery, acute lung injury, sepsis, pneumonia, congestive heart failure, or other cardiopulmonary disease. The oxygenation to a patient on a ventilator can be manipulated by changing not only FiO2, but also the tidal volume,the respiratory rate and having a Positive end-expiratory pressure (PEEP). Generally the FiO2 is maintained at less than 60%. Higher settings can lead to oxygen toxicity.
Oxygen Hemoglobin Dissociation Curve
plots the proportion of haemoglobin in its saturated form on the vertical axis against the prevailing oxygen tension on the horizontal axis. The oxyhaemoglobin dissociation curve is an important tool for understanding how our blood carries and releases oxygen. Specifically, the oxyhaemoglobin dissociation curve relates oxygen saturation (SO2) and partial pressure of oxygen in the blood (PO2), and is determined by what is called "haemoglobin's affinity for oxygen"; that is, how readily haemoglobin acquires and releases oxygen molecules into the fluid that surrounds it.
the part of total blood gas pressure exerted by carbon dioxide. It decreases during heavy exercise, during rapid breathing, or in association with severe diarrhea, uncontrolled diabetes, or diseases of the liver or kidneys. It increases with chest injuries or respiratory disorders. The normal pressures of carbon dioxide in arterial blood are 35 to 45 mm Hg and, in venous blood, 40 to 45 mm Hg.
Atmospheric oxygen partial pressure is approximately 21% of the atmospheric pressure of the location at which you measure (typically around 1 atmosphere at sea level, making the partial pressure of oxygen at seal level 0.21 atm or 21.3KPa).
Normal partial pressure of oxygen:
100 mmHg in the arterial blood. The partial pressure on the alveolar site is about 105 mmHg.
Drainage used in bronchiectasis and lung abscess. The patient's body is positioned so that the trachea is inclined downward and below the affected chest area . Postural drainage is essential in treating bronchiectasis and patients must receive physiotherapy to learn to tip themselves into a position in which the lobe to be drained is uppermost at least three times daily for 10-20 minutes. Most patients find that lying over the side of the bed with head and thorax down is the most effective position . The treatment is often used in conjunction with a technique for loosening secretions in the chest cavity called chest percussion. Chest percussion is performed by clapping the back or chest with a cupped hand. Alternatively, a mechanical vibrator may be used in some cases to facilitate loosening of secretions.
Fluid accumulation in the lungs. It leads to impaired gas exchange and may cause respiratory failure. It is due to either failure of the heart to remove fluid from the lung circulation ("cardiogenic pulmonary edema") or a direct injury to the lung parenchyma ("noncardiogenic pulmonary edema"). Treatment depends on the cause, but focuses on maximizing respiratory function and removing the cause.
also called pulmonary hygiene, is a set of methods used to clear mucus and secretions from the airways. The word pulmonary refers to the lungs. The word toilet is related to the French toilette, refers to body care and hygiene; this root is used in words such as toiletry that also relate to cleansing.
Pulmonary toilet prevents atelectasis (the collapse of the alveoli of the lungs) and rids the respiratory system of secretions, which could cause respiratory infections. It can also decrease pulmonary shunting, increase the functional reserve capacity of the lungs, and prevent respiratory infection after chest trauma. Methods include using suction to remove fluids and placing the patient in a position that allows secretions to drain by gravity.
Methods used for pulmonary toilet include suctioning of the airways, chest physiotherapy, blow bottles, and nasotracheal suction.