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The path that air takes as it enters and exits the lungs.

airway

Where in the lungs does the o2 exchange take place?

the alveoli

What is the process that moves o2 and co2 across the alveolar cell membranes and the the cell membranes of the capillaries surrounding the alveoli>

diffusion

What are the 2 primary muscles used for breathing?

diaphragm and intercostals

What nerves cause the diaphragm to contract?

phrenic nerves

What shape is the diaphragm in when it contracts?

flattened

When the diaphragm contracts and moves downward, what happens to the thoracic cavity?

it increases the size of the chest cavity

What kind of pressure must be constantly present in the lungs for breathing to occur?

negative pressure

How is the negative pressure required for breathing created in the lungs?

The chest cavity expands, therefore causing the lungs to expand and cause the pressure inside the lungs to drop below atmospheric pressure to create negative pressure.

What's another term for inhalation?

inspiration

What's another term for exhalation?

expiration

________ and _________both contribute to the regulation of respirations.

nerves, chemicals

Where in the brain is the respiratory center located?

medulla

Chemical regulation of respirations is influenced by chemoreceptors located in the _______ and ______ bodies, as well as the _________.

carotid, aortic, medulla

What 2 changes are the chemoreceptors programmed to detect?

decrease in o2 levels
changes in the blood pH

When CO2 increases, what happens to the blood?

it becomes acidic

What does the body do in response to an increase in the co2 in the blood?

speeds up the depth and rate of respirations to "blow off" the excess co2

In a normally breathing person, what stimulates the brain to breathe?"

rising levels of co2

Do people with severe lung disease have the same stimulus to breathe as those without lung disease?

no

What stimulates a person with lung disease to breathe?

lower levels of 02

What happens to gas exchange in people with chronic lung disease?

air gets trapped in the alveoli for long periods of time because air cannot diffuse freely across the alveolar membrane. The body gradually acclimates to the higher co2 level because it cannot continue to increase the repiratory rate. Thus co2 no longer stimulates the person to breathe.

Where does external respiration occur?

between the alveoli and capillaries

In external respiration, o2 moves via diffusion from an area of _______ cxt, to an area of _______ cxt.

higher to lower

Where does internal respiration occur?

between the bloodstream and the body cells.

What carries o2 in the blood through the arteries?

hemoglobin

What is the portion of the pleura that lines the chest cavity?

parietal pleura

The pluera covering the lungs themselves is called the:

visceral pleura

What is the space in between the 2 layers of the pleura called?

pleural space

What kind of pressure is in the pleural space?

negative

What happens if air or fluid enters the pleural space?

the lung will collapse

This is when o2 levels in the blood drop below normal range

hypoxemia

during hypoxemia, the blood cannott take adequate amounts of o2 to the tissues, causing:

hypoxia

What are the early signs of hypoxia?

agitation
anxiety
mental changes
disorientation
headache
irritability
restlessness
tacypenea

What are the late signs of hypoxia?

bradycardia
cardiac dysrhythmias
cyanosis
bradypenea
retractions

What are the usual causes of impaired oxygenization?

obstruction
secretions
anemia
damage to the alveoli caused by lung disease
damage or trauma to the lungs
atelecstasis
pnuemothorax
blood clot in the lungs
decreased cardiac output
high altititude
hypoventilation due to anesthetics, sedatives
poor peripheral circulation

What happens to the alveoli when they are damaged as in lung disease?

less o2 goes into the blood, and less co2 goes out of the blood

Is it possible to have a normal pulse oximetery reading and still suffer from hypoxia? why?

yes, because the blood may have adequate amounts of o2 but it may not be crossing the capillary wall and entering the tissue cells.

What is the appropriate action to take if a patient is in respiratory distress-leave and get help or stay with them?

stay with them

As you perform a respiratory assessment, what 3 things will you do?

inspect, palpate, auscultate

What things should be noted in a respiratory inspection?

color of skin, mucous membranes
effort
cough
o2 status
o2 saturation

Where is cyanosis generally observed at on a person?

lips, tip of nose, tops of ears and nailbeds

With a dark skin person, how do you observe cyanosis?

ashen skin, and the color of the mucous membranes, palms and soles of feet

This is when a patient is having difficulty moving air in and out of the lungs

dyspnea

This occurs when a patient has to stop and rest or catch his or her breath when ambulating, or becomes SOB

exertional dyspnea

This is when patients with impaired oxygenation assume a position of sitting upright and leaning forward with arms and head over a table to increase the intrathoracic area which allows them to inhale more air.

orthopneic position

What should you observe about a patients sputum?

color, consistency and amount

What does clear or white sputum indicate?

viral infection

What does yellow or green sputum indicate?

bacterial infection

What does rust colored sputum indicate?

presence of blood, pneumonia, TB

What does gray or black sputum indicate?

the pt has inhaled smoke or soot

What does pink, frothy, bubbly sputum indicate?

fluid and blood mixed together, as in pulmonary edema

Thick, tenacious sputum is difficult to cought out and tends to remain in the lungs and provide a good medium for __________ growth.

bacterial

When inspecting the chest of a pt, what are you looking for?

muscular retractions between the ribs, substernally and around the neck when the patient inhales

During palpation of the chest, the hands are placed on either side of the chest with thumbs together to determine if the chest is moving equally during inhalation and exhalation. This is called:

excursion

Fluid in the thoracic cavity between the visceral and parietal pleura.

pleural effusion

This occurs when a hole allows air to enter the pleural space where there is supposed to be negative pressure

pneumothorax

This is a life threatening pneumothorax that occurs when air is trapped in the pleural cavity surrounding the lungs, which not only compresses and collapses the lungs but also causes pressure on the heart and major blood vessels and causes them to shift within the thorax.

tension pneumothorax

This is air in the subcutaneous tissues in the chest wall, face and neck

crepitus

When auscultating lungs, what 3 things do you observe?

rate, character and quality of respirations

What is the normal range for respirations?

12-20 per minute

What are the 7 patterns of respirations?

tachypnea
bradypnea
eupnea
Kussmauls
cheyne-stokes
biots
apnea

What sound do you chart if the pt has fluid the lungs or airways?

crackles

When assessing the pt's oxygenations status, determine the patients orientation to (3 things)

time, place and person

What type of blood does the pule oximeter use to measure the o2 saturation?

capillary blood

What is the normal range for SaO2?

95-100%

In healthy people, what amount of oxygen saturation is cause for concern?

94% or less

What are the alternative sites for assessing o2 saturation?

earlobe, forehead

When is the best time of day to obtain a sputum specimen?

first thing in the morning

What are the 2 ways to obtain a sputum specimen?

the pt coughs up and expectorates
suction the throat or trachea

What does sputum testing help diagnose?

infection
TB
bleeding
fluid in the lungs

What are throat cultures usually ordered for?

test for strep

What can occur is strep is not treated with antibiotics?

rheumatic fever, rheumatic heart disease

What are the most commonly used arteries for withdrawing ABG's?

radial
femoral
brachial

When withdrawing ABG's, what is inside the syringe that keeps the blood from clotting?

small amount of heparin

Unlike other blood samples, no _______ tube is necessary.

vacuum

ABG's are withdrawn at a ____ degree angle.

90

After blood is withdrawn for ABG, the sample is inserted into a ______ to keep air out and put on ____ to be transported to the lab.

cork, ice

What does the ABG test measure?

partial pressure of o2
carbon dioxide
bicarbonate
oxygen saturation
blood pH

What test is used to diagnose obstructive or restrictive diseases?

pulmonary function test

What does a pulmonary function test show?

lung capacity, volume and flow rates

What test is used to determine the dosage and frequency of some respiratory meds?

peak flow

Pts who are on bedrest or have had surgery must TCDB how often?

q2h

What can occur as a result of a post op or bedridden pt not TCDBing q2h?

hypostatic pneumonia

When a pt has a chest or abdominal incision, what should you encourage them to do when they cough or deep breathe?

splint the incision with a pillow

What is incentive spirometry used most often for?

to prevent postoperative pts from having atelectasis

How often should incentive spirometry be done?

every hour, at least 10 times per hour

What is the purpose of incentive spirometry?

to increase the amount of air inhaled which expands the air sacs in the lungs. prevents pneumonia and atelectasis.

A medication delivery system containing an air compressor and a mask or handheld mouthpiece. Liquid meds (usually bronchodilator) is place in a small cup that attaches to the air compressor via tubing.

nebulizer

Failing to mix nebulizer meds as ordered could lead to:

overdose

_______ without meds may also be used in a nebulizer to provide moisture to the airways to thin tenacious mucous.

normal saline

How do you instruct the pt to breathe in the nebulizer treatment?

slowly and deeply
close lips around the mouthpiece tightly
breathe in through the mouth, out through the nose

If a pt is unable to follow directions using a mouthpiece, what is the alternative delivery system?

using a mask apparatus

What is the percentage of o2 in room air?

21%

What safety procedures should be observed when supplemental o2 is in use? (5)

no smoking
no open flames in the same room as o2 source
ensure there are no frayed wires on electrical devices
use cotton gowns, not synthetics
avoid petroleum based products on the lips

What can happen to a person who breathes a high percentage of o2 for long periods of time?

CNS damage

What can happen if a pt with chronic lung disease is given too much o2?

severe respiratory problems (because decreased o2 levels is what tells the brain to breathe)

In a pt with lung disease, higher levels of o2 may only be used _____-______ to get the pt through the crisis, so not to cause more severe problems.

short-term

If a patient with lung disease receives supplemental o2 at a liter flow above ___ to___L/min beyond acute crisis situations, it can cause resp depression and even death.

2-3 L/min

For safety purposes, always keep supplemental o2 liter flow for pts with chronic obstructive lung disease below_____L/min

3

What is a portable o2 tank called?

e-cylinder

What kind of o2 is often used by pts in the home care setting?

liquid o2`

What muscles do pts with chronic lung disease often have to use to breathe?

accessory muscles in the neck, shoulders

What meal supplement should you encourage for lung disease pts?

pulmocare

What is helpful about the pulmocare supplement?

it increases protein and calories without high carb intake

What does the metabolism of carbs produce?

carbonic acid, which can contribute to acidosis in someone with lung disease

What kind of meal schedule should someone with chronic lung disease follow?

frequent, small meals several times a day. This helps them get more calories before tiring.

This type of supplemental o2 removes o2 from room air and concentrates it for o2 delivery up to 4L/min.

oxygen concentrator

How long can a liquid o2 stroller provide o2?

10 hours at 2L/min

What amount of o2 flow can a nasal cannula provide?

1-6 L/min

What amount of o2 flow can a simple face mask provide?

5-10 L/min

What happens if a simple face mask is set at less than 5L per minute?

carbon dioxide will accumulate in the mask

What amount of o2 flow can a partial rebreathing mask provide?

6-15 L/min

What does a partial rebreathing mask do?

traps carbon dioxide for rebreathing to lower pH levels in alkalosis.

What amount of o2 flow can a non-rebreathing mask provide?

6-15 L/min

What is the purpose of a non-rebreathing mask?

prevents the pt from rebreathing any exhaled air. The bag traps o2 as a reservoir for inhalation. Only delievery devide that can provide 100% of o2 if set at 15 L/min.

What amount of o2 can a venturi mask provide?

24-80%

This type of mask contains a plastic valve between the tubing from the o2 source and the mask which allows a precise mix of room air and o2 to equal a specific percentage of o2. Gives more exact control of inspired o2.

venturi mask

What supplemental o2 device is used for copd?

venturi mask

What amount of o2 can a face tent provide?

8-12 L/min

What supplemental o2 device is ordered by the doctor as a percentage, as opposed to Liters?

venturi mask

What amount of o2 is provided by a trach collar?

4-10 L/min

What is relevant about the o2 delivery by trach collar?

it is highly humidified

What amount of o2 is provided by a t-piece?

4-10 L/min

This is used to assist in maintaining a patent airway.

artificial airway

This type of airway is made of hard plastic in a slighly curved shape and is designed to hold the tongue in place so it cannot obstruct the airway of an unconcious person.

oropharyngeal airway (only used with unconcious pts)

another word for a nasopharyngeal airway

nasal trumpet (inserted through nose into pharynx)

What are 3 reasons that a pt may e unable to clear the airway?

weak cough
decreased LOC
postoperative pain

What are s/sx that the pt needs to be suctioned?

rattling sounds in the throat
SOB
ineffective cough
lung crackles

What is used to remove secretions form the pts nose, throat and mouth?

suction catheter

Hard plastic tubing used to suction the mouth

yankauer (tonsil tip)

What are the reasons for intubating the trachea, as opposed to the pharynx?

when pt is unable to breathe independently due to airway obstruction or respiratory arrest.

A firm but flexible tube that may be inserted through the nose or the mouth into the trachea to support ventilation. connected to a ventilator so o2 is delivered directly to the lungs.

endotracheal tube

What type of pressure does a ventilator provide?

positive pressure

What keeps air from escaping around the sides of the endotracheal tube?

an inflatable cuff

Where are pts with endotracheal tubes cared for at?

critical care settings.

Is suctioning an endotrach considered a sterile procedure?

yes

When is suction applied to the suction catheter when suctioning a trach tube. Entry or exit?

on exit only

What is the max amount of time to hold suction in a trach?

10 seconds

An incision into the trachea that is held open with a tube to promote breathing.

tracheostomy

How long can an endotracheal tube be left in place?

7-10 days

In many cases of airway obstruction when a trach is used, it is often due to

cancer tumors in the larynx

What are the 3 parts of a tracheostomy tube?

outer cannula
obturator
inner cannula

Should the cuff on the traceostomy tube be inflated or deflated when the pt is eating?

inflated

How can you tell if the inner cuff of the tracheostomy is inflated?

the smaller outer balloon is also inflated

This fits inside the outer cannula and forms a smoothe end for inserting the trach tube. It is removed once the tube is in place and kept at bedside incase tube comes out and must be reinserted.

obturator

What part of the trach tube is easily removed for cleaning?

the inner cannula

How often should the inner cannula of a trach tube be cleaned?

q8h

What is the purpose of a chest tube?

to restablish negative pressure in the lungs after secretions or traumatic injury or surgery that prevents lungs from expanding.

When air enters the plueral space, where does it go?

it rises to the top of the cavity

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