89 terms

Gas Exchange

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air trapping
abnormal retention of air in the lungs where it is difficult to exhale completely
-hypoxia & hypercapnia result
barrel chest
occurs because the lungs are chronically overinflated with air, so the rib cage stays partially expanded all the time
bradypnea
abnormally slow breathing
expectorate
cough or spit out phlegm from the throat or lungs.
forced expiratory volume
measures how much air a person can exhale during a forced breath
hypercapnia
abnormally elevated carbon dioxide
hypoxia
inadequate O2 at the cellular level
hypoxemia
an abnormally low concentration of oxygen in arterial blood
incentive spirometry
method of encouraging voluntary deep breathing by providing visual feedback to patients of the inspiratory volume they have achieved.
orthopnea
abnormal condition in which a person must sit or stand to breathe comfortably; SOB when laying flat
peak expiratory flow rate (PEFR)
a test that measures how fast a person can exhale
pulmonary function tests (PFT)
a broad range of tests that measure how well the lungs take in and exhale air and how efficiently they transfer oxygen into the blood
-spirometry
percussion
method of physical examination whereby the location, size, and density of a body part is determined by the tone obtained from the striking of short, sharp taps of the fingers.
postural drainage
getting in positions that make it easier for mucus to drain
pulse oximetry
measures oxygen saturation of the blood
rhonchi
abnormal lung sound auscultated when the patient's airways are obstructed with thick secretions
stridor
a harsh or grating sound
tachypnea
abnormally rapid rate of breathing
Tripod position
a physical stance often assumed by people experiencing respiratory distress (such as chronic obstructive pulmonary disease patients)
ventilation-perfusion (V-Q)
ratio used to assess the efficiency and adequacy of the matching of two variables
vesicular lung sounds
soft and low pitched with a rustling quality during inspiration and are even softer during expiration; "normal"
factors affecting gas exchange
perfusion
oxygenation
ventilation
perfusion
the provision of oxygenated blood flow through the body
oxygenation
mechanisms that facilitate/impair the body's ability to supply oxygen to all cells in the body
ventilation
exchange of CO2 and O2
transport btwn alveoli and vascular system
atelectasis
collapse of alveoli; prevents gas exchange
caused by
-small airway obstruction w/ mucous/other secretions
-immobility
-bedrest
-surgery
manifestations of impaired gas exchange
-confusion
-restlessness
-inability to move secretions
-irritability
-hypercapnia/hypoxia
-hypoxemia
high risk individuals for impaired gas exchange
-those who are unable to cough/deep breathe (cannot move secretions)
-those with cognitive impairment (comatose)
what age groups have the highest incidence of death from influenza/pneumonia?
-1-4 years old
->65 years old
***immunization=key to reducing risk
etiology of pneumonia
-airway distal to pharynx & larynx is sterile
-filtration of air, warming/humidification of air
-epiglottis closure over trachea
-cough reflex
-muco-ciliary escalatory mechanism
-secretion of immunoglobin A
-alveolar macrophages
muco-ciliary elevator mechanism impaired by
-pollution
-smoking cigarettes
-URI
-tracheal intubation
-aging
three ways organisms reach lungs
aspiration
inhalation
hematogenous (blood)
first step to interventions for pneumonia
client health hx
client health history that indicated risk of pneumonia
-lung CA
-COPD
-diabetes mellitus
-debilitating disease
-malnutrition
-AIDS
major types of pneumonia
-community acquired pneumonia (CAP)
-hospital acquired pneumonia (HAP)
-aspiration pneumonia
-opportunistic pneumonia
types of hospital-acquired pneumonia
-ventilator associated pneumonia (VAP)
-healthcare associated pneumonia (HCAP)
community acquired pneumonia
-lower RTI of lung
-onset=best way to diagnose (occurs before or within first 48 hrs of hospitalization)
-highest incidence: midwinter
-most important risk factor: smoking
how to determine whether to treat pneumonia inpatient or outpatient
-pneumonia patient outcome research team (PORT)
-pneumonia severity index (PSI)
hospital-acquired pneumonia
-occurring 48 hours or longer after admission
-not incubating at time of hospitalization
ventilator-accociated pneumonia
-occurring more than 48 hours after endotracheal intubation
risk factors for HAP
immunosuppressive therapy
-anti-rejection medications after transplant
-steroids
general debility
-bedrest
-immobility
endotracheal intubation
treatment for HAP is based on...
-known risk factors
-severity of illness
-multi-drug resistant organisms are a major problem in treating HCAP
aspiration pneumonia
-occurring from abnormal entry of secretions into lower airway
-usually with history of loss of consciousness (gag and cough reflexes suppressed)
forms of aspiration pneumonia
-mechanical obstruction
-chemical injury
-bacterial infection
risk factors for aspiration pneumonia
-difficulty swallowing
-decreased level of consciousness (seizures, anesthetics, head injuries, stroke, alcohol intake)
-NG tube w/ or w/o feeding tube
opportunistic pneumonia
...
individuals at risk for opportunistic pneumonia
those who are debilitated
-AIDS
-homeless shelters
-prison
severe protein-calorie malnutrition
chemo patients
long-term corticosteroid therapy
causes of opportunistic pneumonia
-bacterial and viral agents
-PCP
-cytomegalovirus
-fungi
physical examination findings of CAP
-dullness to percussion
-increased remits
-bronchial breath sounds
-crackles
symptoms of CAP
-sudden onset of fever
-shaking chills
-SOB
-productive cough
-pleuritic chest pain
complications of pneumonia
-atelectasis
-bacteremia
-pleurisy
-pleural effusion
-lung abscess
-empyema
-pericarditis
-endocarditis
-meningitis
pleural effusion
usually is sterile; reabsorbed in 1-2 weeks or requires thoracentesis
-develop in about 40% of pts. with pneumonia
bacteremia
bacterial infection in the blood (sepsis)
lung abscess
caused by S. aureus and gram-negative pneumonias
empyema
purulent exudate in pleural space
pericarditis
inflammation of pericardial sack
endocarditis
infection of endocardium and heart valves
meningitis
inflammation of brain lining
-a pt. who is disoriented, confused, or somnolent should have lumbar puncture
diagnostic tests for pneumonia
-health hx
-physical exam
-chest x-ray (CXR)
-gram stain of sputum
-sputum culture and sensitivity (C & S)
-pulse ox/ABGs
-CBC, differential, chemistries
-blood cultures
CXR
shows pattern characteristic of a particular infecting agent
collaborative care to treat pneumonia
-antibiotic therapy for bacterial infection
-oxygen for hypoxemia
-fluid intake of at least 3L/day
-caloric intake of at least 1500/day
-analgesics for chest pain
-antipyretics for fever
-vaccination for prevention
pneumococcal vaccine
provides protection against 23 different strains of pneumococcal virus
indicated for those at risk
-chronic illness (heart/lung disease, diabetes)
-recovering from severe illness
-age 65+
-in LTC facility
ventilator bundle for VAP
-elevate head of bed 30-45 degrees at all times
-take a sedation vaccine
-prevent venous thrombosis
-prevent peptic ulcer disease
-oral care with chlorohexidine BID
COPD
-airflow limitation not fully reversible
-generally progressive
-abnormal inflammatory response of lungs to noxious particles or gases
-includes chronic bronchitis and emphysema
chronic bronchitis
presence of chronic productive cough for 3 months for 2 consecutive years w/o other causes
emphysema
-abnormal permanent enlargement of air spaces distal to terminal bronchioles
-destruction of their wall w/o fibrosis
COPD significance
-4th leading cause of death in the US
-more women die than men
-usually not diagnosed until moderately advanced
-4x more prevalent among smokers than nonsmokers
risk factors for COPD
-cigarette smoking
-occupational chemicals & dust
-air pollution
-infection
-heredity
-aging
COPD pathophysiology
-chronic inflammation in airways of lungs
-mucus hypersecretion, dysfunction of cilia
-airflow limitation and hyperinflation of the lungs (trapped air)
-gas exchange abnormalities
-pulmonary hypertension & cor pulmonale
INABILITY TO EXPIRE AIR
clinical manifestations of COPD
-chronic cough
-sputum production
-progressive dyspnea
-chest breathing
-chronic fatigue
-underweight w/ adequate caloric intake
-barrel chest
-prolonged expiratory phase
-wheezes
-decreased breath sounds
-polycythemia & cyanosis
progressive dyspnea
begins w/ activity or exertion and then occurs at rest
chest breathing
use of accessory and intercostal muscles
polycythemia
results from increased production of RBCs as the body attempts to compensate for hypoxemia
Hgb >20 g/dl
complications of COPD
-cor pulmonale
-COPD exacerbation
-acute respiratory failure
-peptic ulcer disease
-depression/anxiety
COPD exacerbation
-event in natural course of disease w/ increase in frequency
-change in pts. baseline dyspnea/cough/sputum
-acute in onset
-warrent change in current medication
-causes: bacterial, viral, air pollution
-use bronchodilators and oral systemic corticosteroids
how to confirm diagnosis of COPD
-pulmonary function tests
-CXR
-spirometry
-history
-physical exam
-6-minute walk test
ABG findings for COPD
-low PaO2
-high PaCO2
-low pH
-high bicarbonate level in late stages
primary goals of care for COPD
-prevent progression
-relieve symptoms
-prevent/treat complications
-promote patient participation
-prevent/treat exacerbations
-improve QOL
-reduce mortality risk
treatment of COPD
-usually outpatient
-only hospitalized for exacerbations/complications
nurse teaching
avoid irritants
-aerosal sprays
-smoking
treat exacerbations promptly
drug therapy
-antibiotics
medications for COPD
-bronchodilators
-inhaled corticosteroids
-oxygen
bronchodilators
-relax smooth muscles
-improve ventilation
-B2-adrenergic agonists, anticholinergics, methylxanthines
inhaled corticosteroids
-anti-inflammatory
-moderate to severe
oxygen therapy for COPD
-reduce work of breathing & heart
-maintain PaO2
-improves survival, exercise capacity, cognitive performance, & sleep in hypoxemic pts.
complications of oxygen therapy
-combustion (risk fire w/ smoking)
-CO2 narcosis
-O2 toxicity
-absorption atelectasis
-infection
respiratory & physical therapy for COPD
-breathing retraining
-pursed lip breathing
-effective coughing
-chest physiotherapy
-positioning: tripod position
pursed lip breathing
prolongs exhalation and prevents bronchiolar collapse and air trapping
nutritional therapy for COPD
fluid intake of at least 3 L/day unless pt. has heart/renal failure
low carb, high protein, high calorie
-eating may cause dyspnea and low O2 sat.
-keep weight at 21-25 BMI
-rest before eating, use bronchodilator before meals
-eat 5-6 small meals/day
-drink liquids between meals to avoid distention
-avoid exercises for 1 hour before and after eating
-avoid gas-forming foods to prevent feeling full
pulmonary rehabilitation for COPD
evidence-based intervention that includes many disciplines working together to individualize treatment plan for pt.
-outpatient/inpatient/home settings
-exercise, focus on muscles used in ambulation
-wait 5 minutes after exercise before using B-adrenergic agonists; can use them before exercise
-walk 15-20 mins/day at least 3x/week