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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>
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?
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.
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
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
Do people with severe lung disease have the same stimulus to breathe as those without lung disease?
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.
In external respiration, o2 moves via diffusion from an area of _______ cxt, to an area of _______ cxt.
higher to lower
What are the early signs of hypoxia?
What are the late signs of hypoxia?
What are the usual causes of impaired oxygenization?
damage to the alveoli caused by lung disease
damage or trauma to the lungs
blood clot in the lungs
decreased cardiac output
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
What things should be noted in a respiratory inspection?
color of skin, mucous membranes
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 occurs when a patient has to stop and rest or catch his or her breath when ambulating, or becomes SOB
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.
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.
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:
This occurs when a hole allows air to enter the pleural space where there is supposed to be negative pressure
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.
What are the 7 patterns of respirations?
When assessing the pt's oxygenations status, determine the patients orientation to (3 things)
time, place and person
What are the 2 ways to obtain a sputum specimen?
the pt coughs up and expectorates
suction the throat or trachea
When withdrawing ABG's, what is inside the syringe that keeps the blood from clotting?
small amount of heparin
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.
What does the ABG test measure?
partial pressure of o2
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
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.
_______ without meds may also be used in a nebulizer to provide moisture to the airways to thin tenacious mucous.
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 safety procedures should be observed when supplemental o2 is in use? (5)
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?
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.
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.
For safety purposes, always keep supplemental o2 liter flow for pts with chronic obstructive lung disease below_____L/min
What muscles do pts with chronic lung disease often have to use to breathe?
accessory muscles in the neck, shoulders
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.
What happens if a simple face mask is set at less than 5L per minute?
carbon dioxide will accumulate in the mask
What does a partial rebreathing mask do?
traps carbon dioxide for rebreathing to lower pH levels in alkalosis.
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.
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.
What supplemental o2 device is ordered by the doctor as a percentage, as opposed to Liters?
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)
What are 3 reasons that a pt may e unable to clear the airway?
What are s/sx that the pt needs to be suctioned?
rattling sounds in the throat
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.
When is suction applied to the suction catheter when suctioning a trach tube. Entry or exit?
on exit only
In many cases of airway obstruction when a trach is used, it is often due to
cancer tumors in the larynx
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.
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.
a collection of air or gas in the pleural cavity due to perforation through the chest wall
Where are chest tubes inserted to release air caused by a pneumothorax?
2nd to 4th intercostal space
When blood and drainage are present in the pleural space, they pool in the lower portion of the cavity. This is called:
Where are chest tubes inserted to drain blood due to a hemothorax?
between the 8th and 9th intercostal space
What happens when both blood and air are present and need to be drained from the plueral space?
2 chest tubes are inserted, one high and one lower and connected by a y-tube
What happens to the lungs when negative pressure in the plueral cavity is disrupted?
the lungs can no longer fully expand
Where is the chest tube inserted to release air from the plueral space?
between the 2nd and 4th intercostal space
Where is a chest tube inserted to drain blood and fluid from the pleural space?
8th-9th intercostal space
How will you know that the suction is working on a chest drainage system?
bubbles will be present in chamber one
Why is rapid bubbling in a chest drainage system a problem?
will cause the water to evaporate faster (will not affect rate of suctioning)
This is the motion of the 2nd chamber in a chest drainage system rising and falling as the patient exhales
When might you see bubbles in the second chamber water seal of a chest drain?
when the pt has a pneumothorax
How do you know when a pneumothorax is resolved by looking at the chest drainage system?
there should be no more bubbles in the second chamber (water seal chamber) of the chest drain system.
If you see bubbles in the second chamber (water seal chamber) of the chest drain system and the person has a pneumothorax that has been resolved, what should you do?
check for air leaks
What is the 3rd chamber of the chest drainage system used for?
blood and other fluids are trapped and measured
What do you do when the drainage chamber on a chest drainage system gets full?
change the whole system. Can't open the system up because you will lose negative pressure.
What could a sudden increase in bright red output in the chst tube drainage unit indicate?
hemmorrhage-notify dr. immediately
What is one of the dangers of getting a clot in the tubing of a chest drainage system?
positive pressure can build up and cause a tension pneumothorax
Progressive build-up of pressure in the pleural space pushes the mediastinum to the opposite hemithorax, and obstructs venous return to the heart. This leads to circulatory instability and may result in traumatic arrest
If pt has a tension pnuemothorax, the mideastinal are may shift to one side, causing compression of the heart. This can prevent the previous unaffected lung from optimally ________ ________.
Why is stripping not recommended for chest tube clot removal?
increases positive pressure in the plueral space
If you have a clot in the chest tube, what should you do?
know your facilities policy for removal or check with the physician
If a chest tube comes out and the pt has a pnuemothorax, what should you NOT do and why?
do NOT put occlusive petroleum jelly dressing over it because it will trap the air inside and potentially cause a pneumothorax (use regular gauze to cover)
What's the first thing you should do if a chest tube becomes disconnected from the drainage unit?
place the end of the tube in at least 2 cm of sterile saline to re-establish negative pressure
What are the 2 instances in which using padded hemostats is acceptable for short periods of time?
changing the drainage unit
test pts ability to withstand removal of the chest tube
When the lungs expand, a _________ is created and air is pulled into the lungs to equalize the _______.
causes of hypoxia
decrease cardiac output
poor peripheral circulation
What tests are used to diagnose obstructive lung disease such as copd or asthma?
pulmonary function test
What medication takes water from the body and puts it in the resp tract to thin secretions and must be taken with a full glass of water?
an abnormal pattern of breathing characterized by groups of quick, shallow inspirations followed by regular or irregular periods of apnea.
If your pt has adventicious lung sounds, what is the first thing you should do?
have them TCDB, the reauscultate
What are 2 things that could cause the o2 sat reading to be falsely inflated?
When using a flowmeter, where should the ball be in relation to the numbers on the flowmeter to get an accurate flow reading?
number should be in the middle of the ball
Device that pumps a constant pressurized flow of air through the nasal passages, commonly used during sleep to prevent airway closure in sleep apnea
CPAP (improves oxygenation, decreases co2 retention)
What factors jeapordize a person's airway?
What are 5 mechanisms that keep the airway open?
blowing the nose
involves a pt assuming various positions to facilitate the flow of secretions from various parts of the lung into the bronchi, trachea and throat so they can be cleared and expelled more easily
What will happen if the pressure in the pleural space becomes positive, rather than negative?
The lung will not be able to expand and it will collapse
an accumulation of pleural fluid due to factors causing an increase in protein content and or an increase in fluid entry or a decrease in fluid exit of the pleural cavity
occurs from the rupture in the pleura when air accumlulates in the pleural space more rapidly than it is removed
When someone is in the beginning stages of hypoxia, what happens to their respiratory rate?
it goes up
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