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The path that air takes as it enters and exits the lungs.
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>
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?
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?
What's another term for exhalation?
________ and _________both contribute to the regulation of respirations.
nerves, chemicals
Where in the brain is the respiratory center located?
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?
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?
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?
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
during hypoxemia, the blood cannott take adequate amounts of o2 to the tissues, causing:
What are the early signs of hypoxia?
mental changes
What are the late signs of hypoxia?
cardiac dysrhythmias
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
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
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
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.
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:
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
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
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?
What sound do you chart if the pt has fluid the lungs or airways?
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?
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?
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?
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.
ABG's are withdrawn at a ____ degree angle.
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
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?
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.
Failing to mix nebulizer meds as ordered could lead to:
_______ 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?
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.
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
What is a portable o2 tank called?
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?
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?
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
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?
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.
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
inner cannula
Should the cuff on the traceostomy tube be inflated or deflated when the pt is eating?
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 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?
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
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
Where are chest tubes generally inserted at?
What is the purpose of pursed lip breathing?
to promote co2 elimination
What happens to the lungs when negative pressure in the plueral cavity is disrupted?
the lungs can no longer fully expand
What are the symptoms of atelectasis?
chest pain
respiratory distress
When air enters the pleural space, where does it go?
air rises to the top of the cavity
Where is the chest tube inserted to release air from the plueral space?
between the 2nd and 4th intercostal space
Where do blood and drainage go when they enter the plueral space?
lower portion of the cavity
What is it called when blood and drainage are present in the plueral space?
Where is a chest tube inserted to drain blood and fluid from the pleural space?
8th-9th intercostal space
What is chamber one for in a chest drainage system?
wet suction
How is the suction controlled in a chest drainage system?
by the amount of water in the chamber one
What is the water suction chamber filled with in a chest drainage system?
sterile saline
How much are water do you usually use to fill the chamber of a chest drainage system?
20 cm
How will you know that the suction is working on a chest drainage system?
bubbles will be present in chamber one
How should you set the suction on a chest drainage system?
there should be gentle bubbling
Why is rapid bubbling in a chest drainage system a problem?
will cause the water to evaporate faster (will not affect rate of suctioning)
In chest drainage systems that are dry, how is suction set?
with a dial
What is chamber 2 for in the chest drainage system?
water seal
Why is a water seal necessary in a chest drainage system?
to reestablish negative pressure
What is the standard amount of water used for the water seal in a chest drainage system?
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.
How do you note drainage in a chest drainage system?
mark it on the system, date, time and initial
How often should drainage in a chest drainage system be assessed and recorded?
What could a sudden increase in bright red output in the chst tube drainage unit indicate?
hemmorrhage-notify dr. immediately
How often should you assess the resp status of someone with a chest tube?
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
tension pnuemothorax
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 ________ ________.
exchanging gases
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
The exchange of o2 and co2 is called
deficiency of arterial blood o2
hypoxia results from ________
insufficient o2 present to meet metabolic demands of tissue and cells.
When the lungs expand, a _________ is created and air is pulled into the lungs to equalize the _______.
vaccuum, pressure
What is the only blood test that can tell you what the o2 level is in the arteries?
What system is breathing controlled by?
autonomic nervous system
When ketoacidosis occurs due to diabetes, what type of breathing occurs?
kussmaul (panting)
When lung volume goes up, lung pressure goes _______.
When is the pressure in the lungs greater than atmospheric pressure
during exhalation
What is the first system affected by hypoxia?
What is the normal value range for respirations?
What are respirations >20?
What are respirations <12
What is a bradycardia?
heart rate of <16
causes of hypoxia
decrease cardiac output
high altitudes
poor peripheral circulation
pulmonary embolus
What tests are used to diagnose obstructive lung disease such as copd or asthma?
pulmonary function test
what test is used to determine the dosages for respiratory meds?
peak flow
What does a TB test confirm?
past exposure to TB
What is usually the main purpose of nebulizer txs?
to open bronchioles
What's another name for a nebulizer tx?
updraft tx
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.[1]
How does the pulse ox detect o2 saturation?
detects the amount of light absorbed by hemoglobin
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?
carbon monoxide
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
When is o2 usually humidified?
When the flow is 3L or greater
How high can hi-flow nasal canulas go up to?
10 L/min
When is a simple face mask contraindicated?
when the pt has co2 retention
What is the range in % of o2 that can be delivered via a venturi mask?
What system delivers the highest amount of o2 without intubation?
non-rebreathing mask
What type of supplemental o2 device has no inspiratory valve?
partial rebreathing maks
What 3 types of supplemental o2 delivery can provide high humidity?
face tent
t tube
trach collar
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 are 3 drawbacks of CPAP?
hypercapnia (too much co2)
gastric distention
What does the supplement "pulmocare" help the body get rid of?
excess co2
What factors jeapordize a person's airway?
decreased LOC
ineffective cough
impaired 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
postural drainage
What is the max amount of time an ET tube can stay in?
4 weeks
How often should ET tubes be moved and why?
q shift to prevent pressure ulcers
How many mL's of fluid is there approximately in the plueral space?
4 mL
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
pleural effusion
Why does a pt feel pain with a pnuemothorax?
the atmospheric air irritates the parietal pluera
What is the most common sign of pnemothorax?
occurs from the rupture in the pleura when air accumlulates in the pleural space more rapidly than it is removed
tension pneumothorax
When someone is in the beginning stages of hypoxia, what happens to their respiratory rate?
it goes up
How do you assess for exertional dyspnea?
compare resp rate while at rest and while ambulating a short distance