Oxygenation

When stiffer lungs are not able to expand causing collapse and the alveoli to collapse as well.

The tree branches off the bronchi which connect the larger conducting airways with the lung parenchyma.

breathing, the physical process of moving air into and out of the lungs so gas exchange can take place.

the process in which molecules move from an area of greater concentration or pressure to an area of lower concentration or pressure.

fine hairlike projections in the respiratory tract that help sweep away fluid and particles.

what transports oxygen to tissues

The percentage of O2 that humans breathe in at room temp".

the subjective feeling of labored breathing and breathlessness.

decreased amount of oxygen available to the tissues

below normal amount of oxygen in the blood.

grayish, bluish, purplish skin tone

breathing in excess of metabolic demands, resulting in removal of too much CO2 from the blood.

brething insufficient to meet metabolic demands and adequately remove CO2 from the blood.

• Continuous Positive Airway Pressure,
• uses oxygen under constant pressure
• used frequently at night for sleep apnea.

• Bilevel Positive Airway Pressure,
• uses a mechanical ventilator to assist with inspiration.
• pushes air into the lungs
• the positive pressure helps to prevent atelectasis by keeping the alveoli inflated.
• used frequently for CHF patients with fluid overload

delivers air to the lungs and facilitates in gas exchange.

• mouth
• nose
• pharynx

• trachea
• bronchi
• bronchioles
• alveoli

process of moving air into and out of the lungs

• diaphragm contracts (pulls downward)
• external intercostal muscles (pull outward)
• intrathoracic pressure drops
• air goes into the lungs

outside the body then inside the body

insde the body than you do outside.

alveoli and the blood by diffusion.

of greater concentration to the area of lower concentration.

the partial pressure of carbon dioxide is low.

hemoglobin

rapidly at 30-60 breaths per minute and have episodes of apnea.

20-30 regular breaths per minute

• 12-20 breaths per minute .
• this is the age that many become smokers

• 12-20 breaths per minute
• thoracic walls stiffens
• lungs less able to stretch
• decreased ciliary activity
• gas exchange is affected PaO2 decreases and they have decreased response to hypercapnia (high CO2)
• These factors contribute to higher rates of pulmonary infections (pneumonia)

• in an upright position because it allows for better lung expansion.
• harder to breath when lying down because abdomen push its contents upward towards the diaphragm.

21% and remains relatively constant.

• weather
• air pollution
• 2nd hand smoke
• pollen and allergens

releasing chemicals that cause an inflammatory response.

• emphysema
• chronic bronchitis
• lung cancer
• oral cancer
• cardiovascular disease

the central nervous system and cause a decrease in respirations thus impairing gas exchange

aspiration of stomach contents into the lungs.

thin

keep the immune system healthy

chest movement causing the person to work harder to breathe

• collapse of alveoli
• decreases area for gas exchange
• respiratory muscles consume more O2 because of the amount of work they are doing.

• pneumonia
• smoke inhalation
• pulmonary fibrosis
• acute respiratory distress syndrome (ARDS)
• pain from abdominal surgery
• abdominal distension from gas or fluids
• abdominal or chest binders
• rib injuries or chest deformities
• weakness
• neuromuscular disorders

• response to irritants in the airway
• can be triggered by chemicals, smoke, physical conditions (hot, dry air) and some medications.
• the function is to clear the substance from the airway

• irritation may be the cause
• a cough may be dry or deep to try and clear the mucous
• can originate in the nose versus the lungs access for color, consistency, volume

• is a subjective feeling breathlessness (dyspnea)
• most common cause of SOB is lung disease
• reduces gas exchange, altering O2 levels in the body
• causes include anxiety, congestive heart failure and COPD

cardiac, respiratory or even GI

• client may lean forward to relieve dyspnea
• retractions (especially children)
• Barrel chested (COPD)

• high pitched, short, popping sounds heard during inspiration.
• not cleared with coughing
• located in the alveoli
• pneumonia, congestive heart failure, and fluid in the lungs

• low pitched, bubbling, moist sounds heard throughout inspiration and exhalation. Located in the peripheral airways.
• pneumonia, pulmonary edema, pulmonary fibrosis, and fluid in the lungs.

• resonant: sounding with loud, deep, and clear tones.
• mucous in the upper airways
• low pitched snoring or moaning sounds
• located in the large airways, bronschitis, bronchial obstructions.

• made by directing a jet of air through a narrow channel in the vocal tract towards the sharp edge of the teeth.
• can be located in the large or small airways
• asthma or chronic emphysema

• low pitched, dry grating sound
• heard during inspiration and expiration
• created in the pleural surfaces. when the pleural surfaces are inflamed and rubbing together called pleuritis.

• most sever type of inspiratory wheezing
• more common in children with croup or epiglottitis
• if too severe they may need to be intubated.

• observe the rate and rhythm of respirations
• very slow breathing can cause hypoxia (low O2 levels) and hypercapnia ( high CO2 levels) causing respiratory acidosis.
• fast breathing (hyperventilation) can cause your client to "blow off" too much CO2 (respiratory alkalosis)

• the hands are used assess abnormalties such as tenderness or swelling
• expansion and contraction of the chest
• position of the trachea

used to detect fluid or consolidation in the lungs

• listening to breath sounds with a stethoscope
• are we hearing breath sounds thoughout all the fields
• should be equally loud on both sides
• what type of breath sounds are we hearing
• where are we hearing them

• normal is clear white, no odor, medium consistency
• thick and sticky that is hard to cough up can indicate poor hydration
• sputum form asthma clients is stringy like thickened egg whites
• pink frothy sputum indicates pulmonary edema
• yellow, green or foul smelling sputum indicates infection
• blood tinged sputum indicates airway inflammation usually is not serious can occur with severe coughing such as bronchitis
• hemoptysis is a sign of continuous bleeding and needs investigation.

• vaccines
• hand hygiene
• limit exposure
• sneeze and cough into sleeve
• smoking cessation
• reduce allergens
• monitor peak flow in asthmatics
• adequate hydration
• positioning and ambulation
• cough and deep breathing
• incentive spirometer

• percussion- strike the chest rhythmically with cupped hands over the area where secretions are located
• vibration- similar to percussion- use the hands like a gentle jackhammer
• postural drainage - uses gravity to assist in the movement of secretions

• a drainage device that is placed by MD in the pleural space to drain fluid, air or blood
• it is sutured in place
• usually hooked up to suction.

• detects abnormal fluid or air in the lungs
• pneumothorax (collapsed lung)
• consolidation ( pneumonia)
• underinflated lungs (atelectasis)
• used to determine position of central venous access devices (CVAD) and intubation tubes
• size of the heart

• specialized test measure lung size and airway patency
• helps determine the severity of lung problems
• tests: tidal volume, vital capacity, forced expiratory volume in one second

• gram stain is performed to determine specific agent
• appropriate antibiotics can be used
• usually treated with broad spectrum antibiotic until the culture and sensitivity report come back

• invasive procedure checks arterial blood level, oxygen, CO2 and pH
• Normal values
• PaO2 80-100
• PaCO2 35-45
• pH 7.35-7.45
• HCO3 22-26
• Base excess +/- 2

• levels of hypoxemia
• mild PaO2 60-80 mm Hg
• moderate PaO2 40-60 mm Hg
• severe PaO2 less than 40
• These levels naturally decline with age by 1mm Hg per year over the age of 60
• ABG also determines how effectively the lungs remove CO2. hyperventilation show lower levels of CO2. hypoventilation would show high levels of CO2.
• ABG determines the acidity or alkalinity of the arterial blood: pH less than 7.35 is acidosis. pH higher than 7.45 is alkalosis

• noninvasive way to determine clients O2 saturation
• infrared light that determines the percentage of hemoglobin that combines with oxygen. can be affected by blood flow, room lighting, temperature, dark nail polish, movement, smoking

a suspension of microscopic liquid droplets in air or oxygen.

• add moisture to oxygen being delivered
• hydrate and thin mucous secretions
• administer medications via the airways (bronchodilators, antibiotics, and corticosteriods)

• provides premeasured dose of medication
• usually self administered but the RN may be responsible
• patient needs to breath in the medication and hold their breath

steady stream of medication

a disease process may inhibit amount of O2 in the clients body. Oxygen therapy will help to reverse hypoxia.

• improve tissue oxygenation
• decrease work of breathing
• decrease the work of the heart

liters per minute

a percentage or fraction of inspired oxygen.

to maintain the PaO2 at 90 mm Hg or above or the SaO2 above 93%

• have 22%-44% oxygen capability
• can deliver fromm 1-6 liters of oxygen per minute
• if long term use then humidify with saline

• 24%-50% oxygen capability
• 3-8 liters per minute
• provides precise and consistent O2 delivery
• patient may feel claustrophobic

• 40-60% oxygen capability
• 6-10 L/min
• most common mid range delivery system
• must have a minimum of 5L/min to prevent client from rebreathing exhaled CO2
• not suitable for COPD patients because of the potential for delivering excessive oxygenation.

• delivers up to 90%oxygen capacity
• 10-15 L/min
• used for critcally ill patients
• allows patient to re breath one third of their CO2

• delivers 80-100%
• 10-15 L/min
• has side valves to prevent CO2 from getting into the reservoir.

• health promotion
• adequate hydration
• positioning and ambulation
• cough and deep breathing
• pursed lip breathing
• pulmonary toileting
• medications
• oxygen administration

to transport oxygen and nutrients to the tissues and transport waste to the appropriate organs for excretion.

the amount of blood pumped by the heart each minute

3.5 to 8 liters per minute

the cardiac output

stroke volume x heart rate

• 130-160 beats per minute
• anything less than 100 is not normal

• 60-80 beats per minute
• blood pressure around 120/80

• 60-100 BPM
• many factors can affect the rate

• hypertension
• smoking
• nutrition
• lack of exercise
• diabetes
• obesity
• family history
• medications and drug use
• stress

• changes in vital signs:
• may be hypotensive (systolic of less than 90)
• can mean a decrease in cardiac output
• orthostatic hypotension
• hypertension can lead to kidney failure, congestive heart failure, and other problems
• diminished or absent pulses can indicate decreased blood flow.

• increased heart rate
• body may need more oxygen
• blood pressure may be low
• the heart rate should return to baseline within 3 minutes of rest after activity
• a heart does not increase in rate with exercise may indicate that it is not able to compensate

may increase with cardiac effort and rate

• pale cool clammy if inadequate perfusion
• chronic heart disease may lead to skin lesions and tissue necrosis

• muscle damage, conduction problems or valve dysfunction can lead to decrease output
• myocardial infraction or heart attack is a decrease in blood flow to one of the coronary arteries. Once the muscle is damaged the tissue cannot be replaced
• heart enlargement hypertension can cause this.
• valve dysfunction can be damages from inflammation, infection, trauma or could be geneti cause
• conduction electrical impulse doesnt spread throughout the heart properly

• electrolyte imbalances
• dimish blood flow
• decreased O2 levels
• medcations
• stress

• insufficient blood volume
• insufficient red blood cells
• arterial dysfunction such as atherosclerosis hypertension smoking hyperlipidemia

• decreased cardiac output
• ineffective tissue perfusion
• decreased activity intolerance

• teaching
• lifestyle modifications
• effective coping
• adequate tissue perfusion
• medications

Morphine, Oxygen, Nitroglycerin, Aspirin

cardiac output. driver of the bus (hemoglobin)

60 BPM

a clot that can develop in the arteries or veins