1. Mechanics of Ventilation
    • Inspiration
    • Expiration
  2. Inspiration
    • Occurs when changes decrease intrapleural pressure
    • Air enters the lungs through primary bronchi
    • O2 and CO2 are exchanged in the alveoli
    • Simple diffusion
  3. Expiration
    • Occurs when changes increase intrapleural pressure
    • Primarily passive
    • CO2 expelled
  4. Factors affecting respiration
    • Changes in volume and capacity affected by gender, age, weight, and health status
    • Changes can be measured by pulmonary function tests
    • Changes in air pressure in the thoracic cavity drive inspiration/expiration
    • O2, CO2, and hydrogen ion concentration
    • Airway resistance, lung compliance, and elasticity
    • Alveolar surface tension
  5. Nursing history focuses on:
    • Current illness
    • Observe for respiratory compromise
    • Present health status, medical history, family history, risk factors
    • Lifestyle questions: smoking history, exposure to environmental substances, exercise, use of recreational drugs
  6. Normal breath sounds
    • Vesicular
    • Bronchial
    • Bronchovesicular
  7. Abnormal breath sounds
    • Adventitious sounds
    • Absence of breath sounds
    • Malposition of normal quality breath sounds
  8. Age related changes
    • Decrease in elastic recoil of the lungs
    • Loss of skeletal muscle strength in thorax and diaphragm 
    • Fibrosis in the alveoli
    • Fewer functional capillaries
    • Less effective cough
    • Decrease in PO2
  9. Diagnostic tests to measure ventilation and oxygenation
    • Pulmonary function tests
    • Arterial blood gases
    • Pulse oximetry
    • CBC
  10. Diagnostic tests to visualize respiratory structures
    • Chest x-ray
    • Bronchoscopy
    • Lung scans
  11. Diagnostic tests to identify infections or abnormal cells
    • Throat cultures
    • Sputum cultures 
    • Thoracentesis specimens
  12. Arterial blood gases
    • To assess alterations in acid-base balance
    • pH: 7.35-7.45
    • PaCO2: 35-45 mmHg
    • PaO2: 75-100 mmHg
    • HCO3: 24-28 mEq/L
    • BE: 2 mEq/L
  13. Bronchoscopy
    Direct visualization of the larynx, trachea, and bronchi through a bronchoscope to identify lesions, remove foreign bodies and secretions, obtain tissue for biopsy, and improve tracheobronchial drainage.
  14. CT scan of the thorax
    • When x-rays do not show some areas well
    • Also done to differentiate pathologic conditions (such as tumors, abscesses  and aortic aneurysms), to identify pleural effusion and enlarged lymph nodes, and to monitor treatment
    • Images are shown in cross-section
  15. Pulse oximetry
    • Used to evaluate or monitor oxygen saturation of the blood
    • Normal: 90-100%
  16. Oropharyngeal and Nasopharyngeal suctioning
    • Used when patient is able to cough effectively but unable to clear secretions by expectorating
    • Apply suction after a patient has coughed
  17. Orotracheal and Nasotracheal suctioning
    • Necessary when a patient with pulmonary secretions is unable to manage secretions by coughing and does not have an artificial airway present
    • Sterile procedure
  18. Oral airway
    • Prevents obstruction of the trachea by displacement of the tongue in to the oropharynx
    • Extends from the teeth ro the oropharynx
  19. Endotracheal tube (ET)
    Short term artificial airway to administer mechanical ventilation, relieve upper airway obstruction, protect against aspiration, or clear secretions
  20. Tracheostomy
    • Long term artificial airway
    • A surgical incision is made into the trachea, and a short artificial airway is inserted
    • Patients with a tracheostomy are unable to speak because it is inserted below the vocal cords
  21. Low flow oxygen delivery systems
    • Nasal cannula
    • Simple face mask
    • Partial rebreather mask
    • Non-rebreather mask
  22. Nasal cannula
    • 1-6 L/min
    • 24-44% O2
    • Use with patients with chronic lung disease who need long term therapy
    • Problems include nasal/ear irritation
  23. Simple face mask
    • Minimum flow rate is 5 L/min
    • 40-60% O2
    • Short term therapy/emergency
  24. Partial rebreather mask
    • 6-11 L/min
    • 60-75% O2
    • Reservoir bag with no flaps
  25. Non-rebreather mask
    • 10-15 L/min
    • 90% O2
    • Reservoir bag with flaps to prevent room air from entering
  26. High flow oxygen delivery systems
    • Venturi mask
    • Face tent
    • Aerosol mask
    • Tracheostomy collar
    • T-piece
  27. Venturi mask
    Delivers the most accurate oxygen concentration
  28. Face tent
    • Fits on the chin, top extends halfway over face 
    • Good for facial trauma and burns
  29. Aerosol mask
    Used when high humidity is needed after extubation or upper airway surgery for thick secretions
  30. Tracheostomy collar
    Used to deliver high humidity and desired oxygen to tracheostomy patients
  31. T-piece
    Special adaptor to deliver desired level of oxygen to a patient with a tracheostomy, laryngectomy, or endotracheal tube
  32. Pneumonia definition
    Inflammation of the lung tissue (the respiratory bronchioles and alveoli)
  33. Pneumonia pathophysiology
    • Inflammation by either infectious or noninfectious sources
    • Domino effect starting with an organism getting beyond the respiratory system defenses:
    • Organism enters respiratory tract usually via an infected person coughing, sneezing, or talking, or contaminated aerosolized water, or it may be spread to the lungs via the blood from an infection somewhere else in the body
  34. Pneumonia can result in:
    • Reduced gas exchange
    • Capillary leakage that spreads the infection 
    • Organism moving into blood stream resulting in sepsis
    • Infection moving into pleural cavity and a resulting empyema (pus around the pleural cavity)
    • The fibrin and edema stiffening the lung=decrease vital capacity
    • Atelectasis
  35. Atelectasis definition
    Alveolar collapse = decreased oxygenation --> Hypoxia
  36. Pneumonia with consolidation
    Lack of air spaces as a result of solidification
  37. Pneumonia risk factors
    Elderly, smoking, immobility, surgical procedures, use of multiple medications, malnutrition, and chronic illnesses (COPD, CAD, ect.)
  38. Clinical manifestations of pneumonia
    • Systemic: fever and chills
    • Respiratory: pleuritic chest pain, SOB, crackles and wheezes, cough, sputum production, rapid, shallow respirations, dull percussion over affected areas, bronchial breath sounds
  39. Diagnostic test results for pneumonia
    • Respiratory acidosis as seen with ABG
    • Pulse oximetry <95%
    • Elevated WBC
    • Chest x-ray may show consolidation
    • C & S positive for microorganism (responsible organism not identified in 50% of cases)
    • Hypernatremia
  40. Implementation for patient with pneumonia
    • Administer oxygen and monitor its effectiveness
    • Ensure patent airway
    • Promote lung expansion
    • Mobilize secretions
    • Administer antibiotics per orders
    • Do ongoing focused assessment to determine effectiveness of interventions
  41. Goals for patient with pneumonia
    • Adequate gas exchange
    • Maintain patent airway
    • Be free of invading organism
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