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Pulmonary ventilation
Define
- movement of air into and out of the lungs
- inspiration expiration
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Respiration
gas exchange between atmospheric air in alveoli and blood in the capillaries through the process of diffusion
- Upper Airway
- Lower Airway
- Cilia
- Alveoli
- Surfactant
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Perfusion
the process of oxygenated capillary blood passes through body tissues.
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Upper Airway
warm, filter and humidify inspired air
nose, pharynx, larynx, epiglottis
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Lower Airway
Conduction of air, mucociliary clearance, and production of pulmonary surfactant
- Tracheobronchial tree
- Trachea
- Right and left main stem bronchi
- Segmental bronchi
- Terminal bronchioles
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Pulmonary ventilation
Process
- Diaphragm contracts and descends
- Lengthening thoracic cavity
- External intercostal muscles contract
- Lifting ribs upward and outward
- Sternum pushed forward
- Enlarging chest from front to back
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Lung compliance
Ease of the lungs to be inflated
- the elasticity of lung tissue
- surfactant
- alteration in elasticity - emphysema
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Airway resistance results from impediment or obstruction in the airway
- Foreign substance
- Drowning victim
- Secretions
- Tumors/Edema
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Transport of Respiratory Gases
Oxygen is carried in the body via plasma and red blood cells.
Most oxygen (97%) is carried by red blood cells in the form of oxyhemoglobin.
Hemoglobin also carries carbon dioxide in the form of carboxyhemoglobin.
Internal respiration between the circulating blood and tissue cells must occur.
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Factors affecting ventilation
Musculature condition
Lung elasticity/compliance - ability to stretch
Airway resistance/obstruction - emphysema
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Factors affecting gas exchange
Surface area available
Thickening of alveolar-capillary membrane
Partial pressures of gases
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Auscultation of breath sounds
Vesicular - low-pitched soft sound during expiration heard over most of the lungs
Bronchial - high-pitched and longer, heard primarily over the trachea
Bronchovesicular - medium pitch and sound during expiration, heard over the upper anterior chest and intercostal area
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Factors affecting perfusion
Activity level
Cardiac output (stroke volume
Carbon dioxide transport
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Alterations in Respiration Hypoxia
A condition in which an inadequate amount of oxygen is available to cells. (shortage of O2).
Occurs when there is a problem with ventilation, respiration and/or perfusion.
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Clinical Manifestation of hypoxia
Dyspnea (the most common symptom) – shortness of breath
Increased BP
Increased respiratory rate
Increased pulse rate
Pallor (paleness), Cyanosis (bluish color), Anxiety, Restlessness, Confusion, Drowsiness, small or narrow pulse pressure
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Alterations in Respiration Functioning
Level of health
Developmental Considerations (Table 38-1) page 1405
Medications – especially those affecting CNS
◦Opioids (depresses respiratory drive). Sedatives
Lifestyle – activity level, culture, cigarette smoking
Environment – pollutants, occupational exposure, household cleaning products
Psychological Health – stress, anxiety
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Developmental Consideration
Infants
◦< 34 weeks may have less surfactant
◦Leading to the collapse of alveoli
◦Abdominal breathers (0-5yrs)
◦Short airways and prone to aspiration
Toddlers, Preschoolers, School-aged Children, and Adolescents
◦Elongated and less angular Eustachian tubes, bronchi and bronchioles
Antibody development
Older Adults (Table 38-1)
◦Alveoli less elastic
◦Less efficient diaphragm movement
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Nursing Process: Assessment
Why the patient needs nursing care.
What kind of care is needed to maintain a sufficient intake of air?
Identify current or potential health deviations.
Identify actions performed by the patient for meeting respiratory needs.
Make use of aids to improve intake of air and effects on patient’s lifestyle and relationship with others.
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Assessment
Patient history
Interview patient or family member
Assessment guide 38-1
Current and potential health problems
Actions performed by the patient to meet respiratory needs
Aids used by patient to improve ventilation
Effect on the patient’s lifestyle and relationships
Physical assessment
Inspection, palpation, percussion and auscultation
Laboratory and diagnostic tests
Pulmonary function tests
Common diagnostic tests
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Adventitious (abnormal) Breath Sounds
Crackles—soft, high pitched intermittent popping sounds produced by fluid in airways or alveoli
Wheezes—continuous musical/whistling sounds heard as air passes through airways constricted by swelling, narrowing, secretions, or tumors
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Heart Sounds
S1
Closure of mitral and tricuspid valve
Contraction of the ventricles
Beginning of systole
Lub
S2
Closure of aortic and pulmonic valve
Relaxation of the venticles
Beginning of diastole
Dub
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Pulmonary Function Studies
Spirometry
Peak Inspiratory Flow Rate (PEFR)
Pulse Oximetry
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Common Diagnostic Studies
Arterial blood gas & pH Analysis
Radiography
Lung scan
Electrocardiography
Cardiac biomarkers
Cystologic
Skin test
Endoscopic studies
Complete blood counts
Capnography
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Nursing Diagnosis
Alteration in oxygenation as the problem
Inefective airway clearance r/t recent development of pneumonia AEB…
Impaired gas exchange r/t asbestos in the workplace AEB…
Ineffective breathing pattern r/t pain AEB…
Alteration in respiratory functioning as Etiology
Activity intolerance r/t imbalance in oxygen supply and demand AEB …
Anxiety r/t felling of suffocation AEB …
Disturbed sleep pattern r/t orthopnea and bronchodilators AEB…
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Planning/Expected Outcome
The patient will:
Demonstrate improved gas exchange in lungs by absence of cyanosis and pulse oximetry reading of 95% or greater
Verbalize understanding of causes and demonstrate adaptive methods of coping
Preserve cardiopulmonary function by maintaining an optimal level of activity
Demonstrate behaviors to improve or maintain clear airway
Identify potential complications and initiate preventive or corrective actions
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Interventions
Promoting Optimal Function
Healthy lifestyle
Vaccination
Pollution-free environments
Reducing anxiety
Maintaining good nuturition
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Interventions
Promote optimal functioning of cardiopulmonary systems
Promote comfortPromote and control coughing
Chest physiotherapy - Percussion, Vibrating, Postural
Suctioning airway
Supplemental oxygen
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Interventions
Promoting Comfort
Proper positioning- high Fowler’s position
Adequate fluid intake - 2-3 quarts daily to thin secretions
Humidification
Breathing techniques - Deep, Pursed lip, Diaphagmatic
Pace physical activity
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Interventions Promoting and Controlling Coughing
Voluntary
Involuntary
Cough Medications
Expectorants
Suppressants
Lozenges
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Interventions Medications
Bronchodilators
Albuterol
Theophylline
Corticosteroids
Prednisone
Dexamethasone
Mast Cell Stabalizer
Cromolyn sodium
Antihistamine
Diphenhydramine
Nebulizers
Metered dose inhaler (MDI)
Dry powder inhaler (DPI)
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Interventions Oxygen Delivery
Oxygen is a medication!
In emergencies do not delay oxygen administration!
Nasal cannula
Nasal catheter
Simple mask
Partial rebreather mask
Nonrebreather mask
Venturi mask
Tent
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Intervention Oxygen Therapy in the Home
Safety
No smoking or use open flames within 10 feet of the O2 source
O2 is a combustible gas, sparks ignite
Do not use electrical equipment near O2 administration set
Ground oxygen concentrators
Secure tank in the holder
Allow adequate airflow around the concentrator
Notify local fire department of oxygen use in the home
Administration
Follow prescription
Have HCP number
Ensure enough O2 on hand prior to leaving the home
O2 vendors contact
Signs and symptoms indicating an emergency
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Evaluation
Ongoing process
Compare patient’s health status with previously defined outcomes
Where the outcomes met, partially met or unmet?
Adjust plan of care if outcomes are not met/partially met
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