Resp. lecture 1

• Dif. breathing (breathlessness)
• Have dif eating and ADLs
• Pain may cause this
• HR can cause this

Inability to breath except in sitting position

• Insufficient supply of O2 to body tissues (cells)
• Not enough O2 in body
• May be cause of Pulm. disease
• Blood can't be transported--anemic
• May be because of hemorrage

Difficient O2 in blood

• Result of increased CO2 levels in tissue and decreased O2
• Smoke inhalation
• Drowning
• Foreign body substances
• Cars running

• Blue tinge to skin and mucous membranes
• Result of low arterial O2 level
• Sudden or gradual
• Usually NOT an early symptom

Change in angle of nail because body increases amt of capillaries--trying to get more O2 to tissues--Tissues creat clubbing

Couging up of blood or blood tinge sputum

Deep, regular, sighing respirations--increased rate to it

• Up and down--period of apnea
• Brain trys to turn off body--death

• Normal location of scope is on side of trachea
• Sounds are loud, high pitched, and almost sound hallow
• Can usually hear inspiratory louder. Expiratory can be heard too.

• Far end of resp tract--base/side area
• Soft, lowpitched, harder to hear
• Quiet, wispy inspiratory phase followed by a short, almost silent expiratory phase

• Combination of broncho and vesticular breath sounds
• Normal location just off sternal areas (2nd intercostal space)
• Inspiration is equal to expiration
• (full inspiratory phase with a shortened and softer expiratory phase)

Adventitious breath sounds (observations or auscultation)

• Increased rate of respirations greater than 24
• May be blockage or "dead space"
• People with pneumonia, athsma, CHF

• Meds may do this
• People who have pain with breathing will slow down so it doesn't hurt
• Brain injuries
• Below 12 resps

• don't see chest move on ONE side
• almost always pneumothorax (lung collapse)

• Absense of breathing
• Strokes, meds, head injuries, paralyzing drugs (anesthesia), airway obstruction

• Air that is going through fluid in small airwayrs
• Short, bubbling
• See this in pneumonia, bronchitis, atalectasis
• More common on end of inspiration
• First get pt to cough and cear

• Larger airways (bronchioles) obstructed by fluids or mucous
• Hear better at beginning of expiration
• Chronic pts

• Air passing through narrowed airways
• Continuous musical sounds
• Hear during end of inspiration and beginning of exspiration
• May not even need scope

• Pleura gets inflammed and rubs
• Can hear throughout resp cycle
• Loud, dry, creaking sounds

Test that identifies individuals that have a genetic abnormality that predisposes them to emphysema

• Antitrypsin assay
• Look for RBC and Hemoglobin
• Look for WBC sound with differential

• Take samples and send to lab
• Identifies pres. of TB
• CELL CYTOLOGY-- see if any cancer cells are present

• Non invasive method to measure arterial O2 saturation
• % of arterial hemoglobin

• PA-- posterior anterior view (beam placed on back and works to front)
• AP--anterior posterior view (beam shot from front to back)
• Lateral-- Beam coming from side- aimed at right side to aim to left to look at heart

These tests help determine extent and pattern of disease--fluid? tumor?

• Magnetic--pt mus not have on any jewlery
• See cross-sectional views of the lungs

• (barrium swallow)
• chalky solution
• A radiographic (x-ray) examination of the upper gastrointestinal tract. It is used specifically to analyze the pharynx (back of mouth and throat) and the esophagus

• Fluoroscopy
• may also be used during a barium swallow. Fluoroscopy is a study of moving body structures -- a kind of “x-ray movie.”

• These tests use inhaled and injected radioactive materia to measure breathing (ventilation) and circulation (perfusion) in all areas of the lungs.
• Helps record pulm. activity

• During the perfusion scan, a health care provider injects radioactive albumin into your vein. You are placed on a movable table
• that is under the arm of a scanner. The machine scans your lungs as blood flows through them to find the location of the radioactive
• particles. During the ventilation scan, you breathe in radioactive gas through a mask while you are sitting or lying on a table under the scanner arm.

• A procedure that uses a special dye and x-rays to see how blood flows through the lungs.
• Insert IV cath to arm or femoral artery work work way to heart chambers and into pulm artery

• Once the catheter is in place, dye is injected into catheter. X-ray images are taken to see how the dye moves through the
• lung arteries. The dye helps highlight any blockages in blood flow.

• Scoping of the larynx.
• Can be done at bedside
• Can remove foreigh bodies

• Direct visualization of vocal cords, trachea, and bronchi
• Can take sample of tissue for biopsy
• Can remove foreign bodies like mucous

• VS and resp assessments
• May be blood sputum and may swell
• pts should be NPO until cough and gag reflex returns
• Monitor for bleeding
• Watch for edema
• Watch for STRIDOR--crowy type respiration that laryrngeal edema causes (an abnormal accumulation of fluid in the cavities and intercellular spaces of the body.)

A noninvasive method of assessing the functional capacity of the lungs (TV, IRV, ERV, Residual volume, Vital capacity)

• A procedure to remove fluid from the space between the lining of the outside of the lungs (pleura) and the wall of the chest.
• A long needle is placed through the skin of the chest wall into the space around the lungs, called the pleural space
• Can get sample for biopsy
• Can put meds into space
• Done at bedside with local anesthesia

• Determines the effectiveness of oxygenation, ventilation, and acid-base balance in blood from an artery
• Most reliable means of evaluating oxygenation
• An ABG test uses blood drawn from an artery, where the oxygen and carbon dioxide levels can be measured before they enter body tissues.

• Nursing responsibilities
• 1) Do not change the O2 setting before test
• 2) Hold activities that require energy for at least 20 min
• 3) After the stick, must apply presure for at least 5 min.
• -check for clot, bleeding, hematoma

measures the hydrogen ion concentration of the blood= acid/base determination; expressed as a negative log

7.35-7.45

partial pressure of carbon dioxide in arterial blood

35-45

Bicarbonate concentration in the blood, regulated by the kidney

22-26

partial pressure of O2 in arterial blood

80-100

% of HGB carrying O2, affected by ph, pCO2, and temp

94-100

• delivers 24-45% of O2
• Depends of L flow

• facemask- 40-60% O2
• nonrebreather- go up to 100%
• venturimask- fo up to 100%

Continuous positive airway pressure

• Tight fitting mask--doesnt let pt completely breath out
• Treats hypoxemia
• Good for newborns

• neg pressure- air sucked into lungs (iron lung)
• pos pressure- air pushed into lungs

• pos pressure system in mouth (endotracheal tube)
• Assists/controls if pt needs to breath 12 breaths/min and he is breating 10, it will kick in and give the extra 2. if he is breathing 20, then it will won't do anything to lessen it

• Gives breaths whether you like it or not
• Helps ween pts off ventilators
• The patient could breathe spontaneously while also receiving mandatory breaths.

CPAP but with tube or trache

• Ventilator assed breaths
• Supports pts own efforts and machine will push more ventilation
• The patient initiates the breath and the ventilator delivers support with the preset pressure value.

• Surgical opening into the thoracic cavity
• Help remove air or fluid
• Reexpand collapsed lung

Surgical opening into thoracis cavity and placement of a chest tube

permits the escape of air, blood, fluid, or pus from the pleural space to allow for full expansion of the lung and additional drainage

neg pressure makes sure lungs don't collapse

• Chest tube is connected to a sterile drainage package
• Neg. pressure is mantained--like sypening gas
• *must mark where water was-if large amt of water comes, let md know
• Doesn't let fluid return to pt

• Make sure drainage apparatus is BELOW pts waist
• Make sure connectors are TIGHT

• A one-way valve that allows air to flow out of your chest through a chest tube when you breathe out (exhale), but prevents air from
• entering your chest when you breathe in.
• Maintains neg. pressure

• Ventilation
• Breathing-air moves in and out of lungs

• Perfusion
• O2 and CO2 are exchanged between the blood and the cells

• diffusion
• The process of cell catabolism in which cells turn food into usuable energy in the form of ATP