Gas Exchange Flashcards
1
Q
SSA older adult with pneumonia you will find what assessment data?
A
Lethargy, hemoptysis, elevated RR, LOC changes
2
Q
HF all intervention..
A
I and O, O2, BNP level, discharge info, assess lung function every 2-4 hours
3
Q
HF not improve
A
Urine is 160mL/8hrs and wheezing
4
Q
Do infants typically breathe through their nose or mouth?
A
Their nose
5
Q
RR of newborns
A
30-80 BPM
6
Q
RR of Infants
A
30-60 BPM
7
Q
RR of toddlers
A
20-40 BPM
8
Q
RR of Preschoolers
A
22-34 BPM
9
Q
RR of School-age children
A
15-25 BPM
10
Q
RR of Adolescents
A
12-20
11
Q
RR of Adults
A
12-20
12
Q
RR of Older Adults
A
15-20
13
Q
What does a stridor sound indicate and where does it come from?
A
Stridor sound often indicates an airway obstruction in the upper airway
14
Q
Mild impairments in oxygenation can cause what?
A
- fatigue
- irritability
- discomfort
15
Q
What are some things that can cause alterations in Gas exchange?
A
- COPD, emphysema
- CO2 retention
- Airflow in alveoli blocked by sputum, inflammation, atelectasis, or fluid volume excess
- blood flow in caps blocked by clots, plaque, and emphysemic alveoli
- airway patency
- moderate impairement
16
Q
Define othropnea
A
difficulty breathing when supine
17
Q
To determine if someone has orthopnea what question could you ask your patient?
A
How many pillows do you sleep with? Do you have to sleep in a recliner?
18
Q
Define Kussmaul breathing
A
Deep, rapid exhalations increase the elimination of CO2, affecting the acid-base balance
19
Q
Define Cheyne-strokes respirations
A
Deep, rapid breathing and slow, shallow breathing with periods of apnea
20
Q
When do Cheyne-strokes respirations occur?
A
In CHF, increased intracranial pressure, and drug overdoses
21
Q
Define Biot Respirations
A
Shallow breathing with periods of apnea. Occur in CNS disorders
22
Q
What are some modifiable risk factors for gas exchange?
A
- factors affecting the heart’s ability to circulate blood (hypertension, atherosclerosis)
- Obesity
3, T2 DM - Smoking
- Stress and anxiety
23
Q
If a pt opts to continue smoking or using tobacco what should the nurse do?
A
Respect the pt’s right to choose
24
Q
What anatomical differences do children have in their thoracic cavity?
A
- shorter, narrower airway
- tracheal division hgiher, at a different angle
- lung tissue not fully developed at birth
- children under the age of 6 breath primarily with a diaphragm
25
How can secondhand smoke affect children?
1. causes lungs to develop more slowly
2. increase risk fo respiratory infections
3. can trigger asthma
4. can increase the incidence of wheezing and coughing
26
What health promotion enouragements should you give to parents that smoke?
encourage the parents to quit smoking, or if they decide to continue smoking to smoke outside and away from their kids
27
What things should you look for while assessing an infant's gas exchange ability?
1. check for pectus carinatum (pigeion chest) or pectus excavatum (caved in)
2. during palpation, not facial expression, presence of crying
3. palpate the area near the clavicle for crepitus
4. assess infants for tactile fremitus
5. avoid auscultating through clothing, as breath sounds may be small
28
What should you look for when assessing a toddlers and elementary age kids for gas exchange?
1. inspect for pectus carinatum, pectus excavatum, kyphosis, scoliosis
2. should not be barrel chest over the age of 6
3. should be no retractions
4. have the child repeat words or numbers to assess for tactile fremitus
5. ask the child to breathe deeply during auscultation
29
What are some physiological differences in pregnant women?
1. pregnancy raises the diaphragm which decreases the ability to expand the lungs
2. chest circumference increases
3. changes to upper respiratory mucosa increase the likelihood of developing nasal stuffiness, nosebleeds
4. residual capacity decreases
30
What position should you avoid putting a pregnant women in?
prolonged supine positioning
31
What are the physiologic changes in older adults that affect gas exchange?
1. increased risk of developing respiratory infections
2. increased risk of sleep apnea
3. changes to cough relfex- increased risk of choking on food
4. increased incidence of Gastroesophageal reflux= increased risk of aspiration of food
32
What should you look for when assessing an older adult for gas exchange complications?
1. breath sounds= decreased w/ crackles
2. kyphosis/scoliosis
3. COPD
4. Changes in meds
5. Changes in fluid and nutrition status
6. changes in LOC
33
What are some treatments that put people at risk for Gas Exchange complications?
1. frequent suctioning (decreased gag reflex, the cough reflex/ use lower suction pressure)
2. Pt teaching on enhancing coughing to help clear secretions
3. incentive spirometry
4. assess adherence to the treatment regimen, barriers to adherence
34
What are some signs of hypoxia?
1. Increased restlessness, irritability, and unexplained sudden confusion
2. Rapid HR + rapid RR
35
What hx should you look for when assessing gas exchange?
1. Curie the respiratory probs
2. Hx of respiratory disease
3. Lifestyle
4. Presence of cough
5. Description of sputum
6. Presence of chest pain
7. Risk factors
8. Meds
36
What are some major signs of impaired gas exchange?
Clubbed finger nails, agitation, low RR, kidney output would be decreased
37
What are some diagnostic tests used to evaluate impaired gas exchange?
1. Sputum specimen
2. ABGs
3. Pulse Ox
4. Pulmonary function tests (incentive spirometer, peak exploratory flow rate
5. Chest x-ray
6. Pulmonary angiogram
7. Pulmonary V-Q scans
8. Bronchoscopy
38
Whyat are some interventions for impaired gas exchange?
1. Deep breathing and positioning
2. Smoking cessation
3. Monitoring activity tolerance
4. promoting secretion clearance
5. Suctioning
6. Assist with ADLs
7. Nutrition management
39
If a pt has a new onset of confusion, what should you check first?
O2 sats
40
If an elderly pt falls today how long could it take before you start to see symptoms of confusion?
1-2 months
41
What are some meds used for impaired gas exchange?
1. Bronchodilators (these are rescue meds)
2. Corticosteroids
3. Long-acting veta-agonists
4. Anti cholinergic
5. Xanthines
6. Immunotherapy (allergy shots)
42
What are xanthines and give an example
They are a med that treats asthma, chronic bronchitis, emphysema. They increase HR and renal blood flow. Ex: Theophylline
43
Why can med adherence with gas exchange be a problem?
The expense of meds can be high, there are multiple meds, higher copays, but pharm companies may have programs to help them with costs
44
How does incentive spirometer work?
Expands the lungs, clears mucus secretions, increases amount of O2 delivered to bronchi and alveoli, and it is often prescribed for postop pts as well as some with pulmonary alterations.
45
What is COPD?
A chronic airflow limitation that is not fully reversible. It includes 2 obstructive airway diseases: chronic bronchitis and emphysema.
46
What is a pink puffer?
Someone with pulmonary emphysema
47
What are some indications of pulmonary emphysema?
```
1. High CO2
E3. No cyanosis
3. Pursed lip breathing
4. Dyspnea
5. Ineffective cough
6. Herperrosnance on chest percussion
7. Orthopedic (probably tries to sleep with several pillows at night)
8. Barrel chest
9. Speaks in short jerky sentences
10. Anxious
11. Use of accessory muscles to breathe
12. Thin
13. Leads to right-sides HF
```
48
If your pt is SOB but not cyanosis what lab would you review?
Hemoglobin level
49
What are blue bloaters?
Someone with chronic bronchitis
50
What are some manifestations of blue bloaters?
1. Cyanotic
2. Recurrent cough and high sputum
3. Hypoxia
4. High CO2
5. Respiratory acidosis
6. High Hgb
7. High RR
8. Exertional dyspnea
9. High incidence in heavy cigarette smokers
10. Digital clubbing
11. Cardiac enlargement
12. Accessory muscles while breathing.
51
When can come one be clinically diagnosed with chronic bronchitis?
When they have a productive cough for 3 months or more, in at least two consecutive years
52
What are some signs of PVD?
```
Volumotouous pulses: warm legs
Edema: blood pooling
Irregularly shaped sores
No sharp pain: dull pain
Yellow and brown ankles
```
53
What are some causes of PVD?
Smoking
Diabetes
High cholesterol
High BP
54
Interventions for PVD
EleVate the legs
55
Diagnostic tests for PVD?
Doppler ultrasound
| ABI (compares pressure from arm to pressure from the legs)
56
What is PVD?
When the veins in the legs cannot push the blood back to the heart.
57
What are some treatments for PVD?
```
Anti-platelets
Cholesterol-lowering drugs (statins, no grapefruit)
Angioplasty
Bypass
Cut out the fatty blockage
```
58
What is PAD?
When the arteries cannot push blood to the rest of the body.
59
What are some signs and symptoms of PAD?
1. Cold legs that lack warmth
2. Absent pulses, absent hair= cool and shiney legs
3. Round, red sores
4. Toes and feel pale: black Escher
5. Sharp calf pain: intermittent claudicación
60
What is an intervention for PAD?
HAng the legs
61
What are the 3 C’s of PAD/PVD?
Careful with HOT temps: impaired sensation
Cautious with FOOT trauma
Constriction AVOID
62
What are some interventions to avoid constriction with PAD/PVD?
Avoid:
1. Crossing the legs
2. Constrictive clothing
3. Cigarettes
4. Caffeine
5. Cold temps
63
What is glossitis?
Inflammation of the tongue
64
What is glossitis usually caused by?
An allergic reaction and anemia
65
What are interventions for glossitis?
1. Provide good oral care
2. Monitor the teeth, lips, and gums
3. Soft bristle toothbrush
