L9: Respiratory & Oxygenation Flashcards
(197 cards)
1
Q
What are 3 steps in the process of oxygenation?
A
Ventilation, perfusion, and diffusion
2
Q
The exchange of respiratory gases occurs between the ___________ and the ________.
A
environment and the blood
3
Q
What is Respiration?
A
the exchange of oxygen and carbon
dioxide during cellular metabolism.
4
Q
Where in the lungs does is oxygen from the atmosphere get exchanged for carbon dioxide?
A
alveoli -
specifically the alveolar capillary membrane
5
Q
How do the diaphragm and intercostal muscles work together during inspiration?
A
The diaphragm and external intercostal muscles contract to create a negative pleural pressure and
increase the size of the thorax for inspiration.
6
Q
Is Intrapleural pressure less than or greater than atmospheric pressure during inspiration?
A
Intrapleural pressure is negative, or less than atmospheric pressure, which is 760 mm Hg at sea level.
7
Q
For air to flow into the lungs, intrapleural pressure becomes _______________.
A
more negative, setting up a pressure gradient between the atmosphere and the alveoli.
8
Q
Ventilation
A
The process of moving gases into
and out of the lungs
9
Q
Perfusion
A
The ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs
10
Q
Diffusion
A
Exchange of respiratory gases in
the alveoli and capillaries
11
Q
The major inspiratory muscle of respiration is
A
the diaphragm
12
Q
The diaphragm is innervated by the _________.
A
phrenic nerve, which exits the spinal cord at the fourth cervical vertebra.
13
Q
Diffusion moves respiratory gases from one area to another by ___________.
A
concentration gradients
14
Q
Work of breathing is?
A
The effort required to expand and contract the lungs.
15
Q
Inspiration
A
active process stimulated by chemical receptors in the aorta.
16
Q
Expiration
A
a passive process that depends on the elastic recoil properties of the lungs
17
Q
Surfactant
A
chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing
18
Q
Atelectasis
A
collapse of the alveoli that prevents normal exchange of oxygen
19
Q
Compliance
A
ability of the lungs to distend or expand in response to increased intraalveolar pressure
20
Q
Airway resistance
A
the increase in pressure that occurs as the diameter of the airways decreases from mouth/nose to alveoli. Any further decrease in airway diameter by bronchoconstriction can increase airway resistance
21
Q
What can cause an increase in airway resistance?
A
Diseases causing airway obstruction such as ASTHMA and tracheal edema.
22
Q
The amount of energy expended on breathing depends on ___________.
A
rate and depth of breathing, the ease with which the lungs can be expanded (compliance), and airway resistance.
23
Q
What happens in patients with advanced chronic obstructive pulmonary disease (COPD)?
A
They lose the elastic recoil of the lungs and thorax. As a result, the patient’s work of breathing increases.
24
Q
Pulmonary diseases that decreased surfactant production can sometimes cause _________?
A
atelectasis
25
What can cause a **decrease** in lung compliance?
diseases such as pulmonary edema, interstitial and pleural fibrosis, and congenital or traumatic structural abnormalities such as kyphosis or fractured ribs.
26
How does the **thickness** of the membrane affect the rate of diffusion?
Increased thickness of the membrane impedes diffusion because gases take longer to transfer across the membrane.
27
What can alter the amount of alveolar capillary membrane surface area?
Chronic diseases (e.g., emphysema), acute diseases (e.g., pneumothorax), and surgical processes (e.g., lobectomy)
28
The oxygen transport system consists of the _____ and _________________.
lungs and cardiovascular system
29
Carbon dioxide is a product of _______.
cellular metabolism
30
How is carbon dioxide transported?
CO2 diffuses into red blood cells and is rapidly hydrated into carbonic acid (H2CO3)
The carbonic acid then dissociates into hydrogen (H) and bicarbonate (HCO3-) ions. The (HCO3-) diffuses into the plasma.
31
Oxygen delivery depends on ______?
the amount of oxygen entering the lungs (ventilation), blood flow to the lungs and tissues (perfusion), rate of diffusion, and oxygen-carrying capacity.
32
What 3 things influence the capacity of the blood to carry oxygen?
the amount of dissolved oxygen in the plasma, the amount of hemoglobin, and the ability of hemoglobin to bind with oxygen.
33
What percent of the body's oxygen is transported by hemoglobin?
approximately 97%
34
The hemoglobin molecule combines with oxygen to form ___________.
oxyhemoglobin
35
Deoxyhemoglobin
The process of hemoglobin and oxygen dissociating, which frees oxygen to enter tissues.
** Reduced hemoglobin**
36
What are the 2 types of respiratory regulation?
Neural regulation & Chemical regulation
37
Neural regulation
Central nervous system controls the respiratory rate, depth, and rhythm.
38
What part of the brain regulates the voluntary control of respiration?
Cerebral cortex
39
Chemical regulation
Maintains the rate and depth of respirations based on changes in the blood concentrations of CO2 and O2, and in hydrogen ion concentration (pH).
40
Chemoreceptors
Are located in the medulla, aortic body, and carotid body. They sense changes in the chemical content of O2, CO2, and H (pH) and stimulate neural regulators to adjust.
41
Cardiac output (CO)
Amount of blood ejected from the left ventricle each minute
CO = SV × HR
42
Normal cardiac output is _______ L/min in the healthy adult at rest.
4 - 8
43
Stroke volume (SV)
Amount of blood ejected from the left ventricle with each contraction
44
What are 3 things that affect stroke volume?
preload, afterload, and myocardial contractility
45
**Preload**
the amount of blood in the left ventricle at the end of diastole, often referred to as **end-diastolic volume**.
46
What is **Starling’s law**?
The ventricles stretch when filling with blood. The more stretch on the ventricular muscle, the greater the contraction and the greater the stroke volume.
47
**Afterload**
The resistance to left ventricular ejection. ie the pressure that the heart must overcome to pump blood out during systole.
48
What is a good measure of afterload?
diastolic aortic pressure
49
How does hypertension affect cardiac workload?
In hypertension the afterload increases, making cardiac workload also increase.
50
How does myocardial infarction affect SV and CO?
Poor ventricular contraction decreases the amount of blood ejected. Injury to the myocardial muscle such as an acute MI causes a decrease in myocardial contractility.
51
The myocardium of the older adult is _______________.
stiffer with a slower ventricular filling rate and prolonged contraction time.
52
How does tachycardic HR affect blood flow?
With a sustained heart rate greater than 160 beats/min, diastolic filling time decreases, decreasing stroke volume and cardiac output.
53
What is the role of the cardiac conduction system?
The cardiac conduction system generates and transmits electrical impulses that control the rhythmic relaxation and contraction of the atria and ventricles.
54
How does the **autonomic nervous system** affect the heart?
The autonomic nervous system influences the rate of impulse generation, speed of transmission, and strength of atrial and ventricular contractions.
55
What is the effect of **sympathetic** nerve fibers on the heart?
Sympathetic nerve fibers increase the rate of impulse generation and speed of transmission.
56
What is the effect of **parasympathetic** nerve fibers on the heart?
Parasympathetic nerve fibers, originating from the vagus nerve, decrease the rate of impulse generation.
57
What is considered the "pacemaker" of the heart?
sinoatrial (SA) node
58
Where is the sinoatrial (SA) node located?
The SA node is located in the right atrium next to the entrance of the superior vena cava.
59
What is the **intrinsic rate** of the SA node in an adult at rest?
The SA node initiates impulses at an intrinsic rate of 60 to 100 cardiac action potentials per minute in an adult at rest.
60
What is the function of the **atrioventricular (AV)** node?
The AV node mediates impulses between the atria and the ventricles and assists atrial emptying by delaying the impulse before transmitting it.
61
What pathways do electrical impulses follow after the SA node?
Electrical impulses are transmitted through the atria along intraatrial pathways to the AV node.
62
What structures are involved in transmitting impulses from the AV node?
The impulses are transmitted through the bundle of His and the ventricular Purkinje network.
63
What does an **electrocardiogram (ECG)** do?
An ECG reflects the electrical activity of the conduction system and monitors the regularity and path of the electrical impulse through the conduction system.
64
What does an **ECG** not reflect?
An ECG does not reflect the muscular work of the heart.
65
What is the **normal sequence** on the ECG called?
The normal sequence on the ECG is called the normal sinus rhythm (NSR).
66
What does **NORMAL SINUS RHYTHM (NSR)** imply?
NSR implies that the impulse originates at the SA node and follows the normal sequence through the conduction system.
67
What does the **P WAVE** represent?
atrial depolarization. Atrial contraction follows the P wave.
68
What does the **PR INTERVAL** represent?
The PR INTERVAL represents the impulse travel time from the SA node through the AV node, through the bundle of His, and to the Purkinje fibers.
69
What is the normal length for the **PR interval**?
The normal length for the PR interval is 0.12 to 0.2 seconds.
70
What does a **decrease** in **PR interval** time less than 0.12 seconds indicate?
It indicates the initiation of the electrical impulse from a source other than the SA node.
71
What does the **QRS complex** indicate?
* Ventricular depolarization
* Atrial repolarization.
72
What is the **normal QRS interval** and what does an increase in QRS duration indicate?
Normal QRS duration is 0.06 to 0.1 seconds.
* ventricular depolarization
* atrial repolarization
Increase in QRS interval indicates delayed conduction through the ventricles
73
What usually **follows** the **QRS complex**?
Ventricular contraction usually follows the QRS complex.
74
What is the **normal QT interval** and what does the QT INTERVAL represent?
The QT INTERVAL represents the time needed for ventricular depolarization and repolarization. The normal QT interval is 0.12 to 0.42 seconds.
75
What changes in older adults affect cardiac function?
Calcification of conduction pathways, thicker and stiffer heart valves due to lipid accumulation and fibrosis, and a decrease in the number of pacemaker cells in the SA node.
76
What are rhythm **disturbances** called?
Dysrhythmias, meaning a deviation from the normal sinus heart rhythm.
77
What can cause dysrhythmias(6)?
1) ischemia
2) valvular abnormality
3) anxiety
4) drug toxicity
5) caffeine, alcohol, and tobacco use,
6) acid-base or electrolyte imbalance.
78
How are dysrhythmias classified?
By cardiac response and site of impulse origin.
79
What are the types of cardiac response in dysrhythmias(4)?
1) Tachycardia (greater than 100 beats/min)
2) bradycardia (less than 60 beats/min)
3) premature (early) beats
4) blocked (delayed or absent) beats
80
How do tachydysrhythmias and bradydysrhythmias affect cardiac output?
They lower cardiac output and blood pressure.
81
How do tachydysrhythmias **reduce** cardiac output?
By decreasing diastolic filling time.
82
Why do bradydysrhythmias **reduce** cardiac output?
Because of the decreased heart rate.
83
What is a **common** dysrhythmia in older adults?
Atrial fibrillation.
84
What are **supraventricular** dysrhythmias?
Abnormal impulses originating above the ventricles, with normal ventricular conduction and a normal QRS complex. The abnormality on the waveform is the configuration and placement of the P wave.
85
What is **paroxysmal supraventricular** tachycardia?
A sudden, rapid onset of tachycardia originating above the AV node, often beginning and ending spontaneously.
86
What can **precipitate** paroxysmal supraventricular tachycardia(3)?
1) Excitement
2) fatigue
3) caffeine, smoking, or alcohol use.
87
What do ventricular dysrhythmias represent?
An ectopic site of impulse formation within the ventricles. (Not the SA node)
88
What is characteristic of the QRS complex in ventricular dysrhythmias?
It is usually widened and bizarre, with P waves not always present.
89
What are life-threatening rhythms that require immediate intervention(2)?
**Ventricular tachycardia** - decreased cardiac output and the potential to deteriorate into ventricular fibrillation
**ventricular fibrillation** - a life-threatening condition that occurs when the heart's lower chambers quiver and beat erratically instead of pumping blood, can cause sudden cardiac death.
90
What is **left-sided heart failure**?
An abnormal condition characterized by decreased functioning of the left ventricle.
91
What happens when left ventricular failure is significant?
The amount of blood ejected from the left ventricle drops greatly, resulting in decreased cardiac output.
92
What are the S/Sx of left-sided heart failure(4)?
what are these S/Sx a result of?
1) Fatigue
2) breathlessness
3) dizziness
4) confusion
* due to tissue hypoxia from diminished cardiac output.
93
What occurs as the left ventricle continues to fail?
Blood begins to pool in the pulmonary circulation, causing pulmonary congestion.
94
What are the **clinical findings** of left-sided heart failure(5)?
1) Crackles in the bases of the lungs
2) hypoxia
3) shortness of breath on exertion
4) cough
5) paroxysmal nocturnal dyspnea.
95
What does right-sided heart failure result from?
Impaired functioning of the right ventricle, commonly due to **pulmonary disease or long-term left-sided failure**.
96
What is the primary pathological factor in right-sided heart failure?
Elevated pulmonary vascular resistance (PVR).
97
What happens as pulmonary vascular resistance (PVR) continues to rise?
The right ventricle works harder, increasing the oxygen demand of the heart.
the amount of blood ejected from the right ventricle continues to decline, leading to **blood backing up in the systemic circulation**.
98
What are the **clinical signs** of right-sided heart failure(4)?
1) Weight gain
2) distended neck veins
3) hepatospelomegaly
5) peripheral edema.
99
What is **valvular heart disease**?
Valvular heart disease is an **acquired or congenital disorder** of a cardiac valve that causes either **hardening (stenosis)** or **impaired closure (regurgitation)** of the valves.
100
What happens during **stenosis** in valvular heart disease?
When stenosis occurs, the flow of blood through the valves is obstructed.
As the ventricles contract, blood escapes back into the atria, causing a murmur, or “whooshing” sound.
101
What is angina pectoris?
Angina pectoris is a transient imbalance between myocardial oxygen supply and demand, that often results in chest pain that is aching, sharp, tingling, or burning or that feels like pressure.
102
Where is chest pain typically felt in angina pectoris?
Typically chest pain is left sided and often radiates to the left or both arms, the jaw, neck, and back.
103
How is angina pectoris usually relieved?
It is usually relieved with rest and coronary vasodilators, the most common being a nitroglycerin preparation.
104
What is myocardial infarction (MI)?
**acute coronary syndrome (ACS)**
MI or ACS results from sudden decreases in coronary blood flow or an increase in myocardial oxygen demand without adequate coronary perfusion.
105
How long until cellular death in myocardial ischemia?
Cellular death occurs after 20 minutes of myocardial ischemia.
106
How is chest pain associated with MI typically described in men?
Chest pain associated with MI in men is usually described as crushing, squeezing, or stabbing. The pain is often in the left chest and sternal area; may be felt in the back; and radiates down the left arm to the neck, jaws, teeth, epigastric area, and back.
107
What is the **most common** initial symptom of MI in women?
what are the **atypical symptoms** they often present with(4)?
* The most common initial symptom in women is angina.
* atypical symptoms:
1) such as fatigue
2) indigestion
3) shortness of breath
4) back or jaw pain.
108
What is the risk of dying within the first year after a heart attack for women compared to men?
Women have twice the risk of dying within the first year after a heart attack than men.
109
What is more common, hypertension or hypotension?
Hypertension is more common than hypotension.
110
How is prehypertension diagnosed in adults?
Prehypertension is diagnosed when an average of two or more readings on at least two subsequent visits is between 120 and 129 mm Hg systolic and greater than 80 mm Hg diastolic.
111
What defines hypertension?
Diastolic readings greater than 90 mm Hg and systolic readings greater than 140 mm Hg define hypertension.
112
What are the effects of hypertension on arterial walls?
Hypertension is associated with thickening and loss of elasticity in the arterial walls. Peripheral vascular resistance increases within thick and inelastic vessels. The heart continually pumps against greater resistance.
113
What happens to blood flow in hypertension?
Blood flow to vital organs such as the heart, brain, and kidney decreases.
114
What are modifiable risk factors for hypertension(4)?
1) obesity
2) smoking
3) alcohol consumption
4) high salt.
115
In which populations is a higher incidence of high blood pressure seen?
1) those with diabetes
2) older adults
3) African-Americans
116
What causes hypotension?
* dilation of the arteries
* loss of blood volume
* failure of the heart muscle to pump adequately.
117
What symptoms indicate life-threatening hypotension(6)?
1) pallor
2) skin mottling
3) clamminess
4) confusion
5) tachycardia
6) oliguria
118
What is orthostatic hypotension?
Orthostatic hypotension **(postural hypotension)** occurs when a normotensive person develops symptoms and a drop in systolic pressure by at least 20 mm Hg or diastolic pressure by at least 10 mm Hg within 3 minutes of rising.
119
Who is at risk for orthostatic hypotension(3)?
Patients who are:
1) dehydrated
2) anemic
3) have experienced prolonged bed rest or recent blood loss
120
How should orthostatic hypotension be assessed?
Assess by obtaining BP and pulse in sequence with the patient supine, sitting, and standing. Observe for symptoms such as fainting, weakness, blurred vision, or light-headedness.
121
What should be recorded when measuring orthostatic BP?
Record the patient’s position in addition to the BP measurement.
122
What types of physiological factors that affect oxygenation(4)?
**Decreased oxygen-carrying capacity** - anemia
**Hypovolemia** -reduced circulating blood volume
**Decreased inspired oxygen concentration**
**Increased metabolic rate** -increases oxygen demand, example fever
123
What are the causes of decreased oxygen carrying capacity?
**anemia** (e.g., a lower-than-normal hemoglobin level)
**inhalation of toxic substances** which decrease the oxygen-carrying capacity of blood by reducing the amount of available hemoglobin to transport oxygen.
124
What is hypoxemia?
Hypoxemia is low levels of arterial oxygen.
125
What is the most common toxic inhalant that decreases oxygen-carrying capacity?
Carbon monoxide (CO) is the most common toxic inhalant.
126
What conditions can lead to hypovolemia?
Conditions such as shock and severe dehydration can cause hypovolemia.
127
What is the body's response to significant fluid loss?
The body tries to adapt by peripheral vasoconstriction and increasing the heart rate.
128
What causes decreased inspired oxygen concentration(3)?
1) airway obstruction
2) high altitudes
3) hypoventilation.
129
How does increased metabolic activity affect oxygen demand?
Increased metabolic activity raises oxygen demand, leading to a decline in oxygenation.
130
What adaptations occur due to increased carbon dioxide levels?
The body increases the rate and depth of respiration.
131
What is hypoxemia defined as?
Hypoxemia is defined as arterial oxygen tension or partial pressure of oxygen (PaO2) below normal.
132
What is the normal value for arterial oxygen tension or (partial pressure of oxygen (PaO2)) ?
The normal value is between 80 and 100 mmHg.
133
What is hypoxia?
Hypoxia is the reduction of oxygen supply at the tissue level.
134
What are some conditions that affect chest wall movement(6)?
1) Pregnancy
2) obesity
3) neuromuscular disease
4) musculoskeletal abnormalities
5) trauma
6) CNS alterations
135
the goal of ventilation is to achieve PaCO2 and PaO2 levels at what values?
To produce a normal arterial carbon dioxide tension (PaCO2) between 35 and 45 mm Hg and a normal arterial oxygen tension (PaO2) between 80 and 100 mm Hg.
136
How are hypoventilation and hyperventilation determined?
They are often determined by arterial blood gas analysis.
137
What is hypoventilation?
Hypoventilation occurs when alveolar ventilation is inadequate to meet the oxygen demand of the body or eliminate sufficient carbon dioxide.
138
What stimulates increased ventilation?
Lower oxygen levels detected by peripheral chemoreceptors in the aortic arch and carotid bodies.
139
What effect does administering oxygen greater than 24% to 28% (1 - 3 L/min) have?
It prevents the PaO2 from falling to a level that stimulates the peripheral receptors, destroying the stimulus to breathe.
140
What are the signs and symptoms of hypoventilation?
* Mental status changes
* dysrhythmias
* potential cardiac arrest
* If untreated, it can lead to convulsions, unconsciousness, and death.
141
What other signs and symptoms may indicate hypoventilation(8)?
1) Dizziness
2) headache upon awakening
3) lethargy
4) cardiac dysrhythmias
5) electrolyte imbalances
6) convulsions
7) coma
8) cardiac arrest.
142
What causes hyperventilation(4)?
1) Severe anxiety
2) infection
3) drugs
4) acid-base imbalance.
143
What are the signs and symptoms of hyperventilation(5)?
1) Rapid respirations
2) sighing breaths
3) numbness and tingling of hands/feet
4) light-headedness
5) loss of consciousness.
144
What is the normal SpO2 level?
Greater than or equal to 95%.
145
What are some causes (6) of hypoxia?
1) Decreased hemoglobin level
2) Diminished concentration of inspired oxygen
3) Inability of tissues to extract oxygen
4) Decreased diffusion of oxygen
5) Poor tissue perfusion
6) Impaired ventilation.
146
What are the clinical signs and symptoms of hypoxia(4)?
1) restlessness
2) dizziness
3) decreased level of consciousness and concentration
4) behavioral changes.
147
What vital sign changes occur with hypoxia?
Increased pulse rate and rate and depth of respiration. During early stages of hypoxia blood pressure is elevated unless the condition is caused by shock.
148
What is cyanosis?
Blue discoloration of the skin and mucous membranes caused by desaturated hemoglobin in capillaries.
149
What is central cyanosis and what does it indicate?
Hypoxia. Central cyanosis observed in the tongue, soft palate, and conjunctiva of the eye.
150
What is peripheral cyanosis?
Seen in the extremities, nail beds, and earlobes, is often a result of vasoconstriction and stagnant blood flow.
151
What developmental factors influence oxygenation in infants and toddlers?
Infants and toddlers are prone to respiratory infections due to frequent exposure to other children, an immature immune system, and exposure to secondhand smoke.
152
What are the respiratory risks for school-age children and adolescents?
They are exposed to respiratory infections and risk factors such as cigarette smoking or secondhand smoke.
153
What cardiopulmonary risk factors affect young and middle-aged adults(5)?
1) unhealthy diet
2) lack of exercise
3) stress
4) misuse of drugs (OTC, script, illegal)
5) smoking.
154
How do aging processes affect the cardiac and respiratory systems(5)?
1) calcification of heart valves andSA node,
2) atherosclerotic plaques in arteries
3) changes in thorax size and shape due to osteoporosis
4) enlargement of trachea and bronchi
5) reduced functional cilia.
155
How does severe obesity affect lung function?
Severe obesity decreases lung expansion and increases tissue oxygen demands.
156
How does excessive use of alcohol and drugs impair tissue oxygenation?
Chronic substance abuse leads to poor nutritional intake, decreasing hemoglobin production, and depresses the respiratory center, reducing respiration rate and depth.
157
How does the body respond to anxiety and stress in relation to respiration?
The body responds with an increased rate and depth of respiration.
158
How does the environment influence oxygenation?
The incidence of pulmonary disease is higher in smoggy, urban areas compared to rural areas, and occupational pollutants include asbestos, talcum powder, dust, and airborne fibers.
159
What is required for the presence of chest pain?
An immediate thorough evaluation, including assessment of location, duration, radiation, and frequency. Note any other symptoms associated with chest pain, such as nausea, diaphoresis, extreme fatigue or weakness.
160
What is pleuritic chest pain?
Pleuritic chest pain results from inflammation of the pleural space of the lungs; the pain is peripheral and radiates to the scapular regions.
161
When is musculoskeletal pain often present?
Musculoskeletal pain is often present following exercise, rib trauma, and prolonged coughing episodes.
162
What is bradypnea?
Bradypnea is defined as less than 12 breaths per minute.
163
What is tachypnea?
Tachypnea is defined as greater than 20 breaths per minute.
164
What happens during metabolic acidosis?
In metabolic acidosis, the acidic pH stimulates an increase in the rate of respirations, usually greater than 35 breaths per minute, and depth of respirations (Kussmaul respiration) to compensate by decreasing carbon dioxide levels.
165
What is apnea?
Apnea is the absence of respirations lasting for 15 seconds or longer.
166
What is Cheyne-Stokes respiration?
A breathing pattern that alternates between deep, heavy breathing, shallow breathing, and no breathing at all (apnea). It can occurs when there is decreased blood flow or injury to the brainstem.
167
What are Kussmaul respirations
A medical emergency characterized by deep, rapid, and labored breathing that occurs when the body is trying to correct metabolic acidosis
168
What is nebulization?
Nebulization adds moisture or medications to inspired air by mixing particles of varying sizes with the air.
169
What is tan easy and effective way for maintaining a patent airway.
Coughing
170
What is directed coughing?
Directed coughing is a deliberate maneuver that is effective when spontaneous coughing is not adequate.
171
Describe the cascade cough technique.
In the cascade cough, the patient takes a slow, deep breath and holds it for 2 seconds while contracting expiratory muscles, then opens the mouth and performs a series of coughs throughout exhalation, thereby coughing at progressively lowered lung volumes.
## Footnote
This technique promotes airway clearance and a patent airway in patients with large volumes of sputum.
172
What is the huff cough?
The huff cough stimulates a natural cough reflex and is generally effective only for clearing central airways. While exhaling, the patient opens the glottis by saying the word huff.
## Footnote
With practice, the patient inhales more air and is able to progress to the cascade cough.
173
What is the quad cough technique?
The quad cough technique is for patients without abdominal muscle control, such as those with spinal cord injuries. While the patient breathes out with a maximal expiratory effort, the patient or nurse pushes inward and upward on the abdominal muscles toward the diaphragm, causing the cough.
174
What is diaphragmatic breathing?
Diaphragmatic breathing, or belly breathing, is a technique that encourages deep breathing to increase air to the lower lungs.
175
What is chest physiotherapy?
Chest physiotherapy is a group of therapies used to mobilize pulmonary secretions, including postural drainage, chest percussion, and vibration.
## Footnote
It is important to work collaboratively with respiratory therapists when using these techniques.
176
What is the purpose of ambulation and positioning in lung expansion?
Reduces pulmonary stasis, maintains ventilation and oxygenation.
177
What does incentive spirometry encourage?
Encourages voluntary deep breathing.
178
What are components of pulmonary rehabilitation?
Controlled physical exercise, nutrition counseling, relaxation and stress management, medications, oxygen, compliance, systemic hydration.
179
What is a major factor in developing atelectasis and ventilator-associated pneumonia (VAP)?
Immobility
180
What is the recommended mobilization for intubated patients?
Progressive mobilization from dangling the legs to standing and then walking is safe.
181
What is the most effective position for promoting lung expansion?
The 45-degree semi-Fowler’s position.
182
How should a patient with a pulmonary abscess or hemorrhage be positioned?
Position the patient with the affected lung down.
183
What does incentive spirometry encourage voluntary deep breathing?
By providing visual feedback about inspiratory volume.
184
What does cardiopulmonary rehabilitation aim to achieve?
Helps patients achieve and maintain an optimal level of health.
185
What is the role of respiratory muscle training?
Improves muscle strength and endurance, preventing respiratory failure in patients with COPD.
186
What are the three basic techniques of breathing exercises?
1. Deep-breathing and coughing exercises
2. Pursed-lip breathing
3. Diaphragmatic breathing.
187
What does pursed-lip breathing help prevent?
Prevents alveolar collapse.
188
What is the benefit of diaphragmatic breathing?
Improves efficiency of breathing by decreasing air trapping and reducing the work of breathing.
Useful for patients with pulmonary disease, postoperative patients, and women in labor to promote relaxation and provide pain control.
189
What are the 3 types of oxygen delivery systems are used in a home?
compressed gas cylinders, liquid oxygen, and oxygen concentrators.
190
How quickly can permanent damage occur during cardiac arrest?
Permanent heart, brain, and other tissue damage can occur within 4 to 6 minutes.
191
What does CAB stand for in CPR?
Chest compression, Airway, and Breathing.
192
What does an increase in **PR interval** time mean?
A PR interval time greater than 0.2 seconds indicates a block in the impulse transmission through the AV node.
193
the AHA set a goal for hospitals to deliver the first electrical shock to patients in V fib, what is it?
to deliver the shock in less than 2 minutes
194
what can severe and prolonged hypoxia do to the cardiovascular system?
cardiac arrest
195
what causes barrel chest in emphysema patients?
overuse of accessory muscles and air trapping
196
what does excessive alcohol use and certain other drugs impair tissue oxygenation(2)?
1) chronic abuse => poor nutrition=> poor hemoglobin production
2) depresses the respiratory center
197
what are some vague complaints associated with CO poisoning(3)?
1) general malaise
2) flulike symptoms
3) excessive sleepyness
