Oxygenation - Terms and Diseases Flashcards
(85 cards)
1
Q
Ventilation
A
movement of atmospheric air
2
Q
Respiratory diffusion
A
movement of gases down their concentration gradient across alveolar and capillary membrane
3
Q
Hypercarbia
Hypercapnia
A
carbon dioxide retention
4
Q
Hypercarbia is typically seen in _______________ airway disease
A
obstructive
5
Q
Compliance
A
how easily lungs can stretch and fill with air
6
Q
How would you describe the lungs to be if they had “decreased compliance”?
A
Decrease compliance = lungs are stiffer; harder to expand during inhalation
7
Q
Bronchospasm
A
sudden tightening (constriction) of the muscles around the airways
8
Q
Hypoexmia
vs
Hypoxia
A
Hypoexmia
- low O2 levels in the blood (low PaO2)
Hypoxia
- low O2 supply to tissues
9
Q
Arterial Blood Gases (ABG)
What does it tell you?
A
tells how well a patient is oxygenating and if patient is retaining
10
Q
The best test to measure/determine a patients need for O2 therapy is by measuring the ____________
A
ABGs
11
Q
Pulmonary Function Tests (PFT)
Hint: What does it measure?
A
group of tests that measures forced expiratory volume (see how far meter goes up to see how well patient exhales/rid of CO2)
includes:
- Diffusion capacity
- Lung volume testing
- Spirometry
12
Q
What is the best test to measure airflow in asthma?
A
Pulmonary Function Tests (PFT)
13
Q
When performing a pulmonary function tests, a decrease of what percentage is common in asthma?
A
15 - 20%
14
Q
When using a pulmonary function tests, what key indication confirms the diagnosis of asthma?
A
Asthma diagnosed when values increase by 12% or more after treatment with bronchodilators (confirms reversibility)
15
Q
Hypoxic drive
HInt: What does it mean?
A
patients rely on low O2 levels to stimulate breathing
16
Q
Be able to describe (generally) how gas exchange occurs.
A
Gas Exchange - via ventilation and diffusion
1. Oxygen enters nose/mouth
2. Moves through the airways
- Trachea
- Bronchi
- Bronchioles
- Alveoli (air sac)
3. Exchange of O2 and CO2 between capillaries and alveoli (Respiratory Diffusion)
- O2 moves atmospheric air -> blood (capillaries) -> tissue
- CO2 in blood (capillaries) -> alveoli -> out nose/mouth
4. O2 carries to organs and tissues, while CO2 is exhaled
- CO2 - metabolic waste product
17
Q
T/F: Obstructive airway disease is a lower respiratory problem, whereas restrictive airway disease is an upper respiratory problem.
A
False, both are considered lower respiratory problems
(i think hehehehe, but fs obstructive airway disease is a lower respiratory problem)
18
Q
Know the normal ABG values for the following:
- pH
- PO2
- PCO2
- HCO3
A
pH
- 7.35 - 7.45
PO2
- 80 - 100
PCO2
- 35 - 45
HCO3
- 22 - 28
19
Q
Compare and contrast the characterization of:
Obstructive Airway Disease vs Restrictive Airway Disease
A
Obstructive Airway Disease
- ⬇ in airflow
-> SOB related to inability to expel air
-> Some air remain inside lung after full expiration
Restrictive Airway Disease
- ⬇ in lung volume
-> Difficulty in taking air INSIDE the lungs related to stiffness of lung tissue/wall cavity
20
Q
Describe the general Pathology of Obstructive Airway Disease
A
Difficulty expelling CO2 (CO2 retention):
1. Airways narrow + ⬆airway secretion
2. Air gets trapped
3. Retain CO2 in alveoli and unable to exhale air completely
- Airflow limitation
21
Q
Describe the general Pathology of Restrictive Airway Disease
A
Difficulty taking in O2 (bc reduce lung volume):
- Airways stiffen (do not stretch)
- Limited lung expansion ( = ⬇lung volume/compliance)
- ⬆Work of breathing
- SXS: SOB
22
Q
What are examples of conditions that are categorized as Obstructive Airway Diseases
A
- Asthma
- COPD
-> Emphysema
-> Chronic Bronchitis
23
Q
_________ is linked to long term cigarette use
A
COPD
24
Q
What are examples of conditions that are categorized as Restrictive Airway Diseases
A
SPLAT
- Silicosis
- Pneumonia
- Lobectomy/Lung cancer
- Adult Respiratory Distress Syndome (ARDS)
- Tuberculosis
25
Remodeling is seen in conditions such as ________ and _________
Pulmonary Fibrosis
Emphysema
26
Describe the **characterization** of **Asthma**
- Chronic, reversible airflow obstructive condition
-> episodes/exacerbation
27
Describe the **pathophysiology** of **Asthma**
**1**. Exposure to irritants
- Cold/dry air
- Microorganisms
- Airborne particles
- Exercise
**2**. Mucous membranes lining the airways to become inflamed (Inflammatory Response)
- Bronchioles become inflamed and airways narrow
- Increase mucus production
- Nerve fibers stimulated (bronchospasm)
**3**. Airways become narrowed and airflow is reduced
**4**. Gas exchange impaired
- SXS: Hypoxemia
28
Describe the **Clinical Manifestations (S/S)** of **Asthma**
- Dyspnea (SOB)
- Wheezing
- Chest tightness
- Increase mucus production
- Use of accessory muscles (retraction sternum)
- Barrel chest - uncommon, seen in long standing asthma
- Pruritius (itch)
- Rhinitis (runny nose)
- Coughing
29
Describe the **ways in which you can go about Diagnosing** **Asthma**
**ABG**
- ⬇PaO2 or ⬆PaCO2
- Elevated IgE (in allergic condition)
**Pulmonary Function Tests (PFT)**
- Decrease 15 - 20% (improvement after bronchodilators)
30
What are the 3 main ways to **treat**/**prevent** **Asthma**
- **Control Therapy** (Prophylactic Measures)
-> Anti-inflammatory Agents
->> Corticosteroids
- **Reliever/Rescue Drugs**
- **Bronchodilators**
31
**T/F**: When using control therapy for Asthma, you want to use them weekly to prevent attacks and reduce airway sensitivity
**False**, control therapy should be used daily to prevent attacks and reduce airway sensitivity
32
Antiinflammatory agents, such as corticosteroids, can be used to treat asthma. What is the name of the corticosteroid drug that helps with asthma? Is it oral or inhaled?
**montelukast** (**Singulair**)
-> inhaled corticosteroid
33
What is the purpose of Reliever/Rescue drugs in the treatment of asthma?
- stop asthma attack once it has started
-> reduce asthma episdes
34
T/F: Asthma causes inflammation, therefore, bronchodilators can be used to reduce inflammation and relax the smooth muscle to open up the airways
FALSE. Asthma does cause inflammation, but bronchodilators are only used to relax smooth muscle and open up the aiways. Bronchodilators have NO EFFECT on inflammation !
35
What are the class(es) of bronchodilators that can be used in the treatment of Asthma?
Know when to use them and examples of each.
**Short-acting Beta2 agonist**
- Rapid, short term relief
- Use when attack begins or premedication before activities likely to induce attack
- Ex: Albuterol, terbutaline
**Long-acting Beta2 agonist**
- Prevent attack, but **CANNOT** stop attack
- Ex: Salmetreol, Formoterol
**Cholinergic Antagonists** (**Anticholinergics**)
- Ex: Ipratropium
36
**A 14-year-old patient with a history of asthma presents to the clinic for follow-up. The patient reports experiencing shortness of breath and wheezing during physical education class but is otherwise symptom-free throughout the day. Which of the following medications should the nurse anticipate the provider will prescribe for use before exercise?**
**A**. Salmeterol
**B**. Ipratropium
**C**. Albuterol
**D**. Formoterol
C, albuterol. This is because short-acting drugs (like albuterol) are used prior to exercise that may trigger a asthma attacks.
37
What **self-management education** should the nurse provide to a patient with **asthma**?
**Avoid potential triggers**
- **Drugs**: NSAIDs (aspirin) and Beta Blockers
-> Aspirin = make leukotrienes (cause prolonged inflammation)
- **Foods**: MSGs, food preservatives
- **Irritants**: Dust, mold, fireplaces, hot/cold weather changes, cigarette smoking
**Monitor peak expiratory flow daily**
**Utilize bronchodilator inhalers 30 minutes PRIOR to exercise**
**Wash bedding in hot water**
**Carry relief drug inhalers**
**Stress + Anxiety Reduction**
**Adequate rest and sleep and hydration**
**Know when to seek immediate emergency care**
38
In patients with asthma, it is important to monitor the patients peak expiratory flow daily.
Describe how a patient should go about this.
Use a peak flow meter and florefully exhable into the meter. It will record how **fast** you exhlae the air
Perform 3x in a row and take the highest and ID personal best (nLM says highest number, but Galich said the average)
- **Green**: management effective
- **Yellow**: management not super effects; need rescue inhaler and follow up with primary
- **Red**: Use resure inhalers and seek IMMEDIATE medical attention
39
How does asthma cause barrel chest?
- Asthma is characterized by the narrownig of the airway, making it hard to expel CO2.
- This CO2 becomes trapped in the lungs, causing hyperinflation of the lungs.
- This persistent hyperinflation causes lasting structural changes in the chest wall.
- The anteroposterois (AP) diameter of the chest increases, ribs become more horizontal (instead of having downward slope), and diagram flattens.
- Rather than an oval (normal) shape, the patient begins to have a round (abnormal) shape. his results in the barrel-chest appearance
40
Compare the **Characterization** of:
**Emphysema** vs **Chronic Bronchitis**
**Emphysema**
- Destruction of alveolar walls (loss of elastic recoil)
- **AFFECTS ALVEOLI**
**Chronic Bronchitis**
- Inflammation
- Excessive mucus production
- **AFFECTS AIRWAY**
41
Decribe the **Pathophysiology** of **Emphysema**
**Chronic exposure to inhaled particles** (ex: smoking) - ❗AFFECT **ALEVOLI**
**1**. Elastin breaks down in the alveoli and small airway
**2**. Lack of elasticity leads to narrow and collapsed airways
**3**. Alveoli become flabby (bc less elasticity), become destroyed, or become overstretched (bullae)
- Functional area available for gas exchange decrease due to loss of alveolar tissue
- Air becomes trapped in the lungs (hyperinflation)
**4**. Hyperinflated lungs flatten diaphragm (weakens effectiveness)
**5**. Unable to expel CO2 (CO2 retention; Respiratory acidosis)
42
Describe the **Clinical Manifestations (s/s)** of **Emphysema**
**Pink puffer**
- Pink appearance
- SOB (usually reduced breath sounds)
- Chest sounds are hyperesonant on percussion
- Barrel Chest
- Look older
- Underweight; malnourished
- Air hunger sensation
- X ray show hyperinflation with flattened diaphgrams
43
Decribe the **Pathophysiology** of **Chronic Bronchitis**
**Exposure to irritants (smoking)** - ❗AFFECTS AIRWAYS
**1**. Irritants trigger inflammation, vasodilation, mucosal edema, congestion, and bronchospasm
- Inflammation of bronchi and bronchioles
**2**. Inflammation increases the number and size of mucus-secreting glands
**3**. Glands produce large amount of thick mucus
**4**. Bronchial walls thicken (with mucus)
**5**. Airflow and gas exchange impaired
- ⬇PaO2 or ⬆PaCO2 (respiraotry acidosis)
44
Describe the **Clinical Manifestations (s/s)** of **Chronic Bronchitis**
**Blue bloaters**
- Cyanotic (dusky appearance)
-> Increase Hgb (compensate)
- Peripheral edema
- Overweight
- Excessive sputum production
- Chronic cough
-> Crackles
-> More wheeze (than emphysema sometimes)
45
Orthopnea often occurs with what condition?
left sided heart failure
(seen in COPD)
46
The nurse suspects a patient to have **COPD** due to their pink appearance, SOB, overweight, and have barrel chest. What **assessments** should be done?
**Risk Factors**
- ⬆age
- gender (⬆risk male > female)
- occupation
**Smoking history** (length; # packs/day)
**Orthopnea**
- May indicate cardiac issue (CHF)
**Cough, Sputum Production**
- Productive cough in AM
**Monitor Weight Loss, General Edema**
- ⬆severity = ⬆ likelihood to lose weight
- CHF present with condition
47
Use of accessory muscles in abdomen and neck is commonly seen in patients with _________ and ____________
asthma
emphysema
48
A nurse is performing a physical assessment on a patient who is suspected to have COPD. What physical findings is the nurse likely to expect in patients with COPD.
- Loss of muscle mass extremities
- Thin, enlarged neck muscles
-> Using accessory muscles in abdomen and neck (common in emphysema)
->> breathing with abdomen wall (sucks in during inspriation)
- Orthopnea, dyspnea
- Rapid, shallow respiration (air trapping)
- Diminished breath sounds, wheezes
49
What are some tests you can run to **Diagnose** suspected **COPD**
**ABG**
- ⬇O2 = hypoxemia
- ⬆CO2 - hypercarbia
**CXR**
- **Emphysema**: shows hyperinflation with flattened diaphragm
**Pulmonary Function Tests (PFT)** - assess airflow and lung volume
- Done routinely to monitor change in patients reponse to meds or worsening of disease
**WBC, H/H, Sputum**
- Used to rule out infection
50
What are the main **interventions** to include for someone who has **COPD**
- Monitor respiratory status
- Teach breathing techniques
-> Pursed Lip Breathing
-> Diaphragmatic/abdominal breathing
- Position/Effective coughing
- Encourage fluid (unless contraindicated)
51
What oxygen administration guideline should the nurse follow when caring for a patient with COPD, and why is it important?
**Administer O₂ at 2–4 L/min via nasal cannula**
- Start low and titrate up slowly
- Giving too much oxygen can suppress the patient’s hypoxic drive, leading to ↓ respiratory rate and possible respiratory failure
52
Why is **pursed-lip breathing** taught to patients with **COPD**, and how does it help? This technique is better for the management of what symptom?
**Reduces air trapping by creating resistance during exhalation and prolonged exhalation prevents bronchiole collapse**
- decrease amount of old air in lungs
- Better for management of dyspnea
53
In COPD patients its important to also teach breathing techniques such as diaphragmatic/abdominal breathing. What does it help improve? How should the nurse instruct the patient to perform this technique?
Improves functional capactiy
- Lay on back, bend knee, and have abdomen relax
- Conciously increase movement of diaphragm
- (also breathe through pursed lipds to create resistance)
- This delays airway compression and reduces air trapping
54
For patients with COPD, what position should you have them in?
Upright, HOB elevated to semi/high fowlers
55
A patient with COPD has severe dyspnea. The patient is already sitting upright in a high fowlers position. The nurse wants to change his positioning to something that will enhance breathing. What position should the nurse place them in?
tripod position
56
What is the purpose of encouraging fluid intake in patients with COPD?
thins out secretions
| do not do if contraindicated
57
What **treatment** options are there for patients with **COPD**?
| Hint: pharmacological
**Drug Therapy**
- Bronchodilators
-> Long-Acting Beta 2 agonists
-> Cholinergic antagonists (Anticholinergics)
- Inhalers
- Mucolytics
- Nebulizers
58
T/F: Long acting beta 2 agonists are used to prevent COPD
true
59
Name one drug that is a Long-acting Beta 2 agonists and one drug that is an anticholinergic that are used for COPD patients
**Long Acting Beta 2 Agonists**
- Vilanterol
**Cholinergic Antagonists (Anticholinergics)**
- Tiotropium
60
What is the purpose of inhalers for COPD patients?
**assist in preventing, controlling, and treating conditions**
- inhaled corticosteroids (antiinflammatory): controlling
61
What is the purpose of treating COPD with mucolytics? Name one drug example
- ⬇viscosity of bronchial secretions
- Thins; easier to cough and expel
- Ex: Guaifenesin
62
Nebulizers can be used in patients with COPD. What is the indication to use a nebulizer? Name an example of this drug
- Used when inhalers are less effective
- Ex: Acetycystein
| Delivered directly to respiratory system
63
What are ways to help **manage** **COPD**?
## Footnote
Hint: name non-pharmacological management
**Exercise Conditioning**
- Pulmonary rehabilitation
**Suctioning/Hydration**
**Surgical Management**
64
What is the purpose of pulmonary rehabilitation in management for those with COPD?
Patients develop strategies to cope with the condition and perform exercises to prevent muscle deconditioning
65
Those with COPD may need surgical management of their condition. This can include a _______ or lung ____________ surgery
transplant
lung reduction surgery
66
T/F: When performing suctioning, you should perform it once daily and you should administer CO2 prior to suctioning (minimum 60 seconds)
False, you should perform it **PRN** and should adminster **O2** prior to suctioning (minimum **30** seconds)
67
T/F: Patients with bronchitis also experience emphysema
False, patients with emphysema also experience bronchitis
68
What is the requirement in which to be diagnosed with bronchitis?
Must have bronchitis for 3 months in 2 consecutive years to be diagnosed with COPD
69
Describe the **characterization** of **Pneumonia**
Excess fluids in the lungs caused by inflammatory process
70
Describe the **pathophysiology** of **Pneumonia**
**1**. Pathogen invades
**2**. Inflammatory response occurs
- Lung tissue begins to stiffen
**3**. Accumulation of fluid (pus, debris, mucus) in lungs (usually one sided)
- Occurs in interstitial spaces, alveoli, bronchioles
**4**. Organisms penetrate and multiply
**5**. Travels into blood stream (sepsis)
- If extends into pleural cavity (empyema)
71
What are the **causes** (etiology) of **Pneumonia**
**Pathogens**:
- bacteria
- fungi
- virus
- worms
**Other**:
- aspiriation
- toxic inhalation
- smoke
72
Pneumonia can be categorized as:
- Hospital Acquired
- Health Care associated
- Ventilatory associated
- Community acquired
73
What are the **clinical manifestations (s/s)** of **Pneumonia**
- Sudden onset
- Unexpected confusion (indicate infection)
-> Flushed cheeks
-> Anxious
-> Poor appetite
-> Weakness
- Chest discomfort
- Sputum production, but may complain of dry cough if unable to expel
- Tachypnea, dyspnea
-> SOB with exertion
74
What tests/labs would should you check/perform for patients with **Pneumonia**
- ABGs
- **CXR** (most common)
- Sputum for culture and sensitivity (ID pathogen)
- Blood culture (assess for sepsis)
- CBC, BUN, Na+
-> Monitor elevated WBC
-> Elevated BUN and Na+ = dehyration
75
A CXR was done on a patient with pneumonia. What would this image look like?
areas will look more opaque due to increase in density
will see consolidation (solid looking area due to lung tissue being filled will fluid, pus, etc)
76
What are nursing **interventions** that can be done for patients with **Pneumonia**?
- Assess VS (O2 sat)
- Immunizations
- Avoid large gatherings
- Avoid extreme weather
- Apply O2 prior to suctioning
-> Nasal suctioing
-> Trach suctioning
- Hand Washing
- Hydration
77
**Immunizations** are an important intervention for patients with **pneumonia**. What immunizations should these patients get?
- influenza
- pneumococcal pneumonia
- COVID
78
Out of all the diseases, which one is the major cause of death in the US?
pneumonia
79
Pneumonia are seen in patients who are:
- older adults (bc weak immune system)
- SNF
- Hospitals
- Mechnical ventilates
80
Describe the **characterization** of **Silicosis**
Occupational pulmonary disease
- Long term mineral dust inhalation (mines, pottery, sandblasting)
81
Describe the **pathophysiology** of **Silicosis**
**1**. Breathe in dust -> causes chronic inflammation
**2**. Scarring (fibrosis) builds up (thick/stiff)
- As part of healing process, body lays down scar tissue
**3**. Nodules (cluster of scar tissue) form between alveoli
**4**. Development of chronic fibrosis (stifferening of lung)
- Chronic inflammation and scarring
- SXS appear 10 - 20 years after exposure
82
What are the **Clinical Manifestations (s/s)** of **Silicosis**
- SOB
- Dyspnea on exertion
-> Fatigue (when eating)
->> Weight loss
- Lungs and chest lymph nodes
83
What are nursing **interventions** that can be done for patients with **Silicosis**?
- Obtain history of occupational exposure
- Assess onset of manifestations
- Reduce exposure to dust
-> Refer to social worker for transfer out environemnt or compenstation
- Vaccinations
- Medications
- Pvd long term O2 therapy
- Respiratory therapy
- Lung transplant
84
What class of medications can patients with Silicosis be given?
- Bronchodilators
- ABX
- Corticosteroids
85
Which vaccinations should you encourage patients with Silicosis to get?
- Influenza
- Pneumococcal
