Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

N5 471 > Week 3: Oxygenation > Flashcards

Week 3: Oxygenation Flashcards

(80 cards)

Start Studying
1
Q

Assessment of the respiratory system includes:

A

ABGs

Breath sounds

Meds

PFTs

Structure & function

Common symptoms

Normal changes of aging

Respiratory risk factors

Physical exam

Diagnostic tests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Prednisone (Deltasone)

A

Action: synthetic corticosteroid that is effective as an immunosuppressant; decreases inflammation

Used to treat inflammatory diseases

Route: PO or IV

Side effects: weight gain, N/V, restlessness, insomnia, headache, thinning skin, GI ulcer formation, hyperglycemia, HTN, cushingoid appearance, opportunistic infection

Contraindications: pts with HIV, concomitant immune system disease because it suppresses the immune system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Proair, Ventolin, proventil (albuterol)

A

Action: synthetic sympathimimetic agent, beta 2 adrenergic agonist (relax bronchial smooth muscle), inhibits histamine release, produces bronchodilatation

Relief of bronchospasm

Route: PO/inhalation

Contradictions: pregnancy 🤰 category C (risk/benefit), lactation, children younger than 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Albuterol continues

A

Precautions: CV disease, HTN, hyperthyroidism, DM

Side effects: tremor, anxiety, nervousness, restlessness, convulsions, headache, increased HR, palpitations, HTN, hypotension

Drug interactions: epinephrine, additive effect with other bronchodilators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Atrovent (ipratropium bromide)

A

Action: inhaled anticholinergics; produce a little bronchodilation by preventing bronchoconstriction

Route: inhaled

Side effects: memory impairment, confusion, hallucinations, dry mouth, blurry vision, urinary retention, constipation, tachycardia, increased intraocular pressure, acute angle glaucoma

Duoneb is a respiratory inhalant combo of 2 bronchodilators: albuterol sulfate and ipratropium bromide to open the airways usually in COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

AsthmaNefrin (Epinephrine)

A

Action: nonselective adrenergic agonist. Increased activation of the sympathetic system; increased peripheral resistance via alpha 1 receptor-dependent vasoconstriction and increased cardiac output via binding to beta 1 receptors

Epinephrine/adrenaline is the drug of choice to treat anaphylaxis. Increased HR and facilitates bronchial dilation

Route: IV, SQ, IM, inhalation

Dose: variable depending on situation

Adverse reactions: palpitations, tachycardia, arrhythmia, anxiety, panic attack, headache, tremor, HTN, and acute pulmonary edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pulmicort (Budesonide)

A

Actions: bronchodilator

Inhaled corticosteroid for 6yo+

Route: sterile suspension for inhalation via jet nebulizer

Contraindications: should NOT be used to treat an acute asthma attack

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Montelukast (Singulair)

A

Actions: Leukotriene receptor antagonist/ anti-inflammatory: leukotrienes released in response to inhaling an allergen; decreases asthma and allergy symptoms: reduces swelling and inflammation

Route: PO

Used for prevention and long-term Tx of asthma attacks in adults and children as young as 12

Side effects: headache, drowsiness, rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Fluticasone (Flovent)

A

Action: corticosteroid with potent anti-inflammatory activity

Used for asthma

Dose: starting doses above 100mcg BID for adults and adolescents; 50mcg BID for children 4-11 yo; may be considered for pts with poor asthma control

Side effects: may mask signs of infection

Max benefit may not be achieved for 1-2 weeks or longer after starting Tx

Contraindications: in the primary Tx of status asthmaticus or other acute episodes of asthma where intensive measures are required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Organs/tissues needed for oxygenation

A

Lungs for oxygen intake

Heart for oxygen delivery

Blood vessels and RBCs for oxygen delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Respiratory defense mechanism

A

Nose and sinuses

Warm, humidify and filter: insensible loss = 250 ml/d

Larynx: closure of glottis ➡️ intrathoracic pressure (cough)

Lower airway: carina (landmark= angle of Louis); Right main stem bronchus, smooth muscles in bronchioles; terminal respiratory unit (resp, bronchioles➡️ alveoli): surfactant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

A&P alterations in disease: inspiratory and expiratory muscles

A

Inhalation- active process

Includes:
Diaphragm (phrenic nerve)
External intercostals
Scalene muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

A&P alterations in disease: intrathoracic pressure changes

A

Chest tubes and ventilators alter oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Muscles of respiration

A

Sternomastoid muscles

Scalenes

Inspiratory intercostals

Expiratory intercostals

Diaphragm

External obliques

Expiratory abdominals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A&P alterations in disease: factors ➡️⬇️oxygen diffusion

A

⬇️ Atmospheric O2 (high altitude)

⬇️ Alveolar vent (obstruction/restrictive)

⬇️ Alveolar-capillary membrane surface area (emphysema, asthma, lung cancer, PE, thiracotomy)

⬆️ Alveolar-capillary membrane thickness (inflammation, pulmonary fibrosis, sarcoidosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

A&P alterations in disease: control of respiration

A

Central and peripheral chemoreceptors:

Changes in PaCO2 affect CSF pH: ⬆️ PaCO2 ➡️⬆️rate and depth of ventilation

Changes in PaCO2 (60 mmHg) affect peripheral; hypoxic drive in COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Bronchoscopy

A

Flexible or rigid

Used to diagnose/manage pulmonary diseases

Insertion of tube into airways as far as secondary bronchi to view airway structures and obtain tissue samples for testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

The mallampati score

A

Class I: complete visualization of the soft palate

Class II: complete visualization of the uvula

Class III: visualization of only the base of the uvula

Class IV: soft palate is not visible at all

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Upper airway anatomy

A

Air with oxygen enters the mouth/nose

Moves through airway: trachea, bronchi, bronchioles And into alveoli (air sacs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Gas exchange

A

Interaction between neuro, cardio, and respiratory systems

Chemoreceptors in medulla sense increase in CO2

Impulse to diaphragm & intercostal muscles

Diaphragm contracts, pressure pulls in O2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Bronchial system

A

Carries blood needed to oxygenate lungs

DOES NOT participate in gas exchange

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Pulmonary system

A

Highly vascular

RV into pulmonary artery (PA)

PA branches into arterioles

Forms capillary networks (that are meshed around and through alveoli)

Alveoli site of gas exchange

Capillaries to pulmonary veins to LA to LV to systemic circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Surface Area

A

Alveoli significantly increase the surface area of the lungs

Due to the many surface walls of the alveoli, the lungs have a surface area that is approximately the size of a tennis court

This large surface area allows for rapid gas exchange

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Respiratory processes and partial pressure

A

Exchange of gases between alveoli and blood occurs to simple diffusion

O2 diffusing from alveoli into blood

CO2 from the blood into the alveoli

Diffusion requires a concentration gradient

The concentration (or partial pressure) of O2 in the alveoli must be kept at a higher level than in the blood

The concentration (or partial pressure) of CO2 in the alveoli must be kept at a lower level than in the blood

Continuously breathe in fresh air (with lots of O2 and little CO2) into the lungs and the alveoli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Surfactant
Decreases surface tension which: Increase pulmonary compliance Reduces tendency for alveoli to collapse
26
Variations in gas exchange
Ventilation: inadequate function(bone, muscle, nerve); lack of O2, poor gas exchange (PE, ARDS, pneumonia); narrow airways: bronchoconstriction (asthma), obstruction (bronchitis, cystic fibrosis) Transport: availability of Hgb and ability to carry O2 (anemia) Perfusion: ability of blood to transport Hgb (decreased CO, thrombi, emboli, narrow vessels, vasoconstriction)
27
Changes with Aging
Thoracic cage gets rigid from cartilage calcification, rib osteoporosis, kyphosis or arthritic changes in spine, increased A-P diameter ⬇️chest wall compliance -> loss of elastic recoil of lungs -> ⬆️work of breathing ⬇️muscle strength (intercostals/diaphragm) which alters lung volumes, inspiratory/expiratory force leading to weaker cough; can be reversed with exercise; ⬆️ residual volume, ⬇️forced viral capacity (VC), ⬇️FEV, ⬇️max voluntary ventilation, ⬇️peak expiratory flow Alveoli less elastic and more fibrous (dyspnea) ⬇️alveolar-capillary membrane surface area leading to ⬇️diffusion capacity Elastic recoil capacity ⬇️
28
Consequences of impaired gas exchange
Fatigue, ⬆️HR, RR, T ⬇️SpO2 CO2 transport from the cells to the alveoli lead to buildup of acid Ventilation problem= respiratory acidosis Transport/perfusion problem= Met Acidosis Cellular ischemia, necrosis, death
29
Respiratory health history: Dyspnea
Breathlessness Environmental irritants Orthopnea Post nasal drip (PND)
30
Respiratory health history: Cough
Productive/nonproductive Pattern Duration (>2-3 weeks?) Associated with fatigue, SOB, fever? Interfere with sleep?
31
Respiratory health history: sputum
Production changes: Color Consistency Amount (normal is 100ml/day)
32
Respiratory health history: hemoptysis
Frothy Alkaline pH & bright red Not hematemesis- acidic pH
33
Respiratory health history: wheezing
Phases of respiratory cycle Indicates obstruction
34
Respiratory health history: Chest Pain
COLDSPA
35
Respiratory health history: others and risk factors
Night sweats Occupational and leisure activities Risk factors: smoking, respiratory disorders, family history, environmental irritants, psychosocial history
36
Smoking history
Joint commission requires screening documentation and a Tx program be offered Pack-years (cigarette smoking): # of packs smoked a day x years smoked Note attempts to quit smoking Exposure to second hand smoke Other forms: cigars, pipes, smokeless tobacco, vapes, illegal substances
37
Normal respiratory pattern
Eupnea 12-20 breaths per minute
38
Fast respiratory pattern
Tachypnea >20 breaths per minute
39
Slow respiratory pattern
Bradypnea <12 breaths per minute
40
Abnormal respiratory patterns
Apnea: absence of breathing Hyperventilation (hyperpnea): increased depth Cheyne-Stokes: crescendo/decrescendo respirations/apnea Ataxic- periods of apnea Kussmaul’s: rapid, deep, labored (air hunger) Apneustic: gasping
41
Inspection
Shape and symmetry of thorax A-P diameter S/S of respiratory distress ``` Normal= 1:1.5 COPD= 1:1 ``` Position of trachea, symmetry of chest expansion
42
Palpitation
Fremitus (vibration) Crepitus (sq emphysema)
43
Percussion
Resonance- normal lung tissue Dull- atelectasis, pneumonia, pleural effusion Tympany- pneumothorax
44
Auscultation
“Normal” when heard in proper location Abnormal: Adventitious Crackles Rhonchi Wheezes Pleural friction rub
45
Respiratory Dx tests
CBC, ABG, D-dimer Sputum analysis (organisms or abnormal cells). Best time is upon awakening after rinsing mouth CXR: Verify ett or catheter placement Assess lung pathology: pneumonia, atelectasis, pneumothorax, tumor, pleural fluid CT Scan/MRI: assess soft tissues, identify lesion or clot
46
Respiratory Dx Tests: VQ Scan
Ventilation and Perfusion (VQ) scan is a 2-part test: 1. Ventilation scan 2. Perfusion scan No special post-procedure care
47
Respiratory Dx Tests: pulmonary angiography
Pre- & Post-procedure care NPO, labs, allergy to contrast
48
Respiratory Dx Tests: Horowitz Index for lung function (P/F Ratio)
“P” represents PaO2 from ABG “F” represents FIO2 expressed as a decimal (40% oxygen= FIO2 of 0.40) P divided by F= P/F ratio Rooms air is 20% (0.20) and each L/min of oxygen= +4% (0.04)
49
Respiratory Dx Tests: PFTs
Pulmonary function tests (PFTs) assess lung function and breathing problems; measure lung volumes, capacities, flow rates, diffusion capacity, gas exchange, airway resistance, distribution of ventilation Restrictive vs obstructive disease Tidal volume (Vt)- minute ventilation Patient prep: no smoking 6-8 hours; no bronchodilators 4-6 hours
50
Forced viral capacity (FVC)
Volume of air forcibly exhaled from the point of max inspirations Indicates muscle strength and ventilators reserve
51
Forced expiratory volume in one second (FEV1)
Records the max amount of air that can be exhaled in first second of expiration Normal or increased with restrictive lung disease Reduced with obstructive disease or age FVC/FEV1= ratio that indicates obstruction to airflow
52
Thoracentesis
Needle aspiration of pleural fluid or air from the pleural space Can be done at bedside or IR with assist of CT or U/S Complications: SQ emphysema, infection, pneumothorax
53
Phlebotomy: arterial blood sample
ABG analysis assess: ``` Gas exchange Perfusion (PaO2) Alveolar ventilation (PaCO2) ```
54
Allen’s test (remember 5-15 seconds!)
Normal (positive): hand quickly becomes warm and returns to normal color after in-occluding the radial and ulnar arteries. This means one artery alone will be enough to supply blood to your hands and fingers Abnormal (negative): hand remains cold and pale after in-occluding the arteries. This means that one artery is not enough to supply blood to your hand and fingers. Blood will not be collected from an artery in this hand
55
Respiratory Nursing Interventions: airway management
Positioning to improve ventilation and relieve dyspnea Chest PT DB&C (instruct and encourage) Auscultation Administer bronchodilators Suctioning Fluid intake
56
Respiratory Nursing Interventions: cough Enhancement
Assist pt to sitting position with head slightly flexed, shoulders relaxed, & knees flexed Encourage pt to take several deep breaths Encourage pt to take a deep breath, hold in for 2 seconds, & cough 2-3x in succession Instruct pt to inhale deeply, bend forward slightly & perform 3-4 huffs (against an open glottis) Instruct pt to inhale deeply several times, to exhale slowly, & to cough at the end of exhalation
57
Respiratory Nursing Interventions: Oxygen Therapy
Restrict smoking Maintain airway patency Administer O2 via humidified system Monitor liter flow Monitor effectiveness Monitor skin breakdown Educate
58
Upper airway problems
Rhinitis Sinusitis Acute pharyngitis Acute follicular tonsillitis Acute laryngitis Laryngeal paralysis Laryngeal edema
59
Pertussis
Bacterial infection Bordetella pertussis Highly contagious Most dangerous for infants <1 year: 1 in 4 will get pneumonia; 1 in 2 will have a febrile seizure; 2 in 3 will have apnea
60
Pertussis disease progression
Stage 1: Catarrheal Stage (1-2 weeks): runny nose, low-grade fever, mild occasional cough; highly contagious Stage 2: paroxysmal stage (1-6 weeks; may extend to 10): fits of numerous rapid coughs followed by “whoop” sound; vomiting and exhaustion after coughing fits (called paroxymsms) Stage 3: convalescent stage (lasts 2-3 weeks; susceptible to many other respiratory infections): recovery is gradual; cough lessens but fits of coughing may return
61
Lower airway problems
Acute bronchitis Pneumonia COPD
62
Acute bronchitis
Inflammation of the bronchi and usually trachea (tracheobronchitis) Occurs most often with persons with CLD Extension of URI Typically viral but can be bacterial or irritant Treat symptomatically
63
Pneumonia patho
Colonization- growth of organisms other than normal flora without signs of infection ``` Oropharyngeal colonization: Normal- gram(+) and anaerobic Abnormal- gram (-) Available for aspiration Higher in hospitalized ``` Importance of oral care
64
Pneumonia continued
Acute inflammation of the lung tissue Caused: infection, atelectasis, noxious inhalation, radiation Patho: normal pulmonary defense mechanisms are impaired or overwhelmed, allowing microorganisms to multiply rapidly Entry routes: aspiration (primary route), inhalation, hematogenous spread (proximity of pulmonary blood supply)
65
Pneumonia patho continued
``` Gastric colonization: Normally sterile ⬆️pH= ⬆️colonization ⬆️risk for oropharyngeal colonization Risk factors: enteral feedings, H2 blockers, antacids, aged ``` Contaminated Aerosols: Respiratory & anesthesia equipment ⬇️ frequency of changing vent circuits
66
Lobar pneumonia
Consolidation in a segment or entire lobe of the lung
67
Bronchopneumonia
Diffusely scattered patches around the bronchi
68
Community Acquired Pneumonia (CAP)
Organisms: streptococcus pneumoniae; hemophilus influenza ``` Risk factors: Older adult No pneumococcal vaccination Exposure to respiratory viral or influenza infection Tobacco or alcohol use ```
69
Healthcare Acquired Pneumonia
Organisms: staph aureus, pseudomonas ``` Risk factors: Older adult CLD Gram (-) colonization of mouth, throat, stomach Altered LOC Aspiration Presence of ett, teach, or OG/NG Mechanical ventilator Poor nutritional status Reduced immunity Medications that increase gastric pH or alkaline TF ```
70
Pneumonia diagnosis
Symptoms Assessment Tests: CXR, ABG, pulse ox, CBC, blood culture Fever, rigors, sweats, new cough with or without sputum, change sputum color, chest discomfort, onset of dyspnea
71
Pneumonia interventions
Preventative: hand hygiene, annual flu vaccine, pneumococcal vaccination (at 65 yo or chronic illness), no smoking, healthy diet, adequate hydration (3L water), avoid crowds, increase mobility, DB&C exercises, clean any respiratory equipment, avoid pollutants, adequate rest/sleep Acute
72
Pneumonia prognosis
Prediction model Demographic factors: age, gender, nursing home Comorbid illnesses: neoplasm, liver, CHF, cerebral, renal disease Physical finds: LOC, RR, ⬇️BP, high or low temp, ⬆️pulse Lab finds: ⬇️pH, ⬆️BUN, ⬇️HGB, ⬆️glucose
73
Pneumonia complications
Respiratory failure Lung damage Sepsis
74
Pneumonia nursing care: ineffective airway clearance
NICs: airway management, cough enhancement (hydration, nebulizer, bronchi-active meds), positioning, respiratory monitoring
75
Pneumonia nursing care: impaired gas exchange
NICs: airway management, oxygen therapy, respiratory monitoring
76
Pneumonia nursing care: activity intolerance
NICs: energy management, self-care assistance
77
Pneumonia nursing care: imbalanced nutrition
78
Pneumonia Nursing Care NOCs
Activity tolerance Nutrition status: energy, food and fluid intake Respiratory status: gas exchange, ventilation, vital signs
79
Preventing hospital acquired pneumonia
DB&C, spirometer, ⬆️activity ``` Prevention of ventilator associated pneumonia (VAP)= “vent bundle”: HOB ⬆️30 degrees Oral hygiene Glucose control Gastric ulcer prophylaxis (thoughtful) Sub-glottic suctioning DVT prophylaxis Early mobilization Delirium assessment and prevention ```
80
Chest tube chambers
Chamber I: collects fluid draining from pt Chamber II: water seal prevents air re-entry Chamber III: suction control of system

N5 471 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions