NSG 170 Exam 1 Gas Exchange &
Perfusion-Graded A
What regulates the bicarbonate in ECF? - ANSWER-kidneys
What regulates the CO2, carbonic acid in ECF? - ANSWER-lungs
Normal plasma pH range? - ANSWER-7.35 - 7.45
Major extracellular fluid buffer system? - ANSWER-Bicarbonate-carbonic acid buffer
system
Normal Ranges - ANSWER-pH 7.35-7.45
PaCO2 35-45mmHg
HCO3 22-26 mEq/L
PaO2 80-100 mmHg
Oxygen Sat >94%
Base excess.deficit ~2 mEq/L
Most common cause of hospitalization and illnesses in children, and accounts for
majority of acute illnesses in children? - ANSWER-Respiratory disorders
Interesting fact - ANSWER-Newborns are obligatory nose breathers until at least 4
weeks and can't automatically open mouths to breathe if nose obstructed
Why are children more prone to infection/obstruction in nose and throat? - ANSWER--
Infants are obligatory nose breathers
-Newborns produce little mucus, making more prone to infection
-Newborns have small nasal passages, making prone to obstruction
-Infants' tongues relative to oropharynx are larger, placement of tongue can lead to
airway obstruction
-Children have enlarged tonsillar and adenoid tissue, leading to possible airway
obstruction
Prolonged expiration is a sign of.... - ANSWER-bronchial or bronchiolar obstruction
Wheezing - ANSWER--high pitched sound on expiration
-may occur with obstruction in lower trachea or bronchioles
Rales - ANSWER--crackling sounds heard when alveoli become fluid filled
-may occur with pneumonia
,Common Medical Treatments for Respiratory Disorders - ANSWER--oxygen
-high humidity
-suctioning
-chest physiotherapy and postural drainage
Labs for Asthma - ANSWER--Allergen skin testing
-Sputum culture
-CBC
Diagnostics for Asthma - ANSWER--PFT
-ABG
-CXR
-Pulse Oximetry
Nursing Diagnoses for Asthma - ANSWER--Impaired gas exchange
-Impaired airway clearance
-Ineffective breathing
-Fear
-Anxiety
-Fluid volume deficit
-Nutrition
-Activity intolerance
-Pain
-Risk for infection
Nursing Management for Asthma - ANSWER--maintain open airway
-promoting effective breathing
-promoting adequate gas exchange
-preventing infection
-maintaining adequate hydration
-increasing activity tolerance
-decreasing fear and anxiety
Medications for asthma - ANSWER--anti-inflammatory inhaled
medications:maintenance chronic lung disease
-short acting bronchodilators: wheezing episodes
-supplemental long-term oxygen therapy (may be required in some infants/children)
-antibiotics (for infection)
Teaching for Asthma - ANSWER--nebulizers
-metered-dose inhalers
-spacers
-dry powder inahlers
-diskus
, COPD and Associated Respiratory Diseases - ANSWER--characterized by airflow
limitation that is not fully reversible (chronic bronchitis and emphysema)
-not reversible, once a patient has it they have it
Panlobular Emphysema (PLE) - ANSWER-across bed of alveoli
Centrilobular Emphysema (CLE) - ANSWER-across lobes leading up to bed of alveoli
Pathophysiology of COPD - ANSWER--airflow limitation is progressive
-chronic inflammation damages tissue
-scar tissue results in narrowing
-scar tissue in the parenchyma decreases elastic recoil (compliance)
-scar tissue in pulmonary vasculature causes thickened vessel lining and hypertrophy of
smooth muscle (pulmonary hypertension)
Chronic Bronchitis - ANSWER--cough and sputum production for at least 3 months in
each of 2 consecutive years
-ciliary function reduced, bronchial walls thicken, bronchial airways narrow, and mucous
may plug airways
-alveoli become damaged, fibrosed, and alveolar macrophage function diminished
-pt more susceptible to resp infections
-flu vaccines help deter
Rales and crackles are heard on the ________ side - ANSWER-posterior
Rhonci is heard more on the _______ side - ANSWER-anterior
Greater than ______ O2 sat is accomdating to life - ANSWER-80%
In low O2 Sat patients, expect to see... - ANSWER-increased heart rate >30, cyanosis
or pale palor, and clubbing would be a late sign and irreversible (fingers)
T/F? For patients with chronic bronchitis, the nurse expects to see the major clinical
symptoms of tachypnea and tachycardia? - ANSWER-False. Just for emphysema. For
chronic bronchitis, you'd expect to see sputum.
Emphysema - ANSWER--abnormal distention of air spaces beyond terminal bronchioles
with destruction of the walls of the alveoli
-decreased alveolar surface area in creases in "dead" space, impaired oxygen diffusion
-hypoxemia results
-increased pulmonary artery pressure may cause right-sided heart failure (cor
pulmonale)
Posture of a COPDer - ANSWER-"Pink puffers" --> patients with COPD or emphysema
-typically the patients are thin, because it takes them effort to eat and breathe
Perfusion-Graded A
What regulates the bicarbonate in ECF? - ANSWER-kidneys
What regulates the CO2, carbonic acid in ECF? - ANSWER-lungs
Normal plasma pH range? - ANSWER-7.35 - 7.45
Major extracellular fluid buffer system? - ANSWER-Bicarbonate-carbonic acid buffer
system
Normal Ranges - ANSWER-pH 7.35-7.45
PaCO2 35-45mmHg
HCO3 22-26 mEq/L
PaO2 80-100 mmHg
Oxygen Sat >94%
Base excess.deficit ~2 mEq/L
Most common cause of hospitalization and illnesses in children, and accounts for
majority of acute illnesses in children? - ANSWER-Respiratory disorders
Interesting fact - ANSWER-Newborns are obligatory nose breathers until at least 4
weeks and can't automatically open mouths to breathe if nose obstructed
Why are children more prone to infection/obstruction in nose and throat? - ANSWER--
Infants are obligatory nose breathers
-Newborns produce little mucus, making more prone to infection
-Newborns have small nasal passages, making prone to obstruction
-Infants' tongues relative to oropharynx are larger, placement of tongue can lead to
airway obstruction
-Children have enlarged tonsillar and adenoid tissue, leading to possible airway
obstruction
Prolonged expiration is a sign of.... - ANSWER-bronchial or bronchiolar obstruction
Wheezing - ANSWER--high pitched sound on expiration
-may occur with obstruction in lower trachea or bronchioles
Rales - ANSWER--crackling sounds heard when alveoli become fluid filled
-may occur with pneumonia
,Common Medical Treatments for Respiratory Disorders - ANSWER--oxygen
-high humidity
-suctioning
-chest physiotherapy and postural drainage
Labs for Asthma - ANSWER--Allergen skin testing
-Sputum culture
-CBC
Diagnostics for Asthma - ANSWER--PFT
-ABG
-CXR
-Pulse Oximetry
Nursing Diagnoses for Asthma - ANSWER--Impaired gas exchange
-Impaired airway clearance
-Ineffective breathing
-Fear
-Anxiety
-Fluid volume deficit
-Nutrition
-Activity intolerance
-Pain
-Risk for infection
Nursing Management for Asthma - ANSWER--maintain open airway
-promoting effective breathing
-promoting adequate gas exchange
-preventing infection
-maintaining adequate hydration
-increasing activity tolerance
-decreasing fear and anxiety
Medications for asthma - ANSWER--anti-inflammatory inhaled
medications:maintenance chronic lung disease
-short acting bronchodilators: wheezing episodes
-supplemental long-term oxygen therapy (may be required in some infants/children)
-antibiotics (for infection)
Teaching for Asthma - ANSWER--nebulizers
-metered-dose inhalers
-spacers
-dry powder inahlers
-diskus
, COPD and Associated Respiratory Diseases - ANSWER--characterized by airflow
limitation that is not fully reversible (chronic bronchitis and emphysema)
-not reversible, once a patient has it they have it
Panlobular Emphysema (PLE) - ANSWER-across bed of alveoli
Centrilobular Emphysema (CLE) - ANSWER-across lobes leading up to bed of alveoli
Pathophysiology of COPD - ANSWER--airflow limitation is progressive
-chronic inflammation damages tissue
-scar tissue results in narrowing
-scar tissue in the parenchyma decreases elastic recoil (compliance)
-scar tissue in pulmonary vasculature causes thickened vessel lining and hypertrophy of
smooth muscle (pulmonary hypertension)
Chronic Bronchitis - ANSWER--cough and sputum production for at least 3 months in
each of 2 consecutive years
-ciliary function reduced, bronchial walls thicken, bronchial airways narrow, and mucous
may plug airways
-alveoli become damaged, fibrosed, and alveolar macrophage function diminished
-pt more susceptible to resp infections
-flu vaccines help deter
Rales and crackles are heard on the ________ side - ANSWER-posterior
Rhonci is heard more on the _______ side - ANSWER-anterior
Greater than ______ O2 sat is accomdating to life - ANSWER-80%
In low O2 Sat patients, expect to see... - ANSWER-increased heart rate >30, cyanosis
or pale palor, and clubbing would be a late sign and irreversible (fingers)
T/F? For patients with chronic bronchitis, the nurse expects to see the major clinical
symptoms of tachypnea and tachycardia? - ANSWER-False. Just for emphysema. For
chronic bronchitis, you'd expect to see sputum.
Emphysema - ANSWER--abnormal distention of air spaces beyond terminal bronchioles
with destruction of the walls of the alveoli
-decreased alveolar surface area in creases in "dead" space, impaired oxygen diffusion
-hypoxemia results
-increased pulmonary artery pressure may cause right-sided heart failure (cor
pulmonale)
Posture of a COPDer - ANSWER-"Pink puffers" --> patients with COPD or emphysema
-typically the patients are thin, because it takes them effort to eat and breathe
