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Gas exchange: transfer of oxygen from atmosphere to blood and CO2 from
What is the primary purpose of the
bloodstream to atmosphere
respiratory system?
Right lung: 3 lobes: upper,middle and lower
How many lobes does the right lung have? Left lung: 2 lobes: upper and lower
How many lobes does the left lung have?
-Nasal cavity
-Pharynx
-Adenoids
-Tonsils
What consists of the upper respiratory -epiglottis
tract? -Larynx
-trachea
1. The nose warms,cleans and humidifies air before it enters the lungs
2. Vibrational sounds originate in the larynx which is how we vocalize
4 purposes of the URT? 3. Provides protection to lower airways: nasal passages and epiglottis
4.Has olfactory receptors
What consists of the lower respiratory -bronchi, bronchioles, alveolar ducts, alveoli
tract?
What is the landmark for the LRT? Carina
movement of air in (inspiration: active process) and out of the lungs (expiration:
What is ventilation? passive process)
process of gas exchange, moving oxygen from atmosphere to the bloodstream and
What is respiration? moving CO2 from bloodstream to atmosphere
What is compliance? The measure of the elasticity of the lungs and thorax.
What happens if compliance decreases? If compliance decreases it is more difficult for the lungs to inflate.
What response should be elicited by Cough
stimulation of the carina?
What is the difference between the left and left bronchus has an acute angle
right bronchus? right bronchus has a straighter angle
What are respiratory bronchioles made of? Primarily made of smooth muscles and therefore are prone to bronchodilation and
and what are they prone to? bronchoconstriction
They make up 90% of the alveoli and are the main structural cells, they line the
Explain Type 1 alveoli cells alveolar wall. They play a major role in gas exchange
They are lesser in number. They store, produce and secrete surfactant. When
there's injury to the alveolar wall, they divide and line the surface of the wall and act
Explain Type 2 alveoli cells like type 1 cells.
In pulmonary circulation the deoxygenated blood from the heart becomes
What happens in pulmonary circulation? oxygenated and returns to the systemic circulation to be used. This phases lasts 3/4
How long do the RBC spend in this phase? of a second!
increase temperature, 2-3DPG, Pco2 and decrease in pH (acidosis)
What are 4 factors that result in a right
shift?
decrease in temperature, 2-3 DPG, Pco2 and increase in pH (alkalosis)
What are 4 factors that result in a left shift?
What is methemoglobin? an oxidized form of hemoglobin (Fe2+ --> Fe3+) that does NOT bind O2 as readily
What is carboxyhemoglobin? form of hemoglobin bound to CO in place of O2
4 things to ask for in a respiratory 1. past health history 2. medications (what worked and didn't work for them?) 3.
assessment? recent surgery or other treatments 4. current history
Resonance low-pitched sound heard over normal lungs
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,NSG 4330: quiz 1
lower-pitched, booming sound
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Hyperresonance such as in COPD or acute asthma
drumlike,loud,empty quality heard over gas-filled stomach or intestine or over
Tympany pneumothorax
medium-intensity pitch and duration heard over areas of "mixed" solid and lung
tissue, such as over the top area of the liver, partially consolidated lung tissue
Dull (pneumonia) or fluid filled pleural space
soft, high-pitched sound of short duration heard over very dense tissue in which air
Flat is not present
Amount of air that moves in and out of the lungs during a normal breath, usually
tidal volume 500mls
Venous blood gases
What blood study is NOT reliable for
oxygenation levels?
Carbon dioxide, bicarbonate and pH. we are able to know if a pt has
What information can be found from a
acidosis/alkalosis from these results.
VBG?
Burn patients and patients with carbon monoxide poisoning.
What patients would have contraindication
to using a spirometer?
Acid-fast smear and culture
What sputum study would be used for a TB
patient?
A state in which one or both gas exchanging function are inadequate.
1. O2 transfer to the blood is insufficient
What is respiratory failure? 2. The amount of CO2 being removed from the lung is inadequate
Hypoxemia is decreased oxygen in arterial blood (PaO2 <60 mmhg) and hypoxia is
What is the difference between hypoxemia decreased oxygen in the tissue (cellular level resulting in symptoms such as
and hypoxia? anaerobic metabolism).
What is hypercarbia/Hypercapnia? excessive partial pressure of CO2 in arterial blood, >45mmHg
In a V/Q mismatch, there are areas of high perfusion and areas of low perfusion.
The areas of low perfusion have good ventilation and therefore would have good
stats where the area of high perfusion has less ventilation and will have lower stats.
But because the area of High perfusion has more RBC (that are LESS oxygenated)
What occurs in a V/Q mismatch? this will affect the overall level of oxygenation when those two areas meet and
therefore lower the overall O2 level.
1. O2 therapy is first management
What are interventions for V/Q mismatch? 2. Prone positioning
What causes V/Q mismatch? Pneumonia, PE, COPD,asthma
Shunt refers to blood that moves from the right to the left side of the circulation
without being oxygenated. Therefore high levels of deoxygenated blood is coming
What is shunting? back to the left atrium by the pulmonary vein.
Providing oxygen as there will still be a good amount that goes to the shunt
What intervention would you NOT help a (therefore doesn't get oxygenated) and the overall oxygenation won't improve by
patient who has a respiratory shunt? much
Pulmonary edema and ARDS, because the alveoli is filled with fluid and cannot
What are two possible causes of Shunting? participate in gas exchange due to the inability of oxygen to reach the capillary.
The alveoli is normal but due to an obstruction in the capillary the air is not able to
What is dead space ventilation? participate in gas exchange. Ex: in a PE
Decrease of gas exchange across the alveolar-capillary membrane, hypoxemic at
Diffusion limitations exercise but not rest d/t lack decreased time to participate in gas exchange
The first is hypoxemic which is due to oxygenation failure (problem in the alveoli) the
What are the two types of respiratory
second is hypercapnic which is due to ventilator failure.
failures?
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,NSG 4330: quiz 1
Minute ventilationNSG4330
is tidal volume
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What is minute ventilation? and Which has decreased minute ventilation.
respiratory failure has decreased minute
ventilation?
Pneumothorax where air enters the pleural space
through an opening in the chest wall and can
cause the lung to collapse. Ex:Stab, or gunshot
What is an open pneumothorax?
wounds. "Sucking chest wound"
Air enters into intrapleural space without an
outside wound, chest wall and pleural are intact.
What is a closed pneumothorax?
- Hemothorax is accumulation of blood in intrapleural space usually seen in open
pneumothorax
- Chylothorax is accumulation of lymphatic fluid in pleural space due to leakage from
Explain hemothorax, chylothorax and thoracic duct and usually secondary to incorrect central line insertion gone
phyothorax - Pyothorax (empyema) is accumulation of purulent fluid (bacteria and other
infectious agents) in the pleural space
A high chest tube is inserted to evacuate air and evacuate a pneumothorax.
What does the placement of a high chest
tube indicate? What does the placement of A low chest tube is inserted to drain fluid
a low chest tube indicate?
- Tension pneumothorax can be secondary to chest trauma or blunt trauma, air is
entering the pleural cavity but the visceral cavity acts as a valve and therefore apply
is not to escape out of the pleural space. As the air continues increasing in the
pleural space this puts pressure on the lung resulting in a lung collapse and a
mediastinal shift.
- This shift puts pressure on the cardiovascular system resulting in decrease preload
and cardiac output and therefore hypotension and hypoxemia.
What happens in tension pneumothorax? - THIS IS AN EMERGENT SITUATION, decompression needles are often used to
release the pressure in the pleural space.
- Can be due to invasive CPR, mechanical ventilation, and chest trauma
- Respiratory distress, tachypnea
- Anxious
- Pale
- Diaphoresis
- Weak and thready pulse, high pulse
- Hypotensive
Clinical manifestation of tension
- Neck veins will be engorged
pneumothorax
- Mediastinal and tracheal deviation
- Reduced movement of chest wall of the affected side
It is a life-threatening condition that involves two or more fractures of adjacent ribs -
This causes a flail segment to move in the opposite direction of the other ribs,
What is flail chest? causing trauma and contusions.
What is a specific findings of flail chest? Paradoxical breathing
1. Adequate ventilation (oxygen)
2. Administrations of Fluids (crystalloid IC)
3 initial interventions for flail chest 3. Pain management
Blood rapidly collects in pericardial sac, compresses myocardium because the
pericardium does not stretch and this prevents the heart from pumping effectively.
What is cardiac tamponade?
How do we manage cardiac tamponade? Pericardiocentesis and surgical repair
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, NSG 4330: quiz 1
Transudate pleural effusionexam
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ONLY fluid exits into the pleural space. Seen in CHF patients, increased pressure in
the capillaries and fluid "spills out" into the pleural space.
What is the difference between a Exudate pleural effusion is due to inflammation and results in changes permeability
transudate and exudate pleural effusion? of the capillary and therefore both fluid AND protein/large particles exit into the
pleural space.
How do we determine what type of pleural By conducting a thoracentesis, they take a sample of the fluid in the pleural space
effusion a patient has? and test it to see if there are presence of large particles.
Chest tubes and PleurX often used in malignant pleural effusion.
What are two types of drainage treatment
of pleural effusion?
What is pulmonary edema? Abnormal accumulation of fluid in the alveoli and interstitial spaces of the lungs.
A condition in which one or more arteries in the lungs become blocked by a blood
What is a pulmonary embolism? clot.
-Dyspnea
-Pleuritic chest pain
What is the classic triad of a PE? -Hemoptysis (coughing up blood)
- CT scan
- VQ scanning
Diagnostic studies for PE - Ddimers (indicative of a thrombotic event but not diagnostic)
- ABG (not diagnostic)
In patient with significant renal failure that can't use contrast
When is ventilation perfusion scanning
contraindicated?
- Early ambulation
- Compressive devices to mimic valvular compression
3 preventions of PE - prophylactic anticoagulants
Warfarin
Anticoagulation therapy: 1 vitamin K
Antidote: Vitamin K
antagonist and its antidote
1. unfractionated heparin
2. LMWH
3. Enoxaprin
Anticoagulation therapy: 3 indirect
thrombin inhibitors and their antidote Antidote: Protamine sulpahate (RISK OF ANAPHYLAXIS)
Dabigatran (paradax)
Anticoagulation therapy: 1 direct thrombin
inhibitors and its antidote antidote: Praxbind
Apixaban- Eliquis
Rivaroxaban - Xarelto
Anticoagulation therapy: 2 direct Xa
inhibitor and their antidote Antidote: PCC (prothrombin complex concentrate)
Primary disease or complication of other cardiac and respiratory disorders. There is
an increased blood pressure in the lungs which results in a higher resistance for the
What is pulmonary HTN? right ventricle to overcome. This results in right ventricular hypertrophy.
Most common is dyspnea (SOB) upon exertion
What is the most common sign of 1. Dizziness
pulmonary HTN? what are 3 other signs 2. Chest pain
that may occur? 3. Swelling of legs (Right sided HF)
Viagra can be prescribed for pulmonary HTN because it causes vasodilation.
What is a medication that can be used for
pulmonary HTN but is not is not the
primary intended use?
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