CCBC NURSING 160: EXAM FOUR PREP
What is Oxygenation? - answer The process that maintains oxygen levels necessary for the survival of
living cells.
*The body requires oxygen for ENERGY!*
How much of the air that we breathe is made up of oxygen? – answer 21% air.
*But oxygenation is not JUST the air we breathe! Also the level of exchange at the alveoli and at the
level of the tissues.*
What is a waste product of oxygenation? – answer CO2!
What is hypoxemia? - answer Abnormally low levels of oxygen in the bloodstream.
What is hypoxia? - answer An insufficient or low level of oxygen in the whole body (tissues).
What is oxygen delivery? - answer The rate at which oxygen is transported from the lungs to the tissues
of the body.
What is oxygen consumption? - answer The rate at which oxygen is removed from the blood to be used
by the tissues.
Can alterations in systemic oxygenation affect other systems in the body? - answer YES! Alterations in
O2 can affect EVERY body system! Ex:
1. Homeostasis: acid-base balance affected (there should always be 20 bicarbs to every 1 carbonic acid).
2. Perfusion: need good blood supply to deliver O2 to the tissues.
3. Metabolism: changes in O2 can increase metabolic demand, thus leading to compensation.
,What is involved in the physiology of Oxygenation? – answer
1. Oxygen transport: occurs because we breathe! We take in oxygen through respirations.
2. Respiration: the act of respiring; inhalation and exhalation of air;
breathing---GAS EXCHANGE.
3. Ventilation: the movement of air between the
environment and the lungs via inhalation and exhalation (essentially the same as respiration---the two
go hand in hand).
4. Diffusion and Perfusion: O2 diffuses across alveoli and membranes.
5. Gas exchange: occurs at the level of the alveoli!
What are the different types of *Protectants* used during Oxygenation? – answer
1. *Filtration*: ex, cilia catch debris and irritants from obstructing the airway.
2. *Warmth and Humidification*: the upper airway (mouth and nose) warms and humidifies. Patients
with trachs don't have this ability which can lead to irritation to their respiratory system.
3. *Epiglottis*: protects the trachea against aspiration.
4. *Cough Reflex*: occurs in the CNS; protective mechanism of the airway, therefore as long as it's not
excessive a cough is a good thing.
5. *Mucociliary Escalator Mechanism*: The mucociliary escalator covers most of the bronchi,
bronchioles and nose. The cilia are continually beating, pushing mucus up and out into the throat. The
mucociliary escalator is a major barrier against infection. Microorganisms hoping to infect the
respiratory tract are caught in the sticky mucus and moved up by the mucociliary escalator. Smoking
seems to paralzye the cilia of the mucociliary escalator.
,6. *Immunoglobulin A*: an antibody that plays a critical role in mucosal immunity---acts as a defense
mechanism to help protect the respiratory system. Can result in an accumulation of more fluids to that
area, as well as swelling an inflammation. When this is excessive, it can actually make the respiratory
problems worse.
7. *Alveolar macrophages*: the alveoli have their own supply of macrophages that "eat up the bad
stuff."
What are Cilia? – answer Hair-like projections that line the bronchus to remove microbes and debris
from the interior of the lungs.
What is the difference between Inspiration and Expiration? How does the diaphragm move with each
one? – answer
*Inspiration*: (the diaphragm drops down)
- the diaphragm and intercostal muscles contract.
- thoracic cavity size increases.
- volume of the lungs increases.
- intrapulmonary pressure decreases: intrapulmonary pressure must fall below atmospheric pressure to
cause inspiration.
- air rushes into the lungs to equalize pressure.
*Expiration*: (the diaphragm moves up: this is passive)
- the diaphragm and intercostal muscles relax
- lung volume decreases
- intrapulmonary pressure rises to allow for expiration.
- air is expelled (containing CO2).
What are Alveoli? – answer Small grape-like air sacs at the end of the terminal bronchioles that are a site
of gas exchange---they open and relax as we breathe. Alveoli need to remain open in order to get rid of
CO2.
, Hemoglobin in the blood carries oxygen throughout the body. Is all of the oxygen that is attached to the
hemoglobin actually utilized? – answer No.
What is the *Oxygen-Hemoglobin Dissociation Curve*? – answer The oxy-hemoglobin dissociation curve
is an important tool for understanding how our blood carries and releases oxygen.
Specifically, the oxy-hemoglobin dissociation curve relates oxygen saturation (SO2) and partial pressure
of oxygen in the blood (PO2), and is determined by what is called "hemoglobin's affinity for oxygen,"
that is, *how readily hemoglobin acquires and releases oxygen molecules from its surrounding tissue*.
This can be affected by stress, temperature changes (ex, hemoglobin affinity increases when we're cold),
exercise, etc.
At high oxygen saturation, the hemoglobin more easily "lets go" of the oxygen molecules in order to
deliver them to the body's cells. Basically when we need more O2, the oxy-hemoglobin affinity
decreases.
At lower oxygen saturation, the hemoglobin holds the oxygen molecules more tightly due to the overall
chemical composition of the blood. Basically, when we need less O2, the oxy-hemoglobin affinity
increases.
What is involved in the nursing assessment in regards to Oxygenation? – answer
1. *Health History*: respiratory patho, other diseases (co-morbidities).
2. *Signs and Symptoms*: dyspnea, cough (productive or non-productive), sputum (color? Any change in
the sputum?), chest pain (PQRST), wheezing (or any adventitious lung sounds), hemoptysis (coughing up
blood: is there a lot? a small amount? Because a small amount could simply be from irritation), clubbing
of fingers (indicative of a prolonged/chronic O2 problem), cyanosis (a problem! when fingers/toes are
cyanotic it's an issue with peripheral oxygenation where the body is shunting oxygenated blood to the
core in order to support important organs like the brain and those in the thorax. When there is *central
cyanosis* this is called *circum-oral cyanosis* and it affects the face or mouth---this is a BAD sign
because it means the body doesn't have enough oxygenated blood to shunt).
3. *ADL's*: can they perform them without SOB/DOE?
What is Oxygenation? - answer The process that maintains oxygen levels necessary for the survival of
living cells.
*The body requires oxygen for ENERGY!*
How much of the air that we breathe is made up of oxygen? – answer 21% air.
*But oxygenation is not JUST the air we breathe! Also the level of exchange at the alveoli and at the
level of the tissues.*
What is a waste product of oxygenation? – answer CO2!
What is hypoxemia? - answer Abnormally low levels of oxygen in the bloodstream.
What is hypoxia? - answer An insufficient or low level of oxygen in the whole body (tissues).
What is oxygen delivery? - answer The rate at which oxygen is transported from the lungs to the tissues
of the body.
What is oxygen consumption? - answer The rate at which oxygen is removed from the blood to be used
by the tissues.
Can alterations in systemic oxygenation affect other systems in the body? - answer YES! Alterations in
O2 can affect EVERY body system! Ex:
1. Homeostasis: acid-base balance affected (there should always be 20 bicarbs to every 1 carbonic acid).
2. Perfusion: need good blood supply to deliver O2 to the tissues.
3. Metabolism: changes in O2 can increase metabolic demand, thus leading to compensation.
,What is involved in the physiology of Oxygenation? – answer
1. Oxygen transport: occurs because we breathe! We take in oxygen through respirations.
2. Respiration: the act of respiring; inhalation and exhalation of air;
breathing---GAS EXCHANGE.
3. Ventilation: the movement of air between the
environment and the lungs via inhalation and exhalation (essentially the same as respiration---the two
go hand in hand).
4. Diffusion and Perfusion: O2 diffuses across alveoli and membranes.
5. Gas exchange: occurs at the level of the alveoli!
What are the different types of *Protectants* used during Oxygenation? – answer
1. *Filtration*: ex, cilia catch debris and irritants from obstructing the airway.
2. *Warmth and Humidification*: the upper airway (mouth and nose) warms and humidifies. Patients
with trachs don't have this ability which can lead to irritation to their respiratory system.
3. *Epiglottis*: protects the trachea against aspiration.
4. *Cough Reflex*: occurs in the CNS; protective mechanism of the airway, therefore as long as it's not
excessive a cough is a good thing.
5. *Mucociliary Escalator Mechanism*: The mucociliary escalator covers most of the bronchi,
bronchioles and nose. The cilia are continually beating, pushing mucus up and out into the throat. The
mucociliary escalator is a major barrier against infection. Microorganisms hoping to infect the
respiratory tract are caught in the sticky mucus and moved up by the mucociliary escalator. Smoking
seems to paralzye the cilia of the mucociliary escalator.
,6. *Immunoglobulin A*: an antibody that plays a critical role in mucosal immunity---acts as a defense
mechanism to help protect the respiratory system. Can result in an accumulation of more fluids to that
area, as well as swelling an inflammation. When this is excessive, it can actually make the respiratory
problems worse.
7. *Alveolar macrophages*: the alveoli have their own supply of macrophages that "eat up the bad
stuff."
What are Cilia? – answer Hair-like projections that line the bronchus to remove microbes and debris
from the interior of the lungs.
What is the difference between Inspiration and Expiration? How does the diaphragm move with each
one? – answer
*Inspiration*: (the diaphragm drops down)
- the diaphragm and intercostal muscles contract.
- thoracic cavity size increases.
- volume of the lungs increases.
- intrapulmonary pressure decreases: intrapulmonary pressure must fall below atmospheric pressure to
cause inspiration.
- air rushes into the lungs to equalize pressure.
*Expiration*: (the diaphragm moves up: this is passive)
- the diaphragm and intercostal muscles relax
- lung volume decreases
- intrapulmonary pressure rises to allow for expiration.
- air is expelled (containing CO2).
What are Alveoli? – answer Small grape-like air sacs at the end of the terminal bronchioles that are a site
of gas exchange---they open and relax as we breathe. Alveoli need to remain open in order to get rid of
CO2.
, Hemoglobin in the blood carries oxygen throughout the body. Is all of the oxygen that is attached to the
hemoglobin actually utilized? – answer No.
What is the *Oxygen-Hemoglobin Dissociation Curve*? – answer The oxy-hemoglobin dissociation curve
is an important tool for understanding how our blood carries and releases oxygen.
Specifically, the oxy-hemoglobin dissociation curve relates oxygen saturation (SO2) and partial pressure
of oxygen in the blood (PO2), and is determined by what is called "hemoglobin's affinity for oxygen,"
that is, *how readily hemoglobin acquires and releases oxygen molecules from its surrounding tissue*.
This can be affected by stress, temperature changes (ex, hemoglobin affinity increases when we're cold),
exercise, etc.
At high oxygen saturation, the hemoglobin more easily "lets go" of the oxygen molecules in order to
deliver them to the body's cells. Basically when we need more O2, the oxy-hemoglobin affinity
decreases.
At lower oxygen saturation, the hemoglobin holds the oxygen molecules more tightly due to the overall
chemical composition of the blood. Basically, when we need less O2, the oxy-hemoglobin affinity
increases.
What is involved in the nursing assessment in regards to Oxygenation? – answer
1. *Health History*: respiratory patho, other diseases (co-morbidities).
2. *Signs and Symptoms*: dyspnea, cough (productive or non-productive), sputum (color? Any change in
the sputum?), chest pain (PQRST), wheezing (or any adventitious lung sounds), hemoptysis (coughing up
blood: is there a lot? a small amount? Because a small amount could simply be from irritation), clubbing
of fingers (indicative of a prolonged/chronic O2 problem), cyanosis (a problem! when fingers/toes are
cyanotic it's an issue with peripheral oxygenation where the body is shunting oxygenated blood to the
core in order to support important organs like the brain and those in the thorax. When there is *central
cyanosis* this is called *circum-oral cyanosis* and it affects the face or mouth---this is a BAD sign
because it means the body doesn't have enough oxygenated blood to shunt).
3. *ADL's*: can they perform them without SOB/DOE?
