Med Surg Exam 3 - MOD 5: Respiratory
(Textbook chapters: 7, 23, 24, 25, 26)
* Extra resources at end of study guide
(#Q) = amount of questions on Blueprint!
Oxygen Therapy Management – Ch. 7 (3Q)
Indications: PaO2 < 60 mmHg or SaO2 <90%
o extreme caution with patients who are hypoxic and have chronic hypercapnia or
hypercarbia.
Physiology
o Ventilation – Movement of air in and out of the lungs
o Perfusion – Gas exchange of oxygen and CO2 at alveoli-capillary membrane
Oxygen diffuses across the capillary bed that surrounds the alveoli from an area
of higher concentration to the blood, the area of lower concentration.
o Oxygenation – Process of oxygen passively diffusing from alveoli to the blood/tissues.
o Surfactant - Type II cells (pneumocytes) phospholipid and protein covers alveoli to
prevent collapse by reducing surface tension allowing for gas exchange to take place.
Surface tension is the force present within the alveoli of the lungs that causes
the alveoli to collapse surfactant reduces the surface tension, therefore
reducing the tendency of the alveoli to collapse.
o Compliance (ease of expansion of the lungs) less effort is needed to expand.
Pathophysiology
o Hypoxia – Insufficient oxygen to meet the metabolic demands of the cells, tissues, and
organs.
Hypoxia is low oxygen levels in your tissues.
o Hypoxemia – PaO2 level in blood <60 or SaO2 <90- Pa02 and Sa02 are taken from atrial
blood during an arterial blood gas (ABG)
Hypoxemia is low oxygen levels in your blood.
o Dyspnea – Subjective feeling of difficulty breathing.
Noninvasive Oxygen Delivery Methods:
,o Low flow
Nasal cannula
- Delivers 24% (1L/min)-44% (6L/min)
- Used in all care settings and the home.
- Most common
- Most comfortable
- Mobile
- Least expensive
Simple face mask
- Flow rates 5-10 L/min or 40%-60%
- Used short term.
- Helpful for transport
Partial rebreather
- Simple mask with reservoir bag attached
- Reservoir bag filled with oxygen
- Flow rate of 8-10L/min
- 50%-75% oxygen to patient
Non-rebreather
- One-way valves between mask and bag
- One-way valves on side of mask
- Prevents rebreathing of CO2
- Flow rate 10mL-15L/min
- 90% oxygen to patient
o High flow
Venturi COPD
- Most accurate oxygen concentration
- Flow rate 2-15 L/min
- Oxygen concentration 24%-60%
, Aerosol = Indicated for high-humidity oxygen concentration; Post extubation;
Post upper airway surgery; thick secretions.
T-Piece
Face Tent
High flow nasal cannula
o Note specific diseases require specific masks/FiO2! LOOK THIS UP!!!
Complications of Oxygen Therapy:
o Toxicity a result of the administration of an oxygen concentration equal to or greater
than 50% over 24 to 48 hours.
May cause pulmonary edema, atelectasis, and hemorrhage and can progress to
ARDS.
COPD patients high risk!
o Pulmonary embolism = the obstruction of one or more of the branches of the
pulmonary artery by particulate matter that has an origin elsewhere in the body.
S/S: sudden onset of intense dyspnea, pleuritic chest pain, and tachypnea is
usually the first indication that the patient has an acute PE.
- Dyspnea
- Accessory muscle use
- Pleuritic chest pain
- Tachycardia
- Tachypnea
- Crackles upon auscultation
- Cough
- Hemoptysis
- Unilateral lower extremity edema due to the presence of a deep vein
thrombus (DVT); pain in extremity, with redness and warmth
A pulmonary embolus caused by a thrombus can also be caused by a piece of
tumor, amniotic fluid, air, or fat, referred to as a non-thrombotic pulmonary
embolus.
obstruction impaired ventilation-to-perfusion ratio (V/Q ratio) = decreased or
blocked blood flow or perfusion to functioning alveoli.
Ventilation–perfusion mismatch (V/Q mismatch) = decreased blood flow to
functioning alveoli or areas of the lung where gas exchange can take place if
perfusion is adequate Results in a high-ventilation/low-perfusion scenario
a high V/Q mismatch.
o Pneumothorax* (pg. 533) = a collection of air in the pleural cavity.
Spontaneous pneumothorax may occur w/pneumonia.
(Textbook chapters: 7, 23, 24, 25, 26)
* Extra resources at end of study guide
(#Q) = amount of questions on Blueprint!
Oxygen Therapy Management – Ch. 7 (3Q)
Indications: PaO2 < 60 mmHg or SaO2 <90%
o extreme caution with patients who are hypoxic and have chronic hypercapnia or
hypercarbia.
Physiology
o Ventilation – Movement of air in and out of the lungs
o Perfusion – Gas exchange of oxygen and CO2 at alveoli-capillary membrane
Oxygen diffuses across the capillary bed that surrounds the alveoli from an area
of higher concentration to the blood, the area of lower concentration.
o Oxygenation – Process of oxygen passively diffusing from alveoli to the blood/tissues.
o Surfactant - Type II cells (pneumocytes) phospholipid and protein covers alveoli to
prevent collapse by reducing surface tension allowing for gas exchange to take place.
Surface tension is the force present within the alveoli of the lungs that causes
the alveoli to collapse surfactant reduces the surface tension, therefore
reducing the tendency of the alveoli to collapse.
o Compliance (ease of expansion of the lungs) less effort is needed to expand.
Pathophysiology
o Hypoxia – Insufficient oxygen to meet the metabolic demands of the cells, tissues, and
organs.
Hypoxia is low oxygen levels in your tissues.
o Hypoxemia – PaO2 level in blood <60 or SaO2 <90- Pa02 and Sa02 are taken from atrial
blood during an arterial blood gas (ABG)
Hypoxemia is low oxygen levels in your blood.
o Dyspnea – Subjective feeling of difficulty breathing.
Noninvasive Oxygen Delivery Methods:
,o Low flow
Nasal cannula
- Delivers 24% (1L/min)-44% (6L/min)
- Used in all care settings and the home.
- Most common
- Most comfortable
- Mobile
- Least expensive
Simple face mask
- Flow rates 5-10 L/min or 40%-60%
- Used short term.
- Helpful for transport
Partial rebreather
- Simple mask with reservoir bag attached
- Reservoir bag filled with oxygen
- Flow rate of 8-10L/min
- 50%-75% oxygen to patient
Non-rebreather
- One-way valves between mask and bag
- One-way valves on side of mask
- Prevents rebreathing of CO2
- Flow rate 10mL-15L/min
- 90% oxygen to patient
o High flow
Venturi COPD
- Most accurate oxygen concentration
- Flow rate 2-15 L/min
- Oxygen concentration 24%-60%
, Aerosol = Indicated for high-humidity oxygen concentration; Post extubation;
Post upper airway surgery; thick secretions.
T-Piece
Face Tent
High flow nasal cannula
o Note specific diseases require specific masks/FiO2! LOOK THIS UP!!!
Complications of Oxygen Therapy:
o Toxicity a result of the administration of an oxygen concentration equal to or greater
than 50% over 24 to 48 hours.
May cause pulmonary edema, atelectasis, and hemorrhage and can progress to
ARDS.
COPD patients high risk!
o Pulmonary embolism = the obstruction of one or more of the branches of the
pulmonary artery by particulate matter that has an origin elsewhere in the body.
S/S: sudden onset of intense dyspnea, pleuritic chest pain, and tachypnea is
usually the first indication that the patient has an acute PE.
- Dyspnea
- Accessory muscle use
- Pleuritic chest pain
- Tachycardia
- Tachypnea
- Crackles upon auscultation
- Cough
- Hemoptysis
- Unilateral lower extremity edema due to the presence of a deep vein
thrombus (DVT); pain in extremity, with redness and warmth
A pulmonary embolus caused by a thrombus can also be caused by a piece of
tumor, amniotic fluid, air, or fat, referred to as a non-thrombotic pulmonary
embolus.
obstruction impaired ventilation-to-perfusion ratio (V/Q ratio) = decreased or
blocked blood flow or perfusion to functioning alveoli.
Ventilation–perfusion mismatch (V/Q mismatch) = decreased blood flow to
functioning alveoli or areas of the lung where gas exchange can take place if
perfusion is adequate Results in a high-ventilation/low-perfusion scenario
a high V/Q mismatch.
o Pneumothorax* (pg. 533) = a collection of air in the pleural cavity.
Spontaneous pneumothorax may occur w/pneumonia.
