NU 170
EXAM 1 STUDY GUIDE
Maternal-Child Nursing
Galen College of Nursing
,CARE OF PATIENTS WITH COMPLEX RESPIRATORY PROBLEMS
Structures of the lungs
- Trachea, left/right bronchus, segmental bronchus, subsegmental bronchus, alveoli
- Visceral pleura/parietal pleura lubrication
- Right side of lung (3 lobes)
o Usually aspirate on this side r/t longer/straighter airway
Gas Exchange Structures
- Bronchiole, terminal bronchiole, respiratory bronchioles, alveoli
The Alveoli
- Have about 290 million
- Type 2 pneumocytes secrete surfactant (fatty protein) to keep the alveoli open and keep fluid
away from alveoli
Gas Exchange
- Breath O2 in O2 goes into blood stream CO2 releases from blood stream blow CO2 out
COPD: effect on lungs
- Healthy alveoli expand and contract giving adequate perfusion
- COPD alveoli have lost elasticity and rely on the impulse from the brain when the CO2 in their
blood is too high causing their drive to breath to happen automatically (like kussmaul respirations)
o COPD consists of Emphysema and Chronic Bronchitis
Causing bronchial spasms and dyspnea
Bronchitis and Emphysema
- Chronic Bronchitis
o Caused by smoking, characterized by inflammation and structural changes
o Causes excessive secretions (mucous plug)
- Emphysema
o Elastic fibers destroyed leading to hyperinflation
Acute Respiratory Failure
- Progressive or sudden
- Deterioration of gas exchange function in the lungs
o Hypoxemia – PaO2 of less than 50 mmHg (normal 80-100)
o Hypercapnia – PaCO2 greater than 50 mmHg
Decreased LOC if this happens call the Doc to get blood gas
o Acidosis – pH less than 7.35 (normal 7.35 – 7.45)
- Ventilatory failure – Can’t get O2 in
o Asthma, sleep apnea, myasthemia gravis
- Oxygen failure – O2 getting in but it isn’t getting picked up
o Pneumonia, ARDS, PE, shock
Blood Gas Values
- pH = 7.35 – 7.45, pCO2 = 35 – 45 (respiratory), HCO3 = 22 – 28 (metabolic)
- Increased CO2 = acid build-up, acidosis; Increased HCO3 = alkaline build-up, alkalosis
- ROME (Respiratory Opposite, Metabolic Equal)
1
, Pathophysiology of Respiration
- Occurs at the alveolar capillary units exchange of oxygen and carbon dioxide oxygen
attaches to the circulating hemoglobin molecules 2 processes occur, ventilation and perfusion
- V/Q scan measures how well the alveoli are being ventilated and perfused
o Radioactive dye used to find PE
o Ventilation – perfusion mismatch = PE
Causes of Acute Respiratory Failure
- Decreased respiratory drive (narcotics, COPD w/ too much O2)
- Obstruction of the airways (Bronchitis, sleep apnea, asthma)
- Trauma (Injury to the lung tissue or chest wall)
- Dysfunction of the chest wall (spinal cord injury, any condition that affects breathing)
- Disorders (sleep apnea, PE, overdose of opiods/alcohol)
Clinical Manifestations of Acute Respiratory Failure
- Early: Impaired O2 (give O2), restlessness, fatigue (promote rest), headache, dyspnea, air
hunger, tachycardia, increased BP
o Use interventions
- Progressive: Confusion, lethargy, tachycardia, tachypnea, central cyanosis, diaphoresis,
respiratory arrest
o Call rapid response
- Intervention Rapid response ICU
Medical Management
- Increased oxygenation, intubation, mechanical ventilation, ICU, bronchodilators, antibiotics, anti-
inflammatories
Nursing Management
- Anticipate and assist with intubation
- Monitor (assess): LOC, RR, O2, ABGs continuous pulse oximetry
- Prevent ventilator associated pneumonia
Acute Respiratory Distress Syndrome (ARDS)
- Severe form of acute lung injury, usually results in death
- Starts with Acute Respiratory Failure sudden, progressive pulmonary edema with
increasing bilateral infiltrates in lungs
- Refractory hypoxemia – giving pt 100% FiO2 but it isn’t making a difference in O2 stat
- Reduced lung compliance
Causes of Acute Respiratory Distress Syndrome (ARDS)
- Aspiration – acid destroys alveoli/surfactant leads to inflammation
- Drug ingestion and overdose
- Hematologic disorders (DIC massive transfusions)
o TRALI – Transfusion related acute lung injury
- Prolonged inhalation of smoke or corrosive substances, near drowning
- Infection (pneumonia)
- Metabolic disorders
- Shock, trauma, major surgery
2
EXAM 1 STUDY GUIDE
Maternal-Child Nursing
Galen College of Nursing
,CARE OF PATIENTS WITH COMPLEX RESPIRATORY PROBLEMS
Structures of the lungs
- Trachea, left/right bronchus, segmental bronchus, subsegmental bronchus, alveoli
- Visceral pleura/parietal pleura lubrication
- Right side of lung (3 lobes)
o Usually aspirate on this side r/t longer/straighter airway
Gas Exchange Structures
- Bronchiole, terminal bronchiole, respiratory bronchioles, alveoli
The Alveoli
- Have about 290 million
- Type 2 pneumocytes secrete surfactant (fatty protein) to keep the alveoli open and keep fluid
away from alveoli
Gas Exchange
- Breath O2 in O2 goes into blood stream CO2 releases from blood stream blow CO2 out
COPD: effect on lungs
- Healthy alveoli expand and contract giving adequate perfusion
- COPD alveoli have lost elasticity and rely on the impulse from the brain when the CO2 in their
blood is too high causing their drive to breath to happen automatically (like kussmaul respirations)
o COPD consists of Emphysema and Chronic Bronchitis
Causing bronchial spasms and dyspnea
Bronchitis and Emphysema
- Chronic Bronchitis
o Caused by smoking, characterized by inflammation and structural changes
o Causes excessive secretions (mucous plug)
- Emphysema
o Elastic fibers destroyed leading to hyperinflation
Acute Respiratory Failure
- Progressive or sudden
- Deterioration of gas exchange function in the lungs
o Hypoxemia – PaO2 of less than 50 mmHg (normal 80-100)
o Hypercapnia – PaCO2 greater than 50 mmHg
Decreased LOC if this happens call the Doc to get blood gas
o Acidosis – pH less than 7.35 (normal 7.35 – 7.45)
- Ventilatory failure – Can’t get O2 in
o Asthma, sleep apnea, myasthemia gravis
- Oxygen failure – O2 getting in but it isn’t getting picked up
o Pneumonia, ARDS, PE, shock
Blood Gas Values
- pH = 7.35 – 7.45, pCO2 = 35 – 45 (respiratory), HCO3 = 22 – 28 (metabolic)
- Increased CO2 = acid build-up, acidosis; Increased HCO3 = alkaline build-up, alkalosis
- ROME (Respiratory Opposite, Metabolic Equal)
1
, Pathophysiology of Respiration
- Occurs at the alveolar capillary units exchange of oxygen and carbon dioxide oxygen
attaches to the circulating hemoglobin molecules 2 processes occur, ventilation and perfusion
- V/Q scan measures how well the alveoli are being ventilated and perfused
o Radioactive dye used to find PE
o Ventilation – perfusion mismatch = PE
Causes of Acute Respiratory Failure
- Decreased respiratory drive (narcotics, COPD w/ too much O2)
- Obstruction of the airways (Bronchitis, sleep apnea, asthma)
- Trauma (Injury to the lung tissue or chest wall)
- Dysfunction of the chest wall (spinal cord injury, any condition that affects breathing)
- Disorders (sleep apnea, PE, overdose of opiods/alcohol)
Clinical Manifestations of Acute Respiratory Failure
- Early: Impaired O2 (give O2), restlessness, fatigue (promote rest), headache, dyspnea, air
hunger, tachycardia, increased BP
o Use interventions
- Progressive: Confusion, lethargy, tachycardia, tachypnea, central cyanosis, diaphoresis,
respiratory arrest
o Call rapid response
- Intervention Rapid response ICU
Medical Management
- Increased oxygenation, intubation, mechanical ventilation, ICU, bronchodilators, antibiotics, anti-
inflammatories
Nursing Management
- Anticipate and assist with intubation
- Monitor (assess): LOC, RR, O2, ABGs continuous pulse oximetry
- Prevent ventilator associated pneumonia
Acute Respiratory Distress Syndrome (ARDS)
- Severe form of acute lung injury, usually results in death
- Starts with Acute Respiratory Failure sudden, progressive pulmonary edema with
increasing bilateral infiltrates in lungs
- Refractory hypoxemia – giving pt 100% FiO2 but it isn’t making a difference in O2 stat
- Reduced lung compliance
Causes of Acute Respiratory Distress Syndrome (ARDS)
- Aspiration – acid destroys alveoli/surfactant leads to inflammation
- Drug ingestion and overdose
- Hematologic disorders (DIC massive transfusions)
o TRALI – Transfusion related acute lung injury
- Prolonged inhalation of smoke or corrosive substances, near drowning
- Infection (pneumonia)
- Metabolic disorders
- Shock, trauma, major surgery
2
