Ventilation -Movement of air from the atmosphere to the alveoli (the functional
unit of the lung)
-The act of breathing inspiration and expiration
Respiration -Gas exchange both in the lungs, and ultimately the tissues
Diffusion -Movement of gases from a higher area of concentration to a lower
area across the alveolar-capillary membrane
Perfusion -Blood Flow
-Blood flow to the aveoli, so that gases can be exchanged
-Adequate blood flow through the pulmonary artery
Hypoxemia Decrease in the arterial oxygen tension in the blood
Hypoxia Decrease in oxygen supply to the tissues and cells
Hyoxemic Hypoxia -Decreased oxygen level in the blood resulting in
decreased oxygen diffusion into the tissues
-May be caused by hypoventilation, high altitudes, ventilation-perfusion mismatch
(as in pulmonary embolism), shunts in which the alveoli are collapsed and cannot
provide oxygen to the blood, and pulmonary defects
-Corrected by increasing aveolar ventilation or providing supplemental oxygen
Circulatory Hypoxia -Results from inadequate capillary circulation
-May be caused by decreased cardiac output, local vascular obstruction, low-fow
states such as shock, or cardiac arrest
-Corrected by identifying and treating the underlying cause
Anemic Hypoxia -Result of decreased effective hemoglobin concentration, which
causes a decrease in the oxyegn-carrying capacity of the blood.
-Rarely accompanied by hypoxemia.
,-Carbon monoxide poisoning, because it reduces the oxygen-carrying capacity of
hemoglobin, produces similar effects but is not strictly anemic hypoxia because
hemoglobin levels may be normal
Histotoxic Hypoxia -Occurs when a toxic substance, such as cyanide,
interferes with the ability of tissues to use available oxygen
The nurse is aware that oxygen delivery to tissues is dependent upon
hemoglobin, oxygen content, and cardiac output.
A combination of poor oxygenation, low hemoglobin level, and low cardiac output
may be rapidly fatal
Nursing Assessment
-Health History Common Complaints: Dyspnea, Cough, Sputum Production,
Chest Pain, Wheezing, Clubbing of Fingers & Hemoptysis
Dypsnea: A subjective experience of breathing discomfort that consists of
qualitatively distinct sensations that vary in intensity
-Orthopnea
-Wheeze
-Ask questions such as=What triggers shortness of breath, what makes it better, is
it worse when flat, rating of intensity, the effort required to breathe, etc.
-High Fowler's position may offer relief
-Orthopneic position (patient leaned forward with arms supported on table)
Cough: Reflex that protects the lungs from the accumulation of secretions or the
inhalation of foreign bodies, it can also be a symptom of a number of disorders of
the pulmonary system, or it can be suppressed in other disorders.
-Cough suppressants, antihistamines, decongestants, or nasal corticosteriods can
offer relief
Sputum Production: Reaction of the lungs to any constantly recurring irritant
, -Productive cough is considered more than 30mL/day in sputum
-Increase water intake
-Smoking cessation
Hemoptysis: Vary from blood-stained sputum to a large sudden hemorrhage,
always merit investigation
-Frank bloody sputum may indicate a pulmonary emboli, bronchogenic carcinoma,
or erosion of a bronchial artery by cavitary tuberculosis, whereas blood stained
sputum may indicate inflammation of the nose, nasopharynx, gums, larynx, or
bronchi, or airway trauma from coughing
Chest Pain:
-The nurse assesses the quality, intensity, and radiation of pain, an identifies and
explores precipitating factors and their relationship to the patients position
Wheezing:
-Often the major finding in a patient with bronchoconstriction or airway narrowing
Past and Family History:
-Review Box 8-5 and 8-6 on page 231
-Any previous illnesses
Social History:
-Nurse asks about current or past smoking and calculates pack/year history
-Questions related to sleep-rest patterns
-Tachypnea: Rapid, shallow breathing over 24 breaths a minute.
-Bradypnea: Slower than 10 breaths per minute
-Cheyne-Stokes: Regular cycle in which the rate and depth of breathing increase,
then decrease until apnea occurs.
unit of the lung)
-The act of breathing inspiration and expiration
Respiration -Gas exchange both in the lungs, and ultimately the tissues
Diffusion -Movement of gases from a higher area of concentration to a lower
area across the alveolar-capillary membrane
Perfusion -Blood Flow
-Blood flow to the aveoli, so that gases can be exchanged
-Adequate blood flow through the pulmonary artery
Hypoxemia Decrease in the arterial oxygen tension in the blood
Hypoxia Decrease in oxygen supply to the tissues and cells
Hyoxemic Hypoxia -Decreased oxygen level in the blood resulting in
decreased oxygen diffusion into the tissues
-May be caused by hypoventilation, high altitudes, ventilation-perfusion mismatch
(as in pulmonary embolism), shunts in which the alveoli are collapsed and cannot
provide oxygen to the blood, and pulmonary defects
-Corrected by increasing aveolar ventilation or providing supplemental oxygen
Circulatory Hypoxia -Results from inadequate capillary circulation
-May be caused by decreased cardiac output, local vascular obstruction, low-fow
states such as shock, or cardiac arrest
-Corrected by identifying and treating the underlying cause
Anemic Hypoxia -Result of decreased effective hemoglobin concentration, which
causes a decrease in the oxyegn-carrying capacity of the blood.
-Rarely accompanied by hypoxemia.
,-Carbon monoxide poisoning, because it reduces the oxygen-carrying capacity of
hemoglobin, produces similar effects but is not strictly anemic hypoxia because
hemoglobin levels may be normal
Histotoxic Hypoxia -Occurs when a toxic substance, such as cyanide,
interferes with the ability of tissues to use available oxygen
The nurse is aware that oxygen delivery to tissues is dependent upon
hemoglobin, oxygen content, and cardiac output.
A combination of poor oxygenation, low hemoglobin level, and low cardiac output
may be rapidly fatal
Nursing Assessment
-Health History Common Complaints: Dyspnea, Cough, Sputum Production,
Chest Pain, Wheezing, Clubbing of Fingers & Hemoptysis
Dypsnea: A subjective experience of breathing discomfort that consists of
qualitatively distinct sensations that vary in intensity
-Orthopnea
-Wheeze
-Ask questions such as=What triggers shortness of breath, what makes it better, is
it worse when flat, rating of intensity, the effort required to breathe, etc.
-High Fowler's position may offer relief
-Orthopneic position (patient leaned forward with arms supported on table)
Cough: Reflex that protects the lungs from the accumulation of secretions or the
inhalation of foreign bodies, it can also be a symptom of a number of disorders of
the pulmonary system, or it can be suppressed in other disorders.
-Cough suppressants, antihistamines, decongestants, or nasal corticosteriods can
offer relief
Sputum Production: Reaction of the lungs to any constantly recurring irritant
, -Productive cough is considered more than 30mL/day in sputum
-Increase water intake
-Smoking cessation
Hemoptysis: Vary from blood-stained sputum to a large sudden hemorrhage,
always merit investigation
-Frank bloody sputum may indicate a pulmonary emboli, bronchogenic carcinoma,
or erosion of a bronchial artery by cavitary tuberculosis, whereas blood stained
sputum may indicate inflammation of the nose, nasopharynx, gums, larynx, or
bronchi, or airway trauma from coughing
Chest Pain:
-The nurse assesses the quality, intensity, and radiation of pain, an identifies and
explores precipitating factors and their relationship to the patients position
Wheezing:
-Often the major finding in a patient with bronchoconstriction or airway narrowing
Past and Family History:
-Review Box 8-5 and 8-6 on page 231
-Any previous illnesses
Social History:
-Nurse asks about current or past smoking and calculates pack/year history
-Questions related to sleep-rest patterns
-Tachypnea: Rapid, shallow breathing over 24 breaths a minute.
-Bradypnea: Slower than 10 breaths per minute
-Cheyne-Stokes: Regular cycle in which the rate and depth of breathing increase,
then decrease until apnea occurs.
