MS Gas Exchange – Flashcards

"The process by which oxygen is transported to cells and carbon dioxide is transported from cells"

1. sitting up/tripod 2. Lying horizontally

1. Tachypnea 2. O2 below 95% 3. Tachycardia 4. Elevated temp (may) 5. Anxious 6. Impaired mentation (may) 7. Thorax may be asymmetric with unequal thoracic expansion unilaterally 8. Trachea shift from midline away from lung that is experiencing pneumothorax

• Ischemia • Hypoxia- the state in which the PaO2 has fallen sufficiently to cause signs and symptoms of inadequate oxygenation. • Hypoxemia- low oxygen tension in the blood characterized by a variety of nonspecific clinical signs and symptoms. • Anoxia

Oxygen inhalation into lungs and carbon dioxide exhalation from the lungs

Availability and ability of Hgb to carry O2 from alveoli to cells and to carry CO2 from cells to alveoli to be eliminated

"ability of blood to transport oxygen-containing Hgb to cells and return CO2-containing Hgb to alveoli" (Giddens)

1. Ineffective ventilation 2. Reduced capacity for gas transportation (reduced Hgb and/or RBCs) 3. Inadequate perfusion

• Decreased production of RBCs • Increased loss of RBCs • Premature destruction of RBCs

• Labs: ABG, CBC, sputum culture, biopsy • Radiologic studies: Chest x-ray, CT, MRI, ventilation/perfusion (V/Q) scan, positron emission tomography (PET) scan • Pulmonary function studies • Endoscopy • Other Diagnostic Tests • Pulse oximetry • Chest X-Ray • V/Q Lung Scan • Computerized Tomography (CT) • Pulmonary Angiography • CBC • Lung Biopsy • Sputum exam

• pH 7.45 indicates alkalosis • pH: 7.35-7.45 • PaCO2: 35-45 • PaO2: 75-100 • HCO3: 24-28

1. Infection control 2. Smoking cessation 3. Preventing post-op pulmonary complications • Deep breathing and coughing Q 2 hours • Incentive spirometer • Elastic stockings • Anticoagulant therapy • Early ambulation

1. Ineffective airway clearance 2. Ineffective breathing pattern

- Monitor skin color, temp, and LOC - Assess ABG results and pulse-ox - Proper positioning and O2 prn - Nebulizer treatments - Chest physiotherapy - Encourage fluids - Provide endotracheal suctioning prn

- Monitor vitals and labs - Assist pt with ADSs as needed - Provide rest periods - Admin meds as ordered, including bronchodilators and anti-inflammatory drugs - Teach breathing techniques: • Pursed-lip breathing • Abdominal breathing • Relaxation techniques

True.

1. Aspiration 2. Inhalation 3. Hematogenous spread from primary infection elsewhere in body

- Occurs in pts who have not been hospitalized/resided in a LT care facility within 14 days of the onset of sx. - Can be treated at home or hospitalized dependent on pt condition. - Empiric antibiotic therapy started asap

- HAP: Occurring 48 hours or longer after admission and not incubating at time of hospitalization - VAP: Occurring more than 48 hours after endotracheal intubation - HCAP: New onset pneumonia in a patient who • Was hospitalized for 2+ days w/in 90 days of infection -OR- • Resided in LT care facility -OR- • Received recent IV antibiotics, chemotherapy, or wound care within past 30 days -OR - • Attended a hospital or hemodialysis clinic

• Pain Management • Elevate HOB 30 degrees and have sit up for all meals. • Early mobilization • Incentive spirometry • Bid oral hygiene • Strict medical asepsis • Hand hygiene • Respiratory devices • Suctioning • Avoid unnecessary antibiotic usage

o Frequent assessments o Prompt initiation of antibiotics o Oxygen therapy o Hydration o Nutritional support o Breathing exercises o Early ambulation o Therapeutic positioning o Pain management

• Pleurisy • Pleural effusion • Atelectasis • Bacteremia • Empyema • Pericarditis • Meningitis • Sepsis • Acute respiratory failure • Pneumothorax

- Emphasize need to take course of meds - Drug-drug and drug-food interactions - Adequate rest - Adequate hydration - Avoid alcohol and smoking. - Cool mist humidifier - Warm baths - Chest x-ray, vaccinations

- Chronic inflammatory disorder of airways - Characterized by: recurrent episodes of breathlessness, wheezing, chest tightness, and coughing, Tachypnea, Tachycardia, Anxiety, Apprehension * Inhaled air mixes with trapped air and impairs gas exchange

- Severe, prolonged asthma that does not respond to routine treatment • May lead to respiratory failure without aggressive treatment • Endotracheal intubation, mechanical ventilation, and aggressive drugs may be needed to sustain life

• Focus on controlling symptoms and preventing acute attacks • During acute attacks, therapy focused on restoring alveolar ventilation and airway patency • Peak expiratory flow rate (PEFR) used daily to assess the severity of bronchial hyper-responsiveness • Preventive measures- Avoiding allergens and environmental triggers

• Primary drugs for LT control: LT bronchodilators, anti-inflammatory agents, and leukotriene modifiers • Quick relief drugs provide relief of airflow obstruction and bronchoconstriction with associated cough, wheezing, and chest tightness • Short-acting adrenergic stimulants, anticholinergic drugs, and methylxanthines

o Pts with chronic airflow obstruction due to emphysema and/or chronic bronchitis o Slowly progressive, nonreversible airway obstruction o Periodic exacerbations oftentimes related to respiratory infection o Progressive destructive changes o Chronic bronchitis with excessive mucus production, persistent airway edema, and impaired airway clearance o Emphysema with loss of alveolar walls, airway support, and capillary bed o Most pts have a combination

o Disorder of excessive bronchial mucus, with a chronic productive cough, bronchial edema, and bronchospasm o Onset: After age 35 o Cigarette smoking

o Alveolar wall destruction o Gas exchange affected due to reduced surface area for alveolar-capillary diffusion o Airway instability o Onset: After age 50 (insidious progressive dyspnea) o Cigarette smoking

1. Ineffective airway clearance 2. Imbalanced nutrition: less than body requirements

o Assess respiratory status and ABG results o Weigh patient daily and monitor I;Os o Encourage fluid intake and provide rest periods o Proper positioning and encourage movement o Assist patient with coughing and deep breathing o Collaborate with RT o Admin bronchodilator and expectorant meds as ordered o Provide supplemental oxygen as needed

o Assess nutritional status o Monitor labs o Observe and document food intake o Dietician referral as needed o Frequent, small feedings with supplements in between o Proper positioning for meals o Encourage food selections preferable to patient o Snacks at the bedside- High calorie high protein o Mouth care prior to meals

A nurse is caring for a cachectic patient with COPD. The nurse know the teaching has been effective when the patient states: A) I should drink a lot of water with my meals B) I should eat a diet high in fiber C) I should eat mostly protein and vegetables D) I can eat all the ice cream I want!

B Tobacco use is the most preventable cause of death and disease and is the most important risk factor in the development of impaired gas exchange. Age is not a modifiable risk factor. Drug overdose and immobility both contribute to impaired gas exchange but are not as significant as tobacco use.

B Oxygen and carbon dioxide move across the alveolar membrane based on the partial pressure of each gas. Molecules of oxygen are not exchanged for molecules of carbon dioxide. The pressure gradient of each gas (carbon dioxide and oxygen) in the alveoli is responsible for the movement of each gas.

B The ABG results will indicate the acid-base balance of the arterial blood and the partial pressure of oxygen and carbon dioxide. The ABG does not reveal the ratio of hemoglobin and hematocrit, the adequacy of oxygen transport to the cells, or the presence of a pulmonary embolus.

A. Glucocorticoids (corticosteroids) decrease inflammation and prevent bronchospasm in the patient with asthma. The glucocorticoids are used to prevent problems. Anticholinergics decrease the allergic response and decrease sneezing and rhinorrhea. Antitussives are used to decrease cough, and mucolytics assist in the removal of mucus. Sympathomimetic agents (beta2 agonist) are used to relieve bronchospasm in an acute episode.

D The normal respiratory drive is a person's level of carbon dioxide (CO2) in the arterial blood. The COPD patient had compensated for his chronic high levels of CO2, and his respiratory drive is dependent on his oxygen levels, not his CO2 levels. If the COPD patient's oxygen level is rapidly increased to what would be considered a normal level, it would compensate for his respiratory drive. The patient with COPD who has difficulty breathing should be given low levels of oxygen and closely observed for the quality and rate of ventilation. A dose of glucocorticoids will not address his immediate needs, but it may provide decreased inflammation and better ventilation over an extended period of time. Encouraging coughing and deep breathing in a patient with COPD does not meet his needs as effectively as administration of low-level oxygen does.

D. When air is allowed to enter the pleural space, the lung will collapse and a chest tube will be inserted to remove the air and reestablish negative pressure in the pleural space. Patients with asthma do not require a chest tube. A bronchoscopy is done to evaluate the bronchi and lungs and to obtain a biopsy. A thoracentesis may be done to remove fluid from the pleural space. A chest tube may be inserted if there are complications from the thoracentesis or for the bronchoscopy.