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Chapter 39
Chapter 39 Gas Exchange
| Question | Answer |
|---|---|
| Which gas drives respiration? | Carbon dioxide level |
| Wheezing, breathlessness, chest tightness and coughing are characteristics of what reactive airway disease? | Asthma |
| With age the number of alveoli increase or decrease? | Decrease |
| Parasympathetic (cholinergic) stimulation leads to ________ of airways | Narrowing (Bronchoconstriction) |
| Common triggers for asthma include | Allergens, exercise, respiratory tract infection, stress and pollution |
| Pharmacologic triggers include | Aspirin, NSAIDS, Beta blockers |
| During asthma attacks capillary permeability leads to | Mucosal edema and narrowing of airways |
| Late phase asthma response develops within? | 4 to 12 hours |
| Inaudible breath sounds, reduced wheezing and ineffective cough are indicative of? | Respiratory failure |
| What test is done both before and after aerolized bronchodilators? | Pulmonary function tests |
| Peak expiratory flow rate PEFR of 50% to 80% indicates? | A need for medication or treatment |
| PEFR of less than 50% indicates? | Immediate need for bronchodilator and medical treatment |
| An asthmatic person whom exercises in cold weather should? | Wear a mask to retain humid and warm air while exercising |
| Adrenergic stimulants (B agonists) do? | They relax smooth muscle which bronchodilates |
| Adrenergic side effects may include? | Tachycardia and muscle tremors |
| Theophylline is a long term bronchodilator dosed 1-2 x/day and requires that serum levels remain? | 10-20 mcg/L |
| Montelukast (Singulair) reduces inflammatory response in asthma but also decreases the excretion of what drugs? | Warfarin and theophylline leading to liver toxicity |
| Normal peak flow meter measures are? | 300 - 700 L/min |
| Skin condition that often accompanies asthma? | Eczema |
| What positions reduce the work of breathing and increase lung expansion? | Fowler's, High Fowler's and Orthopneic (head and arms supported by over bed table) |
| Immunoglobulin implicated in asthma? | IgE |
| What does increased work of breathing look like? | Increased effort, nasal flaring, pursed lip breathing and use of accessory muscles. |
| Which phase of breathing is prolonged during an asthma attack? | Expiration prolonged 1:3 or 1:4 |
| When should an asthmatic seek medical treatment? | If they do not respond to usual treatment within 30 minutes. |
| Medication used to quickly releive asthma may include? | B2 agonist such as Albuterol and an IV corticosteroid such as Flovent (fluticasone) |
| Bronchitis is characterized by productive cough lasting? | For 3 months in 2 consecutive years. |
| Recurrent infections are common in pt with bronchitis because? | Ciliary function is impaired and they are unable to effectively clear the mucus that has entrapped pathogens. |
| Increasing airflow limitation and dyspnea on exertion are indicative of this stage of COPD? | Stage 2: Moderate COPD |
| Airflow limitation with chronic cough and sputum production? | Stage 1: Mild COPD |
| Sever airflow limitation with impaired quality of life and potential life threatening exacerbations are stage? | Stage 4: Very severe COPD |
| Worsening of airflow limitations, increased SOB and repeated exacerbations impacting quality of life are staged at? | Stage 3: Severe COPD |
| At risk, normal lung function with chronic cough and sputum production is staged at? | Stage 0: At risk |
| Asthma differs from bronchitis and emphsema in that it is? | Reversible |
| Cor pulmonale is indicative of what stage of COPD? | Indicative of late stage COPD |
| Who is most at risk for COPD? | Smokers because smoking results in mucus production, decreased ciliary function and damage to bronchiolar and alveolar walls. |
| Digital clubbing, exertional dyspnea, dusky or cyanotic color, hypoxia, hypercapnia, acidosis, increased respirations and dependent edema are who? | Picture of a patient with chronic bronchitis (blue bloater) |
| In chronic bronchitis airways ultimately become collapsed and the air gets trapped where? | In the distal portions of the lungs |
| Alveoli in a patient with emphysema lose their ability to? | Stretch and recoil |
| In emphysema what enzymes destroy the connective tissue of the lungs? | Protease and elastase |
| Nutrition is important in the care of emphysema patients because? | They are easily fatigued because of the energy they must expend to breath. |
| Increases mucus thickness in emphysema and should therefore be avoided? | Milk products - use Pulmocare instead |
| Because of the reduced elasticity of the alveoli one would expect the patient to retain ? | Carbon dioxide |
| Emphysema patient often speak in ? | Short jerky sentences |
| Thise methylxanthine stimulates respiratory drive, strengthens diaphragmatic contractions and improves cardiac output for COPD patients? | Theophylline |
| Pulmonary hygiene include? | Hydration (2-3L of H20), effective coughing, percussion, postural drainage to improve clearance of airways. |
| What exercises might be prescribed to an emphysema client to strengthen muscles for breathing? | Walking 20 minutes 3x/week, swimming and golfing. |
| Reduction of ? in person's diet helps to reduce mucus production and keep mucus liquefied? | Sodium |
| Patients with cor polumonale are often administered ? in order to shed fluids. | Lasix |
| Chronic bronchitis and emphysema often worsen at night due to? | Decreased muscle tone which leads to hypoventilation, increased resistance and V/Q mismatch. |
| Common psychosocial nursing diagnosis related to asthma, CB and emphysema? | Anxiety and role changes |
| COPD patients should not eat excess carbohydrates because? | Carbohydrates metabolize to produce CO2 and water, the CO2 can exacerbate their condition. |
| Sources of pulmonary embolisms include? | The right side of the heart, DVT, tumors, fat or bone marrow from fractures, amniotic fluid, air and foreign bodies. |
| High incidence of death from an embolism within the first ? hours. | 50% of deaths from pulm embolism occure within the first 2 hours. |
| Female risk factors for pulmonary embolism include? | Oral contraceptives, estrogen therapy, pregnancy and childbirth. |
| When auscultating the lungs of a patient with a pulmonary embolism the nurse will most likely hear? | Crackles because of the pulmonary hypertension |
| SOB,dyspnea,CP,anxiey,low grade fever,cough,tachycardia,tachypnea are indicative of? | Pulmonary embolism |
| Test that is highly specific to the presence of a thrombus? | D-dimer |
| The MOST definitive test for the presence of a pulmonary embolism would be? | Pulmonary angiography - contrast medium injected into pulmonary circulation and an Xray is shot. |
| Due to tachypnea and hyperventilation during pulmonary embolism the nurse would expect the ABG to reflect? | Hypoxemia (paO2 <80mmHg), respiratory alkalosis (pH>7.45,PaCO2<38 mmHg) |
| Streptokinase, urokinase and TPA tisuue plasminogen activator are used to ? | Lyse blood clots,restore pulmonary blood flow, reduce pulmonary artery and right heart pressures. |
| To prevent pulmonary embolism the nurse will encourage? | Ambulations soon after surgery or illness, application of TEDs and SCDs. Leg exercises,stretching and walking during long travel. |
| To prevent pulmonary embolism the nurse will teach the paient to avoid? | Avoid crossing their legs, avoid immobility for long periods of time and avoid placing pillows underneath their knees. |
| Key element to physical assessment of a patient with suspected pulmonary embolism? | Lung sound, breath sounds, LOC, neck vein distention, o2 saturation and peripheral edema. Observe for hypoxemia - cyanosis,confusion and agitation. |
| What position facilitates lung expansion and reduces venous return to the right side of the heart in a patient with PE? | Fowler's or High Fowler's with lower extremities dependent. |
| Early indicator or reduced cardiac output in a patient with PE? | Reduced urine output, be sure to record I&O's accurately. |
| During a PE decreased perfusion due to cardiopulmonary collapse leads to decreased perusion which increases hypoxia and what pH imbalance? | Acidosis |
| Cough,hemoptysis,diaphoresis or syncopal episode. | Clinical manifestations of a PE |
| Years after experiencing a pulmonary embolus the client may develop? | Pulmonary hypertension |
| A client is at risk for increased chance of bleeding post fibrinolytic therapy during this time period? | 24-48 hrs post administration - must assess for overt signs of bleeding in urine, vomitus, stool, gums, bruisin, joint pain, abdominal or flank pain. |
| Normal arterial pressure measure? | 12-15 mmHg |
| Pulmonary hypertension is defined as? | >25 mm Hg at rest or >30 mm Hg during exercise |
| ABG indicators of respiratory failure are? | PaO2 of less than 50 to 60 mmHg and a PaCO2 of greater than 50 mmHg. |
| The lungs are unable to oxygenate the blood and remove carbon dioxide adequately to meet the body's needs even at rest. | Definition of respiratory failure |
| COPD,lung disease,inhalation trauma,neuromuscular disorders and cardiac conditions. | Common causes of respiratory failure. |
| Ventilation above what vertebrae eliminates the clients ability to breath on their own? | The C3 vertebae |
| A client is tachycardic, hypertensive and manifests dyspnea, restlessness and has difficulty with gross motor function. What's happening? | Respiratory failure |
| Early signs of respiratory failure? | Dyspnea and a headache. |
| In late stage respiratory failure what drives breathing if it is no longer increased CO2 and hydrogen ions? | Hypoxemia |
| You are administering oxygen to a client who was/is in respiratory failure. What Sp02 and PaO2 values are you trying to reach or maintain? | An SpO2 of >=90% and a Pa02 of about 60 mmHg |
| Client was extubated 18 hours ago and you hear an inspiratory stridor upon ausculatation. What do you suspect? | Laryngeal edema - may need to be reintubated |
| What operations are at high risk of creating a PE? | Hip,knee,abdominal and pelvic surgeries |
| What is the largest predisposing factor ARDS? | Pancreatitis |
| ABG's during ARDS will initially reflect? | PaCO2 of less than 60 mmHg and respiratory alkalosis due to tachypnea |
| What symptoms might a client with ARDS manifest? | Dyspnea,tachypnea and anxiety. As it progresses intercostal retractions,acessory muscle use and cyanosis despite O2 administration. |
| Why might a patient with ARDS be administered surfactant? | During ARDS the surfactant producing cells within the alveolar are destroyed from the inflammatory process. |
| A patient with ARDS and on a ventilator has developed atelectasis. What position will you place them in? Why? | Prone to reduces the pressure of surrounding tissue on dependent lung regions and improves oxygenation. |
Created by:
biggerstaff
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