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28 Cards in this Set

  • Front
  • Back
Purposes of the Respiratory System
Gas exchange- transfer of oxygen and CO2 between the atmosphere and blood.
Maintain acid-base balance
Sense of smell
Fluid balance
Upper Respiratory Tract
Nose and sinuses- warm, moisten and filter air; promote vocal resonance
Pharynx and Tonsil- filter bacteria or foreign matter
Larynx- major function is vocalization
Trachea- -or windpipe serves as the passage between the larynx and the bronchi
Lower Respiratory Tract
Alveolar ducts and alveoli
Filter dust and bacteria
Warm air to body temperature
Humidify air
Surfactant production by alveoli
Physiology of Respiration
Ventilation- the mechanical movement of gas or air into and out of the lungs.
Respiration- the exchange of O2 and CO2 during cellular metabolism.
Neurochemical Control of Ventilation
Respiratory center— transmits impulses to the respiratory muscles causing them to contract and relax.
Chemoreceptors– central and peripheral
Central – monitor arterial blood indirectly by sensing changes in the ph.
Peripheral- primarily sensitive to O2 levels in arterial blood.
Factors the Affect the Mechanics of Breathing
Major and accessory muscles—diaphragm and external intercostal muscles.
Elastic properties of the lung and chest wall.
Elastic recoil- tendency of the lungs to return to the resting state after being stretched or distended.
Compliance– measure of lung and chest wall distensibility. It represents the relative ease with which these structures can be stretched.
Airway Resistance- edema, obstruction, bronchospasm.
Physiology of Respiration
Pulmonary circulation or perfusion (blood flow through the pulmonary circulation)
RV---PA ( R and L)—Alveolar-capillary membrane (gas exchange or diffusion)– PV- LA- LV
Ventilation-Perfusion (V/Q)
Ventilation is the movement of gas in and out of the lungs (V).
Perfusion is the filling of the pulmonary capillaries with blood (Q).
Normal V/Q ratio is 1:1.
Conditions that Result In V/Q Mismatch
Increased secretions in the airways (COPD); alveoli (pneumonia), and when bronchospasm is present (asthma).
Alveolar collapse (atelectasis)
Pulmonary embolus—affects perfusion—limits blood flow but has no effect on airflow to the alveoli
Terminology for Ventilatory Insufficency
Hypoxia- deficiency of O2.
Anoxia- without O2.
Hypercapnia- increased amount of CO2 in blood.
Cheyne-Stokes- period of apnea followed by increasing depth and frequency or resp.
Kussmaul breathing- abnormally deep, very rapid sighing respirations.
Physical Assessment
Patient history
Patient History (Upper Respiratory)
Upper Airway
hx of mouth breathing
hx of sinus surgery and/or sinusitis
pain on swallowing
presence of nasal discharge, allergy
change in voice: hoarseness
hx of smoking/alcohol use
Patient History (Lower Respiratory)
Lower Airway
chest pain
cough/sputum production
current medications
Patient History (Use of Oxygen)
Use of Oxygen
Nasal cannula- 1-6 l/min (24%-44%)
Simple mask- 40%-60%. Minimum flow rate 5l/min to prevent rebreathing of exhaled air.
Partial rebreather mask- 60-75% with flow rate of 6-11 l/min.
Nonrebreather mask- >90%
Venturi mask- high flow system; delivers the most accurate O2 concentration-24%-100%
Chest shape and size
Spinal deformities
Skin color, scars, lesions
Type of breathing
Use of accessory muscle
Respiratory rate, depth and rhythm
Symmetry of chest expansion
Tracheal position
Patient Assessment
Percussion- assesses density or aeration of the lungs.
Diaphragm position and movement
Pleural friction rub- creaking or grating sound from roughened, inflamed pleural surface
Diagnostic Studies of the Respiratory System
Blood studies- CBC, ABGs
Sputum studies--Gram stain, C and S, AFB, cytology
Skin tests
Radiologic studies
Chest X-ray V/Q Scan
CT scan/MRI Pulmonary Angiography
PET (Positron Emission Tomography)
Diagnostic studies
Lung Biopsy
Pulmonary Function tests
Arterial Blood Gases
Assess adequacy of oxygenation.
Assess alveolar ventilation
Assess acid-base balance
Monitor patients on ventilators
Establish pre-op baseline parameters
Enlighten electrolyte therapy
Acid-Base Balance
pH: 7.35-7.45
Regulated by chemical, respiratory and renal mechanisms
Change in ph will cause:
Hormone and electrolyte changes, alterations in membrane response and drug uptake.
Acidosis- pH <7.35
Alkalosis- pH >7.45
Components of ABGs
pH 7.35-7.45
PaCO2 35-45 mm Hg
HCO3 22-26 mEq/L
PaO2 80-100 mm Hg
SaO2 93-100%
Arterial Oxygenation
PaO2- amount of O2 dissolved in plasma; Partial pressure exerted by O2 as it diffuses across the alveolocapillary membrane.
SaO2- Percentage of O2 bound to Hg. Changes in Hg concentration affect oxygenation.
ABG Analysis
Examine the PaO2 and SaO2 values to determine oxygen status.
Evaluate each component. Is it acid, or base, or normal?
← Acid (ph 7.35 - 7.45) Base →
← Base (PCO2 35-45) Acid →
← Acid (HCO3 22-26) Base →
ABG Analysis
Determine the extent of compensation.
-Complete= pH is normal
-Partial= pH is abnormal, the value that does not match the PH is not normal.
-Absent= pH is abnormal and the component that does not match the pH is normal (i.e. no compensation occurring yet.)
Interpreting ABGs
J. B, 68, with Acute Pneumonia. He has productive cough, circumoral cyanosis, labored breathing at 28/min and he is using accessory muscle to breath.
PaO2 56 mmHg
SaO2 88%
pH 7.32
PaCo2 50 mmHg
HCO3 24 mEq/L
Interpreting ABGs (answer)
PaO2= 56: SaO2=88%
PaO2 < 80 and SaO2 <93% indicate hypoxemia
2. pH=7.32= (Acid) Acidosis
PCO2=50= (Acid) Acidosis
3. pH and PCO2 match= respiratory acidosis
4. pH is abnormal and HCO3 is normal= no compensation.
Uncompensated respiratory acidosis (Nursing Dx)
Conclusion: Uncompensated respiratory acidosis.
Nursing Dx: Ineffective airway clearance; Impaired Gas Exchange
Interventions: O2; remove secretions to maintain airway patency; HOB elevated for maximum lung expansion.