NUR 211 Final Exam
- what does the use of accessory muscles indicate
Answer an attempt to increase lung volume that results in fatigue is not effective ventilation. indicates ventilatory fatigue, air hunger, or decreased lung expansion
- how does oxygenation of tissues take place
Answer ventilation; the process of moving gases into and out of the lungs
perfusion; the cardiovascular system pumping oxygenated blood to the tissues and return deoxygenated blood to the lungs diffusion; exchange of respiratory gases in the alveoli and capillaries
- how are respirations regulated (chemical and neural)
Answer neural regulation- CNS controls the respiratory rate, depth, and rhythm and cerbral cortex control voluntary respirations
chemical regulation - maintains the rate and depth of respirations based on changes in the blood concentrations of CO2 and O2 and in pH, SO the chemoreceptors sense these changes in chemicals and stimulate the nervous system to adjust
- Factors affecting oxygenation - physiology
Answer decreased o2 carrying capacity, hypovolemia (low blood volume, less hemoglobin to carry O2 through vessels), decreased inspired O2 conc., increased metabolic rate (infection, sepsis),
- factors affecting oxygenation - chest wall movement
Answer prgnancy, obesity, neuromuscular disease, musculoskeletal deformities, trauma, alterations to CNS
- COPD and oxygenation 1 / 4
Answer -these pts have adapted to a high level of CO2, so the CO2 sensitive receptors do not function
-COPD pts stimulus to breathe is low O2, while normally it is high CO2 -receptors in the aortic arch and carotid bodies are sensitive to low O2 level causing increased ventilation when low O2 -SO, administering high levels of O2 to these pts prevents their O2 level from falling and stimulating the receptors, which REMOVES THEIR STIMULUS TO BREATHE
- hyper and hypo ventilation
Answer hyper- breathing in excess of what is required to remove CO2
hypo- inadequate breathing to meet bodys O2 demands or needs to eliminate CO2
- nursing notes on oxygenation - developmental factors
Answer -mental status changes are 1st sign of respiratory problem
-may not complain of dyspea until it affects ADLs
- changes in coughing mechanism may lead to retention of secretions and atelecta- sis (when
using cough suppressants) -diminshed respiratory muscles from changes in thorax lead to issues w chest expansion
- nursing note on oxygenation - lifestyle
Answer smoking (heart disease, COPD, lung cancer), substance abuse (impairs tissue perfusion), stress (increases metabolic rate and oxygen demand of the body)
- nursing note on oxygenation - environmental factors
Answer the incidence of pulmonary disease is higher in smoggy, urban areas
-work place risks include asbestosis, coccidiodomycosis
- thorough assessment of oxygenation and systems 2 / 4
Answer past impairments of circulatory or respiratory function, methods pt uses to optimize oxygenation, review of allergies, physical examination, lab and diagnostic tests.
-HX of chest pain, dyspnea, wheezing, resp. infections, meds, fatigue, cough, smoking, exposures -EXAMINE skin and mucous membranes, LOC, breathing patterns, chest wall movement, palpate chest, feet, legs, pulses, auscultate heart and lung sounds
- how to assess breath sounds
Answer rate, volume (shallow or deep), rhythm (regular or irregular), effort, AP
Answer LAT diameter (1
Answer 2), cough (productive or not) - amt., color, consistency, odor
- what causes decreased or absent breath sounds
Answer pneumothorax, emphyse- ma, removed lung lobes, obstruction, atelectasis
- difference between hypoxia and hypoxemia
- what is a more invasive way than pulse oximetry of determining level of oxygenation
Answer hypoxia - inadequate tissue oxygenation at cell level hypoxemia - low level of oxygen in arterial blood
Answer arterial blood gases (ABGs) - invasive way to measure partial pressure of O2 in blood.
NORMAL 80-100
- acute hypoxia
Answer SUDDEN - causes? - obstructed airway, pulmonary embolism, impaired ventilation (asthma, 3 / 4
pneumonia)
SX- anxious, sitting up, increased RR and HR, confusion, behavior changes, nasal flaring - cyanosis is a late sign
- chronic hypoxia
Answer long term - Causes? - COPD, anemia, impaired ventilation, cardiac abnormalities
SX- fatigue, lethargy, clubbed fingers, barrel chest, SOA, paroxysmal nocturnal dyspnea, orthopnea, activity intolerance
- define orthopnea
Answer shortness of breath that occurs when lying flat
- an H+H diagnostic blood test
Answer hematocrit - % of total blood volume made up by RBCs
MALE - 42-52% FEMALE - 37-47%
= decreased levels are called anemia hemoglobin - iron containing pigment of RBC MALE - 14-
18 FEMALE 12-16
- ways to promote oxygenation
Answer monitor hydration, humidification, administer inhalant medications (expectorants, mucolytics, bronchodilators, anti inflammatory
agents), teach coughing and breathing, perform chest physiotherapy, suction airway, artificial airways
- what is a method that a nurse can teach the pt to do to increase air to lower lungs
Answer diaphragmatic breathing - belly breathing
- what is a method you can teach your pts to prevent alveolar collapse
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