Ventilation
mechanical process of moving air in and out of the lungs
Inspiration
air is being drawn into the lungs
expiration
air leaves the lungs
More airway resistance...
less air flowing into the chest cavity
Lung compliance
change in volume of the chest cavity that results from a specific change in pressure within the chest cavity. Ease with which the chest expands.
More chest expands...
greater lung compliance
Diffusion
process by which gases move between the alveoli and the pulmonary capillaries
Lung Perfusion
circulation of the blood through lungs or pulmonary capillaries
Hemoglobin
protein that carries oxygen through the blood
Oxyhemoglobin
hemoglobin with oxygen
deoxyhemoglobin
hemoglobin without oxygen
Lung perfusion is dependent on...
Adequate blood volume
intact pulmonary capillaries
Efficient pumping of blood by the heart
Carbaminohemoglobin
CO2 is bound to hemoglobin
Respiration
exchange of gases between a living organism and its environment
Cheyne-Stokes respirations
Ventilatory pattern with progressively increasing tidal volume with decreasing volume followed by periods of apnea. Seen in older patients with terminal illness or brain injury
Kussmual's respirations
Deep, rapid breaths. Results from diabetic ketoacidosis that produce metabolic acidosis
Central neurogenic hyperventilation
Deep, rapid respirations. Caused by strokes or injury to the brainstem
Biot's respiration
repeated episodes of gasping ventilations separated by periods of apnea
Apneustic Respirations
long, deep breaths that stop at the inspiratory phase separated by periods of apnea. Result of stroke or severe central nervous system disease.
General Impression of Patient...
Position
Color
Mental status
Ability to speak
Respiratory effort
Pulsus paradoxus
a drop in systolic pressure greater than 10 mmHg
Tachypnea
Respiratory pattern that exceeds a rate of 20 breaths per min
Bradypnea
respiratory pattern that has a rater slower then 12 breaths per min
Acute Respiratory Distress Syndrome(ARDS)
Disorder of lung diffusion that results from increased fluid in the interstitial space. A life-threating condition that adversely affects gas exchange in the lungs. A form of Pulmonary Edema.
ARDS assessment
History of prolonged hypoxia, head/chest trauma, inhalation of gases. Patients with noncardiogenic pulmonary edema have dyspnea, confusion and agitation. Reports of fatigue and reduced exercise ability. Crackles and wheezing may be heard
ARDS management
supplemental O2 is essential for all patients with hypoxia. Establish IV access. Establish cardiac monitor. Suction lung secretions to maintain airway patency. CPAP for patients demonstrating respiratory failure. PEEP via CPAP will help maintain patency o
Emphysema
destruction of the alveolar walls distal to the terminal bronchioles. From continued exposure to noxious substances, such as cigarette smoking.
Emphysema Assessment
History of weight loss, increased dyspnea on exertion, and progressive limitation of physical activity. Question patient about history of cigarette smoking and tobacco use. Barrel chest evidenced increased in the anterior/posterior chest diameter. Tend to
Emphysema Management
Same as chronic bronchitis
Chronic Bronchitis
increase in the number of goblet cells in the respiratory tree. Gas exchange is decreased.
Chronic Bronchitis assessment
History of heavy cigarette smoking and respiratory infections. Productive cough for at least three months per year for 2+ consecutive years. Overweight and can be cyanotic "Blue Bloaters". Auscultation reveals rhonchi due to occlusion of the larger airway
Chronic Bronchitis managment
Monitor patient and prepare to assist in ventilations. Supplimental O2 may decrease respiratory drive and inhibit ventilation. Establish an airway. Apply pulse ox and determine SPO2. CPAP may prevent the need for ET intubation. ET if respiratory failure i
Asthma
chronic inflammatory disorder of the airways. May be induced by "triggers
Asthma assessment
Dyspnea, wheezing, and cough. Severe asthma attack; 1-2 word dyspnea, pulsus paradoxus, tachycardia, and decrease O2 saturation. Obtain a brief history. Determine when symptoms started and what the patient has taken to abort the attack. Question if the pa
Asthma Management
Administer supplemental oxygen to correct hypoxia. Establish IV access and place patient on monitor. Direct initial treatment to reverse bronchospasm. Monitor patient's response to drugs. Be prepared to provide adequate airway management and respiratory s
Upper Respiratory Infection (URI)
most common infections for which patients seek medical attention. Mainly caused by Viri and bacteria.
URI assessment
fever, chills, muscle pains, and fatigue.
URI management
Supplement O2 to any patients with underlying pulmonary disease wit hypoxia. Acetaminophen or ibuprofen to treat headaches and muscle pain.
Pneumonia
infection of the lungs. Elderly and patients with HIV most effected. Bacterial and Viral most common.
Pneumonia assessment
Recent history of fever and chills, weakness, and malaise. Deep productive cough with yellow/brown sputum, pleuritic chest pain. Fatigue, muscle aches, sore throat, abdominal complaints including nausea, vomiting, and diarrhea.
Pneumonia management
Place patient in comfortable position and administer supplemental O2 to correct hypoxia. Severe cases, ventilatory assistance is needed and ET intubation. Establish IV access. Administer fluids if dehydration is appropriate. Give antipyretic agents to red
Severe Acute Respiratory Syndrome (SARS)
Viral respiratory illness. Person is considered infectious as long as he has the symptoms.
SARS assessment
altered mental status, one-two word dyspnea, cough, cyanosis, and hypoxia, sore throat, runny nose, muscle aches, headache, and diarrhea.
SARS management
Place patient in comfortable position and administer supplemental O2 to correct hypoxia. Severe cases, ventilatory assistance is needed and ET intubation. Establish IV access. Administer fluids if dehydration is appropriate. If wheezing, administer nebuli
Lung Cancer
Inhalation of Asbestos and arsenic.
Lung cancer assessment
altered mental status, 1-2 word dyspnea, cyanosis, hemoptysis, hypoxia. Cough, hoarseness, vague chest pain, Crackles, rhonchi, wheezing.
Lung Cancer management
Supplemental O2. IV of 0.9% normal saline. Bronchodilator agents and corticosteroids when signs of obstructive lung disease are present.
Toxic Inhalation
Superheated air, toxic products of combustion, chemical irritants, and inhalation of steam
Toxic inhalation assessment
Determine nature of inhalant or combusted material. Was there LOC? Note any burns or particulate material. Wheezing may indicate bronchospasm
Toxic inhalation management
Ensure safety of personnel. Remove patient from hazardous environment. Establish and maintain airway. Administer humidified O2. As precaution place saline lock.
Carbon monoxide inhalation
odorless, tasteless, colorless, gas produced by incomplete burning of fossil fuels and other carbon containing compounds.
CO assessment
Headache, nausea/vomiting, confusion, agitation, loss of coordination, chest pain, loss of consciousness and seizures
CO management
Safety of personnel. Remove patient from environment. Ensure and maintain airway. O2. If patient is breathing apply CPAP that is TIGHTLY FITTED.
Pulmonary Embolism (PE)
Blood clot or some other particle that lodges in a pulmonary artery
PE assessment
Signs and symptoms vary due to size and location. Severe unexplained dyspnea. May have a cough that is not productive. Physical exam may reveal labored breathing, tachypnea, and tachycardia.
PE management
Supplemental O2. Saline lock. Quick transport to nearest hospital.
Spontaneous Pneumothorax
Occurs in absence of blunt or penetrating trauma.
Spontaneous Pneumothorax assessment
sudden onset of sharp, pleuritic chest or shoulder pain. Dyspnea, decreased breath sounds, tachypnea, diaphoresis, pallor.
Spontaneous Pneumothorax management
Mainly supplemental O2 is all that is required. Place the patient in a comfortable position.
Hyperventilation Syndrome
occurs in anxious patients
Hyperventilation syndrome assessment
rapid breathing, chest pain, numbness. History of fatigue, nervousness, dizziness, dyspnea, tingling around the mouth, hands and feet. Anxious patient. May have spasms in the fingers and feet.
Hyperventilation syndrome management
Instruct the patient to reduce his respiratory rate and depth of breathing. Do not tell the patient to hold his breath or breath into a bag for that can be deadly. Do not with hold O2.