Ch. 41 Oxygenation and perfusion

What does pursed-lip breathing prevent?

Alveolar collapse.

Based on evaluation of the different types of tubes used to maintain oxygenation, which one would a patient receiving general anesthesia require? Nasopharyngeal Tracheostomy Oropharyngeal Endotracheal

Endotracheal

The process of oxygen diffusing across alveolar walls into pulmonary capillaries is called: Internal respiration Ventilation Perfusion External respiration

External respiration In the lungs, oxygen diffuses across alveolar walls into pulmonary capillaries. This exchange of gases between the lungs and blood is called external respiration.

The process of exhalation involves: Intraalveolar pressure rising above atmospheric pressure. Elastic recoil of the lungs, causing the lungs and thoracic cavity to expand. The exchange of carbon dioxide for oxygen in the venous circulation. Lowering of intraalveolar pressure as the atmospheric pressure rises.

Intraalveolar pressure rising above atmospheric pressure.

Symtoms of hyperventilation

Rapid respirations Sighing breaths numbness and tingling of hands/feet light-headedness Loss of conscious

Pacemaker of the heart

SA node; 60-100 bpm

During the inspiratory phase of respiration, the phrenic nerve: Initiates the release of carbon dioxide Signals the intercostal muscles to contract Causes the chest and lung tissues to recoil Stimulates the diaphragm to move downward

Stimulates the diaphragm to move downward

Emphysema

is a progressive COPD characterized by inflamed and damaged alveolar walls in the lungs. This is what happens: Over time, inhaled toxins, such as from cigarette smoke, produce inflammation inside the lungs. This stimulates the release of enzymes that destroy the walls of the bronchioles and alveolar air sacs. The alveoli rupture, forming larger airspaces, which reduces the surface area available for gas exchange. The enlarged inelastic airspaces cause air to become trapped in the lungs during exhalation, further altering gas exchange.

Chronic Bronchitis

A chronic bronchitis, another form of COPD, the lining of the larger airways is damaged, leading to increased difficulty clearing mucus. The mucus builds and the airways narrow. These changes produce the key characteristics of this disorder, which include: Inflammation of the large airways, Increased mucus production, and Chronic cough Air is not able to move through the bronchioles easily and this results in decreased oxygen available for absorption. Smoking cigarettes and exposure to second-hand smoke are the primary risk factors for chronic bronchitis. Exposure to certain types of air pollutants may also trigger the disorder.

Insertion of a pharyngeal airway may be considered for a patient for which reasons? Select all that apply. A decreased level of consciousness The patient is unable to breathe effectively Frequent suctioning needs Loss of muscle tone The patient requires mechanical ventilation

A decreased level of consciousness Frequent suctioning needs Loss of muscle tone

Which patients are at risk of hyperventilation? A patient who has atelectasis A patient who has acute anxiety A patient who has salicylate poisoning A patient who has diabetic ketoacidosis A patient who has cardiac dysrhythmias

A patient who has acute anxiety A patient who has salicylate poisoning A patient who has diabetic ketoacidosis

What are the symptoms associated with pneumonia? Select all that apply. Cough Bronchospasm Fever Dyspnea Hypersecretion of mucus

Cough Fever Dyspnea Hypersecretion of mucus

When a patient with chronic cardiovascular disease is admitted to the unit, which medications should the nurse expect to be on the medication administration record? Select all that apply. Diuretics Anticoagulants Antiarrhythmics Calcium channel blockers Bronchodilators

Diuretics Anticoagulants Antiarrhythmics Calcium channel blockers Diuretics Diuretics increase the flow of urine, reducing excess water in the body and are often prescribed for a patient who is admitted with a cardiovascular disorder. Anticoagulants Anticoagulants prevent clot formation and are often prescribed for a patient who is admitted with a cardiovascular disorder. Antiarrhythmics Antiarrhythmics suppress abnormal heart rates and rhythms, and are often prescribed for a patient who is admitted with a cardiovascular disorder. Calcium channel blockers Calcium channel blockers lower arterial blood pressure and are often prescribed for a patient who is admitted with a cardiovascular disorder. Bronchodilators Bronchodilators increase the diameter of the bronchi and would be anticipated for a patient who is admitted with a pulmonary, not cardiovascular, disorder.

A patient is diagnosed with pneumothorax. Which clinical manifestations is the nurse likely to find in the patient? Chest pain on expiration Hypotension Tachycardia Absence of breath sounds Sharp stabbing pain in the chest

Hypotension Tachycardia Sharp stabbing pain in the chest

After examining a patient's eyes, the primary health care provider confirms cyanotic conjunctivae. What might be the cause of the abnormality? Hypoxia Hypoxemia Hyperlipidemia Bacterial endocarditis

Hypoxemia

What is the reason for heart failure after myocardial infarction (MI)? Increased myocardial workload Increased oxygen demands of the myocardium Inability of the heart chambers to fill adequately Impairment of the contractile function of the ventricle

Impairment of the contractile function of the ventricle

A patient with a chronic respiratory disease is to receive teaching about the breathing process. Information to include is that ventilation starts with inspiration and is triggered by: Impulses in the respiratory center of the brain Phrenic nerve stimulation of the diaphragm Outward expansion of the intercostal muscles Metabolism of oxygen at the cellular level

Impulses in the respiratory center of the brain The movement of air into and out of the lungs is known as ventilation which starts with inspiration (inhalation) triggered by impulses generated in the respiratory center of the brain.

How would the nurse describe the defining characteristics of emphysema? Select all that apply. Inelastic alveoli with decreased surface area Increased mucus production Infection of lung tissue with aspiration Hyperinflation with air trapped in distal alveoli Hypoxia with decreased gas exchange

Inelastic alveoli with decreased surface area Hyperinflation with air trapped in distal alveoli Hypoxia with decreased gas exchange

Which arteries supply oxygenated blood to the heart muscle? Select all that apply. Left main Pulmonary Superior vena cava Left anterior descending Circumflex

Left main Left anterior descending Circumflex

Symtoms of hypoventilation

Mental status changes dysrhythmias potential cardiac arrest

Cheyne-Stokes

Occurs when there is decreased blood flow or injury to brain stem. abnormal respiratory pattern with periods of apnea followed by periods of deep breathing and then shallow breathing followed by more apnea.

A patient who has a history of chronic obstructive pulmonary disease (COPD) and diabetes mellitus develops hypoventilation. What does the nurse suspect is the cause of the hypoventilation? Salicylate poisoning Diabetic ketoacidosis Amphetamine overdose Overdose of oxygen therapy

Overdose of oxygen therapy

Which diagnostic test is used in the daily measurement for early detection of asthma exacerbations? Lung scan Thoracentesis Pulmonary function test Peak expiratory flow rate

Peak expiratory flow rate

During assessment, which finding indicates the presence of pneumothorax? Absence of lung sounds on the affected side Inability to auscultate tracheal breath sounds Pleuritic pain that worsens on inspiration Pursed-lip breathing

Pleuritic pain that worsens on inspiration Pneumothorax is caused by rapid accumulation of air in the pleural space, causing severely high intrapleural pressure. The patient may have pain, because the atmospheric air irritates the pleura. The pain increases on inspiration. Absence of lung sounds may be found in atelectasis. Inability to auscultate and pursed-lip breathing are associated with chronic lung diseases.

Apnea

The absence of respirations lasting longer than 15 sec

A patient is admitted to a hospital with a myocardial infarction. Which common signs or symptoms should the nurse expect in this patient? The patient has a crushing or squeezing chest pain. The pain does not last more than 20 minutes. The pain is not ameliorated by rest or nitroglycerine. There are convulsions and spasms of the extremities. There may be shortness of breath along with chest pain.

The patient has a crushing or squeezing chest pain. The pain is not ameliorated by rest or nitroglycerine. There may be shortness of breath along with chest pain.

The nurse assesses a patient who is short of breath and fatigued. The nurse finds that the oxygen saturation of the blood is reduced. The lab report indicates that the patient's red blood cell count is increased. What do these findings suggest? The patient has anemia. The patient has chronic hypoxemia. The patient has hypoventilation. The patient has an acute infection.

The patient has chronic hypoxemia.

A patient with right ventricular failure asks the nurse about this condition. Which information should the nurse include in the explanation? The right ventricle doesn't function well, and fluid backs up in the systemic circulation. There may be an enlargement of the liver and spleen. The right ventricle doesn't function well, and fluid backs up in the lungs. There is pulmonary edema and fluid accumulation in the lungs. There may be peripheral edema of the hands and feet.

The right ventricle doesn't function well, and fluid backs up in the systemic circulation. There may be an enlargement of the liver and spleen. There may be peripheral edema of the hands and feet.

Kussmaul respirations

depth and rate of insperations increases to compensate the decreasing carbon dioxide levels. Ex: metabolic acidosis