post lecture 17

While Mr. B is recovering, you check on your other patients. Mrs. H, a 57-year-old first-day post-cholecystectomy patient, is also showing signs of rapid breathing, increased heart rate, and decreased pulse oximeter readings. You ask if she has been using her incentive spirometer to make sure she breathes deeply, and she says, "It hurts my belly incision. There wasn't anything wrong with my lungs anyway." "There will be if you don't use it! You really need to do that at least once an hour. It's to keep your alveoli from collapsing." "Why would they collapse? The doctors didn't do anything to them, unless that anesthesia gas was toxic."

-Shallow breathing that does not fill her lungs will only move air into the alveoli in the upper part of her lungs, letting those in the lower part stay closed -The alveoli are lined with water, and attraction between the water molecules pulls them together. This surface tension will pull the alveoli closed if she does not open them with deep breathing -When she is lying down, it is harder for her to expand her chest cavity anyway. She needs to put extra effort into it

Mr. B has been transferred to your floor to wait and see whether the chest tube allows his lungs to completely re-expand. But when he arrives, he is in severe respiratory distress. He says "I felt better before I came into the ER! Is this tube doing anything?" You tell the Clinical Nurse Specialist (CNS). As the two of you move him into the bed, you notice that his chest tube bottle is lying on its side on the gurney, with air going into it. When you point this out to the CNS, she immediately grabs the bottle and sets it upright on the floor. You see air start bubbling through the fluid right away. "That was the problem!" she says. "They lost the water seal, and air was going into his chest from the bottle. You would not believe how many times that happens on transport." When you examine Mr. B, you have trouble detecting his lung sounds on the left. Even stranger, his apical heart sound is in the wrong place - it is over toward the right side of his chest. His respiration rate and heart rate are both increased, and he is struggling to breathe. "Let's give him a little oxygen. He'll be a lot better in a half-hour," says the CNS. "Check back on him." Why would accumulation of air in his pleural space cause his heart sounds to be in the wrong place?

Because the left side of Mr. B's chest is filling up with air, the organs in his chest are being pushed over to the right

A patient with an allergy has an EpiPen. Which would you expect after injection of epinephrine?

Decreased resistance and increased flow

When your clinical ends, Mr. B is resting peacefully. His respiratory rate and heart rate are back to normal, his chest tube is not bubbling anymore, and his breath sounds are even on both sides. Mrs. H is using her spirometer, and the respiratory tech says her vital capacity is a lot better than it was the first time he checked on her. The CNS tells your prof you made a good save in noticing Mr. B's tipped chest tube bottle. A great clinical all around! So you treat yourself to an after-class drink with a fellow student who spent her day in the NICU (neonatal intensive care unit). "You won't believe what happened to me today! The transport from ER collapsed somebody's lung!" "It must be lung day. We have a preemie in the NICU with collapsed lungs as well." "Wow, what happened? Did it have a chest injury? Do they put chest tubes in babies?" "No, she just never inflated them when she was born. The doctors keep talking about surfactant, but the mom didn't understand what that meant. She was so scared; I felt sorry for her. But I don't think I could explain it either!" You are on a roll today, so help your friend come up with a clear explanation of what surfactant does.

The alveoli are lined with water molecules, which are attracted to one another and tend to move closer together, making the alveoli collapse. Surfactant molecules get in between the water molecules, keeping them apart

________, where O2 is passed into the blood

alveoli

All the rest of the respiratory tract- _____________ because it does not pass O2 to the blood

dead space

3. As result, the air pressure in the chest cavity ________.

decreases

1. A healthy person inhales by lowering the ________ and expanding the chest walls outward.

diaphragm

1. Mr. B tries to inhale...he can still move his chest wall and ______.

diaphragm

When you _________, you do not push all the used air out of your dead space

exhale

2. This ______ this size of the chest cavity - like pulling the plunger back on a hypodermic needle.

increases

Next time you _________ you pull the stale air back into your _________. It isn't doing you any good!

inhale; alveoli

You have to _______ deeply enough to pull fresh air down to the _______ or you won't get the __________ you need.

inhale; alveoli; oxygen

2. And air still enters his lungs...but now it leaks in through the puncture into the ______.

pleural space

3. As air fills the ______ the ______ collapse.

pleural space; lungs

4. And air flows through the _______ inflating the lungs.

trachea