Acid Base Imbalances Acid Base Imbalances Medical Surgical Nursing

Page 1 Question What diseases commonly cause acid-base imbalances? (3) _________ and ________ can cause acid-base imbalances as well as losses of fluid and electrolytes. The __________ are the essential buffer system for acids. Why are older adults more prone to acidosis? Answer Diabetes, COPD, kidney disease Vomiting and diarrhea

Kidneys Their kidneys are less able to compensate for an acid load and they commonly have decreased respiratory function 0.0004 mEq/L Tenfold

What is the normal H+ concentrationin body fluids? When expressing H+ in pH, every increase of 1 (i.e. pH of 7 to pH of 8) equals a _________ increase. A person has acidosis when the blood pH is below...

7.35

A person has alkalosis when the pH is above... 7.45

What is the normal ratio of carbonic acid to bicarbonate in the body? How is acidemia different from acidosis?

One part carbonic to every 20 parts bicarbonate 1:20

Acidemia is a blood pH of less than 7.35 Acidosis is the PROCESS of accumulating acids or elimination of base from the body Alkalemia is an arterial pH of more than 7.45 Alkalosis is the PROCESS of accumulating base or eliminating acid Acidosis

How is alkalemia different from alkalosis?

An anion gap is a reflection of normally unmeasured anions in 1

the plasma. It is useful for the differential diagnosis of ___________. The acceptor of hydrogen ions is called a _______. The substance in the body that prevents a large change in pH is called... The negative logarithm of the H+concentration... What are the three mechanisms used by the body to regulate acid-base balance? Which acid-base regulatory system reacts to an imbalance immediately? Which acid-base regulatory system reacts to an imbalance within mimnutes? Base A buffer

pH The buffer system, respiratory system and the renal system The buffer system

The respiratory system

Which acid-base regulatory system reacts to an imbalance within days, but accommodates a persistent imbalance indefinitely? Which acid-base mechanism is the primary regulator?

The renal system

The buffer system

Page 2 Question Which acid-base mechanism is the primary regulator? Carbonic acid-bicarbonate,monohydrogen-dihydrogen phosphate, and intracellular and plasma protein are examples of ________ in the body. A _______ consists of a weakly ionized acid or base and its salt. Which acid does the Carbonic acid-bicarbonate buffer neutralize? Which part of the buffer system creates CO2 and water from acids? Which component of the buffer system creates NaCl, and sodium biphosphate (NaH2PO4) from acids and forms weaker 2 Answer The buffer system Buffers (hemoglobin buffers are also part of this mechanism) Buffer HCl (Hydrochloric acid) Carbonic Acid-Bicarbonate Phosphate buffer

bases and H2O from bases? Which part of the buffer system creates CO2, Hydrogen ions (H+), Ammonia (NH3), OH- (hydroxide) and H2O? _________ is a part of the buffer system that shifts Chloride in and out of Red Blood cells in exchange for carbonate. The ______ acts as a buffer by shifting hydrogen in and out of the cell in exchange for other ions like K+. The _________ help maintain normal pH by excreting CO2 and water, which are by-products of cellular metabolism. What is the rate of excretion of CO2 controlled by? How do the lungs retain CO2? How do the lungs eliminate CO2? How do the kidneys compensate for acidosis? What are the three mechanisms that the kidneys utilize to eliminate acids from the body? ________ imbalances affect carbonic acid concentrations. _________ imbalances affect the base bicarbonate. An increase in carbonic acid is called... A decrease is carbonic acid is called... A decrease in carbonic acid is called... An increase in bicarbonate is called... aPage 3 Question An increase in bicarbonate is called... Hypoventilation causes ____________. When does the renal compensatory system begin to combat respiratory acidosis? Answer Metabolic alkalosis Respiratory acidosis Within 24 hours, therefore, if the bicarbonate level is within normal limits and the carbonic acid is low, compensation hasn't begun and the condition is a recent development Respiratory alkalosis 3 Lungs The respiratory center in the Medulla in the brainstem Hypoventilation Hyperventilation They generate additional bicarbonate and eliminate excess H+ 1. they secrete small amounts of free hydrogen into the renal tubule 2.combines H+ with ammonia (NH3) to form ammonium (NH4+) 3. they excrete weak acids Respiratory imbalances Metabolic Respiratory acidosis Metabolic acidosis Respiratory alkalosis Metabolic alkalosis Intracellular and extracellular proteins Hemoglobin

Hyperventilation causes __________.

The primary cause of respiratory alkalosis is ________. Anxiety, CNS disorders and mechanicaloverventilation can lead to what acid-base imbalance? Why is compensated respiratory alkalosis rare?

Hypoxemia from acute pulmonary disorders Respiratory alkalosis In most cases, hypoxemia is aggressively treated which allows no time for the body to begin compensation False, metabolic acidosis occurs from a build up of acid other than carbonic acid (like lactic acid and ketoacid) Deficits

T/F Metabolic acidosis occurs when there is an accummulation of carbonic acids from disease processes. Metabolic acidosis always results in _______ of bicarbonate, whether the cause is an accumulation of acids or a loss of bicarbonate from body fluids. What conditions can cause metabolic acidosis? Kussmaul respirations can be a compensation for what acid-base imbalance? What can cause metabolic alkalosis? T/F The primary mechanism for compensating for metabolic alkalosis is increased excretion of bicarbonate from the renal system. T/F It is possible to have a near normal pH AND have an acid-base imbalance. T/F It is not possible to have metabolic acidosis and respiratory acidosis at the same time. Mixed acid-base imbalances involve some form of acidosis (respiratory OR metabolic) with some form of alkalosis. What accounts for many of the clinicalmanifestations of alkalosis?

Diabetic Ketoacidosis and Shock (lactic acid build up) Metabolic acidosis Severe vomiting and/or diarrhea, consumption of baking soda and oversuctioning of gastric contents False, the primary mechanism is hypoventilation. The kidneys do excrete excess bicarbonate, but it takes some time. True, it is possible to have more than one acid-base imbalance that causes the pH to be near normal False. You can have any mix of the four imbalances.

Hypocalcemia, which occurs from calcium binding with albumin and lowering the amount that is bioavailable Their acid base status Their underlying cause of the imbalance Their overall oxygenation status Respiratory. Respiratory acidosis Respiratory alkalosis

What patient information can be determined from Arterial Blood Gas (ABG) values? PaCO2 is considered the ________ component of arterial blood gasses. High levels indicate acidosis, low levels indicate alkalosis. Which acid-base imbalance? Lowplasma pH Elevated PaCO2 Normal or high HCO3- Urine pH is under 6 Which acid base imbalance? Highplasma pH Low PaCO2 Normal or 4

low HCO3- Urine pH greater than 6 Which acid base imbalance? Low plasma pH Normal or low PaCO2 Low HCO3- Urine pH less than 6 Metabolic acidosis

Acid Base Imbalances Question Which acid base imbalance? Low plasma pH Normal or low PaCO2 Low HCO3- Urine pH less than 6 Which acid base imbalance? High plasma pH Normal or high PaCO2 High HCO3- Urine pH greater than 6 COPD, barbituate/sedative overdose, obesity, severe pneumonia, atelectasis, Guillain-Barre syndrome, and mechanical hypoventilation are all common causes of what acid-base imbalance? Hypoxia, pulmonary emboli, anxiety, fear, pain, exercise, septicemia, encephalitis,brain injuries, salicylate poisoning and mechanical hyperventilation are common causes of what acid-base imbalance? Diabetic ketoacidosis, lactic acidosis, starvation, severe diarrhea, renal tubular acidosis, renal failure, GI fistulas, and shock are common causes of what acid-base imbalance? Severe vomiting, excessive gastric suctioning, diuretic therapy, potassium deficits, excess intake of baking soda, or excessive mineralcorticoids are all common causes of what acid-base imbalance? Which acid-base imbalance presents with the following symptoms? Drowsiness,disorientation, dizziness, headache, coma, low BP, ventricular fibrillation, warm, flushed skin, seizures and hypoventilation Which acid base imbalance presents with the following signs and symptoms?Drowsiness, confusion, headache, coma, low BP, dysrhythmias, warm, flushed skin, nausea, vomiting diarrhea, abdominal pain, deep, rapid respirations What are main differences in signs and symptoms between respiratory acidosis and metabolic acidosis? Answer Metabolic acidosis Metabolic alkalosis Respiratory acidosis

Respiratory alkalosis

Metabolic acidosis

Metabolic alkalosis

Respiratory acidosis

Metabolic acidosis

Respiratory acidosis causes ventricular fibrillation, seizures, and HYPOVENTILATION...no GI symptoms Metabolic acidosis causes HYPERVENTILATION and GI symptoms (nausea, vomiting, diarrhea), and dysrhythmias

Acidosis, whether metabolic or respiratory, causes high or low Potassium levels? Which acid base imbalance presents with the following signs and symptoms?Lethargy, light-headedness,confusion, tachycardia, dysrhythmias, nausea, vomiting, epigastric pain, tetany, numbness, tingling of extremities, hyperreflexia, seizures, and/or hyperventilation Which acid base imbalance presents with the following signs and symptoms?Dizziness, irritability, nervousness, confusion, tachycardia, dysrhythmias, nausea, vomiting, anorexia, tetany, tremors, tingling of fingers and toes, muscle cramps, hypertonic muscles, seizures, hypoventilation What are main differences in signs and symptoms between respiratory alkalosis and metabolic alkalosis?

High, a lot of the cardiac symptoms are from hyperkalemia Respiratory alkalosis

Metabolic alkalosis

Respiratory Alkalosis: HYPERVENTILATION, epigastric pain, hyperreflexia Metabolic alkalosis: HYPOVENTILATION, anorexia, hypertonic muscles, irritability PaCO2 is 35-45 mmHg if arterial, 40-45 mmHg if venous PaO2 is 80-100 mm Hg if arterial, 40-50 mmHg if venous Oxygen Saturation is 96-100% arterial, 60-85% venous

How do blood gasses differ when drawn from arterial vs. venous locations?

Problems of Oxygenation Ventilation Problems of Oxygenation VentilationMedical Surgical Nursing

Page 1 Question The right lung is divided into ______ lobes, and the left lung is divided into ______ lobes. Breathing through the nasal passages provides protection for the ______ airway, filtering particles larger than 10 micrometers. Where are the olfactory nerve endings located? Adenoids are in the the(nasopharynx/ororpharynx/laryngopharnx?)and tonsils are located in the(nasopharynx/ororpharynx/laryngopharnx?). You are suctioning a patient and all of a sudden they start vigorously coughing. Yourunderstanding of anatomy makes you realize you have touched the ________, which is highly sensitive. 6 Answer Right lung: three-upper, middle and lower Left lung: two-upper and lower Lower In the roof of the nose Adenoids = nasopharynx Tonsils=oropharynx Carina

At what point (where in the body) is inhaled air in the lower respiratory tract? A _______ is where the mainstream bronchi, pulmonary vessels, and nerves enter the lungs through a slit. Which bronchi is the most likely site to locate an aspirated object? Why? Enlarged lymph nodes in the _______, like those that occur with sarcoidosis or tuberculosis,may be visible on a chest xray. What are the conducting airways of the lungs?

When it passes the carina Hilus The right bronchi...it is shorter, wider and straighter than the left. Hilar area (especially with hilar lymphadenopathy) The Trachea, segmental branch of the bronchi, sub-segmental branch of the bronchi, and the non-respiratory bronchioles Respiratory bronchioles, alveolar ducts and alveoli Lobar, segmental and non-segmental bronchi Respiratory bronchioles The area of the respiratory tract that serves as only a conduit of air (nose to the respiratory bronchioles) and performs no gas exchange Anatomic dead space (nose to respiratory bronchioles) 150 mL Alveoli The pores of Kohn The alveolar-capillary membrane

What makes up a respiratory unit in the lungs? The mainstream bronchi divide several times to form ________, ___________, and ___________ bronchi. No exchange of oxygen or carbon dioxide occurs in the lungs until the air enters the ___________. What is anatomic dead space?

VD symbolizes the area of the respiratory tract referred to as.... With each breath, the normal adult inhales 500 mL of air (tidal volume/VT). Only _____ mL is VD. _______ are the functional unit of the lungs. What part of the alveoli allow for movement of air between alveoli? Where is the site of gas exchange in the lungs?

Problems of Oxygenation Ventilation Question Where is the site of gas exchange in the lungs? Why does pulmonary edema reduce gas exchange in the 7 Answer The alveolar-capillary membrane The excess fluid fills the interstitial spaces and alveoli,

lungs? ________ is a lipoprotein that reduces the amount of pressure needed to inflate alveoli and also decreases the tendency for them to collapse. What is the function of a sigh and how often do they occur? ________ refers to collapsed, airless alveoli. How thick is the respiratory membrane? Why is a post-operative patient at risk for atelectasis? The lungs have two diffent types of circulation, pulmonary and bronchial._______ circulation provides blood to the lungs for gas exchange. The lungs have two diffent types of circulation, pulmonary and bronchial._______ circulation provides oxygen to the lung tissue. The _______ artery receives deoxygenated blood from the right ventricle of the heart and branches so that each pulmonary capillary is directly connected to many alveoli. Bronchial circulation starts with the bronchial arteries which arise from the __________. Deoxygenated blood returns from bronchial circulation through the _______ vein into the left atrium of the heart. What makes up the thoracic cage? The thoracic cage, pleura and respiratory muscles are the structures that make up the _________. The chest wall is lined with a membrane called the ________ pleura, and the lungs are lined with a membrane called the _______ pleura. Which pleura in the chest wall have sensory nerve fibers (and thus indicate pain)? How is pleural effusion different from empyema?

covering the capillary-alveolar membrane Surfactant

They usually occur every five-six breaths and they stretch alveoli to promote surfactant secretion Atelectasis 1/5000 of an inch/5 micrometers The effects of anesthesia and the tendency to restrict breathing in response to pain Pulmonary

Bronchial

Pulmonary

Thoracic aorta azygos 24 ribs and the sternum Chest wall Chest wall-parietal pleura Lungs-visceral pleura

Parietal pleura (the source of pain from pleury, pleuritis, etc.) Pleural effusion is an accumulation of fluid in the intrapleural space Empyema is an accumulation of purulent fluid (from bacteria) in the intrapleural space Pleural effusion

The pleural space normally contains 20-25 mL of fluid. An excess of fluid is called... 8

What can cause pleural effusion?

Blockage of lymphatic drainage (i.e. from malignant cells), or from conditions like heart failure where intravascular and oncotic pressures are imbalanced The diaphragm contracts, increasing pressure and pushing the abdominal contents down

What happens to abdominal contents when you take a deep breath in?

A spinal cord injury above the level of ______ results in diaphragmatic paralysis and creates a dependence on a Mechanical ventilator.

C3

Problems of Oxygenation Ventilation Question A spinal cord injury above the level of ______ results in diaphragmaticparalysis and creates a dependence on a mechanical ventilator. What innervates thehemidiaphragms? T/F It is possible to have partialdiaphragmatic paralysis, one side that works, and one side that doesn't. Contraction of the intercostal and scalene muscles increases or decreases intrathoracic pressure? T/F Exhalation involves the neck and shoulder muscles, which assist in the effort. The tendency for the lungs to recoil or reduce in volume after being stretched is called.... In the cases of COPD, or asthma, expiration is a process that requires effort. What muscles assist in expelling air in these conditions? ____________ is a measure of the ease of expansion of the lungs. T/F Lung compliance is increased in conditions like emphysema. 9 The right and left phrenic nerves, located between C3C5 True, it is divided into two hemidiaphragms which are innervated by a left and right phrenic nerve.Paralysis can occur on one side only if only one nerve is injured. Decreases (inhalation)...air flows high to low pressure...atmospheric air is high, intrathoracic low, allowing for air to flow in. False, exhalation is a passive process Elastic recoil Abdominal, intercostal and accessory muscles like the scalenes and trapezius (shoulders and neck). This is what causes bulging and retraction that we look for in health assessments. Compliance True. Compliance is increased in conditions that cause a destruction of alveolar walls and loss of tissue elasticity Answer

PaO2 is... SaO2 is...

The partial pressure of oxygen in arterial blood, the amount of oxygen dissolved in the plasma The arterial oxygen saturation, the amount of oxygen bound to the hemoglobin vs. how much is available to carry oxygen. I.e. 93% means 93 out of every 100 hemoglobins are bound to oxygen. It is a model that explains the affinity of hemoglobin for oxygen. It is used to illustrate the effect certain conditions have on that affinity. Top - lungs Bottom-peripheral tissues

What is the oxygen-hemoglobindissociation curve?

The top of an oxygen-hemoglobindissocation curve reflects ______ condition, the bottom part of the curve represents oxygen binding by hemoglobin in the ____________. When hemoglobin that is saturated with oxygen arrives in the peripheral tissues, it will desaturate (thus delivering oxygen to the tissue) if the PaO2 in the area is ________ mm Hg. What happens if the oxygen dissociation curve shifts to the left? What conditions can cause the oxygen dissociation curve to shift to the left? What happens when the oxygen dissociation curve shifts to the right? What conditions cause a shift to the right in the oxygen dissociation curve? What two tests are useful in assessing the efficiency of gas transfer in the lungs? What is measured in an Arterial Blood Gas (ABG)? What is a benefit of an arterial catheter?

30-40 mm Hg (normal is 80-100 mm Hg in the lungs)

Blood picks up oxygen more readily in the lungs but delivers it less readily to peripheral tissues Alkalosis, hypothermia, and low PaCO2 Blood picks up oxygen less readily in the lungs but delivers oxygen more readily to the tissues. Acidosis, hyperthermia, and high PaCO2 Arterial Blood gasses (ABGs) and oximetry PaO2, PaCO2, pH, and HCO3- (bicarbonate) in arterial blood It permits continuous monitoring of intraarterial blood gasses without repreated arterial punctures

Problems of Oxygenation Ventilation Question Answer 10

What is a benefit of an arterial catheter? T/F Normal PaO2 decreases with advancing age and in higher altitudes. Which patients need careful evaluation before they are cleared for air travel, and why? How is oxygen delivery to tissues or oxygen consumption measured in patients with impaired cardiac output or hemodynamic instability? What is the major difference between blood retrieved for an ABG and blood retrieved through a PA catheter? What is a normal SpO2 reading? What principle guides the use of pulse oximetry?

It permits continuous monitoring of intraarterial blood gasses without repreated arterial punctures True. Patients that are on oxygen therapy or have a PaO2 of less than 72 mm Hg because air travel causes a decrease of 1632 mm Hg in a normal adult Through a pumonary artery (PA) catheter

ABG blood is arterial PA Catheter blood is mixed venous blood 95% and above Saturated blood absorbs light differently than deoxygenated blood does. A pulse Ox measures the amount of light that passes from a light-emitting diode through a part of the patient's body to a photodetector on the other side Sedation or decreased consciousness may mask hypoxia False, an ABG is also periodically needed If the patient's SPO2 is less than 70%, it can be 4% off either way from the actual value (so 66%-74%). Not yet, if the hemoglobin is bound to something other than oxygen (like carbon monoxide, for which it has even a higher affinity) the pulse ox can be incorrect, reflecting instead the amount of hemglobin bound to carbon monoxide (in which case, the patient is probably toast). Patient motion, low perfusion, anemia, cold extremities, bright fuorescent lights, intravascular dyes, thick acrylic nails or dark complected skin. That less oxygen is being delivered to the tissues or that more oxygen is being consumed. Changes in cardiac output or tissue oxygen delivery 60-80% Apprehension, restlessness or anxiety, irritability, tachypnea, 11

Why is pulse oximetry a valuable assessment tool in inteisve care andperioperative situations? T/F Pulse oximetry are all that is needed to determine ventilation and acid-base balance. A patient's SPO2 has been measured with a pulse oximetry. It is reporting a value of 70%. You know this reading might be inaccurate because... A woman brings her husband into the ER stating she found him in a closed garage with the engine running. His pulse ox reading is 97%. Do you breathe a sigh of relief with the wife? What factors can alter the accuracy of a pulse ox reading? What does a decreased SVO2 suggest? What can changes in a SVO2 be an early warning of? What is a normal SVO2? What are early signs of inadequate oxygenation?

tachycardia, and mild HTN. What is usually the first sign of hypoxemia and why? Apprehension, restlessness or irritability because the brain is very sensitive to decreased oxygen delivery (and these are all CNS symptoms) 88%

An SPO2 value of _______% or less while at rest denotes a need for continuous or supplmental oxygen.

Central chemoreceptors for respiration are located in the _________ and response to changes in ________. Changes in PaCO2 regulate ventilation primarily by their effects on the pH of _________. Where are the peripheralchemoreceptors for respiration located?

Located in the medulla and respond to changes in H+ concentrations Cerebrospinal fluid -In the carotid bodies at the bifurcation of the common carotid artery -In the aortic bodies above and below the aortic arch

Problems of Oxygenation Ventilation Question Where are the peripheralchemoreceptors for respiration located? What do the peripheralchemoreceptors of respiration respond to? Lethargy and Combativeness are both early or late CNS signs of inadequate oxygenation? Answer -In the carotid bodies at the bifurcation of the common carotid artery -In the aortic bodies above and below the aortic arch -Decreases in PaO2 -decreases in pH -Increases in PaCO2 Late

Dypnea at rest, use of accessory muscles, retraction, and/or pausing in between words or sentences for breath are early or late respiratory signs of inadequate oxygenation? Dysrhythmias, hypotension, cyanosis and/or cool clammy skin are early or late cardiac signs of inadequate oxygenation? Diaphoresis, decreased urinary output, and/or unexplained fatigue are early or late signs of inadequate oxygenation? What would you expect if a patient's PaO2 is 39% and their SpO2 is 74%? What are the considerations for a patient with a PaO2 of 60% 12

Late (dyspnea at rest can be early or late)

Late (dysrhythmias can be early or late)

Both early and late Tissue hypoxia and cardiac dysrhythmias The patient is adequately oxygenated, but not

and an SpO2 of 90%? What are the considerations for a patient with a PaO2 of 55% and an SpO2 of 88%? What are the considerations for a patient that has a PaO2 of 40% and an SpO2 of 75%?

optimally. They are more at risk for a quick onset problem with oxygenation. If the patient has chronic hypoxemia (like with COPD), this is adequate as long as no cardiac probs occur. These values suggest a need for oxygen therapy. This is inadequate, but acceptable on a short term basis if the patient is also retaining CO2. Oxygen at low concentrations (24%-28%) will gradually increase PaO2. MONITOR FOR DYSRHYTHMIAS Juxtacapillary and irritant mechanical receptors

What type of mechanical receptors signal the pulmonary stretch receptors to activate the pulmonary center to inhibit further lung expansion? Where are the mechanical receptors of respiration located? (4) What is the Hering-Breuer reflex?

Lungs, upper airways, chest wall and diaphragm It is the action of the mechanical receptors that inhibits lung expansion due to an irritant, muscle stretching or alveolar wall distortion. It prevents overdistention of the lungs. Vagus Juxtacapillary (J) receptors -Filtrations of air -mucociliary clearance system -reflex bronchoconstriction -cough reflex -alveolar macrophages Nasal hairs, nasopharynx & larynx, mucosa lining, and bronchi Particles between 1-5 micrometers settle in the nasopharynx or bronchi 5 micrometers

Impulses from the mechanical receptors of inspiration are sent through the _______ nerve to the brain. ________ receptors are believed to cause tachypnea when a patient with pulmonary edema. What are the respiratory defense mechanisms? What structures in the respiratory system are involved in the filtering of air? What is sedimentation as it relates to the respiratory system? Particles greater than _____ micrometers are filtered, never reaching the alveoli. Those that are smaller, like coal dust, can be dangerous. Where does the mucociliary clearance system begin? Mucus is continually secreted at a rate of about _____ mL a day by goblet cells and submucosal glands.

Below the larynx 100 mL

What is in mucus that contributes to protection against bacteria and viruses? 13

Secretory IgA

What areas of the respiratory system are covered with cilia? The further down into thetracheobronchial tree, the faster or slower the cilia beats? What impairs ciliary action?

The trachea to the respiratory bronchioles Slower Dehydration, smoking, inhalation of high oxygen concentrations, infection, and ingestion of medications like atropine, anesthetics, alcohol and/or cocaine. Cilia are often destroyed by upper respiratory infections, which results in impaired secretion clearance, chronic productive coughing, and chronic colonization of bacteria. The cough reflex

Why are patients with COPD and cystic fibrosis more prone to respiratory infections? ________ is a back-up respiratory defense mechanism for the mucociliary clearance system, especially when it is overwhelmed or ineffective. Coughing is only effective in removing secretions above the ________ level. _________ is an intervention that can be used to move secretions upward so they can be removed by coughing. When does reflexbronchoconstriction occur? What is the primary defense mechanism before the respiratory bronchioles? What happens to the debris captured by alveolar macrophages? What recreational activity can inhibit alveolar macrophages? What structural alterations of the respiratory system commonly occur from aging?

Subsegmental (large or main airways) Postural drainage When a person inhales large amounts of irritating substances like dusts or aerosols Alveolar macrophages It is moved to the bronchioles where the cilia move it upwards or the lymphatic system removes it Smoking -decrease in elastic recoil of the lungs -decrease in chest wall compliance -chest wall stiffens -costal cartilages calcify, interfering with chest expansion -outward curvature of the spine is marked -lumbar curve flattens -loss of subQ fat, leading -decrease in number of functional alveoli -remaining alveoli are less elastic -Smaller airways close earlier in expiration resulting in poorer V/P matches, lowering PaO2 -Alveolar macrophages are less effective -cough isn't as forceful -Fewer and less functional cilia -Drier mucus membranes -IgA formation is decreased/decreased cellmediated immunity -Decreased sensation in pharynx -A decreased response to hypoxemia (it takes a greater drop in PaO2 to trigger a change in respiration rate) -A decreased response to hypercapnea (it takes a greater

What changes occur within the lung due to aging?

What changes occur in respiratory defense mechanisms due to aging?

What are the changes in respiratory control that occur due to aging? 14

rise in PaCO2 to trigger a change) You have a patient in his 80's who has come in for a cold. You listen to his lung sounds and notice while auscultating the bases that his breath sounds are diminished. You know that this means... T/F Common changes in the respiratory related to aging result in a lower than normal blood pH and PaCO2. What is a key indicator of symptom control for patients with respiratory conditions like asthma? You have a patient with a chronic cough that is on ACE inhibitor.He expresses he is concerned he has bronchitis because nothing seems to help his cough. You tell him... Nothing, it is a normal finding for an elderly adult to have diminished breath sounds, particularly in the bases of both lungs. False. Those remain normal, however, they will have a lower than normal PaO2 and SaO2. Overuse of short-term bronchodilators A common side effect of ACE inhibitors is a chronic cough

Problems of Oxygenation Ventilation Question You have a patient with a chronic cough that is on ACE inhibitor. He expresses he is concerned he has bronchitis because nothing seems to help his cough. You tell him... A patient comes in complaining that that every time she goes outside in the cold weather she ends up coughing and carrying on for a while. She would like to know what is causing this. You tell her... What is considered a chronic cough? How should a nurse quantify sputum? What is normal sputum color for a smoker? What can differentiate between hemoptysis and hematemesis? What conditions can cause hemoptysis? T/F Wheezing can be caused by postnasal drip. Why should you ask a patient that you suspect has tuberculosis where they have lived and traveled? What fungal infection is a patient who lives in the Mississippi River Valley at risk for? A risk factor for tuberculosis includes having lived or traveled to Asia, Africa, the former Soviet Union, Latin American or any third world country. Histoplasmosis 15 Answer A common side effect of ACE inhibitors is a chronic cough

That it is a common symptoms associated with asthma. Asthma is commonly exacerbated by cold weather, animals or exercise.

A cough that persists longer than 3 weeks In teaspoons, tablespoons, or cups per day. Clear to gray with occasional specks of brown Hematemesis is acidic, so pH testing can differentiate between the two Pneumonia, tuberculosis, lung cancer, or severe bronchiectasis (localized, irreversible dilation of part of the bronchial tree)

What fungal infection are those individuals who have lived or traveled to the Southwest at risk for? How is cigarette smoking quantified in pack years? I.E. what is the formula? Smoking is the most important risk factor for... What are the recommendations for Pneumovax?

Coccidiodomycosis Number of packs smoked per day x the number of years COPD and lung cancer It should be administered to people over 65 with chronic disease and revaccination in 5 years is only necessary if the patient was under 65 for their first dose or are immunocompromised.Immunocompromised people should get one every 5 years. The lungs hyperinflate, leading to a sensation of fullness Dehydration can result in thickened mucus which can create an obstruction in the airway Dyspnea can cause activity intolerance which could lead to incontinence and it can also cause mobility issues which could lead to constipation Shortness of breath (dyspnea) Inspiration Pleuritic chest pain. It is aggravated by deep breathing/coughing and starts mildly on inspiration and becomes sharp towards the end of inspiration.

Why does a patient with COPD often lose weight from getting full too quickly when eating? How does dehydration cause airwayobstructions? How can respiratory disorders lead to problems in elimination? What is the most common complaint of people with respiratory problems? Pleuritic chest pain occurs during inspiration or expiration? A patient comes in complaining that 'it hurts to breathe' You question her further and she tells you that when she breathes in it starts to hurt, like she's being stabbed, and it is right in her chest. She also states coughing makes it really hurt. You suspect she has... Hoarseness, stridor, muffling or a barking cough may indicateabnormalities of the ________.

Upper airway, like GERD or vocal cord dysfunction

Problems of Oxygenation Ventilation Question 16 Answer

Hoarseness, stridor, muffling or a barking cough may indicate abnormalities of the ________. What tools are used to determine the intensity of dyspnea? You have a patient with asthma that states he frequently wakes up at night with chest tightness and wheezing. This leads you to believe he needs what intervention? You have a patient with COPD that is being discharged from the hospital after a bout of pneumonia. You are conducting discharge teaching. Since this patient still has mild hypoxemia, you decide to teach the information (after getting permission) with his wife in the room. Your rationale for this is... ___________ pain is located along the sternal borders and is associated with breathing. What activities prior to sex can help a patient during intimate moments? Bogginess of nasal mucous membranes is indicative of ... Watery discharge from the nose may be indicative of...

Upper airway, like GERD or vocal cord dysfunction The Borg scale or visual analogue scale (VAS) A longer lasting bronchodilator or medication change. This can also be the case for a patient with COPD complaining of the same things. Hypoxemia interferes with the ability to learn and retain information. His wife can reinforce the information later when necessary.

Costochondritis Using their bronchodilator, coughing and deep breathing Edema Allergies or leaking cerebrospinal fluid (most often after a car accident or some type of trauma) CN IX: Glossopharyngeal CN X: Vagus Nothing, shotty nodes are a normal finding. It means they were non-tender, freely moveable and small You should start posteriorly, for women you can assess more readily without disruption from breast tissue and for easily fatigued patients you can get the most information in a short amount of time. 1:02 Pectus carinatum: protrusion Pectus excavatum: indentation

You elicit a gag reflex from a patient during a respiratory assessment. Which CN were tested? A doctor comes out of a patient's room and tell you that the patient has shotty nodes.What does this mean for the patient? When assessing the thorax and lungs, where should you start and why?

Normal AP (Anterior-Posterior) diameter is a ratio of ______ to the transverse diameter. Pectus ________ is a prominent protrusion of the sternum and pectus ________ is an indentation of the lower sternum above the xiphoid process. A patient has a right sided pneumothorax.You would expect the trachea to be shifted to the _______ side.

Left

17

A patient has a right sided pneumonectomy,you would expect the trachea to be shifted to the ________. A patient has a right sided lobar atelectasis, you would expect the trachea to be shifted to the ________. What conditions would cause increased fremitus?

Right Right When the lung is filled with fluid (pleural effusion) or becomes more dense (pneumonia, lung tumors, increased bronchial secretions and in areas above a pleural effusion) Barrel chest/hyperinflation (like with COPD) pneumothorax or atelectasis At the base of the lungs (posteriorly) Tympany (drum-like, loud and empty sounding)

What condition would cause decreased fremitus? What conditions would cause absent fremitus? If you have a patient you suspect will tire easily, where should you begin auscultation of the lung fields? What sound would you expect to percuss over a pneumothorax?

Problems of Oxygenation Ventilation Question What sound would you expect to percuss over an area of pneumonia in the lungs? _________ breath sounds are relatively soft, low pitched, gentle and rustling. Vesicular sounds are heard in all lung areas except for the _________. ___________ sounds are heard anteriorly over the mainstem bronchi on either side of the sternum and posteriorly between the scapulae. Bronchovesicular sounds have a _______ pitch and intensity, with a 1:1 ratio (inspiration is equal to expiration). _______ sounds are loud, high pitched, and resemble air blowing through a hollow pipe. Where are bronchial sounds best heard? Inspiration to Expiration ratios? Vesicularsounds: Bronchovesicular sounds: Bronchial sounds: T/F Abnormal breath sounds are bronchial or bronchovesicular sounds heard in peripheral lung fields. 18 Answer Dullness (you would hear this over a fluid filled pleural space as well) Vesicular Major bronchi Bronchovesicular Medium Bronchial Alongside the trachea Vesicular sounds 3:1 Bronchovesicular sounds 1:1 Bronchial sounds: 2:3, with a gap between Inspiration and Expiration True, you should hear vesicular sounds everywhere but over the scapulae and on either side of the sternum (bronchovesicular)

Crackles, rhonchi, wheezes, and pleural friction rub are called _________ breath sounds. _______ is positive when a person says E but it sounds like A. _________ is positive when a person says ninety-nine and the voice isn't muffled and indistinct, but is instead clear and loud (when listening to the chest with astethoscope). What is whispered pectoriloquy?

Adventitious Egophony Bronchophony

When a patient whispers, "one-two-three" while you listen with a stethoscope. If you hear it clearly and distinctly, it is positive. Pneumonia COPD or asthma COPD, exacerbated asthma, or pulmonary edema. Indicates moderate/severe respiratory distress. Respirations above 25 breaths per minute Adults: 12-20 breaths per minute Elderly: 1625 Inspiration should take half as long as expiration Irregular breathing with apnea every 4-5 breath cycles

What condition would cause a positive egophony, bronchophony, or whispered pectoriloquy? Pursed lip breathing is a common finding in people who have... The tripod position is associated with what respiratory conditions?

What is considered tachypnea in the elderly population? What are normal respiratory rates in adults?In the elderly? Which takes longer, inspiration or expiration? What are Biot's respirations?

Problems of Oxygenation Ventilation Problems of Oxygenation VentilationMedical Surgical Nursing Page 10 Question Rapid, deep breathing is called _________ respirations. An abnormal pattern of respiration characterized by alternating periods of apnea and deep, rapid breathing is called ________ respiration. T/F Cyanosis is an early sign of respiratory problems. Where is cyanosis best observed in dark-skinned patients? 19 Answer Kussmaul Respirations Cheyne Stokes

False, it is a late sign Conjunctivae, lips, palms or under the tongue

Clubbing is a sign of long-standing _________. When inspecting the posterior chest, how should the patient be positioned? Cyanosis reflects _____ g of hemoglobin is not bound with oxygen. What conditions can causeclubbing? (4) What is abdominal paradox? What conditions can cause the two sides of the chest to move unequally during inspiration? Idiopathic pulmonary fibrosis, interstitial edema (early pulmonary edema), alveolar filling (pneumonia), atelectasis, or the early phase of heart failure can all cause what adventitious breath sound? What are the major differences between fine crackles and coarse crackels?

Hypoxemia Leaned forward with their arms folded, this moves the scapulae away from the spine.

Chronic hypoxemia (like with COPD), cystic fibrosis, lung cancer, bronchiectasis It is an inward (rather than the normal outward) movement of the abdomen during inspiration. Atelectasis, pneumothorax, pleural effusion or splinting (which can be purposeful) Crackles (fine)

Fine: short, high pitched, heard at the end of inspiration, caused by equalization of gas pressure Coarse: long, low pitched, evident on inspiration and sometimes expiration, caused by air intermittently passing through an airway partially occluded. Coarse Coarse crackles

_______ crackles are similar to the sound made when blowing bubbles underwater with a straw. Heart failure, pulmonary edema, pneumonia with severe congestion and COPD can all cause what adventitious breath sound? A snoring, rattling sound that are usually caused by obstructions of the large airways with secretions.They are most prominent on expiration. What interventions can help rhonchi? Croup, epiglottitis, vocal cord edema after extubation, or a foreign body can all cause what adventitious breath sound?

Rhonchi

Having the patient cough or by using suctioning Stridor (high-pitched musical/crowing sound)

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