Respiratory

Multiple Choice

Respiration consists of 2 processes. They are:

• Ventilation and Oxygenation

• Inspiration and Expiration

• Oxygenation and Perfusion

• Circulation and Gas Exchange

Involves the intake of air and gas exchange in the lungs.
O2 diffuses across alveolar walls into pulmonary capillaries.
O2 dissolves in blood, binds to hemoglobin and travels to body.

​Oxygenation

Movement of air into and out of the lungs
Starts with inspiration and ends with expiration

​Ventilation

Respiration Processes

Multiple Select

Which of the following cardiovascular issues can affect oxygenation and perfusion? (Select ALL that apply)

• Hypertension

• Heart Failure

• Valvular heart disease

• Coronary Artery Disease

• Cardiac dysrhythmias

Can limit blood flow to parts of the heart and systemic circulation.

Can subsequently lead to heart failure.

​Valvular Heart Disease

HF can lead to increased pulmonary vascular congestion causing decreased oxygenation.

Heart failure leads to decreased cardiac output and decreased systemic perfusion.

Heart Failure

Cardiovascular Factors Affecting Oxygenation and Perfusion

CAD-decreased oxygenated blood reaches the heart
PVD-limits amount of oxygenated blood delivered to tissues

Blood Vessels

Dysrhythmias can lead to decreased cardiac function and decreased perfusion.

​(i.e.: Bradycardia (decreased HR leads to decreased CO)

Cardiac Dysrhythmias

Cardiovascular Factors Con't

Multiple Select

Which of the following respiratory factors can affect oxygenation and perfusion? (Select ALL that apply)

• Respiratory Rate

• Cough

• Acute Infections

• Chronic Lung Infections

• Lung Compliance (Pulmonary Function)

Decreased lung function and capacity leads to decreased oxygenation.

​Decreased lung capacity leads to decreased oxygenation.

​Pulmonary Function

Controlled by respiratory centers in the brain.
Decreased rate...decreased oxygenation.

Respiratory Rate

Respiratory Factors Affecting Oxygenation and Perfusion

Chronic conditions can be obstructive or restrictive in nature.
These conditions lead to decreased oxygenation

Chronic Lung Conditions

Infections can cause increased secretions, inflammation, and blockage resulting in decreased oxygenation.

Acute Infections

Respiratory Factors Con't

Other disorders affecting oxygenation and perfusion

Hematological factors: Anemia(s)

The binding of O2 to hemoglobin is related to pH, Carbon Dioxide, 2,3 Biphosphoglyceric acid, and temperature.
Anemia(s) lowers the O2 capacity of the blood
(Iron deficiency anemia, sickle cell anemia, anemia secondary to blood loss)

Multiple Select

Signs and symptoms of restrictive respiratory diseases include: (Select ALL that apply)

• Decreased O2 saturation

• Barrel Chest

• Increased HR

• Diminished breath sounds

• Sputum production

Multiple Select

Signs and symptoms of obstructive respiratory diseases include (Select ALL that apply)

• Barrel chest

• Chronic cough

• Increased HR

• Sputum production

• Wheezing on auscultation

Inability to effectively exhale Carbon Dioxide

​Obstructs airflow out of the lungs
Examples: COPD (emphysema, chronic bronchitis

​Obstructive

Restricts airflow into the lungs (inability to effectively take in O2).

Examples: PNA, atelectasis

​Restrictive

Respiratory Diseases

Multiple Select

You are assessing a patient for oxygenation and perfusion issues. Which of the following signs/symptoms indicate the patient's issues are cardiovascular in nature as opposed to respiratory? (Select ALL that apply)

• SOB @ rest

• Weight gain

• Sputum production

• Chest pain

• Sleeping on 3 pillows @ night

• SOB @ rest

• Smoking hx

• Hx: respiratory condition

• Cough

• Sputum production

​Respiratory

• Chest pain

• SOB

• Fatigue

• Weight gain

• Increased # pillows to sleep

​Cardiovascular

Assessing Cues

The lining of larger airways are damaged.
Difficulty clearing mucus
Mucus builds up...airways narrow

​Chronic bronchitis

Progressive form of COPD
Inflammed and damaged alveolar walls

​Emphysema

Diseases: COPD

Diseases Con't

Asthma: Chronic disease

Reversible
Causes airway obstruction
Cues:
Cough; Dyspnea; Wheezing

Multiple Select

Which of the following assessment findings might you expect to find in a patient with chronic bronchitis? (Select ALL that apply)

• Chronic cough

• Fever

• Wheezing on auscultation

• Increased mucus production

• Dyspnea

• Increased mucus production

• Chronic cough

• Wheezing on auscultation

Chronic Bronchitis

• Dyspnea

• Chronic cough

• Wheezing on auscultation

​Emphysema

Assessment Findings

Assessment Findings

​Asthma

• Cough

• Dyspnea

• Wheezing

Blockage or collapse of air passage(s)

Atelectasis

Inflammation of the lungs secondary to infection.
Alveoli inflamed and filled with fluid
Can be localized or widespread

​Pneumonia

Diseases:

Multiple Select

Which of the following assessment findings might you expect to find in a patient diagnosed with pneumonia? (Select ALL that apply)

• Chronic cough

• Fever

• SOB

• Abnormal breath sounds (rhonchi or rales)

• Productive cough

• Dyspnea

• Decreased or abnormal breath sounds

Atelectasis

• Productive cough

• Dyspnea

• Fever

• Abnormal breath sounds (rales, rhonchi)

​Pneumonia

Assessment Findings

COPD and ABG's

In all patients with COPD, there is a decrease of pH, PaO2, and increase of PaCO2.
In COPD, the blood is more acidic, as the pH levels are low and the PaCO2 levels are above normal.

COPD is one of the main causes of respiratory acidosis

Multiple Choice

In a patient with COPD experiencing impaired gas exchange, what type of Acid/Base imbalance might you expect to see?

• Respiratory Alkalosis

• Metabolic Alkalosis

• Respiratory Acidosis

• Metabolic Acidosis