Ventilation and Respiration

Ventilation and Respiration

• Ventilation is the process of moving air into and out of the lungs.
• Respiration is gas exchange between the alveoli and capillaries, or between the bloodstream and body cells.

External vs. Internal Respiration

• External respiration occurs between the alveoli and capillaries, requiring clear ventilation and adequate circulation.
• Internal respiration occurs between the bloodstream and body cells, requiring adequate circulation, red blood cells, and hemoglobin.

Inhalation

• During inhalation, the diaphragm contracts due to phrenic nerve stimulation, moving downward.
• Intercostal muscles contract, lifting the ribs up and out, which increases chest cavity size.
• The lungs expand, creating a vacuum that draws air in to equalize pressure.

Exhalation

• During exhalation, muscles relax, decreasing chest cavity size.
• The ribs move inward, the diaphragm rises, and the lungs are compressed, forcing air out.

Chronic Lung Disease Effects on Respiration

• Chronic lung disease can cause air to be trapped in the alveoli for extended periods.
• Trapped air increases blood carbon dioxide (CO2) levels and lowers oxygen levels.
• The body acclimates to the higher carbon dioxide levels, reducing the stimulus for respirations.

Hypoxia Symptoms: Early vs. Late

• Early signs of hypoxia include agitation, anxiety, changes in consciousness, disorientation, headache, irritability, restlessness, tachypnea, and confusion.
• Late signs of hypoxia include bradycardia, cardiac dysrhythmias, cyanosis, bradypnea, and retractions.

Possible Causes of Hypoxia

• Hypoxia can be caused by airway obstruction, anemia, atelectasis and decreased cardiac output.
• Other causes of hypoxia include high altitude, hypoventilation, poor peripheral circulation, pulmonary embolus, and pain.

Respiratory Status Assessment Parameters

• Key assessments include skin and mucous membrane color, blood pressure, pulse, and respiratory effort.
• Other respiratory status assessments consist of cough, chest appearance, oxygenation status, and oxygen saturation.

Respiratory Disorders Assessment Parameters

• Lung sounds, the existence of hypoxia, and the color, amount, and consistency of sputum need assessment.
• The nutritional status also needs assessment.

Pulse Oximetry

• Movement of the sensor and poor circulation at the sensor site can affect pulse oximetry readings.
• Barriers to the sensor's light and extraneous light can also change readings.
• Hemoglobin saturated with carbon monoxide will affect a pulse oximetry reading.

COPD Diagnosis

• A pulmonary function test helps confirm a patient's diagnosis of COPD.

Nursing Interventions for Impaired Oxygenation

• Interventions include turning, coughing, deep breathing exercises, and nebulizer treatments.
• Providing supplemental oxygen and conserving energy are additional helpful interventions.

Deep Breathing

• Incentive spirometry and pursed-lip breathing are deep breathing techniques.

Oxygen Therapy

• A doctor's order is needed for oxygen therapy.
• Oxygen sources can include wall outlets, portable tanks, liquid oxygen units, and oxygen concentrators.

Equipment Needed for Oxygen Therapy

• Equipment includes a flowmeter and an oxygen analyzer.
• A humidifier is used when needed.

Oxygen Delivery Devices

• Oxygen delivery devices include nasal cannulas, simple masks, partial rebreather masks, and non-rebreather masks.
• Other oxygen delivery devices consist of Venturi masks, face tents, oxygen tents, and CPAP masks.

Oxygen Toxicity

• Oxygen toxicity can occur with O2 delivery at 50% or more for 48-72 hours.
• Symptoms include a nonproductive cough, substernal chest pain, GI upset, and nasal stuffiness.
• It can be difficult to reverse oxygen toxicity; therefore, start with the lowest rate/FIO2 as possible.

Oxygen Delivery Safety Precautions

• Place "No Smoking" signs in the room and ensure there are no open flames.
• Check electrical devices for frayed wires and eliminate the possibility of static electricity.
• Avoid using petroleum-based products.
• Ensure portable tanks are secured.

Hyperbaric Oxygen Therapy

• Hyperbaric O2 therapy delivers 100% O2 under pressure to help regenerate new tissue.
• Carbon monoxide (CO) poisoning is treated using hyperbaric O2 therapy.

Conserving Energy

• Patients should place a chair in the shower and use a terry cloth robe.
• Patients are encouraged to use Pulmocare to increase protein and calories intake, while consuming more frequent, smaller meals.
• Patients are encouraged to rest after performing activities of daily living.

Nursing Diagnoses

• Nursing diagnoses include ineffective breathing patterns and impaired gas exchange.
• Other nursing diagnoses include anxiety and risk for injury related to oxygen hazards.