NCM 112 Oxygen Exchange and Utilization Past Paper PDF

NCM 112: Oxygen Exchange and Utilization Cebu Doctors’ University Fated Nurses Ms. Kerstine Iza Benolerao, RN Bambam2017 Bambam2017 AIRFLOW OF THE HEALTHY LUNGS...

NCM 112: Oxygen Exchange and Utilization Cebu Doctors’ University Fated Nurses Ms. Kerstine Iza Benolerao, RN Bambam2017 Bambam2017 AIRFLOW OF THE HEALTHY LUNGS OBSTRUCTIVE LUNG DISEASE Air breathed in will go to the pharynx, then the trachea, the bronchi, bronchioles, and alveoli ASTHMA ALVEOLI – this is where gas exchange happens - Characterized by chronic airway inflammation resulting to airway hyperresponsiveness, mucosal edema and - OBSTRUCTIVE LUNG DISEASE increased mucous production. a. There is lesser gas exchange because of - It is a reversible obstructive lung disease; lesser air flow into and out of the alveoli. however, as pathophysiologic changes b. There is a blockage that is causing an increase it may become irreversible. alteration of the airflow which is present in the following conditions: a. Asthma b. Bronchiectasis c. Chronic Bronchitis d. Emphysema e. Foreign Body Obstruction - RESTRICTIVE LUNG DISEASE I. There is lesser airflow since the lungs are Predisposing Factors: restricted to fill to its full capacity - Atopy II. This is due to stiffness in the lungs or - Female Gender muscles surrounding it. Causal Factors a. Pneumonia Exposure to indoor and outdoor allergens b. Pleurisy Occupational sensitizers c. Pleural Effusion Contributing Factors d, Pneumothorax 1. Respiratory infections e. Respiratory depression 2. Air pollution 3. Active/ passive smoking due to CNS disease/ CNS depressants, Muscular 4. Other ( diet, small size at birth) weakness, chest wall Risk Factors for exacerbations: 1. Allergens Deformities: 2. Respiratory infections - Acute Respiratory Distress Syndrome 3. Exercise and hyperventilation (ARDS) 4. Weather changes - Sudden Infant Death Syndrome (SI) 5. Exposure to sulfur dioxide 6. Exposure to food, additive, medications Symptoms: Wheezing Cough 1  NCM 112: Oxygen Exchange and Utilization Cebu Doctors’ University Fated Nurses Ms. Kerstine Iza Benolerao, RN Bambam2017 Bambam2017 Dyspnea Allergic reactions accompanied with the Chest tightness asthma Laboratory Tests Remember: When there is inflammatory - Eosinophilia will show in blood tests response, mast cells release several chemicals during acute episodes called MEDIATORS and these will include: - Elevated serum IgE if it is due to Histamine, Radicanine, Prostenoids, allergies Ctyokines, Leukotrienes and other mediators. - Arterial blood gas analysis – This will perpetuate the inflammatory response. hypocapnia due to rapid When this happens, there is increased blood flow respirations resulting to respiratory in the vessels, vasoconstriction and there is a leak alkalosis. of fluid from the vasculature because those mediators will increase cell permeability or *If a patient will breathe out fast or rapidly, they get vascular permeability and then it will attract WBCs rid of too much CO2 which cause hypocapnia to the area which will cause mucous secretion and bronchoconstriction. *When there is low CO2 that will lead to respiratory alkalosis CLINICAL MANIFESTATIONS: Pulse oximetry reveal decreased O2 Symptoms occur progressively over a few saturations days before acute attacks. In some cases, it may occur abruptly. MEDICAL MANAGEMENT Cough - may occur with or without mucus Administering O2 when hypoxic production Checking of blood gases during severe Dyspnea – due to constricted airways attacks (to make sure that the patient is not Wheezing – first on expiration then on acidosis) progressing to wheezing on inspiration Pulse oximetry monitoring (for patients who - expiration needs effort and prolonged because are acutely ill or has acute attacks) the body is having difficulty getting rid of the extra Treatment of underlying allergic reaction if air inside the lung due to Bronchoconstriction precipitated by allergens (main precipitants of asthma attacks) Tachycardia Administration of smooth muscles Diaphoresis relaxants and steroids (inhaled or Cyanosis – due to hypoxemia (late sign) systemically) Status Asthmaticus – life threating Spirometry (can be done if patient can condition wherein there is severe tolerate it before giving treatment and also continuous reaction. after giving treatment to see the Respiratory failure if not managed improvement and effectivity of the immediately treatment DIAGNOSTICS PHARMACOLOGIC MANAGEMENT - Medical history and Physical ❑ Short Acting Assessment a. Short-acting beta2- adrenergic agonists (SABA) Known familial history - relaxes smooth muscles Environmental factors e.g. albuterol, levalbuterol, pirbuterol 2  NCM 112: Oxygen Exchange and Utilization Cebu Doctors’ University Fated Nurses Ms. Kerstine Iza Benolerao, RN Bambam2017 Bambam2017 Acute exacerbation: 25 – 5 mg every 20 mins for hours of bronchodilation; albuterol (oral) can give 8 3 doses (nebulized) hours or more of bronchodilation 4 – 6 puffs from MDI (meter dose inhaler) every 20 d. Methylxanthines mins for 3 doses (given via spacer) 1. Theophylline- works by relaxing airway b. Anticholinergics – inhibit muscarinic cholinergic muscle (bronchodilatory effect) and receptors and reduce vagal tone of the airway. supresses response to allergens and irritants e.g. Ipratropium or tiotropium (anti-inflammatory effects) - given in conjunction with Acute exacerbation: 0.5 mg every 20 mins for 3 inhaled corticosteroids to manage nighttime doses (nebulized) can be given together w/ SABA asthma 8 puffs from MDI every 20 mins for 3 doses (given e. Leukotriene modifiers via spacer) Leukotriene receptor antagonists- inhibits TAKE NOTE: acetylcholine binds to muscarinic receptors of cysteinyl leukotrienes which are receptors and lead to bronchoconstriction, increased potent inflammatory mediators, e.g., mucus secretion and inflammation. If we give montelukast and zafirlukast anticholinergics, they will reduce the vagal tone of 5-Lipoxygenase inhibitor- inhibits production the airway and inhibit muscarinic cholinergic of leukotrienes e.g., Zileuton (Zyflo) receptors. f. Immunomodulators ❑ Long- acting Medications - prevent IgE binding to receptors of basophils and a. Corticosteroids mast cells e.g., Omilazumab - mast cells and basophils are part of the - most effective and potent anti – inflammatory inflammatory process so if you prevent the binding - they work by suppressing the inflammatory genes to the receptors, it will also prevent exacerbation to reduce inflammation and mucus production - this can be given via inhalation e.g budesonide, NURSING MANAGEMENT: fluticasone Assess respiratory status- vital signs, pulse - systemic preparations for rapid control of oximeter, breathe sounds, work of breathing symptoms e.g. methylprednisolone, prednisolone, and chest excursions prednisone (oral) Administer medications immediately b. Mast cell stabilizers – stabilizes mast cells, may especially in acute exacerbations and be used for prophylactic treatment; contraindicated monitor response by checking respiratory for acute exacerbations status. Spirometry before and after giving Example: cromolyn Na and nedocromil medications- if the patient is very short of TAKE NOTE: One of the mediators of the breath and they cannot tolerate spirometry inflammatory response are MAST CELLS that is fine, the patient’s needs to be given medications immediately and then after an c. Long-acting beta agonists (LABA)- long term hour spirometry can be done prevention of symptoms particularly those occuring Administer fluids to keep the patient hydrated at night time; indicated for exercise induced asthma. Patient education especially on triggers and (e.g., salmeterol and formoterol (inhaled) give 12 signs and symptoms of progressive or early 3  NCM 112: Oxygen Exchange and Utilization Cebu Doctors’ University Fated Nurses Ms. Kerstine Iza Benolerao, RN Bambam2017 Bambam2017 progression of exacerbations, educate on Abnormal bronchodilation, edema, scarring, the proper use of metered dose inhalers and ulceration emphasize the importance of adherence to a ↓ medication regimen Accumulated secretion cause blockage ↓ BRONCHIECTASIS - a chronic, irreversible dilation of the bronchi and Atelectasis of alveoli distal to the obstruction bronchioles due to the destruction of the muscles and elastic connective tissues ↓ - caused by pulmonary infections, cystic fibrosis, TB, Reduced vital capacity rheumatic disease, and other disorders - affects mostly of the lobes of the lungs and is ↓ usually localized and it also affects women than men Decreased ventilation PATHOPHYSIOLOGY ↓ Pulmonary infection/underlying disease process Ventilation perfusion mismatch ↓ ↓ Inflammatory process Hypoxemia ↓ CLINICAL MANIFESTATIONS: Damage to muscular and elastic structure of the 1. Chronic cough bronchial wall 2. Copious amount of purulent sputum lasting ↓ months to years – some may only produce sputum during acute upper respiratory tract Abnormal bronchodilation, edema, scarring, infection ulceration 3. Hemoptysis- form ulceration in the bronchi ↓ due to acute inflammation 4. Dry bronchiectasis- episodic hemoptysis with Severely impaired clearance of secretions little or no sputum usually a sequela of TB ↓ 5. Dyspnea with extensive bronchiectasis 6. Wheezing may be manifested due to blocked Colonization of bacteria develop airways. 7. Fatigue- because if the patient is hypoxic, ↓ they will have reduced oxygenation so it lead Cycle of inflammation and bronchial damage to fatigue 8. Clubbing of fingers due to respiratory insufficiency DIAGNOSTICS: Medical history and physical exam Sputum analysis CT-scan- reveals bronchial dilation ON THE OTHER HAND 4  NCM 112: Oxygen Exchange and Utilization Cebu Doctors’ University Fated Nurses Ms. Kerstine Iza Benolerao, RN Bambam2017 Bambam2017 Chest X-ray- shows pleural changes, 2. Bronchodilators- to help with management of atelectasis, increased pulmonary markings secretions and improve bronchospasm CBC- nonspecific finding, but may show 3. Corticosteroids- may be considered daily in anemia with elevated WBC count patients with significant obstructive physiology Goals of Treatment: NURSING MANAGEMENT: 1. Promoting bronchial drainage 2. Clear excessive secretions from affected 1. Assess and monitor respiratory status- vital portion of the lungs signs, pulse oximetry, spirometry 3. Prevent of control infection 2. Assist with or perform chest physiotherapy Antibiotic therapy and chest physiotherapy 3. Administer medications as indicated are important modalities of treatment 4. Administer supplemental O2 as needed 5. Ensure adequate nutrition and hydration MEDICAL AND SURGICAL MANAGEMENT: 6. Promote adequate rest Chest physiotherapy with percussion and 7. Provide patient education in promoting postural drainage to manage secretions and postural drainage, importance of hydration lessen infections on assisting with management of secretions, Supportive treatment lifestyle modifications such as cessation of - IVF or oral hydration to maintain hydration smoking, proper nutrition, and immunization status for influenza and pneumococcal pneumonia - oxygen supplementation for hypoxic vaccine patients Bronchoscopy CHRONIC BRONCHITIS - for removal of mucopurulent sputum if - long term inflammation of the bronchi; a form of needed COPD - bronchoscopy is a procedure that will look - defined with presence of cough and sputum directly at the airways in the lungs using a production for at least 3 months a year in 2 thin lighted tube or the bronchoscope and it consecutive years is put in the nose or the mouth and then it - major cause is smoking followed by exposure to moves down to the throat and the windpipe environmental irritants or a family history of then into the airways bronchitis Surgical resection - resection of the bronchioectatic lung in PATHOPHYSIOLOGY patients with advanced disease; involve Smoke/ environmental pollutants (dust, second- sites that will be completely resected for hand smoke, fumes, allergens) optimal symptom control especially for those patients who have massive ↓ hemoptysis Irritation of airways PHARMACOLOGIC MANAGEMENT: ↓ 1. Antibiotic therapy for exacerbations- empiric Inflammatory process occurs coverage while waiting for the results of the sputum culture and sensitivity ↓ - pseudomonas aeruginosa- requires more aggressive oral or IV antibiotic therapy Constant inflammation 5  NCM 112: Oxygen Exchange and Utilization Cebu Doctors’ University Fated Nurses Ms. Kerstine Iza Benolerao, RN Bambam2017 Bambam2017 ↓ Medical Management Increased mucus secreting glands and goblet cells 1. O2 Supplementation for hypoxia depending on severity ↓ 2. Blood gas studies for patient who have acute Increased mucus production shortness of breath 3. Pulmonary rehabilitation – program to help ↓ improve the wellbeing of patients with Mucus plugging chronic respiratory problems a. Exercise program ↓ b. Disease management training c. Nutritional counselling Narrowing of airways d. Psychological counselling ↓ Pharmacologic Management Shortness of breath, hypoxia, chest discomfort Bronchodilators to relax airways Corticosteroids to lessen inflammation in the airways Antibiotics for underlying infection Nursing Management Monitoring respiratory function Administering O2 supplements as needed Administer medications as prescribed and educate patient on its importance Educate patient on lifestyle changes Because of the increased mucus glands, it will cause o Smoking cessation, avoidance of an increased mucus production and inflammation known irritant or wearing of protective that will lead to constriction of airway gear such as masks when constantly exposed to fumes Clinical Manifestation Educate patient on pursed lip breathing to open airways when feeling short of breath 1. Frequent coughing with sputum 2. Wheezing 3. Shortness of breath EMPHYSEMA 4. Chest tightness Abnormal distention of air spaces distal to Diagnostics the terminal bronchioles and destruction of 1. Medical history and physical assessment the alveolar walls leading to a decreased 2. Pulmonary function test to check how much surface area for gas exchange air the lungs can hold Damage and hyperinflation of the alveolar 3. Chest Xray to rule out other causes of cough walls 4. Ct scan of the chest for a clearer picture of Form of COPD the lungs Risk factors: smoking, air pollutant 5. Sputum tests to check for underlying exposure, genetics (deficiency in alpha-1 infections antitrypsin, an enzyme inhibitor that protects 6  NCM 112: Oxygen Exchange and Utilization Cebu Doctors’ University Fated Nurses Ms. Kerstine Iza Benolerao, RN Bambam2017 Bambam2017 the lung parenchyma) and respiratory Clinical Manifestations infections 1. Hallmark presentation: limitation of expiratory flow with intact inspiratory flow Subtypes based on the lung changes a. Longer exhalation time compared to inhalation time 1. Panlobular (panacinar) – destruction of the 2. Chronic cough and sputum production that respiratory bronchiole, alveolar duct and may be present for several years before alveolar onset of dyspnea a. Dilation of airspaces with little 3. Tachypnea and dyspnea on mild exertion inflammatory disease with severe disease 4. Weight loss a. Due to dyspnea interfering with eating and causing increased O2 consumption 5. Barrel shaped chest a. Due to hyperinflation and loss of lung elasticity Diagnostics 2. Centrilobular – localized to proximal 1. Medical history and physical examination respiratory bronchioles with focal destruction 2. Spirometry – done before and after giving a. Most common type associated with inhaled bronchodilators smoking 3. Arterial blood gases – to determine oxygenation status especially in advance diseases 4. Screening for alpha 1 antitrypsin deficiency for patients 90% with the lowest 9. Ensuring comfortable position for the patient possible Fraction of inspired oxygen (FiO2) ad and proper alignment PaO2 of >60 mmHg 10. Educating family members (FiO2 - concentration of Oxygen in the gas Sudden Infant Death Syndrome (SIDS) mixture) - Deaths in infants younger than 12 months Pharmacologic management occurs suddenly, unexpectedly, and cannot be explained despite a thorough investigation - There is no specific Pharmacologic including a complete autopsy, examination of the management for ARDS death scene, and review of the clinical and social - Sedation (Lorazepam, midazolam, Propofol) history or neuromuscular blocking agents (rocuronium, - Classic presentation: An infant put to bed alcuronium, vecuronium) may be given to after feeding, and are normal during interval ventilated patients to: a. Reduce physiological checks but then found dead in the same position stress from respiratory failure they have been placed on b. Improve tolerance of invasive life support Clinical Manifestations This will keep the patient from fighting with the 1. Some live patients may be seen after a Brief machine as the ventilator can be very Resolved Unexplained Event (BRUE) BRUE- uncomfortable to the patient Maybe interrupted SIDS or related to it; or a Nursing Management whole other phenomena a. cyanosis 1. Patents with ARDS are critically ill therefore b. breathing difficulties frequent monitoring of status is needed to c. Abnormal Limb movement evaluate effectiveness of treatment. - Patients with BRUE may have a completely 2. Position the patient to allow better ventilation normal physical exam after the episode (50%), 3. Turning the patient to improve perfusion and febrile (25%), and have infection (25%) drainage secretions Physical findings on patients with SIDS 4. Provide a calm environment to promote rest Serosanguineous watery, frothy mouth, or mucoid discharge from mouth or nose reddish- 18  NCM 112: Oxygen Exchange and Utilization Cebu Doctors’ University Fated Nurses Ms. Kerstine Iza Benolerao, RN Bambam2017 Bambam2017 blue mottling on the face and dependent portion - monitor cardiac and respiratory status of the body closely marks on pressure points well cared for -assist with procedures needed to be taken for appearance with no skin trauma no workup environmental contribution to the unexpected death - educate parents on the procedures to be done and the purpose of cardiorespiratory Diagnostics monitoring, A workup will be done for a patient brought to the 2. Procedure after SIDS ED after a BRUE - Empathize and be compassionate with 1. Rapid bedside glucose test family and inform them in a quiet environment 2. arterial blood gases for severely ill or have - Expression of sorrow and sympathy may be persistent symptoms given but avoid statements like 3. blood workup and urine exam including "I know how you feel" because that will just toxicology screenings induce anger 4. 12 lead ECG Current recommendations on Sleep Positions and the infant sleep environment 5. Complete septic workup which includes lumbar puncture for patients under 2 months or Place the infant on its back for sleep on a firm, if with significant evidence of infection and tight-fitting mattress in a crib that meets current include antibiotic administration federal safety standards 6. Upper airway studies Remove pillows, quilts, comforters, sheepskins, stuffed toys, and other soft items from the crib Medical management Do Not place the infant on a water bed, sofa, soft 1. paramedics who arrived in the scene will mattress, pillow or another soft surface to sleep resuscitate an infant in cardiorespiratory arrest the patient will be brought to the emergency Consider using a sleeper or sleep sack as an department alternative to blankets or other covers Make sure that the infant's head remains uncovered during 2. admission in the icu for cardiac and sleep place the infant so that its feet’s are respiratory monitoring including arterial oxygen positioned at the foot of the crib saturation for critical or unstable patients If a thing blanket is used, tuck it around the crib 3.infants who are stable but had cyanosis altered mattress positioned up only as far as the infant's mental state or tone should be admitted chest 4. stable children will have continuous Prevention cardiorespiratory monitoring to determine apnea or bradyarrhythmia’s - Start prenatal care early Nursing Management - Avoid cigarettes, alcohol or other drugs while pregnant 1. Patients admitted after a BRUE - breastfeed if possible 19  NCM 112: Oxygen Exchange and Utilization Cebu Doctors’ University Fated Nurses Ms. Kerstine Iza Benolerao, RN Bambam2017 Bambam2017 - burp the baby during and after feedings Remove extra air. - place baby on a firm flat mattress in a safety Tension pneumothorax approved crib, avoid pillows, blankets, foam pads or waterbeds → EMERGENCY. Air hunger, cyanosis, Hypotensive. Increased pulse rate. - do not restrain the baby while sleeping Jugular vein distention. - improve the room's ventilation by using a fan Traumatic pneumothorax - side sleeping and prone positioning is not Chest tube drainage → Lower than the advised heart and lungs Oscillation in fluid= normal. - bed sharing should be avoided (suffocation from loose clothing, or a sleeping adult, or to Alarming= bubbles. Leak in tubing/ chest overheating) antibiotic, pain relief for client LEC NOTES: Read on FOR MIDTERMS PASAAR CUTIE~ Pneumonia CARE OF CLIENTS WITH CHEST TUBE DRAINAGE Noninvasive ventilator - tight fitting mask so no air leak. Only when client is breathing on their Acute respiratory distress syndrome→ own. Breathe in with machine secondary disease BIPAP – non-invasive form of therapy for patient → rapid onset of dyspnea suffering from sleep apnea → pulmonary edema- caused by cardiogenic CPAP -continuous positive airway pressure. and respiratory problems. PNP is taken to check. Only 1 steady. A bit difficult for client to exhale. If high it is due to cardiac problems This is usually done in clients who have COPD, (cardiomyopathy etc). continuous oxygen. If result is borderline: GCS8 Intubation: → thoracentesis → difference in X-ray → Sedative medications decreased pulmonary compliance Neuromuscular blocking agent-given before SIDS→ Asthma → Given right away--> intubation. IV. After 1 minute it will start to work. ALBUTEROL- dose is 5.25 every 20 mins monitor every hour Breathe 4-6 times through mouth while Sputum Analysis → green/ rust colored sealing mouthpiece. During acute exacerbations-->albuterol Pleural Effusion will lessen constriction of muscle. Low albumin= lesser pull of fluid, lesser oncotic 8 puffs every __ for 3 doses pressure, fluid seeps out/ increased pressure→ Corticosteroid→ potent anti- inflammatory. If recovered, don’t need to TRANSUDATIVE continue, only to stabilize inflammatory Pneumothorax- air is introduced in pleural process during acute stage. Long acting- space. ->fluticasone Leukotriene modifiers Management of Pneumothorax 20  NCM 112: Oxygen Exchange and Utilization Cebu Doctors’ University Fated Nurses Ms. Kerstine Iza Benolerao, RN Bambam2017 Bambam2017 Spirometry→ Chronic bronchitis→ SIDS usually occurs when a baby is MUCUS PRODUCTION, due to increase asleep, although it can occasionally in goblet cells in airway due to happen while they're awake. inflammation Parents can reduce the risk of SIDS by Bronchiectasis-->dilation of bronchi and not smoking while pregnant or after the bronchioles baby is born, and always placing the If bronchioles constantly dilated → baby on their back when they sleep (see difficult to remove secretions, which then below). accumulates causing dyspnea and a source of infection What causes SIDS? GOAL: The exact cause of SIDS is unknown, but it's thought to be down to a combination of factors. Prevent infection Experts believe SIDS occurs at a particular stage Promote bronchial drainage Help client to in a baby's development and that it affects PULMONARY REHABILITATION: babies vulnerable to certain environmental stresses. Exercise Disease Management This vulnerability may be caused by being born Oxygen Therapy (as needed) prematurely or having a low birthweight, or Counselling because of other reasons that have not been Emphysema→ abnormal distention of air identified yet. spaces. Expanded. Inflated. Difficult to get Environmental stresses could include tobacco rid of CO2 smoke, getting tangled in bedding, a minor Additional Notes from links: illness or a breathing obstruction. There's also an association between co-sleeping (sleeping with Sudden infant death syndrome (SIDS) your baby on a bed, sofa or chair) and SIDS. Sudden infant death syndrome (SIDS) – Babies who die of SIDS are thought to have sometimes known as "cot death" – is the sudden, problems in the way they respond to these unexpected and unexplained death of an stresses and how they regulate their heart rate, apparently healthy baby. breathing and temperature. In the UK, more than 200 babies die suddenly Although the cause of SIDS is not fully and unexpectedly every year. This statistic understood, there are a number of things you can do to reduce the risk. may sound alarming, but SIDS is rare and the risk of your baby dying from it is low. What can I do to help prevent SIDS? Most deaths happen during the first 6 months of Below is a list of things you can do to help a baby's life. Infants born prematurely or prevent SIDS. with a low birthweight are at greater risk. SIDS Do: also tends to be slightly more common in baby boys. always place your baby on their back to sleep 21  NCM 112: Oxygen Exchange and Utilization Cebu Doctors’ University Fated Nurses Ms. Kerstine Iza Benolerao, RN Bambam2017 Bambam2017 place your baby in the "feet to foot" position is unconscious or seems unaware of what's – with their feet touching the end of the cot, going on Moses’ basket, or pram will not wake up keep your baby's head uncovered – their has a fit for the first time, even if they seem blanket should be tucked in no higher than their to recover shoulders Read more about spotting signs of serious let your baby sleep in a cot or Moses basket illness in children. in the same room as you for the first 6 months Support services use a mattress that's firm, flat, waterproof and in good condition If a baby dies suddenly and unexpectedly, there will need to be an investigation into how and why breastfeed your baby, if you can – see benefits of breastfeeding for more information they died. A post-mortem examination will usually be necessary, which can be very Do not: distressing for the family. smoke during pregnancy or let anyone The police and healthcare professionals work smoke in the same room as your baby – both closely to investigate unexpected infant deaths before and after birth and ensure the family is supported. They should be able to put you in touch with local sources of sleep on a bed, sofa or armchair with your help and support. baby Many people find talking to others who have had share a bed with your baby if you or your similar experiences helps them to cope with their partner smoke or take drugs, or if you've been bereavement. drinking alcohol → The Acute Respiratory Distress Syndrome: let your baby get too hot or too cold – a room Pathogenesis and Treatment temperature of 16C to 20C, with light bedding or a lightweight baby sleeping bag, will provide a Lung function tests can be used to: comfortable sleeping environment for your baby Compare your lung function with known Read more about reducing the risk of SIDS. standards that show how well your lungs should be working. Seeking medical advice if your baby is unwell Measure the effect of chronic diseases like Babies often have minor illnesses that you do not asthma, chronic obstructive lung disease need to worry about. Give your baby plenty of (COPD), or cystic fibrosis on lung function. fluids to drink and do not let them get too hot. Identify early changes in lung function that If you're worried about your baby at any point, might show a need for a change in treatment. see your GP or call NHS 111 for advice. Detect narrowing in the airways. Dial 999 for an ambulance if your baby: Decide if a medicine (such as a bronchodilator) stops breathing or turns blue could be helpful to use. is struggling for breath Show whether exposure to substances in your home or workplace may have harmed your 22  NCM 112: Oxygen Exchange and Utilization Cebu Doctors’ University Fated Nurses Ms. Kerstine Iza Benolerao, RN Bambam2017 Bambam2017 lungs. Determine your ability to tolerate You may be asked not to take your breathing surgery and medical procedures. medicines before this test. To get the most accurate results from your Instructions will be given on how to do this test. breathing tests: If you do not understand the instructions, ask the staff to repeat them. Do not smoke for at least 1 hour before the test. It takes effort to do this test and you may become tired. This is expected. Do not drink alcohol for at least 4 hours before the test. If you become light-headed or dizzy during this test, immediately stop blowing and let the staff Do not exercise heavily for at least 30 minutes know. before the test. What are diffusion studies? Do not wear tight clothing that makes it difficult for you to take a deep breath. Diffusion tests find out how well the oxygen in the air you breathe in moves from your lungs into Do not eat a large meal within 2 hours before your blood. the test. Pulmonary Function Tests Ask your health care provider if there are any medicines that you should not take on the day of Pulmonary function tests (PFT’s) are breathing your test. tests to find out how well you move air in and out of your lungs and how well oxygen enters your What is spirometry? blood stream. The most common PFT’s are Spirometry is one of the most commonly ordered spirometry (spy-RAH-me-tree), diffusion studies, tests of your lung function. The spirometer and body plethysmography (ple-thiz-MA-gra- measures how much air you can breathe into fee). Sometimes only one test is done, other your lungs and how much air you can quickly times all tests will be scheduled on the same blow out of your lungs. This test is done by day. having you take in a deep breath and then, as www.thoracic.org fast as you can, blow out all of the air. You will be blowing into a tube connected to a machine Am J Respir Crit Care Med, Vol. 189, P17-P18, (spirometer). To get the “best” test result, the test 2014 is repeated three times. Online Version Updated October 2019 You will be given a rest between tests. The test ATS Patient Education Series © 2014 American is often repeated after giving you a breathing Thoracic Society medicine (bronchodilator) to find out how much better you might breathe with this type of American Thoracic Society medicine. It can take practice to be able to do a spirometry test well. The staff person will work PATIENT EDUCATION | INFORMATION with you to learn how to do the test correctly. SERIES www.thoracic.org It usually takes 30 minutes to complete this test. Like spirometry, this test is done by having you What should I know before doing a spirometry breathe into a mouthpiece connected to a test? machine. You will be asked to empty your lungs by gently breathing out as much air as you can. Then you will breathe in a quick (but deep 23  NCM 112: Oxygen Exchange and Utilization Cebu Doctors’ University Fated Nurses Ms. Kerstine Iza Benolerao, RN Bambam2017 Bambam2017 breath), hold your breath for 10 seconds, and If you are on oxygen, you will usually be asked then breathe out as instructed. to be off oxygen during this test. You will do the test several times. It usually takes Let the staff know if you have difficulty in closed about 30 minutes to complete this test. spaces. What should I know before doing a diffusion What are normal results for lung function tests? test? Do not smoke and stay away from others Because everyone’s body and lungs are different who are smoking on the day of the test. sizes, normal results differ from person to person. For instance, taller people and males If you are on oxygen, you will usually be asked tend to have larger lungs whereas shorter people to be and females have smaller lungs. It is normal for off oxygen for a few minutes before taking this your lung function to fall slightly as you age. test. These standards that your healthcare provider What is body plethysmography? uses, are based on your height, age, and sex at birth. These numbers are called the “predicted Body plethysmography is a test to find out how values”. Your measured values will be compared much air is in your lungs after you take in a deep to these predicted values. breath, and how much air is left in your lungs after breathing out as much as you can. No R Action Steps matter how hard you try, you can never get all of ✔ Ask questions if you do not understand the the air out of your lungs. Measuring the total instructions for the lung function test. amount of air your lungs can hold and the amount of air left in your lungs after you breathe ✔ If you have a cold or flu, let the test center out gives your healthcare provider information know because you may need to reschedule your about how well your lungs are working and helps test. guide your treatment. This test requires that you sit in box with large windows (like a telephone ✔ If you have difficulty with closed booth) that you can see through. You will be spaces(claustrophobia), let the test center know asked to wear a nose clip and you will be given in case one of the tests involves being enclosed. instructions on how to breathe through the mouthpiece. You will be asked to take short, ✔ Ask if there are any medicines you should shallow breaths through the mouthpiece when it stop taking before being tested and for how long is blocked for a few seconds, which may be you should stop it. uncomfortable. If you have difficulty with being in ✔ After your pulmonary function testing is over, closed spaces (claustrophobia), mention this to you can return to your normal activities. your provider ordering the test. This will avoid any misunderstanding and discomfort to you. It Healthcare Provider’s Con usually takes about 15 minutes to complete. Some PFT labs will use other tests instead of REMINDERS FOR 6M MIDTERMS READ ABOUT plethysmography to measure the total volume of CARE OF PATIENTS WITH CHEST TUBE AND air in your lungs. ITS NURSING INTERVENTIONS What should I know before doing a plethysmography test? 24 NCM 112: Oxygen Exchange and Utilization Cebu Doctors’ University Fated Nurses Ms. Kerstine Iza Benolerao, RN Bambam2017 Bambam 25