N103F Fundamental Nursing Practice - Respiratory Care PDF

N103F Foundamental Nursing Practice (Week 8): Respiratory Care I Oct 21, 2024 Learning Outcomes Explain the processes of breathing (ventilation) and gas exchange (respiration) Identify the factors that influence oxygenation to body tissues Describe the clinical manifest...

N103F Foundamental Nursing Practice (Week 8): Respiratory Care I Oct 21, 2024 Learning Outcomes Explain the processes of breathing (ventilation) and gas exchange (respiration) Identify the factors that influence oxygenation to body tissues Describe the clinical manifestations of altered respiratory functions Outline the key components of a pulmonary assessment and diagnostic/ laboratory tests Explain the principles and measures to promote oxygenation. Identify the use of common oxygen therapy devices. Ventilation A mechanical process of moving air in and out of the lungs Nose/Mouth Pharynx Ventilation Flow Larynx Trachea Bronchi Bronchioles Alveoli Story (2020) Mechanism of Ventilation: Inspiration & Expiration Inspiration Expiration Atmospheric pressure > air Air pressure inside the lungs > pressure inside the lungs atmospheric pressure Air moves from the Air moves from the lungs to the atmosphere into the lungs atmosphere (Hubert et al., 2018) Respiration A physiological process of gas exchange (oxygen & carbon dioxide) in alveoli and in the cells Regulated by hormonal and neural sigalling Detects O2 & CO2 concentrations Alter blood flow and bronchiole size External & Internal Respiration External Respiration Internal Respiration Gas exchange between the alveoli Gas exchange occurs between and lung capillaries cells and capillaries CO2 is released from deoxygenated No exchange with the external RBCs environment CO2 diffuses into the lungs for Supplies O2 to cells and removes expiration CO2 Photos from: https://uen.pressbooks.pub/anatomyphysiology2/chapter/external-internal-respiration/ Gas Exchange: Diffusion & Perfusion Diffusion Gases/particles move from areas of high concentration to areas of low concentration Diffusion in respiration O2 moves from alveoli (higher concentration) to capillaries (lower concentration). CO2 moves from capillaries (higher concentration) to alveoli (lower concentration). Process: O2 enters blood; CO2 is exhaled Perfusion: Oxygenated blood flows through body tissues Factors that Influence Oxygenation to Body Tissues Conditions that altered VENTILATION: 1. Condition of the musculature Weak respiratory muscles reduce effective inhalation and exhalation accessory muscles (Abdomen, neck, back) assist during difficult breathing Video from: (khanacademymedicine, April 20, 2019) Conditions that altered VENTILATION: Clinical examples: Body system related Examples Descriptions Chronic Obstructive Respiratory muscles weaken due to chronic Respiratory disorders: Pulmonary Disease (COPD) inflammation, leading to ineffective ventilation. Neuromuscular Amyotrophic Lateral Cause weakness in the muscles responsible for disorders: Sclerosis (ALS) breathing, resulting in reduced ventilation efficiency. Injuries at or above the cervical region can impair the Cerebral and nerve Spinal cord injuries function of the diaphragm and other respiratory disorders: muscles, significantly affecting ventilation. Scoliosis: abnormal sideways curve of the thoracic and lumbar spine Kyphosis: an exaggerated outward curvature of the Musculoskeletal Scoliosis thoracic spine disorders Kyphosis Abnormal spinal curvature restricts chest expansion, reducing lung capacity and impairing effective ventilation. Factors that Influence Oxygenation to Body Tissues Conditions that altered VENTILATION: 2. Lung compliance Refers to how easily the lungs can be inflated High compliance = easy inflation low compliance = more effort required Conditions like emphysema and aging decrease elasticity, reducing compliance Trasevicine-Stewart et al., (2008) Factors that Influence Oxygenation to Body Tissues Conditions that altered VENTILATION: 3. Airway resistance Opposition to airflow in the respiratory tract Increased by obstruction or narrowing of airways Clinical examples: Physical conditions Descriptions Bronchial constriction and inflammation narrow the airways, leading to Asthma significantly increased airway resistance and difficulty breathing Obstructive Sleep Upper airway becomes intermittently blocked during sleep, leading to Apnoea increased resistance and disrupted airflow Foreign Body Inhalation of objects (e.g., food, toys) can obstruct the airway, causing acute Aspiration increases in resistance and potentially life-threatening respiratory distress Tumours Neoplasms in the airway (e.g., lung tumors) can physically obstruct airflow Factors that Influence Oxygenation to Body Tissues Conditions that altered DIFFUSION: Affected by the relative concentration of gases, thickness of membrane and surface area of alveoli Clinical examples: Physical conditions Descriptions Excess fluid leaks into the alveoli, making it harder for oxygen and carbon Pulmonary oedema dioxide to diffuse across the membrane Infected alveoli fill with fluid and pus, reducing the surface area available for Pneumonia gas exchange In atelectasis, collapsed lung tissue limits the area available for oxygen and Atelectasis carbon dioxide diffusion At high altitudes, the reduced oxygen availability decreases the amount of High altitude oxygen that can diffuse into the bloodstream Clinical Examples of Impaired Diffusion in Alveoli Pulmonary oedema Pneumonia Coronary artery disease Heart failure Valvular heart diseases Atelectasis High Altitude Pnemothorax Pleural effusion Factors that Influence Oxygenation to Body Tissues Conditions that altered PERFUSION: Haemoglobin (Hb) carries 97% O2 in the form of oxyhaemoglobin Tissue oxygenation depends on perfusion of O2-rich blood to tissues Anaemia: Low Hb level reduces the blood’s O2- carrying capcity affecting tissue oxygenation even if perfusion is adequate Hypovolemic shock Ventilation/Perfusion ratio: Indicates the efficiency of gas exchange in the lungs For optimal transport of O2 & CO2, amount of blood flow (perfusion) must be matched to the amount of airflow (ventilation) The upright position is optimal for matching ventilation and perfusion Any condition upsets this balance results in mismatch and decrease exchange of O2 & CO2 Factors that Influence Oxygenation to Body Tissues Other factors: Lifestyle Obesity Reduces lung volume and increases the work of breathing due to excess weight Sedentary lifestyle Lack of physical activity can lead to wekened respiratory muscles, reducing lung capacity Decrease cardiovascular fitness, imparing blood flow and reducing the delivery of oxygen-rich blood to tissues Cigarette smoking Leads to inflammation and narrowing of the airways, increasing airway resistance The presence of tar and other toxins in cigarette smoke can damage alveoli, reducing the surface area available for gas exchange Factors that Influence Oxygenation to Body Tissues Other factors: Lifestyle Substance abuse (e.g. alcoholism, inhaling substances) Both alcohol and many drugs can depress the central nervous system, reducing the respiratory drive Substance abuse can cause lung damage and inflammation, the surface area available for gas exchange Stress By triggering the body's "fight or flight" response, which can lead to rapid, shallow breathing (hyperventilation) and increased heart rate, O2 delivery to tissues and gas exchange Environmental Air pollution: incidence of respiratory diseases Occupational harzards, e.g. asbestos, sulfuric acid Household exposures to allergens The Clinical Manifestations of Altered Respiratory Functions Hyperventilation RR 20 breaths/minute, CO2 exhalation Characteristics Arterial CO2