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Welcome to N 152

Welcome to N 152. Diffusion. The tendency of a molecule to move from a region of high concentration to one of lower concentration. Can be altered by: The partial pressure gradient of the gases The thickness of the respiratory membrane Pressure in the pulmonary circulation

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Welcome to N 152

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  1. Welcome to N 152

  2. Diffusion • The tendency of a molecule to move from a region of high concentration to one of lower concentration. Can be altered by: • The partial pressure gradient of the gases • The thickness of the respiratory membrane • Pressure in the pulmonary circulation • Surface area available

  3. Perfusion • The flow of blood that supplies tissues and cells with needed nutrients and oxygen

  4. Chemoreceptor control of respirations • Groups of nerve cells that can distinguish between hydrogen ions and oxygen • Exert greatest influence on the autonomic nervous system’s control of ventilation by correlating acid-base balance with gas exchange requirements • Located both centrally and peripherally (carotid arteries and arch of the aorta)

  5. Anterior Landmarks

  6. Posterior Landmarks

  7. Lateral Landmarks

  8. History • HPI • Current symptoms • Chief complaint • Dyspnea • Cough • Sputum production • Hemoptysis • Wheezing, stridor • Chest pain • Cyanosis

  9. Ability to Breath • Respiratory Rate • Minute ventilation • Vital capacity • Inspiratory force

  10. Chest Diameter

  11. Chest Abnormalities

  12. Percussion Notes • Resonance • Hyperresonance • Dull • Flat • Tympany

  13. Normal Breath Sounds

  14. Adventitious Breath Sounds • Crackles • Rhonchi • Wheezes • Pleural Friction Rub

  15. Normal V/Q

  16. Low V/Q

  17. High V/Q

  18. Silent Unit

  19. Lung Volume Tests • Tidal Volume (VT) • The volume of air inspired and expired during the respiratory cycle. 5-8 ml/kg • Inspiratory Reserve Volume (IRV) • The maximal amount of air that can be inspired after a normal inspiration • Expiratory Reserve Volume (ERV) • The maximal amount of air that can be expired after a normal inspiration • Residual Volume (RV) • The volume of air remaining in the lungs at the end of maximum expiration

  20. Peak Flow Meters

  21. Lung Capacity Tests • Functional Residual Capacity (FRC) • The volume of air remaining in the lungs at the end of normal expiration. Calculated measurement of of airway resistance. • Vital Capacity (VC) • The maximum amount of air that can be expired slowly and completely after a maximum inspiration • Total Lung Capacity (TLC) • The volume of air contained in the lung after maximal inspiration

  22. Pulmonary Spirometry Tests • Forced Vital Capacity (FVC) • The volume of air expired forcefully and rapidly after maximal inspiration • Measured over over a specific interval of time • Peak Expiratory Flow Rate (PEFR) • The maximum flow rate attainable at the beginning of forced expiration

  23. Obstructive Disorders • Increased resistance to airflow • Emphysema, asthma, chronic bronchitis, bronchiectasis •  VC •  TLC •  FRC •  RV •  FEV1

  24. Restrictive Disorders •  Compliance of lungs, chest wall, or both • Neuromuscular diseases: polio, MD, kyphoscoliosis, chest wall abnormalities •  VC •  TLC • Normal FRC • Normal RV •  FEV1

  25. Arterial Blood Gases • pH: 7.35 – 7.45 • PCO2: 35 – 45 mm Hg • HCO3: 22-26 mEq

  26. General Imbalances • Acidosis: < 7.35 • An accumulation of either acids or a loss of bicarbonate • Alkalosis: > 7.45 • An accumulation of base or a loss of acids

  27. Respiratory Acidosis • Etiology: hypoventilation • Causes: pain, drugs, neuromuscular disorders, obstructive/restrictive lung diseases, respiratory center depression, fatigue, mechanical hypoventilation • Sx: decreased mental status, drowsiness, restlessness, tachycardia, hypoventilation, headache, weakness, tremors

  28. Respiratory Acidosis (cont) • Non Invasive Treatment • Voluntary deep breathing • IPPB • Incentive devices • Pain medication • Invasive Treatment • Artificial airway • Mechanical ventilation

  29. Respiratory Alkalosis • Etiology: hyperventilation • Causes: anxiety, fear, pain, fever, sepsis, brain lesion, hypoxia, exercise, mechanical hyperventilation • Sx: increased respiratory rate, increased tidal volume, cramps, tetany, paresthesias, seizures

  30. Respiratory Alkalosis (cont) • Treatment: • Reassurance • Sedation • Pain medication • Rebreathe CO2 • Reduce ventilator settings to decrease RR and tidal volume

  31. Metabolic Acidosis • Loss of Base • Diarrhea • Pancreatic drainage • Renal disease • Fistula • Increased Acids • DKA • Salicylate overdose • Sepsis/lactic acidosis • Renal failure • starvation

  32. Metabolic Acidosis (cont) • Sx: decreased mental status, confusio, seizures, fatigue, drowsiness, hypotension, anorexia, vomiting, nausea • Treatment • Treat the underlying cause • In severe cases, Sodium Bicarbonate may be ordered

  33. Metabolic Alkalosis • Increase Base • Sodium Bicarbonate administration • Ingestion of alkaloids • Decreased Acids • Vomiting • NG tube suctioning • Electrolyte imbalance

  34. Metabolic Alkalosis (cont) • Treatment • Treat the underlying cause • Administer acid (ammonium clloride • Increase bicarbonate excretion with Diamox • In severe cases, dialysis may be ordered

  35. Bronchoscopy

  36. Thoracentesis

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