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NPN120: Medical Surgical

Week

Mrs. Elizabeth Garcia, BSN, RN

Oxygen Delivery - recap

• Nasal Cannula – 24% to 47% = 1 to 6L/min
• Simple mask 40%-60% = 5-8 L/min
• Partial Rebreather 40%-60% = 6-10 L/min (always keep it from deflating)
• Non-rebreather 80%-95% = 10-15 L/min (2/3 full during inspiration/exhalation
• Venturi Mask 24%-50% = 4-10L/min

Pulmonary Circulation

• Functions:
  • Gas exchange
  • Nutrients to lung tissue
  • Reservoir for left ventricle
  • Filtering system (clots, air, and debris)
• Lower pressure than the systemic circulation
• One third of pulmonary vessels are filled with blood at any given time

Bronchial Circulation

• Part of systemic circulation
• Functions:
  • Moistens inspired air
  • Nutrients to airways, large pulmonary vessels, lymph nodes, and membranes around lung
• Does not participate in gas exchange

Ventilation

• Mechanical movement of gas or air into and out of the lungs
• Minute volume
  • Ventilatory rate multiplied by the volume of air per breath
• Alveolar ventilation

Signs and Symptoms of

Pulmonary Disease

• Dyspnea
  • Subjective sensation of uncomfortable breathing
  • Orthopnea
    • Dyspnea when a person is lying down
  • Paroxysmal nocturnal dyspnea (PND)
    • Awaken at night gasping for air

Signs and Symptoms of Pulmonary Disease

• Hypoventilation
  • Hypercapnia
• Hyperventilation
• Hypocapnia
  • Cyanosis
• Clubbing
• Pain

Conditions

Caused by

Pulmonary

Disease or

Injury

• Hypercapnia
  • Increased carbon dioxide concentration in arterial blood
• Hypoxemia
  • Reduced oxygenation of arterial blood
• Hypoxia
  • Insufficient oxygen delivery to the tissues
• Acute respiratory failure
  • When your lungs can't efficiently exchange gases, leading to a buildup of carbon dioxide and low oxygen levels in the blood.

Pneumonia

• Inflammatory process in the lungs that produces excess fluid
  • Triggered by infectious organisms or by aspiration of an irritant resulting in edema and exudate that filles the alveoli.
• Types of Pneumonia
  • Community Acquired (CAP)– common usually result from Influenza
  • Hospital Acquired (HAP) 24-48 hrs after admission
  • Ventilator Acquired (VAP) 48 hrs after ventilation

Pneumonia – Expected Findings

• Anxiety
• Fatigue
• Weakness
• Chest discomfort due to coughing
• Confusion from hypoxia

ASTHMA

• Chronic inflammation of the airways
• Risk factors: IgE mediated response to allergens; family

hx; allergies; environmental exposure

• Causes bronchial hyperresponsiveness, constriction of

airways, and reversible airflow obstruction

Asthma – Excepted Finding

• Dyspnea
• Chest tightness
• Anxiety or stress
• Wheezing
• Mucus production
• Prolonged exhalation
• Low oxygen saturation (Low SAO2)
• Treat with: Corticosteroids, beta-adrenergic agonists, anticholinergics, and anti- inflammatories

Chronic Obstructive Pulmonary Disease

COPD

• COPD encompasses two diseases Emphysema &

Chronic Bronchitis

Obstructive Lung Diseases

• Chronic bronchitis
  • Inflammation of the bronchi and bronchioles due to chronic exposure to irritants
  • Hypersecretion of mucus and chronic productive cough that lasts for at least 3 months of the year and for at least 2 consecutive years
  • Inspired irritants increase mucus production and the size and number of mucous glands
  • The mucus is thicker than normal
  • Bronchodilators, expectorants, and chest physical therapy used to treat