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NPN120: Medical Surgical
Week #3
Mrs. Elizabeth Garcia, BSN, RN
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NPN120: Medical Surgical

Week

Mrs. Elizabeth Garcia, BSN, RN

Oxygen Delivery - recap

  • Nasal Cannula โ€“ 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)โ€“ common usually result from Influenza
    • Hospital Acquired (HAP) 24-48 hrs after admission
    • Ventilator Acquired (VAP) 48 hrs after ventilation

Pneumonia โ€“ 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 โ€“ 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