Advance Exam 2
The lungs primary function is oxygenation and perfusion pg. 544
Remember: the right lung has 3 lobes, and the left contains 2. The right bronchi branches from
the trachea first which is important for intubation and ventilation. We control our breathing rate
by a process of regulation of gas exchange related to meeting metabolic needs.
- Ventilation: movement of air into lungs
- Perfusion: movement and distribution of blood through pulmonary circulation.
- Diffusion: movement of O2 and Co2 across alveolar- capillary membrane.
Oxygen-Hemoglobin Dissociation Curve: watch video on slide 15!
Dissociation occurs depending on what the body’s perfusion needs are.
Pressure = Saturation
- Shift to the left: less oxygen need and metabolization happens slower.
Causes- RBC’s hold onto O2 causing an increase. Increased pH (aLkalosis), decreased
CO2 (Low), and decreased temperature (Low) = LEFT.
- Shift to the right: oxygen needs grow and metabolization happens faster.
Causes- RBC’s releases O2 into the tissues rapidly, decreased O2, decreased pH
(acidosis), increased CO2, and increase in temperature.
Ventilation & Perfusion (V/Q)
- Ventilation involves oxygen intake problems, the body isn’t getting enough blood or
body id unable to remove CO2. Examples = Chest and lung problems like
COPD/Emphysema, issue with the diaphragm, no control of respiratory center, or a CO2
above 45mmHg.
- Perfusion involves CO, and delivery of oxygen to the tissue. Examples = right to left
shunting and ARDS.
Acid Base Balance
Pulmonary Embolism (PE): MEDICAL EMERGENCY! A clot forms in the pulmonary vessels
leading to hypoxia. They are most commonly caused by a DVT, but none the less can come from
ANYWHERE.
- S/S: A feeling of impending doom. Pulmonary – dyspnea, chest pain, clear or crackles
present, dry cough, or bloody sputum. Cardiac – tachycardia, distended neck veins,
syncope (fainting), cyanosis, hypotension, T-wave and ST segment changes. Labs – at first
the patient is in respiratory alkalosis then shunting happens causing respiratory acidosis
followed by metabolic acidosis from the buildup of lactic acid. CT is standard for
diagnosis of a PE.
- Treatment involves PREVENTION including range of motion, ambulation asap, SCD, avoid
restrictive clothing, assess circulation often, elevate the feet to help with venous return,
, turn every 2 hours, no massaging leg muscles, give low molecular weight heparin
(lovenox), no valsalva, stool softeners, and advise to stop smoking!
- Management: Ventilator Support- help recognize dyspnea, anxiety, and dropping O2
saturation. Stabilize cardiopulmonary System- elevate HOB, apply oxygen and keep sats
at 95% or PaO2 greater than 60. Prepare for possible intubation. Circulatory Support-
hypotension, IV fluids, inotropic agents to increase preload (milrinone & dobutamine).
Heparin Therapy- know contraindications, titrate with hospital policy, check labs, the
goal is to PTT 1.5-2.5 times the control value. Long Term Anticoagulation Therapy-
warfarin, will be started on heparin, the goal is INR 2.0-3.0, remember patient teaching!
Surgical Management- Embolectomy (removal of clot), IVC with filter. Decrease Anxiety-
fix the impending doom.
Pleural Effusions- “water on the lungs”. This is not a disease, it is a condition. It is caused by
extra fluid buildup between the layers of the pleura.
- Causes: Protein Poor aka watery fluid heart failure, PE, cirrhosis, and post CABG.
Protein Rich Fluid pneumonia, cancer, PE, kidney disease, inflammatory disease, TB,
autoimmunity’s, bleeding, and meds.
- Types: Cardiogenic Pulmonary Edema: increases the pressure within the heart and
causes increased workload of the LV. The LV is unable to eject the blood so backup
occurs in the lungs. All of the causes are cardiac related. HF, HTN, and cardiomyopathy.
This is the most common. Non-Cardiogenic Pulmonary Edema: high permeability, direct
lung tissue damage, capillaries become too permeable and cause leakage into air sacs
without pressure. Causes are ARDS, sepsis, high altitudes, nervous system problems,
adverse drug reactions, PE, viral infections, lung injury, smoking, and near drowning.
- S/S: RESTLESS AND AGITATION r/t decreased O2 to the brain. “I can’t catch my breath!”,
dyspnea, tachypnea, frothy blood tinged sputum, JVD, wet lung sound, cyanosis, cold
clammy and diaphoretic, and confusion.
- Diagnose by ABG’s, acultation of lung sounds, chest x-ray, CT, ultrasound of the chest,
and a thoracentesis.
- Treatment: Treat the underlining cause (CHF, pneumonia), position sitting upright,
oxygen, diuretics, chest tube or thoracentesis *pg. 533 tactile fremitus.
The body protects itself from hypoxia by increased the depth and rate of respirations, increased
erythropoietin causing increased HGB, increased cardiac output, and increased O2 saturation.
Acute Respiratory Failure: Form of V/Q mismatch caused by a lack of O2, perfusion or both.
- S/S: DYSPNEA, restlessness and apprehension. EARLY tachycardia, tachypnea,
hypertension, dyspnea, cyanosis, and confusion. LATE failed compensation, hypoxia,
and change in respiratory rate from rapid to slow ending in respiratory arrest. ABG
finding show high levels of CO2 (hypercapnia) Fig-68.2
- TX: OXYGEN THEREPY! Do not wait for a doctor’s order! Treat the underlining cause,
intubate the patient or get prepared to, elevate the HOB or higher to increase lung
expansion, relax them (deep breathing techniques). Mobilize their secretions by
The lungs primary function is oxygenation and perfusion pg. 544
Remember: the right lung has 3 lobes, and the left contains 2. The right bronchi branches from
the trachea first which is important for intubation and ventilation. We control our breathing rate
by a process of regulation of gas exchange related to meeting metabolic needs.
- Ventilation: movement of air into lungs
- Perfusion: movement and distribution of blood through pulmonary circulation.
- Diffusion: movement of O2 and Co2 across alveolar- capillary membrane.
Oxygen-Hemoglobin Dissociation Curve: watch video on slide 15!
Dissociation occurs depending on what the body’s perfusion needs are.
Pressure = Saturation
- Shift to the left: less oxygen need and metabolization happens slower.
Causes- RBC’s hold onto O2 causing an increase. Increased pH (aLkalosis), decreased
CO2 (Low), and decreased temperature (Low) = LEFT.
- Shift to the right: oxygen needs grow and metabolization happens faster.
Causes- RBC’s releases O2 into the tissues rapidly, decreased O2, decreased pH
(acidosis), increased CO2, and increase in temperature.
Ventilation & Perfusion (V/Q)
- Ventilation involves oxygen intake problems, the body isn’t getting enough blood or
body id unable to remove CO2. Examples = Chest and lung problems like
COPD/Emphysema, issue with the diaphragm, no control of respiratory center, or a CO2
above 45mmHg.
- Perfusion involves CO, and delivery of oxygen to the tissue. Examples = right to left
shunting and ARDS.
Acid Base Balance
Pulmonary Embolism (PE): MEDICAL EMERGENCY! A clot forms in the pulmonary vessels
leading to hypoxia. They are most commonly caused by a DVT, but none the less can come from
ANYWHERE.
- S/S: A feeling of impending doom. Pulmonary – dyspnea, chest pain, clear or crackles
present, dry cough, or bloody sputum. Cardiac – tachycardia, distended neck veins,
syncope (fainting), cyanosis, hypotension, T-wave and ST segment changes. Labs – at first
the patient is in respiratory alkalosis then shunting happens causing respiratory acidosis
followed by metabolic acidosis from the buildup of lactic acid. CT is standard for
diagnosis of a PE.
- Treatment involves PREVENTION including range of motion, ambulation asap, SCD, avoid
restrictive clothing, assess circulation often, elevate the feet to help with venous return,
, turn every 2 hours, no massaging leg muscles, give low molecular weight heparin
(lovenox), no valsalva, stool softeners, and advise to stop smoking!
- Management: Ventilator Support- help recognize dyspnea, anxiety, and dropping O2
saturation. Stabilize cardiopulmonary System- elevate HOB, apply oxygen and keep sats
at 95% or PaO2 greater than 60. Prepare for possible intubation. Circulatory Support-
hypotension, IV fluids, inotropic agents to increase preload (milrinone & dobutamine).
Heparin Therapy- know contraindications, titrate with hospital policy, check labs, the
goal is to PTT 1.5-2.5 times the control value. Long Term Anticoagulation Therapy-
warfarin, will be started on heparin, the goal is INR 2.0-3.0, remember patient teaching!
Surgical Management- Embolectomy (removal of clot), IVC with filter. Decrease Anxiety-
fix the impending doom.
Pleural Effusions- “water on the lungs”. This is not a disease, it is a condition. It is caused by
extra fluid buildup between the layers of the pleura.
- Causes: Protein Poor aka watery fluid heart failure, PE, cirrhosis, and post CABG.
Protein Rich Fluid pneumonia, cancer, PE, kidney disease, inflammatory disease, TB,
autoimmunity’s, bleeding, and meds.
- Types: Cardiogenic Pulmonary Edema: increases the pressure within the heart and
causes increased workload of the LV. The LV is unable to eject the blood so backup
occurs in the lungs. All of the causes are cardiac related. HF, HTN, and cardiomyopathy.
This is the most common. Non-Cardiogenic Pulmonary Edema: high permeability, direct
lung tissue damage, capillaries become too permeable and cause leakage into air sacs
without pressure. Causes are ARDS, sepsis, high altitudes, nervous system problems,
adverse drug reactions, PE, viral infections, lung injury, smoking, and near drowning.
- S/S: RESTLESS AND AGITATION r/t decreased O2 to the brain. “I can’t catch my breath!”,
dyspnea, tachypnea, frothy blood tinged sputum, JVD, wet lung sound, cyanosis, cold
clammy and diaphoretic, and confusion.
- Diagnose by ABG’s, acultation of lung sounds, chest x-ray, CT, ultrasound of the chest,
and a thoracentesis.
- Treatment: Treat the underlining cause (CHF, pneumonia), position sitting upright,
oxygen, diuretics, chest tube or thoracentesis *pg. 533 tactile fremitus.
The body protects itself from hypoxia by increased the depth and rate of respirations, increased
erythropoietin causing increased HGB, increased cardiac output, and increased O2 saturation.
Acute Respiratory Failure: Form of V/Q mismatch caused by a lack of O2, perfusion or both.
- S/S: DYSPNEA, restlessness and apprehension. EARLY tachycardia, tachypnea,
hypertension, dyspnea, cyanosis, and confusion. LATE failed compensation, hypoxia,
and change in respiratory rate from rapid to slow ending in respiratory arrest. ABG
finding show high levels of CO2 (hypercapnia) Fig-68.2
- TX: OXYGEN THEREPY! Do not wait for a doctor’s order! Treat the underlining cause,
intubate the patient or get prepared to, elevate the HOB or higher to increase lung
expansion, relax them (deep breathing techniques). Mobilize their secretions by
