Nur 245 Exam 3 -
Notes for exam 3
Concepts of Nursing Care of the Adult II
(Hondros College of Nursing)
, Nur 245 Exam 3
Week5
● Gas exchange Giddens chapter 19
● COPD Lewis chapter 28 p. 560-576
● COPD Saunders chapter 51 p.666-667
● Chest tubes Lewis p.525-529
● Vents Lewis p.1548-1561
What is Gas Exchange: Process by which oxygen is transported to cells and carbon dioxide is
transferred from cells.
● Ischemia: insufficient flow of oxygenated blood to the tissues resulting in hypoxia.
● Hypoxia: is insufficient oxygen reaching the cells.
● Ventilation: is the process of inhaling oxygen into the lungs and exhaling carbon
dioxide out of the lungs
● Transport: availability of hemoglobin to transfer into the alveoli
● Perfusion: the ability of blood to transfer oxygen blood and return carbon to the
alveoli.
● Risk factors:
○ Nonmodifiable: Age, sex, air pollution, allergies
○ Modifiable: SMOKING, work hazard environments
○ Assessment: Hx &Ph, cough, sob, chest pain with breathing, vitals,
inspection, auscultation
● Labs:
○ ABG’s
■ Ph, SaO2(sats), PaO2 (partial pressure of arterial oxygen),
PaCO2 (partial pressure of carbon dioxide), HCO3 (when HCO3 is
above normal is alkalosis, below normal is acidotic)
■ CBC: decreased RBC’s means the body has reduced oxygen
carrying abilities which lowers H&H
■ Sputum specimen
■ SKin TB
● Diagnostics:
○ CXR
○ CT
○ PET
○ V/Q scans( used to dx PE’s, radioactive particles are injected into
peripheral veins to detect impaired perfusion into the lungs)
● Pulmonary Function Tests: Asses presence and severity of diseases in large and
small airways,
○ Spirometer measures the volume of air moving in and out of the lungs
● Prevention: Infection control, smoking cessation, Immunizations, preventing
post-op pulmonary complications
● Pharm: bronchodilators, cough suppressants, antihistamines, mucinex,
antimicrobials
,What is Oxygen Therapy: *always administer lowest possible concentration*
● Methods: NC, face mask, partial and non-rebreather, trach, oxygen-conserving
cannula, venturi mask, high flow nasal cannula
○ Non-rebreather: short term therapy (24hr)
○ Venturi mask: low, constant high flow O2
○ Airvo: blends )2 with compressed air administers up to 60L of O2
● Mobilization of Secretions:
○ Positioning: HOB 30 degrees, if aspiration risk *side lying*
■ One sided lung disorders *good lung down*
■ PRONE!
○ Cough and deep breath
○ CHest physiotherapy
○ Suctioning
○ Humidification
○ Hydration(keeps secretions thin and easily moveable)
● Positive Pressure Ventilation:
○ Used if initial measures don’t work
○ Mask over mouth and nose
○ Delivers PPV(positive pressure ventilation)
○ CPAP (continuous), BIPAP(2)
○ BIPAP commonly used with ARF
● Drug therapy:
○ Reduce Inflammation:
■ IV corticosteroids: methylprednisolone
■ Inhaled corticosteroids (LABA, SABA)
○ Relieve Congestion:
■ Lasix
■ Morphine
■ Nitro
○ Reduce discomfort:
■ Opioids
■ Benzodiazepines
● Nutritional Therapy:
○ Optimal caloric intake for hypermetabolic states
○ TPN, PN, Enteral nutrition **Started with in 24-48hours*
, COPD: Preventable, treatable, but often progressive disease. CHaracterized by airflow limitation
caused by inflammation.
● Two Categories: Chronic Bronchitis and emphysema
● Risk factors:
○ Non-Modifiable: MALE! Genetics, pollution, age, Alpha1 amitrypsin
disorder (affects lungs and liver)
○ Modifiable: SMOKING, URI’s, Asthma, occupational hazards
Notes for exam 3
Concepts of Nursing Care of the Adult II
(Hondros College of Nursing)
, Nur 245 Exam 3
Week5
● Gas exchange Giddens chapter 19
● COPD Lewis chapter 28 p. 560-576
● COPD Saunders chapter 51 p.666-667
● Chest tubes Lewis p.525-529
● Vents Lewis p.1548-1561
What is Gas Exchange: Process by which oxygen is transported to cells and carbon dioxide is
transferred from cells.
● Ischemia: insufficient flow of oxygenated blood to the tissues resulting in hypoxia.
● Hypoxia: is insufficient oxygen reaching the cells.
● Ventilation: is the process of inhaling oxygen into the lungs and exhaling carbon
dioxide out of the lungs
● Transport: availability of hemoglobin to transfer into the alveoli
● Perfusion: the ability of blood to transfer oxygen blood and return carbon to the
alveoli.
● Risk factors:
○ Nonmodifiable: Age, sex, air pollution, allergies
○ Modifiable: SMOKING, work hazard environments
○ Assessment: Hx &Ph, cough, sob, chest pain with breathing, vitals,
inspection, auscultation
● Labs:
○ ABG’s
■ Ph, SaO2(sats), PaO2 (partial pressure of arterial oxygen),
PaCO2 (partial pressure of carbon dioxide), HCO3 (when HCO3 is
above normal is alkalosis, below normal is acidotic)
■ CBC: decreased RBC’s means the body has reduced oxygen
carrying abilities which lowers H&H
■ Sputum specimen
■ SKin TB
● Diagnostics:
○ CXR
○ CT
○ PET
○ V/Q scans( used to dx PE’s, radioactive particles are injected into
peripheral veins to detect impaired perfusion into the lungs)
● Pulmonary Function Tests: Asses presence and severity of diseases in large and
small airways,
○ Spirometer measures the volume of air moving in and out of the lungs
● Prevention: Infection control, smoking cessation, Immunizations, preventing
post-op pulmonary complications
● Pharm: bronchodilators, cough suppressants, antihistamines, mucinex,
antimicrobials
,What is Oxygen Therapy: *always administer lowest possible concentration*
● Methods: NC, face mask, partial and non-rebreather, trach, oxygen-conserving
cannula, venturi mask, high flow nasal cannula
○ Non-rebreather: short term therapy (24hr)
○ Venturi mask: low, constant high flow O2
○ Airvo: blends )2 with compressed air administers up to 60L of O2
● Mobilization of Secretions:
○ Positioning: HOB 30 degrees, if aspiration risk *side lying*
■ One sided lung disorders *good lung down*
■ PRONE!
○ Cough and deep breath
○ CHest physiotherapy
○ Suctioning
○ Humidification
○ Hydration(keeps secretions thin and easily moveable)
● Positive Pressure Ventilation:
○ Used if initial measures don’t work
○ Mask over mouth and nose
○ Delivers PPV(positive pressure ventilation)
○ CPAP (continuous), BIPAP(2)
○ BIPAP commonly used with ARF
● Drug therapy:
○ Reduce Inflammation:
■ IV corticosteroids: methylprednisolone
■ Inhaled corticosteroids (LABA, SABA)
○ Relieve Congestion:
■ Lasix
■ Morphine
■ Nitro
○ Reduce discomfort:
■ Opioids
■ Benzodiazepines
● Nutritional Therapy:
○ Optimal caloric intake for hypermetabolic states
○ TPN, PN, Enteral nutrition **Started with in 24-48hours*
, COPD: Preventable, treatable, but often progressive disease. CHaracterized by airflow limitation
caused by inflammation.
● Two Categories: Chronic Bronchitis and emphysema
● Risk factors:
○ Non-Modifiable: MALE! Genetics, pollution, age, Alpha1 amitrypsin
disorder (affects lungs and liver)
○ Modifiable: SMOKING, URI’s, Asthma, occupational hazards
