1. Gas Exchange Michelle Schultz

2. Definition The process by which oxygen is transported to cells and carbon dioxide is transported from cells. (Giddens,p.161) Requires interaction among the neurologic, respiratory, and cardiovascular systems.

3. Impaired Gas Exchange Impaired gas exchange represents a variety of physiologic process. Three board categories that describe these – Ventilation – Transport – Perfusion

4. Ventilation Process of inhaling oxygen into the lungs and exhaling carbon dioxide from the lungs Impaired by the unavailability of oxygen as well as by any disorder affecting the nasopharynx and lungs. Pt had multiple rib fractures cause hemothorax

5. Hemothroax Hemothorax is a collection of blood in the space between the chest wall and the lung (the pleural cavity) Admitting Diagnoses: – Following a fall that caused him to hit head and fractured his ribs – Puncture caused hemothorax

6. Labs, Radiology, Medical Interventions Labs: – Hgb: 7.0 – low due to the blood loss from the chest tube – Hematocrit: 21.1 – low due to the blood loss from the chest tube – PT:16.5- high due to patients heparin drip – INR:1.5- high due to patients heparin dirp – APTT:34.8-WNL heparin is effective Radiology: x-ray of the lungs results: 9-14-14 showed hemothorax at the base of the right lung and fractures of the 8th and 9th right rib. Most recent chest was inserted on 9-23-14 and x-rays showed tubes in the lungs between 6th and 7th intercostal space and the lateral right side. Medical interventions : antiplatelet aggregations, Chest tube

7. Nursing Intervention Body Positioning and its effect on oxygenation-a literature review – Appropriate positioning of the critically ill can dramatically improve gas exchange The ‘good lung down’ theory may be contraindicated in certain lung pathologies such as pulmonary abscess, pulmonary hemorrhage and interstitial emphysema. (Marklew,2006)

8. References Marklew A. Body positioning and its effect on oxygenation -- a literature review. Nursing In Critical Care. 2006 Jan-Feb 2006;11(1):16-22. Giddens, J.(2013). Concepts for nursing practice. (p.161) St. Louis, MO: Mosby/Elsevier.

9. NCLEX Question Patients with suspicious masses in the lung as seen on chest x-ray could have which of the following diagnostic studies to provide information on soft tissue masses? A. Gastrograffin swallow test B. Pulmonary function tests (PFTs) C. Wedge resection of the identified area of the lung D. CAT scan and magnetic resonance imaging (MRI)

10. Rationale: The chest x-ray usually is the first examination that the physician will order. Suspicious masses seen on the chest x-ray could signal the need for CAT scan and an MRI to provide additional information about soft tissue masses. The gastrograffin swallow test would be used to diagnose an esophageal rupture, while a wedge resection would be treatment for a lung mass.

11. NCLEX The nurse is teaching a group of older clients about the functions of the respiratory tract as part of health promotion. Which statement made by patients would indicate a need for further teaching? A. ”The respiratory system helps maintain heat balance in our bodies.“ B. "Our lungs keep the balance of acids and bases in our bodies." C. "Parts of our respiratory system help us produce speech and better communication." D. "The lungs keep our blood pressure in normal range, so we can breathe better."

12. Rationale: The respiratory system performs several secondary functions, including maintenance of acid-base balance, production of speech, and maintenance of body water and heat balance. The heart and cardiovascular system are responsible for the blood pressure.

13. NCLEX All of the following nursing diagnoses are important for a client with chronic pulmonary emphysema (COPD). Which would receive priority when planning nursing interventions? A. Impaired gas exchange B. Activity intolerance C. Self-care deficit D. Ineffective airway clearance

14. A. Impaired Gas Exchange Rationale: Physical assessment of older persons with COPD might find ineffective airway clearance, but the classic physiology alteration is the destruction of the alveoli with resulting complications. Therefore, impaired gas exchange always is present.

15. NCLEX Chest percussion has been ordered for a client on bedrest with respiratory infections and increased secretions. The nurse should use which of the following hand positions to administer chest percussion? A. Cupped-hand position B.Fisted-hand position C. Flexed-hand position D. Flat-hand position

16. A. Cupped-hand position Rationale: Cupped-hand position enhances vibration, which helps to loosen secretions, clear airway, and improve gas exchange. The flat, fisted, and flexed hand positions can cause pain and harm the patient.

17. NCLEX Which of the following is a normal finding when assessing the respiratory system of an elderly client? A. A decreased anteroposterior diameter and increased alveolar surface B.Bronchovesicular breath sounds throughout the lungs C. Decreased mobility of the thorax and increased chest wall stiffness D. Increased thoracic expansion and relaxation of elastin tissues

18. C. Decreased mobility of the thorax and increased chest wall stiffness Rationale: The normal aging process is accompanied by physiologic changes to the respiratory system such as stiffening of elastin and collagen tissues, increased alveolar diameter, decreased alveolar surface, and increased chest wall stiffness. Bronchovesicular breath sounds are heard over major bronchi where fewer alveoli are located.