問題一覧
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➢ is a chemical element that is considered as essential to survival ➢ it is a primary requirement for cells to release energy during chemical reactions. ➢ is a combination of different processes that contribute to bringing the oxygen from the environment into the cells of the body
oxygen
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➢ involves inspiration and exhalation. ➢ Air moves in and out of the lungs because intrathoracic pressure changes in relation to pressure and the airway opening. The cardiovascular, respiratory, and part of hematologic systems function to supply the body’s oxygen demands. If these systems are dysfunctional: heart failure, respiratory failure, hematologic system problems, it leads to O2 deprivation
ventilation
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Processes needed to maintain adequate oxygenation
❖ Ventilation ❖ Pulmonary perfusion ❖ Diffusion
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Important systems involved in oxygenation
➢ Cardiovascular ➢ Nervous ➢ Musculoskeletal ➢ Respiratory
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Basic requirements for good ventilation
1. patent passageway 2. elastic and expansive lungs and tracheobronchial tree 3. adequate musculoskeletal apparatuses 4. pressure gradient
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Normal protective mechanisms of the respiratory systems
• Nose-vibrissae • Mucuciliary clearance • Cough reflex • Reflex bronchoconstriction • Macrophages • Surfactant • Hering-Breuer reflex
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risk factors modifiable
• Smoking • Sedentary lifestyle • Obesity • Diet • Stress • Substance abuse • Environmental factors
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risk factors non modifiable
• Age • Gender • Race • Heredity/Genetics
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procedures/tests common problems
o Chest pain o Dyspnea o Fatigue o Cough o Wheezing o Hoarseness o Palpitation o Body weakness o Intermittent claudication
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PE findings associated with O2 problems - inspection
o Eyes o Xanthelasma/palpebrum o Xanthomas o Corneal arcus(arcus senilis) hyalinosis of the cornea o Pale conjunctiva o Cyanotic conjunctiva o Petichiae of the conjunctiva Mouth and lips o Cyanotic mucosa o Pursed lip breathing(chronic lung disease) Neck vein o Distention-CHF (congestive heart failure) Nose o Nasal flaring- air hunger, dyspnea Chest o Retractions-increased work of breathing o Assymmetry-chest wall injury o Barrel chest-chronic lung disease Skin o Peripheral cyanosis o Central cyanosis o Poor skin turgor o Pallor o Dependent edema o Redness o Gangrene o Bruises/petichiae
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PE findings associated with O2 problems - palpation
o Thoracic Excursion o Areas of tenderness o Tactile fremitus/pectoral fremitus o Thrills o Heaves o Mass or lumps o Pulses o Skin temp o Pitting edema o Capillary refill
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PE findings associated with O2 problems - percussion
o hyperresonance o hyporresonance
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PE findings associated with O2 problems - auscultation
Adventitious breath sounds o Wheezes o Rales/crackles o Ronchi o pleural friction rub Abnormal heart sounds o S3 o S4 o Clicks o Snaps o Murmur o Pericardial friction rub o Bruits
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is a combination of different processes that contribute to bringing the oxygen from the environment into the cells of the body
oxygenation
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The cardiovascular, respiratory, and part of hematologic systems function to supply the body’s oxygen demands. If these systems are dysfunctional: heart failure, respiratory failure, hematologic system problems
o2 deprivation
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ultrasound for the heart
Electrocardiogram
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records hearts electrical activity over a specific period
Electrocardiogram
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use of radioisotopes cardiac structure, perfusion and crontractility
scintigraphy
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evaluate/visualize cardiac chamber, valves, great vessels, and coronary arteries
cardiac catheterization and angiography
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determine the ability of the lungs to efficiently exchange oxygen and CO2
pulmonary function test
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hydrogen ion concentration, partial pressure of CO2 and O2 concentration and oxyhemoglobin saturation
ABG analysis (arterial blood gas)
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is done to assess for adequacy of collateral circulation of hand
allens test
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Air passes through the airways namely
nose , pharynx, larynx, trachea, bronchi and broncheoles.
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causes the mucous lining to produce mucus causing obstruction of the airway.
infections and inflammations
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Infection can be
rhinitis, sinusitis, pharyngitis, tonsillitis, laryngitis, and bronchitis.
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voicebox
larynx
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windpipe
trachea
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However, food and other substances will still tend to enter the airway causing
aspiration
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Routing of food and air to the appropriate pathways happens within the
larynx
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Bronchoconstriction can happen due to the release of chemical mediators
histamine, bradykinin, prostaglandin
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is the exchange of gases between the pulmonary blood and alveoli.
external respiration
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It is the exchange of gases between the cells and capillaries.
internal respiration
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In any case that there is significant increase of pressure in the pulmonary vessels, membrane functioning can fail allowing fluids to pass through it causing accumulation of fluid within the alveolar space causing
pulmonary edema
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If elastic recoil of the alveoli disappears, gases will be trapped causing accumulation of carbon dioxide and deficiency in O2. This happens in
emphysema
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Bronchoconstriction can happen due to the release of chemical mediators histamine, bradykinin, prostaglandin causing sympatholytic response which usually happens in
bronchial asthma
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There are also conditions that cause loss of surface tensions in the lungs causing collapse of the alveoli causing
atelectasis
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Also, alveoli are efficient in their function as lung exchange site without any presence of infection. Infection can cause inflammation of lung parenchyma causing production of exudates thus, decreasing its functionality. This happens in
pneumonia
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A significant decrease of the number of erythrocytes or abnormalities in the structure of the erythrocytes can hinder their ability to carry O2 in
anemia
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Number of RBC’s can also be decreased when clotting mechanism becomes faulty because blood is allowed to escape elsewhere in conditions like thrombocytopenia. This condition consequently causes
shock
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Erythrocytes follow the circulation, passing through the blood vessels in order to bring oxygen into the tissues. However, the current of flow may be disrupted due to overproduction of erythrocytes causing a sluggish flow in
polycythemia
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Oxygen-rich erythrocytes then follow the respiratory gas transport process. Erythrocytes go to the pulmonary veins. As minute as they are, pulmonary capillaries are prone to obstruction. Presence of coagulation substance can hinder the flow of blood. This occurs in
pulmonary embolism
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Moreover, myocardial tissues will die without adequate perfusion which happens in
myocardial infarction
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However, before infarction, cardiac tissues will try to compensate by employing anaerobic metabolism which can cause irritation of tissues that happens in
angina pectoris
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Blood flow along the arteries can also be obstructed due to presence of plaque and/or damage or inflammation of the blood vessel wall or vasoconstriction. This happens in
buerger’s disease and raynaud’s phenomenon.
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However, this exchange can be altered due to increase in pressure causing escape of fluid from the cells into the interstitial spaces causing
edema
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But, due to too much pressure and weakened blood vessel wall, veins become dilated allowing overdistention and accumulation of blood within them causing
varicosities, thrombosis and eventually phlebitis