CCBC Nursing 160: Exam 1 Prep with Questions and Correct Answers
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Course
CCBC Nursing
Institution
CCBC Nursing
What are Alveoli? - Answer Small grape-like air sacs at the end of the terminal
bronchioles that are a site of gas exchange---they open and relax as we breathe. Alveoli
need to remain open in order to get rid of CO2.
Hemoglobin in the blood carries oxygen throughout the body. Is all of the oxyge...
CCBC Nursing 160: Exam 1 Prep with
Questions and Correct Answers
What are Alveoli? - Answer Small grape-like air sacs at the end of the terminal
bronchioles that are a site of gas exchange---they open and relax as we breathe. Alveoli
need to remain open in order to get rid of CO2.
Hemoglobin in the blood carries oxygen throughout the body. Is all of the oxygen that is
attached to the hemoglobin actually utilized? - Answer No.
What is the *Oxygen-Hemoglobin Dissociation Curve*? - Answer The oxy-hemoglobin
dissociation curve is an important tool for understanding how our blood carries and
releases oxygen.
Specifically, the oxy-hemoglobin dissociation curve relates oxygen saturation (SO2) and
partial pressure of oxygen in the blood (PO2), and is determined by what is called
"hemoglobin's affinity for oxygen," that is, *how readily hemoglobin acquires and
releases oxygen molecules from its surrounding tissue*. This can be affected by stress,
temperature changes (ex, hemoglobin affinity increases when we're cold), exercise, etc.
At high oxygen saturation, the hemoglobin more easily "lets go" of the oxygen
molecules in order to deliver them to the body's cells. Basically when we need more O2,
the oxy-hemoglobin affinity decreases.
At lower oxygen saturation, the hemoglobin holds the oxygen molecules more tightly
due to the overall chemical composition of the blood. Basically, when we need less O2,
the oxy-hemoglobin affinity increases.
What is involved in the nursing assessment in regards to Oxygenation? - Answer 1.
*Health History*: respiratory patho, other diseases (co-morbidities).
,2. *Signs and Symptoms*: dyspnea, cough (productive or non-productive), sputum
(color? Any change in the sputum?), chest pain (PQRST), wheezing (or any adventitious
lung sounds), hemoptysis (coughing up blood: is there a lot? a small amount? Because a
small amount could simply be from irritation), clubbing of fingers (indicative of a
prolonged/chronic O2 problem), cyanosis (a problem! when fingers/toes are cyanotic
it's an issue with peripheral oxygenation where the body is shunting oxygenated blood
to the core in order to support important organs like the brain and those in the thorax.
When there is *central cyanosis* this is called *circum-oral cyanosis* and it affects the
face or mouth---this is a BAD sign because it means the body doesn't have enough
oxygenated blood to shunt).
3. *ADL's*: can they perform them without SOB/DOE?
If a patient is having trouble breathing and is NOT wheezing, what could this mean? -
Answer This is NOT a good thing! When you hear wheezing it means that their airway is
open enough to create airflow. When there is no wheezing and they are having trouble
breathing it's a bad sign that their airway could be closed.
What is involved in the physical assessment for Oxygenation? - Answer 1. *Chest
configuration*: how it's shaped, and if the chest is misshapen how this affects their
oxygenation process.
2. *Respiratory Rate*: 12-20 normal. If too high it doesn't allow for proper oxygenation
to get the CO2 out of the body. If the respirations are too shallow then this would mean
not enough to get the 21% of oxygen from the air into the body.
3. *Breathing Patterns*: Dyspnea (SOB/DOE), Kussmaul (rapid inspirations/expirations
that occur because of acidosis), Cheyne-Stokes (associated with acute brain disorders or
injury).
,4. *Percussion*: NOT dullness. When assessing the lungs you should hear tympany
because of the air inside them!
5. *Auscultation*: Listen for adventitious sounds. Ex, crackles/rales, wheezing, or a
pleural friction rub.
There are several different chest configurations that result from oxygenation issues,
what is a "barrel chest"? - Answer A barrel chest while normal during infancy, often
accompanies aging and COPD. It describes a rounded, bulging chest that resembles the
shape of a barrel with an increased anteroposterior diameter and usually some degree
of kyphosis.
What is a "pigeon chest" or Pectus Carinatum configuration? - Answer It is a deformity
of the chest characterized by a protrusion of the sternum and ribs. The sternum is
displaced anteriorly increasing the anteroposterior diameter. The costal cartilages
adjacent to the protruding sternum are depressed.
With the sternum sticking out this makes it difficult for the lungs to move.
What is a "funnel chest" or Pectus Excavatum configuration? - Answer It is the most
common congenital deformity of the anterior wall of the chest, in which several ribs and
the sternum grow abnormally. This produces a caved-in or sunken appearance of the
chest.
*The compression of the heart and the great vessels may cause murmurs= patient will
not oxygenate well.*
What is the breathing pattern that is considered "one step before apnea" or one step
before not breathing at all? - Answer *Agonal breathing* in the dying patient is the last
respiratory pattern prior to terminal apnea. The duration of the gasping respiration
, phase varies; it may be as brief as one or two breaths to a prolonged period of gasping
lasting minutes or even hours.
Agonal breathing has a name that is appropriate because the gasping breaths appear
uncomfortable and raise concern that the patient is suffering and in agony
What are the risk factors associated with Oxygenation issues? - Answer 1. *Smoking*:
it's the #1 contributor to lung disease and can damage cilia to the point where they fall
off.
2. *Family History*: increases the risk of lung disease/problems.
3. *Environmental pollutants or allergens*: this includes work/home hazards.
4. *Exposure*: "3rd Hand Smoke" is a big issue now---when a non-smoker is exposed to
smokers who have residual carcinogens on them. Ex, pediatric populations especially at
risk for lung disease/cancer.
What are the lifespan considerations for Oxygenation issues? - Answer 1. *Vital
Capacity*: max amount/volume of air that you can exhale after breathing in.
- Peak at 20 - 25 years!
- Decreases with age.
- Loss of chest wall mobility.
- Lower oxygen levels in the elderly: however even though they are at risk for being
lower this shouldn't mean that the nurse should EXPECT low PO2 to be normal.
2. *Alveoli*
- Less surface area.
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