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NR 224 Exam 2 Study Guide (Version 5), NR 224 Fundamental, Chamberlain University
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NR 224 Exam 2 Study Guide (Version 5), NR 224 Fundamental, Chamberlain University
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NR 224: Fundamentals SkillsExam 2 Review
Chapter 41: Oxygenation
Know alterations in breathing pattern/ alterations in respiratory functioning.
o The three primary alterations are hypoventilation, hyperventilation, and hypoxia.
o Hypoventilation and hyperventilation are often determined by arterial blood
gas analysis.
o At rest, the NORMAL adult respiration rate is 12 to 20 regular breaths/min.
o Hyperventilation:
» rate and depth of respirations increase
» hypocarbia sometimes occurs (also called hypocapnia, meaning reduced CO2 in
the blood)
» CAUSES OF HYPERVENTILATION:
1. severe anxiety, infection, drugs, or an acid-base imbalance
induces hyperventilation
2. increased body temperature (fever) which causes increased metabolic rate
3. increased CO2 production results in patient’s rate and depth of respiration
to increase
4. sometimes can be chemically induced
» SIGNS & SYMPTOMS OF HYPERVENTILATION:
1. rapid respirations
2. sighing breaths
3. numbness
4. tingling of hands/feet
5. light-headedness
6. loss of consciousness
o Hypoventilation:
» respiratory rate is abnormally low, depth of ventilation is depressed
» hypercarbia sometimes occurs (also called hypercapnia, means too much CO2 in
the bloodstream)
» occurs when alveolar ventilation is inadequate to meet the oxygen demand of the
body or eliminate sufficient carbon dioxide
» can lead to respiratory acidosis and respiratory arrest
» in patients with COPD, the administration of excessive oxygen results in
hypoventilation
, » for patients with atelectasis, a collapse in the alveoli prevents the normal
exchange between oxygen and carbon dioxide, which results in less of the lung
being ventilated, and hypoventilation occurs
» SIGNS & SYMPTOMS OF HYPOVENTILATION:
1. mental status changes
2. dysrhythmias
3. potential cardiac arrest
4. in untreated, patient’s status rapidly declines, leading to
convulsions, unconsciousness, and death
o Hypoxia:
» is inadequate tissue oxygenation at the cellular level.
» it results from a deficiency in oxygen delivery or oxygen use at the cellular level. It is
a life-threatening condition.
» Untreated it produces possibly fatal cardiac dysrhythmias.
» CAUSES OF HYPOXIA:
1. a decreased hemoglobin level and lowered oxygen-carrying capacity of the
blood
2. a diminished concentration of inspired oxygen, which occurs at high altitudes
3. the inability of the tissues to extract oxygen from the blood, as with cyanide
poisoning,
4. decreased diffusion of oxygen from the alveoli to the blood, as in pneumonia,
5. poor tissue perfusion with oxygenated blood, as with shock
6. impaired ventilation, as with multiple rib fractures or chest trauma
» SIGNS & SYMPTOMS OF HYPOXIA:
1. apprehension
2. restlessness
3. inability to concentrate
4. decreased level of consciousness
5. dizziness
6. behavioral changes
7. unable to lie flat and appears both fatigued and agitated
8. VITAL SIGN CHANGES INLCUDE:
— an increased in pulse rate
— increase rate and depth of respiration
— in early stages, blood pressure is elevated unless caused by shock
— when worsens, respiratory rate declines as a result of respiratory
muscle fatigue
, 9. in a late sign of hypoxia, cyanosis, blue discoloration of the skin and
mucous membranes caused by the presence of desaturated hemoglobin in
capillaries would be present
10.central cyanosis observed in the tongue, soft palate, and conjunctiva of the eye
where blood flow is high
o Hypoxemia:
» refers to a decrease in the amount of arterial oxygen.
o Bradypnea:
» rate of breathing is regular and abnormally slow
» less than 12 breaths/min
o Tachypnea:
» rate of breathing is regular but abnormally rapid
» greater than 20 breaths/minute
o Hyperpnea:
» respirations are labored, increased in depth, and increased in rate
» greater than 20 breaths/min; occurs normally during exercise
o Apnea:
» absence of respiration lasting for 15 seconds or longer
» respirations cease for several seconds
» persistent cessation results in respiratory arrest
o Dyspnea:
» associated with hypoxia
» it is the subjective sensation of difficult or uncomfortable breathing
» shortness of breath usually associated with exercise or excitement
» CAUSES OF DYSPNEA:
1. smoking,
2. pollution,
3. cold air
o Orthopnea:
» is an abnormal condition in which a patient uses multiple pillows when reclining
to breathe easier or sits leaning forward with arms elevated
» the number of pillows used usually helps to quantify the orthopnea (e.g., two- or
three-pillow orthopnea). Also ask if the patient must sleep in a recliner chair to
breathe easier.
o Cheyne-Stokes Respiration:
» occurs when there is a decrease blood flow or injury to the brainstem
» respiratory rate and depth are irregular, characterized by alternating periods of
apnea and hyperventilation
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