Overview
This lecture reviews critical alterations in gas exchange, including key respiratory conditions, their pathophysiology, risk factors, clinical presentations, diagnostic methods, and the nurse’s role in management.
Pathophysiology & Types of Gas Exchange Alterations
- Gas exchange alterations include pleural effusion, tension pneumothorax, pulmonary embolism, respiratory failure, and acute respiratory distress syndrome (ARDS).
- Pleural effusion involves fluid accumulation in the pleural space, impeding lung expansion and gas exchange.
- Transudative effusion is due to pressure imbalance; exudative effusion results from increased capillary permeability.
- Tension pneumothorax is lung collapse from trauma or medical procedures, causing rapid respiratory compromise.
- Flail chest involves multiple rib fractures leading to chest wall instability and impaired ventilation.
- Pulmonary embolism (PE) is blockage of pulmonary arteries, disrupting blood flow and causing ventilation-perfusion (V/Q) mismatch.
- Respiratory failure can be hypoxemic (low oxygen) or hypercapnic (high CO2), caused by various pulmonary and non-pulmonary conditions.
- ARDS is an acute, severe inflammatory lung injury with rapid-onset hypoxemia and reduced lung compliance.
Risk Factors & Epidemiology
- Risk factors for pleural effusion include heart failure, liver cirrhosis, nephrotic syndrome, cancer, trauma, and aging.
- Tension pneumothorax risk: trauma, central line placement, mechanical ventilation, lung biopsy, bronchoscopy, CPR.
- PE risk factors: immobilization, hypercoagulability, vessel injury (Virchow’s Triad), and deep vein thrombosis.
- Older adults are at higher risk for respiratory complications due to age-related changes and comorbidities.
Clinical Presentation & Diagnostics
- Pleural effusion: dyspnea, pleuritic chest pain, decreased breath sounds, nonproductive cough.
- Tension pneumothorax: tachycardia, hypotension, jugular distension, sharp pain, cyanosis, respiratory distress.
- Flail chest: severe chest pain, paradoxical chest movement, respiratory insufficiency.
- PE: dyspnea, chest pain, cough, syncope, shock, altered perfusion.
- Diagnostics include chest x-ray, CT scan, ultrasound, ABGs, ECG, and lab tests.
- ARDS: acute onset, refractory hypoxemia, bilateral lung infiltrates on imaging, rapid progression.
Nursing Roles and Management
- Monitor vital signs, respiratory status, and oxygenation.
- Assist with procedures (thoracentesis, chest tube placement, intubation).
- Provide client education on symptom recognition and lifestyle management.
- Manage pain, optimize nutrition, and coordinate care with multiple disciplines.
- Prevent ventilator complications, maintain oral hygiene and skin integrity, and educate patients on oxygen safety.
- For PE, administer anticoagulation therapy and monitor for therapeutic levels (INR).
Key Terms & Definitions
- Pleural Effusion — Fluid buildup in the pleural space around the lungs.
- Transudative Effusion — Fluid caused by pressure imbalance, typically clear.
- Exudative Effusion — Protein-rich fluid from increased capillary permeability, often due to inflammation.
- Tension Pneumothorax — Air in the pleural space causing lung collapse and mediastinal shift.
- Flail Chest — Segment of chest wall moves independently due to multiple rib fractures.
- Pulmonary Embolism (PE) — Blockage of a pulmonary artery by a clot or other embolus.
- V/Q Mismatch — Imbalance between ventilation (airflow) and perfusion (blood flow).
- Respiratory Failure — Inability of lungs to maintain adequate oxygen or CO2 removal.
- ARDS — Acute respiratory distress syndrome, severe lung inflammation and hypoxemia.
- Mechanical Ventilation — Machine-assisted breathing support for compromised patients.
- ECMO — Extracorporeal membrane oxygenation, external blood oxygenation support.
Action Items / Next Steps
- Review acute care content on detailed pathophysiology of respiratory conditions.
- Familiarize yourself with diagnostics and nursing care for respiratory emergencies.
- Complete assigned readings on gas exchange alterations and related nursing interventions.
- Practice identifying clinical signs and developing nursing care plans for these conditions.