28 Assisting With Respiration And Oxygen Therapy Flashcards
Anoxia
Without oxygen, cell metabolism slows down and some cells begin to die
Inspiration of the lungs occurs due to this kind of pressure
Negative
Alveoli contain this, that quickly phagocytize, inhaled bacteria, and other foreign particles
Macrophages
Which nervous system controls respiration
Central nervous system
What indicates the changing of hydrogen ion levels?
pH
Changes in these three levels in the blood trigger the respiratory center in the medulla to send signals through the spinal cord to the nerves that control the respiratory muscles, causing an increase or decrease rate of respiration
Changing levels of hydrogen ions, carbon dioxide, and oxygen in the blood
What receptors that are located in the aorta and carotid arteries sense changes in oxygen or carbon dioxide levels; where do they send their signals
Chemoreceptors; brainstem
About how many mL of air moves in and out of the lungs with each normal breath
500
Oxygen is transported by the hemoglobin molecule, carbon dioxide is transported to the lungs in thIs portion of the blood
Plasma portion
After 70 there is an increase or decrease in elasticity of the thorax and respiratory issues
Decrease
Total body water decreases by what percent after the age of 70 leading to dry respiratory membranes and thicker mucus
50%
Due to the loss of this recoil during expiration, respiratory muscles must be used to complete expiration
Elastic
In the aging; oxygen saturation decreases with partial pressure of oxygen dropping to 75 to 80mm Hg from the usual 80 to 100mm Hg- this is due to what kind of changes in the tissues
Tissue changes, cause thickening of the alveolar membrane, decreasing the ease of gas diffusion across the membrane
The older adult has more or less respiratory reserve, which makes it more difficult for the body to meet increase oxygen demands
Less
The most common cause of respiratory insufficiency
Airway obstruction
This problem with the respiratory system is a disturbance in the levels of gases, oxygen and carbon dioxide in the blood stream
Respiratory insufficiency
Increased level of carbon dioxide in the blood is called
Hypercapnia
Five common causes of hypoxia
Obstruction of the airway, restricted movement of the thoracic cage, or the pleura, decreased neuromuscular function, disturbances in diffusion of gases, and environmental causes
Examples of obstruction of the airway
Occlusion of the tongue; remove his secretions, inflammation from croup, asthma, tracheobronchitis, or laryngitis; chemical and heat burns with inflammation; COPD, causing airway collapse; near drowning
Examples of restricted movement of the thoracic cage, or the pleura
Abdominal surgery; chest injuries; pneumothorax; extreme obesity; diseases (spinal arthritis, peritonitis, societies, or kyphosclerosis)
Examples of decreased neuromuscular function
Depressed central nervous system (drugs, including sedatives in anesthesia agents: brain trauma, stroke) ; coma; diseases (multiple sclerosis, Guillian-barre syndrome, myasthenia gravis)
Disturbances in diffusion of gases examples
Diseases (pulmonary fibrosis, or emphysema) ; trauma, emboli, fat embolus, tumors, respiratory distress syndrome
Environmental causes
High altitude
Early signs of hypoxia and respiratory insufficiency
Sits up to breathe, complaints of not being able to catch breath, memory lapse, mental dullness, restlessness, increased bp, pulse, respirations
RAT stands for what; early signs of what
restlessness, agitation, tachycardia; early sign of respiratory insufficiency
Later signs of hypoxia and respiratory insufficiency
decreased bp & pulse, arrhythmia, use of accessory muscles, stridor, cyanosis, muscle retractions
Tachypnea
fast breathing rate
Stridor
high-pitched, harsh, or musical sounds on inspiration
Retractions; what stage of respiratory insufficiency
muscles moving inward on inspiration- a late sign of respiratory insufficiency
Patients suffering from hypoxia are highly susceptible to respiratory tract infections- true or false
true
Why are patients suffering from hypoxia are highly susceptible to respiratory tract infections
inadequate inflation of the lungs results in a pooling of secretions and provides the perfect growing environment for microorganisms
Jaundice patients may not read on this device
pulse ox
This is the most common cause of airway obstruction in the unconscious person
the tongue
This is the simplest method of clearing the air passages is this
cough effectively
Teaching forceful exhalation
Patient takes two deep breaths, inhales deeply again, then rapidly, and forcefully exhales with their mouth open
Try and have patients in this position when teaching deep breathing and coughing
sitting up, leaning forward slightly. If pt can not sit up then sit them in high fowlers
Teaching deep breathing
-Inhale through the nose; hold the breath for 3 to 5 seconds and then exhale through pursed lips. Keep the shoulders level and use the diaphragm and abdominal muscles to bring air into the lungs- repeat 4 more times
-Take 5 to 10 deep breaths every 2 hours while awake
Effective coughing
-Take a deep breath and hold for 3-5 seconds, then exhale through pursed lips; take another deep breath, and in short segments, forcibly exhale in a ‘huff-cough’ with the mouth open.
(In huff-cough pt performs a series of coughs while saying the word huff, which prevents the glottis from closing and helps clear secretions. [use tissue to cover mouth]) Perform 3x or until all secretions have been cleared.
Use the huff-cough technique at least once every 2-hours while awake or once an hour is preferable
Important to humidify what’s on the inside as well as the outside by doing what
ensuring intake of 1500- 2000mL intake daily
Oxygen concentrations above 60% rarely used due to dangers of this
oxygen toxicity
Purposes artificial airways are used
relieving an obstruction, protect the airway, facilitate suctioning and to provide artificial ventilation
two types of pharyngeal airways-
nasopharyngeal and oropharyngeal airway
pharyngeal airways used to; in this type of pt
keep the tongue from falling back into the throat, often used in postop pts until they have recovered from anesthesia; pt who can breath on their own
Endotracheal tube (ETTs) use on this type of pt
pt’s who are unconscious or unable to breathe on their own
ETTs usually removed after how long; but can stay in place for up to this long
48 - 72 hours; > week
If intubation is needed for an extended period, pt should have this performed
tracheotomy
nasopharyngeal suctioning purpose
to maintain a patent airway by removing accumulated secretions
When pt has a need for nasopharyngeal suctioning, pt should be stimulated to do this to move the secretions up into the trachea
cough
nasopharyngeal suctioning pressure should be set at
80 - 120 mm Hg
Suction catheter based on what
size of pt’s tube and the thickness of the secretions to be removed
What technique is used for all suctioning of the airway structures
aseptic technique
Order between oral and nasal/ nasopharyngeal and tracheobronchial suctioning
nasal to oral, never oral to nasal
Technique for deep suctioning in the tracheobronchial tree and for the intubated pt
sterile technique is mandatory
When a tracheostomy tube has a cuff, it is inflated to seal the space between the tube and the tracheal wall to prevent fluid from being aspirated into the lungs, and aspirated to allow only minimal leakage of air. How often is the pressure check
8 hours
Pharyngeal suctioning should be performed ______ deflating the cuff
before; esp. for new trachs
Any disruption in the negative pressure in the _____ cavity will cause the lungs not to expand
pleural
When would a pt need a chest tube
when air or fluid needs to be drained out of the pleural space and when air or fluid needs to be kept from being sucked back in
When _____ drainage is inadequate to remove air and fluids from a pt with a large pleural leak suction can be applied using either wall suction or a portable suction machine
gravity
The disposable chest drainage unit has a suction control chamber to prevent excessive _____ pressure in the pleural space, as well as a ____-seal chamber and a drainage chamber
negative; water
If suction is used in the water-seal system, there should be constant _____ in the suction chamber
bubbling
How to tell when a lung has reinflated
x-ray, pleural space has decreased
Respiratory assessment is intertwined with _____ assessment
cardiac
Why are respiratory and cardiac intertwined
if the heart is not functioning properly, oxygenated blood will not be delivered to the tissues in adequate amounts
Why are respiratory and cardiac intertwined
if the heart is not functioning properly, oxygenated blood will not be delivered to the tissues in adequate amounts
Atelectasis
collapsed area of the lung; alveoli collapse and fail to fill with air
Which pt should turn, cough, and deep breath (TC & DB) every 2 hours
every pt with a respiratory problem or potential for one
What are the risks of inadequate ventilation that can prolong hospitalization
hypoxia, pneumonitis, and atelectasis
common respiratory complications can be prevented by reinflating the _____ and removing the _____
reinflating the alveoli and removing secretions
With I.S.- The incentive is to reach a certain volume of air and hold it for
3 to 5 seconds
Pt’s should be encouraged to take how many slow, deep breaths every hour when awake
10
How can pillows help a pt with dyspnea when seated in high fowlers
placing pillows under pt’s forearms to relax the shoulder muscles
Tracheostomy care is done every __ hours
8; or as needed to keep secretions from becoming dried, blocking the airway
obturator
a curved guide that facilitates tube placement when it is inserted
In tracheostomy care- When is suctioning carried out; what is the indication
only as needed; the need is indicated by audible respirations or dyspnea
Can the same catheter be used to suction both the nasopharyngeal area and the trachea are suctioned; which technique is to be used
No, use separate catheters and aseptic technique
Suction should last no longer than ___ ____
10 seconds
Preoxygenating the pt is done when; why
before performing tracheal suctioning; hypoxemia can happen by prolonged suctioning and can lead to sudden death
Always suction the nasopharynx before ____ the cuff
deflating
immediately report drainage of more than ____ mL/h
report drainage of more than 100 mL/h
