333 oxygenation Flashcards
ventilation
the movement of gas in and out of the lungs (this is what we measure respirations with, normal is 12-20 we are concerned even if slightly outside of range
diffusion
the oxygen and carbon dioxide exchange between the alveoli and the red blood cells
perfusion
the distribution of the oxygenated red blood cells to the tissues in the body
what type of process is breathing
passive ; it is regulated by O2, CO2 and pH of blood
hypercarbia + bodies response
increasing of CO2 ; body knows to increase rate and depth of breathing to remove CO2
what does lung volume depend on
age, gender, height
tidal volume
amount of air exhaled following normal inspiration
alveoli function
to promote gas exchange
between children and adults, who has a higher respiration rate
children
what type of breathers are children and males vs females
children & males are abdominal breathers and females are thoracic breathers
what could possibly increase RR?
pain, anxiety, medications , ect
expected (normal) breath sounds
bronchial, bronchovesicular, vesicular
adventitious (abnormal) breath sounds
crackles, wheezing, rhonchi, stridor
crackles/rales
fine to coarse bubble sounds, associated with air passing through fluid or collapsed small airways
wheezes
high pitched whistling, narrow obstructed airways pts w/ asthma or having an allergic reaction
rhonchi
loud low pitched rumbling, fluid or mucus in airways, can resolve with coughing
stridor
choking, high pitched and loud -> could hear plural friction rub d/t inflammation (often seen in children)
vesicuclar lung sounds
low pitch, heard over most of normal lung
broncro-vesicular lung sounds
medium pitch, heard over mainstream bronchi
bronchial (tracheal) breath sounds
high pitch, normally heard over trachea
bradypnea
rate of breathing is regular but abnormally slow (<12 breaths/min)
tachypnae
rate of breathing is regular but abnormally rapid (>20 breaths/min)
hyperpnea
respirations are labored, increased depth, and increased in rate (>20 bpm, occurs normally during exercise)
apnea
respirations cease for several seconds -> persistent cessation results in respiratory arrest
hyperventilation
rate and depth of respirations increase (hypocarbia sometimes occurs)
hypoventilation
respiratory rate is abnormally low, and depth of ventilation is depressed (hypercarbia sometimes occurs)
if a pt O2 is 100% on oxygen, what should you do
try to wean their oxygen down to 97/98
SPO2
peripheral, uses red light (what we put on the pt’s finger for vitals)
SAO2
arterial
can physician prescribe certain limits for O2 stats
yes - some populations you don’t want stating in the upper 90s, Drs can prescribe less (ex: wean pt O2 to be 88%)
what can interfere with SPO2
activity, nail polish (dark), if they are cold, if they have edema, arterial disease
work of breathing
the effort to expand and contract lungs, determined by rate and depth / the ease the lungs can be expanded + airway resistance
breathing is inspiration and expiration, what type of process is each
inspiration is an active process (uses muscles), expiration is a passive process (depends on the elastic recoil of our lungs)
what is surfactant
a chemical produced to maintain surface tension of the alveoli to prevent them from collapsing
pt’s w/ COPD lose what which causes them to have an increased work of breathing
the elastic recoil of their lungs
what is a way to evaluate work of breathing
evaluate accessory muscle use -> the intercostal muscles & abdominal muscles, being used to expand the lungs but this will fatigue
compliance
the ability for the lung to distend or expand in response too intra-avila pressure (this relies on the intrathoracic pressure changes)
what is going to increase work of breathing
decreased compliance, increased airway resistance and/or increased accessory muscle use
examples of times that increased airway resistance might be present
decreased diameter related to broncho constriction, asthma, trachyal edema
what are the 4 main factors that affect oxygenation
physiological (main one we focus on), developmental, lifestyle and environmental
factors affecting oxygenation: decreased oxygen-carrying capacity
low hemoglobin levels (anemia, low RBC to carry oxygen), carbon monoxide (a poisoning bc hemoglobin binds w/ carbon monoxide vs oxygen so spreading that through the body)
what are the s/s of anemia
fatigue, decreased activity tolerance, paleness
factors affecting oxygenation: hypovolemia
decreased circulating amounts of blood
factors affecting oxygenation: decreased inspired oxygen concentration
high altitude (decreased oxygen in the air), hypoventilation
factors affecting oxygenation: increased metabolic demand
exercise, wound healing, fever
factors affecting oxygenation: chest wall movement
pregnancy or obesity (reduced lung volumes, might not be able to lay flat) musculoskeletal diseases, trauma, neuromuscular diseases, CNS alterations (phrenic nerve controls diaphragm so C3-5 injury impairs) (medulla oblongata regulates ventilation)
what alters respiratory function
illness and conditions affecting ventilation or oxygen transport
goal of ventilation
normal arterial carbon dioxide tension and normal arterial oxygenation tension
what type of blood do you need to use to know about oxygen levels or CO2 levels in your blood
arterial blood from the arterial artery, usually radial (venous blood has been deoxygenated)
ABG labs
PaO2: 80-100
PaCO2: 35-45
spO2: >95%
EtCo2: 35-45
EtCO
the amount of CO2 at the end of exhalation, less invasion than ABG
hypoventilation
inadequate alveolar ventilation to meet demand (not getting enough gas exchange so not enough O and/or too much CO2)
causes of hypoventilation
medications (sedatives, opioids), alveolar collapse aka atelectasis (lung diseases), anesthesia
S/s of hypoventilation
mental status changes, dysrhythmias -> can lead to cardiac arrest, convulsions, unconsciousness, death
atelectasis
collapsed alveoli which prevents respiratory gas exchange (diagnosed by xray -> white where there should be black); can lead to lung collapse which leads to res distress, pneumonias, res failure
is atelectasis preventable by the nurse
yes -> bed side techniques (incentive spirometer, get pt out of bed, cough, deep breath)
conditions associated with atelectasis
immobility, obesity, sleep apnea, chronic lung disease
hyperventilation
removing CO2 faster than it is produced by cellar metabolism
causes of hyperventilation
anxiety attacks (severe), infection/fever, drugs, pH imbalance, aspirin poisoning, amphetamine use think increased work of breathing
S/s of hyperventilation
rapid respirations, sighing breaths, numbness/tingling of hands & feet, light headedness, loss of consciousness
Hypoxia
inadequate tissue oxygenation at the cellular level so not enough Q to meet needs (can be related to a delivery problem)
why do we care so much about hypoxia
if left untreated can lead to cardiac dysrhythmias because the heart needs oxygen to function
causes of hypoxia
decreased hemoglobin levels/low oxygen caring capability, diminished oxygen concentration of inspired oxygen (high alt), inability of tissues to get oxygen from blood (cyanide poisoning), decreased diffusion of oxygen from alveoli to blood (infections/pneumonia), poor perfusion w/ oxygenated blood (shock), impaired ventilation from traumas (rib fractures -> if it hurts to breath pt will take short, shallow breaths)
S/s of hypoxia
apprehension, restless, inability too concentrate, decreased level of consciousness, dizziness, behavioral changes, difficulty staying still/lying flat, fatigue yet agitated, increases pulse & res, initially increased BP but then leads to shock & low BP, cyanosis (late sign), n/v, chest pain
Cyanosis
blue discoloration of skin / mucous membranes not a reliable sign of oxygen status but is a clue
central cyanosis affects what
tongue, soft palate, conjunctiva of eye (hypoxemia)
peripheral cyanosis affects what
extremities, nail beds, earlobes (vasoconstriction not oxygenation)
chronic hypoxia
associated with chronic lung conditions (most common is COPD) -> s/s cyanotic nail beds, sluggish cap refill, clubbing, barrel chest (1:1)
developmental considerations of oxygenation: young & middle adults
focus on avoidance of oxygenation problem risk factors (smoking, unhealthy lifestyle, environment)
developmental considerations of oxygenation: older adults
mental status changes typically first sign of any issues, more susceptible to respiratory infections & compromise, low reserve
what is dyspnea commonly associated with
hypoxia
what is dyspnea related to
shortness of breath (exercise, excitement, disease)
S/s of dyspnea
use of accessory muscles, nasal flaring, increased rate/depth can be rated on an analog scale
questions to ask related to dyspnea
when does it occur, what improves it, is it worsened by something
DOE
“dyspnea on exertion”
hemoptysis
bloody sputum
what is more effective way to move secretions through the airways- coughing or artificial suctioning
coughing because it is coming from the lung
sputum specimen collection
-best time is early in the morning
-wait 1-2 hours after pt eats
-sterile container
-may require suction if pt can’t cough up enough
**need to know steps, in potter & perry*
sputum culture and sensitivity test
obtained to identify a specific microorganism or organism growing in sputum; identifies drug resistance and sensitivities to determine appropriate antibiotic therapy
sputum for acid-fast bacillus
screens for presence of AFB for detection of TB by early morning specimens on 3 consecutive days
sputum for cytology
obtained to identify lung cancer (differentiates type of cancer cell)
pulmonary function test- basic ventilation studies
function varies by ethnic group determines ability of the lungs to efficiently exchange O and CO2; used to differentiate pulmonary obstructive from restrictive disease
Peak Expiratory Flow Rate (PEFR)
the point of highest flow during maximal expiration (normal in adults is based on age and wt); reflect changes in large airway sizes, excellent predictor of overall airway resistance in pt w/ asthma (daily measures foo early detection of asthma)
Bronchoscopy
looking for masses, pus or foreign bodies
lung scan
looking at the structure for abnormalities
