5.1 Respiratory Therapy and Oxygenation Flashcards
Oxygenation and Perfusion
- Respiratory system oxygenates venous blood and remove CO2 through alveolar system
- Requires properly working cardiovascular system to bring blood to and from the lungs
- Upper airway warms, filters, and humidifies air inspired through nose and pharynx.
- Larynx and epiglottis protect respiratory system from unwanted swallowed substances from entering the lungs
Pulmonary Ventilation
- Respiration refers to gas exchange of oxygen and CO2
- Exchange of gas is called diffusion
- Bringing oxygen to the body is called perfusion
- Oxygen is carried via RBC.
- 97% of oxygen carried via oxyhemoglobin
- CO2 carried via carboxyhemoglobin
General Terminology
Hypoxia - Low oxygen circulating through body
Cyanosis - Blue skin because of hypoxia
Dyspnea - Trouble Breathing
Hypoventilation - Decreased rate/depth of breathing
Hypoxia/Cyanosis
Peripheral Cyanosis - Can be normal especially when cold (blue in extremities)
Central Cyanosis - Lips/tongue/mucus membrane. Never normal (Low oxygen or hole in heart)
- Even when someone is suffering from hypoxia they may not show signs of cyanosis right away
Oxygen Saturation
- Measured with pulse oximeter
(Clip on finger/adhesive strip/clip on earlobe) - Beware of allergies when using adhesive strips
- Earlobe probe may have greatest accuracy at lower saturations. It is not affected by peripheral vasoconstriction.
- Use arm that is not being monitored for blood pressure
- 95%+ is normal.
- People with chronic lung diseases may have 88-92% as normal
Breath Sounds
Vesicular - Low pitched, soft, during expiration. Heard over the lungs
Bronchial - High pitched, heard primarily over trachea
Bronchovesicular - Medium pitch and sound during expiration. Heard over anterior chest and intercostal area.
Assessing Pulmonary Function
Cardiac Exercise Test - Monitor Electrocardiogram and oxygen saturation while patient walks on treadmill
Echocardiogram - Ultrasound of lungs and heart
Holter Monitor - Long-term electric heart monitor reading (24 hours)
Cardiac Biomarkers - Assess injury of heart muscles
Assessing Pulmonary Function (cont)
CBC - Checks for anemia
Lung Scan/Radiography - Assess anomalies or lumps in lungs
(ABG) - Measures levels of O2 and CO2 in blood from an artery
Cytology studies - Assess for cancer
Capillary Refill - Assess blood flow to peripheral extremities.
Pulmonary Function Tests
Tidal Volume (TV) - Air during normal respiration
Vital Capacity (VC) - Maximum air inhaled
Forced Vital Capacity (FVC) - Maximum air exhaled
Forced Expiratory Volume (FEV) - Maximum air exhaled
Total Lung Capacity (TLC) - Volume of air in lungs after full inspiration
Residual Volume (RV) - Air that remains in lungs after full expiration
Peak Expiratory Flow Rate (PEFR) - Maximum flow rate during forceful exhaling.
Nursing Interventions (Respiratory Function)
- Teach about pollution free environments
- Promote comfort to ease anxiety
- Suction airway
- Meet oxygenation needs with medication, oxygen, metered dose inhalers, nebulized medications
Turn, Cough, Deep Breathing (TCDB)
- Improve lung expansion and volume
- Help expel anesthetic gases and mucus from airway
- Facilitates oxygenation of tissues
- Patient should take 3 deep breaths and cough instead of exhale on last breath.
- Splint abdomen with pillow if there is incision
- Post surgical patients should do this every 2 hours
Promoting Proper Breathing
Hypoventilation - Slow deep breaths inhaling through nose and exhaling out mouth 4 times a day
Incentive Spirometry - Encourages patients to maximize lung inflation or reduce atelectasis. Use every 2 hours after surgery
Pursed-Lip Breathing - Used for patients with dyspnea or feelings of panic. Exhale with pursed lips with small opening to slow and prolong expiration
Promoting Proper Breathing
Diaphragmatic Breathing
- Reduces Respiratory Rate
- Increases alveolar ventilation
- Expel as much air as possible during expiration
Breath slowly through nose and protrude abdomen as far as possible. Then breath out through pursed lips while contracting abdomen muscles with one hand pressing inward and upward on abdomen.
- Repeat for 1 minute and rest for 2 minutes
- Beneficial for COPD Patients
Cough Suppressants/Expectorants
Cough Suppressants - Suppress cough to help sleep
Codeine (Robitussin AC)
Dextromethorphan (Robitussin DM)
Expectorants - Thin mucus and help expel from lungs
Guaifenesin (Robitussin or Mucinex)
Chest Physiotherapy (At Home)
Check with doctor for contraindications (broken rib)
- Used cupped hand when preforming (not flat)
- Position Child prone with 2 pillows under hips
- Cup hand and smack back
- Do the same thing with patient lying on each side
- Upper lobes have patient sit on a chair
- At the end have patient take a few breaths and nice hard coughs
Administering Inhaled Medications
Bronchodilators - Opens narrow airways (often with steroids) by the below methods
Metered-Dose Inhalers - Deliver controlled dose of medication with each compression of canister
Nebulizer - Disperse fine particles of liquid medication to deeper passages of respiratory tract (6-8L/Min)
Dry Powder Inhaler - Breath activated delivery of medications
How to Use Meter-Dose Inhaler
- 2 Parts. Canister with Medication and Plastic piece called actuator
- Shake before use so drug can mix with propellant
- Prime inhaler before first use. Do 2 sprays away from yourself
- Sit up right, remove cap from inhaler, shake, Keep thumb on base and index finger on canister, breath out gently, put inhaler on mouth, and breath in slow, once breathed in hold breath for 10 seconds and exhale gently
How to Setup Chest Tube
- Remove packaging using sterile technique
- Fill water seal (2cm line)
- When practitioner is ready remove tubing from back of drain
- When indicated hook up wall suction to suction tube
- Turn on suction and turn pressure up
- Keep chest drain below level of chest (set on floor)
- Mark level of fluid with date and time
- Bubbles mean there is an air leak
Nasal Cannula
- Used to supply oxygen or increased airflow to patient needing respiratory assistance
Pros
Comfortable and convenient
Cons
Cannot Deliver high levels of oxygen (2-4 liters per min) (28-35%) (24-40%)
Oxygen Delivery
Deliver Oxygen Safe for your Patient
Younger - 97-99%
Older - 94-97%
COPD - 88-92%
Simple Face Mask
- Used for short term therapy
- Low amounts of oxygen
- Not very accurate (35-50% Oxygen)
Non-Rebreathing Mask
- Used for higher concentration of oxygen
- Normal mask with reservoir bag
Delivered up to 85%-95% oxygen - Reservoir bag must be inflated before use
- 15L/min flow of oxygen
- Mask must be tight fitting to draw oxygen from reservoir bag
- Requires special referral
(Not used long term)
Venturi Mask
- Regulate oxygen given to patient using a valve
- We know how much oxygen is being delivered
- Changeable with valves (24-60%)
Humidified Oxygen
28-60% Oxygen
- Oxygen is brought through water to humidify air
- Noisy, wet, and needs to be changed regularly
Precautions of Oxygen Administration
- Keep humidified air clean to prevent bacteria growth
- Avoid open flames in patient room
- Place “no smoking” signs in conspicuous places
- Check electrical equipment in rooms are in good working order
- Avoid wearing/using synthetic fabrics (static)
- Avoid using oils in area (oil ignite spontaneously with oxygen)
Artificial Airways
Oral Airways - Prevent obstruction of trachea by displacement of tongue into oropharynx
Endotracheal and Tracheal Airways - Short term use to ventilate relieve upper airway obstructions, protect against aspiration, and clear secretions
Tracheostomy - Long term assistance (surgical incision made into trachea)
Expected Outcomes for Patients
- Demonstrate improved gas exchange by absence of cyanosis, chest pain, and pulse oximetry (>95%)
- Relate causative factors and demonstrate adaptive method of coping
- Preserve pulmonary function by maintaining optimum level of activity
- Demonstrate self-care habits that provide relief from symptoms and prevent further problems
Safety Guidelines (with respiratory issue)
- Sudden change in vital signs, level of consciousness, behavior, may be experiencing profound hypoxia
- Patients with COPD who breath spontaneously should never receive high levels of oxygen therapy
- Preform tracheal suctioning before pharyngeal suctioning whenever possible
- Use of normal saline installation into airway before ET and tracheostomy suctioning is not recommended
- Check institution policy before stripping or milking chest tubes
- Serious tracheostomy complications is airway obstruction which can result in cardiac arrest.
Oxygen Therapy
- Oxygen (Green Label)
- Flow Meter also Green
- Screw flow meter in
- Chamber is calibrated to L/Min of oxygen delivered
- Ball will rise and fall as it is adjusted
Nasal Cannula
- First line of defense is nasal cannula
- Use Christmas tree adaptor to connect to flow meter
- Put curve of nasal prongs towards back of nose
- Wrap loops around ears
Non-rebreather Mask
Non-rebreather masks
(Moving up apparatus from nasal cannula)
- Allows patient to take in more oxygen than co2
AMBU Bag
3rd line of defense
AMBU Bag - Allows nurse to breathe for the patient in respiratory distress and not breathing
- Make sure seal is tight around the nose
- Compress AMBU bag one every 3-5 seconds for rescue breathing
- Look for chest rise and fall
- (Up to 15mL of oxygen)
Peak Flow Meter
- Measures lung capacity using expired breathing
- ## Patient blows out into it (used with asthmatics)
Incentive Spirometer
- Exercises lungs by encouraging slow deep inspirations
- Allows anesthetics to expel out of lungs after surgery
- Patient takes breath in and we can measure how much they inhale
