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