Ch. 39 Oxygenation and Perfusion Flashcards
adventitous
abnormal breath sound heard over the lungs
angina
a temporary imbalance between the amount of oxygen needed by the heart and the amount delivered to the heart muscles
arterial blood gas
a diagnostic test examining arterial blood; used to determine the pressure exerted by oxygen and carbon dioxide in the blood
atelecatasis
incomplete expansion or collapse of a part of the lungs
atrai
upper chambers of the heart
atrioventricular bundle
a bundle of modified heart muscle that transmits the cardiac impulse from the atrioventricular node to the ventricles, causing them to contract
atrioventricular (AV) node
a node of specialized heart muscle located in the septal wall of the right atrium; receives impulses from the sinoatrial node and transmits them to the atrioventricular bundle
bradypena
slow rate of breathing
bronchial
those heard over the larynx and trachea are high pitched, hard “blowing” sounds, with sound on expiration being longer than inspiration
bronchodilator
medication that relaxes contractions of smooth muscles of the bronchioles
bronchovesicular
normal breath sounds heard over the mainstem bronchus; they are moderate blowing sounds, with inspiration equal to expiration
capnography
a method to monitor ventilation and, indirectly, blood flow through the lungs
cardiopulmonary
relating to the heart and the lungs
cardiovascular
relating to the heart and blood vessels
cilia
microscopic, hair like projections that propel mucus upward toward the upper airway so that it can be expectorated
crackles
fine, cracking sounds made as air moves through wet secretions in the lungs
diffusion
tendency of solutes to move freely throughout a solvent from an area of higher concentration to an area of lower concentration until equilibrium is established
dyspnea
difficult or labored breathing
dysrhythmia
an abnormal cardiac rhythm
electrocardiocram
graphic record produced by the electrocardiograph
endotracheal tube
polyvinyl-chloride airway that is inserted through the nose or the mouth into the trachea, using a laryngoscope as a guide
expiration
act of breathing out, synonym for exhalation
hyperventilation
condition in which there is more than the normal amount of air entering and leaving the lungs
hypoventilation
decreased rate or depth of air movement into the lungs
hypoxemia
deficient oxygenation of blood
hypoxia
inadequate amount of oxygen available to the cells
inspiration
act of breathing in, inhalation
internal respiration
exchange of oxygen and carbon dioxide between the circulating blood and tissue cells
ischemia
deficiency of blood in a particular area
nasal cannula
disposable, plastic device that delivers oxygen via two protruding prongs for insertion into the nostrils
oxygenation
the process of providing cells life sustaining oxygen
perfusion
process by which oxygenated blood passes through body tissues
pulmonary ventilation
movement of air into and out of the lungs
pulse oximetry
noninvasive technique that measures the oxygen saturation (SaO2) of arterial blood
respiration
gas exchange between the atmospheric air in the alveoli and blood in the capillaries
sinoatrial (SA) node
a mass of tissue in the upper right atrium, just below the opening of the superior vena cava, that initiates the transmission of electrical impulses, causing contraction of the heart at regular intervals, also known as pacemaker
spirometer
instrument used to measure lung capacities and volumes, one type is used to encourage deep breathing (incentive spirometry)
sputum
respiratory secretion expelled by coughing or clearing the throat
surfactant
detergent like phospholipid that reduces surface tension of the fluid lining the alveoli
tachypnea
rapid rate of breathing
tracheostomy
artificial opening made in the trachea through which a tracheostomy tube is inserted
ventricles
lower chambers of the heart
vesicular
normal sound of respiration heard on auscultation over peripheral lung areas
wheezes
continuous, high pitched squeak or musical sound made as air moves through narrowed or partially obstructed airway passages
tidal volume
TV: total volume amount of air inhaled and exhaled with one breath
vital capacity
VC: maximum amount of air exhaled after maximum inspiration
forced vital capacity
FVC: maximum amount of air that can be forcefully exhaled after a full inspiration
forced expiratory volume
FEV: the amount of air exhaled at a specific time interval: for example, in the first, second and third seconds after a full inspiration
Total lung capacity
TLC: the amount of air contained within the lungs at max inspiration
Residual Volume
RV: the amount of air left in the lungs at max epiration
Peak Expiratory flow rate
PEFR: the max flow attained during the FVC
Ineffective Airway Clearance
:thick yellow secretions, pale skin with circumoral cyanosis, RR is 40 b/m and shallow, coarse crackles are auscultated bilaterally. cannot sit quietly in chair or on bed. ineffective cough
Impaired Gas Exchange
using pursed lip breathing
sitting hunched fwd with overbed table supporting arms
altered blood gases show respiratory acidosis
reports shortness of breath for 1 wk
Ineffective breathing pattern
hyperventilating, tachypneic (40 br/m)
tingling in fingers
cannot catch breath or lay down
Zafirlukast
Bronchodilator
Route: PO
SE: HA, dizziness, N/V
Implications: do not use to treat acute attacks. do not give with meals
Monteleukast
Inhibits: leukotriene release as well as inflammatory reaction
Should be given before bedtime
Albuterol
Bronchodilator
Route: PO. Inhalation
SE: tremors, anxiety, insomnia, HA, palpitations, hypertension, vomiting
Implications: caution the pt not to increase the dosage w/o consulting the primary care provider. be aware that children 2-6 more freq exhibit CNS stimulation
Theophylline (aminophylline)
Bronchodilator
PO, IV, Rectally
SE: N/V, tachycardia, diuresis, irritability, vertigo, convulsions, nervousness
Implications: monitor vital signs closely. force fluids as clinical status allows. monitor serum theophylline levels, especially if the pt does not respond to the drug or if severe side effects develop
Corticosteroids (prednisone, dexamethasone, budesonide, triamcinolone, acetonide)
reduces inflammation
PO, IV, inhalation, intranasal
SE: fluid retention, hypertension, mood swings, weight gain, gastritis, hyperglycemia, insomnia
Implications: reduce sodium intake. make the pt and family aware of potential for labile emotions. weight daily in the morning. monitor blodo pressure and blood sugar
Diphenhydramine
Antihistamine, H1 receptor antagonist
PO
SE: Drowsiness, anorexia, dry mouth, constipation, blurred vision, urinary retention
Implic: warn the pt to only use with the primary health care providers advice in the presence of bronchial asthma
Certrizine
Antihistamine H1 receptor antagonist
PO
SE: headache with limited sedative effect, not associated with anticholinergic effects
Implic: monitor effectiveness of the drug. contraindicated while breastfeeding
Fexofenadine
Antihistamine H1 receptor antagonist
PO
SE: headache, not associated with anticholinergic or sedative effects
Comolyn sodium
Mast cell stabilizer, Asthma prophylactic agent, no bronchodilator, antihistamine, or vasoconstrictor properties
Inhalation - MDI or nasal solution
SE: cough, nausea, nasal stinging and burning, throat irritation
Implic: remind the patient that this medication is used to prevent asthma attacks, not to treat acute episodes. inform the pt that the drug is effective only if taken routinely (2-4 x / wk) Safety is not established during pregnancy and breastfeeding
Nasal Cannula: Low flow
most common. 1-2 L/min = 24-28% 3-5 L/min = 32-40% 6L/min = 44% Priority interventions: Check freq. that both prongs are in the patients nares. for patients with chronic lung disease, limit rate to the minimum needed to raise arterial oxygen saturation to maintain a level of 88-92%
Nasal Cannula: High flow
Max: 60 L/min
10 L/min = 65%
15 L/min = 90%
Interventions: closely monitor the pts respiratory status for changes indicating impending respiratory failure
Pharyngeal pressure is affected by mouth opening or closing, delivered flow, and size of nasal prongs.
High flow nasal cannula oxygen delivery is often better tolerated by children than any other noninvasive delivery methods
Simple Mask
low flow: 5-8 L/min 40-60% (5L in min setting)
Interventions: monitor the pt freq to check placement of the mask.
support the patient if claustrophobia is a concern
secure a medical order to replace the mask with a nasal cannula during mealtime
Partial Rebreather mask
low flow: 8-11 L/min 50-75%
Interventions: set the flow rate so that the mask remains two thirds full during inspiration. keep the reservoir bag free of twists or kinks
:Allows pt to rebreathe first 1/3 of O2 as it is mixed within the bag with 100% O2 to conserve O2.
Nonrebreather mask
Low flow. 10-15 L/min = 80-95%
Interventions: maintain flow rate so that the reservoir bag collapses only slightly during inspiration. check that the valves and rubber flaps are functioning properly (open during expiration and closed during inhalation. Monitor SaO2 with pulse oximeter
:highest concentration of O2. can be used to administer heliox. (helium used to deliver aerosols, reduce fer and anxiety for pts)
Venturi Mask
High Flow: 4-6L/min 24-40%
Interventions: requires careful monitory to verified FiO2 at flow rate ordered. Check that air intake valves are not blocked
:most precise delivery of oxygen.
Transtracheal o2 device
tube is surgically inserted into the trachea. devliers oxygen throughout the respiratory cycle.
Oxygen conserving devices
reservoir cannulas have a reservoir space that stores oxygen during exhalation. on subsequent inhalation the oxygen is restored. adding bolus volume.
Traditional Water-seal (wet-suction) chamber
Desc: 3 chambers, a collection, water-seal (middle), and wet suction control chamber. generally used to provide 20 cm H20 of suction
Comments: Requires that sterile fluid be instilled into the water-seal and suction chambers. Has positive and negative pressure release valves. Intermittent bubbling indicates that the system is functioning properly. additional suction can be added by connecting the system to a suction source.
Dry-suction water seal (dry-suction)
Desc: 3 chambers, water-seal, collection, and dry-suction control chamber. Provides 10-40 cm H20 suction.
Comments: requires that sterile fluid be instilled in the water seal chamber at the 2 cm level. No need to fill the suction chamber with fluid. Suction pressure is set with a regulator. Has positive and negative pressure-release valves. Has an indicator to signify that the suction pressure is adequate. Quieter than traditional water seal systems
Dry-suction (one-way valve)
Desc: has 1 way mechanical valve that allows air to leave the chest and prevents re-entry.
Commencts: no need to fill suction chamber with fluid; can be set up quickly in an emergency. works even if knocked over. making it ideal for pts who are ambulatory.
Kussmaul Respiration
greater than 35 breaths/min.
IE metabolic acidosis, the acidic pH stimulates an increase in breath rate and deapth of respirations
Apnea
the absence of respirations for last for 15 seconds or longers
Cheyne-Stokes respiration
occurs when there is decreased blood flow or injury to the brainstem
SvO2
saturation of venous blood. this is lower because the tissues have removed some of the oxygen from the hemoglobin. usually 70%
