Ch.21 Oxygenation

Question 1

Explain the difference between ventilation and respiration.

Answer 1

Ventilation (the movement of air in and out of the lungs)

Respiration (the exchange of oxygen and carbon dioxide).

Question 2

Differentiate between external and internal respiration.

Answer 2

Internal respiration occurs at the cellular level by means of hemoglobin and body cells.

External respiration takes place at the most distal point in the airway between the alveolar and capillary membranes

Question 3

Name methods for assessing the oxygenation status of clients at the bedside.

Answer 3

Physical Assessment Data

Arterial Blood Gases

Pulse Oximetry

Question 4

List signs of inadequate oxygenation.

Answer 4

• Decreased Energy
• Restlessness
• Rapid, shallow breathing
• Rapid heart rate
• Sitting up to breathe
• Nasal Flaring
• Use of accessory muscles
• Hypertension
• Sleepiness, Confusion, stupor, coma

Question 5

Name nursing interventions that can be used to improve ventilation and oxygenation.

Answer 5

Positioning and teaching breathing techniques are two nursing interventions frequently used to promote oxygenation.

Question 6

Name sources for supplemental oxygen.

Answer 6

• Wall outlet
• Portable tank
• Liquid oxygen unit
• Oxygen concentrator

Question 7

Identify items that may be needed when providing oxygen therapy.

Answer 7

Flowmeter: is a gauge used to regulate the amount of oxygen delivered to the client and is attached to the oxygen source

Oxygen Analyzer: is a device that measures the percentage of delivered oxygen to determine whether the client is receiving the amount prescribed by the physician

Humidifier: a device that produces small water droplets and may be used during oxygen administration because oxygen is drying to the mucous membranes.

Question 8

List common oxygen delivery devices.

Answer 8

Nasal Cannula: is a hollow tube with 1/2-in prongs placed into the client’s nostrils.

Masks: fits over the nose and mouth and allows atmospheric air to enter and exit through side ports

Face tent: provides oxygen to the nose and mouth without the discomfort of a mask

Tracheostomy Collar: delivers oxygen near an artificial opening in the neck

T-piece: fits securely onto a tracheostomy tube or endotracheal tube

Question 9

Discuss hazards related to the administration of oxygen.

Answer 9

Fire Potential: Oxygen itself does not burn, but it does support combustion; in other words, it contributes to the burning process.

Oxygen Toxicity: refers to lung damage that develops when oxygen concentrations of more than 50% are administered for longer than 48 to 72 hours.

Question 10

Describe additional therapeutic techniques that relate to oxygenation.

Answer 10

Positive airway pressure machines: devices that help relieve impaired oxygen levels caused by apnea or hypopnea during sleep.

Water-seal chest tube drainage systems: is a technique for evacuating air or blood from the pleural cavity, which helps restore negative intrapleural pressure and re-inflate the lung.

Hyperbaric Oxygen Therapy (HBOT): consists of the delivery of 100% oxygen at three times the normal atmospheric pressure within an airtight chamber

Question 11

Discuss facts concerning oxygenation that affect the care of older adults.

Answer 11

Alveoli can lose their shape and become baggy.

The diaphragm can, over time, become weaker, decreasing the ability to inhale and exhale.

Question 12

____________ results from pressure changes within the thoracic cavity produced by the contraction and relaxation of respiratory muscles.

Answer 12

Ventilation

Question 13

____________ occurs when there is insufficient oxygen within arterial blood.

Answer 13

Hypoxemia

Question 14

The ____________ position allows room for maximum vertical and lateral chest expansion and provides comfort while resting or sleeping.

Answer 14

Orthopneic

Question 15

____________ breathing, which involves taking in a large volume of air, fills alveoli to a greater capacity, thus improving gas exchange.

Answer 15

Deep

Question 16

A ____________ is a gauge used to regulate the amount of oxygen delivered to the client and is attached to the oxygen source.

Answer 16

Flowmeter

Question 17

A ____________ is a device that produces small water droplets and is used during oxygen administration because oxygen is drying to the mucous membranes.

Answer 17

Humidifier

Question 18

A ____________ mask mixes a precise amount of oxygen and atmospheric air.

Answer 18

Venturi

Question 19

A ____________ collar delivers oxygen near an artificial opening in the neck.

Answer 19

Tracheostomy

Question 20

As a client grows older, the chest walls become stiffer as a result of ____________ of the intercostal muscles.

Answer 20

Calcification

Question 21

During ____________, the dome-shaped diaphragm contracts and moves downward in the thorax.

Answer 21

Inspiration

Question 22

Identify the picture

Answer 22

The figure shows a portable oxygen concentrator that extracts nitrogen and concentrates oxygen to enable clients who require oxygen therapy to travel or maintain their lifestyle without the need for multiple tanks of oxygen.

Question 23

What are the advantages of this equipment?

Answer 23

An oxygen concentrator eliminates the need for a central reservoir of piped oxygen or the use of bulky tanks that must be constantly replaced.
This type of oxygen source is used in home health care and long-term care facilities primarily because of its convenience and economy.
Oxygen concentrators typically provide oxygen flows of 1 to 5 L/min, with some that are capable of flows up to 10 L/min.

Question 24

Measures the percentage of oxygen delivered to the client

Answer 24

Oxygen Analyzer

Question 25

Hollow tube with half-inch prongs placed into the client’s nostrils

Answer 25

Nasal Cannula

Question 26

Oxygen delivery device through which a client inhales a mixture of atmospheric air, oxygen from its source, and oxygen contained within a reservoir bag

Answer 26

Partial rebreather mask

Question 27

A form of controlled ventilation in which the client consciously prolongs the expiration phase of breathing

Answer 27

Pursed-lip breathing

Question 28

A technique for deep breathing, using a calibrated device

Answer 28

Incentive spirometry

Question 29

Presented here, in random order, are steps occurring during ventilation. Write the correct sequence in the boxes provided.

1. The thoracic cavity expands.
2. Air is pulled in through the nose, filling the lungs.
3. The intercostal muscles move the chest outward by elevating the ribs and sternum.
4. Pressure within the lungs falls below pressure in the atmosphere.

Answer 29

3. The intercostal muscles move the chest outward by elevating the ribs and sternum.
4. The thoracic cavity expands.
5. Pressure within the lungs falls below pressure in the atmosphere.
6. Air is pulled in through the nose, filling the lungs.

Question 30

How does a nurse physically assess a client for oxygenation?

Answer 30

The nurse physically assesses oxygenation by the following:

• Monitoring the client’s respiratory rate
• Observing the breathing pattern and effort
• Checking chest symmetry
• Auscultating lung sounds

Additional assessments include the following:

• Recording heart rate and blood pressure
• Determining the client’s level of consciousness
• Observing the color of the skin, mucous membranes, lips, and nailbeds

Question 31

What is an arterial blood gas assessment?

Answer 31

An arterial blood gas assessment is a laboratory test using arterial blood to evaluate oxygenation, ventilation, and acid–base balance.

It measures the partial pressure of oxygen dissolved in plasma (PaO2), the percentage of hemoglobin saturated with oxygen (SaO2), the partial pressure of carbon dioxide in plasma (PaCO2), the pH of blood, and the level of bicarbonate (HCO3) ions.

Question 32

What is pulse oximetry?

Answer 32

Pulse oximetry is a noninvasive, transcutaneous technique for periodically or continuously monitoring the oxygen saturation of blood.

Question 33

What is oxygen therapy?

Answer 33

Oxygen therapy is an intervention for administering more oxygen than present in the atmosphere to prevent or relieve hypoxemia.

It requires an oxygen source, a flowmeter, in some cases an oxygen analyzer or humidifier, and an oxygen delivery device.

Question 34

What are the disadvantages of an oxygen concentrator?

Answer 34

Although an oxygen concentrator is more economical than oxygen supplied in portable tanks, the device increases the client’s electricity bill.

The oxygen concentrator generates heat from its motor and produces an unpleasant odor or taste if the filter is not cleaned weekly.

Clients have to keep a secondary source of oxygen ready in case of a power failure.

Question 35

What is a non-rebreather mask?

Answer 35

A non-rebreather mask is an oxygen delivery device in which all the exhaled air leaves the mask rather than partially entering the reservoir bag.

It is designed to deliver an Fio2 of 90% to 100%.

This type of mask contains one-way valves that allow only oxygen from its source as well as the oxygen in the reservoir bag to be inhaled.

No air from the atmosphere is inhaled.

All the air that is exhaled is vented from the mask.

None enters the reservoir bag.

Question 36

A nurse is caring for a client who is brought to the health care facility with breathing difficulty. The client is diagnosed with hypoxia.

1. In what position should the nurse place the client to promote better breathing?

Answer 36

Unless contraindicated by their condition, clients with hypoxia are placed in the high Fowler position.

This position eases breathing by allowing the abdominal organs to descend away from the diaphragm.

As a result, the lungs have the potential to fill with a greater volume of air.

As an alternative, clients who find breathing difficult may benefit from variations of Fowler position.

One option is a tripod position in which the client is in a seated position with the arms supported on pillows or the arm rests of a chair.

The tripod position increases a client’s breathing capacity by using the arms to lift the chest upward.

Another option is an orthopneic position in bed. In the orthopneic position, the client leans forward over the bedside table or a chair back.

The orthopneic position allows room for maximum vertical and lateral chest expansion and provides comfort while resting or sleeping.

Question 37

What breathing techniques could the nurse teach the client to ensure efficient breathing?

Answer 37

The nurse could teach the client the following techniques to help them breathe efficiently:

Deep breathing, which is a technique for maximizing ventilation that involves taking in a large volume of air that fills the alveoli to greater capacity, thus improving gas exchange

Pursed-lip breathing, which is a form of controlled ventilation in which the client consciously prolongs the expiration phase of breathing

Diaphragmatic breathing, which is breathing that promotes the use of the diaphragm rather than the upper chest muscles

Use of a nasal strip, which is adhesive, available for commercial purchase, and used to reduce airflow resistance by widening the breathing passageways of the nose.