CH41 Oxygenation Flashcards
purpose of incentive spirometer (inspirex)
encourages voluntary deep breathing
use of incentive inspirex
- inhale
- 5-10 breaths per session
- session every hour while awake
T/F: chest tube drainage system must remain above patients chest
false; remain below patients chest
T/F: chest tube must be secured to the chest wall
True
watch for _____ in water-seal chamber (3)
- slow, steady bibbling
- water is filled at prescribed level
- fluctuation of fluid level
T/F: vigorous bubbling is normal in water-seal chamber
False; vigorous bubbling indicates a leak or pneumothorax
Patient on chest tube should be in _____ position
semi-fowlers or higher
routinely evaluate ______ for patients with chest tube (3)
- respiratory rate
- SpO2 levels
- insertion site
patients need to be medicated at least _____ minutes before removal
30 minutes
Educate patients on what it may feel like for removal of chest tube _______ (3)
- burning
- pain
- pulling sensation
Monitor _______ after tube removal (2)
- dressing placed over insertion site
- respiratory status
if tube is unexpectedly removed (connection on patient, insertion site)
cover insertion site with gauze and tape 3 sides
if tube is unexpectedly removed (drainage machine connection site, damaged tube)
place tube 1 inch into sterile water to maintain negative pressure
Cardiopulmonary diagnostic BLOOD studies (5)
- CBC
- Cardiac enzymes
- Cardiac troponin
- serum electrolytes
- cholesterol
determines the number of type of red and white blood cells per cubic millimeter of blood
Complete blood count (CBC)
_________ count assess for presence of infection
White blood cell
_______ blood count and ______ assess for presence of anemia and ability fo the blood to carry oxygen
Red blood cell and hemoglobin
________ used with troponin to diagnose acute myocardial infarcts
cardiac enzymes
values elevates as early as 3 hours after myocardial injury
cardiac troponins
cardiac troponins remain elevated for ______ days after MI
10-14
patients on diuretic therapy are at risk for ______
hypokalemia
low potassium
hypokalemia
patients receiving ACE inhibitors are at risk for ____________
hyperkalemia
high potassium
hyperkalemia
__________ has an effect on cardiac rhythm
potassium
T/F: potassium values do not have parameters
False; want to be as close to normal as possible
contributing factors of cholesterol
- sedentary lifestyle
- intake of saturated fatty acids
Bad cholesterol
LDLs
good cholesterol
HDLs
high ______ indicate risk of cardiac disease
LDLs
Cardiac function DIAGNOSTIC tests (7)
- Holter monitor
- ECG exercise stress test
- Thallium stress test
- Electrophysiological study (EPS)
- Transthoracic echocardiography
- Scintigraphy/ radionuclide angiography
- cardiac catheterization and angiography
portable ECG worn by patient at home; continuous ECG
Holter monitor
patient walks on a treadmill; evaluates cardiac response to physical stress
ECG exercise stress test
ECG stress test with the addition of thallium-201
Thallium stress test
determines coronary blood flow changes with increased activity
Thallium stress test
invasive measure of intracardiac electrical pathways
electrophysiological study (EPS)
provides specific information about difficult to read dysrhythmias
electrophysiological study (EPS)
noninvasive measure of heart structure and heart wall motion
transthoracic echocardiography
used to evaluate cardiac structure, myocardial perfusion, and contractility
scintigraphy/ radionuclide angiography
used to visualize cardiac chambers, valves, the great vessels, and coronary arteries
cardiac catheterization and angiography
ventilation and oxygenation DIAGNOSTIC studies (6)
- arterial blood gasses
- pulmonary function test
- peak expiratory flow rate
- bronchoscopy
- lunch scan
- thoracentesis
provides important information for assessment of patient’s respiratory and metabolic acid/base balance and adequacy of oxygenation
arterial blood gasses
what is measured in arterial blood gas test (5)
- pH
- PCO2
- HCO3
- PO2
- SaO2
normal pH
7.35-7.45
normal PCO2
35-45 mm Hg
normal HCO3
21-28 mEq/L
normal PO2
80-100 mm Hg
normal SaO2
95-100%
normal SaO2 in older adults
95%
determines ability of the lungs to efficiently exchange oxygen and carbon dioxide
pulmonary function test
test to differentiate pulmonary obstructive from restrictive disease
pulmonary function test
reflects changes in large airway sizes
peak expiratory flow rate
test used for asthma
peak expiratory flow rate
visual examination of the tracheobronchial tree
bronchoscopy
test performed to obtain fluid, sputum, or biopsy samples
bronchoscopy
used to identify abnormal masses by size and location
lung scan
specimen of pleural fluid by needle withdrawl- results may indicate an infection
thoracentesis
specimen tests (3)
- sputum culture and sensitivty
- sputum for acid-fast baccilus
- sputum for cytology
obtained to identify a specific microorganism/ identify drug resistance and sensitivities
sputum culture and sensitivity
screens for presence of AFB for detection of tuberculosis
sputum for acid-fast bacillus
obtained to identify lung cancer
sputum for cytology
Rules for suctioning (3)
- only suction on the way out
- suction for 10-15 seconds at a time
- do not suction longer than a total of 5 minutes
inadequate tissue oxygenatin at the cellular level
hypoxia
hypoxia results from
deficiency in oxygen delivery or oxygen use
early signs of hypoxia (10)
-apprehension
-restlessness
-inability to concentrate
-decreased level of consciousness
-dizziness
-behavioral changes
-inability to lie flat
-fatigued and agitated
-increased pulse (tachycardia)
increased rate/depth of resps
-elevated BP
Late signs of hypoxia (2)
cyanosis
respiratory rate decline
Nasal cannula delivers:
1-6L/min with 24-44% oxygen
pros of nasal cannula (5)
- safe and simple
- easily tolerated
- effective for low concetrations
- does not impede eating or talking
- inexpensive, disposable
Oxygen-conserving cannula (oxymizer) delivers:
8L/min with 30-50% oxygen
pros of oxymizer: (2)
- indicated for long-term O2 use at home
- allows for increased O2 concentration and lower flow
Face mask delivers:
6-12 L/min with 35-50% oxygen
Pros of face mask (1)
useful for short periods such as patient transporation
partial/nonrebreather masks deliver:
10-15 L/min with 60-90% oxygen
Pros of partial/nonrebreather masks (4)
- useful for short periods
- delivers increased FiO2
- easily humidifies
- does not dry mucous membranes
High-flow nasal cannula delivers
-up to 60L/min
pros of high-flow nasal cannula (3)
- adjustable- FiO2 with modifiable flow
- wide range of FiO2
- can use on adults, children, and infants
CPAP and BiPap delivers:
21-100% oxygen
pros of CPapa and BiPap (2)
- avoids use of an artificial airway in pts with acute respiratory distress, post-extubation respiratory failure, or neuromuscular disorders
- successfully treats obstructive sleep apnea
Difference between CPap and BiPap
CPap: maintains a steady stream of pressure throughout a patient’s breathing cycle
BiPap: provides assistance during inspiration and preventing alveolar closure during expiration
