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Nursing 330 > Chapter 39: Oxygenation and Perfusion > Flashcards

Chapter 39: Oxygenation and Perfusion Flashcards

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1
Q

Respiratory and cardiovascular system

A

cardiopulmonary system

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2
Q

cardiovascular system

A

heart and BV

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3
Q

oxygentation

A

process of providing life sustaining oxygen to body cells

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4
Q

Importance of data nurse collects about cardiopulmonary system

A

decide if data lead to problem statement, indicate another problem or possible cause of problem

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5
Q

upper airway

A

nose, pharynx, larynx, and epiglottis

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6
Q

function of Upper airway

A

warm, humidify and filter inspired air

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7
Q

lower airway

A

trachea, right and left main bronchi, segmental bronchi and terminal bronchioles

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8
Q

lower airway function

A

air conduction, muco-ciliary clearance and make pulmonary surfactant

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9
Q

mucus

A

traps cells, particles and infectious debris

protect underlying tissues from irritation and infection

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10
Q

Cilia

A

microscopic hairlike projects

propel trapped material and accompanying mucus toward upper airway for coughing removal

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11
Q

role of fluid intake for cilia

A

makes mucus watery and allows easier removal from LRS

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12
Q

geography of lungs

A

from diaphragm to apex, above the first rib

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13
Q

lung composition

A

elastic tissue

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14
Q

alveoli

A

small air sacs; gas exchange bc thin layer of cells in wall

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15
Q

surfactant

A

phospholipid; reduces surface tension between moist membranes of alveoli; preventing collapse

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16
Q

pleural fluid

A

in pleural space btw visceral and parietal pleura; lubricant and adhesive agent that holds lungs in expanded position

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17
Q

pressure in pleural space (intrapleural pressure)

A

negative pressure (less than Atm)

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18
Q

pulmonary ventilation

A

movement of air in and out of lungs

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19
Q

respiration

A

gas exchange between atmosphere air in the alveoli and blood in capillaries

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20
Q

perfusion

A

process by which oxygenated capillary blood passes through tissues

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21
Q

ventilation

A

inspiration (inhale)

expiration (exhale)

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22
Q

events of inspiration

A
  1. diaphragm contracts and descends
  2. lengthening of thoracic cavity
  3. external intercostal muscles contract; lift ribs upward and outward
  4. sternum pushes forward
  5. volume increases and pressure decrease => air from atm moves into lungs
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23
Q

events of expiration

A
  1. diaphragm relaxes
  2. ribs move down
  3. sternum drops back down
  4. decreased volume and increased pressure => air moves out
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24
Q

factors contributing to airflow in and out of lungs

A

condition of musculature
compliance of lung tissue
airway resistance

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25
Q

effects of weakened musculature

A
  • may use accessory muscles of abdomen, neck, back

called RETRACTION

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26
Q

conditions causing harder time inflating lungs (less lung compliance)

A
  • emphysema

- changes associated with aging

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27
Q

airway resistance

A

any process that changes bronchial diameter or width

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28
Q

example airway obstructions

A 
food
coin
toy
liquids (drowning)
thickened secretions
tissues (tumor)
decrease in size of airway passages
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29
Q

Diffusion

A

movement of gas from high to low concentration

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30
Q

Things that affect diffusion of gas in the lungs

A
  • changes in surface area available
  • thickening of the alveolar-capillary membrane
  • partial pressure
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31
Q

Atelectasis

A

incomplete lung expansion or the collapse of the alveoli

prevents pressure changes and the exchange of gas by diffusion

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32
Q

predisposal to Atelectasis

A
  • obstructions of air by foreign bodies or mucus
  • airway constriction
  • external compression by tumors or enlarged BVs
  • immobility
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33
Q

What causes thickening of alveolar-capillary membrane

A

pneumonia, pulmonary edema

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34
Q

Effect of exercise on perfusion

A
  • greater need for O2
  • increase in cardiac output
  • increased blood return to lungs
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35
Q

What affects amount of blood in any given area of lung

A

position of body

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36
Q

What affects perfusion to body’s tissues

A
  • adequate blood supply and proper cardiac functioning
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37
Q

Where is respiratory system in brain

A
  • medulla, above spinal cord
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38
Q

What stimulates medulla of brain

A
  • increased CO2 and H+ ions

- to a lesser degree: decreased oxygen in arterial blood

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39
Q

What stimulates medulla

A
  • chemoreceptors aortic arch and carotid bodies = sensitive to same arterial blood gas levels and blood
  • –CAN BECOME DESENSITIZED WITH CHRONIC CONDITIONS
  • blood pressure
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40
Q

What increases ventilation during body movements

A

Proprioceptors in muscles and joints

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41
Q

Stimulation of medulla

A

increase rate and depth of breathing

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42
Q

Impulse from medulla

A

goes to spinal cord then to respiratory muscles stimulating contraction

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43
Q

Hypoxia

A

inadequate amount of oxygen available to cells

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44
Q

symptoms of hypoxia

A

dyspnea (difficulty breathing), elevated BP with small pulse pressure, increased respiratory and pulse rates, pallor, cyanosis, anxiety, restlessness, confusion, drowsiness

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45
Q

Cause of hypoxia

A
  • hypoventilation

- chronic

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46
Q

effects of hypoxia

A
  • altered thought processes
  • headaches
  • chest pain
  • enlarged heart
  • clubbing of fingers and toes
  • anorexia
  • constipation
  • decreased urine output
  • decreased libido
  • weakness of extremity muscles
  • muscle pain
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47
Q

Circulation

A

continuous one-way circuit of blood through BV

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48
Q

Atria

A

upper chambers of heart

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49
Q

Ventricles

A

lower chambers of heart

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50
Q

Stroke volume

A

how much blood the left ventricle pumps out with each beat

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51
Q

Cardiac output

A

hod much blood the left ventricle pumps out in a min

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52
Q

Internal repsiration

A

exchange of O2 and CO2 between BV and tissues

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53
Q

SA node

A

top of right atrium
pacemaker
initiates transmission of electrical impulses

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54
Q

AV node

A

mass of tissue at bottom of right atrium

delay to let atria contract

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55
Q

AV bundle

A

where impulse is sent after Av node

divides into right and left bundle branches

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56
Q

Purkinje fibers

A

smaller conduction branches in each ventricle wall

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57
Q

Dysrhythmia

A

disturbance of the rhythm of the heart

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58
Q

ischemia

A

decreased oxygen blood supply to the heart caused by insufficient blood supply

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59
Q

Angina

A

temporary imbalance between amount of O2 needed by the heart and amount delivered to heart muscles
causes chest pain

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60
Q

heart failure

A

heart unable to pump sufficient blood supply, inadequate perfusion and oxygenation of tissues

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61
Q

Arterial blood gas supply and pH analysis

A
  • determine pressure exerted by oxygen in arterial blood and pH
  • measures adequacy of oxygenation, ventilation, and perfusion
62
Q

Normal results of Arterial blood gas supply and pH analysis

A 
pH: 7.35-7.45
pCO2: 35-45 mm Hg
PO2: 80-100 mmHg
HCO3: 22-26 mEq/L
base excess or deficit: -2-+2 mmol/L
63
Q

Prep for Arterial blood gas supply and pH analysis

A
  • inform test involves arterial puncture
  • use radial, brachial, or femoral artery
  • perform Allen test to ensure adequate ulnar flow if using radial artery
64
Q

Aftercare for Arterial blood gas supply and pH analysis

A
  • record supplemental O2 or respirator settings on specimen info
  • specimen on ice and to lab
  • apply 5-10 min of pressure
  • watch for bleeding
  • apply more pressure if taking anticoagulants
65
Q

Cardiac Biomarkers

A
  • Creatine kinases and isoenzymes are enzymes released bc of injury to tissues, including heart muscle
  • Troponin found in skeletal and cardiac muscle fibers and released after injury to heart
  • used to monitor cardiac injury and myocardial infarction
  • help determine extent and timing of damage
66
Q

Perp for Cardiac Biomarkers

A
  • review procedures, inform this test can assist in assessing for heart damage
  • series of samples will be taken, sample could be taken 3-4 times in 3-4 hour intervals
  • inform that specimen collection is about 5-10 min
  • address concerns about pain and explain there may be some pain during venipuncture
  • no food, fluid, or med restrictions unless noted by HCP
67
Q

Aftercare for Cardiac Biomarkers

A
  • recognize anxiety
  • provide teaching and info regarding test results
  • reinforce info given by HCP regarding further testing, treatment, or referral to another HCP
  • depending on results, additional testing may be needed to eval or monitor the progression of illness
  • eval test results in relation to patient’s symptoms, HC problems and other tests performed
68
Q

Complete blood count (CBC) preparation

A
  • review proced w pat
  • inform this test eval body’s response to illness
  • inform the collection = 5-10 min
  • address pain concerns and explain some discomfort during venipuncture
  • no food, fluid or med restrictions unless HCP says so
69
Q

Complete blood count (CBC) aftercare

A
  • reinforce info given by HCP regarding further testing, treatment, or referral to another HCP
  • depending on results, additional testing may be needed to eval or monitor the progression of illness
  • eval test results in relation to patient’s symptoms, HC problems and other tests performed
70
Q

Cytologic study

A

microscopic examination of sputum and cells it contains

detect cells that may be malignant, determine organisms causing infection and identify blood or pus in sputum

71
Q

Cytologic study prep

A
  • collect spcimen (morning b4 breakfast)
  • 3 successive days of sputum collection
  • 1 teaspoon needed for specimen
  • pt deep breath and cough
  • sterile container with possible preservative
  • close with tight lid
72
Q

Cytologic aftercare

A
  • label and pack then send to lab
73
Q

thoracentesis definition

A

puncturing chest wall and aspirating pleural fluid

used for either diagnostic purposes or to remove build up of fluid

74
Q

thoracentesis pat position

A

sitting on chair or edge of bed with legs supported and arms folded, resting on pillow on bedside table

75
Q

thoracentesis nursing responsobilities

A
  • collecting baseline data
  • preparation physically and emotionally
  • instruct pt not to cough or breath deeply
  • monitor color, pulse, RR, deviation from baseline
  • fainting, nausea, vomiting
  • send specimen to lab
76
Q

outcomes wanted for improvement in oxygenation

A
  • restore optimum function related to oxygenation
  • alleviate symptoms or side effects of disease or treatment
  • prevent complications
77
Q

Example outcomes for oxygenation

A

pg. 1500

78
Q

nursing interventions related to oxygenation

A
  • promote optimal functioning of cardiopul. systems
  • promote comfort
  • promote and control coughing
79
Q

Hoe nurses can intervene to help oxygenation

A
  • suctioning the airway
  • meeting resp needs with medications
  • providing supplemental oxygen
  • managing chest tubes
  • using artificial airways
  • cleaning obstructed airway
  • CPR
80
Q

How to promote optimal health in those with altered oxygenation

A
  • encourage vaccination
  • teach them importance of living in pollution-free environ
  • minimize anxiety
  • ## promote good nutrition
81
Q

How to promote healthy lifestyle for better cardiopulmonary function

A
  • healthy diet
  • healthy weight
  • exercise (150 min a week)
  • monitor cholesterol, triglyceride, lipoprotein (HDL), and LDL. BP
  • limit alcohol intake and stop smoking
82
Q

Who is at risk for influenza

A

young children, pregnant women, people with chronic health conditions like asthma or heart and lung disease, 65+ yrs old

83
Q

age limit for influenza vaccine

A

6 months of age and older

84
Q

Pneumococcal disease

A

caused by pneumococcus bacteria
types:
- Pneumococcal pneumonia, meningitis, otitis media

85
Q

long of Pneumococcal disease

A
  • brain damage
  • hearing loss
  • limb loss
    GET VACCINE
86
Q

how to prevent exposure to environmental triggers

A
  • job change
  • use of PPE
  • requesting enforcements of anti-pollution laws by governing facilities
  • subcontracting jobs
  • dust and vacuum
87
Q

Effects of smoke inhalation

A
  • increases airway resistance
  • reduces ciliary action
  • increases mucus production
  • causes thickening of alveolar-capillary membrane
  • causes thickening of bronchial walls to thicken and lose elasticity
88
Q

Most common cause of COPD

A

Smoking

89
Q

Cancer and smoking

A

increases risk for cancers of:

  • oral cavity
  • esophagus
  • lung
  • urinary bladder
  • kidneys
90
Q

smoking and BVs

A
  • narrows BV

- causes coronary heart disease

91
Q

increase risks for smoking

A
  • stroke
  • peripheral vascular disease
  • abdominal aortic aneurysm
92
Q

Good eating habits for good cardiopulm health, and decreased obesity

A 
fruits
veggies
low-fat dairy products
whole grains
variety of protein foods
reduced sat fats, trans fats, added sugars, sodium
93
Q

how to promote comfort

A
  • proper positioning
  • adequate fluid intake
  • humidification of inspired air
  • appropriate breathing techniques
94
Q

Comfortable position for people with dyspnea

A

-high- Fowler’s

eases use of accessory muscles

95
Q

Comfortable position for people with acute respiratory distress syndrome

A

prone position

posterior dependent sections of lungs better ventilated and perfused

96
Q

daily fluid intake

A

1.9-2.9 L/ day

97
Q

When increased fluids are needed

A
  • elevated temp
  • people breathing through mouth
  • people coughing
  • people losing excessive body fluids
98
Q

When to LIMIT fluid intake

A
  • heart failure

- low sodium levels (1.5L)

99
Q

Benefits of humidified air

A
  • reduces irritation and infection due to dry air
100
Q

Use of breathing exercises

A

patients achieve more efficient and controlled ventilations
decrease work of breathing
correct respiratory deficits

101
Q

Deep breathing

A

-overcome hypoventilation
- deep breath to bottom of ribs
- start with deep breaths nasally then expire slowly through mouth
(hourly while awake or four times daily)

102
Q

Using incentive spirometry

A
  • assists patient to breathe slowly and deeply to sustain max inspiration
  • can measure own progress
  • optimal gas exchange
  • secretions cleared and expectorated
103
Q

Pursed-lip breathing

A
  • for patients who experience dyspnea and feelings of panic
  • slows and prolongs expiration
  • good for COPD
  • pat sits upright and inhales through nose
  • counts to three
  • exhales slowly against pursed lips
  • tighten ab muscles
  • exhales and counts to 7
  • walking: 2 steps inhale; 4 steps exhale
104
Q

Diaphragmatic Breathing positives

A
  • reduces RR
  • increase alveolar ventilation
  • helps expel as much air as possible during exhalation
105
Q

breathing of people with COPD

A

shallow, rapid, exhausting pattern

106
Q

Steps of Diaphragmatic Breathing

A
  • one hand is one stomach and other on chest
  • patient breathes slowly through nose
  • breathes out through lips
  • allow contraction of ab muscles
  • one hand inward and upward on abdomen
  • repeat for 1 min
  • 2 min rest
107
Q

coughing

A

cleansing mechanism

108
Q

Nonproductive cough

A

dry cough

109
Q

Productive cough

A

produces secretions

110
Q

respiratory secretion expelled by coughing or clearing throat

A

sputum

111
Q

congetion

A

excessive fluid or secretions in organ or body tissue

112
Q

thick resp secretions

A

phlegm

113
Q

series of events producing cough

A
  • initial irritation
  • deep inspiration
  • quick, tight closure of glottis together
  • forceful contraction of expiratory intercostal muscles
  • upward thrust of diaphragm
  • air moves from lower to upper Rt
  • most effective when pat it sitting upraight with feet flat on floor
114
Q

Effective coughing

A

Coughing + deep breathing

115
Q

Early morning cough

A

removes secretions from night

116
Q

Coughing before meals

A

improves taste of food and oxygenation

117
Q

coughing at bedtime

A

improves sleep

removes buildup of secretions

118
Q

assisted cough

A
  • ## firm pressure on abdomen below diaphragm in rhythm with exhalation
119
Q

Involuntary cough

A
  • respiratory tract infections and irritations
  • triggered by secretions
  • must examine cough to determine best kind of medication
120
Q

Expectorants

A
  • reduce viscosity of secretions
  • can make nonproductive cough productive
  • ex Guaifenesin
  • fluid intake and air humidfication
121
Q

Cough supressants

A
  • Codeine (BUT addictive)
  • Non-addictive= dextromethorphan
  • only for sleep
122
Q

Lozenges

A
  • relieve mild nonprod cough without congestion
  • in mouth until it dissolves
  • usually control coughs bc of local anesthetic effects of benzocaine (acts on sensory and motor nerves)
123
Q

Bad effects of cough meds with high sugar or alcohol

A
  • disturb metabolic balance of pt with diabetes mellitus

- tigger relapse of alcoholics

124
Q

Bad effects of cough meds with antihistamines

A
  • anticholinergic action

- problems with people with glaucoma or urinary retention in men with enlarged prostate

125
Q

Bad effects of cough meds

A
  • some bad for hypertension or thyroid/cardiac diseases

- some suppress other bad health effects

126
Q

Chest physiotherapy

A
  • loosen and mobilize secretions
  • percussion, vibrations, postural drainage
  • NOT for children with pneumonia, adults with COPD and postoperative care adults
127
Q

Reason for suctioning of airway

A
  • suctioning pharynx
  • maintain patent airway
  • remove saliva, blood, pulmonary secretions, vomitus, foreign material
128
Q

Negative of suctioning airways

A
  • may induce hypoxemia (insuff ox in blood)
  • – PREOXYGENATE PATIENT
  • irritates mucosa
129
Q

Prep for suctioning airway

A
  • individualized pain management
  • ## oxygen
130
Q

Complications of suctioning airway

A
  • infection
  • cardiac arrhythmias
  • hypoxia
  • mucosal trauma
  • death
131
Q

PPE for suctioning airways

A
  • gloves
    goggles
    mask
    gown
132
Q

What to monitor for during suctioning

A
  • color
  • HR
  • blood
  • cyanosis
133
Q

What to avoid when taking meds used to dilate bronchial airways

A

caffeine

134
Q

Inhaled meds given to open narrowed airways

A

bronchodilators

135
Q

Inhaled meds given to loosen thick secretions

A

mucolytic agents

136
Q

Inhaled meds given to reduce inflammation

A

corticosteroids

137
Q

how inhaled meds are given

A
  • dry powder inhaler (DPI)
  • nebulizer
  • metered-dose inhaler (MDI)
138
Q

Nebulizer

A
  • disperse fine particles of liquid med into deep passages of resp tract
139
Q

MDI

A 
deliver controlled dose of med with each compression of canister 
common mistakes (1506)
140
Q

DPIs

A

breath activated
no coordination to activate it and inhale like with MDIs
Med clump if exposed to humidity

141
Q

Important things to teach about inhaled meds

A
  • overuse= serious side effects and ineffectiveness
  • know how to clean nebulizer effectively
  • must keep track of dosing with MDI
  • must use deep inspirations
  • spacer is using corticosteroid inhaler to prevent oral fungal infection
142
Q

Oxygen prescription

A

must be prescribed EXCEPT if it is an emergency situation or decreasing O2 saturation or tachypnea

143
Q

Therapeutic oxygen

A
  • wall outlet or portable cylinder tank
  • flow meter attached to wall outlet
  • valve regulates O2 flow in meters per minute
  • regulator releases O2 safely and at desired rate
  • —two gauges
  • –one nearest to tank shows pressure or amount of O2 in tank
  • —other indicates number number of liters per minute of O2 being released
144
Q

oxygen concentrators

A
  • concentrate room air to provide the appropriate amount of O2
  • can be used with portable tank
145
Q

oxygen conserving device

A
  • pulse of O2 at beginning of inspiration
146
Q

Oxygen flow rate

A
  • liters per minute
  • determine amount of O2 delivered when using wall outlet or portable cylinders
  • depends on pt condition and route of O2
  • can analyze air pt is breathing to monitor O2 percentage
147
Q

What to monitor with supplemental Oxygen

A
  • RR
  • pule oximetry
  • ABG results
148
Q

Humidification with suppl oxygen

A

only at rate higher than 4L/min

149
Q

safety with O2

A

1509

150
Q

Nasal cannula

A

most common

connect to O2 with flow meter and humidifier

151
Q

Face masks

A
  • Simple
  • —O2 tubing, humidifier, flow meter, vents on both sides
  • –used for increased oxygen for less than 24 hrs
  • —possible skins breakdown bc pressure and moisture
  • —hard to eat and talk
  • –NEVER apply with flow rate < 5l/min
  • Partial rebreather
  • —reservoir bag
  • —should only deflate slightly with inspiration
  • Nonbreather
  • — delivers highest concentration of O2 via mask to spontan. breathing patient
  • — cannot rebreathe exhaled air
  • —can be used for heliox admin
  • Venturi
  • –allows mask to deliver most precise amount of O2
  • –side ports pull O2 in as tube narrows and pressure drops
  • –1511
152
Q

Liquid O2

A

-kept in small container refilled with large tank in home

-

Nursing 330 (3 decks)

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