Chapter 5 - Oxygenation Flashcards
What is hypoxia?
Low on oxygen (Hypo = low)
90% or less = oxygen deficit
http://www.youtube.com/watch?v=isgDtSZUxbw
What does it mean to “desat?”
develop hypoxia
How long can a person be without oxygen before damage begins?
3-4 minutes
What is oxygenation?
the process by which cellular oxygen supply is maintained in the body (to and throughout the body).
The goal is to maintain oxygenation. All stimuli fall into one of four categories:
- Adequate quality of air
- Effective function of cardio-pulmonary system
- Adequacy of circulatory volume and its concentration
- Body’s oxygen demand at a given time.
List an examples/question we could ask for each.
- Is there air clean or smoggy?
- organs must be in tact and working (lungs and heart). Any damage?
- drink enough fluid? dehydrated? without enough water the system has to work harder to circulate oxygen.
- When exercising, the demand for oxygen is greater than at rest. What was patient doing at onset?
Ventilation is the process of respiration that exchanges air between the lungs and atmosphere. _______ replenishes the supply of oxygen in the alveoli. ________ removes carbon dioxide released by the capillaries.
Inhalation
exhalation
What processes are responsible for oxygenation?
- ventilation (inhale and exhale)
- alveolar-capillary gas exchange
- transport of gas to tissues
In 1st level assessment of behavior relative to oxygenation, what are we looking for as “signs/symptoms?”
Change in:
- LOC (level of consciousness)
- Behavior Pattern
- Visual Acuity
- Chest Pain
T or F: Mental status is not a concern in oxygenation assessment.
False. It is an important parameter to assess.
What are some symptoms of hypoxia that you may SEE in the 1st level assessment of oxygentation?
Hint: 1st see mental changes, 2nd visual
Restlessness. Decreased alertness. Increased confusion. Lethargy.
http://www.youtube.com/watch?v=isgDtSZUxbw
(Also: Headache, agitation, irritability, drowsiness, apathy, dizziness, impaired judgment, diminished visual acuity, emotional disturbance, euphoria, poor muscular coordination, fatigue, stupor, unconsciousness.
T or F: When a patient is hypoxic, chest pain, tachycardia alongside increase in respiration depth and rate.
True
Is it important to measure urine ouput when assessing for hypoxia?
Yes. The kidney’s are sensitive to hypoxia. When there is inadequate circulation, renal circulation suggers causing hypovolemia (decreased urine output)
What are some methods to administer oxygen to treat hypoxia?
Low - flow: Nasal Canula, simple mask, non-breathing masks with reservoir bags.
High-flow: oxygen under pressure and mechanical ventilation.
During 1st level assessment, we check respiratory patterns. What are some respiratory patterns to look for?
p.116
- Rate of respiration (normal 12-18 bpm): tachypnea (high >24)? Bradypnea (low <10)? Apnea (absence)?
- Type and volume: rhythmic or effortless? is expiration longer than inspiration (normal)?
- Chest movement: no retractions? excessive use of accessory muscles?
- Breath sounds? (Clear? Swishing? Crackles? Wheezing?)
Breath sounds are produced by air flow. Normal breath sounds can vary but are usually soft and low-pitched. What are some abnormal breath sounds of a patient with hypoxia?
Breath sounds: http://www.youtube.com/watch?v=O8OC7EiqBKQ
- crackles (rales)
- wheezing
- orthopnea (difficulty in breathing that occurs when lying down and is relieved upon changing to an upright position)
- stridor (crowing; can be caused by obstructed trachea; a harsh vibrating sound heard during respiration in cases of obstruction of the air passages)
A patient may report dyspnea. What does this mean?
Dyspnea is the subjective distressing sensation of difficulty breathing.
What are some methods for checking oxygen concentration?
- ABG (Arterial Blood Gas)
2. Pulse Oximeter (transcutaneous monitoring device)
The amount of oxygen in the blood is _ _ %
95
What is hypoventilation?
shallow respirations (hypo - below normal)
What is hyperventilation?
increased rate and depth of breath (hyper-faster)
What is the name of the respiration pattern that cycles from increase, to decrease of breaths followed by apnea (often seen at the end of life)?
Cheyne-Stokes
What is the name of the respiration pattern associated with diabetic acidosis?
Kussmaul’s
If a patient tells you their normal resting heart rate is 40 bpm, do we want to administer medication to increase it to the “normal” range?
No. 40 is THEIR normal.
During our assessment, we need to check the pulse. If checking the peripheral pulse, we can use a grading system. The grades range from 0-4. Which is strongest? Which is weakest?
4 is the strongest; bounding- after a marathon 3 is normal 2 is diminished 1 is very weak/thready 0 is weakest; absent
Where can we check the pulse peripherally?
Neck, wrist, foot (top or side)
A pulse rate below 60 is called _____cardia. A pulse rate above 100 is called _____cardia.
Bradycardia; tachycardia
Blood pressure above 140/90 is called ______tension. Blood pressure below 90/65 is called ______tension.
Hyper;hypo
Can you use the skin to assess oxygenation? If so, examples?
Yes.
Assess color (flush or pale), moisture, capillary refill, turgor (pinch), blue on nail bed?, edema?
When assessing stimuli that could effect ventilation we should check for neurologic damage, muscular controls, and lung tissues to be in tact. If there is no apparent trauma, what can we visually look for next to help assess the situation?
Thoracic shapes:
- Barrel (Emphysema/COPD; ribs are horizontal)
- excavatum, carinatum, scoliosis, kyphosis.
What are some pathologies that could affect transport of gases in the human body?
Cardiovascular diseases such as MI (Myocardial Infarction), CHF (cong. heart failure), HTN.
Anemia, sickle cell anemia (can’t carry oxygen)
Circulatory problems such as dehydration, acid-base abnormalities, fluid overload.
What are some other factors besides structural or pathological that could affect oxygenation?
Stress, Pain, Anxiety
Exercise, or lack thereof
Dietary habits
Increased metabolic need due to fever or pregnancy
Medication (asthma med/cardiac drugs)
Smoking
Air quality or altitude
Is oxygen considered medication? Can you order it for a patient?
Oxygen is considered medication and must be ordered by a doctor.
