Class 4-Oxygenation Flashcards
Highest single preventable factor for lung disease
Cigarettes/tobacco
second hand smoke=
heart disease
Oxygenation
-properly functioning alveolar capillary membrane (gases can’t diffuse)
-oxygenate venous blood
-remove carbon dioxide from blood
Essential to normal functioning of the pulmonary system
Ventilation
-ability to transport air to and from lungs (can’t bring air in)
What do ABG’s measure?
oxygenation & ventilation
Functional units of the respiratory system
-upper airway: warm, filter, humidify (nose/mouth)
-lower airway function: conduction of air, mucocilliary clearance..help to move things up (trachea/lungs)
-alveolar capillary membrane: gas diffusion (terminal airway)
Factors affecting pulmonary functioning
-levels of health
-medications
-lifestyle
-environment
Levels of health
-mobility, decreased nutrition, anemia, lung disease, weakness, muscle wasting of diaphragm
-anemias: carrying capacity of RBCs
-immobile: decreased respiratory rate
Medications
narcotics; analgesics
Lifestyle
sedentary, stasis of secretions, smoking, working environment
Environment
pets, toxins, pollutants
How age effects respiratory function
-Decreased oxygenation
-decreased ventilation
Decreased oxygenation
-INCREASED work of breathing (expiration becomes active)
-DECREASED gas exchange due to decreased number of capillaries & decreased inspiratory lung volumes
Decreased ventilation
-ineffective cough
-drier mucous membranes
-INCREASED risk for aspiration due to decreased gastric motility
-impaired mobility
-meds that decrease ventilation
-tissues and airways become more rigid; diaphragm moves less efficiently –> less air exchange
**things get stiff; harder to move; have to actively exhale (increased work of breathing); thicker secretions
Pack year
packs per day x years smoking
2 pack a day for 20 years= 40 years
Focused pulmonary interview
-how is your breathing?
-do you smoke? (how much?)
-do you have any pets?
-have you traveled recently? (cryptoplasmosis)
-do you experience difficulty breathing or fatigue? if so what causes this?
-where do you sleep?
-who does the shopping?
-do you vacuum?
-what type of work do you or did you do?
-any chest pain?
-do you have a cough? (is it productive? what color? how much volume?)
-have you ever been exposed to fumes? (inhalation effects years later)
-is there a position in which your breathing is most comfortable?
-do you have allergies?
Pulmonary ventilation acute care shift assessment
-inspection
-auscultation
inspection
-respiratory rate
-depth
-pattern
-work of breathing
-using accessory muscles
-chest symmetry
-skin color
-surgical scars
-lights on; look at work of breathing, both sides symmetrically rising; surgical scars; hyperventilation
-watch rate, depth, & pattern of breathing
Auscultation
-adventitious sounds
-wheezes
-crackles
-rhonchi
-on skin (L –> R or R –> L), upper upper, middle middle, lower lower
-listen to front first
-leads you to know what intervention
What term do we not use?
RALES
wheezes
-narrowing of an airway (shrill)
-do something to open it
crackles
-popping; pneumonia; fluid overload; CHF
-cough, rebreathe, if fluid need diuretic
-discontinuous
rhonchi
-secretions in the large airway
-continuous
-make them productive cough
Diagnostic methods for assessing pulmonary function
-Non-invasive
-pulse oximetry (gives oxygenation info only)
-spot check (if normal take off)
-continuous (leave on if abnormal & get instructor)
-CXR (show outline of lung)
-pulmonary function tests (PFTs) (measure depth of respiration; for ventilation)
-Invasive
-Arterial blood gas analysis (going into artery for blood sample; gives idea of ventilation)
-bronchoscopy
How SPO2 correlates to PAO2
-normal pao2 60-80
Pao2= 40%. 50%. 60%. 80%
spo2= 70%. 80%. 90%. 95%
** see slide 18
-want over 95 but over 92 really
Nursing interventions promoting adequate pulmonary functioning
-smoking cessation
-positioning (fowlers: 45-60)
-chest physiotherapy (cup hands & pat back loosens fluid then have them cough, take 3 shallow huffing breaths then have them cough)
-control anxiety
-medications
-guided imagery
-pursed lip breathing (inhale through nose 2 seconds; exhale through pursed lips 4 seconds; COPD to prolong expiratory phase; helps air trapping; get barrel chest)
-adequate fluid intake (2-3L; thin secretions)
-humidified oxygen
-adequate nutrition
-respiratory medications
-coughing and deep breathing
-incentive spirometry
Types of respiratory medications
-cough suppressants (dry cough)
-expectorants (productive)
-bronchodilators (open narrowed airways)
-corticosteroids (reduce inflammation in airways)
Delivery mechanisms for pulmonary medications
-nebulizers: disperse fine particles of medication into deeper passages of respiratory tract where absorption occurs (delivered by inhalation)
-metered dose inhalers: delivers controlled dose of medication with each compression of the canister (rinse after use)
-dry powder inhaler: activated by the patient’s inspiration
MDI
-spacers for MDIs
-rinse after steroid mdi’s (or develop thrush)
-wait 1-5 minutes between sprays
-know the difference between your rescue inhaler and your maintenance inhaler (Saba vs laba)
oxygen delivery systems and fio2 (fraction of inspired oxygen)
Nasal Cannula 1L/NC – 6 L/NC (24%-44% FiO2)
RA=21%
Liters=fio2
1L/NC=24%
2L/NC=28%
3L/NC=32%
4L/NC=36%
5L/NC=40%
6L/NC=44%
Venturi Mask 24% - 40% FiO2
Non Re-Breather 80% - 100 % FiO2
Trach Shield, T-Mist, T-Mask, T-Pieces
CPAP
BiPAP
look at slides for pictures
***look at slide 42 very important!
