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NUR 333 > E1 Oxygenation > Flashcards

E1 Oxygenation Flashcards

1
Q

What are the 3 process of oxygenation?

A

Ventilation, Diffusion, Perfusion

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2
Q

Ventilation

A

=Respiration
Movement of gas in and out of lungs

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3
Q

Diffusion

A

O2 and CO2 exchange between alveoli and RBCs

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4
Q

Perfusion

A

distribution of the oxygenated RBCs to the tissues in the body

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5
Q

When CO2 increases (hypercarbia),

A

body knows to increase rate and depth of breathing

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6
Q

The passive process of breathing is regulated by

A

O2, CO2, and pH of blood

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7
Q

Lung volume caries person to person based on

A

age, gender, and height
Ex. a smaller person has smaller lungs than a larger person

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8
Q

Tidal Volume

A

amount of air exhaled following normal inspiration

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9
Q

Tidal volume varies based on

A

health status
activity
pregnancy
exercise
obesity
obstructive/restrictive lung diseases

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10
Q

Alveoli Function

A

promote gas exchange

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11
Q

What could cause abnormal breathing?

A

Pain, anxiety, meds

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12
Q

What are the three expected breath sounds? Location/ Describe them

A
  1. Bronchial- Heard over trachea & larynx (Neck), Harsh and High pitched
  2. Bronchovesicular- Heard close to sternum anteriorly and down spine posteriorly, Medium in loudness & pitch
  3. Vesicular- Heard over periphery of lung fields, Low pitched
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13
Q

Crackles/ rales

A

Fine course bubbly sounds, associated with air passing through fluid or collapsed small airways

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14
Q

Wheezes

A

-High pitched whistling, narrow obstructed airway
-Asthma and Allergic Reaction

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15
Q

Rhonchi

A

Loud low pitched rumbling, fluid or mucus in airways, can resolve with cough

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16
Q

Stridor

A

Choking, children
High pitched sound, loud

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17
Q

Pleural friction

A

Inflamed pleural space

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18
Q

Bradypnea

A

Rate of breathing is regular but abnormally slow (less than 12)

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19
Q

Tachypnea

A

Rate of breathing is regular but abnormally rapid (greater than 20)

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20
Q

Hyperpnea

A

Respirations are labored, increased in depth and rate (Occurs normally in exercise)

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21
Q

Apnea

A

-Respirations cease for several second
-Persistent cessation results in respiratory arrest

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22
Q

SpO2 vs SaO2

A

Peripheral vs Arterial

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22
Q

What can interfere with SpO2?

A

-Movement
-Dark nail polish
-Cold
-Edematous
-Arterial Disease

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23
Q

Work of breathing

A

-Effort to expand and contract lungs
-Determine by rate and depth
-Evaluate use of accessory muscles

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24
Q

Inspiration vs Expiration

A

-Inspiration is active and uses muscles
-Expiration is passive and depends on elastic recoil of lungs

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25
Q

Surfactant

A

chemical produced to maintain surface tension of the alveoli and prevent from collapsing

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26
Q

______ pts lose elastic recoil and have increased work of breathing

A

COPD

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27
Q

Compliance

A

ability for the lungs to distend or expand in response to increase alveoli pressure

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28
Q

What increases the work of breathing?

A

-Decreased compliance
-Increased airway resistance
-Increased accessory muscle use

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29
Q

What are the 4 main factors of Oxygenation?

A
  1. Physiological
  2. Developmental
  3. Lifestyle
  4. Environmental
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30
Q

What physiological factors affect oxygenation?

A
  1. Decreased oxygen-carrying capacity (Hemoglobin, CO)
  2. Hypoventilation (decreased circulating amounts of blood)
  3. Decreased inspired O2 concentration (altitude, hypoventilation, increased metabolic demand)
  4. Chest Wall Movement (Preg, obese, trauma)
31
Q

Anemia

A

-Low hemoglobin
-Due to overproduction of RBC or loss of RBC)
-Decrease O2 as secondary effect
-Don’t have enough O2 carrying capacity
-Symptoms: fatigue, decreased activity tolerance, pale

32
Q

Oxygenated vs deoxygenated blood

A

Arterial is oxygenated
Venous is deoxygenated

33
Q

Goal of ventilation

A

Normal arterial CO2 tension and normal arterial oxygenation tension

34
Q

PaO2=
PaCO2=
SpO2=
EtCO=

A

PaO2= 80-100
PaCO2= 35-45
SpO2= >95%
EtCO= 35-45 (the amount of CO2 at the end of exhalation)

35
Q

Hypoventilation: Define, Causes, S/S

A
  1. Define: Inadequate alveolar ventilation to meet demand,
    Not enough O2 and/or too much CO2
  2. Causes: Medications (opioids & anesthesia), Atelectasis
  3. S/S: Mental status changes, dysrhythmias
    Can lead to cardiac arrest, convulsions, unconsciousness, death
36
Q

Hyperventilation: Define, Causes, S/S

A
  1. Define: Removing CO2 faster than it is produced
    -Increased work of breathing
  2. Causes: Anxiety attacks, infection/fever, drugs, acids-base imbalance, aspirin poisoning, amphetamine use
  3. S/S: rapid RR, sighing breaths, numbness, tingling of hands/feets, light-headness, loss of unconsciousness
37
Q

Atelectasis

A

-Collapsed alveoli
-Can lead to lung collapse
-Conditions associated: immobility, obesity, sleep apnea, chronic lung conditions (COPD)
-Preventable by nurse

38
Q

Acute Hypoxia

A

-Inadequate tissue oxygenation ( at cellular level, not enough O2 to meet needs)
-Untreated can lead to cardiac dysrhythmias
-Think hypoxia of new onset of restlessness
-Look at PP for causes and S/S

39
Q

Common assessment findings for Chronic Hypoxia

A

-Cyanotic nailbeds
-Sluggish capillary refill
-Clubbing
-Barrel Chest
-Associated with chronic lung conditions (COPD)

40
Q

Developmental considerations of oxygenation

A

Young-middle adult: Focus is on avoidance of oxygenation risk factors

Older adults: Mental status changes (1st sign), more susceptible to respiratory infections, and Low reserve (will deteriorate quickly)

41
Q

Lifestyle and environmental considerations of oxygenation

A

-Smoking
-Obesity
-Air pollution/ quality
-Malnourished (muscle weakness, weak cough)
-Exercise protective (increase metabolic activity
-Substance use
-Occupational exposure

42
Q

Dyspnea

A

-Associated with hypoxia
-Subjective sensation of difficult or uncomfortable breathing
-Related to shortness of breath
-S/S: use of accessory muscles, nasal flaring, increased rate/depth

43
Q

Cough

A

-Protective reflex to clear trachea, bronchi, and lungs of irritants and secretions
-Adequate hydration and coughing helps maintain airway patency
-Encourage coughing: most productive way to move secretions through airway
-Pain is a barrier to coughing

44
Q

How do you collect a sputum sample?

A

Early Morning
1-2 hrs after eating
Sterile specimen container
Used to analyze for pathogen

45
Q

Nursing Diagnosis related to oxygenation

A
  1. Effective airway clearance
  2. Risk for aspiration
  3. Impaired gas exchange
  4. Activity intolerance
46
Q

Long term preventative measures

A

-Vaccinations: Flu and Pneumonia vaccines for older
-Healthy lifestyle: nutrition, exercise
-Environmental and occupational exposures: stop smoking and change jobs potentially

47
Q

Dyspnea management

A

-Difficult to treat
-Treat underlying condition
-Oxygen therapy
-Pharmacologic treatment

47
Q

Airway maintence

A

-CAB: Circulation, Airway, breathing
-Maintaining patent airway is a nursing priority
-Airway can be blocked (choking, recent anesthesia, overdose of pain meds, slumped over

48
Q

Managing pulmonary secretions

A

-Mobilize
-Hydrate
-Humidification
-Medications

49
Q

How does positioning help with respiratory function

A

-Change frequently
-Optimal is upright, unsupported position
-Helps prevent atelectasis
-Helps mobilize secretions

50
Q

How often should a nurse encourage coughing?

A

Q2

51
Q

What does Deep breathing do?

A

increases air to lower lobes of the lungs
-opens small pores btwn alveoli which help promote gas exchange

52
Q

What is a nurses best defense

A

Pulmonary toileting- Turn, cough, deep breath

53
Q

Chest physiotherapy

A

-Need HCP order
-for pts with thick secretions
Includes:
-Postural drainage (R trendelenburg)
-Chest percussion
-Chest Vibration
-Follow activities with coughing and deep breathing

54
Q

Goal of Chest physiotherapy

A

Mobilize pulmonary secretions

55
Q

Who should not use chest physiotherapy?

A

-pregnant
-rib/chest injury
-increased intracranial pressure
-recent abdominal/thoracic surgery
-bleeding disorders
-osteoporosis

56
Q

Best position for postural drainage

A

Lay on unaffected side to promote drainage of one particular lobe
Ex. Infiltration seen on Right lower lobe, lay on left side in trendelenburg

57
Q

Suctioning

A

-used when pt can’t clear secretions on their own through coughing or CPT
-sterile procedure
-Orotracheal and nasotracheal common (less than 10 sec)

58
Q

Incentive spirometer

A

-Promotes lung expansion through deep breathing
-Prevents or treats atelectasis (most often used in the post operative pts)

59
Q

What is the goal of oxygen therapy?

A

Prevent or relieve hypoxia
(must have HCP order)

60
Q

Room air = FiO2 of

A

21%
So give oxygen at higher concentration than our ambient air

61
Q

What can you delegate to CNA regarding oxygen therapy?

A

Applying nasal cannula, oxygen mask

The nurse must assess respiratory system, response to therapy, setup, adjustment responses, etc)

62
Q

What are safety concerns when it comes to O2?

A

-Highly flammable substance (No smoking or open flame)
-Place oxygen in use sign on pts room door

63
Q

Nasal Cannula (low flow)

A

-FiO2: 1-6 L/min 22-44%
-Safe and well tolerated
-FiO2 can vary, can lead to skin breakdown, tubing dislodges easy
-Use humidification if greater than 4L
-Eating Okay

64
Q

Simple face mask (low flow)

A

-6-12 L/min 33-55%
-Best for short periods, transportation
-Not great for claustrophobic patients, skin breakdown, higher risk for aspiration
-Assess for fit
-Contradicted in COPD pts due to retaining CO2

65
Q

Partial rebreather mask (low flow)

A

-FiO2% 6-11 L/min 60-75%
-Used for short periods of dyspnea or other increased oxygen needs
-Patients rebreathe up to 1/3 of exhaled air, helps with humidification
-Keep reservoir bag partially inflated
-Watch for aspiration and hourly assessment
-ICU usually

66
Q

Non-rebreather mask (low flow)

A

-FiO2% 10-15 L/min 80-95%
-Best for pts in critical need of O2, step before intubation
-One-way valve allows for client to inhale max O2 concentration, and 2 exhalation ports that restrict exhaled air from being rebreathed
-Watch for aspiration and hourly assessment
-ICU usually

67
Q

Venturi Mask (High flow)

A

-FiO2: 4-12 L/min 24%-50%
-Provides the ability to deliver precise oxygen concentration with humidity
-not preferable for long periods of time
-Used for pts who need highly regulated O2 concentrations (chronic lung disease)

68
Q

Face Tent

A

-Fits loosely around face and neck
-24-100% O2
-High Humidity
See alot in post operative pts

69
Q

High flow nasal cannula

A

-Tubes bigger
-up to 80L
-100% O2
-ICU usually
-caution eating with

70
Q

Nasal cannula with ETCO2 monitor

A

Flap goes over mouth to read CO2 levels

71
Q

Oxygen humidification

A

-Prevents drying out of mucous membranes
-ALWAYS used greater than 4L or greater than 24hrs of supplemental O2
-Sterile water used
“bubbler” “bubble humidifier”

72
Q

Complications of Oxygen therapy

A

-Drying effects of respiratory mucous membranes
-Oxygen Toxicity
-Skin break Down

73
Q

Oxygen Toxicity symptoms

A

-Pleuritic chest pain
-Chest heaviness
-Coughing
-Dyspnea
-Muscle Twitching
-Nausea/ GI upset

74
Q

What do you never want supplemental oxygen to be at?

A

100%
Means you can ween them down or off of it

75
Q

What is unique about the O2 of COPD pt?

A

Never want them at 100% usually in lower 90s or High 80s

NUR 333 (15 decks)

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