E1 Oxygenation Flashcards
What are the 3 process of oxygenation?
Ventilation, Diffusion, Perfusion
Ventilation
=Respiration
Movement of gas in and out of lungs
Diffusion
O2 and CO2 exchange between alveoli and RBCs
Perfusion
distribution of the oxygenated RBCs to the tissues in the body
When CO2 increases (hypercarbia),
body knows to increase rate and depth of breathing
The passive process of breathing is regulated by
O2, CO2, and pH of blood
Lung volume caries person to person based on
age, gender, and height
Ex. a smaller person has smaller lungs than a larger person
Tidal Volume
amount of air exhaled following normal inspiration
Tidal volume varies based on
health status
activity
pregnancy
exercise
obesity
obstructive/restrictive lung diseases
Alveoli Function
promote gas exchange
What could cause abnormal breathing?
Pain, anxiety, meds
What are the three expected breath sounds? Location/ Describe them
- Bronchial- Heard over trachea & larynx (Neck), Harsh and High pitched
- Bronchovesicular- Heard close to sternum anteriorly and down spine posteriorly, Medium in loudness & pitch
- Vesicular- Heard over periphery of lung fields, Low pitched
Crackles/ rales
Fine course bubbly sounds, associated with air passing through fluid or collapsed small airways
Wheezes
-High pitched whistling, narrow obstructed airway
-Asthma and Allergic Reaction
Rhonchi
Loud low pitched rumbling, fluid or mucus in airways, can resolve with cough
Stridor
Choking, children
High pitched sound, loud
Pleural friction
Inflamed pleural space
Bradypnea
Rate of breathing is regular but abnormally slow (less than 12)
Tachypnea
Rate of breathing is regular but abnormally rapid (greater than 20)
Hyperpnea
Respirations are labored, increased in depth and rate (Occurs normally in exercise)
Apnea
-Respirations cease for several second
-Persistent cessation results in respiratory arrest
SpO2 vs SaO2
Peripheral vs Arterial
What can interfere with SpO2?
-Movement
-Dark nail polish
-Cold
-Edematous
-Arterial Disease
Work of breathing
-Effort to expand and contract lungs
-Determine by rate and depth
-Evaluate use of accessory muscles
Inspiration vs Expiration
-Inspiration is active and uses muscles
-Expiration is passive and depends on elastic recoil of lungs
Surfactant
chemical produced to maintain surface tension of the alveoli and prevent from collapsing
______ pts lose elastic recoil and have increased work of breathing
COPD
Compliance
ability for the lungs to distend or expand in response to increase alveoli pressure
What increases the work of breathing?
-Decreased compliance
-Increased airway resistance
-Increased accessory muscle use
What are the 4 main factors of Oxygenation?
- Physiological
- Developmental
- Lifestyle
- Environmental
What physiological factors affect oxygenation?
- Decreased oxygen-carrying capacity (Hemoglobin, CO)
- Hypoventilation (decreased circulating amounts of blood)
- Decreased inspired O2 concentration (altitude, hypoventilation, increased metabolic demand)
- Chest Wall Movement (Preg, obese, trauma)
Anemia
-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
Oxygenated vs deoxygenated blood
Arterial is oxygenated
Venous is deoxygenated
Goal of ventilation
Normal arterial CO2 tension and normal arterial oxygenation tension
PaO2=
PaCO2=
SpO2=
EtCO=
PaO2= 80-100
PaCO2= 35-45
SpO2= >95%
EtCO= 35-45 (the amount of CO2 at the end of exhalation)
Hypoventilation: Define, Causes, S/S
- Define: Inadequate alveolar ventilation to meet demand,
Not enough O2 and/or too much CO2 - Causes: Medications (opioids & anesthesia), Atelectasis
- S/S: Mental status changes, dysrhythmias
Can lead to cardiac arrest, convulsions, unconsciousness, death
Hyperventilation: Define, Causes, S/S
- Define: Removing CO2 faster than it is produced
-Increased work of breathing - Causes: Anxiety attacks, infection/fever, drugs, acids-base imbalance, aspirin poisoning, amphetamine use
- S/S: rapid RR, sighing breaths, numbness, tingling of hands/feets, light-headness, loss of unconsciousness
Atelectasis
-Collapsed alveoli
-Can lead to lung collapse
-Conditions associated: immobility, obesity, sleep apnea, chronic lung conditions (COPD)
-Preventable by nurse
Acute Hypoxia
-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
Common assessment findings for Chronic Hypoxia
-Cyanotic nailbeds
-Sluggish capillary refill
-Clubbing
-Barrel Chest
-Associated with chronic lung conditions (COPD)
Developmental considerations of oxygenation
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)
Lifestyle and environmental considerations of oxygenation
-Smoking
-Obesity
-Air pollution/ quality
-Malnourished (muscle weakness, weak cough)
-Exercise protective (increase metabolic activity
-Substance use
-Occupational exposure
Dyspnea
-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
Cough
-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
How do you collect a sputum sample?
Early Morning
1-2 hrs after eating
Sterile specimen container
Used to analyze for pathogen
Nursing Diagnosis related to oxygenation
- Effective airway clearance
- Risk for aspiration
- Impaired gas exchange
- Activity intolerance
Long term preventative measures
-Vaccinations: Flu and Pneumonia vaccines for older
-Healthy lifestyle: nutrition, exercise
-Environmental and occupational exposures: stop smoking and change jobs potentially
Dyspnea management
-Difficult to treat
-Treat underlying condition
-Oxygen therapy
-Pharmacologic treatment
Airway maintence
-CAB: Circulation, Airway, breathing
-Maintaining patent airway is a nursing priority
-Airway can be blocked (choking, recent anesthesia, overdose of pain meds, slumped over
Managing pulmonary secretions
-Mobilize
-Hydrate
-Humidification
-Medications
How does positioning help with respiratory function
-Change frequently
-Optimal is upright, unsupported position
-Helps prevent atelectasis
-Helps mobilize secretions
How often should a nurse encourage coughing?
Q2
What does Deep breathing do?
increases air to lower lobes of the lungs
-opens small pores btwn alveoli which help promote gas exchange
What is a nurses best defense
Pulmonary toileting- Turn, cough, deep breath
Chest physiotherapy
-Need HCP order
-for pts with thick secretions
Includes:
-Postural drainage (R trendelenburg)
-Chest percussion
-Chest Vibration
-Follow activities with coughing and deep breathing
Goal of Chest physiotherapy
Mobilize pulmonary secretions
Who should not use chest physiotherapy?
-pregnant
-rib/chest injury
-increased intracranial pressure
-recent abdominal/thoracic surgery
-bleeding disorders
-osteoporosis
Best position for postural drainage
Lay on unaffected side to promote drainage of one particular lobe
Ex. Infiltration seen on Right lower lobe, lay on left side in trendelenburg
Suctioning
-used when pt can’t clear secretions on their own through coughing or CPT
-sterile procedure
-Orotracheal and nasotracheal common (less than 10 sec)
Incentive spirometer
-Promotes lung expansion through deep breathing
-Prevents or treats atelectasis (most often used in the post operative pts)
What is the goal of oxygen therapy?
Prevent or relieve hypoxia
(must have HCP order)
Room air = FiO2 of
21%
So give oxygen at higher concentration than our ambient air
What can you delegate to CNA regarding oxygen therapy?
Applying nasal cannula, oxygen mask
The nurse must assess respiratory system, response to therapy, setup, adjustment responses, etc)
What are safety concerns when it comes to O2?
-Highly flammable substance (No smoking or open flame)
-Place oxygen in use sign on pts room door
Nasal Cannula (low flow)
-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
Simple face mask (low flow)
-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
Partial rebreather mask (low flow)
-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
Non-rebreather mask (low flow)
-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
Venturi Mask (High flow)
-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)
Face Tent
-Fits loosely around face and neck
-24-100% O2
-High Humidity
See alot in post operative pts
High flow nasal cannula
-Tubes bigger
-up to 80L
-100% O2
-ICU usually
-caution eating with
Nasal cannula with ETCO2 monitor
Flap goes over mouth to read CO2 levels
Oxygen humidification
-Prevents drying out of mucous membranes
-ALWAYS used greater than 4L or greater than 24hrs of supplemental O2
-Sterile water used
“bubbler” “bubble humidifier”
Complications of Oxygen therapy
-Drying effects of respiratory mucous membranes
-Oxygen Toxicity
-Skin break Down
Oxygen Toxicity symptoms
-Pleuritic chest pain
-Chest heaviness
-Coughing
-Dyspnea
-Muscle Twitching
-Nausea/ GI upset
What do you never want supplemental oxygen to be at?
100%
Means you can ween them down or off of it
What is unique about the O2 of COPD pt?
Never want them at 100% usually in lower 90s or High 80s
