EX3 Module 8B Oxygination Flashcards
Ventilation
Moving of air (02 & CO2) in the lungs
(External Respiration/Breathing)
Respiration
- Exchange of 02 & CO2 between the
atmospheric air in the alveoli and
blood in the pulmonary capillaries
Diffusion
- Movement of solute from higher to
lower concentration
Alveoli Sac with high of O2
and low CO2 concentration
Red blood cells with high CO2
and low O2 concentration
Perfusion
- Tissue perfusion – blood flow from Lt
side of the heart, through systemic
circulation; oxygenated capillary blood
passes through body tissues
Internal Respiration – exchange of oxygen and carbon dioxide
between the circulating blood and the body tissues.
Assessment for Patient has panic attack
• Rapid respiration
• Sighing breaths
• Paresthesia
(numbness/tingling sensation)
• Loss of consciousness
Patient 68 y.o. diagnosed with
pneumonia couple with COPD
exacerbation.
Assessment
- Lethargic
- Dizziness
- Disorientation
- Cardiac Dysrhythmias
- Electrolytes Imbalances
- Convulsion
- Coma
- Cardiac Arrest
Nursing Diagnosis
Ineffective airway clearance
Ineffective breathing pattern
Impaired gas exchange
Decreased cardiac output
Impaired tissue perfusion
Activity intolerance
Fatigue
Implementation
flower position
Nasal cannula 1L/MIN
chest physiotheraphy
ortopenic position
coughing
diaphrem breathing
suctioning
pursed lip breathing
increase fluid if not contraindicated
Oral Inhalation
- (Fluticasone/Salmeterol) Advair
corticosteroid/beta2-adrenergic
Nebulization
- (Ipratropium) Atrovent
anti-cholinergic - (Albuterol) Proventil
beta2-adrenergic - (Acetylcysteine) Mucomyst
Mucolytic
Factors Affecting Oxygenation
• Physiological Factors
- Hyperventilation/Hypoventilation
- Hypovolemia
- Hypoxia
- Decrease H & H
• Conditions Affecting Chest Wall Movement
• Influences of Chronic Disease
- COPD
1.Afterload
Resistance of the
ejection of blood from
the left ventricle
Stroke Volume
Amount of blood ejected
from the ventricles per
contraction
Preload
Amount of blood at
the end of ventricular
diastole
Nursing History & Physical Findings
• Patient has history of HTN, HF, hyperlipidemia,
smokes 1 pack/day, truck driver
• S/S include the following
o easily gets tired & confused
o dyspnea & SOB (shortness of breath)
o crackles upon auscultation
o LE pitting edema 3+
o upper right abdominal quadrant pain
o chest pain
o weight gain of 10 lbs in the last 5 days
• Patient has history of HTN, HF, hyperlipidemia,
smokes 1 pack/day, truck driver • S/S include the following
o easily gets tired & confused
o dyspnea & SOB (shortness of breath)
o crackles upon auscultation
o LE pitting edema 3+
o upper right abdominal quadrant pain
o chest pain
o weight gain of 10 lbs in the last 5 days
With the fluid in the alveoli sac, the diffusion of C02
and O2 is sluggish causing
hypoxemia
Deficiency of
oxygen in the
arterial blood
Patient’s left ventricle
Contractility
Preload &
Afterload. what happened
Contractility decrease
Preload &
Afterload increase
Cardiac output
- Easily gets tired, confused,
pale or dusky skin
Deficiency of oxygen in the tissue
Hypoxia
CBC ( Complete blood count)
RBC 4.1 x 1012/L L Male: 4.7 – 6.1 x 1012 /L
WBC 10 x 109/L 5.0 – 10.0 x 109/L
Hgb 12g/dL L Male: 14 – 18 g/dL
Hct 37% L Male : 42 – 52%
Platelets 156 x 109/L
Neutrophils 67% 55 – 70%
Lymphocytes 25% 20 – 40%
Basophils 1% 0.5 – 1%
Eosinophils 1% 1 – 4%
Monocytes 4% 2 – 8%
BASIC METABOLIC PANEL (BMP)
- *SODIUM** 132 mEq/L L 136 – 145 mEq/L
- *POTASSIUM** 5.3 mEq/L H 3.5 – 5.0 mEq/L
- *CHLORIDE** 101 mEq/L 98 – 106 mEq/L
- *CO2** 31 mEq/L H 23 – 30 mEq/L
- *BUN** 32 mg/dL H 10 – 20 mg/dL
- *CREATININE** 2 mg/dL H 0.5 – 1.1 mg/dL
- *GLUCOSE** 200 mg/dL H 70 – 110 mg/dL
- *CALCIUM** 9.6 mg/dL 9 – 10.5 mg/dLBASIC METABOLIC PANEL (BMP)
- *SODIUM** 132 mEq/L L 136 – 145 mEq/L
- *POTASSIUM** 5.3 mEq/L H 3.5 – 5.0 mEq/L
- *CHLORIDE** 101 mEq/L 98 – 106 mEq/L
LIPID PROFILE
- *CHOLESTEROL** 300 mg/dL H < 200 mg/dL
- *HDL** 26 mg/dL L Male > 45 mg/dL
- *LDL** 120 mg/dL < 130 mg/dL
- *TRIGLYCERIDES** 290 mg/dL H 40 – 160 mg/dL
BNP (B-type Natriuretic Peptides)
BNP 500 pg/ml H < 100 pg/ml
Nursing Diagnosis with Ineffective airway clearance
Nursing Diagnosis
Ineffective airway clearance
Ineffective breathing pattern
Impaired gas exchange
Decreased cardiac output
Impaired tissue perfusion
Activity intolerance
Fatigue
who Increase preload and
contractility?
Furosemide
Furosemide
- Decrease preload
Lisinopril
- Decrease preload and
afterload
Digoxin
- Increase preload and
contractility
Right Side -Deoxygenated Blood
Superior/Inferior Vena Cava Right Atrium Tricuspid Valve Right Ventricle Pulmonic Valve Pulmonary Artery *Deoxygenated blood goes to the lungs*
- Left Side-Oxygenated Blood
*
- Pulmonary Vein
- Left Atrium
- Bicuspid/Mitral Valve
- Left Ventricle
- Aortic Valve
- Aorta
*Oxygenated Blood goes to the body*
Ventilation is the moving of air in the lungs
- External respiration: inhale oxygen and exhale carbon dioxide leading to an exchange of O2 and CO2
- Example: chest expansion
- External respiration: inhale oxygen and exhale carbon dioxide leading to an exchange of O2 and CO2
Respiration
- is the exchange of o2 and Co2 between the atmospheric air in the alveoli and blood in the pulmonary capillaries
- Diffusion is
- the movement of solute from higher to lower concentration
- Perfusion
- is the blood from the left side of the heart, through systemic circulation, oxygenated cappliary blood passes through body tissue
- Example: capillary refill >3 seconds
Internal respiration is
the exchange of oxygen and carbon dioxide between the circulating blood and body tissues
- Describe common alterations in cardiopulmonary function and oxygenation
- Arrhythmia
- P and T waves abnormal
- Hypoxia
- Identify factors affecting cardiopulmonary function and oxygenation
- Hyperventilation
- Hypoventilation
- Hypoxia
- Decrease H&H
- Conditions affecting chest wall movement COPD
- Discuss changes in cardiopulmonary function and oxygenation related to older adults
- Previous smoker
- Other conditions
- Decrease mobility
- Create a care plan for a patient with ineffective airway clearance, ineffective breathing pattern and impaired gas exchange
- Ineffective airway clearance
- Elevate head of bed during and after meals
- Encourage coughing and deep breathing
- Possible aspiration precautions
- Monitor sputum
- Assess and monitor respiratory status
- Perform chest physiotherapy if needed
- Provide exercise and activity
- Suction pt airway as needed
- Monitor ABG
- Ineffective breathing pattern
- Impaired gas exchange
- Assist ADLs
- Auscultate breath sounds
- Monitor respiratory status
- Monitor signs of respiratory problems
- Perform chest physiotherapy
- Limit agitation
- Encourage incentive spirometry
- Monitor ABG
- Maintain airway
- Afterload, Preload, Stroke Volume
*
- Afterload- resistance of blood from L. ventricle
- Inversely proportional
- Increase in resistance is in aorta, vasoconstriction
- Decrease in resistance, vasodilation
- Increase in afterload causes decrease in stroke volume
- Decrease in afterload causes increase in stroke volume
- Preload- amount of blood at end of ventricular diastole
- Increase in preload causes increase in stroke volume
- Directly proportional to stroke volume
- Stroke volume- amount of blood pumped out ventricle w each beat/contraction
- Directly proportional
- If contractility increase stroke volume increase or vice versa
- Heart Failure
- Left Sided HF
- Backward flow
- Related to lungs & Cardiac output
- Examples: SOB, dyspnea, crackles, easily tired, confusion and chest pain r/t cardiac output
- Right Sided HF
- Symptoms related to systematic except cardiac output
- Edema
- Pain not r/t cardiac output decrease
- Weight gain
- Symptoms related to systematic except cardiac output
- Left Sided HF
- Left Sided HF
- Backward flow
- Related to lungs & Cardiac output
- Examples: SOB, dyspnea, crackles, easily tired, confusion and chest pain r/t cardiac output
*
- Examples: SOB, dyspnea, crackles, easily tired, confusion and chest pain r/t cardiac output
- Right Sided HF
*
- Symptoms related to systematic except cardiac output
- Edema
- Pain not r/t cardiac output decrease
- Weight gain
- Differentiate types of oxygen delivery systems
- Regular nasal cannula
- mustache/ pendant cannula
- Simple face mask
- Partial rebreather with reservoir bag
- Non rebreather with reservoir bag
- High flow nasal cannula
- Venturi mask
- Regular nasal cannula O2
- 1-6 L/min
- 24%-44%
*
- Mustache or Pendent cannula o2
- 3x-4x more than regular cannula with same flow rate
- No humidifier
- Simple face mask o2
- 5-8 L/min
- 40%-60%
- Partial rebreather with reservoir bag 02
- 8-11 L/min
- 50%-75%
- Non Rebreather with reservoir bag o2
- 10-15 L/min
- 80%-95%
- High flow nasal cannula o2
- Max flow 60 L/min
- 10 L/min-65%
- 15 L/min-90%
- Humidifier
- Venturi mask o2
- Deliver precise, high flow rates
- Masks available of 24%, 28%, 31%, 35%, 40%, 60%
- Which o2 methods are low flow?
- Regular cannula
- Mustache or pendant cannula
- Simple face mask
- Partial rebreather
- Non Rebreather
- Which o2 methods are high flow?
- High flow nasal cannula
- Venturi mask
- Which o2 methods are used with a humidifier?
- Regular nasal cannula
- Simple face mask
- High flow nasal cannula
- 3x-4x more than regular cannula with same flow rate
- No humidifier
*
- Simple face mask o2
- 5-8 L/min
- 40%-60%
- Partial rebreather with reservoir bag 02
- 8-11 L/min
- 50%-75%
- Non Rebreather with reservoir bag o2
- 10-15 L/min
- 80%-95%
- High flow nasal cannula o2
- Max flow 60 L/min
- 10 L/min-65%
- 15 L/min-90%
- Humidifier
- Venturi mask o2
- Deliver precise, high flow rates
- Masks available of 24%, 28%, 31%, 35%, 40%, 60%
- Which o2 methods are low flow?
- Regular cannula
- Mustache or pendant cannula
- Simple face mask
- Partial rebreather
- Non Rebreather
- Which o2 methods are high flow?
- High flow nasal cannula
- Venturi mask
- Which o2 methods are used with a humidifier?
- Regular nasal cannula
- Simple face mask
- High flow nasal cannula
- 5-8 L/min
- 40%-60%
*
- Partial rebreather with reservoir bag 02
- 8-11 L/min
- 50%-75%
- Non Rebreather with reservoir bag o2
- 10-15 L/min
- 80%-95%
- High flow nasal cannula o2
- Max flow 60 L/min
- 10 L/min-65%
- 15 L/min-90%
- Humidifier
- Venturi mask o2
- Deliver precise, high flow rates
- Masks available of 24%, 28%, 31%, 35%, 40%, 60%
- Which o2 methods are low flow?
- Regular cannula
- Mustache or pendant cannula
- Simple face mask
- Partial rebreather
- Non Rebreather
- Which o2 methods are high flow?
- High flow nasal cannula
- Venturi mask
- Which o2 methods are used with a humidifier?
- Regular nasal cannula
- Simple face mask
- High flow nasal cannula
- 8-11 L/min
- 50%-75%
*
- Non Rebreather with reservoir bag o2
- 10-15 L/min
- 80%-95%
- High flow nasal cannula o2
- Max flow 60 L/min
- 10 L/min-65%
- 15 L/min-90%
- Humidifier
- Venturi mask o2
- Deliver precise, high flow rates
- Masks available of 24%, 28%, 31%, 35%, 40%, 60%
- Which o2 methods are low flow?
- Regular cannula
- Mustache or pendant cannula
- Simple face mask
- Partial rebreather
- Non Rebreather
- Which o2 methods are high flow?
- High flow nasal cannula
- Venturi mask
- Which o2 methods are used with a humidifier?
- Regular nasal cannula
- Simple face mask
- High flow nasal cannula
- 10-15 L/min
- 80%-95%
*
- High flow nasal cannula o2
- Max flow 60 L/min
- 10 L/min-65%
- 15 L/min-90%
- Humidifier
- Venturi mask o2
- Deliver precise, high flow rates
- Masks available of 24%, 28%, 31%, 35%, 40%, 60%
- Which o2 methods are low flow?
- Regular cannula
- Mustache or pendant cannula
- Simple face mask
- Partial rebreather
- Non Rebreather
- Which o2 methods are high flow?
- High flow nasal cannula
- Venturi mask
- Which o2 methods are used with a humidifier?
- Regular nasal cannula
- Simple face mask
- High flow nasal cannula
- Max flow 60 L/min
- 10 L/min-65%
- 15 L/min-90%
- Humidifier
*
- Venturi mask o2
- Deliver precise, high flow rates
- Masks available of 24%, 28%, 31%, 35%, 40%, 60%
- Which o2 methods are low flow?
- Regular cannula
- Mustache or pendant cannula
- Simple face mask
- Partial rebreather
- Non Rebreather
- Which o2 methods are high flow?
- High flow nasal cannula
- Venturi mask
- Which o2 methods are used with a humidifier?
- Regular nasal cannula
- Simple face mask
- High flow nasal cannula
- Deliver precise, high flow rates
- Masks available of 24%, 28%, 31%, 35%, 40%, 60%
*
- Which o2 methods are low flow?
- Regular cannula
- Mustache or pendant cannula
- Simple face mask
- Partial rebreather
- Non Rebreather
- Which o2 methods are high flow?
- High flow nasal cannula
- Venturi mask
- Which o2 methods are used with a humidifier?
- Regular nasal cannula
- Simple face mask
- High flow nasal cannula
- Regular cannula
- Mustache or pendant cannula
- Simple face mask
- Partial rebreather
- Non Rebreather
*
- Which o2 methods are high flow?
*
- High flow nasal cannula
- Venturi mask
- Which o2 methods are used with a humidifier?
- Regular nasal cannula
- Simple face mask
- High flow nasal cannula
- Which o2 methods are used with a humidifier?
- Which o2 methods are used with a humidifier?
*
- Regular nasal cannula
- Simple face mask
- High flow nasal cannula