EXAM 2- Oxygenation Flashcards
poor oxygenation
a decreased oxygen level in the blood
SpO2
measure of how saturated hemoglobin are with oxygen (measured with pulse oximetry)
hemoglobin-attached to blood to carry it throughout the body
what is the normal accepted O2 sat level?
95-100%
for pts with illness or respiratory distress with supplemental oxygen, what O2 saturation should you aim to keep them above?
92%
what is one of the FIRST signs of poor oxygenation?
restlessness- pt is struggling to recover and catch their breath, causing low amounts of O2 flow to the brain (leading to confusion)
signs/symptoms of poor oxygenation
- restlessness & confusion (first signs)
- decreased bp
- cool extremities
- pallor (paleness) or cyanosis
- slow capillary refill (healthy is < 3 seconds)
all occur because O2 isn’t flowing to where it needs to go
signs/symptoms of poor oxygenation
- restlessness & confusion (first signs)
- decreased bp
- cool extremities
- pallor (paleness) or cyanosis
- slow capillary refill (healthy is < 3 seconds)
all occur because O2 isn’t flowing to where it needs to go
what happens when O2 delievery is inadequate to meet the body’s metabolic demands?
tissue ischemia & cell death
leads to hypoxia
hypoxia
low oxygen in tissues
is restlessness an early or late sign of poor oxygenation?
both
do the lungs have a large surface area? why?
yes, the lungs have a large surface area (due to millions of alveoli) and are constantly exposed to the external environment
what is lung disease greatly influenced by?
what a pt is exposed to:
* environmental- season allergies, wind
* occupational- fumes, chemicals
* personal
* social habits- smoking
alveoli
air sacks in the lungs
(where oxygen exchange occurs)
know the anatomy of the repsiratory system/ lungs
what are pulmonary diseases? what are the types?
somethign keeping the pt from taking in enough oxygen
often classified as:
* acute (new onset, bronchitis) or chronic (long pt hx, asthma)
* obstructive (COPD) or restrictive (pulmonary fibrosis, sarcoidosis)
* infectious (pneumonia) or noninfectious (asthma, COPD, pulmonary fibrosis)
caused by alterations in the lungs or heart, causes scarring of lung tissue
obstructive pulmonary disease
difficulty exhaling
chronic obstructive pulmonary disease (COPD)
restrictive pulmonary disease
difficulty inhaling
pulmonary fibrosis, sarcoidosis
clinical manifestations of respiratory alterations
- cough - acute or cronic
- dyspnea - SOB, inability to get a good breath
- chest pain- from low O2 or coughing
- abnormal sputum/ hemoptysis (coughing up blood) - bloody or green
- altered breathing pattern- tachypnea, bradypnea, use of accessory muscles (CRITICAL)
- cyanosis- bluish discoloration of skin/ mucus membranes
- fever- due to infection in lungs
common anatomical locations of cyanosis
- end of extremities (fingers, toes)
- mouth, mucus membranes
- tip of nose, inside nairs (nostrils)
- earlobes
orthopnea
dyspnea when laying down
pt can breath better when propped/sitting up (allows lung expansion)
clubbing
occurs in heart & lung diseases that reduce levels of O2 in the blood
* chronically low on O2
* fingertips are wide, abnbormal nailbed angle
hypoxemia
low level of oxygen in the blood
* measured with SpO2 - oxygen saturation
hypo (low) + emia (blood)
hypoxia
low levels of oxygen in the tissues & organs
- difficult to measure, can be measured w/ assessment skills, cricical thinking, & observations (head to toe assessment)
- we can assume that a pt with hypoxemia for an extended period of time has hypoxia
what is the difference between arteries & veins?
- arteries - bring in oxygenated blood
- veins - carry away deoxygenated blood
air exchange occurs in alveoles (air sacks)
symptoms of hypoxia
early & late
EARLY:
* Restlessness
* Anxiety
* Tachycardia/ Tachypnea
LATE:
* Bradycardia
* Extreme restlessness
* Dyspnea (severe)
early RAT is late to BED
if a pt is having difficulty breating, what is the MINIMUM angle the HOB should be at?
30º
hypoventilation
breathing too shallow/slow to meet the body’s need for oxygen
* the body holds onto CO2 longer, leads to hypercapnea (excess CO2 in body due to breathing)
normal breathing rate is 12-20 breaths/min
what are some factors that can cause hypoventilation?
- narcotics (morphine, versed)
- sleeping
hyperventilation
breathing too deep/rapid (exceeds the body’s metabolic needs)
* gives off too much CO2, leads to hypocapnea (low CO2 in body)
* breathing into a bag helps because it allows pt to rebreathe in CO2 to increase CO2 levels
what are some factors that can cause hyperventilation?
- anxiety
- exercise (overexertion)
- pain
what are some factors that can cause hyperventilation?
- anxiety
- exercise (overexertion)
- pain
atelectasis
collapses air sacs (alveoli)
* caused by lack of deep breaths or fluid buildup
what can you do to prevent atelectasis in your pt?
- early ambulation
- Turn (increase chest/lung expansion), Cough (clear excretions, increase chest expansion), Deep Breathe
- incentive spirometry - focuses on deep inhalation
aspiration
passage of gastric contents (fluid or solid) into the lungs
can cause aspiration pneumonia
what can you do to prevent aspiration?
- assess pt’s ability to swallow
- keep HOB elevated with tube feedings
- thorough lung assessment
what do you assess for when assessing the respiratory system?
- respiratory rate (12-20)
- use of accessory muscles (critical)
- cyanosis
- oxygen saturation
- adventitous breath sounds (extra/abnormal)- crackles, wheezes, rhonchi, stridor, rubs)
- clubbing
- dyspnea with activity (not normal)
vesicular breath sounds
normal, no extra sounds
fine crackles (rales) breath sounds
most common abnormal lung sound
- similar to velco, or hair rubbing near ear
- high pitch
- fluid in lungs
encourage pt to cough, more common on inspiration
course crackles (rales) breath sounds
- low pitch (compared to fine crackles)
- louder
- lots of fluid/ gunk
encourage pt to cough, more common on inspiration
wheezing breath sounds
more common on expiration
* high pitch (squeaking) or
* low pitch (snoring/moaning)
rhonchi breath sounds
severe wheeze
* often clear after coughing
* low pitch
bronchial breath sounds
normal sound over trachea
* hollow, tubular, clear sound
diagnostic tests for assessing the respiratory system
- imaging- chest x-ray, CT, MRI
- arterial blood gases (ABG)
- suptum culture & sensitivity
- bronchoscopy
- thoracentesis
what does atelectasis appear as on a chest x-ray?
white grainy/fuzzy areas where fluid is present
black is good (air is present)
sputum culture & sensitivity
- culture- examine sputum to see what organisms are present
- sensitivity- test which antibiotics will kill it
CT scan
- can be used with or without IV contrast dye
- provides a trans sectional image, more sophisticated than x-ray
MRI
Magnetic Residence Imaging
* highly sophisticated
* pts with metal implants/devices (pacemaker, rods/pins, defib) cannot obtain an MRI
bronchoscopy
uses a flexible tube to check airway for abnormalities, remove gunk, and obtain a biopsy if needed
thoracentesis
uses a long needle to aspirate fluid to relieve pressure (usually ultrasound guided)
* pulls out fluid
* opens lung space to increase breathing
* obtain culture & sensitivity
what are some ways you can promote lung expansion for your pt?
- position change/turn frequently - Q2 hours
- keep pt upright
- increase daily activites, adequate hyration
- coughing exercises
- deep breathing - incentive spirometry
what are some ways you can promote lung expansion for post op pts?
educate pt before surgery on interventions to increase pt understanding
- incentive spirometry
- TCDB
- splinting incision
is oxygen a drug?
yes
albuterol (Proair) MDI
brochodilator/rescue inahler used for acute difficulty breathing (asthma, COPD)
* **beta 2 agonist (SABAs- short acting beta agonist) **- stimulates fight/flight system and speeds everything up)
* common reactions/side effects: nervousness, tachycardia, headache, throat irritaion
budesonide/ formeterol inhaled (Symbicort)
corticosteroid/brochodilator used to prevent asthma attacks, exercise-induced brochospasm and COPD
* pt must rinse mouth after inhalation - steroids can cause thresh
* used on a regular schedule to prevent SOB
what should you assess when assessing pts with oxygen therapy?
- correct oxygen delivery device
- correct flow rate (L/min)
- respiratory assessment: vitals, oxygen sats, LOC, and s/s of hypoxia, skin
can an RN place a pt on oxygen therapy if an order does not exist?
yes, RN can place the oxygen
once the pt is stablized, the RN should notify the provider & obtain a continuous oxygen order
FIO2
Fraction of Inspired Oxygen
* percent of oxygen a person is inhaling
* room air FIO2 is 21%
* with supplemental oxygen, FIO2 can reach 100%
nasal cannula
most common/ basic/ least invasive
* up to 6L/min (usually no more than 4)
* FIO2 24-44%
when placing a pt on a nasal cannula, at what rate will you usually start at?
2-3 L/min
what products can be harmful to a pt on oxygen?
- smoking (cigarettes, e-cigs, any flames)
- petroleum products (chapstick)
what areas are prone to skin breakdown with a nasal cannula?
- behind ears
- nasal mucus membranes
- under chin
- cheekbones
non-rebreather mask
delivers higher concentrations of oxygen with a reservoir bag (valve opens during expiration and closes during inhalation to increase FIO2/prevent CO2)
- treats hypoxia, decreases breathing workload
- FIO2 60-100% at 10-15 L/min
venturi/venti mask
controls exact concertration of oxygen
* FIO2 24-60% at 4-12L/min
* commonly used for COPD
when documenting oxygen therapy, what should you include?
- date & time of oxygen initiated (RA & supplemental %)
- method of delivery
- flow rate
- pt response to O2
- condition of skin
- respiratory assessment
- patient/family ed
incentive spirometry (IS)
prevents post-op pulmonary complications (atelectasis) by expanding lungs
* voluntary deep breathing (focuses on deep inhalation)
* visual feedback
* explain procedure before surgery (pt should do 10 breaths/ 2 hours)
if a pt is laying still with high respirations per minute, is it a concern?
yes
oxygen toxicity
develops when a person breaths 100% O2 for > 12 hours
* results from effects on CNS & pulmonary systems
s/s of oxygen toxicity
- pallor, sweating, N/V
- seizures, vertigo, muscle twitching
- hallucinations, visual changes, anxiety
- chest pain, dyspnea
what causes pulmonary diseases?
alterations in the lungs or heart, causes scarring of lung tissue
