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CSON IM1 > EXAM 2- Oxygenation > Flashcards

EXAM 2- Oxygenation Flashcards

1
Q

poor oxygenation

A

a decreased oxygen level in the blood

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2
Q

SpO2

A

measure of how saturated hemoglobin are with oxygen (measured with pulse oximetry)

hemoglobin-attached to blood to carry it throughout the body

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3
Q

what is the normal accepted O2 sat level?

A

95-100%

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4
Q

for pts with illness or respiratory distress with supplemental oxygen, what O2 saturation should you aim to keep them above?

A

92%

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5
Q

what is one of the FIRST signs of poor oxygenation?

A

restlessness- pt is struggling to recover and catch their breath, causing low amounts of O2 flow to the brain (leading to confusion)

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6
Q

signs/symptoms of poor oxygenation

A
  • 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

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6
Q

signs/symptoms of poor oxygenation

A
  • 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

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7
Q

what happens when O2 delievery is inadequate to meet the body’s metabolic demands?

A

tissue ischemia & cell death

leads to hypoxia

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8
Q

hypoxia

A

low oxygen in tissues

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9
Q

is restlessness an early or late sign of poor oxygenation?

A

both

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10
Q

do the lungs have a large surface area? why?

A

yes, the lungs have a large surface area (due to millions of alveoli) and are constantly exposed to the external environment

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11
Q

what is lung disease greatly influenced by?

A

what a pt is exposed to:
* environmental- season allergies, wind
* occupational- fumes, chemicals
* personal
* social habits- smoking

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12
Q

alveoli

A

air sacks in the lungs
(where oxygen exchange occurs)

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13
Q

know the anatomy of the repsiratory system/ lungs

A
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14
Q

what are pulmonary diseases? what are the types?

A

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

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15
Q

obstructive pulmonary disease

A

difficulty exhaling

chronic obstructive pulmonary disease (COPD)

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16
Q

restrictive pulmonary disease

A

difficulty inhaling

pulmonary fibrosis, sarcoidosis

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17
Q

clinical manifestations of respiratory alterations

A
  • 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
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18
Q

common anatomical locations of cyanosis

A
  • end of extremities (fingers, toes)
  • mouth, mucus membranes
  • tip of nose, inside nairs (nostrils)
  • earlobes
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19
Q

orthopnea

A

dyspnea when laying down

pt can breath better when propped/sitting up (allows lung expansion)

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20
Q

clubbing

A

occurs in heart & lung diseases that reduce levels of O2 in the blood
* chronically low on O2
* fingertips are wide, abnbormal nailbed angle

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21
Q

hypoxemia

A

low level of oxygen in the blood
* measured with SpO2 - oxygen saturation

hypo (low) + emia (blood)

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22
Q

hypoxia

A

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
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23
Q

what is the difference between arteries & veins?

A
  • arteries - bring in oxygenated blood
  • veins - carry away deoxygenated blood

air exchange occurs in alveoles (air sacks)

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24
Q

symptoms of hypoxia

early & late

A

EARLY:
* Restlessness
* Anxiety
* Tachycardia/ Tachypnea

LATE:
* Bradycardia
* Extreme restlessness
* Dyspnea (severe)

early RAT is late to BED

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25
Q

if a pt is having difficulty breating, what is the MINIMUM angle the HOB should be at?

A

30º

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26
Q

hypoventilation

A

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

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27
Q

what are some factors that can cause hypoventilation?

A
  • narcotics (morphine, versed)
  • sleeping
28
Q

hyperventilation

A

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

29
Q

what are some factors that can cause hyperventilation?

A
  • anxiety
  • exercise (overexertion)
  • pain
30
Q

what are some factors that can cause hyperventilation?

A
  • anxiety
  • exercise (overexertion)
  • pain
31
Q

atelectasis

A

collapses air sacs (alveoli)
* caused by lack of deep breaths or fluid buildup

32
Q

what can you do to prevent atelectasis in your pt?

A
  • early ambulation
  • Turn (increase chest/lung expansion), Cough (clear excretions, increase chest expansion), Deep Breathe
  • incentive spirometry - focuses on deep inhalation
33
Q

aspiration

A

passage of gastric contents (fluid or solid) into the lungs

can cause aspiration pneumonia

34
Q

what can you do to prevent aspiration?

A
  • assess pt’s ability to swallow
  • keep HOB elevated with tube feedings
  • thorough lung assessment
35
Q

what do you assess for when assessing the respiratory system?

A
  • 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)
36
Q

vesicular breath sounds

A

normal, no extra sounds

37
Q

fine crackles (rales) breath sounds

A

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

38
Q

course crackles (rales) breath sounds

A
  • low pitch (compared to fine crackles)
  • louder
  • lots of fluid/ gunk

encourage pt to cough, more common on inspiration

39
Q

wheezing breath sounds

A

more common on expiration
* high pitch (squeaking) or
* low pitch (snoring/moaning)

40
Q

rhonchi breath sounds

A

severe wheeze
* often clear after coughing
* low pitch

41
Q

bronchial breath sounds

A

normal sound over trachea
* hollow, tubular, clear sound

42
Q

diagnostic tests for assessing the respiratory system

A
  • imaging- chest x-ray, CT, MRI
  • arterial blood gases (ABG)
  • suptum culture & sensitivity
  • bronchoscopy
  • thoracentesis
43
Q

what does atelectasis appear as on a chest x-ray?

A

white grainy/fuzzy areas where fluid is present

black is good (air is present)

44
Q

sputum culture & sensitivity

A
  • culture- examine sputum to see what organisms are present
  • sensitivity- test which antibiotics will kill it
45
Q

CT scan

A
  • can be used with or without IV contrast dye
  • provides a trans sectional image, more sophisticated than x-ray
46
Q

MRI

A

Magnetic Residence Imaging
* highly sophisticated
* pts with metal implants/devices (pacemaker, rods/pins, defib) cannot obtain an MRI

47
Q

bronchoscopy

A

uses a flexible tube to check airway for abnormalities, remove gunk, and obtain a biopsy if needed

48
Q

thoracentesis

A

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

49
Q

what are some ways you can promote lung expansion for your pt?

A
  • position change/turn frequently - Q2 hours
  • keep pt upright
  • increase daily activites, adequate hyration
  • coughing exercises
  • deep breathing - incentive spirometry
50
Q

what are some ways you can promote lung expansion for post op pts?

A

educate pt before surgery on interventions to increase pt understanding

  • incentive spirometry
  • TCDB
  • splinting incision
51
Q

is oxygen a drug?

A

yes

52
Q

albuterol (Proair) MDI

A

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

53
Q

budesonide/ formeterol inhaled (Symbicort)

A

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

54
Q

what should you assess when assessing pts with oxygen therapy?

A
  • correct oxygen delivery device
  • correct flow rate (L/min)
  • respiratory assessment: vitals, oxygen sats, LOC, and s/s of hypoxia, skin
55
Q

can an RN place a pt on oxygen therapy if an order does not exist?

A

yes, RN can place the oxygen

once the pt is stablized, the RN should notify the provider & obtain a continuous oxygen order

56
Q

FIO2

A

Fraction of Inspired Oxygen
* percent of oxygen a person is inhaling
* room air FIO2 is 21%
* with supplemental oxygen, FIO2 can reach 100%

57
Q

nasal cannula

A

most common/ basic/ least invasive
* up to 6L/min (usually no more than 4)
* FIO2 24-44%

58
Q

when placing a pt on a nasal cannula, at what rate will you usually start at?

A

2-3 L/min

59
Q

what products can be harmful to a pt on oxygen?

A
  • smoking (cigarettes, e-cigs, any flames)
  • petroleum products (chapstick)
60
Q

what areas are prone to skin breakdown with a nasal cannula?

A
  • behind ears
  • nasal mucus membranes
  • under chin
  • cheekbones
61
Q

non-rebreather mask

A

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
62
Q

venturi/venti mask

A

controls exact concertration of oxygen
* FIO2 24-60% at 4-12L/min
* commonly used for COPD

63
Q

when documenting oxygen therapy, what should you include?

A
  • date & time of oxygen initiated (RA & supplemental %)
  • method of delivery
  • flow rate
  • pt response to O2
  • condition of skin
  • respiratory assessment
  • patient/family ed
64
Q

incentive spirometry (IS)

A

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)

65
Q

if a pt is laying still with high respirations per minute, is it a concern?

A

yes

66
Q

oxygen toxicity

A

develops when a person breaths 100% O2 for > 12 hours
* results from effects on CNS & pulmonary systems

67
Q

s/s of oxygen toxicity

A
  • pallor, sweating, N/V
  • seizures, vertigo, muscle twitching
  • hallucinations, visual changes, anxiety
  • chest pain, dyspnea
68
Q

what causes pulmonary diseases?

A

alterations in the lungs or heart, causes scarring of lung tissue

CSON IM1 (15 decks)

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