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nursing 20030 > interventions for alterations on oxygenation > Flashcards

interventions for alterations on oxygenation Flashcards

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1
Q

O2 is required for…

A

creating energy

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2
Q

what is CO2

A

by-product of energy production and is not used by the body

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3
Q

O2 and CO2 are exchanged between the environment and the cells through…

A

ventilation, respiration, and perfusion

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4
Q

what is ventilation

A

movement of air into and out of lungs

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5
Q

what is respiration

A

gas exchange between atmospheric air in the alveoli and the capillaries

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6
Q

what is perfusion

A

oxygenated capillary blood passes through the body tissues for use

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7
Q

what are the two distinct phases of ventilation

A

inspiration and expiration

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8
Q

describe inspiration

A

-diaphragm and intercostal muscles contract, enlarging the thorax and decreasing intrathoracic pressure, which allows air to rush in
-active, requires energy

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9
Q

describe expiration

A

-diaphragm and intercostal muscles relax, cuasing thorax to get smaller and increase pressure, which forces air our of the lungs
-passive

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10
Q

describe the regulation of ventilation

A

-regulated by CNS, chemoreceptors and baroreceptors
-drive to breathe is the recognition of increasing CO2 and hydorgen ions in the blood (by chemoreceptors)
-propriorecpetors send signal to increase ventilation with increased physical activity
-influenced by airway resistance, muscle tone, lung compliance, abdominal pressure, pleural space

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11
Q

what is the functional unit of respiratory system

A

-alveoli
-surrounded by cpillaries, gases move between them through diffusion
-alveoli collapse -> cant touch capillary -> impaired gas exchange

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12
Q

what is perfusion impacted by?

A

body position, activity level, adequacy of blood supply, and proper cardiovascular function

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13
Q

describe hyperventilation

A

-ventilation in excess of what is required to remove CO2
-possible causes include: anxiety, infection/fever, hypoxia, DKA, aspirin overdose, acid-base issue
-tx: slow breathing, use bag to rebreath CO2

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14
Q

describe hypoventilation

A

-ventilation is inadequate to meet the body’s oxygen demand OR is inadequate to remove sufficient CO2
-possible causes: COPD, obesity hypoventilation syndrome, atelectasis
-tx: ventilator

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15
Q

describe hypoxia

A

-inadequate oxygen available for cells
-possible causes: decreased Hgb, hypoventilation, aspiration, poor tissue perfusion
-tx: fix whats causing it

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16
Q

what are some signs and symptoms of acute hypoxia

A

-anxiety
-restlessness
-confusion
-drowsiness
-increased pulse
-dyspnea
-tachypnea
-increased BP
-cardiac arrythmias

bolded shit are first signs, CNS is first to suffer

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17
Q

what are some signs and symptoms of chronic hypoxia

A

-pallor
-fatigue
-altered thought process
-HA
-CP
-clubbing
-anorexia
-constipation
-decreased urine

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18
Q

name some cardiovascular functions

A

-pumps blood through the body delivering oxygen and nutrients and removing waste (i.e. circulating)
-plumbing and electrical function

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19
Q

describe the plumbing function of the heart

A

-pump (heart)
-pipes (vessels)

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20
Q

describe the electrical function of the heart

A

-pacemaker (SA node)
-electrical signla needs to move in an orderly fashion for the cardiac tissue to adequately function

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21
Q

name some different altered cardiovascular functions

A

-arrhythmia
-ischemia
-cardiac valve stenosis
-heart failure
-hypovolemia

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22
Q

describe arrhythmia

A

electrical conduction problem causing irregular or ineffective beats

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23
Q

describe ischemia

A

-impaired O2 delivery
-myocardial ischemia (causes chest pain) can lead to myocardial infarction
-angina
-CVA

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24
Q

describe cardiac valve stenosis

A

causes ineffective pumping

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25
Q

describe heart failure

A

inefficient pumping of blood supply

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26
Q

describe hypovolemia

A

inadequate blood supply

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27
Q

what is the #1 thing to assess r/t oxygenation

A

assess to ensure patient is not in acute respiratory failure

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28
Q

describe the assessment of history r/t oxygenation

A

-ask questions to identify abnormal function of cardiovascular/respiratory system
-can ask yes or no questions if midly dyspneic or ask if anyone else can help answer questions

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29
Q

describe the physical assessment r/t oxygenation

A

-inspect, palpate, auscultate
-consider expected age-related findings

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30
Q

what blood work can be used to evaluate oxygenation

A

-ABG
-CBC
-cardiac enzymes (CK-MB and troponin)
-cholesterol, lipids, triglycerides

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31
Q

what microbiology lab is used to evaluate oxygenation

A

culture and sensitivity

throat or nasopharyngeal swab, sputum samples

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32
Q

what cardiac function diagnostic tests can be used to evaluate oxygenation

A

-EKG/ECG
-holter monitor
-echocardiogram (throacic or esophageal) (TTE/TEE)
-cardiac stress test
-cardiac angiography

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33
Q

what pulmonary function diagnostic tests can be used to evaluate oxygenation

A

-CXR
-capnography
-lung scan (VQ scan)
-pulmnary function tests
-thoracentesis
-bronchoscopy

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34
Q

what are two types of nursing diagnoses r/t oxygenation

A

-oxygenation is the problem
-oxygenation problems are the cause of other problems

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35
Q

what are some nursing diagnoses examples where oxygenation is the problem

A

-ineffective airway clearance
-impaired gas exchange
-ineffective breathing pattern

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36
Q

what are some examples of nursing diagnoses where oxygenation problems are the cause of other problems

A

-impaired cardiac output
-impaired verbal communication
-activity intolerance
-risk for infection
-anxiety
-fatigue

37
Q

what are some different health promotion thingys for oxygenation

A

-healthy lifestyle
-disease management
-vaccinations
-environmental pollutants

38
Q

health promotion

healthy lifestyle

A

-manage modifiable risk factors (diet, exercise, alcohol, smoking, stress/anxiety)
-smoking cessation

39
Q

health promotion

disease management

A

-BP, cholesterol, triglycerides, HDL, LDL
-COPD, asthma, emphysema, HF

40
Q

health promotion

vaccinations

A

-yearly influnza vaccine for everyone (6mo and older)
-pneumococcal disease (pneumonia, meningitis) for elderly and at risk populations
-COVID-19 vaccine

41
Q

health promotion

environmental pollutants

A

-frequent management of dust at home
-using mask when exposure to irritants is likely
-occupational exposures can trigger respiratory problems
-monitor for pollution alerts and pollen alerts
-use air filters and air conditioners

42
Q

name some interventions for altered respiratory function

A

-dyspnea management
-airway maintenance
-promotion of lung expansion

43
Q

describe dyspnea management

A

-anxiety management
-energy conservation techniques
-pursed lip breathing
-diaphragmatic breathing

44
Q

describe airway maintenance

A

-mobilization of secretions (oral hydration, coughing, C&DB, IS, chest physiotherapy, suctioning)
-management of artificial airways
-CPR

45
Q

describe promotion of lung expansion

A

-positioning
-pain control
-C&DB
-IS
-management of chest tubes

46
Q

dyspnea management

describe the therpeutic effects of pursed lip breathing (smell the roses, blow out the candles)

A

-reduces anxiety/panic by slowing expiration and preventing collapse of smaller airways
-gives sense of control

47
Q

dyspnea management

describe how to pursed lip breathe

A

-sit upright
-inhale through the nose to the count of 3
-exhale slowly and evenly through pursed lips to the count of 7
-contract abdominal muscles while exhaling
-repeat

48
Q

dyspnea management

describe the therapeutic effects of diaphragmatic breathing/belly breathing

A

-to create a more functional respiratory pattern, especially for ppl with COPD
-decreases RR, increases gas exchange in more alveoli

49
Q

dyspnea management

describe how to diaphragmatic breath

A

-place one hand on abdomen and one on chest
-inhale through nose while letting abdomen protrude as mush as possible
-exhale through pursed lips while contracting abdominal muscles and pressing upward and inward with hand
-repeat for 1 minute
-practice several times a day

50
Q

airway maintenance

describe oral hydration

A

2-3 liters of oral fluid intake/day to help thin secretions

51
Q

airway maintenance

describe coughing

A

-productive or nonproductive
-effective (better) or noneffetive (not better)
-medications (expectorants, suppressants, lozenges)

52
Q

airway maintenance

what do expectorants do

A

make it easier to cough out shit

53
Q

airway maintenance

what do suppressants do

A

reduce drive to cough

54
Q

airway maintenance

what do lozenges do

A

-local anesthetic effect
-moisten shit up

55
Q

airway maintenance

describe management of artificial airways

A

-endotracheal tube (intubation)
-tracheostomy

56
Q

which is more invasive? tracheostomy or endotracheal tube

A

endotracheal tube

57
Q

describe deep breathing exercises

A

-in through the nose and out through the mouth
-inhale deeply enough to move the bottom ribs

58
Q

describe incentive spirometry

A

-semi-fowlers position
-splint PRN
-exhale normally, place mouth on mouthpiece and inhale through the mouth. at full inhalation, instruct to hold breath for 3 seconds if possible
-exhale normally

59
Q

how often should you use incentive spirometry for best effect

A

10 times every hour while awake

cause cough if done right

60
Q

following breathing exercises, secretions may have been mobilized and what can help clear the secretions

A

cough

61
Q

describe chest physiotherapy

A

-helps mobilize secretions for large amounts of secretions or ineffective coughs
-selective usefulness in some populations
-usually performed by RT, PT, specially trained nurses
-use of percussion, vibration, and postural drainage

62
Q

when is suctioning required

A

when patient is unable to to clear secretions

perform as often as needed, but avoid excessive suctioning

63
Q

what types of suctioning remove secretions from the pts mouth or upper throat

A

oropharynx or nasopharynx

64
Q

does tracheal suctioning require clean or sterile technique

A

sterile

65
Q

what are some risks of suctioning

A

-hypoxia
-tissue trauma/bleeding
-anxiety
-death (from hypoxia and cardiac stress)

66
Q

what PPE should be used when suctioning

A

gloves, goggles, mask, gown

exposure to secretions is likely

67
Q

promotion of lung expansion

positioning

A

-upright, fowlers, or semifowlers
-tripod
-prone

68
Q

promotion of lung expansion

management of chest tubes

A

-tube placed in the pleural space to remove trapped air, blood, or fluid
-creates negative pressure, allowing lungs to expand more fully

69
Q

room air is __% oxygen

A

21%

70
Q

is oxygen administered with an order?

A

yep, treated like a medication
-must be maanger by a licensed person (LPN, RN, RT, MD, etc)
-however, in an emergency treat the pt first, then get an order

71
Q

and are some indications for oxygen administration

A

-hypoxia
-tachypnea
-tachycardia/CP
-often administered while recovering from anesthesia or while using opioids

72
Q

name some saftey shit to consider with oxygen administration

A

-it is combustable and is often stored in compressed gas cynlinders
-monitor tubing for effectiveness and evaluate over effectiveness of this therapy

73
Q

what is a flow meter

A

-attaches to the O2 outlet to adjust the amount of O2 being delivered
-verify flow meter level regularly (check each time you enter the room)

74
Q

what is a humidifier

A

-container of sterile water which provides moisture to oxygen
-sterlie water prevents infection
-prevents drying, cracking and bleeding of nasal mucosa

75
Q

what is a portable compressed oxygen tank

A

-store upright in an appropriate holder
-verify how much oxygen is iin the tank prior to and during use
-use for transportation, short-term

76
Q

what is a compressor

A

-used in homes and long term care
-changes room air into medical grade oxygen using filters and sieves

77
Q

describe high flow oxygen system

A

-provides total amount of inspired air
-oxygen delivery does NOT vary with breathing pattern/depth

78
Q

describe low flow oxygen system

A

-provides only part of the total inspried air
-more comfy
-oxygen delivery varies with breathing pattern/depth

79
Q

name some common O2 delivery devices

A

-NC
-venturi mask
-simple face mask
-non rebreather mask
-biPAP/CPAP
-ventilator

80
Q

O2 delivery devices

nasal cannula

A

-most common method of delivery
-effective, easy to apply, most comfy
-can be used with mouth breathers
-client can eat, drink, talk, and perform ADLs with NC in place
-generally 1-6L/minute
-specialized NC can deliver high flow oxygen

81
Q

O2 delivery devices

venturi mask

A
  • high flow system
  • 4-6L/min
  • oxygen mixes with the air
  • humidification used
82
Q

O2 delivery devices

simple face mask (SMF)

A

-covers the mouth and nose
-interferes with talking, eating, and drinking
-may lead to claustrophobic reaction
-not suitable for COPD pts
-5-8L/min

-trach collar is a similar device, for use with tracheostomies

83
Q

O2 delivery devices

non-rebreather mask (NRB)

A

-delivery system with a bag attached to the bottom of the mask
-oxygen supply flows into reservoir bag
-has a valve that lergely prevents the inhalation of room or exhaled air
-10-15L/min

84
Q

O2 delivery devices

biPAP

A

-bilevel postive airway pressure
-mechanical ventilator to assist inspiration
-creates different pressures in the airways during inhalation and exhalation
-positive pressure helps to prevent atelectasis
-noninvasive ventilator

85
Q

O2 delivery devices

CPAP

A

-continuous positive airway pressure
-air under constant pressure
used to decrease periodic hypoxemia
-used for sleep apnea

86
Q

O2 delivery devices

ventilator

A

-artifical ventilation of the lungs
-requires artificial pathway
-rate, depth, FiO2, and pressures can be set on ventilator

87
Q

describe evaluation of oxygenation therapies

A

-titrate O2 to mainatin goal SpO2
-SpO2 (pulse oximetry)
-arterial blood gases

88
Q

describe pulse oximetry

A

-non invasive
-generally 95-99% in normal
-% O2 carried by the available Hgb to peripheral tissues
-cold hands/poor circulation can influence results

89
Q

describe aterial blood gases

A

-invasive
-used when precise values are necessary

nursing 20030 (31 decks)

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