interventions for alterations on oxygenation Flashcards
O2 is required for…
creating energy
what is CO2
by-product of energy production and is not used by the body
O2 and CO2 are exchanged between the environment and the cells through…
ventilation, respiration, and perfusion
what is ventilation
movement of air into and out of lungs
what is respiration
gas exchange between atmospheric air in the alveoli and the capillaries
what is perfusion
oxygenated capillary blood passes through the body tissues for use
what are the two distinct phases of ventilation
inspiration and expiration
describe inspiration
-diaphragm and intercostal muscles contract, enlarging the thorax and decreasing intrathoracic pressure, which allows air to rush in
-active, requires energy
describe expiration
-diaphragm and intercostal muscles relax, cuasing thorax to get smaller and increase pressure, which forces air our of the lungs
-passive
describe the regulation of ventilation
-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
what is the functional unit of respiratory system
-alveoli
-surrounded by cpillaries, gases move between them through diffusion
-alveoli collapse -> cant touch capillary -> impaired gas exchange
what is perfusion impacted by?
body position, activity level, adequacy of blood supply, and proper cardiovascular function
describe hyperventilation
-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
describe hypoventilation
-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
describe hypoxia
-inadequate oxygen available for cells
-possible causes: decreased Hgb, hypoventilation, aspiration, poor tissue perfusion
-tx: fix whats causing it
what are some signs and symptoms of acute hypoxia
-anxiety
-restlessness
-confusion
-drowsiness
-increased pulse
-dyspnea
-tachypnea
-increased BP
-cardiac arrythmias
bolded shit are first signs, CNS is first to suffer
what are some signs and symptoms of chronic hypoxia
-pallor
-fatigue
-altered thought process
-HA
-CP
-clubbing
-anorexia
-constipation
-decreased urine
name some cardiovascular functions
-pumps blood through the body delivering oxygen and nutrients and removing waste (i.e. circulating)
-plumbing and electrical function
describe the plumbing function of the heart
-pump (heart)
-pipes (vessels)
describe the electrical function of the heart
-pacemaker (SA node)
-electrical signla needs to move in an orderly fashion for the cardiac tissue to adequately function
name some different altered cardiovascular functions
-arrhythmia
-ischemia
-cardiac valve stenosis
-heart failure
-hypovolemia
describe arrhythmia
electrical conduction problem causing irregular or ineffective beats
describe ischemia
-impaired O2 delivery
-myocardial ischemia (causes chest pain) can lead to myocardial infarction
-angina
-CVA
describe cardiac valve stenosis
causes ineffective pumping
describe heart failure
inefficient pumping of blood supply
describe hypovolemia
inadequate blood supply
what is the #1 thing to assess r/t oxygenation
assess to ensure patient is not in acute respiratory failure
describe the assessment of history r/t oxygenation
-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
describe the physical assessment r/t oxygenation
-inspect, palpate, auscultate
-consider expected age-related findings
what blood work can be used to evaluate oxygenation
-ABG
-CBC
-cardiac enzymes (CK-MB and troponin)
-cholesterol, lipids, triglycerides
what microbiology lab is used to evaluate oxygenation
culture and sensitivity
throat or nasopharyngeal swab, sputum samples
what cardiac function diagnostic tests can be used to evaluate oxygenation
-EKG/ECG
-holter monitor
-echocardiogram (throacic or esophageal) (TTE/TEE)
-cardiac stress test
-cardiac angiography
what pulmonary function diagnostic tests can be used to evaluate oxygenation
-CXR
-capnography
-lung scan (VQ scan)
-pulmnary function tests
-thoracentesis
-bronchoscopy
what are two types of nursing diagnoses r/t oxygenation
-oxygenation is the problem
-oxygenation problems are the cause of other problems
what are some nursing diagnoses examples where oxygenation is the problem
-ineffective airway clearance
-impaired gas exchange
-ineffective breathing pattern
what are some examples of nursing diagnoses where oxygenation problems are the cause of other problems
-impaired cardiac output
-impaired verbal communication
-activity intolerance
-risk for infection
-anxiety
-fatigue
what are some different health promotion thingys for oxygenation
-healthy lifestyle
-disease management
-vaccinations
-environmental pollutants
health promotion
healthy lifestyle
-manage modifiable risk factors (diet, exercise, alcohol, smoking, stress/anxiety)
-smoking cessation
health promotion
disease management
-BP, cholesterol, triglycerides, HDL, LDL
-COPD, asthma, emphysema, HF
health promotion
vaccinations
-yearly influnza vaccine for everyone (6mo and older)
-pneumococcal disease (pneumonia, meningitis) for elderly and at risk populations
-COVID-19 vaccine
health promotion
environmental pollutants
-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
name some interventions for altered respiratory function
-dyspnea management
-airway maintenance
-promotion of lung expansion
describe dyspnea management
-anxiety management
-energy conservation techniques
-pursed lip breathing
-diaphragmatic breathing
describe airway maintenance
-mobilization of secretions (oral hydration, coughing, C&DB, IS, chest physiotherapy, suctioning)
-management of artificial airways
-CPR
describe promotion of lung expansion
-positioning
-pain control
-C&DB
-IS
-management of chest tubes
dyspnea management
describe the therpeutic effects of pursed lip breathing (smell the roses, blow out the candles)
-reduces anxiety/panic by slowing expiration and preventing collapse of smaller airways
-gives sense of control
dyspnea management
describe how to pursed lip breathe
-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
dyspnea management
describe the therapeutic effects of diaphragmatic breathing/belly breathing
-to create a more functional respiratory pattern, especially for ppl with COPD
-decreases RR, increases gas exchange in more alveoli
dyspnea management
describe how to diaphragmatic breath
-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
airway maintenance
describe oral hydration
2-3 liters of oral fluid intake/day to help thin secretions
airway maintenance
describe coughing
-productive or nonproductive
-effective (better) or noneffetive (not better)
-medications (expectorants, suppressants, lozenges)
airway maintenance
what do expectorants do
make it easier to cough out shit
airway maintenance
what do suppressants do
reduce drive to cough
airway maintenance
what do lozenges do
-local anesthetic effect
-moisten shit up
airway maintenance
describe management of artificial airways
-endotracheal tube (intubation)
-tracheostomy
which is more invasive? tracheostomy or endotracheal tube
endotracheal tube
describe deep breathing exercises
-in through the nose and out through the mouth
-inhale deeply enough to move the bottom ribs
describe incentive spirometry
-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
how often should you use incentive spirometry for best effect
10 times every hour while awake
cause cough if done right
following breathing exercises, secretions may have been mobilized and what can help clear the secretions
cough
describe chest physiotherapy
-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
when is suctioning required
when patient is unable to to clear secretions
perform as often as needed, but avoid excessive suctioning
what types of suctioning remove secretions from the pts mouth or upper throat
oropharynx or nasopharynx
does tracheal suctioning require clean or sterile technique
sterile
what are some risks of suctioning
-hypoxia
-tissue trauma/bleeding
-anxiety
-death (from hypoxia and cardiac stress)
what PPE should be used when suctioning
gloves, goggles, mask, gown
exposure to secretions is likely
promotion of lung expansion
positioning
-upright, fowlers, or semifowlers
-tripod
-prone
promotion of lung expansion
management of chest tubes
-tube placed in the pleural space to remove trapped air, blood, or fluid
-creates negative pressure, allowing lungs to expand more fully
room air is __% oxygen
21%
is oxygen administered with an order?
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
and are some indications for oxygen administration
-hypoxia
-tachypnea
-tachycardia/CP
-often administered while recovering from anesthesia or while using opioids
name some saftey shit to consider with oxygen administration
-it is combustable and is often stored in compressed gas cynlinders
-monitor tubing for effectiveness and evaluate over effectiveness of this therapy
what is a flow meter
-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)
what is a humidifier
-container of sterile water which provides moisture to oxygen
-sterlie water prevents infection
-prevents drying, cracking and bleeding of nasal mucosa
what is a portable compressed oxygen tank
-store upright in an appropriate holder
-verify how much oxygen is iin the tank prior to and during use
-use for transportation, short-term
what is a compressor
-used in homes and long term care
-changes room air into medical grade oxygen using filters and sieves
describe high flow oxygen system
-provides total amount of inspired air
-oxygen delivery does NOT vary with breathing pattern/depth
describe low flow oxygen system
-provides only part of the total inspried air
-more comfy
-oxygen delivery varies with breathing pattern/depth
name some common O2 delivery devices
-NC
-venturi mask
-simple face mask
-non rebreather mask
-biPAP/CPAP
-ventilator
O2 delivery devices
nasal cannula
-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
O2 delivery devices
venturi mask
- high flow system
- 4-6L/min
- oxygen mixes with the air
- humidification used
O2 delivery devices
simple face mask (SMF)
-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
O2 delivery devices
non-rebreather mask (NRB)
-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
O2 delivery devices
biPAP
-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
O2 delivery devices
CPAP
-continuous positive airway pressure
-air under constant pressure
used to decrease periodic hypoxemia
-used for sleep apnea
O2 delivery devices
ventilator
-artifical ventilation of the lungs
-requires artificial pathway
-rate, depth, FiO2, and pressures can be set on ventilator
describe evaluation of oxygenation therapies
-titrate O2 to mainatin goal SpO2
-SpO2 (pulse oximetry)
-arterial blood gases
describe pulse oximetry
-non invasive
-generally 95-99% in normal
-% O2 carried by the available Hgb to peripheral tissues
-cold hands/poor circulation can influence results
describe aterial blood gases
-invasive
-used when precise values are necessary
