L1+2 Oxygen And Suction Flashcards
Process of gas exchange
Pulmonary ventilation
Alveolar gas exchange
Transport of oxygen and carbon dioxide
Systematic diffusion
Transportation of oxygen and carbon dioxide
Flow of co2 and o2
Where o2 goes?
What affect rate of oxygen transport
O2 from lung goes into tissue
Co2 goes from tissue to lung (exhale)
o2 combined lossely with hemoglobin in rbs into tissue as oxyhemoglobin
Exercise, cardiac output
Factors that affect respiratory function
Age
Environment
lifestyle
Health status
Stress
Medication
Affecting respiratory function-age
Neonate
Lung filled with amniotic fluid
Fully expand by 2wks old
Older adult
More rigid chest wall and less elastic
Less cough reflex
Environment
Higher altitude=lower po2cold or too hot, cold-) must expend more energy to maintain temperature
How lifestyle affect respiratory function?
Have exercise vs didnt
Lifestyle with physical exercise will increase rate and depth of respiration
Sit-) lack of alveolar expansion and deep breath pattern
Health status& medication affecting respiratory function
Respiratory system disease affect oxygenation of blood
Medication can reduce rate and depth of breathing such as diazepam and opioid
RR has to be monitored with nurse when administering these drugs
Stress affecting respiratory function
Pow increase and pco2 decrease as hyperventilation
Light head, numbness of finger and tows and mouth
Short term symptoms
Other a alteration in respiratory function
Airway patency
Upper airway obstruction
Due to foreign object obstruction e.g. fall tongue
Lower respiratory obstrution
Due to accumulate of mucus or inflammatory exudates
Client may have restlessness, dyspnea
Tachypnea
Bradypnea
Tachypnea: fever, pain, hypoxemia
Brady: drug affected, brain injury
Heath history taking related to respiratory disease
History of respiratory disease
Presence of risk factors
Lifestyle related to respiratory problems
Current respiratory problems
Presence of cough and sputum
Present of chest pain
Environmental history
Medical history
Inspection to sputum
White/ clear: viral infection
Yellow or green: bacteria infection
Black: coal dust
Rusty (blood): pneumococcal pneumonia, TB
Hemoptysis: small to large amount of frank blood
Pink& frothy (泡）
Foul smelling (臭
Other assesment for physical examination
Palpation
Pulse
Skin tempt
Tenderness
Percussion敲
Area of consolidation/ air pocket
Auscultation
Breathing sound
Heart sound
Assesment- pulse oximeter
SpO2=95-100
remove acrylics nails
Remove dirt and skin oil
Minimize patient movement
Assesment- arterial blood gases (ABG)
Sample taken from radial, bradial, femoral pulse
Assesment-sputum samples
-chest x ray
- allergy test
Microscope evaluation of sputum
Xray: provide anterior-posterior view of heart& lung
Allergy test: indentify antigen that may cause hypersensitivity
Assesment- spirometry- peak flow monitoring
Measure the amount of air can be exhale with forcible effort
Diagnosis
-have what problem?
Impaired gas exchange
Activity intolerance
Planning
To expectorate secretion clearly
Maintain patent airway
Improve comfort
Improve on ability to physical activity
Implementation to facilitate pulmonary ventilation
Chest tubes
Artificial airway
Oxygen therapy
Suctioning
Hydration
Incentive spirometry
Promote oxygenation
Raise the bed to semi fowlers or fowlers position
Encourage frauent change if position
Encourage taking deep breath
Deep breathing
Aims*2
Aims
1. Remove secretion
2. Avoid dyspnea
Inhale slowly& evenly thru nose until greatest chest expansion
Hold the breath for 2-3 sec
Cough:
Take deep breath and hold for 2-3 sec, then cough 1-2
Deep breathing for dypsnea client
Ask client to take deep breath as usual using nose
Exhale thru pursed lips
Ask client to tighten abdominal muscles
Incentive spirometry
Sit in upright position
Hold the meter in upright position
Exhale normally
Lips cover the mouthpiece and inhale slowly and deeply
Hold the breath for 2-6 sec
May have cough—) deep breath may loosen mucus
Cough can facilitate removal.
Repeat 4-5 times hourly
Hydration
Nebulizers （面罩）deliver humidity
Humidifier
Artificial airway
Aims?
Types of artificial airway?
Maintain patent airway to client whose airway is obstructed
Oropharyngeal airway
Can hold falling tongue
No gag reflex
Nasopharyngeal airway
Flexible tube insert into nose
Reinsert every 8hrs avoid mucosa necrosis
Endotracheal tube
Thru mouth or nose into trachea
Tracheostomy
Opening into trachea to form a new airway
Concentration of oxygen given? xx%
Why client have hypoxemia?
21%
Loss of lung tissue
Decreased ability to diffuse O2
Anemia leads to not enough rbc to carry O2
Oxygen supply system have what?
Portable system
Wall outlet
Connect humidifier bottle filled with distilled water to the wall outlet
4L/min
Type of flow system
Nasal cannula
Face mask
Oxygen tent
Transtracheal catheter
Introduce oxygen delivery systems- nasal cannula
Nasal cannula
Most common
Inexpensive
Relatively comfy
Flow rate 2-6L
Introduce oxygen delivery system- face mask
Difficult in fit and tolerance to some client
5-8L
Introduce oxygen supply system-transtracheal catheter
Surgically created tract
Clean 2-4 times a day
>15L per minute
Introduction to oxygen supply system (high flow)
Venturi mask, non-rebreathing mask
Venturi mask
4-10L
Non-rebreathing mask
Highest concentration 95-100%
>10L/min
Safety precautions of oxygen therapy
No smoking
Stay up- secretion will drain down to airway
Percussion, vibration, postural drainage
Percussion: rhythmic clapping of chest wall with cupped hand
Suctioning type
Oropharyngeal suctioning
Nasopharyngeal suctioning
Endotracheal suctioning
Tracheostomy suctioning
Indication to suctioning
Dyspnea
Unable to cough up secretion
Tachycardia
Suctioning precauction
Dont apply too frequently cuz:
Will increase intracranial pressure
Cause bronchospasm
Cause o2 saturation decrease
Nasopharyngeal suctioning IMPORTANT STUFF
use sterile water
Use sterile gloves
Do not apply suction when insertion
10-15cm
Medication for oxygenation
Bronchodilators
Cough depressant
Expectorant
Anti-inflammatory drugs
Bronchodilators
Inhalator
Reduce bronchospasm
Open tight airway
Avoid increase of hr/ bp
Increased BP—) do ECG
Medication for oxygenation—) anti-inflammatory drugs
E.g. glucocorticoid
Decrease edema and inflammation
MOUTH WASH AFTER ADMINISTRATION
First broncodilator then anti-inflammatory
Medication- expectorant
Expectorant helps in break up mucus
Cough suppressant given when chronic cough affect sleeping e.g. codeine
Diagnosis of oxygenation problem
Ineffective airway clearance
Inability to clear secretions/ obstruction in respiratory tract to maintain a clear airway
Ineffective breathing pattern
Inhale or exhale do not have adequate ventilation
Impaired gas exchange
Excess of deficit of carbon dioxide elimination at alveolar -capillary membrane
