Lecture 10: Resp Flashcards
alveoli vs trachea
alveoli has TONS of surface area for gas exchange
what is the main goal of ventalation
air in and out
- to get our tissues and remove CO2 from out of the body
what is respiration
similar to ventilation, but has more to do with gas exchange
what does our O2 stat do
- measures O2 level of hemoglobin
- saturated hemoglobin absorbs different amount of light from the O2 stat, in comparison to unsaturated hemoglobin in the finger
normal o2 sat
target >95%
- in hospital 92%
o2 85% = bad = hemoglobin not delivering enough o2 patient will crash
how does an oximeter work
- 2 wavelengths emitted
- light is absorbed (partially) by hemoglobin
- amount differs depending on whether it is saturated or unsaturated w o2
- processor can compute the proportion of hemoglobin which is oxygenated
Optimizing and ventilation of patient
positioning: tripod position
incentive spirometry
- mech device
- makes them take a deep breath, and get more o2 into their body
- make sure pt breathes in and holds it to see how high the ball will go
- try to get ball higher each time
- mimics normal intake and breathing
- helps pt get off o2 faster
atelectasis
- complete or partial collapse of the lung segment
- alveoli become deflated
- can allow fluid to build up in the bottom
- won’t hear anything in a stethoscope, most common in post op patients
most common cause: postoperative hypoxemia
diagnoses: hypoxemia, mild leukocytosis, chest x-ray
treatment: continuous positive airway pressure
pneumonia
- acute inflammation and infection of lower airway
- BIG hospital admission
- defense mech become overwhelmed
- may allow aspiration
how do you get pneumonia
microbes present in air, inhaled
types of pneumonia
- community-acquired (CAP): lower resp infection of lung in community or during first 2 days of hospitalization
- Hospital-acquired (HAP): acquired 48 hrs or longer after admission and not incubating at time of hospitalization
Community-aquired pneumonia bacteria
streptococcus pneumoniae
hospital acquired pneumonia bacteria
many of organisms enter lungs after aspiration of the particles from the pt’s own pharynx
pt has feeding tube - make sure at 30 degrees or higher
pneumococcal pneumonia
harder to treat bc its becoming resistant
pneumonia nurse interventions
- vaccinations
- reposition client q2h
- assist clients at risk for aspiration
- follow strict asepsis
how can pneumonia be diagnosed?
leukocytosis
what is leukocytosis?
- elevated WBC
- normal counts are 5-10x109/L or 5000-10,000/mm3 (microlitres)
hypoxemia vs hypoxia
hypoxemia: low oxygen in the blood
hypoxia: low o2 levels in the tissue
hypoxemia is most common cause of hypoxia
what goes up after surgery
WBC
supplemental oxygen
- ordered by physician
- you want to maintain at least 92%
- for COPD 88%
complications of oxygen therapy
- combustion
- o2 toxicity
- co2 narcosis
what is combustion
supports combustion and increases rate of burning
o2 toxicity
- from prolonged exposure to high levels of o2
- sympt: cough, chest pain, etc
co2 narcosis
- copd pts develop tolerance for high co2 levels
resistant organism examples
- methicillin-resistant staphylococcus aureus (MRSA)
- Vancomycin-resistant enterococci (VRE)
- Carbapenemase-producing organism (CPO)
- penicillin-resistant streptococcus pneumoniae
what % of HAI’s can be prevented
30%
Standard precautions
- all pt’s
- gloves, gown (when body fluids flowing), mask (within 1m), goggles/face shield (within 1 m w body fluids or coughing)
contact precautions
- c. dff, influenza, meningitis, MRSA, varicella
- gloves, gown
droplet precautions
- influenza, meningitis, pertussis
- private/semi-private room
- everything
airborne
- measles, TB, varicella
- private room w negative. airflow
- everything, + negative pressure, and N-95
enhanced resp and contact precautions
- hemorrhagic fevers, pandemic influenza, SARS
- private room w neg airflow
- n-95 and all precautions
