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medsurg > Managing Patients with Oxygenation Disorders > Flashcards

Managing Patients with Oxygenation Disorders Flashcards

Exam 1

1
Q

Indications of supplemental oxygen

A
  1. PaO2 is less than 60 mmHg
  2. SaO2 is less than 90%
  3. Physiological situations that indicate a need for oxygen
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2
Q

Physiological situations that indicate a need for oxygen

A

Fever
Infection
Anxiety
Anemia

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3
Q

Contraindications to Oxygen Administration

A
  1. Hypercapnia
  2. Hypocapnia
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4
Q

How is oxygen monitored and measured?

A
  1. Pulse oximetry
  2. Arterial Blood gas (ABG)
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5
Q

What is included in arterial blood gas (ABG)?

A

pH
PaO2
PaCO2
HCO3
SaO2

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6
Q

Normal ABG Values: pH

A

7.35–7.45

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7
Q

Normal ABG Values: PaO2

A

80–95 mm Hg

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8
Q

Normal ABG Values: PaCO2

A

35–45 mm Hg

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9
Q

Normal ABG Values: HCO3-

A

22–26 mEq/L

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10
Q

Normal ABG Values: SaO2

A

95%–100%

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11
Q

Noninvasive Oxygen Delivery Methods Low Flow include what

A
  1. Nasal canula
  2. Simple face mask
  3. Partial rebreather mask
  4. Nonrebreather mask
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12
Q

Noninvasive Oxygen Delivery Methods Low Flow: Nasal Canula (Delivery, areas of use)

A

Delivers 24% (1L/min)-44% (6L/min)

Used in all care settings and the home

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13
Q

What is the most common delivery method of O2?

A

Nasal Canula

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14
Q

Benefits of the Nasal Canula?

A

Most common
Most comfortable
Mobile
Less expensive

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15
Q

Noninvasive Oxygen Delivery MethodsLow Flow: Simple Face Mask

(Flow rate or delivery); how often is it used? What is it used for?

A

Flow rates 5-10 L/min or 40%-60%

Used short term

Helpful for transport

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16
Q

Noninvasive Oxygen Deliver MethodsLow Flow: Partial rebreather mask

A

Simple mask with reservoir bag attached
Reservoir bag filled with oxygen

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17
Q

Noninvasive Oxygen Deliver MethodsLow Flow: Partial rebreather mask (Flow rate and delivery)

A

Flow rate of 8-10L/min
50%-75% oxygen to patient

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18
Q

Noninvasive Oxygen Delivery MethodsLow Flow: Nonrebreather Mask

A

One-way valves between mask and bag
One-way valves on side of mask
Prevents rebreathing of CO2

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19
Q

Noninvasive Oxygen Delivery MethodsLow Flow: Nonrebreather Mask (flow rate and delivery)

A

Flow rate 10mL/min
90% oxygen to patient

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20
Q

What low flow oxygen delivery system is used for really emergent situations?

A

Nonrebreather mask

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21
Q

Noninvasive Oxygen Delivery MethodsHigh Flow include what?

A
  1. Venturi mask
  2. Tracheostomy collar
  3. Continuous positive airway pressure
    (CPAP)
  4. Bi-level positive airway pressure
    (BIPAP)
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22
Q

Noninvasive Oxygen Delivery MethodsHigh Flow: Venturi Mask- who is it used for specifically?

A

Patients with COPD

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23
Q

Noninvasive Oxygen Delivery MethodsHigh Flow: Venturi Mask (Flow rate and delivery)

A

Flow rate 2-15 L/min
Oxygen concentration 24%-60%

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24
Q

Noninvasive Oxygen Delivery MethodsHigh Flow: Tracheostomy collar- who is it used for?

A

Used for patients with tracheostomy

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25
Q

Noninvasive Oxygen Delivery MethodsHigh Flow: Tracheostomy collar-what is needed for it to function? What does it delivery?

A

Needs humidified oxygen
Can deliver supplemental oxygen

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26
Q

Continuous positive airway pressure (CPAP)

A
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27
Q

Bi-level positive airway pressure (BiPAP)

A
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28
Q

Long term oxygen therapy is indicated for?

A
  1. Indicated for chronic hypoxemia associated with chronic disease

2, May be indicated for specific activities (i.e., during sleep)

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29
Q

Long term Oxygen Therapy: Different forms it is available in?

A

Available in different forms
Liquid oxygen
Compressed oxygen
Oxygen concentrator

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30
Q

Complications of Oxygen Therapy

A
  1. Oxygen toxicity
  2. Absorption atelectasis
  3. Mucous membrane dryness
  4. Infection
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31
Q

Invasive Oxygen Delivery includes:

A
  1. Artificial airways- Endotracheal tube
  2. Artificial airways – Tracheostomy
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32
Q

Invasive Oxygen Delivery Endotracheal tube: How is it placed? What is this placement called? Who is intubation performed by?

A

Passed through the nose or mouth into the trachea

Placement is called intubation

Performed by a credentialed provider

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33
Q

Invasive Oxygen Delivery Endotracheal tube: Who is it managed by? Possible complications of it?

A

Managed by nurse and respiratory therapist

Complications: Unplanned extubation, aspiration, infection

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34
Q

Invasive Oxygen Delivery Tracheostomy tube: When is it indicated?

A

Indicated if mechanical ventilation is required >7-14 days

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35
Q

Invasive Oxygen Delivery Tracheostomy tube: What are the benefits?

A

Decreased airway resistance
Decreased work of breathing
Improved oral care
Improved suctioning
Improved patient comfort

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36
Q

Invasive Oxygen Delivery Tracheostomy Care includes:

A

Suctioning
Replace inner cannula
Clean stoma site
Maintain sterile tracheostomy dressing
Replace Velcro tracheostomy holder if soiled

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37
Q

Therapeutic modalities for oxygen?

A

Incentive spirometry
Chest physiotherapy
Nebulizer treatments
Intermittent positive-pressure breathing

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38
Q

Functions of the Respiratory System

A

Ventilation
Respiration
Acid-base balance
Speech
Sense of smell
Fluid balance

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39
Q

ASSESSMENTHistory of Present Illness could include:

A

Factors that exacerbate or improve symptoms
Pain
Cough
Changes in weight
Dyspnea

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40
Q

ASSESSMENTHealth History could include:

A

Current medications
Allergies
Past medical history
Previous surgeries
Family history
Occupation/Area of residence
Smoking history
Social history
Recent travel

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41
Q

Physical Assessment: Inspection includes:

A

Speech
Clubbing of fingernails
Nose
Mouth
Neck
Thorax
Vital signs

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42
Q

Physical Assessment technique includes:

A
  1. Inspection
  2. Palpation
  3. Percussion
  4. Auscultation
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43
Q

During a physical assessment, what are you palpating?

A

Trachea
Crepitus
Thorax

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44
Q

Diagnostic studies include:

A
  1. Pulse oximetry
  2. Capnography and Capnometry
  3. Sputum analysis
  4. Chest x-ray
  5. Pulmonary function test
  6. Bronchoscopy
  7. Thoracentesis
  8. Lung biopsy
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45
Q

Diagnostic Studies: Pulse oximetry

A

Saturation of hemoglobin with oxygen

95%-99%

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46
Q

Diagnostic Studies: Capnography and Capnometry

A

Continuous PaCO2 monitoring

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47
Q

Diagnostic Studies: Sputum analysis

A

Check for microorganisms and/or abnormal cell growth

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48
Q

Diagnostic Studies: Chest x-ray

A

Identify problems with lungs, heart, and pleural space

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49
Q

Diagnostic Studies: Pulmonary function test

A

Lung volumes
Lung functioning

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50
Q

Diagnostic Studies: Bronchoscopy

A

Direct visualization of respiratory tract
Analysis of tissue specimen
Biopsy

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51
Q

Diagnostic Studies: Thoracentesis

A

Needle into pleural space to remove specimen, fluid, or air

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52
Q

Diagnostic Studies: Lung biopsy

A

Removal of lung tissue for analysis

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53
Q

Infectious Respiratory IllnessInfluenza:

How contagious?

Last flu pandemic?

What types exist?

A

Highly contagious infection
Last flu pandemic was the H1N1 2009
There are three types A, B & C

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54
Q

Infectious Respiratory IllnessInfluenza:

How does it spread? What kind of precautions are needed?

A

Droplets
Incubation period
Formites

Droplet precautions

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55
Q

Clinical Manifestations of Flu

A

Fever
Headache
Sore throat
Severe nasal congestion
Cough
Myalgia
Muscle aches and pains
Malaise
Fatigue

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56
Q

Influenza Management: Medical Management- Diagnosis made how?

A

Viral culture
Rapid influenza diagnostic tests
History and physical

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57
Q

Influenza Management: Medical Management-What kind of treatment?

A

Prevention

Vaccination

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58
Q

Influenza Management: Medical Management-What kind of medications is done?

A

Symptom control:

Antipyretics
Analgesics
Antivirals

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59
Q

Influenza Nursing Management: What kind of assessment and analysis is done?

A

Inflammatory response from virus

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60
Q

Influenza Nursing Management: What kind of nursing diagnoses are made?

A

Ineffective breathing pattern
Decreased activity tolerance
Alteration in gas exchange
Fluid volume deficit

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61
Q

Influenza Nursing Management: What kind of nursing interventions (actions) are done?

A

Initiate isolation precautions
Administer humidified supplemental oxygen
Semi to high Fowlers
Administer medications as ordered
Provide adequate fluid intake
Provide nutritional intake
Obtain cultures

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62
Q

Influenza Nursing Management: What kind of nursing interventions (Teaching) are done?

A

Hand hygiene
Disinfect frequently
Limit contact with others
Report worsening shortness of breath
Maintain adequate fluid intake
Medication teaching
Flu vaccine annually

63
Q

Influenza Nursing Management: What kind evaluations of care outcomes occur?

A

Flu vaccine
Return to baseline oxygenation

64
Q

Pneumonia Epidemiology

A

3-4 million cases annually

1/3 in persons over age 65 due to M R S A colonization

65
Q

Pneumonia occurs in 1/3 persons over the age of 65 due to what?

A

1/3 in persons over age 65 due to M R S A colonization

66
Q

Pnemonia Risk factors

A

Recent antibiotic therapy
Immunosuppression
Chronic disease
Treatment in healthcare facilities

67
Q

Pathophysiology of Pneumonia

A

Inflammation of lung parenchyma from bacterial, viral, fungal infection

68
Q

Two types of pneumonia

A
  1. Localizing
  2. Diffuse pneumonia
69
Q

Pneumonia clinical manifestations:

Mental status, RR, Bp, HR, Temp

A

Altered mental status
Respiratory rate >30
Hypotension
Heart rate >125
Body temperature <35 C or >40 C

70
Q

Pneumonia clinical manifestations:
pH, serum sodium, Hematocrit, PaO2 other features:

A

Arterial blood pH <7.35
Serum sodium level < 130
Hematocrit < 30%
Pa O 2 <60 mm H g on > 40% supplemental O 2
Pleural effusion on C X R or C T scan

71
Q

Pneumonia: Medical Management- Diagnosis

A

Laboratory studies
Imaging studies

72
Q

Pneumonia: Medical Management- Treatment

A

Oxygen administration
Adequate hydration

73
Q

Pneumonia: Medical Management- Medications

A

Bronchodilators
Antibiotics

74
Q

Complications of pneumonia: *= most important

A

Complications:

Necrotizing pneumonia*
Empyema
Bacteremia
Pneumothorax
Sepsis
Acute respiratory failure
Multiple organ failure

75
Q

Pneumonia Nursing Management: Assessment and Analysis

A

Fever, hypoxia, tachypnea, tachycardia, weak pulses

76
Q

Pneumonia Nursing Management: Types of Nursing Diagnoses

A

Impaired peripheral perfusion
Ineffective breathing pattern
Impaired gas exchange
Risk for acute confusion

77
Q

Pneumonia Nursing Management: Nursing Interventions – Assessments

A

Vital signs
Neurologic function
Breath sounds
Peripheral pulses
Respiratory secretions
Laboratory testing
Intake and output

78
Q

Pneumonia: Nursing interventions- Actions

A

Administer humidified oxygen as ordered
Administer medications as ordered
Pulmonary hygiene
Patient positioning
Monitor intake and output
Ensure adequate nutritional support
Activity

79
Q

Pneumonia: Nursing interventions- Teachings

A

Hand hygiene
Encourage adequate rest
Take antibiotics as prescribed
Encourage proper nutrition and fluid intake
Understand signs and symptoms of worsening respiratory status
Pneumonia vaccine

80
Q

Pneumonia: Nursing Management - Evaluating care outcomes

A

Stable vital signs
Absence of fever
Oxygen saturation at bedside
Absence of cough/sputum
Clear chest x-ray
Increased energy levels

81
Q

Tuberculosis epidemiology

A

9,093 new cases in 2017

82
Q

Risk Factors for Tb

A

Homeless and incarcerated populations
Persons with HIV or AIDS

83
Q

Tuberculosis: Clinical Manifestations- two types

A
  1. Primary tuberculosis
  2. Symptomatic TB infection
84
Q

Tuberculosis: Clinical Manifestations: Primary tuberculosis

A

Asymptomatic and not infectious

85
Q

Tuberculosis: Clinical Manifestations: Symptomatic TB infection

A

Fatigue, weight loss, night sweats, cough, rust colored or blood-streaked sputum, dyspnea, orthopnea, rales

86
Q

Tuberculosis: Pathophysiology

A

Droplet transmission

87
Q

Tubeculosis: Medical Management- Diagnosis

A

Laboratory testing
Skin test
Chest x-ray

88
Q

Tuberculosis: Medical Management- Treatment

A

Cure disease
Minimize transmission

89
Q

Tuberculosis: Medical Management- Medications

A

9-12-month medication regimen
Modifications for special populations

90
Q

Tuberculosis: Complications

A

Respiratory failure
Bronchopleural fistula
Pleural effusions
Meningitis
Lymphadenopathy
Bone disease
Liver and kidney failure

91
Q

Tuberculosis: Nursing Management- Assessment and Analysis

A

Body attempts to interact with infection
Unexplained weight loss
Night sweats
Fever
Chills

92
Q

Tuberculosis: Nursing Management- Nursing Diagnoses

A

Ineffective airway clearance
Alteration in gas exchange
Alteration in comfort
Ineffective coping

93
Q

Tuberculosis: Nursing Interventions- Assessments

A

Oxygen saturation
Temperature
Sputum
Breath sounds

94
Q

Tuberculosis: Nursing Interventions- Actions

A

Humidified oxygen
Airborne isolation
Administer antibiotics as ordered
Ensure adequate nutrition

95
Q

Tuberculosis: Nursing Interventions- Teaching

A

Skin/blood testing
Medication
Support systems

96
Q

Tuberculosis: Nursing Management- Evaluating care outcomes

A

Resolving T B infection
Maintain stable body weight
Improved skin turgor and muscle tone
Absence of cough and sputum
Even, unlabored breathing
Cessation of fevers and night sweats

97
Q

Rhinosinusitis: Epidemiology

A

Symptomatic inflammation of nasal and paranasal cavity

One in eight Americans

98
Q

Rhinosinusitis: Clinical Manifestations

A

Purulent nasal drainage, nasal obstruction, facial pain

Fatigue, fever, maxillary dental pain, cough, ear fullness

99
Q

Rhinosinusitis: Medical Management- Diagnosis

A

Physical exam and history
Radiographical imaging

100
Q

Medical Management- Treatment of Rhinosinusitis:

A

Pain relief
Reduction of nasal mucosal inflammation
Treating infection

101
Q

Rhinosinusitis: Nursing Management- Assessment and Analysis

A

Facial pressure
Sense of fullness or pain > nasal obstruction
Presence of purulent nasal discharge

102
Q

Rhinosinusitis: Nursing Management- Nursing Diagnoses

A

Risk for infection
Acute pain

103
Q

Rhinosinusitis: Nursing Interventions- Assessments

A

Vital signs
Physical examination
Percussion of sinuses

104
Q

Rhinosinusitis: Nursing Interventions- Actions

A

Administer medication as prescribed

105
Q

Rhinosinusitis: Nursing Interventions- Teachings

A

Symptoms to report
Correct medication usage
Proper use of normal saline nasal rinse

106
Q

Rhinosinusitis: Nursing Management- Evaluating care outcomes

A

Relief of nasal congestion
Free of pain and pressure
Free from infection
Free from complications

107
Q

Obstructive Sleep Apnea (OSA) effects how many females and males

A

Obstructive Sleep Apnea (OSA)10% to 20% Females,

20% to 30% Males

108
Q

Risk factors for Obstructive Sleep Apnea (OSA) - 7 things

A

Atrial fibrillation
Nocturnal dysrhythmias
Type 2 diabetes mellitus
Heart failure
Pulmonary hypertension
Male gender
Obesity

109
Q

Risk factors for Obstructive Sleep Apnea (OSA). - five things

A

Cigarette smoking
Alcohol use
Age 40-65
Craniofacial or upper airway soft tissue abnormalities
Menopause

110
Q

How does normal breathing compare to OSA breathing?

A

Normal Breathing:
Airway is open
Air flows freely to lungs

OSA:
Airway collapses
Airflow blocked to lungs

111
Q

Obstructive Sleep Apnea: Clinical Manifestations

A

Loud snoring
Snorting
Witnessed apnea
Gasping during sleep
Recurrent waking during sleep
Choking

112
Q

Obstructive Sleep Apnea- Medical Management- Diagnosis done how?

A

Sleep history
Polysomnography (sleep study)

113
Q

Obstructive Sleep Apnea- Medical Management- Treatment

A

Continuous positive airway pressure (CPAP)

Weight management

114
Q

Obstructive Sleep Apnea: Surgical Management

A

Tonsillectomy
Adenoidectomy
Uvulopalatopharyngoplasty
Septoplasty
Nasal polypectomy
Tongue reduction
Epiglottoplasty
Bariatric surgery

115
Q

Obstructive Sleep Apnea: Nursing Management – Assessment and analysis

A

No oxygen exchange
Hypoxia
Hypercapnia

116
Q

Obstructive Sleep Apnea: Nursing Management – Nursing Diagnoses

A

Sleep deprivation
Risk for decreased cardiac tissue perfusion
Ineffective sleeping pattern

117
Q

Obstructive Sleep Apnea: Nursing Interventions – Assessments

A

Vital signs
Height and weight
Sleep, rest, activity
Assess for edema, bleeding, respiratory distress

118
Q

Obstructive Sleep Apnea: Nursing Interventions – Actions

A

Administer medications as ordered
Diagnostic testing

119
Q

Obstructive Sleep Apnea: Nursing Interventions- Teaching

A

Disease process
Instruct patient on medication use
Instruction on C P A P
Instruct patient on weight reduction

120
Q

Obstructive Sleep Apnea: Evaluating care outcomes

A

Improved sleep patterns
Fewer night-time awakenings
Less daytime sleepiness and fatigue
Improved mental alertness
Less irritability

121
Q

Asthma Epidemiology

A

Affects 18 million Americans (6 million are children)
8% of children and 8% of adults have asthma

122
Q

Asthma Epidemiology: In adults, who is asthma most common in?

A

In adults, more common in women than in men

123
Q

Asthma Epidemiology: In children, who is asthma most common in?

A

In children, more common in boys than girls

124
Q

Asthma pathophysiology

A

Intermittent, reversible airway obstruction resulting frominflammation
Tightening of muscles surrounding airways

125
Q

Asthma: what occurs

A

Airway obstruction and bronchial hyperresponsiveness

126
Q

Asthma disease process

A
  1. Exposure to trigger
  2. Inflammatory response
  3. Vasodilation and increased capillary permeability
  4. Airway edema
  5. Mucus production
  6. Airway thickening and bronchial hyper-responsiveness
127
Q

Asthma risk factors

A

Family history
Frequent respiratory infections
Eczema
Allergies

128
Q

Clinical Manifestations of Asthma

A

Wheezing
Dyspnea
Coughing
Increased sputum
Increased respiratory rate

129
Q

Asthma Medical Management: Diagnosis done how?

A

History
Pulmonary function tests
Chest x-ray
Pulse oximetry
Arterial blood gases

130
Q

Asthma Medical Management: Treatment

A

Assessment
Monitoring
Control of environmental factors
Pharmacological treatment
Education

131
Q

Asthma: Medical Management: Medications

A

Anti-inflammatories
Bronchodilators
Anticholinergics

132
Q

Asthma: Nursing Management – Assessment and analysis

A

Vital signs
Oxygen saturation
Arterial blood gas
Breath sounds
Level of consciousness
Ability to speak in full sentences
Cough
Use of accessory muscles
Position
Dyspnea
Previous intubation

133
Q

Asthma Nursing Management: Nursing Diagnoses

A

Ineffective airway clearance related to increased mucus production, bronchospasm, fatigue

Impaired gas exchange related to dyspnea, fatigue

Ineffective breathing pattern related to anxiety

134
Q

Asthma: Nursing Interventions- Actions

A

Provide oxygen to maintain oxygenation >90%
Administer medications as ordered

135
Q

Asthma: Nursing Interventions: Teaching

A

Assist with creating individualized asthma action plan
Avoidance of triggers
Pursed-lip breathing
Medication regimen
Inhaled medication usage
Peak flow meter
Smoking cessation

136
Q

Asthma: Nursing Management- Evaluating care outcomes

A

Decreased E D visits
Decreased use of rescue medications
Minimal symptoms

137
Q

What is the Fourth-leading cause of chronic morbidity and mortality in U S

A

Chronic Obstructive Pulmonary Disease (COPD)

138
Q

In 2014, how many people were affected by COPD in the US? How many are thought to be undiagnosed?

A

In 2014, affected 16 million adults in U S
An additional 12 million adults are thought to be undiagnosed

139
Q

Chronic Obstructive Pulmonary Disease (COPD): Causes and risk factors –

A

Smoking (80-90% of COPD deaths)
Occupational dust and chemicals
Outdoor air pollution
Second-hand smoke
Alpha-1 antitrypsin (AAT) deficiency (<5%)

140
Q

Chronic Obstructive Pulmonary Disease (COPD): Pathophysiology

A

Airflow limitation that is progressive and not fully reversible

141
Q

Chronic Obstructive Pulmonary Disease (COPD): Emphysema

A

Destruction of alveoli

142
Q

Chronic Obstructive Pulmonary Disease (COPD): Chronic bronchitis

A

The presence of cough and sputum production for at least 3 months in each of 2 consecutive years

143
Q

Pathophysiology – Emphysema

A
  1. Injury to alveoli over time by inhaled pollutants
  2. Loss of lung elasticity
  3. Hyperinflation of alveoli
  4. Small airways collapse prematurely
  5. Air trapping
  6. Ineffective O2/CO2 exchange
  7. Non-oxygenated blood enters circulation
144
Q

Chronic Obstructive Pulmonary Disease (C O P D): Clinical Manifestations

A

Increased work of breathing and shortness of breath
Accessory muscle use
Tripod position
Increased A P diameter (barrel chest)
Cough

Increased sputum production
Pursed lip breathing
Skin color changes (red or blue/cyanotic)
Anxiety
S p O2 <90
Crackles
Wheezes

145
Q

Chronic Obstructive Pulmonary Disease(COPD): Medical Management – Diagnosis made how?

A

History
Physical assessment
Spirometry – measurement of lung volumes and air flow
Chest x-ray

146
Q

What does spirometry measure?

A

measurement of lung volumes and air flow
Forced Vital Capacity
F E V1

147
Q

Chronic Obstructive Pulmonary Disease (COPD) : Medical management- goals of treatment

A

Assess and monitor the disease
Reduce risk factors
Manage stable C O P D
Manage exacerbations

148
Q

Chronic Obstructive Pulmonary Disease (COPD) : Medical management- inhaled medications

A

Bronchodilators
Beta2-andrenergic agonists
Anticholinergics
Inhaled glucocorticoids

149
Q

Chronic Obstructive Pulmonary Disease (COPD): Medical Management- Exacerbations treatment

A

Inhaled bronchodilators
Oral glucocorticoids
Antibiotics
Noninvasive positive-pressure ventilation

150
Q

Complications of COPD

A

Secondary spontaneous pneumothorax
Right heart failure
Cor pulmonale

151
Q

Chronic Obstructive Pulmonary Disease (C O P D): Nursing Management- Assessment and analysis

A

Cough
Increased sputum production
Dyspnea
Use of accessory muscles
Tripod positioning
Inability to speak in full sentences
Pursed-lip breathing
Changes in skin color
Anxiety

152
Q

Chronic Obstructive Pulmonary Disease (COPD): Nursing Management- Nursing Diagnoses

A

Impaired gas exchange related to altered oxygen delivery and alveoli destruction

Ineffective airway clearance related to decreased energy, dyspnea, ineffective cough

Activity intolerance related to fatigue and dyspnea

Anxiety related to breathlessness

153
Q
A
154
Q
A

medsurg (4 decks)

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