Managing Patients with Oxygenation Disorders Flashcards
Exam 1
Indications of supplemental oxygen
- PaO2 is less than 60 mmHg
- SaO2 is less than 90%
- Physiological situations that indicate a need for oxygen
Physiological situations that indicate a need for oxygen
Fever
Infection
Anxiety
Anemia
Contraindications to Oxygen Administration
- Hypercapnia
- Hypocapnia
How is oxygen monitored and measured?
- Pulse oximetry
- Arterial Blood gas (ABG)
What is included in arterial blood gas (ABG)?
pH
PaO2
PaCO2
HCO3
SaO2
Normal ABG Values: pH
7.35–7.45
Normal ABG Values: PaO2
80–95 mm Hg
Normal ABG Values: PaCO2
35–45 mm Hg
Normal ABG Values: HCO3-
22–26 mEq/L
Normal ABG Values: SaO2
95%–100%
Noninvasive Oxygen Delivery Methods Low Flow include what
- Nasal canula
- Simple face mask
- Partial rebreather mask
- Nonrebreather mask
Noninvasive Oxygen Delivery Methods Low Flow: Nasal Canula (Delivery, areas of use)
Delivers 24% (1L/min)-44% (6L/min)
Used in all care settings and the home
What is the most common delivery method of O2?
Nasal Canula
Benefits of the Nasal Canula?
Most common
Most comfortable
Mobile
Less expensive
Noninvasive Oxygen Delivery MethodsLow Flow: Simple Face Mask
(Flow rate or delivery); how often is it used? What is it used for?
Flow rates 5-10 L/min or 40%-60%
Used short term
Helpful for transport
Noninvasive Oxygen Deliver MethodsLow Flow: Partial rebreather mask
Simple mask with reservoir bag attached
Reservoir bag filled with oxygen
Noninvasive Oxygen Deliver MethodsLow Flow: Partial rebreather mask (Flow rate and delivery)
Flow rate of 8-10L/min
50%-75% oxygen to patient
Noninvasive Oxygen Delivery MethodsLow Flow: Nonrebreather Mask
One-way valves between mask and bag
One-way valves on side of mask
Prevents rebreathing of CO2
Noninvasive Oxygen Delivery MethodsLow Flow: Nonrebreather Mask (flow rate and delivery)
Flow rate 10mL/min
90% oxygen to patient
What low flow oxygen delivery system is used for really emergent situations?
Nonrebreather mask
Noninvasive Oxygen Delivery MethodsHigh Flow include what?
- Venturi mask
- Tracheostomy collar
- Continuous positive airway pressure
(CPAP) - Bi-level positive airway pressure
(BIPAP)
Noninvasive Oxygen Delivery MethodsHigh Flow: Venturi Mask- who is it used for specifically?
Patients with COPD
Noninvasive Oxygen Delivery MethodsHigh Flow: Venturi Mask (Flow rate and delivery)
Flow rate 2-15 L/min
Oxygen concentration 24%-60%
Noninvasive Oxygen Delivery MethodsHigh Flow: Tracheostomy collar- who is it used for?
Used for patients with tracheostomy
Noninvasive Oxygen Delivery MethodsHigh Flow: Tracheostomy collar-what is needed for it to function? What does it delivery?
Needs humidified oxygen
Can deliver supplemental oxygen
Continuous positive airway pressure (CPAP)
Bi-level positive airway pressure (BiPAP)
Long term oxygen therapy is indicated for?
- Indicated for chronic hypoxemia associated with chronic disease
2, May be indicated for specific activities (i.e., during sleep)
Long term Oxygen Therapy: Different forms it is available in?
Available in different forms
Liquid oxygen
Compressed oxygen
Oxygen concentrator
Complications of Oxygen Therapy
- Oxygen toxicity
- Absorption atelectasis
- Mucous membrane dryness
- Infection
Invasive Oxygen Delivery includes:
- Artificial airways- Endotracheal tube
- Artificial airways – Tracheostomy
Invasive Oxygen Delivery Endotracheal tube: How is it placed? What is this placement called? Who is intubation performed by?
Passed through the nose or mouth into the trachea
Placement is called intubation
Performed by a credentialed provider
Invasive Oxygen Delivery Endotracheal tube: Who is it managed by? Possible complications of it?
Managed by nurse and respiratory therapist
Complications: Unplanned extubation, aspiration, infection
Invasive Oxygen Delivery Tracheostomy tube: When is it indicated?
Indicated if mechanical ventilation is required >7-14 days
Invasive Oxygen Delivery Tracheostomy tube: What are the benefits?
Decreased airway resistance
Decreased work of breathing
Improved oral care
Improved suctioning
Improved patient comfort
Invasive Oxygen Delivery Tracheostomy Care includes:
Suctioning
Replace inner cannula
Clean stoma site
Maintain sterile tracheostomy dressing
Replace Velcro tracheostomy holder if soiled
Therapeutic modalities for oxygen?
Incentive spirometry
Chest physiotherapy
Nebulizer treatments
Intermittent positive-pressure breathing
Functions of the Respiratory System
Ventilation
Respiration
Acid-base balance
Speech
Sense of smell
Fluid balance
ASSESSMENTHistory of Present Illness could include:
Factors that exacerbate or improve symptoms
Pain
Cough
Changes in weight
Dyspnea
ASSESSMENTHealth History could include:
Current medications
Allergies
Past medical history
Previous surgeries
Family history
Occupation/Area of residence
Smoking history
Social history
Recent travel
Physical Assessment: Inspection includes:
Speech
Clubbing of fingernails
Nose
Mouth
Neck
Thorax
Vital signs
Physical Assessment technique includes:
- Inspection
- Palpation
- Percussion
- Auscultation
During a physical assessment, what are you palpating?
Trachea
Crepitus
Thorax
Diagnostic studies include:
- Pulse oximetry
- Capnography and Capnometry
- Sputum analysis
- Chest x-ray
- Pulmonary function test
- Bronchoscopy
- Thoracentesis
- Lung biopsy
Diagnostic Studies: Pulse oximetry
Saturation of hemoglobin with oxygen
95%-99%
Diagnostic Studies: Capnography and Capnometry
Continuous PaCO2 monitoring
Diagnostic Studies: Sputum analysis
Check for microorganisms and/or abnormal cell growth
Diagnostic Studies: Chest x-ray
Identify problems with lungs, heart, and pleural space
Diagnostic Studies: Pulmonary function test
Lung volumes
Lung functioning
Diagnostic Studies: Bronchoscopy
Direct visualization of respiratory tract
Analysis of tissue specimen
Biopsy
Diagnostic Studies: Thoracentesis
Needle into pleural space to remove specimen, fluid, or air
Diagnostic Studies: Lung biopsy
Removal of lung tissue for analysis
Infectious Respiratory IllnessInfluenza:
How contagious?
Last flu pandemic?
What types exist?
Highly contagious infection
Last flu pandemic was the H1N1 2009
There are three types A, B & C
Infectious Respiratory IllnessInfluenza:
How does it spread? What kind of precautions are needed?
Droplets
Incubation period
Formites
Droplet precautions
Clinical Manifestations of Flu
Fever
Headache
Sore throat
Severe nasal congestion
Cough
Myalgia
Muscle aches and pains
Malaise
Fatigue
Influenza Management: Medical Management- Diagnosis made how?
Viral culture
Rapid influenza diagnostic tests
History and physical
Influenza Management: Medical Management-What kind of treatment?
Prevention
Vaccination
Influenza Management: Medical Management-What kind of medications is done?
Symptom control:
Antipyretics
Analgesics
Antivirals
Influenza Nursing Management: What kind of assessment and analysis is done?
Inflammatory response from virus
Influenza Nursing Management: What kind of nursing diagnoses are made?
Ineffective breathing pattern
Decreased activity tolerance
Alteration in gas exchange
Fluid volume deficit
Influenza Nursing Management: What kind of nursing interventions (actions) are done?
Initiate isolation precautions
Administer humidified supplemental oxygen
Semi to high Fowlers
Administer medications as ordered
Provide adequate fluid intake
Provide nutritional intake
Obtain cultures
Influenza Nursing Management: What kind of nursing interventions (Teaching) are done?
Hand hygiene
Disinfect frequently
Limit contact with others
Report worsening shortness of breath
Maintain adequate fluid intake
Medication teaching
Flu vaccine annually
Influenza Nursing Management: What kind evaluations of care outcomes occur?
Flu vaccine
Return to baseline oxygenation
Pneumonia Epidemiology
3-4 million cases annually
1/3 in persons over age 65 due to M R S A colonization
Pneumonia occurs in 1/3 persons over the age of 65 due to what?
1/3 in persons over age 65 due to M R S A colonization
Pnemonia Risk factors
Recent antibiotic therapy
Immunosuppression
Chronic disease
Treatment in healthcare facilities
Pathophysiology of Pneumonia
Inflammation of lung parenchyma from bacterial, viral, fungal infection
Two types of pneumonia
- Localizing
- Diffuse pneumonia
Pneumonia clinical manifestations:
Mental status, RR, Bp, HR, Temp
Altered mental status
Respiratory rate >30
Hypotension
Heart rate >125
Body temperature <35 C or >40 C
Pneumonia clinical manifestations:
pH, serum sodium, Hematocrit, PaO2 other features:
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
Pneumonia: Medical Management- Diagnosis
Laboratory studies
Imaging studies
Pneumonia: Medical Management- Treatment
Oxygen administration
Adequate hydration
Pneumonia: Medical Management- Medications
Bronchodilators
Antibiotics
Complications of pneumonia: *= most important
Complications:
Necrotizing pneumonia*
Empyema
Bacteremia
Pneumothorax
Sepsis
Acute respiratory failure
Multiple organ failure
Pneumonia Nursing Management: Assessment and Analysis
Fever, hypoxia, tachypnea, tachycardia, weak pulses
Pneumonia Nursing Management: Types of Nursing Diagnoses
Impaired peripheral perfusion
Ineffective breathing pattern
Impaired gas exchange
Risk for acute confusion
Pneumonia Nursing Management: Nursing Interventions – Assessments
Vital signs
Neurologic function
Breath sounds
Peripheral pulses
Respiratory secretions
Laboratory testing
Intake and output
Pneumonia: Nursing interventions- Actions
Administer humidified oxygen as ordered
Administer medications as ordered
Pulmonary hygiene
Patient positioning
Monitor intake and output
Ensure adequate nutritional support
Activity
Pneumonia: Nursing interventions- Teachings
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
Pneumonia: Nursing Management - Evaluating care outcomes
Stable vital signs
Absence of fever
Oxygen saturation at bedside
Absence of cough/sputum
Clear chest x-ray
Increased energy levels
Tuberculosis epidemiology
9,093 new cases in 2017
Risk Factors for Tb
Homeless and incarcerated populations
Persons with HIV or AIDS
Tuberculosis: Clinical Manifestations- two types
- Primary tuberculosis
- Symptomatic TB infection
Tuberculosis: Clinical Manifestations: Primary tuberculosis
Asymptomatic and not infectious
Tuberculosis: Clinical Manifestations: Symptomatic TB infection
Fatigue, weight loss, night sweats, cough, rust colored or blood-streaked sputum, dyspnea, orthopnea, rales
Tuberculosis: Pathophysiology
Droplet transmission
Tubeculosis: Medical Management- Diagnosis
Laboratory testing
Skin test
Chest x-ray
Tuberculosis: Medical Management- Treatment
Cure disease
Minimize transmission
Tuberculosis: Medical Management- Medications
9-12-month medication regimen
Modifications for special populations
Tuberculosis: Complications
Respiratory failure
Bronchopleural fistula
Pleural effusions
Meningitis
Lymphadenopathy
Bone disease
Liver and kidney failure
Tuberculosis: Nursing Management- Assessment and Analysis
Body attempts to interact with infection
Unexplained weight loss
Night sweats
Fever
Chills
Tuberculosis: Nursing Management- Nursing Diagnoses
Ineffective airway clearance
Alteration in gas exchange
Alteration in comfort
Ineffective coping
Tuberculosis: Nursing Interventions- Assessments
Oxygen saturation
Temperature
Sputum
Breath sounds
Tuberculosis: Nursing Interventions- Actions
Humidified oxygen
Airborne isolation
Administer antibiotics as ordered
Ensure adequate nutrition
Tuberculosis: Nursing Interventions- Teaching
Skin/blood testing
Medication
Support systems
Tuberculosis: Nursing Management- Evaluating care outcomes
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
Rhinosinusitis: Epidemiology
Symptomatic inflammation of nasal and paranasal cavity
One in eight Americans
Rhinosinusitis: Clinical Manifestations
Purulent nasal drainage, nasal obstruction, facial pain
Fatigue, fever, maxillary dental pain, cough, ear fullness
Rhinosinusitis: Medical Management- Diagnosis
Physical exam and history
Radiographical imaging
Medical Management- Treatment of Rhinosinusitis:
Pain relief
Reduction of nasal mucosal inflammation
Treating infection
Rhinosinusitis: Nursing Management- Assessment and Analysis
Facial pressure
Sense of fullness or pain > nasal obstruction
Presence of purulent nasal discharge
Rhinosinusitis: Nursing Management- Nursing Diagnoses
Risk for infection
Acute pain
Rhinosinusitis: Nursing Interventions- Assessments
Vital signs
Physical examination
Percussion of sinuses
Rhinosinusitis: Nursing Interventions- Actions
Administer medication as prescribed
Rhinosinusitis: Nursing Interventions- Teachings
Symptoms to report
Correct medication usage
Proper use of normal saline nasal rinse
Rhinosinusitis: Nursing Management- Evaluating care outcomes
Relief of nasal congestion
Free of pain and pressure
Free from infection
Free from complications
Obstructive Sleep Apnea (OSA) effects how many females and males
Obstructive Sleep Apnea (OSA)10% to 20% Females,
20% to 30% Males
Risk factors for Obstructive Sleep Apnea (OSA) - 7 things
Atrial fibrillation
Nocturnal dysrhythmias
Type 2 diabetes mellitus
Heart failure
Pulmonary hypertension
Male gender
Obesity
Risk factors for Obstructive Sleep Apnea (OSA). - five things
Cigarette smoking
Alcohol use
Age 40-65
Craniofacial or upper airway soft tissue abnormalities
Menopause
How does normal breathing compare to OSA breathing?
Normal Breathing:
Airway is open
Air flows freely to lungs
OSA:
Airway collapses
Airflow blocked to lungs
Obstructive Sleep Apnea: Clinical Manifestations
Loud snoring
Snorting
Witnessed apnea
Gasping during sleep
Recurrent waking during sleep
Choking
Obstructive Sleep Apnea- Medical Management- Diagnosis done how?
Sleep history
Polysomnography (sleep study)
Obstructive Sleep Apnea- Medical Management- Treatment
Continuous positive airway pressure (CPAP)
Weight management
Obstructive Sleep Apnea: Surgical Management
Tonsillectomy
Adenoidectomy
Uvulopalatopharyngoplasty
Septoplasty
Nasal polypectomy
Tongue reduction
Epiglottoplasty
Bariatric surgery
Obstructive Sleep Apnea: Nursing Management – Assessment and analysis
No oxygen exchange
Hypoxia
Hypercapnia
Obstructive Sleep Apnea: Nursing Management – Nursing Diagnoses
Sleep deprivation
Risk for decreased cardiac tissue perfusion
Ineffective sleeping pattern
Obstructive Sleep Apnea: Nursing Interventions – Assessments
Vital signs
Height and weight
Sleep, rest, activity
Assess for edema, bleeding, respiratory distress
Obstructive Sleep Apnea: Nursing Interventions – Actions
Administer medications as ordered
Diagnostic testing
Obstructive Sleep Apnea: Nursing Interventions- Teaching
Disease process
Instruct patient on medication use
Instruction on C P A P
Instruct patient on weight reduction
Obstructive Sleep Apnea: Evaluating care outcomes
Improved sleep patterns
Fewer night-time awakenings
Less daytime sleepiness and fatigue
Improved mental alertness
Less irritability
Asthma Epidemiology
Affects 18 million Americans (6 million are children)
8% of children and 8% of adults have asthma
Asthma Epidemiology: In adults, who is asthma most common in?
In adults, more common in women than in men
Asthma Epidemiology: In children, who is asthma most common in?
In children, more common in boys than girls
Asthma pathophysiology
Intermittent, reversible airway obstruction resulting frominflammation
Tightening of muscles surrounding airways
Asthma: what occurs
Airway obstruction and bronchial hyperresponsiveness
Asthma disease process
- Exposure to trigger
- Inflammatory response
- Vasodilation and increased capillary permeability
- Airway edema
- Mucus production
- Airway thickening and bronchial hyper-responsiveness
Asthma risk factors
Family history
Frequent respiratory infections
Eczema
Allergies
Clinical Manifestations of Asthma
Wheezing
Dyspnea
Coughing
Increased sputum
Increased respiratory rate
Asthma Medical Management: Diagnosis done how?
History
Pulmonary function tests
Chest x-ray
Pulse oximetry
Arterial blood gases
Asthma Medical Management: Treatment
Assessment
Monitoring
Control of environmental factors
Pharmacological treatment
Education
Asthma: Medical Management: Medications
Anti-inflammatories
Bronchodilators
Anticholinergics
Asthma: Nursing Management – Assessment and analysis
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
Asthma Nursing Management: Nursing Diagnoses
Ineffective airway clearance related to increased mucus production, bronchospasm, fatigue
Impaired gas exchange related to dyspnea, fatigue
Ineffective breathing pattern related to anxiety
Asthma: Nursing Interventions- Actions
Provide oxygen to maintain oxygenation >90%
Administer medications as ordered
Asthma: Nursing Interventions: Teaching
Assist with creating individualized asthma action plan
Avoidance of triggers
Pursed-lip breathing
Medication regimen
Inhaled medication usage
Peak flow meter
Smoking cessation
Asthma: Nursing Management- Evaluating care outcomes
Decreased E D visits
Decreased use of rescue medications
Minimal symptoms
What is the Fourth-leading cause of chronic morbidity and mortality in U S
Chronic Obstructive Pulmonary Disease (COPD)
In 2014, how many people were affected by COPD in the US? How many are thought to be undiagnosed?
In 2014, affected 16 million adults in U S
An additional 12 million adults are thought to be undiagnosed
Chronic Obstructive Pulmonary Disease (COPD): Causes and risk factors –
Smoking (80-90% of COPD deaths)
Occupational dust and chemicals
Outdoor air pollution
Second-hand smoke
Alpha-1 antitrypsin (AAT) deficiency (<5%)
Chronic Obstructive Pulmonary Disease (COPD): Pathophysiology
Airflow limitation that is progressive and not fully reversible
Chronic Obstructive Pulmonary Disease (COPD): Emphysema
Destruction of alveoli
Chronic Obstructive Pulmonary Disease (COPD): Chronic bronchitis
The presence of cough and sputum production for at least 3 months in each of 2 consecutive years
Pathophysiology – Emphysema
- Injury to alveoli over time by inhaled pollutants
- Loss of lung elasticity
- Hyperinflation of alveoli
- Small airways collapse prematurely
- Air trapping
- Ineffective O2/CO2 exchange
- Non-oxygenated blood enters circulation
Chronic Obstructive Pulmonary Disease (C O P D): Clinical Manifestations
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
Chronic Obstructive Pulmonary Disease(COPD): Medical Management – Diagnosis made how?
History
Physical assessment
Spirometry – measurement of lung volumes and air flow
Chest x-ray
What does spirometry measure?
measurement of lung volumes and air flow
Forced Vital Capacity
F E V1
Chronic Obstructive Pulmonary Disease (COPD) : Medical management- goals of treatment
Assess and monitor the disease
Reduce risk factors
Manage stable C O P D
Manage exacerbations
Chronic Obstructive Pulmonary Disease (COPD) : Medical management- inhaled medications
Bronchodilators
Beta2-andrenergic agonists
Anticholinergics
Inhaled glucocorticoids
Chronic Obstructive Pulmonary Disease (COPD): Medical Management- Exacerbations treatment
Inhaled bronchodilators
Oral glucocorticoids
Antibiotics
Noninvasive positive-pressure ventilation
Complications of COPD
Secondary spontaneous pneumothorax
Right heart failure
Cor pulmonale
Chronic Obstructive Pulmonary Disease (C O P D): Nursing Management- Assessment and analysis
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
Chronic Obstructive Pulmonary Disease (COPD): Nursing Management- Nursing Diagnoses
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