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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
Noninvasive Oxygen Delivery Methods High Flow: Tracheostomy collar-what is needed for it to function? What does it delivery?
Needs humidified oxygen Can deliver supplemental oxygen
26
Continuous positive airway pressure (CPAP)
27
Bi-level positive airway pressure (BiPAP)
28
Long term oxygen therapy is indicated for?
1. Indicated for chronic hypoxemia associated with chronic disease 2, May be indicated for specific activities (i.e., during sleep)
29
Long term Oxygen Therapy: Different forms it is available in?
Available in different forms Liquid oxygen Compressed oxygen Oxygen concentrator
30
Complications of Oxygen Therapy
1. Oxygen toxicity 2. Absorption atelectasis 3. Mucous membrane dryness 4. Infection
31
Invasive Oxygen Delivery includes:
1. Artificial airways- Endotracheal tube 2. Artificial airways – Tracheostomy
32
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
33
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
34
Invasive Oxygen Delivery Tracheostomy tube: When is it indicated?
Indicated if mechanical ventilation is required >7-14 days
35
Invasive Oxygen Delivery Tracheostomy tube: What are the benefits?
Decreased airway resistance Decreased work of breathing Improved oral care Improved suctioning Improved patient comfort
36
Invasive Oxygen Delivery Tracheostomy Care includes:
Suctioning Replace inner cannula Clean stoma site Maintain sterile tracheostomy dressing Replace Velcro tracheostomy holder if soiled
37
Therapeutic modalities for oxygen?
Incentive spirometry Chest physiotherapy Nebulizer treatments Intermittent positive-pressure breathing
38
Functions of the Respiratory System
Ventilation Respiration Acid-base balance Speech Sense of smell Fluid balance
39
ASSESSMENT History of Present Illness could include:
Factors that exacerbate or improve symptoms Pain Cough Changes in weight Dyspnea
40
ASSESSMENT Health History could include:
Current medications Allergies Past medical history Previous surgeries Family history Occupation/Area of residence Smoking history Social history Recent travel
41
Physical Assessment: Inspection includes:
Speech Clubbing of fingernails Nose Mouth Neck Thorax Vital signs
42
Physical Assessment technique includes:
1. Inspection 2. Palpation 3. Percussion 4. Auscultation
43
During a physical assessment, what are you palpating?
Trachea Crepitus Thorax
44
Diagnostic studies include:
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
45
Diagnostic Studies: Pulse oximetry
Saturation of hemoglobin with oxygen 95%-99%
46
Diagnostic Studies: Capnography and Capnometry
Continuous PaCO2 monitoring
47
Diagnostic Studies: Sputum analysis
Check for microorganisms and/or abnormal cell growth
48
Diagnostic Studies: Chest x-ray
Identify problems with lungs, heart, and pleural space
49
Diagnostic Studies: Pulmonary function test
Lung volumes Lung functioning
50
Diagnostic Studies: Bronchoscopy
Direct visualization of respiratory tract Analysis of tissue specimen Biopsy
51
Diagnostic Studies: Thoracentesis
Needle into pleural space to remove specimen, fluid, or air
52
Diagnostic Studies: Lung biopsy
Removal of lung tissue for analysis
53
Infectious Respiratory Illness Influenza: 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
54
Infectious Respiratory Illness Influenza: How does it spread? What kind of precautions are needed?
Droplets Incubation period Formites Droplet precautions
55
Clinical Manifestations of Flu
Fever Headache Sore throat Severe nasal congestion Cough Myalgia Muscle aches and pains Malaise Fatigue
56
Influenza Management: Medical Management- Diagnosis made how?
Viral culture Rapid influenza diagnostic tests History and physical
57
Influenza Management: Medical Management-What kind of treatment?
Prevention Vaccination
58
Influenza Management: Medical Management-What kind of medications is done?
Symptom control: Antipyretics Analgesics Antivirals
59
Influenza Nursing Management: What kind of assessment and analysis is done?
Inflammatory response from virus
60
Influenza Nursing Management: What kind of nursing diagnoses are made?
Ineffective breathing pattern Decreased activity tolerance Alteration in gas exchange Fluid volume deficit
61
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
62
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
63
Influenza Nursing Management: What kind evaluations of care outcomes occur?
Flu vaccine Return to baseline oxygenation
64
Pneumonia Epidemiology
3-4 million cases annually 1/3 in persons over age 65 due to M R S A colonization
65
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
66
Pnemonia Risk factors
Recent antibiotic therapy Immunosuppression Chronic disease Treatment in healthcare facilities
67
Pathophysiology of Pneumonia
Inflammation of lung parenchyma from bacterial, viral, fungal infection
68
Two types of pneumonia
1. Localizing 2. Diffuse pneumonia
69
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
70
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
71
Pneumonia: Medical Management- Diagnosis
Laboratory studies Imaging studies
72
Pneumonia: Medical Management- Treatment
Oxygen administration Adequate hydration
73
Pneumonia: Medical Management- Medications
Bronchodilators Antibiotics
74
Complications of pneumonia: *= most important
Complications: Necrotizing pneumonia* Empyema Bacteremia Pneumothorax Sepsis Acute respiratory failure Multiple organ failure
75
Pneumonia Nursing Management: Assessment and Analysis
Fever, hypoxia, tachypnea, tachycardia, weak pulses
76
Pneumonia Nursing Management: Types of Nursing Diagnoses
Impaired peripheral perfusion Ineffective breathing pattern Impaired gas exchange Risk for acute confusion
77
Pneumonia Nursing Management: Nursing Interventions – Assessments
Vital signs Neurologic function Breath sounds Peripheral pulses Respiratory secretions Laboratory testing Intake and output
78
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
79
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
80
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
81
Tuberculosis epidemiology
9,093 new cases in 2017
82
Risk Factors for Tb
Homeless and incarcerated populations Persons with HIV or AIDS
83
Tuberculosis: Clinical Manifestations- two types
1. Primary tuberculosis 2. Symptomatic TB infection
84
Tuberculosis: Clinical Manifestations: Primary tuberculosis
Asymptomatic and not infectious
85
Tuberculosis: Clinical Manifestations: Symptomatic TB infection
Fatigue, weight loss, night sweats, cough, rust colored or blood-streaked sputum, dyspnea, orthopnea, rales
86
Tuberculosis: Pathophysiology
Droplet transmission
87
Tubeculosis: Medical Management- Diagnosis
Laboratory testing Skin test Chest x-ray
88
Tuberculosis: Medical Management- Treatment
Cure disease Minimize transmission
89
Tuberculosis: Medical Management- Medications
9-12-month medication regimen Modifications for special populations
90
Tuberculosis: Complications
Respiratory failure Bronchopleural fistula Pleural effusions Meningitis Lymphadenopathy Bone disease Liver and kidney failure
91
Tuberculosis: Nursing Management- Assessment and Analysis
Body attempts to interact with infection Unexplained weight loss Night sweats Fever Chills
92
Tuberculosis: Nursing Management- Nursing Diagnoses
Ineffective airway clearance Alteration in gas exchange Alteration in comfort Ineffective coping
93
Tuberculosis: Nursing Interventions- Assessments
Oxygen saturation Temperature Sputum Breath sounds
94
Tuberculosis: Nursing Interventions- Actions
Humidified oxygen Airborne isolation Administer antibiotics as ordered Ensure adequate nutrition
95
Tuberculosis: Nursing Interventions- Teaching
Skin/blood testing Medication Support systems
96
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
97
Rhinosinusitis: Epidemiology
Symptomatic inflammation of nasal and paranasal cavity One in eight Americans
98
Rhinosinusitis: Clinical Manifestations
Purulent nasal drainage, nasal obstruction, facial pain Fatigue, fever, maxillary dental pain, cough, ear fullness
99
Rhinosinusitis: Medical Management- Diagnosis
Physical exam and history Radiographical imaging
100
Medical Management- Treatment of Rhinosinusitis:
Pain relief Reduction of nasal mucosal inflammation Treating infection
101
Rhinosinusitis: Nursing Management- Assessment and Analysis
Facial pressure Sense of fullness or pain > nasal obstruction Presence of purulent nasal discharge
102
Rhinosinusitis: Nursing Management- Nursing Diagnoses
Risk for infection Acute pain
103
Rhinosinusitis: Nursing Interventions- Assessments
Vital signs Physical examination Percussion of sinuses
104
Rhinosinusitis: Nursing Interventions- Actions
Administer medication as prescribed
105
Rhinosinusitis: Nursing Interventions- Teachings
Symptoms to report Correct medication usage Proper use of normal saline nasal rinse
106
Rhinosinusitis: Nursing Management- Evaluating care outcomes
Relief of nasal congestion Free of pain and pressure Free from infection Free from complications
107
Obstructive Sleep Apnea (OSA) effects how many females and males
Obstructive Sleep Apnea (OSA) 10% to 20% Females, 20% to 30% Males
108
Risk factors for Obstructive Sleep Apnea (OSA) - 7 things
Atrial fibrillation Nocturnal dysrhythmias Type 2 diabetes mellitus Heart failure Pulmonary hypertension Male gender Obesity
109
Risk factors for Obstructive Sleep Apnea (OSA). - five things
Cigarette smoking Alcohol use Age 40-65 Craniofacial or upper airway soft tissue abnormalities Menopause
110
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
111
Obstructive Sleep Apnea: Clinical Manifestations
Loud snoring Snorting Witnessed apnea Gasping during sleep Recurrent waking during sleep Choking
112
Obstructive Sleep Apnea- Medical Management- Diagnosis done how?
Sleep history Polysomnography (sleep study)
113
Obstructive Sleep Apnea- Medical Management- Treatment
Continuous positive airway pressure (CPAP) Weight management
114
Obstructive Sleep Apnea: Surgical Management
Tonsillectomy Adenoidectomy Uvulopalatopharyngoplasty Septoplasty Nasal polypectomy Tongue reduction Epiglottoplasty Bariatric surgery
115
Obstructive Sleep Apnea: Nursing Management – Assessment and analysis
No oxygen exchange Hypoxia Hypercapnia
116
Obstructive Sleep Apnea: Nursing Management – Nursing Diagnoses
Sleep deprivation Risk for decreased cardiac tissue perfusion Ineffective sleeping pattern
117
Obstructive Sleep Apnea: Nursing Interventions – Assessments
Vital signs Height and weight Sleep, rest, activity Assess for edema, bleeding, respiratory distress
118
Obstructive Sleep Apnea: Nursing Interventions – Actions
Administer medications as ordered Diagnostic testing
119
Obstructive Sleep Apnea: Nursing Interventions- Teaching
Disease process Instruct patient on medication use Instruction on C P A P Instruct patient on weight reduction
120
Obstructive Sleep Apnea: Evaluating care outcomes
Improved sleep patterns Fewer night-time awakenings Less daytime sleepiness and fatigue Improved mental alertness Less irritability
121
Asthma Epidemiology
Affects 18 million Americans (6 million are children) 8% of children and 8% of adults have asthma
122
Asthma Epidemiology: In adults, who is asthma most common in?
In adults, more common in women than in men
123
Asthma Epidemiology: In children, who is asthma most common in?
In children, more common in boys than girls
124
Asthma pathophysiology
Intermittent, reversible airway obstruction resulting from inflammation Tightening of muscles surrounding airways
125
Asthma: what occurs
Airway obstruction and bronchial hyperresponsiveness
126
Asthma disease process
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
Asthma risk factors
Family history Frequent respiratory infections Eczema Allergies
128
Clinical Manifestations of Asthma
Wheezing Dyspnea Coughing Increased sputum Increased respiratory rate
129
Asthma Medical Management: Diagnosis done how?
History Pulmonary function tests Chest x-ray Pulse oximetry Arterial blood gases
130
Asthma Medical Management: Treatment
Assessment Monitoring Control of environmental factors Pharmacological treatment Education
131
Asthma: Medical Management: Medications
Anti-inflammatories Bronchodilators Anticholinergics
132
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
133
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
134
Asthma: Nursing Interventions- Actions
Provide oxygen to maintain oxygenation >90% Administer medications as ordered
135
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
136
Asthma: Nursing Management- Evaluating care outcomes
Decreased E D visits Decreased use of rescue medications Minimal symptoms
137
What is the Fourth-leading cause of chronic morbidity and mortality in U S
Chronic Obstructive Pulmonary Disease (COPD)
138
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
139
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%)
140
Chronic Obstructive Pulmonary Disease (COPD): Pathophysiology
Airflow limitation that is progressive and not fully reversible
141
Chronic Obstructive Pulmonary Disease (COPD): Emphysema
Destruction of alveoli
142
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
143
Pathophysiology – Emphysema
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
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
145
Chronic Obstructive Pulmonary Disease(COPD): Medical Management – Diagnosis made how?
History Physical assessment Spirometry – measurement of lung volumes and air flow Chest x-ray
146
What does spirometry measure?
measurement of lung volumes and air flow Forced Vital Capacity F E V1
147
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
148
Chronic Obstructive Pulmonary Disease (COPD) : Medical management- inhaled medications
Bronchodilators Beta2-andrenergic agonists Anticholinergics Inhaled glucocorticoids
149
Chronic Obstructive Pulmonary Disease (COPD): Medical Management- Exacerbations treatment
Inhaled bronchodilators Oral glucocorticoids Antibiotics Noninvasive positive-pressure ventilation
150
Complications of COPD
Secondary spontaneous pneumothorax Right heart failure Cor pulmonale
151
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
152
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
153
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Medsurg (21 decks)

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