Module 1 - Breathing Flashcards
What is oxygen therapy?
Oxygen therapy is a drug that is used for people who have difficulties ventilating areas of their lung (eg pneumonia or asthma) or whose gas exchange is impaired (eg heart failure). Its role is to prevent hypoxia.
In emergency situations can the nurse initiate oxygen therapy without medical orders.?
YES
What is the common target value for oxygen saturation in a hospital environment?
> 95%
What is the oxygen saturation target for acute medical conditions?
92% to 96%
What is the oxygen saturation target for people who have COPD or ARDS?
88% to 92%
What can giving too much oxygen lead to?
Oxygen Toxicity
What is the fraction of inspirated Oxygen (FIO2) of room air?
21%
What are the most common ways of administrating low flow oxygen on a medical or surgical ward?
- Nasal cannula
- Simple face mask
- Non re-breathing mask
In a hospital where would you find a supply of oxygen?
The supply of oxygen in hospitals is usually piped into wall outlets at patient bed areas.The oxygen that is adminstered from these units is dry.
What percentage of O2 concentration can nasal prongs deliver?
24%-45% with flow rates of 2-6L/min
What percentage of O2 concentration can the hudson mask deliver?
40-60% with flow rates of 5-8L/min.
When would you use a ventri mask?
When the amount of oxygen delivered must be precisely regulated.
What percentage of oxygen can a non-rebreather mask deliver?
Up to 100%
When is this non-rebreather mask often required?
Used on critically ill and unstable patients as it’s the highest possible rate without mechanical ventilation.
Subjective Data
As a nurse you can’t observe it, can’t prove it.
For example, the patient pain level or if they have tingling in their legs. Patients past experiences, how they feel, etc.
Objective Data
Data that you can see, feel, touch, observe.
If you can observe it, you can measure it.
For example, vital signs, bleeding, vomiting.
What is a primary survey?
A Primary survey involves the initial assessment and if required, emergency management of potential or actual life threatening conditions.
What is a primary survey comprised of?
- Airway
- Breathing
- Circulation
- Disability (GCS)
- Environment/Exposure
What is a secondary survey comprised of?
- Gathering information
- history and mechanism of injury
- reviewing vital signs
- head to toe assessment
- pain control
- reassure and speak with family and friends.
Why is dentifying the mechanism of injury important?
Vital to predicting actual and associated injuries.
What are the two most common forms of injury?
Blunt trauma and Penetrating Trauma.
Name the main passages of the lower airways.
Thorax (chest) which includes:
- trachea
- lungs
- bronchi
- bronchioles
- alveoli
In adults what shape is the thorax?
Oval
Name 3 normal breathing sounds.
Vesicular, bronchovesicular, bronchial
What are abnormal breathing sounds called?
Adventitious breath sounds
What are the four types of adventitious breath sounds?
- Crackles
- Gurgles
- Friction Rub
- Wheeze
Why is the sitting position prefferred when assessing the thorax and lungs?
This position maximises chest expansion.
Describe crackle breath sound.
Fine, short, interupted crackling sounds and high pitched.
Best heard on inspiration.
Describe gurgles (rhonchi)
Continous low pitched, course, gurgling, harch, louder sounds with a moaning or snoring quality.
Describe a wheeze.
Continous , high or low pitched muscical quality. Best heard on expiration.
When can a high pitch wheeze be heard (smaller airway narrowing in broncospasm)?
In asthma.
When can a low pitch wheeze be heard (smaller airways narrow due to secretions)?
Chronic bronchitis.
Describe a friction rub breathing sound.
Low pitched, grating sound similar to the sound of walking on snow. Heard during inspiration.
What is a pneumothorax?
Collapsed lung.
If the position of the trachea is not midline, what can this indicate?
This could indicate a pneumothorax and is a medical emergency.
What is tactile fremitus?
Tactile fremitus, known by many other names including pectoral fremitus, tactile vocal fremitus, or just vocal fremitus, is a vibration felt on the patient’s chest during low frequency vocalization.
What is percussion?
Percussion is an assessment technique which produces sounds by the examiner tapping on the patient’s chest wall.
What does percussion help determine?
To detrmine if the underlying tissues are filled with air, fluid or solid material.
Percussion.
What sounds are normal over lung tissue?
Low pitched hollow sounds.
Percussion.
What sounds are normal over solid areas and bone?
Dull sounds.
Percussion.
What sounds are normla over organs like the liver?
Thud like/ dull sounds.
What could thud like/ dull sounds over lung tissue indicate?
Pneumonia or tumours.
What might hyperresonant sounds indicate?
Hyperinflated lungs as evident in COPD or asthma.
When is supplemental oxygen therapy required?
When a person is hypoxaemic. Short term acute use or chronic long term use.
Name 3 types of disorders that might indicate oxygen therapy?
- Respiratory disorders
- cardiovascular disorders
- central nervous system disorders
What 4 things is oxygen delivery reliant on?
- venitilation
- gas exchange
- haemoglobin
- circulation.
URTI’s may require medical intervention when what happens?
Bacterial infection.
What are some common URTIs in children?
- Croup,
- Epiglottitis
- Pertussis
What is croup?
An upper airway infection that blocks breathing and has a distinctive barking cough.
Does viral croup respond to antibiotics, expectorants, bronchodilators or anthistimines?
NO.
To help assess the severity of croup, what common signs have been identifed to look for?
- severity of chest wall in drawing
- presence of stridor at rest or only during agitation
- stridor during inspiration or also during expiration
- cyanosis
- lethargy
What is Epiglottitis?
Epiglottitis is inflammation of the epiglottis—the flap at the base of the tongue that keeps food from going into the trachea (windpipe).
Is epiglottisitis a medical emergency?
YES.
Rapidly progressive cellulitis between the base of the tongue and the epiglottis causes the epiglottis to swell and become inflamed. Surrounding tissue also becomes swollen and pushes the epiglottis posteriorly. This swelling and oedema threaten the airway.
What are some clinical manifestations of epiglottitis in children?
- pallor
- lethargy
- drooling
- fever
- difficulty swallowing
- muffled voice
- extreme anxiety
- children sit upright with their mouth open and chin thrust forward
- Inspiratory stridor
- nasal flaring
What is asthma?
Asthma is a long-term lung condition of the airways (the passage that transports air into our lungs). At the moment, there is no cure, but it can be managed.
Name 5 common types of asthma.
- Allergic asthma,
- Non- allergic asthma
- Occupational Asthma
- Exercise-induced asthma
- noctural asthma
Name at least 5 nursing considerations when treating asthma.
- health history
- respiratory assessment
- O2 therapy
- diagnostic tests
- posture
- reassurance
- education
- medication administration
- chest physiotherapy
- assistance with ADLs.
- Assess respiratory status every 5-10 minutes initially, and as condition improves, 1-2 hourly
- Assess cough for effort and sputum amount and colour
- an ineffective cough may indicate worsening of condition
What is pnuemonia?
Pneumonia is an infection in the lung tissue specifically in the alveoli.
The alveolar tissue becomes inflamed and leaks fluid filling the alveoli with infected fluid impairing gas exchange. This is usually caused by bacteria (such as Staphylococcus Aureus) or viruses (such as Influenza) that we pick up in the community – known as community acquired pneumonia.
Pnuemonia.
What position should the patient be placed in to encourage ventilation of the entire lung?
Fowlers/ high fowlers
What diagnostic tests be used to diagnose pnuemonia?
- FBE (white cell count)
- C-reactive protein blood test (CRP)
- Sputum
- Chest X-ray
What nursing interventions are required when caring for a person with pnuemonia? (ineffective airway clearance)
- Place in Fowlers position to encourage ventilation (expansion) of the entire lung.
- Encourage frequent deep breathing and cough exercises to promote airway clearance.
- Refer to physiotherapist for treatment.
- Provide adequate fluid intake to prevent the secretions from becoming tenacious.
- Maintain FBC to prevent fluid overload.
- Provide humidified oxygen therapy to moisten secretions.
- Administer medications such as antibiotics and monitor the effects.
- Provide analgesia if necessary to promote coughing and to prevent splinting or non-use of some lung due to pain
The ___________ _____________ is an early indicator of deterioration of a patient’s condition,
respiratory rate
Respiratory assessment.
If a patient is using their accessory muscles scuh as abdominals or scalene muscles, what does this indicate?
Indicates increased work or difficulty breathing.
