N200 Midterm Chapter 40: Oxygenation Flashcards
Upper respiratory tract includes
Mouth
Nose
Pharynx
Larynx
Lower respiratory tract inlcudes
Trachea Bronchi Bronchioles Alveoli Pulmonary capillary network Pleural membranes
_____prevents alveoli from collapsing. In infants, surfactant factor very important. Maintains tension at alveoli level.
surfactant
CO2 is byproduct of ____ _____.
cellular metabolism.
The process of moving gases into and out of the lungs
ventilation
Moves blood to and from the alveolar capillary membranes for gas exchange
Pulmonary circulation
An active process stimulated by chemical receptors (surfactant, helps with the tension) in the aorta and a passive process for expiration
Inspiration/expiration
Exchange of respiratory gases in the alveoli and capillaries
Diffusion
Diffuses into red blood cells and is hydrated into carbonic acid
Carbon dioxide transport
Describe the process of breathing (inspiration part only)
Diaphragm and intercostals contract Thoracic cavity size increases Lung volume increases Intrapulmonary pressure decreases Air rushes in lungs to equalize pressure
With inspiration, what happens with oxygen?
Blood picks up oxygen. Oxygenated blood heads thru pulmonary vein to heart and systemic circulation.
What happens when we breath (just expiration part)
Diaphragm and intercostals relax
Intrapulmonary pressure rises
Air is expelled
How does deoxygenated blood become oxygenated?
Deoxygenated Blood from systematic circulation and heart heads thru pulmonary artery to alveoli where CO2 is kicked out
What factors Influence Respiratory Fxn?
- Age: smoking, inability for diffusion gas/exchange; probs w/ circulation; cardiac issues (pumping probs)
- Environment: exposure to smog, 2nd had smoke, occupation ex. coal miners lung. barrel chest from ??
- Lifestyle: smoking
- Health Status
- Medications: do they need bronchodilators
- Stress: increases HR, RR, BMR
What lifestyle factors influence respiratory fxn?
- Nutrition: healthy or unhealthy diet, obesity affects diaphragm mvmt; emaciation: muscles that aid in respiration are affected and is emaciated person taking in enough O2
- Exercise
- Cigarette smoking
- Substance abuse: huffing, smoking pot, snorting cocaine, amphetamine use (speed)
- Anxiety and stress
What two factors affect oxygenation?
Physiological
Conditions affecting chest wall mvmt
Describe physiological factors affecting oxygenation?
- Decreased oxygen-carrying capacity: not enough RBCs to support O2 transport. think Anemia. inhalation of CO2 or toxic substance can also decrease O2 carrying capacity.
- Decreased inspired oxygen: make sure you don’t oversedate your patient.
- Hypovolemia: low blood volume; caused by shock, dehydration. Body starts vasoconstriction due to low volume, causes HR increase, need increase in O2 demand
- Increased metabolic rate: w/ exercise, vasodilation to reduce heat, lots of RBCs moving around needs O2
What conditions affect chest wall movement (affecting oxygenation)?
- Pregnancy: diaphragm gets pressed
- Obesity: same as pregnancy, can’t get full lung expansion
- Musculoskeletal abnormalities: kyphosis decreases lung expansion
- Trauma: decreased lung expansion, broken ribs don’t want to breath.
- Neuromuscular disease: w/ injury to medulla oblangata
- CNS alterations: w/ injury Ex C4 or C5 issue, no signal for breathing
Developmental Factors:
- Premature infants need ____, lung development, not fully fxnl, is brain dvlpd enough to send signal for normal insp/expiration.
- Infants and toddlers: infants teethe, w/ dvlpt of teeth, get stuffy nose, prone to _______ infections.
- School-age children and adolescents: big factors _____ and 2nd hand smoke
- Young and middle-age adults: look at diet, _____, where working (all from other slide)
- Older adults: osteoporosis? heart status: hardening of valves or arteries? cilia changes (in lung lining) some _____ of heart muscle makes it harder to pump
- surfactant
- upper respiratory
- asthma
- exercise
- thickening
Hyperventilation:
- Caused by: ___, ___ and ____ , get hyperoxygenated, need for balance
- fever causes _____ in BMR; get the paper bag to rebreath.
3: Definition: _____ in excess of that required to eliminate carbon dioxide produced by ______.
- stress, fever and pain; CO2
- increase
- Ventilation; cellular metabolism
Hypoventilation:
- signs and symptoms: change in ____ status, confusion, crazy behavior. Heart dysrhythmias: heart muscle not getting enough _____.
- Definition: ____ ventilation inadequate to meet the body’s oxygen demand or to _____ sufficient carbon dioxide
- mental; oxygen
2. Alveolar; eliminate
Hypoxia:
- decrease in ____, patient that is anemic or has pneumonia, anyone w/ shock or trauma usually has hypoxia. Poor tissue ____ at tissue level.
- Decrease in ____ oxygen. Ex. going to Denver, hard to breath at high altitude.
- Definition: Inadequate _____oxygenation at the cellular level
- Hgb; perfusion
- inspired
- tissue
What diagnostic tests could be performed with oxygenation issues?
- CBC: look at RBCs and platelets
- Pulmonary Function tests
- Bronchoscopy
- Lung Scan VQ scan (checks for clots)
- Thoracentesis: 6 in needle in pleural cavity wherever fluid collection occurs.
- Sputum cultures: For CS, AFB
- Cytology looking for cancer or mold growth
- MANII test: for Tb
For health promotion:
- Influenza and _____ vaccine: pneumonia vaccine can be given to infant in series of 4 shots. Normally give pneu vac to people w/ history and elderly. Make sure pts that are immunocompromised get flu shot.
- Environmental modifications: if living in house & child develops asthma, teach parents why they can’t smoke around child anymore.
pneumococcal
What 4 nursing interventions can be performed for dyspnea management?
- Positioning
- Medications
- Oxygen therapy
- Psychosocial techniques
Describe purpose of intervention:
1. Position: reposition and breathing
- REposition patient: provides bigger tidal volume capacity. Patients shrink in bed;
- Deep breathing: with Atelectasis alveoli covered in mucus, no gas exchange, get pt to do deep breathing and coughing to open up lungs and cough away mucus.
Describe purpose of intervention:
2. Medications
- get meds to break up mucus; get bronchodilators, nebulizers, musiex: prescribed dosage of guifenisin. Surfactant tension: pt has potential for pneoumothorax (collapsed lung)
Describe purpose of intervention:
3. Oxygen Therapy
- Pulse Ox., Oxygen requires physician order. Start at 2-4 Liters. KNow what pt diagnosis is! if COPD or emphysema, then don’t want to put high oxygen on! can cause full respiratory failure.
Describe purpose of intervention:
4. Psychosocial
for hyperventilation or sleepy over medicated or back from surgery. Work w/ them for deep breathing/coughing exercises to work out anesthesia.
- ______is the amount of air exhaled after normal inspiration.
- _____ the amount of air left in the alveoli after a full expiration.
- _______is the maximum amount of air that can be removed from the lungs during forced expiration
- Tidal volume
- Residual volume
- Forced vital capacity
Starlings law of the heart.
As the myocardium stretches, the strength of the subsequent contraction increases
In patients with COPD, the administration of ___ ____ results in hypoventilation. These patients have adapted to a high carbon dioxide level so their carbon dioxide–sensitive chemoreceptors are essentially not functioning.
excessive oxygen
Signs and symptoms of ______ include rapid respirations, sighing breaths, numbness and tingling of hands/feet, light-headedness, and loss of consciousness
hyperventilation
The clinical signs and symptoms of _____ include apprehension, restlessness, inability to concentrate, decreased level of consciousness, dizziness, and behavioral changes. The patient with ____ is unable to lie flat and appears both fatigued and agitated.
hypoxia
During early stages of ____the blood pressure is elevated unless the condition is caused by shock. As the____worsens, the respiratory rate declines as a result of respiratory muscle fatigue.
hypoxia
_________ results when the supply of blood to the myocardium from the coronary arteries is insufficient to meet myocardial oxygen demands. Two common outcomes of this ischemia are angina pectoris and MI.
Myocardial ischemia
_______ or acute coronary syndrome (ACS) results from sudden decreases in coronary blood flow or an increase in myocardial oxygen demand without adequate coronary perfusion; occurs because ischemia is not reversed. Cellular death occurs after 20 minutes of myocardial ischemia
Myocardial infarction (MI)
Inhaled _____ causes vasoconstriction of peripheral and coronary blood vessels, increasing blood pressure and decreasing blood flow to peripheral vessels.
nicotine
The following assessment characteristics would indicate???
1. Confusion, Decreased activity, Fatigue
Irritability, Restlessness, Sleepiness
2. Dyspnea, Nasal flaring, Tachypnea, Use of accessory muscles
3. Diaphoresis, Pallor, Cyanosis
4. Decreased respiratory excursion
Abnormal, distant lung sounds
Impaired Gas Exchange Related to Decreased Lung Expansion
Possible nursing diagnoses for alterations in oxygenation.. (13!)
- Activity intolerance
- Decreased cardiac output
- Fatigue
- Impaired gas exchange
- Impaired spontaneous ventilation
- Impaired verbal communication
- Ineffective airway clearance
- Ineffective breathing pattern
- Ineffective health maintenance
- Risk for aspiration
- Risk for imbalanced fluid volume
- Risk for infection
- Risk for suffocation
What is Trendelenburg’s position?
Head lower than lung (lay on side that doesn’t have issue)
Oxygenation therapy is performed to _______ and methods of supply include ____ and ____.
To prevent or relieve hypoxia
Nasal cannula
Oxygen mask
To prevent or relieve hypoxia:
- get pulse Ox
- look at rhythm, depth,
- need to reposition
- get pt up and moving
What are 5 techniques used for restorative and continueing care?
- Cardiopulmonary rehabilitation
- Hydration
- Coughing techniques (splinting and dehissance).
- Purse Lipped-Breathing (hyperventilation)
- Diaphragmatic breathing
What are 5 tools used for oxygen therapy?
- nasal cannula
- simple face mask.
- partial rebreather mask: fill partially, want space, O2 breathed in mixes with CO2 in bag
- nonrebreather: disks prevent backflow of room air (gets more oxygen
- venturi: most accurate means of delivery for oxygen, (other than a respirator) gauge to actual %
Nasal Cannula: what % O2 at each Liter?
1L
2L
3L
1L=24%
2L=28%
3L=32%
- Simple Mask: what %O2 at:
- 5-6L
- 7-8L
- 10L
- 5-6L=40%
- 7-8L =50%
- 10L= 60%
- Partial Rebreather Mask: what % and how many Liters?
- 6-10L =40% O2
- The level of O2 will depend on pts overall respiratory and health.
- Should not run below 5L.
- Reservoir bag should never be fully collapsed.
- Non Rebreather Mask: has the little disc, what % O2?
- will deliver 80-100% O2
- should not run below 5L
- reservoir bag should never be fully collapsed
venturi O2 concentration high or low?
-delivers higher concentration of O2
What are 3 ways to mobilize pulmonary secretions?
Hydration
Humidification
Nebulization
Name 5 ways for dyspnea management?
Airway management Mobilization of pulmonary secretions Humidification Nebulization Chest physiotherapy
What are 3 ways to maintain a patent airway?
Coughing techniques
Suctioning techniques
Artificial airways
When are Oropharyngeal and nasopharyngeal artificial airways used?
Used when the client can cough effectively but is not able to clear secretions
When are Orotracheal and nasotracheal artificial airways used?
Used when the client is unable to manage secretions
What are 4 ways to maintain and promote lung expansion?
- Positioning: Reduces pulmonary stasis, maintains ventilation and oxygenation
- Incentive spirometry: Encourages voluntary deep breathing
- Chest physiotherapy: percussing and vibrating posterior chest.
- Chest tubes: A catheter placed through the thorax to remove air and fluids from the pleural space or to prevent air from reentering or to reestablish intrapleural and intrapulmonic pressures
With a chest tube set-up, how is air kept from entering the lung from the environment?
negative pressure b/w visceral and parietal pleura keeps air from entering lung from outside, only can go out machine…
_______ are short-term artificial airways to administer mechanical ventilation, relieve upper airway obstruction, protect against aspiration, or clear secretions. ETs are generally removed within __ days
Endotracheal tubes (ETs) 14
A ______ is a surgical incision is made into the trachea, and a short artificial airway (a tracheostomy tube) is inserted. If the client requires long-term assistance from an artificial airway
tracheostomy
A chest tube is a catheter inserted through the thorax to remove air and fluids from the _____ _____, to prevent air or fluid from reentering the pleural space, or to reestablish normal intrapleural and intrapulmonic _____.
pleural space
pressures
A ______ is a collection of air in the pleural space. The loss of____ intrapleural pressure causes the lung to collapse.
pneumothorax
negative
what are 3 forms of respiratory muscle training?
Breathing exercises
Pursed-lip breathing
Diaphragmatic breathing
_______ is actively assisting the client to achieve and maintain an optimal level of health through controlled physical exercise, nutrition counseling, relaxation and stress management techniques, prescribed medications, and oxygen administration
Cardiopulmonary rehabilitation
DOE
dyspnea upon exertion
