Notes: Ch 41 - Oxygenation Flashcards
What is the normal range of pH?
7.35 - 7.45
What is the normal range for PaCO2?
45-35
What is the normal range for HCO3?
22-26
PaCO2 is related to what system?
Respiratory
HCO3 is related to what system?
Metabolic
What are the three compensations for acidosis/alkalosis issues?
- Uncompensated
- Partially-compensated
- Fully-compensated
How would you layout the Acidotic/Alkalotic tic-tac-toe chart?
AC / N. / ALK
pH
(R) PaCO2
(M) HCO3
When using the Acidosis/Alkalosis tic-tac-toe method, how is an uncompensated issue indicated?
- Either PaCO2 or HCO3 will be in the Normal column
When using the Acidosis/Alkalosis tic-tac-toe method, How is partial compensation indicated?
One both PaCO2 and HCO3 are abnormal and pH is not in the normal column
When using the Acidosis/Alkalosis tic-tac-toe method, How is fully compensanted indicated?
- pH is normal
- PaCO2 and HCO3 are both abnormal to opposite sides.
What is the diagnosis?
pH = 7.5
PaCO2 = 22
HCO3 = 16
Partially Compensated Respiratory Alkalosis
What is the diagnosis?
pH = 7.39
PaCO2 = 35
HCO3 = 20
Uncompensated Metabolic Acidosis
What is the diagnosis?
pH = 7.31
PaCO2 = 30
HCO3 = 14
Partially Compensated Metabolic Acidosis
What is the diagnosis?
pH = 7.59
PaCO2 = 49
HCO3 = 30
Partially Compensated Metabolic Alkalosis
What is the diagnosis?
pH = 7.45
PaCO2 = 30
HCO3 = 24
Uncompensated Respiratory Alkalosis
Is Hypoventilation associated with Acidosis or Alkalosis?
Acidosis
Hypoventilation results in the retention of _____ and the need for _____.
CO2, O2
What type of drugs result in respiratory depression?
opioids
Name six opioids that can lead to respiratory depression.
- Fenanyl
- Percocet
- Dilaudid
- Oxycodone
- Codeine
- Morphine
Accumulation of fluid around or in the lungs can cause…
CHF
Congestive Heart Failure
What other item can lead to CHF?
Pulmonary Edema
What is the major characteristic of pneumonia?
fluid in the lungs
Fluid in the lungs is also called…
consolidation
How do we assess for consolidation?
Auscultation and checking for fremetis
How would consoidation be indicated during auscultation?
crackles
Absent, weak, or altered fremetis vibrations indicate…
possible consolidation
Name some things that can cause hypoventilation that could lead to acidosis
- Opioids
- Fluid in or around lungs
- Pneumonia
- Pulmonary Edema
- Asthma/bronchiole constriction
- COPD
Chronic bronchitis and Emphysema are two types of…
COPD
Chronic Obstructive Pulmonary Disorder
CPD is a _____ retainer
CO2
Emphysema is an overinflation of…
the alveoli
What is the biggest factor that leads to COPD?
smoking
RR for hypoventilation is…
< 12
RR of < 12 can lead to…
acidosis
RR of > 20 can lead to…
alkalosis
Hyperventilation leads to loss of
CO2
How would you supply CO2 to someone who is hyperventilating?
Give them a mask/bag so they breathe back in the expelled CO2
What are some factors that cause hyperventilation?
- Anxiety
- Hysteria
- Excitement
- Panic attacks
- Fever
- Aspirin toxicity
- Person on ventilation
- may get over oxygenated causing hyperventilation in attempt to get rid of O2
Hyperventilation will require _____.
CO2
Hypoventilation will need _____.
O2
Name seven early signs of hypoxia.
- Restless
- Irritable
- Confusion
- Heart/Respiration increased
- Decreased LOC
- Tachypnea
- Tachycardia
or RAT (early),
Restless, Anxiety, Tachycardia/Tachypnea
BED (late)
Bradypnea/Bradycardia, Extreme restlessness, Dyspnea (severe)
Name five late signs of hypoxia.
- Bradypnea
- Bradycardia
- In/out of Conciousness
- Sleepy
- Cyonosis
What are the characteristics of Stridor?
- EMERGENT
- Indicative of occlusion,
- complete blockage of airway by the soft structures and tissues and narrow airway in children
What does URI stand for?
Upper Respiratory Infection
What does GERD stand for?
Gastroesophageal reflux disease
What are four early signs of hypoxia for children?
FINES
- Feeding difficulty
- Inspiratory Stridor
- Nares Flare
- Expiratory grunting
- Sternal retractions
What are six things that trigger Asthma?
E.A.R. H.U.G.
- Exercise
- Air pollutants
- Respiratory Infections
- Hypersensitivity
- URI
- GERD
True or False
Asthma tends to run in the family.
True
Define Hypoxia
Hypoxia is a condition or state in which the supply of oxygen is insufficient for normal life functions
Define Hypoxemia
Hypoxemia is a condition or state where there is a low arterial oxygen supply
What are three indicators of Hypoxemia?
- Tachycardia
- Tachypnea
- Restlessness
What are six characteristics of Asthma?
- Productive cough
- SOB
- Wheezing/Prologned expiration
- CO2 retention
- Chest tightness
- Retractions
What are respiratory retractions?
The areas below the ribs, between the ribs, and in the neck sink in with each attempt to inhale.
Define Asthma
Asthma is a condition in which your airways narrow and swell and produce extra mucus
What are the characteristics of Status Asthmaticus?
- Status asthmaticus is more commonly known as acute severe asthma or a severe asthma exacerbation.
- It refers to an asthma attack that doesn’t improve with traditional treatments, such as inhaled bronchodilators
- It is EMERGENT
If Asthma symptoms do not respond to usual treatment within 30 minutes, what is it indicative of?
Status Asthmaticus
Asthma is also known as a _____ _____ _____.
reactive airway disease
Those with Chronic Bronchitis are in need of…
O2
What are some symptoms of Chronic Broncitis?
- Darker to cyanotic color
- Productive cough
- Hypoxia
- Hypercapnia
- Respiratory acidosis
- Inc RR
- Inc Hbg
- Exertional Dyspnea
- Clubbing
Chronic bronchitis can lead to
- Cardiac enlargement
- Use of Accessory Muscles to breathe
- right-sided heart failure
Define Emphysema
It is an overinflation of the alveoli which inhibits gas exchange
What are some characteristics of emphysema?
- CO2 retention
- Pursed lip breathing
- Orthopneic
- Barrel chest
- Exertional dyspnea
- Prolonged expiration
- Speaks in bursts as breath allows
- Anxious
- tri-pod stance common
COPD shares symptoms with _____ and _____ as they are components of COPD.
emphysema and chronic broncitis
What is the order of physical assessment for respiratory ailments?
- Inspection
- Palpation
- Percussion (advanced practice only)
- Auscultation
What are we assessing during Inspection?
- Skin and mucous membranes
- LOC
- Breathing patterns
- Chest wall movement
What are we assessing during Paplation?
Pulses at chest, feet, and legs.
What are we assessing during Percussion?
- Presence of abnormal fluid/air
- Diaphragmatic excursion
What are we assessing during Auscultation?
- Normal and abnormal heart and lung sounds
What are the Nursing Responsibilities for physical assessment in oxygenation issues?
- Lung auscultation and breathing pattern
- Abdominal use in breathing
- Urine output
- Skin and mucous membranes
- Heart souns
- Circulation
- Edema
- DVT
What are the three oxygen delivery devices?
- Nasal cannula
- Simple face mask
- Venturi mask
What is the volume of oxygen that can be delivered via nasal cannula?
1-6 Liters
What is the volume of oxygen that can be delivered via a simple face mask?
5-8 Liters
(can go over 8, but O2 would stay at 60% max)
What is the volume of oxygen that can be delivered via a venturi mask?
4-12 Liters
(Can go up to 15L for 100% O2)
What are four advantages to nasal cannula?
- Safe and simple
- Easily tolerated
- Does not impede eating or talking
- Inexpensive and disposable
What is an advantage of a simple face mask?
Provides humidified oxygen automaticaly due to higher delivery rate
Advantage of the Venturi mask?
- most accurate
- allows control for a specified oxygen concentration
Disadvantage of the nasal cannula?
- can dry out mucus membranes
- will require order for humidified O2
