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NUR 118 Lecture > NUR 118 - Lecture 7/8 - Oxygenation > Flashcards

NUR 118 - Lecture 7/8 - Oxygenation Flashcards

1
Q

LECTURE OBJECTIVE

Identify structures of the upper and lower airway​

A

Upper:
Nasopharynx
Nasal air passage
Pharynx
Oropharynx
Mouth
Epiglottis

Lower:
Trachea, bronchi, bronchioles, alveoli,

-Above the Larynx is Upper Airway, below is lower airway

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2
Q

LECTURE OBJECTIVE

Distinguish Between External and Internal Respirations​

A

External: Exchange is in lungs at alveoli
Internal: Exchange is at body organs & tissues

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3
Q

LECTURE OBJECTIVES

Respiratory Assessment: Inspection

A
  1. Color of skin & mucus membranes: (Clubbing and Cyanosis)
  2. Cough & Sputum - COCAF
  3. Respiratory Rate
    • Rhythm, depth, pattern, effort
  4. Symmetry of chest movement
  5. Inspect shape of chest: normal vs barrel chest
  6. Spinal deformities: (AP Diameter)
  7. Edema
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4
Q

LECTURE OBJECTIVES

Respiratory Assessment:

Inspection - What are the 9 breathing patterns?

A

-Eupnea​: normal respirations
-Tachypnea​: Fast, shallow respirations
-Bradypnea​: Slow respirations
-Dyspnea: Difficulty breathing
-Orthopnea​: Difficulty breathing when supine
-Apnea : No breathing

-Kussmaul’s Respirations​: Fast & abnormally deep; metabolic acidosis

-Cheyne-Stokes Respirations: Fast, deep respirations, then decreased depth to apnea

-Biot’s Respirations​: Irregular fast and shallow

-Stridor = EMERGENCY​

​

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5
Q

LECTURE OBJECTIVES

Respiratory Assessment:

Inspection - 8 observations that indicate respiratory effort​

A
  1. Nasal Flaring
  2. Retractions
  3. Use of accessory muscles
  4. Grunting
  5. Body position (to help respirations(
  6. Conversational Dyspnea
  7. Stridor
  8. Wheezing
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6
Q

LECTURE OBJECTIVES

Respiratory Assessment: Palpation

What to check when palpating?

A

check anterior, posterior and lateral

1.Pain/Tenderness
2.Masses
3.Normal Chest Excursion: Symmetric thoracic expansion when breathing
- (Place thumbs adjacent, have patient breath in and out

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7
Q

LECTURE OBJECTIVES

Respiratory Assessment: Auscultation

What is the technique? (JUST Technique)

A

Technique​:
- Start above clavicle-below xiphoid process-nipple area-ribcage-abdomen
- Left to right, right to left, down

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8
Q

LECTURE OBJECTIVES

Respiratory Assessment: Auscultation

What are normal lung sounds?

A

Normal lung Sounds​:
Bronchial: over trachea
Broncho-vesicular: Over sternum in front, between clavicles posteriorly
Vesicular: Heard over lower lung fields

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9
Q

LECTURE OBJECTIVES

Respiratory Assessment: Auscultation

What are abnormal lung sounds?

A

Abnormal lung Sounds:

Rales (crackles) ​- Air bubbling through fluid in alveoli
- Rales in the tails (Alveoli

Grunting: ​Grunting noise; trapped air that is forced out on expiration

Rhonchi ​- Rumbling snoring sound; air through mucus in large airways = bronchi
- Rhonchi in Bronchi

Wheezes - Musical, whistling sound; Narrow/constricted small airways from partial obstruction
- Think: Whistling through narrow airway

Pleural friction rub​: Like leather rubbing together; pleural layers rubbing together

Stridor​: Loud whistle/gasping; Upper airway partial obstruction; EMERGENCY

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10
Q

LECTURE OBJECTIVE

List labs and diagnostics related to gaseous transfer

May need to add more detail later on

A

CBC
- WBC: Infection
- Hemoglobin + Hematocrit: O2 carrying capacity of blood

Allergy Testing

Sputum: for infection
>TB
>Culture

PPD​
ABG’s​
Peak Flow Meter
Chest X-Ray
Pulse Oximetry​

Sleep Studies​
- For sleep apnea

Bronchoscopy​
CAT Scan​
Thoracentesis​
Pulmonary Function Tests​​

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11
Q

LECTURE OBJECTIVE

Gaseous Transfer Nursing Interventions

A

Position for maximum ventilation​
>HIGH FOWLER’S - ORTHOPNEIC ​

Mobilize Secretions​
>Coughing, deep breathing, chest PT​
>Maintain hydration - Increase fluids to thin secretions​

Assist with incentive spirometry​
Respiratory Medications: ex; bronchodilators, corticosteroids, cough suppressants

Support Smoking Cessation​
Teaching - Health promotion - diet & exercise​
Provide Oxygen Therapy if needed​
Suction if needed

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12
Q

LECTURE OBJECTIVE

Hypoxia S/S — Describe Early and Late signs of hypoxia

(aka: inadequate oxygenation of tissue/organ)

A

Early S/S: (R-A-T)
- Restlessness
- Anxiety
- Tachycardia/Tachypnea
- Confusion

Late S/S: (B-E-D)
-Bradycardia
-Extreme Restlessness
-Dyspnea

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13
Q

LECTURE OBJECTIVE

What is COPD?

A

Chronic Obstructive Pulmonary Disease (COPD):

A preventable and treatable disease state of airflow limitations involving the airways, lung tissue or both

  • Chronic inflammatory lung disease that causes obstructed airflow
  • It includes emphysema & chronic bronchitis
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14
Q

LECTURE OBJECTIVES

COPD - Chronic Bronchitis

Definition, etiology, s/s, diagnosis tests

A

Definition: Inflammation and hypersecretion of mucus in bronchi & bronchioles, d/t chronic exposure to irritants, results in airway obstruction
- Excess mucus in bronchi bc of irritants = obstruction

Etiology: Smoking (90% of cases), occupational, air pollution, asthma, cystic fibrosis

Signs and Symptoms: Chronic cough, thick sputum, rhonchi in the bronchi, Hypoxemia & hypoxia, tachycardia & tachypnea, dyspnea & SOB

Diagnosis: PFT, Chest X-Ray, ABG

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15
Q

LECTURE OBJECTIVES

COPD - Chronic Bronchitis

Treatment

A

Bronchodilators, Corticosteroids, expectorants
Antiinfectives if r/t infection
Controlled Oxygen delivery or BiPAP
Pulmonary Rehab
Stop smoking

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16
Q

LECTURE OBJECTIVES

COPD - Emphysema

Definition, etiology, s/s, diagnosis tests

A

Emphysema: Destruction of alveoli, narrowing of bronchioles and trapping of air resulting in loss of lung elasticity

Etiology: Smoking (90% of cases), occupational exposures, air pollution

S/S: Difficulty exhaling, pursed lip breathing, barrel chest, weight loss, tripod position, clubbing d/t chronic hypoxia

Diagnosis tests: PFT, Chest X-Ray, ABG

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17
Q

LECTURE OBJECTIVES

COPD - Emphysema

Treatment

A

Bronchodilators, corticosteroids, expectorant

Anti-Infectives if r/t infection
Controlled oxygen delivery / BiPAP
Pulmonary Rehab
Stop Smoking

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18
Q

LECTURE OBJECTIVES

Sleep Apnea

Definition, risk factors, s/s, diagnostic tests

A

A periodic interruption in breathing during sleep–an absence of air flow through the nose or mouth during sleep
- Pauses last 10-30 seconds

Risk factors: Small upper airway, overweight, large neck, Age > 40, smoking, alcohol

s/s: snoring, period of apnea of 10-120 seconds, morning headache, daytime sleepiness, dry mouth in am

Diagnostics: Sleep studies overnight

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19
Q

LECTURE OBJECTIVES

Sleep Apnea

Treatments

A

Continuous positive airway pressure (CPAP) - Delivers forced air to keep airways open

BiPAP (Bi-level positive airway pressure) - Similar to CPAP, but airflow changes primarily with breathing in but also breathing out

  • Side lying positioning for sleep, avoid blockage of airway
  • No smoking, no alcohol
20
Q

LECTURE OBJECTIVES

Differentiate between normal stimulus to breathe and the “hypoxic drive”​

A

Normal Stimulus:
- Increase levels of CO2 stimulate breathing to eliminate excess CO2
- Respiratory centers in brainstem control breathing
- Chemoreceptors detect changes in blood pH

COPD = Chronic Bronchitis:
- Decreased levels of O2

21
Q

LECTURE OBJECTIVES

What independent nursing interventions can be used for patients with respiratory distress?

A
  • HOB up, high fowlers
  • Pull up in bed
  • Orthopneic position
22
Q

LECTURE OBJECTIVES

In which situations do we apply supplemental O2?

A

-Patient is dyspneic​
- <90% O2 SAT / Impaired gas exchange
-Restless​
-Cyanotic​
-Gray​
-Difficulty ventilating all areas of their lungs
-Heart Failure
-MI (Myocardial infarction)

We will usually start with nasal cannula​

23
Q

LECTURE OBJECTIVES

When to suction using yankauer and suction catheter?

A

Suctioning is done as needed (prn), independent nursing intervention

Yankauer:

-Upper airway
-Secretions in mouth or back of throat, that CANNOT be expectorated

Suction Catheter:

-Lower airway
-STERILE procedure
-Pre-oxygenate with 100% O2
-Duration of each suction should be limited to 10 seconds
-# of passes: 3 or less

24
Q

LECTURE OBJECTIVES

Medications Guaifenesin

A

Class: Expectorant
- Reduces viscosity of tenacious secretions by increasing respiratory tract fluid
(Remember suctioning is used if expectorants aren’t enough)

Implications: FINISH THIS

25
Q

LECTURE OBJECTIVE

Medications: Codeine

A

Class: Antitussive, opioid analgesic
- Used for cough suppressant

Implications: Respiratory depression, sedation, constipation, hypotension

26
Q

Classification corticosteroids

Function, side effects

A

Function: Decreases inflammation, suppresses immune system

Side effects: HTN, weight gain, infection risk,

27
Q

Classification-Bronchodilators

Function, side effects

A

Function: Relax muscle bands in airway, keeps airways dilated (OPEN)

Side effects: Dry mouth, trembling, nervousness, palpitations

28
Q

Differentiate between Ventilation, Respiration and Oxygenation

A

Ventilation - Movement of air into and out of lungs through breathing

Respirations - Exchange of O2 and CO2 in lungs; internal and external

Oxygenation: How well the cells, tissues and organs are supplies with oxygen

29
Q

Factors Affecting Ventilation

A

Rate - How fast you breathe​

Depth - How much lungs expand to take in air​

Hyperventilation - Fast & Deep - Too much air = Loss of CO2​

Hypoventilation - Slow & Shallow - Too little air = Low O2​

Lung elasticity - Ability of lung to recoil - Loss = Inhibits deflation ​

Lung compliance - Ease of Lung inflation - Loss r/t H20 (edema) - scaring ​

Airway resistance - Airflow in Airways - Large diameter = Good Air Flow ​
Decrease in diameter = ^ resistance - ​
R/T - Secretions - Bronchospasms - Inflammation - Obstruction​

30
Q

Define the following inadequacy of ventilation:

Hypoxemia
Hypoxia
Hypercarbia
Hypocarbia

A

Hypoxemia - Low blood oxygen levels
Hypoxia - Low oxygen levels in tissue
Hypercarbia - Elevated blood CO2 levels, caused by hypoventilation
Hypocarbia - Low blood CO2 levels, caused by hyperventilation

31
Q

KAHOOT

Hypoventilation results in what?

A

Hypoxemia
Hypoxia
Hypercarbia

32
Q

Abnormal Lungs Sounds

A

Rales (Crackles) - Pneumonia
Rhonchi -
Wheezes -
Stridor - Upper airway
Pleural Friction Rub - Inflammation (low pitched sneaker squeak)
Grunting -

33
Q

What to treat in children in order to prevent cardiac arrest?

A

Respiratory arrest leads to cardiac arrest

34
Q

Interventions

A

Positioning: High fowler’s, orthopneic
Mobilize secretions: coughing, deep breathing, fluids (thin secretions)
Assist with incentive spirometry
Respiratory medications
Support smoking cessation
Teaching / health promotion
O2 Therapy
Suction, if needed

35
Q

How to check if infants can breath?

A

Feed them, they will reflexively spit out and/or smack food away if they’re not breathing

36
Q

List 4 factors that affect oxygenation

A

Anything that affects ventilation can affect oxygenation: Lung elasticity/compliance, airway resistance; COPD, Pneumonia, Asthma, bronchitis

Hyperventilation/hypoventilation

Hypoxia
Oxygen & CO2 transport issues
Anemia

37
Q

SUPPORT QUESTION

Describe the methods of Pursed-Lip Breathing and Belly/Diaphragmatic Breathing

A

Pursed-Lip Breathing:
Nose inhale, mouth exhale (blow out candle)

Belly Breathing (Diaphragmatic breathing):
- Place hands anteriorly on rib cage
- Slow deep nose inhale
- Hold breath, 2-5 sec
- Slow, complete mouth exhale

38
Q

SUPPORT QUESTION

What are the purposes of Pursed-Lip and Belly/Diaphragmatic Breathing?

A

Pursed-Lip Breathing:
- Improves Ventilation
- Releases trapped air
- General relaxation
- Relieves shortness of breath

Belly/Diaphragmatic Breathing:
- Stimulates surfactant production
- Prevents alveolar collapse

39
Q

SUPPORT QUESTION PART 1

A patient is short of breath and or has copious secretions.

State 3-4 Priority
Nursing Interventions to promote oxygenation

A

HOB up = High Fowler’s
DB&C / Diaphragmatic
Pursed Lip Breathing
Increase fluids

40
Q

KAHOOT

WHICH IS NOT AN APPROPRIATE ETIOLOGY FOR INEFFECTIVE AIRWAY CLEARENCE

-EXCESSIVE MUCOUS
-RETAINED SECRETIONS
-PNEUMONIA
-FOREIGN BODY IN AIRWAY

A

Pneumonia is NOT an appropriate etiology for ineffective airway clearance

All of the others ARE appropriate.

41
Q

KAHOOT

WHICH SIGNS AND SYMPTOMS SUPPORT THE NURSING DIAGNOSIS, INEFFECTIVE BREATHING PATTERN

-DYSPNEA AT REST
-REQUIRING ORTHOPNIC POSITIONING
-TACHYPNEA
-PULSE OXYMETRY READING OF 94% ON ROOM AIR

A

All of the above

42
Q

KAHOOT

List interventions to mobilize secretions

A

Coughing, deep breathing, chest percussion

Maintain hydration/Increase fluids

43
Q

KAHOOT

Which medications interfere with pulmonary function causing decreased respirations?

A

Opioids
Anesthesia
Antianxiety
Sedative-hypnotics

44
Q

KAHOOT

Which medications promote ventilation and oxygenation?

A

Bronchodilators
Expectorants
Antihistamines

45
Q

What is the harm in giving patients with COPD too much supplemental oxygen?

A

Patients with COPD use the hypoxic drive to stimulate breathing. I.e. when their O2 levels are low, they breathe

But if they’re receiving too much O2, then they will not breathe

46
Q
A

NUR 118 Lecture (14 decks)

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