NUR 118 - Lecture 7/8 - Oxygenation Flashcards
LECTURE OBJECTIVE
Identify structures of the upper and lower airway
Upper:
Nasal air passage
Nasopharynx
Mouth
Oropharynx
Pharynx
Epiglottis
Lower:
Trachea, bronchi, bronchioles, alveoli,
-Above the Larynx is Upper Airway, below is lower airway
LECTURE OBJECTIVE
Distinguish Between External and Internal Respirations
External: Exchange is in lungs at alveoli
Internal: Exchange is at body organs & tissues
LECTURE OBJECTIVES
Respiratory Assessment: Inspection
- Color of skin & mucus membranes: (Clubbing and Cyanosis)
- Cough & Sputum - COCAF
- Respiratory Rate
- Rhythm, depth, pattern, effort
- Symmetry of chest movement
- Inspect shape of chest: normal vs barrel chest
- Spinal deformities: (AP Diameter)
- Edema
LECTURE OBJECTIVES
Respiratory Assessment:
Inspection - What are the 9 breathing patterns?
-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
LECTURE OBJECTIVES
Respiratory Assessment:
Inspection - 8 observations that indicate respiratory effort
- Nasal Flaring
- Retractions
- Use of accessory muscles
- Grunting
- Body position (to help respirations(
- Conversational Dyspnea
- Stridor
- Wheezing
LECTURE OBJECTIVES
Respiratory Assessment: Palpation
What to check when palpating?
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
LECTURE OBJECTIVES
Respiratory Assessment: Auscultation
What is the technique? (JUST Technique)
Technique:
- Start above clavicle-below xiphoid process-nipple area-ribcage-abdomen
- Left to right, right to left, down
LECTURE OBJECTIVES
Respiratory Assessment: Auscultation
What are normal lung sounds?
Normal lung Sounds:
Bronchial: over trachea
Broncho-vesicular: Over sternum in front, between clavicles posteriorly
Vesicular: Heard over lower lung fields
LECTURE OBJECTIVES
Respiratory Assessment: Auscultation
What are abnormal lung sounds?
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
LECTURE OBJECTIVE
List labs and diagnostics related to gaseous transfer
May need to add more detail later on
CBC:
- WBC: Infection
- Hemoglobin + Hematocrit: O2 carrying capacity of blood
Allergy Testing
Sputum: for infection
>TB
>Culture
PPD (Tuberculin Skin Test): Detect antibody form of tubercle bacillus
ABG’s: Acid/Base balance in blood,
Peak Flow Meter:
Chest X-Ray:
Pulse Oximetry:
Sleep Studies:
- For sleep apnea
Bronchoscopy: Visualization of tracheobronchial tree
CAT Scan: Inspect tissue densities, shows lesion
Thoracentesis: Sampling of pleural fluid; analysis of the fluid for cellular composition and chemical constituents like glucose, protein and LDH.
Pulmonary Function Tests (PFTs): Measure ability of resp. system to do gas exchange; assesses ventilation, diffusion
LECTURE OBJECTIVE
Gaseous Transfer Nursing Interventions
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
LECTURE OBJECTIVE
Hypoxia S/S — Describe Early and Late signs of hypoxia
(aka: inadequate oxygenation of tissue/organ)
Early S/S: (R-A-T)
- Restlessness
- Anxiety
- Tachycardia/Tachypnea
- Confusion
Late S/S: (B-E-D)
-Bradycardia
-Extreme Restlessness
-Dyspnea
LECTURE OBJECTIVE
What is COPD?
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
LECTURE OBJECTIVES
COPD - Chronic Bronchitis
Definition, etiology, s/s, diagnosis tests
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
LECTURE OBJECTIVES
COPD - Chronic Bronchitis
Treatment
Bronchodilators, Corticosteroids, expectorants
Antiinfectives if r/t infection
Controlled Oxygen delivery or BiPAP
Pulmonary Rehab
Stop smoking
LECTURE OBJECTIVES
COPD - Emphysema
Definition, etiology, s/s, diagnosis tests
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
LECTURE OBJECTIVES
COPD - Emphysema
Treatment
Bronchodilators, corticosteroids, expectorant
Anti-Infectives if r/t infection
Controlled oxygen delivery / BiPAP
Pulmonary Rehab
Stop Smoking
LECTURE OBJECTIVES
Sleep Apnea
Definition, risk factors, s/s, diagnostic tests
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
LECTURE OBJECTIVES
Sleep Apnea
Treatments
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
LECTURE OBJECTIVES
Differentiate between normal stimulus to breathe and the “hypoxic drive”
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
LECTURE OBJECTIVES
What independent nursing interventions can be used for patients with respiratory distress?
- HOB up, high fowlers
- Pull up in bed
- Orthopneic position
LECTURE OBJECTIVES
In which situations do we apply supplemental O2?
-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
LECTURE OBJECTIVES
When is suctioning done; is it independent or dependent?
When to suction using yankauer and suction catheter?
Describe the suction catheter procedure.
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
LECTURE OBJECTIVES
Medications Guaifenesin
Class: Expectorant
- Reduces viscosity of tenacious secretions by increasing respiratory tract fluid
(Remember suctioning is used if expectorants aren’t enough)
Implications: FINISH THIS
LECTURE OBJECTIVE
Medications: Codeine
Class: Antitussive, opioid analgesic
- Used for cough suppressant
Implications: Respiratory depression, sedation, constipation, hypotension
Classification corticosteroids
Function, side effects
Function: Decreases inflammation, suppresses immune system
Side effects: HTN, weight gain, infection risk,
Classification-Bronchodilators
Function, side effects
Function: Relax muscle bands in airway, keeps airways dilated (OPEN)
Side effects: Dry mouth, trembling, nervousness, palpitations
Differentiate between Ventilation, Respiration and Oxygenation
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
Factors Affecting Ventilation
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
Define the following inadequacy of ventilation:
Hypoxemia
Hypoxia
Hypercarbia
Hypocarbia
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
KAHOOT
Hypoventilation results in what?
Hypoxemia
Hypoxia
Hypercarbia
Abnormal Lungs Sounds
Rales (Crackles) - Pneumonia = air bubbling through fluid; rales in the tails
Rhonchi - Bronchitis = snoring sounds; rhonchi in the bronchi
(Expiratory) Wheezes - constricted airways r/t obstruction; sthma/bronchospasms = whistling sounds
Stridor - upper airway obstruction = high pitched sound
Pleural Friction Rub - pleural layers rubbing together = leather rubbing sound Inflammation (low pitched sneaker squeak)
Grunting - trapped air forced out on expiration = Grunting
What to treat in children in order to prevent cardiac arrest?
Respiratory arrest leads to cardiac arrest
General Nursing Interventions
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
How to check if infants can breath?
Feed them, they will reflexively spit out and/or smack food away if they’re not breathing
KAHOOT
WHICH IS NOT AN APPROPRIATE ETIOLOGY FOR INEFFECTIVE AIRWAY CLEARENCE
-EXCESSIVE MUCOUS
-RETAINED SECRETIONS
-PNEUMONIA
-FOREIGN BODY IN AIRWAY
Pneumonia is NOT an appropriate etiology for ineffective airway clearance
All of the others ARE appropriate.
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
All of the above
KAHOOT
List interventions to mobilize secretions
Coughing, deep breathing, chest percussion
Maintain hydration/Increase fluids
KAHOOT
Which medications interfere with pulmonary function causing decreased respirations?
Opioids
Anesthesia
Antianxiety
Sedative-hypnotics
KAHOOT
Which medications promote ventilation and oxygenation?
Bronchodilators
Expectorants
Antihistamines
What is the harm in giving patients with COPD too much supplemental oxygen?
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
