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XIO > Nurs 50 - week 4 - day 1 - oxygenation > Flashcards

Nurs 50 - week 4 - day 1 - oxygenation Flashcards

1
Q

Systems requirement:

A

Systems requirement:
Musculoskeletal and neurological systems
 Regulate movement of air into and out of the lungs
Pulmonary system
 Oxygenates blood
Heart
 Circulates the blood which carries oxygen to body tissues and CO2 away from the body and out through the lungs
if you see utilization of accessory muscle, shoulders, person could die w/in minutes - breathing fast

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2
Q

surfactant

A

 Made of type II pneumocyte (type II alveolar cells)
 Prevents collapse of alveoli
 Decreases surface tension between water molecules

pulmonary embolism - dead space, blocks oxygen (usually dead space is ok, but not with an embolism)

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3
Q

ALTERATIONS In VENTILATION (breathing) - factors (either lungs can’t expand, or there is resistance) vent resists compliance

A
  1. Lung Compliance - lung expandability
  2. Airway Resistance - asthma patients
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4
Q

External respiration (what has contact with the external environment?)

A

alveolar-capillary gas exchange)
 O2 is diffused from alveoli to pulmonary capillaries; CO2
diffused out of blood into alveoli to be exhaled
 Rate of diffusion depends on thickness of membrane and total surface of lung tissue available for gas exchange
 Rate of exchange affected by pleural effusion, pneumothorax, and bronchospasm

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5
Q

Internal respiration (where does INTERNAL exchange happen?)

A

capillary-tissue gas exchange
 Occurs when O2 diffusion from blood to cellular membrane
of tissues for metabolism
 Waste product of cellular metabolism diffuses from cell
membrane to blood and transported to lungs and exhaled

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6
Q

ALTERATIONS IN GAS EXCHANGE (the 4 Hs)

A
  1. Hypoxemia
  2. Hypoxia
  3. Hypercapnia/hypercarbia (extra CO2)
  4. Hypocapnia/hypocarbia
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7
Q

Hypoxemia (noxema for your arteries) and the number

A

low arterial blood oxygen levels (O2 level less than 80)

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8
Q

Hypercapnia**and is it acute or chronic?

A

Excess of dissolved carbon dioxide (C02) in the blood
 Hypercapnia can be acute or chronic
 In chronic conditions, kidneys can compensate for high blood pH (kidney produces bicarbonate)
 Severe hypercapnia causes CNS depression that may lead to somnolence and progress to coma and death

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8
Q

Hypocapnia (and what are the causes) (shelley is a total hypo)

A

Low levels of dissolved C02 in the blood
Etiology: Hyperventilation
 In most cases, except in high altitude, the blood oxygen level is normal
 Severe hypocapnia
cerebral vasoconstriction → cerebral hypoxia
respiratory alkalosis (↓CO2 = ↑pH) →
causes reduced calcium → symptoms of hypocalcemia (twitching or tetany, paresthesia in the face and lips

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9
Q

Structural Abnormalities in lungs (abnormalities in RIO)

A

 Restrictive (fracture rib)
 Airway inflammation
 Airway obstruction

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10
Q

Hypocapnia (and what causes it)

A

Hypocapnia
Low levels of dissolved C02 in the blood
Etiology: Hyperventilation
 In most cases, except in high altitude, the blood
oxygen level is normal
 Severe hypocapnia
cerebral vasoconstriction → cerebral hypoxia
respiratory alkalosis (↓CO2 = ↑pH) → reduced
ionized Ca → symptoms of hypocalcemia (twitching
or tetany, paresthesia in the face and lips

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11
Q

Alveolar- capillary membrane disorders

A

decreases surfactant
 Change in consistency of lung tissue in alveolar level
(stiff lung; pulmonary edema, acute respiratory distress
syndrome ARDS, pulmonary fibrosis)

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12
Q

Alveolar- capillary membrane disorders

A

Alveolar- capillary membrane disorders
 Change in consistency of lung tissue in alveolar level
(stiff lung; pulmonary edema, acute respiratory distress
syndrome ARDS, pulmonary fibrosis)

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13
Q

**Atelectasis (on exam) - what is the main cause?

A

collapse of lung d/t deflated or fluid filled alveoli and chronic hypoventilation
 Most common respiratory complication post-op

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14
Q

Respiratory Infections***(flu, upper, lower, that’s it)

A

Common Respiratory Infections that Interfere with Gas Exchange
1. Upper Respiratory infections
2. Influenza
3. Lower Respiratory Tract Infection (pneumona)

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15
Q

COPD Pathophysiology - main cause

A

Chronic Obstructive Pulmonary Disease is a chronic
inflammatory lung disease leading to obstructed airways
 Increased risk for developing heart disease
 Cause: smoking (most common) , pollutants, hereditary
 COPD pts have adapted to high C02 and low baseline O2 levels
 Giving excessive O2 may knock out their respiratory drive
 Avoid high levels of O2 (keep between 85-90% O2 sat if no
overt respiratory distress or COPD exacerbation)

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16
Q

COPD Signs and Symptoms (weezy has COPD and she SOBs)

A

 SOB, Chronic cough with mucus production, frequent respiratory infections, wheeze

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17
Q

COPD manifestations

A

• Easily fatigued
• Frequent respiratory
• Infections
• Use of accessory muscles
• Wheezy
• Pursed lip breathing
• Chronic cough
• Barrel chest
• Dyspnea
• Prolonged expiratory time
Cor Pulmonale (cause of right side heart failure pulmonary disease. constant increased pressure in right heart, heart has to pump harder, chronic edema)
• Thin appearance
Increased sputum
• Digital clubbing (160)

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18
Q

ATELECTASIS

A

 Loss of lung volume due to inadequate lung expansion (collapse) of the alveoli that prevents normal ventilation
-One of the most common respiratory complications after surgery.
can happen after surgery to any patient

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19
Q

RESPIRATORY ASSESSMENT***

A
  1. Health Assessment
     Demographics (age, residence (exposed to pollutants, occupation)
     Health history (allergies (pets, pollen), medications, health problems)
     Lifestyle – smoking, recreational drugs
  2. Physical Assessment
    *** Inspect: rates, effort, symmetric, cyanosis, nails
     Palpate: tactile fremitus (vibration of lungs - check both sides at the same time), crepitus (air in subcutaneous tissue - it’s a little bump)
     Percuss: consolidation (if normal, it should be hollow)
     Auscultate: rhonchi, crackles, wheezing
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20
Q

BREATHING RATES

A

 Eupnea - Normal rate of breathing
 12-20 breaths per minute
 Bradypnea – Slow rate of breathing
 < (less than) 12 breaths / minute
 Causes: sedative, opioid meds, neuromuscular dysfunction
 Tachypnea – Fast rate of breathing
 > than 20 breaths per minute; usually shallow
 Generally caused by hypoxia or increase 02 demand from exercise or fever; shallow breathing limits air intake and result in hypoventilation

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21
Q

Assessing Respiratory Effort

A
  1. NASAL FLARING
     visible enlargement of the nostrils with inhalation
     helps reduce resistance to airflow in nose and keep nasal passages open
  2. RETRACTIONS
     Visible pulling in of intercostal, supraclavicular and subcostal tissue
     Caused by negative pressure generated in the chest; to ↑ inhalation depth
  3. USE OF ACCESORY MUSCLES
     During inspiration; use intercostal, abd, neck, shoulder muscles d/t increase 02 demand or ventilation issues
  4. GRUNTING (usually in babies)
     Noisy difficult breathing; forced exhalation against closed glottis
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22
Q

Assessing Respiratory Effort**

A
  1. BODY POSITIONING
     Tripod breathing (leaning forward) – sign of respiratory distress
  2. CONVERSATIONAL DYSPNEA
     Inability or difficulty to speak complete sentences without stopping to breath, pausing for breath
    **7. STRIDOR
     High-pitched whistling sound (hear a lot in babies, if in adult, very serious. ALWAYS go to stridor patient first, everything else can wait)
     Caused by partial obstruction of larynx or trachea
  3. WHEEZE
     Musical sound produced by air passing through narrow airways

chronic COPD or heart failure, important to assess talking, if they can only speak in 2 words without breath, they are getting worse.

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23
Q

ASSESSING COUGH (sputum colors)

A

Dry, productive, hacking
 Sputum characteristics:
-Amount: scant, small, moderate, or copious
-Consistency: thick (bacterial) or thin (viral)
-Color: yellow, green (bacteria) blood-tinged (blood thinners can cause blood), hemotysis (actively coughing up blood - TB)
pulmonary edema - pink and frothy

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24
Q

SPUTUM COLORS

A

SPUTUM COLORS
COLOR/APPEARANCE SIGNIFICANCE
WHITE OR CLEAR Viral infection; common cold, viral bronchitis – supportive care
YELLOW OR GREEN Sign of infection
HEMOPTYSIS Lung damage, lung injury, TB
PINK AND FROTHY Pulmonary edema

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25
Q

diagnostic testing - PULSE OXIMETRY

A

 Estimate of arterial blood 02 sat (Sa02)
 Reflects % of hgb molecules carrying 02
 (anemia and CO poisoning can give false O2 saturation)
 Reflection of oxygenation
 Normal – 95-100%

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26
Q

SPIROMETRY (ICS-Incentive spirometry)

A

 Measures estimate volume of air inhaled
 Frequently used in post-op patients to reduce risk of post-op PNA

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27
Q

CAPNOGRAPHY (measures what - cap is CO2)

A

 Measures Et (exhilation) C02 – end tidal CO2 in exhaled air
 Reflection of ventilation as it shows C02 levels

28
Q

ARTERIAL BLOOD GAS (measures what - art is my ph)

A

 Measures blood pH, p02 and pC02 in arterial blood
 Blood sample obtained from artery

how to obtain it - arterial- very invasive

29
Q

**Nursing Diagnosis - what the main lung issue you need to be aware of?

A

 Ineffective Airway Clearance
 Ineffective Breathing Pattern
 Impaired Gas Exchange
 Impaired Spontaneous Ventilation (too much pain meds, stroke)
 Dysfunctional Oxygenation Weaning
 Risk for Aspiration
**** Risk for Atelectasis

30
Q

Nursing Intervention/Implementation**#1 device for breathing problems

A
  1. Med administration such as inhalers, nebulizers***(every 4 hours as needed, or for acute every 4 hours around the clock. for someone who is wheezing, but don’t give it too often bc it’s a CNS stimulant)
  2. Promote Optimal Respiratory Function
     Deep breathing exercises, infection prevention,
    immunization, smoking cessation, positioning, ICS, treat
    PNA, aspiration precaution
  3. Mobilizing secretions (loosen and mobilize)
     Turn, cough and deep breathing promotes ventilation
    and gas exchange
     Maintain hydration to keep secretions thin and mobile
     Perform Chest Physiotherapy (physically helping patient to loosen secrection in lungs)
  4. Postural drainage, chest percussion, chest vibration
31
Q

Nursing Intervention/Implementation

A
  1. Oxygen Therapy
     Check ordered device and O2 parameters
     Ex. Titrate nasal cannula to keep O2 sat > 92%
  2. Artificial Airways
     Oropharyngeal, nasopharyngeal, endotracheal
  3. Suctioning Airways
     Remove secretions and maintain patency
  4. Invasive and Non-invasive mechanical Ventilation
  5. Chest Tube maintenance
32
Q

type 1 and 2 pneumocytes

A

type 1 - gas exchange***
type 2 - surfactant

33
Q

hypercapnia

A

too much CO2

34
Q

mortality rate goes up by…

A

20% if patient is intubated

35
Q

Lung Compliance (and example)

A

a measure of the lung expandability.
C (compliance) = V (volume) / P (pressure)
-Example: COPD, emphysema

36
Q

Airway Resistance (and ex.)

A

resistance to the airflow within the airway (determined by diameter of the airway)
-example: asthma

37
Q

hypoxia (chicken pox in the tissue)

A

inadequate oxygenation of the organs and tissues
-Decreased oxygen supply: acute blood loss,

-Altered internal respiration: severe sepsis
-Shunting: septum foramen ovale (baby)
-Circulatory compromise: severe heart failure, cardiogenic shock

***lactic acid - excess in aerobic respiration

38
Q

Hypercapnia can be acute or

A

chronic

39
Q

hypercapnia - in chronic conditions,

A

kidneys can compensate for high blood pH (kidney produces bicarbonate)

40
Q

 Severe hypercapnia causes

A

CNS depression that may lead to somnolence and progress to coma and death
***COPD patients retain CO2 high CO2 can cause cardiac arrest

41
Q

hypercapnia - ** Respiratory drive changes to low O2 vs high CO2 as in

A

COPD - don’t over oxygenatic or correct CO2 levels in these patients

42
Q

 Severe hypercapnia causes***

A

CNS depression that may lead to somnolence and progress to coma and death
***COPD patients retain CO2 high CO2 can cause cardiac arrest

43
Q

hypercapnia causes

A

 Hypoventilation***caused by too many sedatives - ativan, valium
 Sedatives
 Lung disorders (chronic COPD)

44
Q

** Respiratory drive with hypercapnia changes to

A

ow O2 vs high CO2 as in COPD - don’t over oxygenatic or correct CO2 levels in these patient

45
Q

***COPD patients retain high…

A

CO2 and it can cause cardiac arrest

46
Q

 Restrictive (the fracture is restrictive)

A

fractured ribs, kyphosis, pneumothorax (collapsed lung)

47
Q

 Airway inflammation (the OPD is inflamed)

A

COPD

48
Q

 Airway obstruction

A

d/t allergic reaction, asthma,
irritants from smoke, mechanical obstruction, swollen
tonsils

49
Q

Upper Respiratory infections - symptoms

A

Stuffy nose, sore throat, cough, sneezing, tearing

50
Q

Influenza

A

Viral infections more severe than common cold, may
involve lower respiratory tract, cold-like symptoms,
fever, fatigue

51
Q

Lower Respiratory Tract Infection

A

***Pneumonia is RESPIRATION (increases secretion in airways, affects respiration and gas exchange in alveoli), Respiratory Syncytial Virus (RSV),
tuberculosis

**elderly get more sick from respiration, Covid causes scarring of lung tissue

52
Q

nursing diagnosis, treatment plan, goal (you need this for nursing care plan) for impaired spontaneous ventilation

A

1) maintain ventilation 2) check sedation scale 3) if medicine is too strong, have doc lower strength of opiates 4) ambulation

53
Q

ventilation is movement of____respiration is exchange of____

A

air, gases (O2 and CO2) in the lungs

54
Q

diaphragm inhale

A

lungs expand and diaphragm relaxes - moon shape

55
Q

what brings oxygen and blood to the lungs?

A

pulmonary artery

56
Q

what disease is Lung Compliance an issue?

A

COPD - need more pressure to expand lungs

57
Q

what disease is airway resistance an issue?

A

asthma

58
Q

Hypoxia causes (the main one)**

A

-Decreased oxygen supply: acute blood loss,
- fever (more oxygen is needed)
-Ineffective external respiration: pneumonia, pulmonary edema,
-Shunting: septum foramen ovale
-Circulatory compromise: severe heart failure, cardiogenic shock

59
Q

pneumonia causes what in regards to oxygen? (if you can’t breathe, you can’t get oxygen, so..)

A

It’s Ineffective external respiration, so hypoxia

60
Q

internal cause of hypoxia? (remember dope hypoxia)

A

severe sepsis

61
Q

what sound with edema?

A

stridor

62
Q

how to prevent atelectasis? (I ate spiro)

A

****prevent collapse use spirometer, get patient to cough, ambulate, sit patient up, pain medication!

63
Q

in ER, if a patient is tripoding, should you see them first, or last?

A

first, they are in disress - trying to bend over to expand lung volume

64
Q

pulse oximetry for someone with anemia?

A

lower O2 saturation.

65
Q

interventions if patient becomes hypoxic - order of masks from least aggressive to most (CFVOCI) - Cedar Falls is Very Oakey Causing Ice

A

nasal cannula
simple face mask (also inhaling some of their oxygen so it’s more concentrated)
venturi mask
oronasal face - one way valve mask
cpap
intubation

66
Q

use a venturi mask if you want to..

A

titrate a patient

67
Q

good O2 % level for ppl with COPD

A

90- 92%

68
Q

Weakest Link

A

Transmission

XIO (372 decks)

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