Oxygen Flashcards
Upper Airway Located above the ______ includes the _________ (3)
Located below the ________ the lower airway includes the __________________
larynx, the upper airway includes the nasal passages, mouth, and pharynx:
Located below the larynx, the lower airway includes the trachea, bronchi, and bronchioles.
The pharynx (throat) contains =
The trachea lies just in front of the=
The epiglottis is a = ( 3 )
the openings to the esophagus and trachea.
esophagus
small flap of tissue superior to the larynx:
- closes trachea during swallowing so that food and fluids do not enter the lower airway.
-It opens during breathing to allow air to move through the airway
Fluid Balance –
up to 900 ml of
insensible water loss
TIDAL VOLUME
normal volume of air moved in and out in quiet breathing varies with individuals
Inspiratory Reserve Volume (significance)
All the additional air you can inhale after a normal inspiration
IRV determines how much the tidal volume can increase when oxygen demands increase.
Expiratory reserve volume (ERV)
(Significance)
state normal values/relation to emphysema
The maximum extra amount of air that can be forcefully exhaled after the end of a normal tidal expiration.
Ranges from 1,000 to 1,500 mL.
- Some diseases (e.g., emphysema) cause collapse of alveoli and airways, which traps extra air in the lungs. This “trapped” air cannot be exhaled and lowers ERV.
Residual Volume
The amount of air remaining in the lungs after the maximal exhalation.
Ranges from 1,000 to 1,500 mL.
Inspiratory capacity (IC)
state normal ranges
The combination of the tidal volume and inspiratory reserve volume (VT + IRV).
Ranges from 2,500 to 3,500 mL.
Functional RESIDUAL
Disorders that cause air trapping _______ the FRC
The combination of expiratory reserve volume and residual volume (ERV + RV).
Ranges from 2,000 to 3,000 mL.Exhalation of additional air requires effort to force more air out.
This is the amount of air that stays in the lungs at the end of a normal passive, quiet exhalation. Disorders that cause air trapping increase the FRC.
Total lung capacity
max volume of air that lungs can contain
Functionsof oxygen need ( 3)
Ventilation is the process by which air moves in and out of the lungs.
Diffusion is the spontaneous movement of gases, without the use of any energy or effort by the body, between the alveoli and the
capillaries in the lungs.
Perfusion is the process by which the cardiovascular system pumps blood throughout the lungs.
Surfactant
a lipoprotein that lowers the surface tension within alveoli to allow them to inflate during breathing.
Clear Air Passages (3)
warmed
filtered
moistened
cilia
reflex
(clear air passages)
sneeze reflex
cough reflex
forcefully expels foreign matter from upper airway
forcefully expels foreign matter from larynx, trachea and bronchi
Four requirements essential for adequate ventilation
- Adequate Atmospheric Oxygen
- Clear Air passages
- Adequate stretch ability
- Intact Central Nervous system
Intact Central Nervous system
functionof medulla vs pons
Medulla - Inspiration
Pons- Expiration
STIMULI FOR RESPIRATION
A. Neural and chemical controls
– CO2 & H+
B. Respiratory Center
– 1st (primary drive to breath): increase CO2
- Medulla oblongata: CO2 signals to take a breath
– 2nd (secondary drive to breath): O2:
chemoreceptors in aorta & carotid arteries
respond to decrease O2 levels - Chronic Lung
Disease
– Hypoxic drive - Triggered to
breathe by O2 - Nursing: low O2
flow only
Celluar respiration
flow chart
Inspired Air
Lungs
Heart/blood vessels
Cells
hear/bv
exipration
Blood Values ( RBC / hematocrit/ hemoglobin/ state red flag)
RED BLOOD CELLS (RBC)
– MEN 4.2-5.4 million/mm3
– WOMEN 3.6- 5.0 million/mm3
- HEMATOCRIT (Hct)= % RBC’S IN PLASMA
– 40%- 54% MEN
– 37%- 50% WOMEN
– RED FLAG 30% - HEMOGLOBIN (HGB)
– OXYGEN CARRYING
CAPACITY OF RBC
– 14-16 gm/dl MEN
– 12-15 gm/dl WOMEN
– RED FLAG 10 GM
Hypoxia
an oxygen deficiency in the body tissues
Chronic Hypoxia
signsand symptoms (2)think of apperanace and hands
- Fatigue
– Expending much
energy to
oxygenate body - Clubbing
– Base of nail
swells
– Ends of fingers
and toes in
size
Hypoxic CENTRAL NERVOUS SYSTEM tissue causes
Hypoxic RENAL TISSUE causes abnormal
Hypoxic LIMB results in abnormal
abnormal brain functioning (e.g., altered level of consciousness)
kidney functioning (e.g., poor urine output)
results in abnormal muscle functioning (e.g., muscle weakness and pain with exercise)
Pursed lip breathing
PURPOS/ steps
- Chronic obstructive
pulmonary Disease
(COPD)
Smell a rose
Blow out a candle
* This forces out CO2
that is retained
R.A.T vs B.E.D
hypoxia
Early:
R-Restlessness.
A-Anxiety.
T-Tachycardia / Tachypnea.
Late Hypoxia:
B-Bradycardia.
E-Extreme Restlessness.
D-Dyspnea. ( cyanosis)
Cyanosis (central vs peripheral)
- Central: (NEVER NORMAL)
*
-skin/mucous membranes
decrease sat of arterial blood
– Core heart problem
-late sign.
- Peripheral ( MAY BE NORMAL)
– Poor distribution of O2 to
extremities
–Blood vessel problems
-LOCALIZED
Discuss the developmental changes affecting the respiratory
- ** Infancy:
Lung Development: At birth, the lungs transition from a fluid-filled state to an air-filled state. Alveoli, the tiny air sacs where gas exchange occurs, continue to develop after birth, increasing the surface area available for oxygen exchange.
Breathing Patterns: Infants primarily breathe through their noses. Their breathing rate is faster than that of adults, and they have a higher diaphragmatic breathing pattern.
Immune System: Immature immune systems make infants more susceptible to respiratory infections, such as colds and bronchiolitis.
*5. ** Elderly Population:
Decreased Lung Function: Lung elasticity continues to decline in old age, leading to decreased lung function. Reduced ciliary action in the respiratory tract and weakened cough reflex increase susceptibility to respiratory infections.
Decreased Respiratory Muscle Strength: Respiratory muscles weaken, making it more challenging to clear mucus from the airways and leading to an increased risk of respiratory illnesses.
Muscles of Inhalation:
Diaphragm:
The diaphragm is the primary muscle of respiration. It is a dome-shaped muscle located at the base of the lungs. During inhalation, the diaphragm contracts and moves downward, increasing the volume of the thoracic cavity and creating a negative pressure that allows air to be drawn into the lungs.
Abdominal Muscles
name muscles/we dont want to use (2)
name:Rectus Abdominis and External Obliques):
During forced exhalation, these muscles can contract to increase intra-abdominal pressure. This increased pressure pushes the diaphragm upward, aiding in forceful exhalation.
Internal Intercostal Muscles:
These muscles are located deep between the ribs. During forced exhalation (not typically used during quiet breathing), the internal intercostal muscles contract, pulling the ribs downward and decreasing the thoracic cavity’s volume.
Muscles of Exhalation:
Diaphragm (Relaxation):
During quiet breathing, exhalation is a passive process. When the diaphragm relaxes, it recoils back to its dome shape, reducing the volume of the thoracic cavity. This passive recoil of the diaphragm, along with the elasticity of the lungs and chest wall, causes air to be expelled from the lungs.
External Intercostal Muscles: ( WE LIKE THIS)
These muscles are located between the ribs. During inhalation, the external intercostal muscles contract, elevating the ribs. This action further expands the thoracic cavity, aiding in inhalation.
sputum
Source: Sputum is produced in the lower respiratory tract, including the lungs and bronchial tubes. dont drink water.
Composition: Sputum is thicker and may contain mucus, pus, blood, cellular debris, and microorganisms. Its color and consistency can vary based on the underlying respiratory condition.
Purpose: Sputum helps in clearing the respiratory tract by trapping and removing foreign particles, such as bacteria or dust. It is essential for the body’s defense against respiratory infections.
Diagnostic Use: Medical professionals often analyze sputum samples to diagnose respiratory conditions, including infections like pneumonia, bronchitis, or tuberculosis. The analysis can provide valuable information about the type of infection and guide appropriate treatment.
Incentive spirometer
- Method to measure how much a
patient can breath in with force
Biot’s breathing’
explain reason
describes an abnormal respiration pattern.
Biot’s breathing occurs when periods of apnea alternate irregularly with series of breaths
caused by brain damage leading to apena/ raise in co2 causing tachpnea to get rid of it
Changes in rate or pattern
Rate:
Tachypnea
Bradypnea
Apnea
Shallow
Deep
Tachypnea: Tachypnea is an increased respiratory rate, meaning a person is breathing more rapidly than normal. It can be a sign of various medical conditions, such as fever, respiratory distress, or metabolic disorders.
Bradypnea: Bradypnea is a slower than normal respiratory rate. It can be caused by certain medications, neurological problems, or metabolic imbalances.
Apnea: Apnea refers to a temporary cessation of breathing. It can be obstructive (caused by a physical blockage in the airway) or central (caused by a problem in the brain’s respiratory control centers). Sleep apnea is a common condition where a person temporarily stops breathing during sleep.
Volume:
Shallow Breathing: Shallow breathing refers to breathing that is limited in depth and can often be seen in conditions where lung expansion is restricted, such as in some respiratory disorders or pain conditions.
Deep Breathing: Deep breathing, also known as hyperpnea, refers to breathing that is deeper and more rapid than normal. It can occur during exercise or in certain medical conditions, such as diabetic ketoacidosis.
Rhythm:
Regular
Irregular
Periodic
Cheyne stokes
Biots
Muscles used in Respirations
DOE- Dyspnea on Exertion
Changes in pulse
rate
rhythm
quality
Regular Rhythm: Breaths are taken evenly with consistent intervals between them.
Irregular Rhythm: Breaths are taken unevenly with inconsistent intervals between them.
Periodic Breathing: Breaths follow a regular pattern of alternating deep and shallow breathing, often seen in certain neurological or cardiovascular conditions.
Cheyne-Stokes Respiration: A specific type of periodic breathing characterized by gradual increase and decrease in breathing, followed by a period of apnea (temporary cessation of breathing). It can occur during sleep or in individuals with certain medical conditions like heart failure.
Biots (Biot’s Respiration): Irregular breathing pattern characterized by groups of quick, shallow inspirations followed by irregular pauses. This pattern is often seen in severe brain damage or increased intracranial pressure.
Muscles Used in Respiration:
DOE (Dyspnea on Exertion): Shortness of breath or difficulty in breathing that occurs during physical activity or exertion.
Changes in Pulse:
Rate: The number of heartbeats per minute.
Rhythm: The regularity or irregularity of the heartbeat.
Quality: The strength or amplitude of the pulse, indicating the volume of blood ejected from the heart with each beat.
how do we measure something in NPW?
add the rate, goal should not be be about pain!!
bypass
bypass
ASSESSMENTS PRIOR TO AND DURING O2 THERAPY
Vital signs which include
Breathing
Airway
Circulation
REASONS FOR OXYGEN THERAPY(5)
Low O2 in blood
Low O2 in air
Trauma
Blood loss
Ischemic tissues
PULSE OXIMETER (rates for healthy /copd)
Pulse oximetry is a noninvasive estimate of arterial blood oxygen saturation (Sao2). Sao2 reflects the percentage of hemoglobin molecules carrying oxygen.
Measures oxygen saturation in hemoglobin
95% or > in healthy adult
92% >with breathing problem/ copd
ARTERIAL BLOOD GASES procedure
from artery! INVASIVE. need to be specialed trained
Measurements obtained to assess adequacy of oxygenation and ventilation, evaluate acid base balance and to monitor effectiveness of therapy.
TRANSPORTING A PATIENT WITH OXYGEN
nsure the patient is stable for transport. Evaluate vital signs, including oxygen saturation levels, and address any immediate medical needs.
inspirometers
to measure amount of inspiration
turn, deep breath , cough ( help with)
maximize alveolar expansion
Nursing Responsibilities for therapy
Body Image Changes - listening skills, health teach benefits6trdsadsa of O2 therapy
Compliance - mask (prevent eating n drinking make communication difficult c/o feeling hot and claustrophobic
Dryness
a. humidifier between oxygen source and administration device
b. drink liquids 2500 ml/day depending on cardiac and renal status
oral care q2 - 4hrs prn
Discomfort
Mask (5)
Nasal cannula
Simple face mask
Partial rebreather
Non rebreather
Venturi
Nasal Cannula (Liter Flow/Nursing action)
a. 1-6 L/min =
b check placement /assess for skin breakdown above ears
oxygen device that can be delivered with specific
venturi mask
Hemoglobin low
tachypnea/tachycardia
simple face mask
covers nose and mouth
5-10 L/min
assess for anxiety/ smell and face for odor
Partial rebreather
has reservoir bag to capture exhaled gases
6-15 L/min
cant tolerate lungs
Nurse should measure bag
Non rebreather
with reserve bag + one valve to prevent inhalation of room air
6-15 L/min
Nursing : short term use ONLY
Venturi
mask with built in adaptor allows control of oxygen
24% to 50% SPECFIC
NURSES SHOULD CHECK MD ORDERS ANF SPECIFIC NUMBERS ( FOCUS ON 02 NOT FLOW RATE)
Respiratory depression
Respiratory depression refers to a reduction in the rate and depth of breathing, leading to inadequate oxygen intake and carbon dioxide elimination.
Circulatory depression
This can lead to inadequate perfusion of vital organs and tissues, potentially resulting in life-threatening complications
Atelectasis
he collapse of part or all of a lung, is caused by a blockage of the air passages (bronchus or bronchioles) or by pressure on the lung.
Tracheo-bronchitis
inflammation of the trachea and bronchi. It is characterised by a cough, fever, and purulent (containing pus) sputum and is therefore suggestive of pneumonia. It is classified as a respiratory tract infection.
Oxygen toxicity
occurs when reactive oxygen species overwhelm the natural antioxidant defense system.
Cardiac output =
SV x heart rate
BP =
CO x SVR
Peripheral Vascular Disease: Arterial (heart to peripheral)
risk/acute vs chronic
risk: obesity/smoking
Acute
Emergency condition (clot )
Chronic
Pulse may be very weak or unpalatable
May need doppler ( like stethoscope for ears)
ACTIVITY INTOLERANCE documentation
-needs documented change in VS
-specific ( need numbers )
-time frame
-realistic
PVD : Venous ( body to heart)
acute* 2/chronic3*think about the process
Acute
Thrombus
Thrombophlebitis
Chronic-
Incompetent valves
Stasis Ulcer
Varicose veins ( out pouching)
Path of Blood Flow
Heart: The journey begins in the heart, a muscular organ that acts as a pump. Blood is pumped out of the heart through two main pathways:
a. Pulmonary Circulation (to the Lungs):
Oxygen-poor blood from the body returns to the right atrium of the heart through two large veins called the superior vena cava and inferior vena cava.
When the right atrium contracts, blood is pushed into the right ventricle.
The right ventricle contracts and sends the oxygen-poor blood to the lungs through the pulmonary artery.
In the lungs, carbon dioxide is exchanged for oxygen. Oxygen-rich blood returns to the heart.
b. Systemic Circulation (to the Body):
Oxygen-rich blood from the lungs enters the left atrium through the pulmonary veins.
When the left atrium contracts, blood is pushed into the left ventricle.
The left ventricle contracts and sends the oxygen-rich blood to the rest of the body through the aorta, the largest artery in the body.
Arteries: The aorta branches out into smaller arteries, which carry oxygenated blood away from the heart to various organs and tissues throughout the body.
Arterioles: Arteries further divide into smaller vessels called arterioles, which control the blood flow to specific areas of the body.
Capillaries: Arterioles lead to tiny blood vessels called capillaries. Capillaries are where the exchange of oxygen, nutrients, and waste products occurs with the body’s cells.
Venules: After passing through the capillaries, blood collects in small vessels called venules.
Veins: Venules merge into larger veins, which carry the deoxygenated blood back towards the heart.
Superior and Inferior Vena Cava: The veins from the upper part of the body (superior vena cava) and the lower part of the body (inferior vena cava) return deoxygenated blood to the right atrium of the heart, completing the circulatory loop.
ASSESSMENT OF TISSUE PERFUSION (arterial vs venous)
pain
hair
sensation
skin color
texture
temperature
edema
pulses
cap refill
Arterial Perfusion Assessment:
**1. Color:
Arterial: Pale or blanched skin indicates poor arterial perfusion. Cyanosis (bluish discoloration) can also be a sign of inadequate oxygenation.
Capillary Refill: Assess the capillary refill time by pressing a fingernail or toenail and observing how long it takes for the color to return. Prolonged capillary refill time (>2 seconds) suggests poor perfusion.
**2. Temperature:
Arterial: Cool extremities can indicate decreased arterial perfusion, whereas warmth may suggest inflammation or infection.
**3. Pulses:
Arterial: Assess pulses (radial, femoral, dorsalis pedis, etc.). Absence or weak pulses can indicate impaired arterial perfusion.
Pulse Strength: A diminished or absent pulse indicates reduced blood flow to the area.
**4. Sensation and Movement:
Arterial: Assess for numbness, tingling, or muscle weakness. Severe arterial insufficiency can lead to decreased sensation and mobility.
**5. Pain:
Arterial: Intermittent claudication (pain with movement) or rest pain in extremities can be signs of arterial insufficiency.
Venous Perfusion Assessment:
**1. Color:
Venous: Skin may appear reddish-brown due to hemosiderin staining in chronic venous insufficiency. Venous stasis ulcers may be present, indicating longstanding poor perfusion.
**2. Temperature:
Venous: Generally normal or warm, especially in cases of inflammation or infection.
**3. Edema:
Venous: Edema, particularly in the lower extremities, is a common sign of venous insufficiency.
**4. Pain:
Venous: Aching or cramping pain, often relieved by elevation, is typical in venous insufficiency.
**5. Skin Changes:
Venous: Look for stasis dermatitis, lipodermatosclerosis (thickened, woody appearance of the skin), and venous ulcers, which are common signs of chronic venous insufficiency.
**6. Pulses:
Venous: Pulses are typically present and normal in venous insufficiency.
**7. Homans’ Sign (Not Commonly Used):
Venous: This is a controversial test where pain is elicited by dorsiflexing the foot. Positive Homans’ sign may suggest deep vein thrombosis, but it’s not considered a reliable indicator.
ARTERIAL ASSESSMENT P’s
five
Pain
Pallor
Pulslessness
Paresthesia
Polar temp
Ineffective tissue perfusion
Ineffective tissue perfusion
peripheral arterial
peripheral venous
Pitting Edema
state numbers
Dependent Part
1+ - Slight Pit, Normal contours
2+ - 1/4”, still see normal contours
3+ - < 1/4 - 1/2”> barely see land marks
4+ - > 1/2” deep pit, see no landmarks
Ineffective tissue perfusion: peripheral arterial R/T decreased arterial flow AMB absence of pulse, cool foot, ischemic painGoal: TPW
a.Have absence of edema, pain and heme staining at all times
b. + pedal pulses, extremities pink and warm to touch, and immediate capillary refill this shift
c. decreased pain in extremities when legs are elevated
b
Effect circulation
Heat
dilate blood vessels, circulation
Diathermy Unit
is a therapeutic treatment that uses electric currents (radio and sound waves) to generate heat in layers of your skin below the surface.
Diathermy means “deep heating.” This treatment helps relax muscles and joints, reduce inflammation and swelling, and improve blood circulation
BODY’S CONTROL OF TEMP
where
Hypothalmus
Autonomic nervous system
LOCAL HEAT (7)
decrease (3) increase (3)
increase :blood flow, capill permeablity, prespiration, tissues metabolism
decrease: blood viscosity,venous congestion, muslce tension
LOCAL COLD (7)
decrease (5) increase (2)
increase: blood viscosity, muscle tension
decrease:blood flow, capillary permeability, lymph flow, metabolic needs, skin sensation
SAFETY MEASURES WITH THERMAL RX
Adhering to these safety measures ensures that thermal and cold treatments are applied effectively while minimizing the risk of complications or adverse reactions. Healthcare providers should consider the patient’s overall health status, individual characteristics, and specific treatment goals when deciding on the appropriate use of thermal or cold modalities.
Developmental Considerations
Child
Non verbal communication
Immature neurological system
Thin skin layers
Elderly
sensory responses
Thin skin layers
FACTORS WHICH affect THERMAL
think impaction how well someone recieves thermal therapy ( 11)
Integrity of skin
Ability to feel or detect
Diabetes – neuropathy ( sensation)
Scar
Subcutaneous layer
Peripheral vascular disease
Confusion, coma
Peripheral vascular disease
Spinal cord injury
Malignancy
Muscle spasm
Heat ( dry) ( advantages vs disadvantages - think of heat pad )
Advantages: risk of burns, risk of skin maceration, retained longer.
Disadvantages: blood loss of fluids through sweating
Heat (moist)
Advantages: drying of skin, deeper penetration of skin, softening of wound exudate
Disadvantages: risk for burns, risk of maceration
Cold (dry)
Advantages: less likely to cause maceration of skin, molds easily to body.
Disadvantages: ability to penetrate tissue
Cold (moist)
Advantages: more penetration of tissues, molds well to body parts
Disadvangtages: risk to prolonged exposure causing maceration to skin.
leg pain occurs, especially with walking. This is called
intermittent claudication.
hand held nebulizer
Handheld nebulizers are valuable tools in managing respiratory conditions, providing an effective and convenient way to administer medication directly to the lungs. It’s essential for patients to follow prescribed treatment plans, use the nebulizer as directed, and consult with healthcare providers for any concerns or adjustments to their respiratory care
ventilation factors that affect it (5)
1.rate
2.depth
3.complinace
4. Elasticity
5.resistance
