Oxygen

Question 1

What is Oxygen Therapy?

Answer 1

Oxygen therapy is the administration of supplemental oxygen to a client to prevent or reduce hypoxia, a condition where there is insufficient oxygen to meet the metabolic demands of the tissues and cells.

Question 2

What is ventillation?

Answer 2

the exchange of gases in and out of the lungs

Question 3

What is perfusion?

Answer 3

the distribution of RBCs to and from pulmonary capillaries

Question 4

What is compliance? (of the lungs)

Answer 4

the ability of the lungs to distend or expand in response to increased intra-aveolar pressure; decreased in diseases such as pulmonary edema, interstitial and pleura fibrosis, and congenital or traumatic structural abnormalities such as kyphosis or fractured ribs

Question 5

What is resistance?

Answer 5

In respiratory physiology, airway resistance is the resistance of the respiratory tract to airflow during inspiration and expiration.

Question 6

define tidal volume

Answer 6

typical amount of air that can be inhaled byforcible inspiration after completion of a normal inspiration

Question 7

What is the difference between inspiratory reserve volume and expiratory reserve volume?

Answer 7

inspiratory reserve volume: amount of air that can beforcibly expelledfrom the lungs after breathing in as deeply as possible

expiratory reserve volume:air remaining in the lungs after the most complete expiration possible;it is elevated in diffuse obstructive emphysema and during an attack of asthma. Also known as residual air.

Question 8

What is vital capacity?

Answer 8

the maximal volume of air that can beforcefully exhaledafter taking the deepest breath

Question 9

What is residual volume?

Answer 9

the amount of gasremaining in the lung at the end of a maximal exhalation

Question 10

What is total lung capacity?

Answer 10

the maximal volumeto which the lungs can be expanded with the greatest possible inspiratory effort; it is equal to vital capacity plus the residual volume and is approx.5800 mL

Question 11

Define eupnea

Answer 11

the normal rate and depth of ventilation

Question 12

What is bradypnea VS tachypnea?

Answer 12

bradypnea: rate of breathing is regular but abnormally slow (less than 12 breaths per minute)
tachypnea: rate of breathing is regular but abnormally rapid (greater than 20 breaths per minute)

Question 13

What is hyperventilation VS hypoventilation?

Answer 13

hyperventilation: rate and depth of respirations increase; hypocarbia may occur
hypoventilation: respiratory rate is abnormally low and depth of ventilation may be depressed; hypercarbia may occur

Question 14

Define apnea

Answer 14

respirations cease for several seconds; persistent cessation results in respiratory arrest

Question 15

Define dyspnea

Answer 15

clinical sign of hypoxia and manifests as breathlessness; sometimes related to exercise; associated with pulmonary diseases, cardiovascular diseases, neuromuscular conditions & anemia

Question 16

Define orthopnea

Answer 16

abnormal condition in which the person must use multiple pillows when lying down or must sit with the arms elevated and leaning forward to breathe

Question 17

What is cheyne-stokes respiration?

Answer 17

pattern of breathing where increasingly longer and more frequent periods of apnea alternates with hyperpnea;

Question 18

What is biota’s respiration?

Answer 18

respirations are abnormally shallow for two to three breaths, followed by regular period of apnea

Question 19

What are adventitious breath sounds?

Answer 19

Abnormal breath sounds such as crackles, wheezes and stridor

Question 20

What are crackles?

Answer 20

discontinuous, explosive, “popping” sounds that originate within the airways. Heard more commonly during inspirations than expiration. Significant as they imply either accumulation of fluid secretions or exudate within airways or inflammation and edema in the pulmonary tissue

Question 21

What is a “wheeze”?

Answer 21

continuous musical tones that are most commonly heard at the end of inspiration or early expiration

Question 22

What is stridor?

Answer 22

abnormal, high-pitched, musical breathing sound caused by a blockage in the throat or voice box (larynx). Usually heard when taking a breath

Question 23

What is stertor?

Answer 23

heavy snoring sound in respiration.

Question 24

What is pleural fiction rub?

Answer 24

dry, rubbing or grating sound, usually caused by inflammation of pleural surfaces; heard during inspiration or expiration; loudest over lower lateral anterior surface

Question 25

Define cyanosis

Answer 25

blue discolouration of the skin and mucous membranes caused by the presence of desaturated hemoglobin in capillaries, is a late sign of hypoxia

Question 26

What is hemoptisis?

Answer 26

bloody sputum

Question 27

What is hypoxia?

Answer 27

decrease in the amount of arterial oxygen

Question 28

What is hypoxemia?

Answer 28

inadequate concentration of oxygen in arterial blood

Question 29

What is a barrel chest?

Answer 29

permanently rounded chest commonly found in people with emphysema, due to trapped air in the lungs causing the rib cage to remain partially expanded

Question 30

What is kyphosis?

Answer 30

increased convexity in curvature of thoracic spine

Question 31

What is clubbing?

Answer 31

rounded and bulbous, the angle of the nail bed

Question 32

What are the indications for incentive spirometry?

Answer 32

* method of encouraging voluntary deep breathing by providing visual feedback to clients about inspiratory volume * use of incentive spirometer to promote lung expansion and thus prevent postoperative pulmonary complications following surgery

Question 33

Provide instructions for spirometry

Answer 33

1. sit on edge of bed if possible, or as far up as you can in bed 2. hold incentive spirometer in upright position 3. place mouthpiece in your mouth and seal your lips tightly around it 4. breathe in slowly and as deeply as possible, raising the yellow piston toward the top of the column. The yellow coach indicator should be in the blue outlined area 5. hold your breath as long as possible (at least 5 seconds), allow piston to fall to bottom of column 6. rest for a few seconds and repeat steps 1-5 at least 10 times every hour when you are awake 7. position yellow indicator on the left side to show best effort and use it as a goal during each repetition 8. after each set of 10 deep breaths, practice coughing to be sure your lungs are clear. If you have an incision, make sure to support it by placing a pillow firmly against it

Question 34

When is a peak flow meter used?

Answer 34

Used regularly to monitor lung function and response to treatment over the short- and long-term. Determines the severity of an asthma attack.

Question 35

Provide instructions for the flow meter

Answer 35

1. peak flow meter should read zero or its lowest reading when not in use 2. use peak flow meter while standing up straight 3. take in as deep a breath as possible 4. place the peak flow meter in the mouth, with the tongue under the mouthpiece 5. close the lips tightly around the mouthpiece 6. blow out as hard and fast as possible; do not throw the head forward while blowing out. breathe a few normal breaths and then repeat the process 2 more times 7. write down the highest number obtained

Question 36

Describe the use of pulse oximetry.

Answer 36

non-invasive method allowing the monitoring of oxygenation of the patient's hemoglobin

Question 37

What are the signs and symptoms of hypoxia?

Answer 37

``` Signs: • rapid breathing • cyanosis • poor coordination • lethargy • executing poor judgement Symptoms: • air hunger • dizziness • headache • mental and muscle fatigue • nausea • hot and cold flashes • tingling • visual impairment • euphoria ```

Question 38

What are the indications & what flow rates are used for the nasal cannula?

Answer 38

* low-flow device used for oxygen delivery * 2 cannulas, approx 1.5 cm long, protrude from the centre of a disposable tube and are inserted into the nares * flow rate: 1-6 LPM @ 24-44% O2

Question 39

What are some indications & what flow rates are used for the simple face mask?

Answer 39

* shaped to fit snugly over the mouth and nose and secured in place with a strap * used to deliver oxygen as the patient breathes through either mouth or nose * can be used to give O2 quickly and for short period of time * flow rate: 5-8 LPM @ 30-60% O2

Question 40

What are some indications & what flow rates used for the venturi mask?

Answer 40

* can deliver precise, high flow rates of O2 * also known as air-entrainment mask * medical device to deliver a known oxygen concentration to patients on controlled oxygen therapy * flow rate: 4-12 LPM @ 24-60% O2

Question 41

What are some indications & what flow rates used for the partial rebreather mask?

Answer 41

* light weight and easy to use * not recommended for patient with COPD * bag should not be allowed to deflate during inspiration * exhaled air is directed through a 1-way valve in the mask  * prevents the inhalation of room air and the re-inhalation of exhaled air * valve, along with sufficient seal around the patient's mouth and nose, allows for administration of high concentrations of O2 * flow rate: 6-10 LPM @ 60-90% O2

Question 42

What are some indications & what flow rates used for the partial rebreather mask?

Answer 42

non-rebreather mask • utilized for patients with physical trauma, chronic airway limitation, chronic obstructive pulmonary diseases, smoke inhalation and carbon monoxide poisoning, or any other patients who require high-flow oxygen but do not require breathing assistance • flow-rate: 6-10 LPM @ 60-100% O2

Question 43

Describe the potential effects of oxygen therapy?

Answer 43

• Nasal Irritation • Diminished Respiratory Drive ○ Leads to depressed breathing • Damage to lung lining tissues and air sacs

Question 44

What is the major stimulus for breathing?

Answer 44

• CO2 levels

Question 45

Danger of administering high levels of oxygen to hypoxic dependent breathers?

Answer 45

• The drive for a person to breath is low CO2 levels which stimulates the body to intake more oxygen/air. If you give a person with COPD oxygen, more CO2 will build up in their body further decreasing their respiratory rate.

Question 46

What information must be documented about a client receiving oxygen therapy?

Answer 46

***Oxygen must be considered as a medication and the use of oxygen must be documented for each patient  • All oxygen therapy administered must be documented on appropriate chart. • Any Risks • Oxygen is not addictive and causes no side effects when used as prescribed. Complications from oxygen therapy used in appropriate situations are infrequent. Respiratory depression, oxygen toxicity, and absorption atelectasis are the most serious complications of oxygen overuse. • A physician should be notified and emergency services may be required if the following symptoms develop: • frequent headaches • anxiety • cyanotic (blue) lips or fingernails • drowsiness • confusion • restlessness • slow, shallow, difficult, or irregular breathing

Question 47

Name some techniques for lung expansion

Answer 47

- positioning - breathing exercises - incentive spirometry

Question 48

Techniques for mobilizing secretions

Answer 48

hydration humidification nebulization chest physiotherapy

Question 49

Name the breathing exercise techniques (3)

Answer 49

- deep breathing and coughing - pursed lip breathing - diaphragmatic breathing

Question 50

Explain the pursed lip breathing technique

Answer 50

involves deep inspiration followed by prolonged expiration through pursed lips maintains positive pressure from the airway and prevents alveoli from collapsing

Question 51

Explain the diaphragmatic breathing technique

Answer 51

similar to deep breathing used for patients: post operative pulmonary disorders in labour

Question 52

Explain the technique for deep breathing

Answer 52

○ assist client into a comfortable sitting or standing position ○ ask her to place the palms of her hands along the interior borders of ribcage ○ align hands so that tips of 3rd fingers lightly touch ○ instruct client to take slow deep breath through nose and attempt to separate middle fingers hold for count of 3 and then exhale

Question 53

How to deep breath in the supine position

Answer 53

○ instruct client to place 1 hand flat below zyphoid process and other hand 2-3 cm below ○ ask client to sniff ○ teach client to concentrate on expanding the diaphragm on controlled exhalation as client exhales the lower hand should move outward

Question 54

What is incentive spirometry?

Answer 54

- method used to encourage deep breathing by providing visual feedback - used to prevent or treat actelectasis and improve lung expansion and oxygenation

Question 55

What are the instructions for the incentive spirometry?

Answer 55

○ with mouthpiece in place, client must inhale briskly to elevate balls and keep elevation for as long as possible ○ wash hands and assist client to high or semi-fowlers position