Oxygenation

Question 1

Respiratory system

Answer 1

Activity is controlled by the medulla in the brain stem

Question 2

Pulmonary Ventilation

Answer 2

Inhalation or inspiration: diaphragm contracts & lowers; increases thoracic cavity; intercostal muscle & lift ribs & sternum; intra-pulmonic pressure lowers (allows air into lungs)
Exhalation or expiration: thoracic components relax, moves diaphragm upwards & increases pulmonic pressure; air is forced out of the lungs

Question 3

Factors contributing to ventilation

Answer 3

Weak muscles lead to less effective inhalation & exhalation
Accessory muscles: used when respiratory system is not functioning properly (dyspnea) (abdomen, neck, & back muscles)-movement of these muscles is called retraction!
Compliance (ease) of lung tissue; elasticity needed to fill lung tissues (aided by surfactant- reduces surface tension/ friction on lungs)
Emphysema- affects alveoli in the lungs
Age-related changes
Airway resistance: anything that reduces air flow through airways (constriction, obstruction, allergy, medical conditions)

Question 4

Terminal

Answer 4

Adventitious: abnormal breath sounds
Atelectasis: incomplete lung expansion or collapse of alveoli (lungs not functioning at high capacity)

Question 5

Deoxygenated Oxygenated

involved in gas exchange

Answer 5

Superior & inferior vena cava-> right atrium-> tricuspid valve-> right ventricle-> pulmonary valve-> pulmonary arteries-> lungs-> pulmonary veins-> left atrium-> mitral valve-> left ventricle-> aortic valve-> aorta-> arteries-> capillaries-> veins

Question 6

Cardiovascular issues that can effect oxygenation

Answer 6

Anemia (low # of RBC’s; doesn’t provide enough O2 to tissues
Dysrhythmia’s (abnormal heart beats)
Ischemia (dead tissue from lack of O2)
Heat failure ( not pumping effectively)

Question 7

Diffusion

Answer 7

High to low concentration; takes place in alveoli & capillaries of lungs; disrupted if surface area in alveoli changes (lung removal, disease, atelectasis) or if alveoli thicken (edema); environmental factors can alter diffusion (toxins, allergies, supplemental O2)

Question 8

Perfusion

Answer 8

Moves blood with O2 through body; affected by circulation, low hemoglobin, BP & cardio output, high activity requires more perfusion

Question 9

Influencing factors

Answer 9

Health status, age, physical alternations, meds, lifestyle, environment, & psychological health

Question 10

S/S of impaired breathing

Answer 10

Anxiety, restlessness, trachy/brady pnea, decreased pulse ox, early cyanosis, increased HR, altered LOC, difficulty speaking, activity intolerance, use of accessory muscles, adventitious breath sounds

Question 11

Normal valves

Answer 11

12-20 respirating rate 
95-100% O2 saturation
Clear lung sounds
Appropriate skin tone to ethnicity 
Steady respiratory rhythm
Exhalation time > inhalation time

Question 12

Respiratory function tests

Answer 12

Pulmonary function test: test lung compliance & disease presence/progression (not done by nurses)
ABG (arterial blood gas): monitor blood O2, pH, CO2 levels
Spirometry: measures values of inhaled/exhaled air (non-invasive)
Pulse ox: measures amount of O2 in blood (non-invasive)
Peak expiratory flow rate: level of O2 in exhalation
Capnography: measures exhaled CO2 levels

Question 13

Pharmacological interventions

Answer 13

Metered dose inhaler (small burst of meds into the lungs; need to wait one minute in-between doses if needed multiple, rinse mouth out  after if steroids 
Dry powder inhaler (dry meds into the lungs; rise mouth out after)
Nebulizer (meds administered by mist; liquids only)
Oral Meds (pills or liquids)

Question 14

Meds

Answer 14

Beta 2- adrenergic agonist/ (bronchodilator) used to open airways; side affects: tremors/tachycardia
Inhaled anticholinergic/ block receptors in bronchi; side effects: hoarseness/ dry mouth
Corticosteroids - Glucocorticoids/ prevent inflammation in airways; side effects: increased blood sugar/infection
Methylxanthines/ relax smooth muscle of RT leading to bronchodilation; side effects: upset stomach/dysrhythmias
Mucolytic/ thin and enhance the flow of respiratory secretions; side effects: dizziness/ hypotension, bronchospasm
Expectorants/ remove sputum from tract; side effects: upset stomach/dizziness
Antihistamines/ relieve allergy symptoms
Antitussives/cough suppressants
Decongestants/shrink blood vessel which allows the nasal secretions to exit body

Question 15

Breathing Techniques

Answer 15

Pursed-lips, diaphragmatic, deep breathing, and coughing

Question 16

Chest physiotherapy

Answer 16

Percussion, vibration, postural drainage

Used to break up secretions

Question 17

Supplemental O2

Answer 17

Nasal cannula- into nostrils; prongs downward
Simple mask- cover nose & mouth
Venturi mask- cover nose & mouth
Non-rebreather- cover nose & mouth
Need provider order, monitor for skin breakdown (ears/ face), use carefully for COPD pts, NO smoking/ flames. Tubing can be a hazard

Question 18

Oral suctioning (YanKauer)

Answer 18

Used to clear out airway & anything from mouth/ throat
Use during ADL’s such as oral care
Used on compromised pts such as infants and adults with neuromuscular disorders

Question 19

Considerations when performing suctioning

Answer 19

humidification to lossen secretions, use chest physiotherapy before, pressure 120-150 mmHg, not sterile; medical asepsis, encourage pt to cough during it, sputum specimen can be collected, 10-15 second intervals, naso & endotracheal suctioning are sterile!

Question 20

Nursing interventions

Answer 20

Promote nutrition & hydration
Reduce anxiety
Reduce environmental pollutants
Encourage healthy life-style 
Position pt for good air exchange 
Allow rest
Teach breathing techniques

Question 21

Nursing Dx for oxygenation

Answer 21

Ineffective airway clearance
Impaired gas exchange
Ineffective breathing pattern