Oxygenation Flashcards
Respiratory system
Activity is controlled by the medulla in the brain stem
Pulmonary Ventilation
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
Factors contributing to ventilation
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)
Terminal
Adventitious: abnormal breath sounds
Atelectasis: incomplete lung expansion or collapse of alveoli (lungs not functioning at high capacity)
Deoxygenated Oxygenated
involved in gas exchange
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
Cardiovascular issues that can effect oxygenation
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)
Diffusion
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)
Perfusion
Moves blood with O2 through body; affected by circulation, low hemoglobin, BP & cardio output, high activity requires more perfusion
Influencing factors
Health status, age, physical alternations, meds, lifestyle, environment, & psychological health
S/S of impaired breathing
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
Normal valves
12-20 respirating rate 95-100% O2 saturation Clear lung sounds Appropriate skin tone to ethnicity Steady respiratory rhythm Exhalation time > inhalation time
Respiratory function tests
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
Pharmacological interventions
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)
Meds
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
Breathing Techniques
Pursed-lips, diaphragmatic, deep breathing, and coughing
Chest physiotherapy
Percussion, vibration, postural drainage
Used to break up secretions
Supplemental O2
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
Oral suctioning (YanKauer)
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
Considerations when performing suctioning
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!
Nursing interventions
Promote nutrition & hydration Reduce anxiety Reduce environmental pollutants Encourage healthy life-style Position pt for good air exchange Allow rest Teach breathing techniques
Nursing Dx for oxygenation
Ineffective airway clearance
Impaired gas exchange
Ineffective breathing pattern
