Anatomy Airway - Moisten - Warm - Filter - Cilia

Upper Airway - Pharynx - Trachea - Epiglottis Lower Airway - Trachea - R&L Bronchi - Bronchioles

External Factors Influencing Pulmonary Function - Developmental stage Changes in pulmonary A&P place OLDER ADULT at HIGHER RISK for RESPIRATORY INFECTIONS - ↓ lung expansion and less alveolar inflation (d/t costal cartilage calcifications and reduction in chest wall movement during breathing) - Loss of recoil and alveoli elasticity - Drier mucus membranes and less cilia

External Factors Influencing Pulmonary Function cont'd - Exhalation less efficient - Decline in immune response - GERD more common (leading to risk for aspiration) - Slow chemoreceptor response (makes hypoxemia more likely) All of these changes place the older adult at risk for respiratory infections

Oxygenation Flashcards by Kaylie Krauzyk

Important Concepts

Oxygenation

Respiration

Ventilation

Respirations and ventilations oxygenate the blood

Oxygenation of the blood, and subsequently organs and tissues depends on an adequate ventilation

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Is the exchange of gases oxygen and carbon dioxide in the lungs

Respiration

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Is the movement of air in and out of the lungs through the act of breathing

Ventilation

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Refers to how well the cells in tissues and organs of the body are supplied with oxygen

Oxygenation

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Anatomy

Airway

Moisten
Warm
Filter
Cilia

Upper Airway

Pharynx
Trachea
Epiglottis

Lower Airway

Trachea
R&L Bronchi
Bronchioles

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Airway

In addition to allowing air to flow in and out of the lungs, the airway also moistens air - moist mucous membranes add water to the inhaled air

Warms air (body heat is transferred to passageways through blood flow), and filters air - cells secrete sticky mucous whose action is to filter foreign particles

___ - tiny, hair-like projections on the airway walls, that move like a sweeping motion and pick up trapped debris up and out of the airway

Cilia

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Upper airway

Nasal passageways

Mouth

Pharynx (throat)

Trachea

___ (flap of tissue that closes off trachea during swallowing to prevent food from entering the trachea and opens during breathing to allow air into lungs)

Epiglottis

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Lower airway (STERILE)

Trachea

Bronchi

Bronchioles

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Walls of bronchi and bronchioles have ____ which can narrow the airway and obstruct blood flow with ___

layers of smooth muscles

bronchospasm

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Lungs

Are soft, spongy cone-shaped organs separated by the mediastinum
The right lung has ___ lobes and the left lung has ___ lobes
The ___ is the upper portion of the lung, usually extends upward above the clavicle
The base of the lungs is the lower portion of the lungs that rests on the diaphragm
___ are tiny little air sacs with thin walls surrounded by a network of capillaries where gas exchange occurs

3; 2

apex

alveoli

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Pulmonary System Functions - Pulmonary Ventilation

Ventilation is achieved through cycles of ___ and ___

___ is the expansion of the chest cavity and lungs creating negative pressure inside the lungs causing air to be drawn in through the nose or mouth and airways

___ occurs when the diaphragm and intercostal muscles relax allowing the chest and lungs to return to their normal resting size

inhalation; exhalation

Inhalation

Exhalation

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The ___ is the major muscle of breathing

The ___ are small muscles around the ribs

The ___ covers the lungs and lung expansion creates a negative pressure to draw in air

diaphragm

intercostal muscles

pleural membrane

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Respiratory rate is how fast you breathe

Respiratory depth is how much your lungs expand to allow room for air

___ occurs with a decreased rate or shallow breathing and it moves only small amounts of air into in and out of the lungs leading to ___ less oxygenated air reaches the alveoli

Hypoventilation

hypoxemia

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___ occurs when a person breathes too fast so large amounts of air entered into the lungs causing too much carbon dioxide to be removed from the alveoli

Lung elasticity or lung recoil is the ability of elastic fibers to return to their original position; this allows the lung to inflate easily but inhibits deflation leaving air trapped in the alveoli - similar to the overstretching of an elastic band

Hyperventilation

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Lung compliance is the ease of lung inflation - which should inflate easily

Airway resistance is the resistance to air flow within the airways - the larger the diameter of the airflow the easier the air moves through it

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Respiration (Gas Exchange)

External - At the level of the ___ (alveoli)

Internal - At the level of the ___ and ___

lungs

tissues & organs

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External respiration or alveolar-capillary gas exchange occurs in the alveoli of the lungs

Where oxygen diffuses across the capillary membrane into the blood of the pulmonary capillaries and carbon dioxide diffuses out of the blood and into the alveoli to be exhaled

Rate of diffusion is going to depend on the thickness of the membrane and the total surface of the lung tissue available for that lung exchange

* Conditions that slow diffusion include pleural effusion, pneumothorax, and asthma

If blood is not adequately oxygenated in the alveoli - hypoxemia (low blood oxygen levels) may occur

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Internal respirations or capillary-tissue gas exchange occurs in body organs and tissues

So, oxygen diffuses from the blood through the capillary-cellular membrane into the cells where it’s used for metabolism and carbon dioxide (which is a waste product of cellular metabolism) diffuses from the cells through the capillary-cellular membrane into the blood and then it’s transported to the lungs where it’s going to be exhaled

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What controls breathing?

Chemoreceptors

* Detect changes in pH, O₂, & CO₂ (increase or decrease in ventilation)

Lung receptors

* Sensitive to breathing patterns, lung expansion, lung compliance, airway resistance, and respiratory irritants

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Located in the middle of the brainstem, the carotid arteries, and aorta

Detect changes in blood pH, O₂, and CO₂ levels and send messages to the central respiratory system in the brainstem in response the respiratory system increases or decreases in ventilation to maintain normal blood levels of pH, pO₂ and pCO₂

Chemoreceptors

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High levels of carbon dioxide stimulate breathing to eliminate that excess carbon dioxide - very important to know that blood carbon dioxide levels provide the primary stimulus to breathe; PRIMARY DRIVE TO BREATHE

Low blood oxygen levels stimulate breathing to get more oxygen into the lungs, so hypoxemia is a SECONDARY DRIVE TO BREATHE

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___ - PRIMARY DRIVE TO BREATHE

___ - SECONDARY DRIVE TO BREATHE

CO₂ blood levels

Hypoxemia

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Lung receptors

Are located in the __ and ___

Are sensitive to breathing patterns, lung expansion, lung compliance, airway resistance, and respiratory irritants

For example, if lung receptors sense respiratory irritants like dust, cold, air, or tobacco smoke - that will trigger respiratory centers to constrict the airway and produce a more rapid, shallow pattern of breathing

lung & chest wall

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External Factors Influencing Pulmonary Function

Developmental stage

Changes in pulmonary A&P place OLDER ADULT at HIGHER RISK for RESPIRATORY INFECTIONS

↓ lung expansion and less alveolar inflation (d/t costal cartilage calcifications and reduction in chest wall movement during breathing)
Loss of recoil and alveoli elasticity
Drier mucus membranes and less cilia

External Factors Influencing Pulmonary Function cont’d

Exhalation less efficient
Decline in immune response
GERD more common (leading to risk for aspiration)
Slow chemoreceptor response (makes hypoxemia more likely)

All of these changes place the older adult at risk for respiratory infections

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External Factors Influencing Pulmonary Function Environment \* Stress \* Allergic reactions \* Air quality \* Altitude \* Temperature & humidity

? Is an example of an allergic reaction that affects the eyes, nose, or sinuses and it's caused by the release of histamine that triggers an inflammatory response leading to the accumulation of nasal fluid, swollen nasal membranes, nasal congestion, itchy, swollen watery eyes \* Antihistamines are effective to combat it

Hay fever

? Is an allergic reaction that occurs in the bronchioles of the lungs where a slow reacting substance of anaphylaxis is released which causes bronchoconstriction in lower airway, edema, and spasms making breathing difficult and ineffective

Asthma

External Factors Influencing Pulmonary Function cont'd Lifestyle \* Pregnancy \* Occupational hazards \* Nutrition \* Obesity (respiratory infections, sleep apnea) \* Exercise \* Substance abuse \* Smoking

Obesity \* May cause respiratory infections d/t pressure from excess abdominal fat on the diaphragm preventing full chest expansion and leading to hypoventilation and dyspnea on exertion; sleep apnea laying down limits chest expansion Smoking \* Constricts bronchioles, increases fluid secretion in the airways, causes inflammation and swelling of the bronchial lining, and paralyzes cilia Longer a person smokes and the more cigarettes they smoke the greater the risk of cancer and other chronic diseases

External Factors Influencing Pulmonary Function cont'd Medications - **Decrease** pulmonary function ⇒ respiratory depression \* General anesthetics, opioids, anti-anxiety drugs, sedative hypnotics, neuromuscular blocking agents, and magnesium sulfate

External Factors Influencing Pulmonary Function cont'd Medications - **Improve** pulmonary function \* Bronchodilators, anti-inflammatory agents like corticosteroids, cough suppressants, expectorants, and decongestants

Pathophysiological Conditions Affecting Gas Exchange Types of Alterations in Gas Exchange ? Is inadequate oxygenation of organs and tissues and this results from either hypoxemia or circulatory disorders

Hypoxia

? Is low arterial blood oxygen levels, and this happens when there's poor oxygen diffusion across the alveolar capillary membrane and into the blood Hypoventilation can lead to this

Hypoxemia

? Is an excess of dissolved CO₂ in the blood and can result from hypoventilation or it can result from an acute airway obstruction or drug overdose Can lead to somnolence, coma and death

Hypercarbia (or hypercapnia)

? Is a low level of dissolved carbon dioxide in the blood and can result from hyperventilation and lead to some muscle twitching or spasms due to the stimulation of the nervous system and numbness and tingling of the face and lips

Hypocarbia (or hypocapnia)

**Important to know... Box 36.2 p 964**

Respiratory Infections Upper respiratory infections (URI) \* Most commonly caused by \_\_\_ \* COMMON COLD, rhino sinusitis, pharyngitis (sore throat) \* Stuffy nose, sore throat, cough, sneezing, tearing, & mild fever

viruses

Respiratory Infections ? - More severe than common cold - Affects nose, throat, lungs - Highly contagious VIRUS - Spread by droplets in the air or by contact with droplets - Cold symptoms and headache, muscle pain, fatigue, weakness, exhaustion, high fever, less common - vomiting & diarrhea

Influenza

Respiratory Infections Influenza \* Prevention is key - annual influenza vaccination - 6 months and older

Treatment - Swabs for culture (determine whether infection is viral or bacterial) - Antiviral medications - Tamiflu (started within first 48 hours) - OTC medications: Antipyretics, antihistamines, decongestants, antitussives; acetaminophen, ibuprofen, naproxen - body aches

Respiratory Infections - ASSESSMENT Data Collection - Risk factors - Immunizations - h/o fever & chills, hoarseness, laryngitis, sore throat, rhinitis, fatigue & malaise

Physical Assessment - Inspect throat - look for redness - Palpate for enlarged lymph nodes - Assess fever, ↑ RR, skin turgor, fluid intake, auscultate lungs

Respiratory Infections - Interventions Colds - FLUIDS - REST - Medications - Avoid tobacco smoke - Saline nasal sprays - Antipyretics, antihistamines, analgesics

Respiratory Infections - Interventions Influenza - FLUIDS - Cough & deep breathing exercises - Ambulate - REST - Positioning

Respiratory Infections - Interventions Ongoing Assessment - Respiratory status - Lung sounds - Cough & sputum

Respiratory Infections - Interventions Teaching - Stop spread - Wash hands - Disinfect surfaces Antibiotics ONLY for bacterial infections Not used for common cold & influenza - Must complete FULL COURSE of antibiotics

Respiratory Infections - Lower respiratory infections (LRI) **Acute Bronchitis** - Infection of bronchi - Viral or bacterial - Symptoms: fever, cough, chills, malaise, chest wall pain from cough - Bacterial - productive cough w/yellow sputum - Viral - non-productive cough; aggravated by cold, dry, or dusty air - bouts of continuous coughing

Respiratory Infections - Lower respiratory infections (LRI) **Tuberculosis** - Acid-fast bacillus Mycobacterium tuberculosis - Airborne droplets - Dormant/latent (LTBI) or active - Symptoms: fatigue, weight loss, anorexia, night sweats, and blood-tinged sputum - Diagnosis: sputum cultures or chest x-ray - Medications are CORNERSTONE: isoniazid (INH), rifampin (RIF), ethambutol (EMB), pyrazinamide (PZA) - Antibiotics taken for 6-9 months

Respiratory Infections - Lower respiratory infections (LRI) Respiratory Syncytial Virus (RSV) - Upper and lower respiratory tract - Mostly infants, young children & older adults - Airborne droplets & direct or indirect contact - Can survive on surfaces for hours

Respiratory Infections - Lower respiratory infections (LRI) - Pneumonia - Infection caused by bacteria, fungi, viruses - Inflammatory response that leads to EDEMA in small airways and deposits debris and exudate in the alveoli - Healthcare-associated pneumonia (HCAP) - Ventilator-associated pneumonia (VAP)

? Is a lung infection that develops after 48 hours of patient being placed on mechanical ventilation by means of endotracheal tube or tracheostomy

Ventilator-associated pneumonia (VAP)

? Is a lung infection in non-hospitalized patients who had a recent contact with healthcare system either in a long-term care facility or an outpatient treatment of the hospital such as hemodialysis

Healthcare-associated pneumonia (HCAP)

Transmission - Coughing, sneezing, talking - Contaminated equipment - VAP - Spread to lung via blood, nose, throat - HCAP Signs & Symptoms - Cough, malaise, pleural pain, discolored sputum, fever, chills, dyspnea, elevated WBC Diagnostics - Blood testing, chest x-ray, sputum culture & pulse oximetry

Assessment - h/o immunizations, fever, chills, cough, pleural pain, discolored sputum, dyspnea, SOB, malaise Examination includes: \* AUSCULTATION, sputum (color/consistency/amount), cough, temperature, increased respiratory rate and difficulty breathing

Interventions - Humidity or moistening of inhaled air - Hydration / rest - Deep breathing and coughing - Positioning - TRIPOD - Pulmonary hygiene Medications: antipyretics (for fever), expectorants (to mobilize secretions), anti-infectives, chest physiotherapy (postural drainage, chest percussion, and chest vibration), oxygen therapy

Prevention - Immunizations adults age 65+ and children younger than 5 - Individuals with health conditions Teaching - Diet, rest, exercise, avoid smoking, avoid other with URI, hydration, handwashing, medical treatment

Pathophysiological Conditions Affecting Gas Exchange Other Disorders Affecting Gas Exchange Pulmonary System Abnormalities - Structural abnormalities (fractured rib, pneumothorax) - Airway inflammation & obstruction - Alveolar-capillary membrane disorders (anything that leads to change of consistency in the lung tissue in the alveolar level); e.g. pulmonary edema, ARDS, pulmonary fibrosis - Atelectasis (anything that's going to reduce the ventilation like obstruction of the airway or tumor or an alveolar collapse)

Pulmonary Circulation Abnormalities - Pulmonary embolus (obstruction of pulmonary arterial circulation by a blood clot or fat) - Pulmonary hypertension (elevated pressure within the pulmonary arterial system may happen with right-sided heart failure)

Central Nervous System Abnormalities - Trauma & stroke - Spinal cord injuries - Immature breathing patterns (in pre-term infants)

Neuromuscular Abnormalities - Affecting muscles or nerves

Nursing Process - Assessment Assessing for Risk Factors - Data collection \* Demographic data, health history, respiratory history, cardiovascular history, environmental history, and lifestyle

Nursing Process - Assessment Physical Examination \* Inspection - Pallor/cyanosis/clubbing (presence or absence of edema) - Nasal flaring/accessory muscle use/sputum \* Palpation - Pulses/skin temperature/tenderness/subcutaneous emphysema (areas of tenderness) \* Percussion \* Auscultation - Adventitious lung sounds \* Pain assessment - slow & shallow (patients are at risk to develop atelectasis)

Nursing Process - Assessment - Breathing Patterns - Eupnea - Tachypnea - Bradypnea - Kussmaul's - Biot's - Cheyne-Stokes (near-death) - Apnea

Nursing Process - Assessment - Assessing Respiratory Effort - Closed questions to reduce dyspnea - Dyspnea gradual or sudden?

Assess for: - Nasal flaring / retractions - Accessory muscle usage / grunting - Tripod position / paroxysmal noctural dyspnea - Conversational dyspnea / stridor - Wheezing / diminished or absent breath sounds

? Is the sudden awakening due to a shortness of breath - the patient feels panic and extreme dyspnea and must sit upright immediately

Paroxysmal nocturnal dyspnea

? Is a musical sound produced by air passing through a partially obstructed small airway usually heard in asthma and lung congestion patients

Wheezing

? Is a high-pitched, harsh crowing inspiratory sound caused by the partial obstruction of the larynx or trachea; you can actually hear it without a stethoscope

Stridor

Nursing Process : Assessment - Physical Assessment Assess Cough - Normal response of respiratory system - Persistent cough should be checked by HCP \> weeks - Types of cough: dry, productive, or hacking - Obtain data on WHEN, HOW LONG, WHAT MAKES IT WORSE, ANY TREATMENTS?

Allergy associated - Nasal congestion, sneezing, watery eyes, nose discharge - Tx OTC antihistamines

URI associated - Fever, chest congestion, noisy breath sounds, sputum production - Tx antibiotics

Obstruction or constriction associated - Dyspnea, chest tightness, wheezing - ASTHMA - Tx corticosteroids and bronchodilators

Nursing Process: Assessment - Physical Assessment Assess sputum - Color/appearance \* White/clear \* Yellow/green \* Black \* Rusty \* Pink FROTHY \* Foul-smelling - Amount - Timing

White/clear - usually present in viral infections Yellow/green - indicates infection Black - associated with coal, smoke, or soot inhalation Rust - may be associated with pneumococcal pneumonia, TB, & presence of blood = hemoptysis is the coughing up of blood or bloody sputum Pink frothy - associated with pulmonary edema Foul-smelling - usually indicates bacterial infection

Nursing Process : Assessment - Diagnostic Testing Diagnostic Testing - Sputum samples - Skin testing (Tuberculin, skin testing) - Pulse oximetry - Capnography - Spirometry - Peak flow monitoring - ABGs

? Not invasive and it estimates arterial blood oxygen saturation or SaO₂which reflects the percentage of hemoglobin molecules that are carrying oxygen Normal values are 95-100%; anything lower than 94% is considered abnormal in health people

Pulse oximetry

? Measures the CO₂ in inhaled and exhaled air

Capnography

? Is the measure of air that moves into and out of the lungs

Spirometry

? Measures the amount of air that can be exhaled with forcible effort

Peak flow monitoring or peak expiratory flow rate (PEFR)

? These analyze levels of oxygen and carbon dioxide in arterial blood

Arterial blood gases

ABG analysis measures pH, partial pressure of oxygen PO₂, partial pressure of carbon dioxide PCO₂, saturation of oxygen SaO₂, and bicarbonate levels HCO₃

Blood sample is obtained from an artery, usually the brachial, radial, or femoral artery

It's important to know that hemoglobin is the iron-containing pigment of red blood cells; this is called ___ that carries oxygen in the blood

oxyhemoglobin

PO₂ (or partial pressure of oxygen) is the amount of oxygen available to combine with the hemoglobin and make the oxyhemoglobin And SaO₂ (or saturation of oxygen) is the oxygen that is actually bound to hemoglobin

Also important to know is the percentage of oxygen in the air that patient is inhaling, and this is known as ____ or ___ also known as atmospheric oxygen or room air and that is 21% of oxygen

fraction of inspired oxygen; FiO₂

Nursing Diagnosis - Ineffective airway clearance - Ineffective breathing pattern - Gas exchange impairment - Aspiration risk

Nursing Interventions Administering Medications - Bronchodilators \* Relax smooth muscles lining the airways; dilate airways \* Administered orally or inhaled \* e.g. beta-2 adrenergic agonists; anticholinergics; xanthines (e.g. caffeine & theophylline)

Xanthines

Sympathomimetics

Anticholinergics

Nursing Process - Nursing Interventions Administering Medications \* Respiratory Anti-Inflammatory Agents - Combat inflammation in the airways - Treats hypersensitive airways & airway inflammation (asthma) - e.g. corticosteroids, cromolyn, leukotriene modifiers

Inhaled steroids: beclomethasone (Beconase), budesonide (Pulmicort), fluticasone (Flovent), DECREASE INFLAMMATORY RESPONSE; may mask infection

Leukotriene modifiers - Leukotriene release leads to contraction, mucus production & inflammation in the lungs - so leukotriene modifiers prevent the release of leukotrienes Zafirlukast (Accolate), Montelukast (Singulair)

Cromolyn (NasalCrom) (MAST CELL STABILIZERS) - Prevent release of inflammatory and broncho-constricting substances like histamine

Inhaled steroids

Leukotriene Receptor Antagonists

Administering Medications - Nasal Decongestants - Relieve stuffy, blocked, nasal passages - May have systemic adrenergic effects \> elevated BP, tachycardia, palpitations - e.g. ephedrine, pseudoephedrine, phenylephrine

\* Decrease overproduction of secretions by causing local vasocontriction to UR tract; leads to shrinking of swollen mucus membranes \* Opens clogged nasal passages, and promotes drainage of secretions

Administering Medications - Antihistamines - Prevents effects of histamine release - Treats upper respiratory and nasal allergy symptoms

- e.g. diphenhydramine (Benadryl), chlorpheniramine, brompheniramine, loratidine (Claritin), fexofenadine (Allegra), cetirizine (Zyrtec)

Administering Medications - Cough Preparations \_\_\_ (cough suppressants) - reduce frequency of involuntary, hacking, nonproductive cough; suppress cough reflex Expectorants make cough MORE productive Goal is to reduce the frequency of dry, unproductive coughing while making voluntary coughing more productive

Anti-tussives

\* e.g. codeine, hydrocodone, dextromethorphan - act on medullary cough center of brain and suppress cough reflex \* Contraindicated in patients who need to cough to maintain airway like postoperative patients; asthma patients b/c cough suppression can lead to accumulation of secretions and further obstruct airways; sensitivity to narcotics - addiction; may cause sedation and drowsiness; avoid in pregnancy & lactation d/t crossing placenta & entering breast milk

\* These agents are often found mixed together in one preparation to achieve both desirable effects with one medication

Nursing Interventions - Promoting Optimal Respiratory Function - Breathing exercises - Prevention URI - Smoking cessation

Nursing Interventions - Promoting Optimal Respiratory Function cont'd - Positioning - Incentive spirometry (encourage patients to take deep breaths and reach a goal directed volume of air) - Preventing aspiration (d/t decreased loc, diminished gag or cough reflex, difficulty swallowing)

Nursing Interventions - Mobilizing Secretions - Deep breathing & coughing - Hydration (oral or IV) - Humidified air - Chest physiotherapy

\_\_\_ allows for the movement of secretions into the large central airways & makes it easier for the patient to expectorate or allow these secretions to be suctioned \* Involves postural drainge, chest percussion, chest vibration usually done by RT's

Chest physiotherapy

\_\_\_ involves positioning the patient to promote drainage from the lungs by gravity; e.g. if the patient has a pneumonia of the right lower lobe, you will place the patient on her left side and elevate the foot of the bed to allow the right lower lobe to drain

Postural drainage

Chest percussion & chest vibration is used in conjunction with postural drainage & it loosens & mobilizes secretions

Chest percussion involves a rhythmic clapping of the chest wall using cupped hands and chest vibration is the vibration of the chest wall with the palms of the hands

Nursing Interventions - Providing Oxygen Therapy - Oxygen is a MEDICATION and requires an HCP ORDER - Oxygen Hazards \> Over-oxygenating may lead to lung tissue damage \> Combustible - Transtracheal O₂ delivery \> Tracheostomy \> Permanent or temporary

Oxygen therapy provides oxygen at concentrations that are higher than what is found in room air Room air contains 21% of oxygen medication

\* Oxygen toxicity can develop when concentrations of more than 50% of oxygen are administered for longer than 48-72 hours and this is due to the fact that high O2 concentrations reduces ___ production and it will lead to ___ and reduced lung elasticity

surfactant alveolar collapse

A ___ is a surgical opening into the trachea through the neck; it can be permanent or temporary and oxygen can be delivered through it

tracheostomy

Providing Oxygen Therapy - Artificial Airways - Provide an open airway directly into pharynx or deeper into trachea - Pharyngeal airways \> Mouth - ___ airway \> Nose - ___ airway

oropharyngeal nasopharyngeal

Providing Oxygen Therapy - Artificial Airways Endotracheal Airways \* Directly into trachea through Mouth - ___ tube Nose - ___ tube Neck - ___ tube

orotracheal nasotracheal tracheostomy

? Provide an open airway for patients who are at risk for airway obstruction; these can be placed directly into the pharynx or deeper into the trachea

Artificial airways

? Allow for air passage by holding the tongue away from the pharynx

Pharyngeal airways

? Are used for patients who cannot breathe effectively because of airway obstruction or respiratory or cardiac failure

Endotracheal airways

Oropharyngeal vs Nasopharyngeal Oropharyngeal

Oropharyngeal vs Nasopharyngeal Nasopharyngeal

Orotracheal vs Nasotracheal Orotracheal

Orotracheal vs Nasotracheal Nasotracheal

Nursing Interventions - Suctioning Airways Goal to remove secretions & maintain airway patent WHEN to suction? \* Agitation/restlessness, gurgling sounds during respiration, labored respirations, decreased oxygen saturation, increased heart & respiratory rates, adventitious breath sounds on auscultation

Nursing Interventions - Suctioning Airways cont'd Preoxygenation VERY IMPORTANT Suctioning Upper Airway (oro or naso-pharyngeal) Suctioning Lower Airway \* Orotracheal/Nasotracheal/Tracheostomy

\* Very important to know that although suctioning helps remove secretions it also removes air from the airways and causes the patient's O₂ levels to drop therefore suctioning must be done quickly and is also accompanied by supplemental oxygenation (pre-oxygenation)

\* Sterile technique, lubricate suction catheter, oxygenate, insert the catheter and suction ONLY when withdrawing catheter, ONLY FOR 10 seconds - wait 1-3 minutes between suctioning

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Oxygenation Flashcards

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