Oxygenation Flashcards
ventilation
movement of gas in/out of lungs
diffusion
CO2/O2 exchange in alveoli/RBC
perfusion
distribution of oxygenated RBC to all tissues
breathing is a ___ process
passive
what regulates breathing
O2, CO2, and pH of blood
hypercarbia
increase in CO2
what happens when CO2 increases
increase rate and depth of breathing
what changes lung volume
age
gender
height
tidal volume
amount of air exhales following normal inspiration
function of alveoli
promote gas exchange
assessment of breathing
normal: 12-20, rate/depth/rhythm
abnormal: above 27 risks cardiac arrest, pain, clogging, anxious, irregular
what muscles do m/f/children use to breath
male and children: abdominal muscles
female: thoracic muscles
crackles
fine to coarse bubbly sounds, associated w air passing through fluid or collapsed small airways
wheezes
high pitched whistling, narrow obstructed airways
rhonchi
loud low pitched rumbling, fluid/mucus in airway
- resolved with coughing
stridor
choking, children
pleural friction rub
inflamed pleural space
vesicular lung sounds
low pitched
broncho vesicular
medium pitched
bronchial
high pitch
bradypnea
rate of breathing is regular but abnormally slow
- less than 12
tachypnea
rate of breathing is regular but abnormally rapid
- more than 20
apnea
resp cease for several seconds, persistent cessation results in resp arrest
hyperventilation
rate and depth of respirations increase
- removing CO2 faster than produced by cellular metabolism
- caused by anxiety, infection, fever, drugs, acid base imbalance, aspirin poisoning
-s/s: rapid respirations, sighing breaths, numbness/tingling, light headedness, loss of consciousness
increased WOB
hypoventilation
resp rate is abnormally low and depth is depressed
- inadequate alveolar ventilation to meet demand (too much CO2, not enough O2)
- caused by medications, collapsed lung
- s/s: mental status changes, dysrhythmias, cardiac arrest, death
- often result of drug OD
how is diffusion/perfusion measure
O2 sat
what is SpO2 vs SaO2
peripheral oxygenation vs arterial oxygenation
- normal measure is 95-98% but limits can be lower if have COPD
work of breathing
effort to expand and contract lungs
- determined by rate and depth of breath
- inspiration = active
- expiration = passive
compliance
ability of lung to distend and expand
decrease compliance, increase resistance, and/or increase accessory muscles ___ work of breathing
increase
factors that affect oxygenation
-decrease o2 carrying capacity (RBC)
-hypovolemia (blood volume)
-decreased inspired o2 (altitude, hypoventilation)
-chest wall movement (obesity, pregnancy)
goal of ventilation
normal arterial carbon dioxide tension and normal arterial oxygenation tension
- PaO2: 80-100
- PaCO2: 35-45
atelectasis
collapsed alveoli (deflated sacs or filled w fluid)
- associated w immobility, obesity, sleep apnea, lung conditions
- can lead to collapsed lung –> respiratory distress
hypoxia
inadequate tissue oxygenation
- not enough oxygen at cellular level
why can hypoxia lead to cardiac dysrhythmia?
cardiac muscle/cells not getting any O2
causes of hypoxia
-decreased hemoglobin
- diminished o2 conc
- inability of tissues to get oxygen from blood
- decreased diffused o2 from alveoli to blood bc infection
- poor perfusion like shock
- impaired ventilation from trauma
s/s of hypoxia
-restlessness
-inability to conc
- difficulty lying flat
- fatigue but agitated
- increase pulse/resp
- initial inc in bp, then low/shoch level bp
-cyanosis of skin/mucous mems (late sign)
Differentiate between early new late hypoxia
early:
- rat: restlessness, anxiety, tachycardia
late:
- bed: bradycardia, extreme restlessness, dyspnea
chronic hypoxia
associated with chronic lung conditions (COPD)
- usually have cyanotic nail beds, sluggish cap refill, clubbing fingers, barrel chest
lifestyle/env affecting O2
- smoking
- obesity
- air pollution/quality
- malnourishment
- lack of exercise
- substance abuse
- occupational exposure
dyspnea
associated w hypoxia
subjective–> I cant breath
- s/s: use of accessory muscles, nasal flaring, inc rate/depth
-1-10 rate it
cough
protective reflex to clear trachea, bronchi, lung of irritants and secretions
- un/productive
- chronic vs acute
- adequate hydration
- encourage coughing
- measure pain
specimen collection (sputum)
to analyze for pathogens
- best collected in morning, 1-2 hr after eating
- sterile specimen container
- as much sputum or can suction too
sputum culture. sensitivity
identify a specific microorg
sputum for acid fast bacillus
detection of TB, continuous for 3 days
sputum for cytology
lung cancer
basic ventilation studies
ability of lungs to efficiently exchange o2 and co2
- pulmonary obstructive vs restrictive disease
peak expiratory flow rate
point of highest flow during maximal expiration
- reflects changes in airway size, predicts overall airway resistance
bronchoscopy
visual examination of the tracheobronchial tree to obtain fluid, sputum, or biopsy samples
lung scan
nuclear scanning to identify abnormal masses
nursing diagnosis related to oxygenation
- priority problems
- ineffective airway clearance
- risk for aspiration
- impaired gas exchange
- activity intolerance
long term prevention
- vaccinations
- healthy lifestyle
- env and occupational exposures
dyspnea management
hard to treat but start w underlying condition
- o2 therapy
- pharmacological treatment (bronchodilators, inhaled steroids, etc)
- mobility can worsen problem
airway maintenance
CAB: circulation, airway, breathing
maintain patent airway is nursing priority
- always watch pulse while problems occur
managing pulmonary secretions
mobile: promotes lung expansion
hydrate: reduces viscosity
humidification: moistens airways, loosens secretions
medications
positioning
position for max respiratory function
- change frequently
- mobilizes secretions
- prevents atelectasis
cough and deep breath
- cough keeps airway clear and gets rid of sputum
- deep breathing increases air to lower lungs, promotes gas exchange at alveolar level
cascade cough
huff cough
quad cough
nurses best defense
turn cough deep breath
chest physiotherapy
goal: mobilize pulmonary secretions
- postural drainage, chest percussion, chest vibrations–> follow with cough, deep breath
- indications: thick secretions, weak muscles so can’t cough
- contraindications: pregnant, torso injury, bleeding disorder, osteoporosis
postural drainage
lay on unaffected side to promote drainage
- ex: infiltration on right lower lobe so lay on left in tberg
suctioning
indicated when pt cant clear secretion on own
- sterile procedure
- orotracheal and nasotracheal
- extremely uncomfortable and should be less than 10 secs
incentive spirometer
promotes lung expansion through deep breathing
- prevents/treats atelectasis
- know how to use correctly
what is a goal of oxygen therapy?
- prevent or relieve hypoxia
what is the conc of o2 given during therapy
anything higher than ra (21%)
what must you have to administer o2
HCP order
can o2 be delegated?
can delegate to CNA
- applying nasal cannula, oxygen mask
nurse must assess and respond to pt needs and adjustments
safety precautions for o2
highly flammable
- should have sign on door
- no open flames, smoking around it
nasal cannula
1-6 L (22-44%), safe and well tolerated
- can lead to skin breakdown in ears, nose
- tubing can dislodge easily to make sure always connected
- use humidification if greater than 4 L
simple face mask
6-12 L (33-55%), best for short periods of time like transportation
- not great is claustrophobic, risk for skin breakdown, higher risk of aspiration
- assess for proper fit
partial rebreather
6-11 L (60-75%), used for short periods of dyspnea or other increase o2 needs
- rebreathe up to 1/3 of exhaled air
- helps w humidification
- reservoir bag partially inflated
non-rebreather
10-15 L (80-95%), pt in critical need for o2
- step before intubation
- one way valve allowing client to inhale max o2 conc, exhalation ports restrict exhaled air from being rebreathed
- watch for aspiration
- hourly assessments
ventri mask
4-12 L (24-50%)
- provides precise o2 delivery with humidity
- not for long periods of time
- used when pt needs highly regulated o2 conc
other types of face masks for o2
- face tent: 24-100%, high humidity, usually post operative
- high flow nasal cannula
- nasal cannula with entitle co2 monitor (telemetry)
why humifidication
prevents drying out mucous membranes
- use when greater than 4 L
- sterile water
- aka bubbler
complications of O2 therapy
- drying mucous membranes
- o2 toxicity
- skin breakdown
assessment cues
- cough
- pain:
- dyspnea
- shortness of breath
- breath sounds
