Oxygenation Flashcards
Poor oxygenation
decrease levels of oxygen in the blood
SpO2 measures
saturated hemoglobin with oxygen
Does nurse have discretion on how to keep a patient’s O2 levels above a certain level?
Yes
Signs and symptoms of poor O2
Restlessness/Confusion
decrease in BP
Cool extremities
Cyanosis
Slow capillary refill
When O2 is inadequate to meet metabolic demands of the body, …
tissue ischemia and cell death
Hypoxia
when blood does not carry enough oxygen to the tissues to meet body’s needs
What causes Lung Disease? And greatly influenced by
large surface and constantly exposed to the eternal environment
greatly influenced by patient exposure environment, occupation, personal, and social habits
Acute Lung Disease
bronchitis
Chronic Lung Disease
asthma
Obstructive Lung Disease
COPD - difficulty exhaling
Restrictive Lung Disease
scaring pulmonary fibrosis - difficulty inhaling
Infectious Lung Disease
pneumonia - fluid becomes infected
Noninfectious Lung Disease
asthma, COPD, pulmonary fibrosis
Clinical Manifestations of Lung Diseases
cough - acute/chronic
dyspnea
chest pain
abnormal sputum
hemoptysis
altered breathing patterns
cyanosis
fever
Dyspnea
shortness of breath, feeling of inability to get good breath
Hemoptysis
cough up blood
Altered breathing patterns
Bradypnea, tachypnea, use of accessory muscles
Cyanosis
bluish discoloration of the skin and mucous membranes (distal, mouth, the tip of the nose and inside nares, ear lobes)
Orthopnea
dyspnea when laying down
-breaths better when sitting up
-if chronic, sleep better in a recliner
Clubbing
often in heart or lung diseases reduce amount of oxygen in the blood (strange angle and wide fingers)
Hypoxemia
low oxygen levels in the blood
Hypoxia
low levels of oxygen in tissues and organs
-patient with hypoxemia for an extended amount of time
Signs and Symptoms of Hypoxia
Mnemonic
R-estlessness
A-nxiety
T-achycardia/tachypnea
is Late to
B-radycardia
E-xtreme restlessness
D-yspnea (severe)
Hypoventilation
breathing too shallow or slow to meet body’s oxygen needs
-narcotics, sleeping
Hypercapnia
hold too much carbon dioxide
Hyperventilation
breathing too rapid or deep
-exceeds metabolic need
-anxiety, exercise, pain
How to prevent Atelectasis?
early ambulation, turn, cough, deep breathing, and incentive spirometry
Atelectasis
collapsed air sacs (alveoli)
- bedridden
Aspiration
passage of gastric contents (fluid/solid) into the lungs
-causes aspiration pneumonia
-through lung assessment
How to prevent aspiration?
patient’s ability to swallow, keep head elevated with tube feedings
Assessment of Respiratory System
rate
use of accessory muscles
cyanosis
SpO2
adventitious breath sounds (abnormal)
clubbing
dyspnea with activity
Bronchial/Vesicular lung sounds
normal
Fine Crackles lung sounds
little pops (rubs hair against ear)
most common
during inspiration
Coarse crackles lung sounds
lot of fluid
during inspiration
Wheeze lung sounds
expiration (whale or moan)
Rhonchi lung sounds
wheeze with fluid (snore/gurgle)
Diagnostic testing of lungs
chest x-ray
arterial blood gases
sputum culture (what it is) and sensitivity (how to kill it)
CT scan
MRI (Magnetic Resonance Imagery)
bronchoscopy
thoracentesis
In a chest x-ray, what color is good and which is bad?
Black is good
White is bad - fluid/tissue
Interventions Prior to Oxygen Use
promotes lung expansion
-position change frequently every 2 hours
-keep upright
-increase daily activities; ensure adequate hydration
-coughing exercises
-deep breathing
postoperative
-IS, TCDS, Splinting incision
Albuterol (ProAir) MDI
REACTION
-rescue inhaler for acute difficulty breathing (asthma, COPD)
-Short Action Beta Agonist
-relaxes and smooths muscles
-2 puffs inhaled 4-6 hours prn
-2 puffs every 5-30 mins before exercise
Albuterol (ProAir) MDI = Common Reactions
nervousness, tachycardia, headache, throat irritations
Symbicort (Budesonide/Formoterol) Inhaled
Reaction
-Corticosteroid/Bronchodilator
-Long-acting Beta Agonist
-2 puffs twice a day
-treatment for prevention of asthma attacks and exercise-induced bronchospasm and COPD
RINSE MOUTH AND SPIT AFTER USE
Symbicort (Budesonide/Formoterol) Inhaled = Common Reactions
tachycardia, nervousness, palpations, and oral candidsis
Is oxygen flammable?
yes
Is oxygen considered a drug in hospitals?
yes
Nurses can put O2 on a patient to stabilize but
have to get an order from a physician after
Assessing Patients on oxygen therapy
equipment on L/min
correct oxygen delivery device
check flow rate
respiratory assessment
Fraction of Inspired O2
FIO2
percent of oxygen a person is inhaling
Room Air FIO2
21 percent
(with supplement O2 can reach 100)
Nasal Cannula
Top L/min? FIO2 percentage?
O2 delivery up to 6L/min
FIO2 24-44 percent
If orders are above 92 percent of oxygen in a nasal cannula, then put them on how many Liters?
2-3
Advantages of nasal cannula
safe and simple
easily tolerated
increase mobility
Disadvantages of nasal cannula
dry and skin breakdown
What is the most invasive oxygen method device?
Non-rebreather mask
Non-rebreather masks
face mask with reservoir bag
valves to prevent decreases in FIO2 or build-up of CO2
-delivers a higher concentration of O2 (approx. 100 percent)
-treat hypoxia
-decrease the workload of breathing
Nonrebreather mask: FIO2 of 60-100%, then set the flow rate to
10-15 L for 100%
Venturi Mask Advantages
FIO2 percentage and Liters
-controls the exact concentration of O2
-delivers FIO2 of 24-60% flow rate from 4-12 L/min
Venturi Mask Disadvantages
-hot
-interferes with eating and talking
-common with COPD
What method of breathing device is used for mouth breathers?
Venturi mask
Face Tent Advantages
Percentage and Flow Rate
delivers 28-100% with a flow rate of 8-12 L/min
alternative for claustrophobia
Face Tent Disadvantages
difficult to control concentration of oxygen
Documentation of Oxygen
-date and time
-method of delivery
-flow rate in L/min
-patient response to oxygen
-condition of patient’s skin where device rests
-respiratory assessment
-teaching
Factors that Alter Accuracy of Pulse Ox
motion/incorrect placement
BP monitoring device
bright lights, polish, acrylic
poor arterial flow
edema
cold hands
poor capillary filling
anemia
Incentive Spirometry
Purpose: prevent post-Op pulmonary complication (atelectasis). provides volume of deep breathing, visual feedback
Technique: explain procedure, positioning
Nurse Considerations having a minimum of 10 breaths every 2 hours
Oxygen Safety
-no smoking
-no aerosol spray
-no petroleum products
-administer by order or RN judgement in emergency
Oxygen Toxicity
100% oxygen for more than 12 hours
results effects on CNS and Pulmonary
Signs and Symptoms of O2 Toxicity
pallor, sweating, nausea, and vomit
seizures, vertigo, muscle twitching
hallucinations, visual changes, anxiety
chest pain, dyspnea
Should you be concerned, when laying in bed with high respiratory rates?
Yes, very
