OXYGENATION Flashcards
Oxygen O2
required for creating energy
Carbon Dioxide CO2
by-product of this energy production and is not used by the body
O2 and CO2 exchange
exchanged between the environment and the cells through ventilation, respiration, and perfusion
ventilation (breathing)
movement of air into and out of the lungs
respiration
gas exchange between atmospheric air in the alveoli and the capillaries
Perfusion
oxygenated capillary blood passes through body tissues for use
inspiration
diaphragm and intercostal muscles contract, enlarging the thorax and decreasing intrathoracic pressure, which allows air to rush in
Expiration
diaphragm & intercostal muscles relax, causing the thorax to get smaller and increases pressure, which forces air out of the lungs
regulation of ventilation
Regulated by the Central Nervous System (medulla and brainstem), chemoreceptors, & proprioceptors
- drive to breathe is the recognition of increasing CO2 and hydrogen ions in blood
propriioeceptors
send signals to increase ventilation with increased physical activity. What our body is doing ((walking down stairs without having to look at the stairs to do so)
airway resistance
asthma, positioning, etc
lung compliance
Ex: emphysema, pregnancy
respiration
Diffusion from an area of greater concentration to a lower concentration
neonates
alveoli stays opened by deep breathing.
But they require surfactant to keep the alveoli open. Does Not happening during a certain week of gestation; therefore, if born too early they will need help.
perfusion
Delivery of oxygen to cells of the body and returning CO2 to the lungs is the process of perfusion
- Impacted by body position, activity level, adequacy of blood supply, and proper cardiovascular function (pumping)
hyperventilation
Ventilation in excess of what is required to remove CO2. getting rid of CO2 too fast
- Possible causes include: anxiety, infection/fever, hypoxia, diabetic ketoacidosis, aspirin Overdose
tx: Breath into paper bag.
Hypoventilation
Ventilation is inadequate to meet the body’s oxygen demand OR is inadequate to remove
sufficient CO2. not getting enough oxygen in or sufficiently remove CO2
- Possible causes include: COPD, obesity, hypoventilation, syndrome, atelectasis
tx: Ventilator
hypoxia
Inadequate oxygen available for the cells
- Possible causes include: decreased hemoglobin, hypoventilation, aspiration, poor tissue perfusion
tx: Blood transfusion, oxygen, find cause first before fix
Hypoxia acute EMERGENCY
Anxiety, Restlessness, Confusion
- Brain takes 25% of oxygen and can alter mental status
Drowsiness
Increased pulse
Dyspnea
Tachypnea
Increased blood pressure
Cardiac arrhythmias
hypoxia chronic
Pallor
Fatigue
Altered thought processes
Headache
Chest pain
Clubbing of the nails
Anorexia
Constipation, Decreased urine
Cardio Function
Pumps blood throughout the body delivering oxygen and nutrients and removing waste (i.e., circulating)
arrhythmia
electrical conduction problem causing irregular or ineffective beats
ischemia
impaired oxygen delivery
- Myocardial Ischemia can lead to myocardial infarction (MI)
- Angina
- Cerebrovascular Accident (CVA)
cardiac valve stenosis
causes inefficient pumping. Possible back flow
heart failure
inefficient pumping of blood supply
left side HF
SOB, crackles
right sided HF
edema, swelling, JVD
hypovolemia
inadequate blood supply
Assessment priority
1: Assess to ensure the patient is not in acute respiratory distress!
age-related findings
At risk for respiratory complication related to decreased cilia
smaller/ younger people have an increased respiratory rate
Diagnostic Tests**
blood work, microbiology lab, cardiac function, pulmonary function,
blood work ABG
ABG: arterial sample of blood that helps to evaluate how much gas (CO2, O2, PH, BiCARB) assesses acid base values in the body.
blood work CBC
hbg, hct, RBC, etc
blood work cardiac enzymes
a sample of blood that can be tested to evaluate if there is damage to cardiac tissue. Tissue will release these enzymes if there is damage to the cardiac tissue. elevated in the blood if there is damage to cardiac tissue. Take every 6 hours.
cholesterol lipids, triglycerides
respiratory function since it requires adequate perfusion. Only one that has prep** don’t eat for 12 hours (fast)
culture & sensitivity
(throat or nasopharyngeal swab, sputum samples)
EKG/ ECG
electrical tracing of the electrical conduction of the heart. Tell us when the heart is contracting.
Holter monitor
outpatient/ ambulatory test. POTS (you wear for 24-48 hours and carry it with you)
echocardiogram (Thoracic or Esophageal) [TTE/TEE]
ultrasound of the heart. Look primarily at the valves of the heart to see how the blood is moving through the valves of the heart.
- TEE: goes through the esophagus to look at your heart. More invasive and more accurate. Conscious sedation, NPO
- TTE: ultrasound probe
cardiac stress test
in controlled situations they try to assess what the heart does when it is stressed. run/walk until you cant anymore. Physical: running on a treadmill
Pharmacological: before surgery/ procedure. Under controlled situations they inject medication to have the heart respond to stress.
cardiac angiography (catheterization)
physician places in radial vein and threads up into the heart. Looks at vessels that supply oxygenated blood (narrowing, blockages, etc)
- Diagnostic or curative
- Have to be paralyzed during and watch for bleeding and distal pulses after the procedure.
pulmonary function: x-ray
helps physician tell if there is atelectasis, pneumonia
pulmonary function: capnography
measures CO2 instead of O2.
pulmonary function: lung scan (VQ scan)
pt. Has to lay flat. Injected dye, evaluate kidney function
pulmonary testing function:
objective measurements of lung capacity. mask
thoracentesis
can be done at the pt. Bedside. Enters through the side, puncture to create more room to expand lunds.
- Nurse job: hug them so they don’t move during the procedure. Pt. immediately feels better unless they puncture the lung.
- Watch for bleeding, internal bleeding, liver functions, etc
bronchoscopy
most invasive. A flexible tube with a camera goes through the bronchioles. Moderate anesthesia. Direct test to see inside the lungs.
- Pre-procedure: NPO
- Post-procedure: respiratory distress, reflex return
healthy lifestyle
Manage modifiable risk factors (diet, exercise, alcohol, smoking, stress/anxiety)
Smoking cessation
disease management
BP, cholesterol, triglycerides, HDL, LDL
COPD, asthma, emphysema, HF
vaccinations
Yearly influenza vaccine for everyone (6 months and older)
Vaccine against pneumococcal disease (pneumonia, meningitis) for eldery and at-risk populations
COVID-19 vaccine
environmental pollutants
Frequent management of dust at home (frequent vacuuming, removing carpeting,etc)
Using a mask when exposure to irritants is likely
Occupational exposures can trigger respiratory problems (paint, varnish, asbestos, fumes)
Monitor for pollution alerts and pollen alerts
Use air filters, air conditioners
dyspnea management
Anxiety management
Energy conservation techniques
Pursed-lip breathing/ Smell the Roses, Blow out the Candles
- Reduces anxiety/panic by slowing expiration and preventing collapse of smaller airways
- Gives a sense of control
How-to:
- Sit upright. Inhale through the nose to the count of 3. Exhale slowly and evenly through pursed lips to the count of 7. Contract abdominal muscles while exhaling. Repeat.
diaphragmatic breathing/ belly breathing
To create a more functional respiratory pattern, especially for people with COPD.
Decreases RR, increases gas exchange in more alveoli
How –to:
- Place one hand on the abdomen and one on the chest. Inhale through the nose while letting the abdomen protrude as much as possible. Exhale through pursed lips while contracting abdominal muscles and pressing upward and inward with your hand. Repeat for 1 minutes. Practice several times a day.
airway maintenance: oral
Mobilization of secretions
Oral hydration
- 2-3 liters of oral fluid intake/day to help thin secretions
- CHF can’t do a full 3 liters
airway maintenance: coughing
Coughing
Productive or Nonproductive
Effective or Noneffective
Medications
- Expectorants
- Suppressants
- Lozenges
airway maintenance tools
cough and deep breathiing, and spirometer
airway maintenance: chest physiotherapy
Helps to mobilize secretions for large amounts of secretions or ineffective coughs
Selective usefulness in some populations
Usually performed by RT, PT, specially trained nurses
Use of percussion, vibration, and postural drainage
airway maintenance: suctioning
Required when patient is unable to clear secretions
- Perform as often as necessary, but avoid excessive suctioning
Oropharynx or nasopharynx suctioning removes secretions from the patient’s mouth or upper throat
Tracheal suctioning
- Requires sterile technique
Risks of suctioning
- Hypoxia: bc ur removing air
- Tissue trauma/bleeding
- Anxiety
- Death (from hypoxia and cardiac stress)
Use proper PPE, as exposure to secretions is likely (gloves, googles, mask, gown)
Management of artificial airways
Endotracheal Tube (Intubation): more invasive.
Tracheostomy: longer term use to protect the airway
promote lung expansion
Positioning
- Upright, Fowlers, or Semi-
Fowlers
- Tripod
- Prone
Pain control
C&DB
IS
promote lung expansion: chest tubes
Tube placed in the pleural space to remove trapped air, blood, or fluid
Creates negative pressure, allowing the lungs to expand more fully
promote lung expansion: breathing exercises
Deep Breathing
- In through the nose and out through the mouth. Inhale deeply enough to move the bottom ribs.
Incentive Spirometry
- Semi-Fowlers or upright position
- Splint PRN
- Exhale normally, place your mouth on the mouthpiece and inhale through the mouth. At full inhalation, instruct to hold breath for 3 seconds, if possible
- Exhale normally
- For best effect, use 10 times every hour while awake
Following either of these activities, secretions may have been mobilized and a cough can help clear those secretions
oxygen administration
Room air is 21% Oxygen
Oxygen is administered with an order (treated like medication)
- Must be managed by a licensed person (LPN, RN, RT, MD, etc.)
- However, in an emergency treat the patient first, then get the order
administration indications
- Hypoxia/Decreasing SpO2
- Tachypnea
- Tachycardia/Chest pain
- Often administered while recovering from anesthesia or while using opioids
Safety: It is combustible and is often stored in compressed gas cylinders
- Monitor tubing for effectiveness and evaluate overall effectiveness of this therapy
flow meter
Attaches to the O2 outlet to adjust the amount of O2 being delivered
Verify flow meter level regularly
- Check each time you enter the room
humidifier
Container of sterile water which provides moisture to the oxygen
- Sterile water prevent infection
- Prevent drying, cracking and bleeding of nasal mucosa
portable compressed oxygen tank
Store upright in an appropriate holder
Verify how much oxygen is in the tank prior to and during use
Use for transportation, short-term
compressor
Used i homes and long-term care
Changes room air into medical grade oxygen using filters and sieves
high flow oxygen
Provides total amount of inspired air
Oxygen delivery does NOT vary with breathing pattern/depth
low flow oxygen
Provides only part of the total inspired air
More comfortable
Oxygen delivery varies with breathing pattern/depth
nasal cannula
Most common method of delivery
Effective, easy to apply, most comfortable
Can be used with mouth breathers
Clients can eat, drink, talk, and perform ADL’s with NC in place
Generally, 1-6 L/minute
24-44% FiO2
*Specialized nasal cannula can deliver high flow oxygen
venturi mask
High flow system
4-6 L/min
The oxygen mixes with the air
24-40% FiO2
simple face mask
Covers mouth and nose
Interferes with talking, eating, and drinking
May lead to claustrophobic reaction
Not suitable for COPD patients
5-8L/min
40-60% FiO2
- Trach collar is similar device, for use with tracheostomies
non-rebreather mask
Delivery system with a bag attached to the bottom of the mask
Oxygen supply flows into reservoir bag
Has to valve that largely prevents the inhalation of room or exhaled air
10-15 L/min
80-95% FiO2
biCAP/ CPAP
Bilevel positive airway pressure
- Mechanical ventilator to assist inspiration
- Creates different pressures in the airways during inhalation and exhalation
- Positive pressure helps prevent atelectasis
ventilator
Artificial ventilation of the lungs
Requires an artificial airway
Rate, depth, FiO2, and pressure can be set on the ventilator
AIRVO
Treatment for spontaneously breathing patients who would benefit from receiving high flow oxygen
Flow may be from 2 - 60L/min depending on the patient
Oxygen percent ranges from 21%-100%
Used in hospitals and long term care facilities
Humidified and warmed air
evaluation
SpO2 (Pulse oximetry)
- Non-invasive
- Generally, between 95-
99% is normal
- % of oxygen carried by the available hemoglobin to peripheral tissues
- Cold hands/poor
circulation can influence
results
Arterial Blood Gasses
- Invasive
- Used when precise values are necessary
