Oxygenation Flashcards
what is poor oxygenation?
a decreased oxygen level in the blood
oxygen saturation
can be used to asses oxygen level
SpO2
measure of how saturated hemoglobin are with oxygen (pressure of O2 in blood)
95%-100%
hemoglobin
carries oxygen in blood
reasons O2 is low
low on blood
blockage in blood flow
blockage in airway
anything that decreases blood or ways to get oxygen to blood
signs/symptoms of poor oxygenation
restlessness/confusion: not good oxygenation to brain
decreased blood pressure: low BP
cool extremities
pallor (pale) or cyanosis (blue) of extremities
slow capillary refill
tissue ischemia and cell death
when oxygen delivery is inadequate to meet metabolic demands of the body
tissues starving for oxygen
hypoxia
low oxygen in your tissues
when your blood doesn’t carry enough oxygen to the tissues to meet the body’s needs
can be difficult to measure
we can assume that a patient with hypoxemia for an extended amount of time has this
lung disease
the lungs have a large surface area that is constantly exposed to the external environment
lung disease is greatly influenced by what a patient is exposed to
-environmental: ex. dust, coal, mining, chemicals
-occupational: ex. painter
-personal: ex. smokers
-social
celia
moves things around, coughing is the celia trying to remove particles
pulmonary disease
are often classified as chronic, obstructive or restrictive, infectious or noninfectious and is caused by alterations in the lungs or heart
acute pulmonary disease
bronchitis
chronic pulmonary disease
asthma
obstructive pulmonary disease
chronic obstructive pulmonary disease (COPD): something that keeps lungs from fully expanding
restrictive pulmonary disease
pulmonary fibrosis (scarring of lung), sarcoidosis (clusters of scarring)
infectious pulmonary disease
pneumonia: most common lung infection; fluid on the lungs
noninfectious pulmonary disease
asthma, COPD, pulmonary fibrosis
clinical manifestations of respiratory alterations
cough- acute or chronic
dyspnea- shortness of breath, feeling of inability to get a good breath
chest pain- not good blood flow to heart
abnormal sputum: different colors than normal
hemoptysis- coughing up blood
altered breathing patterns- tachypnea (fast), bradypnea (slow), use of accessory muscles (muscles around clavicle and intercostals)
cyanosis- bluish discoloration of skin and mucus membranes (lighter can see it on skin, darker look at mucous membrane)
fever
orthopnea
dyspnea when laying down
patients can breathe better when propped up slightly
people with chronic lung disorders may sleep better sitting up in a recliner
clubbing
often occurs in heart and lung diseases that reduce the amount of oxygen in the blood
happens in a person who has continuously low levels of oxygen
distorted angle of nail bed
hypoxemia
low level of oxygen in the blood
symptoms of hypoxia
Early
R- restlessness
A-anxiety
T- tachycardia/tachypnea
Late
B- bradycardia
E- extreme restlessness
D- dyspnea (severe)
ventilation
movement of chest and the process of breathing in or out
respiratory depression
decreased respiratory rate
hypoventilation
breathing top shallow or too slow to meet the body’s needs for oxygen
holding onto CO2 and CO2 levels are high, leads to hypercapnia
-sleep, sedative, illness, and chest pain
hyperventilation
breathing that is too rapid or too deep
breathing exceeds the body’s metabolic demands
blowing too much CO2 causes hypocapnia
-anxiety, exercise
atelectasis
collapsed air sacs (alveoli)
shuts off oxygen exchange
Prevention-
-early ambulation: even if short of breath
-turn, cough (force air into airsacs) , deep breath
-incentive spirometry
aspiration
passage of gastric contents (fluid or solid) into the lungs: things that are supposed to go to GI tract go into lungs
can cause aspiration pneumonia
prevention
-assess patients ability to swallow
-keep head of bed elevated with tube feedings
-thorough lung assessment: lung complications can creep up fast
-eating or tube feeding raise head of bed at least 30 degrees
assessment of respiratory system
respiratory rate: 12-20
use of accessory muscles
cyanosis
oxygen saturation
adventitious (abnormal) breath sounds (crackles, wheezes, rhonchi, stridor, or rubs): anything that does not sound normal
clubbing
dyspnea with activity
chest x-ray
normal: black spaces show air and are good
any white is congestion or fluid
CT scan
horizontal view of lungs
MRI
much clearer than a CT scan
have to be careful about metals in and on the body
bronchoscopy
can detect obstruction, abnormality, and can also remove something to be biopsied
used to check the airways for any abnormalities
thoracentesis
pulls off fluid, relieves patient, and is able to be used for testing
pulls out fluid with syringe
Interventions prior to oxygen use
promotion of lung expansion
-position change frequently
-keep upright
-increase daily activities; ensure adequate hydration: hydration helps with sputum (lack of hydration leads to thicker sputum that is harder to clear)
-coughing exercises
-deep breathing
albuterol (proair)
bronchiodialator
rescue inhaler for acute difficulty breathing (asthma, COPD): used PRN
Beta 2 agonist (SABAs) short-acting beta agonist
(beta cells: fight or flight- turns up and causes things to move fast)
2 puffs every 4-6 hrs PRN
-common reactions: nervousness, tachycardia (high heart rate), headache, and throat irritation
Symbicort (budesonide/formetrero inhaled)
scheduled med
corticosteroid/bronchodilator
beta 2 agonist (LABA) long-acting beta agonist
2 puffs per day
-common reactions: tachycardia, nervousness, palpitations, oral candidiasis
** rinse mouth and spit out after inhalation: when giving an oral steroid by inhalation- steroids increase sugar, which causes increased risk of oral yeast infection
fraction of inspired oxygen FIO2
percent of oxygen a person is inhaling at any point in time
room air FIO2 is 21%
with supplemental O2, FIO2 can reach 100%
nasal canula
what you want to start patient on
can deliver up to 6L/min of O2 (usually no more than 4)
-FIO2 24%-44%
advantages
-safe and simple
-increased mobility
disadvantages
-dries membranes (higher rate of O2 causes higher likelihood of dry out) (can use humidifier to decrease dry out) ; skin breakdown
non-breather mask
face mask with reservoir bag
has one way valves that open during expiration and close during inhalation to prevent decrease in FIO2 or build up of CO2
step before intubation
delivers higher concentrations of oxygen
treat hypoxia
decreases the workload of breathing
FIO2 of 60%-100%
at 10-15L for 100%
venturi mask/venturi mask valves
advantages:
-controls exact concentration of O2
-delivers FIO2 of 24%-60% at flow rates from 4-12L/min
typically used for mouth breathers
disadvantages:
-hot and confining
-interferes with eating and talking
- commonly used for COPD patients
face tent
advantages
-delivers 28%-100% with flow rate of 8-12L/min
-alternative for claustrophobia
disadvantages
-difficult to control concentration of oxygen
factors that alter accuracy of pulse ox
physical
-motion/incorrect placement
-BP monitoring device
-bright lights, polish, or acrylics
physiological
-poor arterial flow or edema
-cold hands; poor capillary filling
-anemia
if not working properly: change finger/location, or warm area
incentive spirometry (IS)
purpose: (forces air sacs open)
-helps prevent post-op pulmonary complications (atelectasis)
-provides voluntary deep breathing
-gives visual feedback
technique
-explaining procedure
-positioning
frequency: 10 breaths every 2 hours
oxygen toxicity
can develop when a person breathes 100% O2 for <12 hours
signs/symptoms
-pallor, sweating, nausea and vomiting
-seizures, vertigo, muscle twitching
-hallucinations, visual changes, anxiety
-chest pain dyspnea
