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Ruben's Nursing 50B > Oxygenation > Flashcards

Oxygenation Flashcards

1
Q

Blood is oxygenated through which mechanisms?

A
  • Ventilation
  • Perfusion
  • Transport of respiratory gases
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2
Q

What controls the rate and depth of respiration in response to changing tissue oxygen demands?

A
  • neural regulators

- chemical regulators

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3
Q

Which system provides the the transport mechanism to distribute oxygen to cells and tissues of the body?

A

cardiovascular system

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4
Q

Where does the exchange of respiratory gases occur?

A

between the environment and the blood

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5
Q

What is respiration?

A

the exchange of oxygen and carbon dioxide during cellular metabolism

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6
Q

What are the three steps in the process of oxygenation?

A
  1. Ventilation
  2. Perfusion
  3. Diffusion
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7
Q

What moves gases into and out of the lungs?

A

pressure changes

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8
Q

What causes air to flow into the lungs?

A

Intrapleural pressure becomes more negative, setting up a pressure gradient between the atmosphere and the alveoli.

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9
Q

Which muscles are used for inspiration?

A
  • diaphragm
  • intercostal muscles
    note: these muscles contract to create a negative pleural pressure and increase the size of the thorax for inspiration.
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10
Q

What is the process of moving gases into and out of the lungs?

A

Ventilation

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11
Q

What is the major inspiratory muscle of respiration?

A

diaphragm

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12
Q

Which nerve innervates the diaphragm?

A

phrenic nerve

note: exists in the spinal cord at the fourth cervical vertebra.

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13
Q

What is the term that relates to the ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs?

A

Perfusion

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14
Q

How is inspiration stimulated?

A

Chemical receptors in the aorta

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15
Q

What is the chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing?

A

Surfactant

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16
Q

What is the collapse of alveoli that prevents normal exchange of oxygen and carbon dioxide?

A

Atelectasis

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17
Q

Which observation of a patient’s breathing can indicate ventilatory fatigue, air hunger, or decreased lung expansion?

A

elevation of the patient’s clavicles during inspiration

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18
Q

What is the term for the ability of the lungs to distend or expand in response to increased intraalveolar pressure?

A

Compliance

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19
Q

How do diseases such as pulmonary edema, insterstitial and pleural fibrosis, and congenital or traumatic structural abnormalities such as kyphosis or fractured ribs effect respiratory compliance?

A

decreases compliance

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20
Q

What is the term for the increase in pressure that occurs as the diameter of the airway decreases from mouth/nose to alveoli?

A

Airway Resistance

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21
Q

What is tidal volume?

A

the amount of air exhaled after normal inspiration

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22
Q

What is residual volume?

A

the amount of air left in the alveoli after a full expiration

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23
Q

What is forced vital capacity?

A

the maximum amount of air that can be removed from the lungs during forced expiration.

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24
Q

What is the process for exchange of respiratory gases in the alveoli and the capillaries?

A

Diffusion

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25
Q

How does the thickness of the alveolar capillary membrane effect diffusion?

A

increased thickness impedes diffusion.

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26
Q

What are the three factors that influence the capacity of the blood to carry oxygen?

A
  1. The amount of dissolved oxygen in the plasma
  2. The amount of hemoglobin
  3. The tendency of hemoglobin to bind with oxygen
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27
Q

Which physiological process produces CO2

A

cellular metabolism

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28
Q

Which characteristics of respiration does the CNS control?

A

respiratory rate, depth, and rhythm

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29
Q

Which characteristics of respiration does the cerebral cortex regulate?

A

voluntary control of respiration (delivers impulse to the respiratory motor neurons by way of the spinal cord)

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30
Q

Which characteristics of respiration is controlled by chemicals?

A

rate and depth: changes in CO2, O2, H ions (pH)
stimulate the chemoreceptors located in the medulla, aortic body, and carotid body, which in turn stimulate neural regulators to adjust rate & depth.

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31
Q

What is stroke volume?

A

the volume of blood ejected from the ventricles during systole

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32
Q

How does hemorrhage and dehydration effect stroke volume?

A

decrease in volume = decrease in stroke volume

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33
Q

What is the Frank-Starling (Starling’s) law of the heart?

A

As the myocardium stretches, the strength of the subsequent contractions increases

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34
Q

What happens when the myocardium is stretched beyond the physiological limits of the heart?

A

Results in insufficient stroke volume

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35
Q

What does an insufficient stroke volume lead to?

A

back up in the pulmonary (left heart failure) or systemic (right heart failure) circulation

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36
Q

What is cardiac output?

A

the amount of blood ejected from the left ventricle

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37
Q

What is the normal CO in a healthy adult at rest?

A

4-6L/min

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38
Q

What is the term for the amount of blood in the left ventricle at the end of diastole?

A

Preload

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39
Q

What is the term for the resistance to left ventricular ejection?

A

Afterload

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40
Q

Which part of the Autonomic nervous system increases the rate of impulse generation and speed of transmission?

A

sympathetic

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41
Q

Which part of the Autonomic nervious system decreases the rate of impulse generation and speed of transmission?

A

parasympathetic

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42
Q

Where does the conduction system of the heart originate?

A

SA node

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43
Q

What are four factors that influence adequacy of circulation, ventilation, perfusion, and transport of respiratory gasses to the tissues?

A
  1. Physiological
  2. Developmental
  3. Lifestyle
  4. Environmental
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44
Q

How does anemia and inhalation of toxic chemicals effect respiratory function?

A

Decreases the oxygen-carrying capacity of blood by reducing the amount of available hemoglobin to transport oxygen.

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45
Q

What is the physiological response to hypoxemia?

A

The development of increased red blood cells (polycythemia)

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46
Q

What is the most common toxic inhalant that decreases the oxygen-carrying capacity of blood?

A

Carbon monoxide

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47
Q

how does CO toxicity effect oxygen carrying capacity?

A

Hemoglobin strongly binds with CO, creating a functional anemia.

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48
Q

What is the term for abnormally low circulating blood volume?

A

hypovolemia

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49
Q

How does the body adapt to significant fluid loss?

A
  • peripheral vasoconstriction
  • increased HR
  • increased CO
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50
Q

What is FiO2?

A

fraction of inspired oxygen

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51
Q

What causes decreases in FiO2?

A

upper and lower airway obstruction, or hypoventilation

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52
Q

How does increased metabolic activity effect oxygen demand?

A

increases oxygen demand

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53
Q

How does the body adapt to increases in CO2?

A

increases rate and depth of respiration

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54
Q

Which patients are at a greater risk for hypoxemia?

A

patients with pulmonary diseases

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55
Q

What are the three primary alterations in respiratory functioning?

A
  1. hypoventilation
  2. hyperventilation
  3. hypoxia
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56
Q

What is the normal arterial CO2 tension (PaCO2) range?

A

35-45 mmHg

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57
Q

What is the normal arterial O2 tension (PaO2) range?

A

80-100 mmHg

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58
Q

What is the normal SpO2?

A

greater than or equal to 95%

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59
Q

What happens when alveolar ventilation is inadequate to meet the oxygen demand of the body or eliminate sufficient carbon dioxide?

A

Hypoventilation

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60
Q

What is the maximum 02 administration for a patient with COPD?

A

24% to 28% (1-3L/min)

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61
Q

What does excessive retention of carbon dioxide lead to?

A

respiratory acidosis and respiratory arrest

62
Q

What are the initial symptoms of hypoventilation?

A
  • mental status changes
  • dysrhythmias
  • potential cardiac arrest
63
Q

What happens if hypoventilation is left untreated?

A
  • status rapidly declines
  • convulsions
  • unconsciousness
  • death
64
Q

What is the state of ventilation in which the lungs remove carbon dioxide faster than it is produced by cellular metabolism?

A

Hyperventilation

65
Q

Which 4 conditions induce hyperventilation?

A
  • severe anxiety
  • infection
  • drugs
  • acid/base imbalance
66
Q

What does excessive ventilation of carbon dioxide lead to?

A

respiratory alkalosis

67
Q

What are signs and symptoms of hyperventilation?

A
  • rapid respirations
  • sighing breaths
  • numbness and tingling of hands/feet
  • lightheadedness
  • loss of consciousness
68
Q

What is the term for inadequate tissue oxygenation at the cellular level?

69
Q

What are 6 possible causes of hypoxia?

A
  • decreased hemoglobin
  • diminished concentration of inspired oxygen
  • inability of the tissues to extract oxygen from blood
  • decreased diffusion of O2 from alveoli to the blood
  • poor tissue perfusion with oxygenated blood
  • impaired ventilation
70
Q

What are the clinical signs and symptoms of hypoxia?

A
  • apprehension
  • restlessness
  • inability to concentrate
  • decreased LOC
  • dizziness
  • behavioral changes
71
Q

How are vital signs affected by hypoxia?

A
  • increased pulse rate

- increased rate/depth of respiration

72
Q

What causes cyanosis?

A

presence of desaturated hemoglobin in capillaries

73
Q

How does a nurse assess hypoxia via cyanosis?

A

central cyanosis as observed in the tongue, soft palate, and conjunctiva of the eye where blood flow is high

74
Q

What does peripheral cyanosis indicate?

A

often result of vasoconstriction and stagnant blood flow

75
Q

What is the term for a deviation from the normal sinus rhythm caused by electrical impulses that do not originate from the SA node?

A

dysrhythmias

76
Q

How are disrhythmias classified?

A

By cardiac response and site of impulse origin.

77
Q

What makes atrial fibrillation irregular?

A

multiple pacemaker cites and the unpredictable conduction to the ventricles

78
Q

What are abnormal impulses originating above the ventricles called?

A

supraventricular dysrhythmias

79
Q

What is the sudden, rapid onset of tachycardia originating from above the AV node called?

A

Paroxysmal supraventricular tachycardia

80
Q

What are the disrhythmias caused by an ectopic site of impulse formation within the ventricles called?(2)

A
  • Ventricular tachycardia

- Ventricular fibrillation

81
Q

Why is ventricular tachycardia life-threatening?

A

decreased CO and the potential to deteriorate into ventricular fibrillation or sudden cardiac death

82
Q

What are clinical findings of left-sided heart failure?

A
  • crackles at base of lungs
  • hypoxia
  • dyspnea during exertion
  • cough
  • paroxysmal nocturnal dyspnea
83
Q

What are clinical findings of right-sided heart failure?

A
  • weight gain
  • distended neck veins
  • hepatomegaly and splenomegaly
  • dependent peripheral edema
84
Q

What are the two types of impaired valvular function?

A
  • stenosis (hardening)

- regurgitation (impaired closure)

85
Q

What are two common outcomes of myocardial ischemia?

A
  • angina pectoris

- MI

86
Q

Why are infants and toddlers at risk for upper respiratory tract infections?

A
  • frequent exposure to other children
  • immature immune system
  • exposure to secondhand smoke
87
Q

What are the 4 characteristics of chest pain that a nurse needs to assess for?

A
  • location
  • duration
  • radiation
  • frequency
88
Q

What is the term for an abnormal condition in which a person must sit or stand to breathe comfortably?

89
Q

What is hemoptysis?

A

blood sputum

90
Q

What are characteristics of abnormal sputum?

A
  • green
  • bloody (hemoptysis)
  • think/thin
  • foul odor
  • increased/decreased
91
Q

If hemoptysis is present, where are likely sources of blood?

A
  • upper respiratory tract
  • sinus drainage
  • GI tract (hematemesis)
92
Q

How can pH testing help to determine the source of bloody sputum?

A

blood from upper respiratory/sinus will have alkaline pH, blood from GI will be acidic.

93
Q

What are the most common sources of environmental exposure in the home?

A
  • cigarette smoke
  • CO
  • radon
94
Q

What do clubbed nails often indicate?

A
  • prolonged oxygen deficiency
  • endocarditis
  • congenital heart defects
95
Q

what is the term for the when the chest wall contracts during inspiration and expands during exhalation?

A

paradoxical breathing (asynchronous breathing)

96
Q

What is the term for an increased rate and depth of respirations?

A

Kussmaul respiration

97
Q

What is the term for the absence of respirations for a period of time?

98
Q

What is the term for when the respiratory pattern has periods of apnea followed by periods of deep breathing and then shallow breathing followed by more apnea?

A

Cheyne-Stokes respiration

99
Q

What causes Cheyne-Stokes respiration?

A

decreased blood floow or injury to the brainstem

100
Q

What is the cause of xanthelasma (yellow lesions on the eyelids)?

A

hyperlipidemia

101
Q

What is the cause of corneal arcus (whitish opaque ring around junction of cornea and sclera)?

A

Abnormal finding in young to middle-age adults with hyperlipidemia (normal finding in older adults with arcus senilis)

102
Q

What is the cause of pale conjunctivae?

103
Q

What is the cause of cyanotic conjunctivae?

104
Q

What is the cause of petechiae on conjunctivae?

A

fat embolus or bacterial endocarditis

105
Q

What is the cause of cyanotic mucous membranes?

106
Q

What is the cause of pursed-lip breathing

A

associated with chronic lung disease

107
Q

What is the cause of neck vein distention?

A

associated with right-sided heart failure

108
Q

What is the cause of flaring nares?

A

air hunger, dyspnea

109
Q

What is the cause of chest retractions?

A

increased WOB, dyspnea

110
Q

What is the cause of chest asymmetry?

A

chest wall injury

111
Q

What is the cause of peripheral cyanosis?

A

vasoconstriction and diminished blood flow

112
Q

What is the cause of central cyanosis?

113
Q

What is the cause of decreased skin turgor?

A

dehydration (normal in older adults d/t decreased skin elasticity)

114
Q

What is the cause of dependent edema?

A

associated with right and left-sided heart failure

115
Q

What is the cause of periorbital edema?

A

associated with kidney disease

116
Q

What is the cause of cyanosis in the fingertips and nail beds?

A

decreased CO or hypoxia

117
Q

What is the cause of splinter hemorrhages in the nail beds?

A

bacterial endocarditis

118
Q

Why are cardiac enzymes tested?

A

To diagnose acute myocardial infarcts

119
Q

What is the normal range for the cardiac enzyme creatinine kinase (CK)?

A

male: 55-170 units/L
female: 30-135 units/L

120
Q

Why are cardiac troponins tested?

A

value elevates as early as 3 hours after myocardial injury. Value for cardiac troponin I often remains elevated for 7-10 days; value for cardiac troponin T for 10-14 days

121
Q

What is the normal range for cardiac troponin I?

A

<0.03 ng/mL

122
Q

What is the normal range for cardiac troponin T?

A

<0.1 ng/mL

123
Q

Why is myoglobin tested?

A

Early index of damage to myocardium in myocardial infarction or reinfarction. increases within 3 hours.

124
Q

What is the normal range for myoglobin?

125
Q

What is the normal range for serum potassium?

A

3.5-5 mEq/L

126
Q

Patients taking ACE inhibitors are at risk for an increase in which electrolyte?

A

potassium (hyperkalemia)

127
Q

What is the normal range for fasting cholesterol?

128
Q

What is the normal range for LDLs?

129
Q

What is the normal range VLDLs (very low density lipoproteins)?

130
Q

What is the normal range for HDLs?

A

male: >45 mg/dL
female: >55 mg/dL

131
Q

What is the normal range for triglycerides?

A

male: 40-160 mg/dL
female: 35-135 mg/dL

132
Q

What is the normal range for pH?

133
Q

What is the normal range for PCO2?

A

35-45 mmHg

134
Q

What is the normal range for HCO3?

A

21-28 mEg/L

135
Q

What is the normal range for PO2?

A

80-100 mmHg

136
Q

What is the normal range for SaO2 saturation?

137
Q

What is the normal range for Base excess?

A

0 ± 2 mEq/L

138
Q

At what O2 rate is humidification necessary?

139
Q

What is the procedure that adds moisture or medication to inspired air by mixing particles of varying sizes with the air?

A

Nebulization

140
Q

How does a nurse evaluate the effectiveness of coughing?

A
  • sputum expectoration
  • patient’s report of swallowed sputum
  • clearing of adventitious lung sounds
141
Q

What are the 4 coughing techniques

A
  • deep breathing and coughing
  • cascade cough
  • huff cough
  • quad coughing
142
Q

What are the 3 types chest physiotherapy (CPT) techniques?

A
  • postural drainage
  • chest percussion
  • vibration
143
Q

What are two examples of NPPV?

A

NPPV= noninvasive positive-pressure ventilation

  1. Continuous positive airway pressure (CPAP)
  2. Bilevel airway presure (BiPAP)
144
Q

Which patients are treated with CPAP?

A
  • obstructive sleep apnea
  • heart failure
  • preterm infants with underdeveloped lungs
145
Q

What is the term for a catheter inserted through the thorax to remove air and fluids from the pleural space?

A

chest tube

146
Q

What are chest tubes commonly used to treat?

A

pneumothorax or hemothorax to promote lung reexpansion

147
Q

What is the term for a collection of air in the pleural space?

A

pneumothorax

148
Q

What causes a pneumothorax?

A

The loss of negative intrapleural pressure which causes the lung to collapse

149
Q

What does PEEP stand for?

A

Positive end-expiratory pressure

150
Q

What is the term for the accumulation of blood and fluid in the pleural cavity between the parietal and visceral pleura?

A

hemothorax

151
Q

What is the most serious tracheostomy complication?

A

airway obstruction

152
Q

What is the junction where the trachea branches into the right and left mainstem bronchi?

Ruben's Nursing 50B (15 decks)

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