Oxygenation Flashcards
what is the highest single preventable factor in decreasing lung disease?
cigarette smoking
smoking has been historically ____?
embedded in culture
more smokers in rural or urban cities?
urban
what does smoking do to lungs?
breaks down and destroys alveolar capillaries and tissue- decreases life expectancy
what is EVALI?
e-cig product use associated with lung injury
what is oxygenation?
properly functioning alveolar capillary membrane
what blood does oxygenation oxygenate?
venous
what does oxygenation remove from blood?
carbon dioxide
what is ventilation?
ability to transport air to and from lungs
*can’t bring air in
COPD oxy or vent issue?
oxygenation issue
asthma oxy or vent issue?
ventilation issue
obstructions vent or oxy issue?
ventilation issue
which is required to get proper levels of O2 to the tissues?
both oxygenation and ventilation
function of upper airway?
warm, filter, humidify air
*not actually a function, has to be provided
function of lower airway?
conduction of air, mucocilliary clearance
*helps clear airways
what impairs mucocilliary fibers moving air?
anesthesia
function of alveolar capillary membrane?
gas diffusion
factors affecting pulmonary functioning?
-levels of health
-medications (like analgesics)
-lifestyle
-environment
examples of lifestyle factors?
sedentary- stasis of secretions
pollution
smoking
work environment
obesity- hypoventilators
pets
what issue do cardiac and lung problems cause?
respiratory
affect of chronic resp issue?
muscle wasting - includes diaphragm (not working as well) leads to increased workload
anemia affect?
low RBC=low oxygen (hemoglobin carries oxygen) resp rate increases to compensate
how would left sided heart failure affect the lungs?
build up and back flow into lungs
opioid effect?
depressed respiratory system
how does age affect oxygenation function?
decreased oxy
-increased work of breathing:
expiration becomes active, should be passive (have to work harder to breath)
-decreased gas exchange due to:
decreased capillaries (where gas exchange takes place)
decreased inspiratory lung volumes
how does age affect ventilation function?
decreased vent
-ineffective cough (thicker secretions)
-drier mucous membrane
-delayed gastric emptying= increase aspiration risk
-impaired mobility- impacts resp system
-meds that decrease vent
-tissues and airways more rigid/stiff; diaphragm moves less efficient=less air exchange
increased work of breathing causes?
decreased oxygenation
decreased gas exchange causes?
decreased oxygenation
what’s included in a focused pulmonary interview?
-how is your breathing?
-do you smoke?
-what kind of house? (asbestos, older, stairs/levels, pets)
-who does the cleaning? shopping?
-what type of work?
-chest pain?
-cough? how long? productive? what color?
-fume/smoke exposure? (pulmonary fibrosis)
-most comfy position for breathing?
-allergies?
-travelled? (cryptoplasmosis encounters)
what does using accessory breathing muscles cause?
increased work to breathe
what are PACK years?
packs per day x years smoking
ex. 1 pack per day for 30 years = 30 pack year hx
*significant lung probs after 35 years
productive cough colors?
red - TB
green - infection, bacterial pneumonia
yellow - not so bad
how much?
what term do you NOT use?
rales
involved in pulmonary assessment?
inspection
auscultation
involved in inspection?
-resp rate
-depth
-pattern
-work of breath
-accessory muscle use
-chest symmetry
-skin color
-surgical scars
adventitious sounds in ausculation?
wheezing
crackles
rhonchi
what do wheezes sound like?
continuous high pitched squeak or musical continuous sound
*air moving through narrow or partially obstructed airway passages
*heard on inhale and exhale
VENTILATION ISSUE
ex. asthma, obstruction, tumor
treatment for wheezes?
bronchodilator
what do crackles sound like?
fine, popping/crackling discontinuous sounds
*air moving through wet secretions
*causes alveolar collapse (pneumonia, fluid overload)
*can be coarse or fine!
what does rhonchi sound like?
low pitched coarse continuous snoring quality
*secretions in larger airways
need to clear secretions through coughing or suction
how to cough for rhonchi?
- breathe in
- 3 small coughs (work secretions up closer to exit)
- breathe in
- one big cough
noninvasive ways to check pulmonary function?
pulse ox
chest x ray (lung outline)
pulmonary function test (volume in 1 second, max expiratory pressure: blow as fast and hard as you can to measure volumes, also for vent)
what does pulse ox measure?
arterial hemoglobin, saturation of oxygen
when to do continuous pulse ox measurement?
if abnormal- less than 90
what is a pulse ox spot check?
on during vital reading then taken back off
what are the invasive way to assess pulmonary function?
arterial blood gas analysis (go into artery for sample: gives oxy, bicarb, ph, and co2= oxy and vent)
bronchoscopy (tube into lungs)
what is SpO2? PaO2?
SpO2: saturation
PaO2: partial pressure of oxygen (from invasive monitoring in ABG)
if spo2 is 70%, what is pao2?
40%
if spo2 is 80%, what is pao2?
50%
if spo2 is 90%, what is pao2?
60%
if spo2 is 95%, what is pao2?
80%
what is normal pao2?
60-80
tumors are?
vascular
what to do after lung tumor biopsy?
watch for blood, position them upright
interventions for adequate pulmonary functioning?
-smoking cessation
-positioning (Fowler’s is best [45-60])
-chest physiotherapy (cut hands and repeatedly tap area to loosen fluid= easier to cough up, several shallow huffing breaths then final forceful cough)
-anxiety control
-pursed lip breathing (for COPD- prolongs expiratory phase, inhale 2 exhale 4)
-adequate fluid intake (hydrations thin secretions)
-humidified oxygen
-nutrition
-resp meds
-coughing and deep breathing
-incentive spirometry
what is ARDS?
adult respiratory depressed syndrome (put in prone position for better breathing)
what is a yankauer?
suction tube for aspiration precautions
what are cough suppressants for?
dry cough
what are expectorants for?
productive cough- get secretions out
what do bronchodilators do?
open narrowed airways
what do corticosteroids do?
reduce airway inflammation
recommended fluid intake?
2-3L
what is SMILE incentive spirometry?
sustained maximum inspiratory lung expander
what does a nebulizer do?
disperse fine particles of med into deeper passages of respiratory tract where absorption occurs
metered dose inhalers
delivers controlled dose of med with each compression of canister
(regular inhaler)
dry powder inhaler
activated by patients inspiration
needed for metered dose inhaler to work properly?
spacer, wait 1-5 mins between sprays
what do you have to do after using a steroid metered dose inhaler?
rinse, possible thrush (fungal infection) if you don’t
rescue inhaler duration?
short acting beta agonists (SABA)
maintenance inhaler duration?
long acting beta agonist (LABA)
nasal cannula goes to how many liters? fio2 %?
6L
24-44%
room air is?
21% fio2
1L/NC?
24% Fio2
2L/NC?
28% fio2
3L/NC?
32% fio2
4L/NC?
36% fio2
5L/NC?
40% fi02
6L/NC?
44% fio2
what is the “christmas tree”?
measures fio2
nasal cannula injury?
behind ears and in nose bc pressure from tubing and drying skin
*can use surgilube
how does a non rebreather mask work?
oxygen fills reservoir and exhaled air goes out the sides (not re-breathing air they brought in)
*delivers a lot of oxygen
*80%-100% fio2
how much fio2 in venturi mask?
24%-40%
can dial in precisely how much oxygen is titrated in mask
what is CPAP (continuous positive airway pressure) for?
obstructive sleep apnea
*can be oxygen delivery or just pressure
when is CPAP used?
only during sleep
how does a BIPAP (biphasic positive airway pressure) work?
decreases pressure so you are not exhaling against restistance
*only delivers pressure on inhalation
what color is oxygen?
GREEN
what color is air?
YELLOW
where do you read O2 liters?
middle of little ball
what kind of oxygen for highflow nasal cannula?
humidified
10LPM?
60% fio2
15LPM?
80% fio2
20LPM?
90% fio2
30LPM?
98% fio2
