Oxygenation Flashcards
…. is the passage of fluid through the circulatory system or lymphatic system to an organ or a tissue, usually referring to the delivery of blood to a capillary bed in tissue.
Perfusion
Occurs via diffusion movement of oxygen and carbon dioxide between the air and blood
Gas exchange
Gas Exchange
Inspiration & Expiration
Are collectively known as
Ventilation
Respiration occurs between
( ______ –> ______)
Alveolar —> Capillary
Gas Exchange
Perfusion is between these two parts of the body
(Capillary –> Tissues)
Organs of the Respitory Tract
Flash Game Review
Think about poor little Andy
Chemoreceptors
Found in the medulla respond to these 2 chemical changes
Hydrogen ion (H+)
partial pressure of Carbon Dioxide (PaCO²)
Mechanical Receptors
Found in the conducting upper airways
Do these two things
Initiate cough reflex
Aid in control of respiration
Infant- short airways
Risk for
Aspiration
ABC
Is always the priority
Airway
Breathing
Circulation
Hypoxia is defined as
PO² <
80 mm Hg
Condition in which inadequate oxygen is available to the cells
Hypoxia
Common signs
Decreased energy
Restlessness (Early)
Rapid, Shallow breathing
Sitting up to breath
Hypoxia
Noninvasive Diagnositic Methods
Hypoxia
SpO² (Pulse Oximetry)
Pulmonary Function Studies
Peak expiratory flow
Measures SaO²
95 - 99% normal
Treat if <92%
COPD 88%
Must know Hgb
Pulse Oximetry
Noninvasive Studies for Hypoxia that require an order
(2)
Chest X ray
Sputum for analysis
Peak expiratory flow rate
Over 80% of personal best means
All Good, no further action
50 - 70%
Less than 50%
50 - 70%
Take “green zone medications & inhaled bronchodilator, inhaled Anti-inflammatory.
After 20 - 60 minutes if not feeling better or peak flow is less than 70% of personal best, Get Immediate Help
Take Yellow Zone Meds, oral corticosteroids (prednisone)
Get Immediate Help
palpable or audible popping, crackling, grating, or crunching sensation that can occur when air is pushed through the soft tissue in the chest
Crepitus
Brief, discontinuous sounds heard during inspiration or expiration. They can be fine (high-pitched) or coarse (low-pitched), indicating conditions like pneu
Crackles (Rales)
Continuous, musical sounds heard mainly during expiration. Suggests narrowed airways, common in asthma or chronic obstructive pulmonary disease (COPD).
Wheezes (Rhonici)
High-pitched, crowing sound often heard during inspiration, indicating upper airway obstruction, such as in croup.
Stridor
Grating or rubbing sound heard during inspiration and expiration, indicating inflammation of the pleural surfaces, often seen in conditions like pleurisy.
Pleural friction rub
Decreased / absent lung sounds indicate….
Indicates reduced airflow and can be due to conditions like pneumothorax or pleural effusion.
Normal lung sounds are referred to as ____ breath sounds.
Abnormal lung sounds fall into the category of ____ sounds, which include crackles (rales), wheezes (rhonchi), stridor, pleural friction rub, and decreased or absent
vesicular= normal
adventitious= abnormal
Rapid, Shallow breathing
Rapid heart rate
Sitting up to breathe
Nasal flaring
Use accessory muscles
Hypertension
Cyanosis
Are all signs of
Hypoxia
Peak flow meter use
Blow as hard as possible
How many time?
Which reading do you take
3
Highest
Invasive test
ABG
PO²
PCO²
NORMS
80-100 mm Hg (PO²)
35-45 mm Hg (PCO²)
Invasive test
Bronchopscopy HIGH RISK
Function
Before and After TEACHINGS
Visualize structures & remove substances
NPO Before
NPO until gag reflex returns
Invasive test
CT scan
Contradictions
Iodine allergy
Metformin
ABG
PH
7.35- 7.45
ABG
bicarbonate HCO3
____ mEq/L
22 - 26
Thoracentesis is a procedure….
to remove fluid or air from around the lungs
A needle is put through the chest wall into the pleural space.
The pleural space is the thin gap between the pleura of the lung and of the inner chest wall
During thoracentesis if chest tube becomes dislodged
Cover with gauze and call physician
If Dr. Doesn’t arrive quick, Call Code
Proper breathing techniques
(5)
Deep breathing
Cough
Incentive spirometer
Pursed Lips breathing
Abdominal breathing
When would you use a Antitussive Cough syrup
Give examples
Suppression of cough
Codine
Dextromethorphan (Robitussin DM)
Post operative, Pain Management, Sleep Disturbance
To promote cough give this type of syrup
Expectorant
Guaifenesin (Robitussin)
Reinforce deep breathing
Promote cough
Max lung inflation
Reduce Atelectasis
Optial gas exchange
Incentive spirometer
Percuss lungs to loosen secretions
How long & Often
30 - 60 seconds
3x daily
How know patient isn’t tolerating suctioning
Respiratory Distress
Hypoxia/ cyanosis
Change in heart rate
In situations of acute respiratory distress, such as an asthma attack or exacerbation of COPD, ________ can help relieve symptoms and improve airflow.
bronchodilators
Albuterol (Proventil)
Bronchodilator
Montelukast (Singulair)
Bronchodilator
Theophylline (Slo-bid)
Bronchodilator
Tiotropium (Spiriva)
Bronchodilator
Purpose: They are primarily used for Acute relief of narrowing of the airways.
They quickly improve airflow and alleviate symptoms like wheezing and shortness of breath.
Bronchodilators
Purpose: They are used to manage chronic inflammatory conditions and prevent exacerbations.
They have a slower onset of action
Steroids - Anti-inflammatory
Budesonide (Pulmicort)
Prednisone
In summary, ________ provide rapid relief by relaxing airway muscles,
while ____ address underlying inflammation and are often used for long-term management and prevention of exacerbations in chronic respiratory conditions.
bronchodilators
steroids (prednisolone)
Antihistamines are commonly used to manage allergic reactions, but they may also have a role in certain respiratory conditions.
rhinitis (hay fever)
Name 3
Benadryl (Diphenhydramine)
Claritin (Loratadine)
Zyrtec (Cetrizine)
Supp Oxygen
Therapeutic Goal
Arterial PO² & PCO²
Po² 80 - 100
PCO² <45
Nasal Cannula
Room air = ___ %
21
Nasal Cannula
1L = ___ %
2L
3L
4L
5L
6L
1L = 24%
2L = 28%
3L = 32%
4L = 36%
5L = 40%
6L = 44%
Nasal Cannula rate no higher than __ LPM
6
Nasal Cannula/ High Flow
Who is it best tolerated by
10L - 15L 65 - 90%
Children
Simple Face Mask
Delivers __ - __ L/min
Never less than 6 lpm
. A minimum of 6 L/minute of oxygen flow is needed to prevent rebreathing of exhaled carbon dioxide.
Hypercapnic
Shorter periods
___ - ___ hrs
6 - 10
12 - 24hr
This device is used when an increase of oxygen is needed for a short period of time.
Flow rate 5 - 10 lpm 40% - 60%
Simple face Mask
_______ Masks are used for individuals who are still able to breathe on their own but require additional oxygen (e.g., traumatic injury to the lungs; smoke inhalation; carbon monoxide poisoning; any chronic disorder of the airways that limits the amount of oxygen reaching the lungs, such as chronic obstructive pulmonary disease [COPD], cystic fibrosis, pulmonary fibrosis, and sarcoidosis).
Non-rebreather
The main difference between the two masks is in how much recycled air you rebreathe. A ______ mask has two-way valves instead of one-way valves. This means you rebreathe a small amount of outside air. With a ________, the one-way valve doesn’t allow you to breathe in any outside air.
partial rebreather
non-rebreather mask
Partial rebreather mask
Flow: 6 - ____ LPM
70% - 90%
How much should the bag deflate?
15LPM
Only partially
This mask provides the highest concentration of O²
Up to 100%
Nonrebreather Mask
Provides most precise level of Oxygen
Usually from 4 - 10L
Venturi Masks
Used in unconscious persons
Prevents the tongue from blocking the airway
nasopharyngeal airway (NPA)
Oropharyngeal airway
deliver oxygen to the lungs if you’re unable to breathe normally after an injury or accident, or because your muscles are very weak
allow you to breathe if your throat is blocked – for example, by a swelling, tumour or something stuck in the throat
reduce the risk of food or fluid entering the lungs (aspiration) if you find coughing difficult
Uses of what
Tracheostomy
Tracheostomy
Palpate around stoma for ______, which occurs if air leaks out into muscle planes from tracheal wall erosion or dislodged tube.
What does it feel like
subcutaneous Emphysema
Rice krispies
These devices blow humidified, heated oxygen into the nostrils. They can deliver up to 60 liters of oxygen per minute.
High Flow nasal cannula
surgically created hole _____ in your windpipe (trachea) that provides an alternative airway for breathing
Tracheostomy
(stoma)
Difference in appearance from an Oral / Nasopharyngeal Tube
Oral: Pirate Hook shaped
Nasal: longer / curved type tube
An _____ is a thin, curved piece of hard plastic or rubber that is inserted into the tracheostomy tube (cannula) to help with placing the tube into the trachea.
The ____ provides a smooth surface to guide the tube into the airway without damaging the inner lining of the trachea
obturator
Tumors or bronchial cancer.
Airway blockage (obstruction)
Narrowed areas in airways (strictures)
Inflammation and infections such as tuberculosis (TB), pneumonia, and fungal or parasitic lung infections.
Interstitial pulmonary disease.
Indicated for…
Bronchoscopy
How do you know patient can tolerate suctioning
How do you know they can’t tolerate it
Cough = Tolerate
Pulse Ox Drops = Not tolerate
Patients with good coordination and inhalation abilities often prefer ( MDIs, DPI, Nebulizer);
( MDIs, DPI, Nebulizer) inhalers are suitable for those who may struggle with the hand-lung coordination.
( MDIs, DPI, Nebulizer) are typically used for patients, especially young children or those with severe respiratory conditions, who may find it challenging to use inhalers effectively.
( MDIs, DPI, Nebulizer)
Turn up oxygen when giving a Nebulizer treatment
True or False
True
This type of mask is most commonly used post surgery and delivers 6 - 10L.
Short term use only 12 - 24 hrs
Simple Mask
This type of mask is used to maintain CO² Levels
Partial rebreather
Highest concentration of O² & Fastest release of CO²
Non Rebreather
Occlusion or closure of the one-way valves in a _____ mask can lead to an increase in oxygen concentration, potentially exceeding safe levels.
partial rebreather
Air comes in but doesn’t come out describes
COPD
Concerns with tracheostomy (4)
Airway Management: Ensuring the patency of the tracheostomy tube and assessing for any signs of obstruction or dislodgment.
Infection Control:
Suctioning: Regular suctioning
Humidification:
Suctioning a tracheostomy is sterile procedure
True or False
True
When do you suction
Going in or Pulling out
Pulling out
Passy-Muir valve….
Helps patients with a tracheostomy talk better
Too much oxygen can be dangerous for patients with … (2)
COPD
chronic obstructive pulmonary disease (COPD)
Hypercapnia (partial pressure of carbon dioxide in arterial blood greater than 45 mm Hg).
_____, or “crepitation,” are short, high-pitched sounds.
______ are a lower pitch and last longer.
Fine crackles
Coarse crackles
The sound of a _____ is a high-pitched, continuous whistle-like, musical sound. This is caused by air passing through an obstructed, narrow airway.
classic wheeze: Sibilant wheeze
Deep, low-pitched rumbling or coarse sound, as air moves through tracheal/bronchial passages in the presence of mucus or respiratory secretions.
Refered to as (2)
Rhonchi: Sonorous wheeze
Commonly heard in the bases of the lung lobes during inspiration.
Crackles can be further categorised as coarse or fine.
_____ crackles sound quality is low-pitched and moist; it may be heard in pulmonary oedema and bronchitis.
____ crackles sound quality is like hair rubbing near the ear and may be heard in congestive heart failure and pulmonary fibrosis.
Coarse / Fine
Bronchial breath sounds can be auscultated where?
A. Peripheral lung fields
B. Sternal area
C. Mid-scapulae area
D. Tracheal area
D. Tracheal area
These type of breath sounds are found at the site of the bronchi and are located anteriorly at the 1st and 2nd intercostal space & posteriorly in between the scapulae?
A. Crackles
B. Wheezes
C. Bronchovesicular
D. Vesicular
C. Bronchovesicular
These breath sounds are found anteriorly and posteriorly throughout the peripheral lung fields?
A. High-pitched wheezes
B. Vesicular
C. Discontinuous
D. Bronchial
B. Vesicular
While assessing a patient’s lung sounds you note bronchial breath sounds in the peripheral lung fields. What could this finding represent?
A. This is a normal finding.
B. Pulmonary emboli
C. Lung consolidation like with pneumonia
D. Pleuritis
The answer is C.
Bronhical breath sounds should only be heard in the trachael area. It is ABNORMAL to hear them in the perpherial lung fields. If this happens, it could represent lung consolidation like with pnemonia.
Select all of the following that are considered discontinuous breath sounds:
A. High-pitched wheeze
B. Stridor
C. Pleural friction rub
D. Fine crackles
E. Low-pitched wheeze
F. Coarse Crackles
C. Pleural friction rub
D. Fine crackles
F. Coarse Crackles
The answer is C, D, and F. The other options are CONTINUOUS breath sounds.
True or False: Low-pitched wheezes are polyphonic sounds that can be cleared when coughing.
True
False
The answer is FALSE. Low-pitched wheezes are MONOPHONIC (have one sound quality to them) that are not usually cleared by coughing.
This lung sound is continuous, high-pitched with musical instrument sound that is polyphonic and occurs mainly during expiration but can be present with inspiration as well?
A. Stridor
B. Fine crackles
C. High-pitched wheeze
D. High-pitched crackles
C. High-pitched wheeze
On auscultation of a patient in respiratory distress, you hear a high-pitched, harsh sound that is monophonic and is present only during inspiration. This is known as:
A. Stridor
B. Vesicular
C. Rales
D. Rhonchi
A. Stridor
You are auscultating a patient’s lung sounds. During your assessment, you note there is a low-pitched harsh, grating sound that sounds like a pleural friction rub. However, you’re not sure if this is a pleural friction rub or pericardial friction rub. What do you do next to determine the difference?
A. Have the patient cough and see if the sound clears
B. Assess the posterior lower lobe only
C. Have the patient hold their breath and note if the sound is still present
D. Place the patient in supine position and reassess for the sound
The answer is C. A pleural friction rub can sound similar to a pericardial friction rub. If you are unsure about what you are hearing, have the patient hold their breath which will cause the lungs to stop inflating and deflating. If you still hear the sound, it is possible the patient has a pericardial friction rub rather than pleural friction rub. All the other options are incorrect.
True or False: The left lung has 3 lobes: left upper lobe, left middle lobe, and left lower lobe.
True
False
The answer is FALSE. The right lung has THREE lobes and the left lung has TWO lobes.
During auscultation, the anterior part of the chest mainly provides an assessment of the upper lobes of the right and left lungs, while the posterior part of the chest provides mainly provides an assessment of the lower lobes of the right and left lungs.
True
False
The answer is TRUE.
When auscultating the anterior part of the chest, specifically the apex of the lungs, it is best to auscultate where with the stethoscope?
A. Slightly above the clavicle
B. 2nd intercostal space mid-clavicular
C. 4th intercostal space mid-clavicular
D. 6th intercostal space mid-axillary line
A. Slightly above the clavicle
When auscultating the posterior part of the chest the upper lobes are found?
A. Between C9 to T10
B. Between T3 to T10
C. Between C7 to T3
D. Directly over the scapulae
The answer is C.
C. Between C7 to T3
Thoracentesis treats _____ or excess fluid in the space between your lungs and your chest wall.
It helps relieve symptoms and figure out what might be causing the fluid, so that your provider can treat it appropriately
pleural effusion
Venturi mask is most likely used in which type of patient
COPD
Aerosolized
10L - 15L
Best tolerated by children
Nasal Cannula/ High Flow
6 - 15L
Deflation of bag w/ inspiration (less than 2/3)
Hypercapnia
Partial rebreather
Highest concentration O²
Exhale through side ports
Faster release of Co²
Set at 15 L / min
70 - 100% O²
Non-rebreather
Occlusion of Venturi mask can cause
O² LEVELS TOO HIGH
3 types of artificial airways
Nasopharyngeal/ Oropharyngeal
Endotracheal Tube
Tracheostomy
