Oxygenation Flashcards
What is poor oxygenation?
A decreased oxygen level in the blood
Oxygen Saturation can be used to assess what?
Oxygen level
SpO2 measures what?
Measure of how saturated hemoglobin are with oxygen
How is a SpO2 measured?
Pulse oximetry
What is considered an acceptable SpO2 range?
95%-100%
What are signs and symptoms of poor oxygenation?
Restlessness/Confusion
Decreased blood pressure
cool extremities
pallor or cyanosis of extremities
slow capillary refill
What is the 1st sign of poor oxygenation in a patient
Restlessness
What happens when oxygen delivery is inadequate to meet metabolic demands of the body
Tissue ischemia and cell death
Define hypoxia
Hypoxia is when your blood doesn’t carry enough oxygen to the tissues to meet the body’s needs (low oxygen in your tissues)
What are some early signs of poor oxygenation in a patient?
Restlessness
tachycardia
tachypnea
dyspnea
increased agitation
diaphoresis
retractions
altered LOC
anxiousness
What are some late signs of hypoxia in a patient?
Increased restlessness
Somnolence (sleepy/lethargic)
Stupor
dyspnea
decreased resp
bradycardia
cyanosis
Lung disease is greatly influenced by what a patient is exposed to… for example….
environment- Think about the environment we live in–> Lubbock dirt
occupational– think about coal miners–> exposure to pollutants.
personal
social habits
Gas exchange happens were
Alveoli
The anatomy of the lung includes
2 lungs
Trachea/Wind pipe –> bronchi –> bronchioles —> Alveoli (air sacs)
What are pulmonary diseases?
They are often classified as acute or chronic, obstructive or restrictive, infectious or non infectious and is caused by alterations in the lungs or heart
What is an example of an acute pulmonary disease?
Bronchitis
What is an example of a chronic pulmonary disease?
Asthma
What is an example of an obstructive pulmonary disease?
COPD– Chronic Obstructive Pulmonary disease
What is an example of Restrictive pulmonary disease?
Pulmonary fibrosis, sarcoidosis (scaring)
What is an example of infectious pulmonary disease?
Pneumonia
What is an example of a noninfectious pulmonary disease
asthma, COPD, Pulmonary fibrosis
What are some clinical manifestations aka symptoms of respiratory alterations?
Cough
Dyspnea– shortness of breath, feeling of inability to get a good breath
Chest pain
Abnormal Sputum
Hemoptysis– coughing up blood also a form of abnormal sputum
Cyanosis
Fever
Altered breathing patterns
Where is cyanosis normally seen?
End of extremities– fingers or toes
Around our mouth and mucus memebranes
tip of nose
inside of nares
earlobes
What is orthopnea?
Dyspnea when laying down
Why is it easier for us to breath when we are sitting up?
Our lungs have more room to expand
True or False: people with chronic lung disorders may sleep better sitting up in a recliner
True
Why do people experiencing orthopnea have difficulty breathing?
Fluid settles when they lie down making it harder to breath
What is clubbing?
Clubbing often occurs in heart and lung diseases that reduce the amount of oxygen in the blood
What is hypoxemia?
low levels of oxygen in the BLOOD
What is hypoxia?
Low levels of oxygen in the tissues and organs
How do we assess for hypoxia?
Through our assessment
True or false: We can assume that a patient with hypoxemia for an extended amount of time has hypoxia
True
What are early symptoms of hypoxia?
Restlessness
tachypnea
tachycardia
dyspnea
increased agitation
diaphoresis
retraction
altered LOC
What are late symptoms of hypoxia
Increases restlessness
somnolence
stupor
dyspnea
decreased resp rate
Bradycardia
Cyanosis
low o2 sats
severe shortness of breath
What is hypoventilation?
Breathing too shallow or too slow to meet the body’s need for oxygen
What is hyperventilation?
Breathing that is too rapid or too deep. Breathing exceeds the body’s metabolic demands
What is atelectasis?
Collapsed air sacs (alveoli)
How can we prevent atelectasis?
Early ambulation
turn, cough, deep breathe
incentive spirometry
True or False: a patient who ambulates often is more likely to develop atelectasis than a patient who is bedridden
False
When looking at an XRAY is the black areas good or bad?
Good
When looking at an Xray is the white area good or bad?
typically, Bad– often indicates fluid or tissue
What is aspiration?
Passage of gastric contents (fluid or solid) into the lungs
Aspiration can cause what?
Aspiration pneumonia
How can we prevent aspiration?
Assess patients ability to swallow
keep head of bed elevated with tube feedings
thorough lung assessment
What kind of exam might a doctor order if a patient is have difficulty swallowing?
MBS– modified barium swallow or swallow test.
What kind of exam might a doctor order if a patient is have difficulty swallowing?
MBS– modified barium swallow or swallow test.
When we are doing an assessment of the respiratory system what are we assessing?
Resp rate
use of accessory muscles
cyanosis
SpO2
adventitious breath sounds (crackles, wheezes, rhonchi, stridor, rubs)
clubbing
dyspnea
What kind of diagnostic tests can we run on patients with poor oxygenation?
Chest xray
ABG– arterial blood gases
Sputum culture and sensitivity
CT scan
MRI
Bronchoscopy
Thoracentesis
Sputum and culture sensitivity is a diagnostic exam we can do. How does the sensitivity part work?
Once the sputum is sent to the lab it exposed to many different types of antibiotics to see what can kill this organism
What is a bronchoscopy?
Exam that uses a bronchoscope to view the airways and check for abnormalities, suck sputum out or biopsy lung
Where is the most common place a patient will have a bronchoscopy done?
Endo lab
True or false: A bronchoscopy can’t be done at the patients bedside?
False– it can be done at bedside. Rare that it does
What is a ultrasound- guided thoracentesis?
It is where the radiologist take a needle and aspirates fluid out of the lung
Where is a thoracentesis normally done?
Interventional radiology
Is the patient awake or asleep during a thoracentesis?
awake– they have to be sitting leaning over to increase between ribs and allow for lung expansion
What are some interventions we as nurses can implement prior to oxygen use?
Promote lung expansion
Turn patients regularly– every 2hrs
keep upright
increase daily activities; ensure adequate hydration
coughing exercises
deep breathing
What are some interventions we as nurses can implement in a post op pt prior to using oxygen
Pre-Op education
IS (incentive Spirometry)
TCDB ( turn, cough, deep breath)
splinting incision
Albuterol is considered a bronchodilator but is only used when…..
when patients are in distressed
needed for acute difficulty breathing— it is considered a rescue inhaler
Beta cells have to do with what?
Our fight and flight
What happens when beta cells are activated?
They speed thing up
What could a side effect from albuterol be?
nervousness,
tachycardia,
headache
throat irritation
Symbicort (budesonide/formoterol inhaled) is considered a corticosteriod/bronchodilator and is to be used when?
Daily or as prescribed for the treatment and prevention of asthma attacks and exercise-induced bronchospasm and COPD
Because Symbicort is a steroid inhaler what must patients do after each use?
Rinse mouth and spit it out after inhalation
What are some common reactions to symbicort?
tachycardia
nervousness,
palpitations
oral candidiasis
What could happen if you do not rise you mouth out after using an inhaler with steriods?
Thrush
What should we asses on a patient that will have oxygen therapy.
Equipment
Correct oxygen delivery device
correct flow rate
respiratory assessment
-vitals
-o2 sats
-level of consciousness, s/s of hypoxia
skin
What is FIO2?
Fraction of inspired oxygen— it is the % of oxygen a person is inhaling
What is the FIO2 of room air?
22 %
True or False: with supplemental oxygen, FIO2 can reach 100%
True
How much oxygen delivery can a nasal cannula give a patient?
Up to 6L/min but usually no more that 4
How much fraction of inspired oxygen or FIO2 does a nasal cannula provide a patient?
24%-44%
What are the advantages of nasal cannulas?
Safe & Simple
Easily tolerated
Increased mobility
Easy to eat/drink
True or false: the nasal cannula is the most invasive method of oxygen delivery ?
False
What are the disadvantages of a nasal cannula?
dries membranes; skin breakdown
A patient wearing a nasal cannula wants to take a shower… do you keep the nasal cannula on or allow them to remove?
Leave on
What should you not use when using oxygen?
Vasaline/carmax
What is the typical level (L) that we start a patient on with a nasal cannula?
2-3L
True or false: oxygen is considered a medicine and you must have an order for it?
True– remember it is within our scope to administer oxygen if we see that our patient needs it before an order is in place. Once that patient is stable you would call provider and ask for order
Describe a-non rebreather 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
True or false: A non-rebreather is the most invasive type of oxygen delivery method?
True
True or False: A non-rebreather can help treat hypoxia and decrease the workload of breathing?
True
True or False: the non-rebreather delivers a small concentration of oxygen
False
What is the FIO2 level when where a non-rebreather
60%-100%
What do you normally set flow meter to when using a non-rebreather?
10-15L for 100%
How can we help prevent a patients nose from drying out when using a nasal cannula?
Provide a humidifier
True or false: A non-rebreather provides the highest level of o2 being delivered without having to intubate the patient
True
Typically, when a patient is on a non-rebreather, they will need to have what on all the time?
Continuous pulse ox
What are the advantages to a Venturi mask?
We can control the exact concentration of oxygen
delivers FIO2 of 24%- 60%
flow rates from 4-12L/min
What are some of the disadvantages of the venturi mask?
Hot and confining
interferes with eating talking
True or false: nonrebreathers are good for mouth breathers?
True
Your patient who is using a venturi mask needs to eat. How would you go about this?
You can provide the patient with a nasal cannula however if a patient is needing to be on a venturi mask it is probably wiser to monitor patient while eating and as they chew hold the mask over patient face and then remove when patient needs another bite
When you document that you provided oxygen to a patient what should you include?
date and time oxygen initiated
medthod of delivery
flow rate in L/min
patients response to o2
condition of patients skin where device rests
resp assesment
patient/family teaching
What are some physical factors that alter accuracy of pulse ox?
motion/incorrect placement
BP monitoring device
bright lights
polish/acrylics
What are some physiological factors that alter accuracy of pulse ox
poor arterial flow or edema
cold hands; poor capillary refill
anemia
What is the purpose of a Incentive Spirometry (IS)
helps prevent post-op pulmonary complications–atelectasis
provides voluntary deep breathing
gives visual feedback
How would you explain to a patient how to use the incentive spirometer IS
Place the mouth piece in your mouth, take a deep breath in, your focus is to allow the indicator to dangle in the middle. You do not want to suck in as quick as you can instead just a nice slow inhale. It is not effective for exhaling. Our goal is taking nice deep breaths to open up our lungs
How often is it recommended that you use a incentive spirometer
Take ten breaths every 2hrs
Should you teach a patient pre op or post op how to use an incentive spirometer
Pre op so that the patient can recall easier
What are some tips for oxygen safety?
Do not smoke
do not use aerosol sprays
do not use any petroleum products
True or false: you can overdose on oxygen?
True
What is oxygen toxicity
Too much oxygen
When can a person develop oxygen toxicity?
Can develop when a person breathes 100% oxygen for more than 12hrs
What are some signs and symptoms of oxygen toxicity?
pallor, sweating, nausea & voming
seizures, vertigo, muscle twitching
hallucinations, visual changes, anxiety
chest pain, dyspnea
True or False: since oxygen is considered a medication it is important to wean to the lowest amount that is safest for the patient
true
