Oxygenation Flashcards
What are the parts of a thorough respiratory assessment?
Respiratory rate, depth, rhythm; oxygenation saturation; breath sounds; accessory muscle use; history of respiratory conditions; work of breathing; occupational exposures, environmental exposures, respiratory meds, smoking history, pain, cough (COCA)
What factors affect oxygenation
- oxygen carrying capacity, think hem levels, carbon monoxide
- hypovolemia
- decreased inspired oxygen concentration, think altitude, hypoventilation, increased o2 demand (exercise or wound healing)
- chest wall movement, think pregnancy, obesity, MSK diseases, trauma (C3-C5 injury - paralysis of phrenic nerve would controls diaphragm, below C5 - no use of accessory muscles, flail chest), neuromuscular disease (ALS, guillain barre, myasthenia gravis), CNS alteration
Hypoventilation definition, causes, and S/S
Shallow, slow breathing which results in inadequate alveolar ventilation to meet demand => not enough o2 and/or too much co2
Causes: medication, alveolar collapse (atelectasis)
S/S: confusion, drowsiness, change in LOC, mental status changes, dysrhythmias, convulsions, unconsciousness, death
Atelectasis definition and associated conditions
Alveolar collapse from deflation or fluid resulting in impaired gas exchange
Associated with immobility, obesity, sleep apnea, chronic lung conditions (asthma, COPD, cystic fibrosis), older age, difficulty swallowing, surgery, anesthesia, spinal cord injury, neuromuscular conditions, pain with cough, smoking
CAN RESULT IN LUNG COLLAPSE
Hypoxia
Low oxygen in the tissues which can ultimately lead to dysrhythmias
S/S: apprehension, restlessness, inability to concentrate, Dec. LOC, dizziness, behavior changes, increased pulse, increased respirations, inc. b/p initially but later Dec. b/p, cyanosis
Dyspnea
Subjective sensation of difficult or uncomfortable breathing
Causes: exercise, disease
S/S: accessory muscle use, nasal flaring, increased rate/depth of respiration
Bronchial breath sounds
High pitched, heard over the trachea
What is tidal volume and what factors impact TV?
Amount of air exhaled following normal inspiration
- affected by health status, exercise, pregnancy, obesity, obstructive/restrictive lung diseases
Bronchovesicular
Moderate pitched breath sounds, heard over the main bronchus
Vesicular breath sounds
Low pitched sounds, heard over the lung
Crackles/rales
Fine to coarse bubbly sounds (caused by air passing through fluid or collapsed small airways)
Wheezes
High pitched musical whistling caused by narrow/obstructed airways, think asthma
Rhonchi
Low pitched rumbling sounds caused by fluid or mucous in the airways; coughing resolves
Stridor
Choking sound
Pleural friction rub
Harsh, grating sound caused by inflamed pleural space
Factors that affect SPO2 reading
-interference with light transmission: motion, jaundice, intravascular dyes, dark nail polish
-interference with arterial pulsation: PVD, hypothermia, vasoconstriction (think medicine), dec. CO, edema, probe too tight
Factors that affect work of breathing
- airways resistance (bronchoconstriction I.e. asthma, tracheal edema)
- compliance = ability of lungs to distend/expand
- accessory muscle use
Which part of the brain controls respiration?
Medulla Oblongata
What is the goal of ventilation?
Normal arterial carbon dioxide tension and normal arterial oxygenation tension
What is a normal PaO2?
80-100
What is a normal PaCO2?
35-45
What is normal SPO2?
> 95%
What is normal EtCO2?
35-45
Hyperventilation definition, causes, and S/S
Removal of CO2 faster than produced by cellular respiration
Causes: anxiety attacks, infection/fever (inc. metabolic rate and CO2 production), drugs, acid-base balance (metabolic acidosis), ASA poisoning, amphetamine use
S/S: rapid respiration, sighing breaths, numbness/tingling to hands/feet, lightheadedness, loss of consciousness
Central cyanosis
Tongue, soft palate, conjunctiva of the eye = hypoxemia
Peripheral cyanosis
Extremities, nail beds, earlobes = vasoconstriction not oxygenation problem
Early signs of hypoxia
Restlessness, anxiety, tachy, tachypnea
Late signs of hypoxia
Brady, extreme restlessness, dyspnea
S/S of chronic hypoxia
Often seen with COPD: cyanotic nail beds, sluggish cap refill, clubbing, Barrel chest (1:1)
Cough
Protective reflex to clear trachea, bronchi, and lungs
Want to know frequency, COCA, strength
Elements of sputum collection
-collect in the morning (at least 1-2 hours after eating)
-do not touch inside of container
-if patient too weak, may need to suction
Sputum culture and sensitivity
Used to ID microorganism and determines drug resistance/sensitivities to determine appropriate ATB therapy
Sputum for acid-fast bacillus (AFB)
Looks for acid-fast bacteria to assess for TB by early-morning specimens on 3 consecutive days
Cytology
Used to ID lung cancer and differentiates type (small, oat, or large cell)
Long-term interventions to improve oxygenation
Vaccinations, nutrition, exercise (esp. aerobic), smoking cessation, limit occupational exposures (change jobs if need to)
Cascade Cough
Slow, deep breath
Hold for 2 seconds while contracting expiratory muscles
Open the mouth
Perform series of coughs throughout exhalation (coughing at progressively lower lung volumes)
**airway clearance in patients with lots of sputum
Huff Cough
Start exhaling
Open glottis by saying “huff”
Can combine with cascade cough
**generally effective only for clearing central airways
Quad Cough
Patient breaths out with max expiratory effort
Patient or nurse pushes in and up on the abdominal muscles toward diaphragm, thereby producing cough
**patients without abdominal muscle control (think spinal cord injuries)
“Nursing’s BEST defense”
Turn, Cough, Deep Breathe
Chest Physiotherapy Activities **NEED AN ORDER
Postural drainage
Chest percussion
Chest vibration
…follow with cough and deep breath
CPT Contraindications
Pregnancy, rib/chest injury, increased ICP, recent abdominal/thoracic surgery, bleeding disorders, osteoporosis
CPT Nsg Considerations
-1 hr before or 2 hr after eating
-use bronchodilators and nebs 30 minutes before postural drainage
-spend 10-15 in each position with postural drainage
-with dizziness or fainting stop
-be cognizant that antihypertensives and diuretics may result in patients unable to tolerate positional changes
-increased ICP, spinal cord injuries, abdominal aneurysm resection contraindicate postural drainage
-thoracic trauma or surgery contraindicates percussion and vibration
-must be able to follow commands
-must be able to tolerate activity (can be fatiguing)
Goal of oxygen therapy
Prevent or relieve hypoxia
Room Air FIO2
21%
Nasal Cannula
FiO2: 1-6L/min: 22-44%
FIO2 can vary, can lead to skin breakdown, tubing dislodges easily
Use humidification if greater than 4L
Simple Face Mask
6-12 L/min: 33-55%
Best for short periods, transportation
Not great for claustrophobic patients, can cause skin breakdown, higher risk for aspiration, contraindicated for CO2 retainers
Partial Rebreather
FiO2 6-11L/min: 60-75%
Used for short periods of dyspnea or inc. O2 demands
Patients rebreathe up to 1/3rd of exhaled air which helps with humidification
reservoir bag stays partially inflated
CANNOT EAT
MUST PRIME
Nonrebreather
FiO2 10-15L/min: 80-95%
Critical need for O2 - steps leading up to intubation
One-way valve allows for client to inhale max O2 concentration and 2 exhalation ports restrict exhaled air from being rebreathed
WATCH FOR ASPIRATION, HRLY ASSESSMENTS
MUST PRIME
Venturi
FiO2 4-12L/min: 24-50%
PRECISE oxygen delivery, think chronic lung diseases
Not great for long periods of time
S/S of O2 Toxicity
Pleuritic chest pain, chest heaviness, coughing, dyspnea, muscle twitching, nausea/GI upset
Pharyngeal Airways
People still “breathing on their own” but decreased LOC, decreased muscle tone, needing suctioned more often
- can go through nose or mouth
Trach indications
Airway obstruction, airway protection (think neck ca surgery), removal of secretions (think weak cough, head injury, stroke), prolonged intubation (>10 days) =>less trauma to airway, increased comfort, able to eat, more secure
Shiley Trach
Plastic
Disposable inner cannula
CUFF = snug fit, think vented patient, aspiration prevention
Dangers of prolonged or overinflated cuff
Increased mucosal pressure = ischemia, softened cartilage, mucosal erosion
CAN RESULT IN TRACHEOESOPHAGEAL FISTULA
How often should Trach care be done?
Every 12 hours
What are the parts of a Trach assessment
Type, size, cuff inflated?, patient comfort?, oxygenation?
Fenestrated Trach
Trach with holes, for stable patients
Environmental Safety for Trach
Obturator, O2, Flowmeter, Xmas Tree, Suction, Extra Trach (one size smaller), Ambu bag with adapter, Spare inner cannula
Comfort Needs for Patients with Trach
Oral Care, Lip Moisturizer, Way to Communicate (hand signals, picture boards, pad and paper, etc)
