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NUR 333 > Oxygenation > Flashcards

Oxygenation Flashcards

1
Q

What are the parts of a thorough respiratory assessment?

A

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)

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2
Q

What factors affect oxygenation

A
  • 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
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3
Q

Hypoventilation definition, causes, and S/S

A

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

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4
Q

Atelectasis definition and associated conditions

A

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

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5
Q

Hypoxia

A

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

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6
Q

Dyspnea

A

Subjective sensation of difficult or uncomfortable breathing
Causes: exercise, disease
S/S: accessory muscle use, nasal flaring, increased rate/depth of respiration

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7
Q

Bronchial breath sounds

A

High pitched, heard over the trachea

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8
Q

What is tidal volume and what factors impact TV?

A

Amount of air exhaled following normal inspiration
- affected by health status, exercise, pregnancy, obesity, obstructive/restrictive lung diseases

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9
Q

Bronchovesicular

A

Moderate pitched breath sounds, heard over the main bronchus

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10
Q

Vesicular breath sounds

A

Low pitched sounds, heard over the lung

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11
Q

Crackles/rales

A

Fine to coarse bubbly sounds (caused by air passing through fluid or collapsed small airways)

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12
Q

Wheezes

A

High pitched musical whistling caused by narrow/obstructed airways, think asthma

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13
Q

Rhonchi

A

Low pitched rumbling sounds caused by fluid or mucous in the airways; coughing resolves

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14
Q

Stridor

A

Choking sound

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15
Q

Pleural friction rub

A

Harsh, grating sound caused by inflamed pleural space

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16
Q

Factors that affect SPO2 reading

A

-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

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17
Q

Factors that affect work of breathing

A
  • airways resistance (bronchoconstriction I.e. asthma, tracheal edema)
  • compliance = ability of lungs to distend/expand
  • accessory muscle use
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18
Q

Which part of the brain controls respiration?

A

Medulla Oblongata

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19
Q

What is the goal of ventilation?

A

Normal arterial carbon dioxide tension and normal arterial oxygenation tension

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20
Q

What is a normal PaO2?

A

80-100

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21
Q

What is a normal PaCO2?

A

35-45

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22
Q

What is normal SPO2?

A

> 95%

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23
Q

What is normal EtCO2?

A

35-45

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24
Q

Hyperventilation definition, causes, and S/S

A

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

25
Central cyanosis
Tongue, soft palate, conjunctiva of the eye = hypoxemia
26
Peripheral cyanosis
Extremities, nail beds, earlobes = vasoconstriction not oxygenation problem
27
Early signs of hypoxia
Restlessness, anxiety, tachy, tachypnea
28
Late signs of hypoxia
Brady, extreme restlessness, dyspnea
29
S/S of chronic hypoxia
Often seen with COPD: cyanotic nail beds, sluggish cap refill, clubbing, Barrel chest (1:1)
30
Cough
Protective reflex to clear trachea, bronchi, and lungs Want to know frequency, COCA, strength
31
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
32
Sputum culture and sensitivity
Used to ID microorganism and determines drug resistance/sensitivities to determine appropriate ATB therapy
33
Sputum for acid-fast bacillus (AFB)
Looks for acid-fast bacteria to assess for TB by early-morning specimens on 3 consecutive days
34
Cytology
Used to ID lung cancer and differentiates type (small, oat, or large cell)
35
Long-term interventions to improve oxygenation
Vaccinations, nutrition, exercise (esp. aerobic), smoking cessation, limit occupational exposures (change jobs if need to)
36
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
37
Huff Cough
Start exhaling Open glottis by saying “huff” Can combine with cascade cough **generally effective only for clearing central airways
38
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)
39
“Nursing’s BEST defense”
Turn, Cough, Deep Breathe
40
Chest Physiotherapy Activities **NEED AN ORDER
Postural drainage Chest percussion Chest vibration …follow with cough and deep breath
41
CPT Contraindications
Pregnancy, rib/chest injury, increased ICP, recent abdominal/thoracic surgery, bleeding disorders, osteoporosis
42
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)
43
Goal of oxygen therapy
Prevent or relieve hypoxia
44
Room Air FIO2
21%
45
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
46
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
47
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
48
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
49
Venturi
FiO2 4-12L/min: 24-50% PRECISE oxygen delivery, think chronic lung diseases Not great for long periods of time
50
S/S of O2 Toxicity
Pleuritic chest pain, chest heaviness, coughing, dyspnea, muscle twitching, nausea/GI upset
51
Pharyngeal Airways
People still “breathing on their own” but decreased LOC, decreased muscle tone, needing suctioned more often - can go through nose or mouth
52
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
53
Shiley Trach
Plastic Disposable inner cannula CUFF = snug fit, think vented patient, aspiration prevention
54
Dangers of prolonged or overinflated cuff
Increased mucosal pressure = ischemia, softened cartilage, mucosal erosion CAN RESULT IN TRACHEOESOPHAGEAL FISTULA
55
How often should Trach care be done?
Every 12 hours
56
What are the parts of a Trach assessment
Type, size, cuff inflated?, patient comfort?, oxygenation?
57
Fenestrated Trach
Trach with holes, for stable patients
58
Environmental Safety for Trach
Obturator, O2, Flowmeter, Xmas Tree, Suction, Extra Trach (one size smaller), Ambu bag with adapter, Spare inner cannula
59
Comfort Needs for Patients with Trach
Oral Care, Lip Moisturizer, Way to Communicate (hand signals, picture boards, pad and paper, etc)

NUR 333 (1 decks)

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