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