Oxygenation Flashcards
Exam 1
1
Q
What is tidal volume?
A
The amount of air exhaled following normal inspiration
2
Q
What impacts tidal volume?
A
Health status, activity, pregnancy, exercise, obesity, and obstructive/restrictive lung diseases
3
Q
What is the function of alveoli?
A
To promote gas exchange
4
Q
What is the range for a normal respiration rate?
A
12-20 breaths per minute
5
Q
What 3 breath sounds are normal?
A
Bronchial, bronchovesicular, and vesicular
6
Q
List examples of abnormal breath sounds.
A
crackles/rales, wheezes, rhonchi, stridor, pleural friction rub.
7
Q
Describe crackles/rales breath sounds.
A
fine to course bubbly sounds, associated with air passing through fluid or collapsed small airways
8
Q
Describe wheezes.
A
High pitches whistling, narrow obstructed airways
9
Q
Describe rhonchi breath sounds.
A
Loud low pitched rumbling, fluid or mucus in airways, can resolved with coughing.
10
Q
When can stridor breath sounds be heard?
A
In children, or when someone is choking
11
Q
What is pleural friction rub?
A
When the pleura are inflamed
12
Q
Describe bronchial breath sounds.
A
high pitched, normally heard over the trachea
13
Q
Describe bronchovesicular breath sounds.
A
medium-pitched, heard over mainstream bronchi
14
Q
Describe vesicular breath sounds.
A
low pitched, heard over most of normal lung
15
Q
What is bradypnea?
A
Rate of breathing is regular but abnormally slow (less than 12 breaths/min)
16
Q
What is tachypnea?
A
Rate of breathing is regular but abnormally rapid (greater than 20 breaths/min)
17
Q
What is hyperpnea?
A
Respirations are labored, increased in depth, and increased in rate (greater than 20 breaths/min) (occurs normally during exercise).
18
Q
What is apnea?
A
Respirations cease for several seconds. Persistent cessation results in respiratory arrest.
19
Q
What is hyperventilation?
A
The rate and depth of respirations increase. Removing CO2 faster than it is produced by cellular metabolism.
20
Q
What is hypoventilation?
A
The respiratory rate is abnormally low, and depth of ventilation is depressed. Inadequate alveolar ventilation to meet demand. Not enough O2 and/or too much CO2
21
Q
What is a normal SpO2/SaO2?
A
95-100%
22
Q
What can interfere with an SPO2 reading?
A
Movement, patient is wearing dark nail polish, extremities are cold, arterial disease
23
Q
Describe how the effort to expand and contract the lungs should be in a healthy person.
A
Quiet, with minimal effort.
24
Q
How do you determine the patients work of breathing?
A
By the rate and depth. Evaluate accessory muscle use.
25
What is compliance?
The ability for the lungs to distend or expand in response to increased alveolar pressure.
26
What can increase work of breathing?
Decreased compliance, increased airway resistance, and/or increased accessory muscle use.
27
What are possible factors that could affect oxygenation?
Decreased oxygen-carrying capacity, hypovolemia, decreased inspired oxygen concentration, and chest wall mocement.
28
Describe why decreased oxygen-carrying capacity affects oxygenation.
- Hemoglobin levels could be low due to anemia which can cause fatigue, decreased activity tolerance, and being pale
- Carbon monoxide is essentially poisoning. The hemoglobin binds to carbon monoxide instead of oxygen.
29
Describe why hypovolemia affects oxygenation.
It is a decreased amount of circulating blood in the body
30
Describe why decreased inspired oxygen concentration affects oxygenation.
Can be due to amplitude which may decrease the amount of oxygen in the air. Hypoventilation- low RR = < oxygen intake. An increased metabolic demand can be due to exercise, wound healing or a fever.
31
List what chest wall movement could affect oxygenation.
Pregnancy- reduced lung volume, and may not be able to lay flat. Musculoskeletal diseases, trauma, neuromuscular diseases, central nervous system (CNS) alterations (ex: spinal cord paralysis).
32
What is the goal of ventilation?
Normal arterial carbon dioxide tension and normal arterial oxygenation tension
33
What should the PaO2 in an ABG be?
80-100
34
What should the PaCO2 be in an ABG?
35-45
35
What should ETCO2 be?
35-45
36
What are possible causes for hypoventilation?
Medications, alveolar collapse=atelectasis (lung diseases)
37
What are signs and symptoms associated with hypoventilation?
Mental status changes, dysrhythmias. Can lead to cardiac arrest, convulsions, unconsciousness, death.
38
What are possible causes for hyperventilation?
Anxiety attacks (severe), infection/fever, drugs, acid-base imbalance (pH), aspirin poisoning, amphetamine use
39
What are signs and symptoms associated with hyperventilation?
Rapid respirations, sighing breaths, numbness/tingling of hands/feet, light-headedness, loss of consciousness
40
What is atelactasis?
Collapsed alveoli. Prevents normal respiratory gas exchange.
41
What conditions is atelectasis associated with?
IMMOBILITY, obesity, sleep apnea, chronic lung conditions
42
What can atelectasis lead to?
Lung collapse which can then lead to respiratory distress syndromes/pneumonias/respiratory failure
43
What is hypoxia?
Inadequate TISSUE OXYGENATION. Meaning at the cellular level, not enough oxygen is there to meet needs. This can be related to a delivery problem.
44
Why can untreated hypoxia lead to cardiac dysrhythmias?
The heart needs oxygen in order to function
45
What are potential causes of hypoxia?
Decreased hemoglobin levels/low oxygen-carrying capability, diminished O2 concentration of inspired O2, inability of tissues to get O2 from blood, decreased diffusion of O2 from alveoli to blood-infections/pneumonia, poor perfusions with oxygenated blood, impaired ventilation from traumas
46
What are the signs and symptoms of hypoxia?
Apprehensions, restlessness, inability to concentrate, decreased level of consciousness, dizziness, behavioral changes, difficulty staying still or lying flat, fatigued yet agitated, causes increased pulse, increased respirations (rate and depth). Initially increased blood pressure, then leads to shock/low blood pressure
47
What is a late sign of hypoxia?
Cyanosis
48
What is cyanosis?
Blue discoloration of skin/mucous membranes
49
Why is cyanosis not a reliable measure of oxygen status?
-Central cyanosis -> tongue, soft palate, conjunctiva of the eye = hypoxemia
-Peripheral cyanosis -> extremities, nail beds, earlobes = vasoconstriction not oxygenation problem
50
What is the acronym for the symptoms of hypoxia?
Early RAT is LATE to BED
51
What does early RAT is late to BED stand for?
RAT: R: restlessness, A: anxiety, T: tachycardia/tachypnea
BED: B: bradycardia, E: extreme restlessness, D: dyspnea
52
What is chronic hypoxia associated with?
Chronic lung conditions. CPOD is most common.
53
What are common assessment findings associated with chronic hypxia?
Cyanotic nail beds, sluggish capillary refill, clubbing, barrel chest (AP diameter 1:1
54
What is the development consideration in young-middle adults when it comes to oxygenation?
The focus is on avoidance of oxygenation problem risk factors such as smoking, unhealthy lifestyle, and environmental considerations.
55
What is the development consideration in older adults when it comes to oxygenation?
-Mental status changes are typically the first sign of any issue
-More susceptible to respiratory infection and compromise
-Low reserve and once it is compromised they can deteriorate quickly.
56
What lifestyle factors can affect oxygenation?
Smoking (secondhand), obesity, air pollution/quality, malnourished, substance use, occupational exposure
57
What should you evaluate when assessing oxygenation?
Cough, dyspnea, pain, pulmonary history, environmental exposures, occupational exposures, shortness of breath, breath sounds, smoking history, medication use
58
What is dyspnea?
Subjective sensation of difficult or uncomfortable breathing. Associated with hypoxia and related to shortness of breath.
59
What can cause dyspnea?
Can be precipitated by exercise/excitement, often disease related.
60
What are signs and symptoms of dyspnea?
Use of accessory muscles, nasal flaring, increased rate/depth
61
What questions should you ask about dyspnea?
When does it occur?
What improves it?
Worsened by something? Laying down?
62
What is a cough?
Protective reflex to clear trachea, bronchi and lungs of irritants and secretions
63
What questions should be asked when assessing cough?
How often is cough (frequency)?
Productive/Unproductive?
If there is sputum- What does it look like?
Chronic versus acute?
64
What is the word for bloody sputum?
Hemoptysis
65
Why do we collect sputum samples?
To analyze for pathogens (usually pneumonia, cytology)
66
Describe specimen collection.
-Best to collect in early morning
-Wait 1-2 hours after patient eats
-Sterile specimen container-teach patient to not touch the inside of the container or lid
-Tell patient to cough into container and get as much expectorate sputum as possible
May require suctioning if patient is too weak or cannot get expectorate into container
67
What is the normal test result for sputum collection?
Negative
68
What is a sputum culture and sensitivity collected to test for?
Identify a specific microorganism or organism growing in sputum.
Identifies drug resistance and sensitivities to determine appropriate antibiotic therapy.
69
What is a sputum for acid-fast bacillus (AFB) collected to test for?
Screens for presence of AFB for detection of tuberculosis by early-morning specimens on 3 consecutive days
70
What is a sputum for cytology collected to test for?
Obtained to identify lung cancer.
Differentiates type of cancer cells (small cell, oat cell, large cell)
71
What does a basic ventilation study test for?
Determines ability of the lungs to efficiently exchange oxygen and carbon dioxide.
Used to differentiate pulmonary obstructive from restrictive disease.
72
What does a bronchoscopy test for?
Visual examination of the tracheobronchial tree through a narrow, flexible fiberoptic bronchoscope.
Performed to obtain fluid, sputum, or biopsy samples; remove mucous plugs or foreign bodies
73
What are nursing diagnoses related to oxygenation?
Ineffective airway clearance, risk for aspiration, impaired gas exchange, activity intolerance
74
What are long-term, preventable measures to improve oxygenation
Vaccinations (flu, pneumonia vaccine >65), healthy lifestyle, environmental and occupational exposures (STOP SMOKING)
75
Describe dyspnea management.
Difficult to treat
Treat underlying condition (asthma, pneumonia, heart failure, etc)
Oxygen therapy
Pharmacologic treatment (bronchodilator, inhaled steroid, mucolytic, anti-anxiety medication)
76
How would you mange pulmonary secretions?
Mobilize- promotes lung expansion and gas exchange
Hydrate- systemic hydration, helps reduce viscosity of secretions
Humidification- keeps airway moist and loosens secretion
Medication
77
Describe cough and deep breath
Coughing helps keep airways clear and expectorate sputum, mucous
Typically encourage patients to initiate coughing every 2 hours when experiencing lung conditions/upper respiratory problems
Deep breathing increases air to the lower lobes of the lungs
78
What is the nurses best defense?
Turn, cough, and deep breath
79
What is the indication for chest physiotherapy?
Patients with thick secretions
80
What is the goal of chest physiotherapy?
Mobilize pulmonary secretions
81
What activities does chest physiotherapy include?
Postural drainage, chest percussion, chest vibration, along with coughing and deep breathing
82
What is needed in order to perform chest physiotherapy?
Doctors order
83
What are the contraindications for chest physiotherapy?
Pregnant, rib/chest injuries, increased intracranial pressure, recent abdominal/thoracic surgery, bleeding disorders, osteoporosis
84
Describe how to perform postural drainage.
Lay on unaffected side to promote drainage of one particular lobe in trendelenburg.
85
What is the goal of oxygen therapy?
Prevent or relieve hypoxia
86
What should room air be (FiO2)?
FiO2 = 21%
87
What is FiO2?
Fraction of inspired O2
88
What is needed in order to administer oxygen therapy?
Healthcare order- must follow the six rights of medication administration
89
Describe low flow oxygen delivery using a nasal cannula.
-FiO2: 1-6 L/min: 22-44%
-Safe and well tolerated
-FiO2 can vary, can lead to skin breakdown, tubing dislodges easily
-Use humidification if greater than 4L of flow
90
Describe low flow oxygen delivery using a simple face mask
-6-12 L/min: 33-55%
-Best for short periods, transportation
-Not great for claustrophobic patients, skin breakdown, higher risk of aspiration
-Assess for fit, watch for aspiration risk
91
Describe low flow oxygen delivery using a partial rebreather mask.
-FiO2: 6-11 L/min; 60-75%
-Used for short periods of dyspnea or other increased oxygen needs
-Patients' rebreathe up to 1/3 of exhaled air, help with humidification
-Keep reservoir bag PARTIALLY inflated
92
Describe low flow oxygen delivery using a non-rebreather mask.
-FiO2: 10-15 L/min; 80-95%
-Best for a patient in critical need of oxygen, steps before intubation
-One-way valve allows for client to inhale maximum O2 concentration, and two exhalation ports that restrict exhaled air from being rebreathed
-Hourly assessments
93
Describe high flow oxygen delivery using a venturi mask.
-FiO2: 4-12 L/min; 24-50%
-Provides the ability to deliver PRECISE oxygen concentration with humidity
-Not preferable for long periods of time
-Used for patients who need highly regulated oxygen concentrations (chronic lung disease)
94
Describe oxygen humidification.
Prevents drying out of mucous membranes
Use with oxygen use ALWAYS when greater than 4LPM or greater than 24 hours of supplemental oxygen
Sterile water is used
95
What are possible complications of oxygen therapy?
- Drying effects of respiratory mucous membranes
-Oxygen toxicity- pleuritic chest pain, chest heaviness, coughing and dyspnea; muscle twitching, nausea/GI upset
-Skin breakdown
