Oxygenation

Question 1

What is pulmonary ventilation?

Answer 1

Breathing.
Movement of air into and out of the lungs with two phases: inspiration and expiration

Question 2

What is respiration?

Answer 2

Exchange of gases through diffusion
(Gas exchange between the atmospheric air in the alveoli and blood in the capillaries through the process of diffusion)

Question 3

Whats diffusion?

Answer 3

Movement of gas or particles from areas of high pressure or concentration to areas of lower pressure or concentration

in order for diffusion to occur, there must be adequate “surfactant” to prevent collapse of the alveoli (atelectasis)
-without the natural alveoli surfactant, the alveoli will collapse

Question 4

Whats internal respiration?

Answer 4

Exchange of oxygen and carbon dioxide between the circulating blood and tissue cells

Question 5

what’s perfusion?

Answer 5

Process by which oxygenated capillary blood passes through body tissues (pumping action of the left ventricle)

Question 6

What is the action of the respiratory center located in the medulla?

Answer 6

It is stimulated by an increased concentration of carbon dioxide thereby increases the rate and depth of ventilation (breathing) to blow off carbon dioxide and increase oxygen levels operating in a negative feedback loop.

the medulla controls our breathing

Question 7

Patients with COPD are accustomed to increased concentration levels of carbon dioxide
TRUE/FALSE

Answer 7

TRUE!

Their drive to breath is the lack of oxygen in the blood (hypoxemia) and in the cells (hypoxia)

Question 8

What is the most common symptom of hypoxia?

Answer 8

Dyspnea; some alterations of in respiratory system include hypoventilation vs hyperventilation

Question 9

Does the medulla directly control the autonomic nervous system?

Answer 9

Yes! It affects the heart rate/ rhythm and blood pressure (vasoconstriction/ vasodilation)

*the conductive system within the heart is another way the heart controls contraction (rate/rhythm)

Question 10

What are some alterations in cardiovascular function, due to inadequate oxygenation?

Answer 10

Dysrhythmia (arrhythmia), myocardial ischemia (angina/infarction), heart failure

Question 11

What are the symptoms of left heart failure?

Answer 11

= related to the lungs - dyspnea, pulmonary edema, fatigue, poor urine output

Question 12

What are the symptoms of right sided heart failure?

Answer 12

will be more systemic because of backflow

-jugular vein distention, pitting edema, enlarged liver, cor-pulmonae

Question 13

What’s cor-pulmonae?

Answer 13

Right sided heart failure by lung disease

Question 14

What oxygen therapy would a COPD patient need?

Answer 14

Low flow oxygen 1-2 L nasal cannula

Question 15

What oxygen therapy would COPD exacerbation/threat to life need?

Answer 15

High flow/supplemental oxygen

Question 16

Whats the difference between hyperventilation and hypoventilation?

Answer 16

Hyper: panic attack, rapidly breathing and give out CO2, which makes CO2 low.
(Instruct patient to take a slow deep breath, relax, calm down, or breathe into a paper bag)

Hypo: shallow breathing, oxygen is low, CO2 is high
(You could develop CO2 narcosis)

Question 17

Explain a high flow nasal cannula (High flow system-variable performance)

Answer 17

Maximum flow 60 L/min
10 L/min - 65%
15 L/min - 90%
System is heated and humidified for comfort and tolerance.

Question 18

Explain a Venturi mask (High flow system-fixed performance)

Answer 18

Deliver precise, high-flow rates of oxygen.
Masks are available for delivery of 24%, 28%, 31%, 35%, 40% and 60%

Don’t use humidifier - Back-pressure may activate the safety valve on the humidifier causing it to burst. The large amount of room air that a Venturi mask uses will humidify the oxygen adequately.

Question 19

Explain a simple face mask (low flow system-variable performance)

Answer 19

5-8 L/min around 40%-60%

-may use a humidifier, but not required. The mask provide adequate humidification of inspired air.

humidifier helps prevent drying effects and may help liquefy thick secretions

Question 20

Explain a non-rebreather mask with a reservoir bag (low flow system-variable performance)

Answer 20

10-15 L min at 80%-95% oxygen delivery

DONT use humidifier Humidifier causes rain-out effect on the reservoir bag which may alter oxygen being delivered to the patient.
-reservoir bag should be filled with oxygen

Question 21

Explain a regular nasal cannula (low flow system - variable performance)

Answer 21

1-6 L/min
24%-44% oxygen delivery

Humidifier for flow rate greater than 4 L/ min to prevent drying effects

Question 22

Explain a oxymizer cannula “mustache” or “pendant” style (low flow system - Variable performance)

Answer 22

Deliver oxygen concentration 3 to 4x more compared to regular nasal cannula with the same flow rate.

DON’T USE HUMIDIFIER Humidifier causes rain-out effect (moisture accumulation in the “mustache” or “pendant”) which may alter oxygen delivered to patient

Question 23

Discuss oxygenation changes related to older adults

Answer 23

normal aging may affect oxygenation in older adults
-the tissues and airways in the respiratory tract including the alveoli become less elastic
-reduced power of the respiratory and abdominal muscles
-the chest is unable to stretch resulting in decline in maximum inspiration and expiration
-airways collapse more easily
-may not be able to maintain adequate cardiac output in response to situations that cause physical/emotional stress
-decreased physical activity, physical deconditioning, decreased elasticity of blood vessels and stiffening of heart valves
-impaired mobility and inactivity, effects of medications

Question 24

Discuss nursing strategies of oxygenation changes related to older adults

Answer 24

-encourage rest periods as necessary
-encourage cessation of smoking and second-hand smoke exposure
-teach breathing exercises
-remind about avoiding air pollutants
-caution about effects of extreme weather conditions
-instruct to avoid opioids and sleeping pills
-teach avoidance of infection and preventative measures (vaccines)
-use pillows as necessary to sleep
-fowlers position
-discourage use of OTC medications
-teach avoidance of milk products they are troublesome (increased risk of asthma attacks)

Question 25

Discuss assessment techniques focused on oxygenation

Answer 25

1st- conducts detailed health history and physical assessment
-inspect level of consciousness, any respiratory or cardiac distress (restlessness/anxiousness) skin color, chest diameter (COPD- barrel shape chest) and spine curvature, breathing pattern (tachypnea/bradypnea)
Auscultate breath sounds (normal or adventitious), heart sounds (normal or abnormal)

Question 26

Correlate health history and physical assessments with results of diagnostic tests

Answer 26

-arterial blood gas (ABG)
-cardiac biomakers - CK; troponin (more specific after injury to the heart)
-complete blood count (CBC)
-cytologic studies (detect malignancy)
-electrocardiography (EKG)
-pulse oximetry
-capnography
-thoracentesis
-pulmonary function studies (done mostly by respiratory therapists)

Question 27

If hemoglobin is low…

Answer 27

You could have a high oxygen saturation

Question 28

Discuss nursing interventions focused on oxygenation: Implementing

Answer 28

-Healthy lifestyles (eat healthy diet, maintain a healthy weight, exercise, monitor cholesterol and blood pressure, limit alcohol, stop smoking)
-Vaccinations (COVID, flu, pneumonia)
-Teach about pollution free environments
-Reduce anxiety
-Maintain good nutrition (fruits and vegetables, low-fat dairy, whole grains, variety of protein and reduced saturated fats, trans fats, sugars and sodium: six small meals
-Oral hygiene
-Patients with COPD (high protein/high calorie)
-Positioning (patient with dyspnea- high fowlers position)
(acute respiratory distress syndrome- alternating prone & supine)
-Maintain adequate fluid intake (1.5 to 2 L daily to keep secretions thin) (
(Patient with HF 1-2 L daily)
-Provide humidified air
-Deep breathing exercises / pursed-lip breathing / diaphragmatic breathing
-Use of incentive spirometry (maximize lung inflation / prevent atelectasis)

Question 29

Discuss nursing interventions focused on oxygenation: Implementing pt 2

Answer 29

-Promoting/ controlling cough (using cough medications- expectorants, cough suppressants, lozenges)
-Performing chest physiotherapy (includes percussion, vibration, and postural drainage)
-Providing supplemental oxygen
-Postitive airway pressure (continuous positive airway pressure (CPAP) vs bilevel positive airway pressure (BiPAP)