Oxygenation Flashcards
1
Q
At what flow rate will you use a humidifier to prevent drying of the mucosa with a nasal cannula?
A
4L +
2
Q
Are there any contraindications with using a humidifier with a nasal cannula?
A
No. So if a patient with a flow rate of less than 4L asks for a humidifier then it is ok to give it to them.
3
Q
How many L per minute can a nasal cannula deliver?
A
1-6 L
4
Q
What is the oxygen percentage delivered by nasal cannula?
A
24-44%
5
Q
How should you place the pronges of the nasal cannula?
A
With the bend inwards - otherwise the air will be obstructed.
6
Q
Why do we not give more than 6L per min via nasal cannula?
A
Because the air will just go out and not be inhaled by the patient.
7
Q
What is an oxymizer nasal cannula also called?
A
“mustache” or “pendant style”
8
Q
How much more air does an oxymizer cannula give the patient compared to a normal nasal cannula?
A
3-4 times more.
9
Q
Why do you not use a humidifier on a mustache cannula or a pendant cannula?
A
Because there is a reservoir attached to the cannula and the humidifier will cause water inside the reservoir and the patient will not be getting the correct amount of oxygen.
10
Q
How many liters of oxygen can a simple face mask deliver?
A
5-8 L per minute
11
Q
How many % may the oxygen be on a simple face mask?
A
40-60%
12
Q
Can we give a humidifier with a simple face mask?
A
Yes, but its not required.
13
Q
How many L’s of oxygen does the non-rebreather mask deliver per minute?
A
10-15 L per minute
14
Q
What oxygen percentage does the non-rebreather mask provide to the patient?
A
80-95%
15
Q
Can you place a humidifier on the non-rebreather mask?
A
Due to the mask having a reservoir.
16
Q
Why is the the non=rebreather mask called “non-rebreather”
A
Because the patient does not breather in the CO2 that they exhale like you do with a simple face mask. This happens because there is a one way valve.
17
Q
how many L can a high flow nasal cannula deliver per minute?
A
60 L per minute.
With 10 L you will get the precise 60% oxygen concentration
With 15 L/min you will get the precise 90% oxygen concentration.
18
Q
Which two types of masks gives a precise percentage of oxygen concentration?
A
High flow nasal cannula and venturi mask.
19
Q
Which type of mask has a color coded system for the precise oxygen concentration?
A
The venturi mask.
20
Q
Can you use a humidifier on the venturi mask?
A
No, it will cause it to burst due to back pressure
21
Q
What are some precautions to take with the venturi mask to ensure that the patient is getting the adequate oxygen concentration?
A
Do no cover it with a blanket. The masks have little windows/vents that needs to not be obstructed to allow the patient to get the right amount of oxygen.
22
Q
What is the difference between a slow flow system/ variable performance and the fast flow system/fixed performance?
A
Slow flow system/variable performance : We do not know how much oxygen concentration the patient is getting.
Fast flow system/fixed performance : We know the exact oxygen concertation the patient is getting
23
Q
Explain the circulatory system
A
24
Q
Explain the pulmonary system
A
25
What is pulmonary ventilation?
Exchange of air into and out of the lungs (breathing). consist of inspiration and expiration.
26
What is respiration?
The gas exchange between the alveoli and pulmonary capillaries of O2 and CO2 through the means of diffusion.
27
What is perfusion?
The action of the left cardiac ventricle pumping oxygen rich blood out to the systemic capillaries in the body.
28
What is internal respiration?
Diffusion between the systemic capillaries and the systemic cells. Exchange of CO2 from the cells and O2 from the systemic capillaries.
29
What is the concentration of oxygen in the air?
21%
30
Which side of you heart goes to the pulmonary artery?
The right side
31
Does the pulmonary artery and pulmonary capillaries oxygen contain rich or oxygen poor blood?
Oxygen poor blood high in CO2. The pulmonary capillaries rich in CO2 and the oxygen rich alveoli meet and exchanges gasses by the means of diffusion.
32
What prevents collapse of the alveoli due to oxygen and water both being inside the alveoli when breathing?
Surfactant which decreases surface tension of water and dispersion so that it is spread out evenly.
33
What delivers oxygen rich blood to the heart and to which side is it delivered?
The Pulmonary vein delivers oxygen rich bloo to the left side of the heart.
34
Why does the systemic cells need oxygen?
To maintain adequate metabolic processes.
35
What is the waste product of the cells metabolic processes?
CO2
36
Where does the CO2 rich blood go from the systemic capillaries?
Back to the right side of the heart via the vena cava and from the heart through the pulmonary artery and into the pulmonary capillaries for Co2 and O2 exchange.
37
Where is the respiratory center located?
In the medulla. The medulla controls breating.
38
Explain how breathing happens by a negative feedback loop.
When we are not out the CO2 level in our body will increase and our blood become acidic. The rise in acidity triggers a response initiated by the medulla for a person to exhale the CO2 and inhale O2 to lower the blood acidity caused by the higher levels of CO2
39
In COPD patients, why is the stimulus for breathing not caused by an increase in CO2 but rather a decrease in O2?
The body of COPD patients have become accustomed to a high CO2 level and so the increased CO2 levels doesn't initiate the breathing, however when the body is becoming low in O2, this is when the breathing is initiated by the medulla.
40
What is Hypoxemia?
Lack of oxygen in the blood.
41
What is Hypoxia?
Lack of oxygen in the cells
42
With COPD patients, would you use low or high flow oxygen delivery?
Low flow oxygen. If they receive high flow oxygen they could potentially stop breathing because their body is receiving enough oxygen and wont initiate breathing. The only exception to this is if there is an exacerbation of the COPD and it is a life threatening situation, then they need higher amounts of oxygen.
43
If a person is hypoventilating, what is their breathing like?
Their breathing will be shallow. oxygen will be low and CO2 will be high. The patient could develop CO2 narcosis ( condition that occurs when there is too much carbon dioxide in the bloodstream, causing a decreased level of consciousness) We need to give the patient oxygen.
44
If a person is hyperventilating, what is their breathing like?
Rapid breathing, blowing off large amounts of CO2 (Panic attacks may trigger) . Co2 is now low. Patient needs to take slow deep breaths to try to calm their breathing and sometimes it helps to breathe into a paper bag to rebreathe some of the Co2 that they've been blowing off.
45
Other than breathing, what else does the medulla control?
The heart rate and blood pressure - Sympathetic and Parasympathetic responses.
46
Apart from the autonomic nervous system, what controls the contractions of the heart?
The heart also has its own conduction system via the SA node, then the AV node.
47
What happens if there is an issue with the conduction system of the heart?
The person will have dysrhythmias/arrythmias.
48
Explain A-fib.
Instead of impulses to contract coming from the SA node, the impulse comes from ectopic beats from anywhere in the Atria. It will fire up beats in an unsynchronized manner which will signal to the ventricle to contract and pump irregularly to the signal of the ectopic beat. A-fib is there for an irregular beat whihc will lead to a rapid ventricular response which will decrease cardiac output.
49
How do you differentiate between a normal heart beat and A-fib on an EKG?
On a normal EKG you will see a P wave because all the impulses will start with the SA node. However with A-fib there will be no P wave and the QRS is irregular due to the ectopic beats.
50
What is Myocardial Ischemia?
Lack of oxygen to the heart tissue. (Ischemia is lack of oxygen to the tissue) It could be temporary or permanent.
51
What causes temporary Myocardial Ischemia?
A problem with the coronary artery and the patient will experience angina.
52
What happens with permanent Myocardial Ischemia?
Heart attack, injury or infarction which will cause dead tissue on the heart (necrosis)
53
How is Heart Failure related to lack of oxygen to the heart?
May be left or right sided heart failure. Left heart sided heart failure always leads to right sided heart failure. Left sided heart failure is also most commonly associated with lack of oxygen to the heart.
54
Why does left sided heart failure result in right sided heart failure?
Due to backflow of blood that will not go to the systemic circulation but back into the pulmonary vein and back into the lungs and into the right side of the heart.
55
What are some symptoms of left sided heart failure?
Symptoms will be related to the lungs such as dyspnea, pulmonary edema. And symptoms related to poor cardiac output such as fatigue and poor urinary output.
56
What are some symptoms of right sided heart failure.
More systemic symptoms due to the backflow of blood such as jugular vein distention, pitting edema and enlarged liver to name a few.
57
What is Cor Pulmonale?
Right sided heart failure caused by pulmonary disorders. This condition does not cause left sided heart failure.
58
As we age there is a decreased strength in the Thorax, how is this affecting our breathing?
We are not able to blow out the Co2/air and this becomes trapped in the alveoli which will cause residual volume in the lungs. Due to this residual volume we are not able to inhale the amount of air that is optimal due to occupied space of the residual air in the alveoli. This results in decreased vital capacity.
59
In older adults, we know that residual air gets trapped in the alveoli. What compensates for this in terms of exhaling the air?
The use of accessory muscles.
60
In older adults, there may be fibrose tissue in the alveoli. How does this affect respiration?
The alveoli will be non functioning. Also, as we age there will be fewer pulmonary capillaries. This will result in less exchange of Co2 and O2 by diffusion.
61
What is the weather condition and why should we be cautious of this in terms of older adults with breathing difficulties?
When we breathe in humid or hot air, there will be a problem with breathing due to the air being moist/water in the air. With cold weather there is less oxygen in the air.
62
Why should we be careful when administering opioids and sleeping pills to older adults?
Opioids may depress their breathing.
63
What causes decreased ventilation and ineffective cough?
More secretion is trapped in the lungs and upper respiratory system. Secretion is thick due to the dry mucous membrane. this secretion could be aspirated by the older adult.
64
True/False
Fever is the first sign of infection in older adults.
False
65
How does lack of mobility in older adults affecting their lungs?
There will be lack of expansion due to sitting which will result in less ventilation.
66
How does chronic pain in older adults affect their breathing?
With chronic pain ( which is common with older adults) there is a tendency to breathe shallower.
67
How does splinting of the thorax help older adults with coughing?
It can help reduce the pain associated with coughing. due to added support to the chest wall.
68
Should older adults who are experiencing ineffective coughing and pain drink a lot of milk?
No. This may exacerbate the problems.
69
Why may there be an issue with the heart rate when older adults are experiencing stress?
In older adult it take the heart longer to respond to stress. We know that stress increases heart rate but in older adults this happens much slower due to hardening of the vessels and plague buildup which affects cardiac output.
70
How do we physically assess a patient with suspected lack of oxygenation? What are some signs and symptoms? (long answer)
The patient may have affected consciousness (lethargic, stupor or comatose).
Patient may hypoventilate (decrease in oxygen and increase in Co2) which may lead to Co2 narcosis and coma state.
Patient will be restless of anxious due to not getting enough oxygen.
Skin color may be pallor (lack of oxygen in the blood) or cyanosis (due to Co2 buildup in the blood). Skin temperature may be cold due to lack of oxygen.
Chest diameter may be increased (Barrell chest- due to accessory muscles being used when exhaling)
Spine curvature (kyphosis or sclerosis) may affect breathing pattern.
Vital signs : Tachypnea or bradypnea.
PMI (point of maximum impulse) - checking the apical pulse. which is normally in the 5th intercostal space, however if the heart is enlarged this may now be in the 6th intercostal space.
Vibration : is there vibration in any of the heart valves?
Peripheral pulses and capillary refill will tell us if there is adequate perfusion.
Auscultate for breath sounds and heart sounds.
71
What are the diagnostic tests that should be done if there is suspicion of decreased oxygenation?
ABG : (Arterial blood gas)
Check for troponin which will be released by the cardiac cells during a heart attack (levels will be high). CK-MB: to assess for problems with heart muscle.
CBC
Cytologic study : to assess for cancer cells during bronchoscopy.
EKG : 12 lead to check the conductive system of the heart to diagnose angina, ischemia, infarct or necrosis or to point out which are of the heart is affect.
Pulse oximeter
Capnography : to assess Co2 levels
Thoracentesis : Removing fluid in the pleural space.
BNP : (B natriuretic peptide) indication of exacerbation of heart failure. Released in body if there is excessive fluid. Natural diuretic of the body.
72
Explain what an Allen's test is.
Done before an ABG test to evaluate blood flow to the hand.
1) Locate the radial and ulnar and radial arteries at the wrist
2) Compresses both arteries.
3) Retain pressure on both arteries
4 ) Release the ulnar artery and notes how long it takes for the palm to regain its normal color.
A negative Allen test result means that the patient likely doesn't have enough blood flowing to the hand, which could indicate that the planned procedure shouldn't be performed or that further evaluation is needed.
73
What does the ABG assess?
PH
PCO2
PO2
HCO3
Base excess or base deficit
O2 saturation
74
At what pH level does the blood start to become acidic and at what level does it start to become alkaline (Basic)?
pH less than 7.35 is acidic.
pH greater than 7.45 is alkaline.
75
What does the PCO2 levels indicate. At which level is it alkaline and at what level is it acidic?
The PCO2 levels will indicate if the problem is related to the respiratory system. Less than 35 is alkaline and over 45 is acidic.
76
What would a acidic pH level and acidic PCO2 level indicate?
Respiratory acidosis.
77
What does the HCO3 levels indicate. At which level is it alkaline and at what level is it acidic?
HCO3 is bicarb in the body and this reflects the kidneys (metabolic) Less than 22 is acidic and over 26 is alkaline.
78
What would a acidic pH level and acidic HCO3 level indicate?
Metabolic acidosis
79
Which organs does the PCO2 give us information about and which organs does the HCO3 give us information about?
PCO2 are the lungs (respiratory) and HCO3 (metabolic) are the kidneys.
80
What will the kidney do if the patient is suffering from respiratory acidosis?
They will compensate by releasing more bicarb and excreting more Hydrogen in the urine.. This means that on the ABG reading, the PCO2 levels will indicated acidity and the HCO3 levels will be alkaline to compensate. If the pH level is acidic it means that they kidney's are partly compensation and if the pH levels are normal then the kidneys are fully compensating. If the HCO3 levels are normal then the kidneys are not compensating.
81
What does an oxygen concentration of less than 80 indicate?
Hypoxemia (low oxygen in blood).
Its a fucking problem Jim
82
What does an oxygen concentration of more than 100 indicate?
Indicates risk of oxygen toxicity.
83
What does CBC stand for and what does it meassure?
Complete Blood Count. Meassures Hemoglobin and Hematocrit (H&H) Platelet count and White Blood Cell count.
84
On a CBC blood test, what represents the red blood cells?
The hematocrit and hemoglobin.
85
What is the 3 times rule?
Hemoglobin x 3 always equals hematocrit.
86
Does women or men have higher blood volume?
Men have higher blood volume and therefore also higher hemoglobin and hematocrit levels than women.
87
What is the viscosity of the blood represented by on a CBC?
The hematocrit.
88
What is the oxygen carrying capacity measured by in the CBC?
The hemoglobin.
89
When it comes to WBC, why would we measure the differential count?
Because the WBC count may be normal, however if you have a higher neutrophil concentration in your WBC's this may indicate an acute bacterial infection.
90
How many leads should we use when getting an EKG?
12.
6 chest leads
4 length leads : 2 on each hand and 2 on each foot.
91
On the each of the 12 leads used for the EKG what will we see on the picture?
A PQRST from each lead. This will give us information on the capacity of the heart and where there is a problem.
92
What is a stress test?
An EKG done of for example a thread mill. This is to stimulate a stress situation and determine if there are any arrythmias.
93
What is a Holter monitor?
Its a EKG monitor that you carry around while doing ADL's. This can narrow down event or activities where arrythmias may occur.
94
What does a low hemoglobin indicate on an ABG?
Low oxygen concentration. this is why we need to not always trust the pulse oximeter. Because the pulse oximeter may show a normal oxygen concentration, however a person may have low hemoglobin concentration which are supersaturated with oxygen. So we always want to cross reference. You can have an anemic patient with 100% oxygen saturation.
95
What is Capnography?
Measures carbon dioxide. We use this before we intubate a patient or with a nasogastric tube.
96
Where should the nasogastric tube be inserted into?
The stomach. We need to be very careful not to insert it into the lungs which will increase Co2 which will indicate that you are not in the stomach.
With intubation it will detect that we are in the lungs and not in the stomach because if we are in the stomach there will be no increase of Co2 and you will need to reintubate your patient.
97
What is Thoracentesis?
A process where fluid is removed from the pleural space of patient. Patient should be instructed not to cough or take deep breath and remain still during the procedure as the doctor may then damage the pleural space or puncture the lungs while performing the procedure. Lungs should expand once the fluid is removed.
