Oxygenation Flashcards
What 3 things influence the capacity of the blood to carry O2?
Amount of dissolved O2 in the plasma
Amount of hemoglobin
Ability of the Hb to bind with O2
What regulates ventilation?
Central Nervous System
Define:
Hypoventilation
Hyperventilation
Hypoxia
Hypoventilation: alveolar ventilation is inadequate to meet the O2 demand of the body or eliminate sufficient CO2
Hyperventilation: lungs remove CO2 faster than it is produced by cellular metabolism
Hypoxia: inadequate tissue oxygenation at the cellular level
What would it mean if the patient gained 5lb in one day?
Hypervolemia- a fluid imbalance- increases risk of heart failure
Explain the differences between early and late hypoxia
Early: apprehension, restlessness, elevated BP (unless shock), unable to lie flat, fatigued, agitated
Late: cyanosis, decreased HR/BP/RR
What vaccinations influence oxygenation?
Influenza
Pneumococcal
What are some environmental pollutants
Secondhand smoke
Work chemicals/pollutants
List 3 ways Dyspnea can be managed?
Medications
Oxygen
Relaxation
What are some methods of airway maintenance?
Hydration to manage secretions
suctioning
Chest physiotherapy (CPT)
Nebulizers
How are pulmonary secretions mobilized?
Suction, repositioning
Explain 2 breathing exercises
Pursed-lip breathing
-deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse
Diaphragmatic breathing
-Increased tidal volume, decreases respiratory rate, leads to overall improved breathing pattern/quality of life
What is the goal of oxygen therapy?
To prevent or relieve hypoxemia by delivering the lowest amount of oxygen possible to achieve adequate tissue oxygenation
Explain 3 forms of low flow oxygen therapy
Nasal Cannula 1-6L (24-44%)
-simple, easily tolerated, can eat/drink/talk
Simple Face Mask 6-12L (35-50%)
-Short term, transport
Partial & Non-rebreather 10-15L
(60-90%)
-Short term, increased FiO2
Explain 2 forms of high flow oxygen therapy
Venturi mask (24-50%)
-Very specific amount of O2
-similar to simple mask
High flow nasal cannula
Explain 2 forms of non-invasive ventilation to avoid artificial airway in acute situations
Continuous positive pressure airway (CPAP) 21-100%
-pushes air in and out- sleep apnea
Bilevel positive airway pressure (BiPAP) 21-200%
What is FiO2?
Fraction of inspired oxygen concentration
How often should incentive spirometry be used?
5-10 breaths per session every hour when awake
Who is an oral airway used for?
Prevents obstruction of trachea by displacement of the tongue into oropharynx
Only used on non-alert/awake patients- causes puking if they’re awake
What is a management/safety consideration of an ET tube?
Ventilator-associated pneumonia
What are chest tubes used for?
Pneumothorax
Hemothorax
List the key safety guidelines
Know the baseline vital sign range
Limit introduction of catheter to 2 times with each suctioning procedure
Do tracheal suctioning before pharyngeal suctioning whenever possible
Caution when suctioning patients w/ head injury
NS instillation into airway before suctioning is not recommended
Review institutional policy before stripping or milking chest tubes
Most serious tracheostomy complication is airway obstruction
Patients with COPD who are breathing spontaneously should cautiously receive high levels of O2 therapy
A patient with a tracheostomy has thick tenacious secretions. To maintain the airway, the most appropriate action for the nurse includes:
Tracheal suctioning
Which skills can the nurse delegate to AP? Select any:
Initiate O2 therapy via nasal cannula
Perform nasotracheal suctioning on a patient
Educate patient about incentive spirometer use
Assist w/ care of established tracheostomy tube
Reposition a patient w/ a chest tube
Assist w/ care of established tracheostomy tube
Reposition a patient w/ a chest tube
The nurse is caring for a patient w/ pneumonia. On entering the room, the nurse finds the patient lying in bed, coughing, and unable to clear secretions. What should the nurse do first?:
Start O2 at 2L/min via nasal cannula
Elevate head of bed to 45degrees
Encourage patient to use incentive spirometer
Notify the healthcare provider
Elevate head of bed to 45 degrees
Which assessment findings indicate that the patient is experiencing an acute disturbance in oxygenation and requires immediate intervention? Select any:
SpO2 value of 95%
Chest retractions
RR of 28 breaths/min
Nasal flaring
Clubbing of fingers
Chest retractions
RR of 28 breaths/min (tachypnea)
Nasal flaring
Clubbing is a sign of chronic O2 desatt, not acute
Define:
Orthopnea
Tachypnea
Orthopnea: patient must use pillows to prop themselves up to breathe at night
Tachypnea: >20 breaths/min
Define:
Hemoptysis
Expectorate
Hemoptysis: blood sputum
Expectorate: to cough/spit out something
Is SpO2 of 95% acceptable in older adults?
Yes
Explain CPT
Chest Physiotherapy: firm pats on anterior thorax to break up lung secretions
Is a provider order necessary for O2 therapy?
No- but they should be informed right after
What kind of O2 therapy care can be delegated to an AP?
AP can apply the nasal cannula or O2 mask after the method of delivery and % of O2 is determined.
What can immobility lead to?
Atelectasis
What kind of technique is used for oropharyngeal and nasotracheal suctioning?
What about tracheal?
Clean
Sterile
How long can orotracheal and nasotracheal suctioning last?
What about tracheal?
10-15 seconds
10 seconds
What is the pressure range for tracheal suctioning?
80-120 mm Hg
Is saline/lubricant used for tracheal suctioning?
NO
What kind of suctioning tasks can be delegated to AP?
oropharyngeal and well-established tracheal suctioning can be delegated if the patient is assessed and stable
When is an Endotracheal tube established?
When the patient cannot breathe for themselves
Short-term artificial airway to administer invasive mechanical ventilation
How should chest tubes be maintained?
Keep sealed
Clean drainage cannister
When are chest tubes used?
Removes air from pneumothroax
Removes blood/fluids from hemothorax
