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nursing 101 > Oxygenation > Flashcards

Oxygenation Flashcards

0
Q

Cardiopulmonary physiology

A

Provides oxygen to tissues and removes Co2 and waste products from the body

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1
Q

Oxygenation

A

Process by which oxygen is transported to the cells and carbon dioxide is transported from the cells

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2
Q

Ventilation

A

Movement of air in and out of the lungs

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3
Q

Diffusion

A

Movement of gases between air spaces and the bloodstream

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4
Q

Respiration

A

Exchange of oxygen and carbon dioxide during cellular metabolism

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5
Q 
Movement of blood into and out of the lungs to the organs and tissues of the body and supported by the heart
Ventilation 
Diffusion
Respiration 
Perfusion
A

Perfusion

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6
Q

Need to get oxygen across

A

Alveolar membrane

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7
Q

Need to get oxygen into

A

Rbcs

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8
Q

Need to get oxygen into

A

Body cells

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9
Q

Inadequate tissue oxygenation with a deficiency in oxygen delivery at cellular level
Hypoxia
Hypoxemia

A

Hypoxia

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10
Q

Hypoxemia

A

Abnormal deficiency in concentration of oxygen in arterial blood. Low partial pressure of oxygen

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11
Q

Ventilation which is inadequate to meet demands of the body and results in hypercapnea. Respiratory acidosis

A

Hypo ventilation

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12
Q

Increase in respiratory rate which results in excess co2 elimination. Respiratory alkalosis

A

Hyperventilation

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13
Q

Clinical signs of hypoxemia

A 
Dyspnea
Tachypnea
Restlessness motor function 
Anxiety mental status change 
Hyper or hypotension
Pallor or cyanosis 
Blurred or tunnel vision
Nausea and vomiting
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14
Q

The angle of Louis is at the junction between

A

The Manubrium and the body of the sternum

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15
Q

The Lower lobes project

A

Laterally and anteriorly

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16
Q

Posteriorly the tip or inferior margin of the scapula lies approximately at the level of the
Eighth
Seventh
Ninth

A

Seventh rib

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17
Q

Breathlessness

A

Dyspnea

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18
Q

Risk factors for HIV or TB

A

Persistent cough, hemoptysis, unexplained weight loss, fatigue, anorexia, night sweats and fever.

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19
Q

Normal chest contour

A

Ap diameter 1/3to 1/2 of the size of the transverse or side to side diameter

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20
Q

Barrel shaped chest characterizes

A

Chronic lung dx

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21
Q

Patients with breathing problems may do this

A

Lean over a table or splint the side of the chest

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22
Q

When breathing bulging or retraction indicates

A

Patient using great effort to breathe

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23
Q

Normal resp rate

A

12 to 20

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24
Q

Bronchi vesicular and vesicular sounds are normally heard over
Anterior
Posterior

A

Posterior thorax

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25
Q

Medium pitched blowing sounds normally heard

A

Between the scapulae

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26
Q

Where are vesicular sounds normally heard over

A

Periphery of the lungs

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27
Q

Vesicular sounds are

A

Soft
Breezy
Low pitched
And insp phase is three times longer than exp phase

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28
Q

Stress

A

Hyperventilation

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29
Q

Anxiety

A

Bronchospasm

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30
Q

Four things you do during physical assessment

A

Inspection
Palpation
Percussion
Auscultation

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31
Q

Inspection

A 
Shape and symmetry 
Trachea
Color 
Resp rate
Sputum
Distress 
Fingernail clubbing
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32
Q

Palpating

A 
Bulges
Tenderness 
Abnormal movements
Temp 
Tactile fremitus 99
Presence or absence of crepitation
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33
Q

Percussion

A

Compare one side with other

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34
Q

Resonant

A

Lungs

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35
Q

Hyperressonant

A

Emphysematous lungs

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36
Q

Flat

A

Bone

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37
Q

Dull

A

Organs

Consolidation

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38
Q

Tympanic

A

Stomach

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39
Q

Heard over large airways
Caused by spasm
Mucous secretions

Wheezes
Crackles
Rhonchi
Pleural friction rub

A

Rhonchi

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40
Q 
Heard over lung fields
Cause is increase in interstitial lung water or deflated alveoli 
High pitched
Static like
Discontinuous

Rhonchi
Pleural friction rub
Crackles
Wheezes

A

Crackles (rales)

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41
Q

Heard over lung fields and airways
Caused by narrow airways

Pleural friction rub
Wheezes
Rhonchi

A

Wheezes

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42
Q

Dry grating due to inflammation

Wheezes
Rhonchi
Pleural friction rub

A

Pleural friction rub

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43
Q

Peak flow meter

A

Estimate volume of air that can be forcibly exhaled

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44
Q

Measures oxygen saturation of arterial blood

A

Pulse ox

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45
Q

Abnormal pulse ox

90
85
80

A

Below 85

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46
Q

Procedure of entering pleural cavity and aspirating fluid usually done at bedside

A

Thoracentesis

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47
Q

Used to diagnose and treat airway and lung disorders

A

Bronchoscopy

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48
Q

Nursing diagnosis

Impaired gas exchange related to pulmonary infection

A

Dyspnea
Sp02 82 percent
Rr 36 breaths
Coarse lung sounds

49
Q

Interventions

A

02 at 1 liter min to maintain sp02 greater than 92 percent
High fowler position
Monitor lung sounds
Monitor results of chest X-ray

50
Q

Nursing diagnosis

Fatigue related to decreased oxygen

A

Sp02 82%
Decrease in activity level
Inability to perform ADL’s

51
Q

Interventions

A

Alternate rest and activity periods
Limit enviromental stimuli to promote relaxation
Monitor nutritional intake to include high nutrient intake

52
Q

Nursing diagnosis

Acute pain related to frequent cough

A

Complaints of chest pain
Pulse rate of 120 beats per min
Patients hold chest when coughing

53
Q

Intervention

A

Administer analgesics
Explore factors that improve or worsen pain
Teach pain management
Teach effective coughing techniques

54
Q

Nursing diagnosis

Ineffective airway clearance related to pulmonary secretions

A

Temp 102
Thick yellow sputum
Dyspnea

55
Q

Intervention

A

Cough and deep breathe every two hours
Increase fluids to 2800 ml for 24 hours
Administer antipyretic
Administer analgesics as needed before coughing

56
Q

Is suctioning a sterile procedure
How long should procedure last
How long in between

A

Yes
10 to 15 seconds
20 to 30 seconds

57
Q

Right lung is made up of how many lungs

58
Q

Essential for normal lung function. Without adequate amts, the alveoli would collapse on expiration leading to impaired gas exchange

A

Surfactant

59
Q

Successful ventilation depends on

A

Neuro and chemo receptors

60
Q

Tissues most sensitive to hypoxia are the

A

Brain
Heart
Pulmonary vessels
Liver

61
Q

Signs and symptoms of hypoxia include

A

Tachycardia
Peripheral vasoconstriction
Dizziness
Mental confusion

62
Q

Causes of hypoxia

A 
Anemia
Monoxide poisoning 
High altitudes
Airway obstruction
Septic shock
Cyanide poisoning 
COPD
impaired ventilation from rib fractures, chest trauma, spinal cord injury
Left shifted oxyhemoglobin dissociation curve
63
Q

Causes of hypoxemia

A 
Decreased diffusion as in pneumonia and atelectasis
Decreased alveolar oxygen tension
Cardiac arrhythmia 
Ventricular fibrillation
A Systole
64
Q

Treatment of hypoxemia

A

Oxygen

Correction of underlying cause

65
Q

Treatment of hypoxia

A

Cardiac and resp stimulant drugs
Oxygen
Mechanical ventilation
Frequent analysis of blood gases

66
Q

As ventilation decreases, what increases

67
Q

Signs and symptoms of hypoventillation

A 
Dizziness
Occipital headache on awakening
Lethargy 
Disorientation 
Decreased ability to follow instructions
Cardiac dysrhythmias
Electrolyte embalance
Convulsions
Possible coma
Cardiac arrest
68
Q

Chronically elevated pac02 and copd

A

Inappropriate administration of excessive oxygen may result in hypo ventilation

69
Q

Hypercapnea

A

High carbon dioxide

70
Q

Patients with COPD and hypercapnea adapt better to higher or lower carbon dioxide level

A

Higher

24 to 28%

71
Q

Treatment for hypo ventilation

A

Treating underlined cause
Improving tissue oxygenation
Restoring ventilation
Achieving acid-base balance

72
Q

Causes of hyperventilation

A 
Severe anxiety 
Infection
Head injury
Meds
Acid based imbalance
73
Q

Hyperventilation signs and symptoms

A 
Tachycardia
SNOB
chest pain
Dizziness
Lightheadedness
Decreased concentration
Paresthesia
Extremity numbness 
Tinnitus
Blurred vision
Tetany
74
Q

Treatment for hyperventilation

A 
Treating underlined cause
Improving tissue oxygenation
Restoring ventilation
Reducing resp rate
Achieving acid base balance
75
Q

Early clinical signs and symptoms of hypoxemia

A 
Anxiety
Change in level of consciousness
Restlessness 
Increased hr
Increases rr and bp
Cardiac dysrhythmias such as PAC's, PVC's, and sinus tachycardia
76
Q

Pulmonary patients are at risk for

A

Hypoxemia and hypercapnea

77
Q

Cervical trauma at c3 to c5 results in

A

Paralysis of phrenic nerve

78
Q

Cardiac pain radiates into where in males

A

Left arm and jaw

79
Q

Cardiac pain in women symptoms

A 
Epi gastric pain
Complaints of indigestion
Nav
Choking feeling
Dyspnea
80
Q

Is pericardial pain radiating or no radiating

A

Nonradiating and occurs with inspiration or when leaning forward

81
Q

Pleuritic chest pain is

A

Peripheral
Usually radiates to scapular area
Knifelike

82
Q

Muskoskelatal pain is often confused with what kind of chest pain

A

Pleuritic chest pain

83
Q

Orthpnea

A

Difficulty breathing when lying and uses mult pillows

84
Q

Hemoptysis

A

Bloody sputum

85
Q

What herb should cv patients not take

86
Q

Patients with asthma should not take

A

Ephedrine containing products such as bronchodilators because they cause increased bronchospasm and resp arrest

87
Q

Is the mouth considered clean or dirty

A

Clean thus oral and nasopharyngeal suctioning requires only clean technique

88
Q

Most effective position for CP dx is in the
90 degree fowler
45 degree semi fowler

A

45 degree semi fowler position

89
Q

How do you position a patient with unilateral lung dx such as pneumothorax or atelectasis
Healthy lung up or down

90
Q

Pneumothorax

A

Collection or air or gas in the pleural space

91
Q

Accumulation of air in the pleural space usually as a result of trauma

A

Hemothorax

92
Q

What is the usual CPAP setting

A

5 to 20 cm

93
Q

Affects person oxygenation by binding strongly with hemoglobin preventing the formation of oxyhemoglobin

A

Carbon monoxide

94
Q

Low concentration carbon monoxide causes

A

Nausea
Dizziness
Headache
Fatigue

95
Q

High concentration carbon monoxide causes

96
Q

Persons comfort zone is between
40 to 90 C
18 to 23

A

18 to 23 or 65 and 75 F

97
Q

High pitched continuous musical sounds bilateral over lung fields

98
Q

Fine bubbling sounds heard on auscultation

99
Q

Clinical findings indicate central cyanosis

A

Bluish discoloration of lips and mouth and conjunctivae

Heart dx

100
Q

Clinical signs of peripheral cyanosis

A

Blue lips, earlobes, and nail beds

Indicates peripheral vasoconstriction

101
Q

Bulging of of the tissues of nail base

102
Q

Primary reason for giving morphine for patient experiencing MI

A

Decreased oxygen demand on heart

103
Q

Mental status changes, agitation, and falls early signs of

A

Worsening cardiac status

104
Q

Resistance of ejection of blood from the left ventricle

105
Q

Increased risk of developing ventilator associated pneumonia

A

Pooling of secretions in the oropharynx

106
Q

Associated with VAP

A

Fever

Progressive infiltrates on chest X-ray 3 days after on mechanical vent

107
Q

VAP is associated with colonization of the

A

Resp and digestive systems

108
Q

Accumulation of blood and fluid in the pleural cavity between the
Parietal and visceral pleurae

A

Hemothorax

109
Q

Shortness of breath or difficulty in breathing caused by certain heart or lung conditions or strenuous exercise

110
Q

A collapse of alveoli preventing the normal respiratory exchange of oxygen and carbon dioxide

A

Atelectasis

111
Q

What do bibasilar crackles and diminished breath sounds indicate

A

Fluid from heart failure or bilateral pneumonia

112
Q

In assessing breath sounds, where should the nurse listen first
Lung bases
Lung Apices

A

Lung Apices

113
Q

The nurse auscultation vesicular breath sounds in the periphery lung field. Is this a normal finding

114
Q 
Tenacious means
Odor
Color
Frequency 
Consistency
A

Consistency

115
Q

After determining the priority nursing diagnoses, what step should the nurse take next in developing the plan of care

A

Establish goals and outcomes

116
Q

What is an early sign of hypoxia

A

Restlessness

117
Q

When applying a nasal cannula it is most important for the nurse to provide which instructions

A

Remind client and family that oxygen is combustible and must be kept 10 feet away from open flames

118
Q

What is the best technique for the nurse to assess respirations accurately

A

Place a hand on chest and count the hand motion

119
Q

Early signs of hypoxemia include

A

Anxiety
Change in level of consciousness
Restlessness

120
Q

Are patients with pulmonary diseases at greater risk for

Hypoxemia or hypoxia

121
Q

What are examples of NS diseases that result in hypoventillation

A

Myasthenia gravis
Gillian Barre dx
Poliomyelitis

nursing 101 (15 decks)

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