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Nursing Fundamentals > Oxygenation > Flashcards

Oxygenation Flashcards

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1
Q

Concept of Oxygenation

A
  • mechanism that facilitates the body’s ability to supply oxygen to all cells of the body
  • function is to obtain oxygen from atmospheric air, transport this air through the respiratory tract into the alveoli
  • achieved through respiration, processes of inspiration & expiration
  • oxygen to alveoli to be exchanged for carbon dioxide which is then expelled from the body
  • ventilation is the actual exchange of oxygen and carbon dioxide
  • ability to supply oxygen to all cell from the air (this is done by respiration)
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2
Q

How many lobes are in the lungs?

A

left: 2 lobesright: 3 lobes

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3
Q

Children Lifespan Considerations

A
  • alveoli # is 10% of adults, not fully developed
  • airway is shorter and narrower-respiratory rate is faster
  • abdominal breathers
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4
Q

Older Adults Lifespan Considerations

A
  • decreases in peak airflow and gas exchange
  • decreases in measures of lung function
  • weakening of the respiratory muscles
  • decline in the effectiveness of lung defense mechanisms=infections (cilla and cough mechanisms)
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5
Q

Eupnea

A

12-20 bpm normal respiratory rate

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6
Q

Tachypnea

A

greater than 21 bpm

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7
Q

Bradypnea

A

less than 10 bpm

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8
Q

Apnea

A

absence of breathing (abnormal respiration) ex: sleep apnea

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9
Q

Hyperventilation

A

increased movement of air into and out of the lungs (alveolar hyperventilation)

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10
Q

Hypoventilation

A

inadequate alveolar ventilation

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11
Q

Dyspnea

A

difficult breathing

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12
Q

Orthopnea

A

inability to breath except in an upright or standing position

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13
Q

Hypoxemia

A

decreased level of oxygen

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14
Q

Hypoxia

A

-insufficiency of oxygen -restlessness is the first sign

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15
Q

Anoxia

A

without oxygen

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16
Q

Cyanosis

A

bluish discoloration of skin, nail beds & mucous membranes

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17
Q

Pneumothorax

A

lung collapse

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18
Q

Partial obstruction of upper airway

A

indicated by low pitched snoring sound during inhalation

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19
Q

Complete obstruction of the upper airway

A

indicated by extreme inspiratory effort that produces no chest movement (other than retractions)

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20
Q

Stridor

A

a high pitched, harsh sound (like blowing of the wind) heard during inspiration with laryngeal obstruction

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21
Q

Concepts that relate to oxygenation

A
  • Acid-Base balance: respiratory acidosis (low pH level in blood)
  • Cellular Regulation: anemia, increases systemic workload
  • Cognition: decrease oxygen to brain causes changes
  • Comfort: pain from ischemic events, cerebral, cardiac
  • Perfusion: decrease leads to oxygen deficit to organs
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22
Q

Nonmodifiable Risk Factors

A
  • genetic effect of hemoglobin and hematocrit: can impact oxygen carrying capacity such as Thallasemia
  • women have lower concentrations of hemoglobin and hematocrit
  • lower hemoglobin/hematocrit=anemia (reduced oxygen carrying capacity)
  • Thallasemia: malformed red blood cells; lower oxygen carrying capacity; genetic disorder
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23
Q

Prevention

A
  • Management of environmental air quality: reduce smoking by the population, work place, smog
  • Vaccination: older adults (influenza & pneumonia) & children (pertussis)
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24
Q

Modifiable Risk Factors

A
  • hypertension
  • atherosclerosis
  • obesity
  • type 2 diabetes
  • smoking (biggest thing to change)
  • stress
  • anxiety
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25
Q

Interview Assessment: what to ask

A
  • current respiratory problems-history of respiratory disease
  • lifestyle (smoker?)
  • Presence of cough (when?)
  • Description of sputum (amount? color?)
  • Presence of chest pain (what causes?)
  • Presence of risk factors (obese? cardiac issues?)
  • Medication history
26
Q

Nasal Assessment

A
  • midline and symetrical

- nares mucosa is pink and moist, no drainage

27
Q

Respiratory Assessment

A

regular, depth, effort

28
Q

Thoracic cavity inspection

A

anterior/posterior diameter is 1/2 the transverse diameter

29
Q

Muscles of breathing assessment

A
  • chest wall gently rises and falls
  • neck muscles are relaxed
  • intercostal muscles
30
Q

Thoracic Wall Assessment

A

symertrical hand placement shows symetrical movement of the hands

31
Q

Vesicular (normal breath sound)

A
  • “gentle sighing” sounds

- air moving through smaller airways (alveoli and bronchioles)

32
Q

Bronchovesicular (normal breath sound)

A

-moderate pitched “blowing” sounds as air moves through the larger airways (bronchi)

33
Q

Bronchial (normal breath sound)

A

-high-pitched, loud, “harsh” sounds as air moves through the trachea

34
Q

Normal color of skin, nail beds, and mucous membranes

A

pink color (well oxygenated blood)

35
Q

Dusky hue of skin, nail beds, and mucous membranes

A

poorly oxygenated blood

36
Q

Cyanosis

A
  • bluish discoloration

- severe oxygen deprivation

37
Q

Crackles (abnormal breath sounds)

A
  • high pitched, heard during inspiration, not cleared by cough, discontinuous-fluid on lungs
  • heard at base of lungs 1st
38
Q

Rhonchi (abnormal breath sounds)

A
  • coarse sounds like a snore

- may clear with cough or suctioning-upper chest

39
Q

Wheeze (abnormal breath sounds)

A

musical noise, louder on expiration, continuous, throughout lungs

40
Q

Stridor

A
  • high pitched, harsh sound hear during inspiration with laryngeal obstruction
  • in the throat
41
Q

Chest Radiograph

A

see fluid, air or masses (xray)

42
Q

CT/MRI

A

more detail can be seen

43
Q

Arterial blood gas

A

provides direct indication of oxygen and carbon dioxide exchange and acid-base balance

44
Q

Pulmonary function tests

A

info about ventilation airflow, lung volumes, lung capacity, diffusion of gas

45
Q

Bronchoscopy

A

direct visualization of the lungs via bronchoscope

46
Q

Thoracentesis

A

drain excessive pleural fluid, then the fluid is analyzed

47
Q

Sputum Specimen

A

collect in the morning, identify microbes, inflammation and immunoglobulins.

48
Q

Pulse Oximetry

A
  • a noninvasive procedure that helps measure the client’s arterial oxygen saturation to detect
  • sensor is attached to finger, earlobe, nose, or forehead-normal is 95%-100%-less than 70% is critical
  • under 90% be concerned-notify physician-each patient will have their own normal
49
Q

Ineffective breathing patterns

A

-anxiety and pain as manifested by shortness of breath, orthopnea, nasal flaring, and grunting with a respiratory rate of 32 (adult)

50
Q

Ineffective Airway Clearance

A

thick sputum, secondary to pneumonia, and fatigue as manifested by nasal flaring, tachypnea,dyspnea, abnormal breath sounds, orthopnea and cyanosis

51
Q

Independent Interventions(Positioning)

A
  • Semi-fowlers: 30-45 degrees (tube feeds-decrease aspiration)
  • Fowlers: HOB 45-60 degrees (increase comfort during eating etc)
  • High Fowlers: HOB 80-90 degrees (feeding, breathing treatment)
  • Orthopenic: head and arms over bed table, to facilitate lung expansion
52
Q

Independent Interventions

A
  • Encourage smoking cessation-monitor activity tolerance
  • promote secretion clearance (TCDB and suctioning as needed)
  • breathing exercises (for clients with restricted chest expansion–COPD and some abdominal surgery)
  • abdominal breathing and pursed-lip breathing
  • slow diaphragmatic breathing
  • forceful exhalation of air
53
Q

Incentive Spirometer

A
  • device that stimulates the patient to achieve maximum voluntary lung expansion, prevents atelectasis
  • should perform 10 times per hour
  • patient should be encouraged to cough and expectorate any secretions loosened by the deep breathing
  • place lips over mouthpiece. and inhale as deeply as possible. At maximum inflation there should be a slight pause and the patient then relaxes and exhales.
54
Q

Collaborative Interventions

A
  • Improve nutrition (nutritionist)
  • Pharmacologic Therapy (pharmacist, physician)
    • bronchodilators, anti-inflammatory, expectorants and any other medications that improve oxygenation and decrease the workload of the heart
  • oxygen therapy (respiratory therapy/physician)
55
Q

Nasal Cannula

A
  • does not provide exact concentration of oxygen
  • do not use with more than 6L/min
  • inexpensive
  • better tolerated by client, can eat/drink with cannula on
  • check every 8 hrs for flow, patency, trauma to ears and nares
  • humidifier if greater than 2L/min flow to prevent
56
Q

Nasal Cannula oxygen %

A
  • room air is 21%
  • 1L/min=24%
  • 2L/min=28%
  • 3L/min=32%
  • 4L/min=36%
  • 5L/min=40%
  • 6L/min=44%
57
Q

Simple face mask

A
  • provides oxygen at 5-8L/min

- gives 30-60% of oxygen

58
Q

Partial Rebreather Mask

A
  • not used much
  • delivers oxygen from 60-95% at liter flows of 6-10L/min
  • oxygen reservoir bag hold first 1/3 of exhaled air
  • partial rebreather bag must not totally deflate during inspiration to avoid carbon dioxide build up
59
Q

Non-rebreather Mask

A
  • used in emergency situations or short term
  • delivers highest oxygen concentration possible
  • 95-100% with liter flow of 10-15L/min
  • one way valve to prevent intake of room air
  • no expired air in bag
  • bag must not totally deflate during inspiration to prevent carbon dioxide build up
60
Q

Venturi Mask

A
  • used to be very exact
  • delivers oxygen concentrations from 24%-60% at liter flow rates of 4-12 L/min
  • color-coded jet adapters correspond to precise oxygen concentration and liter flow
  • can be used to administer low or high concentrations
61
Q

Collaborative Techniques used to mobilize secretions

A
  • often done by respiratory therapists
  • chest physiotherapy: group of therapies used in combination to mobilize secretions
  • postural drainage
  • chest percussion
  • vibration
  • suctioning

Nursing Fundamentals (4 decks)

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